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CogSMART Compensatory Cognitive Training for Traumatic Brain Injury: Effects Over 1 Year

Twamley, Elizabeth W. PhD; Thomas, Kelsey R. MS; Gregory, Amber M. BA; Jak, Amy J. PhD; Bondi, Mark W. PhD; Delis, Dean C. PhD; Lohr, James B. MD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP

Journal of Head Trauma Rehabilitation: November/December 2015 - Volume 30 - Issue 6 - p 391–401
doi: 10.1097/HTR.0000000000000076
Original Articles

Objective: There are very few evidence-based treatments for individuals with mild to moderate traumatic brain injuries. We developed and tested a 12-week, manualized, compensatory cognitive training intervention, Cognitive Symptom Management and Rehabilitation Therapy (CogSMART), which targeted postconcussive symptom management, prospective memory, attention, learning/memory, and executive functioning. The intervention focused on psychoeducation and compensatory strategies such as calendar use, self-talk, note taking, and a 6-step problem-solving method.

Setting: VA Healthcare System.

Participants: A total of 50 Veterans with mild to moderate traumatic brain injuries receiving supported employment.

Design: Twelve-month randomized controlled trial with participants assigned to receive CogSMART or additional supported employment sessions for the first 12 weeks. Outcome assessments were administered at baseline and 3, 6, and 12 months.

Main Measures: Assessments measured postconcussive symptoms, neuropsychological performance, functional capacity, psychiatric symptom severity, quality of life, and weeks worked during the 12-month trial.

Results: Hierarchical linear modeling analyses using all 4 time points demonstrated significant CogSMART-associated reductions in postconcussive symptoms (r = −0.28, P = .026, d = 0.64) and improvements in prospective memory (r = 0.35, P = .031, d = 0.55) and quality of life (r = 0.34, P = .009, d = 1.0). The groups did not differ on weeks worked during the trial.

Conclusion: CogSMART has the potential to improve postconcussive symptoms, cognitive performance, and self-rated quality of life in individuals with mild to moderate traumatic brain injuries.

Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California (Drs Twamley, Jak, Delis, and Lohr); Department of Psychiatry, University of California, San Diego, La Jolla, California (Drs Twamley, Jak, Bondi, and Lohr); Department of Clinical and Health Psychology, University of Florida, Gainesville (Ms Thomas); Department of Psychology, The University of Alabama at Birmingham, Birmingham (Ms Gregory); Psychology Service, VA San Diego Healthcare System, San Diego, California (Drs Jak and Bondi).

Corresponding Author: Elizabeth W. Twamley, PhD, Neuropsychology Unit, Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, 3350 La Jolla Village Dr (116A), San Diego, CA 92161 (

This research was funded by Department of Defense Award W81XWH-08-2-0193 to Dr Twamley.

The authors acknowledge the assistance of Drs Dewleen G. Baker and Rebecca E. Williams for their support of the study and the helpful consultation of Jennifer Vasterling and Paul Wehman. They also thank Laurie Arnold, MS, CRC, and Sabrina Castañeda, MS, CRC, for their work with their participants and recognize the previous contributions of Sarah K. Noonan, Gauri N. Savla, and Dawn Schiehser to the CogSMART treatment manual.

The authors declare no conflicts of interest.

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