INS NYC 2024 Program

Symposium	Symposia 8 Program Schedule 02/15/2024 04:00 pm - 05:25 pm Room: West Side Ballroom - Salon 1 Symposia 8: Interventions for neuropsychological conditions Simposium #4 Compensatory Cognitive Training for Unstably Housed Veterans in Residential Mental Health Treatment Amber Keller, UCSD, La Jolla, United States Jacqueline Maye, VA San Diego Healthcare System, San Diego, United States Tara Austin, VA San Diego Healthcare System, San Diego, United States Jessica Zakrzewski, UCSD, La Jolla, United States Delaney Pickell, VA San Diego Healthcare System, San Diego, United States Category: Cognitive Intervention/Rehabilitation Keyword 1: cognitive rehabilitation Keyword 2: traumatic brain injury Keyword 3: post-traumatic stress disorder Objective: Addressing homelessness in returning Veterans is a national priority. Contributors to homelessness include traumatic brain injury (TBI), psychiatric illness, substance abuse, and other medical conditions that are associated with cognitive impairment. Difficulty with planning, organization, and learning/memory can interfere with tasks necessary to sustain income to support housing, as well as to navigate, access, and sustain engagement in psychiatric rehabilitation. Thus, cognitive impairment may be a barrier to ending homelessness. Compensatory Cognitive Training (CCT) is an intervention that teaches compensatory cognitive strategies to improve functioning in prospective memory, attention, learning/memory, and executive functioning. The current randomized controlled trial examined the efficacy of CCT compared to a Holistic Cognitive Education (HCE) control condition. Participants and Methods: 79 post-9/11 Veterans who were homeless or unstably housed and receiving residential psychiatric rehabilitation completed assessments at baseline, midpoint (5 weeks), and post-treatment (10 weeks). Veterans were randomized to receive 10 once-weekly, 1-hour manualized individual sessions of either CCT or HCE. CCT targeted the four cognitive domains listed above along with neurobehavioral symptoms (e.g., via stress reduction techniques, sleep education, and lifestyle strategies). HCE was a robust control condition involving psychoeducation about potential medical and psychiatric conditions that can affect cognition (e.g., alcohol and substances, TBI, PTSD, depression, sleep disturbance, pain). Outcome measures included self-reported symptom ratings (e.g., Neurobehavioral Symptom Inventory) and a neuropsychological assessment (an expanded MATRICS Consensus Cognitive Battery) measuring attention/vigilance, processing speed, working memory, verbal/visual learning, and executive functioning. Multi-level modeling was used to examine treatment-related improvements in neuropsychological functioning and neurobehavioral symptoms at post-treatment. Results: Participants were mostly male (99%), White/Non-Hispanic (64%), and on average, were 37 years old with 14 years of education. Most (69%) had no employment in the past 6 months and 55% had lived in their car, in public, or in a shelter for at least one week in the past 6 months. On average, participants had clinically significant depressive, PTSD, and insomnia symptoms; 91% had a history of TBI; 90% reported pain. Groups did not significantly differ on baseline demographics, neurobehavioral symptoms, or neuropsychological performance. The models revealed that compared to the HCE group, the CCT group demonstrated greater improvement in attention/vigilance performance at post-treatment (estimate=3.6 [SE=1.7]; t=2.2; p=0.042). There was a trend toward those in the CCT group reporting less severe neurobehavioral symptoms (estimate=-4.8 [SE=2.3]; t=-2.1; p=0.051) at post-treatment. HCE participants demonstrated greater improvement in speed of processing at post-treatment compared to CCT participants (estimate=-3.3 [SE=1.3]; t=-2.5; p=0.017). Conclusions: CCT has the potential to improve objective attention/vigilance and self-reported neurobehavioral symptoms in unstably housed Veterans with complex medical and psychiatric comorbidities.

Symposium

02/15/2024
04:00 pm - 05:25 pm
Room: West Side Ballroom - Salon 1

Symposia 8: Interventions for neuropsychological conditions

Simposium #4

Compensatory Cognitive Training for Unstably Housed Veterans in Residential Mental Health Treatment

Amber Keller, UCSD, La Jolla, United States
Jacqueline Maye, VA San Diego Healthcare System, San Diego, United States
Tara Austin, VA San Diego Healthcare System, San Diego, United States
Jessica Zakrzewski, UCSD, La Jolla, United States
Delaney Pickell, VA San Diego Healthcare System, San Diego, United States

Category: Cognitive Intervention/Rehabilitation

Keyword 1: cognitive rehabilitation
Keyword 2: traumatic brain injury
Keyword 3: post-traumatic stress disorder

Objective:

Addressing homelessness in returning Veterans is a national priority. Contributors to homelessness include traumatic brain injury (TBI), psychiatric illness, substance abuse, and other medical conditions that are associated with cognitive impairment. Difficulty with planning, organization, and learning/memory can interfere with tasks necessary to sustain income to support housing, as well as to navigate, access, and sustain engagement in psychiatric rehabilitation. Thus, cognitive impairment may be a barrier to ending homelessness. Compensatory Cognitive Training (CCT) is an intervention that teaches compensatory cognitive strategies to improve functioning in prospective memory, attention, learning/memory, and executive functioning. The current randomized controlled trial examined the efficacy of CCT compared to a Holistic Cognitive Education (HCE) control condition.

Participants and Methods:

79 post-9/11 Veterans who were homeless or unstably housed and receiving residential psychiatric rehabilitation completed assessments at baseline, midpoint (5 weeks), and post-treatment (10 weeks). Veterans were randomized to receive 10 once-weekly, 1-hour manualized individual sessions of either CCT or HCE. CCT targeted the four cognitive domains listed above along with neurobehavioral symptoms (e.g., via stress reduction techniques, sleep education, and lifestyle strategies). HCE was a robust control condition involving psychoeducation about potential medical and psychiatric conditions that can affect cognition (e.g., alcohol and substances, TBI, PTSD, depression, sleep disturbance, pain). Outcome measures included self-reported symptom ratings (e.g., Neurobehavioral Symptom Inventory) and a neuropsychological assessment (an expanded MATRICS Consensus Cognitive Battery) measuring attention/vigilance, processing speed, working memory, verbal/visual learning, and executive functioning. Multi-level modeling was used to examine treatment-related improvements in neuropsychological functioning and neurobehavioral symptoms at post-treatment.

Results:

Participants were mostly male (99%), White/Non-Hispanic (64%), and on average, were 37 years old with 14 years of education. Most (69%) had no employment in the past 6 months and 55% had lived in their car, in public, or in a shelter for at least one week in the past 6 months. On average, participants had clinically significant depressive, PTSD, and insomnia symptoms; 91% had a history of TBI; 90% reported pain. Groups did not significantly differ on baseline demographics, neurobehavioral symptoms, or neuropsychological performance. The models revealed that compared to the HCE group, the CCT group demonstrated greater improvement in attention/vigilance performance at post-treatment (estimate=3.6 [SE=1.7]; t=2.2; p=0.042). There was a trend toward those in the CCT group reporting less severe neurobehavioral symptoms (estimate=-4.8 [SE=2.3]; t=-2.1; p=0.051) at post-treatment. HCE participants demonstrated greater improvement in speed of processing at post-treatment compared to CCT participants (estimate=-3.3 [SE=1.3]; t=-2.5; p=0.017).

Conclusions:

CCT has the potential to improve objective attention/vigilance and self-reported neurobehavioral symptoms in unstably housed Veterans with complex medical and psychiatric comorbidities.