Evaluating the implementation of virtual Goal Management Training among Veterans with posttraumatic stress disorder

LAY SUMMARY Posttraumatic stress disorder (PTSD) is a mental health disorder experienced by many Canadian Veterans. In addition to symptoms such as distressing memories, nightmares, and emotional distress, PTSD has been linked to changes in the brain that affect an individual’s ability to function in daily life. These changes include difficulties with memory, concentration, attention, and learning new tasks. Goal Management Training (GMT) is a therapy designed to improve these areas of brain function, and it has been adopted by the Québec City Occupational Stress Injury (OSI) Clinic to help treat clients with PTSD and other mental health disorders. During the COVID-19 pandemic, the clinic converted GMT to an online program. The aim of this study was to examine whether the use of online GMT at the clinic was practical and effective. To do so, the authors conducted and analyzed two virtual focus groups with 11 OSI clinicians. They found that GMT seemed to improve functioning in some Veterans and that participation in GMT groups helped improve participants’ self-esteem. Offering an online GMT option may make participation easier for some Veterans, and offering both online and in-person options may help reach more clients and improve outcomes. Introduction: Posttraumatic stress disorder (PTSD) is associated with changes in cognitive functioning across multiple domains that negatively affect Veterans’ ability to engage in functional activities. Goal Management Training (GMT), a cognitive remediation strategy that aims to improve cognitive functioning of people with several neurological and neuropsychiatric conditions, was adapted to an online telemedicine format for use in the treatment of Veteran clients of an operational stress injury (OSI) clinic in Québec City, Québec, Canada, during the COVID-19 pandemic. The aim of this study was to evaluate the implementation of online GMT to determine its feasibility and effectiveness with OSI clients. Methods: The authors conducted and thematically analyzed two structured virtual focus groups with 11 OSI clinicians. Focus groups were recorded, and transcripts were thematically analyzed. Results: Clinicians reported that the cognitive strategies provided by GMT helped to improve functioning among some Veterans referred to the groups. Participation in GMT was also felt to have an overall positive effect on participants’ affect and morale. Adaptations to fit both the online format and the needs of Veteran participants appeared key to maximizing effectiveness of the GMT program. Discussion: Adapting GMT to an online setting may assist in expanding accessibility of this cognitive remediation program to Veterans who could not otherwise benefit from this therapy in person. Moving forward, OSI clinics may want to consider implementing both in-person and online GMT groups to expand GMT uptake and improve clinical outcomes.