Emotion & Attention Training for TBI and PTSD

Overseen By Julia K Waid-Ebbs, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Schizophrenia, Bipolar, Chronic diseases, others

Compensation: Varies

Number of Visits: 27

Duration: 8 weeks

20 Participants Needed

Trial Summary

What is the purpose of this trial?

Poor emotion recognition has been associated with poor quality of interpersonal relationships, loss of employment, behavioral problems, reduced social reintegration, social isolation and even suicide. Deficits in emotion recognition are common in traumatic brain injury (TBI) and in post-traumatic stress disorder (PTSD) but these deficits have not been well studied in Veterans with both mild TBI (mTBI) and PTSD. Currently there are no interventions for emotion recognition in Veterans with mTBI and PTSD, and interventions for severe TBI have lacked training of both facial and vocal emotion recognition. In a preliminary study of an innovative combination of facial and vocal modalities, a multimodal affect recognition training (MMART) showed promise but lacked attention training that is an essential component in recognizing emotions in our daily lives. Given the need to improve relationships and productivity in Veterans with mTBI and PTSD, a study is needed to determine the effectiveness of a MMART combined with attention training.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Attention Training, Multimodal Affect Recognition Training (MMART) combined with Attention Training, Brain Health Workshop, Multimodal affect recognition training, Multimodal Affect Recognition Training (MMART), Facial and Vocal Emotion Recognition Training for TBI and PTSD?

Research shows that people with traumatic brain injury (TBI) often struggle to recognize emotions from facial and vocal cues, which can affect their social interactions. Studies suggest that training focused on recognizing facial emotions can help improve these skills, as seen in individuals with chronic TBI who showed improvements after such training. ^{1 2 3 4 5}

Is the Emotion & Attention Training for TBI and PTSD safe for humans?

The research articles provided do not contain specific safety data for the Emotion & Attention Training or its related programs. However, these types of cognitive and emotional training programs are generally considered safe as they focus on improving cognitive functions and emotional recognition without invasive procedures. ^{4 5 6 7 8}

How is the Emotion & Attention Training treatment for TBI and PTSD different from other treatments?

This treatment is unique because it combines attention training with multimodal affect recognition training, which focuses on improving the ability to recognize emotions from facial and vocal cues. Unlike other treatments, it specifically targets the social communication challenges faced by individuals with TBI and PTSD, which are often overlooked in traditional therapies. ^{1 2 3 4 5}

Research Team

Julia K. Waid-Ebbs, PhD

Principal Investigator

North Florida/South Georgia Veterans Health System, Gainesville, FL

Eligibility Criteria

This trial is for Veterans who have mild traumatic brain injury (mTBI) and PTSD, can hear and see normally, speak English fluently, and struggle with recognizing emotions or paying attention. It's not for those with chronic diseases, schizophrenia, or bipolar disorder.

Inclusion Criteria

My hearing is within normal range.

Corrected vision within normal limits

Presence of attention deficit

Exclusion Criteria

Premorbid history of schizophrenia

I have a long-term illness or a condition affecting my nervous system.

Premorbid history of bipolar disorder

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo MultiModal Affect Recognition Training (MMART) combined with attention training over 8 weeks

8 weeks

16 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

14 weeks

Assessments at week 11 and week 22

Treatment Details

Interventions

• Attention Training
• Brain Health Workshop
• Multimodal affect recognition training

Trial Overview The study tests a new training program combining National Geographic Movies, Multimodal affect recognition training (MMART), Attention Training, and Brain Health Workshops to help improve emotion communication in veterans.

Participant Groups

Group I: MMART and attention training Experimental Treatment 2 Interventions

Training to recognize affect and prosodic expressions of emotions combined with attention training.

Group II: Brain Health Workshop and National Geographic Movies Placebo Group 2 Interventions

an inactive arm that matches sessions of intervention. BHW is education about the brain and cognition. National Geographic movies are viewed with the clinician and the participant answers questions about the movies.

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Findings from Research

In a study of 203 adults with moderate-to-severe traumatic brain injury (TBI), participants were found to recognize vocal emotions more accurately than facial emotions, highlighting a significant impairment in facial affect recognition.

Facial affect recognition impairment was observed in 34% of participants, compared to 22% for vocal recognition, with low intensity emotions being particularly difficult to identify across both modalities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Recognition of facial and vocal affect following traumatic brain injury. Zupan, B., Babbage, D., Neumann, D., et al.[2019]

The modified Facial Affect Recognition (FAR) training delivered via telepractice effectively improved the ability of two adults with chronic traumatic brain injury (TBI) to identify emotions from static facial expressions.

Both participants demonstrated measurable gains in recognizing facial emotions after therapy, indicating that targeted social communication skills training can be beneficial for individuals with moderate to severe TBI.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Facial Affect Recognition Training Through Telepractice: Two Case Studies of Individuals with Chronic Traumatic Brain Injury. Williamson, J., Isaki, E.[2020]

Individuals with severe traumatic brain injury (TBI) often struggle to recognize emotions in others, which can significantly impact their social interactions and psychosocial functioning.

The review highlights the need for targeted rehabilitation interventions to improve emotion perception in TBI patients, drawing on existing research from other cognitively impaired groups and emphasizing the importance of practical, context-based training.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Emotion perception deficits following traumatic brain injury: a review of the evidence and rationale for intervention. Bornhofen, C., McDonald, S.[2022]

In a study of 45 individuals with mild-to-severe traumatic brain injury (TBI), 51% exhibited at least moderate difficulties in recognizing facial emotions, indicating a significant issue in this population.

The findings suggest that screening for facial affect recognition difficulties in TBI patients could enhance rehabilitation outcomes, highlighting the need for further research and treatment development in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Facial affect recognition difficulties in traumatic brain injury rehabilitation services. Biszak, AM., Babbage, DR.[2019]

Individuals with traumatic brain injury (TBI) often struggle to recognize emotions from facial expressions, which can lead to poor interpersonal skills and negative social outcomes.

Research suggests that treatment strategies developed for individuals with autism, who also experience similar affect recognition impairments, could be effective for improving emotional recognition in those with TBI.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Overview of impaired facial affect recognition in persons with traumatic brain injury. Radice-Neumann, D., Zupan, B., Babbage, DR., et al.[2014]

The GOALS cognitive rehabilitation program, which combines mindfulness and goal management strategies, was associated with significant improvements in attention and executive functioning in 33 Veterans with PTSD and mild TBI.

Improvements in cognitive control processes after GOALS training were linked to reductions in hyperarousal symptoms of PTSD, suggesting that enhancing cognitive skills can also positively impact emotional distress in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improvement in executive functioning after Goal-Oriented Attentional Self-Regulation training is associated with reduction in PTSD hyperarousal symptoms among veterans with comorbid PTSD and mild TBI. Maruyama, BA., Abrams, G., Kornblith, E., et al.[2023]

The study outlines a design for a web-based cognitive remediation training aimed at enhancing neurocognitive functions that may help prevent the development of PTSD in trauma survivors.

By focusing on early intervention shortly after trauma exposure, the study aims to address the challenges of administering targeted training to improve emotional reactivity and regulation, potentially reducing PTSD symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluating web-based cognitive-affective remediation in recent trauma survivors: study rationale and protocol. Fine, NB., Achituv, M., Etkin, A., et al.[2020]

Individuals with traumatic brain injury (TBI) struggle to recognize emotions, particularly due to challenges in interpreting vocal cues, which are crucial when facial expressions are unclear.

The article highlights that both facial and vocal affect recognition share neural pathways, suggesting that improving vocal affect interpretation could enhance emotional understanding and social outcomes for those with TBI.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The importance of vocal affect to bimodal processing of emotion: implications for individuals with traumatic brain injury. Zupan, B., Neumann, D., Babbage, DR., et al.[2014]

References

1. England pubmed.ncbi.nlm.nih.gov

Recognition of facial and vocal affect following traumatic brain injury. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Facial Affect Recognition Training Through Telepractice: Two Case Studies of Individuals with Chronic Traumatic Brain Injury. [2020]

3. England pubmed.ncbi.nlm.nih.gov

Emotion perception deficits following traumatic brain injury: a review of the evidence and rationale for intervention. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Facial affect recognition difficulties in traumatic brain injury rehabilitation services. [2019]

5. England pubmed.ncbi.nlm.nih.gov

Overview of impaired facial affect recognition in persons with traumatic brain injury. [2014]

6. United States pubmed.ncbi.nlm.nih.gov

Improvement in executive functioning after Goal-Oriented Attentional Self-Regulation training is associated with reduction in PTSD hyperarousal symptoms among veterans with comorbid PTSD and mild TBI. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Evaluating web-based cognitive-affective remediation in recent trauma survivors: study rationale and protocol. [2020]

8. United States pubmed.ncbi.nlm.nih.gov

The importance of vocal affect to bimodal processing of emotion: implications for individuals with traumatic brain injury. [2014]