Posttraumatic stress disorder (PTSD) is linked to altered physiologic functioning, including increased blood pressure and heart rate, especially in response to stressors. Increased cardiovascular reactivity to trauma-related stressors may link PTSD to poorer cardiovascular health and thus an increased risk of cardiovascular disease. Prior work by our lab suggests that these effects of trauma may be due to persistent changes in the central and peripheral nervous systems’ stress-response system. While there is an urgent need to address these effects, limitations in our ability to effectively measure these changes have led to a paucity of data regarding the impact of current PTSD treatments on these important endpoints.
We propose to develop a novel emotional Stroop task that will quantify physiologic reactivity to interpersonal and affective cues, and quantify the impact of affective and physiologic reactivity on cognitive control. In a Veteran sample, we will characterize how performance on this task relates to PTSD symptom burden and physiologic reactivity to tilt-table testing, and gather pilot data assessing its response to pharmacologic treatment.
Trauma and posttraumatic stress disorder (PTSD) are common in veteran and civilian populations. Meanwhile, observationally estimated half of people cared for at UW autonomic nervous system (ANS) disorder clinic have a history of trauma. Increasingly, research explains this observation through an evolving understanding of the complex interplay of peripheral and central catecholamine signaling that appear to underlie much of the persistent impact of trauma. An improved understanding of ANS changes in trauma and their relationship to the complex symptoms people experience is an important research frontiers to improve a) our understanding of PTSD, b) our ability to predict effective treatment for a given person, and c) the development of new treatments for PTSD. We propose implementing a novel analysis method for non-invasive autonomic testing in context of several clinical studies at VA Puget Sound. The proposed research aims to 1) make use of ANS testing results already available to provide quantitative data for adrenergic signaling, 2) test associations of extracted biomarkers with symptoms of PTSD, and 3) collect prospective data to test the relationship of peripheral autonomic signaling to quantitative measures of central nervous system (CNS) catecholamine signaling measured by event-related potential (ERP).
Post-traumatic stress disorder (PTSD) and substance use often go hand in hand, with many people using substances like cannabis to manage their symptoms. This concept, known as the self-medication hypothesis, suggests that people might use cannabis differently depending on the nature of their symptoms. Symptoms are classically split into domains – hyperarousal, emotional numbing, re-experiencing, and avoidance. However, it remains unclear whether different patterns of cannabis use might correspond to specific symptom domains, which could reveal distinct clinical phenotypes of PTSD.
By analyzing data from the PREDICT clinical trial, this study will apply advanced statistical methods to identify unobservable (“latent”) factors that characterize cannabis use in individuals with PTSD and examine their relationship with symptom presentation. In statistics and psychometrics, latent refers to a variable that cannot be directly observed—such as internal motivations, behavioral tendencies, or physiological dependence—but which can be inferred from patterns in observed data (e.g., questionnaire responses). These patterns could offer insights into subgroups of people with PTSD who experience different symptom profiles, also known as phenotypes, and may respond to treatments in unique ways. Ultimately, this research could contribute to more personalized, targeted interventions for individuals living with PTSD.
The COVID-19 pandemic facilitated simultaneous paradigm shifts in healthcare delivery: virtual care (telehealth and videoconferencing) and the need for “Whole Person” healthcare that targets mind, body, and spirit, per recent US Surgeon General1 and National Academy of Medicine2 calls-to-action. The pandemic also highlighted treatment delivery inequities involving rural Veterans. The current proposal will address these trends, assessing virtual VA Whole Health care use in Primary Care-Mental Health Integration (PC-MHI) for rural and non-rural Veterans with chronic pain and co-occurring posttraumatic stress disorder (PTSD).
The objective of the project is to evaluate the implementation and impact of the Acute Pain Services Expansion Program (APSEP), an expansion of the independent and formal set of services that provide comprehensive inpatient pain management consultative services and is designed to meet perioperative care needs of veterans receiving inpatient pain management.
This multi-method, participatory study centers Black Veterans and seeks to understand barriers and facilitators to weight loss among Black Veterans. The overall goal of this project is to reduce disparities between Black Veterans and White Veterans in the effectiveness of weight loss treatments.
We developed VetASSiST (Veterans Activating Social Support for Self-management and Treatment engagement) to help patients with multimorbidity overcome barriers to self-management and improve HRQoL. This trial has several aims: 1) Test the effect of VetASSiST, compared to usual care, on the primary outcome of baseline to one-year change in physical HRQoL, and secondary outcomes of mental HRQoL and health care utilization; 2a) Describe differences between VetASSiST and usual care on baseline to one-year changes in intermediate outcomes reflecting the functions of peer support and intervention targets; 2b) Examine whether intermediate outcomes mediate intervention-associated differences in HRQoL; and 3) Evaluate feasibility of translating VetASSiST into practice.
Opportunities for trainees may exist but a VA WOC appointment is required.
We developed a behavioral intervention that seeks to support healthy lifestyles among Veterans by harnessing their social support networks called HealthyTogether. This trial has several aims: 1) Test whether HealthyTogether results in greater weight loss than usual care at six months among Veterans (primary); 2) Examine differences between HealthyTogether and usual care groups in secondary Veteran and partner outcomes, including health behaviors and relationship quality; 3) Examine Veteran and partner contributions to changes in their own and each other’s outcomes using dyadic analyses; and 4) Assess determinants of implementation.
Opportunities for trainees may exist but a VA WOC appointment is required.
The proposed research will determine whether primary care clinics should offer medications or talk therapy first to treat posttraumatic stress. In addition, for patients who do not respond to the first treatment, the STEPS trial will determine what treatment should be offered next. More information on our info sheet.
This clinical trial is designed to pilot an electroretinogram (ERG) biomarker for predicting treatment response to SSRIs in PTSD. Serotonergic brain centers project to the retina, and ERG allows assessment of brain serotonergic signals via retinal signals. In this study we are characterizing the ERG waveform in veterans with PTSD before and after SSRI administration. Patients then enter an open label phase of the study, with those who have initiated an SSRI through routine medication management invited back for a follow up study visit. This pilot data will: 1)be valuable as a feasibility study for assessing the practical application of ERG in the setting of a mental health clinic and 2)serve as a foundation for a long-term goal of developing physiologic biomarkers to match veterans to corresponding pharmacological treatments in PTSD and other mental health disorders.
