US Department of Defense
Advancing Blast Injury Research to Protect and Heal Those Who Serve

Enhanced Cognitive Rehabilitation to Treat Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) are frequently observed co-morbidities in Service Member and Veteran populations. Persistent post-concussive symptoms including cognitive and emotional control challenges associated with TBI can often impede recovery from PTSD and vice versa. Furthermore, chronic cognitive deficits resulting from the TBI or from PTSD can limit the effectiveness of traditional Cognitive Processing Therapy (CPT), which is considered the standard of care for treatment of PTSD.

Multifunctional Smart Catheter illustration
Model of dynamic relationship between etiology, symptom development and persistence, and treatment in comorbid PTSD and TBI.1 Used with permission of authors.

Researchers at the VA Medical Center in San Diego are conducting a randomized trial of the new SMART-CPT therapy in Iraq and Afghanistan Veterans who have a history of either mild or moderate TBI and PTSD. SMART-CPT is a hybrid training program that combines traditional CPT with Cognitive Symptom Management and Rehabilitation Therapy (CogSMART), a manualized treatment approach used to teach Veterans strategies to compensate for cognitive difficulties. The aim is to specifically address the cognitive deficits associated with TBI while simultaneously treating PTSD (Figure). The researchers predict that those receiving SMART-CPT will have a greater reduction in PTSD and neurobehavioral symptoms, including cognitive functioning, and a notable improvement in quality of life, than those receiving traditional CPT.

Researchers have recently completed recruitment and data collection for this randomized trial. Initial results are promising with researchers observing that participants in the SMART-CPT group tend to stay in treatment longer than those in the CPT group and have greater improvements in several domains of cognitive functioning. By taking into account the complex interplay between PTSD and TBI, this hybrid treatment has the potential to effectively treat Service Members and Veterans with comorbid PTSD and TBI as opposed to treating each disorder independently. This project is funded by the Joint Program Committee 5/Military Operational Medicine Research Program (JPC-5/MOMRP) and managed through the Congressionally Directed Medical Research Program (CDMRP).


Jak, A. J., Aupperlee, R., Rodgers, C. S., Lang, A. J., Schiehser, D. M., Norman, S. B., & Twamley, E. W. (2015). Evaluation of a hybrid treatment for Veterans with comorbid traumatic brain injury and posttraumatic stress disorder: Study protocol for a randomized controlled trial. Contemporary Clinical Trials, 45(B), 210-216. doi:10.1016/j.cct.2015.10.009.

Boyd, B., Rodgers, C., Aupperle, R., & Jak, A.J. (2016). Case Report on the Effects of Cognitive Processing Therapy on Psychological, Neuropsychological, and Speech Symptoms in Comorbid PTSD and TBI. Cognitive and Behavioral Practice, 23(2), 173-183.

Jak, A.J., Crocker, L., Aupperle, R., Clausen, A., & Bomyea, J. (2017). Neurocognition in PTSD: Treatment Insights and Implications. Current Topics in Behavioral Neurosciences: Behavioral Neurobiology of PTSD. In Press. doi: 10.1007/7854_2016_62.

Jurick, S. M., Crocker, L. D., Sanderson-Cimino, M., Keller, A.V., Trenova, L. S., Boyd, B., Twamley, E. W., Rodgers, C. S., Schiehser D. M., Aupperle, R. L., & Jak, A. J. Contributions to Executive Dysfunction in Operation Enduring Freedom/Operation Iraqi Freedom Veterans with Post-Traumatic Stress Disorder and History of Mild Traumatic Brain Injury. Journal of Head Trauma Rehabilitation. Accepted for Publication.

Last modified: 14-Sep-2017