Memory, problem-solving skills and attention to detail can all play a major role in a Veteran’s everyday life. They are rooted in one thing: cognitive ability.
Improving the ability to think more clearly can affect everything from completing simple tasks more efficiently to building positive relationships or finishing that tough grad school course. CogSMART — a program developed in part by VA researchers — is helping Veterans improve their cognitive functioning through learning new strategies to work around cognitive difficulties.
The CogSMART intervention has been shown to improve cognitive performance and quality of life in Veterans and civilians alike. Studies reveal improvements in attention, memory and problem-solving, which can lead to improvements in everyday functioning at home, work and school and in relationships as well. CogSMART strategies have been used to treat patients with traumatic brain injury (TBI) and various mental health conditions.
VA employees and CogSMART team members from left to right: Elizabeth Twamley, Zanjbeel Mahmood, Ryan Van Patten, Michelle Seewald, Mili Parikh, Matthew Morgan, Amber Keller.
Key focus areas
CogSMART focuses on a few areas of cognitive ability that can be improved by taking simple actions over time. Goals of the CogSMART intervention include helping patients:
Improve attention: Becoming aware of details in conversation to improve attention span over time.
- Plan ahead: Using daily calendars and to-do lists to keep a schedule on track and avoid missing important deadlines.
- Improve learning and memory: Applying multiple strategies to increase learning, such as visualizing information to be learned, and to make memories “stick.”
- Effectively solve problems: Defining problems and brainstorming potential solutions.
CogSMART strategies and habits help Veterans with tasks like planning and assigning due dates, using daily calendars, prioritizing tasks, using “can’t miss reminders” to cue tasks, writing things down and creating a home for frequently misplaced items like keys, wallets and cellphones. These skills are important to all Veterans — especially students, whose activities often require focusing and time management. In addition, building these skills not only improves cognitive ability but also reduces the potential for cognitive slip-ups that increase stress.
Positive feedback from Veterans
Time and time again, Veterans say in evaluations that they would recommend CogSMART to other Veterans with cognitive difficulties like their own. They report that CogSMART has practical applications in their lives, including:
- Reducing stress in daily life
- Providing tools for managing big and small tasks
- Establishing a daily routine
- Increasing organization
CogSMART and Veteran mental health
Veterans may experience challenges related to cognitive ability, especially when managing the effects of posttraumatic stress disorder (PTSD), TBI or other conditions that may have cognitive symptoms. The good news: Research shows that the CogSMART program can be effective regardless of the cause of a Veteran’s particular cognitive challenges.
CogSMART strategies have been combined with cognitive processing therapy (CPT) to more efficiently treat PTSD and cognitive symptoms; in research trials it is referred to as SMART-CPT. One study compared the effectiveness of SMART-CPT to standard CPT: One hundred Veterans with cognitive complaints, PTSD and history of mild-to-moderate TBI received either CPT or SMART-CPT for 12 weeks. The results revealed that both groups’ PTSD symptoms improved, but compared with traditional CPT, SMART-CPT produced greater improvement in participants’ attention, memory recall, forward-thinking memory and problem-solving skills.
The future of CogSMART
The expanding capabilities of artificial intelligence and related technologies continue to push the boundaries of mental health care. For example, one VA research team is developing a robot with potential uses for cognitive therapy. Through exciting technologies like this, CogSMART and related training programs will reach even more Veterans within the VA health care system and beyond.
The CogSMART treatment manual is available at www.cogsmart.com and as a web-based app that can be used in a self-guided manner or in conjunction with a clinician. For an introduction to the program, visit the CogSMART YouTube channel.
About the Authors:
Elizabeth Twamley, Ph.D., is a neuropsychologist specializing in cognitive rehabilitation. She is the director of the Clinical Research Unit at the Center of Excellence for Stress and Mental Health in the VA San Diego Healthcare System (VASDHS) and a professor of psychiatry at the University of California San Diego.
Amy Jak, Ph.D., is a clinical neuropsychologist who serves as the director of the Polytrauma Support Clinic and TBI Cognitive Rehabilitation Clinic in the VASDHS and the associate director of the Clinical Research Unit at the VASDHS Center of Excellence for Stress and Mental Health. She is also an associate professor within the University of California San Diego Department of Psychiatry.
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