Investigating Neuropsychological Functioning, Functional Impairment, and Cognitive Remediation in Posttraumatic Stress Disorder

Abstract

Posttraumatic stress disorder (PTSD) is associated with significant functional impairments and disruptions in cognitive functioning. Functional recovery and remediation of cognitive difficulties are oft over-looked treatment targets in this population, despite their significant contribution to the burden of PTSD to the individual and to society. Existing literature suggests that functional impairment and cognitive dysfunction may not respond to first-line treatments for PTSD. Thus, the focus of this thesis was to examine symptom dimensions associated with cognitive dysfunction and functional impairment among individuals with PTSD, and to investigate a novel approach to cognitive remediation, Goal Management Training (GMT), in this population. Study one in this thesis is a review in which we identified a strong relation between dissociative symptoms and neuropsychological functioning, transdiagnostically and among individuals with PTSD. The hypothesis that dissociative symptoms would be strongly related to functional impairment among individuals with PTSD was explored in study two. We found that dissociative symptoms mediated the relation between PTSD symptoms and functional impairment among a sample of military members, veterans, and first responders with PTSD. Study three identified that emotion regulation difficulties and dissociative symptoms most strongly predicted functional impairment among civilians with PTSD and high rates of exposure to childhood abuse and neglect. In study four we investigated the effectiveness of a cognitive training program, Goal Management Training (GMT), in improving cognitive functioning, clinical symptoms, and functional impairment among inpatients with PTSD. Participation in GMT was associated with improved cognitive functioning and increased ability to engage in goal directed behaviours when highly emotional. This thesis highlights the importance of assessing emotion regulation difficulties and dissociative symptoms in order to target functional impairment and cognitive dysfunction among individuals with PTSD. Moreover, it provides evidence for a potential treatment approach to ameliorate these difficulties.