Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment (2014) / Chapter Skim
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Appendix E: Detailed Descriptions of PTSD Research in the Department of Defense, the Department of Veterans Affairs, and the National Institutes of Health
Appendix E: Detailed Descriptions of PTSD Research in the Department of Defense, the Department of Veterans Affairs, and the National Institutes of Health
Pages 261-284
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From page 261... ...
The committee tried to identify the main funding source so that the study would be counted only once, but this was not always possible and some studies, particularly studies funded jointly by DoD and VA, were counted twice. A 1 A list of these studies can be obtained by contacting the National Academies Public Access Records Office.
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From page 262... ...
• A few projects comparing other anxiety disorders such as social anxiety disorder with PTSD to understand the similarities and dif ferences in the mechanisms underlying the pathophysiology across the different disorders. • Projects investigating the mechanisms of the stress response and the hypothalamic pituitary axis, its neural circuitry, and factors that modify that circuitry.
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From page 263... ...
• Several studies focused on the hypothalamic pituitary axis, spe cifically the corticotrophin-releasing factors and corticotrophin releasing hormone, associated receptors, and how those enhance fear memory consolidation. • A few studies focused on the selective serotonin reuptake inhibitors (SSRIs)
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From page 264... ...
The second aim examined the effect of combat trauma history and subsequent drinking behavior and subjective response to alcohol. • A project to evaluate if a dose response relationship existed be tween level of exposure to stressors and functioning over time; to understand the role of resilience and psychopathology in level of functioning; and to understand the role of healthy coping strategies and social supports as associated with functioning.
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From page 265... ...
The studies that did fall into this area focused on the influence of stress and norepinephrine on fear responses; sex differences in corticotrophin releasing factor in the prefrontal cortex; adenylate cyclase-activity polypeptide, its antagonists, and its interaction with the bed nucleus of the stria terminalis during fear learning; and morphological differences (gross differences or at the synaptic levels in the prefrontal cortex) between males and females.
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From page 266... ...
Most of the rodent animal models under this research target were concerned with identifying and understanding mechanisms of resilience, memory formation, fear responses, and learned fear. • Two rodent models were used to identify genetic and biologic fac tors that may influence risk for PTSD and comorbid alcohol use disorders.
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From page 267... ...
• One study examined if paroxetine changed fMRI responses in vet erans with PTSD. • One study aimed to develop psychophysiological, neuropsychologi cal, and self-report models to predict PTSD symptom response to pharmacotherapy, psychotherapy, and combined pharmacotherapy and psychotherapy in veterans with PTSD.
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From page 268... ...
PREVENTION DoD = 21; VA = 9; NIMH = 18; Other NIH Institutions = 4; Other = 8 The committee identified several studies that investigated the prevention of PTSD through stress-management interventions and pharmacological interventions. Some of those studies included the following: • Several studies investigated the development of or severity of PTSD symptoms when substances such as hydrocortisone, oxytocin, di azepam, and polyunsaturated fatty acid were administered around the time of the trauma.
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From page 269... ...
Some of the specific studies in this area include the following: • One study focused on predicting mental health and substance abuse service needs in OEF and OIF military personnel within the first 12 months of returning from deployment. • One study focused on the associations among military sexual trauma, PTSD symptoms, health behaviors, and physical health problems in male and female marine recruits.
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From page 270... ...
• One study examined psychological mechanisms of resilience in combat veterans. SCREENING DoD = 4; VA = 5; NIMH = 3; Other NIH Institutes = 0; Other = 0 The studies in this target area were mostly focused on screening for PTSD, mild TBI, PTSD comorbid with substance abuse, cognitive symptoms of PTSD, interpersonal violence, or exposure to military sexual trauma.
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From page 271... ...
DIAGNOSIS AND DETERMINING SYMPTOM SEVERITY DoD = 5; VA = 5; NIMH = 1; Other NIH Institutes = 0; Other = 0 In this target area, several studies were identified that investigated tools for diagnosing PTSD and determining PTSD symptom severity. • Two studies used positive emission tomography to investigate ob jective biologic markers, one used positive emission tomography for a limited aspect of PTSD, negative expectancies, and another used it to study region-specific metabolic changes to identify dif ferences between mild TBI and PTSD.
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From page 272... ...
Other drugs un der study included lithium augmentation of SSRIs for its effects on hyperarousal and modafinil versus placebo augmentation. • Several studies investigated propranolol to block memory consoli dation and physiological hyperresponsivity and reduce symptoms of PTSD.
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From page 273... ...
• Bright light and trigeminal nerve stimulation were two other novel treatments under exploration, each in randomized controlled trials. Target A.3: Psychotherapies DoD = 4; VA = 12; NIMH = 6; Other NIH Institutes = 2; Other = 20 The committee found numerous treatment studies that were psychotherapy-specific.
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From page 274... ...
• One study investigated the potential to augment any evidence based treatment with an additive CBT module designed to specifi cally address issues related to killing in a war zone. • One study compared PE with a non-trauma-focused present centered psychotherapy approach called Trauma Affect Regulation: Guide for Education and Therapy (TARGET)
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From page 275... ...
Target A.5: Complementary and Alternative Treatments DoD = 15; VA = 14; NIMH = 0; Other NIH Institutes = 4; Other = 12 The committee identified a range of complementary and alternative medicine studies, including those that focused on mindfulness, relaxation, yoga, mantram repetition, acupuncture, acupressure, biofeedback, and guitar music therapy. Specific studies in this category included • Different forms of meditation, such as mindfulness-based, loving kindness, self-compassion and transcendental meditation, were found most often in randomized controlled trials with either an active or inactive control.
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From page 276... ...
Target A.6: Different Models for the Delivery of PTSD Care DoD = 24; VA = 19; NIMH = 4; Other NIH Institutions = 2; Other = 10 The committee identified several projects that tested new technologies to deliver telehealth using a remotely located clinician, to provide supplementary self-help material via websites, to monitor patient reactions using patient-worn sensors connected to mobile devices between sessions, and to use interactive voice response telephone monitoring systems to maintain patient engagement. Some of the studies in this area included the following: • Three projects that focused on primary care settings, including ways that the primary care model could maximize accessibility of care and the added value of an array of technologies to improve the stepped care model.
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From page 277... ...
• Nine telehealth studies were identified: One focused on PE, three tested CPT, one tested an Internet writing intervention, two tested a behavioral activation approach, and two tested general CBT approaches. • Five virtual reality exposure therapy projects were identified: One studied the development of a virtual reality exposure therapy sys tem, one dismantled the virtual reality component of the therapy to see if showing only still images would be sufficient for reduc ing PTSD symptoms, and the other three compared virtual reality exposure therapy with traditional PE (one of which also tested the interaction with D-cycloserine)
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From page 278... ...
One focused on comparing efficacy of massed versus spaced trials for PE therapy delivery in recently returned active-duty service members. Another PE study compared delivery in a traditional PE one-on one format versus cognitive behavioral conjoint therapy for PTSD, which is a trauma-focused approach designed to be delivered in a couples format to produce greater improvement in intimate rela tionship functioning.
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From page 279... ...
There were also a few studies related to pharmaceutical agents, technological applications, and yoga. Examples of specific studies included the following: • A study examined prescribing patterns for PTSD and bipolar dis order to better characterize and understand prescribers' decision making.
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From page 280... ...
• Other studies of comorbidity include narrative exposure therapy versus treatment-as-usual for PTSD with borderline personality dis order; tailored CBT treatment of PTSD in conjunction with serious mental illness such as psychosis and bipolar disorder; treatment of PTSD with panic attacks or panic disorder with multiple channel exposure therapy; and the use of repetitive transcranial magnetic stimulation for suicidality in those who have PTSD, depression, and mild TBI. • Several studies investigated treatments for patients who have PTSD and depression using quetiapine, aripiprazole, vilazodone, and pra zosin.
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From page 281... ...
However, there were two studies that investigated variations in institutional review board functioning, one study that focused on transitioning care from DoD to VA, and two studies that were focused on identifying barriers for delivering novel treatments, such as acupuncture. LONG-TERM OUTCOMES ASSOCIATED WITH PTSD DoD = 9; VA = 10; NIMH = 4; Other NIH Institutes = 5; Other = 0 The committee identified several studies that investigated long-term health outcomes in people who had a diagnosis of PTSD.
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From page 282... ...
INTIMATE PARTNER VIOLENCE DoD = 0; VA = 4; NIMH = 2; Other NIH Institutes = 2; Other = 1 The committee identified a few studies that included reference to associations between PTSD and intimate partner violence. • One study focused on mental health and physical health of men who sustain partner violence and their children.
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From page 283... ...
• One study aimed to provide data to support the associations be tween PTSD and heightened rates of intimate partner violence in a veteran population. The primary objective was twofold: to describe the differences and examine factors that facilitate the detection by providers of intimate partner violence perpetrated by veterans and to describe and examine what variables might promote accurate detection.
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From page 284... ...
Target B: Research or Training Grants for Career Development DoD = 0; VA = 1; NIMH = 13; Other NIH Institutions = 8; Other = 0 The committee identified several k-awards or training grants in the NIH RePORT database. Some of the major topic areas of these awards and grants included the impact of PTSD on older veterans; laboratory methods for PTSD; the molecular basis of emotional learning; the use of fMRI for emotional memory research in PTSD; olfaction and PTSD; the neural basis of safety learning and fear inhibition by safety; and the genetic and environmental etiology of depression, anxiety disorders; s and PTSD.
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