Testing and evaluating a PTSD treatment for military members and veterans in an outpatient setting

My name is Charlene O’Connor. I’m an occupational therapist with PhD training in clinical and neuropsychology. I work as the senior manager of research and innovation at Homewood Health Center in Guelph, Ontario, Canada. I’ve worked for many years on the research development and clinical delivery of Goal Management Training, originally at Baycrest Centre with Dr. Brian Levine, the creator of Goal Management Training and responsible for its ongoing development, and in recent years at Homewood Health and Homewood Research Institute with Dr. Margaret McKinnon.

In Dr. McKinnon’s lab, we have worked to understand how Goal Management Training can be used to help people who struggle with the cognitive and self-regulation effects of trauma, specifically military members, veterans, public safety personnel and civilians with PTSD. Any number of health conditions can contribute to breakdowns in high-level cognitive functioning. A person who suffered a traumatic brain injury may find it difficult to organize their day. A person with chronic pain may find it difficult to concentrate and follow conversations. A military veteran with PTSD may find that they become overwhelmed easily and are unable to stay on task. The cognitive skills required are called executive functions. Executive functions allow people to integrate and coordinate their thinking and their actions so they can engage in goal-directed, purposeful activities in daily life. Activities like planning your day, and following through with that plan, keeping track of the multiple steps it takes to make a meal, remembering to make that critical phone call later in the day, and making a decision between two equally bad or good options.

When executive functioning breaks down successful and consistent performance of these types of daily tasks may become a struggle. Days may feel disorganized, unproductive, unsatisfying, frustrating and confusing. Functioning at work, at home and in relationships may suffer with devastating consequences on emotional well-being and quality of life. Goal Management Training, or GMT, is a cognitive remediation program that targets executive processing, helping people to learn and practice strategies to train and reactivate executive functioning following illness and injury. Delivered in small groups, although one-on-one sessions are also possible, over nine weeks with one session per week, GMT addresses inattentive or disorganized daily performance by focusing on functional goals and tasks. Participants learn or relearn strategies to self-monitor, set goals, follow through, overcome mind-wandering and distraction, and evaluate their performance.

GMT uses skill-learning techniques that capitalize on the brain’s capacity to change and adapt. Remediating the underlying cognitive skills that, once learned and practiced, become transferable and applicable to all tasks. This is an important feature of the GMT: the acquisition of a set of generalizable cognitive skills that are required to complete any task, big or small, in daily life. This program originally was developed to address cognitive impairment that accompanies aging and neurological disease or injury like traumatic brain injury and stroke. In recent years, with increased recognition that people with post-traumatic stress disorder, mood, anxiety and other mental health disorders often struggle with high-level cognitive issues. The effectiveness of GMT in these populations has been explored. Results of these studies have been promising, pointing to the benefits of GMT improving cognitive and functional outcomes for people with mental health challenges.

As studies examining its effectiveness continue, training for clinicians to deliver GMT is becoming more accessible and different versions of GMT that can be delivered in a wider range of clinical settings are being developed. Through many years of research and development, increasingly GMT is recognized as an important intervention for people struggling with cognitive problems that affect daily functioning, no matter what the cause.