# Optimizing Cognitive Remediation in VA Mental Health Rehabilitation Settings

> **NIH VA IK2** · VA SAN DIEGO HEALTHCARE SYSTEM · 2020 · —

## Abstract

Over one hundred thousand Veterans annually utilize mental health residential rehabilitation programs
(RRTPs) and psychosocial rehabilitation and recovery centers (PRRCs). Through support and comprehensive
programming, these mental health rehabilitation milieus help Veterans with mental illness overcome barriers to
community reintegration. Despite the success of these milieus, cognitive impairment is commonly observed in
Veterans with mental illness, reduces gains from programming, and limits successful recovery. Cognitive
impairment is a common transdiagnostic illness dimension conferred both directly and indirectly by mental
illnesses. Cognitive rehabilitation through remediation strategies can potentially attenuate cognitive impairment
for these Veterans and improve outcomes, but there are two inter-related problems that limit the effectiveness
of such interventions. First, we are not able to identify which Veterans will benefit from mental health
rehabilitation programming at program entry. Second, we are not able to predict which Veterans are going to
benefit from any specific cognitive remediation intervention.
This CDA-2 application seeks to test whether an electroencephalographic (EEG) biomarker, mismatch
negativity (MMN), can be used to predict Veteran recovery in mental health rehabilitation treatment settings,
and identify Veterans who will respond to cognitive remediation interventions. MMN is an event-related
potential which is considered to be a biomarker of information processing, linked to cognition in healthy
subjects and cognitive impairment in a variety of neuropsychiatric illnesses. MMN also mediates psychosocial
and functional outcomes in individuals without any psychiatric comorbidities and individuals with mental illness.
Recent work also suggests that MMN can identify individuals who will experience gains from a full course of
cognitive remediation when measured over the first hour of cognitive remediation. These biomarker
relationships (cognition, cognitive remediation sensitivity, functioning) have not yet been definitively established
in a heterogenous Veteran population receiving care in real-world settings like RRTPs and PRRCs.
Veterans with mental illness will be recruited from the VA San Diego Healthcare system RRTP and PRRC at
program entry. Baseline measures of functioning, psychosocial disability, cognition and treatment engagement
will be collected. Following these assessments, Veterans will undergo testing to collect MMN data, and then
will be challenged with a one-hour cognitive remediation exercise, which is a typical component of full multi-
hour cognitive remediation programs. Veterans will be followed with monthly assessments of psychosocial
disability and treatment engagement. At the end of study, functioning will also be re-assessed.
If successful, results from the studies proposed will create an objective, precision-medicine platform which
could fundamentally change how RRTP and PRRC approach rehabilita...

## Key facts

- **NIH application ID:** 9950832
- **Project number:** 1IK2RX003395-01
- **Recipient organization:** VA SAN DIEGO HEALTHCARE SYSTEM
- **Principal Investigator:** Yash B Joshi
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-05-01 → 2025-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9950832

## Citation

> US National Institutes of Health, RePORTER application 9950832, Optimizing Cognitive Remediation in VA Mental Health Rehabilitation Settings (1IK2RX003395-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9950832. Licensed CC0.

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