Zulkayda Mamat, Danielle C. Mathersul, & Peter J. Bayley
January 27, 2026
For clinicians treating veterans with post-traumatic stress disorder (PTSD), the primary goal is clear: reduce the debilitating symptoms that interfere with daily life. But what if effective PTSD treatment does more than just ease hyper vigilance, nightmares, and intrusive thoughts? What if it also helps restore cognitive abilities that have been compromised by trauma?
Our study recently published in Journal of Traumatic Stress reveals encouraging news: when veterans receive evidence-based PTSD treatment, their cognitive function improves along with their core symptoms. This finding has important implications for how we understand and communicate the benefits of PTSD treatment to our patients.
The Cognitive Cost of PTSD
Many veterans with PTSD struggle with more than just the disorder's hallmark symptoms. They experience difficulties with memory, attention, and learning that can affect work performance, relationships, and daily functioning. Cognitive dysfunction in PTSD is a diagnostic criteria (DSM-5, 2013), with individuals frequently exhibiting deficits in attention, working memory, episodic memory, information processing speed, and executive functioning (Scott et al., 2015). Moreover, there is evidence for cognitive dysfunction as a core feature of PTSD pathophysiology rather than merely as a secondary consequence of emotional distress (Quinones et al., 2020). These cognitive challenges often go unaddressed in treatment, partly because we haven't known whether standard PTSD interventions could impact them.
What New Research Has Revealed
In our recently published study, we followed 62 veterans with clinically significant PTSD symptoms who were randomly assigned to receive either Cognitive Processing Therapy (CPT; Resick et al., 2024), a gold-standard trauma-focused therapy, or Sudarshan Kriya Yoga (SKY; Brown & Gerbard, 2025), a breathing-based complementary intervention (Bayley et al., 2022). We measured veterans' cognitive abilities before and after the two treatments using computerized assessments.
The results were striking. Regardless of which treatment veterans received, they showed meaningful improvements:
- Cognition (defined as a composite of episode visual memory, motor and comprehension difficulties, visual attention, and working memory) showed overall improvement following treatment.
- Episodic visual memory improved significantly, suggesting better ability to recall specific events and details.
- Motor learning showed gains, indicating enhanced procedural memory.
- Sustained attention strengthened, reflecting improved ability to maintain focus over time.
In addition to the cognitive improvements, both depression and PTSD symptoms improved following treatment in both groups. Changes in cognition did not differ between the two treatment groups. Importantly, we found that veterans who experienced greater symptom relief also showed larger cognitive gains.
Clinical Implications
These findings offer several practical takeaways for clinicians:
- Set broader treatment expectations: When discussing treatment with veterans, we can now emphasize that effective PTSD treatment may improve not just emotional symptoms but also cognitive functioning. This may motivate veterans who are hesitant about therapy.
- Validate patient experiences: Many veterans notice cognitive improvements during treatment but may not connect these changes to their PTSD therapy. Helping patients recognize this connection can reinforce treatment engagement and improve monitoring.
- Consider complementary approaches: Both CPT and SKY produced cognitive improvements, suggesting that different treatment modalities can benefit cognitive function. Clinicians may also choose depending on patient preference.
Future research should explore which specific cognitive domains are most responsive to different treatments and whether cognitive improvements persist long-term. For now, clinicians can share hopeful news with their patients: treating PTSD doesn't just reduce distressing symptoms--it may also help restore the cognitive sharpness that trauma has dulled.
Discussion Questions
- How do clinicians currently assess cognitive complaints in patients with PTSD, and do these findings change how we might approach cognitive concerns during treatment?
- Given that both trauma-focused therapy (CPT) and breathing-based practices (SKY) improved cognition, how might this inform treatment selection for veterans with diverse backgrounds who express concerns about cognitive difficulties?
About the Authors
Zulkayda Mamat, PhD is a postdoctoral fellow at the War Related Illness & Injury Study Center in VA Palo Alto as well as at Stanford University. She earned her doctorate in Medical Sciences (Cognitive Neuroscience) from Trinity College at University of Cambridge. During her doctoral studies, she mostly focused on the intersection between thought control and mental wellbeing. Her primary research project was to develop a videoconferencing & app-based cognitive training program to suppress unwanted worries to improve mental wellbeing. She is currently translating this work to a clinical population of veterans with PTSD.
Danielle C. Mathersul, PhD is a Senior Lecturer in Psychology at Murdoch University. She is a psychologist clinician researcher passionate about mental health. Her research strives to determine the most effective non-drug treatments for mental health, focusing on mindfulness-based psychotherapies and mind-body/mindful movement (yoga) interventions. She takes a transdiagnostic, non-disorder-specific approach to mental health to better understand neurophysiological mechanisms (HR/HRV, EEG, fMRI, SCR, EMG, actigraphy) of treatment efficacy and emotion dysregulation more broadly.
Peter J Bayley, PhD is the Director of Research at the War Related Illness & Injury Study Center in VA Palo Alto, and Clinical Associate Professor at Stanford University. Dr. Bayley’s lab is active in the development of innovative treatments and novel approaches to healthcare. His research interests include rehabilitation for chronic pain and PTSD using a mind-body approach such as yoga and meditation. He takes a cognitive perspective to explore mechanisms of action.
Reference Article
Mamat Z, Mathersul DC, Bayley PJ. Cognition improvement in U.S. veterans undergoing treatment for posttraumatic stress disorder: Secondary analyses from a randomized controlled trial. J Trauma Stress. 2025 Dec 24. doi: 10.1002/jts.70033. Epub ahead of print. PMID: 41439447.
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (5th ed.). (2013). American Psychiatric Association.
Bayley, P. J., Schulz-Heik, R. J., Tang, J. S., Mathersul, D. C., Avery, T., Wong, M., Zeitzer, J. M., Rosen, C. S., Burn, A. S., Hernandez, B., Lazzeroni, L. C., & Seppälä, E. M. (2022). Randomised clinical non-inferiority trial of breathing-based meditation and cognitive processing therapy for symptoms of post-traumatic stress disorder in military veterans. BMJ Open, 12(8), e056609. https://doi.org/10.1136/bmjopen-2021-056609
Brown, R. P., & Gerbarg, P. L. (2005). Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part I—Neurophysiologic Model. The Journal of Alternative and Complementary Medicine, 11(1), 189–201. https://doi.org/10.1089/acm.2005.11.189
Quinones, M. M., Gallegos, A. M., Lin, F. V., & Heffner, K. (2020). Dysregulation of inflammation, neurobiology, and cognitive function in PTSD: An integrative review. Cognitive, Affective, & Behavioral Neuroscience, 20(3), 455–480. https://doi.org/10.3758/s13415-020-00782-9
Resick, P. A., LoSavio, S. T., Monson, C. M., Kaysen, D. L., Wachen, J. S., Galovski, T. E., Wiltsey Stirman, S., Nixon, R. D. V., & Chard, K. M. (2024). State of the Science of Cognitive Processing Therapy. Behavior Therapy, 55(6), 1205–1221. https://doi.org/10.1016/j.beth.2024.04.003
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