Goal-Oriented Attention Self-Regulation Training Improves Executive Functioning in Veterans with Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury

Novakovic-Agopian, Tatjana; Posecion, Lainie; Kornblith, Erica; Abrams, Gary; McQuaid, John R.; Neylan, Thomas C.; Burciaga, Joaquin; Joseph, Jose; Carlin, Gerald; Groberio, Jessica; Maruyama, Brian A.; Chen, Anthony J.-W.

doi:10.1089/neu.2019.6806

Cited by 13 publications

(9 citation statements)

References 37 publications

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“…Another study [ 22 ], including 112 participants, showed that an 8-week interdisciplinary, individually tailored intervention based on a gradual return to activities and principles from cognitive behavior significantly reduced PCS at 3 months. Novakovic-Agopian et al [ 23 ] found some efficacy in a goal-oriented attentional self-regulation training program performed during 5 weeks by 40 veterans with comorbid PTSD and mTBI on cognitive functions, emotional regulation, and functional performance. Nevertheless, another study [ 24 ] compared different cognitive rehabilitation interventions (psycho-education, computer-based training, therapist-directed manualized training, and integrated therapist-directed training combined with cognitive-behavioral psychotherapy) but did not find any difference between techniques concerning the primary outcome criterion, the Paced Auditory Serial Addition Test.…”

Section: Resultsmentioning

confidence: 99%

“… 22 -PCS: RPCSQ -Depression: Montgomery–Åsberg Depression Rating Scale -Electrovestibulography recording Participants who had a more recent injury (<one year) and who received active rTMS showed significant improvements compared to those who received sham and to those with a longer duration of injury (>14 months) who received active rTMS. + A Novakovic et al, 2020 [ 23 ] Single-blinded controlled RCT 45.3 y.o. 12% female military >6 months To assess the efficacy of cognitive rehabilitation of executive functions using Goaloriented attention self-regulation training (GOALS) in veterans with mTBI and PTSD.…”

Section: Table A1mentioning

confidence: 99%

“… Risk of Bias for each study included in the Section 3.1 , assessed using the Cochrane Rob2 tool revised version [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 80 ]. …”

Section: Table A1mentioning

confidence: 99%

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A Systematic Review of Treatments of Post-Concussion Symptoms

Heslot

Azouvi

Perdrieau

et al. 2022

JCM

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Approximately 10–20% of patients who have sustained a mild Traumatic Brain Injury (mTBI) show persistent post-concussion symptoms (PCS). This review aims to summarize the level of evidence concerning interventions for PCS. Following the PRISMA guidelines, we conducted a systematic review regarding interventions for PCS post-mTBI until August 2021 using the Medline, Cochrane, and Embase databases. Inclusion criteria were the following: (1) intervention focusing on PCS after mTBI, (2) presence of a control group, and (3) adult patients (≥18 y.o). Quality assessment was determined using the Incog recommendation level, and the risk of bias was assessed using the revised Cochrane risk-of-bias tool. We first selected 104 full-text articles. Finally, 55 studies were retained, including 35 that obtained the highest level of evidence. The risk of bias was high in 22 out of 55 studies. Cognitive training, psycho-education, cognitive behavioral therapy, and graded return to physical activity demonstrated some effectiveness on persistent PCS. However, there is limited evidence of the beneficial effect of Methylphenidate. Oculomotor rehabilitation, light therapy, and headache management using repetitive transcranial magnetic stimulation seem effective regarding somatic complaints and sleep disorders. The preventive effect of early (<3 months) interventions remains up for debate. Despite its limitations, the results of the present review should encourage clinicians to propose a tailored treatment to patients according to the type and severity of PCS and could encourage further research with larger groups.

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Section: Resultsmentioning

confidence: 99%

Section: Table A1mentioning

confidence: 99%

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A Systematic Review of Treatments of Post-Concussion Symptoms

Heslot

Azouvi

Perdrieau

et al. 2022

JCM

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“…15 GOALS training improves attention and executive functioning in patients with chronic TBI. [15][16][17][18] However, it has been still unclear if GOALS training could lead to microstructural changes in attention-associated prefrontal tracts (e.g. anterior corona radiata), and whether these brain changes are correlated with attention improvements in the participants.…”

Section: Discussionmentioning

confidence: 99%

Goal-Oriented Attentional Self-Regulation Training in Chronic Mild Traumatic Brain Injury Leads to Microstructural Plasticity in Prefrontal White Matter

Karbasforoushan,

Wren-Jarvis,

Hwang

et al. 2023

Preprint

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Impaired attention is one of the most common, debilitating, and persistent consequence of traumatic brain injury (TBI), which impacts overall cognitive and executive functions in these patients. Previous neuroimaging studies, trying to understand the neural mechanism underlying attention impairment post TBI, have highlighted the role of prefrontal white matter tracts in attentional functioning in mild TBI. Goal-Oriented Attentional Self-Regulation (GOALS) is a cognitive rehabilitation training program that targets executive control functions in participants by applying mindfulness-based attention regulation and goal management strategies. GOALS training has been demonstrated to improve attention and executive functioning in patients with chronic TBI. However, its impact on microstructural integrity of attention-associated prefrontal white matter tracts is still unclear. Here, using diffusion MRI in a pilot randomized controlled trial, we investigated the effect of GOALS training on prefrontal white matter microstructure in US military veterans with chronic mild TBI (mTBI), compared to a matched control group of veterans with chronic mTBI who received standard of care brain health education. We also tested for an association between microstructural white matter changes and sustained attention ability in these patients pre- and post-GOALS training. Our results show significantly better white matter microstructural integrity in left and right anterior corona radiata in the GOALS group compared to the control group post-training. Moreover, we found a significant correlation between sustained attention ability of GOALS training participants and white matter integrity of their right anterior corona radiata pre- and post-training. Finally, our findings indicated that the improved white matter integrity of the anterior corona radiata in GOALS training participants was the result of increased neurite density and decreased fiber orientation dispersion within this tract.

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“…Computerized and non-computerized adjunctive interventions aimed at secondary prevention [ 750 ] and cognitive rehabilitation of PTSD are in development to address the impacts of such deficits, including for military populations, where TBIs are common and military training emphasizes ongoing vigilance to threat [ 751 , 752 ]. Attention Control Training, for instance, normalizes attentional function by targeting fluctuations of attention towards and away from threats, which may underlie hypervigilance, avoidance, and dissociation [ 750 ].…”

Section: Emerging and Novel Approaches To The Treatment Of Ptsdmentioning

confidence: 99%

Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review

Burback

Brémault‐Phillips

Nijdam

et al. 2024

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This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of treatment yields a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.

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Goal-Oriented Attention Self-Regulation Training Improves Executive Functioning in Veterans with Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury

Cited by 13 publications

References 37 publications

A Systematic Review of Treatments of Post-Concussion Symptoms

A Systematic Review of Treatments of Post-Concussion Symptoms

Goal-Oriented Attentional Self-Regulation Training in Chronic Mild Traumatic Brain Injury Leads to Microstructural Plasticity in Prefrontal White Matter

Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review

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