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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00062

Computer-based Executive Function Training for Combat Veterans with PTSD: A Pilot Clinical Trial Assessing Feasibility and Predictors of Dropout

 Ashley N. Clausen1, 2, 3*, Joan Thelen4, Alex J. Francisco4,  Jared Bruce4,  Laura Martin5, Joan McDowd4 and Robin L. Aupperle1, 6
  • 1Laureate Institute for Brain Research, United States
  • 2VA Mid-Atlantic Health Care Network, United States
  • 3Brain Imaging and Analysis Center, Duke University, United States
  • 4University of Missouri–Kansas City, United States
  • 5University of Kansas Medical Center, United States
  • 6University of Tulsa, United States

Background: While evidence-based PTSD treatments are often efficacious, 20-50% of individuals continue to experience significant symptoms following treatment. Further, these treatments do not directly target associated neuropsychological deficits. Here, we describe the methods and feasibility for computer-based executive function training (EFT), a potential alternative or adjunctive PTSD treatment.
Methods: Male combat veterans with full or partial PTSD (n = 20) and combat-exposed controls (used for normative comparison; n = 20) completed clinical, neuropsychological and functional neuroimaging assessments. Those with PTSD were assigned to EFT (n = 13) or placebo training (word games; n = 7) at home for six weeks, followed by repeat assessment. Baseline predictors of treatment completion were explored using logistic regressions. Individual feedback and changes in clinical symptoms, neuropsychological function, and neural activation patterns are described.
Results: Dropout rates for EFT and placebo training were 38.5% and 57.1%, respectively. Baseline clinical severity and brain activation (i.e., prefrontal-insula-amygdala networks) during an emotional anticipation task were predictive of treatment completion. Decreases in clinical symptoms were observed following treatment in both groups. EFT participants improved on training tasks but not on traditional neuropsychological assessments. All training completers indicated liking EFT, and indicated they would engage in EFT (alone or as adjunctive treatment) if offered.
Conclusion: Results provide an initial framework to explore the feasibility of placebo-controlled, computerized, home-based executive function training (EFT) on psychological and neuropsychological function and brain activation in combat veterans with PTSD. Clinical severity and neural reactivity to emotional stimuli may indicate which veterans will complete home-based computerized interventions. While EFT may serve as a potential alternative or adjunctive PTSD treatment, further research is warranted to address compliance and determine whether EFT may benefit functioning above and beyond placebo interventions.

Keywords: cognitive training, post traumatic stress, executive funciton, fMRI, neuropsychological, traumat treatment, Cognitive Inhibition, Placebo-controlled trial

Received: 26 Nov 2018; Accepted: 28 Jan 2019.

Edited by:

Rafael C. Freire, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil

Reviewed by:

Fiammetta Cosci, Università degli Studi di Firenze, Italy
William Berger, Federal University of Rio de Janeiro, Brazil
Helga R. Rodrigues, Federal University of Rio de Janeiro, Brazil  

Copyright: © 2019 Clausen, Thelen, Francisco, Bruce, Martin, McDowd and Aupperle. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Ashley N. Clausen, Laureate Institute for Brain Research, Tulsa, United States,