Cognitive Remediation in Posttraumatic Stress Disorder (PTSD)

The effects of CRT will be examined in 30 combat veterans with current PTSD, to be
randomized to either CRT or to a non-therapeutic video game. PTSD status and other clinical
data will be collected via interview to include the Clinician Administered PTSD Scale; the
Hamilton Depression Rating Scale; and the Structured Clinical Interview for DSM-IV (SCID).
Subjects will also complete self-report measures, including the Posttraumatic Stress
Disorder Checklist-Stressor Specific Version; Deployment Risk and Resilience Inventory;
Combat Exposure Scale; Trauma History Questionnaire; Childhood Trauma Questionnaire;
State-Trait Anxiety Inventory-State; Beck Depression Inventory-II; Post-Traumatic Cognitions
Inventory; Connor-Davidson Resilience Scale; and the Inventory of Daily Living. Baseline
cognitive functioning will be assessed using the Measurement and Treatment Research to
Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery; the vocabulary and
block design tasks of the Wechsler Adult Intelligence Scale-III; the Wide Range Achievement
Test-III; and the Logical Memory Test, the Letter-Number Sequencing task, and the Digit Span
tasks from the Wechsler Memory Scale-III.

After evaluation, 15 subjects will be randomized to receive 10 weekly 60-minute sessions of
CRT using CogPack Professional (version 8.2, Marker Software, Mannheim, Germany).
Approximately six different exercises will be presented in each training session, with the
starting level of difficulty individualized on the basis of baseline neuropsychological
performance and difficulty level adjusted based on the subject's performance on CogPack
exercises.

Another 15 subjects will be randomized to use a non-therapeutic video game, Tetris. Tetris
is a video puzzle game that involves manipulating falling shapes. The object of the game is
to manipulate these shapes, by moving them sideways or rotating them, to create a horizontal
line of blocks without gaps. As the game progresses, the shapes fall faster. This game
primarily involves using visuospatial and motor abilities, rather than memory and
attentional abilities, and thus will serve as an adequate control condition to Cogpack.
Subjects will use Tetris in 10 weekly 30-minute sessions.

Subjects will again complete neuropsychological and psychiatric evaluations (with the
exception of the SCID) in addition to self-report measures after 10 weeks of CRT or video
games. Changes from baseline will be examined in the cognitive measures as well as in PTSD
symptom severity, other clinical measures, and overall functioning.