VISN 17 Center of Excellence
Acceptance & Commitment Therapy for Co-Occurring PTSD and SUD in Veterans
Substance use disorders and PTSD are both common among Veterans and often occur together. This research aims to test the effectiveness of Acceptance and Commitment Therapy (ACT) on treating these disorders as symptoms frequently do not improve when both disorders are not treated simultaneously.
Project SERVE (Study Evaluating Returning Veterans Experiences)
This longitudinal research aims to evaluate trajectories of patient’s symptoms over time, to identify areas for treatment to be most effective in shifting trajectories that indicate severe symptoms that may be persistent or intractable without intervention.
Brain Connectivity and TBI
Military veterans commonly suffer lasting effects of blast-related mild traumatic brain injuries (mTBIs), which damage the brain’s white matter pathways and disrupt communication across large networks of the brain. Magnetic resonance imaging (MRI) techniques such as diffusion MRI and functional MRI can be used to study how such disrupted brain networks can result in chronic physical and cognitive symptoms, including headaches, memory problems, anxiety, and personality changes. Through these techniques, it is possible to examine how disruptions of specific brain areas that are critical to integrating information in the brain network, called brain network “hubs”, may induce particularly widespread and disabling TBI symptoms. Through this research, we can begin to identify targeted treatments.
Research Examining Gulf War Illness in Our Nations Service Members (REGIONS)
One in four of the 700,000 Veterans who participated in the 1990-1991 Gulf War suffer from Gulf War Illness. There is no known treatment. Because many of the symptoms of GWI are similar to fibromyalgia, REGIONS will determine if two FDA approved medications for fibromyalgia (duloxetine and pregabalin) can provide relief for these long suffering Veterans.
Treatment of TBI Symptoms Using EEG Neurofeedback
Traumatic brain injuries (TBI) are a common problem among Veterans who have been exposed to explosive blasts or other high impact to the head. This can lead to many other investigating ways of using the brain’s electrophysiology to treat TBI and post-traumatic stress disorder. Regulating Oscillations in Brain Injury (ROBI), is the first double-blind, sham-controlled study designed to study neurofeedback attempting to treat neurocognitive disorder secondary to TBI. This study investigates whether teaching people to change the brain’s electrical fields has a lasting effect on the way that neurons are connected to each other, and, ultimately, whether this leads to a better quality of life.
Treatment of PTSD Using TMS
Transcranial magnetic stimulation (TMS) has been proven effective in the treatment of depression and has the potential to be an effective, non-invasive, and safe treatment for post-traumatic stress disorder (PTSD). PTSD effects between 20% and 30% of returning war Veterans, and many of these Veterans either will not participate in current evidence-based treatments or fail to improve following treatment. In addition, pre- and post-dTMS functional MRI (fMRI) can provide the means to better understand the mechanism of action by which dTMS affects brain circuitry implicated in PTSD symptomatology.
Observation and Assessment of Social Interaction and Suicide (OASIS)
Despite an aggressive campaign by VA to reduce suicide, 22 of our Veterans die each day by suicide. The goal of OASIS is to examine the link between social cognition and suicide risk in Veterans who suffer from PTSD. With a better understanding of this relationship, mental health professionals may be able to identify veterans who display a high risk of suicide and provide them with pre-emptive care. One of the most robust predicators of suicide risk is social support. Modifiable factors that explain the association between social support and suicide are understudied. By examining patients with schizophrenia or schizoaffective disorder, this study hopes to find a link between suicide and dysfunctional social cognition. This research could lead to a novel understanding of patients who suffer from suicidal ideations and eventually influence the treatment of veterans who display some of the risks associated with social cognition.
Examination of the Utility of Marinobufagenin as a Biomarker of PTSD
Marinobufagenin (MBG) is a cardiotonic steroid involved in initiating and sustaining the inflammation and vascular damage that occurs in some diseases. In civilian groups, MBG is elevated in those who have experienced a Traumatic Brian Injury (TBI). The purpose of this study as to compare MBG levels, neurocognitive functioning, and brain fluid volume in Veterans with and without PTSD and TBI. The findings of this research may help us develop specific treatments for neuroinflammation in Veterans who have experienced trauma.
Pilot Study of Concerned Loved One’s Addition to Safety Plan (CLASP)
This research aims to review the qualitative addition of safety planning with family members, or concerned significant others, as a predictor of decreased suicidal risk. Should this pilot intervention indicate support for family member safety planning, this will promote provider education re: intentionally including family members in care planning.
Veterans Tactical Response (VTR): Keeping Law Enforcement & Veterans Safe
The VISN 17 COE has partnered with local agencies in Texas, including the Austin Police Department, Office of Acquired Brain Injury, and Central Texas Veterans Health Care System, to develop training for law enforcement personnel on military culture and responding effectively to mental health issues in Veterans. This training has been provided multiple times to agencies including local law enforcement in Texas, the Federal Bureau of Investigation (FBI), and the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF&E) and has been well received. This program has served to reduce stigma regarding Veteran mental health issues.
Double-Blind Placebo Controlled Study of Lithium for Preventing Repeated Suicidal Self-Directed Violence in Patients with Depression or Bipolar Disorder
Research has demonstrated that lithium can prevent suicide in patients with bipolar disorder and depression. The question about the effectiveness of lithium for suicide prevention is one of major scientific, clinical and public health significance. The objective of this CSP study is to test the hypothesis that lithium augmentation of enhanced usual care will reduce the rate of repeated episodes of suicidal self-directed violence (repeated suicide attempts, interrupted attempts, hospitalizations specifically to prevent suicide and deaths from suicide) in Veterans with bipolar disorder or depression who have survived a recent event.
The Effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) in Depressed VA Patients
This study aims to test the efficacy, safety, durability of benefit, and cost-effectiveness of rTMS on treatment resistant major depression. There are no options available for Veterans who do not respond to psychotherapy or antidepressants. This non-invasive technique may provide effective and affordable, much needed relief.
VA Cooperative Studies Program #572: Genetics of Functional Disability in Schizophrenia and Bipolar Illness
This study aims to find a connection between schizophrenia and bipolar disorder and certain genetic factors. Success in this subject would increase our understanding of these disorders and improve and personalize patient care.
Implementation of VA Rollout of Strength at Home
The goal of this research is to implement the “Strength at Home” program for preventing intimate partner violence across nine sites within the VA Healthcare System to address a gap in services and initiate a VA rollout.
Below is a sample of some of our recent published work:
Young, K. A., Thompson, P. M., Cruz, D. A., Williamson, D. E., Selemon, L. D. (2015). BA11 FKBP5 expression levels correlate with dendritic spine density in postmortem PTSD and controls. Neurobiology of Stress, 2, 67-72.
Nelson, S. M., Savalia, N. K., Fishell, A. K., Gilmore, A. W., Zou, F., Balota, D. A., & McDermott, K. B. (2015). Default mode network activity predicts early memory decline in healthy young adults aged 18-31. Cerebral Cortex, 2015, 1–11.
Cook, A. J., Meyer, E. C., Evans, L. D., Vowles, K. E., Klocek, J. W., Kimbrel, N. A., Gulliver, S. B., & Morissette, S. B. (2015). Chronic pain acceptance incrementally predicts disability in polytrauma-exposed veterans at baseline and 1-year follow-up. Behavior Research & Therapy, 73, 25-32. doi:10.1016/j.brat.2015.07.003
Evans, L. D., Stock, E. M., Zeber, J. E., Morissette, S. B., MacCarthy, A. A., Sako, E. Y., Lappin, J., Lawrence, V. A., MacCarthy, D. J., & Copeland, L. A. (2015). Post-transplantation outcomes in veterans with serious mental illness. Transplantation, 99(8), 57-65. doi: 10.1097/TP.0000000000000616
Hiraoka, R., Meyer, E.C., Kimbrel, N.A., DeBeer, B.B., Gulliver, S.B., & Morissette, S.B. (2015). Self-compassion as a prospective predictor of PTSD symptom severity among trauma-exposed U.S. Iraq and Afghanistan war veterans. Journal of Traumatic Stress, 28, 1-7. DOI: 10.1002/jts.21995
Creech, SK. Johnson, E; Borgia, M; Bourgault, M; Redihan, S; O’Toole, T (2015). Identifying mental and physical health correlates of homelessness among first-time and chronically homeless Veterans. Journal of Community Psychology.43 (5), 619-627. doi: 10.1002/jcop.21707
Hayes, M.A., Gallagher, M.W., Stavitsky Gilbert, K., Creech, S.K., DeCandia, C.J., Beach, C.A., & Taft, C.T. (2015) Targeting Relational Aggression in Veterans: The Strength at Home Friends and Family Intervention. Journal of Clinical Psychiatry, 76(6), 774-778. doi: 10.4088/JCP.14m09155
Hiraoka, R., Cook, A.J., Bivona, J.M., Meyer, E.C., & Morissette, S.B. (2015). Acceptance and Commitment Therapy in the treatment of depression related to military sexual trauma in a woman veteran: A case study. Clinical Case Studies, 1-14. DOI: 10.1177/1534650115594004
Proctor, S.P., Nieto, K., Heaton, K.J., Dillon, C.C., Schlegel, R.E., Russell, M.L., & Vincent, A.S. (2015) Neurocognitive Performance and Prior Injury Among U.S. Department of Defense Military Personnel. Military Medicine, 180(6), 660-669. doi: 10.7205/MILMED-D-14-00298
Kimbrel, N. A., DeBeer, B. B., Meyer, E. C., Silvia, P. J. Beckham, J. C., Young, K. A., & Morissette, S. B. (2015). An examination of the broader effects of warzone experiences on returning Iraq/Afghanistan veterans' psychiatric health. Psychiatry Research, 226(1), 78-83. http://dx.doi.org/10.1016/j.psychres.2014.12.007
Wilson, L. C., Simmons, B. L., Leheney, E. K., Ballman, A. D., Meyer, E. C., DeBeer, B. B., Morissette, S. B., & Kimbrel, N. A. (2015). Does military sexual trauma moderate the impact of critical warzone experiences? Psychiatry Research, 229, 596-598. doi: 10.1016/j.psychres.2015.07.023
Kimbrel, N. A., Meyer, E. C., & Beckman, J. C. (2015). A clinician's perspective on memory reconsolidation as the primary basis for psychotherapeutic change in PTSD. Invited commentary on Lane, Ryan, Nadel & Greenberg. Memory reconsolidation, emotional arousal and the process of change in psychotherapy: New insights from brain science. Behavioral and Brain Sciences. 38(8). doi: 10.1017/S0140525X1400017X.
Kimbrel, N. A., Morissette, S. B., Meyer, E. C., Chrestman, R., Jamroz, R., Silvia P.J., Beckham J. C., & Young, K. A. (2015). Effect of the 5-HTTLPR polymorphism on posttraumatic stress disorder, depression, anxiety and quality of life among Iraq and Afghanistan veterans. Anxiety Stress & Coping, 28(4), 456-466. DOI:10.1080/10615806.2014.973862
Laumann, T. O., Gordon, E. M., Adeyemo, B., Snyder, A. Z., Joo, S. J., Chen, M-Y., Gilmore, A. W., McDermott, K. B., Nelson, S. M., Dosenbach, N. U. F., Schlaggar, B. L., Mumford, J. A., Poldrack, R. A., & Petersen, S. E. (2015). Functional system and areal organization of a highly sampled individual human brain. Neuron, 87, 1-14.
Neta, M., Miezin, F.M., Nelson, S.M., Dubis, J.W., Dosenbach, N.U., Schlaggar, B.L., & Petersen, S.E. (2015) Spatial and temporal characteristics of error-related activity in the human brain. The Journal of Neuroscience, 35(1), 253-66. doi: 10.1523/Jneuroscie. 1313-14.2015
Wilson, L.C., Kimbrel, N.A., Meyer, E.C., Young, K.A. & Morissette, S.B. (2015). Do child abuse and maternal care interact to predict military sexual trauma? Journal of Clinical Psychology, 71(4), 378-386. doi: 10.1002/JCLP.22143.
Below is a sample of some of our recent professional presentations:
Creech, SK; Taft, CT. (2015, November). Use and Experience of Recent Intimate Partner Violence Among Women Veterans who Deployed to Iraq and Afghanistan. Poster presentation at International Society for Traumatic Stress Studies. New Orleans, LA.
DeBeer, B.B., Kimbrel N.A., Meyer, E.C., Kittel, J., Davidson, D. & Morissette S.B. (November, 2015). Social cognition as a novel risk factor for suicidal ideation in veterans with PTSD. Poster session presented at the International Society for Trauma and Stress Studies, New Orleans, LA.
Meyer, E.C., DeBeer, B.B., Kimbrel, N.A., Gulliver, S.B., & Morissette, S.B. (2015, November). The influence of peritraumatic dissociation and experiential avoidance on mental health symptoms over time in war veterans. In Fleming, C.J. (Chair) Understanding Trauma-Related Dissociation: Risk Factors and Outcomes. Presented at the 49th annual meeting of the Association for Behavioral and Cognitive Therapies, Chicago, IL.
Evans, L.D., Morissette, S.B., Wills, S., Schouest, T., & Peebles-Beckworth, B. (2015, October). Veterans Tactical Response: Implementing a train-the-trainer program in law enforcement agencies. Training workshop to be presented at the Texas Commission on Law Enforcement (TCOLE) Training Coordinators Conference, Corpus Christi, TX.
Creech, S., Swift, R., Zlotnick, C., Street, A., Taft, C. (2015, August). Combat Exposure, Mental Health, and Family Functioning Among Women Veterans. In JC Flanagan & ML Kelley (Chairs), Mental Health, Alcohol Use, and Relationship Satisfaction among Military Members and Veterans. Symposium to be presented at the 2015 APA annual convention, Toronto.
Mignogna, J., Martin, L.A., Mott, J., Cao, Y., Thakur, E., Kauth, M., Kunik, M.E., Naik, A.D., & Cully, J.A. (2015, May). Mixed-Methods Analyses of an Implementation Strategy of Brief Psychotherapy in Primary Care. Poster presented at the 18th Annual VA Psychology Leadership Conference in San Antonio, Texas.
DeBeer, B.B., Meyer, E.C., Silvia, P.J., Beckham, J.C., Young, K.A., Morissette, S.B., & Kimbrel, N. A. (2015, May). Understanding the broader effects of critical warzone experiences on returning veterans psychological health. In Wilson, L.C. & Kimbrel, N.A. (Chairs) Recent advances in understanding the broad impact of critical warzone experiences on returning Iraq and Afghanistan veterans' psychological health. Symposium presented at the annual meeting of the Association for Psychological Science, New York.
Evans, L.D. (2015, May). Strength In Numbers: Keynote address. Invited address given to the NAMI Mental Health Awareness event as part of the National Mental Health Awareness Month project, Waco, TX.
Kittel, J.A., Pronove, L.M., DeBeer, B.B., Kimbrel, N.A., Meyer, E.C., Gulliver, S.B., & Morissette, S.B. (April 2015). Obesity as a moderator between the association between post-traumatic stress disorder symptoms and suicidal ideation. Poster presented at the annual meeting of the American Association for Suicidology (AAS), Atlanta, GA.
DeBeer, B.B., Kittel, J.A., Cook, A., Davidson, D., Kimbrel, N. A., Meyer, E. C., Gulliver, S. B. & Morissette, S. (April 2015). New avenues for suicide prevention in trauma exposed veterans: The role of health-promoting behaviors. Paper presented at the annual meeting of the American Association for Suicidology (AAS), Atlanta, GA.
Mignogna, J., Martin, L.A., Mott, J., Cao, Y., Thakur, E., Kauth, M., Kunik, M.E., Naik, A.D., & Cully, J.A. (2015, April). Mixed-Methods Analyses of an Implementation Strategy of Brief Psychotherapy in Primary Care. Poster presented at the 36th Society of Behavioral Medicine Annual Meeting, in San Antonio, Texas.
Cook, A.J., Meyer, E.C., Evans, L.D., Vowles, K.E., Klocek, J.W., Kimbrel, N.A., Gulliver, S.B., & Morissette, S.B. (2015, April). Chronic pain acceptance incrementally predicts disability in polytrauma-exposed veterans. Poster presented at the annual scientific meeting of the Society of Behavioral Medicine, San Antonio, TX.
Meyer, E.C., Hiraoka, R., Kimbrel, N.A., Gulliver, S.B., & Morissette, S.B. (2014, November). Self-compassion as a mediator of PTSD symptom severity over time in trauma-exposed Iraq/Afghanistan war veterans. Poster presented at the 48th Annual Convention of the Association for Behavioral and Cognitive Therapies, Philadelphia, PA.
Scheinfeld, D.E. (2014, October). From Battlegrounds to the Backcountry: The Intersection of Masculinity and Outward Bound Programming on Psychosocial Functioning for Male Military Veterans. Poster presented at the Association for Experiential Education International Conference, Chattanooga, TN.
Scheinfeld, D.E. (2014, October). Interpersonal Context in Adventure Therapy. Workshop presented at the Association for Experiential Education International Conference Therapeutic Adventure Program Group Pre-Conference, Chattanooga, TN.
Meyer, E.C., Konecky, B., Kimbrel, N.A., Marx, B.P., Schumm, J., Gulliver, S.B., & Morissette, S.B. (2014, March). The structure of posttraumatic stress disorder symptoms: Associations with functional impairment in war veterans. Poster presented at the annual meeting of the Anxiety and Depression Association of America. Chicago, IL.
Cobb, A., Lancaster, C., Meyer, E.C., Lee, H-J., & Telch, M. (2014, March). Interactive diatheses in soldiers deployed to Iraq: A prospective, multiwave analysis of PTSD, anxiety, and depression symptoms. Poster presented at the annual meeting of the Anxiety and Depression Association of America. Chicago, IL.