Center for the Studyof Traumatic Stress
Building Bridges Since 1987

2016 Annual ReportOne of the many ways
we accomplish our
mission is by building
bridges. These bridges
connect and unite
disciplines, agencies,
institutions, states,
and countries.

CONTENTS
From the Director.................................................................................................1
First CSTS Neuroscience Fellowship Award..........................................................3
Our Mission.........................................................................................................4
Research...............................................................................................................5
Education and Training.......................................................................................16
Consultation......................................................................................................24
CSTS Publications in 2016.................................................................................27
CSTS Presentations, Briefings, Interviews and Awards in 2016..........................31
CSTS Directors, Scientists, Scientific Advisory Board and Staff .........................34
CSTS Funded Grants in 2016..............................................................................38
CSTS Partnerships..............................................................................................39

From the Director
Dear Center Colleagues and Friends,
The Center for the Study of Traumatic Stress (CSTS)
is an integral part of the Department of Psychiatryof the School of Medicine of the Uniformed Services
University (USU). CSTS’s
activities support the USU
Strategic Framework and themission of the Department of
Defense. The mission of CSTS
is to mitigate the impact of
trauma from exposure to war,disasters, terrorism, community violence and publichealth threats. We achieve
our mission through leadership, education and training, research and scholarship, service and outreach,and global health engagement to maintain readiness.
In accomplishing our mission, we enhance national
security and serve an essential role for the Department of Defense and the nation. We have been successfully fulfilling our mission for the past 29 years,
since the Center was established in 1987.
CSTS bridges multiple disciplines, groups andstrategies for change and health. We bridge thesciences from cellular to circuits and synapses toneurons. We link across disciplines and fill gaps inknowledge and communication, while creating newpartnerships. We build these bridges in laboratories, in classrooms, in our communities, across ournation, and around the world. These bridges connect
and unite disciplines, agencies, institutions, states,
countries and most importantly people. We build
these bridges through research, outreach, training,education, consultation, intervention and leadership.
Our research bridges the divide between factors thatplace people in danger of harm and those that keeppeople safe in times of war, disasters and terrorist
events.
The bridges we build are part of what makes
the Center unique. For example, we bridge military
psychiatry and disaster psychiatry. Our Center has

helped define and advance the integration of these
two separate but interrelated fields. We connect
findings from scholarly mental health research toreal-world problem-solving in order to address themental and behavioral health problems of those
exposed to war, disaster and other traumatic events.
The Center is dedicated to research in translational
science to bridge the gaps between laboratory science and applied health care. These bridges translateknowledge into applications in the neuroscience andneurobiology of stress and trauma.
The Center has a broad reach with a focus on
health issues of special interest to the military
including posttraumatic stress disorder (PTSD),
mild traumatic brain injury (mTBI), suicide andsuicide-related behavior. CSTS helps inform ournation’s policies and responses to the impacts of
exposure to trauma from disasters, both man-madeand natural. We are a multi-disciplinary and collaborative team of scientists, educators, clinicians
and leaders who provide the research, teaching,outreach, consultation and leadership to advance themission and our goals.
Throughout 2016, the Center broadened andshared its knowledge base. Looking ahead, we
continue to build bridges to the future by training

CSTS bridges multiple disciplines, groups
and strategies for change and health. We
bridge the sciences from cellular to circuits
and synapses to neurons. We link acrossdisciplines and fill gaps in knowledge
and communication, while creating newpartnerships. We build these bridges
in laboratories, in classrooms, in ourcommunities, across our nation, and aroundthe world.

2016 ANNUAL REPORT | 1

and mentoring the next generation of dedicatedscientists and leaders who will continue to carry
our mission forward.
The Center continues to provide rapid consultation, education and knowledge support to personnel who responded to crises around the nation. In
2016, these events included:■■ the water crisis in Flint, Michigan■■ the floods in Louisiana■■ Hurricane Matthew which impacted the southeastern United States■■ the warehouse fire in Oakland, California■■ the mass shooting at the Pulse Night Club in
Orlando, Florida
This Annual Report includes the many contributions we are making to enhance psychologicalhealth, recovery and prevention of the consequencesof trauma on individuals, families, communities andthe nation in both military and civilian populations.
This work builds on the importance of trauma informed care for our health care systems.
On behalf of everyone at CSTS, I would like toextend our appreciation to all our colleagues andfriends who have collaborated with us and supported
our work throughout this past year.
Robert J. Ursano, MD
Professor of Psychiatry and Neuroscience
Chair, Department of Psychiatry
Director, Center for the Study of TraumaticStress
Uniformed Services University

These bridges connect and unite disciplines, agencies, institutions, states,
countries and most importantly people. We build these bridges throughresearch, outreach, training, education, consultation, intervention andleadership. Our research bridges the divide between factors that place
people in danger of harm and those that keep people safe in times ofwar, disasters and terrorist events.

Serving our nation since 1987

2 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

First CSTS Neuroscience FellowshipAwarded in 2016
In 2015, the Center initiated a Pre-doctoral
Fellowship Award for USU neuroscience doctoral students to foster the development of thenext generation of scientists and investigators
who will tackle problems relevant to the CSTS
mission. The Center awarded its first annual
pre-doctoral fellowship in 2016.
This award is in support of a USU
graduate student for innovative
basic or clinical research studies
leading to a PhD degree while
addressing the primary mission of
the CSTS, namely, to research thehealth consequences of trauma,
disaster, and terrorism. The award
provides two years of salary support while the pre-doctoral student
works on their doctoral studies.
The 2016 CSTS Pre-doctoral FellowshipAward recipient was Francis T. Djankpa for his
project “The KCC2 influence on neuronal migration in a ferret model of cortical dysplasia.”

Words from Francis Djankpa“I am a fourth year graduate student in theneuroscience program at USU with a focus on
neocortical development and associated errors of brain malformation. I started my career
studying the broad aspects of animal life for
my bachelor’s degree in Zoology in 2005 at the
University of Ghana. I then studied the gener-

al functions of human systems for my MPhil
degree in physiology in 2009 at the Universityof Ghana. As part of my MPhil thesis, I assessed
the sensitivity and efficacy of a neurothesiometer as an alternative to the tuning fork in theclinical diagnosis of peripheral neuropathy indiabetic clinics. In 2010, I accepted an appointment as a physiology
lecturer in a newly establishedmedical school (School of Medical Sciences, University of Cape
Coast, Ghana) where I taught undergraduate students in the Medical and Allied Health Sciences
programs for two years. I served
as part of a team that investigatedthe effects of natural dietary supplements on obesity and diabetes using animalmodels. Because of my passion to reach out
to rural communities, in 2010, I established a
non-governmental organization (Nterm-Ghana,www.ntermghana.com). Under my leadership,
Nterm-Ghana has been reaching out to many
communities with health, education and other development projects. I plan to pursue myultimate goal of teaching, conducting research
and mentoring students in the neurosciences
and related fields. I also hope to one day lead anationwide campaign in Ghana to develop thestudy of neurosciences in collaboration withother international organizations.”

This award is in support of a USU graduate student for innovative
basic or clinical research studies leading to a PhD degree while
addressing the primary mission of the CSTS, namely, to research thehealth consequences of trauma, disaster, and terrorism.

2016 ANNUAL REPORT | 3

Our Mission
As an integral part of USU, CSTS’s activities support the USU Strategic Framework and the missionof the Department of Defense (DoD). CSTS is committed to advancing trauma-informed care. We arededicated to furthering the nation’s understandingof the impact of trauma on individuals, families andcommunities. The Center is part of our nation’s federal medical school at USU and the Center’s missionis aligned with the needs of the DoD and the nation,and is well-positioned to rapidly respond to DoD
mission-relevant activities.
The Center’s work includes a broad range of trauma exposures: combat, terrorism, natural andhuman-made disasters, public healththreats, and humanitarian
operations. CSTS has been

4 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

involved in nearly every major disaster our nation has
experienced in the past nearly 30 years. The Center
helps to ensure that behavioral health is addressedin the face of public health threats, disaster planningand disaster recovery.
Mitigating the effects of disaster and trauma in
military and civilian populations is part of the effort
to foster community and national resilience. The Center informs and educates community, regional, state,national and global stakeholders in government, industry, healthcare, public health, and academia. CSTS
contributes to advancing trauma-informed care byproviding leadership in research, education,
training, consultation, global health,and service.

Research
RESEARCH ON SERVICE MEMBERS
Study to Assess Risk and Resilience inServicemembers — Longitudinal Study(STARRS-LS)[formerly Army Study to Assess Risk andResilience in Servicemembers (ArmySTARRS)]

Army STARRS (2009-2015) and now STARRS-LS(2014-2019) were designed and conducted under the
direction of CSTS as a collaborative effort between
USU, the University of California San Diego (UCSD),
Harvard University and the University of Michigan.
Army STARRS included a number of separate
but integrated studies designed to comprehensively
examine the mental health and resilience of Soldiers
including Regular Army, Army National Guard andactivated Army Reserve. It involved the collection,
integration and analysis of an enormous volume ofdata from large and representative samples of Soldiers, making it the largest research study of mental
health risk and resilience ever conducted among military personnel. One of the studies was an historicalcohort study of the more than 1.6 million Soldierson active duty from 2004 to 2009. Army STARRS
also included cross-sectional studies, a longitudinal
study, and case-control studies that involved collecting data directly from more than 100,000 active
duty Soldiers throughout the U.S. and overseas. The
research included questionnaires, neurocognitive
tests, blood collection, state-of-the-art genetic andother biomarker assays, and linking these data to existing Army/DoD records. This produced large andrich datasets to serve the goals of Army STARRS,
but can also be used to serve broader goals involving
many other outcomes besides mental health.
At the end of 2016, there were 41 Army STARRS
publications, eight papers in press, eight papers

under consideration for publication, and many additional papers in progress. Benefits for the Army, andthe nation as a whole, continue to emerge from thisextraordinary, groundbreaking and complex project.
Army STARRS, called the Framingham of
mental health studies, is now continuing as theCenter is furthering the research through a five-year
DoD-funded project, STARRS-LS. This project is
conducted under the scientific direction and leadership of CSTS with the same consortium of four universities (USU, UCSD, Harvard University, and the
University of Michigan) that designed and conducted Army STARRS. STARRS-LS involves two major
research activities: 1) continue using the STARRS
platforms, systems and data to conduct further analyses, derive further findings, and extract additional
value; and 2) extend, expand and enhance the datawith a longitudinal follow up of participants.

Largest Genome-Wide Association
Study (GWAS) of PTSD to Date
The Army STARRS paper entitled“Genome-wide association studies of
posttraumatic stress disorder in 2 cohortsof U.S. Army soldiers” published in JAMA
Psychiatry (2016) was the largest GWASof PTSD to date. In a very nice editorial by
Kerry Ressler MD, PhD (Harvard Professor,
Howard Hughes Fellow, and Chair of the
Army STARRS Scientific Advisory Board)that appeared in the same issue of JAMA
Psychiatry, he stated: “The Army STARRS
project represents an unprecedented andhighly successful collaboration between
the National Institutes of Health and theDepartment of Defense to understand theeffect of trauma exposure on the brain
and to identify differential risk factors fora number of trauma-related sequelae in
Soldiers.”
2016 ANNUAL REPORT | 5

of posttraumatic stress, e.g., somatization, anger andhostility), health risk behaviors including increases
in alcohol and drug use, resilience and psychologicalwell-being, and instrumental and emotional support.
During 2016, we continued collecting surveys andpreliminary data analysis focused on deployment exposures and identification with the dead. These studies have implications for early intervention, training,education, leadership and health surveillance.

Troop Education for Army Morale (TEAM)
Throughout 2016, the research team obtained additional existing Army/DoD administrative records
for all active duty Soldiers from 2010 to 2015. Oncecomplete, this will allow analyses of an historicalcohort of all Soldiers on active duty over a twelveyear period (2004 to 2015). The research team also
designed and began data collection in 2016 forthe STARRS-LS longitudinal follow-up study thatseeks to follow a cohort of more than 72,000 Army
STARRS participants. This will include collecting
two waves of additional questionnaire data andlinking those data to additional Army/DoD administrative records. This follow-up study will extend
the time-frame of Army STARRS to collect further
outcome information throughout the Soldiers’ Army
careers, and to follow those who transition out of the
Army through their adjustment to civilian life.

Psychological Stress and Resilience in
Mortuary Affairs (MA) Soldiers: Longitudinal
Study
Since 2005, CSTS has conducted research on
the stresses of mortuary affairs operations during
the wars in the Middle East. U.S. Army mortuary
affairs (MA) Soldiers, who work with the dead of
battle, are exposed to some of the highest stressorsof war, combat death. In addition, MA Soldiers deal
with the stress of deployment and returning home.
This research has examined training and preparation, stressors specific to working with the dead,and adjustment to family and work after returningfrom deployment. Empirical and descriptive data iscollected on PTSD, depression, distress (symptoms
6 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

TEAM is a stress management and resiliencebuilding early intervention study with the goal of
improving post-deployment readjustment in MA
Soldiers. TEAM involves a randomized group of
MA Soldiers and a comparison group (usual care)
immediately after return from deployment. The
study is designed to help the Soldiers cope with thedaily challenges of post-deployment life, including
re-integration into family and garrison life. TEAM
is based on the five evidence-informed principles of
Psychological First Aid (physical and psychologicalsafety, calming, connectedness, self-efficacy, andhope/optimism) and delivered through four group
workshops, informational handouts, a dedicatedwebsite, and support through concierge phone andemail services. A total of 125 MA Soldiers in 10
cohorts participated in the study. MA Soldiers in the
study have a high number of traumatic deployment
exposures, and rates of probable PTSD and depression, that are similar to combat troops. While theintervention did not reduce rates of PTSD, TEAM
skills training targets were reported to be helpful andhad no negative effects. As expected, Soldiers who
attended more workshops reported fewer symptoms
and were more likely to rate TEAM as helpful.

Reserve Component of the U.S. Armed
ForcesThe Center is strongly committed to supporting
the Reserve Component (RC) of the United States
Armed Forces and continues to conduct extensive
research with the RC, a traditionally under-studied
population that experiences unique stressors when
the nation is at war or when they are called for emergency service such as disaster relief. These stressors

are substantially different from those experienced
by the Active Component (AC). In collaboration
with Dr. Sandro Galea at Boston University, CSTS is
conducting longitudinal research on the health andmental health of National Guard and Reserve Service members nationwide. The study addresses the
epidemiology and trajectory of posttraumatic stress,
deployment stress, health risk behaviors and healthcare utilization in the National Guard and in the
Reserves of the Army, Navy, Air Force and Marine
Corps. There have been four waves of data collection
to date, and the team is actively analyzing this richdata set. A protocol has been developed to add afifth wave in order to extend our data on trajectories
of health in this important population. This research
is unique in that it uses a representative national cohort and specifically addresses the experiences of theGuard and Reserve, as distinct from the experiencesof the AC.
Army STARRS and STARRS-LS provide an
unprecedented opportunity to further examine
the health and mental health of RC members. The
Army STARRS New Soldier Study included surveys of approximately 23,000 RC Soldiers during
their first week of basic training. Many participantsalso provided blood samples for the examination of
biomarkers. This collection of data at the beginningof Soldiers’ military service provides an opportunity
to follow them through the course of their military
careers and beyond in order to identify risk factors
for health outcomes, as well as factors that promoteresilience. In addition, Army STARRS included RC
members in the All Army Study and in the in-theater
study of Soldiers serving in Afghanistan, again yielding data that can be used in long-term studies whileproviding a snapshot of current health and mental
health. This creates the opportunity for assessmentof concentrations of risk in order to develop futureinterventions to promote and sustain military health.
In STARRS-LS, both in-depth analysis of existing
data, and collection of new data on members of theRC, are important aims.
The CSTS portfolio of research on the RC isrounded out by studies of biomarkers conducted in
National Guard units before and after deployment
for combat tours in Afghanistan. Taken together, thiscombination of studies geared specifically to the RC,
along with inclusion of RC members in other CSTS
research including the Child and Family Program,gives CSTS a key role in expanding knowledge of thespecial needs of the Citizen Soldiers on whom ournation relies.

RESEARCH IN THE CHILD AND FAMILYPROGRAMThe Center’s Child and Family Program (CFP) isa national leader in advancing scientific and clinicalknowledge, and providing educational resources
addressing the needs of children and families affected by trauma, especially our nation’s militaryfamilies and children. CFP projects shed light onfamily bereavement, child neglect and maltreatment,
and combat injury in military and civilian communities. Dr. Stephen Cozza, CSTS Associate Director,
underscores both the strength and vulnerability ofthese children and families that result from theseexperiences. The Child and Family Program addresses these complex issues through pioneering research,by educating professional audiences including military and government stakeholders at conferences,and through scholarly publications and consultation
to DoD leadership and national media outlets.

2016 ANNUAL REPORT | 7

Family Bereavement
The National Military Family Bereavement Study(NMFBS)NMFBS is the first scientific study to examine the impact of a U.S. Service member death on
surviving family members. It aims to describe thepopulation of Service members who have diedsince 9/11 and to identify experiences of the Service
member’s bereaved family members — how psychological, physical and/or behavioral outcomes of thegrieving process are influenced by military-uniquecontributions, as well as family members’ pre-existing
psychological and physical health and support. An
optional part of the study examines saliva samples
for genetic biomarkers associated with outcomes.
More than 2,200 adult participants have completed
questionnaires. The longitudinal portion of the study,
which consists of annual interviews over three years,
continues until 2017. Approximately 850 adults and120 children are participating in the longitudinal portion of the study. During 2016, data from this study
were used to evaluate criteria for Persistent Complex
Bereavement Disorder leading to a publication in theAmerican Journal of Psychiatry. Several additional
manuscripts have been written and submitted for
publication.

8 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Stepping Forward in Grief (SFG)
NMFBS found that a sizeable portion of surviving
military family members are suffering from high levelsof grief and distress, putting them at risk for harmful
long-term changes in physicaland mental health. Recognizing the need to help thesefamilies, the NMFBS formeda partnership with the Centerfor Complicated Grief at Columbia University to develop
an intervention study, Stepping Forward in Grief, for bereaved military families.
Funding for the SFG study was awarded in May 2015.
The SFG study involves the development and testingof a digital intervention (GriefSteps) that is designed
to lower grief and decrease risk for long-term problems. The GriefSteps intervention is being adaptedfrom Complicated Grief Therapy (CGT) that has beenshown to be helpful in civilian populations. CGT helps
to resolve grief complications and promote wellness.
The SFG study is a randomized controlled trial. Participants will be assigned to one of two groups: either anintervention group to receive GriefSteps, or a control
group to receive WellnessSteps that will focus onbuilding resilience. The study will compare how people in the GriefSteps intervention group do, compared to the WellnessSteps control group, in overall
improvement in grief severity and adaptation to loss.
All SFG study participants will be able to complete
their programs virtually, either on an app or on theInternet. In addition, both groups will have “guides”
who can help and answer questions about the study.
Through the SFG study, we will learn how to best
assist military family survivors with their grief andreduce the long-term problems that can occur aftera loss, resulting in an extremely helpful resource forcurrent and future survivors who suffer the death ofa military loved one. Military Service members may
also be consoled by knowing that such services areavailable to families if they or a close unit member orfriend should die while on active duty. During 2016,
the GriefSteps and WellnessSteps conditions weredeveloped. Participant recruitment will launch in2017.

Study of Long-Term Outcomes of TerrorismRelated Grief
The Child and Family Program partnered with
Voices of September 11th (VOICES), a not-for-profit
organization that provides services for 9/11 families, and the Canadian Resource Centre for Victimsof Crime (CRC), an organization that is engaged
with, and supportive of, family members who were
bereaved by the Air India Flight 182 bombing. The
study partners are investigating long-term positive
and negative bereavement outcomes that follow aterrorism-related death, including grief, traumatic
symptoms, resilience characteristics and posttraumatic growth. More than 400 participants who arefamily members bereaved by the bombing of Air
India Flight 182 on June 23, 1985 or by the events of
September 11, 2001 completed an online questionnaire about their experiences related to the aftermath of these events and the death of their family
member(s). The study will determine predictors of
bereavement outcomes and use findings to develop
preliminary working models for understanding risk
and protective factors for bereaved family membersof terrorism-related deaths. This study will build abasis for ongoing research to inform training andcounsel for disaster and terrorism victims and theirfamilies. Data from this study were presented at the2016 Annual Meeting of the International Society
for Traumatic Stress Studies in Dallas, Texas. Scientific journal manuscripts are being developed topresent these findings to the research community.

Child Neglect and Maltreatment in U.S.
Military Communities and Families
Military-Related Risk for Child Neglect in DoD
Families: A Population Study to Inform Future
DoD Child Neglect Prevention Efforts
The Child and Family Program was awarded a
grant from the Department of Defense in 2016 tocomplete a two-year study investigating child maltreatment and neglect across all Service branches of
military families. Using existing data from militaryfamilies with substantiated cases of child abuse and/or neglect and matched control groups for comparisons, the project will: (1) identify risk and protective

factors for various types of child physical abuse, sexual abuse and neglect in military families; (2) ascertain
the effectiveness of military family participation in
the New Parent Support Program (NPSP) for reducing child abuse and neglect prevalence; (3) examine
the interaction of abuse and neglect correlates and
NPSP participation on child abuse and neglect outcomes; and (4) identify which at-risk families benefit
most from NPSP and where additional preventive
programming may be needed. To date, efforts havefocused on reviewing the existing empirical literature, and identifying datasets and variables to include
in analyses and gaining access to the datasets.
Deployment Family Stress: Child Neglect and
Maltreatment in U.S. Army Families
This study describes the characteristics of substantiated child neglect cases in the Army and identifies factors that contribute to healthy family functioning as well as to child maltreatment. Data werecollected from over 1,000 questionnaires and fromthe records of 400 substantiated child neglect cases
from Army installations across the country. In 2015,
we published the first reports of types, subtypes
and severities of substantiated child neglect cases in
the U.S. Army, as well as demographic information
about child victims and offenders by type and subtype. A second manuscript about military-specificrisk factors, including deployment-related risk andits association with different types of child neglect
is currently under review for publication. A third
manuscript that identifies parent and family risk
factors associated with distinct types of neglect isforthcoming.

Combat Injured Families
A Study of Combat Injured Families
This study examines the short- and long-term
impact of severe combat injury on military families
through interviews conducted at Operation Purple
Healing Adventures (OPHA), an annual summer
camp program for combat injured Service members
and their families sponsored by the National Military Family Association (NMFA). Forty families wereassessed and qualitative data were collected from2016 ANNUAL REPORT | 9

focus groups to assess the issues related to combat
injury and family functioning. We are currently
analyzing the collected data to better understandthe complex effects and challenges experienced bycombat injured Service members and their families.
Addressing the Needs of Children and Families of
the Combat Injured
This study investigates the impact of combat
injury on military families over time. All information has been collected from consenting militaryfamilies at Walter Reed National Military Medical
Center (WRNMMC) and San Antonio Military
Medical Center (SAMMC). The data are currently
being analyzed to identify the short- and long-term
effects of parental combat injury on Service members and their families and children and to inform
intervention strategies for this population. Data
collection for this study concluded in 2015 andpreliminary analyses of the data has begun.
FOCUS-CI: A Preventive Intervention withChildren and Families of the Combat Injured
The Families Over Coming Under Stress - Combat Injury study (FOCUS-CI) is the first of its kindto pilot a preventive intervention with the children
and families of combat injured Service members,
to examine the feasibility of its use, and to study
its efficacy in this context. Using a randomized
controlled trial approach, the study was designed
to test the effectiveness of a new family-centered,strength-based, evidence-informed intervention forseverely combat injured Service members and theirfamilies. FOCUS-CI provides instrumental support
to families and teaches emotion regulation, problem solving, communication, and goal-setting skills.
Data were collected from military families from
Washington, DC, San Antonio, Texas and Chapel
Hill, North Carolina who participated in the study.
We continue to examine the effectiveness of theintervention on family functioning by comparing
FOCUS-CI to the existing standard of care on theeffects of key aspects of family functioning. These
data will help us better understand the experienceof combat injury, its impact on Service members
and their families, and to inform programmatic
10 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

intervention that can better address the needs ofmilitary families.
The Family Violence and Trauma Project (FVTP)
Through the FVTP, CSTS continued to support
the U.S. Army Installation Management Commandand the Medical Command in projects that promote public health approaches to preventing maltreatment. We also supported research in a variety
of approaches to this same end. We analyzed therates of child and intimate partner violence for the
total Army and for 38 installations. These reports
were prepared as a set of briefing books for Family
Advocacy Program (FAP) managers to describe thenumbers and rates of maltreatment by gender, type,severity, military-civilian status, and whether theincident occurred on or off the military installation.
We also supported the Army’s fatality review board
in preparing a report of maltreatment fatalities forthe fiscal year 2014. Other ways we supported the
Army FAP was by providing consultations, briefings,
and research literature to answer important questions involving spouse and child maltreatment. We
assisted investigators in the field with their research
related to the Army FAP. We continue to publish
two newsletters semi-annually: Joining Forces Joining
Families (JFJF) and Research Reviews (RR). JFJF
publishes an interview of a prominent maltreatment
researcher. RR provides highlights of current FAP
research in non-technical language to help FAP personnel grasp current issues in an abbreviated format.
Both JFJF and RR are broadly distributed within theArmy, the Department of Defense and applicable civilian agencies concerned with family maltreatment.

RESEARCH IN NEUROSCIENCE AND
NEUROBIOLOGYThe Center’s laboratory and clinical research in neuroscience and the neurobiology of stress has been
active in seeking effective interventions for trauma
and stress-related disorders. We continued our cutting-edge research in a number of military-related
health issues including PTSD, mTBI and suicide.

Laboratory Research in Neuroscience and
Neurobiology
Genetics and Biomarkers
CSTS laboratory research activities in 2016 included a range of different assays related to studying
neuroscience and neurobiology in military Service
members. These assays included genetic biomarkers,
cortisol levels, and telomere length.
The CSTS biomarker research involved thepurification of DNA from saliva samples and blood
samples collected from Soldiers, and genotyping the
DNA for several target genes including BDNF andFKBP5.
In other laboratory research, CSTS scientists
measured serum cortisol levels before and after
the development of PTSD in Guamanian National Guard Soldiers, in order to examine changes inserum cortisol levels related to PTSD. Serum cortisol
levels for Soldiers with PTSD were also compared tomatched controls without PTSD.
CSTS scientists measured telomere length in
DNA extracted from blood samples collected from
U.S. Army Special Operations Units deployed during
the Iraq and Afghanistan wars. This study is investigating the relationship between hostility and leukocyte telomere length (LTL). Hostility scores were
measured using five items from the Brief Symptom
Inventory (BSI). The LTL was assessed using quantitative polymerase chain reaction methods. Telomere
attrition may represent a novel mechanism involvedin the effects of hostility on aging. Prevention andtreatment efforts designed to reduce hostility might
help mitigate risk for accelerated cellular aging in the
U.S. military population.

Drug Development for the Treatment of PTSD
The Center, in collaboration with the University of California, Irvine (UCI), is initiating an
exciting new avenue of research to examine novel compounds for the treatment of PTSD using
a non-mammalian rapid throughput model. The
zebrafish, or Danio rerio, will be used as a rapid
throughput model for early screening. The goalof this research is to improve the identificationof candidate therapeutic agents for the treatment
of PTSD. Early phase evaluations in zebrafish
will allow for selection from a wide array of compounds in vivo, using behavioral profiles to detect
response. This selection process is expected toincrease the success rate of subsequent evaluations
in higher-order animal studies. The zebrafish laboratory is currently establishing baseline procedures
and behavioral signatures of response to medications
commonly used for the treatment of PTSD. The firstnovel compounds to be tested after completion of
baseline procedures will be fatty acid amide hydrolase (FAAH) inhibitors, with activity in the endocannabinoid system. CSTS will prepare for future use of
the model by performing comparisons of behavioral
response to compounds tested in both zebrafish andan established rodent model at UCI.

2016 ANNUAL REPORT | 11

placebo. We also hypothesize that spectroscopychanges in the amygdala, anterior cingulate cortex
and hippocampus will associate positively with improvement due to riluzole compared to placebo. This
multiyear study is in the final months of recruitment
and will begin data analysis and publication of findings in 2017.

Clinical Research in Neuroscience and
Neurobiology
Riluzole Augmentation Treatment for ComplicatedCombat-Related PTSD
CSTS continued to conduct a multi-site clinical trial at WRNMMC and the Syracuse Veterans
Affairs Medical Center. This study is evaluating theefficacy of the medication riluzole in veterans with
combat-related PTSD who have not achieved reliefof their symptoms from current evidence-based
treatments. Current recommended medications forcombat-related PTSD increase the availability of
selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs)
in the brain, but do not adequately relieve symptoms
for many patients. This study addresses an urgent
need to investigate other medications and othermechanisms that may be more effective. Riluzole
modifies activity of glutamate, a highly prevalentneurotransmitter in all brain regions. Preclinical research suggests it may help reverse damage to areasof the brain such as the amygdala, anterior cingulate
cortex and hippocampus, where an excess of glutamate is believed to contribute to PTSD symptoms.
This is a randomized, controlled, double-blind trial
comparing the effect of riluzole against placebo
over eight weeks of treatment. PTSD, depression
and anxiety symptoms are assessed once per week.
An exciting aspect of this study is the incorporationof magnetic resonance spectroscopy comparing
concentrations of neurotransmitters and related
chemicals in specific brain regions associated with
PTSD before and after treatment. We hypothesizethat treatment with riluzole will result in greater
PTSD symptom improvement, greater improvement
in depression and anxiety symptoms, and greater
improvement in overall well-being compared to
12 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Enhancing Fear Extinction via Angiotensin Type
1 Receptor Inhibition: A Randomized Controlled
Trial in Posttraumatic Stress Disorder
CSTS is a partner in a multi-center clinical trial
investigating the efficacy of the medication losartan
for treatment of PTSD. Losartan is an angiotensin receptor blocker currently in common use as a
blood pressure medication. This study adds to the
CSTS portfolio of investigations aimed at expanding
medication options for patients with PTSD. CSTS is
recruiting participants at WRNMMC for this multisite study. Other study sites include Massachusetts
General Hospital, Atlanta VA Medical Center, andGeorge Washington University. Preclinical investigations suggest losartan enhances fear extinction in animal models, and retrospective data in humans fromthe Grady Trauma Project identified lower rates of
PTSD in trauma patients treated with angiotensin
receptor blockers. This randomized, controlled, double-blinded trial will compare the effect of losartan
against placebo on PTSD symptoms over ten weeks
of treatment. We will evaluate PTSD and depression
symptoms, as well as side effects of medication every
two weeks. In addition, this study will examine thecontribution of variations in the angiotensin converting enzyme (ACE) gene to treatment response. We
hypothesize that treatment with losartan will resultin greater reduction of PTSD symptoms than placebo, and that patients with a particular variant of the
ACE gene will respond more favorably to treatment
with losartan. This clinical trial is currently recruiting participants through 2018.
The VA National PTSD Brain Bank
The mission of the National PTSD Brain Bank,
which opened in 2015, is to improve the lives of veterans with PTSD. This is the first brain tissue repository dedicated to researching the physical impact ofstress, trauma and PTSD on brain tissue. This Brain
Bank is a critical step toward identifying potential
biomarkers of susceptibility and developing newtreatments that target PTSD at the cellular level. The
National PTSD Brain Bank will help pave the way for
new approaches to the diagnosis and treatment of
individuals with PTSD.
The Brain Bank has collected brain tissue from
more than 100 donors so far. Nearly half of the donors were diagnosed with PTSD. The Brain Bank isalso collecting tissue from persons without PTSD to
be used in studies as controls. In addition, more than
50 living persons have enrolled in the longitudinalfollow-up registry as future donors.
CSTS scientists direct the Brain Bank’s Assessment Core and serve on the Brain Bank’s Scientific
Advisory Board. The Brain Bank is now accepting
applications from outside investigators in addition to
conducting intramural research.
At a National PTSD Brain Bank meeting in Boston this year, it was decided that CSTS will coordinate with the Collaborative Health Initiative Research Program (CHIRP) to perform whole genome
sequencing and methylation, in collaboration with
Yale, for the Brain Bank’s first core study. CHIRP
is a precision medicine-based collaborative effort
between the National Institutes of Health (NIH) andthe DoD. CHIRP is based at USU on the campus
shared with WRNMMC.
The Brain Indices Study
It is estimated that tens of thousands of combat
veterans with TBI will develop PTSD and otheradverse sequelae, including depression and suicidal behaviors. The goal of the Brain Indices Study is
to develop reliable and valid predictors of negative
outcomes to inform targeted treatments that can be
implemented early, and thereby improve the lives of
our wounded warriors and their families. The study,
directed by CSTS, is conducted in the Brain Assessment Research Laboratory at Walter Reed National
Military Medical Center and Fort Belvoir Community Hospital, and funded by the DoD CongressionallyDirected Medical Research Programs (CDMRP) andthe Center for Neuroscience and Regenerative Medicine (CNRM). This longitudinal study was designed

to identify measures of brain structure and functionthat predict PTSD and other negative outcomes in
Service members with mTBI. We are examining cerebral consequences of blast versus impact TBI, as wellas the progression of symptoms over time, in injured
Service members with mTBI. The brain measures,
which include neuroimaging, electrophysiological,
neurocognitive, and neurological assessments, areassessed soon after injury, and 3 and 6 months later.
The goal is to identify associations between the mechanism of brain injury (i.e., blast versus impact) and thenature and severity of outcome in order to ameliorate
and/or prevent the debilitating consequences of mTBI
and PTSD.
We completed enrollment and final evaluations of
the mTBI and injured control participants. The focus
then shifted to recruiting and testing subjects to serveas healthy Service members (HSM) matched on demographic variables but with no history of concussion
or blast exposure. These Service members underwent
the same assessment battery at the three time points,
and data collection was completed in late 2015. The
HSM group is important in interpreting the results, aspreliminary analyses of the imaging and electrophysiology data revealed similar findings between Service
members with mTBI and those with extracranial
injuries who screened negative for TBI.
Our efforts in 2016 were directed to data processing and analysis. The primary objective is to evaluate
associations between indices of brain structure andfunction at baseline, and the course of PTSD symptoms, post-concussive symptoms, and overall mental
and physical health status in Service members with
TBI or other injuries over the subsequent 6-month
period. Our secondary objective is to characterize
brain changes and clinical outcomes in Service members with blast versus impact TBI.
The Chronic Effects of Neurotrauma
Consortium Study 1: Observational Study on Late
Neurologic Effects of OEF/OIF/OND Combat
CSTS is directing this longitudinal, multisite investigation aimed at evaluation of the chronic sequelae
and comorbidities associated with mTBI. Veteransand Service members who sustained mTBI in OEF/
OIF/OND are evaluated on an extensive battery
2016 ANNUAL REPORT | 13

of physiological, psychological, occupational andsocial functioning measures. Subjects then undergo
periodic in-person and telephone reassessments tomonitor them for evidence of neurologic (cognitive,
behavioral, physical) decline.
As part of this study, CSTS is evaluating active
duty Service members at Fort Belvoir Community
Hospital using electrophysiological assays of cognitive function. Event-related brain potentials thatreflect multimodal working memory and long-term
memory access are recorded. Cerebral function
derived from the EEG is also evaluated. These measures are aimed at: (a) seeking physiologic evidenceof neurodegeneration, (b) clarifying the functionalsignificance of changes in neurobiological variables
through real-time measure of neural coordination,and (c) characterizing the neurocognitive mechanisms of impairments shown on cognitive performance tests.
This longitudinal cohort will allow for an assessment of the prevalence, natural history, and response
to interventions of chronic symptoms, conditions,and associated comorbidities after mTBI. Cross-sectional analyses of the sample will allow for ananalysis of the effect of time post-injury on chronic
symptoms, conditions, associated comorbidities, andevidence of neurodegeneration after mTBI.
Application of Somatosensory Evoked Potentials
to the Diagnosis of Traumatic Brain Injury (TBI): A
Translational ApproachThis FDA-funded study, directed by CSTS, aims
to: (a) determine the utility of specific EEG biomarkers as diagnostic tools in Service members withblast-induced TBI based on translational work inanimal models; (b) evaluate neurosensory effectsof brain injury by looking at early and late components of the somatosensory evoked potential (SEP);
and (c) assess within-subject and between-subjects
correlations between the magnitude of EEG changes
and the severity of brain injury, as defined by clinicalexams and/or neuroimaging studies. This work is
aimed at providing a foundation for the use of SEPs
as an EEG-based biomarker for a rapid, field-deployable diagnostic system for TBI. Data collection willcommence upon IRB approval.
14 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Ecological Momentary Assessment of
Posttraumatic Stress Symptoms in U.S. MilitaryService Members (Daily Diary Study)
This study uses ecological momentary assessment
to collect data throughout the day on posttraumaticstress symptoms (PTSS), sleep, pain, substanceuse and other areas of health and functioning in
U.S. militaryServicemembers.
This “daily
diary”
methodology allows for detailed assessment ofvariability of symptom patterns as they occur
throughout the day, providing important insights
into the interaction between symptoms andenvironment, psychosocial relatedness and brain
processes. This cutting-edge methodology provides
assessments over the course of the Service member’s
daily routine, four times a day over 15 continuousdays. In Phase I of the study, participants completed
daily assessments on paper questionnaires. In Phase
II, participants completed daily assessments onelectronic tablets using a sophisticated application
developed in collaboration with the National Center
for Telehealth and Technology (T2) specifically foruse in this study. Psychiatric disorders, including
PTSD and depression, are assessed at baseline andin one and three month follow-up assessments. By
the end of 2016, 98 Service members had joined thestudy. A total of 1,933 paper and 1,849 electronic
daily assessments had been collected, and 30 bloodand 26 saliva samples had been collected. Also in
2016, we examined daily variation in posttraumaticstress symptoms and their relationship to sleep
and PTSD in Phase I data. A manuscript has been
submitted and further analyses of daily variationin posttraumatic stress symptoms in Phase I andPhase II are underway. This innovative study
has implications for interventions and program
development through awareness of posttraumatic
symptom variability. This methodology informs
future use of technology in psychiatric assessment,
treatment, and research.

RESEARCH ON TERRORISM AND
DISASTERS

recovery issues in individuals and communities
following exposure to natural disasters.

Florida Department of Health Response toMultiple Hurricanes

Washington, DC Area Sniper Study

Since its beginning, the CSTS has focused on
the risk and protective factors for posttraumatic
disorders, distress and health risk behaviors associated with traumatic events affecting both civilian
and military populations. This study examines thepsychological and behavioral responses of Florida Department of Health workers to the multiple
hurricanes that occurred during the 2004 and 2005
hurricane seasons. The current focus is on the influence of community collective efficacy following
the four hurricanes and one tropical storm in 2004
on residents’ self-reports of daily physical and mental health nine months after the storms, as measured by the CDC Health-Related Quality of Life
Healthy Days assessment. These individuals were
not only first responders to the multiple hurricanes
but were also affected personally by the storms.
This included injury to self and family, and damage
to homes, some requiring relocation. This research
provides actionable recommendations for community leaders and clinicians to address longer-term

CSTS collected data at the time of the 2002
Washington, DC sniper attacks from individuals
living in the area. Few studies have examined thisevent due to the dearth of empirical data. The
Center research in this area makes a unique contribution to the literature on terrorist events. The
study examines the relationship of identification
with victims of the sniper attacks, TV viewing,prior life-threatening events and other factors toposttraumatic stress and depressive symptoms.
This study, which includes 1,238 Washington, DC
area residents, found that the amount of event-related television viewing and exposure to previous
life-threatening events were related to identification with the victims of the sniper attacks. Further
research continues to explore the interrelationshipsof these characteristics and others in order to better
prepare for terrorist events and inform interventions with individuals and communities.

2016 ANNUAL REPORT | 15

Education and Training
A core component of the Center’s mission is education and training. Center scientists educate andtrain USU medical students committed to service
in our nation’s Army, Air Force, Navy and Public
Health Service. The Center educates leaders andhealth care providers in public and private agencies. In addition, the Center sponsors conferences,seminars and symposia that have educational andtraining objectives. The Center advances the field of
military and disaster psychiatry through presentations, outreach and training, as well as through participation in conferences, collaborations and workshops across the U.S. and internationally. The Center
also educates and expands knowledge throughpublic health efforts and interventions during andafter disasters.
One way in which the Center educates is throughthe dissemination of educational materials to informstakeholders including: healthcare providers, first
responders, community leaders, families, teachingprofessionals and policy makers. For more than
two decades, the Center has created customized,
easy-to-read, just-in-time educational fact sheets toassist Center stakeholders to effectively manage theadverse effects of traumatic stress through enhanced
preparation and response to disaster events.
In 2016, the Center provided educational resources to partners throughout the DoD, as well as
to other Federal agencies, state and local agencies,
professional associations, and others. The Center
responded to many disaster events in 2016 including the water crisis in Flint, Michigan; the floods
in Louisiana; Hurricane Matthew which impacted
the southeastern United States; the warehouse firein Oakland, California; and the Pulse Night Club
shooting in Orlando, Florida.

DISASTER RESPONSE AND PUBLICEDUCATION
Since its inception in 1987, the Center has been
providing disaster response consultation and edu16 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

cation in many forms and in many situations. These
activities include on-the-ground support to disasterevents, such as the 9/11 Pentagon response in 2001,
the mass shooting at Fort Hood, Texas in 2009 andthe active shooter incident at the Washington Navy
Yard in 2013.
CSTS emphasizes disaster preparation, as well as
disaster response and education. The Center Director
serves as Chair of the American Psychiatric Association Disaster Committee. Current and former Center
personnel have been called upon to provide expert
guidance on disaster preparation and response activities as a result of the experience and subject-matter
expertise obtained while working at the Center.
The following are examples of Center disaster
response and education activities in 2016:■■ The Center provided educational materials andother support to the Executive Director of the
National Association of State Mental Health
Program Directors (NASMHPD), the Michigan
Department of Health and Human Services, andthe Michigan Psychiatric Society in response to
the water crisis in Flint, Michigan. This included
information to assist with their response efforts, education on the management of disasters
involving exposure and contamination, the use ofrisk communication strategies, and how best to
support the affected communities in the recovery
process.
■■ CSTS presented a poster on disaster fact sheetsand emergency action plans at the Learning in
Disaster Health symposium sponsored by the
National Center for Disaster Medicine and Public
Health (NCDMPH). The disaster mental healthfact sheet poster received an outstanding poster award. At the request of NCDMPH, CSTS
scientists also presented the material via a global
webinar.
■■ Following the catastrophic flooding in Louisiana,
which resulted in the disinterment of bodies fromcemeteries, CSTS developed and disseminatededucational materials that addressed mental

health issues related to exposure and handling of
human bodies and mass death. These materials
provided an overview of important psychological and cultural considerations for relief workers,
first responders, and healthcare providers.
■■ In a new collaboration with the University ofCalifornia, Los Angeles (UCLA) and the National Institute of Justice, the Center began serving
as part of a multi-site protocol examining mental
health and resilience factors impacting communities exposed to mass shooting events. The
primary site of study is the Washington Navy
Yard because of the 2013 workplace mass shooting incident. This collaboration was built on an
existing partnership between the Center and theNaval Sea Systems Command (NAVSEA) to provide assessment and interventions in support of
NAVSEA personnel who have experienced socialand occupational difficulties after the Washington Navy Yard mass shooting event.
■■ The Center collaborated with the embedded
health care team attached to the U.S. Air Force
480th Intelligence, Surveillance and Reconnaissance Wing at Langley Air Force Base to assess
stress and mental health in the intelligence

■■

■■

■■

■■

CSTS scientist CDR Morganstein receiving an
outstanding poster award from the National
Center for Disaster Medicine and Public Health(NCDMPH).

operators managing information from remotely
piloted combat aircraft. The goal is to enhance
personal wellness, mitigate stress, and optimize
performance.
The Center partnered with the Drug Enforcement
Administration (DEA) to provide a 3-day training
event for DEA agents returning from high-threat
overseas posts. Center scientists provided training that included information on understanding
stress, identifying adverse signs of stress, thebenefits of seeking help and how to overcome
barriers, such as stigma. The presentation served
as the introduction for the first-ever Reintegration Training for DEA agents and their spouses orsignificant others.
CSTS assisted the Western New York PsychiatricSociety (WNYPS) with standing-up their disaster
response team by providing disaster preparedness and response training. On the day of thepresentation, a steel refinery in the area caught
fire and set ablaze six blocks before finally being
contained, and required extensive ongoing monitoring of air quality in the region for months after
the incident. As a result, the Center presentation
to the WNYPS served as just-in-time training
to assist with their efforts to support the mental
health of those involved or impacted by the fire,as well as response and recovery efforts.
CSTS provided training to the Regional Medical
Officer Psychiatrist team of the U.S. Departmentof State on a public health approach to military
medical response to mass violence. The training
provided the psychiatrists, who are critical toensuring the mental health of personnel involved
in international diplomacy engagement, with
updates on mental health effects of disasters on
individuals and communities, evidence-based
early interventions, and effective risk and crisis
communication strategies.
For the third consecutive year, a Center scientist
was invited to present a one-day seminar to thesenior psychiatry residents at the University of
Maryland/Sheppard Pratt Psychiatry Residency
Program. The seminar provided the only education in disaster psychiatry for these junior psychiatrists. Residents from this training program used2016 ANNUAL REPORT | 17the information in response to episodes of civil
unrest and community violence in Baltimore,
Maryland.
■■ A Center Associate Director conducted three
trainings in behavioral health factors in preparedness, response, and recovery for Maryland Local Emergency Planning Groups inHoward County, Carol County, and all Western
Maryland Counties. These trainings provided
evidence-based information regarding disasterbehavioral health to a wide range of stakeholders.

NEUROSCIENCE MODULE FOR PRECLERKSHIP USU MEDICAL STUDENTS
The neuroscience module, co-directed by the
Department of Psychiatry, including CSTS scientists,
and the USU Department of Anatomy, Physiology,
and Genetics, prepares pre-clerkship medical students for their clerkship period, as well as providing
a foundation of knowledge that will inform theirlong-term education. The neuroscience module covers a breadth of information from basic neuroanatomy to clinical skills in neurology and psychiatry.

EDUCATION AND TRAINING IN
COMBAT AND OPERATIONAL STRESSCONTROL: OPERATION BUSHMASTER
CSTS scientists are an integral part of combat
and operational stress control (COSC) education
at USU as part of the annual medical field training
exercise, Operation Bushmaster. Students participate in a four-day large-scale medical simulation
challenging them to practice medicine in a realistic
combat environment. CSTS faculty have developed
a collection of realistic COSC scenarios seamlessly
integrated into the simulation and use these scenarios to assess student performance in basic combat
and operational stress control skills.

HOMELAND SECURITY TRAINING
CSTS partnered with the Army’s Comprehensive
Soldier Fitness program to implement a training
program in psychological first aid/team resilience
18 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

building for the Department of Homeland Security(DHS) in 2015. The DHS and the Center collaboratively developed and pilot tested a cutting-edge resilience training program that incorporated findings
from an initial assessment of existing DHS programs
and included elements of Psychological First Aid,
Decision Making in High Stress Environments, andindividual and team resilience. In 2016, the Center
provided ongoing consultation, as the DHS expanded its Responder Resiliency and Decision Making
program to agencies within the Department who
requested additional training based on the Center’spilot program.

MORTUARY AFFAIRS OFFICEREDUCATION
CSTS provided ongoing officer education at the
Joint Mortuary Affairs Center and School at Fort
Lee, Virginia, assisting the active duty forces and themortuary affairs school as they trained and deployed
new Soldiers in response to changing missions. The
program addressed resiliency, preparedness, training
and education of military personnel for the stressesof deployment and working with the dead. Content
experience comes directly from our research findings
and intervention with Mortuary Affairs Soldiers.

FAMILY SAFETY EDUCATION
Families are the guardians of safety for theirmembers — this spans across the home and neighborhood. This includes protecting children frommedications, asking about safety in home visits, aswell as teaching how to cross the street, avoid falls
and injuries, and when to seek medical care. Prevention of PTSD from injury and suicide from poisonsand firearms are under-tapped areas for learning
about and enhancing family safety education. For example, evidence suggests that adopting safe storagepractices can reduce the likelihood of deaths due tofirearms.
The Center partnered with the Yellow Ribbon
Reintegration Program (YRRP) and the Defense
Suicide Prevention Office (DSPO) to develop the
Personal Firearm Safety Education Project. The

project created multimodal educational materials on
personal firearm safety. This targeted effort strategically supports DoD suicide prevention efforts byeducating Service members on the importance of
personal firearm safety. This training program, implemented in conjunction with pre-and post-deployment events, promotes evidence-based gun safety
practices to enhance the safety of Service members
and their families. As part of continued efforts tobetter understand the importance of family safety and how best to train our health care providers
who strive to decrease PTSD and suicide risk, CSTS
organized a Forum on Health and National Security,
gathering experts from across the country to meetwith scholars from the military health system toconsider the issues. This forum is scheduled to takeplace in January 2017.

TEXTBOOK ON COMPLEMENTARY AND
ALTERNATIVE MEDICINE (CAM) FOR
PTSD
CSTS Associate Director COL Benedek andCenter scientist LTC Wynn published the textbook
Complementary and Alternative Medicine for Posttraumatic Stress Disorder. This text, an invited project from Oxford University Press, is a first of its kindcomprehensive look at a variety of complementary
and alternative treatment modalities. Each chapter
reviews a different CAM treatment, its evidencebase and the potential clinical utility for those suffering from PTSD. The treatments covered include acupuncture, yoga, meditation, animal assisted therapy,transcranial magnetic stimulation, virtual reality,
smart phone applications, alternative pharmacology
and family therapy. This project includes chapter
contributions by several Center members including
the chapter “Family Therapy” by Center Associate
Director Dr. Stephen Cozza.

UPCOMING TEXTBOOK OF DISASTERPSYCHIATRY (SECOND EDITION)
Since the publication of the first edition of the
Textbook of Disaster Psychiatry in 2007 (edited byRobert Ursano, Carol Fullerton, Lars Weisaeth andBeverley Raphael), there has been a proliferation ofdisasters worldwide. The second edition of the Textbook of Disaster Psychiatry, scheduled to be published by Cambridge University Press in 2017, brings
together a distinguished group of international experts to provide an updated, comprehensive reviewof the psychological, biological and social processesof response to, and intervention for, disaster mental
health needs. Chapters from the first edition havebeen updated, and fourteen new chapters have been
added to the second edition. The second edition has
a Scientific Advisory Board of leaders on the cuttingedge of disaster psychiatry and represents a decadeof advances in disaster psychiatry: the epidemiology of disaster response, the neurobiology of disaster exposure, socio-cultural issues, interventions,actionable research and advances in public healthresponses to disaster.

UPCOMING TEXTBOOK ON PTSD
Center scientist LTC Wynn and Center Associate
Director COL Benedek recently contracted to edit
the American Psychiatric Association’s textbook
on PTSD. Working with the American PsychiatricPress, Drs. Wynn and Benedek will engage with experts in the field of PTSD to put together a full professional title work on the topic. The textbook will
cover a wide spectrum of topics from the basics ofdiagnosis and neurobiology to working with special
populations and cultural considerations. The book isslated for publication in 2018.

EDUCATIONAL CONFERENCES
The Center sponsored two educational conferences in 2016: the 11th Annual Amygdala, Stress and
PTSD Conference and the Artiss Symposium.

Amygdala, Stress and PTSD Conference: The
Effects of Stress and Loss
For the past decade, the Center has sponsoredthe Amygdala, Stress and PTSD Conference at USU
every year in April. In 2016, the Center presented
the “11th Annual Amygdala, Stress and PTSD Conference: The Effects of Stress and Loss.” The Center2016 ANNUAL REPORT | 19

works in collaboration with the USU Departmentof Psychiatry, USU Neuroscience Program, USU
Department of Family Medicine, and the WRNMMC
Department of Psychiatry on this annual conference.
The 2016 conference included more than 400 individuals registered for a day of world class presentations
aimed at bringing together scientists, clinicians andpolicy makers working towards solving the biological basis of stress, fear and PTSD. The conference

speakers represented prestigious universities andresearch institutions from across the country and internationally including University of Michigan, Johns
Hopkins University, Georgetown University and the
University of Cape Town, South Africa. The speakers
presented and discussed topics such as the use of big
data in neuroscience research, the biology of empathy and the experience of trauma in South Africa. In
addition to the conference, the Center partnered with
the Journal of Neuroscience Research to put together
a special issue based on the conference. The special
issue from the 11th Annual Amygdala conference iscurrently in process and should be available summerof 2018.

Artiss Symposium: Understanding thePatients’ Experiences: Beyond Diagnostic
LabelsThe Center is a sponsoring partner for the annual
Walter Reed National Military Medical Center(WRNMMC) Artiss Symposium. Kenneth L. Artiss,MD (1913–2001), the namesake of the symposium,
an Army officer, a research psychiatrist and instruc20 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

tor at Walter Reed Army Medical Center inspired
generations of military psychiatry residents to conduct high quality research. This year’s symposium,“Understanding the Patients’ Experiences: Beyond
Diagnostic Labels,” examined why a diagnosis byitself is not sufficient, why clinicians need to look beyond the diagnosis and go beyond the obvious to try
to understand the patient, and how to make an effective intervention with complex patients that both thepatient and other clinicians understand. The Artiss
symposium featured expert speakers in clinical andresearch leadership positions from throughout the
Military Health System.

Forum on Health and National Security
Since the mid-1980s, the Center has held a seriesof conferences, the Forum on Health and National
Security, bringing together experts from across thecountry with a wide range of expertise, perspectives
and vantage points to meet with scholars from themilitary health system to think and talk togeth-

er about topics of importance to the military. Bybringing together people who have thought throughdifferent parts of a problem, but who may have nevertalked together, our goal is to generate new knowledge, new thoughts and new ways of thinking about
issues. The focus of the forums have addressed diverse topics: individual and group behavior in toxic
and contained environments — psychological effects
of chemical and biological warfare; military womenin combat deployment and contingency operations;stress and coping with war; Army family violence;planning for biological events — responses to terrorism and infectious disease outbreaks; workplace
preparedness for terrorism; stigma and barriers tocare — caring for those exposed to war, disaster andterrorism; military families in transition — stress,
resilience, and well-being; and financial stress andbehavioral health in Service members — risk, resilience, mechanisms and targets for intervention. The
next conference in this series is scheduled to takeplace in January 2017.

CSTS research support staff.
2016 ANNUAL REPORT | 21

Examples of CSTS Fact Sheets

TRAINING TO SUPPORT RESEARCH
CSTS is actively involved in training our own
staff, including our Research Assistants (RAs),
Program Coordinators and Program Managers as
research support teams for the future. A team of
Research Assistants at CSTS support our scientists
in many research-related tasks, including literaturesearches, data collection, data entry, data editing,writing meeting minutes, and writing summary
reports of meetings and other activities. Whileperforming these tasks, the RAs are trained by thescientists and leadership at CSTS in many aspects ofthe design and implementation of research projects. CSTS also provides professional development
opportunities for the RAs. Through these tasks andactivities, the RAs learn practical skills and gain
experience in conducting research, and they become
familiar with the process of manuscript preparationand the presentation of research findings to thescientific community and the general public. This
training and experience prepares the RAs for advanced degree programs and careers in research and
22 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

other related fields.
Recently, we were pleased to have CSTS Research Assistants move on to further their education
at Yale, Notre Dame, Johns Hopkins, Duke, USU,
as well as other institutions. Opportunities our
Research Assistants have pursued following theirtraining and experience at CSTS include:■■ PhD programs in psychology and related fields■■ Medical school■■ Law school■■ Master degree programs in counseling, publichealth and social work■■ Careers with the FBI

DISSEMINATION AND
IMPLEMENTATION OF HEALTH AND
RESEARCH KNOWLEDGE
Fact Sheets
Fact sheets are a long-standing communication
tool of CSTS. Fact sheets are easy to understand,topic-focused tools that CSTS develops using expert
knowledge to communicate the basics surrounding

an often difficult and/or crisis related issue. CSTS
developed, updated and maintained a growing
repository of fact sheets on disaster preparedness
and response, risk and crisis communication, andhealth risk education. Fact sheets address the needsof different partners and stakeholders, including
health care providers, family members, safety andemergency workers, policy makers, and community leaders. CSTS fact sheets provide readers withresources tailored to the unique aspects of eachdisaster event. The Center develops, updates andrapidly disseminates fact sheets, in real time, following major disasters and traumatic events suchas community violence, terrorism and bioterrorism,
and public health threats.
Fact sheets the Center recently developed include“Preparing, Responding and Recovering from a Mass
Shooting,” “CBRN Events and Psychological Issues
Healthcare Providers Need to Know,” “Military
Leadership in Stressful Situations,” “Information for
Healthcare Providers in Body Recovery from Mass
Death,” “Information for Relief Workers in Body
Recovery from Mass Death,” “Leadership Communication: Anticipating and Responding to Stressful
Events” and “Coping with Stress Following a Mass
Shooting.”

WebsiteWe use the Center website (www.CSTSonline.
org) to further our goal of disseminating relevant
and timely information to a wide range of stakeholders. This year, we continued refining the website
to make more material available, and to make thematerial more easily accessible. Material available
on the website includes current research citations,newsletters and conference reports. A “What’s New”
section of the website highlights recent disaster fact
sheets, research initiatives, publications, conference
summaries and announcements of upcoming events.
In 2016, the CSTS website was visited by 17,326
people. Most of those people (75%) were from theUnited States. The 12,884 people from the U.S. who
visited our website represented all 50 states and theDistrict of Columbia. The people outside the U.S.
who visited our website were from 142 different
countries.

Social MediaIn 2016, the Center continued to expand its online presence through the use of social media. Thesesocial media resources allow for the timely dissemination of relevant content to our partners. Our
Twitter followers increased by 7% and our Facebook
followers increased by 41% in the past year. The
Center added to its social media portfolio with theaddition of a YouTube channel and new Facebook
pages for three of our research studies to disseminate information about the Center and our research
to interested members of the research community
and the public.
We encourage people to visit and follow ourpostings via Twitter and Facebook to stay up-to-dateon new CSTS activities and publications. “Like” us
on Facebook at Center for the Study of TraumaticStress and follow us on Twitter at @CSTS_USU.

2016 ANNUAL REPORT | 23

Consultation
CONSULTATIVE PARTNERSHIPS
Since its inception, consultative relationships
have been a cornerstone of CSTS’s mission, including a wide variety of partner organizations both
inside and outside government, and internationally.
Such collaborations build bridges that provide opportunities to contribute our resources and expertisein the service of others and to monitor real timeneeds of partners and stakeholders. The following
are examples of some of our long-standing consultations as well as some new consultations in 2016.

National Association of State Mental Health
Program Directors (NASMHPD)
NASMHPD, a membership organization representing state mental health authorities (Commissioners), has a long-standing relationship with CSTS.
The Commissioners are responsible for directing the
public mental health system in their states, and address the many challenges inherent in those systems.
CSTS and NASMHPD leadership are in frequentcontact to share experience and meet mutual needs.
The leadership at NASMHPD changed in 2016
with the appointment of a new Executive Director.
CSTS arranged for the new Executive Director tovisit the Center for a day of orientation and information sharing. The result has been a continued
strengthening of the long-term ties between CSTS
and NASMHPD.
CSTS made a presentation about the Center aspart of a webinar conducted by the NASMHPD. The
webinar was attended by 13 State Mental HealthCommissioners and 24 other representatives from19 states. The purpose was to acquaint (and reacquaint) the State Commissioners of Mental Healthwith CSTS and explore ways in which CSTS can
support the activities of, and shared goals with, theCommissioners.
CSTS made a presentation as part of a seminarfor newly appointed State Mental Health Directors
from twelve states. The presentation provided vital
24 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

information to the new state directors in areas suchas trauma, working with the military, disaster preparedness and response, and crisis communication.

Substance Abuse and Mental Health Services
Administration (SAMHSA)SAMHSA is one of the oldest and most important federal partners for CSTS. Located within
the Department of Health and Human Services,
SAMHSA is the lead federal entity responsible forsupporting and improving mental health services in
the nation. CSTS continued to serve on the Disaster
Distress Helpline (DDH) Steering Committee to provide guidance and feedback to this SAMHSA-funded resource that assists those needing help in theirrecovery from disasters.

University of Pittsburgh Medical Center,
Center for Health Security
CSTS participated in a small group of healthleaders convened by the Center for Health Security,
University of Pittsburgh Medical Center. With funding from the Robert Wood Johnson Foundation, thegroup examined the adequacy and appropriateness of
disaster health programs and approaches in light ofchanging health systems. They studied recent disasterevents, anticipated potential changes in the healthcare system over the next decade, and convened several small groups to provide input and advice. CSTS
provided the only behavioral health professional
involved, and participated in review and input into
subsequent reports and findings of the group.

The National Center for Disaster Medicine
and Public Health (NCDMPH)
CSTS assisted in the distribution of NCDMPH’s
new video entitled, “Empowering the Community: Blindness and Emergency Preparedness.” Using
CSTS’s network of partners, the video was distributed to key stakeholders who are well-positioned touse the video for training and consultation purposes,
such as NASMHPD and SAMHSA, and to distrib-

ute it further. For example, NASMHPD leadership
distributed it to all its members.

The American Psychiatric Association
CSTS has extended its knowledge and reachthrough working with the national medical associations educating and training on disaster mental
health. This includes the American Psychiatric
Association (APA). CSTS was part of the foundingof the APA’s efforts in disaster psychiatry and has
been part of its Committee on Disaster Psychiatry
since its founding in 1992. This year CSTS scientists
provided formal and informal disaster consultationand education resources to APA District Branches in
response a wide range of disaster events, including
the lead water crisis in Flint, Hurricane Matthew,
Fort Lauderdale airport shootings, and the Pulse
Nightclub shootings in Orlando. Consultation services include guidance and resources on enhancing
preparedness, response and recovery following disasters. Education fact sheets serve as an importantresource for District Branches to assist them in rapidly disseminating critical, time-sensitive, actionable
information to optimize the well-being of patientsand other community members.
The Center Director continued his leadershiprole as the Chair for the APA Disaster Committee.
Part of his work and other Center scientists working with the committee involved the development
and dissemination of an APA position statement on
mental health and climate change related disasters.
This document will serve to guide the APA’s involvement and partnership with national and global
health entities working to mitigate the adverse mental health effects of weather-related disasters.
At the APA Annual Meeting, CSTS scientists
presented a workshop on hospital-based violence,
including mass shootings and acts of terrorism.
During the interactive presentation, panel members
and attendees discussed effective preparedness andresponse measures in health care settings as well as
ethical considerations for providers as they balancecompliance with response protocols, such as shelter-in-place or evacuation, with the duty to care forpatients.
At the Annual Conference for the Institute of

Psychiatric Services, which was organized by the
APA, the Center Director served as the moderator
for a symposium on the mental health effects of achanging global climate and a Center scientist provided the keynote presentation addressing the intersection of weather-related disasters and psychiatricpractice. The presentation served as a springboard
for discussions about how to become more engaged
in disaster mental health care and efforts to address
mental health effects of weather-related disasters
through effective preparedness and response.

GLOBAL HEALTH
Global Health Engagement
The Center Director participated in the USU
School of Medicine Strategic Planning meeting todiscuss the mission of
the School of Medicine
as it relates to the DoD’s
initiatives in addressing
national security, global
health and global healthengagement. As a resultof this meeting, USU
decided to consolidate
its activities into the USU Center for Global HealthEngagement (CGHE). CSTS hosted representativesof the newly formed CGHE as the first in a seriesof ongoing meetings intended to increase CGHE’s
understanding of the roles of CSTS and the Department of Psychiatry.
A Center scientist was appointed as the U.S.
Representative to the NATO Research Task Group“Leveraging Technology in Military Mental Health”
as a result of his work on a previous NATO Exploratory Team. This Research Task Group (RTG) is aNATO-approved, three-year, multi-country effort
to evaluate and understand the use of technologicaladvances for improved mental health care in the
military.
Center scientists participated in a meeting entitled “Out of the Shadows: Making Mental Health a
Global Development Priority” at George Washington University sponsored by the World Bank Groupand the World Health Organization. The meeting2016 ANNUAL REPORT | 25

was to share information, perspectives, and experiences regarding promoting enhanced focus on awide variety of mental health issues. By participatingin this meeting, CSTS made an important knowledge/relationship bridge between CSTS interests/
activities and others around the world.
The Center provided consultation and training
development support to the Navy South Command
medical team in anticipation of humanitarian mission Operation Continuing Promise-17 (CP-17). This
90-day mission will involve Navy medical care being
given to thousands of underserved individuals inseveral South American countries. In an effort to reduce adverse psychological symptoms in healthcare
providers exposed to extremes of poverty, resource
limitations, and severe medical conditions during
this humanitarian mission, the Navy requested CSTS
assistance in developing mental health and resilience
preparedness training for providers and staff.
CSTS scientists contributed once again to thevery limited published literature on the topic ofmental health issues in military humanitarian response (see West & Morganstein, 2016 in the CSTS
publications section). This chapter contains a reviewof the limited existing literature in an area with little
guidance to assist those who oversee preparedness
and response efforts to humanitarian activities. The
chapter served as the foundation for the support efforts CSTS provided to the CP-17 team noted above.
Several CSTS members contributed to the article“Global Mental Health: Optimizing Uniformed Services Roles” published in Joint Force Quarterly (seeFlynn, et al, 2016 in the CSTS publications section),a publication that is read by many political and military top leaders. Informing this audience is a significant step forward in assuring that the relevance andscope of mental health issues and opportunities in
the field of global health engagement are reflected inpolicy development and implementation.

International Outreach
The Center sent a scientist to Ghana to support
the DoD on a Defense Institute for Medical Operations (DIMO) mission. DIMO facilitates healthcare
education and training to international partners by
utilizing subject matter experts (SME) from the DoD
26 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

to develop curriculum and teach courses around theworld. On this mission, CSTS provided global mental
health education and training by sharing the fundamentals of Disaster Psychiatry with the Ghanaian
Military. The mission, called 21st Century Warrior,included basic trauma response, psychological firstaid, handling remains, provider burnout, PTSD andsuicide. Participants included 45 Ghana military Service members ranging from hospital administrators
to psychiatrists and surgeons.
The Center continued working internationally ina collaboration with a seismologist at the Natural Resources Canada on issues of risk communication byseismologists in the wake of earthquakes, and CSTS
published two articles related to this collaboration in
2016. There was a unique opportunity on February
5, 2016 to apply the content of this collaboration.
On that day, there was an earthquake swarm of four
small earthquakes in McAdam, New Brunswick(population approximately 1,200). The seismologist
at the Natural Resources Canada shared a publishedarticle about communicating in the wake of theseswarms with the Department of Earth Sciences at
the University of New Brunswick in Fredericton.
Two faculty members at the University used the article to craft a message, along with supporting links
to more specific guidance in French and English, for
the Mayor of the Village of McAdam to use when
speaking to his community.

Extreme Weather-Related Disasters andMental HealthCenter scientists served as the only DoD representatives and co-authors for the mental healthand well-being chapter of the landmark federal
multi-agency report, “The Impacts of Climate
Change on Human Health in the United States: A
Scientific Assessment,” delivered to the U.S. President and Congress during Public Health Week.
This document, a first of its kind, details the current
state of scientific knowledge regarding the impacts
of weather-related disasters on health and serves toaugment scientific information in previous U.S. National Climate Assessments. This report will serve to
guide national and global policies on health, energy,transportation, communication and defense.

CSTS Publications in 2016
(Names in bold text are CSTS personnel)

JOURNAL ARTICLESAkula, N., Wendland, J. R., Choi, K. H., &McMahon, F. J. (2016). An integrative genomic
study implicates the post-synaptic density
in the pathogenesis of bipolar disorder.
Neuropsychopharmacology. 41, 886-895.
Biggs, Q. M., Fullerton, C. S., McCarroll, J. E., Liu,X., Wang, L., Dacuyan, N. M., & Ursano, R. J.
(2016). Early intervention for PTSD, depression
and quality of life in mortuary affairs soldiers
post-deployment. Military Medicine. 181(11),e1553-60.
Carpenter, W. T., & Regier, D. (2016). Diagnostic
categories: Provisional, not otherwise classified,or place-holder? Schizophrenia Bulletin. 42(6),1305-1306.
Castro-Gomes, V., Bergstrom, H. C., McGuire, J. L.,
Parkers, C. C., Coyner, J., Landeira-Fernandez,J., Ursano, R. J., Palmer, A. A., & Johnson, L.
R. (2016). A dendritic organization of lateral
amygdala neurons in fear susceptible andresistant mice. Neurobiology of Learning andMemory. 127, 64-71.
Cox, K. L., Nock, M. K., Biggs, Q. M., Bornemann,
J., Colpe, L. J., Dempsey, C. L., Heeringa, S.
G., McCarroll, J. E., Ng, T. H., Schoenbaum,
M. Ursano, R. J., Zhang, B. G., Benedek, D.
M., & Army STARRS Collaborators. (2016).
An examination of potential misclassificationof Army suicides: Results from the Army
Study to Assess Risk and Resilience inServicemembers. Suicide and Life-Threatening
Behavior. doi:10.1111/sltb.12280
Cozza, S. J., Fisher, J. E., Mauro, C., Zhou, J.,
Ortiz, C. D., Skritskaya, N., Wall, M. M.,
Fullerton, C. S., Ursano, R. J., & Shear, M.
K. (2016). Performance of DSM-5 persistentcomplex bereavement disorder criteria in acommunity sample of bereaved military family
members. American Journal of Psychiatry.
173(9), 919-29.
Cozza, S. J., Fisher, J. E., Mauro, C., Zhou, J., Ortiz,

C. D., Skritskaya, N., Wall, M. M., Fullerton, C.
S., Ursano, R .J. & Shear, M. K. (2016). Toward a
Better Recognition of Clinically Impairing Grief:
Response to Smid and Boelen. American Journalof Psychiatry, 173(11), p. 1150.
Crum-Cianflone, N. F., Powell, T. M., LeardMann,
C. A., Russell, D. W., & Boyko, E. J. (2016).
Mental health and comorbidities in U.S. military
members. Military Medicine. 181(6), 537-545.
Fink, D. S., Cohen, G. H., Sampson, L. A., Gifford,
R. K., Fullerton, C. S., Ursano, R. J., & Galea, S.
(2016). Incidence of and risk for post-traumaticstress disorder and depression in a representative
sample of U.S. Reserve and National
Guard. Annals of Epidemiology. 26(3), 189-197.
Fink, D. S., Lowe, S., Cohen, G. H., Sampson, L. A.,
Ursano, R. J., Gifford, R. K., Fullerton, C. S.,& Galea, S. (2016). Trajectories of posttraumaticstress symptoms after civilian or deployment
traumatic event experiences. PsychologicalTrauma: Theory, Research, Practice, and Policy.
doi:10.1037/tra0000147
Flynn, B. W., Morganstein, J. C., Ursano, R.
J., Regier, D. A., West, J. C., Wynn, G. H.,
Benedek, D. M., & Fullerton, C. S. (2016).
Global mental health: Optimizing uniformed
services roles. Joint Force Quarterly. 83.
Joiner, T. E., Hom, M. A., Rogers, M. L., Chu, C.,
Stanley, I. H., Wynn, G. H., & Gutierrez, P. M.
(2016). Staring down death. Crisis. 37(3), 212-7.
Kessler, R. C., Stein, M. B., Petukhova, M. V., Bliese,
P., Bossarte, R. M., Bromet, E. J., Fullerton, C. S.,
Gilman, S. E., Ivany, C., Lewandowski-Romps, L.,
Bell, A. M., Naifeh, J. A., Nock, M. K., Reis, B. Y.,
Rosellini, A. J., Sampson, N. A., Zaslavsky, A. M.,
Ursano, R. J., & Army STARRS Collaborators.
(2016). Predicting suicides after outpatientmental health visits in the Army Study to Assess
Risk and Resilience in Servicemembers (ArmySTARRS). Molecular Psychiatry. doi: 10.1038/
mp.2016.110
Lamontagne, M., & Flynn, B. W. (2016). Perceptionof earthquake hazard and risk in the province
2016 ANNUAL REPORT | 27

of Quebec and the need to raise earthquake
awareness in this intraplate region. SeismologicalResearch Letters. 87(6), 1426-1432.
Lamontagne, M., Flynn, B. W, & Goulet, C. (2016).
Facing the communication challenges during anearthquake swarm period. Seismological Research
Letters. 87(6), 1373-1377.
Lee, B. H., Park, T. Y., Lin, E., Li, H., Yang, C. H.,& Choi, K. H. (2016). Altered acoustic startle,
pre-pulse inhibition, and peripheral brainderived neurotrophic factor in morphine selfadministered rats. International Journal of
Neuropsychopharmacology. doi: 10.1093/ijnp/
pyw107
Mash, H. B. Herberman, Fullerton, C. S., Ng, T.
H., Nock, M. K., Wynn, G. H., & Ursano, R.
J. (2016). Alcohol use and reasons for drinking
as risk factors for suicidal behavior in the U.S.
Army. Military Medicine. 181(8), 811-820.
Mash, H. B. H., Ursano, R. J., Benevides, K. N.,& Fullerton, C. S. (2016). Identification withterrorist victims of the Washington, D.C. sniper
attacks: Posttraumatic stress and depression.
Journal of Traumatic Stress. 29(1), 1-8.
Meyer E. G., Writer B. W., & Brim W. (2016).
The importance of military culturalcompetence. Current Psychiatry Reports. 18(3),26.
Morganstein, J. C. (2016). Mobile applications
for mental health providers. Psychiatry:Interpersonal and Biological Processes. 79(4),358-363.
Morganstein J. C., Benedek D. M., & Ursano R.
J. (2016). Post-traumatic stress in disaster first
responders. Disaster Medicine and Public HealthPreparedness. 10(1), 1-2.
Naifeh, J. A., Colpe, L. J., Aliaga, P. A., Sampson,
N. A., Heeringa, S. G., Stein, M. B., Ursano, R. J.,
Fullerton, C. S., Nock, M. K., Schoenbaum, M.,
Zaslavsky, A. M., & Kessler, R. C. (2016). Barriers
to initiating and continuing mental healthtreatment among soldiers in the Army Study toAssess Risk and Resilience in Servicemembers(Army STARRS). Military Medicine. 181(9),1021-1032.
Naifeh, J. A., Nock, M. K., Ursano, R. J., Vegella,
P. L., Aliaga, P. A., Fullerton, C. S., Kessler, R.
28 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

C., Wryter, C. L., Heeringa, S. G., & Stein, M. B.
(2016). Neurocognitive function and suicide in
U.S. Army soldiers. Suicide and Life-Threatening
Behavior. doi:10.1111/sltb.12307
Nishida, K. S., Park, T. Y., Lee, B. H., Ursano, R.
J., & Choi, K. H. (2016) Individual differences
in initial morphine sensitivity as a predictor
for the development of opiate addiction in rats.
Behavioural Brain Research. 313, 315-323.
Pitts, B. L., Safer, M. A., Russell, D. W., & CastroChapman, P. L. (2016). Effects of hardinessand years of military service on posttraumaticstress symptoms in U.S. Army medics. Military
Psychology. 28(4), 278-284.
Polimanti, R., Chen, C. Y., Ursano, R. J., Heeringa,
S. G., Jain, S., Kessler, R. C., Nock, M. K., Smoller,J., Sun, X., Gelernter, J., & Stein, M. B. (2016).
Cross-phenotype polygenic risk score analysis
of persistent post-concussive symptoms in
US Army soldiers with deployment-acquired
traumatic brain injury. Journal of Neurotrauma.
doi:10.1089/neu.2016.4550
Pollard, H. B., Shivakumar, C., Starr, J., Eidelman,
O., Jacobowitz, D. M., Dalgard, C. L., Srivastava,M., Wilkerson, M. D., Stein, M. B., & Ursano,R. J. (2016). “Soldier’s heart”: A genetic basis forelevated cardiovascular disease risk associatedwith post-traumatic stress disorder. Frontiers in
Molecular Neuroscience. 9(87).
Rosselini, A .J., Monahan, J., Street, A. E., Heeringa,
S. G., Hill, E. D., Petukhova, M., Reis, B.Y.,
Sampson, N. A., Bliese, P., Schoenbaum, M.,
Stein, M. B., Ursano, R. J., & Kessler, R. C.
(2016). Predicting non-familial major physicalviolent crime perpetration in the U.S. Armyfrom administrative data. Psychological
Medicine. 46(2), 303-16.
Rosellini, A. J., Monahan, J., Street, A. E., Hill, E.
D., Petukhova, M., Reis, B. Y., Sampson, N. A.,
Benedek, D. M., Bliese, P., Stein, M. B., Ursano,R. J., & Kessler, R. C. (2016). Using administrative
data to identify U.S. Army soldiers at high-riskof perpetrating minor violent crimes. Journal of
Psychiatric Research. 84, 128-136.
Russell, C. A., Swasy, J. L., Russell, D. W., &Engel, L. (2016). Eye-tracking evidence
that happy faces impair verbal message

comprehension: The case of health warnings
in direct-to- consumer pharmaceuticaltelevision commercials. International Journal ofAdvertising. 82-106.
Sonnenberg, S. M., & Ursano, R. J. (2016).
Psychoanalysis and psychoanalytic
psychotherapy: Technique. Reference Module in
Neuroscience and Biobehavioral Psychology. 415422.
Stein, M. B., Campbell-Sills, L., Gelernter, J., He,
F., Heeringa, S. G., Nock, M. J., Sampson, N.
A., Sun, X., Jain, S., Kessler, R. C., & Ursano,R. J. (2016). Alcohol misuse and co-occurring
mental disorders among new soldiers in the U.S.
Army. Alcoholism: Clinical and Experimental
Research. 41(1), 139-148.
Stein, M. B., Chen, C. Y., Ursano, R. J., Cai, T.,
Gelernter, J., Heeringa, S. G., Jain, S., Jensen K.
P., Maihofer, A. X., Mitchell, C., Nievergelt, C.
M., Nock, M. K., Neale, B. M., Polimanti, R.,
Ripke, S., Sun, X., Thomas, M. L., Wang, Q.,
Ware, E. B., Borja, S., Kessler, R. C., & Smoller, J.
W. (2016). Genome-wide association studies of
posttraumatic stress disorder in 2 cohorts of US
Army soldiers. JAMA Psychiatry. 73(7), 695.
Stein, M. B., Ursano, R. J., Campbell-Sills, L.,
Colpe, L. J., Fullerton, C. S., Heeringa, S. G.,
Nock, M. K., Sampson, N. A., Schoenbaum,

M., Sun, X., Jain, S., & Kessler, R. C. (2016).
Prognostic indicators of persistent postconcussive symptoms after deploymentrelated mild traumatic brain injury: A
prospective longitudinal study in U.S. Armysoldiers. J Neurotrauma. 33, 1-8.
Street, A. E., Rosellini, A. J., Ursano, R. J., Heeringa,
S. G., Hill, E. D., Monahan, J., Naifeh, J. A.,
Petukhova, M. V., Reis, B. Y., Sampson, N. A.,
Bliese, P. F., Stein, M. B., Zaslavsky, A. M., &Kessler. R. C. (2016). Developing a risk model
to target high-risk preventive interventions forsexual assault victimization among female U.S.
Army soldiers. Clinical Psychological Science.
4(6), 939-956.
Ursano, R. J., Kessler, R. C., & Stein, M. B. (2016).
Suicide attempts in the US Army – Reply. JAMA
Psychiatry. 73(2), 176-7.
Ursano, R. J., Kessler, R. C., Stein, M. B., Naifeh, J.
A., Aliaga, P. A., Fullerton, C. S., Wynn, G. H.,
Vegella, P. L., Ng, T. H., Zhang, B. G., Wryter,
C. L., Sampson, N. A., Kao, T. C., Colpe, L. J.,
Schoenbaum, M., McCarroll, J. E., Cox, K.L.,
Heeringa, S.G., & Army STARRS Collaborators.
(2016). Risk factors, methods, and timing ofsuicide attempts among US Army soldiers. JAMA
Psychiatry. 73(7), 741.
Ursano, R. J., Kessler, R. C., Stein, M. B., Naifeh, J.

2016 ANNUAL REPORT | 29

A., Nock, M. K., Aliaga, P. A., Fullerton, C. S.,
Wynn, G. H., Ng, T. H., Dinh, H. M., Sampson,
N. A., Kao, T. C., Schoenbaum, M., McCarroll,J. E., Cox, K. L., & Heeringa, S. G. (2016).
Medically documented suicide ideation among
U.S. Army soldiers. Suicide and Life-Threatening
Behavior. doi:10.1111/sltb.12316
Ursano, R. J., Wang, J., Ramsawh, H., Russell,
D. W., Benfer, N., Gifford, R. K., Cohen, G.
H., Galea, S., & Fullerton, C. S. (2016). Posttraumatic stress disorder, depression, and binge
drinking in the reserve component of the U.S.
Armed Forces. Military Medicine. 181(10), 12871293.
Wagner, J., Schroeder, H. M., Piskorowski, A.,
Ursano, R. J., Stein, M. B., Heeringa, S. G., &Colpe, L. J. (2016). Timing the mode switch in asequential mixed-mode survey: An experimental
evaluation of the impact on final response rates,
key estimates, and costs. Social Science Computer
Review doi:10.1177/0894439316654611

BOOK CHAPTERS
Cozza, S. J. (2016). Parenting in military families
faced with combat related injury, illness ordeath. In A. H. Gewirtz, & A. M. Youssef (Eds.),
Parenting and Children’s Resilience in Military
Families (pp. 151-174). Switzerland: Springer
International.
Cozza, S. J. (2016). Family-focused interventions for
PTSD: Lessons from military families. In D. M.
Benedek & G. H. Wynn (Eds.), Complementaryand Alternative Medicine for PTSD (pp. 179-202)
New York, NY: Oxford University Press.
Dodgen, D., Donato, D., Kelly, N., La Greca, A.,
Morganstein, J., Reser, J. P., Ruzek, J., Schweitzer,
S., Shimamoto, M. M., Thigpen Tart, K., &Ursano R. J. (2016). Ch. 8: Mental Health andWell-Being. The Impacts of Climate Change on
Human Health in the United States: A Scientific
Assessment (pp. 217-246). Washington, DC: U.S.
Global Change Research Program.
Morganstein J. C., West J. C ., Huff L. A., Flynn B.
W., Fullerton C. S., Benedek D. M., & Ursano

30 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

R. J. (2016). Psychosocial Responses to Disasterand Exposures: Distress Reactions, Health Risk
Behavior, and Mental Disorders. In J. Shigemura,
R.K. Chhem (Eds.), Mental Health and Social
Issues Following a Nuclear Accident — The Caseof Fukushima. Tokyo, Japan: Springer
West J. C., & Morganstein J. C. (2016).
Psychological Effects of Military Personnel
Assigned to Humanitarian Assistance andDisaster Response Missions. In G. Christodoulou,
J. Mezzich, N. Christodoulou, D. Lecic-Tosevski,(Eds.). Disasters: Mental Health Context andResponses. Cambridge Scholars Publishing.
Cambridge Scholars Publishing. Newcastle, UK.

BOOKS/VOLUMES
Benedek, D. M., & Wynn, G. H. (Eds).
Complementary and Alternative Medicine for
PTSD. Oxford University Press, New York, 2016.
Prager, E. M., Wynn, G. H., & Ursano, R. J.,(Eds.). (2016). Special Issue: The Amygdala:
Dysfunction, Hyperfunction and Connectivity.
Hoboken, NJ: John Wiley & Sons.

CSTS Presentations, Briefings, Interviews
and Awards in 2016
(The names in bold text are CSTS personnel.)

PRESENTATIONS
Medical and Public Health Preparedness: Mental
Health and Resilience. Ursano, R. J. Presented
at forum on Medical and Public HealthPreparedness for Catastrophic Events, Institute ofMedicine, Washington, DC, February, 2016.
Complementary and Alternative Medicine for
Posttraumatic Stress Disorder. Wynn, G. H.
Presented at Grand Rounds, Depart of Psychiatry,
Walter Reed National Military Medical Center,
Bethesda, MD, February 2016.
DSM-5, RDoC, and the Language of God. Regier, D.
A. Presented at the American Psychopathological
Association Annual Meeting, New York, NY,
March, 2016.
Introduction to the Center for the Study of TraumaticStress. Flynn, B. W. Presented in a webinar
hosted by the National Association of Mental
Health Program Directors, March, 2016.
Update on Antipsychotics. Wynn, G. H., Presented
at Walter Reed National Military Medical Center
Department of Psychiatry, Bethesda, MD, March,
2016.
Arts & the Brain: Art Therapy & PTSD — The
Practice & Science of Healing with Art in the
Military. Wynn, G. H. & Walker, M. Presented at
Strathmore Arts Center, Bethesda, MD, March,
2016.
An ecological momentary assessment approach tothe study of post-traumatic stress symptoms in
U.S. military service members. Biggs, Q. M.,
Fullerton, C. S., Probe, D., Carr, R. B., Dacuyan,N., Franz, M., Paxton, M., Wang, L., & Ursano,R. J. Poster presented at the meeting of theSociety of Behavioral Medicine, Washington, DC,
April, 2016.
Behavioral Health Factors in Preparedness, Response
and Recovery. Flynn, B. W. & Barbara, J.
Presented at the quarterly Local Emergency
Planning Meeting sponsored by the Officeof Emergency Operations of Howard County
Maryland, Howard County, MD. April, 2016.
Crisis Management, Disasters & Crisis
Communication. Flynn, B. W., & Morganstein, J.
C. Presented at the Newly Appointed State Mental
Health Directors Training Conference, National
Association of State Mental Health Program
Directors, Falls Church, VA, April, 2016.
Military Medical Response to Mass Violence: A Public
Health Approach. Morganstein, J. C., West, J. C.,& Benedek, D. M. Presented at the Annual Mental
Health Training Conference for Regional Medical
Psychiatrists, Department of State, Atlanta, GA,
May, 2016.
The National Military Family Bereavement Study.
Cozza, S. J. Presented at the 22nd Annual TAPS
National Military Survivor Seminar, Arlington, VA,
May, 2016.
Riluzole Augmentation for PTSD. West, J. C.
Presented at the Military Operational Medical
Research Program Interim Review Panel, Fort
Detrick, MD, June, 2016.
DSM-5 Field Trials in Large Academic Settings: A
Pragmatic Test-Retest Reliability Study. Regier,
D. A. Presented at the Joint Statistical Meetings,
Chicago, IL, August, 2016.
Coordinated Disaster Response for Offsite Facilities
using a Customized Emergency Action Plan.
Meyer, E. G., Hastings, J. M., Flynn, B. W., West,
J. C., & Morganstein, J. C. Poster presentation
at the Disaster Health Education Symposium:
Innovations for Tomorrow, National Center for
Disaster Medicine and Public Health, Bethesda,
MD, September, 2016.
Coping with Traumatic Stress. Morganstein, J.
C. Presented at the Reintegration from HighThreat Posts and Military Deployments seminar,
Drug Enforcement Administration, Department ofJustice, Quantico, VA, September, 2016.
Education Fact Sheets: Tailored and Timely Disaster
Mental Health Response. Meyer, E. G., Hastings,
2016 ANNUAL REPORT | 31

J. M., Flynn, B. W., West, J. C., & Morganstein,
J. C. Poster presentation at the Disaster Health
Education Symposium: Innovations for Tomorrow,
National Center for Disaster Medicine and Public
Health, Bethesda, MD, September, 2016.
Troop Educational for Army Morale (TEAM): A post
deployment educational intervention for Mortuary
Affairs Soldiers. Biggs, Q. M., Fullerton, C. S.,
McCarroll, J. E., Liu, X., Wang, L., Dacuyan, N.,
Zatzick, D., & Ursano, R. J. Poster presentation
at the Disaster Health Education Symposium:
Innovations for Tomorrow, National Center for
Disaster Medicine and Public Health, Bethesda,
MD, September, 2016.
Coordinated Disaster Response for Offsite Facilities
using a Customized Emergency Action Plan.
Meyer E. G., Hastings, J. M., Flynn, B. W.,
West, J. C., & Morganstein, J. C. Poster
presentation at the Disaster Health Education
Symposium: Innovations for Tomorrow, National
Center for Disaster Medicine and Public Health,Bethesda, MD, September, 2016.
Mobile Applications in Just-in-Time Learning forDisaster Health Professionals. Liu, A., StraussRiggs, K. Poster presentation at the Disaster
Health Education Symposium: Innovations
for Tomorrow, National Center for Disaster
Medicine and Public Health, Bethesda, MD,
September, 2016.
Counterintuitive Victim Behavior: Expert Testimony
in Military Court’s Martial. Benedek, D. M.
Presented at the annual meeting of the American
Academy of Psychiatry and the Law (AAPL),
Portland, OR, October, 2016.
Disaster Mental Health and Climate Change: Making
the Connection. Morganstein, J. C. Keynote
presented at the Annual Conference, Instituteof Psychiatric Services, American Psychiatric
Association, Washington, DC, October, 2016.
PTSD and Other Trauma and Stressor Related
Disorders: from PTSD to Suicide. Ursano, R.
J. Presented as the Joseph P. Tupin Lecturer
and Visiting Professor during Grand Rounds,
University of California Davis Department of
Psychiatry and Behavioral Sciences, Davis, CA,
October, 2016.
Behavioral Health Factors in Preparedness,
Response, and Recovery. Flynn, B. W. Presented
32 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

at a meeting of the Carroll County Disaster
Preparedness Group (DPG), Westminster, MD,
November, 2016.
Disaster Psychiatry: Critical Concepts. Morganstein,
J. C. Presented at the Western New York
Psychiatric Society, American Psychiatric
Association, Buffalo, NY, November, 2016.
Terrorism-Related Grief Reactions Fifteen Years
After 9-11: Public Health Implications. Fisher,
J. E., Fetchet, M., Zhou, J., Dinh, H. & Cozza,
S. J. Presented the 32nd Annual Meeting of theInternational Society for Traumatic Stress Studies,
Dallas, TX, November, 2016.
Military Family Members Bereaved by Sudden andViolent Death: Differentiating Grief, Depressionand Trauma-related Symptom Clusters. Cozza,
S. J., Fisher, J. E., Zhou, J., Fullerton, C. S.,& Ursano, R. J. Presented at the 32nd Annual
Meeting of the International Society for TraumaticStress Studies, Dallas, TX, November, 2016.
Performance of DSM-5 Criteria for Persistent Complex
Bereavement Disorder. Mauro, C., Shear, M. K.,
Cozza, S. Reynolds, C., Simon, N., Zisook, S.,
Skritskaya, N., Wang, Y., Lebowitz, B., Duan,N., Gribbin, C., Fisher, J. E., Zhou, J., Ortiz,C., Fullerton, C. S., Ursano, R. J., Wall, M.,
Ghesquiere, A., First, M., & Glickman, K. Presented
at the 32nd Annual Meeting of the International
Society for Traumatic Stress Studies, Dallas, TX,
November, 2016.
The protective effect of social and support networks
among US Army Soldiers at risk for suicide.
Dempsey, C. L., Benedek, D., Nock, M. K., Cox,
K. L., Wu, H., Wang, L., Karp, J., Ng, T. H., &Long, W. Poster presentation at the 32nd Annual
Meeting of the International Society for TraumaticStress Studies, Dallas, TX, November, 2016.
Couple Reports of Family Functioning following
Combat-related Injuries: Association of Individual
Psychiatric Symptoms with Family Function andwithin Couple Agreement. Whaley, G., Todd,
K., Herman, M., Engle, K., & Cozza, S. J. Poster
presentation at the 32nd Annual Meeting of theInternational Society for Traumatic Stress Studies,
Dallas, TX, November, 2016.
Trauma and Stressor Related Disorders. Ursano, R.
J. Presented as part of a six part webinar series
called “Understanding War Trauma”, American
Psychoanalytic Association, December, 2016.

BRIEFINGS AND INTERVIEWS
■■

■■

■■

■■

■■
■■

■■

■■

Dr. Stephen Cozza was a guest speaker at theWhite House for a forum on “Operation Educate
the Educators: Committed to Recognizing andSupporting our Military-Connected Students.”
The forum was hosted by Second Lady Dr. Jill
Biden who is a military mom and lifelong educator. The forum was part of the “Month of theMilitary Child” celebration and part of Dr. Biden’s“Joining Forces” initiative.
Dr. Ursano presented an update of the status
and findings for Army STARRS and STARRS-LS
at the Military Operational Medicine Research
Program (MOMRP) Suicide Prevention Interim
Progress Report (IPR) at Fort Detrick, Maryland.
Dr. Ursano held interviews with several news
outlets in anticipation of the publication, “Risk
Factors, Methods, and Timing of Suicide Attempts Among US Army Soldiers.” The news
outlets included: USA Today, Wall Street Journal, Reuters, CBS News Radio, MedicalResearch.
com, STAT News, FiveThirtyEight, Marine Corps
Times, NBC News (national), WGN Radio (Chicago), Medical Daily, Military Times, Health Day
News and Stars and Stripes.
Dr. Ursano held a podcast interview with Dr.
Abbey Strauss of “The Experts Speak” project.
The podcast focused on mental health responses
after disasters and discussed common post-event
reactions, interventions and support methods.
Dr. Ursano was interviewed by the Orlando Sentinel about Army STARRS.
Dr. Ursano made a presentation at the STARRSLS Government Steering Committee (GSC)
meeting at the Office of the Deputy Undersecretary of the Army. The presentation described
the progress made by the research team on the
STARRS-LS project. Dr. Gifford, Paul Hurwitz
and Susan Moss also attended the meeting.
Dr. Ursano was interviewed by Army News Service about results from the Army STARRS project and the continuation of the research under
the STARRS-LS project.
Dr. Wynn was a guest on a Public Radio segment
called “SmartTalk” as a result of being a panel
member for a showing of the documentary film
“Thank you for your service” at the U.S. Army

Heritage and Education Center at the U.S. Army
War College.
■■ Dr. Wynn was quoted in The New York Times regarding complementary and alternative medicine
for PTSD.
■■ Dr. Wynn was a guest on the “Calling All Veterans”
radio show on KVSF in Santa Fe, New Mexico.
He discussed military mental health, healthcareof veterans, and complementary and alternative
medicine for PTSD related to the recent publication of his book on the topic.

AWARDS
■■

■■

■■

■■

■■

■■

LTC Wynn was given the Class of 2018 Engaging
Module Director Award as voted on by the Class
of 2018. It is given to the Module Director that had
the greatest impact on pre-clerkship education andwho set a standard to which all School of Medicine
faculty members should aspire.
LTC Wynn was awarded the Meritorious Service Medal for his work as Research Psychiatrist,
Department of Military Psychiatry, Walter Reed
Army Institute of Research. LTC Wynn’s hard
work and dedication to the mission led to cuttingedge treatments for behavioral health problems
and critical programs designed to build the resilience of Soldiers and families.
LTC Wynn was awarded the Army Medical Department (AMEDD) “A” Proficiency Designator
which recognizes the highest level of professional
achievement within each AMEDD Corps’ specialty.
Dr. Wynn was formally appointed as the U.S. Representative to the NATO Technical Team (HFM279 ‘Leveraging Technology in Military Mental
Health’) which is a three year, multi-country effort
to evaluate and understand the use of technological advances for improved care of mental health in
the military.
Dr. Ursano was the Joseph P. Tupin Lecturer andVisiting Professor at the University of California,
Davis.
LTC Wynn was inducted into The Order of Medical Military Merit which recognizes excellence
among Army Medical Department personnel.

2016 ANNUAL REPORT | 33

CSTS Directors, Scientists, Scientific
Advisory Board and Staff
CSTS DIRECTORS
Robert J. Ursano, MD
Chair, Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Director
Center for the Study of TraumaticStress
Uniformed Services University
David M. Benedek, MD
COL, MC, USA
Deputy Chair, Professor
Department of Psychiatry
Associate Director, Consultationand Education
Center for the Study of TraumaticStress
Uniformed Services University
Stephen J. Cozza, MD
Professor
Department of Psychiatry
Associate Director, Child andFamily Program
Center for the Study of TraumaticStress
Uniformed Services University
Brian W. Flynn, EdD
Adjunct Professor
Department of Psychiatry
Associate Director, Health Systems
Center for the Study of TraumaticStress
Uniformed Services University
Carol S. Fullerton, PhD
Research Professor
Department of Psychiatry
Scientific Director
Center for the Study of TraumaticStress
Uniformed Services University
Robert K. Gifford, PhD
Assistant Professor
Department of Psychiatry

Executive Officer, and Associate
Director, Homeland Security
Studies
Center for the Study of TraumaticStress
Uniformed Services University

Shenglin Chen, PhD
Biostatistician
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

John A. Stuart, PhD
Research Assistant Professor
Department of Psychiatry
Director, Resource Management
Center for the Study of TraumaticStress
Uniformed Services University

Kwang Choi, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

CSTS SCIENTISTSDavid M. Benedek, MD
COL, MC, USA
Deputy Chair, Professor
Consultant to the U.S. Army
Surgeon General for Forensic
Psychiatry
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Quinn M. Biggs, PhD, MPH
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Robert Bossarte, PhD
Adjunct Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Maria Braga, DDS, PhD
Associate Professor
Department of Anatomy,
Physiology and Genetics
Center for the Study of TraumaticStress
Uniformed Services University

34 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Kelly L. Cozza, MD, DFAPA,
FAPM
Associate Professor / Psychiatry
Clinical Clerkship Director
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Stephen J. Cozza, MD
Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Brian Crowley, MD
Adjunct Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Catherine L. Dempsey, PhD, MPH
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Connie C. Duncan, PhD
Research Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Joscelyn E. Fisher, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Brian W. Flynn, EdD
Adjunct Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Michael C. Freed, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Carol S. Fullerton, PhD
Research Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Frances Gabbay, PhD
Research Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Robert K. Gifford, PhD
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Oscar I. Gonzalez, PhD
CPT, USA
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Derrick Hamaoka, MD
Lt Col, USAF, MC, FS
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress

Uniformed Services University
Jill Harrington-LaMorie, DSW,LCSW
Senior Field Researcher
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Harry C. Holloway, MD
Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Marjan G. Holloway, PhD
Associate Professor
Department of Medical & ClinicalPsychology
Center for the Study of TraumaticStress
Uniformed Services University
Tomoko I. Hooper, MD
Professor
Department of Preventive
Medicine & Biostatistics
Center for the Study of TraumaticStress
Uniformed Services University
Edmund G. Howe III, MD, JD
Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Elie Karam, MD
Professor and Chairman
Department of Psychiatry
American University — Beirut
Beirut, Lebanon
David S. Krantz, PhD
Professor
Department of Medical andClinical Psychology
Center for the Study of TraumaticStress
Uniformed Services University
He Li, MD, PhD
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Xian Liu, PhD
Research Professor
Deployment Health Clinical Center
Walter Reed Army Medical Center
Holly H. Mash, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
James E. McCarroll, PhD, MPH
Research Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Luke Johnson, PhD
Adjunct Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Eric Meyer II, MD
Maj, USAF, MC
Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

Tzu Cheg Kao, PhD
Professor
Department of Preventive
Medicine and Biometrics
Center for the Study of TraumaticStress
Uniformed Services University

Joshua C. Morganstein, MD
CDR, USPHSAssociate Professor of Psychiatry
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

2016 ANNUAL REPORT | 35

James A. Naifeh, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Darrel A. Regier, MD, MPH
Adjunct Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Dori B. Reissman, MD, MPH
CAPT, USPHS
Medical Director, World Trade
Center Responder Health
Program
Senior Medical Advisor, National
Institute of Occupational Safety
and Health
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Dale Russell, PhD
Behavioral Science Researcher
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Patcho N. Santiago, MD, MPH
CDR, MC, USN
Psychiatry Residency Program
Director
Walter Reed National Military
Medical Center
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Patricia Spangler, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
John A. Stuart, PhD
Research Assistant Professor
Department of Psychiatry

Center for the Study of TraumaticStress
Uniformed Services University
E. Fuller Torrey, MD
Executive Director
Stanley Medical Research Institute
Robert J. Ursano, MD
Chair, Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Director, Center for the Study ofTraumatic Stress
Uniformed Services University
Jing Wang, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Maree J. Webster, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Director, Laboratory of Brain
Research
Stanley Medical Research InstituteLars Weisaeth, MD
Professor, Division of Disaster
Psychiatry
University of Oslo
Oslo, Norway
James (Curt) West, MD
CAPT, MC, USN
Associate Professor of Psychiatry
Clerkship Director
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Gloria Whaley, PhD
Child Psychologist Researcher
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Anthony Woodson, DHA
Associate Administrator

36 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Kathleen Wright, PhD
Former Director (Retired)
Force Health Protection Program
USAMRU-E
Walter Reed Army Institute of
Research
Gary H. Wynn, MD
LTC, MC, USA
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Suzanne Yang, MD, PhD
Research Psychiatrist
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University
Lei Zhang, MD
Associate Professor
Department of Psychiatry
Center for the Study of TraumaticStress
Uniformed Services University

CSTS SCIENTIFIC
ADVISORY BOARDJames E. Barrett, PhD
Chair, Professor
Department of Pharmacology andPhysiology
Drexel University, College ofMedicineCharles W. Beadling, MD
Col (Ret), MC, USAF
Director, Assistant Professor
Center for Disaster & Humanitarian
Assistance Medicine
Department of Military andEmergency Medicine
Uniformed Services University
M. Richard Fragala, MD
Col (Ret), USAF, MC, FS
Professor, Department of Psychiatry
Uniformed Services University

Matthew J. Friedman, MD, PhD
Professor, Department of
Psychiatry
Professor, Department ofPharmacology & Toxicology
Dartmouth University, Geisel
School of Medicine
Director, Leahy-Friedman National
PTSD Brain Bank
Senior Advisor, National Center for
Posttraumatic Stress Disorder
U.S. Department of Veterans
Affairs

Robert J. Ursano, MD
Chair, Professor of Psychiatry and
Neuroscience, Department of
Psychiatry
Director, Center for the Study ofTraumatic Stress
Uniformed Services University

Carol S. Fullerton, PhD
Research Professor, Department of
Psychiatry
Scientific Director, Center for the
Study of Traumatic Stress
Uniformed Services University

DISTINGUISHED FORMERSCIENTIFIC ADVISORY
BOARD MEMBERS &EMERITUS FRIENDS OF CSTSDavid S. Krantz, PhD
Professor, Department of Medical
and Clinical Psychology
Uniformed Services University
Craig H. Llewellyn, MD
Professor, Department of Militaryand Emergency Medicine
Uniformed Services University
Francis O’Conner, MD, MPH
COL, MC, USA
Chair, Professor, Departmentof Military & Emergency
Medicine
Uniformed Services University
Robert M. Post, MD
Head, Bipolar Collaborative
Network
Former Chief, Biological Psychiatry
BranchNational Institute of Mental HealthArieh Y. Shalev, MD
Professor, Department of
Psychiatry
New York University
Professor, Department of
Psychiatry
Hadassah University School of
Medicine
Jerusalem, Israel

Lars Weisaeth, MD
Professor, Division of Disaster
Psychiatry
University of Oslo
Oslo, Norway

Herbert A. Hauptman, PhD(1917–2011)1985 Nobel Laureate, Chemistry
President, Hauptman-Woodward
Medical Research InstituteResearch Professor, Department ofBiophysical Sciences
Adjunct Professor, Department ofComputer Science
University of Buffalo
Joshua Lederberg, PhD,
ForMenRS (1925–2008)
1958 Nobel Laureate, Physiology or
Medicine
Professor Emeritus, Departmentof Molecular Genetics andInformatics
Rockefeller University
Founder, Department of Medical
Genetics
University of Wisconsin-Madison
David H. Marlowe, PhD(1931–2014)
Senior Lecturer, Department of
Psychiatry
Uniformed Services University
Former Chief, Department ofMilitary Psychiatry
Walter Reed Army Institute of
Research
Fellow, American Anthropological
Association

CSTS STAFF
Deborah Probe Adams
Pablo Aliaga
TSgt Rondricueas Barlow
Danielle Bartolanzo
K. Nikki Benevides
Alexandra Burris
Nicole Caulfield
Enryka Christopher
Thomas Cullerton
Nicole Dacuyan
Hieu Dinh
Krista Engle
Alice Fladung
Elyse Frank
Mackenzie Franz
Alissa Gutierrez
TSgt. Jorge Hastings
MSgt. Syrus Henderson
Michelle Herman
Lizabelle HernandezPaul Hurwitz
Jamon Jex
Daniel Jureller
Jeremy Karp
Gail Kohls
F. Julian Lantry
Megan Lindberg
Alex Liu
Sarah Meirama
Diana Monday
Susan Moss
Stanley Ng
Nichole Nicholas
Thomas Park
Maegan Paxton
Joseph Piemontese
Maria RevillaCharlotte Riggs
Stephanie Singer
Trevor Stephens
Natara Strother-Ware
Kelly Todd
Tung Tu
Leming Wang
Sydney West
Christina Wryter
Holly Wu
Jing Zhou

2016 ANNUAL REPORT | 37

CSTS Funded Grants in 2016
GRANT

FUNDING INSTITUTION

Resilience Building for Homeland Security: A Specialized Training and Collaborative Consultation

DHS

Development of an Education Curriculum for Personally Owned Firearms Safety Enhancements Initiative

DSPO

Riluzole Augmentation Treatment for Complicated Posttraumatic Stress Disorder

USAMRMCPTSD/TBI Clinical Consortium Coordinating Center and Clinical Sites Award (INTRuST)

UCSD

Traumatic Stress and Biomarkers in a Military Population

USAMRMC

Education of the Safety and Pharmacokinetics of the FAAH Inhibitor URB597

USAMRMC

Brain Bank Project: Consortium for the Translational Neuroscience and Treatment of Stress and PTSD
(VA Biorepository Brain Bank: PTSD Brain Bank Protocol)

VA

Study to Assess Risk and Resilience in Servicemembers — Longitudinal Study (STARRS-LS)

DHP

Behavioral-based Predictors of Workplace Violence in the Army STARRSHarvard

Family Violence and Trauma Project

IMCOM

The Impact of Service Member Death on Military Families: A National Study of Bereavement

CDMRP

GREAT-SF (Grief-Focused Resilience Activities and Training for Surviving Families): An Online Selective
Intervention for Bereaved Military Families

CDMRP

Bereavement due to Terrorism: Families of those who died on Air India
Flight 182 or on September 11th

Voices of September 11

Military-Related Risk for Child Neglect in DoD Families: A Population Study to Inform Future DoD 		
Child Neglect Prevention Efforts
MCFP
Enhancing Fear Extinction via Angiotensin Type 1 Receptor Inhibition: A Randomized Controlled Trial in
Posttraumatic Stress Disorder

UCSD

Center for the Study of Traumatic Stress (CSTS) Program

DHP

38 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

CSTS Partnerships
The Center for the Study ofTraumatic Stress would like toacknowledge and thank our partners and collaborators. The Center has worked with organizationsin the public and private sector
through research partnerships,
project collaborations, consultations and trainings.
Alfred P. Sloan Foundation
American Academy of Child andAdolescent Psychiatry
American Gold Star Mothers
American Psychiatric Association
American Psychological
Association

Defense Centers of Excellence
for Psychological Health andTraumatic Brain Injury
Department of Mental Health,the District of Columbia
Deployment Health ClinicalCenterDover Air Force Base
Drexel University
Drug Enforcement
Administration
Emory University
Federal Bureau of Investigation
Florida Department of Health
Ft. Bragg, North Carolina
Ft. Hood, Texas
Ft. Lee, Virginia

Architect of the Capitol
Armed Forces Retirement Home
Broad Institute
The Carter Center
California Mental Health Services
Authority
Catholic University of America
Center for Forensic Behavioral
Sciences
Center for Health Care Research
Medical University of South
Carolina
Centers for Disease Control andPrevention
Columbia University
Cornell University
Dartmouth University

CSTS INTERNATIONAL COLLABORATIONS IN 2016
CANADANORWAYBELGIUM

NETHERLANDSGERMANY

UNITED
KINGDOM

JAPAN

ITALY
SOUTH KOREAISRAELPHILIPPINESTHAILANDGHANA

SINGAPOREKAZAKHSTANAUSTRALIANEW ZEALAND

2016 ANNUAL REPORT | 39

Ft. Stewart, Georgia
George C. Marshall Center for
European Security
George Washington University
Gold Star Wives of America
Hadassah Medical Organization,
Jerusalem, Israel
Harvard University Medical
SchoolHarvard University School of
Public HealthHenry M. Jackson Foundation for
the Advancement of Military
Medicine
International Society forTraumatic Stress Studies
Inter-university Consortium for
Political and Social Research
Italian Embassy, Washington, DC
Joint Base Lewis-McChord
Joint Mortuary Affairs Center andSchool, Fort Lee, Virginia
Las Vegas Psychiatric Association
Maryland Emergency
Management Authority
Massachusetts General Hospital
Medical Research Command at
Ft. Detrick
Michigan Department of Healthand Human Services
Michigan Psychiatric Society
Military Child Education
Coalition
Miller School of Medicine of the
University of Miami
National Association for PTSD
National Association of State
Mental Health Program
Directors
National Center for PTSD of
the Department of Veterans
Affairs
National Child Traumatic Stress
Network
National Committee for Employer

Support of the Guard andReserve
National Fallen Firefighters
Foundation
National Intrepid Center of
Excellence
National Institute for
Occupational Safety and
HealthNational Institute of Mental
HealthNational Institutes of HealthNational Institute of JusticeNational Military Family
Association
Naval Sea Systems Command
North Atlantic Treaty
Organization
Psychiatric Genomics
Consortium
Rockefeller University
Rutgers University Cell & DNA
Repository
Sesame Workshop
Sheppard Pratt Health System
Stanford University
Substance Abuse andMental Health Services
Administration
Syracuse University
Syracuse VA Medical Center
Tragedy Assistance Program for
Survivors
Tulane School of Social Work
Uniformed Services University
Union Pacific Railroad
University of California, Los
Angeles
University of California, San
Diego
University of Maryland
University of Michigan
University of Pennsylvania
University of Pittsburgh
University of South Carolina

40 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

University of Virginia
University of Virginia’s Critical
Incident Analysis Group
University of Washington
U.S. Air Force
U.S. Army
U.S. Army Family Advocacy
Program
U.S. Army Family Programs
U.S. Army Installation
Management Command
U.S. Army Medical Research andMateriel Command
U.S. Department of Agriculture
U.S. Department of Defense
U.S. Department of Energy
U.S. Department of Health andHuman Services
U.S. Department of Homeland
Security
U.S. Department of Justice
U.S. Department of State
U.S. Department of Veterans
Affairs
U.S. Postal Service
VA Connecticut Healthcare
SystemVeterans Administration Medical
Center of DC
Virginia Commonwealth
University
Voices of September 11th
Walter Reed Army Institute of
Research
Walter Reed National Military
Medical CenterWest Virginia University
Western New York PsychiatricSociety
Wright State University
Yale University
Yellow Ribbon Reintegration
ProgramZero to ThreeSnapshots of CSTS

CSTS 2016 Army 10-Miler Team.

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University of the Health Sciences
4301 Jones Bridge Rd
Building B, Rm. 3068
Bethesda, MD 20814
www.cstsonline.org