Combining attention and metacognitive training to improve goal directed behavior in Veterans with TBI

背景：TBI可能是一个疾病过程的开始，产生持续的变化， 导致衰弱的慢性TBI创伤。一些研究发现， 到30%的持续mTBI的人有持续的症状。持久认知 mTBI后的缺陷对完全功能恢复和重新进入社会角色构成障碍。 执行功能障碍、注意力不集中和记忆困难是最多的 mTBI幸存者面临的持续性残疾。估计44%的mTBI退伍军人也 有多重症状的创伤后应激障碍50%的战斗人员报告注意力问题 退伍军人是其他对日常运作至关重要的认知过程所必需的 例如记忆力、解决问题的能力、语言技能和行为的认知控制。 需要有效的干预措施来解决慢性mTBI导致的认知缺陷。 在目前临床实践中使用的注意力和执行功能治疗中， 缺乏那些有大量证据支持有效性的人。当前认知 对mTBI退伍军人的干预措施不包括具体的注意力训练，缺乏严格的 培训或发现改善只对自我报告的症状。为了提高翻译质量， 建议在进行注意力培训的同时进行战略培训。目标管理 训练（GMT）就是这样一种策略训练，并且被发现可以提高执行功能 mTBI退伍军人的技能。然而，GMT缺乏具体的注意力训练，这是一个局限性 因为注意力是目标管理中正常执行功能的一个组成部分。 考虑到mTBI缺乏注意力训练的严格性，注意力与目标的关系 管理，并承诺结合注意力训练和目标管理训练， 我们将创新性地将元认知干预，GMT，与训练方法结合起来， 注意力训练，也包括注意力恢复的个人功能目标。 方法：这是一项随机对照的初步研究，以确定GMT+的有效性 50名mTBI退伍军人的注意力训练。研究设计是一项平行研究， 随机分配至治疗组或对照组，在治疗前/治疗后和6个月进行试验给药 治疗后。将使用多元线性回归模型确定是否存在 治疗效果与合并症如创伤后应激障碍、抑郁症 焦虑、疼痛、睡眠、药物滥用等。

Background: TBI can be the beginning of a disease process that produces change that continue years after injury resulting in debilitating chronic TBI symptomatology. Some studies find that up to 30% of people that have sustained mTBI have persistent symptoms. Enduring cognitive deficits after mTBI present barriers to full functional recovery and re-entry into societal roles. Executive dysfunction, poor attention-concentration, and memory difficulties are the most persistent disabilities faced by mTBI survivors. An estimate 44% of Veterans with mTBI also have PTSD with overlapping symptoms. Attention problems are reported by 50% of combat Veterans which are requisite for other cognitive processes that are vital to everyday functioning such as memory, problem solving, language skills, and the cognitive control of behavior. Effective interventions are needed to address the cognitive deficits resulting from chronic mTBI. Of the attention and executive function treatments currently used in clinical practice, there is a dearth of those with substantial evidence to support effectiveness. Current cognitive interventions for Veterans with mTBI did not include specific attention training, lacked rigorous training or found improvement only on self-reported symptoms. In order to improve translation, strategy training has been recommended to accompany attention training. Goal Management Training (GMT) is such a strategy training and has been found to be improve executive function skills in Veterans with mTBI. However, GMT lacks specific attention training, which is a limitation in that attention is a component of the normal executive function used in goal management. Given the need in mTBI lack of rigor in attention training, the relationship of attention to goal management, and the promise of combined attention training and goal management training, we will innovatively combine the metacognitive intervention, GMT, with a drill method of attention training that also includes individual functional goals for attention recovery. Method: This is a randomized control pilot study to determine effectiveness of GMT plus Attention Training in 50 Veterans with mTBI. The research design is a parallel study with randomization to treatment or control with test administration at pre/post and six months following treatment. A multiple linear regression model will be used to determine if there is a significant association between treatment effect and comorbidities such as PTSD, depression, anxiety, pain, sleep, substance abuse, etc.