The clinical implementation trial will evaluate effectiveness and feasibility, acceptability, appropriateness, barriers, and facilitators of implementing SMART-CPT, a treatment targeting the two primary factors leading to poor outcomes following concussion, in Veterans. It will test effectiveness and broad implementation feasibility of SMART-CPT compared to standard Cognitive Processing Therapy (CPT).

Inclusion Criteria:

• PTSD diagnosis;
• mild TBI sustained greater than three months prior to enrollment;
• cognitive complaints;
• not medicated or stable on prescribed psychiatric medication for at least 6 weeks prior to study enrollment with no anticipated/pending medication changes;
• English literacy.

Exclusion Criteria:

• mTBI sustained less than 3 months previously;
• history of moderate, severe, or penetrating TBI;
• history of other significant neurological condition unrelated to TBI;
• severe psychiatric disturbance expected to interfere with successful completion of the study;
• current severe alcohol or other substance use disorder;
• suicidal intent or attempt within the previous month;
• current homicidal ideation;
• impaired decision making capacity;
• prior completion of five or more sessions of CPT or cognitive rehabilitation; -concurrent participation in other intervention studies for PTSD or TBI;
• life threatening or unstable medical illness;
• inability to read;
• dementia

All de-identified data will be uploaded to FITBIR for aggregation and secondary analyses by other investigators.

at study completion

FITBIR is publicly available researchers at fitbir.nih.gov