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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve how Veterans with mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) recognize emotions. It combines training in recognizing facial and vocal emotions with attention training to enhance relationships and social interactions. Participants will either receive this combined training or join a placebo group that involves educational sessions and watching National Geographic movies. Veterans with both mTBI and PTSD, who struggle with recognizing emotions and have attention issues, might be a good fit for this trial. As an unphased trial, this study offers Veterans a unique opportunity to contribute to research that could enhance emotional recognition and social interactions.

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 prior data suggests that this training is safe for Veterans with mTBI and PTSD?

Research has shown that training to recognize emotions through facial expressions and voices has been studied for its effectiveness and safety in individuals with conditions like traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Early results suggest that this training is generally well-tolerated. For instance, a small initial study tested a program aimed at improving emotion recognition and found it promising, with no major safety concerns reported.

Attention training, often used alongside emotion recognition training, also appears safe. Studies examining how attention training can enhance emotion recognition have not identified any major negative effects. Instead, these studies suggest that attention training might positively affect brain functions related to understanding emotions.

In summary, studies have shown that both emotion recognition training and attention training are safe, with no major safety issues reported. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the combination of attention training and multimodal affect recognition training for TBI and PTSD because it takes a unique approach by focusing on enhancing emotional recognition and attention skills. Unlike traditional treatments that might involve medication or talk therapy, this method directly targets the cognitive processes involved in recognizing emotions and maintaining attention, which are often impaired in these conditions. By training individuals to better understand and respond to emotional cues, this treatment has the potential to improve social interactions and quality of life for those affected by TBI and PTSD.

What evidence suggests that this trial's treatments could be effective for TBI and PTSD?

This trial compares two approaches for individuals with mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD). One arm combines training to recognize emotions in various ways, known as multimodal affect recognition training (MMART), with attention training. Studies have shown that this combination helps people better understand emotions by aiding in the recognition of emotions in both faces and voices. This approach aims to improve social interactions and personal relationships by enhancing focus on emotional signals. The other arm, the Brain Health Workshop and National Geographic Movies, serves as a placebo comparator, offering education about the brain and cognition without active emotion and attention training. ^{1 2 6 7 8}

Who Is on the Research Team?

Julia K. Waid-Ebbs, PhD

Principal Investigator

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

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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 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]

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 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]

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]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT05478759

Innovative Multimodal and Attention Training to Improve ... In a preliminary study of an innovative combination of facial and vocal modalities, a multimodal affect recognition training (MMART) showed promise but lacked ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12293806/

Response to Training in Emotion Recognition Function ... Conclusions: Our data show promising clinical potential and warrant future research, given the importance of developing novel interventions to ...

3. clinicaltrial.be clinicaltrial.be/en/details/15763?per_page=20&recruiting=1&enrolling_by_invitation=1&active_not_recruiting=1&not_yet_recruiting=0&completed=0&only_recruiting=0&only_eligible=0

Innovative Multimodal and Attention Training to Improve E... In a preliminary study of an innovative combination of facial and vocal modalities, a multimodal affect recognition training (MMART) showed ...

4. researchgate.net researchgate.net/publication/394013208_Response_to_Training_in_Emotion_Recognition_Function_for_Mild_TBIPTSD_Survivors_Pilot_Study

(PDF) Response to Training in Emotion Recognition ... Response to Training in Emotion Recognition Function for Mild TBI/PTSD Survivors: Pilot Study. MDPI. Brain Sciences. July 2025; 15(7).

5. centerwatch.com centerwatch.com/clinical-trials/listings/condition/590/brain-injury?activelyRecruiting=false&page=142

Brain Injury Clinical Research Trials Hypothesis 1. MMART combined with attention training will significantly improve performance on tests of emotion recognition. Hypothesis 2: Treatment gains will ...

6. mdpi.com mdpi.com/2076-3425/15/7/728

Response to Training in Emotion Recognition Function for ... We developed and tested an innovative treatment to improve recognition of both affect (facial expression of emotion) and prosody (spoken expression of emotion).

7. myneuronews.com myneuronews.com/2025/07/29/response-to-training-in-emotion-recognition-function-for-mild-tbi-ptsd-survivors-pilot-study/

Response to Training in Emotion Recognition Function for ... This pilot study investigates the effectiveness of a training program designed to improve emotion recognition skills in individuals with ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5741514/

Attention Training Modulates Resting-State ... These initial neurophysiological outcome data suggest that ACT modulates visual pathways, while ABMT modulates threat-processing regions, but that both are ...