{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T20:48:35Z","timestamp":1740170915662,"version":"3.37.3"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"5-6","funder":[{"DOI":"10.13039\/100006380","name":"VA Rehabilitation Research and Development","doi-asserted-by":"crossref","award":["I01RX000254"],"award-info":[{"award-number":["I01RX000254"]}],"id":[{"id":"10.13039\/100006380","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006380","name":"VA Rehabilitation Research and Development","doi-asserted-by":"crossref","award":["I01RX000254"],"award-info":[{"award-number":["I01RX000254"]}],"id":[{"id":"10.13039\/100006380","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,18]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Mild traumatic brain injury (mTBI), depression, and PTSD are highly prevalent in post-9\/11 veterans. With the comorbidity of depression and PTSD in post-9\/11 veterans with mTBI histories and their role in exacerbating cognitive and emotional dysfunction, interventions addressing cognitive and psychiatric functioning are critical. Compensatory Cognitive Training (CCT) is associated with improvements in prospective memory, attention, and executive functioning and has also yielded small-to-medium treatment effects on PTSD and depressive symptom severity. We sought to examine neuropsychological correlates of PTSD and depressive symptom improvement in veterans with a history of mTBI who received CCT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Thirty-seven post-9\/11 veterans with mTBI histories and cognitive complaints received 10 weekly 120-minute CCT group sessions. Participants completed a baseline neuropsychological assessment, including tests of premorbid functioning, attention\/working memory, processing speed, verbal learning\/memory, and executive functioning, and completed psychiatric symptom measures (PTSD and depression) at baseline, post-treatment, and a 5-week follow-up. Paired samples t-tests were used to examine statistically significant changes in PTSD (total and symptom cluster scores) and depressive symptom scores over time. Pearson\u2019s correlations were calculated between neuropsychological scores and PTSD and depressive symptom change scores at post-treatment and follow-up. Neuropsychological measures identified as significantly correlated with psychiatric symptom change scores were entered as independent variables in multivariable regression analyses to examine their association with symptom change at post-treatment and follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Over 50% of CCT participants had clinically meaningful improvement in depressive symptoms (\u226517.5% score reduction), and over 20% had clinically meaningful improvement in PTSD symptoms (\u226510-point improvement) at post-treatment and follow-up. Examination of PTSD symptom cluster scores revealed a statistically significant improvement in avoidance\/numbing at follow-up. Bivariate correlations indicated that worse baseline performance on Category Fluency was moderately associated with PTSD symptom improvement at post-treatment. Worse performance on both Category Fluency and Category Switching Accuracy was associated with improvement in depressive symptoms at post-treatment and follow-up. Worse performance on Trail-Making Number-Letter Switching was also associated with improvement in depressive symptoms at follow-up. Subsequent regression analyses revealed that worse processing speed and worse aspects of executive functioning at baseline were associated with depressive symptom improvement at post-treatment and follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Worse baseline performances on tests of processing speed and aspects of executive functioning were significantly associated with improvements in PTSD and depressive symptoms during the trial. Our results suggest that cognitive training may bolster skills that are helpful for PTSD and depressive symptom reduction and that those with worse baseline functioning may benefit more from treatment because they have more room to improve.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usad442","type":"journal-article","created":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T18:02:50Z","timestamp":1700071370000},"page":"e1263-e1269","source":"Crossref","is-referenced-by-count":0,"title":["Neuropsychological Correlates of\u00a0PTSD and\u00a0Depressive Symptom Improvement in\u00a0Compensatory Cognitive Training for\u00a0Veterans With a History of\u00a0Mild Traumatic Brain Injury"],"prefix":"10.1093","volume":"189","author":[{"given":"Jillian M R","family":"Clark","sequence":"first","affiliation":[{"name":"Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System , La Jolla, CA 92161,","place":["USA"]},{"name":"Mental Health Service, VA San Diego Healthcare System , La Jolla, CA 92161,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2972-784X","authenticated-orcid":false,"given":"Amber V","family":"Keller","sequence":"additional","affiliation":[{"name":"Research Service, VA San Diego Healthcare System , La Jolla, CA 92161,","place":["USA"]},{"name":"SDSU\/UC San Diego Joint Doctoral Program in Clinical Psychology , San Diego, CA 92120,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline E","family":"Maye","sequence":"additional","affiliation":[{"name":"Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System , La Jolla, CA 92161,","place":["USA"]},{"name":"Mental Health Service, VA San Diego Healthcare System , La Jolla, CA 92161,","place":["USA"]},{"name":"Department of Psychiatry, University of California San Diego , La Jolla, CA 92093,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy J","family":"Jak","sequence":"additional","affiliation":[{"name":"Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System , La Jolla, CA 92161,","place":["USA"]},{"name":"Mental Health Service, VA San Diego Healthcare System , La Jolla, CA 92161,","place":["USA"]},{"name":"Department of Psychiatry, University of California San Diego , La Jolla, CA 92093,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maya E","family":"O\u2019Neil","sequence":"additional","affiliation":[{"name":"VA Portland Health Care System , Portland, OR 97239,","place":["USA"]},{"name":"Department of Psychiatry, Oregon Health & Science University , Portland, OR 97239-3098,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rhonda M","family":"Williams","sequence":"additional","affiliation":[{"name":"VA Puget Sound Health Care System , Seattle, WA 98108,","place":["USA"]},{"name":"Department of Rehabilitation Medicine, University of Washington School of Medicine , Seattle, WA 98195,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron P","family":"Turner","sequence":"additional","affiliation":[{"name":"VA Puget Sound Health Care System , Seattle, WA 98108,","place":["USA"]},{"name":"Department of Rehabilitation Medicine, University of Washington School of Medicine , Seattle, WA 98195,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen F","family":"Pagulayan","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, University of Washington School of Medicine , Seattle, WA 98195,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8693-8782","authenticated-orcid":false,"given":"Elizabeth W","family":"Twamley","sequence":"additional","affiliation":[{"name":"Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System , La Jolla, CA 92161,","place":["USA"]},{"name":"Research Service, VA San Diego Healthcare System , La Jolla, CA 92161,","place":["USA"]},{"name":"Department of Psychiatry, University of California San Diego , La Jolla, CA 92093,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,11,10]]},"reference":[{"issue":"1","key":"2025012315140995700_R1","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1002\/jts.21979","article-title":"Deployment-related psychiatric and\u00a0behavioral conditions and\u00a0their association with functional disability in\u00a0OEF\/OIF\/OND veterans: disability in\u00a0returning veterans","volume":"28","author":"Lippa","year":"2015","journal-title":"J Trauma Stress"},{"author":"Inoue","key":"2025012315140995700_R2","article-title":"Veteran and\u00a0military mental health issues"},{"issue":"1","key":"2025012315140995700_R3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/HTR.0000000000000478","article-title":"Prevalence and\u00a0severity of\u00a0psychiatric disorders and\u00a0suicidal behavior in\u00a0service members and\u00a0veterans with and\u00a0without traumatic brain injury: systematic review","volume":"35","author":"Greer","year":"2020","journal-title":"J Head Trauma Rehabil"},{"issue":"8","key":"2025012315140995700_R4","doi-asserted-by":"publisher","first-page":"e732","DOI":"10.1212\/WNL.0000000000006034","article-title":"Comprehensive analysis of\u00a0the predictors of\u00a0neurobehavioral symptom reporting in\u00a0veterans","volume":"91","author":"Andrews","year":"2018","journal-title":"Neurology"},{"issue":"5","key":"2025012315140995700_R5","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1056\/NEJMoa072972","article-title":"Mild traumatic brain injury in\u00a0US soldiers returning from Iraq","volume":"358","author":"Hoge","year":"2008","journal-title":"N Engl J Med"},{"issue":"8","key":"2025012315140995700_R6","doi-asserted-by":"publisher","first-page":"1699","DOI":"10.1093\/arclin\/acac040","article-title":"Contributory etiologies to cognitive performance in\u00a0multimorbid post-9\/11 veterans: the deployment trauma phenotype","volume":"37","author":"Kim","year":"2022","journal-title":"Arch Clin Neuropsychol"},{"issue":"1","key":"2025012315140995700_R7","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1017\/S1355617718000851","article-title":"Mild traumatic brain injury burden moderates the relationship between cognitive functioning and\u00a0suicidality in\u00a0Iraq\/Afghanistan-era veterans","volume":"25","author":"Crocker","year":"2019","journal-title":"J Int Neuropsychol Soc"},{"issue":"1","key":"2025012315140995700_R8","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1017\/S1355617709990841","article-title":"Symptom complaints following combat-related traumatic brain injury: relationship to traumatic brain injury severity and\u00a0posttraumatic stress disorder","volume":"16","author":"Belanger","year":"2010","journal-title":"J Int Neuropsychol Soc"},{"issue":"6","key":"2025012315140995700_R9","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1682\/JRRD.2009.11.0181","article-title":"Self-reported cognitive symptoms following mild traumatic brain injury are poorly associated with neuropsychological performance in\u00a0OIF\/OEF veterans","volume":"47","author":"Spencer","year":"2010","journal-title":"J Rehabil Res Dev"},{"issue":"1","key":"2025012315140995700_R10","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s11065-012-9190-5","article-title":"Neuropsychological sequelae of\u00a0PTSD and\u00a0TBI following war deployment among OEF\/OIF veterans","volume":"22","author":"Dolan","year":"2012","journal-title":"Neuropsychol Rev"},{"issue":"2","key":"2025012315140995700_R11","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1682\/JRRD.2014.12.0301","article-title":"Association between mild traumatic brain injury and\u00a0mental health problems and\u00a0self-reported cognitive dysfunction in\u00a0Iraq and\u00a0Afghanistan veterans","volume":"53","author":"Seal","year":"2016","journal-title":"J Rehabil Res Dev"},{"issue":"2","key":"2025012315140995700_R12","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1080\/02699052.2020.1861656","article-title":"Factors increasing risk of\u00a0suicide after traumatic brain injury: a state-of-the-science review of\u00a0military and\u00a0civilian studies","volume":"35","author":"McIntire","year":"2021","journal-title":"Brain Inj"},{"issue":"1","key":"2025012315140995700_R13","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1682\/JRRD.2013.01.0020","article-title":"Cognitive Symptom Management and\u00a0Rehabilitation Therapy (CogSMART) for\u00a0veterans with traumatic brain injury: pilot randomized controlled trial","volume":"51","author":"Twamley","year":"2014","journal-title":"J Rehabil Res Dev"},{"issue":"6","key":"2025012315140995700_R14","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1097\/HTR.0000000000000076","article-title":"CogSMART compensatory cognitive training for\u00a0traumatic brain injury: effects over 1 year","volume":"30","author":"Twamley","year":"2015","journal-title":"J Head Trauma Rehabil"},{"issue":"1","key":"2025012315140995700_R15","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1097\/HTR.0000000000000228","article-title":"Compensatory cognitive training for\u00a0Operation Enduring Freedom\/Operation Iraqi Freedom\/Operation New Dawn veterans with mild traumatic brain injury","volume":"32","author":"Storzbach","year":"2017","journal-title":"J Head Trauma Rehabil"},{"issue":"3","key":"2025012315140995700_R16","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1136\/jnnp-2018-319315","article-title":"SMART-CPT for\u00a0veterans with comorbid post-traumatic stress disorder and\u00a0history of\u00a0traumatic brain injury: a randomised controlled trial","volume":"90","author":"Jak","year":"2019","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"2","key":"2025012315140995700_R17","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1016\/j.neuropharm.2011.02.008","article-title":"Executive function and\u00a0PTSD: disengaging from trauma","volume":"62","author":"Aupperle","year":"2012","journal-title":"Neuropharmacology"},{"issue":"2","key":"2025012315140995700_R18","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1176\/appi.neuropsych.17090180","article-title":"Traumatic brain injury and\u00a0posttraumatic stress disorder: conceptual, diagnostic, and\u00a0therapeutic considerations in\u00a0the context of\u00a0co-occurrence","volume":"30","author":"Vasterling","year":"2018","journal-title":"J Neuropsychiatry Clin Neurosci"},{"issue":"6","key":"2025012315140995700_R19","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1017\/S1355617716000424","article-title":"Neurocognitive correlates of\u00a0successful treatment of\u00a0PTSD in\u00a0female veterans","volume":"22","author":"Haaland","year":"2016","journal-title":"J Int Neuropsychol Soc"},{"key":"2025012315140995700_R20","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.brat.2018.07.004","article-title":"Worse baseline executive functioning is associated with dropout and\u00a0poorer response to trauma-focused treatment for\u00a0veterans with PTSD and\u00a0comorbid traumatic brain injury","volume":"108","author":"Crocker","year":"2018","journal-title":"Behav Res Ther"},{"issue":"1","key":"2025012315140995700_R21","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1682\/JRRD.2009.02.0019","article-title":"A pilot study examining effects of\u00a0group-based Cognitive Strategy Training treatment on\u00a0self-reported cognitive problems, psychiatric symptoms, functioning, and\u00a0compensatory strategy use in\u00a0OIF\/OEF combat veterans with persistent mild cognitive disorder and\u00a0history of\u00a0traumatic brain injury","volume":"47","author":"Huckans","year":"2010","journal-title":"J Rehabil Res Dev"},{"issue":"7","key":"2025012315140995700_R22","doi-asserted-by":"publisher","first-page":"2955","DOI":"10.1002\/hbm.24052","article-title":"Neural correlates of\u00a0reduced depressive symptoms following cognitive training for\u00a0chronic traumatic brain injury","volume":"39","author":"Han","year":"2018","journal-title":"Hum Brain Mapp"},{"key":"2025012315140995700_R23","article-title":"WRAT 4: Wide Range Achievement Test","volume-title":"Psychological Assessment Resources","author":"Wilkinson","year":"2006"},{"key":"2025012315140995700_R24","doi-asserted-by":"publisher","DOI":"10.1037\/t15169-000","volume-title":"Wechsler Adult Intelligence Scale\u2014Fourth Edition (WAIS\u2013IV)","author":"Wechsler","year":"2008"},{"key":"2025012315140995700_R25","doi-asserted-by":"publisher","DOI":"10.1037\/t15082-000","volume-title":"Delis-Kaplan Executive Function System","author":"Delis","year":"2001"},{"issue":"3","key":"2025012315140995700_R26","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1076\/clin.13.3.348.1749","article-title":"Construct and\u00a0concurrent validity of\u00a0the Hopkins Verbal Learning Test\u2013revised","volume":"13","author":"Shapiro","year":"1999","journal-title":"Clin Neuropsychol"},{"author":"Weathers","key":"2025012315140995700_R27","article-title":"The PTSD Checklist (PCL): Reliability, Validity, and Diagnostic Utility"},{"issue":"8","key":"2025012315140995700_R28","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1016\/S0005-7967(00)00084-X","article-title":"The validity of\u00a0the PTSD checklist as a measure of\u00a0symptomatic change in\u00a0combat-related PTSD","volume":"39","author":"Forbes","year":"2001","journal-title":"Behav Res Ther"},{"issue":"2","key":"2025012315140995700_R29","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1037\/1040-3590.20.2.131","article-title":"Change in\u00a0posttraumatic stress disorder symptoms: do clinicians and\u00a0patients agree?","volume":"20","author":"Monson","year":"2008","journal-title":"Psychol Assess"},{"key":"2025012315140995700_R30","doi-asserted-by":"publisher","DOI":"10.1037\/t00742-000","volume-title":"Manual for the Beck Depression Inventory (BDI-II)","author":"Beck","year":"1996"},{"issue":"4","key":"2025012315140995700_R31","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1016\/j.apmr.2008.10.028","article-title":"Sensitivity and\u00a0specificity of\u00a0the Beck Depression Inventory-II in\u00a0persons with traumatic brain injury","volume":"90","author":"Homaifar","year":"2009","journal-title":"Arch Phys Med Rehabil"},{"issue":"15","key":"2025012315140995700_R32","doi-asserted-by":"publisher","first-page":"3269","DOI":"10.1017\/S0033291715001270","article-title":"Minimal clinically important difference on\u00a0the Beck Depression Inventory-II according to the patient\u2019s perspective","volume":"45","author":"Button","year":"2015","journal-title":"Psychol Med"},{"issue":"3","key":"2025012315140995700_R33","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1192\/bjp.bp.107.045922","article-title":"Verbal memory and\u00a0treatment response in\u00a0post-traumatic stress disorder","volume":"193","author":"Wild","year":"2008","journal-title":"Br J Psychiatry"},{"issue":"08","key":"2025012315140995700_R34","doi-asserted-by":"publisher","first-page":"e1023","DOI":"10.4088\/JCP.14m09438","article-title":"Response to psychotherapy for\u00a0posttraumatic stress disorder: the role of\u00a0pretreatment verbal memory performance","volume":"76","author":"Nijdam","year":"2015","journal-title":"J Clin Psychiatry"},{"issue":"Suppl 2","key":"2025012315140995700_R35","doi-asserted-by":"publisher","first-page":"S55","DOI":"10.1093\/schbul\/sbr059","article-title":"Compensatory cognitive training for\u00a0psychosis: who benefits? Who stays in\u00a0treatment?","volume":"37","author":"Twamley","year":"2011","journal-title":"Schizophr Bull"},{"issue":"2","key":"2025012315140995700_R36","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1097\/HTR.0000000000000510","article-title":"Factors associated with response to adapted cognitive behavioral therapy for\u00a0anxiety and\u00a0depression following traumatic brain injury","volume":"35","author":"Ponsford","year":"2020","journal-title":"J Head Trauma Rehabil"},{"issue":"1","key":"2025012315140995700_R37","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1089\/neu.2014.3423","article-title":"Telephone and\u00a0in-person cognitive behavioral therapy for\u00a0major depression after traumatic brain injury: a randomized controlled trial","volume":"32","author":"Fann","year":"2015","journal-title":"J Neurotrauma"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/5-6\/e1263\/57825407\/usad442.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/5-6\/e1263\/57825407\/usad442.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T15:15:12Z","timestamp":1737645312000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/189\/5-6\/e1263\/7422391"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,10]]},"references-count":37,"journal-issue":{"issue":"5-6","published-online":{"date-parts":[[2023,11,10]]},"published-print":{"date-parts":[[2024,5,18]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usad442","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"type":"print","value":"0026-4075"},{"type":"electronic","value":"1930-613X"}],"subject":[],"published-other":{"date-parts":[[2024,5,1]]},"published":{"date-parts":[[2023,11,10]]}}}