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UBC Theses and Dissertations

A novel intervention for persistent memory symptoms after concussion : a pilot randomized controlled trial Rioux, Mathilde


BACKGROUND. Although objectively measurable memory impairments typically resolve within weeks after a concussion, many people continue to report memory symptoms for extended periods. The current standard of care, cognitive rehabilitation, addresses objective memory deficits by teaching compensatory strategies, but this traditional approach to treatment is likely ineffective and misdirected. I propose that treatment for persistent memory symptoms after concussion should not focus on improving memory ability but rather on addressing the psychological mechanisms that perpetuate excessively negative perceptions of memory ability. The primary aim of the study was to assess the feasibility of the trial methods, including the novel CBT intervention. A secondary aim was to find evidence of an efficacy signal for the novel CBT intervention. METHODS. I conducted a pilot randomized controlled trial to evaluate the feasibility of a new CBT-based treatment designed to improve persistent memory symptoms after concussion. I recruited 24 participants from a characterizing study for Functional Cognitive Disorder after concussion. Participants were randomized (1:1) stratified by memory concern severity into CBT or traditional cognitive rehabilitation. All individuals participated in 11 x 50-minute sessions delivered online by supervised clinical psychology graduate students. Prespecified feasibility criteria for a successful pilot were set for (1) recruitment, (2) patient-perceived credibility of treatment, (3) patient adherence to treatment, (4) therapists’ compliance with the treatment protocol, and (5) retention. For the secondary aim, I measured memory concern (primary efficacy outcome) as well as avoidance of normal memory use and catastrophizing (mechanistic outcomes). RESULTS AND IMPLICATIONS. The study is still ongoing. Of the 24 enrolled participants, 11 completed participation in the study. Data for recruitment and treatment credibility is fully collected, and both fall within the acceptable range. Data collection is ongoing for patient adherence, therapist compliance, and retention, with preliminary results looking promising. Given the lack of a full dataset, I did not estimate the efficacy signal of the CBT intervention. However, descriptive statistics are reported for primary and mechanistic outcomes. This pilot study is an essential step toward improving clinical care for patients with persistent memory symptoms after concussion. The results could support progression to an efficacy-focused clinical trial.

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