Compensatory cognitive training for unstably housed, post-9/11 veterans in residential mental health treatment: A randomized controlled trial.

Addressing homelessness in returning Veterans is a national priority. Contributors to homelessness include traumatic brain injury (TBI), psychiatric illness, substance abuse, and other medical conditions that are associated with cognitive impairment, which can interfere with obtaining income, housing, and rehabilitation. Compensatory Cognitive Training (CCT) is an intervention that teaches compensatory cognitive strategies to improve functioning in prospective memory, attention, learning/memory, and executive functioning, along with strategies to reduce stress and improve sleep. The current randomized controlled trial examined the efficacy of CCT compared to a robust control condition, Holistic Cognitive Education (HCE). Post-9/11 Veterans (n = 79) who were homeless or unstably housed and receiving VA residential psychiatric rehabilitation completed assessments at baseline, midpoint (5 weeks), and post-treatment (10 weeks). Veterans were randomized to receive 10 once-weekly, 1-hour manualized individual sessions of either CCT or HCE. Outcome measures included self-reported symptom and functioning ratings and a neuropsychological assessment. Multi-level modeling was used to examine treatment-related improvements in neuropsychological functioning and neurobehavioral symptoms at post-treatment. The models revealed that compared to the HCE group, the CCT group demonstrated greater improvements in attention/vigilance performance (d = 0.89), cognitive symptoms (d=-1.53), and interpersonal functioning (getting along with others; d=-0.87). HCE participants demonstrated greater improvement in speed of processing (a domain not targeted by CCT; d=-0.65). CCT has the potential to improve objective attention/vigilance and self-reported cognitive symptoms and interpersonal difficulties in unstably housed Veterans with complex medical and psychiatric comorbidities.