Cognitive Training and Integrated Primary Prevention

Cognitive training has arisen in the last several years as an approach to leveraging neuroplasticity toward the goals of improving cognitive performance and psychological well-being. The purpose of this review is to evaluate the potential for cognitive training to serve as a means of preventing maladaptive behaviors, particularly substance use disorder and suicidal thoughts and behaviors in a military population.

We identified the outcomes of peer-reviewed, published randomized controlled trials (RCTs) using 2 common and well-validated approaches to cognitive training: SMART (and its online adaptation, SMART+) and BrainHQ. We also reviewed recent data from deploying SMART+ and BrainHQ within the National Guard, thus supplementing historical RCTs data with recent data collected in a military population. Finally, we conducted a literature review to determine whether there is evidence that the benefits of cognitive training have a documented relationship to risk of substance use and suicide.

We observed 3 pathways by which cognitive training appears to reduce the risk of maladaptive behaviors: (1) improved higher order cognitive functions; (2) reduced symptoms of psychological distress; and (3) improved social connectedness.

Maladaptive behaviors arise in response to a complex, highly individuated set of psychosocial and situational conditions. Prevention of maladaptive behaviors is, therefore, likely to require a wide variety of interventions. Based upon this literature review, there is a compelling case for cognitive training to be among these interventions. Not only does cognitive training bolster protective factors such as emotional regulation, problem-solving, and psychological well-being, but it reduces risk factors such as social isolation and impaired social skills. Furthermore, because cognitive training is beneficial to healthy (ie, nonclinical) populations, it can be appropriately framed as a tool to improve brain fitness, rather as a "mental health" intervention, the latter of which may be met with some resistance in military populations. Based upon this literature review, we recommend prospective research be conducted to further quantify the relationship between cognitive training and primary prevention of maladaptive behaviors in a military population.