Enhancement of PTSD Treatment With Computerized Executive Function Training
| Status: | Recruiting |
|---|---|
| Conditions: | Psychiatric, Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 55 |
| Updated: | 12/27/2018 |
| Start Date: | July 2, 2018 |
| End Date: | September 30, 2022 |
| Contact: | Laura D Crocker, PhD |
| Email: | Laura.Crocker@va.gov |
| Phone: | (858) 642-6484 |
This study focuses on helping Iraq and Afghanistan Veterans with posttraumatic stress
disorder (PTSD) benefit fully from therapy by first enhancing their thinking abilities. PTSD
has been associated with thinking problems, including difficulty planning/organizing,
thinking flexibly, and inhibiting distracting emotional information. There is some evidence
that computerized training programs are helpful for improving thinking. Therefore, this study
tests whether computerized cognitive training will in fact improve individuals' thinking
abilities and if this will in turn improve PTSD treatment outcomes and lead to more
individuals completing treatment and showing greater improvements in emotional symptoms and
quality of life than standard therapy (when paired with a word training condition).
disorder (PTSD) benefit fully from therapy by first enhancing their thinking abilities. PTSD
has been associated with thinking problems, including difficulty planning/organizing,
thinking flexibly, and inhibiting distracting emotional information. There is some evidence
that computerized training programs are helpful for improving thinking. Therefore, this study
tests whether computerized cognitive training will in fact improve individuals' thinking
abilities and if this will in turn improve PTSD treatment outcomes and lead to more
individuals completing treatment and showing greater improvements in emotional symptoms and
quality of life than standard therapy (when paired with a word training condition).
PTSD affects approximately 14% of OEF/OIF Veterans and leads to considerable personal and
societal costs (e.g., increased morbidity, reduced work productivity, poorer relationships).
Although cognitive behavioral therapy (CBT) is one of the most effective treatments for PTSD,
a substantial portion (approximately 50%) of individuals drop out prematurely, do not respond
to treatment, or relapse.
Treatment engagement is worse for OEF/OIF Veterans, who attend fewer sessions and have higher
dropout rates than civilians and Veterans from other eras. One likely barrier to treatment
engagement and effectiveness is the executive functioning problems present in individuals
with PTSD. Executive functions (EFs) are the set of higher-level cognitive skills that
organize and integrate lower-level cognitive processes in order to perform complex,
goal-directed tasks. PTSD has been associated with EF deficits, including impairments in
inhibitory control, working memory, and cognitive flexibly, as well as dysfunction in a
network of brain regions that support EFs (e.g., prefrontal cortex [PFC], cingulate).
EFs are essential for CBT in order to engage the cognitive skills involved in treatment
(e.g., self-monitoring, inhibiting distorted thoughts, and flexibly generating/evaluating
alternative thoughts). This is particularly true for Cognitive Processing Therapy (CPT), a
frontline CBT treatment for PTSD, which involves identifying and challenging maladaptive
trauma-related thoughts to alter their impact on emotions and behavior. Thus, EF deficits may
lead to reduced CPT engagement and responsivity. In fact, worse EF at baseline has been
associated with poorer response to CBT in several disorders (e.g., generalized anxiety
disorder, obsessive compulsive disorder, and schizophrenia). Further, a study of brain
functioning during an EF task demonstrated that dysfunction in EF-related brain regions
including PFC and cingulate cortex at baseline predicted nonresponse to CBT for PTSD.
Directly targeting EF prior to CPT via cognitive training would strengthen executive networks
and likely boost treatment effectiveness, allowing Veterans to fully engage in and benefit
more from components of CPT (e.g., cognitive restructuring). Evidence suggests that
computerized cognitive training improves EF and functioning in EF-related brain regions,
increases mental health treatment completion rates, and goal of the proposed study is to
examine whether administering computerized EF training (CEFT) immediately prior to CPT will
improve executive functioning and enhance treatment adherence, completion rates, and
psychological and functional outcomes in OEF/OIF Veterans with PTSD.
Objective (neuropsychological) and subjective (self- report) measures of EF will be collected
to determine if CEFT enhances EF and if this in turn mediates the relationship between
treatment condition and PTSD symptom improvement. Functional neuroimaging during EF tasks
will also be collected at baseline to determine whether functioning within an EF network
predicts treatment response, above and beyond traditional paper-and-pencil measures of EF.
Veterans will be randomized to either 12 weeks of CEFT-CPT or a placebo word training
condition plus CPT.
Assessments will be administered at baseline, immediately after CEFT or word training (prior
to CPT), and after CPT completion. The proposed research aims to reduce barriers to treatment
engagement and has potential to significantly enhance current treatments for PTSD by
combining cognitive and psychotherapeutic approaches. Targeting EF directly and independently
represents a logical, innovative, and empirically-informed method for augmenting existing
treatments for PTSD in order to optimize outcomes. Findings from the proposed study will not
only directly inform clinical practice, but also have the potential to significantly improve
the quality of Veterans' lives, reduce societal costs and burden, improve access to care, and
reveal ways to better match individuals with treatments they are most likely to benefit from.
societal costs (e.g., increased morbidity, reduced work productivity, poorer relationships).
Although cognitive behavioral therapy (CBT) is one of the most effective treatments for PTSD,
a substantial portion (approximately 50%) of individuals drop out prematurely, do not respond
to treatment, or relapse.
Treatment engagement is worse for OEF/OIF Veterans, who attend fewer sessions and have higher
dropout rates than civilians and Veterans from other eras. One likely barrier to treatment
engagement and effectiveness is the executive functioning problems present in individuals
with PTSD. Executive functions (EFs) are the set of higher-level cognitive skills that
organize and integrate lower-level cognitive processes in order to perform complex,
goal-directed tasks. PTSD has been associated with EF deficits, including impairments in
inhibitory control, working memory, and cognitive flexibly, as well as dysfunction in a
network of brain regions that support EFs (e.g., prefrontal cortex [PFC], cingulate).
EFs are essential for CBT in order to engage the cognitive skills involved in treatment
(e.g., self-monitoring, inhibiting distorted thoughts, and flexibly generating/evaluating
alternative thoughts). This is particularly true for Cognitive Processing Therapy (CPT), a
frontline CBT treatment for PTSD, which involves identifying and challenging maladaptive
trauma-related thoughts to alter their impact on emotions and behavior. Thus, EF deficits may
lead to reduced CPT engagement and responsivity. In fact, worse EF at baseline has been
associated with poorer response to CBT in several disorders (e.g., generalized anxiety
disorder, obsessive compulsive disorder, and schizophrenia). Further, a study of brain
functioning during an EF task demonstrated that dysfunction in EF-related brain regions
including PFC and cingulate cortex at baseline predicted nonresponse to CBT for PTSD.
Directly targeting EF prior to CPT via cognitive training would strengthen executive networks
and likely boost treatment effectiveness, allowing Veterans to fully engage in and benefit
more from components of CPT (e.g., cognitive restructuring). Evidence suggests that
computerized cognitive training improves EF and functioning in EF-related brain regions,
increases mental health treatment completion rates, and goal of the proposed study is to
examine whether administering computerized EF training (CEFT) immediately prior to CPT will
improve executive functioning and enhance treatment adherence, completion rates, and
psychological and functional outcomes in OEF/OIF Veterans with PTSD.
Objective (neuropsychological) and subjective (self- report) measures of EF will be collected
to determine if CEFT enhances EF and if this in turn mediates the relationship between
treatment condition and PTSD symptom improvement. Functional neuroimaging during EF tasks
will also be collected at baseline to determine whether functioning within an EF network
predicts treatment response, above and beyond traditional paper-and-pencil measures of EF.
Veterans will be randomized to either 12 weeks of CEFT-CPT or a placebo word training
condition plus CPT.
Assessments will be administered at baseline, immediately after CEFT or word training (prior
to CPT), and after CPT completion. The proposed research aims to reduce barriers to treatment
engagement and has potential to significantly enhance current treatments for PTSD by
combining cognitive and psychotherapeutic approaches. Targeting EF directly and independently
represents a logical, innovative, and empirically-informed method for augmenting existing
treatments for PTSD in order to optimize outcomes. Findings from the proposed study will not
only directly inform clinical practice, but also have the potential to significantly improve
the quality of Veterans' lives, reduce societal costs and burden, improve access to care, and
reveal ways to better match individuals with treatments they are most likely to benefit from.
Inclusion Criteria:
- Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans enrolled at
Veterans Affairs San Diego Healthcare System (VASDHS)
- aged 18-55
- current posttraumatic stress disorder (PTSD) diagnosis
- endorsement of cognitive complaints
- no pending medication changes
- English-speaking.
Exclusion Criteria:
- active substance use disorder in the last month
- suicidal intent or attempt within the last month
- schizophrenia, psychotic disorder and/or bipolar disorder
- dementia
- premorbid IQ < 70
- participation in other concurrent PTSD intervention studies
- previous completion of more than 4 Cognitive Processing Therapy (CPT) sessions
- history of a documented neurological disorder (e.g., Parkinson's disease, multiple
sclerosis, epilepsy)
- moderate to severe traumatic brain injury (TBI) (i.e., loss of consciousness greater
than 30 minutes or post-traumatic amnesia greater than 24 hours).
We found this trial at
1
site
San Diego, California 92161
Principal Investigator: Laura D. Crocker, PhD
Phone: 858-642-3657
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