The Short Answer Educational content only. Any suspected concussion warrants medical evaluation. Consult concussion specialists and treating providers before starting any new therapy. Cognitive behavioral therapy (CBT) is effective for post-concussion syndrome symptoms (Silverberg et al., 2020). Strong evidence base with multiple randomized controlled trials supports CBT for PCS including anxiety, depression, sleep problems, catastrophizing, avoidance behaviors, and functional impairment. CBT addresses psychological factors affecting recovery including illness beliefs, symptom expectations, coping strategies, and activity pacing. First-line treatment for mood and anxiety symptoms in PCS. Trauma-focused CBT for co-occurring PTSD common in blast injury, motor vehicle accidents, and assault-related concussions. CBT typically 8-16 sessions with concussion-experienced therapist. CBT is first-line for PCS psychological symptoms. First-line treatment. Strong evidence base supports CBT for PCS. Strong evidence base. Concussion-experienced therapist recommended. Concussion-experienced therapist. What CBT Addresses in PCS Anxiety. Anxiety symptoms. Depression. Depression symptoms. Sleep problems. Sleep problems. Catastrophizing. Catastrophizing thinking patterns. Avoidance behaviors. Avoidance behaviors. Fear avoidance. Fear avoidance. Symptom hypervigilance. Symptom hypervigilance. Illness beliefs. Illness beliefs. Coping strategies. Coping strategies. Activity pacing. Activity pacing. Return-to-activity anxiety. Return-to-activity anxiety. Chronic pain. Chronic pain. PTSD symptoms. PTSD symptoms. CBT Techniques Psychoeducation about concussion. Psychoeducation about concussion. Cognitive restructuring. Cognitive restructuring. Behavioral activation. Behavioral activation. Graded exposure. Graded exposure. Activity scheduling. Activity scheduling. Pacing strategies. Pacing strategies. Sleep hygiene. Sleep hygiene. Relaxation training. Relaxation training. Mindfulness training. Mindfulness training. Problem-solving skills. Problem-solving skills. Communication skills. Communication skills. Value clarification. Value clarification. Evidence for CBT in PCS Multiple RCTs support CBT for PCS. Multiple RCTs support. Silverberg CBT-c protocol evidence. Silverberg CBT-c evidence. Vestibular rehabilitation plus CBT. Vestibular rehab plus CBT. Reduced symptom persistence. Reduced symptom persistence. Reduced anxiety. Reduced anxiety. Reduced depression. Reduced depression. Improved sleep. Improved sleep. Improved function. Improved function. Faster return to activity. Faster return to activity. Reduced healthcare utilization. Reduced healthcare utilization. Catastrophizing and PCS Recovery Catastrophizing predicts poor recovery. Catastrophizing predicts poor recovery. Catastrophizing amplifies symptom experience. Catastrophizing amplifies symptoms. Catastrophizing increases avoidance. Catastrophizing increases avoidance. Cognitive restructuring addresses catastrophizing. Cognitive restructuring addresses. Psychoeducation reduces catastrophizing. Psychoeducation reduces. Reduced catastrophizing improves outcomes. Reduced catastrophizing improves. Avoidance Behaviors in PCS Avoidance of activity common. Activity avoidance common. Avoidance of screens. Screen avoidance. Avoidance of social situations. Social avoidance. Avoidance of exercise. Exercise avoidance. Avoidance worsens deconditioning. Avoidance worsens deconditioning. Avoidance increases fear. Avoidance increases fear. Graded exposure addresses avoidance. Graded exposure addresses. Behavioral activation increases activity. Behavioral activation increases activity. Sleep and CBT-I in PCS CBT for insomnia (CBT-I) evidence-based. CBT-I evidence-based. Sleep hygiene training. Sleep hygiene training. Sleep restriction therapy. Sleep restriction therapy. Stimulus control therapy. Stimulus control therapy. Cognitive therapy for insomnia. Cognitive therapy for insomnia. Relaxation training. Relaxation training. Sleep improvement supports overall recovery. Sleep improvement supports recovery. Trauma-Focused CBT for Co-Occurring PTSD PTSD common after blast injury. PTSD common after blast. PTSD common after MVA concussion. PTSD common after MVA. PTSD common after assault concussion. PTSD common after assault. PTSD-Checklist screening. PCL-5 screening. Prolonged exposure therapy. Prolonged exposure therapy. Cognitive processing therapy. Cognitive processing therapy. EMDR sometimes used. EMDR sometimes used. Trauma-focused therapist essential. Trauma-focused therapist essential. Program Structure Initial evaluation 60-90 minutes. Initial evaluation 60-90 minutes. Sessions 45-60 minutes weekly. Sessions 45-60 minutes weekly. 8-16 sessions typical course. 8-16 sessions typical. Extended course for chronic PCS. Extended course chronic PCS. Homework between sessions. Homework between sessions. Reassessment every 4-8 sessions. Reassessment every 4-8. Psychoeducation Components Concussion natural history. Concussion natural history. Expected recovery timeline. Expected recovery timeline. Symptom fluctuation normalization. Symptom fluctuation normalization. Activity guidelines. Activity guidelines. Return-to-activity progression. Return-to-activity progression. Symptom exacerbation understanding. Symptom exacerbation understanding. Distinguishing PCS from anxiety. Distinguishing PCS from anxiety. Realistic outcome expectations. Realistic outcome expectations. Finding a Qualified CBT Therapist Licensed mental health provider. Licensed mental health provider. Psychologist, LCSW, LMFT, LMHC. Psychologist LCSW LMFT LMHC. Concussion experience. Concussion experience. Health psychology background. Health psychology background. Rehabilitation psychology background. Rehab psychology background. Neuropsychology background sometimes. Neuropsychology background. Concussion clinic referral. Concussion clinic referral. Trauma-focused training for PTSD. Trauma-focused training. Insurance Coverage Most insurance covers CBT. Most insurance covers CBT. Mental health parity supports coverage. Mental health parity supports coverage. Verify network provider. Verify network provider. Diagnosis codes for PCS mental health. PCS mental health diagnosis codes. Prior authorization sometimes required. Prior authorization sometimes required. Session limits by plan. Session limits by plan. Supporting Mobility Routine These exercises support CBT treatment through nervous system regulation and stress reduction. JME 155 Diaphragmatic breathing supports vagal tone and parasympathetic regulation during concussion recovery. 10 breaths every 60-90 minutes. JME 14 Chin tucks reduce upper cervical tension common in concussion injury. 10 repetitions with 5-second holds. JME 1 Cervical rotation supports cerebral blood flow and nervous system regulation. 10 repetitions each direction. JME 150 Thoracic rotation restores breathing depth shallow during concussion recovery. 8 repetitions per direction. Start your 3-day free trial for joint-specific mobility programs that support nervous system regulation through concussion recovery. Common Mistakes About CBT for PCS Assuming CBT means symptoms are psychological. CBT addresses psychological factors affecting recovery. Avoiding CBT due to stigma. Stigma avoidance. Seeing therapist without concussion experience. Concussion experience important. Not completing homework. Homework essential. Discontinuing after initial improvement. Complete course. Does CBT mean my concussion symptoms are psychological? No. CBT addresses psychological factors affecting concussion recovery including catastrophizing, avoidance, illness beliefs, and coping strategies. Physiological concussion pathology and psychological factors interact. CBT does not mean symptoms are psychological. CBT supports recovery by addressing psychological amplifiers of physiological symptoms. Complementary to physical rehabilitation. How many CBT sessions do I need for PCS? Typical CBT course for PCS 8-16 sessions weekly. Chronic PCS sometimes requires 16-24 sessions. Trauma-focused CBT for co-occurring PTSD 12-24 sessions. Duration varies based on symptom severity, complexity, and treatment response. Reassessment every 4-8 sessions determines continuation. Will insurance cover CBT for PCS? Most insurance covers CBT with mental health parity. Post-concussion syndrome mental health diagnosis codes support coverage. In-network provider verification recommended. Prior authorization sometimes required. Session limits vary by plan. Anxiety and depression diagnoses commonly used for coverage. What is CBT-I and how does it help PCS sleep problems? CBT for insomnia (CBT-I) is evidence-based treatment for chronic insomnia. Components include sleep hygiene, sleep restriction therapy, stimulus control therapy, cognitive therapy for insomnia, and relaxation training. Sleep improvement supports overall PCS recovery. CBT-I recommended before sleep medication for PCS insomnia. Should I do CBT with a therapist who has concussion experience? Yes, concussion experience important for CBT effectiveness in PCS. Concussion-experienced therapists understand concussion natural history, PCS psychology, symptom fluctuation, return-to-activity progression, and psychological amplifiers of PCS. Health psychology and rehabilitation psychology backgrounds common. Concussion clinic referral supports appropriate therapist selection. References Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. PubMed Silverberg, N. D., et al. (2020). Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Archives of Physical Medicine and Rehabilitation, 101(2), 382-393. PubMed