Cognitive Control Training for Extinction in PTSD

The proposed study will test whether a working memory training (WMT) program improves fear extinction learning and its underlying neural circuitry in Veterans with posttraumatic stress disorder (PTSD). WMT is designed to improves the ability to maintain task-relevant information in mind. The project will further validate the relationship between working memory and fear extinction using novel computational and multivariate analyses that link to specific PTSD symptoms. If WMT can enhance fear extinction learning, then WMT may be a powerful adjunctive treatment that can enhance exposure therapy outcomes or be leveraged as a stand-alone treatment. This project supports the Department of Veteran Affairs mission of developing viable targets of treatment for Veterans with PTSD.

Inclusion Criteria: * Fluent in English * Meet current DSM-5 criteria for Posttraumatic Stress Disorder * Are willing to attend 8 total remote sessions of working memory training over course of four weeks * Are willing to attend MRI scans pre and post working memory training * 4-week stability on pharmacological and psychosocial treatments Exclusion Criteria: * A lifetime history of psychotic disorders, lifetime history of bipolar disorder * Past-year severe substance use and severe alcohol use disorder. Mild-to-moderate alcohol use disorder will be allowed to enhance generalizability in our sample due to the high comorbidity of alcohol use and PTSD * History of any neurological disorder that might be associated with cognitive dysfunction (e.g., cerebrovascular accident, intracranial surgery, aneurysm, seizure disorder) * Acute suicidality requiring immediate clinical intervention * Moderate to severe traumatic brain injury (TBI). However, mild to moderate levels of TBI (mTBI) will be included * Receiving benzodiazepines or medications with anticholinergic effects that may affect fear learning measures * Inability to safely complete fMRI session (i.e., metal in body, medical implants)