Advertisement

Mental Health Does Not Moderate Compensatory Cognitive Training Efficacy for Veterans With a History of Mild Traumatic Brain Injury

      Highlights

      • This study examined psychiatric moderators of cognitive rehabilitation intervention efficacy.
      • This was a secondary analysis of a randomized controlled trial of compensatory cognitive training.
      • Baseline mental health symptoms did not moderate intervention efficacy.

      Abstract

      Objective

      To examine the potential moderating effects of mental health symptoms on the efficacy of compensatory cognitive training (CCT) for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans with a history of mild traumatic brain injury (mTBI).

      Design

      Secondary analysis of a randomized controlled trial of CCT. Posttraumatic stress disorder, depression, and substance dependence symptom severity were examined as potential moderators of CCT efficacy for subjective cognitive complaints, use of cognitive strategies, and objective neurocognitive performance.

      Setting

      Three Veterans Affairs medical centers.

      Participants

      Participants included veterans with history of mTBI (N=119): 50 participated in CCT and 69 received usual care (UC).

      Intervention

      CCT is a 10-week group-based (90 minutes per session) manualized cognitive rehabilitation intervention.

      Main Outcome Measures

      Objective (neuropsychological functioning) and subjective (self-report) cognitive functioning and use of cognitive strategies.

      Results

      Baseline mental health symptoms did not moderate CCT efficacy: veterans who received CCT reported significantly greater improvement in cognitive difficulties and use of cognitive strategies compared with the UC group, regardless of baseline mental health symptom severity. The CCT group also demonstrated significant improvements on neuropsychological measures of attention, learning, and executive functioning compared with the UC group, regardless of baseline mental health symptom severity.

      Conclusions

      CCT is efficacious for improving objective cognitive functioning and compensatory strategy use for veterans with a history of mTBI, regardless of the severity of comorbid psychiatric symptoms.

      Keywords

      List of abbreviations:

      CCT (compensatory cognitive training), mTBI (mild traumatic brain injury), OEF (Operation Enduring Freedom), OIF (Operation Iraqi Freedom), OND (Operation New Dawn), PTSD (posttraumatic stress disorder), RCT (randomized controlled trial), TBI (traumatic brain injury), UC (usual care)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Taylor B.C.
        • Hagel E.M.
        • Carlson K.F.
        • et al.
        Prevalence and costs of co-occurring traumatic brain injury with and without psychiatric disturbance and pain among Afghanistan and Iraq War Veteran V.A. users.
        Med Care. 2012; 50: 342-346
        • Hanson K.L.
        • Schiehser D.M.
        • Clark A.L.
        • et al.
        Problem alcohol use in veterans with mild traumatic brain injury: associations with cognitive performance and psychiatric symptoms.
        J Clin Exp Neuropsychol. 2016; 38: 1115-1130
        • Combs H.L.
        • Berry D.T.
        • Pape T.
        • et al.
        The effects of mild traumatic brain injury, post-traumatic stress disorder, and combined mild traumatic brain injury/post-traumatic stress disorder on returning veterans.
        J Neurotrauma. 2015; 32: 956-966
      1. U.S. Department of Veterans Affairs. VA/DoD clinical practice guidelines: management of concussion-mild traumatic brain injury (mTBI) (2016). Available at: http://www.healthquality.va.gov/guidelines/Rehab/mtbi/. Accessed November 14, 2016.

        • Storzbach D.
        • Twamley E.W.
        • Roost M.S.
        • et al.
        Compensatory Cognitive Training for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans with mild traumatic brain injury.
        J Head Trauma Rehabil. 2017; 32: 16-24
        • Gossop M.
        • Darke S.
        • Griffiths P.
        • et al.
        The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users.
        Addiction. 1995; 90: 607-614
        • Twamley E.W.
        • Jak A.J.
        • Delis D.C.
        • Bondi M.W.
        • Lohr J.B.
        Cognitive symptoms management and rehabilitation therapy (CogSMART) for veterans with traumatic brain injury: pilot randomized controlled trial.
        J Rehabil Res Dev. 2014; 51: 59-70
        • Twamley E.W.
        • Thomas K.R.
        • Gregory A.M.
        • et al.
        CogSMART compensatory cognitive training for traumatic brain injury: effects over 1 year.
        J Head Trauma Rehabil. 2015; 30: 391-401
        • Walter K.H.
        • Jak A.J.
        • Twamley E.W.
        Psychiatric comorbidity effects on compensatory cognitive training outcomes for veterans with traumatic brain injuries.
        Rehabil Psychol. 2015; 60: 303-308
        • Scott J.C.
        • Matt G.E.
        • Wrocklage K.M.
        • et al.
        A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder.
        Psychol Bull. 2015; 141: 105-140
        • Hammar A.
        • Ardal G.
        Cognitive functioning in major depression–a summary.
        Front Hum Neurosci. 2009; 3: 26
        • Gould T.J.
        Addiction and cognition.
        Addict Sci Clin Pract. 2010; 5: 4-14