CBT Effective for Combat-Related PTSD, Even in the Presence of Traumatic Brain Injury

Posttraumatic stress disorder (PTSD) affects approximately 5%-20% of U.S. troops returning from Iraq and Afghanistan.  Another 11%-23% suffer from traumatic brain injury (TBI).  While treatment strategies employing cognitive-behavioral therapy (CBT), including prolonged exposure therapy and cognitive-processing therapy (CPT), have been empirically validated for the treatment of PTSD symptoms, cognitive limitations may interfere with an individual’s ability to adhere to and receive benefit from CBT. Specifically, given the clinical overlap between TBI and combat-related PTSD,  it is important to understand how TBI might affect treatment outcomes in patients pursuing CBT for PTSD.

In a recent study, Kaloyan Tanev, MD, MPH and colleagues from Home Base  and the MGH Department of Psychiatry, examined outcomes in a group of military service members and veterans seeking treatment for combat-related PTSD.  The study included 23 participants aged 18-50 years with PTSD symptoms of at least one year’s duration.  Of these, 16 participants had mild TBI (mTBI).  

Cognitive abilities (including new learning, memory, processing speed, complex attention, inhibition, and flexibility) were assessed at baseline.  Outcomes were assessed using the PTSD Checklist for DSM-5 (PCL-5) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5).  Participants received 12 manualized sessions of either prolonged exposure or cognitive-processing therapy, based on therapist recommendations and patient choice. 

While the researchers initially predicted that worse cognitive functioning at baseline would be associated with worse outcomes in those receiving CBT for PTSD, this study demonstrated that neither cognitive performance at baseline nor the presence of comorbid mild TBI predicted poorer response to CBT for PTSD.

Tanev KS, Federico LE, Greenberg MS, Orr SP, Goetter EM, Resick PA, Pitman RK.  Baseline Cognitive Performance and Treatment Outcomes From Cognitive-Behavioral Therapies for Posttraumatic Stress Disorder: A Naturalistic Study.  J Neuropsychiatry Clin Neurosci. 2020 Summer; 32(3):286-293. 

Tanev KS, Pentel KZ, Kredlow MA, Charney ME.   PTSD and TBI co-morbidity: scope, clinical presentation and treatment options.  Brain Inj. 2014;2 8(3):261-70. 

Kaloyan Tanev, MD, MPH is the Director of Clinical Neuropsychiatry Research at MGH and the Medical Director of the Outpatient Program at Home Base.