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In the Netherlands about 650.000 people live with the consequences of brain damage. Each day more than 350 people suffer a brain injury due to stroke or trauma. Post injury depressive and anxiety symptoms are common in one third of the survivors. Emotional consequences may hinder societal participation, reduce the quality of life and will also impact the caregivers of patients. Early interventions are necessary to avoid the development of a major depression or anxiety disorder with further negative impact on participation and quality of life. Cognitive behavioural therapy (CBT) has been shown effective in the general population and many forms of chronic diseases, but not after brain injury. CBT aims at changing irrational cognitions and negative thoughts but this may not be the effective mechanism after a brain injury because these thoughts and cognitions about future functioning are realistic when the consequences of the injury have changed one’s life drastically.


Based on the disappointing results regarding conventional CBT, we put forward that third wave psychotherapy such as Acceptance and Commitment Therapy (ACT) has more potential because it can help patients accept the lasting consequences and move forward with life. Third wave psychotherapy approaches target on the process of thoughts rather than the content thereby helping people to become aware of their thoughts and emotions, and to accept them for what they are. After brain injury this may be a more effective mechanism but evidence is lacking.


We will test this hypothesis in a multicenter randomized single-blind controlled trial (RCT) investigating both clinical and cost effectiveness of ACT in comparison to an active control condition being psycho-education. We aim for a reduction of post injury depression and anxiety (primary outcome measure). Secondary, we expect an increase of psychological flexibility, resilience, and participation and quality of life. We expect that ACT is more cost-effective than psycho-education from a societal perspective.


Patients with brain injury (stroke and traumatic brain injury) who have been referred to psychologists in hospitals and rehabilitation centers because of depressive and/or anxiety symptoms will be eligible for participation in the study. They will be randomly allocated to ACT or psycho-education. Treatment will be offered in groups for a period of eight weeks. Outcome measurements will be done post treatment and at 6 and 12 months follow up. Implementation in clinical practice can follow immediately if results turn out promising.


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