title: Description of an early cognitive behavioral intervention (UPFRONT-intervention) following mild traumatic brain injury to prevent persistent complaints and facilitate return to work.
abstract: OBJECTIVE
  Many patients with mild traumatic brain injury do not fully return to work owing to persistent posttraumatic complaints. Research suggests that preventing chronic complaints might be prevented by giving cognitive behavioral therapy early after injury. Therefore, a new cognitive behavioral intervention (UPFRONT-intervention) was developed to not only prevent chronic complaints but to also establish a more successful return to work. The intervention is currently being evaluated in a multicenter randomized controlled trial design (trial number ISRCTN86191894) in mild traumatic brain injury patients who are at-risk of negative outcomes (patients with high numbers of early complaints). Two case examples are presented to demonstrate the application of the intervention.
  
  
  BACKGROUND
  Psychological factors, like cognitive appraisal and coping, play an important role in the persistence of posttraumatic complaints. Some patients are less able to adapt and thus to cope with the injury and its initial consequences than others. Dealing with the injury in a passive, avoidant way, focusing on negative feelings, will hamper recovery and is therefore a valuable target for an intervention. Theory into practice: The UPFRONT intervention is a short cognitive behavioral therapy intervention for patients that are at-risk of developing persistent posttraumatic complaints. Patients will undergo five sessions of cognitive behavioral therapy within 4-10 weeks after trauma. The intervention aims to enhance patients' feeling of competency of dealing with the consequences of mild traumatic brain injury by providing psycho-education, identifying and challenging unrealistic illness perceptions and improving coping style (decreasing maladaptive coping and enhancing adaptive coping).
authors.affiliation: 1 Department of Neuropsychology, University of Groningen, Groningen, The Netherlands.
authors.forename: Myrthe E
authors.initials: ME
authors.lastname: Scheenen
authors.affiliation: 1 Department of Neuropsychology, University of Groningen, Groningen, The Netherlands.
authors.forename: Annemarie C
authors.initials: AC
authors.lastname: Visser-Keizer
authors.affiliation: 2 Department of Neurology, University of Groningen, Groningen, The Netherlands.
authors.forename: Joukje
authors.initials: J
authors.lastname: van der Naalt
authors.affiliation: 1 Department of Neuropsychology, University of Groningen, Groningen, The Netherlands.
authors.forename: Jacoba M
authors.initials: JM
authors.lastname: Spikman
mesh_terms: D000223:Adaptation, Psychological; D001924:Brain Concussion / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D018479:Early Intervention, Educational / Q000379:methods*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011788:Quality of Life; D020127:Recovery of Function; D062707:Return to Work / Q000706:statistics & numerical data*; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Intervention; cognitive behavioral therapy; coping; mild traumatic brain injury; return to work