There are currently more than 50 brain banks in the United States. The focus of these brain tissue repositories is on investigating alcoholism, Alzheimer's disease, depression, schizophrenia and a variety of neurological disorders. Yet there has never been a PTSD brain bank--until now.
With recently appropriated funding from Congress, the National Center for PTSD is leading a research consortium developing a national PTSD brain bank. This will be the first brain tissue repository dedicated to researching the physical impact of stress, trauma and PTSD on brain tissue, thereby advancing the scientific knowledge of PTSD, particularly PTSD biomarkers. Dr. Matthew Friedman, Senior Advisor to the Center and its former Executive Director, is directing the consortium. Plans are for the brain bank to become operational by early 2015.
Since 2003, leading academic and research institutions have collaborated in an effort, led by Friedman and Dr. Robert Ursano, Chair of Psychiatry at the Uniformed Services University of Health Sciences (USUHS), to establish a national PTSD brain bank. But various impediments, including lack of reliable funding, held up the project for a decade.
"We have wanted to do this for a long time, but only now have we received the funding we needed," Friedman explained. Sen. Patrick Leahy (D-VT), a steadfast supporter of the Center's mission to improve the lives of Veterans living with PTSD, spearheaded the successful effort to secure Congressional funding for the brain bank last year. Because of the pivotal roles played by Leahy and Friedman, the brain bank's official name is "The Leahy-Friedman National PTSD Brain Bank."
Like the National Center for PTSD, the brain bank is organized as a consortium with sites across the United States. Friedman directs the initiative from the Center's Executive Division in White River Junction, Vermont. The primary site for receiving brain tissue is the VA Medical Center in Boston in conjunction with the National Center's Boston-based Behavioral Science Division. The secondary receiving site is at the VA Medical Center in San Antonio, Texas. The USUHS in Bethesda, Maryland, serves as the primary assessment site, while the National Center's Clinical Neurosciences Division in West Haven, Connecticut, is the primary research site.
The Leahy-Friedman National PTSD Brain Bank will be a national resource to support VA and other academic researchers. As Friedman and co-author Dr. William W. Harris foretold in "Toward a National PTSD Brain Bank" (Winter 2004 special issue of Psychiatry , edited by Ursano), "It is expected that applicants who wish to utilize tissue housed in the brain bank would submit their proposals for peer review by a scientific committee convened for this purpose. Prioritization of submitted proposals would be conducted along time-tested peer review procedures."
The Leahy-Friedman National PTSD Brain Bank is a major advancement in the fight against PTSD.
"Although we have learned a great deal about abnormalities in brain structure and function from brain imaging research, there is no substitute for looking at the neurons themselves," said Friedman. "Understanding the cellular and circuit contributions to abnormal brain activity in PTSD is critical in the search for potential biomarkers of susceptibility, illness and treatment response and for developing new treatments targeting the conditions at the cellular level. The National PTSD Brain Bank's findings should help pave the way for new approaches to diagnosis and treatment of individuals with PTSD."
On August 29th, the Department of Veterans Affairs' (VA) National Center for Posttraumatic Stress Disorder (PTSD) celebrated its 25th anniversary. For the past 25 years, the Center has been the leader in research and education helping those who are living with PTSD.
The proposal for creating a National Center for PTSD arose from the growing mental health needs of Vietnam Veterans and others, and the recognition in 1980 of the PTSD diagnosis by the American Psychiatric Association. In 1984 Congress directed VA to form a National Center for PTSD "to carry out and promote the training of health-care and related personnel in, and research into, the causes and diagnosis of PTSD and the treatment of Veterans for PTSD."
VA established the Center in 1989 as a center of excellence that would set the agenda for research and education on PTSD. Although initially organized as a consortium of five divisions, the Center now consists of seven divisions across the United States, with headquarters in White River Junction, VT. Other divisions are located in Boston, MA, West Haven, CT, Palo Alto, CA, and Honolulu, HI. Each contributes to the overall Center mission through specific areas of focus.
"When we started, PTSD was a controversial diagnosis," said Dr. Matthew Friedman, the Center's Senior Advisor and its Executive Director from 1989 through 2013. Our research and educational initiatives helped establish the scientific basis for PTSD, and disseminated that information globally."
From the very beginning, the Center's initiatives have been making a critical difference in the understanding, assessment and treatment of PTSD.
Assessment and diagnosis. The Center's first meeting in 1989 launched the development of the Clinician-Administered PTSD Scale, the CAPS, which became the gold standard for assessing PTSD. Since then we have developed other leading assessment measures for trauma and PTSD for use in VA, the Department of Defense, and around the world. These assessment measures have advanced the clinical care of Veterans living with PTSD and research on PTSD by ensuring accurate diagnosis and assessment.
Applying technology to educate and disseminate information about PTSD. In 1991, our Published International Literature on Traumatic Stress database (PILOTS) became available to the public, providing a comprehensive cross-discipline index to all published research on trauma. In 1995, the Center launched its website, www.ptsd.va.gov, which has since become one of the world's leading websites on PTSD.
The Center has become the leader in online PTSD continuing education and technology-based education and resources for trauma survivors. In 2011 the Center partnered with the Department of Defense for the first publicly available VA mobile app, the award-winning PTSD Coach. Other self-help and treatment companion apps followed, as did an expanded desktop version of the Coach app, PTSD Coach Online. AboutFace, an online video gallery of Veterans talking about living with PTSD and how treatment has turned their lives around, breaks down barriers to seeking care and misconceptions about PTSD and its treatment. We continue to use technology to expand our reach, recently releasing our first YouTube Whiteboard video What is PTSD?.
Research, training and provider support. The National Center for PTSD also improves care of Veterans and others through its research into the prevention, causes, assessment, and treatment of traumatic stress disorders. Our investigators have been at the forefront of research demonstrating alterations in brain function associated with PTSD, which has significantly enhanced the science and understanding of PTSD and improved PTSD identification and care. They have also conducted leading research on the treatment of PTSD, particularly the main evidence-based psychotherapies: Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE).
Our staff assisted VA with national clinical training programs in these therapies, helping make available state of the art treatment for PTSD to Veterans across the country. To support evidence-based PTSD care, in 2008 the Center helped create the VA Mentoring Program, which encourages implementation of evidence-based treatments for PTSD , and in 2011 helped establish the VA PTSD Consultation Program, which advises VA clinicians on PTSD.
As Elana Newman and Bruce Shapiro wrote in the International Society for Traumatic Stress Studies' (ISTSS) newsletter on our 20th anniversary, "The Center has clearly advanced science and promoted understanding of traumatic stress in ways that the Senators who envisioned the Center never imagined would be realized. In fact, much of the knowledge we have about PTSD at this point has been generated and disseminated through the efforts of the National Center staff. The Center has sparked changes in the field that have fostered general understanding of PTSD as well as translated into concrete benefits for survivors of trauma, the VA/DoD system, and family members."
While the Center has made great strides in PTSD research and education over the past 25 years, we look forward to making even greater progress in prevention, resilience and recovery as well as diagnosis and treatment. We have many exciting initiatives in progress.
For example, the National Center for PTSD is creating the nation's first brain tissue repository, or brain bank, dedicated to researching the physical impact of stress, trauma and PTSD on brain tissue. The administration of the Brain Bank has been organized, and its construction is well under way.
Last year President Obama announced the award of $45 million over five years to the Consortium to Alleviate PTSD (CAP), co-led by the Center, to advance PTSD diagnosis, prevention and treatment for service members and Veterans. CAP will research the biology/physiology of PTSD development and treatment response to inform diagnosis, prediction of disease outcome, and new or improved treatment methods.
Dr. Paula Schnurr, the Center's Executive Director, is lead principal investigator in a $10 million groundbreaking study that will compare the two major evidence-based psychotherapies for PTSD: Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). The study's results will help inform choices about the delivery of PTSD care in VA, and will also be broadly relevant to the scientific and clinical communities outside VA.
"We have come a long way in the past 25 years, but there remains much more to be done," said Dr. Schnurr. "We must continue to increase our scientific understanding of PTSD through research and develop better evidence-based treatments as well as prevention strategies. We also need to raise public awareness of PTSD and help people with this mental health problem get the care they need. I am confident that we can and will meet these challenges."
For more information about the Center's accomplishments, history, and future projects, visit our About the National Center.
In observance of PTSD Awareness Month: June 2014, the National Center for PTSD presented the following profile of a Veteran who is living with PTSD and turning her life around with treatment.
Finding it hard to be home alone or feel comfortable in public places, Marine and MST survivor Laura Hendrixon is determined to get better for her family.
Laura Hendrixon had always thought PTSD came only after combat exposure--until it happened to her. "After being in the Marines for a year and a half, I was sexually assaulted by another Marine who was also a co-worker and a friend of mine," she said. "It's embarrassing to talk about, but I don't want to be scared anymore. I want to be stronger."
The trauma affected her so much that she was afraid to take a shower when she was home alone. "...I would basically be in panic mode the whole time," she said. "I would think..."Oh my gosh, I want to get a shower, but I can't get a shower because I'm home by myself, and if I'm in the shower, I'm not going to be able to hear if somebody comes in the house." I would get scared to the point that I wouldn't close my eyes when I'm taking a shower."
Laura was diagnosed with PTSD. Her doctor at VA suggested she get into treatment. "I finally had a doctor point out to me that, you know, it would be really good if I went through this treatment," she recalled. "I knew I needed to do it because I can't wait to have kids, and I was like, "I cannot be this person with kids. I'm going to, like, wrap them up in bubble wrap."
Laura's treatment at VA was a form of talk therapy called Prolonged Exposure (PE). In PE, the goal is for the patient to have less fear about her memories. It is based on the idea that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic event. By talking about her trauma repeatedly in a safe environment with a therapist, the patient learns to get control of her thoughts and feelings about the trauma. She learns that she does not have to be afraid of her memories.
"I made a list of things I needed to be able to do: make left-hand turns, ride in an elevator, go somewhere by myself, get showers. It's like, I need to learn how to deal with this stuff, now," she explained. "It was very difficult at first. I had to go back to that moment and, you know, describe exactly how I felt, and emotions and fears, and everything about the moment. It did get easier. You actually record yourself, and then you listen to it, so in some way it tricks your brain into accepting that this did happen to me and, you know, I'm going to be OK, and it's going to get better."
Laura also credits her husband for much of the progress she has made. "My husband is a lifesaver," she said. "We're going to counseling together, and they're helping us talk through some of the daily struggles that I have with PTSD. He's so good for me; he encourages me to do things I'm not comfortable with. I definitely plan to keep moving forward with it. I'm always thinking, like, "Just do it!" I can do all kinds of stuff."
You can see the entire AboutFace video profile of Laura Hendrixon on YouTube.
For more information on PTSD and ways to raise awareness of this mental health problem during June and throughout the year, professionals and members of the public can visit our PTSD Awareness page.
When the President makes an announcement, you know it must be about something big. On August 10, 2013, President Obama announced at the Disabled American Veterans National Convention in Orlando, Florida, a $107 million grant to research the diagnosis and treatment of PTSD and mild traumatic brain injury (mTBI) over a five-year period. Of this amount, $45 million will be provided to the Consortium to Alleviate PTSD (CAP), co-led by the National Center for PTSD and the STRONG STAR Consortium at the University of Texas Health Science Center at San Antonio.
"I don't think we've ever gotten anything this big in one grant," said Dr. Matthew J. Friedman, Senior Advisor to the Center and its former Executive Director. "$25 million of the $45 million will go to support research at VA sites, and there are a number of projects embedded in that." CAP Co-Director Terence Keane, Director of the Center's Behavioral Science Division, noted that these research projects are designed to answer many critical questions about PTSD.
"Is combat-related PTSD uniquely different and more difficult to treat?" he gave as one example.
"Would outcomes improve with early interventions delivered soon after trauma exposure? Can combat-related PTSD be cured? Few national health crises are more deserving of the greatest efforts of the world's top scientists to answer these questions."
These research initiatives will include efforts to learn more about the development of PTSD, including biomarkers of PTSD, treatment response (to inform diagnosis, prediction of disease outcome,) and new or improved treatment methods.
"Our programmatic capability will be expanded through this very important CAP partnership," Friedman said. "One of the Center's top operational priorities is biomarker research, and this will certainly be a big boost to that priority. We would also like to leverage this money and expertise to compete for additional money for other projects."
Many outstanding research organizations throughout the United States vied for this award. "The competition for the award was extraordinary," said Friedman. "It's clear that there are now a number of superb groups conducting research on PTSD in the United States. The fact that the National Center for PTSD came out on top with STRONG STAR is wonderful, but people should not lose sight of the fact that there is outstanding research being done elsewhere, and we will continue to collaborate with those who are doing this research."
For more information, visit www.ConsortiumToAlleviatePTSD.com
On February 19, 2014, former President George W. Bush, speaking at a summit he convened on Veterans' issues, said that posttraumatic stress disorder (PTSD) has been mislabeled as a "disorder" and that calling it just "post-traumatic stress" would go a long way in erasing the stigma that affects many returning Veterans. See Bush wants change in how PTSD is handled (The Dallas Morning News, February 19, 2014) In this story, Dr. Matthew Friedman, Senior Advisor to the National Center for PTSD and its former Executive Director, disagreed with the former president, stating:
Others, including some doctors and high-ranking military officials, previously called for such a change, The Dallas Morning News noted. In 2011, then-Army Vice Chief of Staff Gen. Peter W. Chiarelli asked the American Psychiatric Association to drop "disorder" from the term posttraumatic stress disorder in the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM). In his November 3, 2011 letter to Gen. Chiarelli, APA President Dr. John Oldham, disagreed, stating:
"...it is our belief that merely changing the diagnostic label of PTSD will not solve the problem. In fact, the distinction between posttraumatic stress and PTSD is very important and useful in terms of prompt diagnosis and treatment, as people can (and often do) recover from PTSD."
At the APA's annual conference in 2012, Dr. Friedman and Gen. Chiarelli addressed this issue on the same panel. Dr. Friedman, who chaired the committee that updated the trauma section of the fifth revision of the DSM (DSM-5, released May 2013), said the net effect of such a modification would be to tinker with a psychiatric diagnosis rather than help patients. Instead, he suggested the U.S. military consider the Canadian military's approach. The Canadian military coined the term "Operational Stress Injury (OSI)" for, among other things, combat-related PTSD. See Key Psychiatric Doctor Rejects Name Change for PTSD (PBS, May 10, 2012)