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Anxiety and adjustment following SCI: a transdiagnostic psychological intervention combining Cognitive Behavioural Therapy (CBT) and Coping Effectiveness Training (CET)

Spinal Cord Series and Cases volume 11, Article number: 22 (2025) Cite this article

Subjects

Abstract

Introduction

Spinal cord injury (SCI) is a life-changing experience which can result in a substantial range of psychological challenges. Although anxiety is elevated following SCI, evidence suggests that it is underreported and underdiagnosed, with consequences for long-term physical and mental health. In the UK, Cognitive Behavioural Therapy (CBT) is recommended as the first-line intervention for anxiety. However, people with SCI often face additional and complex challenges, which can limit the efficacy of protocol-delivered CBT. Pre-injury vulnerabilities can compound psychological challenges by influencing primary and secondary appraisals and perceived manageability of injury, resulting in poorer mental health and rehabilitation outcomes.

Case presentation

A transdiagnostic treatment intervention using a SCI-specific adjustment model alongside CBT and Coping Effectiveness Training (CET) of an adult with post-injury anxiety and adjustment difficulties (as measured by the GAD-7 and the ADAPSS), and history of depression (as measured by the PHQ-9). Individual psychological treatment for anxiety maintenance cycles, low mood and reduction of threat appraisals are reported, alongside multidisciplinary collaboration to enhance engagement. Outcomes included improved symptoms of anxiety, reduction of loss appraisals and development of resilience appraisals.

Discussion

Case studies of psychological treatment are sparse within the SCI literature. This case provides a detailed application of one of the most recognised psychological treatment modalities - CBT - and its integration with CET within an adjustment model for SCI. This study also highlights the importance of providing psychological support, psychoeducation and self-management strategies for all individuals with SCI, that is not dependent upon the degree of psychological morbidity.

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Data availability

Any data or client information used in the current study were obtained from clinical notes and confidential records made by the treating Clinical Psychologist for the purposes of the treatment intervention and are, therefore, not publicly available.

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Acknowledgements

The authors would like to thank Larry for permission to share his story and members of the MDT who participated in Larry’s goal planning and supported his rehabilitation. The authors would also like to thank their clinical supervisors and in particular JD would like to thank and acknowledge the supervision and feedback from the clinical supervisor and participants in the supervision group attended as part of her British Association of Behavioural and Cognitive Psychotherapist accreditation.

Author information

Authors and Affiliations

  1. Department of Clinical Psychology, National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK

    J. Duff & L. C. Grant

  2. The Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Isis Education Centre, Warneford Hospital, Oxford, UK

    L. C. Grant

Authors
  1. J. Duff
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  2. L. C. Grant
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Contributions

JD was responsible for the study design and treatment intervention. JD and LCG contributed equally to the researching, writing and editing of this publication.

Corresponding author

Correspondence to J. Duff.

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Competing interests

The authors declare no competing interests.

Ethical approval

The authors would like it to be known that Larry is a pseudonym selected and used to maintain anonymity. Ethical approval was not required as the case study was retrospective and part of routine clinical care. Written informed consent was gained from the individual for his case to be used in this written publication. All other ethical requirements were followed prior to publication. All methods were performed in accordance with the relevant guidelines and regulations.

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Duff, J., Grant, L.C. Anxiety and adjustment following SCI: a transdiagnostic psychological intervention combining Cognitive Behavioural Therapy (CBT) and Coping Effectiveness Training (CET). Spinal Cord Ser Cases 11, 22 (2025). https://doi.org/10.1038/s41394-025-00713-1

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