Furthermore, given the variation in the colloquial use of “brain fog”,20 it is also apparent that the patients reporting it may not be referring to the same phenomenon. To better elucidate “brain fog” in individuals with PTSD, employing a phenomenological qualitative approach (eg, with semi-structured in-depth interviews, focus groups) may provide an opportunity to initially understand the component parts of this construct and the features that differentiate it from subjective cognitive complaints in other conditions. Furthermore, learning about the lived experiences of individuals with PTSD and “brain fog” symptoms may provide insight into functional correlates and clinical areas to target. While there may be some disassociation between the measurement of objective and subjective cognitive symptoms among individuals with PTSD, the probable underlying domain of these deficits appears similar. Namely, attentional and executive deficits often contribute to deficits across other cognitive domains and are also likely to underlie the subjective symptoms cited in the experience of “brain fog” (eg, concentration issues, “slowness”).
Treatment & Support
The treatment plan used to target “brain fog” is dependent on the underlying mechanisms contributing to symptoms (eg, is it due to PTSD, comorbid mental health conditions, or health issues). Research suggests that “brain fog” symptoms that appear to be rooted in psychopathology tend to improve following psychological treatments (see Krysta et al,140 for a review). Based on the results of the current review, specifically targeting dissociation, emotion dysregulation, low self-efficacy, and melancholic depression in therapy may mediate clinically significant improvement.
- The remaining 6 studies adopted diverse instruments, namely the TSC-C, HTQ, IES-R, PCL-5, ETI-CA, and CROPS.
- In NMA, the Surface Under the Cumulative Ranking curve (SUCRA) serves as a metric for quantifying and ranking the relative efficacy of various treatments.
- These patients failed to initiate the program, withdrew from the study, or discontinued the intervention.
- Some scholars have argued that when both self-reported and clinician-rated PTSD symptom scores are available, self-reported scores are generally preferred, as they are considered to more accurately reflect the actual symptoms experienced by children and adolescents with PTSD 79.
Other Literature Sources
Compared to the delayed treatment control group (waiting list), the participants treated with iCBT demonstrated statistically significant improvements in symptoms of depression at post-treatment and at alcoholism 14 week follow-up. The included systematic reviews were from Germany,21 Canada,14 and the Netherlands.5 All three reviews5,14,21 were published in 2016. Relevant primary studies included in the systematic reviews were published between 2007 and 2016. Comorbidities in general appear to be common in CPTSD (Maercker Reference Maercker, Cloitre and Bachem2022).
- In addition to BPD, comorbidity occurs with depressive and anxiety disorders, drug and alcohol use problems, dissociative and somatic symptom disorders (Longo Reference Longo, Cecora and Rossi2019) and, not least, with quasi-psychotic symptoms.
- First-line psychological interventions for PTSD include cognitive-behavioral therapy, cognitive-processing therapy, and prolonged exposure therapy.139 For individuals that report “brain fog” or subjective cognitive complaints, an augmented treatment approach may be most appropriate.
- CBT for PTSD includes the development of coping mechanisms to help clients handle thoughts and emotions related to the traumatic event.
- The heterogeneity observed in the analysis is likely attributed, at least in part, to the diversity of routine care provided across studies.
- Symptoms include distressing memories or nightmares, flashbacks, or even physiological and emotional reactions to cues similar to the original event.
- Existing standardizing screening interviews for cognitive complaints (eg, Cognitive Complaints Toolkit California Alzheimer’s Disease Centers; Cognitive Complaint Interview)127 have largely centered on evaluating for cognitive complaints in the context of dementia, which may not be appropriate for cognitive complaints seen in “brain fog” for PTSD.
Effectiveness can vary
CBT has been used in children and adolescents suffering from PTSD, even in pre-schoolers, with positive outcomes. CBT has been culturally validated, and has been used successfully by community therapists following brief training, in individual and group settings. In addition to the traditional face-to-face and group settings, there has been increasingly effective use of the technique via the Internet. In spite of reports of efficacy in many studies, nonresponse to CBT for PTSD can be as high as 50%. This is contributed to by various factors, including comorbidities and nature of the study population. Refugees with PTSD often present with complicated traumatic symptoms, prolonged and repeated exposure to traumatic events, acculturation, and social problems.
- Previous research has indicated that mind–body exercises contribute to improvements in both physical and mental health, providing multiple positive effects for individuals with PTSD 81.
- Neuropsychological assessment using standardized measures with greater levels of sensitivity to mild to moderate cognitive deficits may be required in this condition.
- The decision to combine the waitlist control group and the no-treatment group was made due to the limited number of studies in the no-treatment group; separating them would not have added substantial value to the analysis.
The complexity of the condition and the availability of multiple tools or interviews used to diagnose PTSD may have also contributed. In addition, while all studies5,14,21,36,37 investigated iCBT, the interventions were heterogeneous with respect to program content, number of modules, duration, type of support (e.g., phone, email, combination), and frequency of support. Concerns have been raised that these patients are often excluded from studies into treatment approaches for CPTSD, which limits the extent to which findings can cognitive behavioral therapy be translated into real practice (Karatzias Reference Karatzias, Murphy and Cloitre2019b; Coventry Reference Coventry, Meader and Melton2020).
