Cognitive Rehabilitation With Mobile Technology and Social Support for Veterans With TBI and PTSD: A Randomized Clinical Trial

Abstract

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.

Trial registration: ClinicalTrials.gov NCT01410721.

Figures

Figure 1.

Study Procedures, Screening, and Participant Enrollment

Figure 2.

Modeled treatment-associated changes in main outcome variables. Note. Negative scores reflect reductions from baseline, positive scores increases. Standardized units (Cohen’s d) are depicted with raw modeled change scores reported in parentheses. Error bars represent 95% confidence intervals. CALM = Cognitive Applications for Life Management; CW = DKEFS Color-Word inhibition task; BIS = Barratt Impulsiveness Scale; DAR = Dimensions of Anger; HIBS = Head Injury Behavior Scale; LD = listwise deletion; ITT = intent to treat.