An Open-Label Feasibility Trial Examining the Effectiveness of a Cognitive Training Program, Goal Management Training, in Individuals With Posttraumatic Stress Disorder

Jenna E Boyd; Charlene O'Connor; Alina Protopopescu; Rakesh Jetly; Shawn G Rhind; Ruth A Lanius; Margaret C McKinnon

doi:10.1177/2470547019841599

An Open-Label Feasibility Trial Examining the Effectiveness of a Cognitive Training Program, Goal Management Training, in Individuals With Posttraumatic Stress Disorder

Chronic Stress (Thousand Oaks). 2019 Apr 18:3:2470547019841599. doi: 10.1177/2470547019841599. eCollection 2019 Jan-Dec.

Authors

Jenna E Boyd^{1

2

3}, Charlene O'Connor^{3

4}, Alina Protopopescu^{1

2

3}, Rakesh Jetly^{5

6}, Shawn G Rhind⁷, Ruth A Lanius^{3

8

9

10}, Margaret C McKinnon^{1

2

3

11}

Affiliations

¹ Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada.
² Mood Disorders Program, St. Joseph's Healthcare Hamilton, Ontario, Canada.
³ Homewood Research Institute, Guelph, Ontario, Canada.
⁴ Program for Traumatic Stress Recovery, Homewood Health Center, Guelph, Ontario, Canada.
⁵ Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Department of National Defence, Ottawa, Ontario, Canada.
⁶ Department of Psychiatry, University of Ottawa, Ontario, Canada.
⁷ Defence Research and Development Canada, Toronto Research Centre, Ontario, Canada.
⁸ Department of Psychiatry, Western University, London, Ontario, Canada.
⁹ Department of Neuroscience, Western University, London, Ontario, Canada.
¹⁰ Imaging Division, Lawson Health Research Institute, London, Ontario, Canada.
¹¹ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.

Abstract

Background: Posttraumatic stress disorder (PTSD) is associated with dysfunction across multiple cognitive domains including executive functioning, attention, and verbal memory. This dysfunction is associated with negative impacts on functional outcomes (e.g., work or social functioning) and reduced response to psychotherapy for PTSD. Despite this knowledge, little work has investigated the efficacy of cognitive remediation strategies in improving cognition and functional outcomes among individuals with PTSD.

Objective: The current study investigated the efficacy of an established cognitive remediation program, Goal Management Training (GMT), in improving cognitive functioning in a pilot sample of individuals with PTSD symptoms in an inpatient treatment setting.

Method: Thirty-four inpatients with PTSD symptoms participated in either GMT in addition to treatment as usual (TAU; consisting of psychiatric management, group and individual psychotherapy) (TAU+GMT; n = 18) or TAU alone (n = 16). The TAU+GMT group received neuropsychological assessment at baseline and posttreatment, while both the TAU+GMT and TAU groups received assessment with clinical self-report measures at baseline and posttreatment.

Results: Paired-sample t-tests revealed significant improvements on measures of executive functioning (e.g., response inhibition, cognitive flexibility), processing speed, sustained attention, and verbal memory in the TAU+GMT group. Mixed-design analyses of variance (ANOVAs) revealed a trend toward an interaction effect indicating potentially greater improvements on a measure of the ability to engage in goal-directed behaviors while highly emotional in the TAU+GMT group as compared to the TAU group.

Discussion: The results of this small feasibility investigation of GMT in PTSD point toward the potential efficacy of GMT in ameliorating cognitive difficulties in individuals with PTSD.

Keywords: Goal Management Training; cognitive dysfunction; cognitive remediation; emotion regulation; posttraumatic stress disorder.