Neuroimaging Studies of PTSD and PTSD Treatment among Combat Veterans

Many of us have imagined the possibility of reading someone’s mind, but in the successful treatment of PTSD and other mental health problems, so much untapped potential lies in the ability to read someone’s brain. For example, what alterations in the intricate circuitry and function of the brain contribute to the nightmares, flashbacks, depression, anxiety, social withdrawal, and numerous other symptoms associated with PTSD? Likewise, how do our brains influence our response to trauma, and how do physical and emotional trauma impact the brain? When someone receives successful treatment for PTSD, what, if any, changes in brain structure and function occur as a result? Is it possible that new interventions could be designed to stimulate those same changes and enhance treatment?

STRONG STAR investigators are in a unique position to help answer these questions, thanks to the size and variety of the Consortium’s clinical PTSD treatment trials and the world-class resources and faculty expertise at the University of Texas Health Science Center at San Antonio’s Research Imaging Institute. Peter Fox, MD, director of the imaging institute and of the STRONG STAR Neuroimaging Core, has designed a STRONG STAR investigation that will apply advanced neuroimaging methods to study PTSD in the context of ongoing treatment trials to address

• the underlying neuroanatomical pathology (changes in the anatomy of the nervous system or nervous tissue that accompany the development of PTSD);
• the underlying pathophysiology (functional changes in the brain that are associated with the disorder); and
• neurobiological changes corresponding with PTSD treatment.

The ultimate goal is to shed light on the underlying neurobiology of PTSD in hopes of developing more effective, targeted treatment interventions.

Previous obstacles yield new opportunities for discovery

Dr. Fox’s study will utilize the strength’s of STRONG STAR to overcome previous obstacles in neuroimaging research on PTSD, enabling his research team to realize the full potential of this state-of-the-art research technique.

Opportunity #1: A large number of similar patients. Previous neuroimaging studies on PTSD have generally employed small, diverse samples of PTSD patients, typically including some individuals with childhood onset of PTSD, often resulting from abuse, and some individuals with adult onset of PTSD, often resulting from various causes, including accidents, assaults, and combat exposure. With so much variability among a small group of study participants, it has been difficult for researchers to discern the subtle consequences of PTSD, including how PTSD affects neural circuitry regulating emotional processing and general cognitive function. Unlike these previous studies, Dr. Fox’s STRONG STAR trial will include a large number of more homogeneous participants; all will be military personnel or veterans whose PTSD is related to combat exposure.

Opportunity #2: Consideration of resting brain activity and TBI. Other neuroimaging studies on PTSD have not examined resting state brain activity, which has shown significant promise as a marker for other neurological and psychiatric conditions. Another shortfall has been the inability of previous PTSD studies to examine the impact of co-occurring traumatic brain injury, which is a significant problem among veterans of the wars in Iraq and Afghanistan. Both of these are key components of Dr. Fox’s investigation.

Opportunity #3: Ability to see the effects of treatment. PTSD treatment studies have largely not been used to examine the underlying neural changes associated with successful treatment – an area of research that holds vast potential for radical treatment advances. This is a primary focus of this STRONG STAR trial led by Dr. Fox.

STRONG STAR participants, STRONG STAR results

Study participants will be recruited from various STRONG STAR clinical trials, including one trial using cognitive-behavioral therapy to treat PTSD and a second trial looking at the influence of alcohol dependence and alcoholic subtype on response to drug therapy for PTSD. Researchers also will recruit a control group of soldiers who returned from deployment to Iraq or Afghanistan without PTSD. Using a combination of state-of-the-art brain imaging methods and various cognitive and emotional tests and physical challenges, researchers will look for PTSD-specific patterns of brain activity in PTSD patients compared to the control group. Because study participants will undergo the same tests and assessments before and after treatment, researchers also expect to identify changes in patterns of brain activity associated with successful PTSD treatment.

STRONG STAR researchers expect these investigations to improve understanding of the neurobiology of PTSD and the underlying mechanisms of successful treatment, which in turn should lead to improved PTSD prevention and treatment for veterans and civilians alike.