Enhancing Rehabilitation for Veterans with Serious Mental Illness via Biomarker-Informed Cognitive Training

Project Summary: This application addresses the critical need for innovative therapeutic interventions in Veterans with serious mental illnesses (SMI) receiving care in VA Psychosocial Rehabilitation and Recovery Centers (PRRCs). The vast majority of individuals with SMI suffer from cognitive impairments, leading to chronic functional disability, and impaired outcomes, causing a significant strain on support networks and the VA healthcare system. Targeted Cognitive Training (TCT) is an approach to cognitive remediation designed to enhance basic sensory information processing that robustly promotes gains in clinical, cognitive, and psychosocial functioning in non- Veterans living with schizophrenia and other brain disorders. This investigative group has further identified EEG biomarkers measurable at the onset of TCT treatment, that predict benefits after a three-month treatment period. While preliminary studies have shown both TCT and biomarker assessments to be feasible and well-tolerated in Veterans with SMI receiving care within PRRCs, a full 30-hour TCT regimen has yet to be evaluated in real- world, transdiagnostic Veterans with SMI. This application aims: 1) To assess the effectiveness of TCT in enhancing clinical, cognitive, and functional outcomes in PRRC Veterans with SMI; 2) To determine whether the biomarkers identified in non-Veteran schizophrenia patients can similarly predict TCT therapeutic response among Veterans with SMI; and 3) To evaluate the acceptability of TCT and biomarker testing, identifying any barriers and facilitators to implementation from the perspectives of both Veterans and PRRC clinicians. This application is aligned with the RRD's priority to “conduct feasibility studies using a multidisciplinary team collaboration,” and “to enhance the treatment and rehabilitation of Veterans with multisensory chronic conditions.” A successful outcome will pave the way for future TCT deployment in VA PRRC settings, promising a significant transformation in the lives of Veterans with SMI by offering effective, personalized therapy. In this envisioned approach, Veterans with the highest potential to benefit from TCT would be identified via biomarkers and receive optimized treatment in PRRCs. Thus, this application bolsters the rehabilitative potential of the VA healthcare system and advances PRRC effectiveness, providing comprehensive, individualized care to Veterans grappling with SMI and who live with chronic functional disability.