Samuelson Kristin W, Engle Krista, Abadjian Linda, Jordan Joshua, Bartel Alisa, Talbot Margaret, Powers Tyler, Bryan Lori, Benight Charles
Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States.
Department of Psychiatry, University of California San Francisco, San Francisco, San Francisco, CA, United States.
Front Neurol. 2020 Nov 26;11:569005. doi: 10.3389/fneur.2020.569005. eCollection 2020.
Although there is evidence of mild cognitive impairments for many individuals with mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD), little research evaluating the effectiveness of cognitive training interventions has been conducted. This randomized controlled trial examined the effectiveness of a 9-h group cognitive training targeting higher-order functions, Strategic Memory Advanced Reasoning Training (SMART), compared to a 9-h psychoeducational control group in improving neurocognitive functioning in adults with mTBI and PTSD. A sample of 124 adults with histories of mild TBI ( = 117) and/or current diagnoses of PTSD ( = 84) were randomized into SMART ( = 66) or Brain Health Workshop (BHW; = 58) and assessed at three time points: baseline, following training, and 6 months later. Participants completed a battery of neurocognitive tests, including a test of gist reasoning (a function directly targeted by SMART) as well as tests of verbal, visual, and working memory and executive functioning, functions commonly found to be mildly impaired in mTBI and PTSD. The two groups were compared on trajectories of change over time using linear mixed-effects models with restricted maximum likelihood (LMM). Contrary to our hypothesis that SMART would result in superior improvements compared to BHW, both groups displayed statistically and clinically significant improvements on measures of memory, executive functioning, and gist reasoning. Over 60% of the sample showed clinically significant improvements, indicating that gains can be found through psychoeducation alone. A longer SMART protocol may be warranted for clinical samples in order to observe gains over the comparison group.
尽管有证据表明许多轻度创伤性脑损伤（mTBI）和创伤后应激障碍（PTSD）患者存在轻度认知障碍，但评估认知训练干预效果的研究却很少。这项随机对照试验比较了针对高阶功能的9小时小组认知训练——策略性记忆高级推理训练（SMART）与9小时心理教育对照组，以检验其对改善mTBI和PTSD成人神经认知功能的有效性。124名有轻度TBI病史（n = 117）和/或目前诊断为PTSD（n = 84）的成年人被随机分为SMART组（n = 66）或脑健康工作坊（BHW；n = 58），并在三个时间点进行评估：基线、训练后和6个月后。参与者完成了一系列神经认知测试，包括要点推理测试（SMART直接针对的一项功能）以及言语、视觉和工作记忆与执行功能测试，这些功能在mTBI和PTSD中通常会出现轻度受损。使用限制最大似然法的线性混合效应模型（LMM）比较两组随时间的变化轨迹。与我们的假设（即SMART组相比BHW组会有更显著的改善）相反，两组在记忆、执行功能和要点推理测量上均显示出具有统计学意义和临床意义的改善。超过60%的样本显示出临床显著改善，这表明仅通过心理教育就能取得成效。为了观察到相对于对照组的改善，对于临床样本可能需要更长的SMART训练方案。
