SMART-CPT for PTSD and History of Concussion: A Pragmatic Implementation Trial
Abstract
The proposed work targets the third FY22 TBIPHRP PCRA Focus Area: Treat, by testing a behavioral (psychotherapy) intervention for helping Veterans with a history of mild traumatic brain injury (mTBI), post-traumatic stress disorder (PTSD), and cognitive complaints (such as memory or attention). These conditions occur together in a large proportion of post-9/11-era Veterans seeking treatment for persistent symptoms following mTBI. This common combination of conditions often complicates recovery from each condition and leads to poorer day-to-day functioning than would each of the conditions occurring in isolation since cognitive, emotional, and neurobehavioral symptoms are strongly intertwined. Typically, these conditions are treated separately from each other, despite overlap in symptoms and treatment strategies. Given the interconnectedness of these conditions, integrating treatments to fully target the overlapping symptoms simultaneously will lead to better outcomes for Veterans and reduce time and cost burdens. We previously conducted a preliminary study at a single site of an integrated intervention, SMART-CPT, which combines Cognitive Processing therapy (CPT) for PTSD (a gold standard treatment for PTSD) with cognitive symptom management and rehabilitation training (CogSMART) for treatment of persistent post-concussive symptoms and thinking difficulties associated with TBI. We found that, in addition to reducing PTSD and post-concussive symptoms, SMART-CPT (as compared to standard CPT) led to significant improvements in thinking abilities in several areas, including attention, memory, and problem solving. However, additional data are needed to confirm the broad effectiveness and feasibility of SMART-CPT when delivered at different sites by different treatment providers. Particularly, we need to understand the implementation of the therapy to be sure it can successfully be carried out by VA, DOD, and/or community partner sites. We need to further study the acceptability of the treatment by Veterans and identify any barriers and/or facilitators of implementing SMART-CPT. Therefore, we propose to examine SMART-CPT in a multi-site hybrid implementation trial. Consistent with community based participatory research principles, the trial will be informed at all stages by a Veteran lived-experience consultant. We hypothesize those Veterans who complete SMART-CPT will have greater improvements in objective cognitive functioning, quality of life, and day-to-day functioning than those receiving standard CPT. We also hypothesize that SMART-CPT can be successfully implemented across both VA/DOD and community partner sites. The proposed study targets Veterans with PTSD, cognitive complaints, and history of mTBI; half will be randomly assigned to receive SMART-CPT and half to receive standard CPT. Both interventions will last twelve weeks and will be delivered in an individual format. Veteran patients will also undergo assessments of mental health, quality of life, and cognitive functioning prior to therapy, at the end of therapy, and three months after the end of treatment. Expected near-term benefits include direct, immediate, and practical applications to treatment of Veterans. The intervention takes three months to complete and in this time we anticipate that individuals will see a notable reduction in post-concussive and PTSD symptoms, increases in cognitive functioning, and improvements in quality of life. We also anticipate ease of implementation of SMART-CPT by mental health clinicians in the near term, and optimization of implementation for expanded adoption of the treatment in the in the months after the completion of the trial. Both treatment groups are receiving all the standard elements of CPT; therefore, both groups are receiving the standard of care for PTSD and risks to participating would be minimal and similar to participating in any psychotherapy. Because there are currently no empirical
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310528
Entities
People
- Amy J. Jak
Organizations
- United States Army
- Veterans Medical Research Foundation of San Diego