Psychological Symptoms and Rates of Performance Validity Improve Following Trauma-Focused Treatment in Veterans with PTSD and History of Mild-to-Moderate TBI

Abstract

Objective:Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance.Method:Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass).Results:Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.Conclusion:Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.

A systematic review on integrated care for traumatic brain injury, mental health, and substance use

“…Table 5 presents barriers and facilitators reported in the articles. An additional nine studies did not explicitly report barriers and facilitators to treatment activities but noted that compensatory strategies to address cognitive challenges associated with TBI were incorporated in the treatment design [ 54 , 58 – 60 , 66 , 72 , 79 , 84 , 92 ].…”

“…While screening and the receipt of a diagnosis may provide opportunities to access treatments, MHSU diagnosis may also be a barrier to TBI treatment. Indeed, some RCTs included in this review had exclusion criteria based on types of MHSU or severity of TBI [ 52 , 54 , 58 , 59 , 66 , 67 , 71 , 72 , 74 , 76 , 79 , 82 , 84 , 90 , 95 , 103 , 107 ]. As such, potential negative consequences of TBI and/or MHSU diagnosis should be considered when implementing screening as a form of integrated care.…”

Role of the Treatment of Post-Concussion Syndrome in Preventing Long-Term Sequela Like Depression: A Systematic Review of the Randomized Controlled Trials

“…In addition, the study included a performance validity test (PVT) to measure the engagement of veterans in the neuropsychological test evaluation. Although both PVT pass and PVT fail groups showed clinically significant improvement in mental health after the treatment, the PVT fail group demonstrated better test engagement at follow-up [6]. The study provides empirical support to enroll the PVT fail group in traumafocused treatment as they may benefit from assessment after treatment [6].…”

“…The symptoms may go on to become more prolonged [5]. Prolonged post-concussion syndrome (PPCS) is associated with poor outcomes resulting in lower community reintegration, higher healthcare utilization, higher economic cost, greater cognitive burden, and elevated reporting of psychiatric symptoms [6]. Particularly, depressive disorders are very common and seem to be important as their prevalence continues to be high in chronic stages of traumatic brain injury (TBI) [7,8].…”

“…Another study by Jurick et al has reinforced this evidence and has emphasized the relations between the inadequate engagement of testing in veterans with mTBI and the increased reporting of psychiatric symptoms. They compared two groups (a) cognitive processing therapy (CPT) combined with the components of cognitive training from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) to (b) the standard CPT[6]…”