Trauma focussed CBT and exercise for people with chronic whiplash and PTSD

28 July 2021

What is the research about?

Many people with chronic whiplash associated disorders (WAD) also have symptoms of posttraumatic stress disorder (PTSD), but this is rarely considered in usual treatments that focus on exercise only.

This study aimed to investigate if adding treatment that addresses PTSD (trauma focused cognitive behavioural therapy: TF-CBT) to exercise is effective for people with chronic WAD and PTSD.

What did the researchers do?

We conducted a clinical trial where 103 people in Queensland and Denmark with chronic WAD and PTSD were randomised to receive either TF-CBT and exercise or supportive therapy and exercise. TF_CBT focuses on improving symptoms of psychological trauma and supportive therapy involved discussion of the injured person’s problems without addressing trauma symptoms. Both treatments were delivered by a psychologist for 10 weeks, followed by 6 weeks of exercise with a physiotherapist. Participants were followed up over 12 months.  

What you need to know:

For people with chronic WAD and PTSD either psychological treatment combined with exercise may be helpful in improving pain, disability and mental health.

For health care providers either treatment could be provided depending on expertise and resources available.

What did the researchers find?

While both groups improved over time, there was no difference between the groups for pain and disability at 16 weeks, 6 and 12 months follow-ups. The TF-CBT and exercise group showed slightly greater improvements in PTSD symptoms.

How can you use this research?

Future research needs to establish more effective interventions for people with chronic WAD and to work out whether some patients benefit more from one intervention over the other.

About the researchers

 Professor Michele Sterling leads the Improving health outcomes after musculoskeletal injury program at RECOVER. Dr Nigel Armfield is a Senior Research Fellow at RECOVER. Ms Simone Scott-Requena is a research assistant at RECOVER. Dr Annick Maujean is a Senior Research Fellow at Griffith University. A/Prof Tonny Andersen and Dr Sophie Ravn are research fellows at the University of Southern Denmark.



Andersen TE, Ravn SL, Armfield N, Maujean A, Requena SS, Sterling M. Trauma-focused cognitive behavioural therapy and exercise for chronic whiplash with comorbid posttraumatic stress disorder: a randomised controlled trial. Pain. 2021 Apr 1;162(4):1221-1232. doi: 10.1097/j.pain.0000000000002117. PMID: 33086286.


Whiplash associated disorders; posttraumatic stress disorder; psychology; exercise

Contact information, acknowledgements

The study was funded by the NHMRC.