Non-Pharmacological Approaches Reduce Depression and Anxiety in Adults Recovering from TBI: Study

Although standard non-pharmacological modalities manage psychiatric sequelae of TBI, previous acceptance and commitment therapy (ACT) reviews focused on general chronic conditions rather than this specific neurological cohort, leaving a clinical gap in understanding its precise therapeutic impact. To address this, lead author Sravanthi Penubarthi from the Department of Psychiatry at Kamineni Institute of Medical Sciences, with colleagues from the All India Institute of Medical Sciences (AIIMS), systematically evaluated the therapeutic efficacy of ACT on post-TBI depression and anxiety.

Therefore, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this meta-analysis pooled data from four randomized controlled trials in specialist and veteran settings to compare Acceptance and Commitment Therapy (ACT) against control treatments over one to three months. Excluding pediatric and non-clinical groups, a random-effects model evaluated primary depression and anxiety outcomes alongside secondary measures like psychological flexibility, functional disability, and quality of life.

Key Clinical Findings of the Review Includes:

• Alleviated Psychological Distress: ACT significantly reduced combined depression and anxiety scores compared to control groups, demonstrating a moderate standardized effect size (Cohen's d = 0.54; 95% confidence interval [CI] = 0.18–0.90; p = .003).

• Enhanced Psychological Flexibility: The therapy significantly enhanced the adaptive capacity of patients to help overcome post-injury cognitive rigidity and experiential avoidance (Cohen's d = 0.36; 95% CI = 0.19–0.53; p < .001).

• Reduced Functional Disability: Patients receiving ACT experienced a uniform and robust reduction in daily functional limitations post-injury (Cohen's d = 0.47; 95% CI = 0.18–0.76; p = .001).

• Improved Mental Well-Being: The intervention significantly enhanced mental health-related QOL, though results varied slightly across the included trials (Cohen's d = 0.24; 95% CI = 0.02–0.49; p = .015).

• No Significant Physical or Rehabilitation Benefits: ACT did not significantly improve physical health-related QOL (Cohen's d = 0.08; 95% CI = -0.10–0.26; p = .383) or rehabilitation participation (Cohen's d = 0.24; 95% CI = -0.02–0.49; p = .065) compared to controls.

The results suggest that ACT serves as a highly viable intervention for alleviating post-injury emotional distress, as evidenced by its moderate therapeutic effect size of 0.54 on depression and anxiety and its uniform benefit on functional outcomes.

Thus, the review concludes clinicians may consider integrating ACT into existing neurorehabilitation frameworks as a supportive, transdiagnostic strategy to foster emotional resilience and facilitate healthy cognitive adaptation during the long-term recovery phase.

While these preliminary findings are restricted by a small pool of four randomized trials and low-to-moderate evidence certainty, they highlight an exciting avenue for future large-scale, methodologically rigorous investigations to explore the long-term sustainability and optimal delivery formats of this novel psychological intervention.

Reference

Penubarthi S, Reddy M, Donthu RK, Guhan N, Ravindra AG, Bhongir AV. Efficacy of Acceptance and Commitment Therapy in Improving Depression and Anxiety in Adults with Traumatic Brain Injury: A Systematic Review and Meta-analysis. Indian J Psychol Med. 2026;48(4):358–365.