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

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 Quebec 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 Quebec City, Quebec, Canada, during the coronavirus disease 2019 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. Introduction : Le trouble de stress posttraumatique (TSPT) est associe a diverses modifications du fonctionnement cognitif, qui nuisent a la capacite des veteran(e)s a s'engager dans des activites fonctionnelles. Pendant la pandemie de COVID 19, l'Entrainement a la gestion des buts (EGB), une strategie de remediation cognitive pour ameliorer le fonctionnement cognitif des personnes souffrant d'atteintes neurologiques et neuropsychiatriques, a ete adapte au format de la telemedecine en ligne afin de servir au traitement de la clientele veterane d'une clinique de Quebec, au Canada, qui traite les blessures de stress operationnel (BSO). La presente etude avait pour objectif d'evaluer l'implantation en ligne de l'EGB, afin de determiner sa faisabilite et son efficacite aupres de la clientele atteinte d'une BSO. Methodologie : Les auteur(e)s ont anime deux discussions structurees en groupes virtuels avec 11 clinicien(ne)s specialise(e)s en BSO. Les discussions des groupes ont ete enregistrees et les transcriptions ont ete analysees par themes. Resultats : Les clinicien(ne)s rapportent que les strategies cognitives fournies par l'EGB ont aide a ameliorer le fonctionnement d'une partie de leur clientele veterane. La participation a l'EGB aurait eu un effet globalement positif sur l'etat affectif et le moral de la clientele participante. Les adaptations apportees au programme d'EGB pour qu'il convienne autant au format en ligne qu'aux besoins de la clientele veterane participante semblent essentielles pour maximiser son efficacite. Discussion : L'adaptation de l'EGB a une utilisation en ligne pourrait aider a elargir l'accessibilite de ce programme de remediation cognitive aux veteran(e)s qui ne peuvent en beneficier en personne. A l'avenir, les cliniques qui traitent les BSO devraient envisager de mettre en place des groupes d'EGB en personne et en ligne, afin d'elargir le recours a l'EGB et d'ameliorer les resultats cliniques.