U n i f o r m e d S e rv i c e s U n i v e r s i t yCenter for the Study of Traumatic Stress2013 Annual Report

The Next Quarter Century

The Next Quarter Century

The Center for the Study of Traumatic Stress entered its second quarter century

of service to our nation in 2013. The Center’s mission is to advance scientific andacademic knowledge, interventions, educational resources and outreach to mitigate
the impact of trauma from exposure to war, disasters, terrorism, community
violence and public health threats. Our research in neuroscience and theneurobiology of stress is dedicated to finding effective interventions for a number ofhealth issues that are of special interest to the military such as posttraumatic stressdisorder (PTSD), mild traumatic brain injury (mTBI) and suicide. Findings frommany of our groundbreaking studies will have an impact on individual, family andcommunity resilience in the face of traumatic events into the next quarter century.

The Center’s scientists, educators and clinicians lead the nation in trauma-informedcare, and rapidly moving findings from bench to bedside and from war to disaster.

Contents
From the Director of CSTS	
An Interview with Dr. Carol S. Fullerton
Military PsychiatryChild and Family Program
Disaster Psychiatry and DisasterBehavioral HealthPublic Education Outreach and Resources
Presentations, Conferences and Trainings
2013 Funded Grants
Publications
CSTS Directors, Scientists, and	Scientific Advisory Board

An American flag flies above debris in Moore, Okla.,
May 21, 2013. Members of the Oklahoma National
Guard worked to help the city, which suffered severe
damage during a tornado that struck May 20, 2013.
The guardsmen are members of the 63rd Civil Support
Team. U.S. Army photo by Sgt. 1st Class Kendall James.

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From the Director of CSTS
Dear Center Colleagues and Friends,
The Center for the Study of Traumatic Stress(CSTS) entered its second quarter century of service
to our nation in 2013. Our mission — to advancescientific and academic knowledge, interventions,educational resources andoutreach to mitigate theimpact of trauma fromexposure to war, disasters,
terrorism, community
violence and public healththreats — continues to be
essential to the Departmentof Defense and the nation.
Center scientists, educators and clinicians continue to bring scholarly andresearch oriented problem solving to the mental andbehavioral health problems of those exposed to war,disaster and traumatic events.
Our activities in 2013 highlight our unique contributions in military and disaster psychiatry, twoseparate yet interrelated fields, which our Centerhas helped define and advance. The bridging ofthese disciplines strengthened our response to the
September 16th Washington Navy Yard Shooting.
Center Scientists, Navy Commander Patcho Santi-

Memorial service to honor victims of the Washington
Navy Yard shootings.

ago, led a team from Walter Reed National Military
Medical Center (WRNMMC) to support the Special
Psychiatric Rapid Intervention Team (SPRINT) thatprovided Psychological First Aid to the Sailors andNavy civilians working aboard the Navy Yard, U.S.
Public Health Service CDR Josh Morganstein, M.D.,
RADM (Ret.) Brian Flynn, Ed.D., and LCDR Jennifer
Bornemann provided ongoing expert consultation
to local officials and DOD personnel involved in thedisaster response. The CSTS response was featured
in the APA’s Psychiatric News Alert titled, “Mental
Health Response Quickly Follows Navy Yard Shooting.” CSTS also distributed customized, just-in-timefact sheets to over 2,000 government and private
sector stakeholders on diverse topics including“leadership in the face of workplace tragedy”, “stressmanagement” and “managing a workplace after adisaster”.
2013 also saw two natural disasters, domestic
and international, and a terrorist event that engaged
our Center’s expertise. We provided educational
outreach, just-in-time education and consultation
to community leaders in the wake of the Moore,
Oklahoma tornado, the Boston Marathon bombingsand Typhoon Haiyan. The outreach included Army,
Air Force and Navy Psychiatry consultants and Navymental health leadership, and is described in moredetail in the Military Psychiatry and Disaster Psychiatry and Behavioral Health sections.
The Center is also engaged in groundbreaking
scientific studies whose findings will inform the next
quarter century. The Army Study to Assess Risk andResilience in Servicemembers (Army STARRS), thelargest study of mental health risk and resilience everconducted among military personnel, is increasing
our knowledge of the risks and protective factorsthat underlie vulnerability and resilience in the faceof traumatic exposure for Service members who
have and will serve our nation for years to come. In
its fourth year, Army STARRS has analyzed morethan a billion data points in existing Army and DOD
records for more than 1.6 million past Active Duty
2013 Annual Report—The Next Quarter Century | 1

soldiers. To date, eight papers have been published,
three papers were accepted for publication, four
papers were submitted and are under review for
publication, and thirty additional papers are in various stages of development.
The Center’s research in neuroscience and theneurobiology of stress is dedicated to finding effective interventions for a number of health issues of
special interest to the military such as posttraumaticstress disorder (PTSD), mild traumatic brain injury (mTBI) and suicide. Center scientists span frombench to bedside and their findings help inform
our nation’s policy around the impact of traumatic
exposure. COL David Benedek, M.D., Associate Director, Consultation and Education, participated in
the White House Office of Science and Technology
Policy’s discussion on the research action plan for a
Presidential Executive Order on “Improving Accessto Mental Health Services for Veterans, Service
Members, and Military Families”. The Center helda very successful 8th Annual Amygdala, Stress and
PTSD Conference to bring basic science knowledge
and clinical care knowledge together.
Our Child and Family Program (CFP) is a voice
to the nation in bringing attention to a large population of U.S. Service members and their families
who have been and will continue to be affected foryears to come by serious combat injuries or military
parental death. A January article in the New YorkTimes, “A Soldier’s Requiem, Never Fading Away”,
addressed these issues and cited the Center’s in-volvement in The National Military Family Bereavement Study, a five-year project begun in 2011 under
the leadership of Dr. Stephen Cozza, Associate
Director of the Center, who heads up our Child andFamily Program.
Disaster behavioral health is another area inwhich the Center provides leadership for the nation.
Center Associate Director, Brian Flynn, Ed.D., anexpert in behavioral health public policy and systems, represented the Center as a member of theInstitute of Medicine’s Committee on Crisis Standards of Care: A Toolkit for Indicators and Triggers.
This committee is addressing issues such as ‘altered
standards of care’ in events that overwhelm theresources of the health system, a significant issue indisaster behavioral health moving forward.
Looking ahead, we continue to engage in theimportant task of transmitting our Center’s uniqueknowledge and experience in trauma research, education, consultation and training throughout the nation and in particular to our younger colleagues. Dr.
Carol Fullerton, CSTS Scientific Director, addresses
this important role of the Center in a personal interview on page 3.
As Director of our Center since its establishment
in 1987, I look forward to sharing with you on thefollowing pages the many contributions that we aremaking to enhance psychological health, recovery
and prevention of the negative consequences of trauma on an individual, family, community and national
level in both our military and civilian populations. I
am proud of our Center scientists and our Center’s
work that has assisted the Department of Defense
in leading the nation in trauma-informed care, andrapidly moving findings from bench to bedside andfrom war to disaster. To our many colleagues andfriends who have collaborated with us and who havesupported our work, we wish to thank you.
Robert J. Ursano, M.D.
Professor of Psychiatry and Neuroscience
Chair, Department of Psychiatry, Uniformed 		Services University
Director, Center for the Study of Traumatic Stress

U.S. troops assist victims of Typhoon Haiyan.

2 | Center for the Study of Traumatic Stress, USU An Interview with Dr. Carol S. Fullerton
Carol S. Fullerton,
Ph.D. is Research Professor in the Department of Psychiatry of
Uniformed Services
University and also
serves a key role as
the Scientific Directorof the Center for the
Study of Traumatic Stress. Dr. Fullerton brings theunique perspective of having worked at the Center
since its inception in 1987, and in 2013, along with
Dr. Robert Ursano, the Center’s Director, entered its
second quarter century of trauma research, education, consultation and training.
This interview reflects Dr. Fullerton’s unique perspective on the scientific process, the activities of theCenter and her strong commitment to educating thenext cohort of Center scientists who will carry thework forward into the future.
In addition to the many studies in which you arepresently engaged, what is most meaningful to youat this stage of your career?
“Training and working with the Center’s juniorscientists. It’s about moving the field ahead. Withouttransferring skills and knowledge, the field of trauma
research will not advance. I view my role as providing the ‘scientific glue’ between the current andfuture generation of scientists.”
You have been with the Center since its inception in
1987. Can you share some background about thisperiod and its implications for your work today?
“In my first conversation with Bob Ursano, he
asked whether I could handle being deployed to thesite of a mass casualty disaster involving military
personnel, with the mission to gain entrée and establish a research collaboration. My prior work conducting research on the adolescent units at Chestnut
Lodge Psychiatric Hospital involved gaining entrée
into a difficult setting and establishing a research

program. So I responded, “I think I can do it!” I
learned early on that what was most important wasestablishing collaborations whether in a psychiatricsetting, the site of a plane crash, or a community
devastated by an earthquake or hurricane.
I have participated in a number of such missions. I now take a leadership role training others togain entrée into disaster sites and establish ongoing
research collaborations. This work enables us tobetter understand the immediate and longer-term
responses of individuals and communities to trauma
and disasters. We have also conducted some of thefirst studies of spouse and community support fordisaster workers.
I understand that Harry Holloway championed
bringing you into the Department because of yourprior background and training.
“That is correct. Dr. Holloway felt my training inhuman development would be an asset. He believedthat people who study human development are‘multi variable’ people. According to Harry, ‘they
approach a problem from multiple domains’.

Dr. Carol S. Fullerton, Scientific Director of theCenter for the Study of Traumatic Stress, discusses
a research project with Drs. Holly Mash and Quinn
Briggs.
2013 Annual Report—The Next Quarter Century | 3

Without transferring skills and knowledge, the field of trauma
research will not advance. I view my role as providing the‘scientific glue’ between the current and future generation ofscientists.
How has the multi variable approach benefitted
your scientific research?
The Center has been involved in nearly every
major disaster in our nation over the past 25 years.
We have studied many disaster populations fromdisaster workers and spouses, Soldiers and families,
postal workers, public health workers and the homeless population in Washington, D.C. following the
DC sniper attacks, as well as others. We have worked
extensively with Soldiers returning from deployment
and their spouses. In all our work we examine multiple factors affecting responses to trauma and disasters. Why do some people develop posttraumatic
distress while others become more resilient following such experiences? We examine multiple factorsthat affect recovery. These questions are reflectedin every aspect of the research from designing the
instruments to evaluating the data and determining
new directions for future research. Another important aspect of our work is that we have taken amultilevel approach — examining both individual aswell as community level factors.

Are these the items that are taught and passed on
to the next generation of trauma scientists?
“Yes, basically, you train their minds. Learning tothink as a researcher is a very different process thanlearning content. In the former, you learn to put
ideas together in new and innovative ways. A true
scientific discovery is often the result of the coming
together of seemingly disparate ideas, which when
examined together become greater than simply thesum of the two. As scientists we want to understandthe mechanisms that underlie this relationship. In
my years of integrating into the disaster settings,
developing surveys, collecting data, analyzing data towriting it up, I’ve developed a sense of ‘context’— somewhat intangible yet teachable.”
How would you describe the Center’s role in transferring this scientific knowledge to those invested indoing trauma research?
There is a great line from the movie, The Paper
Chase. Professor Kingsfield addresses his law students on the first day of class, “You teach yourselves
the law, but I train your minds. You come in herewith a skull full of mush; you leave thinking like alawyer.”A quarter century of research on trauma anddisaster, with many studies conducted in the field,
invariably leads to a mindset in which the science isinformed by multiple factors and the unique experiences of the scientist. As we look ahead to the next
quarter century, I believe our Center’s contributions
will be reflected in the ‘mindset’ of those young scientists we have mentored.

The Center has been involved in nearly every major disasterin our nation over the past 25 years. We have studied many
disaster populations from disaster workers and spouses,
Soldiers and families, postal workers, public health workers andthe homeless population in Washington, D.C. following the DC
Typhoon Haiyan in the Philippines.

4 | Center for the Study of Traumatic Stress, USU sniper attacks, as well as others.

Military Psychiatry
The ten-year war on terrorism has resulted inhigh rates of stress, posttraumatic stress disorder(PTSD), depression, suicide, co-morbid concussions,traumatic brain injuries, and other combat-related
mental and behavioral health issues. These injuries,
visible and invisible, have disrupted the lives of thousands of Service members, families and children who
will bear the effects for years to come. Almost one
million Service members or former Service members who served in Iraq or Afghanistan have been
diagnosed with at least one psychiatric disorder andalmost half of those members were diagnosed withmultiple disorders according to a recent Institute ofMedicine report.
The Center for the Study of Traumatic Stress,
established in 1987 as part of the Department of

Psychiatry of the Uniformed Services University,
has been and continues to be on the forefront ofresearch, education, consultation and training inmilitary psychiatry, which addresses the psychiatric,
psychological and mental health issues that affectand occur within the military community (Service
members, their families and children) including
Active Duty, Guard and Reserve personnel andveterans.
The Center advances the field of military psychiatry through: 1) translational research in neuroscience and the neurobiology of stress to better
understand the origins of and inform treatments
for traumatic stress disorders; 2) education of
USU medical students committed to service in our
nation’s Army, Air Force, Navy and Public Health

The Center advances the field of military psychiatry through:1) translational research in neuroscience and the neurobiology
of stress to better understand the origins of and inform
treatments for traumatic stress disorders; 2) education of USU
medical students committed to service in our nation’s Army,
Air Force, Navy and Public Health Service; 3) development
and dissemination of educational resources on timely issuesof military health and mental health to educate physicians,
military and civilian, and healthcare providers engaged inmilitary and trauma-informed care, and; 4) consultation with
DOD leadership, government, academia, industry and the
media to foster knowledge, educational and clinical resources,and outcomes for optimizing and sustaining military health andinfluencing military health policy.

2013 Annual Report—The Next Quarter Century | 5

Service; 3) development and dissemination of educational resources on timely issues of military healthand mental health to educate physicians, militaryand civilian, and healthcare providers engaged inmilitary and trauma-informed care, and; 4) consultation with DOD leadership, government, academia,
industry and the media to foster knowledge, educational and clinical resources, and outcomes for optimizing and sustaining military health and influencing military health policy. In 2013, the Center was
actively involved in all of these four areas.
The Center’s neuroscience research has resulted
in the discovery of potential biomarkers for PTSD,
suicide risk, and increased understanding of gene
expression patterns that underlie biomarkers. Thesefindings can ultimately be used to diagnose diseases promptly and accurately, to identify individuals
at high-risk for certain diseases, and to follow thecourse of response to treatment. As new candidate
biomarkers are identified, access to large collectionsof bio samples from persons exposed to trauma[CSTS research found] that in Service memberswith PTSD exposed to six or more traumatic events,
telomeres were significantly shorter than in agematched controls, indicating that more traumatic
events were associated with shorter telomeres in thosewith PTSD in a trauma dose-related manner.

6 | Center for the Study of Traumatic Stress, USU (with and without PTSD or other disorders) will
be important resources for scientists attempting to
replicate and validate initial studies.
In 2013, Center neuroscientists studying PTSD in
Soldiers from high operational tempo units made animportant discovery about telomeres, the segmentof repetitive nucleotide DNA that occurs at the ends
of chromosomes and protects the chromosome fromdeterioration. Over time and with each cell division,
the telomere ends become shorter, showing telomere
length as an emerging marker of biological age thatpredicts incidence of age-related diseases. Centerscientists found that Service members with PTSD
had shorter telomeres than age-matched Service
members without PTSD. A particularly striking
finding was that in Service members with PTSD
exposed to six or more traumatic events, telomeres
were significantly shorter than in age-matched
controls, indicating that more traumatic eventswere associated with shorter telomeres in PTSD ina trauma dose-related manner. The reduction in telomere length was greater in the PTSD subjects, aged
18-30, compared with age-matched controls than inolder subjects. This suggested that the telomere wasa target of stress, especially in younger aged subjects. These findings provided additional evidenceof telomere shortening in PTSD, and demonstrated
telomere length as a potential biomarker for risk of
PTSD. Specific changes of telomere length among
subjects with PTSD who had experienced traumatic
events may depend, at least partially, on the degree
or frequency of traumatic exposure.
The study (see Publication section, p. 22), which
was published in Molecular Psychiatry, bridges a gap
between basic science research and clinical practicewith regard to aging and PTSD. As the adult veteran
population ages the study is of increasing scientificand public interest. Regarding the Center’s continued efforts to identify biomarkers for stress-related disorders and behaviors as well as markers
for susceptibility and resilience, Center scientists
extended their existing biomarker protocol to allow
for collection of mid-deployment biospecimen andsurvey data from troops deployed to Afghanistan
in 2013 and collected this data in-theater. By thesummer of 2014, the Center will have collected dataon a population of activated National Guardsmen
pre-, mid- and post-deployment and this data will
represent a one-of-a kind repository for potential
biomarker identification in deployed troops.
The Center also advanced its work in neuroscience and the neurobiology of stress through its
continued oversight and leadership of the National
Capital Area Integrated Clinical Study Site. Center
Associate Director COL David Benedek, M.D. directs this established network of clinician-researchers at Walter Reed National Military Medical Center(WRNMMC), the D.C. Veterans Administration
Hospital and the Armed Forces Retirement Home.
The site is one of 10 such study sites across thenation, which participates in the INTRuST Consortium for Psychological Health and TBI. In 2013, theconsortium completed data collection for several
clinical trials of novel medication and psychotherapy treatment for PTSD and other combat-relateddisorders. Results of the Consortium’s trial of highdose Transcranial Magnetic Stimulation (TMS) for
suicidal ideation and behavior in veterans—conducted at Walter Reed and the Charleston, SC Veterans
Administration Hospital—are pending publication
at the time of this report. There were also significant advances in another consortium study being
conducted within the National Capital Area Integrated Clinical Study Site, The Brain Indices of Risk
for PTSD after Mild TBI, a protocol that seeks to
identify predictors of PTSD risk using brain-imaging
technologies in persons with TBI. Dr. Connie Duncan and the Brain Indices team presented the study’s
initial findings to the Congressionally Directed

Medical Research Program, the U.S. Army Medical& Materiel Command, and to DOD officials. The
data has shown significant delays in state-of-the-art
electrophysiological measures of information processing following recent mild traumatic brain injury.
Dr. Duncan presented her work at the 53rd Annual
Conference of the Society for PsychophysiologicalResearch in Florence, Italy.
Dr. Duncan was also appointed as the Site Principal Investigator at Fort Belvoir Community Hospital and will serve as Co-Investigator of the protocol
for, Evaluation of Military Service and Family Members for Post Concussive and Posttraumatic Stress
Symptoms, which aims to facilitate the recruitment,
screening, and registry of Service members andindividuals eligible for care in the DOD healthcare
system.
Beyond its affiliation with the INTRuST Consortium, the Center also conducts social and epidemiologic studies to identify modifiable risk andresilience factors of Service members and theirfamilies. Dr. James Naifeh presented a poster at the
Association for Psychological Science convention
that reported on a study finding that low perceived
social support from peers and low unit morale
increase risk of PTSD in previously deployed Active
Duty Soldiers, after controlling for demographic
variables and level of combat exposure. The study
demonstrates the importance of unit characteristics in post-deployment mental health, and it is an
important step in beginning to identify risk factorsthat are modifiable within the existing structure andculture of the Army.
The Army Study to Assess Risk and Resiliencein Servicemembers (Army STARRS) combines two
Center research methodologies drawing uponepidemiology and neurobiology. Under Dr. Ursano’s direction, the complex operations of Army STARRS are managed byCenter Associate Director, Dr. Robert Gifford who
serves as Army STARRS Senior Project Director;
Paul Hurwitz, MPH, Senior Program Manager; andSusan Moss, CPA, Senior Financial Manager. Army
STARRS is supported by many Center scientists, ourteam of Biostatisticians, and Center staff at all levels.
2013 Annual Report—The Next Quarter Century | 7

Research with the Reserve Component (RC) of the United States Armed Forces

Reserve drill sergeants volunteer to train Afghan
counterparts.
The Center continues to conduct extensive
research with the Reserve Component (RC) of
the United States Armed Forces, a traditionally
under-studied population that experiences special stressors when the nation is at war, substantially different from those experienced by the
Active Component (AC). In collaboration with
Dr. Sandro Galea at Columbia University, CSTS
is conducting a nationwide longitudinal researchstudy of the health and mental health of National
Guard and Reserve Service members. The study
addresses the epidemiology and trajectory of
posttraumatic stress, deployment stress, healthrisk behaviors, and health care utilization in the
National Guard and in the Reserves of the Army,
Navy, Air Force, and Marine Corps. In 2013, thestudy team conducted the fourth wave of datacollection. This research is unique in that it uses
a representative national cohort and specificallyaddresses the experiences of the Guard and Reserve, as opposed to the more common research
practice of creating surveys for the AC andconsidering the RC only as a subset of the larger
population.
Army STARRS also provides an unprecedented opportunity to examine the health and mental health of Reserve Component (RC) members.
The New Soldier Study, one of the project’s

8 | Center for the Study of Traumatic Stress, USU 

seven studies, includes surveys of approximately
23,000 RC Soldiers during their first week ofbasic training. Many of these also provided genetic samples. This collection of data at the very
beginning of their military service provides anopportunity to study them through the courseof their military careers and beyond in order todetermine risk factors for health problems, aswell as factors that promote resiliency. In addition, Army STARRS included RC members in its
All Army Survey and in the In-theater study ofSoldiers serving in Afghanistan, again yielding
data that can be used in long-term studies whileproviding a snapshot of their current health andmental health, and creating the opportunity forassessment of concentrations of risk in orderto develop future interventions to promote andsustain military health.
The CSTS portfolio of research on the RC isrounded out by studies of biomarkers conductedin National Guard units before and after deployment for combat tours in Afghanistan. Taken
together, this combination of studies geared
specifically to the RC, along with inclusion of RC
members in numerous other CSTS activities including its Child and Family Program research,gives the CSTS a key role in expanding ourknowledge of the special needs of the Citizen
Soldiers on whom our nation relies.

Army STARRS has collected about 77,000 tubesof blood from about 52,000 soldiers, and analyzed
more than a billion existing Army and DOD records
for more than 1.6 million past Active Duty soldiers.
This five-year project, which examines the mental
health and resilience of Active Duty U.S. Army Soldiers, aims to identify modifiable risk and protective
factors that could be used to prevent or mitigate suicidal behaviors of Soldiers, improve overall mental
health and resilience of Soldiers, deliver actionablefindings to the Army rapidly, and establish Army cohorts for future follow-up studies that will continue
to benefit the Army. Army STARRS is a collaborative
effort with the University of California, San Diego;
Harvard University; The University of Michigan, theNational Institute of Mental Health, and the Army aspartners. This initiative, involving seven independent
but integrated studies, has recruited and collected
data from more than 100,000 current Soldiers at
more than 70 different Army locations throughout
the U.S. and abroad, collected about 77,000 tubesof blood from about 52,000 Soldiers, and analyzed
more than a billion data points in existing Army and
DOD records for more than 1.6 million past Active
Duty Soldiers.
As data collection ended in 2013 for six of theseven studies, the research team began shifting focus
to analyzing the huge volume of broad, complex,rich and diverse Army STARRS data. These data
include data collected from Soldiers (questionnaires
and neurocognitive tests), data obtained from many
Army and DOD sources, and data resulting fromassays performed on the blood samples. As theseanalyses progressed, the research team also beganwriting manuscripts for publication. At the end of
2013, eight papers were published, three papers
were accepted for publication (see Publications, p.
21), four papers were submitted and under review
for publication, and thirty additional papers were invarious stages of development.
Throughout this project, as findings have become available, the researchers have been reporting results directly to senior Army leadership in
regularly-scheduled briefings so the Army would
have the ability to apply the findings to ongoinghealth-promotion, risk-reduction, and suicide-prevention efforts. The benefit from this extraordinary,groundbreaking, immensely successful undertaking,
Army STARRS, is just beginning to emerge andwill increase substantially over time as researchers
extract that value in the final year of the project, andover many years beyond the initial five-year project.
Troop Education for Army Morale (TEAM; PI —Carol S. Fullerton, Ph.D., CSTS Scientific Director,
in collaboration with Center Scientists, Drs. Quinn
Biggs and James E. McCarroll) is an innovative
early intervention designed to examine and facilitate
post-deployment readjustment in U.S. Army Mortuary Affairs Soldiers and their spouses. TEAM, oneof the few intervention studies at the Center, began
in 2008 and will continue through 2014 — making
it one of the longest ongoing studies at the Center.

U.S. Soldiers receive instruction on conducting
mortuary affairs work at the Mortuary Affairs
Collection Point at Bagram Airfield, Afghanistan,Aug. 10, 2011.

2013 Annual Report—The Next Quarter Century | 9

In 2013, a total of 30 soldiers were recruited into
TEAM, bringing the total number of participants to135. Participants are randomized either into an educational intervention or a no-intervention comparison group. The intervention is based on the five evidence informed principles of Psychological First Aid:safety (physical and psychological), calming, connectedness, self-efficacy, and hope/optimism). These
concepts are delivered through four group workshops, informational handouts, a dedicated website,and supported through concierge phone and email
services. Ongoing data analysis includes examination of the impact of TEAM on: symptoms of PTSD
and depression, quality of life, personal functioning, social interactions, morale, and the helpfulnessof specific components of TEAM (e.g., managing
stress, reducing arousal). Results have been presented a several professional meetings, including: theInternational Society for Traumatic Stress Studies
Annual Meeting; and the Association of Behavioral
and Cognitive Therapies Annual Meeting. Several
manuscripts are currently in process. Findings fromTEAM will inform future interventions with militaryand civilian populations.
In early 2013 subject recruitment began for, theDaily Diary Study (PI — Carol S. Fullerton, Ph.D.,
in collaboration with Center Scientist Quinn Biggs,
Ph.D.; Project Coordinator, Deborah Probe, M.A.).
This innovative study uses an ecological momentary
assessment methodology to monitor in real time
posttraumatic stress symptoms of Active Duty Service members. The study examines the association ofvariability in stress symptoms, collected four times
daily over a 15 day period, and psychiatric disorders(e.g., PTSD, depression), sleep, pain, health risk
10 | Center for the Study of Traumatic Stress, USU 

Website for the Forum on Health and National
Security conference: Military Families in Transition:
Stress, Resilience, and Well-being.
behaviors (e.g., alcohol and tobacco use), and otherareas of health and functioning. In 2013, 38 Service
members were recruited into Phase I of the study
and completed daily assessments on paper questionnaires. In Phase II, due to begin in 2014, Service
members will complete assessments using electronic
tablets programmed with a sophisticated application
developed specifically for this project through thecollaboration of CSTS and the National Center for
Telehealth and Technology (T2). Initial Phase I data
analysis is currently in process, and preliminary findings have been submitted for presentation at the International Society for Traumatic Stress Studies 2014
Annual Meeting. This important study will increase
our understanding of the relationship between daily
variability in posttraumatic stress symptoms andmental health conditions, as well as inform future
use of technology in psychiatric assessment, treatment, and research.
Drawing upon its expertise in military anddisaster psychiatry and public health, the Center

The intersection between military and disaster psychiatry andpublic health is also communicated by the Center throughparticipation in professional conferences and presentations to
medical colleagues, DOD leadership and policy stakeholders.

responded to the September 16th Washington Navy
Yard Shooting. Center scientist, Navy Commander
Patcho Santiago, M.D., led a WRNMMC team thatprovided Psychological First Aid to the Sailors andNavy civilians working aboard the Navy Yard. CSTS
also distributed customized, just-in-time fact sheets
to over 2,000 government and private sector stakeholders on diverse topics: leadership in the face ofworkplace tragedy, stress management, managing aworkplace after a disaster and restoring well-being
in children after a traumatic event. Center scientists,
Joshua Morganstein, CDR, United States Public
Health Services (USPHS) and Brian Flynn, RADM
(retired) USPHS, provided immediate and extended expert consultation to local officials and DOD
personnel who were directly responsible for planning and implementation of disaster response. The
CSTS response was featured in the APA’s PsychiatricNews Alert titled, “Mental Health Response Quickly
Follows Navy Yard Shooting.”
The intersection between military and disaster
psychiatry and public health is also communicatedby the Center through participation in professional
conferences and presentations to medical colleagues,
DOD leadership and policy stakeholders. 2013highlights include some of the activities of COL
David Benedek, M.D., MC, Professor and Deputy
Chair, Department of Psychiatry, USU and Center
Associate Director for Consultation and Education.
COL Benedek presented “Military Mental HealthResponse in Disaster: A Public Health Approach” atthe ARCENT Key Leader Engagement Symposium
on “The role of military health systems in national
disaster preparedness” to an audience of approximately 40 military medical leaders from multiple
nations within the U.S. Army’s Central Command.
COL Benedek also participated in the WhiteHouse Office of Science and Technology Policy’s discussion on the research action plan for the Presidential Executive Order on “Improving Access to Mental
Health Services for Veterans, Service members, andMilitary Families.”
The Center sponsored several important conferences in 2013. The 8th Annual Conference on Amygdala, Stress and PTSD, “Extinction of Fear” was heldat USUHS in April. The annual and highly presti-

gious event brought
together scientists
and clinicians working towards solving
the biological basisof stress, fear and
PTSD. This year’s
conference also celebrated the contributions of Dr. Harry C. Holloway, former and first
Chair of the Department of Psychiatry at USUHS.
In June, Dr. Robert J. Ursano, CSTS Director,
COL Benedek, and other CSTS staff attended the2013 Kenneth L. Artiss Symposium focusing on“Psychiatry and Sleep Disorders.” Dr. Ursano wasa member of the organizing committee and COL
Benedek served as Co-Chair of the Artiss Award
Committee, introduced the program’s honored guest(Mrs. Carola Artiss) and with her presented theArtiss awards. In September, the Center hosted a
two-day Forum on Healthand National Security
titled, “Military Families inTransition: Stress Resilience, and Well-being”
at Walter Reed Army Institute of Research (WRAIR),
which featured leaders inresearch and policy fromthe military, community,
and academic arenas. COL
Benedek served as a panel Chair and moderated theafternoon sessions of that conference.
The Center has expanded its contributions in thefield of military psychiatry over a quarter of a century to strengthen the performance, the health andmental health of our troops in combat and in operations other than war, and to foster the resilience ofmilitary families and children. 2013 marks the firstyear of the next quarter century for the Center, atime for sustained commitment to trauma research,education and outreach to improve the lives of ournation’s Soldiers, Sailors, Airmen and Marines andthe many military families throughout the country
and abroad whose quality of life and resilience isvital to them and to our national security.
2013 Annual Report—The Next Quarter Century | 11

Child and Family Program
Over a decade of war in Iraq and Afghanistan has
taken a toll on thousands of Service members, families and children, many of whom have been impacted
by war-related injuries such as loss of limbs or serious burns; through the invisible injuries of war suchas posttraumatic stress disorder (PTSD), depression,
traumatic brain injuries; and, from post-deployment
health risks in the form of alcohol and substancemisuse that can result in child maltreatment, neglect
and family violence. Many families have also lost
loved ones through combat fatalities and suicide.
Nearly 45% of the over 2 million Service members
who have deployed in the past ten years have children. While most military families are resilient andhave had positive experiences, a large population of
military families, including those of the Guard andReserve, will require health and mental health careand services for years to come.
Established in 2006, the Center’s Child andFamily Program (CFP) has distinguished itself as anational leader in advancing scientific and clinicalknowledge, as well as educational resources that address the needs of children and families affected bytrauma, especially our nation’s military families andchildren. Dr. Stephen J. Cozza, Associate Director,
speaks about the ‘intergenerational quality’ of thework of CFP, which he directs. “An intergenerational
perspective relates to the impact of events withinfamilies and across relationships, especially thoseaffected by PTSD, TBI and a multitude of combat
injuries. These conditions impact a person’s capacity
for satisfaction and affect parenting, interpersonal
relationships with spouses, partners and children,
as well as work. We want to help families minimize these risks by effectively educating them, andproviding them with skills and strategies to better
manage and be aware of the challenges that they face
so they can be less impactful in a negative way.”
The Child and Family Program addresses thesecomplex issues through pioneering research, byChild and Famiy Program staff: L to R: Susan Van Ost, April Harris, Sara Pula, Claudio Ortiz, Lareina LaFlair,
Stephen Cozza, Jill Harrington-LaMorie, Freda Denis-Cooper, Joscelyn Fisher, Allison Holmes, Jing Zhou.

12 | Center for the Study of Traumatic Stress, USU The website home page and portal to the National
Military Family Bereavement Study 		
(www. militarysurvivorstudy.org).

The website home page and portal to the Families
OverComing Under Stress – Combat Injury (FOCUSCI) study (www.cifamilies.org).

educating professional audiences including militaryand government stakeholders at presentations andconferences, through scholarly publications, andthrough consultation to DOD leadership and national media outlets.
Four CFP research projects continue to shed lighton military bereavement, the combat injured family, and child maltreatment and neglect in militarycommunities. The first rigorous scientific study to
examine the impact of a U.S. Service member deathon surviving family members, The National Military
Family Bereavement Study (NMFBS; PI — Stephen
Cozza, M.D. and project manager — Joscelyn Fisher, Ph.D.), aims to describe the population of Service
members who have died since 9/11 and to identify experiences of the Service member’s bereaved
family members — how psychological, physical and/or behavioral outcomes of the grieving process are
influenced by military-unique contributions, as well
as family members’ pre-existing psychological andphysical health, support, and genetic factors. An
optional part of the study examines saliva samples
for biomarkers associated with outcomes. 2013
saw continued data collection culminating in 1315
completed participant Phase 1 questionnaires. Study
participants include both adults and children. Expert
consults from Columbia University, UCLA, andUniversity of Michigan are also involved and collaborating on study analyses.
Families OverComing Under Stress-Combat
Injury (FOCUS-CI; PI — Stephen Cozza, M.D. andproject manager Allison Holmes, Ph.D.) is a randomized controlled trial that tests the effectivenessof a newly developed family-centered, strengthbased intervention to be used with severely combat
injured Service members and their families. This
intervention provides instrumental support to families teaching emotion regulation, problem solving,communication, and goal-setting skills. The study
is conducted in the Washington, DC, San Antonio,
TX and Chapel Hill, NC communities. Families arefollowed for two years to assess the intervention’s
impact on key aspects of the long-term recovery
trajectory: child distress and functioning, parent
distress and functioning, and family functioning
and injury communication. 2013 saw the expanded
enrollment of 42 families and the inclusion of a newsite, the University of North Carolina at Chapel Hill.
Both The National Military Family Bereavement
Study and FOCUS-CI have effectively used the web
and social media to engage eligible study participants. These vehicles promote understanding of thestudy, generate interest in participating, and provide
updates through the study’s website or its Facebook
2013 Annual Report—The Next Quarter Century | 13

page. NMFBS, a national study, has representationfrom every state. Both studies have over 200 Facebook friends and FOCUS CI uses Twitter.
The Deployment Family Stress: Child Neglect and
Maltreatment in U.S. Army Families study seeks todescribe the characteristics of substantiated childneglect cases in the Army, and to identify factors
within the family, the military community and thecivilian community that contribute to family healthor child maltreatment. Findings from this study will
help to develop strategies for effective prevention
with this population and to foster child and family
health in the community. 2013 activity has included
the preparation of two manuscripts using the datasets collected from 1,088 questionnaires representing 26 Army installations in the United States.
In addition to research, the Center’s CFP disseminates its knowledge of child and military child trauma at professional conferences, through scholarly
publications and national media outlets, and throughconsultation to DOD leadership and organizations.
Notable activities in 2013 includes Dr. Cozza’s participation in a prestigious journal of social science
research, The Future of Children, which is a collaboration of the Woodrow Wilson School of Public andInternational
Affairs at Princeton University
and the Brookings Institution. The mission of the Future of Children is to translate the bestsocial science research about children and youth into
information that is useful to policymakers, practitioners, grant-makers, advocates, the media, and students of public policy. Dr. Cozza co-edited MilitaryChildren and Families, (see Publication Section p.
21) and was the lead author of its policy brief, Keeping the Promise: Maintaining the Health of Military
and Veteran Families and Children. In addition, Dr.
Cozza co-edited the American Psychiatric Press volume Care of Military Service Members, Veterans,
and Their Families with Drs. Matthew Goldenberg
and Robert Ursano. This volume, which provides
important information for health care providers

14 | Center for the Study of Traumatic Stress, USU The Center’s Child and Family Program (CFP) has distinguisheditself as a national leader in advancing scientific and clinicalknowledge, as well as educational resources that address theneeds of children and families affected by trauma, especiallyour nation’s military families and children.
about the needs of Service members and veterans,
and the impact of their conditions on their families,
will be published in 2014.
Among the many conferences attended in 2013,
Dr. Cozza served as Co-Chair of the Science Board
for The Military Child Education Coalition, chaired
a workshop at the American Academy of Child andAdolescent Psychiatry on Disaster Child Psychiatry,and participated in the White House Joining Forces
Joining Families Conference hosted by First Lady,
Michelle Obama.
Dr. Cozza also served as a consultant for the
newly created DOD/VA website, Parenting forService Members and Veterans, http://www.militaryparenting.org, part of a coordinated public healthinitiative to help Veterans and Service members
improve their parenting skills. Raising awareness ofthe challenges of military families and children is yet
another means of public education. A January New
York Times feature drew upon the Center’s National Military Family Bereavement Study and quoted
Dr. Cozza in an article, “A Soldier’s Requiem, NeverFading Away.”
The Center has become the voice to the nation on
the impact of military family trauma. The Child andFamily Program is recognized as a leading authority
on military families and children. Leadership carries
the heavy burden of responsibility and relevance. Itis essential to bridge science to inform quality careand interventions that support and sustain populations at risk. The Center enters its second quarter
century with expanded knowledge and commitment
to improve the lives of our military families andchildren, and to mitigate the impact of trauma on allof our nation’s children and families.

Disaster Psychiatry and Disaster Behavioral
HealthNatural disasters are an enduring phenomenon
affecting individuals, families, communities andnations across the globe. Natural disasters disrupt
lives, displace many people, and can result in publichealth crises, injuries and fatalities. These events also
can have substantial affects on first responders andindividuals in close proximity to, and even far away
from, the actual event. The Center has been involvedin nearly every disaster since its establishment 26
years ago through post-disaster research, education, and consultation to leadership and community stakeholders in areas of disaster preparedness,
response and recovery.
Disaster psychiatry and behavioral health also
address human-made disasters such as community
violence and terrorism. In 2013, the Center provided
educational outreach and consultation to community leaders in the wake of the Moore, Oklahoma
tornado and the Boston Marathon bombings. Boston’s major hospitals circulated an important Center
fact sheet on grief leadership, “Grief Leadership:
Leadership in the Wake of Tragedy.” In response to
Typhoon Haiyan, the Center disseminated 13 fact
sheets developed specifically for this disaster. These
fact sheets were distributed to Army, Air Forceand Navy Psychiatry consultants and Navy mental
health leadership. Topics included “leadership stressmanagement”, “reducing distress in relief workers

Explosion at the Boston Marathon.

and disaster victims”, “restoring a sense of safety inchildren after disaster”, “managing emotions related
to handling body remains”, among others.
Center Associate Director of Health Systems,
Brian Flynn, Ed.D., provides Center leadership in
the area of disaster behavioral health policy and systems. Dr. Flynn served as a member of the Instituteof Medicine (IOM) Committee on Crisis Standardsof Care: A Toolkit for Indicators and Triggers. The
committee was charged to develop a product to be
used for health care provider organizations to determine what indicators to monitor and critical benchmarks that may result in altered standards of care in
events that overwhelm the capacity of elements of
the healthcare and public health system. The resulting IOM publication provides a framework to makesystem decisions such as identifying the tipping
point when an institution has to change standardsof care in the face of large-scale disasters such as
pandemic flu, earthquake, mass fatalities and death.
The impact of overwhelming resources post-disaster
necessitating altered standards of care will be an important disaster behavioral health trend into the next
quarter century with significant implications for ourhealthcare and public health systems and our nation.
The Center will continue to use its broad expertise to
assist in anticipating and responding to challenges tohealth resulting from extreme events.
The Center also addresses the intersection between disaster psychiatry and public health. Dr.
Flynn made three presentations at a conference,“Preparing for the Public’s Health: Building Sustainable Coalitions for Healthcare & Public HealthPreparedness” that was sponsored by the West Virginia Department of Health and Human Resources,
Center for Threat Preparedness.
Center Director, Dr. Robert Ursano appointed
Dr. Flynn to represent the Center and the Department of Psychiatry on the USUHS Global Health
Program Working Group (GHPWG), which wasestablished by USUHS President Dr. Charles Rice to2013 Annual Report—The Next Quarter Century | 15

increase integration of USUHS global health efforts
and to facilitate interaction with groups with similarinterests outside USUHS.
Representing the Center, Dr. Flynn was an invited member of the Community Resilience Working
Group of the National Biodefense Science Board. The
Community Health Resilience Working Group (CHR
WG) was established under the National Biodefense
Science Board (NBSB) to explore the concepts andissues related to Community Health Resilience and to
make actionable recommendations as a part of thereport to the United States Department of Healthand Human Services (HHS), Office of the Assistant
Secretary for Preparedness and Response (ASPR).
Extreme events will doubtless continue to challenge the global community. The Center’s work in disaster psychiatry and disaster behavioral health willcontinue to expand its influence in areas of publichealth and public health policy, community efficacy
and global health. This requires that the Center bepositioned at the forefront of anticipating emerging
challenges and driving the field. Dr. Flynn believes
there will be at least three important disaster behavioral health challenges emerging in the next 25
years. “First, there will be different kinds of disasters
necessitating new learning and new responses suchas pan flu, cyberterrrorism and massive infrastructure failure. Second, research challenges will include
being able to implement findings and design efficacious approaches in the context of limited and slow
to emerge intervention research. Lastly, integrationof effort will require working across disciplines andengaging the public and private sector.” The Center’s
leadership in defining and advancing the fields ofdisaster psychiatry and disaster behavioral healthhas laid a foundation in research, education andapplication. The Center is in a unique and fortunate
position to lead thefield and the nation in
addressing these andother critical issues
as we move into the
future.
Oklahoma tornado
clean-up.
16 | Center for the Study of Traumatic Stress, USU The First Study of Community Strength(Collective Efficacy) and Post Disaster 		Mental HealthWork done in 2013 resulted in the publicationof an innovative and important study, PosttraumaticStress Disorder and Community Collective Efficacy
Following the 2004 Florida Hurricanes (Ursano et.
al., PLoS ONE 9(2): e88467, doi:10.1371/journal.
pone.0088467). This study examining the responsesof Florida Department of Health (FDOH) workers
to the multiple hurricanes of 2004, was conductedunder the leadership of Robert J. Ursano, M.D.,
Director, CSTS, Carol S. Fullerton, Ph.D., ScientificDirector, CSTS, and Dori Reissman, M.D., M.P.H., CSTS
and Centers for Disease Control (CDC) Scientist (ref:Ursano RJ, McKibben JBA, Reissman, DB, Liu X, Wang
L, Sampson, RJ, Fullerton, CS. (2014). This project
represented collaboration between CSTS, CDC, FDOH,
and Harvard University. Ongoing data analysis isbeing conducted including examination of the relationship of depression and distress and community
collective efficacy.
■■ Collective efficacy is a key measure of community strength and cohesion.
■■ Strong communities are associated with lower
rates of Posttraumatic Stress Disorder (PTSD)
following the Florida hurricanes of 2004.
■■ Higher levels of community strength wereassociated with lower levels of PTSD in Florida
Department of Health workers 9 months following the hurricanes.
■■ For individuals who had high injury or damage asa result of the hurricanes, the probability of having
PTSD is 16% in communities with low community
strength. This decreases to 5% in communities withhigh community strength — representing a 69%
reduction in PTSD.
■■ Similarly, for those with lower injury or damage asa result of the hurricane, the probability of PTSD
was 8% in communities with low community
strength. This decreased to 2% in communities
with high community strength — representing a
75% reduction in PTSD.
■■ Programs enhancing community strength may
be an important part of prevention practices andpossibly lead to a reduction in the rate of PTSD.
■■ Intervening at a community level is often
cost-effective and practical, and may reachindividuals who may not seek or have available
individual interventions post-disaster.

Public Education Outreach and Resources
The Center for the
Study of Traumatic Stressprovides a wide range ofeducational activities andresources that advanceits expertise in disasterand military psychiatry,social and organizational
psychiatry, neuroscience,family violence, workplace
preparedness and public
education. The Center
hosts professional conferences, develops fact sheets
and just-in-time fact sheets in the immediate aftermath of a major traumatic event, creates innovative health campaigns that address timely trauma
needs, and works with cutting edge technologies
and organizations to produce podcasts and distance learning products, and to communicate via
social media outlets. In 2003, the Center established an Office of Public Education and Preparedness (OPEP) under the direction of Center Associate Director, Nancy Vineburgh, M.A., to support
and coordinate many of these activities.
2013 saw a number of notable achievements.
Drawing upon a library of military health fact
sheets from the Courage to Care campaign as wellas CSTS fact sheets addressing disaster psychiatry
and disaster behavioral health, the Center published Disaster, Disease and Distress: Resources
to Promote Psychological Health and Resiliencein Military and Civilian Communities edited byedited by James McCarroll, Ph.D., Nancy Vineburgh, M.A. and Robert Ursano, M.D. This bookcontains fact sheets and resources written over a
10-year period on topics related to military healthfor Service members and families and disasterbehavioral health topics for community leadership.
This resource book can be accessed on the Center’s
website, www.cstsonline.org.
The Center developed and disseminated a number of customized, just-in-time fact sheets in theaftermath of the Washington Navy Yard shooting (see p. 10–11) andTyphoon Haiyan (seep. 15), which supported
the outreach of DOD
leadership and civilian
first responders.
The Center hosted
two major conferencesin 2013. The 8th Annual
Conference on Amygdala, Stress and PTSD, “Extinction of Fear” was heldat USUHS in April. The annual and highly prestigious event brought together scientists and clinicians working towards understanding the biologicalbasis of stress, fear and PTSD. The Center hosted
a two-day Forum on Health and National Security,“Military Families in Transition: Stress Resilience,and Well-being” at Walter Reed Army Institute of
Research (WRAIR), which featured leaders in research and policy from the military, community, andacademic arenas.
The Center distributed three of its fact sheets inhonor of June 27th as PTSD Awareness Day and theCongressional designation of June 2013 as National
Post-Traumatic Stress Disorder Awareness Month.
These fact sheets, sent directly to Congressional
stakeholders, included “Post Deployment Healthand Distress Responses: Overview for Practitioners,”“The Invisible Injuries of War: Impact on Military
Families and Children,” for healthcare providers, and“The Impact of Invisible Injuries: Helping Your Family and Children,” for Service members and families.
Entering its second quarter century of service to
our nation, the Center is fully committed to continuing to translate its knowledge of disaster and military
psychiatry into actionable resources that support
and guide the efforts of DOD, government, state,
local and organization leadership in meeting theneeds of those impacted by natural and human madedisasters around the globe.
2013 Annual Report—The Next Quarter Century | 17

Presentations, Conferences and Trainings
Center scientists advance their knowledge ofmilitary and disaster psychiatry and disaster behavioral health through presentations to professional
audiences and organizations, through conference
participation, through briefings to DOD leadership,
and through consultation and training in the United States and abroad. Highlights of 2013 activities
include:Grand Rounds
Dr. Ursano presented Grand Rounds at WrightState University and at Ohio State University on the
topic, “PTSD and Other Trauma Disorders.”
The White House
COL Benedek participated in the White House
Office of Science and Technology Policy’s discussion on the research action plan for the Presidential
Executive Order on “Improving Access to Mental
Health Services for Veterans, Service Members, andMilitary Families.”
Dr. Cozza participated in the White House Joining Forces Joining Families Conference hosted byFirst Lady Michelle Obama.

Dr. Ursano delivers a presentation at the Washington,
D.C. Embassy of Italy’s symposium, “The Mass
Disasters in Metropolitan Areas —Preparedness andResponse: Theoretical and Practical Aspects.”
18 | Center for the Study of Traumatic Stress, USU DOD Leadership
Dr. Ursano presented research findings at ARMYSTARRS Interim Progress Reports at the Pentagon,
a quarterly briefing to the Secretary of the Army, theArmy Chief of Staff, the Army Vice Chief of Staff, theArmy Surgeon General, among others.
Dr. Ursano participated in a Media Roundtable as part of the Military Health System Research
Symposium. The Roundtable brought together asmall group of experts to discuss how our knowledgeof mental health and traumatic brain injuries has
evolved over the last decade of war.
Professional Associations and Conferences
COL Benedek presented, “PharmacologicalTreatment of PTSD” at the annual meeting of theLas Vegas Psychiatric Society to an audience ofapproximately 500 psychiatrists, a sizable numberof whom work in VA settings and/or treat military
veterans.
Dr. Ursano attended the 166th annual meetingof the American Psychiatric Association as a council
member on research and quality care. He chaired theDisaster Psychiatry Committee and presented “AcuteStress Disorder DSM-5.”
Dr. Flynn presented, “Disaster Behavioral Health:
Designing, Building, and Traveling a Road to Recovery” at the first Center for Disaster Preparedness& Emergency Response Statewide Conference on
Disaster Behavioral Health, at Rutgers University in
New Jersey.
Dr. Ursano, COL Benedek and other CSTS staff
attended the 2013 Kenneth L. Artiss Symposium
focusing on “Psychiatry and Sleep Disorders.” Dr. Ursano was a member of the organizing committee and
Col Benedek co-presented the awards.
Center scientists, Drs. Ursano, Cozza, Fisher,
Ortiz, Harrington-Lamorie, Dempsey, Holmes,
Fullerton, Biggs, Flynn, McCarroll, Mash, Naifeh,
Mr. Sottile, Ms. Benevides and Ms. Niemeyer,
participated in and presented multiple posters at
the ISTSS 29th Annual Meeting, “Resilience AfterTrauma: From Surviving to Thriving.”
The Washington, D.C. Embassy of Italy, in collaboration with Uniformed Services University andWashington Psychiatric Society, held a symposium,
The Mass Disasters in Metropolitan Areas —Preparedness and Response: Theoretical and Practical
Aspects. Drs. Robert Ursano, Daniel Balog andDavid Benedek of the Center for the Study ofTraumatic Stress provided individual presentations:“Mental Health and Behavioral Responses to Terrorism: Lessons for Planning”, “Emergency Mental
Health Response”, “Preparing US Embassies abroad:
Disaster and Terrorism. Psychiatric Response andRecovery”.

International Outreach
COL Benedek delivered 2-day training on “Psychological Rehabilitation of Combatants” to facultyof Kazakhstan National Defense University, Astana,
Kazakhstan that was coordinated by Marshall Center
for Peace, Garmisch Germany and Office of International Cooperation, U.S. Embassy Kazakhstan.
Dr. Duncan presented her paper, “Information
Processing in Combat-Injured U.S. Military Service
Members: An Event-Related Brain Potential Analysis.” at the 53rd Annual Conference of the Society for
Psychophysiological Research in Florence, Italy.
Topics of Interest
Family Violence
Dr. Ursano presented “Exposure to Violence in
the Community, in the Home, in the Media, and on

the Battlefield” as part of an IOM panel at the National Academy of Science.

Impact of Terrorism on Understudied
Populations
Dr. Ursano, Dr. Fullerton, Dr. Mash, Dr.
Dempsey, and Ms. Nikki Benevides presented aposter for USUHS Research Days entitled: “Washington, D.C. Sniper Attacks: Psychological Outcomes and Perceived Safety.”
Public Health Preparedness
Dr. Flynn made three presentations at a conference titled, “Preparing for the Public’s Health:
Building Sustainable Coalitions for Healthcare &Public Health Preparedness” sponsored by the West
Virginia Department of Health and Human Resources, Center for Threat Preparedness.
Combat Injury and Bereavement
Dr. Allison Holmes presented her paper, “Child
Well-being in Combat-Injured Military Families: The
Moderating Effects of Adaptive Parenting and Parental Mental Health” at the Biennial Meeting of theSociety of Research in Child Development in Seattle.
A paper, “Developing and conducting national
field research with a unique sub-population: A briefreport,” prepared by Drs. Cozza, HarringtonLaMorie, Fisher, Ortiz, Fullerton, and Ursano, waspresented at the Association for Death Education
and Counseling, Hollywood, CA.

2013 Annual Report—The Next Quarter Century | 192013 Funded Grants
Study

Funding Institution

Addressing the Needs of Children and Families of Combat Injured

CDMRP

Deployment Family Stress: Child Neglect and Maltreatment in U S Army Families

CDMRP

FOCUS-CI Preventive Intervention with Children and Families of Combat Injured

USAMRAA

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

CDMRP

PTSD/TBI Clinical Intrust

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

The Injury and Traumatic Stress (INTRuST) CONSORTIUM Biorepository

UC San Diego

Riluzole Augmentation Treatment for Complicated PTSD

MOMRPResilience Building for Homeland Security

DHS

InTRUST Brain Indices StudyUCSD

Family Violence and Trauma Project III

US ArmyCSTS - Program Grant

DCoE

PTSD Trajectory, Comorbidity and Utilization of MH Services

USAMRAA

Modifiable Risk and Protective Factors for Suicidal Behaviors in the US Army

NIMH

Personally Owned Firearms
Behavioral-based Predictions of Workplace Violence in The Army STARRS

H.A./DOD
Harvard University

Mortuary Affairs Soldiers: Early Intervention and Altering Barriers to Care for Traumatic Stress and PTSD

20 | Center for the Study of Traumatic Stress, USU CDMRPPublications
Journal Articles
Allen K.J. & Gabbay F.H. (2013). The amphetamine
response moderates the relationship between
negative emotionality and alcohol use. Alcoholism: Clinical and Experimental Research, 37(2):348–360.
Bergstrom H.C., McDonald C.G., Dey S., Fernandez
G.M., & Johnson L.R. (2013). Neurons activatedduring fear memory consolidation and reconsolidation are mapped to a common and new topography in the lateral amygdala. Brain Topography,
26(3): 468–478.
Chambers R.A., McClintick J.N., Sentir A.M., Berg
S.A., Runyan M., Choi K.H., & Edenberg H.J.
(2013). Cortical-striatal gene expression inneonatal hippocampal lesion (NVHL)-amplified
cocaine sensitization. Genes, Brain and Behavior,
12(5): 564–575.
Coyner J., McGuire J.L., Parker C.C., Ursano R.J.,
Palmer A.A., & Johnson L.R. (2013). Mice selectively bred for high and low fear behavior show
difference in the number of pMAPK (p44/42
ERK) expressing neurons in lateral amygdala following Pavlovian fear conditioning. Neurobiology
of Learning and Memory, advance online publication, 28 June 2013.
Choi K., Im H.J., Kim J., Choi K.H., Jon D.I., Hong
H., Hong N., Lee E., & Seok J.H. (2013). Relationship of early-life stress and resilience to militaryadjustment in a young adulthood population.
Social Psychiatry and Psychiatric Epidemiology,
48(11): 1767—1776.
Cozza S.J., Haskins R., & Lerner R.N. (2013). Keeping the promise: Maintaining the health of military and veteran families and children. MilitaryChildren and Families, 23(2): 1–8.
Cozza S.J., Holmes A.K., & Van Ost S.L. (2013).
Family-centered care for military and veteranfamilies affected by combat injury. Clinical Child
Family Psychology Review, 16(3): 311–321.
Fullerton C.S., McKibben J.B.A., Reissman D.B.,
Scharf T., Kowalski-Trakofler K.M., Shultz J.M.,& Ursano R..J. (2013). PTSD, depression, alcoholand tobacco use in public health workers following the 2004 Florida hurricanes. Disaster Medicine and Public Health Preparedness, 7(1): 89–95.
Gibbons S.W., Shafer M., Aramanda L., Hickling
E.J., & Benedek D.M. (2013). Combat health careproviders and resiliency: Adaptive coping mechanisms during and after deployment. Psychological Services, advance online publication, 15 July
2013.
Heeringa S.G., Gebler N., Colpe L.J., Fullerton C.S.,
Hwang I., Kessler R.C., Naifeh J.A., Nock M.K.,
Sampson N.A., Schoenbaum M., Zaslavsky A.M.,
Stein M.B., & Ursano R.J. (2013). Field procedures in the Army Study to Assess Risk andResilience in Servicemembers (Army STARRS).
International Journal of Methods in PsychiatricResearch; 22(4): 276–287.
Herberman Mash H.B., Fullerton C.S., Kowalski-Trakofler K., Reissman D.B., Scharf T., Shultz
J.M., & Ursano R.J. (2013). Florida Department of
Health workers’ response to 2004 hurricanes: A
qualitative analysis. Disaster Medicine and Public
Health Preparedness, 7(2): 153–159.
Herberman Mash H.B., Fullerton C.S., & Ursano R.J.
(2013). Complicated grief and bereavement inyoung adults following close friend and sibling
loss. Depression and Anxiety, 30(12): 1202–1210.
Kaplow J.B., Layne C.M., Saltzman W.R., Cozza S.J.,& Pynoos R.S. (2013). Using multidimensionalgrief theory to explore the effects of deployment,
reintegration, and death on military youth andfamilies. Clinical Child Family Psychology Review, 16(3): 322–340.
Kessler R.C., Colpe L.J., Fullerton C.S., Gebler N.,
Naifeh J.A., Nock M.K., Sampson N.A., Schoenbaum N., Zaslavsky A.M., Stein M.B., Ursano
R.J., & Heeringa S.G. (2013). Design of the Army
Study to Assess Risk and Resilience in Servicemembers (Army STARRS). International Journal of Methods in Psychiatric Research; 22(4):267–275.
2013 Annual Report—The Next Quarter Century | 21

Kessler R.C., Heeringa S.G., Colpe L.J., Fullerton
C.S., Gebler N., Hwang I., Naifeh J.A., Nock
M.K., Sampson N.A., Schoenbaum M., Zaslavsky
A.M., Stein M.B., & Ursano R.J. (2013). Response
bias, weighting adjustments, and design effects in
the Army Study to Assess Risk and Resilience inServicemembers (Army STARRS). International
Journal of Methods in Psychiatric Research; 22(4):288–302.
Kessler R.C., Santiago P.N., Colpe L.J., Dempsey
C.L., First M.B., Heeringa S.G., Stein M.B., Fullerton C.S., Gruber M.J., Naifeh J.A., Nock M.K.,
Sampson N.A., Schoenbaum M., Zaslavsky A.M.,& Ursano R.J. (2013). Clinical reappraisal of theComposite International Diagnostic Interview
Screening Scales (CIDI-SC) in the Army Study
to Assess Risk and Resilience in Servicemembers(Army STARRS). International Journal of Methods in Psychiatric Research; 22(4): 303–321.
McGuire J.L., Bergstrom H.C., Parker C.C., Le T.,
Morgan M., Tang H., Selwyn R.G., Silva A.C.,
Choi K., Ursano R.J., Palmer A.A., & Johnson
L.R. (2013). Traits of fear resistance and susceptibility in an advanced intercross line. European
Journal of Neuroscience, 38(9): 3314–3324.
McKibben J.B.A., Fullerton C.S., Herberman Mash
H.B., Nock M.K., Naifeh J.A., Kessler R.C., Stein
M.B., & Ursano R.J. (2013). Suicidal behaviors
and the use of mental health services among
active duty Army soldiers. Psychiatric Services,advance online publication, 2 December, 2013.

22 | Center for the Study of Traumatic Stress, USU Nock M.K., Deming C.A., Fullerton C.S., Gilman
S., Goldenberg M., Kessler R.C., McCarroll J.E.,
McLaughlin K.A., Peterson C., Schoenbaum M.,
Stanley B., & Ursano R.J. (2013). Suicide amongsoldiers: A review of psychosocial risk and protective factors. Psychiatry, 76(2): 97–125.
Ortiz C.D., Cozza S.J., Fullerton C.S., & Ursano R.J.
(2013). Feasibility of a multimedia program forparentally bereaved children. Child & Youth Care
Forum, 42: 489–506.
Santiago P.N., Ursano R.J., Gray C.L., Pynoos R.S.,
Spiegel D., Lewis-Fernandez R., Friedman M.L.,& Fullerton C.S. (2013). A systematic review
of PTSD prevalence and trajectories in DSM-5
defined trauma exposed populations: Intentionaland non-intentional traumatic events. PLoS One,
8(4): e59236.
Thomas M.L., Brown G.G., Gur R.C., Hansen J.A.,
Nock M.K., Heeringa S., Ursano R.J., & Stein
M.B. (2013). Parallel psychometric and cognitivemodeling analyses of the Penn Face Memory Testin the Army Study to Assess Risk and Resiliencein Service Members. Journal of Clinical and Experimental Psychology, 35(3): 225–245.
Umhau J.C., George D.T., Heaney R.P., Lewis M.D.,
Ursano R.J., Heilig M., Hibbeln J.R., & Schwandt
M.L. (2013). Low vitamin D status and suicide: A
case-control study of active duty military service
members. PLoS One, 8(1): e51543.
Ursano R.J. (2013). Ask the expert: Posttraumaticstress disorder and brain injury. FOCUS, 11(3):1–3.
Zhang L., Benedek D.M., Fullerton C.S., Forsten
R.D., Naifeh J.A., Li X.X., Hu X.Z., Li H., Jia M.,
Xing G.Q., Benevides K.N., & Ursano R.J. (2013).
PTSD risk associated with BDNF Val66Met and
BDNF over-expression. Molecular Psychiatry,advance online publication, 15 January 2013.
Zhang L., Hu X.Z., Benedek D.M., Fullerton C.S.,
Forsten R.D., Naifeh J.A., Li X., Li H., Benevides
K.N., Smerin S., Le T., Choi K., & Ursano R.J.
(2013). The interaction between stressful life
events and leukocyte telomere length is associated with PTSD. Molecular Psychiatry, advanceonline publication, 5 November 2013.

Book Chapters
Dempsey C.L., Fullerton C.S., Herberman Mash
H.B., Ramsawh H., Naifeh J.A., & Ursano R.J.
(2013). New approaches in suicide research. In
M.S. Mortensen (Ed.), Explorations in social
causality: A tribute to Eilert Sundt. Oslo, Norway:
Atlantic Press.
Ursano A.M., Sonnenberg S.M., & Ursano R.J.
(2013). Physician-patient relationship. In A.
Tasman, J. Kay, R.J. Ursano (Eds.), The PsychiatricInterview: Evaluation and Diagnosis (pp. 31–46).
New Jersey: Wiley-Blackwell Press.
Xing G., Carlton J., Jiang X., Jia M., Sharma P., Choi
K.H., & Li H. (2013). Delayed effects of repeatedinescapable severe stress on brain cannabinoid
receptor expression and acoustic startle response
in adolescent male rats: Relevance to the development of posttraumatic stress disorder andstress-related brain atrophy. In E. Forman & J.

Fuller (Eds.), Post-Traumatic Stress Disorder:
New Research. Hauppauge, NY: Nova Sciences
Publishers, Inc.
Zhang L., Li C.T., Su, T-P., Hu X-Z., Smerin S., Li H.,
Li X., & Ursano R.J. (2013). Potential biomarkers
for bipolar disorder: P11 expression and PET. In
N.B. Moore (Ed.), Bipolar Disorder: Symptoms,
Management and Risk Factors. Hauppauge, NY:
Nova Sciences Publishers, Inc.

Books
McCarroll J.E., Vineburgh N., & Ursano R.J. (Eds.).
(2013). Disaster, Disease and Distress: Resources
to Promote Psychological Health and Resiliencein Military and Civilian Communities. Bethesda,
MD: Center for the Study of Traumatic Stress.
Tasman A., Kay J., & Ursano R.J. (Eds.). (2013). The
Psychiatric Interview: Evaluation and Diagnosis.
New Jersey: Wiley-Blackwell Press.

2013 Annual Report—The Next Quarter Century | 23

CSTS Directors, Scientists, and Scientific
Advisory Board
CSTS Directors

CSTS Scientists

Robert J. Ursano, M.D.
Professor and Chair, Department of Psychiatry
Uniformed Services University
Director, Center for the Study of Traumatic Stress

Col Daniel J. Balog, M.D., USAF, MC, FS
Assistant Professor and Assistant Chair
Department of Psychiatry
Uniformed Services University

COL David M. Benedek, M.D. MC, USA
Professor and Deputy Chair, Department of
Psychiatry
Uniformed Services University
Associate Director, Consultation and Education
Center for the Study of Traumatic Stress

COL David M. Benedek, M.D., MC, USA
Professor and Consultant to the U.S. Army Surgeon General for Forensic Psychiatry
Department of Psychiatry
Uniformed Services University

Stephen J. Cozza, M.D.
Professor, Department of Psychiatry
Uniformed Services University
Associate Director, Child and Family Program
Center for the Study of Traumatic Stress
Brian W. Flynn, Ed.D.
Adjunct Professor, Department of Psychiatry
Uniformed Services University
Associate Director, Health Systems
Center for the Study of Traumatic Stress
Carol S. Fullerton, Ph.D.
Research Professor, Department of Psychiatry
Uniformed Services University
Scientific Director
Center for the Study of Traumatic Stress
Robert K. Gifford, Ph.D.
Assistant Professor, Department of Psychiatry
Uniformed Services University
Executive Officer, and Associate Director, Homeland
Security Studies
Center for the Study of Traumatic StressJohn A. Stuart, Ph.D.
Assistant Professor, Department of Psychiatry
Uniformed Services University
Director, Resource Management
Center for the Study of Traumatic Stress
Nancy T. Vineburgh, M.A.
Assistant Professor, Department of Psychiatry
Uniformed Services University
Associate Director, Public Education and Preparedness
Center for the Study of Traumatic Stress

24 | Center for the Study of Traumatic Stress, USU 

Quinn M. Biggs, Ph.D., M.P.H.
Research Assistant Professor
Department of Psychiatry
Uniformed Services University
Maria Braga, D.D.S., Ph.D.
Associate Professor
Department of Anatomy, Physiology and Genetics
Uniformed Services University
Kwang Choi, Ph.D.
Research Assistant Professor
Department of Psychiatry
Uniformed Services University
Stephen J. Cozza, M.D.
Professor
Department of Psychiatry
Uniformed Services University
Brian Crowley, M.D.
Clinical Assistant Professor
Department of Psychiatry
Uniformed Services University
Catherine L. Dempsey Ph.D., M.P.H.
Research Assistant Professor
Department of Psychiatry
Uniformed Services University
Connie Duncan, Ph.D.
Research Associate Professor
Department of Psychiatry
Uniformed Services University
Richard S. Epstein, M.D., P.A.
Clinical Professor
Department of Psychiatry
Uniformed Services University

Col Charles Engel, M.D., M.P.H., MC, USA
Associate Professor
Department of Psychiatry
Uniformed Services University

Allison K. Holmes, Ph.D.
Project Director/Research Psychologist
Department of Psychiatry
Uniformed Services University

Joscelyn E. Fisher, Ph.D.
Project Director/Research Psychologist
Department of Psychiatry
Uniformed Services University

Tomoko I. Hooper, M.D.
Assistant Professor
Department of Preventive Medicine/Biometrics
Uniformed Services University

Brian W. Flynn, Ed.D.
Adjunct Professor
Department of Psychiatry
Uniformed Services University

Edmund G. Howe III, M.D., J.D.
Professor
Department of Psychiatry
Uniformed Services University

Michael C. Freed, Ph.D.
Research Assistant Professor
Department of Psychiatry
Uniformed Services University

Luke Johnson, Ph.D.
Assistant Professor
Department of Psychiatry
Uniformed Services University

Carol S. Fullerton, Ph.D.
Research Professor
Department of Psychiatry
Uniformed Services University

Tzu Cheg Kao, Ph.D.
Professor
Department of Preventive Medicine and Biometrics
Uniformed Services University

Frances Gabbay, Ph.D.
Research Associate Professor
Department of Psychiatry
Uniformed Services University

Elie Karam, M.D.
Professor and Chairman
Department of Psychiatry
American University — Beirut
Beirut, Lebanon

Col Gary Gackstetter, USAF
Associate Professor
Department of Preventive Medicine/Biometrics
Uniformed Services University
Robert K. Gifford, Ph.D.
Assistant Professor
Department of Psychiatry
Uniformed Services University
Lt Col Derrick Hamaoka, M.D., USAF, MC, FS
Assistant Professor
Department of Psychiatry
Uniformed Services University
Jill Harrington-LaMorie, DSW, LCSW
Senior Field Researcher
Department of Psychiatry
Uniformed Services University
Harry C. Holloway, M.D.
Professor
Department of Psychiatry
Uniformed Services University
Marjan G. Holloway, Ph.D.
Assistant Professor
Department of Medical & Clinical Psychology
Uniformed Services University

Lareina LaFlair, Ph.D., M.P.H.
Research Psychologist
Department of Psychiatry
Uniformed Services University
He Li, M.D., Ph.D.
Associate Professor
Department of Psychiatry
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
Uniformed Services University
Holly B. Mash, Ph.D.
Research Assistant Professor
Department of Psychiatry
Uniformed Services University
James E. McCarroll, Ph.D., M.P.H.
Research Professor
Department of Psychiatry
Uniformed Services University
2013 Annual Report—The Next Quarter Century | 25

CDR Joshua Morganstein, M.D., MC, USPHSAssistant Professor
Department of Psychiatry
Uniformed Services University

Susan Van Ost, Ph.D.
Senior Child Psychiatrist
Department of Psychiatry
Uniformed Services University

James Naifeh, Ph.D.
Research Assistant Professor
Department of Psychiatry
Uniformed Services University

Nancy T. Vineburgh, M.A.
Assistant Professor
Department of Psychiatry
Uniformed Services University

Claudio Ortiz, Ph.D.
Research Psychologist
Department of Psychiatry
Uniformed Services University

Jing Wang, Ph.D.
Research Psychologist
Department of Psychiatry
Uniformed Services University

Holly Ramsawh, Ph.D.
Research Assistant Professor
Department of Psychiatry
Uniformed Services University

Maree J. Webster, Ph.D.
Assistant Research Professor
Stanley Medical Research Institute
Bethesda, MD 20889

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
Department of Psychiatry
Uniformed Services University

Lars Weisaeth, M.D.
Professor
Department of Psychiatry
Uniformed Services University

MAJ Dale Russell, Ph.D., MSC, USA
Research Psychologist
Department of Psychiatry
Uniformed Services University
LCDR Patcho Santiago, M.D., M.P.H., MC, USN
Assistant Professor
Department of Psychiatry
Uniformed Services University

CDR Curt West, M.D., MC, USN
Assistant Professor
Clerkship Director
Department of Psychiatry
Uniformed Services University
Anthony Woodson, D.H.A.
Associate Administrator
Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University

Patricia Spangler, Ph.D.
Clinical Research Psychologist
Department of Psychiatry
Uniformed Services University

Kathleen Wright, Ph.D.
Deputy Chief
Department of Military Psychiatry
Division of Neuropsychiatry
Walter Reed Army Institute of ResearchJohn A. Stuart, Ph.D.
Research Assistant Professor
Department of Psychiatry
Uniformed Services University

LTC Gary Wynn, M.D., MC, USA
Assistant Professor
Department of Psychiatry
Uniformed Services University

E. Fuller Torrey, M.D.
Associate Director for Research
Stanley Medical Research Institute
Bethesda, MD

Lei Zhang, M.D.
Assistant Professor
Department of Psychiatry
Uniformed Services University

Robert J. Ursano, M.D.
Professor and Chair
Department of Psychiatry
Uniformed Services University

26 | Center for the Study of Traumatic Stress, USU 

Scientific Advisory Board
James E. Barrett, Ph.D.
Department of Pharmacology and Physiology
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
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.
Research Professor, Department of Psychiatry
Scientific Director, Center for the Study of TraumaticStress
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 Clinical Psychology
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
Larry W. Laughlin, M.D., Ph.D.
Dean
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799

Craig H. Llewellyn, M.D.
Professor
Department of Military and Emergency 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
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)
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
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
Robert J. Ursano, M.D.
Professor and Chairman, Department of Psychiatry
Director, Center for the Study of Traumatic Stress
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

2013 Annual Report—The Next Quarter Century | 27

Staff
Pablo Aliaga
Daniel Alvarez
Abby Anderson
Jean Arlt
TSgt Rondricueas Barlow
Erin Beech
K. Nikki Benevides
Natasha Benfer
LCDR Jennifer Bornemann
Christina Buckley
Nina Calmenson
Freda Denis-Cooper
Amanda Devane
TSgt Theda Franklin

28 | Center for the Study of Traumatic Stress, USU 

Katie Grein
April Harris
Karly Hrank
Paul Hurwitz
Jessica Kansky
Natalie Kodsy
David Kopp
Thien Le
Alex Liu
Mona Mendelson
Diana Monday
Susan Moss
Stefanie Moynihan
Stanley Ng
Nichole Nicholas
April Perez

Joseph Piemontese
Karen Plummer
Deborah Probe
Sara Pula
Heidi Shul
James Sottile
Chad Spiegel
Natara Strother-Ware
Allison Stuppy
Jamie Sullivan
Patti Vegella
Leming Wang
Holly Wu
Bailey Zhang
Jing Zhou

Photo Credits
Inside front cover:
Moore, Oklahoma Disaster Response
U.S. Army photo by Sgt. 1st Class Kendall Jamesp. 1 Washington Navy Yard Shooting Memorial
Service
Defenseimagery.mil
p. 2 U.S.Troops Assist Victims of Typhoon Haiyan
DefenseImagery.mil
p. 3 Dr. Carol S. Fullerton
Brian W. Flynn

p. 12 Child and Family Program Staff
Brian W. Flynn
p. 15 Explosion at the Boston Marathon
The Boston Globe
p. 16 Oklahoma Guard Conduct Search,
Rescue Operations in Moore
DefenseImagery.mil
p. 13 Homecoming
DefenseImagery.mil

p. 3 Dr. Fullerton and Drs. Mash and Quinn
Brian W. Flynn

p. 18 Dr. Ursano at D.C. Embassy of 		
Italy’s Symposium
D.C. Embassy of Italyp. 4 Typhoon Haiyan in the Pillipines
The Boston Globe

p. 19 Service Member and Family
DefenseImagery.mil

p. 6 Telomeres
National Institute of Healthp.22 American Flag Reflection on Water
Donna Flynn

p. 7 U.S. Army Soldier
DefenseImagery.mil

p.23 Arlington National Cemetery
Brian W. Flynn

p. 8 Reserve Drill Sergeants
DefenseImagery.mil

p. 28 Left and middle Service Member Images
DefenseImagery.mil

p. 9 Mortuary Affairs Collection Point at Bagram
Airfield, Afghanistan Defenseimagery.mil
By Sgt. 1st Class Peter Mayes

Inside back cover
Brian W. Flynn
All other photographs: Ingimages.com

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road
Bethesda, MD 20814-4712
www.CSTSOnline.org