Treatments for social cognitive difficulties following moderate-to-severe traumatic brain injury: A systematic review and meta-analysis

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Emery, Holly
McDonald, Skye
Wong, Dana
Carrier, Sarah
Gertler, Paul
Simpson, Grahame
Ownsworth, Tamara
Douglas, Jacinta
Wearne, Travis
Skromanis, Sarah
Honan, Cynthia A
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2025
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Abstract

Interventions targeting social cognition following moderate-to-severe Traumatic Brain Injury (TBI) have shown some benefit, however, there remains a need to systematically review, statistically synthesize, and evaluate these interventions to inform the development of Clinical Practice Guidelines. Six databases were searched from inception to May 2024. Eligible studies targeted adults with a moderate-to-severe TBI (P); evaluated interventions targeting social cognition (I); compared to a control, baseline performance, or phase without treatment (C); based on objective social-cognitive ability/performance (O). Studies were screened by two independent reviewers. A random effects model estimated treatment effects for RCTs (Hedge’s g) and observational (pre–post) studies (SMD) separately. Risk of bias was assessed. Certainty of evidence was evaluated using GRADE. Twenty-five studies were eligible, including 478 participants. RCTs targeting emotion perception and ToM produced a small effect (g = 0.38 (95%CI, 0.17, 0.59), p < .001). Observational studies targeting emotion perception and ToM produced a small-medium effect (SMD = 0.42 (95% CI 0.22, 0.61), p < .001). Interventions targeting empathy or alexithymia were limited. Our review provides initial evidence for the effectiveness of social-cognitive interventions targeting emotion perception and/or ToM. More research is needed to develop and evaluate interventions for other social-cognitive domains, including empathy and alexithymia.

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Neuropsychological Rehabilitation

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© 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.

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This publication has been entered in Griffith Research Online as an advance online version.

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Neurosciences

Allied health and rehabilitation science

Clinical and health psychology

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Emery, H; McDonald, S; Wong, D; Carrier, S; Gertler, P; Simpson, G; Ownsworth, T; Douglas, J; Wearne, T; Skromanis, S; Honan, CA, Treatments for social cognitive difficulties following moderate-to-severe traumatic brain injury: A systematic review and meta-analysis, Neuropsychological Rehabilitation, 2025

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