Evaluating web-based cognitive-affective remediation in recent trauma survivors: study rationale and protocol

Abstract

Background: The immediate aftermath of traumatic events is a period of enhanced neural plasticity, following which some survivors remain with post-traumatic stress disorder (PTSD) whereas others recover. Evidence points to impairments in emotional reactivity, emotion regulation, and broader executive functions as critically contributing to PTSD. Emerging evidence further suggests that the neural mechanisms underlying these functions remain plastic in adulthood and that targeted retraining of these systems may enhance their efficiency and could reduce the likelihood of developing PTSD. Administering targeted neurocognitive training shortly after trauma exposure is a daunting challenge. This work describes a study design addressing that challenge. The study evaluated the direct effects of cognitive remediation training on neurocognitive mechanisms that hypothetically underlay PTSD, and the indirect effect of this intervention on emerging PTSD symptoms. Method: We describe a study rationale, design, and methodological choices involving: (a) participants’ enrolment; (b) implementation and management of a daily self-administered, web-based intervention; (c) reliable, timely screening and assessment of treatment of eligible survivors; and (d) defining control conditions and outcome measures. We outline the rationale of choices made regarding study sample, timing of intervention, measurements, monitoring participants’ adherence, and ways to harmonize and retain interviewers’ fidelity and mitigate eventual burnout by repeated contacts with recently traumatized survivors. Conclusion: Early web-based interventions targeting causative mechanisms of PTSD can be informed by the model presented in this paper.

Cognitive Flexibility Predicts PTSD Symptoms: Observational and Interventional Studies

“…Within 7–14 days after trauma exposure, and after being discharged from the hospital, the identified individuals were contacted by telephone for an initial screening. The telephone screening was conducted by MA level clinicians that were trained in the specific assessment tools [see ( 38 ) for detailed description]. After verbal consent, the PTSD Checklist (PCL) was administered to assess risk of PTSD development.…”

Neuroanatomical Risk Factors for Post Traumatic Stress Disorder (PTSD) in Recent Trauma Survivors

“…This version showed high internal consistency (0.94) and test-retest reliability (0.82), and was previously used in recent longitudinal studies of recent trauma survivors (55,56). Individuals which met PTSD symptom criteria and did not meet any of the exclusion criteria, received verbal information about the study.…”

Neurobehavioral moderators of post-traumatic stress disorder (PTSD) trajectories: study protocol of a prospective MRI study of recent trauma survivors

“…Longitudinal studies of the early development of post-traumatic psychopathology present significant technical and conceptual challenges (Fine et al, 2018;Qi et al, 2018;Shalev et al, 2011). Technical challenges include reaching out to, enrolling, evaluating and retaining participants in sufficient numbers and proportions to ensure power and reduce retention bias.…”

“…It was shown to have high testretest reliability over a three-day period (r = 0.96) and very high internal consistency (α = 0.97) as well as a high correlation with CAPS (Blanchard, 1996). This measure was cross-translated to Hebrew and used in previous studies (Ben-Zion et al, 2018;Fine, Achituv, Etkin, Merin, & Shalev, 2018).…”