Project Details for

Funding Agency: Department of Defense
On-Going Research Projects

Title: Neuroendocrine Correlates of PTSD Before and After Treatment
Synopsis: This project will examine biological and psychological alterations in veterans with post-traumatic stress disorder (PTSD) before and after treatment.
Overall Summary: Though trauma is the proximal cause of post traumatic stress disorder (PTSD), most combat-exposed veterans do not develop PTSD. This observation has led to a search for biological and psychological risk factors that increase the probability of developing PTSD following trauma exposure. Since some who develop PTSD also recover, there are also factors associated with recovery. It is imperative to determine the extent to which recovery from PTSD depends on modifying the status of putative (modifiable) risk factors for PTSD. Indeed, recovering from PTSD may not depend on changing risk factors, but rather, to the presence or emergence of a different set of biological and psychological factors that serve to lesson the probability of developing PTSD to a subsequent trauma (i.e., promote "resilience"). Such factors might only be observable in persons after treatment gains are made and may not be strongly correlated with changes in symptom severity. Alternatively, resilience factors may predict treatment response and be observable even in those with severe symptoms. Without knowing how biologic alterations relate to symptoms over time, the clinical significance of cross-sectional findings cannot be interpreted.
Overall Project Objective: Our objective is to delineate biological and psychological correlates, and their interactions, associated with risk, symptom severity, and recovery in recently returning Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with PTSD by examining several biological and psychological variables, and their interactions, in those who do or do not show recovery in response to 10 weeks of a cognitive behavioral intervention, Prolonged Exposure (PE) therapy, that alleviates PTSD symptoms in many subjects compared to those in a Wait-List (WL) condition. This provides a method for longitudinal evaluation of critical variables and their interactions related to symptom change. The biological markers include measurements of several hormones and neuropeptides associated with stress responses in general, but most importantly, at least one aspect of risk, symptom severity, or recovery of PTSD. The psychological measures include pre-deployment stress and combat severity (risk factors that should not change over time), maladaptive cognitions, trait anxiety, coping and resilience, and symptom severity.

We hypothesize that biologic measures associated with risk for PTSD or resilience will remain unaltered after both PE and WL conditions, but present a series of alternate hypotheses for immutable vs. changeable risk factors. Biologic measures associated with state-related symptom severity will show greater alterations over time in the PE group. Resilience factors that associated with recovery are not predicted to change in response to PE and WL, but alternative hypotheses are also presented. We further predict that biological and psychological measures related to risk and resilience will be associated with each other in a similar manner when measured at baseline and at post-treatment. We further expect that the association of biological measures related to risk and psychological measures related to symptom severity will be significantly diminished post-treatment than pretreatment because the former (risk measures) will not change while the latter will. We hypothesize that for measures associated with risk, there will be no differences at baseline, or in response to treatment, in those subsequently deemed "responders" vs. "non-responders" on the basis of symptom improvement. We also hypothesize a smaller change in the correlation between the change in measures pre- and post-treatment between measures reflecting risk and measures reflecting symptoms. Finally, we predict a greater, but modest, correlation between the difference in biological and psychological measures pre- and post-treatment between measures reflecting resilience and symptoms and the greatest correlation among change in biological and psychological measures associated with symptom severity.
Results to Date: Not currently available
Project: DOD-PR054149
Agency: Department Of Defense
Program: CDMRP
Location: Bronx Veterans Medical Research Foundation, Inc.
P.I. Name: Rachel Yehuda
Status: Ongoing
Study Start Date: May 02, 2006
Estimated Completion Date: June 01, 2010
Specific Aims: The primary aim is to examine longitudinally, biological and psychological alterations and their interactions, in veterans of OEF/OIF with PTSD randomized to either PE or WL. This will allow us to examine the extent to which psychological and biological indices of risk, symptom severity, and resilience/recovery are related at baseline and in response to symptom change; the extent to which symptom reduction is predicted by biological and psychological factors associated with risk, symptom severity, and/or resilience; and the extent to which symptom reduction alters biological and psychological risk and/or resilience in the entire sample, and in persons defined as responders or non-responders to PE.
Publications:
No Publications at this time...