Trauma Informed Goal Management Training With a "Support Person" Module for Individuals Impacted by Post-Traumatic Stress

A Pilot Study Examining the Addition of a "Support Person" Module to Enhance a Trauma-Informed Cognitive Remediation Program (TIGMT) for Individuals Impacted by Post-Traumatic Stress (TIGMT-Assist)

The purpose of this study is to determine whether adding a Support-Person Module to Trauma-Informed Goal Management Training (TIGMT) can improve engagement and recovery among individuals who have experienced traumatic events and are currently experiencing post-traumatic stress. Post-Traumatic Stress Disorder (PTSD) and symptoms of trauma-related stress can occur following traumatic events such as physical, sexual, or emotional abuse, car accidents, or working in public safety roles. Individuals experiencing post-traumatic stress may feel overwhelmed by memories of traumatic events, avoid trauma reminders, remain on high alert for danger, and experience difficulties managing emotions. Cognitive difficulties, including problems with memory, attention, and planning, are also common and can interfere with everyday functioning. There has been limited research examining how best to address these cognitive challenges. This study will compare two versions of a program designed to improve daily functioning and reduce trauma-related distress by strengthening cognitive skills. Trauma-Informed Goal Management Training (TIGMT) is a 9-week, trauma-informed adaptation of Goal Management Training (GMT). GMT is designed to improve cognitive skills, including attention, multitasking, mental flexibility, planning, and problem-solving, as well as the ability to achieve goals in everyday life. TIGMT adapts GMT by incorporating education about trauma-related symptoms and their effects on cognitive functioning, as well as mindfulness and strategies targeting emotional regulation. Trauma-Informed Goal Management Training-Assist (TIGMT-Assist) builds on TIGMT by adding a Support-Person Module. Each participant selects a trusted adult, such as a family member, partner, or friend, to serve as a support person. Participants complete the full 9-week TIGMT program and attend three additional Support-Person Module sessions with their selected support person. Support persons attend only these three additional sessions. The sessions are designed to increase understanding of the program and provide strategies for reinforcing skills learned during TIGMT. By comparing TIGMT with TIGMT-Assist, the study aims to determine whether involving a support person improves program engagement, retention and use of learned skills, cognitive functioning, trauma-related symptoms, and quality of life. Findings may help inform future approaches to trauma-informed cognitive training for individuals experiencing post-traumatic stress.

This pilot study uses a two-arm, non-randomized controlled design to evaluate the feasibility, acceptability, and preliminary efficacy of Trauma-Informed Goal Management Training-Assist (TIGMT-Assist) compared with Trauma-Informed Goal Management Training (TIGMT). TIGMT-Assist was developed to examine whether structured involvement of a trusted support person can enhance engagement with trauma-informed cognitive remediation and facilitate the application and retention of cognitive and self-regulatory strategies in everyday life. TIGMT is a trauma-informed adaptation of Goal Management Training (GMT), a manualized cognitive remediation intervention targeting executive control and goal-directed behaviour. TIGMT retains the core GMT framework while incorporating psychoeducation regarding post-traumatic stress, dissociation, changes in arousal and the "window of tolerance," and the effects of trauma-related symptoms on cognitive functioning. Trauma-informed modifications are also incorporated into intervention examples and present-mindedness exercises to increase their relevance and tolerability for individuals affected by trauma. The intervention incorporates interactive cognitive tasks, mindfulness practice, homework, group discussion, and strategies targeting present-mindedness, working memory, goal setting, decision-making, and management of complex tasks. The TIGMT-Assist condition retains the nine core TIGMT sessions and adds a three-session Support-Person Module. Primary participants identify a trusted adult, such as a family member, partner, or friend, to participate as a support person. Support persons participate in the Support-Person Module but do not attend the nine core cognitive remediation sessions. The module is intended to provide support persons with a framework for understanding post-traumatic stress and associated cognitive and functional difficulties, while increasing familiarity with the principles and strategies taught during TIGMT so that these strategies can be reinforced outside of the TIGMT intervention sessions. The Support-Person Module consists of two introductory psychoeducational sessions and one consolidation session. The first two sessions introduce post-traumatic stress and its clinical features, the effects of trauma on cognition and executive functioning, emotion regulation, interpersonal relationships and functioning, and the goals and strategies of TIGMT. The final session consolidates learning related to post-traumatic stress, social functioning, cognitive impacts, social support, and the application of TIGMT strategies to daily life. The second half of the final session includes a focus-group discussion with primary participants and their support persons regarding their experiences with the intervention. Participants are assigned to TIGMT or TIGMT-Assist based on availability for scheduled group sessions and whether a support person is available and willing to participate. Due to the nature of the interventions, participants and facilitators cannot be blinded to study condition. Research staff conducting assessments and data analysis are blinded to treatment condition. The study includes baseline and post-intervention assessment periods. Post-intervention assessments occur immediately following completion of the 9-week TIGMT condition or 12-week TIGMT-Assist condition. Quantitative assessment is designed to characterize change in clinical symptoms, cognitive functioning, executive functioning, disability, and related functional domains. Intervention adherence is also tracked through session attendance, homework completion, and participant dropout. As a pilot study, a central focus is determining the feasibility and acceptability of adding structured support-person involvement to TIGMT. Feasibility is evaluated through factors including recruitment, retention, treatment adherence, attendance, homework completion, and intervention tolerability. Feedback from primary participants and support persons is used to identify perceived benefits, barriers to participation, and opportunities to refine the Support-Person Module. The study also examines whether TIGMT-Assist shows preliminary evidence of improving treatment engagement, adherence, skill retention, cognitive functioning, trauma-related symptoms, and real-world functioning relative to TIGMT alone. Quantitative analyses will follow intention-to-treat principles. Linear mixed-effects models will include fixed effects for treatment condition, time, and the condition-by-time interaction, with random intercepts for participants to account for repeated measurements. Planned contrasts will examine between-group differences and within-group change, with adjustment for multiple comparisons. Missing-data patterns will be evaluated, with multiple imputation used under Missing at Random assumptions where appropriate and sensitivity analyses comparing complete-case and imputed datasets. Secondary analyses will explore whether changes in self-reported cognitive functioning mediate treatment effects on clinical outcomes. Qualitative information collected through participant feedback and the TIGMT-Assist focus group will complement quantitative findings by examining participants' subjective experiences of the intervention and support-person involvement. Focus-group data will be examined using an inductive thematic analysis approach based on Braun and Clarke's six-step framework. Multiple coders will contribute to initial coding and development of the coding framework, with themes reviewed at semantic and latent levels and refined to represent relevant content across transcripts. Together, the pilot study is designed to establish whether incorporating structured support-person psychoeducation into trauma-informed cognitive remediation is feasible and acceptable and to generate preliminary evidence regarding whether this approach may enhance engagement, generalization of learned strategies, and cognitive and psychosocial recovery.

Inclusion Criteria:

• be able to read, write, and speak English fluently
• reside in Ontario
• be able to provide written informed consent
• be between the ages of 18 and 65 (to ensure generalizable results)
• meet screening criteria for PTSD or Complex-PTSD (CPTSD) on the ITQ, administered at the time of screening, to be corroborated with the results of the ITI
• be able to attend regular online, 2-hour sessions once/week for 9 weeks, and be willing to complete the pre-, post-intervention, and follow-up assessments
• have reliable access to a computer with a working microphone and camera, and
• have reliable and consistent access to the internet.

Exclusion Criteria:

• use benzodiazepines daily or almost daily
• use narcotics daily or almost daily
• meet criteria for Alcohol/Cannabis use that may interfere with their ability to participate in the study, as assessed by the AUDIT and CUDIT-R embedded into the eligibility pre-screener and corroborated with the DART (to be determined by the clinical team)
• have a history of Moderate to Severe brain injury or loss of consciousness with prolonged effects that interfere with daily functioning at school, work, or within the family unit
• have a history of a neurological disorder that may interfere with their ability to participate in the study (to be determined by Dr. McKinnon's clinical team)
• have a diagnosis of psychotic disorder, borderline personality disorder, or bipolar disorder
• have a diagnosis of a neurodevelopmental disorder that may interfere with their ability to participate in the study (to be determined by Dr. McKinnon's clinical team)
• have other conditions/impairments/considerations that could interfere with completion of study tasks or participation in the study (to be determined by Dr. McKinnon's clinical team)
• have previously participated in GMT
• are receiving treatment with anti-cholinergics, anti-psychotic medication, or psychostimulants
• have had ECT within the past year
• are currently engaged in a trauma-focused intervention that may confound the findings of the current study (to be determined by Dr. McKinnon's clinical team)
• are an active serving member of the Canadian Armed Forces.