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PTSD changes the brain. Research by the Cincinnati VA aims to change it back

A marine in uniform puts his head in his hands.
Marines from Arlington, VA, United States
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Many Marines return to the states with vivid memories of their combat experiences, and the array of emotions they face internally may be hard to detect. While changes in behavior are more obvious, symptoms can also manifest in physical form.

The Cincinnati VA's focus on evidence-based treatments and cutting edge research makes it a leader in treating veterans with post-traumatic stress disorder. One of its current studies into the biological differences of people with PTSD is the largest in the world and could streamline diagnosis and treatment.

"No one wants to go through a lengthy assessment to find out if they have anything, whether it be a cancer diagnosis or a PTSD diagnosis," says Kate Chard, director of PTSD programs at the Cincinnati VA. "And so, one of the things we're looking at now is looking at blood and saliva and even EEG brainwave data to try to find biological differences. We know that PTSD creates a change in the brain. We also know that treatment can change it back."

In addition to biological differences, Chard suspects there are multiple kinds of PTSD the research could unveil and each one could respond differently to treatment.

More than 400 veterans nationwide are participating in the study, which started in 2019. Though it was slowed down by COVID, it's scheduled to end in December.

Treating PTSD

Post-traumatic stress disorder is a mental health condition triggered by trauma. It affects one's amygdala — which controls the fight, flight or freeze response — and prefrontal cortex, which directs behavior and decision making.

About 6% of the U.S. population has PTSD. That number is roughly double among veterans, according to the U.S. Department of Veteran Affairs. Those who served in Operation Iraqi Freedom and Enduring Freedom may have up to a 20% PTSD diagnosis rate.

"What's different about the military is we have people in the military who have the same childhood traumas as the rest of us — maybe car accidents, natural disasters — but they also can have traumas related to combat," Chard said, adding that the VA provides a space where veterans can get treatment without judgment of what they may have experienced in combat.

Chard says a diagnosis is the first step to getting better.

The Cincinnati VA offers cutting edge options for in- or out-patient treatment. The program focuses on evidence-based practices rather than only traditional talk therapy or medication.

"We have all sorts of veterans who come in telling us this is their last stop, that they've tried everything, that they are ready to end it all if this doesn't work. And they walk out of the program transformed," she said.

'We never stop'

The three kinds of evidence-based treatment the Cincinnati VA focuses on are cognitive processing therapy, prolonged exposure and EMDR.

Cognitive processing therapy helps people deal with their experiences without having to relive them in a detailed way. Prolonged exposure therapy takes an opposite approach, where people tell their traumas again and again. The third treatment, Eye Movement Desensitization and Reprocessing, is a combination of the first two.

"I think the thing that makes Cincinnati really stand out is we never stop. If one treatment doesn't work for you, then let's try something else," Chard says. "We're always going to be there for you to help you address your PTSD."

The future of PTSD diagnosis and treatment is ever changing. It could include the streamlined diagnosis her study is working on. Or it might include yet-to-be discovered medication that treats the cause instead of the symptoms of PTSD.

"The beauty is the sky's the limit," Chard says. "If our goal that we put at the top of the page is always to make as many people better as we possibly can, as fast as we can, then the goal will always be to improve treatments."

Chard's work at the Cincinnati VA was recently featured in a documentary called Here. Is. Better. It follows the stories of Cincinnati veterans, giving a raw account of what they experience day-to-day and during treatment.

For more information about PTSD at the Cincinnati VA, visit the VA Cincinnati Healthcare System website.