# Comparing the effectiveness of telehealth to in-person delivery of a combined metacognitive and attention training in Veterans with mTBI/PTSD

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Background. Over 70% of Veterans with mild traumatic brain injury (mTBI), seeking services at the Veterans’
Health Administration, suffer from comorbid post-traumatic stress disorder (PTSD). These Veterans commonly
experience concomitant executive dysfunction in goal setting, concentration, and attention that impairs their
performance in complex daily tasks. Others and we have studied Goal Management Training (GMT) to
address this problem. Collectively, the data have shown that GMT improved some aspects of executive
function in mTBI/PTSD but did not restore cognition to normal during complex tasks. Goal management for
performing complex tasks requires cognitive processes such as attention, and direct-attention training may be
beneficial in improving cognition. GMT with attention training have been used in other studies, but those did not
involve Veterans with either mTBI or mTBI/PTSD. We recently conducted a pilot study combining GMT and
direct-attention training (GMT+ATT) in Veterans with mTBI and PTSD. We discovered a large treatment effect
(Cohen d=2.23) in the NIH EXAMINER Executive Composite score and a significant treatment response in the
NIH EXAMINER Cognitive Control subdomain and the Unstructured Task.
 GMT or ATT is typically administered in-person. In-person treatment can impose problems such as limited
treatment access, poor cost-effectiveness, and unexpected situations (like the COVID-19 pandemic). As an
alternative method, telehealth has been used increasingly to meet the need for care in Veterans living in rural
areas and during the pandemic. Telehealth delivery of cognitive interventions in Veterans with mTBI or with
PTSD has shown effectiveness that is comparable to that of in-person treatment. However, GMT+ATT has not
been studied in these Veterans. Therefore, we have recently developed the format for telehealth delivery of
GMT+ATT in Veterans with mTBI/PTSD. Our preliminary data demonstrate the feasibility of this delivery
platform and similar treatment outcomes as compared to in-person therapy.
Objective & Hypotheses. The objective of this randomized controlled trial is to determine and compare the
effect of in-person and telehealth delivery of GMT+ATT in Veterans with mTBI/PTSD.
Hypothesis 1a. In-person GMT+ATT will improve cognition vs. control group (Brain Health Workshop (BHW).
Hypothesis 1b. Telehealth GMT+ATT will improve cognition vs. BHW control group
Hypothesis 2. Telehealth delivery of GMT+ATT will produce response comparable to in-person treatment.
Primary measure. The NIH EXAMINER executive composite score will assess overall executive function with
subdomains such as complex task performance requiring goal management, as well as tests underlying
cognitive control such as attention and working memory. Secondary functional measures. 1) Unstructured Task
and 2) Test of Grocery Shopping Skills (ToGSS), which captures naturalistic real-world function. Exploratory
Objective. To study the capability of the Attention Net...

## Key facts

- **NIH application ID:** 10731059
- **Project number:** 5I01RX003984-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Julia Kay Waid-Ebbs
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-11-01 → 2026-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10731059

## Citation

> US National Institutes of Health, RePORTER application 10731059, Comparing the effectiveness of telehealth to in-person delivery of a combined metacognitive and attention training in Veterans with mTBI/PTSD (5I01RX003984-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10731059. Licensed CC0.

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