Abstract
Post-traumatic stress disorder (PTSD) is a severe psychiatric illness that disproportionately affects military personnel, veterans, and public safety personnel (PSP). Evidence demonstrates that PTSD is significantly associated with difficulties with emotion regulation (ER) and difficulties with cognitive functioning, including difficulties with attention, working memory, and executive functioning. A wide body of evidence suggests a dynamic interplay among cognitive dysfunction, difficulties with ER, and symptoms of PTSD, where numerous studies have identified overlapping patterns of alterations in activation among neuroanatomical regions and neural circuitry. Little work has examined interventions that may target these symptoms collectively. The primary objective of this pilot randomized controlled trial (RCT) with a parallel experimental design was to assess the effectiveness of goal management training (GMT), a cognitive remediation intervention, in reducing difficulties with cognitive functioning, and to determine its effects on PTSD symptoms and symptoms associated with PTSD, including difficulties with ER, dissociation, and functioning among military personnel, veterans, and PSP. Forty-two military personnel, veterans, and PSP between the ages of 18 and 70 with symptoms of PTSD were recruited across Ontario, Canada between October 2017 and August 2019. Participants were randomized to either the waitlist (WL) (n = 18) or the GMT (n = 22) condition. Participants in both conditions received self-report measures and a comprehensive neuropsychological assessment at baseline, post-intervention, and 3-month follow-up. Following their completion of the 3-month follow-up, participants in the WL condition were given the opportunity to participate in GMT. Assessors and participants were blind to intervention allocation during the initial assessment. A series of 2 (time) × 2 (group) ANOVAs were conducted to assess the differences between the WL and GMT conditions from pre- to post-intervention for the self-report and neuropsychological measures. The results demonstrated significant improvements in measures of executive functioning (e.g., verbal fluency, planning, impulsivity, cognitive shifting, and discrimination of targets) and trending improvements in short-term declarative memory for participants in the GMT condition. Participants in the GMT condition also demonstrated significant improvements from pre- to post-testing in measures of subjective cognition, functioning, PTSD symptom severity, difficulties with ER, dissociative symptom severity, and depression and anxiety symptoms. No adverse effects were reported as a result of participating in GMT. The results of this pilot RCT show promise that GMT may be a useful intervention to improve symptoms of cognitive dysfunction, symptoms of PTSD, and symptoms associated with PTSD within military personnel, veterans, and PSP. Future work is needed to address the small sample size and the durability of these findings.
Highlights
Post-traumatic stress disorder (PTSD) is a severe psychiatric illness that occurs as a result of experiencing, witnessing, or learning about a traumatic event or events [1]
The results from this study demonstrated that patients who participated in a modified goal management training (GMT) protocol while receiving treatment as usual experienced improvements in several areas of cognitive functioning, including executive functioning, processing speed, sustained attention, and verbal memory
Within the WL and GMT conditions, 77.8% and 90% of the participants, respectively, met the diagnostic criteria for PTSD according to the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)
Summary
Post-traumatic stress disorder (PTSD) is a severe psychiatric illness that occurs as a result of experiencing, witnessing, or learning about a traumatic event or events [1]. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [1], PTSD is characterized by re-experiencing symptoms (e.g., intrusive and distressing memories, dreams, or flashbacks), avoidance, alterations in mood and thoughts (e.g., negative beliefs about oneself, others, the world; persistent low mood or anhedonia), and changes in arousal (e.g., hypervigilance, angry outbursts). Individuals with PTSD may experience symptoms of dissociation associated with feelings of derealization (i.e., feeling as though the world around oneself is unreal or strange) or depersonalization (i.e., perception of the self feels unreal or strange) and may be diagnosed with the dissociative subtype of PTSD [1]. Approximately 16% to 19% of veterans diagnosed with PTSD meet the criteria for this subtype [8]
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