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, 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.

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 (DoD), two consortia to improve treatment for PTSD and mild TBI
  • 2014
    • Found that cognitive processing therapy (CPT) delivered via videoteleconferencing 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

top

New, Ongoing, and Published Research

VA has a continuing commitment to fund efforts to understand, prevent, 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 occurs.

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, Vt.

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 are bringing together leading scientists and researchers throughout the nation, and are part of VA and DoD's response to an executive order to improve access to PTSD services for Veterans, service members, and military families.

top

➤ Main treatments for PTSD

VA offers several 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).

Some medications have also been shown to be effective in treating PTSD, especially selective serotonin reuptake inhibitors (SSRIs), which are also used to treat depression.

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.

In 2006, a VA study found that the symptoms of Veterans with PTSD were significantly reduced in those who received CPT.

Prolonged exposure therapy—VA researchers demonstrated, in 2013, the effectiveness of PE, or 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 repeatedly with therapists, in hopes of gaining control of thoughts and feelings about these difficult experiences.

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

Virtual reality studies—Researchers with the Long Beach VA Health Care System and the University of Southern California's Institute for Creative Technology are now conducting a study to determine whether virtual reality systems can improve the ability to deliver PE to those who have experienced military sexual trauma.

EMDR—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.

top

➤ Other PTSD treatments

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.

In 2013, a VA cooperative study (CSP #563) demonstrated that prazosin offered clinically meaningful benefits in reducing combat trauma nightmares in active-duty soldiers, and that there might be additional benefit in combining prazosin with evidence-based psychotherapies.

Deep brain stimulation—In 2014, physicians at the VA Greater Los Angeles Health Care System performed the first-ever trial 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.

DBS is a surgical procedure used to treat a variety of disabling neurological symptoms, especially those related to Parkinson's disease. It uses a surgically implanted, battery-operated device called a neurostimulator. The device delivers electrical stimulation to targeted areas in the brain.

In this case, doctors implanted two electrodes in the patient's amygdala, an almond-shaped cluster of neurons found on either side of the brain that help control emotion, memory, and other functions. 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 patient has shown dramatic improvement, with far less frequent and intense nightmares. For the near future, the team plans to do only one new procedure every six months, so that Veterans undergoing the procedure can be carefully monitored and observed.

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.

Service dogs—VA researchers are 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, Ore.

To date, there is ample evidence on the benefits of service dogs for people with physical disabilities, but very little such evidence in the area of mental health.

top

➤ Afghanistan/Iraq Veterans and PTSD

Benefits of prompt medical care—A 2014 study led by researchers at the San Francisco VA Medical Center 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 that 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.

Effects of guerrilla tactics—A 2015 study of 738 Veterans by the National Center for PTSD found that guerrilla tactics such as suicide attack and roadside bombs may trigger more posttraumatic stress than conventional warfare.

Researchers in the study identified three distinct phases of the Iraq War: the initial invasion phase, the insurgency phase and the surge phase. They found that men, who made up about half of the overall group, were more than twice as likely to have a diagnosis of PTSD if they served during the insurgency phase, during which more guerilla-style tactics were used, compared with those who served in either of the other two phases.

This trend, however, was not seen among the women in the sample.

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.

Physical ailments—In 2011, researchers from VA's Palo Alto Health Care System and Stanford University found Iraq and Afghanistan Veterans diagnosed with PTSD have more physical ailments than Veterans without the condition. In particular, women Veterans with PTSD were found to be more susceptible to physical health issues than their male counterparts.

Amygdala volume—In 2012, Durham VA Medical Center and Duke University researchers found that recent combat veterans with PTSD have less volume in the amygdala of their brains—an area that is critical in determining how people respond to fear and anxiety. The team did not determine whether this physiological difference was caused by a traumatic event, or whether PTSD develops more readily in those with smaller amygdalae.

Differences in brain function—In 2015, researchers from VA and Duke found that regions of the brain function differently among people with PTSD, causing them to generalize nonthreatening events as if they were the original trauma.

The team looked at 67 Veterans who had been deployed to conflict zones within Iraq and Afghanistan, and who had been involved in traumatic events. Thirty-two had been diagnosed with PTSD, and 35 did not have the disorder.

The findings suggest that exposure-based PTSD treatment strategies might be improved by focusing on cues that resemble the initial event, but are still distinct from it.

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.

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.

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.

top

➤ Vietnam Veterans and PTSD

Dorsal anterior cingulate—VA's Seattle Epidemiologic Research and Information Center (ERIC) maintains a registry of approximately 7,000 twins, all of whom served in the military during the Vietnam War era. The Vietnam Era Twin Registry is one of the largest national twin registries in the United States, and has been in existence in more than 20 years.

Using data from this registry, a team of researchers from VA, Massachusetts General Hospital, and Tufts University found in 2011 that an area in the brain called the dorsal anterior cingulate is activated more greatly in response to stimuli in Veterans who developed PTSD and their twins who did not serve in combat, as opposed to the Veterans and who did not develop PTSD after serving in combat and their twins.

Women Vietnam Veterans study—The HealthVIEWS: Health of Vietnam Era Women's Study, conducted by VA's Cooperative Study Program (CSP No. 579), is a study of approximately 10,000 women who served in the U.S. military during the Vietnam War. It includes those who served in Vietnam, those who served in countries near Vietnam, and those who served primarily in the United States. It is the most comprehensive study to date of the mental and physical health of women Vietnam-era Veterans.

The five-year study looked at the lifetime and current incidence of conditions in women Vietnam-era Veterans, including PTSD, depression, diabetes, heart disease, and disability.

A 2015 paper based on data from the study found that 20.1 percent of women Veterans who served in Vietnam developed PTSD either during or after their service. By contrast, 11.5 percent of those who served near Vietnam, and 14.1 percent of those who served in the United States, developed PTSD at some time during their lives.

According to the research team, the prevalence of PTSD for women who served in Vietnam was higher than previously documented, and Vietnam service significantly increases the chances of developing PTSD relative to service in the United States. The results suggest that the mental health effects of Vietnam-era service among women Veterans are long-lasting, and that earlier and better interventions may help avert the late-life mental health consequences of military service for newer generations of military women.

top

➤ Women Veterans and PTSD

PE therapy's value in women—VA researchers are learning about how women and men respond to combat and other traumas. Some findings suggest that they respond similarly to these situations, while other research points to possible gender differences.

In a 2007 study of women Veterans and active-duty personnel, VA researchers learned that prolonged-exposure therapy was more effective in reducing PTSD symptoms than a supportive intervention called present-centered therapy.

Partly as a result of this study, VA launched a nationwide effort to train more clinicians in PE.

Prevalence among women Veterans—In a national study of women Veterans from various eras published in 2013, 13 percent screened positive for PTSD. Among U.S. women in general, the lifetime prevalence of PTSD is just under 10 percent.

The study was the first to establish the overall prevalence of PTSD among women U.S. Veterans. Earlier studies focused only on those who use VA care, or women who served during a specific era.

Risk in women serving in combat—A 2015 study by VA researchers and researchers with the University of California, San Francisco, School of Medicine found that women who serve in combat are at the same risk of developing PTSD as men.

The study looked at more than 2,300 pairs of men and women deployed to Iraq and Afghanistan who were matched based on variables such as combat exposure, age, race, military occupation, marital status, and pay grade.

After following the pairs for an average of seven years, the research team found that 6.7 percent of the women and 6.1 percent of the men in the study developed PTSD. The difference was not statistically significant.

Accordingly, the researchers concluded that gender alone is not an indicator of PTSD risk, and that future research and treatment should focus on the types of traumatic experiences people have been exposed to, rather than any inherent gender differences in the development of PTSD.

Study of brain changes—The Brain Sciences Center is an interdisciplinary research institute and training center located at the Minneapolis VA Health Care System. The center focuses on the mechanisms underlying the active, dynamic brain in both health and disease.

The center's investigators are using neuroimaging and genotyping in a study that will attempt to determine which women Veterans are most likely to develop PTSD following exposure to potentially traumatic events,

Women Veterans with and without PTSD will be asked to complete diagnostic interviews, and undergo a noninvasive type of brain scan called magnetoencephalography. They will also be asked to provide a blood sample for genetic analysis.

top

➤ Additional trauma and PTSD

Boston Marathon and flashbacks—Many Veterans living in the Boston area who have been diagnosed with PTSD experienced anxiety, flashbacks, unwanted memories, and other psychological effects as a result of the bombing that took place near the finish line of the Boston Marathon in April 2013, according to a 2013 study conducted by VA's National Center for PTSD.

Researchers conducted 71 telephone interviews within a week of the bombing. Because they had symptom data from Veterans they had interviewed two months previously, they were able to compare their level of PTSD symptoms with results from the interviews.

Of those interviewed, 38 percent reported that they were emotionally distressed by the bombing and the subsequent lockdown of Boston and other communities. A majority of those participating said the bombing caused them to experience flashbacks and the reemergence of unwanted memories related to their own past trauma.

top

➤ Cardiovascular disease and PTSD

How PTSD affects the heart—A number of 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.

Combat deployment and heart disease—In 2014, VA and DoD researchers found that not only were PTSD symptoms linked to heart disease, but so was combat deployment. The study found that while there was a link between PTSD and coronary heart disease (CHD), that link was largely explained by the presence of two conditions that often accompany the disorder: depression and anxiety. When the team adjusted for those two mental health conditions, the relationship was no longer significant.

However, combat deployment itself was linked to CHD. There were 627 newly reported cases of the disease among the study population of more than 60,000 service members and recent Veterans, and the odds of this diagnosis were 60 percent higher among combat deployers, versus noncombat deployers. The researchers hypothesized that experiencing intense stress may increase the risk for CHD over a relatively short period among young adults.

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 when 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

SKA2 gene may predict risk—Biomarkers are measurable indicators of health and disease. One well-known example is cholesterol levels. Many biomarkers don't provide a definitive diagnosis of disease, but, along with other health information, may indicate risk and possible avenues of treatment.

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 posttraumatic stress disorder (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 cerebral cortex is the thin outer layer of the brain's cerebral hemisphere. It acts as the body's main control center and information processing center and is responsible for thought, perception, and memory. The prefrontal cortex is a region of the cerebral cortex that covers the front part of the frontal lobe and plays a role in regulating complex cognitive, emotional and behavioral functioning.

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.

RNA, or ribonucleic acid, is a nucleic acid present in all living cells. Its main role is to act as a messenger carrying instructions from DNA for controlling the synthesis of proteins.

The researchers tested blood samples from 58 Iraq and Afghanistan Veterans. Some of the Veterans had a combination of TBI and PTSD, some had only one of the conditions, and others had neither.

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 that 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 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.

TBI 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. Researchers are continuing to analyze the data.

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 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.

Biomarker of resilience—In 2013, VA researchers in Minneapolis found what one called a "biomarker of resilience," which may help explain why some people who are exposed to trauma never develop PTSD.

In the study, scans of PTSD-affected brains showed clusters of neurons (nerve cells that are the basic building blocks of the nervous system) that were locked into long-term interactions with other neurons. As a result, they weren't able to encode new information. Study participants who did not develop PTSD showed no such patterns.

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.

Mantram technique—Another team of researchers, from the VA San Diego Healthcare System, is investigating the "mantram" technique of meditation, a simple technique in which Veterans silently repeat a word or phrase that holds personal meaning for them.

A 2014 study found that mantram practice improved mindful attention in a group of 71 Veterans who received care at a VA outpatient PTSD clinic, compared to 75 Veterans who received treatment as usual

Mindful attention, which involves paying attention to thoughts and feelings without believing there is a right or wrong way to think or feel in a given moment, has been shown to reduce the severity of PTSD symptoms and to enhance psychological well being. The team believes that a program of mantram repetition may be a beneficial addition to usual care in Veterans with PTSD.

Yoga therapies—Researchers at the VA Palo Alto Health Care System are studying a meditation-based treatment called Sudarshan Kriya Yoga, a technique that involves a sequence of breathing exercises and improves sleep quality. If successful, the intervention may reduce the nightmares and insomnia that are common in PTSD patients.

Another team, at the Richard L. Roudebush VA Medical Center in Indianapolis, is comparing the effects on Veterans with PTSD of a 16-week holistic yoga program with a 16-week wellness lifestyle program. The team will also look at the effects of the two interventions on PTSD symptoms, and will create a manual for the yoga program to enable experienced yoga teachers to provide this type of therapy for individuals with PTSD.

Expressive writing—In a 2015 study of nearly 1,300 returning Veterans reporting problems reintegrating into society, those who completed online expressive-writing sessions showed more improvements than their peers who had either not written at all or had engaged only in factual writing.

The study was led by researchers from the Minneapolis VA Health Care System, the National Center for PTSD, and the University of Minnesota. Compared with no writing at all, expressive writing was better at reducing PTSD symptoms. It was also better than no writing for reducing anger, distress, reintegration problems and physical complaints and for improving social support. In terms of improving overall life satisfaction, no difference was seen between the study arms.

Those in the two writing groups wrote for at least 20 minutes on up to four separate days within a 10-day period. The expressive writing group wrote about their thoughts and feelings relating to their transition from soldier to civilian, and the factual writing group wrote about the information needs of new Veterans.

The team believes that this simple intervention may be a promising strategy for improving symptoms and functioning among Veterans who have had trouble reintegrating after their discharge.

top

More on Our Website

top

Selected Scientific Articles by Our Researchers

Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. Monson CM, Schnurr PP, Resick PA, Friedman MJ, Young-Xu Y, Stevens SP. This trial provided some of the most encouraging results of PTSD treatment for veterans with chronic PTSD and supports increased use of cognitive-behavioral treatments in this population. J Consult Clin Psychol. 2006 Oct;74(5):898-907.

Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. Schnurr PP, Friedman MJ, Engel CC, Foa EB, Shea MT, Chow BK, Resick PA, Thurston V, Orsillo SM, Haug R, Turner C, Bernardy N. Prolonged exposure therapy is an effective treatment for PTSD in female Veterans and active-duty military personnel. It is feasible to implement prolonged exposure across a range of clinical settings. JAMA, 2007 Feb 28;297(8):820-30

Complementary and alternative medicine in VA specialized PTSD treatment programs. Libby DJ, Pilver CE, Desai R. The widespread use of CAM treatments in VA PTSD programs presents an opportunity for researchers to assess the effect of CAM on PTSD service use and PTSD symptoms among Veterans. Psychiatr Serv. 2012 Nov;63(11):1134-6.

A Trial of Prazosin for Combat Trauma PTSD With Nightmares in Active-Duty Soldiers Returned From Iraq and Afghanistan. Raskind MA, Peterson K, Williams T, Hoff DJ, Hart K, Holmes H, Homas D, Hill J, Daniels C, Calohan J, Millard SP, Rohde K, O'Connell J, Pritzl D, Feiszil K, Petrie EC, Gross C, Mayer CL, Freed MC, Engel C, Peskin ER. Prazosin is effective for combat-related PTSD with trauma nightmares in active-duty soldiers, and benefits are clinically meaningful. Am J Psychiatry. 2013 Sep;170(9):1003-10.

Psychological effects of the marathon bombing on Boston-area Veterans with posttraumatic stress disorder. Miller MW, Wolf EJ, Hein C, Prince L, Reardon AF. Participants with PTSD were assessed by telephone within one week of the end of the Boston Marathon bombing; 42.3 percent of participants reported being personally affected by the bombings or the manhunt that followed. J Trauma Stress. 2013 Dec;26(6):762-6.

The role of military social support in understanding the relationship between PTSD, physical health, and healthcare utilization in women Veterans. Lehavot K, Der-Martirosian C, Simpson TL, Shipherd JC, Washington DL. Maintaining the social support of military peers after active duty is associated with better physical health among women Veterans, regardless of whether they have PTSD. J Trauma Stress. 2013 Dec;26(6)772-5.

Preliminary evaluation of PTSD Coach, a smartphone app for post-traumatic stress symptoms. Kuhn E, Greene C, Hoffman J, Nguyen T, Wald L, Schmidt J, Ramsey KM, Ruzek J. The PTSD Coach mobile application has the potential to be an effective self-management tool for PTSD. Mil Med. 2014 Jan;179(1):12-8.

Gender differences in the effects of deployment-related stressors and pre-deployment risk factors on the development of PTSD symptoms in National Guard Soldiers deployed to Iraq and Afghanistan. Polusny MA, Kumpula MJ, Meis LA, Erbes CR, Arbisi PA, Murdoch M, Thuras P, Kehle-Forbes SM, Johnson AK. Elevated PTSD symptoms among female service members were not explained simply by gender differences in pre-deployment or deployment-related risk factors. J Psychiatr Res, 2014 Feb;49:1-9

Association between traumatic brain injury and risk of posttraumatic stress disorder in active-duty Marines. Yurgil KA, Barkauskas DA, Vasterling JJ, Nievergelt CM, Larson GE, Schork NJ, Litz Bt, Nash WP, Baker DG; Marine Resiliency Study Team. Even when accounting for predeployment symptoms, prior TBI and combat intensity, TBI during the most recent deployment is the strongest predictor of post-deployment PTSD symptoms. JAMA Psychiatry. 2014 Feb 1;71(2);149-57.

Heart rate variability characteristics in a large group of active-duty marines and relationship to posttraumatic stress. Minassian A, Geyer MA, Baker DG, Nievergelt CM, O'Connor DT, Risbrough VB; Marine Resiliency Study Team. There is an association between PTSD and reduced heart rate variability when accounting for TBI and depression symptoms. Psychosom Med. 2014 May;76(4):292-301.

Impact of treatment beliefs and social network encouragement on initiation of care by VA service users with PTSD. Spoont MR, Nelson DB, Murdoch M, Rector T, Sayer NA, Nugent S, Westermeyer J. VA service users' social networks, veterans' perceptions of their need for mental health care, and their beliefs about PTSD treatment effectiveness may be fruitful targets for future treatment engagement interventions. Psychiatr Serv. 2014 May 1;65(5):654-62.

Prisoner of war status, posttraumatic stress disorder, and dementia in older veterans. Meziab O, Kirby KA, Williams B, Yaffe K, Byers AL, Barnes DE. POW status and PTSD increase risk of dementia in an independent, additive manner in older Veterans. Alzheimers Dement. 2014 Jun;10(3 Suppl):S236-41.

Deep brain stimulation of the basolateral amygdala for treatment-refractory combat post-traumatic stress disorder (PTSD): study protocol for a pilot randomized controlled trial with blinded, staggered onset of stimulation. Koek RJ, Langevin JP, Krahl SE, Kosoyan HJ, Schwartz HN, Chen JW, Melrose R, Mandelkern MJ, Sutzer D. Describes the protocol design for a Phase 1 pilot study of deep brain stimulation for severely ill, functionally impaired combat Veterans with PTSD who do not respond to conventional treatments. Trials. 2014 Sep 10;15:356.

Timing of mental health treatment and PTSD symptom involvement among Iraq and Afghanistan Veterans. Maguen S, Madden E, Neylan TC, Cohen BE, Bertenthal D, Seal KH. Interventions to reduce delays in initiating mental health treatment may improve Veterans' treatment response. Psychiatr Serv. 2014 Dec 1;65(12):1414-9.

Select small nucleolar RNAs in blood components as novel biomarkers for improved identification of comorbid traumatic brain injury and post-traumatic stress disorder in veterans of the conflicts in Afghanistan and Iraq. Ho L, Lange G, Zhao W, Wang J, Rooney R, Patel DH, Fobler MM, Helmer DA, Elder G, Shaughess MC, Ahlers ST, Russo SJ, Pasinetti GM. Biological interactions between TBI and PTSD may contribute to the clinical features of Veterans with comorbid mild TBI and PTSD. Am J Neurodegener Dis, 2014 Dec 5;3(3):170-81.

Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial. Fortney JC, Pyne JM, Kimbrell TA, Hudson TJ, Robinson DE, Schneider R, Moore WM, Custer PJ, Grubbs KM, Schnurr PP. Telemedicine-based collaborative care can successfully engage rural Veterans in evidence-based psychotherapy to improve PTSD outcomes. JAMA Psychiatry. 2015 Jan;72(1):58-67.

A national cohort study of the association between the polytrauma clinical triad and suicide-related behavior among US Veterans who served in Iraq and Afghanistan. Finley EP, Bollinger M, Noel PH, Amuan ME, Copeland LA, Pubh JA, Dassori A, Palmer R, Bryan C, Pugh MJ. Although the polytrauma clinical triad was a moderate suicide-related behavior predictions, interactions among its conditions, particularly PTSD, and depression or substance abuse had larger risk increases. Am J Public Health. 2015 Feb;105(2):380-7.

Elevated risk for autoimmune disorders in Iraq and Afghanistan Veterans with posttraumatic stress disorder. O'Donovan A, Cohen BE, Seal KH, Bertenthal D, Margaretten M, Nishimi K, Neylan TC. Trauma exposure and PTSD may increase the risk of autoimmune disorders such as rheumatoid arthritis. Biol Psychiatry, 2015 Feb 15;77(4):365-74.

Airborne hazards exposure and respiratory health of Iraq and Afghanistan Veterans. Falvo MJ, Osinubi IY, Sotolongo AM, Helmer DA. Published data based on case reports and retrospective cohort studies suggest a higher prevalence of respiratory symptoms and respiratory illness consistent with airway obstruction in Veterans deployed to Iraq and Afghanistan. Epidemol Rev. 2015;37;116-30.

The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans: a meta-analysis. Fulton JJ, Calhoun PS, Wagner HR, Schry AR, Hair LP, Feeling N, Elbogen E, Beckham JC. This meta-analysis examined 33 studies published between 2007 and 2013 and PTSD. J Anxiety Disord. 2015 Apr;31:98-107.

Sexual dysfunction in Veterans with post-traumatic stress disorder. Tran JK, Dunckel G, Teng EJ. Sexual dysfunction, including erectile difficulties in males and vaginal pain in females, is common among Veterans with PTSD. J Sex Med. 2015 Apr;1294):847-55.

Posttraumatic stress disorder and incident heart failure among a community-based sample of US Veterans. Roy SS, Foraker RE, Girton RA, Mansfield AJ. Prevention and treatment efforts for heart failure and its associated risk factors should be expanded among US Veterans with PTSD. Am J Public Health, 2015 Apr;105(4):757-83.

Obstructive sleep apnea and posttraumatic stress disorder among OEF/OIF/OND Veterans. Colvonen PJ, Masino T, Drummond SP, Myers US, Angkaw AC, Norman SB. Iraq and Afghanistan Veterans with PTSD screen as high risk for obstructive sleep apnea at much higher rates than those seen in community studies. J Clin Sleep Med. 2015 Apr 15;11(5):513-8.

Is Post-Traumatic Stress Disorder Associated with Premature Senescence? A Review of the Literature. Lohr JB, Palmer BW, Eldt CA, Aailaboyina S, Mausbach BT, Wolkowitz OM, Thorp SR, Jeste DV. PTSD may be associated with a phenotype of accelerated senescence. Am J Geriatr Psychiatry. 2015 Jul;23(7):709-25.

Mindfulness-based stress reduction for posttraumatic stress disorder among Veterans: a randomized clinical trial. Polusny MA, Erbes CR, Thuras P, Moran A, Lamberty GJ, Collins RC, Rodman JL, Lim KO. Among veterans with PTSD, mindfulness-based stress reduction therapy, compared with present-centered group therapy, resulted in a greater decrease in PTSD symptom severity. However, the magnitude of the average improvement suggests a modest effect. JAMA. 2015 Aug 4;314(5):456-65.

Longitudinal assessment of gender differences in the development of PTSD among US military personnel deployed in support of the operations in Iraq and Afghanistan. Jacobson IG, Donoho CJ, Crum-Cianflone NF, Maguen S. Women do not have a significantly different risk for developing PTSD than men after experiencing combat. J Psychiatr Res. 2015 Sep;68:30-6.

Prevalence of posttraumatic stress disorder in Vietnam-era women Veterans: the health of Vietnam-era women's study (HealthVIEWS). Magruder K, Serpi T, Kimerling R, Kilbourne AM, Collins JF, Cypel Y, Frayne SM, Furey J, Huang GD, Gleason T, Reinhard MJ, Spiro A, Kang H. The prevalence of PTSD for women Veterans serving in Vietnam is higher than previously documented. JAMA Psychiatry. 2015 Nov;72(11):1127-34.

Veterans' perspectives on initiating evidence-based psychotherapy for posttraumatic stress disorder. Hundt NE, Mott JM, Miles SR, Amey J, Cully JA, Stanley MA. Ambivalence and delaying evidence-based psychotherapies for PTSD are common. Psychol Trauma. 2015 Nov;7(6):539-46.

The effect of enemy combat tactics on PTSD prevalence rates: a comparison of Operation Iraqi Freedom deployment phases in a sample of male and female Veterans. Green JD, Bovin MJ, Erb SE, Lachowicz M, Gorman KR, Rosen RC, Kean TM, Marx BP. The nature of combat may be a risk factor for the development of PTSD among males. Factors other than enemy tactics may be more important to the development of PTSD among females. Psychol Trauma. 2015 Dec 14. (Epub ahead of print.)

Fear learning circuitry is biased toward generalization of fear associations in posttraumatic stress disorder. Morey RA, Dunsmoor JE, Haswell CC, Brown VM, Vora A, Weiner J, Stjepanovic D, Wagner HR 3rd, VA Mid-Atlantic Mirecc Workgroup, LaBar KS. Fear generalization in PTSD is biased toward stimuli with higher emotional intensity than the original conditioned-fear stimulus. Transl Psychiatry. 2015 Dec 15;5:e700.

Emotion regulatory brain function and SSRI treatment in PTSD: neural correlates and predictors of change. MacNamara A, Rabinak CA, Kennedy AE, Fitzgerald DA, Liberzon I, Stein MB, Phan KL Patients who show the most improvement from SSRIs are those who showed the least activation of the right ventrolateral prefrontal cortex before treatment. Neuropsychopharmacology. 2016 Jan;41(2):611-8.

SKA2 methylation is associated with decreased prefrontal cortical thickness and greater PTSD severity among trauma-exposed veterans. Sadeh N, Spielberg JM, Logue MW, Wolf EJ, Smith AK, Lusk J, Hayes JP, Sperbeck E, Milberg WP, McGlinchey RE, Salat DH, Carter WC, Stone A, Schichman SA, Humphries DE, Miller MW. DNA methylation of the SKA2 gene in blood indexes points to its potential value as a biomarker of stress exposure and susceptibility. Mol Psychiatry, 2016 Mar;21(3):357-63.

Tinnitus self-efficacy and other tinnitus self-report variables in patients with or without post-traumatic stress disorder. Fagelson MA, Smith SL. Individuals with tinnitus and concurrent PTSD reported significantly poorer tinnitus self-efficacy and more handicapping tinnitus effects when compared to individuals with other psychological conditions or those with tinnitus alone. Ear Hear. 2016 Mar 4. (Epub ahead of print).

Posttraumatic stress disorder is associated with worse endothelial function among Veterans. Grenon SM, Owens CD, Alley H, Perez S, Whooley MA, Neylan TC, Ascenbacher K, Gasper WJ, Hilton JF, Cohen BE. After adjusting for demographic, comorbidity and treatment characteristics, PTSD remained associated with worse endothelial function in an outpatient population. J Am Heart Assoc. 2016 Mar 23;4(3):e003010.

top

Posttraumatic Stress Disorder Fact Sheet

fact sheet thumbnail

Download PDF

VA Research in the News

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.