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Psychological Symptoms and Rates of Performance Validity Improve Following Trauma-Focused Treatment in Veterans with PTSD and History of Mild-to-Moderate TBI

Published online by Cambridge University Press:  29 October 2019

Sarah M. Jurick*
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
Laura D. Crocker
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
Victoria C. Merritt
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
Samantha N. Hoffman
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
Amber V. Keller
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
Graham M. L. Eglit
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
Kelsey R. Thomas
Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
Sonya B. Norman
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA National Center for PTSD, White River Junction, VT, USA
Dawn M. Schiehser
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
Carie S. Rodgers
PsychArmor Institute, San Diego, CA, USA
Elizabeth W. Twamley
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
Amy J. Jak
VA San Diego Healthcare System (VASDHS), San Diego, CA, USA Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
Correspondence and reprint requests to: Sarah M. Jurick, Ph.D., 3350 La Jolla Village Dr., MC 151B, San Diego, CA 92161, USA. E-mail:



Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance.


Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass).


Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.


Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.

Regular Research
Copyright © INS. Published by Cambridge University Press, 2019. 

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