Psychotherapy Articles

Psychotherapy Articles

Trauma-related symptoms have been observed and documented in veterans of military engagement since the existence of the ancient Greeks. While these symptoms have been identified by a plethora of other names, including shell shock, war neurosis, battle fatigue, and soldier’s heart, it wasn’t until 1980 that these symptoms were formally recognized as post-traumatic stress disorder (PTSD; Chekroud et al., 2018). Due to the prevalence of veterans experiencing PTSD-related symptoms, the majority of the research on PTSD stems from studying veterans who experienced trauma related to their military experience, typically in combat settings. PTSD can develop, however, from a variety of traumatic events or stressors (i.e., motor vehicle accidents, sexual and physical assaults, natural disasters). Most individuals do not develop PTSD after experiencing a traumatic event or stressor (Howlett & Stein, 2016). In fact, approximately 70% of individuals will experience at least one traumatic stressor throughout their lives and about 20% of these individuals will be diagnosed with PTSD (Almli et al., 2013). One significant risk factor for PTSD that has more recently been recognized through studying Iraq and Afghanistan veterans is experiencing a traumatic brain injury (TBI). A TBI can result from any of the PTSD stressors (i.e., motor vehicle accidents, sexual and physical assaults, natural disasters). The injury sustained in TBI typically leads to some sort of disruption to the brain’s normal functioning that is caused by a blow, bump, blast, or jolt to the head, or a penetrating head injury (National Institute of Neurological Disorders and Stroke, 2023). Studies on Iraq and Afghanistan veterans found high rates of co-occurrence between PTSD and TBI, which lead to further query in this area (Yoder & Norman, n.d.).

Although this observation has led to more focused attention on the co-occurrence of PTSD and TBI, the research remains unclear on the causality of this relationship. In fact, there have been zero randomized controlled trials to date on the impact of psychotherapeutic intervention on co-occurring PTSD and TBI (Howlett & Stein, 2016). This has put limitations on the development of evidence-based practices and resources for mental health professionals (MHP) who treat patients with this presentation. Additionally, the significant overlap in symptoms, high co-occurrence rates, and similar comorbidities between PTSD and TBI make it more challenging for clinicians to accurately diagnose and treat patients with this presentation. The aim of this paper is to provide: 1) An overview of the literature, the prevalence of comorbidity, and various co-occurring symptoms; 2) Considerations for psychotherapeutic intervention; and, 3) Recommendations for MHPs with a differential symptom table (Table 1) to reference.

Prevalence and Co-occurrence of PTSD and TBI Diagnoses

Concentrated research efforts on PTSD and TBI-related symptoms has revealed the importance of understanding the prevalence and co-occurrence of these diagnoses by MHPs. According to the current literature, there is a 6% lifetime prevalence of PTSD and a 5% annual prevalence for individuals living in the United States. In 2020 alone, about 13 million Americans lived with PTSD (Schnurr, n.d.). When looking at the data for TBIs, the Centers for Disease Control and Prevention (2016) estimated that 1.5 million Americans experience a TBI every year, remaining a leading cause of death for children and young adults in the United States. Of these 1.5 million people, approximately 80,000-90,000 will live with long-term disability as a result of the TBI. These numbers translate into the approximation that 5.3 million people in the United States live with permanent TBI-related disability (Centers for Disease Control and Prevention, 2016). Although the current research has not demonstrated a significant causal relationship between PTSD and TBI, it has identified a strong association between these diagnoses with up to half of the individuals with a mild TBI meeting criteria for PTSD (Simonovic et al., 2023). Another study found that patients presenting to a trauma center for physical injury were about twice as likely to develop PTSD if they experienced a mild TBI than patients who did not experience a TBI (Bryant, 2010). These significant findings emphasize the importance of distinguishing symptomology and integrating treatment modalities that address both conditions.

Symptom Overlap and Differential Diagnosis of PTSD and TBI

There are significant challenges to identifying and distinguishing PTSD and TBI symptoms, making it imperative for MHPs to acknowledge and understand the presence of these conditions when symptom criterion are met. Such overlapping symptoms that are observed in both PTSD and TBI presentations are described in Table 1 and represented in Figure 1. Some of these symptoms include depressed mood, anxiety, insomnia, difficulty concentrating, fatigue, hyperarousal, avoidance, irritability, derealization, depersonalization, decreased awareness of surroundings, and emotional numbing (Howlett & Stein, 2016).

While identifying the etiology of any mental health disorder and neurological condition can benefit psychotherapeutic intervention and a MHP’s conceptualization, it may not be as clear when treating patients with co-occurring PTSD and TBI as overlapping symptoms may impact and cloud clinical judgment. For example, cognitive changes (i.e., impaired memory, difficulty concentrating), emotional dysregulation (i.e., irritability, anger, aggression), and behavioral challenges (i.e., impulsivity, avoidance) can be seen in both PTSD and TBI patients. Yet, etiology may not be as important in treatment. Most of the overlapping symptoms, apart from brain-based cognitive symptoms, can be treated successfully without identifying their etiology. However, differential diagnosis is crucial for certain symptoms that require more focused and individualized approaches to treatment. This is specifically important to successfully treat PTSD since there are particular evidence-based modalities (i.e., exposure-related interventions) that require diagnostic awareness by the MHP. Untreated PTSD in TBI patients can unintentionally worsen TBI symptoms and may impede a patient’s ability to cope with TBI sequelae, emphasizing the importance of understanding the intricacies to each symptom expression (Vasterling et al., 2018).

Comorbid Diagnoses with PTSD and TBI

Further exacerbating the complexities that exist in co-occurring PTSD and TBI presentations is the potential presence of other psychiatric comorbidities that are prevalent in both conditions. Some of these comorbidities include major depressive disorder (MDD), substance use disorder (SUD), and chronic pain. In addition to this is the possibility that these conditions existed prior to the TBI, as a result of the TBI and/or PTSD, or are exacerbated by the TBI and/or PTSD symptoms (Howlett & Stein, 2016).

Symptoms of depression are highly prevalent in both conditions with many studies demonstrating that TBI increases the risk for developing depression (Kreutzer et al., 2001; Seel et al., 2003). Additionally, some of the core symptoms for PTSD and TBI are also found in individuals meeting criteria for MDD. These symptoms include difficulty concentrating, memory problems, reduced motivation, irritability, and fatigue (Jorge et al., 1993; Silver et al., 2001; Varney et al., 1987). The symptom overlap between TBI, PTSD, and depression can muddle the clinical presentation and make it more difficult to distinguish symptoms.

Another comorbid diagnosis that is frequently seen with PTSD and co-occurring TBI is SUD. Many studies have demonstrated a trend of increased substance use overtime for individuals with TBI (Corrigan et al., 2013; Parry-Jones et al., 2006). Additionally, PTSD is highly comorbid with SUD (Brady et al., 2009), creating an increased probability of substance use for patients with co-occurring PTSD and TBI. Substance use can greatly impede healing from TBI and exacerbate PTSD-related symptoms, further complicating psychotherapeutic treatment focused on PTSD and TBI-related symptoms exclusively (Gros et al., 2015). These findings demonstrate both the difficulty in differential diagnosis and the importance of gathering as much information as possible prior to ruling in or ruling out diagnoses.

In addition, chronic pain has been found to be commonly associated with diagnoses of TBI, PTSD, and depression, complicating this matter further for clinicians (Gasquoine, 2000). Pain can interact with TBI and PTSD in ways that may initially be difficult to distinguish. For example, pain from a traumatic injury that resulted in a TBI can trigger the re-experiencing symptoms of PTSD (Bryant & Hopwood, 2006). Identifying the etiology of the pain can be helpful to understand the complex interaction amongst these conditions. Adding on to these complications is the fact that several symptoms of TBI and PTSD are non-specific and may be unrelated to either TBI or PTSD. These include headaches, sleep disturbance, memory problems, irritability, somatization, and psychiatric pain generators (Bryant, 2022). This emphasizes the importance of understanding the history and onset of each symptom in order to provide the most appropriate treatment.

Clinical Implications When Treating Co-occurring PTSD and TBI

Accurately diagnosing a mental health disorder can be challenging. When attempting to identify and distinguish symptoms that are present in both PTSD and TBI diagnoses (i.e., cognitive, behavioral, and emotional changes, sleep disturbance, chronic pain, avoidance) this challenge takes on a whole new meaning that can cause unintentional harm if it is not handled with extreme care. If a MHP is not aware of the significant overlap in symptoms, it is even easier to misdiagnose, under-diagnose, or over-diagnose a patient. This could lead to a myriad of negative outcomes that are avoidable and unnecessary. For instance, requesting a brain imaging study to identify TBI-related brain damage when the patient’s symptoms are an expression of PTSD. Even the MHPs who have extensive training in PTSD presentations may feel less competent when confronted with co-occurring TBI-related symptoms and the inherent symptom overlap. This means that MHPs may misattribute symptoms to PTSD instead of TBI, unintentionally putting the responsibility for improved mental health on the patient who has little neurocognitive control. Additionally, when PTSD symptoms are misattributed to a physical brain injury, a patient’s expectations of recovery are reduced, leading to a process called “diagnosis threat” (Howlett & Stein, 2016). This threat informs patients that their recovery is not in their control, potentially decreasing their engagement in psychotherapy, reducing feelings of hope, and limiting insight and awareness into their symptoms.

The treatment of PTSD when co-occurring with TBI presents special challenges that MHPs should be aware of in order to avoid treating these conditions in isolation of one another. It is crucial for MHPs to understand that patients with TBIs may underreport their PTSD symptoms for a variety of reasons (i.e., limited awareness of symptoms, misattributed symptoms to TBI diagnosis; Nash et al., 2015). This puts the responsibility on MHPs to continue gathering information throughout the treatment process to identify and distinguish symptom overlap more accurately. With the lack of evidence to inform and guide treatment for co-occurring PTSD and TBI, MHPs must incorporate the available research with an individualized approach depending on the symptom presentation and interaction. The importance of an individualized approach is emphasized in presentations where the cognitive and TBI sequelae interfere with treatment progress, the symptom overlap is significant, or when treatment indications for one diagnosis contradict treatment recommendations for the other (Bryant et al., 2010; Howlett & Stein, 2016).

Clinical Considerations and Treatment Options for PTSD and TBI

In summary, PTSD and TBI symptoms are difficult to distinguish, often occur together, and necessitate recognition to treat effectively. In conjunction with the table referenced above, below is a list of treatment and intervention options for various symptoms present in both conditions.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Restful sleep is a crucial aspect to physical and psychological healing. CBT-I should be introduced to treat sleep disturbances prior to referring patients for a sleep study or for a medication evaluation. This is a manualized therapeutic approach with a strong evidence base that takes approximately 10-12 sessions to complete.

Cognitive Processing Therapy (CPT) combined with a Cognitive Training Routine

CPT is a type of trauma-focused CBT approach where patients focus on restructuring dysfunctional cognitions related to a traumatic event. Integrating CPT with cognitive training interventions can improve cognitive functioning in areas of verbal memory, working memory, and problem solving (Jak et al., 2019).

Cognitive Functioning Strategies

Improved cognitive functioning can aid in better treatment outcomes. The following are strategy options: implement pomodoro technique when engaging in cognitively demanding activities to reduce cognitive fatigue and increase encoding, simplify delivery of therapy materials and discussions, utilize written instructions for memory impairments, form new strategies to minimize reliance on attentional focus, and utilize reminders and alarms for time management difficulties.

Behavioral Interventions

Using an Antecedent-Behavior-Consequences (ABC) approach can be helpful in identifying the antecedent of the problematic behavior along with the associated consequences. Once those aspects are identified, altering the trigger for the behavior and related consequences are the next steps.

Pain Psychology Interventions

Managing pain symptoms is crucial for improved treatment outcomes. It is also important to understand the biopsychosocial factors that modulate pain symptoms. The following are intervention options: implement activity pacing in the form of an activity-rest cycle, pace tasks based on time rather than pain symptoms, utilize relaxation training techniques, and employ coping skills training for pain. Alternative treatment interventions include biofeedback, pain sensitization and desensitization techniques, and monitoring when pain can trigger emotional trauma.

Mindfulness-Based Interventions

There are a multitude of mindfulness-based practices that have demonstrated beneficial effects for TBI and PTSD symptoms, including Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, and Self- Compassion approaches. These techniques have been shown to decrease somatic and emotional symptoms and improve a patient’s ability to cope with and respond to stress (Lovette et al., 2022). Implementing present moment attention, a mindful cognitive approach, and a non-judgmental perspective are significant aspects to mindfulness-based practices that have proven effective in treating the overlapping symptoms seen in TBI and PTSD (Boyd et al., 2018).

Psychopharmacological Interventions

Due to the significant symptom overlap, it can be beneficial to utilize interventions that target these symptoms specifically using psychopharmacological resources. Selective serotonin reuptake inhibitors can be beneficial for mood symptoms in both conditions; Prazosin can decrease nightmares; hypnotics can be introduced for sleep impairments; anticonvulsants and antipsychotics may assist with affect dysregulation (Stein & McAllister, 2009). It is imperative to remain cautious when utilizing psychopharmacological interventions due to the varied impact the side effects may have on both conditions. It is imperative to consider the special risk factors involved with prescribing psychotropic medications as they may worsen TBI symptoms, including problems with balance, memory impairments, seizures, and sensory processing difficulties (Howlett & Stein, 2016).

Recommendations for Clinicians and MHPs for PTSD and TBI

Be thorough when evaluating patients

TBI patients may underreport PTSD symptoms, making it crucial to be curious and thorough to accurately diagnose and treat. Additionally, understanding the course of symptoms and their timeframe through detailed information gathering can assist in distinguishing etiology. While symptoms of PTSD may have a delayed onset and tend to worsen over time, TBI symptoms are typically expressed acutely and have a tendency to lessen over time (Carroll et al., 2004; Nash et al., 2015).

Avoid diagnosis threat phenomenon

Diagnosis threat can be avoided by using a cautious approach when conclusively attributing symptoms to a physical brain injury when other causes can also explain the symptom presentation. Additionally, it is important for clinicians to emphasize the possibility of recovery and hope for an improved prognosis.

Remain flexible and adaptable

Cognitive changes and other sequelae of TBI may interfere with treatment engagement and effectiveness. These sequelae include difficulty understanding, remembering, and engaging with therapy resources, challenges with impulse control, and cognitive fatigue. Remaining flexible and adaptable in the psychotherapeutic setting can model these skills for patients to implement in their recovery.

Consult with patient’s medical team

Coordination of care for this population is especially important due to the nature of TBIs. MHPs may benefit from consulting with neuropsychologists, health psychologists, physical medicine specialists, psychiatrists, speech, occupational, and physical therapists, ophthalmologists, and/or neurology specialists. Consulting with other professionals can provide support to better understand and differentiate organic, overlapping symptoms and non-organic symptoms.

Conclusion

Clarifying PTSD and TBI symptomatology is an ongoing effort. The literature presents significant symptom overlap, requiring MHPs to consider ongoing therapeutic assessment. This means that MHPs need to consistently monitor overlapping symptoms and initiate problem-solving techniques with patients to address them. By having an awareness of the comorbid prevalence of PTSD and TBI and the significant symptom overlap that is present, MHPs can incorporate treatment interventions to target these symptoms specifically. The range in treatment recommendations for co-occurring PTSD and TBI demonstrates the need for an individualized approach that is informed through curiosity, consultation, and re-evaluation. Although this can be a challenging clinical presentation to identify and treat, there is significant hope for symptom reduction and improved well-being for individuals seeking therapeutic support.

Figure 1: Overlapping PTSD and TBI Symptom Categories

Table 1: Differential Symptoms in TBI and PTSD

Symptom Category Traumatic Brain Injury (TBI) Post-Traumatic Stress Disorder (PTSD)
Avoidance Avoidance of engaging in cognitively difficult tasks; avoidance of people/places that serve as a reminder of baseline functioning Avoidance of reminders or triggers of traumatic event(s); avoidance of people/places that serve as reminders of traumatic event(s)
Behavioral Changes Difficulty with social interactions; refusal to engage in activities; lack of motivation to initiate activities; difficulty with task initiation; poor impulse control; limited awareness of TBI effects Changes in irritability and impulsiveness; hypervigilant and easily aroused; reckless behavior; difficulty with reactivity; increased outbursts of anger
Chronic Pain Headaches; nerve pain; spasticity of muscles causing pain; unidentifiable pain sensations Increased pain due to dysregulated stress response from hypervigilance and arousal; increased pain detection; pain related or unrelated to traumatic event; pain as a reminder of traumatic event
Cognitive Changes Slowed thinking; impairments with attention, memory, and problem solving; easily distractible; periods of confusion Impairments with attention, memory, and problem solving; reduced social cognitive abilities; experiences with flashbacks, derealization, and depersonalization
Emotional Changes Reduced emotional awareness; restlessness; anxious; depressed; dependent on area of brain injury; influenced by substance use Poor emotional control; negative mood; panic; anxious; overwhelmed by emotions; emotionally numb; shame; guilt
Irritability and Anger Sudden and unpredictable behavior; easily triggered; sensitive to surroundings; poor emotional regulation and awareness increasing frequency of these emotional expressions On-edge; easily irritated due to hyperarousal; quick to anger depending on traumatic event(s)
Sleep Disturbance Difficulty with sleep initiation; fragmented sleep patterns; insomnia (more common with mild TBI); excessive daytime drowsiness; increased risk of behavioral and emotional difficulties due to lack of sleep; restless leg syndrome; teeth grinding or clenching (bruxism); sleep apnea; sleepwalking Nightmares; insomnia; restless leg syndrome; increased experiences with sleep talking; bruxism; avoidance of nighttime silence, increasing poor sleep patterns

 

Lacy Sohn (she/her) is completing her third year in the APA accredited PsyD program in Clinical Psychology at Alliant International University in Sacramento, California. She has plans to earn her PsyD in Clinical Psychology in the spring of 2025. Lacy is currently a clinical trainee at a group private practice and has experience working in multiple clinical settings, including an intensive outpatient program and a medical hospital. Her clinical interests reside at the intersection of medical and emotional traumas, anxiety disorders, obsessive-compulsive and related disorders, education, and advocacy. Lacy is a native Californian and she moved to Reno, Nevada to pursue her bachelor’s degree in Business Administration with a minor focus on biological sciences from the University of Nevada, Reno. In her spare time, Lacy enjoys being in nature, hiking and mountain biking in the warmer months and snow-shoeing in the colder months, reading books, and spending time with family and friends.

Cite This Article

Sohn, L., & Ramezani, A. (2024, April). Treatment considerations for co-occurring post-traumatic stress disorder and traumatic brain injury. Psychotherapy Bulletin, 59(3).

References

Alexander, M. P. (1995). Mild traumatic brain injury. Neurology45(7), 1253–1260.

Almli, L. M., Fani, N., Smith, A. K., & Ressler, K. J. (2013). Genetic approaches to understanding post-traumatic stress disorder. International Journal of Neuropsychopharmacology, 17(2), 355-370. https://doi.org/10.1017/s1461145713001090

Boyd, J. E., Lanius, R. A., & McKinnon, M. C. (2018). Mindfulness-based treatments for posttraumatic stress disorder: A review of the treatment literature and neurobiological evidence. Journal of Psychiatry & Neuroscience, 43(1), 7-25. https://doi.org/10.1503//jpn.170021

Brady, K. T., Tuerk, P. W., Back, S. E., Saladin, M. E., Waldrop, A. E., & Myrick, H. (2009). Combat posttraumatic stress disorder, substance use disorders, and traumatic brain injury. Journal of Addiction Medicine, 3(4), 179-188. https://doi.org/10.1097/adm.0b013e3181aa244f

Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology68(5), 748–766. https://doi.org/10.1037//0022-006x.68.5.748

Bryant, R. A. (2010). Posttraumatic stress disorder and mild brain injury: Controversies, causes and consequences. Journal of Clinical and Experimental Neuropsychology23(6), 718–728. https://doi.org/10.1076/jcen.23.6.718.1024

Bryant, R. A. (2022). Post-traumatic stress disorder vs traumatic brain injury. Dialogues in Clinical Neuroscience13(3), 251–262. https://doi.org/10.31887/dcns.2011.13.2/rbryant

Bryant, R. A., & Hopwood, S. (2006). Commentary on “Trauma to the Psyche and Soma.” Cognitive and Behavioral Practice, 13(1), 17-23. https://doi.org/10.1016/j.cbpra.2005.03.002

Bryant, R. A., O’Donnell, M., Creamer, M., McFarlane, A. C., Clark, C. R., & Silove, D. (2010). The psychiatric sequelae of traumatic injury. American Journal of Psychiatry, 167(3), 312-320. https://doi.org/10.1176/appi.ajp.2009.09050617

Carroll, L., Cassidy, J. D., Holm, L. W., Kraus, J. F., & Coronado, V. G. (2004). Methodological issues and research recommendations for mild traumatic brain injury: The WHO collaborating center task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 36, 113-125. https://doi.org/10.1080/16501960410023877

Carroll, L., Cassidy, J. D., Holm, L. W., Kraus, J. F., & Coronado, V. G. (2004). Methodological issues and research recommendations for mild traumatic brain injury: The WHO collaborating center task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 36, 113-125. https://doi.org/10.1080/16501960410023877

Chekroud, A., M., Loho, H., Paulus, M.P., & Krystal, J. H. (2018). PTSD and the war of words. Chronic Stress, 2. https://doi.org/10.1177/2470547018767387

Corrigan, J., Adams, R. S., & Larson, M. J. (2013). When addiction co-occurs with traumatic brain injury. American Journal of Psychiatry, 170(4), 351-354. https://doi.org/10.1176/appi.ajp.2012.12121602

Dossi, G., Delvecchio, G., Prunas, C., Soares, J. C., & Brambilla, P. (2020). Neural bases of cognitive impairments in post-traumatic stress disorders: A mini-review of functional magnetic resonance imaging findings. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00176

Gasquoine, P. G. (2000). Postconcussional symptoms in chronic back pain. Applied Neuropsychology7(2), 83–89. https://doi.org/10.1207/s15324826an0702_3

Grigsby, J., & Kaye, K. (1993). Incidence and correlates of depersonalization following head trauma. Brain Injury7(6), 507–513. https://doi.org/10.3109/02699059309008178

Gronwall, D., & Wrightson, P. (1981). Memory and information processing capacity after closed head injury. Journal of Neurology, Neurosurgery, and Psychiatry, 44(10), 889-895. https://pubmed.ncbi.nlm.nih.gov/7310407/

Gros, D. F., Korte, K. J., Horner, M. D., Brady, K. T., & Back, S. E. (2015). Co-occurring traumatic brain injury, PTSD symptoms, and alcohol use in veterans. Journal of Psychopathology and Behavioral Assessment, 38(2), 266-274. https://doi.org/10.1007/s10862-015-9513-y

Hayes, J. P., VanElzakker, M. B., & Shin, L. M. (2012). Emotion and cognition interactions in PTSD: A review of neurocognitive and neuroimaging studies. Frontiers in Integrative Neuroscience, 6. https://doi.org/10.3389/fnint.2012.00089

Howlett, J. R., & Stein, M. B. (2016). Post-traumatic stress disorder: Relationship to traumatic brain injury and approach to treatment. In D. T. Laskowitz & G. Grant (Eds.), Translational research in traumatic brain injury (1st ed.). CRC Press.

Iverson, G. (2006). Misdiagnosis of the persistent postconcussion syndrome in patients with depression. Archives of Clinical Neuropsychology21(4), 303–310. https://doi.org/10.1016/j.acn.2005.12.008

Jak, A. J., Jurick, S. M., Crocker, L. D., Sanderson‐Cimino, M., Aupperle, R. L., Rodgers, C. S., Thomas, K. R., Boyd, B. L., Norman, S. B., Lang, A. J., Keller, A. V., Schiehser, D. M., & Twamley, E. W. (2019). SMART-CPT for veterans with comorbid post-traumatic stress disorder and history of traumatic brain injury: A randomized controlled trial. Journal of Neurology, Neurosurgery, and Psychiatry, 90(3), 333-341. https://doi.org/10.1136/jnnp-2018-319315

Jorge, R., Robinson, R., Starkstein, S., & Arndt, S. (1993). Depression and anxiety following traumatic brain injury. The Journal of Neuropsychiatry and Clinical Neurosciences5(4), 369–374. https://doi.org/10.1176/jnp.5.4.369

King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the clinician-administered PTSD scale: Evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment10(2), 90–96. https://doi.org/10.1037//1040-3590.10.2.90

Kreutzer, J., Gourley, E., & Seel, R. (2001). The prevalence and symptom rates of depression after traumatic brain injury: A comprehensive examination. Brain Injury15(7), 563–576. https://doi.org/10.1080/02699050116884

Larsen, S. E., & Hadiandsmyth, K. E. (2023). Chronic pain and PTSD. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/professional/treat/cooccurring/chronic_pain_guide.asp#two

Lovette, B. C., Kanaya, M. R., Bannon, S., Vranceanu, A., & Greenberg, J. (2022). “Hidden gains”? Measuring the impact of mindfulness-based interventions for people with mild traumatic brain injury: A scoping review. Brain Injury, 36(9), 1059-1070. https://doi.org/10.1080/02699052.2022.2109745

Mayo Clinic. (2022, December). Post-traumatic stress disorder (PTSD). https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

Model Systems Knowledge Translation Center. (2022). Changes in emotions after traumatic brain injury. https://msktc.org/tbi/factsheets/changes-emotion-after-traumatic-brain-injury

Model Systems Knowledge Translation Center. (2021a). Traumatic brain injury and chronic pain: Part 1. https://msktc.org/tbi/factsheets/traumatic-brain-injury-and-chronic-pain-part-1

Model Systems Knowledge Translation Center. (2021b). Understanding and coping with irritability, anger, and aggression after TBI. https://msktc.org/tbi/factsheets/understanding-and-coping-irritability-anger-and-aggression-after-tbi

Model Systems Knowledge Translation Center. (2021c). Understanding behavior changes after TBI. https://msktc.org/tbi/factsheets/understanding-behavior-changes-after-tbi

Nash, W. P., Boasso, A., Steenkamp, M. M., Larson, J. L., Lubin, R. E., & Litz, B. T. (2015). Posttraumatic stress in deployed Marines: Prospective trajectories of early adaptation. Journal of Abnormal Psychology, 124(1), 155-171. https://doi.org/10.1037/abn0000020

National Institute of Neurological Disorders and Stroke. (2023, November). Traumatic Brain Injury. https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi

Parry-Jones, B., Vaughan, F. L., & Cox, W. M. (2006). Traumatic brain injury and substance misuse: A systematic review of prevalence and outcomes research. Neuropsychological Rehabilitation, 16(5), 537-560. https://doi.org/10.1080/09602010500231875

Pineles, S. L., Mostoufi, S., Ready, C. B., Street, A. E., Griffin, M. G., & Resick, P. A. (2011) Trauma reactivity, avoidant coping, and PTSD symptoms: A moderating relationship? Journal of Abnormal Psychology, 120(1), 240-246. https://doi.org/10.1037/a0022123

Rethink. (n.d.). PTSD explained: The causes, symptoms, and treatment. https://www.rethink.org/advice-and-information/about-mental-illness/learn-more-about-conditions/post-traumatic-stress-disorder-ptsd/

Schnurr, P. P. (n.d.). Epidemiology and impact of PTSD. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/professional/treat/essentials/epidemiology.asp

Seel, R. T., Kreutzer, J. S., Rosenthal, M., Hammond, F. M., Corrigan, J. D., & Black, K. (2003). Depression after traumatic brain injury: A national institute on disability and rehabilitation research model systems multicenter investigation. Archives of Physical Medicine and Rehabilitation84(2), 177–184. https://doi.org/10.1053/apmr.2003.50106

Silver, J. M., Kramer, R., Greenwald, S., & Weissman, M. (2001). The association between head injuries and psychiatric disorders: Findings from the New Haven NIMH Epidemiologic Catchment Area Study. Brain Injury15(11), 935–945. https://doi.org/10.1080/02699050110065295

Simonovic, M., Nedovic, B., Radisavljevic, M., & Stojanovic, N. (2023). The co-occurrence of post-traumatic stress disorder and depression in individuals with and without traumatic brain injury: A comprehensive investigation. Medicina, 59(8), 1467. https://doi.org/10.3390/medicina59081467

Stein, M. M. B., & McAllister, T. W. (2009). Exploring the convergence of posttraumatic stress disorder and mild traumatic brain injury. American Journal of Psychiatry, 166(7), 768-776. https://doi.org/10.1176/appi.ajp.2009.08101604

UpToDate. (2023, July). Sleep-wake disorders in patients with traumatic brain injury. https://www.uptodate.com/contents/sleep-wake-disorders-in-patients-with-traumatic-brain-injury

U.S. Department of Veterans Affairs. (n.d.). Sleep problems and PTSD. https://www.ptsd.va.gov/understand/related/sleep_problems.asp

Varney, N. R., Martzke, J. S., & Roberts, R. J. (1987). Major depression in patients with closed head injury. Neuropsychology1(1), 7–9. https://doi.org/10.1037/08944105.1.1.7

Vasterling, J. J., Jacob, S. N., & Rasmusson, A. M. (2018). Traumatic brain injury and posttraumatic stress disorder: Conceptual, diagnostic, and therapeutic considerations in the context of co-occurrence. Journal of Neuropsychiatry and Clinical Neurosciences, 30(2), 91-100. https://doi.org/10.1176/appi.neuropsych.17090180

Yitzhaki, T., Solomon, Z., & Kotler, M. (1991). The clinical picture of acute combat stress reaction among Israeli soldiers in the 1982 Lebanon War. Military Medicine156(4), 193–197. https://doi.org/10.1093/milmed/156.4.193

Yoder, M., & Norman, S. (n.d.). Co-occurring PTSD and neurocognitive disorder (NCD). U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/professional/treat/cooccurring/ncd_cooccurring.asp

 

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