Expert consensus on trauma-focused PTSD treatments for adults with acquired brain injury

Posttraumatic stress disorder (PTSD) frequently co-occurs with acquired brain injury (ABI), yet limited evidence guides treatment for this population. This study aimed to establish expert consensus on the applicability of trauma-focused PTSD treatments for adults with ABI, identify commonly used adaptations, and clarify treatment challenges.

A Delphi study was conducted with Dutch clinicians experienced in delivering PTSD treatment to adults with ABI across mental health, rehabilitation, and hospital settings. Through two iterative survey rounds, participants evaluated statements regarding feasibility, safety, and modifications of psychological therapies for PTSD after ABI. Quantitative agreement ratings were supplemented with qualitative comments.

Consensus across two Delphi rounds (51 and 50 experts) indicated that trauma-focused treatments were feasible for adults with ABI. Core therapeutic principles were considered valid, and procedural adaptations, such as shorter sessions, slower pacing, and simplified language, were sometimes recommended for cognitive or sensory impairments. Structural modifications were less commonly endorsed. Opinions diverged regarding side-effect profiles: some reported similarities to non-ABI patients, whereas others noted increased fatigue, irritability, or somatic complaints. No consensus emerged on the adequacy of current PTSD assessment instruments, with concerns about symptom overlap and a need for ABI-specific validation or adapted administration.

Clinicians agreed that trauma-focused treatments can be feasible for adults with ABI when adaptations are applied on a case-by-case basis. The study also highlights uncertainty regarding PTSD assessment tools and the need for systematic evaluation of treatment adaptations and adverse effects. These practitioner-informed findings provide direction for clinical practice and guideline refinement.