CDA Overview: This application proposes a mentored training program supporting Dr. Maya O?Neil?s development into an independent VA Rehabilitation Research & Development (RR&D) investigator with expertise in posttraumatic stress disorder (PTSD), cognitive rehabilitation, and behavioral clinical trial methods. Dr. O?Neil is a licensed psychologist at the Portland VA, Assistant Professor of Psychiatry and Medical Informatics & Clinical Epidemiology at Oregon Health & Science University (OHSU), and recent K scholar. Training: Dr. O?Neil will increase expertise in PTSD and cognitive rehabilitation research, enhance skill in the conduct of behavioral clinical trials, and learn how to use VA resources (e.g., Corporate Data Warehouse, CDW) to support trials. The training plan integrates formal coursework, content trainings, and mentor guidance. Mentors: Dr. Daniel Storzbach, Portland VA Director of Neuropsychology, Associate Professor of Psychiatry and Neurology at OHSU; Dr. Kathleen Carlson, Core Investigator at the RR&D National Center for Rehabilitative Auditory Research (NCRAR) and Health Services Research & Development (HSR&D) Center of Innovation (COIN), PI of the Portland Chronic Effects of Neurotrauma study site; Dr. Elizabeth Twamley, VA rehabilitation researcher, Professor of Psychiatry at UCSD, Director of the Clinical Research Unit of the Center of Excellence for Stress and Mental Health at the San Diego VA, lead author of Compensatory Cognitive Training (CCT); and Dr. Nina Sayer, Associate Director of the HSR&D COIN and PI of the Minneapolis VA EBP4PTSD CREATE, and Associate Professor of Medicine and Psychiatry at University of Minnesota. Project Background: PTSD is associated with deficits in cognitive functioning including memory, learning, processing speed, concentration, attention, and executive functioning. Though many Veterans benefit from evidence-based psychotherapy (EBP) for PTSD, there is little research examining the extent to which cognitive problems are present before and after EBP and are related to change in PTSD symptoms, quality of life, and functioning. Dr. O?Neil?s pilot research suggests that many Veterans have cognitive functioning deficits even after completing EBP for PTSD, though there are no evidence-based treatments for these Veterans. CCT is improves cognitive functioning in Veterans with brain injury history, but is not yet tested in Veterans with PTSD. Project Aims: The proposed studies will (1) determine the types and magnitude of cognitive problems and changes in cognitive functioning following EBP and (2) evaluate feasibility, acceptability, and participant characteristics, and estimate effect sizes, in a pilot test of CCT for Veterans with PTSD-related cognitive problems. Data from these studies will form the basis for a RR&D Merit submission testing the effectiveness of CCT for cognitive problems in Veterans with PTSD in a clinical trial during year 4 of the CDA. Project Methods: We will recruit Veterans from local VA mental health clinics, using the CDW to identify potentially eligible Veterans if needed. For Study 1, we will examine cognitive functioning, mental health symptoms, and quality of life in 150 Veterans before and after EBP for PTSD. In Study 2, we will compare CCT vs. treatment as usual for 36 Veterans with PTSD-related cognitive functioning deficits. We will calculate rates of recruitment, retention, and intervention participation. Statistical significance will be examined, though our focus will be on effect size estimates, score ranges, and variability to plan for a follow-up, fully powered RCT. Anticipated Impact: PTSD-related cognitive functioning deficits are a significant problem for many Veterans. CCT is an effective cognitive rehabilitation intervention for Veterans with a history of brain injury, but VA clinicians need data on its effectiveness for Veterans with PTSD-related cognitive functioning deficits. These studies will provide the data necessary for a larger scale RCT proposal which will be pursued during the fourth year of the CDA if results show that CCT is as promising as expected for Veterans with PTSD.
Approximately half a million Veterans receiving services at the VA have Posttraumatic Stress Disorder (PTSD). PTSD is strongly associated with cognitive functioning deficits in areas of concentration, attention, memory, learning, verbal abilities, processing speed, and multitasking. The proposed research will determine the extent to which cognitive functioning deficits remain even after evidence-based PTSD treatment. Compensatory Cognitive Training (CCT) is an evidence-based intervention for cognitive problems that is effective in other Veteran populations such as those with a history of traumatic brain injury (TBI), but CCT has not yet been tested in Veterans with PTSD who don?t have a history of TBI. We will conduct a pilot randomized controlled trial (RCT) of CCT in Veterans who have been treated for PTSD but continue to have cognitive functioning deficits. We will examine feasibility, acceptability, participant characteristics, and effect size estimates in preparation for a fully-powered RCT of CCT for PTSD-related cognitive functioning deficits.
