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

Year: 2026

Type: article

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.

Source: BMJ Open

DOI: 10.1136/bmjopen-2026-125787