• Eric B Elbogen, Paul A Dennis, Elizabeth E Van Voorhees, Shannon M Blakey, Jacqueline L Johnson, Sally C Johnson, Wagner H Ryan HR, Robert M Hamer, Jean C Beckham, Tom Manly, and Aysenil Belger.
• Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina (Drs Elbogen, Dennis, Van Voorhees, Wagner, and Beckham); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Drs Elbogen, Dennis, Van Voorhees, Wagner, and Beckham); Departments of Psychology and Neuroscience (Ms Blakey) and Psychiatry (Drs S. C. Johnson, Hamer, and Belger), University of North Carolina, Chapel Hill; Rho, Inc, Chapel Hill, North Carolina (Dr J. Johnson); and Department of Neuroscience, University of Cambridge, Cambridge, United Kingdom (Dr Manly).
• J Head Trauma Rehabil. 2019 Jan 1; 34 (1): 1-10.

ObjectiveTo investigate effects of cognitive rehabilitation with mobile technology and social support on veterans with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD).ParticipantsThere were 112 dyads, comprised by a veteran and a family member or friend (224 participants in total).DesignDyads were randomized to the following: (1) a novel intervention, Cognitive Applications for Life Management (CALM), involving goal management training plus mobile devices for cueing and training attentional control; or (2) Brain Health Training, involving psychoeducation plus mobile devices to train visual memory.Main MeasuresExecutive dysfunction (disinhibition, impulsivity) and emotional dysregulation (anger, maladaptive interpersonal behaviors) collected prior to randomization and following intervention completion at 6 months.ResultsThe clinical trial yielded negative findings regarding executive dysfunction but positive findings on measures of emotion dysregulation. Veterans randomized to CALM reported a 25% decrease in anger over 6 months compared with 8% reduction in the control (B = -5.27, P = .008). Family/friends reported that veterans randomized to CALM engaged in 26% fewer maladaptive interpersonal behaviors (eg, aggression) over 6 months compared with 6% reduction in the control (B = -2.08, P = .016). An unanticipated result was clinically meaningful change in reduced PTSD symptoms among veterans randomized to CALM (P < .001).ConclusionThis preliminary study demonstrated effectiveness of CALM for reducing emotional dysregulation in veterans with TBI and PTSD.

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