Man holding his head in hand

What is the study about?

This study aims to address the gap in treatments for psychological distress (feeling sad, afraid, anxious, depressed, etc.) in persons with traumatic brain injury (TBI). This study examined Acceptance and Commitment Therapy (ACT). ACT is focused on helping people to accept whatever they are thinking or feeling, rather than judging thoughts or feelings as positive or negative. This acceptance can help stop people from struggling with their thoughts and feelings, which often causes further emotional pain. ACT also focuses on helping people commit to act in ways that lead them toward values goals, regardless of how they are thinking or feeling.

What did the study find?

This study found that the ACT group showed significantly greater reduction of psychological distress, greater psychological flexibility (not getting stuck on thoughts and feelings) and increased commitment to act in ways that lead them toward goals that they value. The study showed that people with TBI can benefit from ACT, even if their injury occurred a long time ago. However, they need the ACT treatment to be changed a bit to accommodate TBI-related cognitive impairments. For example, they may need to be provided with written materials about what they learn in therapy, and they may need pictures to help them understand concepts.

Who participated in the study?

Individuals with medically-documented complicated mild to severe TBI, normal-to-mildly normal impaired memory, and clinically significant psychological distress at least 1 year after injury (n=93).

How was the study conducted?

This study was a randomized control trial study. Participants were randomized to receive eight weeks of ACT or a needs assessment, brief counseling/education, and referral.

How can people use the results?

Individuals with TBI and their families can use the results of this study to learn about ACT and understand how it could benefit their mental health and wellbeing. Practitioners can use the results of this study to think about how to adapt ACT to meet the needs of persons with TBI. Researchers can use the results to improve upon this study’s limitations when examining ACT in future clinical trials. For example, ensuring that a structurally equivalent control group is used.


Sander, A.M., Clark, A.N., Arciniegas, D.B., Tran, K., Leon-Novelo, L., Ngan E., Bogaards, J., Shere, M., & Walser, R. (2020). A randomized controlled trial of acceptance and commitment therapy for psychological distress among persons with traumatic brain injury. Neuropsychological Rehabilitation. doi:


The contents of this quick review were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPKT0009). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this quick review do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.