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Psychological Symptoms and Rates of Performance Validity Improve Following Trauma-Focused Treatment in Veterans with PTSD and History of Mild-to-Moderate TBI

Published online by Cambridge University Press:  29 October 2019

Sarah M. Jurick Open the ORCID record for Sarah M. Jurick [Opens in a new window] ,
Laura D. Crocker ,
Victoria C. Merritt Open the ORCID record for Victoria C. Merritt [Opens in a new window] ,
Samantha N. Hoffman ,
Amber V. Keller ,
Graham M. L. Eglit ,
Kelsey R. Thomas Open the ORCID record for Kelsey R. Thomas [Opens in a new window] ,
Sonya B. Norman ,
Dawn M. Schiehser  and
Carie S. Rodgers
...Show all authors
Sarah M. Jurick*
Affiliation:
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
Laura D. Crocker
Affiliation:
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
Victoria C. Merritt
Affiliation:
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
Samantha N. Hoffman
Affiliation:
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
Amber V. Keller
Affiliation:
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
Graham M. L. Eglit
Affiliation:
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
Kelsey R. Thomas
Affiliation:
Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
Sonya B. Norman
Affiliation:
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA National Center for PTSD, White River Junction, VT, USA
Dawn M. Schiehser
Affiliation:
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
Carie S. Rodgers
Affiliation:
PsychArmor Institute, San Diego, CA, USA
Elizabeth W. Twamley
Affiliation:
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
Amy J. Jak
Affiliation:
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
*
Correspondence and reprint requests to: Sarah M. Jurick, Ph.D., 3350 La Jolla Village Dr., MC 151B, San Diego, CA 92161, USA. E-mail: sjurick@ucsd.edu
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Abstract

Objective:

Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance.

Method:

Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass).

Results:

Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.

Conclusion:

Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.

Keywords

TBIPosttraumatic stress disorderPerformance validityEffortCognitive rehabilitationPost-concussive symptomsDepressive symptoms
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 26 , Special Issue 1: Rehabilitation , January 2020 , pp. 108 - 118
Copyright
Copyright © INS. Published by Cambridge University Press, 2019. 

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