Simultaneous Treatment of Neurocognitive and Psychiatric Symptoms in Veterans with Post-Traumatic Stress Disorder and History of Mild Traumatic Brain Injury: A Pilot Study of Mindfulness-Based Stress Reduction.

Treating patient populations with significant psychiatric and neurocognitive symptomatology can present a unique clinical dilemma: progress in psychotherapy can be significantly fettered by cognitive deficits, whereas neurocognitive rehabilitation efforts can be ineffective because of psychiatric overlay. Application of mindfulness-based interventions to address either cognitive or psychiatric symptoms in isolation appears efficacious in many contexts; however, it remains unclear whether this type of intervention might help address simultaneous neurocognitive and psychiatric symptomatology. In a pre-post mixed methods design pilot study, nine Veterans with post-traumatic stress disorder (PTSD) and a history of mild traumatic brain injury with chronic cognitive complaints participated in Mindfulness-Based Stress Reduction (MBSR). Clinical interview, questionnaires, and attention and PTSD measures were administered immediately before, immediately after, and 3 months after MBSR completion. Qualitative and quantitative findings suggest high levels of safety, feasibility, and acceptability. Measurement of attention revealed significant improvement immediately following MBSR (p < 0.05, d = 0.57) and largely sustained improvement 3 months after completion of MBSR (p < 0.10, d = 0.48). Significant reduction in PTSD symptoms was found immediately after MBSR (p < 0.05, d = -1.56), and was sustained 3 months following MBSR completion (p < 0.05, d = -0.93). These results warrant a randomized controlled trial follow-up. Potential mechanisms for the broad effects observed will be explored.

Differential learning and memory performance in OEF/OIF veterans for verbal and visual material.

OBJECTIVE: Memory complaints are particularly salient among veterans who experience combat-related mild traumatic brain injuries and/or trauma exposure, and represent a primary barrier to successful societal reintegration and everyday functioning. Anecdotally within clinical practice, verbal learning and memory performance frequently appears differentially reduced versus visual learning and memory scores. We sought to empirically investigate the robustness of a verbal versus visual learning and memory discrepancy and to explore potential mechanisms for a verbal/visual performance split. METHOD: Participants consisted of 103 veterans with reported history of mild traumatic brain injuries returning home from U.S. military Operations Enduring Freedom and Iraqi Freedom referred for outpatient neuropsychological evaluation. RESULTS: Findings indicate that visual learning and memory abilities were largely intact while verbal learning and memory performance was significantly reduced in comparison, residing at approximately 1.1 SD below the mean for verbal learning and approximately 1.4 SD below the mean for verbal memory. This difference was not observed in verbal versus visual fluency performance, nor was it associated with estimated premorbid verbal abilities or traumatic brain injury history. In our sample, symptoms of depression, but not posttraumatic stress disorder, were significantly associated with reduced composite verbal learning and memory performance. CONCLUSIONS: Verbal learning and memory performance may benefit from targeted treatment of depressive symptomatology. Also, because visual learning and memory functions may remain intact, these might be emphasized when applying neurocognitive rehabilitation interventions to compensate for observed verbal learning and memory difficulties.