Abstract
Background: While evidence-based PTSD treatments are often efficacious, 20–50% of individuals continue to experience significant symptoms following treatment. Further, these treatments do not directly target associated neuropsychological deficits. Here, we describe the methods and feasibility for computer-based executive function training (EFT), a potential alternative or adjunctive PTSD treatment.Methods: Male combat veterans with full or partial PTSD (n = 20) and combat-exposed controls (used for normative comparison; n = 20) completed clinical, neuropsychological and functional neuroimaging assessments. Those with PTSD were assigned to EFT (n = 13) or placebo training (word games; n = 7) at home for 6 weeks, followed by repeat assessment. Baseline predictors of treatment completion were explored using logistic regressions. Individual feedback and changes in clinical symptoms, neuropsychological function, and neural activation patterns are described.Results: Dropout rates for EFT and placebo training were 38.5 and 57.1%, respectively. Baseline clinical severity and brain activation (i.e., prefrontal-insula-amygdala networks) during an emotional anticipation task were predictive of treatment completion. Decreases in clinical symptoms were observed following treatment in both groups. EFT participants improved on training tasks but not on traditional neuropsychological assessments. All training completers indicated liking EFT, and indicated they would engage in EFT (alone or as adjunctive treatment) if offered.Conclusion: Results provide an initial framework to explore the feasibility of placebo-controlled, computerized, home-based executive function training (EFT) on psychological and neuropsychological function and brain activation in combat veterans with PTSD. Clinical severity and neural reactivity to emotional stimuli may indicate which veterans will complete home-based computerized interventions. While EFT may serve as a potential alternative or adjunctive PTSD treatment, further research is warranted to address compliance and determine whether EFT may benefit functioning above and beyond placebo interventions.
Highlights
Post-traumatic stress disorder (PTSD) is a debilitating traumarelated disorder encompassing psychological and cognitive complaints [1, 2]
When asked hypothetically if executive function training (EFT) was found to be effective for PTSD and offered as a treatment, one veteran indicated they would engage in the current treatment offered alone, while seven indicated they would engage in EFT combined with psychotherapy
Our results provide an initial framework to explore the impact of EFT on psychological symptoms, neuropsychological function and brain activation
Summary
Post-traumatic stress disorder (PTSD) is a debilitating traumarelated disorder encompassing psychological and cognitive complaints [1, 2]. The Veteran’s Health Administration is disseminating two evidence-based psychological treatments for PTSD, including Prolonged Exposure [6] and Cognitive Processing Therapy [7]. Only 23–40% of veterans seek out psychological treatment [8] Of those who do engage in treatment, up to 60% continue to experience clinically significant symptoms [9]. Evidence-based PTSD treatments do not directly target related cognitive and neuropsychological deficits including alterations in processing speed, executive functions, and verbal memory [1, 10]. While evidence-based PTSD treatments are often efficacious, 20–50% of individuals continue to experience significant symptoms following treatment. These treatments do not directly target associated neuropsychological deficits. We describe the methods and feasibility for computer-based executive function training (EFT), a potential alternative or adjunctive PTSD treatment
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