Rocky Mountain MIRECC - Theresa D. Hernández, PhD - MIRECC / CoE
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Rocky Mountain MIRECC - Theresa D. Hernández, PhD

Rocky Mountain MIRECC for Veteran Suicide Prevention

Updated: 7 July 2017


Theresa D. Hernández, PhDTheresa D. Hernández, PhD
Title: Clinical/Research Psychologist
Dr. Hernández leads a clinically-based program of research dedicated to the use of scientifically rigorous experimental designs to investigate the role of Complementary and Alternative Medicine (CAM) in the treatment of traumatic brain injury and stress resilience. She is currently investigating the efficacy of acupressure as an intervention for reducing the stress response in Veterans.

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Recent Publications

Bahraini NH, Breshears RE, Hernández TD, Schneider AL, Forster JE, Brenner LA. Traumatic Brain Injury and Posttraumatic Stress Disorder. Psychiatr Clin North Am. 2014 Mar;37(1):55-75.
Given the upsurge of research in posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI), much of which has focused on military samples who served in Iraq and Afghanistan, the purpose of this article is to review the literature published after September 11th, 2001 that addresses the epidemiology, pathophysiology, evaluation, and treatment of PTSD in the context of TBI. Published by Elsevier Inc.
PubMed Keywords: Brain injury, Evaluation, Imaging, Pathophysiology, Posttraumatic stress, Treatment
Brenner L, Bahraini N and Hernández TD (2012). Perspectives on creating clinically relevant blast models for mild traumatic brain injury and post traumatic stress disorder symptoms. Front. Neur. 3:31.
Military personnel are returning from Iraq and Afghanistan and reporting non-specific physical (somatic), behavioral, psychological, and cognitive symptoms. Many of these symptoms are frequently associated with mild traumatic brain injury (mTBI) and/or post traumatic stress disorder (PTSD). Despite significant attention and advances in assessment and intervention for these two conditions, challenges persist. To address this, clinically relevant blast models are essential in the full characterization of this type of injury, as well as in the testing and identification of potential treatment strategies. In this publication, existing diagnostic challenges and current treatment practices for mTBI and/or PTSD will be summarized, along with suggestions regarding how what has been learned from existing models of PTSD and traditional mechanism (e.g., non-blast) TBI can be used to facilitate the development of clinically relevant blast models.
Keywords: PTSD, Traumatic Brain Injury (TBI)
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Brenner LA, Stearns-Yoder KA, Hoffberg AS, Penzenik ME, Starosta AJ, Hernández TD, Hadidi DA, Lowry CA. Growing literature but limited evidence: A systematic review regarding prebiotic and probiotic interventions for those with traumatic brain injury and/or posttraumatic stress disorder. Brain Behav Immun. 2017 Jun 9. pii: S0889-1591(17)30192-7. doi: 10.1016/j.bbi.2017.06.003.
Traumatic brain injury (TBI) is highly prevalent among a wide range of populations, including civilians, military personnel, and Veterans. TBI sequelae may be further exacerbated by symptoms associated with frequently occurring comorbid psychiatric conditions, including posttraumatic stress disorder (PTSD). This is particularly true among the population of military personnel from recent conflicts in Iraq and Afghanistan, with a history of mild TBI (mTBI) and PTSD. The need for efficacious treatments for TBI and comorbid PTSD is significant, and evidence-based interventions for these frequently co-occurring conditions are limited. Based on findings suggesting that inflammation may be an underlying mechanism of both conditions, anti-inflammatory/immunoregulatory agents, including probiotics, may represent a novel strategy to treat TBI and/or PTSD-related symptoms. The focus of this systematic review was to identify and evaluate existing research regarding prebiotic and probiotic interventions for the populations of individuals with a history of TBI and/or PTSD. Only 4 studies were identified (3 severe TBI, 1 PTSD, 0 co-occurring TBI and PTSD). Although findings suggested some promise, work in this area is nascent and results to date do not support some claims within the extensive coverage of probiotics in the popular press. Published by Elsevier Inc.
KEYWORDS: Bifidobacteria; Lactobacilli; PTSD; Persistent post-concussive symptoms; Posttraumatic stress disorder; Prebiotic; Probiotic; Synbiotic; Systematic review; TBI; Traumatic brain injury
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McFadden, K. L., Healy, K.M., Dettmann, M. L., Kaye, J. T., Ito, T. A., & Hernández, TD. (2011). Acupressure as a non-pharmacological intervention for traumatic brain injury (TBI). Journal of Neurotrauma, 28, 21-34.
Acupressure is a complementary and alternative medicine (CAM) treatment using fingertips to stimulate acupoints on the skin. Although suggested to improve cognitive function, acupressure has not been previously investigated with a controlled design in traumatic brain injury (TBI) survivors, who could particularly benefit from a non-pharmacological intervention for cognitive impairment. A randomized, placebo-controlled, single-blind design assessed the effects of acupressure (eight treatments over 4 weeks) on cognitive impairment and state of being following TBI, including assessment of event-related potentials (ERPs) during Stroop and auditory oddball tasks. It was hypothesized that active acupressure treatments would confer greater cognitive improvement than placebo treatments, perhaps because of enhanced relaxation response induction and resulting stress reduction. Significant treatment effects were found comparing pre- to post-treatment change between groups. During the Stroop task, the active-treatment group showed greater reduction in both P300 latency (p=0.010, partial η²=0.26) and amplitude (p=0.011, partial η²=0.26), as well as a reduced Stroop effect on accuracy (p=0.008, partial η²=0.21) than did the placebo group. Additionally, the active-treatment group improved more than did the placebo group on the digit span test (p=0.043, Cohen's d=0.68). Together, these results suggest an enhancement in working memory function associated with active treatments. Because acupressure emphasizes self-care and can be taught to novice individuals, it warrants further study as an adjunct treatment for TBI.
Keywords: Traumatic Brain Injury (TBI), Complementary and Alternative Medicine 
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McFadden KL, Hernández, TD, Ito TA. Attitudes toward complementary and alternative medicine influence its use. Explore (NY). 2010 Nov-Dec;6(6):380-8.
OBJECTIVE: The aim of this study was to explore how attitudes toward complementary and alternative medicine (CAM) and conventional medicine influence CAM use in a healthy population, and how health locus of control and exercise further affect CAM use. DESIGN: A cross-sectional survey design was used. PARTICIPANTS: The sample consisted of 65 healthy graduate students. MAIN OUTCOME MEASURES: Since previous studies have focused on the attitudes of medical providers toward CAM, there are currently no standard, widely used measures of attitudes toward CAM from the perspective of the healthcare recipient. Thus, a new measure, the Complementary, Alternative, and Conventional Medicine Attitudes Scale (CACMAS) was created to address how attitudes of healthcare recipients affect CAM use. The Multidimensional Health Locus of Control Scale (MHLC) was used to investigate effects of health locus of control on CAM use, and participants reported which of 17 listed CAM treatments they had used in the past, were currently using, or would likely use in the future. Participants also reported days of exercise in the past month to explore if those engaging in healthy behaviors might report more CAM use. RESULTS: Having a philosophical congruence with CAM and agreement with holistic balance was associated with increased CAM use. Dissatisfaction with conventional medicine was also related to increased CAM use, but to a lesser extent. Those attributing health to personal behaviors (an internal health locus of control) reported more CAM use, as did those engaging in more resistance training in the previous month.
Keywords: Complementary and Alternative Medicine 
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McFadden KL, Hernández, TD. Cardiovascular benefits of acupressure (Jin Shin) following stroke. Complement Ther Med. 2010 Feb;18(1):42-8. Epub 2010 Feb 6.
OBJECTIVES: Acupressure, a complementary and alternative medicine (CAM) treatment, uses fingertips, rather than needles, to stimulate acupoints on the skin and has been implicated as a successful treatment for a variety of medical disorders. However, acupressure's underlying mechanisms remain unclear. One theory is that acupoint stimulation modulates autonomic nervous system activity. Previous studies have suggested that acupressure may positively affect heart rate and blood pressure. The current study investigated the effects of a type of acupressure, Jin Shin, on cardiovascular function in stroke survivors, a population that could especially benefit from a treatment promoting cardiovascular health. The study tested the hypothesis that active acupressure treatments would reduce heart rate and blood pressure (i.e., induce a greater relaxation response) above and beyond that seen during placebo acupressure treatments. METHODS: A randomised, placebo-controlled, single-blind crossover design was utilised, in which 16 participants received 8 weeks of either active or placebo acupressure followed by washout and crossover into the opposite treatment condition. Heart rate and blood pressure measurements were taken throughout treatments. RESULTS: Active acupressure treatments were associated with a significantly greater (p=.043, eta(2)=.30) and faster (p=.002, eta(2)=.76) reduction in heart rate compared to that seen during placebo treatments. No treatment effect on blood pressure was found. CONCLUSIONS: Active acupressure reduced heart rate significantly more than did placebo acupressure during treatments. Although no treatment effect on blood pressure was found, this could be due to 67% of participants taking antihypertensive medications during the study.
Keywords: Complementary and Alternative Medicine 
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Examining the Internal Construct Validity of the Neurobehavioral Symptom Inventory Using Rasch Model Analysis (NSI Validation)
Veterans AdministrationVeterans Administration
Yoga Pilot Study
Veterans AdministrationVeterans Administration
Acupressure and Stress Resilience - Using Complementary and Alternative Medicine (CAM) to Promote Stress Relilience in Those with Co-Occurring Mild TBI and PTSD
Department of DefenseDepartment of Defense
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