CENTER FOR THE STUDY
OF TRAUMATIC STRESS

2011 Annual Report

RESEARCH | EDUCATION | CONSULTATION | TRAINING

WWW.CSTSONLINE.ORG

ENDURING

Commitment

HISTORY
The Center for the Study of Traumatic Stress (CSTS)
was established in 1987 to address U. S. Departmentof Defense concerns around the psychological impact
and health consequences resulting from the traumatic
impact of: 1) the possibility, or actual use, of weaponsof mass destruction (WMD) during combat, acts ofterrorism or hostage events; 2) combat, peacemaking,peacekeeping, and operations other than war; 3) natural disasters such as hurricanes, tornadoes, or floods;
and, 4) more common stress producing events suchas physical assaults and motor vehicle, shipboard, or
airplane accidents in both the uniformed and civilian
communities.

THE CENTER:■■ Develops and carries out research programs toextend our knowledge of the medical and psychiatric consequences of war, deployment, trauma,
disaster and terrorism, including weapons of mass
destruction.

■■ Educates and trains health care providers, lead-ers, individuals and public and private agencies on
how to prevent, mitigate and respond to the negative consequences of war, deployment, traumatic
events, disasters, and terrorism.
■■ Consults with private and government agencies
on medical care of trauma victims, their families
and communities, and their recovery following
traumatic events, disasters and terrorism.
■■ Maintains an archive of medical literature on thehealth consequences of traumatic events, disasters
and terrorism for individuals, families, organizations, and communities.
■■ Provides opportunities for post-doctoral trainingof medical scientists to respond to and research
the health consequences of trauma, disaster, andterrorism.

The Center has been involved in nearly every majordisaster our nation has faced in the past 25 years,
including the BP oil spill in the Gulf.

The Center’s research supports the psychologicalhealth and resilience of our nation’s soldiers,
sailors, airmen and marines from bench
to bedside, from war to disaster.
In its seventh year, the Center’s Courage to Care initiative was
the first e-communication campaign on military unique healthissues, especially those related to our nation’s war on terrorism.
In continuous publication for over 15 years, the Center’s Joining
Forces newsletter advances research knowledge and bestpractices in family violence, child neglect and maltreatment to
the U.S. Army’s Family Advocacy Program professionals.

En duri n g C o m m itmen t
Dear Colleagues and Friends,
Since its establishment in 1987, The Center for the Study ofTraumatic Stress (CSTS) has demonstrated an enduring commitment to trauma research, education, training and consultation. Our work is aimed at improving the psychological healthand resilience of individuals, groups and communities exposedto traumatic stress and traumatic events, especially thoserelated to war, disasters, terrorism and public health threats. As
part of the Department of Psychiatry in the School of Medicineof the Uniformed Services University (USUHS), the Center’sscientists, educators and clinicians bring scholarly and researchoriented problem solving to the mental and behavioral healthproblems of the Department of Defense and the nation.
2011 marked a year of great productivity for our Center. Continuing our work to support the soldiers, sailors, marines andairmen of the Department of Defense, we advanced existing projects and undertook new andunprecedented research that supports psychological health, resilience, and post deployment
function of service members, their families and children. The Center made great strides in its
collaborative involvement in Army STARRS (Study to Assess Risk and Resilience in Servicemembers), a 5-year study funded by the Army and the National Institute of Mental Health,and the largest study ever to address suicide in the Army and perhaps suicide as a national
health problem. Among a number of achievements, the Center, in collaboration with Harvard
University, University of Michigan, and University of California, San Diego, completed thegroundbreaking task of obtaining, assembling, integrating and documenting more than 1.1
billion data records on demographic, socio-economic, health care, and service member experiences from nearly forty different DoD and Army databases.
The Center and its Child and Family Program received funding to conduct The National
Military Family Bereavement Study, the first major study to systematically examine the impactof a U.S. service member’s death on survivingfamily members, an example of the Center’scommitment to pursuing new frontiers inresearch. Our Center is often called upon
to consult with leadership in government,
healthcare, industry and academia. This year,
our Center, along with USUHS, provided consultation to the Office of the First Lady of the
President of the United States to support its
Joining Forces initiative, a national campaignthat promotes awareness and brings expertiseto bridge the military and civilian communities around military-specific health and social
issues. In addition, members of the Center
participated in a number of Institute of Medicine workshops, conferences and committees
as experts on disaster and emergency care and preparedness.

Annual Report 2011 | 1

The Center’s rich history in trauma research bridges both militaryand disaster psychiatry. In 2011, the Center responded to significant
national and international disasters. We offered assistance to the stateof Arizona in the aftermath of the shooting rampage and assassination attempt on Representative Gabrielle Giffords. The Center provided important trauma-informed resources, translated into Japanese with the assistance of a former Disaster Psychiatry Fellow living
in Japan, in the aftermath of the Great Eastern Japanese Earthquake.
This outreach has led to an ongoing consultative relationship with
the Japanese Cabinet.
Our educational resources include development and distribution of fact sheets on theimpact of combat injury on intimacy. The timeliness and attention to an often forgotten
aspect of injury recovery generated extensive media coverage in both DoD and non-military media outlets throughout 2011.
Additionally, the Center’s work received recognition on many levels. A Center Associate
Director received the Frank Ochberg Award for Media and Trauma Study, which recognizes significant contributions by clinicians and researchers on the relationship of media
and trauma. I am pleased to have been named to receive the American College of Physicians William C. Menninger Memorial Award for Distinguished Contributions to the
Science of Mental Health.
The following pages describe in more detail our extensive research portfolio and projects,
and the Center’s 2011 scholarly publications, national and international conference andposter presentations. The facing page depicts our extensive research network and the manycollaborative organizations and funders who make our work possible.
At the close of 2011, the Center enters its quarter century benchmark — 25 years of service and translational research involving a sustained focus on collaboration from basic to clinical sciences, from laboratory tofield research, from direct clinical care to populationlevel prevention. We assist the Department of Defense
in leading the nation in trauma-informed care, andrapidly moving findings from bench to bedside andfrom war to disaster. Our work is strengthened by ourbeing part of the Uniformed Services University of the
Health Sciences, supported by the Henry M. JacksonFoundation for the Advancement of Military Medicine, a partnering center of the Defense
Centers of Excellence for Psychological Health and Traumatic Brain Injury, and our proximity and clinical research interface with Walter Reed National Military Medical Center. I
want to take this opportunity to thank you for your interest in the Center for the Study ofTraumatic Stress and its enduring commitment to the psychological and behavioral healthof our nation’s military and civilian communities, and our nation’s public health in theaftermath of war, natural disasters and traumatic events.

Robert J. Ursano, M.D.									Director

2 | Center for the Study of Traumatic Stress, USUHSU.S. CSTS Colleagues and Collaborations
nnn
Washington

n Vermontn New Yorkn Michigan
n
Ohio

nnn
California

nnn
Massachusettsn Connecticutn New Jerseyn Pennsylvania
n n Washington, DC
n Marylandn n Virginian n n North Carolina
n South Carolina

n Hawaiin n Georgia

nnn
Texas

n Louisiana

n VA Hospitals

n Army STARRSn CSTS Collaborating Organizations

Boston, MA
Central Texas
Charleston, SC
Cincinnati, OH
Durham, NC
East Orange, NJ
Hartford, VT
Honolulu, HI
Palo Alto, CA
San Diego, CA
Tacoma, WA
Washington, DC
West Haven, CT

Ann Arbor, MI (University of Michigan)
Bethesda, MD (WRNMMC)
Boston, MA (Harvard Medical School)
Ft. Bragg, NC
Ft. Hood, TX
Ft. Stewart, GA
San Diego, CA (UC San Diego)
Tacoma, WA (JB Lewis-McChord)

Alexandria, VA (NASMHPD; National Military Family
Association)
Atlanta, GA (CDC)
Boston, MA (Harvard — FOCUS-CI project; 		
Bereavement project)
Ft. Bragg, NC (Traumatic Stress & Biomarkers project)
Harker Heights, TX (Military Child Education Coalition)
Los Angeles, CA (UCLA — FOCUS-CI project; NCTSN)New Orleans, LA (Tulane School of Social Work —Disaster Mental Health)
New York, NY (Columbia University — Bereavement
project; Sesame Workshop)
Philadelphia, PA (Drexel University — Bereavement project)
Seattle, WA (University of Washington — FOCUS-CI project)
Washington, DC (NIOSH; DHS; Zero to Three; TAPS;
American Gold Star Mothers; American Gold Star Wives)

Annual Report 2011 | 3

EnduringCommitment

The Psychological and Behavioral Hea
Our nation’s wars in Iraq and
Afghanistan have led to high rates of
posttraumatic stress, posttraumaticstress disorder (PTSD), depression,suicide, co-morbid concussions,traumatic brain injuries (TBIs),
and other issues of combat-related
mental and behavioral health.
Numerous studies have shown thatveterans with PTSD also experience
relationship and financial problems,poor self-care and increased suicidal
ideation.

The Center’s translational research model bridges its
pioneering work in neuroscience and the neurobiology of stress to the improved clinical care of militaryunique health issues, especially posttraumatic stressdisorder (PTSD), mild traumatic brain injury (mTBI)
and suicide. 2011 saw advances in the Center’s laboratory-based research in the neurobiology of stress andits clinical and epidemiologic studies, which encompass psychopharmacology, the application of cuttingedge medical technology and studies that address themodifiable risk and protective factors of suicide andsuicide ideation.

Biomarkers for PTSD
The Center’s neuroscience research has resulted in the
discovery of potential biomarkers for PTSD, potential
biomarkers for suicide risk and increased understanding of gene expression patterns that underlie
biomarkers. These findings may ultimately be used todiagnose diseases promptly and accurately, to identify
individuals at high-risk for certain diseases and to follow the course of response to treatment.
In 2011, CSTS neuroscientists found that a brainderived neurotrophic factor (BDNF) is associatedwith PTSD and startle response (a major arousal
manifestation of PTSD) in 461 U.S. military service
members who were deployed during the wars in
Iraq and Afghanistan. BDNF, a member of the nerve
growth factor family of neurotrophins, was discovered in the early 1980s by Barde, et al. This family ofproteins that induce the survival, development, andfunction of neurons has been found to have central
roles in the development, physiology, and pathologyof the nervous system. Substantial evidence demonstrates that BDNF is associated with stress and stressrelated behaviors.
CSTS neuroscientists also found that the subjects with
PTSD had higher levels of BDNF in their peripheral
blood plasma than the non-PTSD controls. Finally,
complementing the data from the human subjects, it
was demonstrated that in a rodent model BDNF levels
were significantly increased in both blood plasma andbrain hippocampus by inescapable tail shock. Those
data are accompanied by an obvious elevation of thestartle response. This initial data suggest that BDNF

4 | Center for the Study of Traumatic Stress, USUHS

lth of Service Members
is involved in abnormal stress responses underlying
PTSD risk. BDNF blood levels and SNP Val66Met
may serve as useful biomarkers to detect and further
our mechanistic understanding of PTSD risk.

INTRuST Consortium Research
The Center plays an important research role throughits leadership of The National Capital Area Integrated Clinical Study Site, an established network ofclinician-researchers at Walter Reed National Military
Medical Center (WRNMMC), the D.C. Veterans Administration Hospital, and the Armed Forces Retirement Home who are initiating clinical trials for novel
medications and psychotherapy treatment for PTSD
and other combat-related disorders. The site is one of
10 such study sites across the nation which comprisethe INTRuST (Injury and Traumatic Stress) Consortium for Psychological Health and TBI. 2011 saw
advances in some of the network’s important projects.
Recruitment and enrollment in the INTRuST Consortium’s randomized control trial of Acceptance andCommitment Therapy (ACT) was initiated. This study
is a pilot exploration of a mindfulness-based therapeutic intervention to help soldiers cope with postdeployment distress and disorders such as depression,
mild TBI, and PTSD despite the symptoms they may
be experiencing. A second Consortium study conducted in collaboration with the Washington, D.C. VA
seeks to examine the effectiveness of Ganaxolone, asynthetic neurosteroid for PTSD. This study received
Institutional Review Board (IRB) approval, and recruitment and enrollment commenced in 2011.
The Veterans Administration’s Office of Research andDevelopment has recognized the importance of a
PTSD biorepository—a collection of various biological specimens such as blood and saliva from donors
with PTSD and other deployment related illnesses, aswell as healthy controls, and a larger national biorepository for all neuropsychiatric illnesses. In 2011,
the INTRuST Biorepository Protocol received IRB approval to be conducted in conjunction with INTRuST
consortium clinical trials including Acceptance andCommitment Therapy, Ganaxolone, and Transcranial
Magnetic Stimulation (TMS) at WRNMMC.

Sgt. Chad Parrott and Capt. Greg Reger demonstrate
a simulator used to help in the treatment of
PTSD at Madigan Army Medical Center.
neuropsychological and electrophysiological assessments, as well as neuroimaging and neurological soft
signs, to evaluate the associations between baseline
indices of brain structure and function, and thecourse of PTSD symptoms over a 6-month followup period in service members with TBI and nonTBI injuries. As with most of the INTRuST studies,
the Brain Indices Study is multi-site, and involves
researchers from prestigious institutions including
USUHS, Harvard, University of California, San Diego,
Dartmouth, and Duke.

Innovative Medical Technologies
The Center is also conducting research that involves
the use of innovative medical technologies. In collaboration with the Medical University of South Carolina
and the INTRuST Consortium, the Center received
IRB approval to conduct A Pilot Safety and Feasibility
Study of High Dose Left Prefrontal Transcranial Magnetic Stimulation for the rapid stabilization of acutesuicidal behavior. TMS, an FDA-approved therapy fortreatment of depression, involves the application of astrong, pulsing magnetic field to an individual’s head,thus reaching his or her cerebral cortex. This study
will examine the effectiveness of TMS for treatment
of PTSD and suicidal behaviors.

There was also IRB approval to begin collecting data
for the Brain Indices Study. This study will conduct
Annual Report 2011 | 5

Army STARRSThe Center is involved in a 5-year project funded by
the Army and the National Institute of Mental Health,Army STARRS (Study to Assess Risk and Resilience inServicemembers). Army STARRS is the largest project
ever to address suicide in the Army and perhaps
suicide as a national health problem in the general
population. The project is examining both risk andprotective factors for suicidal behaviors. The ultimate
goal of the project is to develop data-driven methods
for mitigating or preventing suicide behaviors, andimproving the overall mental health and behavioral
functioning of Army Soldiers during and after their
Army service.

Soldiers assigned to the 4th BCT, 1st Cavalry Division,
watch an instructional video before providing saliva
samples for DNA collection at the University of Texas.
The Soldiers volunteered for a battery of tests designed
to track how their brains and bodies function before
and after their upcoming deployment to Iraq.
2011 saw phase one of a new study using an innovative electronic, hand-held devise and methodology,
Ecological Momentary Assessment (EMA). EMA isused to examine symptoms of PTSD and depression“in real time” in service members undergoing rehabilitation. The study, Ecological Momentary Assessmentof Posttraumatic Stress Symptoms in Service Members
Undergoing Rehabilitation, will provide a new perspective on identifying PTSD symptom patterns andenvironmental influences that may foster more effective treatments.

Traumatic Stress and Biomarkers
An exciting study building upon the Center’s finding of p11 as a genetic marker for PTSD in rats is its
Traumatic Stress and Biomarkers in a Military Population Study. This study is seeking to replicate p11 findings from the animal studies, as well as explore otherpotential biomarkers that have been identified in
non-CSTS studies. In 2011, Center scientists deployeda team to Ft. Bragg, NC to collect survey data, bloodand saliva samples from volunteer research subjects
from the 82nd Airborne Division.
6 | Center for the Study of Traumatic Stress, USUHSCalendar year 2011 was a very productive period forArmy STARRS resulting in enormous progress on
many of the component studies. The Historical Data
Study completed its groundbreaking task of obtaining,assembling, integrating and documenting more than
1.1 billion data records from nearly forty different
DoD and Army databases. This extraordinarily rich,de-identified data resource on demographic, socioeconomic, health care, and military and personal
experiences represents more than 1.6 million Soldiers
who were on active duty from 2004 through 2009.
This is a landmark effort not only because of the sheer

establish procedures, collaboration, and agreementsfrom six separate IRBs, as well as developing andobtaining approval for five sets of site-specific consent
materials. Soldier recruitment and data collection for
SHOS-A began late in 2011.
The Army STARRS team also designed the instruments and procedures, and obtained IRB approvals,
for the Pre/Post Deployment Study. This study will
involve collection of survey data and blood samples
from approximately 10,000 Soldiers shortly before
deployment, and additional survey data and blood
samples from as many as possible after they returnfrom deployment. We successfully completed a pilot
study in the fall of 2011.

volume and complexity of these data, but because itis the first time these disparate databases have been
linked and integrated. The Army STARRS team began
preliminary analyses of this historical cohort.
In early 2011, data collection began for the New
Soldier Study. This study involves collecting baseline personal demographic, behavioral health, social
and neurocognitive data at three Army Forts froma sample of Soldiers during their first week in the
Army. By the year’s end, data was collected from morethan 18,200 Soldiers. Blood collection was added tothis study in the fall and blood samples were obtained
from more than 3,700 Soldiers by year’s end.

Unprecedented in its breadth, depth and complexity,
2011 marked three significant and historic achievements. The Secretary of the Army wrote a letter
acknowledging and supporting the confidentiality
requirements of Army STARRS. The challenges weresuccessfully met of bringing together multiple IRBs
to agree on and approve SHOS-A. Lastly, the Army
STARRS team obtained and integrated large and complex datasets containing more than 1.1 billion records
from nearly forty different DoD and Army databases
for more than 1.6 million Soldiers.
The Center hosted the 6th Annual Amygdala Stressand PTSD Conference in April. Over 300 scientists,
leaders and professionals attended the conference,
which focused on Frontiers in Behavioral Neuroscience
Special Topics “Fear in the Human Mind.”

The commencement of data collection for the All
Army Study also took place in early 2011. This study
involves collecting personal demographic, behavioral health, social, and neurocognitive data from a
representative sample of active duty Army Soldiers.
It includes Army units inside and outside the U.S.,
including in-theater units. As of the end of 2011, there
was data collected from more than 14,100 Soldiers.
The Soldier Health Outcomes Study (SHOS) involves
two case-control studies (SHOS-A and SHOS-B).
SHOS-A is a study of active duty Soldiers who attempted suicide, and SHOS-B is a study of active
duty Soldiers who died by suicide. In 2011, the study
design and procedures were finalized for both studies,and the required approvals from multiple IRBs wereobtained. SHOS-A required a monumental effort to

ABOVE: Soldiers complete the Post-Deployment HealthReassessment. LEFT: U.S. Army soldiers search the roofof an Afghan home for weapons and explosives during
an air-assault mission in Khost province, Afghanistan.

Annual Report 2011 | 7

EnduringCommitment

The Psychological Health of MilitaryMore than two million children haveexperienced one or more parental
deployments. While many militaryfamilies manage well, the impact
of multiple deployments, single
parenting under stress, combat injury
and parental death is associated withelevated distress among adults andchildren in military communities.
Reducing these negative effects
requires robust community healthstrategies and prevention programs
based upon sound research.
Educational outreach that extends
awareness and knowledge of theseissues to health and community
support professionals in military andcivilian communities is critical tomilitary family health.

8 | Center for the Study of Traumatic Stress, USUHS

2011 Child and Family Program Activity
and Achievements
The Child and Family Program (CFP) of the Centerfor the Study of Traumatic Stress has distinguisheditself, since its establishment in 2006, as a national
leader in advancing scientific knowledge, clinicalinterventions, and educational resources addressing
the needs of children and families affected by trauma,
especially our nation’s military families and children.
The research of CFP examines deployment stress,
parenting and family function and the impact of war
injury, illness and death on military children andfamilies. In 2011, the CSTS and its CFP received funding to conduct the first study on the impact of service
member death on military families (described below).
Another unique aspect of CFP has been its versatility
in translating its expertise in military family trauma
to support the educational outreach of national media
initiatives. For the past few years, the Center and its
CFP have served in an advisory capacity to Sesame
Workshop in developing its three-part, multimedia
series, Talk, Listen, Connect, to help military children
cope with deployments, homecomings, wartime illness and injury, and most recently parental death.
Apropos to this unique involvement and numerous
others, the CSTS and its CFP won the Frank Ochberg
Award for Media and Trauma Study, which recognizes
significant contributions by clinicians and researchers
on the relationship of media and trauma.
In 2011, CFP received funding to conduct The National Military Family Bereavement Study, the first
rigorous scientific study (Congressionally Directed
Medical Research Program) to examine the impactof a U.S. service member death on surviving family
members. U.S. military active duty deaths have totaled
over 15,000 since September 11, 2001. Over a thirdof the deaths are attributable to the wars in Iraq and
Afghanistan. Conservative estimates tell us that 6–10
individuals are impacted for each service member
who dies, thus affecting approximately 120,000 family members or more. The need to study individualand family bereavement resulting from U.S. military
service member death is critical to understanding
the grief and loss experiences of this unique survivor
population. This study’s findings will provide a scientific basis to inform policies effecting survivor care.

Families and Children
Leadership consultation is another important role of
CFP. In 2011, CFP, CSTS and USUHS provided expertise in military family trauma, health and resilienceto The Office of the First Lady of the President of theUnited States in support of Joining Forces, the firstnational initiative to bridge military and civilian community response through heightened and informed
awareness of the unique health and social challengesof military life. In this way, CFP joins our national
discourse extending its knowledge to our nation’scommunities.
2011 saw important advances in ongoing research
related to combat injury, child neglect and maltreatment (see page 15 for a complete listing of theseresearch projects). In the area of public education,
CFP developed and disseminated a series of fact
sheets under the banner, Resources for Recovery, which
address the impact of visible and invisible injuries
on intimacy. Because of their timeliness and attention to an often, overlooked aspect of combat injury
recovery, these fact sheets generated extensive media
coverage in both DoD and non-military media outlets
throughout 2011. The fact sheets for health providers
and for service members and their families are available on the Center’s website, www.cstsonline.org.
CFP’s Director and a number of the program’s
research and clinical staff were actively engaged inpresentations to military and civilian professionals at
national and international conferences throughout
the year. CFP has demonstrated an enduring commitment to improving the psychological and behavioral
health of our nation’s military families and children

Intimacy and Health: The Impact of PTSD
and Stress-Related Disorders On Returning
Service Members■■ The impact of injury on intimacy is an often

neglected aspect of healthcare and one thatis especially important in caring for our nation’s service members and families.

■■ Service members who feel in some waychanged for the worse by their war experiences may find it hard to share themselves
in intimate, physical relationships or they
may worry that they will pass on this negative change to their partner through intimacy.

This Resources
for Recovery
fact sheet isone of four ina series that
addresses
the impactof emotional
and physicalinjury on
intimacy andrelationshiphealth.

through its research, its educational activities andproducts and its extensive consultative outreach to
all levels of DoD, the federal government, and diverse
stakeholders. CFPs work and impact is strengthened
by its collaborations with National Child TraumaticStress Network (NCTSN), Zero to Three, MilitaryChild Education Coalition (MCEC) and National
Military Family Association (NMFA), the Tragedy
Assistance Program for Survivor (TAPS), Army Survivor Outreach Services (SOS), and its interface andproximity to the National Intrepid Center of Excellence (NICoE) and the Walter Reed National Military
Medical Center (WRNMMC).

Annual Report 2011 | 9

EnduringCommitment

Disaster Mental Health
Disaster mental health examines
the impact and implicationsof individual, community andorganizational responses to traumatic
events from natural disasters suchas hurricanes, earthquakes andtsunamis, to human made disasters
such as the Gulf Oil Spill and terrorist
events such as the Washington, D.C.
sniper attacks. Through research,education and consultation, theCenter has been involved in nearly
every major disaster our nation has
faced in the past 25 years.

In 2011, the Center for the Study of Traumatic Stressresponded to some significant national and international disasters providing valuable educational
resources and expert consultation. The Center also
advanced its ongoing disaster research and disastertraining projects, and disseminated its knowledge indisaster psychiatry and disaster mental health throughpresentations and participation in professional conferences, briefings and media-related activity.

Domestic Disaster Response
Disaster anniversaries provide opportunities forneeded remembrance and oftentimes, teachable moments to reinforce disaster preparedness behaviors. In
early 2011, the Center’s Director discussed the public
response to national disasters, and how they affect thenational psyche on a Minnesota Public Broadcasting
Service Radio Show as part of the 25th anniversary of
the space shuttle Challenger disaster. Shortly afterwards, the Center offered consultative assistance tothe Executive Director of the National Association ofState Mental Health Program Directors (NASMPHD)
in the aftermath of the Arizona shooting rampage
and assassination attempt on Representative Gabrielle
Giffords. An Associate Director of CSTS was a major participant in the development of an importantresource, the NASMHPD publication, “Responding toa High-Profile Tragic Incident Involving a Person witha Serious Mental Illness: A Toolkit for State Mental
Health Commissioners.”
The Center provided consultative assistance onanother domestic event with disaster implications, providing written and phone consultation to the Missouri
Department of Mental Health (MO DMH) regarding
the destruction by the Army Corps of Engineers of thelevee at Birds Point, Missouri. This outreach was useful to all parts of Missouri’s government including its
public information officers and coroners.

International Disaster Response
In March, the Center provided extensive disastereducation resources to support the response efforts to
the Great Eastern Japan Earthquake. A former USUHSDisaster and Preventive Psychiatry Fellow living in
Sendai, Japan and working with the Japanese Defense
Forces at the National Defense School of Medicine,
10 | Center for the Study of Traumatic Stress, USUHS

facilitated the translation from English into Japaneseof relevant Center fact sheets. These disaster response
fact sheets were widely disseminated, and captured
the attention of the Japanese Cabinet, which has engaged the Center’s expert consultation up to the present. The Center also consulted with the International
Initiative for Mental Health Leadership on short-termand long-term mental health needs in the aftermathof the earthquake in Christchurch, New Zealand.

Disaster Mental HealthInterventions and Research
Throughout the Center’s history, its trauma research
has identified and addressed vulnerable and oftentimes underserved populations. Three years ago,
Center scientists developed and introduced a Psychological First Aid-based intervention called Troop Education for Army Morale (TEAM). TEAM was designed
to help U.S. Army Mortuary Affairs Soldiers andspouses cope with the complex challenges of deployment and exposure to body handling and recovery inthe combat theater. TEAM offered post deploymentgroup workshops, handouts, a dedicated website,
concierge support phone and email services, andencouraged natural support systems such as spouseand buddy care. 2011 preliminary findings indicatethat TEAM was helpful for managing stress, connecting and communicating with others (important for
reducing barriers to seeking care), and for providing
support to fellow soldiers. Relaxation training was
beneficial for common anxiety and sleep problems,and soldiers especially enjoyed the open and interactive group discussions that enabled them to shareexperiences and solutions to their problems.

Behavioral and Public Health
Initiatives
Center scientists also address issues related to behavioral and public health. An Associate Director of
the Center served on an Expert Advisory Board to
the Rosalynn Carter Institute for Caregiving (RCI),
advising on future directions of their programs. The
focus of these programs is to better understand andsupport family caregivers whose family members,
including veterans, have a wide variety of chronic
medical conditions. The potential impact of this effort
is to influence corporate giving for veterans populations, building on existing, high quality programming,and to increase attention to and focus upon family
caregiving for veterans.
Throughout the year, CSTS scientists were actively
involved in addressing issues related to terrorism,
humanitarian assistance and disaster relief missions,
violence as a contagious disease and PsychologicalFirst Aid. These presentations and collaborative relationships involved such organizations as the National
Library of Medicine, the American Psychiatric Association, Centers for Disease Control and Prevention, the Annual Rosalynn Carter Symposium on
Mental Health Policy, as well as numerous DoD sites
throughout the country.

Below: Sgt. David Bentley uses a transient to determine
right angles at an excavation site. Bentley and 28 other
U.S. Army Reserve and National Guard Soldiers wereparticipating in a search and recovery exercise held June 19
at the Mortuary Affairs training site at Fort Lee, Va.
LEFT: Senior Chief Personnel Specialist Amy Henson,from Sheboygan, Wi, and Chief Yeoman Kenneth Vinoya,from Jacksonville, Fl, clear debris in the aftermathof the massive tsunami in Japan on March 11th.

Annual Report 2011 | 11

EnduringCommitment

2011 Timeline of CSTS Presentations, Br
Professional Associations, MediaCSTS scientists disseminate knowledge on their research and trauma-informedcare through content briefings to military and government leaders, participation in
professional and scientific conferences, national and international, through consultations and training, media events and features, and participation on medical andscientific boards. Here are some highlights of the Center’s 2011 monthly activities:
January 2011

March 2011

April 2011n ‘Midmorning,’ Minnesota PBS Radio:n Tale of Our Cities 2011: Planning
for an Interdisciplinary Response to
Terrorist Use of Explosives, sponsoredby the City of New York and the Centers
for Disease Control and Prevention:
Presented “Terrorism by Explosives:
Public Health and Mental HealthResilience”

n American Society for Pharmacology& Experimental Therapeutics (ASPET)
Annual Meeting, Washington, DC:
Presented “Overview of the Clinical
Problem of PTSD in the Military” at the
Neurobiology of Post-Traumatic Stress
Disorder (PTSD) and Implications for
Treatment Symposiumn American Occupational HealthConference, Washington, DC: Presented“From War to Work: Understanding theStrengths and Needs of Returning Guard
and Reserve Members”

n 6th Annual Amygdala, Stress and
PTSD Conference, Bethesda, MD:“Frontiers in Behavioral Neuroscience
Special Topics.” Hosted this conference
attended by over 300 scientists,
academic leaders and professionals

Discussed the public response to national
disasters as part of the 25th anniversary of
the space shuttle Challenger disastern Research Advisory Group: Hosted expert

panel drawn from Tragedy Assistance Program for Survivors (TAPS), the National Center for PTSD (NCPTSD), Harvard, Columbia,
University of Pittsburgh, and UCLA as part ofa CDMRP study recommended for funding on
Military Family Bereavementn Arizona Shooting Rampage: Offered as-

sistance to the National Association of State
Mental Health Program Directors and Mental
Health Authority in aftermath of Arizona
mall shooting disasterFebruary 2011n Military Operational Medicine
Research Program (MOMRP)
Conference. Ft. Detrick, MD: Presented
Army STARRS (Army Study to Assess
Risk and Resilience in Servicemembers)
and the interim progress report for“Acceptance and Commitment Therapy(ACT) for Distress and Impairment in
OEF/OIF Veterans” studyn Pentagon Channel: Interviewed
on the impact of injury, physicaland emotional, on intimacy and its
relationship challenges for service
members and their loved onesn American Forces Press Service:
Interviewed for a feature entitled,“Center Provides Advice on PostDeployment Intimacy Issues”

n National Child Traumatic Stress
Network All-Network Conference,Tampa, FL: Served on workshop panel,“Enhancing Military Family Resilience:
Current Models, Specific Strategies andOpportunities”
n White House Initiative: Attended
meeting of experts regarding the First
Lady’s public education campaign,“Enhancing the Well-being andPsychological Health of the Military
Family”n 2011 DoD/VA Suicide Prevention
Conference, Boston, MA: Presented“Suicide Prevention Research in the
Acute Clinical Setting: Challenges andOpportunities”
n Annual Meeting of the Anxiety
Disorders Association of America, New
Orleans, LA: Presented “Promoting
Resilience in Disaster First Responders:A Psychological First Aid-based
Approach”
n Navy Bureau of Medicine and Surgery(BUMED): Consultation and educational
resource support to assist the Navy
Surgeon General’s response to The
Great Eastern Japan Earthquaken Disaster Information Management
Center, National Library of Medicine:
Participated in the Disaster Information
Outreach Symposium addressing
information processing in high stresssituationsn Society for Research in Child
Development, Montreal, QC, Canada:
Presented “Military Children during
Wartime: Risk, Resilience, andCommunity Response”
n CDC Deployment Safety and
Resilience Team, Atlanta, GA: Conductedtraining for 27 CDC staff responsible forthe well being of CDC staff domestic andglobaln George Washington University:
Presented “Psychiatric Consequences ofTerrorism” to Political Science graduate
students
n VA’s Federal Coordinating Center’s(FCC) Reception, Denver, CO:
Represented the United States Public
Health Service (USPHS) Services
Access Teams, which established alearning environment for players to
exercise emergency response plans,
policies and procedures pertaining to a
National Disaster Medical System

Legendn Red = media-related activities
n BLUE = military-related activitiesn GREEN = disaster and traumarelated activities

iefings, Consultations, Scientific andMay 2011

June 2011 (continued)

October 2011

164th Annual Meeting of the American
Psychiatric Association, Honolulu, HI:n Work, Stress, and Health 2011
Conference, Orlando, FL: Presented“Challenges in US Army Mortuary
Affairs Remains Recovery Mission to2010 Haiti Earthquake”

n George Washington University Schoolof Medicine, Washington, DC: Presented
the Seymour Perlin Lecture, “FromBattlefront to Homefront and Homefront
to Battlefront: Health Risk Behaviors and
PTSD”

n “Scope, Current Evidence, andInnovative Approaches in Managing
PTSD”;n “Updates on the Psychological
Impacts of the Wars in Afghanistan
and Iraq”;
n “Overview of PsychologicalTrauma, Posttraumatic Stress,
Posttraumatic Stress Disorder andTrauma Disorders: Biomarkers
for Resilience, Treatment andPrevention”
n RTI Policy Forum 6, Washington,
DC: Presented “Heroes at Home:
Understanding the Impacts of Wartime
Deployments on Military and Veteran
Families”
n Scientific Advisory Board of the Ohio
Army National Guard Mental Health
Initiative: Provided scientific guidance
for major longitudinal Guard, mental
health study

June 2011n US Army’s PTSD Subject Matter
Expert Working Group: Reviewed
current medications for PTSD andassociated symptoms
n TBI/PTSD Imaging Collaboration
Conference, Ft. Benning, GA: Presented“Posttraumatic Stress: War, Disaster andTrauma Recovery” to Commanders, and“PTSD: From War to Disaster and Benchto Bedside” to Ft. Benning’s health careprovidersn Casualty Affairs Board,
Fredericksburg, VA: Presented Overview
of National Bereavement Studyn New Jersey Health Care System/Deptof Veterans Affairs’ 8th Annual Best
Practices, Best Outcomes Conference:
Presented the keynote address,“Fostering Resilience in Returning
Combat Veterans”
n New Jersey Academy of Family
Physicians (NJAFP): Presented on apanel, “Caring for Returning Veterans”

n 2011 USPHS Scientific & Training
Symposium: Presented “National Guard
and Reserve Members: Returning toWork from War”

July–August 2011
n Army STARRS: Hosted a 2-day
meeting addressing study for USU,
HJF, NIMH leadership and the ScientificOversight Committee (SOC)n Huffington Post, Reuters and CBS
Radio: Participated in an interview
regarding, “Children of Military Service
Members”
n Wounded Warriors and Rehabilitative
Justice Conference, Washington, DC:
Presented “PTSD and Legal Issues in
Returning Veterans”
n U.S. Medicine: Facilitated a feature on
the Center’s Resources for Recovery fact
sheets on the impact of injury on service
members and their families
n DCoE Monthly Webinar: Presented
Post-traumatic Stress Disorder andNatural Disasters, presenting specificallyon “Terrorism, Toxins, Communicating
and Caring”

September 2011
n Institute of Medicine’s Workforce
Resiliency Programs: Presented“Defining Long-Term Resiliency for the
Department of Homeland Security”
n Naval Medical Center Portsmouth’s
Annual Macklin Symposium:“Humanitarian Assistance Conference:
Presented public mental healthprinciples, including Psychological First
Aid, and the medical perspective ofhumanitarian assistance and disaster
relief missions

n NIH Fall Research Festival, Bethesda,
MD: Presented “PTSD and Traumatic
Brain Injury: Defining the Problem(s)”n Association of the United States Army
(AUSA) Annual Meeting, Washington,
DC: Presented “America’s Families:
Honoring Our Survivors”
n American Academy of Child andAdolescent Psychiatry Annual Meeting,
Toronto, ON, Canada: Chaired the“Disaster Psychiatry: The State of theField” workshop
n Grand Rounds, Behavioral Health,Camp Lejeune, NC: Presented “Updateon Pharmacotherapy for PTSD”

November 2011n International Society for TraumaticStress Studies 27th Annual Meeting,
Baltimore, MD: Discussant for featured
symposium, “The Great Eastern Japan
Earthquake: Responses of Japanese
Mental Health Professionals and theJapanese Society of Traumatic StressStudies (JSTSS)”n American Psychiatric Association’s
Institute on Psychiatric Services
Meeting, San Francisco, CA: Presented“Scope, current evidence, and innovative
approaches in managing PTSD in the
military”
n 6th Biannual INTRuST Consortium
Meeting, San Diego, CA: Presented,“Brain Indices of Risk for PosttraumaticStress Disorder after Mild Traumatic
Brain Injury”

December 2011n Military Continuing Legal Education
Conference for Disability Counselors
and Judge Advocates, Arlington, VA:
Presented “Reintegration Challenges for
Returning Veterans”

EnduringCommitment

Recognition and Remembrance
Recognition
Each year the work of Center scientists receives recognition from national organizations and prestigious
professional associations. In 2011, this recognitionreflects contributions from science to public education, and the versatility of educational venues fromresearch organizations to national media outlets.
Dr. Robert J. Ursano, Chairman, Department of
Psychiatry, Professor of Psychiatry and Neuroscience,
Uniformed Services University Medical School, wasnotified to receive the American College of Physicians
William C. Menninger Memorial Award for Distinguished Contributions to the Science of Mental Health.
Dr. Ursano serves as Director of the Center for the
Study of Traumatic Stress.
Dr. Stephen J. Cozza, Professor, Department of
Psychiatry, Uniformed Services University Medical School and Associate Director, Child and Family
Program, Center for the Study of Traumatic Stress,
received the Frank Ochberg Award for Media andTrauma Study. This award recognizes significant
contributions by clinicians and researchers on therelationship of media and trauma. Both DoD andcivilian media sources have sought out his expertisein the impact of deployment and combat injury on
military families and children.

Dr. Connie Duncan was elected as a Fellow of theSociety of Clinical Psychology (Division 12) of theAmerican Psychological Association (APA), which is inrecognition of the contributions she has made to theunderstanding of brain dysfunction in neuropsychiatric disorders, including schizophrenia and traumaticbrain injury. Dr. Duncan is Research Associate Professor, Department of Psychiatry, Uniformed Services
University Medical School.
Center scientists, Dr. Matthew M. Goldenberg, Lt
Col Derrick Hamaoka, LCDR Patcho Santiago and
Dr. James E. McCarroll, won the MedEdPORTALsponsored Call for Culturally Competent Training/
Learning Modules for Treatment of U.S. Service
Members and their Families at the 2011 Association ofAmerican Medical Colleges Annual Meeting. Theirwinning submission was titled, “Basic Training: A
Primer on Military Life and Culture for Health Care
Providers and Trainees.”
Nancy Vineburgh, Associate Professor of Psychiatry, Uniformed Services University Medical School
and Associate Director, Office of Public Education
and Preparedness, Center for the Study of TraumaticStress, received the 2011 American Graphic DesignAward for the 2010 CSTS Annual Report.

Dr. Herbert Hauptman Remembrance
It is with deep sadness that wereport the 2011 passing of a distinguished CSTS Scientific Advisory
Board member, Dr. Herbert Hauptman, aged 94. In 1985 Hauptman
and Jerome Karle received theNobel Prize in Chemistry for theirdevelopment of revolutionary methods for determining the structureof molecules vital to life. Dr. Hauptman’s groundbreaking work in the field of X-ray
crystallography continues to have monumental
implications for the design of therapeutic drugs
to prevent and treat life-threatening diseases,
and he was instrumental in defining the field of

14 | Center for the Study of Traumatic Stress, USUHS

biomedical research itself over the
decades. As president of the Hauptman-Woodward Medical ResearchInstitute, he helped to build it into aworld-renowned research center.
According to Satish K. Tripathi,
President, University of Buffalo, “Dr.
Hauptman was widely considered tobe the most important scientist everto have lived in Western New York.” Dr. Hauptman’s daughter, Dr. Carol Fullerton, is Professorof Psychiatry at Uniformed Services University
Medical School and Director of Scientific Research,Center for the Study of Traumatic Stress.

2011 Funded Grants
Study	Funding Institution
Family Violence and Trauma Project III	US Army
Protecting the Health, Safety & Resilience of Deployed Staff

CDC

Clinical Study Site for PTSD and TBI (sub-award)	UC San Diego
Addressing the Needs of Children and Families of Combat Injured

CDMRP

Mortuary Affairs Soldiers: Early Intervention and Altering Barriers to Care for Traumatic Stressand PTSD	CDMRPDeployment Family Stress: Child Neglect and Maltreatment in U S Army Families

CDMRP

Mental Health and Service Utilization Among Reserve and National Guard Forces (sub award)
University

Columbia

PTSD trajectory, co-morbidity, and utilization of mental health services among Reserve forces (sub award)		
Columbia University
PTSD trajectory, co-morbidity, and utilization of mental health services among National Guard SoldiersCDMRPCSTS — Program Grant 2008	DCoE
CSTS — Program Grant 2010	DCoE
CSTS — Program Grant 2011	DCoE
FOCUS-CI Preventive Intervention with Children and Families of Combat Injured

CDMRP

Brain Indices of Risk for PTSD after Mild TBI

CDMRP

Evaluation of Sesame Workshop’s “Talk, Listen, Connect”

Sesame Workshop

Initial Randomized Controlled Trial of Acceptance and Commitment Therapy (ACT) for Distress andImpairment in OEF/OIF Veterans
CDMRP
A Pilot Safety and Feasibility Study of High Dose Left Prefrontal Transcranial Magnetic Stimulation (TMS) 		
	UC San Diego
A Proof-of-Concept, Double-blind, Randomized, Placebo-Controlled Study of Ganaxolone in PTSD	UC San
Diego
Modifiable Risk and Protective Factors for Suicidal Behaviors in the US Army	NIMH
Modifiable Risk and Protective Factors for Suicidal Behaviors in the US Army — ARRA	NIMH
Modifiable Risk and Protective Factors for Suicidal Behaviors in the US Army – Supplement	NIMH
Impact of Service Member Death on Military Families: A National Study of Bereavement

CDMRP

The Injury and Traumatic Stress (INTRuST) CONSORTIUM Biorepository	UC San Diego
Riluzole Augmentation Treatment for Complicated PTSD (MOMRP)	US Army

Annual Report 2011 | 15

EnduringCommitment

2010–2011 Publications (Dept. of Psychi
Biggs QM, Fullerton CS, Reeves JJ, Grieger TA, Reissman DB, Ursano RJ. Acute stress disorder, depression
and tobacco use in disaster workers following 9/11.
Am J Orthopsychiatry. 2010;80(4): 586–592.
Biggs QM, Guimond JM, Fullerton CS, Ursano RJ, and
ASD Workgroup (Gray C, Goldenberg MN, Reissman DB, McCarroll JE, Santiago P, Tyler MP). The
epidemiology of acute stress disorder and other early
responses to trauma in adults. In: Beck JG & Sloan
DM, eds. The Oxford Handbook of Traumatic Stress
Disorders. New York, NY: Oxford University Press;
2012: 69–83.
Cozza SJ, Guimond JM, McKibben JBA, Chun RS,
Arata-Maiers TL, Schneider B, Maiers A, Fullerton
CS, Ursano RJ. Combat-injured service members andtheir families: The relationship of child distress andspouse-perceived family distress and disruption. J
Trauma Stress. 2010;23(1): 112–115.
Diebold C, Waits W, Brown M, Benedek DM. Military
psychiatry graduate medical education. In: RitchieEC, ed. Textbook of Combat and Operational Psychiatry. Borden Institute Textbooks of Military Medicine,
Office of the Surgeon General of the United States
Army; 2011: 669–692.

Ritchie EC, Benedek DM. Psychological issues andmass fatality. In: Gursky EA, Fierro MF, eds. Death In
Large Numbers: The Science, Policy and Managementof Mass Fatality Events. American Medical Association; 2011: 279–304.
Flynn BW. Community and organizational responses
to disaster. In: Kaufman R, Edwards R, Mirsky J,
Avgar A, eds. Crisis As An Opportunity: Organizational And Community Responses to Disasters. University
Press of America; 2011: 1–15.
Fullerton CS, Reissman DB, Gray C, Flynn BW,
Ursano RJ. Earthquake response and psychosocial
health outcomes: Applying lessons from integrating
systems of care and recovery to Haiti. Disaster Med
Public Health Prep. 2010;4(1): 15–17.
Fullerton CS, McCarroll JE, Feerick M, McKibben JBA,
Cozza S, Ursano RJ, Child Neglect Workroup. Childneglect in Army families: A public health perspective.
Mil Med, 2011;176(12): 1432–1439.
Lang AJ, Schnurr PP, Jain S, Raman R, Walser R,
Bolton E, Chabot A, Benedek DM. Evaluating transdiagnostic treatment for distress and impairment inveterans: A multi-site randomized controlled trial of
Acceptance and Commitment Therapy. Contemp Clin
Trials. 2012;33(1): 116–123.
McKibben JBA, Fullerton CS, Ursano RJ, Reissman
DB, Kowalski-Trakofler K, Shultz JM, Wang L. Sleep
and arousal as risk factors for adverse health andwork performance in public health workers involvedin the 2004 Florida hurricane season. Disaster Med
Public Health Prepared. 2010;4(supple 1): S55–S62.
Jia M, Meng F, Smerin S, Xing G, Zhang L, Su DM,
Benedek DM, Ursano RJ, Su YA, Li H. An animalmodel of PTSD for revealing biomarkers and behavioral correlates. J Visual Exps. In press.
Jiang X, Chen A, Smerin S, Zhang L, Li H. Pharmacology of 5-HT2 modulation of amygdala & hypothalamus in anxiety disorders. In: Kalinin V, ed.
Anxiety Disorders. InTech; 2011: 39–50.

This award-winning photo taken by Brian Flynn,
CSTS Associate Director, depicts the United States
Public Health Service (PHS) ribbon bar wornon the uniform of a member of the United States
Public Health Service Commissioned Corps.
16 | Center for the Study of Traumatic Stress, USUHS

Schneider B, Bradley J, Warner CH, Benedek DM.
Psychiatric medications in military operations. In:
Ritchie EC, ed. Textbook of Combat and Operational
Psychiatry. Borden Institute Textbooks of Military
Medicine, Office of the Surgeon General of the UnitedStates Army; 2011: 151–162.

atry)
Shigemura J, Fullerton CS, Ursano RJ, Wang L,
Querci-Daniore R, Horikawa N, Yoshino A, Nomura
S. Gender differences in the fear of terrorism among
Japanese individuals in the Washington, D.C. area.
Asian J Psychiatry. 2010;3(3): 117–120.
Terhakopian A, Benedek DM, Ritchie EC. Disaster
psychiatry. In: Ritchie EC, ed. Textbook of Combat
and Operational Psychiatry. Borden Institute Textbooks of Military Medicine, Office of the Surgeon
General of the United States Army; 2011: 579–592.
Ursano RJ, Fullerton CS, Benedek DM. What is psychopathology after disasters? Considerations about
the nature of the psychological and behavioral consequences of disasters. In: Neria Y, Galea S, Norris FH,
eds. Mental Health and Disasters. Cambridge, UK:
Cambridge University Press; 2010: 131–142.
Ursano RJ, Goldenberg MN, Zhang L, Carlton J,
Fullerton CS, Li H, Johnson L, Benedek DM. Posttraumatic stress disorder and traumatic stress: Frombench to bedside, from war to disaster. Ann NY Acad
Sci. 2010;1208: 72–81.
Ursano RJ, Goldenberg MN, Hamaoka D, Benedek
DM. Disaster public health: Heath needs, psychological first aid and cultural awareness. In: Stein DJ,
Friedman MJ, Blanco C, eds. Post-traumatic Stress
Disorder. West Sussex, UK: John Wiley & Sons Ltd;
2011: 275–280.

Xing G, Carlton J, Zhang L, Jiang X, Fullerton CS, Li
H, Ursano RJ. Cannabinoid receptor expression andphosphorylation are differentially regulated between
male and female cerebellum and brain stem after
repeated stress: Implication for PTSD and drug abuse.
Neurosci Lett. 2011;502(1): 5–9.
Zhang L, Hu X, Li H, Li XX, Smerin S, Benedek DM,
Ursano RJ. Startle response related genes. Med Hypotheses. 2011;77(4): 685–691.
Zhang L, Li CT, Su TP, Hu XZ, Lanius RA, Webster MJ,
Chung MY, Chen YS, Bai YM, Barker JL, Barrett JE, Li
XX, Li H, Benedek DM, Ursano RJ. P11 expression and
PET in bipolar disorders. J Psychiatric Res. 2011;45(11):1426–1431.
Zhang L, Ursano, RJ, Li H. P11: A potential biomarker
for posttraumatic stress disorder. Methods Mol Bio.
2012;829(5): 453–468.
Zhang L, Hu X, Li H, Li XX, Smerin S, Ursano RJ. Potential blood tests for mental disorders. In: Columbus
AM, ed. Advances in Psychological Research. Volume 89.
NOVA Science Publishers; 2011: 97–114.
Zhang L, Hu X, Li XX, Li H, Ursano RJ. PTSD and current translational research. In: Kalinin V, ed. Anxiety
Disorders. InTech; 2011: 69–96.
Zhang L, Li H, Hu X, Li XX, Smerin S, Ursano RJ.
Glucocorticoid-induced p11 over-expression and chromatin remodeling: A novel molecular mechanism of
traumatic stress? Med Hypotheses. 2011;76(6): 774–777.

Brian Flynn, CSTS Associate Director, photographed the images: Ft. Lee’s Joint Mortuary AffairsCenter sign, and two flag headstones at the US Naval Academy Cemetery.
Annual Report 2011 | 17

EnduringCommitment

CSTS Directors, Scientists and Scientif
CSTS Directors

CSTS Scientists

Robert J. Ursano, M.D.
Director, CSTS
Chairman, Department of Psychiatry
Professor of Psychiatry and Neuroscience
F. Edward Hebert School of Medicine
Uniformed Services University

Col Daniel J. Balog, M.D., USAF, MC, FS
Assistant Professor, Assistant Chair,
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Col David M. Benedek, M.D. MC, USA
Associate Director, Consultation and
Education, CSTS
Professor/Deputy Chair, Department of
Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Stephen J. Cozza, M.D.
Associate Director, Child and Family
Program, CSTS
Professor, Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Brian W. Flynn, Ed.D.
Associate Director, Health Systems, CSTS
Adjunct Professor, Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Carol S. Fullerton, Ph.D.
Director, Scientific Research, CSTS
Professor, Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Robert K. Gifford, Ph.D.
Executive Officer, andAssociate Director, Homeland Security
Studies, CSTS
Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
John A. Stuart, Ph.D.
Director, Resource Management, CSTS
Assistant Professor, Department of
Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Nancy T. Vineburgh, M.A.
Associate Director, Public Education andPreparedness, CSTS
Assistant Professor, Department of
Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

COL David M. Benedek, M.D., MC, USA
Professor
Consultant to the U.S. Army Surgeon
General for Forensic Psychiatry
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Quinn M. Biggs, Ph.D., M.P.H.
Research Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Maria Braga, D.D.S., Ph.D.
Associate Professor
Department of Anatomy, Physiology andGenetics
F. Edward Hebert School of Medicine
Uniformed Services University

Col Charles Engel, M.D., M.P.H., MC,
USA
Associate Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Margaret Feerick, Ph.D.
Senior Research Psychologist, CSTS
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Joscelyn E. Fisher, Ph.D.
Project Director/Research Psychologist
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Brian W. Flynn, Ed.D.
Adjunct Professor, Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Michael C. Freed, Ph.D.
Research Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Kwang Choi, Ph.D.
Research Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Carol S. Fullerton, Ph.D.
Research Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Daniel W. Cox, Ph.D.
Research Psychologist
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Frances Gabbay, Ph.D.
Research Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Stephen J. Cozza, M.D.
Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Col Gary Gackstetter, USAF
Associate Professor
Department of Preventive Medicine/
Biometrics
F. Edward Hebert School of Medicine
Uniformed Services University

Brian Crowley, M.D.
Clinical Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Catherine L. Dempsey Ph.D., M.P.H.
Research Psychologist
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Connie Duncan, Ph.D.
Research Associate Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Richard S. Epstein, M.D., P.A.
Clinical Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

18 | Center for the Study of Traumatic Stress, USUHS

Robert K. Gifford, Ph.D.
Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Matthew N. Goldenberg, M.D.
Assistant Professor of Psychiatry, CSTS
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Kristie Gore, Ph.D.
Research Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Thomas A. Grieger, M.D.
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

ic Advisory Board
Lt Col Derrick Hamaoka, M.D., USAF,
MC, FS
Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Jill Harrington-LaMorie, DSW, LCSW
Senior Field Researcher
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Harry C. Holloway, M.D.
Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Marjan G. Holloway, Ph.D.
Assistant Professor
Department of Medical & ClinicalPsychology
F. Edward Hebert School of Medicine
Uniformed Services University
Allison K. Holmes, Ph.D.
Project Director/Research Psychologist
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Tomoko I. Hooper, M.D.
Assistant Professor
Department of Preventive Medicine/
Biometrics
F. Edward Hebert School of Medicine
Uniformed Services University
Edmund G. Howe III, M.D., J.D.
Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Xianzhang Hu, M.D., Ph.D.
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Luke Johnson, Ph.D.
Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Tzu Cheg Kao, Ph.D.
Professor
Department of Preventive Medicine andBiometrics
F. Edward Hebert School of Medicine
Uniformed Services University
Elie Karam, M.D.
Professor and Chairman
Department of Psychiatry
American University — Beirut
Beirut, Lebanon

He Li, M.D., Ph.D.
Associate Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Xian Liu, Ph.D.
Research Assistant Professor
Deployment Health Clinical Center
Walter Reed Army Medical CenterDavid Marlowe, Ph.D.
Senior Lecturer
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Holly B. Mash, Ph.D.
Research Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
James E. McCarroll, Ph.D., M.P.H.
Research Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Jodi McKibben, Ph.D.
Research Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Lt Col Kristina Money, M.D.
Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

LCDR Patcho Santiago, M.D., M.P.H., MC,
USN
Assistant Professor
CSTS
F. Edward Hebert School of Medicine
Uniformed Services University
Janet A. Schmidt, Ph.D.
Senior Scientist
CSTS
F. Edward Hebert School of Medicine
Uniformed Services University
John A. Stuart, Ph.D.
Research Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
E. Fuller Torrey, M.D.
Executive Director
Stanley Medical Research Institute
Bethesda, MD
Robert J. Ursano, M.D.
Chairman, Department of Psychiatry
Professor of Psychiatry and Neuroscience
F. Edward Hebert School of Medicine
Uniformed Services University
Nancy T. Vineburgh, M.A.
Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Maree J. Webster, Ph.D.
Assistant Research Professor
Stanley Medical Research Institute
Bethesda, MD 20889

Jamie Naifeh, Ph.D.
Research Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Lars Weisaeth, M.D.
Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

John Newby, Ph.D.
Research Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Anthony Woodson, Ph.D.
Associate Administrator, CSTS
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Claudio Ortiz, Ph.D.
Research Psychologist
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Kathleen Wright, Ph.D.
Deputy Chief
Department of Military Psychiatry
Division of Neuropsychiatry
Walter Reed Army Institute of Research

CAPT Dori B. Reissman, M.D., M.P.H.,
USPHS
Medical Director, World Trade Center
Responder Health Program
Senior Medical Advisor, National Institute ofOccupational Safety and Health, CDC
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Guoqiang Xing, M.D.
Research Scientist
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Lei Zhang, M.D.
Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
Annual Report 2011 | 19

StaffGerard Adore
Pablo Aliaga
Daniel Alvarez
Abby Anderson
Martin Atherton
K. Nikki Benevides
LCDR Jennifer Bornemann
Christina Buckley
MSgt Louella Campbell
Freda Denis-Cooper
Shelby Farrish
TSgt Theda Franklin
Christine Gray
Julie Grieco
April Harris
LaKesha Henry
Mara Huber
Paul Hurwitz
Angelika Jones
Cynthia Jones
Jessica Kansky
Natalie Kodsy
Sarah Koenig
David Kopp
Rosemary Leier
Andrew Melmed
Mona Mendelson
Susan Moss
Stefanie Moynihan
Joseph Piemontese
Karen Plummer
MSgt Derek Power
Deborah Probe
Sara Pula
Stephanie Riley
Craig Sadler
Heidi Shul
James Sottile
Chad Spiegel
Natara Strother-Ware
Allison Stuppy
Susan Van Ost
Patti Vegella
Leming Wang
Holly Wu

Scientific Advisory
Board
James E. Barrett, Ph.D.
Department of Pharmacology andPhysiology
Drexel University, College of Medicine
245 N. 15th Street
Mail Stop 488, Room 8213
Philadelphia, PA 19102-1192

Col Charles W. Beadling, USAF, MC
Academic Division Director
Department of Military and Emergency
Medicine
F. Edward Hebert School of Medicine
Uniformed Services University
4301 Jones Bridge Road
Bethesda, MD20814-4799
BG (ret) William T. Bester, RN, MSN,
CNAA, BC
Vice President for Distributed Learning;
Acting Vice President of External Affairs
Uniformed Services University
F. Edward Hebert School of Medicine
Uniformed Services University of the Health
Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
M. Richard Fragala, M.D.
P.O. Box 182
Malverne, NY 11565
Matthew J. Friedman, M.D.
Executive Director
National Center for Posttraumatic Stress
Disorder (116D)
VAM & ROC
215 North Main Street
White River Junction, VT 05001-3833
Carol S. Fullerton, Ph.D.
Scientific Director, Center for the Study ofTraumatic Stress
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University of the Health
Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
CAPT Paul S. Hammer, MC USN
Director,
Defense Centers of Excellence (DC0E) for
Psychological Health and Traumatic
Brain Injury
David S. Krantz, Ph.D.
Chair, Department of Medical and ClinicalPsychology
F. Edward Hebert School of Medicine
Uniformed Services University of the Health
Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
Larry W. Laughlin, M.D., Ph.D.
Dean
F. Edward Hebert School of Medicine
Uniformed Services University of the Health
Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799

20 | Center for the Study of Traumatic Stress, USUHS

Craig H. Llewellyn, M.D.
Professor
Department of Military and Emergency
Medicine
F. Edward Hebert School of Medicine
Uniformed Services University of the Health
Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
David H. Marlowe, Ph.D.
Senior Lecturer
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University of the Health
Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
Robert M. Post, M.D.
Head, Bioplar Collaborative Network
3502 Turner Lane
Chevy Chase, MD 20815
CAPT Gerald V. Quinnan, Jr., MC, USN
Professor and Chair, Preventive Medicine &Biometrics
RADM, USPHS (Ret)F. Edward Hebert School of Medicine
Uniformed Services University of the Health
Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
Arieh Y. Shalev, M.D.
Professor and Chairman
Department of Psychiatry
Hadassah University School of Medicine
Jerusalem, Israel
CAPT Trueman Sharp, MC, USN
Department Chair, Military and Emergency
Medicine
F. Edward Hebert School of Medicine
Uniformed Services University of the Health
Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
Robert J. Ursano, M.D.
Chairman, Department of Psychiatry
Professor of Psychiatry and Neuroscience
F. Edward Hebert School of Medicine
Uniformed Services University of the Health
Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
Lars Weisaeth, M.D.
Professor and Chairman
Division of Disaster Psychiatry
University of Oslo
Oslo, Norway

FACES OF CSTS

All “Faces of CSTS” photographs by Brian Flynn.

Acknowledgements
The Center for the Study of Traumatic Stress (CSTS)
would like to acknowledge and thank each of theseorganizations for their continued support, guidance,and leadership throughout the past year.
■■

Uniformed Services University of the Health Sciences■■

Defense Centers of Excellence for Psychological
Health and Traumatic Brain Injury■■

The Henry M. Jackson Foundation for the
Advancement of Military Medicine■■

The National Center for PTSD■■

Deployment Health Clinical Center

We wish to acknowledge ourresearch relationships andsupport from:
U.S. Army
Centers for Disease Control(various agencies)
The Carter Center
Sesame Workshop
NCTSN
NIMH
Medical Research Command(MRC) at Ft. Detrick
We want to acknowledge andthank DoD’s Defenseimagery.mil whose photos appear
throughout this Annual Report.

DEFENSE CENTERS
OF EXCELLENCEFor Psychological Health& Traumatic Brain Injury

CENTER FOR THE STUDY OF TRAUMATIC STRESS
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road, Bethesda, MD 20814-4799
Tel: 301-295-2470 | Fax: 301-319-6965
www.usuhs.mil/csts | www.CSTSonline.org