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Mechanisms of change during exposure therapy for persistent post-concussion symptoms: insights from session-level
Skye King1,2, Fenna Konings1, Ieke Winkens1,2
1Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
Brain Injury
|July 22, 2026
Summary
Intensive exposure therapy effectively reduces fear beliefs in persistent post-concussion symptoms. This approach targets psychological mechanisms, offering personalized treatment for mild traumatic brain injury recovery.
Area of Science:
- Neuroscience
- Psychology
- Rehabilitation Medicine
Background:
- Persistent post-concussion symptoms impact many after mild traumatic brain injury (mTBI).
- Intensive exposure therapy targets psychological mechanisms maintaining these symptoms.
- This study examines the clinical processes of exposure therapy for mTBI.
Purpose of the Study:
- To provide insight into the clinical processes of intensive exposure therapy for persistent post-concussion symptoms.
- To analyze therapy session-level data to understand treatment mechanisms.
- To evaluate the effectiveness of exposure therapy in reducing fear-based beliefs.
Main Methods:
- Mixed-methods analysis of therapy session data from two single-case experimental design studies.
- Eight participants with persistent post-concussion symptoms were included.
- Focus on targeted feared expectations and exposure tasks.
Main Results:
- Significant within-session reduction in belief strength regarding feared outcomes (p < 0.001).
- Commonly targeted fears included cognitive failure and catastrophic symptom consequences.
- Exposure tasks involved cognitive challenges, sensory environments, and social interaction.
- Individual differences in belief reduction were observed, with some residual concerns.
Conclusions:
- Feared beliefs in persistent symptoms are multidimensional and personalized.
- Individualized behavioral experiments are clinically valuable.
- Findings inform targeted implementation of exposure therapy for mTBI.
