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Peer-reviewedCC BY-NC 4.0BMJ Open

Cognitive behavioural therapy compared to compensatory strategy training for persisting memory symptoms after concussion in adults: protocol for a randomised controlled trial

  • Noah D. Silverberg1,2,3
  • Matthew J. Burke4,5,6
  • Chantel T Debert7,8
  • Tasha Klotz1,2
  • Roger Zemek9,10
  • Julia Schmidt2,11
  • William J. Panenka12,13
  • David L. Perez14
  • Mark T. Bayley15,16
  • Maria Carmela Tartaglia17,18
  • Artee Srivastava18
  • Andrew Howard12,19
3 more authors
  • Craig Mitton20
  • Michel Rathbone21
  • Miles Byworth22
22 affiliations
  1. 1Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
  3. 3Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
  4. 4Department of Psychiatry and Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  5. 5Hurvitz Brain Sciences Program and Tory Trauma Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
  6. 6Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  7. 7Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
  8. 8University of Calgary, Calgary, Alberta, Canada
  9. 9Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  10. 10Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
  11. 11Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
  12. 12Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
  13. 13Institute of Mental Health, The University of British Columbia, Vancouver, British Columbia, Canada
  14. 14Mass General Brigham Departments of Neurology and Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
  15. 15Hull-Ellis Concussion Concussion Clinic, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
  16. 16Physical Medicine and Rehabilitation, Temerty Medicine, University of Toronto, Toronto, Ontario, Canada
  17. 17Tanz Centre for Research in Neurodegenerative Diseases, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
  18. 18Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
  19. 19BC Neuropsychiatry Program, The University of British Columbia, Vancouver, British Columbia, Canada
  20. 20Centre for Clinical Epidemiology and Evaluation, The University of British Columbia, Vancouver, British Columbia, Canada
  21. 21McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
  22. 22Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Abstract

Introduction Persisting cognitive symptoms after concussion are common and often disabling. Cognitive rehabilitation involving compensatory strategy training (CST) is the current standard of care, despite equivocal evidence supporting this approach. Cognitive behavioural therapy (CBT) is well-suited to target the psychological mechanisms theorised to perpetuate cognitive symptoms. We previously demonstrated that both CBT tailored to memory concerns (CBT-Mem) and CST are feasible to deliver via videoconference to adults with persisting cognitive symptoms after concussion. The present paper describes a study protocol to evaluate their efficacy.Methods and analysis We will conduct a multisite three-arm trial to compare CBT-Mem and CST to a covert usual care-waitlist condition and to each other. The primary outcome will be subjective memory functioning after concussion, measured by the Multifactorial Memory Questionnaire-Satisfaction scale 20 weeks following enrolment. Participants will be adults aged 18–59 years with persisting memory symptoms 6–36 months after a concussion, where their symptoms are not fully explained by another neurological or psychiatric condition or medication side effects. CBT-Mem and CST will be manualised and delivered over 10 weekly videoconference sessions. The stratified, fixed randomisation sequence with a 2:2:1 (CBT-Mem:CST:usual care-waitlist) allocation ratio will be concealed from the research team. Participants will be blinded to the non-assigned conditions and study hypotheses. Outcome assessors will also be blinded.Ethics and dissemination Study procedures were approved by the University of British Columbia Clinical Research Ethics Board and REB exchange (UBC CREB # H24-02486; University of Calgary REBX PSite −25-0010) and Sunnybrook Health Sciences Centre Research Ethics Board (CTO Project ID 5153), Children’s Hospital of Eastern Ontario Research Ethics Board (ID: 25/100X). All participants will provide written e-consent. Participants randomised to the covert usual care-waitlist condition will be debriefed and offered either CBT-Mem or CST at week 20. The findings will be disseminated through a primary peer-reviewed journal publication, following reporting guidelines.Trial registration number NCT06956417.

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Cite

BibTeXRIS
BibTeX
@article{silverberg2026cognitive,
  title = {{Cognitive behavioural therapy compared to compensatory strategy training for persisting memory symptoms after concussion in adults: protocol for a randomised controlled trial}},
  author = {Noah D. Silverberg and Matthew J. Burke and Chantel T Debert and Tasha Klotz and Roger Zemek and Julia Schmidt and William J. Panenka and David L. Perez and Mark T. Bayley and Maria Carmela Tartaglia and Artee Srivastava and Andrew Howard and Craig Mitton and Michel Rathbone and Miles Byworth},
  journal = {BMJ Open},
  year = {2026},
  month = oct,
  doi = {10.1136/bmjopen-2026-125787},
  url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-125787},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Cognitive behavioural therapy compared to compensatory strategy training for persisting memory symptoms after concussion in adults: protocol for a randomised controlled trial
AU  - Noah D. Silverberg
AU  - Matthew J. Burke
AU  - Chantel T Debert
AU  - Tasha Klotz
AU  - Roger Zemek
AU  - Julia Schmidt
AU  - William J. Panenka
AU  - David L. Perez
AU  - Mark T. Bayley
AU  - Maria Carmela Tartaglia
AU  - Artee Srivastava
AU  - Andrew Howard
AU  - Craig Mitton
AU  - Michel Rathbone
AU  - Miles Byworth
PY  - 2026
DA  - 2026/10/23
JO  - BMJ Open
DO  - 10.1136/bmjopen-2026-125787
UR  - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-125787
AB  - Introduction Persisting cognitive symptoms after concussion are common and often disabling. Cognitive rehabilitation involving compensatory strategy training (CST) is the current standard of care, despite equivocal evidence supporting this approach. Cognitive behavioural therapy (CBT) is well-suited to target the psychological mechanisms theorised to perpetuate cognitive symptoms. We previously demonstrated that both CBT tailored to memory concerns (CBT-Mem) and CST are feasible to deliver via videoconference to adults with persisting cognitive symptoms after concussion. The present paper describes a study protocol to evaluate their efficacy.Methods and analysis We will conduct a multisite three-arm trial to compare CBT-Mem and CST to a covert usual care-waitlist condition and to each other. The primary outcome will be subjective memory functioning after concussion, measured by the Multifactorial Memory Questionnaire-Satisfaction scale 20 weeks following enrolment. Participants will be adults aged 18–59 years with persisting memory symptoms 6–36 months after a concussion, where their symptoms are not fully explained by another neurological or psychiatric condition or medication side effects. CBT-Mem and CST will be manualised and delivered over 10 weekly videoconference sessions. The stratified, fixed randomisation sequence with a 2:2:1 (CBT-Mem:CST:usual care-waitlist) allocation ratio will be concealed from the research team. Participants will be blinded to the non-assigned conditions and study hypotheses. Outcome assessors will also be blinded.Ethics and dissemination Study procedures were approved by the University of British Columbia Clinical Research Ethics Board and REB exchange (UBC CREB # H24-02486; University of Calgary REBX PSite −25-0010) and Sunnybrook Health Sciences Centre Research Ethics Board (CTO Project ID 5153), Children’s Hospital of Eastern Ontario Research Ethics Board (ID: 25/100X). All participants will provide written e-consent. Participants randomised to the covert usual care-waitlist condition will be debriefed and offered either CBT-Mem or CST at week 20. The findings will be disseminated through a primary peer-reviewed journal publication, following reporting guidelines.Trial registration number NCT06956417.
SN  - 2044-6055
SN  - 2044-6055
ER  -