An Open-Label Feasibility Trial Examining the Effectiveness of a
Cognitive Training Program, Goal Management Training, in Individuals With
Posttraumatic Stress Disorder

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Abstract

Background

Posttraumatic stress disorder (PTSD) is associated with dysfunction across multiple cognitive domains including executive functioning, attention, and verbal memory. This dysfunction is associated with negative impacts on functional outcomes (e.g., work or social functioning) and reduced response to psychotherapy for PTSD. Despite this knowledge, little work has investigated the efficacy of cognitive remediation strategies in improving cognition and functional outcomes among individuals with PTSD.

Objective

The current study investigated the efficacy of an established cognitive remediation program, Goal Management Training (GMT), in improving cognitive functioning in a pilot sample of individuals with PTSD symptoms in an inpatient treatment setting.

Method

Thirty-four inpatients with PTSD symptoms participated in either GMT in addition to treatment as usual (TAU; consisting of psychiatric management, group and individual psychotherapy) (TAU+GMT; n = 18) or TAU alone ( n = 16). The TAU+GMT group received neuropsychological assessment at baseline and posttreatment, while both the TAU+GMT and TAU groups received assessment with clinical self-report measures at baseline and posttreatment.

Results

Paired-sample t-tests revealed significant improvements on measures of executive functioning (e.g., response inhibition, cognitive flexibility), processing speed, sustained attention, and verbal memory in the TAU+GMT group. Mixed-design analyses of variance (ANOVAs) revealed a trend toward an interaction effect indicating potentially greater improvements on a measure of the ability to engage in goal-directed behaviors while highly emotional in the TAU+GMT group as compared to the TAU group.

Discussion

The results of this small feasibility investigation of GMT in PTSD point toward the potential efficacy of GMT in ameliorating cognitive difficulties in individuals with PTSD.

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Most cited references 38

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Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans.

Michelle J Bovin, Brian P Marx, Frank W Weathers … (2016)

This study examined the psychometric properties of the posttraumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5; Weathers, Litz, et al., 2013b) in 2 independent samples of veterans receiving care at a Veterans Affairs Medical Center (N = 468). A subsample of these participants (n = 140) was used to define a valid diagnostic cutoff score for the instrument using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers, Blake, et al., 2013) as the reference standard. The PCL-5 test scores demonstrated good internal consistency (α = .96), test-retest reliability (r = .84), and convergent and discriminant validity. Consistent with previous studies (Armour et al., 2015; Liu et al., 2014), confirmatory factor analysis revealed that the data were best explained by a 6-factor anhedonia model and a 7-factor hybrid model. Signal detection analyses using the CAPS-5 revealed that PCL-5 scores of 31 to 33 were optimally efficient for diagnosing PTSD (κ(.5) = .58). Overall, the findings suggest that the PCL-5 is a psychometrically sound instrument that can be used effectively with veterans. Further, by determining a valid cutoff score using the CAPS-5, the PCL-5 can now be used to identify veterans with probable PTSD. However, findings also suggest the need for research to evaluate cluster structure of DSM-5. (PsycINFO Database Record

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The Cognitive Failures Questionnaire (CFQ) and its correlates.

R. Parkes, Anthony P. Fitzgerald, Marcus P. Cooper … (1982)

This paper describes a questionnaire measure of self-reported failures in perception, memory, and motor function. Responses to all questions tend to be positively correlated, and the whole questionnaire correlates with other recent measures of self-reported deficit in memory, absent-mindedness, or slips of action. The questionnaire is however only weakly correlated with indices of social desirability set or of neuroticism. It is significantly correlated with ratings of the respondent by his or her spouse, and accordingly does have some external significance rather than purely private opinion of the self. The score is reasonably stable over long periods, to about the same extent as traditional measures of trait rather than state. Furthermore, it has not thus far been found to change in persons exposed to life-stresses. However, it does frequently correlate with the number of current psychiatric symptoms reported by the same person on the MHQ; and in one study it has been found that CFQ predicts subsequent MHQ in persons who work at a stressful job in the interval. It does not do so in those who work in a less stressful environment. The most plausible view is that cognitive failure makes a person vulnerable to showing bad effects of stress, rather than itself resulting from stress.

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Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members.

Brett T Litz, Jennifer H Wortmann, Alan Peterson … (2016)

The Posttraumatic Stress Disorder Checklist (PCL-5; Weathers et al., 2013) was recently revised to reflect the changed diagnostic criteria for posttraumatic stress disorder (PTSD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). We investigated the psychometric properties of PCL-5 scores in a large cohort (N = 912) of military service members seeking PTSD treatment while stationed in garrison. We examined the internal consistency, convergent and discriminant validity, and DSM-5 factor structure of PCL-5 scores, their sensitivity to clinical change relative to PTSD Symptom Scale-Interview (PSS-I; Foa, Riggs, Dancu, & Rothbaum, 1993) scores, and their diagnostic utility for predicting a PTSD diagnosis based on various measures and scoring rules. PCL-5 scores exhibited high internal consistency. There was strong agreement between the order of hypothesized and observed correlations among PCL-5 and criterion measure scores. The best-fitting structural model was a 7-factor hybrid model (Armour et al., 2015), which demonstrated closer fit than all other models evaluated, including the DSM-5 model. The PCL-5's sensitivity to clinical change, pre- to posttreatment, was comparable with that of the PSS-I. Optimally efficient cut scores for predicting PTSD diagnosis were consistent with prior research with service members (Hoge, Riviere, Wilk, Herrell, & Weathers, 2014). The results indicate that the PCL-5 is a psychometrically sound measure of DSM-5 PTSD symptoms that is useful for identifying provisional PTSD diagnostic status, quantifying PTSD symptom severity, and detecting clinical change over time in PTSD symptoms among service members seeking treatment. (PsycINFO Database Record

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Author and article information

Journal

Journal ID (nlm-ta): Chronic Stress (Thousand Oaks)

Journal ID (iso-abbrev): Chronic Stress (Thousand Oaks)

Journal ID (publisher-id): CSS

Journal ID (hwp): spcss

Title: Chronic Stress

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Electronic): 2470-5470

Publication date (Electronic): 18 April 2019

Publication date Collection: Jan-Dec 2019

Volume: 3

Electronic Location Identifier: 2470547019841599

Affiliations

[1 ]Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada

[2 ]Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Ontario, Canada

[3 ]Homewood Research Institute, Guelph, Ontario, Canada

[4 ]Program for Traumatic Stress Recovery, Homewood Health Center, Guelph, Ontario, Canada

[5 ]Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Department of National Defence, Ottawa, Ontario, Canada

[6 ]Department of Psychiatry, University of Ottawa, Ontario, Canada

[7 ]Defence Research and Development Canada, Toronto Research Centre, Ontario, Canada

[8 ]Department of Psychiatry, Western University, London, Ontario, Canada

[9 ]Department of Neuroscience, Western University, London, Ontario, Canada

[10 ]Imaging Division, Lawson Health Research Institute, London, Ontario, Canada

[11 ]Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada

Author notes

[*]Margaret C. McKinnon, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, Canada. Email: mmckinno@ 123456stjoes.ca

Author information

Jenna E. Boyd https://orcid.org/0000-0001-8710-2066

Alina Protopopescu https://orcid.org/0000-0001-6610-9365

Article

Publisher ID: 10.1177_2470547019841599

DOI: 10.1177/2470547019841599

PMC ID: 7219918

PubMed ID: 32440592

SO-VID: f49fa257-a779-4b9e-9477-e2bc89b7d962

License:

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 16 January 2019

Date accepted : 13 March 2019

Funding

Funded by: J.P. Bickell Foundation, FundRef ;

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cover-date January-December 2019

Keywords: cognitive dysfunction,cognitive remediation,emotion regulation,goal management training,posttraumatic stress disorder

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Keywords: cognitive dysfunction, cognitive remediation, emotion regulation, goal management training, posttraumatic stress disorder

An Open-Label Feasibility Trial Examining the Effectiveness of a Cognitive Training Program, Goal Management Training, in Individuals With Posttraumatic Stress Disorder

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Abstract

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Results

Discussion

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Creative methods for psychotherapy

Most cited references 38

Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans.

The Cognitive Failures Questionnaire (CFQ) and its correlates.

Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members.

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