PTSD: National Center for PTSD
Behavioral Science Division Research
Behavioral Science Division Research
The Behavioral Science Division, located in Boston, MA, conducts research on assessment, post-deployment adjustment, genomic and neuroscience mechanisms of psychopathology, aging and health, plus innovative approaches to intervention and treatment delivery.
Prospective Cohort Studies
Key projects include two large prospective cohort studies. The first is a registry of 1,649 combat Veterans, both men and women, who have become users of VA services since 2002. This Department of Defense (DoD) funded project aims to provide data about outcomes associated with PTSD that will be used to supplement clinical information collected routinely through the VA electronic medical record. A prominent feature is use of standardized diagnostic interviews to validate PTSD diagnosis in the medical record, with recently published findings on the concordance between medical record diagnosis and diagnosis derived from the diagnostic interview. A Time 2 assessment retained over 80% of the original sample and Time 3 data collection currently is underway.
The second large investigation, the Neurocognition Deployment Health Study (NDHS), began data collection at the outset of the Iraq War/OIF in 2003. Military personnel were assessed before deployment to Iraq and at several intervals afterward, making it the first prospective, longitudinal study ever conducted on the psychological impact of war zone stress. The most recent data collection was funded by VA Cooperative Studies Program (CSP# 566) and was completed in June 2014. It examines long term emotional and neuropsychological outcomes of war zone stress and traumatic brain injury (TBI), as well as health-related quality of life and occupational functioning. The ongoing Family Foundations Study, a NDHS component funded by NIMH, examines the adjustment of family members (partners and children) in relation to the development and course of PTSD experienced by the military Servicemember.
Epidemiology and Risk/Resilience
The Division is collaborating with other investigators at VA Boston Healthcare System to study the long-term effects of military service, including combat and service-related stressors, on mental and physical health among aging Veterans. One project funded by the National Institute on Aging has created a website to provide researchers with information about military service variables that are available in a number of publicly accessible longitudinal data sets. This project has recruited a national, multidisciplinary group of experts to develop and implement a research agenda on this topic. A conference was convened in May 2014 at which attendees presented preliminary papers examining the long-term effects of military service on aging using data derived from this array of datasets. These papers are being prepared for publication in a volume reporting results of the conference. Another project under development aims to develop and evaluate a group intervention to improve functioning and quality of life for older Veterans with partial and full PTSD. A new study will soon be launched to test the efficacy of psycho-educational discussion groups for older Veterans who are experiencing late-onset stress.
Ongoing efforts include a psychometric evaluation of a new measure to assess the dissociative subtype of PTSD and examination of the impact of the dissociative subtype on response to PTSD treatment. A related line of research involves new data collection funded by the University of Minnesota Press Test Division to study the use of the new MMPI-2 Restructured Form scales for the assessment of DSM-5 PTSD, the dissociative subtype of PTSD, and PTSD-related malingering.
Division investigators participated in a consortium of private industry, universities, and government agencies working with the Defense Advanced Research Projects Agency (DARPA) to develop novel analytical tools to assess the psychological status of Warfighters. These tools examine patterns in everyday behaviors to detect subtle changes associated with PTSD, depression, and suicidal ideation. Many of these tools are about to be tested in a comprehensive field trial. VHA Mental Health administrators have expressed interest in transitioning some of these developed technologies for use in VA to improve psychological health awareness and promote timely help seeking, and these opportunities are being explored.
Division investigators are examining neural biomarkers of PTSD and blast-related traumatic brain injury (bTBI) in OEF/OIF/OND Veterans. This research aims to clarify the contribution of mild bTBI and psychiatric conditions to the various deficits experienced by military personnel with blast injury. A recent project used diffusion tensor imaging to examine the structural integrity of connections in the brain in relation to both bTBI and PTSD. A key finding is that bTBI accompanied by loss of consciousness is associated with decreased structural integrity of the brain compared with either blast exposure with no resulting TBI or bTBI without loss of consciousness. Furthermore, the index of brain integrity is directly associated with memory performance. A newly funded study will examine genetic influences on structural brain integrity following bTBI and PTSD.
Biomarker research at the Division also includes a rapidly growing portfolio of genetic studies. So far, this line of work yielded the first published genome-wide association study of PTSD, several published candidate gene studies, and a new gene expression study implicating glucocorticoid signaling gene in PTSD. Division investigators are engaged in neuroimaging-genetic analyses focused on PTSD-related neurodegeneration in collaboration with the Translational Research Center for TBI and Stress Disorders (TRACTS) at VA Boston. Other analyses are focused DNA methylation in relationship to PTSD and the use of DNA methylation profiles as a marker of cellular age and accelerated aging in PTSD. Division investigators also are collaborating with the Psychiatric Genomic Consortium (PGC) PTSD workgroup on large-scale genome-wide association analysis (GWAS) and methylation studies.
In collaboration with TRACTS investigators, Division researchers have identified alterations in brain morphology and functional connectivity that are associated with impulsivity in PTSD. A recent study found impulse control deficits were associated with reduced cortical thickness in frontal brain regions involved in flexible decision-making and emotion regulation in individuals with high (but not low) PTSD symptom severity. Further, disruptions in network connectivity between these frontal regions and regions that are involved in selective attention, memory/learning, and response preparation were associated with PTSD-related impulsivity. A pilot study currently is underway to assess motivations for engagement in different types of reckless and self-destructive behavior in trauma-exposed Veterans, and a related effort aims to validate a new measure of risky, impulsive, and self-destructive behavior. The newest study in the line of collaborations with TRACTS examines how methylation-based biomarkers of suicide risk predict neurodegeneration and symptoms of PTSD in OEF/OIF Veteran.
Another line of work continues to evaluate the dissociative subtype of PTSD. This includes a published paper using a GWAS to examine genetic markers for the symptoms that define the dissociative subtype of PTSD. This project found that a variant in the ADCY8 gene, which is involved in synaptic plasticity and neurogenesis, may be implicated in posttraumatic symptoms of derealization and depersonalization.
Finally, the Division is conducting functional and structural magnetic resonance imaging (MRI) studies to identify neural processes and structures relevant to reduction of PTSD. This research is based on the idea that the heightened emotional processing in PTSD has a detrimental impact on cognitive functioning and that treatment can be guided by understanding of the neural circuitry that is involved. Preliminary data for these projects have identified specific brain regions within the prefrontal cortex that are recruited when individuals with PTSD engage in regulation strategies to manage negative emotions. In addition, volumetric studies have identified specific subregions of the hippocampal formation that show reduced volume in PTSD. The findings may yield new insights into brain pathways that can be targeted to enhance emotional regulation and cognitive performance.
The Division continues to conduct pioneering research on treatments for PTSD, with key aims being to overcome barriers to seeking care, reducing dropout, and increasing the efficiency of care delivery. A prime example is a randomized clinical trial of an 8-session internet-based treatment (VetChange) designed for OEF/OIF/OND combat Veterans who report both risky use of alcohol and PTSD-related distress. The intervention reduced drinking and PTSD symptoms. The National Center and Bristol Myers Squibb Foundation are now supporting development of a mobile adaptation of VetChange and an app to further increase access to care. Division investigators are serving as clinical experts for another technology-based project aimed at improving care, a collaboration between VA and IBM to develop a Clinical Reasoning System, with a particular focus on PTSD.
Other efforts are aimed at developing and testing efficient therapist-delivered interventions or treatment extenders. The expectation is that these approaches will require less professional staff time and will be easier for patients to complete. For example, a previous study demonstrated strong symptom reduction and high satisfaction ratings for a brief, exposure-based treatment for PTSD delivered to non-Veteran patients. Now, with funding from NIMH, the Division is investigating whether this brief intervention is as effective as (i.e., noninferior to) Cognitive Processing Therapy. Similarly, recruitment is ongoing for a VA-funded study of group-based cognitive behavioral treatment for chronic PTSD. A proposal for DoD funding has been submitted to continue this line of treatment research with active duty service men and women.
The Division is also involved in research to identify the mechanisms by which cognitive-behavioral interventions promote recovery from PTSD and related disorders. Related projects under development include work to evaluate the Unified Protocol (UP) as an intervention for PTSD. A funding proposal under review aims to apply UP with active duty military members. Other planned studies will examine UP as an early intervention for civilians with PTSD and as a treatment for emotional disorders that frequently accompany PTSD.
Research on factors that link PTSD with aggression toward intimate partners, particularly within OEF/OIF/OND military families, led to the development and evaluation of interventions designed to reduce ongoing aggression and to prevent future aggression toward partners. Clinical trials examining two such interventions have been completed during the past year and, contingent upon positive outcomes, efforts will be made to disseminate these programs more widely within the VA.
In the area of complementary interventions, a pilot study investigating Tai Chi exercise for PTSD-related distress demonstrated high satisfaction and enthusiasm for this treatment modality by Veteran participants. Further studies are planned to examine Tai Chi for Operations Desert Storm and Desert Shield Veterans and to measure the impact of Tai Chi on chronic pain that is comorbid with PTSD.
Highlighting the innovative work within the Division, a recently funded study will examine the efficacy of a low-level light treatment protocol for Veterans with TBI that is comorbid with PTSD. This novel approach is extrapolated from established methods in photo medicine and based on pre-clinical studies showing that doses of red and near-infrared light improve mitochondrial functioning within damaged brain cells. The result of this improved cellular functioning is expected to be improved cognitive functioning of the individuals. Results from a published series of open-protocol, case studies with chronic TBI and TBI-PTSD cases show improvements on neuropsychological testing and measures of psychosocial functioning. The approach is being applied to Veterans who served during Operations Desert Storm and Desert Shield under a VA-funded study that has begun data collection.