Functional Improvements 6+ Months After GOALS Training Predicted Decreased PTSD Symptoms Among Veterans with PTSD/mTBI

Research Objectives: To examine whether long-term improvements in functional outcomes following Goal-Oriented Attentional Self-Regulation (GOALS) training predicts changes in PTSD symptoms among veterans with comorbid PTSD and mild TBI (mTBI).

Design: Archival data from a randomized-controlled, evaluator-blinded, trial for GOALS executive function training. Assessments of daily and emotional functioning were completed at baseline and 6 months post-treatment.

Setting: VA Medical Center

Participants: 24 veterans with a history of chronic mTBI and a confirmed diagnosis of PTSD that completed GOALS training.

Interventions: GOALS is a cognitive rehabilitation intervention that incorporates mindfulness-based attention regulation training, and goal management strategies applied to participant-defined goals. It consists of ten 2-hour sessions administered in small group format, and three individual 1-hour sessions.

Main Outcome Measures: The Mayo-Portland Adaptability Inventory (MPAI) and PTSD Checklist, Military Version (PCLM) were chosen from archival data collected from the original study.

Results: Paired-samples T-Tests indicate significant improvements 6 months post GOALS training in total PTSD symptoms on PCLM-Total (p=.007), Re-experiencing (p=.009) and Hyperarousal (p=.002). There were also significant improvements in overall functioning on MPAI-Total (p=.007), including Participation (e.g. initiation, socialization, employment; p=0.01) and Ability (e.g. problem solving, memory, attention; p=0.014) 6 months post GOALS training.

Results from simple linear regressions indicate that improved MPAI-Participation 6 months post GOALS training predicted decreases in PCLM-Hyperarousal (R²=.29), PCLM-Avoidance (R²=.20), and PCLM-Reexperiencing (R²=.17). Further, improved MPAI-Ability also predicted decreases in PCLM-Hyperarousal (R²=.19), PCLM-Avoidance (R²=.27), and PCLM-Reexperiencing (R²=.18).

Conclusions: Persistence of improvements in functional abilities 6+ months after GOALS training predicted decreased PTSD symptoms in Veterans with mTBI and PTSD. The results highlight the impact functional status has on emotional functioning, and suggest that improvements in functional abilities following cognitive rehabilitation training may strengthen emotional regulation skills, resulting in decreases in emotional distress.

Author(s) Disclosures: None