Working Memory Training for PTSD

Overseen By Daniel M Stout, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Must not be taking: Benzodiazepines, Anticholinergics

Disqualifiers: Psychotic disorders, Bipolar, Severe substance use, others

Stay on Your Current Meds You can continue your current medications while participating

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 8

Duration: 4 weeks

120 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines whether a special brain training program, called Working Memory Training (WMT), can help veterans with PTSD (posttraumatic stress disorder) manage their symptoms more effectively. By improving working memory—the ability to retain important information—the trial aims to enhance veterans' ability to unlearn fear responses, a key aspect of PTSD. Participants will engage in either the real training or a less demanding version to determine any differences. Veterans who may be suitable are those fluent in English with PTSD, willing to participate in remote sessions and MRI scans. As an unphased trial, this study offers veterans the chance to contribute to innovative research that could lead to new PTSD treatments.

Will I have to stop taking my current medications?

The trial requires that you have been stable on your current medications for at least 4 weeks before starting. However, if you are taking benzodiazepines or medications with anticholinergic effects, you may need to stop those, as they can affect the study's measures.

What prior data suggests that this working memory training is safe for Veterans with PTSD?

Research has shown that computerized working memory training (WMT) is generally safe. In one study, veterans with PTSD participated in a 16-session working memory training program and did not experience significant negative effects. Additionally, Cogmed, a popular digital tool for improving working memory, has been used in similar situations without major safety issues. This suggests that the training is likely safe and could be a helpful addition to PTSD treatments. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Working Memory Training (WMT) for PTSD because it offers a new, non-pharmaceutical approach to treatment. Unlike traditional therapies, which often focus on medication and talk therapy, WMT targets cognitive processes directly by enhancing working memory through a computer-administered program. As participants improve, the program adapts to become more challenging, offering a personalized experience that could lead to lasting cognitive changes. This adaptive and interactive nature sets WMT apart, providing a novel way to potentially reduce PTSD symptoms by strengthening mental capacity rather than relying solely on medication.

What evidence suggests that Working Memory Training is effective for PTSD?

Research has shown that working memory training (WMT), which participants in this trial may receive, might help improve symptoms in Veterans with PTSD. One study found that a 16-session WMT program boosted working memory and may help reduce fear responses, known as fear extinction. This improvement could help Veterans manage PTSD symptoms better by enhancing their ability to remember important information. As working memory improves, it might also enhance the effects of exposure therapy, a common PTSD treatment. While more research is needed, these findings suggest that WMT could be a helpful tool for those with PTSD. ^{1 2 6 7 8}

Who Is on the Research Team?

Daniel M Stout, PhD

Principal Investigator

VA San Diego Healthcare System, San Diego, CA

Are You a Good Fit for This Trial?

This trial is for Veterans with PTSD who can participate in a program designed to improve their memory and ability to focus. It's not suitable for individuals who might have other conditions that could interfere with the training or its assessment.

Inclusion Criteria

Fluent in English

I am willing to do 8 memory training sessions online over 4 weeks.

I have been diagnosed with PTSD according to the DSM-5.

Exclusion Criteria

Inability to safely complete fMRI session (i.e., metal in body, medical implants)

Acute suicidality requiring immediate clinical intervention

Lifetime history of psychotic disorders

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo 8 sessions of working memory training (WMT) or sham-training (ST) over a four-week period

4 weeks

8 sessions (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessments of behavioral and neural changes

5-6 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Working Memory Training

Trial Overview The study is testing a working memory training (WMT) program against sham training to see if it helps Veterans with PTSD learn how to better manage fear responses. The effectiveness of WMT will be measured through changes in brain function and PTSD symptoms.

How Is the Trial Designed?

Group I: Working Memory Training Experimental Treatment 1 Intervention

Computer-administered working memory training program. WMT is a modified working memory capacity task designed to train working memory functioning. WMT is designed to contain high interference across trials and is adaptive to performance. As participants improve working memory, the task becomes more difficult.

Group II: Sham Training Placebo Group 1 Intervention

The Sham condition requires participants to complete a similar computer task for the same length of time. The Sham Training is a modified working memory capacity task designed to place less demands on working memory.

Working Memory Training is already approved in European Union, United States, Canada for the following indications:

Approved in European Union as Cogmed Working Memory Training for:

• Attention Deficit Hyperactivity Disorder (ADHD)
• Learning Disabilities
• Cognitive Impairment

Approved in United States as Cogmed Working Memory Training for:

• ADHD
• Learning Disabilities
• Amnestic Mild Cognitive Impairment (MCI)

Approved in Canada as Cogmed Working Memory Training for:

• ADHD
• Learning Disabilities
• Cognitive Impairment

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 randomized controlled trial aimed to assess the impact of a cognitive task intervention on intrusive memories after trauma but was prematurely terminated due to the COVID-19 pandemic, with only 16 participants recruited out of the planned 148.

The study highlights the challenges of conducting clinical research during a pandemic, including the need for face-to-face interactions and the impact of reduced patient flow in emergency departments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A simple cognitive task intervention to prevent intrusive memories after trauma in patients in the Emergency Department: A randomized controlled trial terminated due to COVID-19. Kanstrup, M., Singh, L., Göransson, KE., et al.[2021]

Cogmed Working Memory Training (CWMT) has shown statistically significant improvements in working memory and executive functions among over 280 child and adolescent trainees based on pre- and post-training assessments.

Feedback from families indicates positive changes experienced by trainees, although the study's one-group pre-test post-test design has limitations that should be considered when interpreting the results.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Parental Perceptions of the Efficacy of Cogmed Working Memory Training. Graham, AR., Benninger, WB.[2018]

Playing the TraumaGameplay (TGP) app, either with or without memory retrieval tasks, did not significantly reduce the frequency of trauma-related intrusions in healthy university students after exposure to a trauma film, based on two experiments involving a total of 212 participants.

These results challenge previous studies suggesting that engaging in a visuospatial video game like Tetris can effectively reduce intrusive memories, highlighting potential differences in methodology and the complexities of replicating psychological research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development and testing of TraumaGameplay: an iterative experimental approach using the trauma film paradigm. Asselbergs, J., Sijbrandij, M., Hoogendoorn, E., et al.[2020]

Cogmed training significantly improved working memory in adults with ADHD, with participants showing lasting benefits in both verbal and visuospatial memory capacities even 6 months after the training ended.

Despite these improvements in working memory, the study found that the benefits did not extend to enhancing nonverbal reasoning, executive function in daily life, or reducing ADHD symptoms, questioning the overall effectiveness of the program for broader ADHD treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Working Memory Training for Adults With ADHD. Dentz, A., Guay, MC., Parent, V., et al.[2022]

CogMed Working Memory Training (CWMT) was found to be safe and acceptable for adult patients with glioma, with an 80% retention rate and no adverse events related to the study.

While CWMT led to medium to large improvements in objectively assessed working memory, participants reported only moderate perceived benefits, suggesting that the intensity and time commitment of the program may have affected their overall satisfaction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Working memory training for adult glioma patients: a proof-of-concept study. Braun, SE., Aslanzadeh, FJ., Lanoye, A., et al.[2022]

In a study involving 164 participants with acute and chronic PTSD, cognitive and affective computerized training showed significant improvement in identifying fearful faces and a trend towards reducing PTSD symptoms, particularly in re-experiencing symptoms.

The training was more effective for individuals with better cognitive performance at baseline, suggesting that cognitive capacity may influence the effectiveness of such interventions in treating PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-delivered computerized cognitive & affective remediation training for the treatment of acute and chronic posttraumatic stress disorder: Two randomized clinical trials. Fonzo, GA., Fine, NB., Wright, RN., et al.[2020]

Veterans with a history of PTSD participated in classes that adapted existing clinical and educational tools to improve their memory skills and self-management.

These classes provided a supportive environment for veterans to develop coping strategies and enhance their overall mental health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Memory Skills Classes to Address Cognitive Concerns in Older Veterans With a History of Posttraumatic Stress Disorder. Trittschuh, E., Thielke, S.[2020]

The study found that web-based working memory training (Cogmed QM) is feasible during inpatient cancer rehabilitation, with 89.6% of eligible patients starting the training and 89.6% adhering to it during their hospital stay.

While participants showed significant improvements in working memory tasks, adherence to the home-based training after discharge was lower (65.5%), indicating that barriers such as time constraints and lack of motivation need to be addressed in future studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Feasibility of Web-Based Working Memory Training in Patients With Cancer Attending Inpatient Rehabilitation. Engan, H., Skanke, F., Dahl, V., et al.[2023]

The EPIREMED study aims to assess the long-term effects of the Cogmed cognitive training program on visuospatial processing in very preterm children, involving 166 participants aged 5½ to 6 years over an 18-month period.

The study seeks to demonstrate that early cognitive training can improve working memory and overall neuropsychological development, potentially leading to better learning outcomes and reduced behavioral issues in this vulnerable population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized EPIREMED protocol study on the long-term visuo spatial effects of very preterm children with a working memory deficit. Gire, C., Beltran Anzola, A., Kaminski, M., et al.[2021]

In a pilot study involving Veterans with elevated PTSD symptoms, both adaptive (n-back) and less potent (1-back) online working memory training led to significant decreases in PTSD symptoms, indicating potential efficacy of such interventions.

The n-back training group showed a trend towards better improvement in reexperiencing symptoms, suggesting that more challenging working memory tasks may be particularly beneficial for individuals with PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A pilot randomized trial of a dual n-back emotional working memory training program for veterans with elevated PTSD symptoms. Larsen, SE., Lotfi, S., Bennett, KP., et al.[2020]

Adaptive working memory training (Cogmed QM) significantly improved inhibitory control in patients on sick leave, indicating that this aspect of cognitive function can be modified through targeted training.

However, the training did not lead to improvements in overall working memory capacity or self-perceived memory functioning, suggesting that while specific cognitive skills can be enhanced, general memory capacity may not be affected.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of Working Memory Training among Subjects Currently on Sick Leave Due to Complex Symptoms. Aasvik, JK., Woodhouse, A., Stiles, TC., et al.[2023]

Cogmed working-memory training (CWMT) has been shown to significantly improve both visuospatial and verbal working memory, with strong evidence from multiple studies indicating these effects can last for up to 6 months.

In addition to enhancing working memory, CWMT also appears to improve attention, suggesting that it could have valuable applications in everyday functioning, although further controlled studies are needed to solidify these claims.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cogmed WM training: reviewing the reviews. Shinaver, CS., Entwistle, PC., Söderqvist, S.[2018]

Citations

1. sciencedirect.com sciencedirect.com/science/article/pii/S0022395624007003

Randomized controlled trial of computerized working ... The current study evaluated a 16-session working memory training (WMT) program in Veterans with PTSD, focusing on two levels of interference control training.

2. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/39642474/

Randomized controlled trial of computerized working memory ... The current study evaluated a 16-session working memory training (WMT) program in Veterans with PTSD, focusing on two levels of interference control training.

3. centreforevidence.org centreforevidence.org/article/20241129-randomized-controlled-trial-of-computerized-working-memory-training-for-veterans-with-ptsd

Randomized controlled trial of computerized working ... The current study evaluated a 16-session working memory training (WMT) program in Veterans with PTSD, focusing on two levels of interference control training.

4. researchgate.net researchgate.net/publication/386540872_Randomized_controlled_trial_of_computerized_working_memory_training_for_Veterans_with_PTSD

Randomized controlled trial of computerized working ... The current study evaluated a 16-session working memory training (WMT) program in Veterans with PTSD, focusing on two levels of interference ...

5. cogmed.com cogmed.com/

Cogmed Cogmed is the world's most proven digital tool for improving working memory and attention. The program's ability to grow cognitive capacity has been ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT02305212

NCT02305212 | Cogmed for Working Memory After TBI All subjects will undergo repeat assessments following completion of the working memory training protocol after the 7th week and again at 13 weeks to document ...

7. cogmed.com cogmed.com/training

Reclaim your attention with Cogmed With the most proven neuroscientific tool to increase attention, lasting results are only five weeks away. Start today. How it works: Five Weeks of Training.

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7851279/

Treating Post-traumatic Stress Disorder with ... A pilot study published in 2015 investigated the feasibility of treating PTSD symptoms with a combination of computerized working memory training and prefrontal ...