The co-occurrence of posttraumatic stress disorder (PTSD) and hazardous drinking (HD) can be particularly devastating; though evidence-based treatments exist, many individuals with this co-occurrence drop out from or do not or cannot access specialty care. Text-messaging is a mode of intervention delivery that is low-cost, low-burden, and accessible to most people; development and testing of self-directed text message interventions that use evidence- and theoretically-based strategies to reduce PTSD and HD symptom burden is highly needed. Such interventions have the potential for great clinical significance via providing additional, novel treatment options that are readily scalable and have wide reach and thus can have a large impact on individual and public health.
Targeted Condition: PTSD
The PREDICT study: a personalized medicine approach to prazosin for PTSD
Prazosin, like many of our most effective treatments for PTSD, seems to be significantly more effective for some individuals than others. We have hypothesized that this is because prazosin works to compensate for increased noradrenergic signaling, which is a primary driver of symptoms in some, but not all, individuals with PTSD. If we could identify individuals where increased or inappropriate noradrenergic signaling is driving PTSD symptoms, it would not only help us match individuals with treatments that will work well for them, but would also help us identify new treatment options.
The PREDICT study is a 5-year clinical trial designed to (1) test whether clinically-relevant biomarkers can predict in advance who is most likely to benefit from prazosin for PTSD; and (2) test a working model of how pre-synaptic and post-synaptic changes in the regulation of noradrenaline may combine together to produce the symptoms of PTSD.
The ATTEND study for Healthcare Workers and First Responders
Healthcare workers and first responders working during the COVID-19 pandemic have experienced increased exposure to suffering and loss; prolonged work hours; and increased personal risk. Although associated increases in psychiatric symptoms and occupational burnout are well documented, what aspects of the experiences are most strongly associated with negative outcomes over time – and what interventions are most likely to protect healthcare workers and first responders – are poorly understood.
The ATTEND study is designed to address the impact of occupational stress related to working during the COVID-19 pandemic on health care workers and first responders (police, fire, EMTs) through a national longitudinal survey paired with a local interventional clinical trial. The interventional clinical trial is designed to test the impact of treating sleep disruption with prazosin during or shortly after the period of exposure.
Communication and Recovery Enhancement (CARE) clinical trial
This study aims to refine and test a brief intervention (CARE) that aims to promote recovery in recent sexual assault survivors. CARE is delivered to supporters of sexual assault survivors (e.g., friends, family members, romantic partners), with or without the survivor present. It aims to encourage conversations about the assault and decrease negative reactions by the supporter. In stage 1 of this study, we will conduct feedback sessions with 8-10 dyads of survivors and their supporters to finalize the intervention materials. In stage 2, we will conduct a pilot clinical trial of CARE with 60 dyads, who will be randomized to dyadic intervention, supporter-only intervention, or waitlist control.
Project THRIVE pilot
This study involved developing and preliminarily testing a new app to prevent PTSD and alcohol misuse following recent sexual assault.
Understanding mental health problems and health risk behaviors among LGBT Veterans
LGBT Veterans have faced a long history of stigma, discrimination, and exclusionary policies that were intended to exclude them from military service. Despite recent shifts in policy and increased staff trainings, existing evidence suggests that this group is at high risk for health disparities, particularly with respect to mental health and health risk behaviors. While informative, the research to date has been limited in several respects: cross-sectional designs, collapsing LGBT subgroups, severe lack of data on some subgroups, problems with identifying a comparison group, and lack of data on risk and protective factors and care experiences. This prospective cohort study will fill these gaps, recruiting and conducting surveys online with 1,600 Veterans to identify health disparities, test a conceptual model of prospective risk and protective factors, and assess VA utilization, barriers to care, and treatment preferences. Data from this study will inform future intervention efforts to achieve health equity for LGBT Veterans.
Pilot trial of a computerized treatment for mental health symptoms in primary care
This pilot study will leverage Veteran expertise to inform user-centered design improvements and will pilot the effectiveness of a computerized intervention targeting anxiety sensitivity among this patient population.
Developing pragmatic adherence measures for dialectical behavior therapy (DBT)
This project aims to develop pragmatic self-report measures of: 1) clinician adherence to Dialectical Behavior Therapy (DBT), and 2) DBT program fidelity. These measures will be tested among DBT clinicians in routine practice settings to evaluate their reliability and validity.
MOVE!+UP: Testing a tailored weight management program for Veterans with PTSD
This Hybrid Type 1 Trial will test the effectiveness of MOVE!+UP, a behavioral weight management intervention tailored to address PTSD-based weight loss barriers. The trial will compare MOVE!+UP to VA’s standard weight loss program on weight and PTSD symptom changes. The study also will identify implementation barriers and facilitators to help understand effectiveness findings and inform future implementation.
Development of F-18-Labeled Radiotracers for PET Imaging of Brain Alpha1A Adrenoceptor: A Tool for Precision Medicine in PTSD
Prazosin, a drug that prevents the neurotransmitter norepinephrine from binding to its alpha1 receptor (alpha1-AR) subtype has shown efficacy in reducing PTSD symptoms in most, but not all, studies of trauma-exposed Service Members, Veterans, and civilians. However, it is not effective in all patients and its use is complicated by variability in effective doses, a short duration of action, and frequent orthostatic hypotension at dose initiation.
We propose to develop a fluorine-18-labeled radiotracer for PET imaging of brain alpha1A-ARs (implicated in the pathophysiology of PTSD) in human subjects so as to create a PET-based method to identify alpha1A-AR blocking drugs that are more broadly effective and lack the shortcomings of prazosin. Displacement of radiotracer binding by drug candidates will allow assessment of their actions at brain alpha1A-ARs and facilitate the development of novel PTSD therapeutics.
