Second, this age group has the highest rates of anxiety symptoms (approximately 40%), even in the absence of an injury. First, mTBIs are particularly common among this population. Importantly, live video delivery enables safe participation while maintaining social distancing, in line with guidelines issued by the Centers for Disease Control and Prevention and the World Health Organization following the COVID-19 pandemic.Ĭollege-aged adults with mTBI and comorbid anxiety are in high need of a live video mind-body intervention for several reasons. Live video represents a promising avenue for delivering preventative care for individuals with acute mTBI and anxiety, who face many barriers to in-person visits, such as symptom burden, time and cost associated with travel, decreased flexibility in scheduling, and lower access to trained providers relative to live video delivery. Mind-body interventions can also be effectively delivered via live videos. Furthermore, they do not carry stigma that is often associated with traditional mental health referrals and are well tolerated and popular among patients with neurological conditions. Mind-body interventions effectively treat both individual symptoms common to mTBI (eg, headache, insomnia, and fatigue ) and anxiety. Thus, it is critical to develop a prevention intervention that is feasible, accepted, and efficacious. To date, there are no evidence-based psychosocial interventions for patients with recent mTBI (acute and subacute periods, up to 3 months postinjury ) and anxiety, which are focused on breaking the cycle of avoidance and preventing symptom persistence. As such, patients with anxiety and mTBI are at risk for decreased functioning across occupational, social, and recreational contexts and for experiencing persistent symptoms. For patients with anxiety, following recommendations for re-engagement is challenging because of maladaptive beliefs that rest is beneficial and activity is dangerous as well as physiological manifestations of anxiety that mimic postconcussion symptoms. Accumulating evidence suggests that re-engagement in activities of daily living is healthy and promotes recovery, whereas rest and avoidance induces or maintains nonspecific symptoms and perpetuates activity avoidance. We have previously shown that both catastrophizing and activity avoidance mediate the relationship between anxiety and postconcussion symptoms in patients with mTBI, supporting the applicability of the fear avoidance model to patients with mTBI.įor the substantial proportion of patients with mTBI and anxiety, current approaches are inadequate to prevent symptom persistence and disability. These mechanisms are consistent with the fear avoidance theoretical model, which explains the transition from acute to chronic pain, and they provide a useful conceptualization for how anxiety causes or amplifies mTBI symptoms and leads to symptom persistence.
Anxiety may contribute to symptom persistence after mTBI by mimicking or amplifying symptoms, increasing hypervigilance and misattributions, and motivating activity avoidance. Rather, symptom persistence after mTBI reflects a complex mind-body interaction, with anxiety playing a prominent role. Unlike moderate-to-severe traumatic brain injury (TBI), the prognosis of mTBI is not well correlated with injury severity or clinical findings. It is therefore critical to provide early interventions to prevent symptom persistence. Spontaneous symptom improvement is unlikely beyond this period. Indeed, at 3 months and 1 year postinjury, up to 64% and 44% of patients with mTBI, respectively, continue to report 3 or more persistent symptoms.
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Although many patients make a full recovery, a substantial proportion of patients experience persistent symptoms that can become intractable over time.
Nearly all patients report physical (eg, headache), emotional (eg, irritability), behavioral (eg, insomnia), or cognitive (eg, difficulty concentrating) symptoms in the week following an mTBI. Every year, approximately 42 million people worldwide sustain a mild traumatic brain injury (mTBI), also known as concussion, with particularly high rates among college-aged individuals.
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