Cognitive Training to Increase Resilience

Abstract

Introduction: Warfighters must maintain an elevated level of readiness and psychological health (collectively referred to as "brain fitness") to facilitate optimal performance and rapid recovery in the event of trauma, injury, or disease. Preliminary results from Warfighter Brain Fitness (WBF), a large-scale implementation study, demonstrate online cognitive training improves resiliency and overall brain health.

Materials and methods: National Guard participants in WBF engaged in 2 scientifically validated, complementary cognitive training approaches: BrainHQ and Strategic Memory Advance Reasoning Trianing (SMART+) in a crossover design. Participants took an online BrainHealth Index (BHI) before and after 3-month training periods and at the study conclusion (2 years). The BHI includes top-down and bottom-up cognitive measures and standardized self-report surveys on sleep, social support, social engagement, happiness, cognitive resilience, quality of life, depression, anxiety, and stress. These variables were grouped using factor analysis into 3 composite domains: "Clarity" (cognitive performance, executive function), "Emotional -Balance" (mood, psychological well-being), and "Connectedness" (resilience-related traits-social support, purpose, engagement). Measures contributing to "Connectedness" represent a composite of cognitive, trait, and social resilience.

Results: Four hundred and six individuals were enrolled and randomly assigned to 1 of 4 crossover sequences. Of these, 62 were assigned to a waitlist control period before 1 of 2 training sequences, 177 were assigned to SMART+ followed by BrainHQ, and 167 were assigned to BrainHQ followed by SMART+. Following training, participants demonstrated within-subject improved resilience at 3 months (t(93.5) = 1.87, P = .033, d = .47) and 6 months (t(91.7) = 1.74, P = .043, d = 0.51), relative to the control period, as measured by Connectedness. During the 3-month wait period, the waitlist control group (A) did not show statistically significant improvement.

Conclusions: These interim results support the hypothesis that online cognitive training can improve resilience among healthy, -military-affiliated adults. Additional research will expand upon this work to understand how brain fitness protocols can be individualized to maximize benefits to military personnel.