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Research paper
SMART-CPT for veterans with comorbid post-traumatic stress disorder and history of traumatic brain injury: a randomised controlled trial
  1. Amy J Jak1,2,3,4,
  2. Sarah Jurick2,4,
  3. Laura D Crocker2,3,
  4. Mark Sanderson-Cimino4,
  5. Robin Aupperle5,
  6. Carie S Rodgers6,
  7. Kelsey R Thomas1,4,
  8. Briana Boyd3,
  9. Sonya B Norman1,2,4,7,
  10. Ariel J Lang2,4,
  11. Amber V Keller3,
  12. Dawn M Schiehser2,3,4,
  13. Elizabeth W Twamley2,4
  1. 1 Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
  2. 2 Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
  3. 3 Research Service, VA San Diego Healthcare System, San Diego, California, USA
  4. 4 Department of Psychiatry, University of California, San Diego, California, USA
  5. 5 Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, USA
  6. 6 PsychArmor Institute, San Diego, California, USA
  7. 7 National Center for PTSD, White River Junction, Vermont, USA
  1. Correspondence to Dr Amy J Jak, Psychology Service, VA San Diego Healthcare System, San Diego, CA 92161, USA; ajak{at}


Objective To better concurrently address emotional and neuropsychological symptoms common in veterans with comorbid post-traumatic stress disorder (PTSD) and history of traumatic brain injury (TBI), we integrated components of compensatory cognitive training from the Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) programme into cognitive processing therapy (CPT) for PTSD to create a hybrid treatment, SMART-CPT (CogSMART+CPT). This study compared the efficacy of standard CPT with SMART-CPT for treatment of veterans with comorbid PTSD and history of TBI reporting cognitive symptoms.

Methods One hundred veterans with PTSD, a history of mild to moderate TBI and current cognitive complaints were randomised and received individually delivered CPT or SMART-CPT for 12 weeks. Participants underwent psychological, neurobehavioural and neuropsychological assessments at baseline, on completion of treatment and 3 months after treatment.

Results Both CPT and SMART-CPT resulted in clinically significant reductions in PTSD and postconcussive symptomatology and improvements in quality of life. SMART-CPT resulted in additional improvements in the neuropsychological domains of attention/working memory, verbal learning/memory and novel problem solving.

Conclusion SMART-CPT, a mental health intervention for PTSD, combined with compensatory cognitive training strategies, reduces PTSD and neurobehavioural symptoms and also provides added value by improving cognitive functioning.

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  • Contributorship All authors made significant contributions to the preparation and intellectual content of this manuscript. AJJ, RA, CSR, BB, SBN, AJL, DMS and EWT made substantial contributions to the conception or design of the work. AJJ, SJ, LDC, MS-C, CSR, KRT, BB, AVK and EWT made substantial contributions to the acquisition, analysis and/or interpretation of data. All authors made substantial contributions to drafting the work and revising it critically for important intellectual content.

  • Funding Funding was provided by the Department of Defense (award W81XWH-11-1-0641). LDC received salary support during this work from the VA Interprofessional Polytrauma and TBI Fellowship and Career Development (award number IK2 RX002459) from the VA Rehabilitation Research & Development (RR&D) Service. DMS received salary support from VA RR&D MERIT (award 1 I01 RX001691).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The VA San Diego Healthcare System Institutional Review Board approved the study. The US Army Medical Research and Materiel Command (USAMRMC), Office of Research Protections (ORP), Human Research Protection Office (HRPO) approved the subject protocol.

  • Provenance and peer review Not commissioned; externally peer reviewed.