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Cognitive Rehabilitation With Mobile Technology and Social Support for Veterans With TBI and PTSD: A Randomized
Eric B Elbogen1, Paul A Dennis, Elizabeth E Van Voorhees
1Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina (Drs Elbogen, Dennis, Van Voorhees, Wagner, and Beckham); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Drs Elbogen, Dennis, Van Voorhees, Wagner, and Beckham); Departments of Psychology and Neuroscience (Ms Blakey) and Psychiatry (Drs S. C. Johnson, Hamer, and Belger), University of North Carolina, Chapel Hill; Rho, Inc, Chapel Hill, North Carolina (Dr J. Johnson); and Department of Neuroscience, University of Cambridge, Cambridge, United Kingdom (Dr Manly).
Objective:
To investigate effects of cognitive rehabilitation with mobile technology and social support on veterans with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD).
Participants:
There were 112 dyads, comprised by a veteran and a family member or friend (224 participants in total).
Design:
Dyads were randomized to the following: (1) a novel intervention, Cognitive Applications for Life Management (CALM), involving goal management training plus mobile devices for cueing and training attentional control; or (2) Brain Health Training, involving psychoeducation plus mobile devices to train visual memory.
Main Measures:
Executive dysfunction (disinhibition, impulsivity) and emotional dysregulation (anger, maladaptive interpersonal behaviors) collected prior to randomization and following intervention completion at 6 months.
Results:
The clinical trial yielded negative findings regarding executive dysfunction but positive findings on measures of emotion dysregulation. Veterans randomized to CALM reported a 25% decrease in anger over 6 months compared with 8% reduction in the control (B = -5.27, P = .008). Family/friends reported that veterans randomized to CALM engaged in 26% fewer maladaptive interpersonal behaviors (eg, aggression) over 6 months compared with 6% reduction in the control (B = -2.08, P = .016). An unanticipated result was clinically meaningful change in reduced PTSD symptoms among veterans randomized to CALM (P < .001).
Conclusion:
This preliminary study demonstrated effectiveness of CALM for reducing emotional dysregulation in veterans with TBI and PTSD.
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