Office of Research & Development

Overview of VA research on

Posttraumatic Stress Disorder (PTSD)


Introduction

In earlier wars, it was called "soldier's heart," "shell shock," or "combat fatigue." Today, doctors recognize the issues described by each of these terms as a distinct medical condition called posttraumatic stress disorder, or PTSD.

PTSD can occur after a traumatic event such as combat, an assault, or a natural disaster. While stress is common after a trauma, for those with PTSD reactions such as reliving an event in their mind and feeling distant or angry do not go away over time, and can even get worse.

While PTSD can affect people who have experienced a wide range of life-threatening events, in Veterans the condition is commonly associated with combat trauma. It has taken a significant toll on many war Veterans who currently use VA health care, including Iraq and Afghanistan Veterans. Military sexual assault or harassment can also lead to PTSD.

The disorder can lead to distressing and persistent symptoms, including re-experiencing the trauma through flashbacks or nightmares, emotional numbness, insomnia, relationship problems, sudden anger, and drug and alcohol abuse. Recently, reckless and self-destructive behavior has been added as a PTSD symptom.

top

Selected Major Accomplishments in VA Research

  • 1989: Created the National Center for PTSD to address the needs of Veterans and other trauma survivors with PTSD
  • 2007: Confirmed the value of prolonged exposure therapy as a treatment for women Veterans with PTSD
  • 2013: Funded, along with the Department of Defense, two consortia to improve treatment for PTSD and mild traumatic brain injury (mTBI)
  • 2014:
  • Found that cognitive processing therapy delivered via videoconferencing is as effective for PTSD as in-person therapy
  • Found that Veterans who sought and received care soon after the end of their service had lower rates of PTSD than those who waited to get treatment
  • Established the VA National PTSD Brain Bank
  • 2016:
  • Announced the PTSD Psychopharmacology Initiative to foster work on identifying, testing, and confirming the most effective PTSD medications for Veterans
  • Learned that Veterans with PTSD had different patterns of brain activity than Veterans with mTBIs
  • 2017: Found that prolonged exposure therapy could be delivered as effectively by videoconferencing as in person

top

New, Ongoing, and Published Research

VA has a continuing commitment to fund efforts to understand, diagnose, assess, and treat PTSD. The wide-ranging nature of current PTSD research includes studies of Veterans, subgroups of Veterans, families, and couples. Veterans of all eras are included in these studies.

VA researchers are advancing the understanding of PTSD and its effects, developing and testing treatments for the condition, and working to find ways to prevent PTSD from occurring after trauma. Ongoing studies range from investigations of the genetic or biochemical foundations of the disorder to evaluations of new or existing treatments.

VA's National Center for PTSD (NCPTSD) is a world leader in research and education programs focusing on PTSD and other psychological and mental consequences of traumatic stress. It currently consists of seven VA academic centers of excellence across the United States, with headquarters in White River Junction, Vermont.

VA's National PTSD Brain Bank is a brain tissue repository that supports research on the causes, progression, and treatment of PTSD. The bank is responsible for tissue acquisition and preparation, diagnostic assessment, and storage. Most of the brains stored in the bank are from people once diagnosed with PTSD. Others are from donors who had major depressive disorders. Other brains are from healthy controls. The goal is to help to pinpoint how PTSD affects brain structure and function.

In 2013, VA and the Department of Defense (DoD) announced that the two departments together were committing more than $100 million to fund two new consortia aimed at improving diagnosis and treatment of PTSD and mild traumatic brain injury.

These organizations, the Consortium to Alleviate PTSD and the Chronic Effects of Neurotrauma Consortium, are bringing together leading scientists and researchers throughout the nation, and are part of VA and DoD's efforts to improve access to PTSD services for Veterans, service members, and military families.

For more information on PTSD, visit our Depression, Mental Health, Suicide Prevention, Substance Use Disorders, Traumatic Brain Injury, and Women Veterans topic pages.

➤ Main treatments for PTSD

VA offers evidence-based treatments for PTSD that have helped many Veterans. Primarily, the department provides two forms of cognitive behavioral therapy: cognitive processing therapy (CPT) and prolonged exposure (PE) therapy. Many VA providers also offer a third type of behavioral therapy, called eye movement desensitization and reprocessing (EMDR).

According to the National Center for PTSD's online Treatment Decision Aid tool, 53 of 100 patients who receive one of these three therapies will no longer have PTSD. In contrast, with medication alone, only 42 of 100 will achieve remission. VA is currently conducting a head-to-head comparison of PE and CPT. The trial, sponsored by VA's Cooperative Studies Program, will involve 900 Veterans at nearly 20 VA medical centers nationwide.

Cognitive processing therapy—In the 1980s, Dr. Patricia Resick developed CPT, a 12-session cognitive behavioral treatment originally designed to help victims overcome symptoms of sexual trauma. Those undergoing CPT therapy are helped to understand and change how they think about their trauma and its aftermath. The goal is to understand how certain thoughts about the trauma cause stress and make symptoms worse.

Prolonged exposure therapy—VA researchers with the National Center for PTSD demonstrated, in 2013, the effectiveness of exposure therapy for treating PTSD and depression in male and female Veterans of all eras. In PE, the goal is to make memories of traumatic events less fearful. Patients talk about their traumas with therapists in a safe, gradual way and listen to recordings of their trauma narratives in between sessions, in hopes of gaining control of thoughts and feelings about these difficult experiences.

A 2017 study by researchers at the Ralph H. Johnson VA medical center in Charleston found that PE could be delivered as effectively by videoconferencing as in person. This could enable Veterans to benefit from the treatment at home without having to travel to a VA facility for care.

A VA cooperative study is now comparing CPT and PE head to head, to better understand the pros and cons of each for specific types of patients.

In addition, a 2016 study led by researchers at the VA Palo Alto Health Care System found that both CPT and PE are offered at every VA health care facility, and that many clinicians who once considered PTSD incurable in Veterans have seen both therapies lead to major improvement in some patients.

The study also points out, however, that the use of both psychotherapies at VA mental health clinics is "highly variable," with data suggesting some VA sites are not using the therapies as often as they could.

An ongoing study at the Minneapolis VA Health Care System is looking at reducing the numbers of Veterans who drop out from VA programs. Another, at the Central Arkansas Veterans Healthcare System in Little Rock, Arkansas, is looking at helping VA mental health providers use these therapies in outpatient clinic settings through the use of a computer-assisted tool.

PTSD therapies are still effective in Veterans with traumatic brain injury—In 2016, researchers at the Salem, Virginia, VA medical center found that both PE and CPT are effective treatments for Veterans with PTSD regardless of their TBI status. Some clinicians are reluctant to use these therapies for patients with both PTSD and TBI because they feared they would be less able to tolerate the therapy, or that cognitive limitations would make the therapy less effective. The researchers noted that their study had some limitations, because it was not a randomized trial, and the sample size was small.

Combination of therapies may be effective—Dialectical behavior therapy (DBT) emphasizes individual psychotherapy and group skills training classes to help people learn and use new skills and strategies to develop a life that they experience as worth living. DBT skills include skills for mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

In 2017, researchers at the Minneapolis VA Health Care System found that a combination of DBT and PE may be a safe and effective means of treating Veterans with PTSD and borderline personality disorder. In their study, 22 Veterans underwent a 12-week intensive outpatient program combining the two treatments. After the treatment, 91 percent of participants showed a significant reduction in their PTSD symptoms.

Eye movement desensitization and reprocessing—EMDR also helps to change the way those with PTSD react to memories of their trauma. While thinking of or talking about their memories, those undergoing EMDR therapy focus on other stimuli like eye movements, hand taps, and sounds. A 2013 study of randomized clinical trials of treatments for PTSD done by the National Center for PTSD found that EMDR was an effective psychotherapy for the disorder, along with CPT and PE. No other psychotherapies were found to be effective.

top

➤ Other PTSD treatments

Deep brain stimulation—In 2014, physicians at the VA Greater Los Angeles Health Care System performed the first-ever test of deep brain stimulation (DBS) to treat PTSD, as part of a study to determine whether Veterans who did not respond to current treatments could benefit from the surgical procedure. The clinical trial is currently recruiting participants.

DBS is a surgical procedure used to treat a variety of disabling neurological symptoms, especially those related to Parkinson's disease. Doctors implanted two electrodes in the patient's amygdala, an almond-shaped cluster of neurons found on either side of the brain. The small electrical current from the neurostimulator is designed to "calm down" the amygdala, keeping the patient from feeling the same level of fear in response to his or her traumatic memories.

Ten months after the procedure took place, the research team reported that the first patient showed dramatic improvement, with far less frequent and intense nightmares.

Stellate ganglion block—A procedure called stellate ganglion block, which involves injecting a local anesthetic into nerve tissue in the neck, is used to treat certain pain conditions. The procedure may also be able to stop nerve impulses to the brain that trigger anxiety in patients with PTSD. A 2017 VA evidence review urged further study of this possible treatment. A study is now ongoing at the VA Long Beach Healthcare System.

PTSD Coach application—VA's National Center for PTSD developed a smartphone application called PTSD Coach that helps Veterans and others learn about and manage PTSD symptoms. It features reliable information on PTSD and treatments that work; tools for screening, tracking, and handling PTSD symptoms; and direct links to support and help.

In 2014, the National Center conducted a survey and focus groups with 45 users of the app, all in residential treatment for PTSD. Nearly 90 percent of the Veterans were "moderately to extremely satisfied" with it. Some used the app on their own phones, while others borrowed an iPod Touch as part of the study, which concluded that PTSD Coach has potential to be an effective self-management tool for PTSD.

The VA Palo Alto Health Care System is now conducting a randomized controlled trial of the app to see if it is effective in reducing PTSD symptoms and increases Veterans’ use of mental health care.

Service dogs—VA researchers are currently studying whether Veterans with PTSD can benefit from the use of service dogs or emotional support dogs. The study, being overseen by VA's Cooperative Studies Program, is enrolling 230 Veterans with PTSD from Atlanta, Iowa City, and Portland, Oregon. To date, there is ample evidence on the benefits of service dogs for people with physical disabilities, but very little such evidence in mental health.

Electroencephalograms and PTSD—PTSD and mild traumatic brain injury (mTBI) often carry similar symptoms such as irritability, restlessness, hypersensitivity to stimulation, memory loss, fatigue, and dizziness. In 2016, a team of researchers from the Defense and Veterans Brain Injury Center used electroencephalograms (EEGs) to learn there were patterns of brain activities at different locations on the scalp for mTBI and PTSD in Iraq and Afghanistan Veterans.

This finding can reduce the possibility these conditions can be confused with each other, thereby improving diagnosis and treatment. It also shows that electrical activity in the brain appears to be affected long after combat-related mTBI, suggesting long term changes in the signaling between cells in the nervous system.

Another study, published in 2017, found that a technique called magnetoencephalography can map activity in the brains of patients with PTSD and mTBI, and that in PTSD, but not mTBI, alpha brain waves measured using that technique showed reductions in network structure (the interconnected system of neurons in the brain), thereby providing another way for clinicians to differentiate between the two conditions.

Medical marijuana—Researchers from VA's Portland Health Care System and the Oregon Health and Science University published a 2017 study describing their search of multiple databases for studies on marijuana use for treating PTSD, and for studies on the potential harms of marijuana use. (They also published another study on the possible uses of marijuana for treating chronic pain.)

Their literature review found limited evidence that marijuana use might alleviate neuropathic pain in some patients, and that it might reduce spasticity associated with multiple sclerosis, but found insufficient evidence to assess the effects of marijuana on PTSD. VA is not currently able to prescribe medical marijuana to Veterans, but can look at marijuana as an option for treating Veterans.

In addition, a new study at the VA Ann Arbor Healthcare System is looking at characterizing and understanding patterns of marijuana use and how they relate to health, functioning, and service utilization among VHA primary care patients. The study, which began in 2017, seeks to understand how Veterans are using cannabis, and what impact that has on their physical and mental health. Researchers will look for any links between using cannabis and taking other psychoactive medications like opioids; substance use; mental illness; and pain. 

Drug treatments for PTSD—There are currently only two medications approved by the Food and Drug Administration (FDA) for PTSD: sertraline, sold as Zoloft, and paroxetine, sold as Paxil. Both drugs only reduce symptoms, rather than eliminate them, and no new medications have been approved for PTSD since 2001.

A 2017 article by a group of VA researchers recommended that finding effective drug treatments for PTSD should be a national mental health priority. The authors also recommended more early-phase clinical trials of new medications, the development of new drug trial designs, and studies on the effectiveness of treatments for the disorder. They suggested the development of a clinical trials workforce and infrastructure, more studies of the biology underlying PTSD, and an investment in linking basic neuroscience with clinical studies.

In response, VA announced a new initiative based in public-private partnerships to spur innovative research into drugs used to treat PTSD in Veterans, called the PTSD Psychopharmacology Initiative. The initiative calls for new proposals from VA investigators, and includes clinical trials training and other measures to expedite research in this area.

Researchers at the Minneapolis VA Health Care system are looking at ways to increase the prescription rate of evidence based drug therapies for PTSD by primary care providers in VA community-based outpatient clinics by testing a new decision support tool and developing additional training on pharmacotherapy. The project hopes to provide primary care providers with the tools they will need to fully partner with mental health providers.

Cortisol level changes linked to better responses to treatment—Cortisol is a hormone released by the adrenal glands in response to stress. Researchers at the Atlanta and Ann Arbor VA health care systems found, in 2017, that changes in the levels of cortisol in saliva predicted how well 30 Veterans with PTSD responded to either PE or present-centered therapy.

Those patients with a greater increase in their cortisol levels over the course of their treatment had less reduction of their PTSD symptoms. However, overall cortisol levels did not predict how well patients would respond to their treatment.

Bacteria as a treatment for PTSD—Researchers at the VA Eastern Colorado Health Care System and the University of Denver are conducting a clinical trial of 40 Veterans with PTSD, half of whom are receiving Lactobacillus reuteri, a bacterium isolated and derived from human breast milk. The other half are receiving a placebo mix of sunflower oil and other substances. The bacterium was chosen after earlier animal trials suggested it produced anxiety-fighting responses in the body.

The trial, to be completed in 2018, aims to determine whether L. reuteri can reduce the Veterans' physiological and psychological responses to stressful situations. It will evaluate the feasibility, acceptability, tolerability, and safety of the bacterium, perhaps in an injected form, to treat PTSD.

Predicting response to SSRIs—Brain scans of Veterans with PTSD have led researchers to an area of the prefrontal cortex that appears to be a good predictor of how well Veterans who receive treatment with SSRIs will respond to that treatment.

The prefrontal cortex is the part of the brain responsible for emotions and mood regulation. Paroxetine (sold as Paxil) and sertraline (Zoloft) are among the SSRI class of antidepressants, and are currently the only drugs approved by the Food and Drug Administration to treat PTSD. Fluoxetine (Prozac) is another SSRI, but it has not yet been approved to treat PTSD.

The 2016 study, led by investigators from the Jesse Brown VA Medical Center and the University of Illinois at Chicago, showed that patients who showed the most improvement from receiving SSRIs were those who showed the least activation of a brain area called the right ventrolateral prefrontal cortex before their treatment—even though that area of the brain was not the exact area that appeared to be affected by the treatment.

SSRIs and Dementia—A 2017 study by researchers at the Iowa City VA Health Care System that analyzed the health records of more than 417,000 Veterans found that patients with PTSD who were treated with SSRIs, novel antidepressants, or atypical antibiotics were more likely to be diagnosed with dementia later in life, relative to those with or without a PTSD diagnosis but not using any of these drugs.

The authors cautioned that further research is needed to help delineate whether these findings are due to differences in PTSD severity, psychiatric comorbidity, or the independent effects of psychotropic medications on cognitive decline.

top

➤ Afghanistan/Iraq Veterans and PTSD

Benefits of prompt medical care—A 2014 study led by researchers at the San Francisco VA Health Care System looked at nearly 40,000 Iraq and Afghanistan Veterans who received VA mental health care between 2001 and 2011 and had a post-deployment diagnosis of PTSD.

They found PTSD symptoms can be significantly improved in Veterans who receive prompt mental health care. Veterans who sought and received care soon after the end of their service had lower levels of PTSD a year after they initiated care. For each year that a Veteran waited to initiate treatment, there was about a 5 percent increase in the odds of PTSD symptoms either not improving or worsening.

Percentage of Iraq and Afghanistan Veterans with PTSD—Another 2015 VA study looked at combined data and found that, on average, 23 percent of Iraq and Afghanistan Veterans have been diagnosed with PTSD. The research team looked at 33 studies published between 2007 and 2013. Some of these studies included hundreds of thousands of Veterans, while others were conducted on a smaller scale.

The team said their new results should be interpreted with caution because of methodological differences among the existing studies and other limitations, including the fact that most studies included only Veterans enrolled in VA health care, which may skew their estimates upward.

Autoimmune disorders—A 2015 study of more than 666,000 Veterans of Iraq and Afghanistan found that those with PTSD were more likely to have autoimmune disorders such as rheumatoid arthritis. The study, led by researchers at the San Francisco VA Medical Center, found a twofold increased risk of such disorders among those with PTSD compared with those who had no psychiatric disorders, and an even greater risk compared with those who had other psychiatric disorders than PTSD.

Other autoimmune disorders these Veterans were at increased risk of developing included multiple sclerosis, lupus, inflammation of the thyroid, and inflammatory bowel disease. The study did not show that PTSD causes autoimmune disease, only that there is a relationship between the two conditions.

Sleep apnea—Obstructive sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts during sleep. Sleep apnea warning signs include snoring and choking, gasping, and silent breathing pauses during sleep.

In 2016, researchers at the VA San Diego Healthcare System and the University of California found that the probability that Iraq and Afghanistan Veterans would be at high risk of obstructive sleep apnea increased as the severity of their PTSD symptoms increased. Every clinically significant increase in the severity of PTSD symptoms was associated with a 40 percent increase in the probability of being at high risk for sleep apnea.

The investigators looked at 195 Iraq and Afghanistan Veterans, more than 93 percent men, who had visited a VA outpatient PTSD clinic for evaluation of their symptoms. Using clinical questionnaires to evaluate both levels of PTSD and the likelihood of sleep apnea, they found that 69.2 percent of these Veterans were at high risk of developing sleep apnea, and that the risk increased with the severity of their PTSD symptoms. This was despite the fact that many of them did not have a high body mass index or high blood pressure, considered classic predictors of sleep apnea.

Traumatic brain injury as a predictor—The Marine Resiliency Study, based in San Diego, involves some 2,600 Marines. VA and DoD researchers are probing dozens of risk factors, from biological to behavioral, that may affect the abilities of service members to withstand emotional stress.

In 2014, Marine Resiliency Study researchers learned that traumatic brain injury during a deployment was by far the strongest predictor of post-deployment PTSD symptoms in service members and Veterans. It was far more significant than prior traumatic brain injuries or the intensity of combat they experienced.

top

➤ Additional trauma and PTSD

Risky behavior—Researchers with the National Center for PTSD found in 2017 that engaging in risky behavior, a symptom of PTSD, could in turn lead to worse PTSD symptoms. The researchers found that risky behaviors such as dangerous alcohol or drug use, drunken driving, gambling, and aggression were common among these Veterans, and that such behaviors were tied both to other PTSD symptoms and to experiencing other potentially traumatic events that could lead to worse symptoms in the future.

These findings suggest that many Veterans with PTSD continue to experience stressful events that may prolong or worsen their PTSD symptoms, even years after the initial trauma.

Co-occurring PTSD with mental health/substance use disorders—Several studies are looking at PTSD in the context of other mental health disorders. One, by researchers at the Ralph H. Johnson VA Medical Center in Charleston, South Carolina, is hoping to develop a clear standard of care for treating Veterans with PTSD who also have severe forms of mental illness. Another, by researchers at the VA Greater Los Angeles Healthcare System is looking at how depression care can be improved for patients who also have PTSD and substance use disorders. And a third, being conducted at the VA Palo Alto Health Care System, is looking at how well substance use problems are being detected and treated among Veterans with PTSD.

top

➤ Cardiovascular disease and PTSD

As a group, Veterans are at especially high risk for developing heart disease. According to a 2017 article by two researchers with the VA San Francisco Health Care System, numerous population-based studies have shown that people with PTSD are more likely to develop cardiovascular disease (CVD) and to die from it, and that the risk of developing heart disease is equally problematic for both men and women. According to the article, there is strong evidence that patients with PTSD have a greater burden of fatty deposits in their arteries and reduced blood flow to the heart that can lead to CVD events.

PTSD a 'fast track' to cardiovascular disease?—Several VA studies have found that exposure to trauma affects not only the mind, but also the body—especially the heart. One such study, published in 2013, suggested that PTSD might be a fast track to developing premature cardiovascular disease, and examined the changes in the body PTSD causes that might be responsible for this association. Researchers with VA and the University of California, San Diego, conducted the study.

Another 2013 study looked at 663 Veterans at two VA facilities, and found that Veterans with PTSD were more likely to have reduced blood flow to the heart, or ischemia. The condition was present in 17 percent of those with PTSD, and 10 percent of the non-PTSD group. After adjusting for factors known to influence heart disease, the researchers found that PTSD was associated with more than double the risk for ischemia—and the more severe the PTSD symptoms were, the greater the risk.

Risk of heart failure—A 2015 study by researchers with the VA Pacific Islands Health Care System, VA's National Center for PTSD, and two universities looked at more than 8,000 Veterans living in Hawaii and the Pacific Islands, and found that those with PTSD had a nearly 50 percent greater risk of developing heart failure over about a seven-year follow-up period, compared with Veterans who did not have PTSD.

About 21 percent of the total study group had a diagnosis of PTSD. Of the 371 cases of heart failure that occurred during the study, 287 occurred among those with PTSD, whereas only 84 cases occurred among the group without PTSD. According to the study's authors, this was the first large-scale longitudinal study to report an association between PTSD and heart failure in an outpatient sample of U.S. Veterans.

Endothelial dysfunction—A 2016 study led by researchers at the San Francisco VA Medical Center and the University of California found that blood vessels of Veterans with PTSD are unable to expand normally in response to stimuli, compared to Veterans without PTSD. This condition, called endothelial dysfunction, has been linked to heart disease.

The investigators used a standard test called flow-mediated dilation (FMD) to gauge how well an artery in the arm relaxes and expands in response to the squeezing of a blood pressure cuff. The blood vessels of 67 Veterans with PTSD expanded 5.8 percent, whereas among a control group of 147 Veterans without PTSD, blood vessels expanded 7.5 percent, on average.

The researchers concluded that chronic stress may impact the health of blood vessels—a possible explanation for the higher heart disease risk among Veterans with PTSD.

top

➤ Genomics and PTSD

Nearly two decades ago, researchers with VA and other institutions reported on a gene that appeared to be linked to schizophrenia. A similar process is underway for PTSD. A 2016 article in VA Research Currents reported on VA's significant progress in this area, and on some genes researchers believe may affect a person's risk of developing PTSD.

Genetic risk factors for PTSD—A large international study involving several VA researchers examining genetic risk factors for PTSD was completed in 2017. The study included some 200 billion pieces of genetic information from more than 20,000 adults throughout the world. The researchers claim their results demonstrate genetic influences on the development of PTSD, identify shared genetic risks between PTSD and other psychiatric disorders, and highlight the importance of multiethnic and multiracial samples.

According to the researchers, even larger samples are needed to hone in on the specific genes that may be linked to the disorder.

SKA2 gene may predict risk—Biomarkers are measurable indicators of health and disease. A 2016 study by researchers at VA's National Center for PTSD, the VA Boston Healthcare System, and the Boston University Healthcare System identified a gene, SKA2, that could potentially be used as a biomarker to help predict, before deployments, which service members may be more at risk to develop severe PTSD as the result of a high lifetime burden of stress and subsequent combat exposures.

The research team performed magnetic resonance imaging brain scans and examined blood samples from 200 Iraq and Afghanistan Veterans whose health information is part of a database maintained by VA's Translational Research Center for TBI and Stress Disorders.

They found that a chemical change, called methylation, had switched off the function of the SKA2 gene in some of those Veterans. This change in brain chemistry was correlated with decreases in the thickness of the prefrontal cortex, and with greater PTSD severity.

The research team emphasizes that more research is needed to better understand the associations they observed between SKA2 status, cortical thickness, and PTSD severity. Nonetheless, they suggest that in the future it may be possible to use genetic blood tests to help assess the susceptibility of service members for combat-related PTSD.

RNA deficiencies—In 2015, researchers at the James J. Peters VA Medical Center in the Bronx and VA's War-Related Illness and Injury Study Center in East Orange, New Jersey, learned that four specific RNA molecules, known by the designations ACA48, U35, U55, and U83A, were found at lower-than-normal levels in Veterans who had traumatic brain injuries (TBIs) along with PTSD.

The researchers tested blood samples from 58 Iraq and Afghanistan Veterans. Veterans with only PTSD had significantly lower levels of only the U55 RNA module, and Veterans who only had a TBI and not PTSD had normal levels of all four modules. The team hopes their study will eventually result in a simple blood test to help diagnose the two issues in Veterans.

PATRIOT study—Researchers with VA's PATRIOT study (CSP #575) are currently recruiting 20,000 Iraq and Afghanistan Veterans in hopes of pinpointing the genes that affect a person's response to the experience of deployment, especially combat exposures. By conducting careful assessments in Veterans affected by combat-related PTSD and, with their consent, analyzing their DNA samples, researchers hope to help pinpoint genetic variants that contribute to PTSD.

top

➤ Complementary and integrative health and PTSD

Mindfulness meditation—In 2015, a study of mindfulness meditation therapy found that it was modestly more successful than standard group therapy in treating PTSD. In the study, researchers with the Minneapolis VA Health Care System gave 58 Veterans nine sessions of mindfulness-based stress reduction therapy. This type of therapy focuses on teaching patients to attend to the present moment in a nonjudgmental, accepting manner.

Another 58 Veterans received nine weekly group therapy sessions focused on current life problems. Two months after the sessions were completed, nearly half (48.9 percent) of those in the meditation group reported clinically significant improvement in the severity of their PTSD symptoms, compared with 28 percent of those who received group therapy.

A new study, by a team with the VA Puget Sound Health Care System Seattle Division, will look at whether a mindfulness-based stress reduction therapy can help Persian Gulf War Veterans with chronic multisymptom illness. The study is scheduled to be completed in 2021.

YogaResearchers with the Atlanta VA Medical and Rehab Center are studying whether women Veterans who have experienced military sexual trauma can benefit from a form of "trauma-sensitive" yoga that may be able to reduce PTSD symptoms, chronic pain, and insomnia. The study is scheduled to be completed in 2020.

Spirituality—A 2016 study by researchers with the VA Center of Excellence for Suicide Prevention in Canandaigua, New York, found that, in 477 Veterans with PTSD, those who did not participate regularly in spiritual practices, were angry at a higher power, or felt they had fallen short of religious expectations were more likely to have suicidal thoughts than those who had positive thoughts about religion and religious practices.

Researchers at the Durham VA Medical Center, the Charlie Norwood VA Medical Center in Augusta, Georgia, and Augusta University are conducting a survey to determine what role, if any, spirituality plays in the life of Veterans with PTSD, and whether they would be interested in having that therapy available. The team hopes, in the future, to conduct a randomized control trial to compare current psychotherapy approaches such as CPT and PE with one that incorporates a spiritual element. The therapy would be voluntary and would incorporate the patient's own religion and religious texts.

top

More on Our Website

top

Selected Scientific Articles by Our Researchers

It is time to address the crisis in the pharmacotherapy of posttraumatic stress disorder: a consensus statement of the PTSD psychopharmacology working group. Krystal JH, Davis LL, Neylan TC, Raskind M, Schnurr PP, Stein MB, Vessicchio J, Shiner B, Gleason TD, Huang GD. Recommendations for dealing with the crisis in the area of drug treatment for PTSD are discussed. Biol Psychiatry, 2017 Oct 1; 82(7):e51-e59.

Stress-related mental health symptoms in Coast Guard: incidence, vulnerability, and neurocognitive performance. Servatius RJ, Handy JD, Doria MJ, Myers CE, Marx CE, Lipsky R, Ko N, Avcu P, Wright WG, Tsao JW. Rates of PTSD and major depressive disorder are comparable among Coast Guard personnel serving boat stations to those of larger military services following deployment. Front Psychol. 2017 Sep 14;8:1513.

Automated measurement of hippocampal subfields in PTSD: Evidence for smaller dentate gyrus volume. Hayes JP, Hayes S, Miller DR, Lafleche G, Logue MW, Verfaellie M. Dentate gyrus abnormalities are associated with symptoms of PTSD. J Psychiatr Res. 2017 Sep 9;95:247-252.

Delivery of mental health treatment to combat Veterans with psychiatric diagnoses and TBI histories. Miles SR, Hank JM, Jundt NE, Mignogna J, Pastorek NJ, Thompson KE, Freshour JS, Yu HJ, Cully JA. PTSD, anxiety, depression, and TBI history were associated with the number of psychotropic medication management visits to VA facilities. PLoS Once, 2017 Sep 8;12(9):e0184265.

Benefits and harms of plant-based cannabis for posttraumatic stress disorder: a systematic review. O'Neill ME, Nugent SM, Borasco BJ, Freeman M, Low A, Kondo K, Zakher B, Elven C, Motu'apuaka M, Paynter R, Kansagara D. Evidence is insufficient to draw conclusions about the benefits and harms of plant-based cannabis preparations in patients with PTSD. Ann Intern Med, 2017 Sep 5;167(5):332-340.

CRP polymorphisms and DNA methylation of the AIM2 gene influence associations between trauma exposure, PTSD, and C-reactive protein. Miller MW, Maniates H, Wolf EJ, Logue MW, Schichman SA, Stone A, Milberg W, McGlinchey R. PTSD was positively correlated with serum C-reactive protein levels, with PTSD cases more likely to have levels in the clinically-elevated range compared to those without a PTSD diagnosis. Brain Behav Immun. 2017 Sep 1. Pli:S0889-1591(17)30412-9.

VA's national PTSD Brain Bank: a national resource for research. Friedman MJ, Huber BR, Brady CB, Ursano RJ, Benedek DM, Kowall NW, McKee AC, Traumatic Stress Brain Research Group. This article describes the organization and operations of NPBB with specific attention to: tissue acquisition, tissue processing, diagnostic assessment, maintenance of a confidential data biorepository, adherence to ethical standards, governance, accomplishments to date, and future challenges. Curr Psychiatry Rep, 2017 Aug 25;19(10):73.

Reckless self-destructive behavior and PTSD in Veterans: the mediating role of new adverse events. Lusk JD, Sadeh N, Wolf EJ, Miller MW. Reckless self-destructive behaviors are common among Veterans exposed to trauma and may perpetuate PTSD symptoms by increasing exposure to new adverse events. J Trauma Stress, 2017 Jun:30(3):270-278.

PTSD, psychotropic medication use, and the risk of dementia among U.S. Veterans: a retrospective cohort study. Mawanda F, Wallace RB, McCoy K, Abrams TE. PTSD diagnosis is associated with an increased risk for dementia diagnosis that varied with receipt of psychotropic mediations. J Am Geriatr Soc, 2017 May:65(5):1043-1050.

Changes in salivary cortisol during psychotherapy for posttraumatic stress disorder: a pilot study in 30 Veterans. Rauch SAM, King AP, Liberzon I, Sripada RK. Compared to high treatment responders, low treatment responders showed greater increases in salivary cortisol output over the course of treatment. J Clin Psychiatry. 2017 May;78(5):599-603.

Largest GWAS of PTSD (N=20 070) yields genetic overlap with schizophrenia and sex differences in heritability. Duncan LE et al. Results demonstrate genetic influence on the development of PTSD, identify shared genetic risk between PTSD and other psychiatric disorders and highlight the importance of multiethnic and multiracial samples. Mol Psychiatry, 2017 Apr 25 (epub ahead of print).

Treating Veterans with PTSD and borderline personality symptoms in a 12-week intensive outpatient setting: findings from a pilot program. Meyers L, Voller EK, McCallum EB, Thuras P, Shallcross S, Velasquez T, Meis L. PTSD can be safely and effectively treated among Veterans with comorbid symptoms of borderline personality disorder through the combination of concurrent intensive dialectical behavior therapy and prolonged exposure therapy. J Trauma Stress, 2017 Apr;30(2):178-181.

Contrasting effects of posttraumatic stress disorder and mild traumatic brain injury on the whole-brain resting-state network: a magnetoencephalography study. Rowland JA, Stapleton-Kotloski JR, Alberto GE, Rawley JA, Kotloski RJ, Taber KH, Godwin DW. Alpha brain wave network results demonstrate reductions in network structure associated with PTSD, but no differences associated with mTBI. Brain Connect, 2017 Feb 7(1):45-57.

A non-inferiority trial of prolonged exposure for posttraumatic stress disorder: in person versus home-based telehealth. Aciemo R, Knapp R, Tuerk P, Gilmore AK, Lejuez C, Ruggiero K, Muzzy W, Egede L, Hernandez-Tejada MA, Foa EB. Telehealth prolonged exposure therapy delivered directly into patients' homes may dramatically increase the reach of this evidenced-based therapy for PTSD without diminishing effectiveness. Behav Res Ther. 217 Feb:89:57-65.

Trauma exposure and disordered eating: a qualitative study. Breland JY, Donalson R, Dinh JV, Maguen S. Trauma exposure can be associated with disordered eating; disordered eating can provide short-term, but not long term, relief from the effects of trauma; and disordered eating can provide a way to avoid unwanted attention from potential and past perpetrators of trauma. Women Health, 2017 Jan 17:1-18.

A review of studies on the system-wide implementation of evidence-based psychotherapies for posttraumatic stress disorder in the Veterans Health Administration. Rosen CS, Matthieu MM, Wiltsey Stirman S, Cook JM, Landes S, Bernardy N, Chard KM, Crowley J, Eftekhari A, Finley EP, Hamblen JL, Harik JM, Kehle-Forbes SM, Meis LA, Osei-Bonsu PE, Rodriguez AL, Riggiero KJ, Ruzek JI, Smith BN, Trent L, Watts BV. A literature review highlighted key areas of progress in implementation of evidence-based psychotherapies, identified continuing challenges and research questions, and discussed  implications for future efforts. Adm Policy Ment Health, 2016 Nov;43(6):957-997.

How Veterans with post-traumatic stress disorder and comorbid health conditions utilize eHealth to manage their health care needs: a mixed-methods analysis. Whealin JM, Jenchura EC, Wong AC, Zulman DM. A survey showed 44.6 percent of Veterans used eHealth technology to support their complex health care needs 1-3 times per month, and 21.4 percent used technology less than once per month. M Med Internet Res. 2016 Oct 26;18(10):e280.

Development and validation of a computerized-adaptive test for PTSD (P-CAT). Eisen SV, Schultz MR, Ni P, Haley SM, Smith EG, Spiro A, Osei-Bonsu PE, Nordberg S, Jette AM. The P-CAT appears to be a promising tool for efficient and accurate assessment of PTSD symptomatology. Psychiatr Serv, 2016 Oct 1:67(10):1116-1123.

Effectiveness of prolonged exposure and cognitive processing therapy for U.S. Veterans with a history of traumatic brain injury. Ragsdale KA, Voss Horrell SC. TBI status should not preclude individuals from being offered trauma-focused PTSD treatment. J Trauma Stress. 2016 Oct;29(5):474-477.

Distinction in EEG slow oscillations between chronic mild traumatic brain injury and PTSD. Franke LM, Walker WC, Hoke KW, Wares JR. PTSD is associated with decreases in low-frequency brain wave power, while blast related mTBI is associated with increases in low-frequency power. Int J Psychophysiol, 2016 Aug:106:21-9.

Suicidal behavior and spiritual functioning in a sample of Veterans diagnosed with PTSD. Kopacz MS, Currier JM, Drescher KD, Pigeon WR. Enhanced or diminished spiritual functioning is associated with suicidal thoughts and attempts among Veterans dealing with PTSD. J Inj Violence Res. 2016 Jan;8(1):6-14.

top

Posttraumatic Stress Disorder Fact Sheet

fact sheet thumbnail

Download PDF

VA and other U.S. Government Online Resources


Questions about the R&D website? Email the Web Team.

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.