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A randomized control trial of a novel approach to cognitive training in public safety personnel with post-traumatic stress injuries

Keywords: cognitive performance, Goal Management Therapy, PTSI

Summary

Public safety personnel (PSP) are more likely to be exposed to traumatic events such as natural disaster, violence, and death, due to their roles in maintaining the safety and security of individuals and the community. Exposure to traumatic events is associated with a number of mental health difficulties, including major depressive disorder, substance use and anxiety disorders, and post-traumatic stress disorder (PTSD). In addition to its damaging emotional and functional impacts, PTSD is associated with cognitive difficulties, including with memory, attention, learning, and executive functioning. These cognitive deficits can negatively impact the ability of PSP to return to, and remain at work. Currently, very little is known about the effectiveness of cognitive remediation therapies for PSP with PTSD, or how cognitive remediation may impact brain structure and functioning. This study conducts a randomized control trial of Goal Management Training (GMT)- a cognitive remediation strategy that aims to improve cognitive functioning among individuals with a range of neurological conditions. Specifically, early data from initial treatment studies investigating the effectiveness of GMT suggest moderate improvements in both working and long-term memory, executive functioning, mental health status, and other functional outcomes. The study investigates whether a standardized 9-session GMT program will result in long-term improvements in cognitive functioning among outpatient PSP who have been exposed to trauma. The researchers also aim to determine whether participation in GMT leads to functional improvements (e.g. return to work; stay at work; social and family functioning).

Interview with the Researchers

Are there any additional questions or challenges that your research might help to address?

In addition to our primary research aims, our study also investigates the potential for alterations in brain structure and functioning in PSP with PTSD. Using functional magnetic resonance imaging (fMRI) technology, we will examine whether changes in brain structure and functioning are associated with poor baseline (pre-treatment) functioning in PTSD, and if so, whether these alterations show improvement following GMT therapy.

What is exciting about your work for the PSP community? For example, how will your results help PSP frontline workers? PSP families? PSP leaders?

PSP are tasked with protecting the public even in the presence of personal risk. This is exemplified by the recent COVID-19 pandemic, wherein PSP have remained on duty throughout numerous lockdowns amid this public health threat. In addition to impacting mental health, frequent exposure to duty-related trauma can lead to difficulties maintaining the cognitive demands required in public safety professions. Currently, for those PSP struggling with PTSD and its associated cognitive difficulties, the pandemic has rendered it more difficult to access mental health support and occupational therapies, placing strain on individuals, departments, and families. Many PSP are also not aware of the connection between PTSD and cognitive difficulties, and as a result may question their capability and competence in their professions. With the current additional strain on our frontline workers, determining effective treatments for members of this community is of urgent priority. Should GMT prove effective in improving cognitive functioning, a standardized treatment protocol can be established and implemented by various mental health treatment providers in order to allow PSP to return to work and remain at work. Fundamentally, an effective cognitive remediation program can improve quality of life for Canada’s PSP.

When do you expect to have results to share with the PSP community?

We expect that preliminary results from the neuropsychological component of our study will be disseminated by our lab in the early Fall of 2022. Dissemination of neuroimaging results will begin in early 2023.

 

Principal Researchers

Dr. Margaret McKinnon, is a clinical psychologist and serves as the Homewood Chair in Mental Health and Trauma, as well as Senior Scientist at the Homewood Research Institute. She is also an Associate Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University and Clinical Neuropsychologist at St. Joseph’s Healthcare Hamilton.

Dr. Ruth Lanius, Harris-Woodman Chair in Psyche and Soma, and professor in the Department of Psychiatry at the University of Western Ontario.

Charlene O’Connor, is a highly experienced occupational therapist and the Senior Manager of Research and Innovation in the Traumatic Stress Injury and Concurrent Program at Homewood Health Centre.

Dr. McKinnon, Dr. Lanius, and Ms. O’Connor will provide exemplary supervision to project staff, including post-doctoral research fellows and graduate students from McMaster University’s Trauma and Recovery Lab.

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