Medical-Psychological Support of Patients with Post-Concussion Syndrome

- Проноза-Стеблюк, Катерина Володимирівна (orcid.org/0000-0003-4053-1589) (2026) Medical-Psychological Support of Patients with Post-Concussion Syndrome Doctoral thesis, Інститут психології імені Костюка.

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Abstract

Pronoza-Stebliuk K. V. Medical-Psychological Support of Patients with Post-Concussion Syndrome. – Qualification scientific work on the rights of the manuscript. Thesis for the degree of Doctor of Philosophy in the field of knowledge 05 – Social and Behavioural Sciences, speciality 053 – Psychology. – G. S. Kostiuk Institute of Psychology of the National Academy of Educational Sciences of Ukraine, Kyiv, 2026. The issue of organising medical and psychological support for patients with the consequences of mild traumatic brain injury (mTBI), in particular post-concussion syndrome (PCS), is of fundamental importance for domestic medicine and medical psychology in the context of the current Russo-Ukrainian war. According to clinical observations, head injuries account for up to a third or more of all combat injuries, with MBI occupying a leading place in their structure. A significant proportion of military personnel and veterans develop PCS in the long term, with a clinical picture combining somatoneurological, vegetative and pronounced psycho-emotional disorders, leading to prolonged loss of working capacity, risk of disability, social maladjustment and secondary socially dangerous forms of behaviour. At the same time, existing clinical approaches are dominated by a pharmacotherapeutic orientation, while systematically structured, evidence-based medical and psychological support for PTSR remains underdeveloped in both theoretical and methodological and practical terms. In this work, medical and psychological support for patients with PCS is considered as a holistic, step-by-step process that integrates clinical diagnosis, pathopsychological assessment, instrumental methods (neurophysiological, cardiovegetative) and trauma-focused psychotherapeutic interventions aimed not only at reducing symptoms, but also at restoring mental and behavioural health, social functioning, and the ability to self. An additional problem identified in previous studies is the gap between the subjective perception of one's own condition (complaints, perceptions of illness, experiences) and objective clinical and neurophysiological indicators in patients with mTBI. This complicates the formation of a therapeutic alliance, reduces compliance, and limits the effectiveness of standard psychodiagnostics and psychotherapeutic approaches, especially in the absence of coping strategies. In this context, it is important to develop models of medical and psychological support that consider the mechanisms of apperception and metaphorisation of traumatic experiences, as well as tools capable of "bypassing" resistance, deficits in awareness and difficulties in verbalisation. The empirical basis of the dissertation research: military personnel and veterans with a history of mine-blast mTBI, among whom a group of patients with clinically confirmed PTSD (according to the criteria of F07.2 ICD-10) and a comparative group of individuals who had undergone mTBI without the formation of PTSD were identified. The clinical and psychological examination was supplemented by neurophysiological methods (corrected electroencephalography, assessment of heart rate variability, cognitive evoked potentials P300), as well as a set of psychometric instruments: the Cicerone Current Mild Traumatic Brain Injury Questionnaire, the PCL-M PTSD self-assessment scale (military version), the Impact of Events Scale (with subscales for "avoidance," "intrusion," and "hyperarousal"), Wein's Vegetative Dysfunction Questionnaire, Asthenic State Scale (ASS), Hospital Anxiety and Depression Scale (HADS), additional tools for assessing subjective cognitive complaints and psychosocial functioning. At the intervention stage, patients with PTSD were randomised into an experimental group, where a complex of trauma-focused and cognitive-behavioural techniques was used in combination with the author's model of metaphorical associative cards (MAC) "KPS", and a control group that received drug therapy and a standardised set of CBT protocols without the use of MAC. Emphasis is placed on the theoretical and empirical justification of the approach, which combines trauma-focused psychotherapy with apperceptive-metaphorical mediation of traumatic experiences. For this purpose, the author's set of MAC "KPS" was developed and tested, consisting of 74 photographic images processed using computer graphics and structured into clusters: 8 elementary and 4 basic emotions; images reflecting the internal picture of the disease in psychosomatic pathology; typical behaviour strategies in conflict situations; basic self-preservation needs; basic emotional needs in interaction (author of the method Kateryna Pronoza-Stebliuk, artist – Anastasia Klymenko). The methodology involves the patient freely selecting cards according to their current emotional state and "attractive" images, followed by narrative interpretation, which allows the nature of apperceptive processes, the level of awareness of one's own needs, emotions and symptoms, as well as leading coping strategies (including avoidance) to be identified. In a separate sample of individuals with anxiety-depressive symptoms, the MAC "KPS" was validated by comparing the results of associative selection with data from PHQ-9, HADS and the Perceptual Deficit Questionnaire (PDQ), which demonstrated a high (80–100%) level of correspondence between metaphorical representations, psychometric indicators and clinical interviews. The results of the study confirmed that among individuals with combat mTBI PCS, a significant proportion of victims are formed, and their clinical and psychological profile clearly differs from the profile of individuals who have recovered without the syndrome. Patients with PTS had ≈20% higher integral severity of somatic, neurological, and psychoemotional symptoms, as well as a significantly higher frequency and severity of autonomic dysfunction. A combination of post-concussion symptoms with PTSD, generalised anxiety, and depressive manifestations was found. However, not all patients with PCS met the full criteria for PTSD, which allowed their condition to be considered as a combined syndrome with its own pathopsychological structure, rather than simply the "sum" of the traumatic brain injury and PTSD. Neurophysiological data showed that the disorders were mainly functional in nature (signs of cortical irritation, changes in evoked potentials, deviations in heart rate variability), which is consistent with the need for a medical-psychological rather than a purely neurological focus of support. At the intervention stage, it was established that the use of the developed complex of medical and psychological support, with the inclusion of MAC "KPS", provides more pronounced positive dynamics than standard protocols. The experimental group showed a statistically significant (p<0.05) more intense reduction in the integral indicator of mTBI consequences, headache intensity, sleep disturbances, irritability, and concentration difficulties compared to the control group. The PCL-M scale and the Impact of Events Scale (sub-scales "avoidance," "intrusion," "hyperarousal") revealed a more profound reduction in traumatic distress and trauma processing symptoms, with avoidance and hyperarousal scores being the most sensitive to interventions that combined trauma-focused exposure with metaphorization of the experience through MAC. The use of the MAC "KPS" also contributed to a significantly better reduction in the severity of anxiety and depression according to the HADS questionnaire compared to standard therapy, while vegetative and asthenic symptoms showed positive dynamics in both groups without significant intergroup differences. The results obtained made it possible to conceptualise medical and psychological support for post-concussion syndrome as a structured, evidence-based, multidisciplinary process, within which trauma-focused cognitive-behavioural interventions are complemented by apperceptive-metaphorical techniques that enhance awareness, narrative processing and symbolisation of traumatic experiences. The author's model of MAC "KPS" has proven effective as a tool for primary psychodiagnostic screening, a mechanism for increasing motivation for therapy, and a means of in-depth work with the emotional and bodily-need dimensions of experience in patients with PCS and other stress-associated disorders. The practical implementation of the proposed approaches confirmed the potential to enhance the effectiveness of medical and psychological support for this category of patients and outlined the prospects for integrating these techniques into the standards of medical and rehabilitation care for military personnel and veterans in Ukraine. The scientific novelty of the results obtained lies in the fact that for the first time - a comprehensive concept of medical and psychological support for patients with post-concussion syndrome (PCS) in the context of modern warfare has been theoretically substantiated, integrating clinical-neurological, neurophysiological, psychometric, medical-social and psychotherapeutic parameters into a single model of diagnosis, rehabilitation and long-term observation. PCS is considered not only as a neurological consequence of mild TBI, but as a multifactorial medical-psychological syndrome with its own structure of pathopsychological; - The effectiveness of a trauma-focused medical and psychological approach to PTSC has been empirically proven, combining standardised TF-CBT protocols for PTSD, cognitive-behavioural therapy for depression and generalised anxiety disorder with apperceptive-metaphorical techniques for working with traumatic experiences. It has been proven that such a combined approach provides a statistically significant reduction in the intensity of somatic, post-concussion, post-traumatic, anxiety and depressive symptoms compared to standard medical and psychological support; - the clinical and psychological structure of post-concussion syndrome in veterans and servicemen of the Armed Forces of Ukraine who have suffered mine-blast injuries has been clarified; improved - the understanding of the relationship between subjective perception of the condition and objective neurophysiological indicators in PCS; - the methodology of psychodiagnostics in post-concussion syndrome. It has been shown that the inclusion of apperceptive-metaphorical procedures in the structure of primary screening increases diagnostic sensitivity to hidden or minimised manifestations of mental and behavioural maladjustment, allows for a more accurate identification of areas of emotional hyperreactivity, cognitive distortions and unmet basic needs, and increases the motivational involvement of patients in the treatment process; have been further developed - The concepts of apperception and metaphorisation in clinical trauma psychology. The paper proposes and theoretically develops the concept of apperceptive-metaphorical mediation of traumatic experience as a mechanism by which dangerous, fragmented or partially repressed memories of explosive trauma are transformed into symbolically processed images that are accessible for awareness, verbalisation, and cognitive restructuring. It is shown that the metaphorisation of traumatic experience in a safe therapeutic field is an intermediate link between the "bodily memory" of trauma and its integration into the "I" narrative; - the idea of the place of medical and psychological support in a multidisciplinary system of rehabilitation for veterans with mild TBI. Based on an analysis of requests for medical and psychological assistance, readiness to participate in psychotherapy, and the dynamics of clinical and psychometric indicators, it is justified that systematic medical and psychological support (with a clear logic of assessment, planning, intervention and remote observation) is a critical factor in the prevention of chronic PTS, social maladjustment, autoaggressive behaviour and secondary alcoholism. Theoretical and practical significance of the results obtained. The results obtained in the dissertation deepen the current understanding of medical and psychological support for patients with post-concussion syndrome as a holistic, step-by-step, and syndrome-oriented process that integrates neurological, psychiatric, psychotherapeutic, and rehabilitation approaches. At the theoretical level, the etiopathogenetic mechanisms that form the clinical and psychological picture of post-concussion syndrome in combatants have been clarified, including structural changes in the mental sphere, the combination of post-concussion symptoms with PTSD, anxiety-depressive disorders, asthenic and vegetative disorders. A concept of medical and psychological support for post-concussion syndrome has been developed, within which this support is considered not as episodic assistance, but as a continuous, evidence-based, multidisciplinary process: from initial detection and psychodiagnostics to targeted trauma-focused interventions and long-term monitoring. The practical significance of the work lies in the fact that a specific model of medical and psychological support for patients with post-concussion syndrome, adapted to the conditions of wartime and the Ukrainian healthcare system, has been proposed and tested. Algorithms for the selection, examination and routing of patients, protocols for psychotherapeutic interventions for different variants of PCS (with a predominance of PTSD, generalised anxiety, depression) have been developed, and criteria for assessing the effectiveness of support based on clinical, psychometric and neurophysiological indicators have been defined. New tools for medical and psychological support have been created and implemented: metaphorical associative cards "KPS," whose use enhances the screening, diagnostic, and motivational components of support, improves the patient's understanding of their condition, and increases the effectiveness of trauma-focused psychotherapy within a comprehensive medical and psychological approach. Keywords: war, traumatic brain injury, mild traumatic brain injury, acoustic trauma, concussion, post-concussion syndrome, combat stress, post-traumatic stress disorder, medical and psychological support, trauma-focused psychotherapy, metaphorical associative cards.

Item Type:	Thesis (Doctoral)
Keywords:	war, traumatic brain injury, mild traumatic brain injury, acoustic trauma, concussion, post-concussion syndrome, combat stress, post-traumatic stress disorder, medical and psychological support, trauma-focused psychotherapy, metaphorical associative cards.
Subjects:	Science and knowledge. Organization. Computer science. Information. Documentation. Librarianship. Institutions. Publications > 1 Philosophy. Psychology
Divisions:	Institute of Psychology after N.Kostiuk > Synytsya department of education
Depositing User:	Катерина Проноза-Стеблюк
Date Deposited:	11 Jun 2026 10:38
Last Modified:	11 Jun 2026 10:38
URI:	https://lib.iitta.gov.ua/id/eprint/749468

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