Worse baseline executive functioning is associated with dropout and poorer response to trauma-focused treatment for veterans with PTSD and comorbid traumatic brain injury

Crocker, Laura D.; Jurick, Sarah M.; Thomas, Kelsey R.; Keller, Amber V.; Sanderson‐Cimino, Mark; Boyd, Briana L.; Rodgers, Carie S.; Twamley, Elizabeth W.; Jak, Amy J.

doi:10.1016/j.brat.2018.07.004

Cited by 45 publications

(40 citation statements)

References 77 publications

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“…These findings are particularly important given the critical impact of cognitive dysfunction on functioning and on treatment outcomes among individuals with PTSD. 6,9,10,13,14,59 On balance, remediation of cognitive dysfunction is expected to allow patients with PTSD to achieve greater benefit from cognitively demanding treatments (e.g., CBT), 13,14 to reduce deficits in day-to-day functioning that persist beyond PTSD symptom recovery 6 and to reduce the overall economic and societal burden of this disorder. [9][10][11]…”

Section: Discussionmentioning

confidence: 99%

“…59 In the current study, we investigated GMT delivered simultaneously with TAU. Given that cognitive dysfunction in PTSD has been found to negatively impact treatment outcome, 13,14 it would be interesting to investigate the differential impact of GMT on treatment outcome if it was administered prior to, as compared to being delivered in conjunction with, other psychological treatments for PTSD. Future research should aim to investigate this question.…”

Section: Discussionmentioning

confidence: 99%

“…12 Further, impaired cognitive functioning has been associated with reduced treatment response among individuals with PTSD. 13,14 Specifically, poor verbal memory performance predicted decreased response to cognitive behavioral therapy (CBT) for PTSD. 13 Moreover, among veterans with PTSD and co-morbid mild to moderate TBI, worse pretreatment executive functioning was associated with increased dropout and poorer response to treatment with cognitive processing therapy.…”

Section: Introductionmentioning

confidence: 99%

“…13 Moreover, among veterans with PTSD and co-morbid mild to moderate TBI, worse pretreatment executive functioning was associated with increased dropout and poorer response to treatment with cognitive processing therapy. 14 Cognitive dysfunction appears to be stable over time among individuals with PTSD, such that although clinical symptoms fluctuate over time, cognitive and functional impairments demonstrate relative stability. 15 However, one study reported improvements in executive functions following psychotherapy for PTSD in a small sample of 15 individuals.…”

Section: Introductionmentioning

confidence: 99%

“…The mechanisms for this are not yet fully understood; however, it has been hypothesized that executive dysfunction may be related to increased difficulty in coping with PTSD symptoms and thus increased emotional distress leading to reduced functioning in social and occupational roles. 10,14 Furthermore, difficulty encoding and recalling meaningful information (e.g., verbal memory deficits) may impact directly, response to psychotherapies such as CBT, where there is a significant component of encoding, recalling, and applying verbal information. 13 These findings indicate that treatment of cognitive dysfunction among individuals with PTSD who are experiencing cognitive difficulties is essential in achieving functional recovery from PTSD and in promoting symptomatic recovery by allowing these individuals to better respond to psychological interventions.…”

Section: Introductionmentioning

confidence: 99%

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An Open-Label Feasibility Trial Examining the Effectiveness of a Cognitive Training Program, Goal Management Training, in Individuals With Posttraumatic Stress Disorder

et al. 2019

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Background Posttraumatic stress disorder (PTSD) is associated with dysfunction across multiple cognitive domains including executive functioning, attention, and verbal memory. This dysfunction is associated with negative impacts on functional outcomes (e.g., work or social functioning) and reduced response to psychotherapy for PTSD. Despite this knowledge, little work has investigated the efficacy of cognitive remediation strategies in improving cognition and functional outcomes among individuals with PTSD. Objective The current study investigated the efficacy of an established cognitive remediation program, Goal Management Training (GMT), in improving cognitive functioning in a pilot sample of individuals with PTSD symptoms in an inpatient treatment setting. Method Thirty-four inpatients with PTSD symptoms participated in either GMT in addition to treatment as usual (TAU; consisting of psychiatric management, group and individual psychotherapy) (TAU+GMT; n = 18) or TAU alone ( n = 16). The TAU+GMT group received neuropsychological assessment at baseline and posttreatment, while both the TAU+GMT and TAU groups received assessment with clinical self-report measures at baseline and posttreatment. Results Paired-sample t-tests revealed significant improvements on measures of executive functioning (e.g., response inhibition, cognitive flexibility), processing speed, sustained attention, and verbal memory in the TAU+GMT group. Mixed-design analyses of variance (ANOVAs) revealed a trend toward an interaction effect indicating potentially greater improvements on a measure of the ability to engage in goal-directed behaviors while highly emotional in the TAU+GMT group as compared to the TAU group. Discussion The results of this small feasibility investigation of GMT in PTSD point toward the potential efficacy of GMT in ameliorating cognitive difficulties in individuals with PTSD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

An Open-Label Feasibility Trial Examining the Effectiveness of a Cognitive Training Program, Goal Management Training, in Individuals With Posttraumatic Stress Disorder

et al. 2019

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Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms

et al. 2022

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IMPORTANCEPosttraumatic headache is the most disabling complication of mild traumatic brain injury. Posttraumatic stress disorder (PTSD) symptoms are often comorbid with posttraumatic headache, and there are no established treatments for this comorbidity.OBJECTIVE To compare cognitive behavioral therapies (CBTs) for headache and PTSD with treatment per usual (TPU) for posttraumatic headache attributable to mild traumatic brain injury. DESIGN, SETTING, AND PARTICIPANTSThis was a single-site, 3-parallel group, randomized clinical trial with outcomes at posttreatment, 3-month follow-up, and 6-month follow-up.

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Inhibitory Control Moderates the Intervention Effects of a Preventive Parenting Program on Posttraumatic Stress Disorder Symptoms Among Male Service Members

Zhang

Buchanan

Monn³

et al. 2021

Journal of Traumatic Stress

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Military servicemembers face substantial challenges due to war-related trauma exposure, including posttraumatic stress disorder (PTSD). Individuals with deficits in inhibitory control (IC) may have an increased risk of developing PTSD due to a reduced ability to regulate their cognitive responses to and disengage from trauma-related stimuli. After Deployment, Adaptive Parenting Tools (ADAPT) is a mindfulnessinfused parenting program for military families that has also been found to have crossover effects on parental mental health. The present study examined whether fathers' IC at baseline affected their response to this emotional skills-focused intervention and further influenced their PTSD symptoms 1 year later. The sample included 282 male National Guard and Reserve (NG/R) service members who had recently been deployed to Iraq or Afghanistan. Fathers were randomly assigned to either the ADAPT program or a control condition, with IC measured at baseline and PTSD symptoms measured at baseline and 1-year follow-up. Intent-to-treat analyses revealed no significant main effect of the intervention on fathers' PTSD symptoms. However, fathers' IC moderated intervention effects on PTSD symptoms, f 2 = 0.03. The intervention had more beneficial effects on reducing fathers' PTSD symptoms for participants with low IC at baseline. These findings are consistent with compensatory effects in the risk moderation hypothesis, which suggests that prevention or intervention programs are more effective for high-risk subgroups.Nearly 3,000,000 members of the United States military have been deployed in Iraq and Afghanistan since the start of combat operations following the September 11, 2001, terrorist attacks (U.S. Department of Defense, 2019). Combat experiences and war zone exposure can result in substantial psychological and emotional stress for military service members. Research on the "invisible wounds" of war has highlighted the impact of posttraumatic stress disorder (PTSD) on military service members (Tanielian et al., 2008). PTSD can develop after a serious threat to an individual's life or bodily integrity (e.g., combat) and is characterized by heightened arousal or emotional numbing, at-This research was funded by a grant from the National Institute on Drug Abuse (R01 DA030114) to Abigail H. Gewirtz. We are grateful to the research team and the remarkable military family participants in this study.

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Worse baseline executive functioning is associated with dropout and poorer response to trauma-focused treatment for veterans with PTSD and comorbid traumatic brain injury

Cited by 45 publications

References 77 publications

An Open-Label Feasibility Trial Examining the Effectiveness of a Cognitive Training Program, Goal Management Training, in Individuals With Posttraumatic Stress Disorder

An Open-Label Feasibility Trial Examining the Effectiveness of a Cognitive Training Program, Goal Management Training, in Individuals With Posttraumatic Stress Disorder

Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms

Inhibitory Control Moderates the Intervention Effects of a Preventive Parenting Program on Posttraumatic Stress Disorder Symptoms Among Male Service Members

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