Citation

Elbogen EB, Dennis PA, Van Voorhees EE, Blakey SM, Johnson JL, Johnson SC, Wagner HR, Hamer RM, Beckham JC, Manly T, Belger A. J. Head Trauma Rehabil. 2019; 34(1): 1-10.

Affiliation

Veterans 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).

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/HTR.0000000000000435

PMID

30169439

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 (Β = -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 (Β = -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.

Language: en