“I wish I had that!”: A qualitative analysis of psychosocial treatment preferences among young adults with recent concussion and anxiety

Objective To assess psychosocial treatment preferences and factors that may impact treatment participation among young adults with a recent concussion and co-occurring anxiety. Design In-depth semi-structured individual qualitative interviews, followed by thematic analysis using a hybrid deductive-inductive approach. Setting Academic medical center in the US Northeast. Participants Seventeen young adults (18-24) who sustained a concussion within the past 3-10 weeks and reported at least mild anxiety (≥5 on the General Anxiety Disorder-7 questionnaire). Interventions Not applicable. Main Outcome Measures Primary outcomes include preferences for program content (e.g., topics and skills), delivery modality, format, and barriers and facilitators to participation. Results We identified four domains characterizing participants’ perceptions of and preferences for treatment. (1) Program content: Participants preferred a program early after injury that includes psychoeducation and coping skills (e.g., activity pacing, deep breathing, mindfulness). (2) Therapeutic processes: Participants preferred a person-centered approach in which clinicians normalize anxiety post-concussion and reassure them of recovery. (3) Program logistics: Participants endorsed that a brief, virtual program would be acceptable. They preferred access to program components through multiple modalities (i.e., audio, video) and accommodations to manage concussion symptoms. (4) Barriers and facilitators to participation: Barriers included acute concussion symptoms (e.g., screen sensitivity), time constraints, and forgetting sessions. Facilitators included a program that is flexible (format, scheduling), personalized (self-chosen mode for reminders, measure of accountability), and accessible (i.e., advertising through healthcare professionals or social media). Conclusions Participants need psychosocial support that normalizes their experiences and provides education and coping tools. Treatments should be accessible, flexible, and person-centered. Psychosocial treatments meeting these preferences may help optimize the recovery of young adults with recent concussion and anxiety.