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Overview of VA research on

Posttraumatic Stress Disorder (PTSD)


Introduction

In earlier wars, it was called "soldier's hearat," "shell shock," or "combat fatigue." Today, doctors recognize these issues as a distinct medical condition called posttraumatic stress disorder, or PTSD.

PTSD can occur after a traumatic event such as military combat, a physical assault, or a natural disaster. While stress is common after a trauma, people with PTSD often relive a traumatic event in their minds. They may also feel distant from friends and family and experience anger that does not go away over time, or may even get worse.

PTSD can affect individuals who have experienced a wide range of life-threatening events. VA’s National Center for PTSD estimates that about 8% of the population will have PTSD at some point in their lives. In Veterans, PTSD is commonly associated with combat trauma. It has taken a significant toll on many Veterans who currently use VA health care. For example, according to the National Center for PTSD the prevalence of PTSD in Veterans who have served in Iraq or Afghanistan is about 11–20%. Military sexual trauma (MST), which can happen to both men and women, can also lead to PTSD.

People with PTSD can experience a number of distressing and persistent symptoms, including re-experiencing trauma through flashbacks or nightmares, emotional numbness, sleep problems, difficulties in relationships, sudden anger, and drug and alcohol misuse. Recently, reckless and self-destructive behavior has been added as a PTSD symptom.

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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
    • 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
  • 2018: Found , in a large multisite clinical trial, that the drug prazosin did no better than placebo in treating PTSD-related nightmares, although subgroups of Veterans may benefit from the treatment
  • 2019:
    • Showed the value of mantram therapy—a form of meditation in which a person repeats a word or phrase with personal spiritual meaning—to reduce PTSD symptoms and insomnia in Veterans
    • Launched a study to see whethercannabidiol, or CBD—a compound derived from cannabis plants—can help easePTSD. The $1.3 million VA-funded study will enroll 136 Veterans, from all service eras.

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New, Ongoing, and Published Research

VA is committed to funding research to better understand, diagnose, assess, and treat PTSD. VA research has led the way in developing effective psychotherapies for PTSD and exploring other approaches such as medications, behavioral interventions, and therapeutic devices. VA also has a strong track record of moving PTSD research into clinical practice.

VA researchers are working to better understand the underlying biology of PTSD, advance new treatments, and refine diagnostic approaches. Ongoing studies range from investigations of genetic or biochemical foundations of PTSD to evaluating new treatments and drugs.

VA research aims to improve Veterans’ quality of life by increasing the number and type of evidence-based treatments and identifying additional personalized approaches for treating PTSD. Current PTSD research includes studies of Veterans, their families, and couples. Veterans of all eras are included in these studies.

VA's National Center for PTSD (NCPTSD) is the world’s leading research and educational center of excellence on PTSD and other 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 brain 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 individuals who serve as controls. The goal is to help pinpoint how PTSD affects changes in brain structure and function.

In 2013, VA and the Department of Defense (DOD) announced that they 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 Long Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC), bring together leading scientists and researchers throughout the nation. They 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 , andWomen Veterans topic pages.

➤Main treatments for PTSD

VA offers evidence-based treatments for PTSD that have helped many Veterans. Three forms of trauma-focused therapy that are used in treating PTSD are  cognitive processing therapy  (CPT), prolonged exposure  therapy, and eye movement desensitization and reprocessing (EMDR).

According to the National Center for PTSD, 53 of 100 patients who receive one of these three therapies will no longer have PTSD. With medication alone, 42 of 100 will achieve remission. VA conducted a head-to-head comparison of prolonged exposure and CPT. The clinical trial, sponsored by VA's Cooperative Studies Program ( VA CSP #591 ), involves 916 Veterans at 18 VA medical centers nationwide. Currently, study results are pending.

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. It is a specific type of cognitive behavioral therapy (CBT), a form of psychological treatment that involves efforts to change thinking patterns. People 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 prolonged exposure therapy, 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.

Eye movement desensitization and reprocessing—EMDR also helps to change the way individuals with PTSD react to memories of their trauma. While thinking of or talking about their memories, people 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 by the National Center for PTSD found that EMDR was an effective psychotherapy for the disorder, along with CPT and prolonged exposure therapy. No other psychotherapies were found to be effective.

CPT quality of life improvements differ by gender—While CPT has been shown to improve PTSD symptoms, the treatment’s effect on quality of life is less well understood. In a study published in 2020, a team led by researchers from the VA San Diego Healthcare System found that women Veterans with PTSD whose symptoms of depression were reduced were most likely to see improvements in their quality of life. For men, however, reducing symptoms of anger had a greater effect on improving the quality of their lives. The researchers believe that the effectiveness of PTSD treatment should be evaluated within the context of gender.

PTSD therapies are still effective in Veterans with traumatic brain injury—In 2016, researchers at the Salem, Virginia, VA medical center  found  that both prolonged exposure therapy 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 fear patients would be less able to tolerate 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) utilizes individual psychotherapy and group skills training classes to help people learn and use new skills and strategies to develop a personally meaningful life. DBT teaches skills to foster mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.

In 2017, researchers at the Minneapolis VA Health Care System  found  that a combination of DBT and prolonged exposure therapy 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% of participants showed a significant reduction in their PTSD symptoms.

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➤Other PTSD treatments

Present-centered therapy—Present-centered therapy (PCT) focuses on patients’ current lives and how they can cope with PTSD symptoms. It does not directly confront trauma memories as CBT does. In a review published in 2019, VA’s National Center for PTSD researchers and their colleagues looked at 12 previous trials of PCT and CBT, and found that PCT reduces PTSD severity compared with no treatment, and that fewer patients drop out of PCT compared to CBT. However, the studies also showed that CBT is a more effective way to reduce PTSD severity compared to PCT.

Because of the lower dropout rate, however, PCT may be a useful treatment for patients whose PTSD is resistant to CBT.

Theta-burst transcranial magnetic stimulation—Transcranial magnetic stimulation (TMS) is a medical treatment that uses an electromagnetic coil to produce a magnetic field that is applied to specific points on the skull to stimulate areas of the brain. Theta-burst stimulation (TBS) is a newer form of TMS in which magnetic pulses are applied in a certain pattern, called bursts.

Researchers from the Providence VA Medical Center and Brown University used TBS on 50 Veterans with chronic PTSD. They applied the technique intermittently to the right dorsolateral prefrontal cortex (an area in the front of the brain) in hopes of reducing activity in areas involved in PTSD.

In 2019, the research team published their findings , which were that TBS “appears to be a promising new treatment for PTSD.” They noted, however, that most clinical improvements from TBS occurred in the first week of treatment, and suggested further investigation to find the best course of treatment.

Prazosin and sleep disorders—In 2007, researchers from the VA Puget Sound Health Care System in Seattle and the University of Washington  demonstrated  that an inexpensive generic drug called prazosin, used by millions of Americans for high blood pressure and prostate problems, could also be used to reduce nightmares in Veterans with PTSD.

The researchers found that patients taking prazosin got an average of 94 minutes of additional sleep a night, increased the time and duration of their rapid eye movement sleep cycles, had fewer trauma-related nightmares, woke up less in the middle of the night in distress, and appeared to have more normal dreams.

However, in a large multisite clinical trial involving more than 300 combat Veterans whose results were published in 2018, the drug did no better than placebo pills in reducing nightmares. VA now believes the decision to use prazosin should be made by Veterans and their medical providers.

Not every Veteran who subjectively reports nightmares in the context of a PTSD diagnosis is going to respond to prazosin, said the study authors, but there is clearly a subgroup of people who do respond.

Individual placement and support helps Veterans find employment—Individual placement and support (IPS), a person-centered model to help Veterans find and keep jobs, is more effective than older methods of vocational rehabilitation, according to a multi-site VA study published in 2018.

The study ran from 2013 to 2017 and involved 541 Veterans with PTSD at 12 medical centers. IPS helped nearly twice as many participants in the study to get steady jobs as a program using transitional work. PTSD often interferes with a person’s ability to function at work, making it harder to stay employed or earn a higher income. Veterans with PTSD are more likely to be unemployed than those without the disorder.

The model begins with in-depth interviews to explore individual Veterans’ interests and aspirations. Employment specialists spend time in the community, networking and developing job possibilities geared to Veterans’ experiences, interests, and backgrounds. The outreach and support are more intensive during the first few months after a Veteran is placed in a job, then tapers off as the Veteran gets stabilized in the work setting. Long-term career development continues afterwards.

Mantram therapy may reduce hyperarousal—Hyperarousal, a common symptom of PTSD, is a heightened state of anxiety that is more difficult to treat using common treatments than other PTSD symptoms. In a study published in 2019, researchers with the San Diego VA Healthcare System asked Veterans to practice mantram repetition to deal with hyperarousal.

Mantram is a simple meditation technique in which Veterans silently repeat a word or phrase that holds personal meaning for them. The team found that Veterans using the technique had greater reductions in hyperarousal, compared with those using standard psychotherapy only. They also found that Veterans with reduced hyperarousal had greater overall PTSD symptom reduction. The results show that mantram treatment focused specifically on hyperarousal could lead to lower levels of PTSD symptoms, according to the study authors.

Stellate ganglion block—A procedure called stellate ganglion block, which involves injecting a local anesthetic into 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. The VA Long Beach Healthcare System initiated a stellate ganglion block clinical program in 2017 and now has treated more than 60 Veterans using this procedure. Researchers are exploring the safe use of this emerging therapy in more broad applications. The treatment was featured in the June 16, 2019, edition of “ 60 Minutes .”.

PTSD Coach application—VA's National Center for PTSD has 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 evidenced-based treatments; tools for screening, tracking, and handling PTSD symptoms; and direct links to support for individuals with PTSD.

In 2014, the National Center for PTSD conducted a survey and focus group with 45 users of the app, all in residential treatment for PTSD. Nearly 90% 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 PTSD Coach app to see whether it is effective in reducing PTSD symptoms and whether it 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 three-year study, overseen by VA's Cooperative Studies Program, is enrolling 230 Veterans with PTSD from Atlanta; Iowa City, Iowa; 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 applications.

Electroencephalograms (EEG) and PTSD—PTSD and mild traumatic brain injury (mTBI) often share 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 EEGs to discover  different patterns of brain activity, at different locations in the brain, in Iraq and Afghanistan Veterans with mTBI and PTSD.

This evidence can help reduce the possibility that mTBI and PTSD are 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 (MEG) can map activity in the brains of patients with PTSD and mTBI. Using MEG, researchers discovered that alpha brain waves in individuals with PTSD, but not mTBI, showed reductions in network structure (the system of neurons in the brain). Their findings provide another way for clinicians to differentiate between the two conditions.

Medical marijuana—In 2017, researchers from the VA Portland Health Care System and the Oregon Health and Science University published a systematic review  of studies that examined marijuana use for treating PTSD, and the potential harms of marijuana use. (They also published another  study  on the possible uses of marijuana for treating chronic pain.)

The literature review found limited evidence that marijuana might alleviate neuropathic pain in some patients, and that it might reduce spasticity associated with multiple sclerosis. However, researchers did not find sufficient evidence to assess the effects of marijuana on PTSD. VA providers are not currently able to prescribe medical marijuana to Veterans or help them obtain it. Researchers can study the effectiveness of marijuana for treating Veterans, and VA providers can discuss marijuana use with Veterans as part of comprehensive care planning.

In addition, a 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 VA 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—Four antidepressant medications have the strongest evidence for effectively treating PTSD: sertraline, sold as Zoloft; paroxetine, sold as Paxil; fluoxetine, sold as Prozac; and venlafaxine, sold as Effexor. Medications can reduce the symptoms of PTSD, but do not eliminate them entirely. 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. Eleven medication studies are currently being funded.

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 prolonged exposure therapy 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.

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

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

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➤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 Veterans with PTSD, and that such behaviors were tied to experiencing other PTSD symptoms and additional 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.

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➤Other Illnesses and PTSD

Suicide, accidental injury, and viral hepatitis—A study published in 2019, led by researchers at the White River VA Medical Center in Vermont, found that Veterans who have been treated for PTSD are twice as likely as other Americans to die from suicide, accidental injury, and viral hepatitis (a viral infection that causes liver inflammation). Of the Veterans who died by accidental injury, more than half succumbed to poisoning.

The investigators reviewed data on nearly 500,000 former service members who underwent PTSD treatment in the VA health care system from 2008 to 2013. They found that Veterans with PTSD were also more likely to die than other Americans from diabetes and chronic liver disease, and were 5% more likely to die from any cause. They were less likely to die from cerebrovascular disease, which can cause stroke or brain aneurysms, or from cancer.

According to the research team, these findings suggest that behavioral factors may contribute to excess mortality risk, because Veterans with PTSD may engage in unhealthy or risky lifestyle behaviors like injecting illegal drugs.

Heart 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.

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 with 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 expands in response to the squeezing of a blood pressure cuff. The blood vessels of 67 Veterans with PTSD expanded 5.8%, whereas among a control group of 147 Veterans without PTSD, blood vessels expanded 7.5%, 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.

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➤Genomics and PTSD

Locations on the human genome mapped for PTSD—A team of researchers from the VA Connecticut Healthcare System, the VA San Diego Healthcare System, Yale University, and the University of California San Diego used data from the Million Veteran Program to identify multiple locations on the human genome that are related to the risk of reexperiencing traumatic memories, the most distinctive symptom of PTSD. MVP is a national VA research program that aims to learn how genes, lifestyle, and military exposures affect health and illness.

By studying data from more than 165,000 Veterans, the team found , in 2019, eight separate regions in the genome associated with re-experiencing symptoms. Three regions were highly significant: gene CAMKV, a region near genes KANSL1 and CRHR1, and gene TCF4. The results also showed genetic overlap between PTSD and many other physical and mental health conditions, like schizophrenia and hypertension.

Genetic risk factors for PTSD—A large international  study  involving several VA researchers that examined 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 home 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, and other institutions identified a gene, SKA2, that could potentially be used as a biomarker to help predict risk in service members for developing PTSD, prior to deployment. Certain service members may be at greater risk for developing severe PTSD as the result of a high lifetime burden of stress and 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 Veterans. The change in brain chemistry was correlated with decreases in the thickness of the prefrontal cortex, and with greater PTSD severity.

The research team said that more research is needed to better understand the associations they observed between SKA2, 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.

PTSD biomarkers identified—Researchers headed by a team at the Richard L. Roudebush VA Medical Center in Indiana and Indiana University have identified hundreds of blood-based genetic markers for psychological stress that could lead to improved, earlier diagnostics for PTSD and other stress-related disorders, and offer new leads for the development of drug or natural compound-based therapeutics.

The 10-year study , involving more than 250 male and female Veterans, highlighted 285 individual biomarkers associated with 269 genes. One of the top biomarkers was FKBP5, a gene well recognized for its involvement in stress response. The team hopes their work will lead to earlier testing for PTSD before people show symptoms, to identify those at greatest risk for the disorder and to begin early treatment. 

PATRIOT study—Researchers with VA's PATRIOT  study (CSP #575) are currently recruiting 20,000 Iraq and Afghanistan Veterans in hopes of pinpointing genes that influence combat stress reactions (PTSD) in service members. Combat stress reactions are common and are a serious problem among military personnel. By conducting careful assessments of Veterans with and without combat-related PTSD and analyzing DNA samples (with Veteran consent), researchers hope to help pinpoint genetic variants that contribute to or protect against PTSD.

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More on Our Website

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Selected Scientific Articles by Our Researchers

Towards precision medicine for stress disorders: diagnostic biomarkers and targeted drugs . Le-Niculescu H, Roseberry K, Levey DF, Rogers J, Kosary K, Prabha S, Jones T, Judd S, McCormick M, Wessel AR, Williams A, Phalen PL, Mamdani F, Sequeira A, Kurian SM, Niculescu AB. Molecules in the blood can help track stress intensity. Mol Psychiatry. 2020 May;25(5):918-938.

Home based delivery of variable length prolonged exposure therapy: a comparison of clinical efficacy between service modalities . Morland LA, Mackintosh MA, Glassman LH, Wells SY, Thorp SR, Rauch SAM, Cunningham PB, Tuerk PW, Grubbs KM, Golshan S, Sohn MJ, Acierno R. Providers can effectively deliver prolonged exposure therapy through telehealth and in-home, in-person modalities, although the rate of treatment completion was higher in in-home, in person care. Depress Anxiety. 2020 Apr;37(4):346-355.

Development of a tailored behavioral weight loss program for Veterans with PTSD (MOVE!+UP): a mixed methods uncontrolled iterative pilot study. Hoerster KD, Tanksley L, Simpson T, Saelens BE, Unutzer J, Black M, Greene P, Sulayman N, Reiber G, Nelson K. Veterans with PTSD lose less weight in the VA weight management program (MOVE). The MOVE!+UP program, tailored for Veterans with PTSD, provided acceptable results. Am J Health Promot. 2020 Mar 12. Online ahead of print.

Predictors of quality of life following cognitive processing therapy among women and men with post-traumatic stress disorder . Glassman LH, Mackintosh MA, Wells SY, Wickramasinghe I, Walter KH, Morland LA. Improvements in quality of life may be predicted by different symptoms for men and women following evidence-based PTSD treatment. Mil Med. 2020 Feb 20. Online ahead of print.

Present-centered therapy (PCT) for post-traumatic stress disorder (PTSD) in adults . Belsher BE, Beech E, Evatt D, Smolenski DJ, Shea MT, Otto JL, Rosen CS, Schnurr PP. Present-centered therapy can reduce PTSD symptoms, but is less effective than cognitive behavioral therapy. It could be a useful PTSD treatment when patients are resistant to CBT. Cochrane Database Syst Rev. 2019 Nov 18;2019(11):CD012898.

Theta-burst transcranial magnetic stimulation for posttraumatic stress disorder. Philip NS, Barredo J, Aiken E, Larson V, Jones RN, Shea MT, Greenberg BD, van’t Wout-Frank M. Transcranial magnetic stimulation appears to be a promising new treatment for PTSD. Am J Psychiatry. 2019 Nov1;176(11):939-948.

International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci . Nievergelt CM, et al. Between 5% and 20% of PTSD risk can be identified to inherited genes, with heritability higher in women than men. In addition, a gene previously linked to Parkinson’s disease is also associated with PTSD. Nat Commun. 2019 Oct 8;10(1):4558.

Targeting hyperarousal: mantram repetition program for PTSD in US Veterans. Crawford HN, Talkovsky AM, Bormann JE, Lang AJ. Interventions focused on the management of hyperarousal may play an important role in recovery from PTSD. Mantram repetition appears efficacious in reducing hyperarousal, and thereby impacting other PTSD symptom clusters. Eur J Psychotraumatol. 2019 Sep 30;10(1):1665768.

Genome-wide association study of post-traumatic stress disorder reexperiencing symptoms in >165,000 US Veterans . Gelernter J, Sun N, Polimanti R, Pitrzak R, Levey DF, Bryois J, Lu Q, Hu Y, Li B, Radhakrishnan K, Aslan M, Cheung KH, Li Y, Rajeevan N, Sayward F, Harrington K, Chen Q, Cho K, Pyarajan S, Sullivan PF, Quaden R, Shi Y, Hunter-Zinck H, Gaziano JM, Concato J, Zhao H, Stein MB; VA Cooperative Studies Program (#575B) and the Million Veteran Program. Multiple locations in the human genome are related to the risk of re-experiencing traumatic memories. Nat Neurosci. 2019 Set;22(9):1394-1401.

Causes of excess mortality in Veterans treated for posttraumatic stress disorder . Forehand JA, Peltzman T, Westgate CL, Riblet NB, Watts BV, Shiner B. Veterans with PTSD have an elevated risk of death from suicide, accidental injury, and viral hepatitis. Preventive interventions should target these important causes of death. Am J Prev Med. 2019 Aug;57(2):145-152.

Efficacy of integrated exposure therapy vs integrated coping skills therapy for comorbid posttraumatic stress disorder and alcohol use disorder: a randomized clinical trial. Norman SB, Trim R, Haller M, Davis BC, Meyers US, Colvonen PJ, Blanes E, Lyons R, Siegel EY, Angkaw AC, Norman GJ, Mayes T. Exposure therapy is more efficacious in treating PTSD than a more commonly available integrated treatment without exposure for comorbid PTSD and alcohol use disorder. JAMA Psychiatry. 2019 Apr 24;76(8):791-799.

Validation of an electronic medical record-based algorithm for identifying posttraumatic stress disorder in U.S. Veterans. Harrington KM, Quaden R, Stein MB, Honerlaw JP, Cissell S, Pietrzak RH, Zhao H, Radhakrishnan K, Aslan M, Gaziano JM, Concato J, Gagnon DR, Gelernter J, Cho K; VA Million Veteran Program and Cooperative Studies Program. An algorithm to identify PTSD in electronic health records has high accuracy when compared with manual chart review. J Trauma Stress. 2019 Apr;32(2):226-237.

Posttraumatic stress symptom persistence across 24 years: association with brain structures. Franz CE, Hatton SN, Hauger RL, Kredlow MA, Dale AM, Eyler L, McEvoy LK, Fennema-Notestine C, Hagler Jr. D, Jacobson KC, McKenzie RE, Panizzon MS, Gustavson DE, Xian H, Toomey R, Beck A, Stevens S, Tu X, Lyons MJ, Kremen WS. Posttraumatic stress symptoms can persist decades after trauma exposure and are lined to lower hippocampal volume. Brain Imaging Behav. 2019 Mar 4;10.

Sticking it out in trauma-focused treatment for PTSD: It takes a village . Meis LA, Noorbaloochi S, Hagel Campbell EM, Erbes CR, Polusny MA, Velasquez TL, Bangerter A, Cutting A, Eftekhari A, Rosen CS, Tuerk PW, Burmeister LB, Spoont MR. Clinicians initiating trauma-focused treatments with Veterans should routinely assess how open Veterans' support systems are to encouraging Veterans to face their distress. J Consult Clin Psychol. 2019 Mar;87(3):246-256.

Shame as a mediator between posttraumatic stress disorder symptoms and suicidal ideation among Veterans. Cunningham KC, LoSavio ST, Dennis PA, Farmer C, Clancy CP, Hertzberg MA, Kimbrel NA, Calhoun PS, Beckham JC. Shame may be an effective point of treatment intervention to reduce suicidal ideation among Veterans with PTSD. J Affect Disord. 2019 Jan 15;243;216-219.

Do functional impairments promote or hinder mental health treatment seeking: differential results for women and men . Vogt D, Danitz SB, Fox AB, Sanders W, Smith BN. Relationship impairment interferes with treatment seeking for men but facilitated treatment seeking for women. Psychiatry Res. 2019 Jan;271:614-620. 

Effect of evidence-based supported employment vs transitional work on achieving steady work among Veterans with posttraumatic stress disorder: a randomized clinical trial. Davis LL, Kyriakides TC, Suris AM, Ottomanelli LA, Mueller L, Parker PE, Resnick SG, Toscano R, Scrymgeour AA, Drake RE. Individual placement and support is more effective than older methods of vocational rehabilitation at helping Veterans with PTSD find sustainable competitive employment. JAMA Psychiatry. 2019 Apr 1;75(4):316-324.

Trial of prazosin for post-traumatic stress disorder in military Veterans. Raskind MA, Peskind ER, Chow B, Harris C, Davis-Karim A, Holmes HA, Hart KL, McFall M, Mellman TA, Reist C, Romesser J, Rosenheck R, Shih MC, Stein MB, Swift R, Gleason T, Lu Y, Huang GD. In this trial involving military Veterans with chronic PTSD, prazosin did not alleviate distressing dreams or improve sleep quality. N Engl J Med. 2018 Feb 8;378(6):507-517, 2018.

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Posttraumatic Stress Disorder Fact Sheet

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