Center for the Study of Traumatic Stress2010 Annual Re port
Improving Psychological
Health and Resilience

Through Trauma Research,
Education and Consultation
www.CSTSOnline.org

In response to the Deepwater
Horizon oil spill in the Gulf of
Mexico, U.S. Soldiers with the
Alabama Army National Guard
assemble a wall of Hesco barrier
containers in July 2010.

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 our research 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
Photos on front and inside covers, and pages 4, 6,
and 8, courtesy of DoD’s DefenseImagery.mil. CSTS
photographs on pages 20–21 by Brian W. Flynn.

Director’s Letter
For nearly a quarter of a century, the Centerfor the Study of Traumatic Stress (CSTS) has been on theforefront of translational research on the psychological effects
and health consequences of exposure to traumatic events,
especially those related to war, disasters, terrorism and publichealth threats. The Center, part of the Department of Psychiatry in the School of Medicine of the Uniformed Services
University, has been uniquely attuned and responsive to ournation’s trauma history encompassing events of national andinternational impact such as 9/11, the anthrax attacks, major
hurricanes and H1N1. As a component center of the Defense
Centers of Excellence for Psychological Health and Traumatic
Brain Injury (DCoE), the Center brings scholarly and research oriented problem solving to
the mental and behavioral health problems of the Department of Defense and the nation.
In 2010, the Center continued to focus its activities on the effects of the ongoing war in Iraq
and Afghanistan, which have led to high rates of posttraumatic stress, posttraumatic stressdisorder (PTSD), depression, suicide, co-morbid concussions, traumatic brain injuries (TBIs),
and other combat-related mental and behavioral health needs affecting service members, theirfamilies and loved ones.
The Center’s advances in neuroscience are aimed at improving the psychological health, resilience and post deployment function of service members through identification of biomarkers
and other genetic components involved in PTSD and suicide, as well as discovery of novel
pharmacologic interventions to prevent and eradicate PTSD symptoms. The Center works onsocial and epidemiologic studies to identify modifiable risk and resilience factors of service
members and their families. Our work is also focused on improving the psychological healthand resilience of military families and children. Through research, education and consultation, we are addressing new areas of need such as the care and communication around special
risk groups such as body handlers, training for supervisors in fostering resilience, addressing risks for suicidal behaviors and other health risk behaviors, and better understanding theimpact of combat injury and parental loss on military children.
Our Center’s work is characterized by a sustained
focus on collaboration from basic to clinical sciences, fromlaboratory to field research, from direct clinical care to
population level prevention. We assist the Department of
Defense in leading the nation in trauma focused care andrapidly moving findings from bench to bedside and fromwar to disaster. In 2010, two Center scientists deployed to
Iraq and Afghanistan bringing the Center’s expertise inmilitary and disaster psychiatry to care for those in harm’s
way. Upon their return, these real world experiences
further enrich our ongoing trauma research and outreach.
This year our Center has also responded in real time tolarge-scale disasters such as the Haiti earthquake and the Gulf Oil Spill, and we have been
training military and federal responders in the principles of Psychological First Aid.
Annual Report 2010 | 1

In addition, CSTS scientists and clinicians have been busy disseminating knowledge throughpresentations at national and international scientific conferences, through participation in
professional and academic review boards and by chairing committees that influence the policy
and practice of trauma and disaster care. As part of the Forum on
National Security and Health, we brought together national andinternational thought leaders for The Forum’s first conference,
Stigma and Barriers to Care: Caring for Those Exposed to War,
Disaster and Terrorism. Our Center also sponsored its prestigious,
5th Annual Conference on Amygdala, Stress and PosttraumaticStress Disorder (PTSD), Fear in the Human Mind.
The Center has expanded rapidly and successfully to meet new
challenges. At the end of 2010, the Center’s support and professional staff numbered over 75 people representing experienced
researchers, scientists and administrators, enabling us to continue
to grow and contribute as a world class research facility.
In addition, CSTS scientists continue to be highly productive inpublishing important papers, book chapters and books on subjects ranging from the impact of the sniper attacks on the homeless population in Washington, D.C. to knowledge gained from acollection of interviews with world renowned scholars and practitioners on family violence
research, assessment and interventions. CSTS scientists and their work have won recognition
this year in the form of our membership on major national
advisory groups on disaster and mental health care, partnering with an Emmy award winning presentation, being voted,
for the second consecutive year, “Best Doctor of the Year” forseveral of our Scientists and receiving a “Presidential Commendation” from the Association for Academic Psychiatry.
All of these activities and contributions are described on thefollowing pages, which we hope provides a sense of the Center’s
scope and mission: integrating basic science and clinical science
to better understand the effects of stress and trauma. Our research projects are combining psychosocial, epidemiologic andneuroscience methodologies that will lead to a better understanding of the vulnerability, protective factors and treatments
for trauma disorders. This approach, from laboratory to bedside to bench, will drive both
short-term and long-term objectives for all of our Center projects related to research, education, consultation, and training.
We wish to thank the many individuals, organizations and colleagues who have worked withus this year to support and advance trauma knowledge and trauma informed care.
Robert J. Ursano, M.D.
Professor of Psychiatry and Neuroscience
Chair, Dept. of Psychiatry, USU
Director, Center for the Study of Traumatic Stress

2 | Center for the Study of Traumatic Stress, USUHS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.

CSTS Director
Robert J. Ursano, M.D.
Executive Officer

CSTS
Scientific Advisory Board

CSTS Deputy Director
COL. David M. Benedek, M.D., MC, USA

CSTS Scientific Director
Carol S. Fullerton, Ph.D.

A S S O C I AT E D I R E C TO R S
Homeland Security
Robert K. Gifford, Ph.D.

Health Systems
Brian W. Flynn, Ed.D.

Public Education &Preparedness
Nancy T. Vineburgh, M.A.

Families and Children
Stephen J. Cozza, M.D.

Consultation & Education
COL. David M. Benedek,
M.D., MC, USA

Resource Management
John A. Stuart, Ph.D.

Workplace &Organizational
Response

Families & Children

BRANCHES
National Capital Area
Integrated ClinicalStudy Site

Epidemiology &Community
Assessment

Neuroscience

Distance Learning &Distributed
Information

Intervention,
Treatment &Health Services

Data Management &Resource Support

Annual Report 2010 | 3

Improving the Psychological Health
The Center for the Study of Traumatic Stress (CSTS)
conducts pioneering research in neuroscience and theneurobiology of stress to inform prevention, treatment and resiliency-based interventions for traumainduced disorders, especially posttraumatic stressdisorder (PTSD) and the risk and protective factorsof suicide. Center scientists work as a team and incollaboration with neuroscientists from leading academic and research institutions including the National Institutes of Health/National Institute of Mental
Health, Harvard University, Columbia University,
Yale University and the University of Michigan.
Driven by a need and commitment to find solutions
to optimize military performance and to enhance andtreat military health risks such as PTSD and suicide,the work of the Center and its colleagues has implications for all individuals affected by traumatic eventsand for the public health of our nation.

The Center for the Study of TraumaticStress (CSTS) conducts pioneering researchin neuroscience and the neurobiology ofstress to inform prevention, treatment
and resiliency-based interventions fortrauma-induced disorders, especially
posttraumatic stress disorder (PTSD) andthe risk and protective factors of suicide.

4 | Center for the Study of Traumatic Stress, USUHSThe Center’s neuroscience research has resulted in the
discovery of potential biomarkers for PTSD, potential
biomarkers for suicide risk, increased understandingof gene expression patterns that underlie biomarkers, and the role of fear memory consolidation andextinction. These studies seek to identify and informnew treatments that have the potential to not justalleviate symptoms of trauma-induced disorders,
but to prevent and treat those whose symptoms havebeen resistant to current interventions. In 2010, CSTS
scientists worked on the following research projects:

Biomarkers for PTSD and Suicide Risk
Biomarkers are increasingly used to diagnose diseases
promptly and accurately, to identify individuals athigh risk for certain diseases and to follow the courseof response to treatment. In the absence of clinicalbiomarkers for PTSD, diagnosis has been dependent
on only the assessment of clinical symptoms. These
symptoms are often missed, misdiagnosed, and/or
left untreated in thousands of affected individuals(military and civilian), thus disrupting the quality of
their lives and the lives of their families and children.
Center scientists identified a potential biomarker
for PTSD, a protein and its associated gene known
as p11. This finding has significant implications for
PTSD diagnosis and treatment since its expression

and Resilience of Service Members
pattern was identified not only in animal models but
in human PTSD brain tissue.
In 2010, the Center expanded it neuroscience research to address biomarkers for suicide risk. While
all major mental disorders carry an increased risk ofsuicide, it has been found that there is a significant
correlation between PTSD and suicide risk. Individuals with PTSD are 15 times more likely to attempt
suicide. This has great importance given the prevalence of both mental health issues in our military
population, especially those who have or are deployedto Iraq and Afghanistan.
Using blood samples from suicide attempters andnon-attempters, and post-mortem brain tissue frompatients who had committed suicide and non-suicide
controls, Center scientists examined levels of peripheral blood mononuclear cell (PBMC) p11 mRNA to
determine how these levels might help differentiate
between those individuals who would attempt orcomplete suicide versus those who would not. The
results demonstrated for the first time that PBMC p11
mRNA level is a potential adjunctive biomarker forthe assessment of suicide risk in mental disorders.

Novel Approaches for PTSD Treatment
Center neuroscientists are working on developing
new, pharmacologic interventions aimed at preventing or treating stress-induced affective disorders
such as PTSD. Most research performed thus far has
focused on the effectiveness of a few classes of compounds in alleviating symptoms instead of preventing
or treating the origin or the chain of events leading to
the disease. Center research in 2010, using a PTSD rat
model, has addressed an urgent need to seek a novel
5-HT2A receptor antagonist that can demonstrate
maximum efficacy with minimum adverse reactionin the treatment of PTSD. In the Center’s current
research, administration of the novel 5-HT2A antagonist, MDL 11,939, administered within 30 minutes
before or after exposure to traumatic stress, is hypothesized to prevent traumatic event-induced exaggerated fear response in an animal model of PTSD. The
use of such compounds that act specifically at the
5-HT2A receptor would also be expected to preventthe undesirable side effects that occur in humansubjects who are treated with SSRIs and antidepressants. This research will benefit active duty military,
reservists and veterans, as well as civilians exposed totraumatic circumstances.
Center scientists are in the formative stages of a new
study using an innovative electronic, hand-held devise and methodology, Ecological Momentary Assessment (EMA). EMA is used to examine symptoms of
PTSD and depression “in real time” in service members undergoing rehabilitation. The study, EcologicalMomentary Assessment of Posttraumatic Stress Symptoms in Service Members Undergoing Rehabilitation,
will provide a new perspective on identifying PTSD
symptom patterns and environmental influences that
may foster more effective treatments.

Fear Memory and Fear Memory Forgetting toEnhance PTSD Interventions
Two current Center studies using PTSD rat models
are addressing brain processes that are likely to playa role in developing and sustaining PTSD symptoms.
The inability to forget traumatic memories is a key
characteristic of PTSD. This failure in forgetting often
produces vivid and painful flashbacks years after thetrauma experience. Emerging evidence suggests thatadministering corticosterone at the proper time anddosage can promote the memory forgetting process
in animals and in healthy humans. This finding has
implications for PTSD interventions that will preventor mitigate the onset of PTSD. The Genetic Biomarkers for Attenuation of Fear Memory study has foundthat administering corticosterone before exposure
to stress can attenuate delayed and enhanced fear
response in an animal model of PTSD. This research
project, which seeks to provide a detailed cellular andmolecular mechanism associated with energy biomarkers for the resilience of traumatic stress, will help
in the development of a better therapeutic strategy forenhancing resilience in patients suffering from PTSD.
The Center is also looking at gene expression patterns
present in brain tissue and in white blood cells that
may contribute to the origin and neuropsychiatricphenotypes of PTSD. Using a PTSD rat model, andAnnual Report 2010 | 5

developing a rat mitochondria-focused gene chip,scientists will subject rats to the stress protocol developed by He Li, M.D., Ph.D. to look for specific gene
expression patterns. The novel diagnostic biomarkers
and pharmacologic interventions described above
have the potential for broad use both in military
populations (active duty, reservists and veterans) andin civilian populations exposed to traumatic events
such as natural disasters, vehicle crashes, etc.

mild traumatic brain injury (mTBI) and health risk
behaviors can disrupt social, occupational, or interpersonal function.
The Center is engaged in some major research
projects that address the neurobiology of trauma
with implications for PTSD and related brain injury
prevention and treatment.

The Army has also devoted unprecedented resources(including a recent $50 million grant) to studying
suicide in the hopes of better understanding thephenomenon and preventing future tragedy. The
5-year study funded by the National Institute of
Mental Health, U.S. Army STARRS (Studies to Assess Risk and Resilience in Service Members), is thelargest study ever to address suicide in the Army andperhaps suicide as a national health problem in thegeneral population. The study is a “Framingham” typestudy, meant to identify risk and resilience factors—
psychological, interpersonal, community, and neurobiological—for suicidal behaviors and also for PTSD,
depression, and substance abuse.
In 2010, CSTS staff finalized study designs, developed
research instruments, and completed pilot testing forthe two largest components of Army STARRS: theAll Army Study and the New Soldier Study. Preparations were made and approvals were obtained for the
production phases of these two components, which
will begin in Jan/Feb of 2011. In 2010, the data analyses for the Historical Data Study began, and the twocomponents of the Soldier Health Outcomes Study
were finalized and are scheduled to begin in 2011.
Planning and approvals for the OCONUS in-theater
portion of the All Army Study are progressing witha planned start date in 2011. In addition, the project
entered into a new subaward with University of California, San Diego in 2010 to enhance the planningand design of this complex and multi-faceted project.

PTSD and Post Deployment Function
Studies suggest that between 10% and 20% of combat
veterans serving in Iraq and Afghanistan develop
PTSD. There is increasing evidence that there is arelationship between PTSD and other adverse psychosocial outcomes of war including substance abuse,
aggression, and suicide. Persistent PTSD symptoms,

6 | Center for the Study of Traumatic Stress, USUHSTherapeutic Interventions
The National Capital Area Integrated Clinical Study
Site (NCAICSS), which comprises an establishednetwork of clinician-researchers at WRAMC, NNMC,
the D.C. Veterans Administration Hospital, and theArmed Forces Retirement Home, has initiated clinical
trials for novel medications and psychotherapy treatment for PTSD and other combat-related disorders(including mTBI). NCAICSS, one of the ten sites of
the Congressionally Directed Medical Research Program’s Clinical Consortium for Psychological Healthand TBI directed by Dr. Murray Stein at the University of California San Diego, is currently engaged infour studies.
In 2010, enrollment began for the Acceptance andCommitment Therapy Study. The aim of this mindfulness-based therapeutic intervention is to help soldierscope with post-deployment distress and disorders
such as depression, mTBI, and PTSD despite thesymptoms they may be experiencing. A second study
to be conducted in collaboration with the Washing-ments. Simultaneous sampling of blood and saliva has
been conducted in an effort to identify genetic markers for those who meet the criteria/diagnosis of these
disorders. The study has expanded to include surveying and biospecimen collection from the members of
the 82nd Airborne Division.

ton, D.C. Veterans Administration will examine theeffectiveness of Ganaxolone, a synthetic neurosteroid
for PTSD. Both studies required an extensive approval
process involving the Consortium’s External Scientific
Advisory Board and individual Institutional Review
Board (IRB) approval at each participating site.

In 2010, the Veterans Administration’s Central Officeof Research and Development recognized the importance of not only a PTSD biorepository, but also alarger national biorepository for all neuropsychiatricillnesses. The Center’s involvement in thisVA-DoD
PTSD CNS Tissue Repository initiative continues
through planning meetings with experts from the VA
in specimen collection and storage and in bioinformatics as part of developing plans for collection ofdata and specimens at the local level with an emphasis on PTSD and commonly co-morbid conditions.

A third project nearing IRB approval involves collaboration with the Medical University of South Carolina to conduct A Pilot Safety and Feasibility Studyof High Dose Left Prefrontal Transcranial Magnetic
Stimulation (TMS) 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.

The Center, in collaboration with Dr. Sandro Galeaof the University of Michigan, is engaged in a nationwide research project on the health and mental healthof National Guard and Reserve service members, an
at risk population that has been understudied. The
study addresses the epidemiology and the trajectoryof posttraumatic stress, deployment stress, healthrisk behaviors and health care utilization in National
Guard and Reserve. 2010 saw the completion of thefirst wave of data collection and preparation of thesurvey for the second wave of the study.

The fourth study is a 5-year, 2 million dollar neuroimaging, cognitive testing, and electrophysiological
profiling study of service members with mild traumatic brain injury.

Psychosocial Measures and Neuroscience
An exciting study building upon the Center’s findingof p11 as a genetic marker for PTSD in rats is its Stress& Biomarkers in a Military Population Study, which
is seeking to replicate p11 findings from the animalstudies, as well as explore other potential biomarkers identified in other (non-CSTS) studies. In 2010,
Center scientists made three trips to Ft. Bragg, to administer an 18-page questionnaire addressing PTSD,
alcohol and substance use, depression, and otherco-morbidity to the soldiers in the Special Operations
Command who have experienced the challenges ofvarious combat exposures including close contact
with enemy fire, IED blasts, and multiple deployAnnual Report 2010 | 7

Improving the Psychological Health
Military children and families face many challenges
related to the extended and multiple deployments ofservice member parents. Repeated deployments, single
parenting and the distress of separation can affect marital and parent/child relationships, which may contribute to the increased rates of military child maltreatment
and neglect recently reported in the scientific literature.
In addition to separations, anxiety about the health andwellbeing of deployed service members and the challenges of reunifications, military families may also be
faced with service member injury, illness (e.g. PTSD
and other combat stress disorders) or death.
In 2010, the CSTS Child and Family Program (CFP)
research portfolio expanded to include more thanseven million dollars in funding. The following research
initiatives address the impact of deployment and war
injuries on military families and children, military childmaltreatment, and evaluation of the impact of parental
death on children in the military and in the general
population.

The Impact of Combat Injury
CFP is engaged in three research projects that address
the effects of and interventions for families and children of wounded service members.

Repeated deployments, single parenting
and the distress of separation can affectmarital and parent/child relationships,
which may contribute to the increased
rates of military child maltreatment andneglect recently reported in the scientific
literature.

Addressing the Needs of Children and Families of the Combat
InjuredThis 4-year study with primary sites at Walter Reed
Army Medical Center (WRAMC) and San Antonio
Military Medical Center (SAMMC) is designed tolongitudinally investigate the impact of combat injury
on military families along 5 major dimensions of parent
and family functioning: 1) child and parent distress;
2) parent/child/family functioning; 3) parent-child/family communication; 4) alterations to family schedule and structure; and, 5) long term impact of injury
on child, parent and family interaction. The study will
follow families through three points over the courseof one year to gain insight into the long term recovery
process of the combat injured.
FOCUS-CI: A Preventive Intervention with Children and Familiesof the Combat Injured
This study evaluates a newly refined intervention forseverely combat injured service members and their

8 | Center for the Study of Traumatic Stress, USUHS

and Resilience of Military Families and Children
families using two existing approaches: “Families
Overcoming and Coping Under Stress” (FOCUS) is a
resiliency-building intervention
for military families experiencing the challenges of multiple
deployments and parental,
combat-related psychologicaland physical problems; “Early
Combined Collaborative
Care” (ECCC) addresses the long-term, changing
needs of traumatically injured patients transitioning from hospital to home. The new intervention(FOCUS-Combat Injured CI) will be administered
at WRAMC, SAMMC, and Madigan Army Medical Center (MAMC). Participating families will befollowed for two years to learn about the long-term
recovery trajectory.

Child and Family Trauma Program: A Study of Combat Injured
Families
This study examines the impact of severe combat injury on military families through interviews conducted at Operation Purple Healing Adventures (OPHA),an annual summer camp program for combat injured
service members and their families sponsored by The
National Military Family Association (NMFA). Forty
families were assessed in summers 2009 and 2010.
Qualitative data is being collected from focus groups
to assess the issues related to combat injury and family
functioning. Among the issues to be studied is how
combat injury effects family life.

The Impact of Child Neglect, Maltreatment andParental Loss
Deployment Family Stress: Child Neglect and Maltreatment in
US Army Families
The goal of this in-depth study of child maltreatment
and neglect among Army personnel is to describe thecharacteristics of substantiated child neglect cases andto identify factors within the family, the military community and the civilian community that contributeto family health or child maltreatment. This 4-year
study employs three cross-informing methodologies:
1) a clinical record review of approximately 400 childneglect cases at 4 military bases around the country;2) surveys administered to selected stakeholders in-volved in child services at 26 military bases; and,3) an epidemiological examination of selected installation and civilian community characteristics andresources to help identify risk and protective factors ofchild maltreatment.

Understanding and Meeting the Needs of Children Following
Family Member Death
This study, funded by Sesame Workshop, is the CFP’s
preliminary research initiative into the area of family
bereavement. It addresses the impact of parental
death on children andtheir caretakers in bothmilitary and civilian
populations by evaluating the helpfulness of a
Sesame Workshop DVD
and supplemental materials designed for grieving families. The study collects data on the health andwellbeing of surviving children (ages 2–18) who havelost a parent since September 11, 2001 as observed bytheir current caretaker. The purpose is to better understand diverse experiences and needs in bereavement.
The study also evaluates the usefulness of the Sesamematerials for the survivors and their grieving process.
Data have been collected throughout 2010. Initial results of the project were provided to Sesame Workshop
in January 2011. This study has provided a springboard
for further CFP bereavement related research.
The Center’s CFP also provides a wide range of consultation to and development of educational resources
for professionals in healthcare, child trauma, and toacademic, scientific and government leaders. CFP collaborates with National Child Traumatic Stress Network (NCTSN), Zero to Three, Military Child Education Coalition (MCEC) and National Military Family
Association (NMFA) to improve knowledge and carefor military families and children. In 2010, CFP also
provided its expertise in military injury and family careto the National Intrepid Center of Excellence (NICoE)
and at an impressive number of scientific and professional conferences. Highlights of the CFP educational
activities are featured on pages 14–15.
Annual Report 2010 | 9

Improving the Psychological HealthTraumatic Events and Disasters
Since its establishment in 1987, the Center has helped
shape the landscape of disaster mental health. Disaster mental health examines the impact and implications of individual, community and organizational
responses to traumatic events from natural disasters
such as hurricanes, earthquakes and tsunami, 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,
the Center has been involved in nearly every majordisaster our nation has faced in the past 25 years.
The Center is currently engaged in several important
projects described below that address the psychological health and resilience of first responders andthe role of “collective efficacy” in communities (i.e.,
conditions/resources within a group that lead to ashared vision and the capacity to produce effects for
its members) in disaster response and recovery.

Disaster mental health examines theimpact and implications of individual,
community and organizational responses
to traumatic events from natural disasters
such as hurricanes, earthquakes and thetsunami, to human made disasters such as
the Gulf Oil Spill and terrorist events suchas the Washington D.C. sniper attacks.

Psychological and Behavioral Responses in Public HealthWorkers: A Study of the Florida Department of Health toMultiple Hurricanes
Partnering with Centers for Disease Control andPrevention (CDC), the National Institute of Occupational Safety and Health, the University of Miami and
the Florida Department of Health, Center scientists
have been collecting data as part of a multilevel, longitudinal study to understand the impact of the 2004
and 2005 Hurricanes on our nation’s first responders
including Florida Department of Health personnel
who assumed this role.
In 2010 Center scientists examined community level
data and found that communities with lower ratesof PTSD and PTSD symptoms were associated withhigher rates of collective community efficacy. The
implications of these findings, submitted in a qualitative paper, will help target more effective post disasterinterventions and public health disaster care.

Disaster Mental Health Interventions for First Responders
The Center has been applying evidence-informed
approaches to trauma and disaster response. Centerscientists are engaged in two important projects basedon the principles of Psychological First Aid (PFA), as
10 | Center for the Study of Traumatic Stress, USUHS

and Resilience of Individuals and Communities Exposed towell as educational resources developed by the Center
to benefit military and civilian populations at risk andworkplace preparedness.

Intervention with Soldiers Returning from Deployment andSpouses: TEAM
Troop Education for Army Morale (TEAM) is a Psychological First Aid based intervention designed tohelp U.S. Army Mortuary Affairs Soldiers and spouses
cope with the complex challenges of deployment andexposure to body handling and recovery in the combat theater. Completing its second year of workshops,
TEAM uses natural support systems such as spouses
and buddy care based on the principles of Psychological First Aid. 2010 preliminary findings indicatethat the TEAM intervention is effective in addressing
posttraumatic stress as well as other adjustment issues
following deployment.

Centers for Disease Control and Prevention:
Disaster Preparedness in the Workplace and First
Responders
In 2008, the Centers for Disease Control and Prevention (CDC) collaborated with CSTS to conduct anorganizational assessment of its disaster preparedness, deployment operations, policy and practices
in an effort to identify factors to sustain resiliencein CDC emergency responders. The following year,
the Center developed and began implementation ofa first-responder resiliency officer training program
incorporating the principles of Psychological First
Aid to strengthen the outreach and resilience of its
Deployment Safety and Resiliency Team officers who
travel worldwide to address public health threats andmajor disasters. In 2010, the Center conducted its
3rd training at CDC. As further training sessions are
conducted evaluation of effectiveness will continue
and outcome reports will be generated.

Disaster Mental Health Consultation at the State
and National Level
Center scientists serve on academic, scientific, community, workplace and government advisory boards
to advance disaster and behavioral health knowledge

and principles. This involvement helps community,
workplace and government and public health leadership in disaster planning and response at the local,
regional and national level. Highlights of 2010 include
the following participation:

The Mental Health Subcommittee of the National Biodefense
Science Board (NBSB)
NBSB released two important documents: first, a
set of recommendations regarding Federal priorities
around disaster mental health; and second, to assess
the state of integration of Federal disaster behavioral
health efforts across the Federal government. Center scientists participated in analyses of results anddevelopment of the final report to the NBSB that was
accepted in September 2010. The combined documents provide an important blueprint for what theFederal government needs to do to move the field of
disaster behavioral health forward as well as recommendations for better integration of Federal efforts inthis arena.
The National Association of State Mental Health Program
Directors (NASMHPD)The Center assisted in the development and publication of the handbook, “Responding to a High-Profile
Tragic Incident Involving a Person with a Serious
Mental Illness: A Toolkit for State Mental HealthCommissioners.” This handbook is a practical guidefor Commissioners and leaders dealing with acts ofviolence perpetrated by people with suspected or
actual mental illness.
The President’s National Commission on the BP Deepwater
Horizon Oil Spill and Offshore Drilling
The Center provided consultation to the Commission on disaster behavioral health issues that will beincorporated into its final report. The consultation,
which will continue throughout 2011, will identify
important topics and documents that support thesignificance and implications of disaster behavioral
health as integral to planning for and responding toevents.

Annual Report 2010 | 112010 Timeline of CSTS Presentations, Briefings, Consultations,
Trainings and Board Participation
In 2010, CSTS scientists disseminated knowledge on the Center’s trauma
research and expertise through briefings, presentations, training, consultation, and participation on medical and scientific boards. Here are somehighlights of 2010’s monthly activities:

J a n u a r y 2010
Briefed the Senior Military Medical Advisory
Council and DoD Senior Officers Council on
Army STARRS (Army Study to Assess Risk andResilience in Service members)
Chaired the Science Board of the Centers for
Disease Control (CDC) Office of Public HealthPreparedness and Response review of its
Emergency Operations Center
Spoke to students at the University of
Maryland Winter Symposium on addressing
behavioral health needs of student veterans
Presented the second round of the Deployment Safety and Resiliency Team training
to CDCF e b r u a r y 2010

A p r i l 2010

Pre-briefed Army on Army STARRS prior to
March briefing the Army Vice Chief of Staff(VCSA)

Served as a military behavioral healthpanelist at Interagency Institute for Executive
Medicine, Canadian Embassy

Presented “Families Over Coming Under
Stress - Combat Injured (FOCUS-CI): A
Program for Supporting the Combat Injured
and their Families” as part of a panel toinform the Defense Centers of Excellence(DCoE) about the proposed family programfor recovering service members and theirfamilies at the National Intrepid Centers of
Excellence (NICoE)

Presented “The Impact of Combat Injury on
Military Families and Children: Research
Developments,” to the Military Family
Research Institute at Purdue University

M a r c h 2010
Briefed the Secretary of the Army, VCSA, and
the Army Surgeon General on STARRS
Chaired a breakfast symposium entitled“Understanding the Needs of Very Young
Military Children” at the International Societyof Infant StressPresented “Impact of military mission anddeployment on Service members” for the
National Child Traumatic Stress Network’s“Essentials for those who care for militarychildren” master speaker series
Sponsored “Stigma and Barriers To Care,” thefirst meeting of the Forum on Health andNational Security
Presented “Stigma and Barriers to Care in
Terrorism and Public Health Emergencies:
System Issues” at the Stigma and Barriers toCare meeting

12 | Center for the Study of Traumatic Stress, USUHS

Presented “Psychological Responses toTraumatic Exposures” and “Public Health
Issues for Planners and Policy Makers” tograduate students in political science andinternational studies at George Washington
University
Presented “Re-Engineering Systems ofPrimary Care Treatment in the Military(RESPECT-MIL)” to post-doctoral
psychologists at the Baltimore Veterans
Affairs (VA), University of Maryland
Presented a poster entitled, “TraumaticStress and Increased Tobacco Use in 9/11
Disaster Workers” at the American Societyof Addiction Medicine (ASAM) 41st Annual
Medical Scientific Conference
Hosted “Theater of War”, a presentationof readings of Sophocles’ plays, Ajax andPhiloctetes, to military communities acrossthe United States
Served on the Scientific Advisory Boardand participated in the Pentagon launch of
Sesame Workshop’s Talk, Listen, and Connect(TLC)-III “When Families Grieve”
Hosted the 5th Annual Conference on
Amygdala, Stress and Posttraumatic Stress
Disorder (PTSD) entitled, “Fear in the HumanMind”

M a y 2010J u ly 20 10

N o v e m b e r 2010

Participated in a three day meeting as amember of the Diagnostic and Statistical
Manual of Mental Disorders-V (DSM-V)
Posttraumatic Stress Disorder (PTSD) task
force

Presented a poster entitled, “Deployment
family stress: Child neglect andmaltreatment in US Army families” at the18th annual colloquium of the American
Professional Society on the Abuse of Children

Presented “The Cost of War” at King’s College,
University of London Symposium, National
Press Club in Washington, D.C.

Chaired the Disaster Psychiatry Committee ofthe American Psychiatric Association (APA)
meeting in New Orleans

A u g u s t 2010

Presented “PTSD: War to Disaster and Benchto Bedside to Public Health” at the APA
meeting
Presented “Integrating Psychosocial Factors
in Effective Crisis Communications for
Biological Incidents” at the BioDefense 2010
Conference in Washington, D.C.
Presented “Psychological first aid: Helping
victims in the immediate aftermath ofdisaster and beyond” to nurse practitioners
at Walter Reed Army Medical Center
Presented a poster entitled, “Early
educational intervention for Mortuary
Affairs soldiers post deployment: Preliminary
results” at the Uniformed Services Universityof the Health Sciences (USUHS) Research
Week
Presented “Children and Families of Combat
Veterans” for the American Academy of Childand Adolescent Psychiatry Advocacy Day at
the US Congress
Presented “PTSD: War to Disaster and Benchto Bedside to Public Health” at the American
Psychiatric Association meeting
Presented “The Children and Familiesof Combat Injured Service Members” at
the Navy and Marine Corps Combat andOperational Stress Conference: Taking Action,
Measuring Results

J u n e 2010
Presented a talk, “Military children andfamilies: They also serve” to the National
Child Care Advisory Group and the National
Association of Child Care Resources & Referral
Agencies
Briefed the Secretary of the Army and VCSA
Chief of Staff of the Army on progress of the
Army STARRS
Served as reviewer for Institute of Medicine,National Academy of Sciences, draft report“assessing the effects of the Gulf Of Mexico
Oil Spill on Human Health
Briefed the Uniformed Services University(USU) Board of Regents on Army STARRS

Delivered a presentation entitled “Interest
in Receiving Mental Health Services after
Combat Deployment to Iraq: Overcoming
Stigma and Barriers to Care” at the Force
Health Protection Conference

S e p t e m b e r 2010
Met with the United States Army Surgeon
General and a representative of the Sergeant
Major of the Army in reference to STARRS
Delivered Deployment Safety and Resiliency
Team first responder training to CDC first
responders, met with CDC Occupational
Health regarding first responder training
outcomes research
Conducted the third of four workshops forcohort 3, and conducted the final survey
with cohort 1 as part of the Troop Education
for Army Morale (TEAM)
Attended a Working Group Meetingin response to the National Defense
Authorization Act (NDAA) 2010, Section
722, “Study, Plan, and Pilot for the Mental
Health Care Needs of Dependent Children on
Members of the Armed Forces”

Presented “Epidemiology and Challenges”
at the Defense Science Review Committee/
DARPA (Defense Advanced Research Projects
Agency) meeting on suicide in the military
Presented “Behavioral Health Surveillancein Disasters, Terrorism and Public Health
Emergencies” at CDC
Presented “TEAM: An early intervention for
Mortuary Affairs soldiers post deployment;
Preliminary results from the first threecohorts” at the 26th annual meeting of theInternational Society for Traumatic StressStudies
Presented “Differences in PTSD’s factor
structure based on different PTSD
assessment instrumentation” at the 26th
annual meeting of ISTSS
Presented “Young Children in US Military
Families: How Are They Doing and What
Are We Doing About it?” at the 26th annual
meeting of ISTSS
Presented “PTSD from Bench to Bedside” atthe Society for Neuroscience Public Advocacy
Forum
Presented “A distinct pattern of amygdala
neuronal activation dissociates auditory andcontextual fear memory” at the Society for
Neuroscience Public Advocacy ForumD e c e m b e r 2010
O c t o b e r 2010
Served on Advisory Board for the Disaster
Mental Health Subcommittee of the
National Biodefense Science Board report,“Integration of Mental and Behavioral
Health in Federal Disaster Preparedness,
Response, and Recovery: Assessment andRecommendations”
Provided telephone consultation to staffof the National Commission on the BP
Deepwater Horizon Oil Spill & Offshore
Drilling around behavioral health impact
Chaired a symposium on the Gulf Oil
Spill Disaster at the American Psychiatric
Association (APA) Psychiatric Institute in
BostonPresented “Psychological Health Effects of
Deployment on Significant Others of Soldiersand Veterans” at the 3rd Annual Trauma
Spectrum Conference
Conducted orientation for cohort 4 as part of
the Troop Education for Army Morale (TEAM)
project at Ft. Lee, Virginia
Provided expert guidance at a meeting of the
Defense Health Board (DHB) Medical Ethics
Subcommittee
Participated in the DHB Subcommittee
meeting on care provider training fordelivery of psychopharmacologic andcomplimentary/alternative treatments
for behavioral health issues in the combat
theaterPresented “Psychological Health Effects of
Deployment on Significant Others of Soldiersand Veterans” at the 3rd Annual Trauma
Spectrum Conference
Participated in the National Child TraumaticStress Network (NCTSN) Webinar SeriesImproving Psychological Health and
The Center for the Study of Traumatic Stress provides
a wide range of educational activities and resourcesthat advance its expertise in disaster and military
psychiatry. The Center hosts professional conferences,develops fact sheets, often in real time, in response tonational and international disasters, creates innovative health campaigns that address timely trauma
needs, and works with cutting edge technologies
and organizations to facilitate podcasts and distancelearning products, and to communicate via social
media outlets.
Here are some educational highlights for 2010.

Conferences
The Center for the Study of Traumatic Stress hosted
a conference, Stigma and Barriers to Care: Caring
for Those Exposed to War, Disaster and Terrorism on
March 24th through 26th, 2010. National and international thought leaders discussed and developed aset of recommendations in the areas of education,
training, leadership and research that can help overcome the stigma and barriers to care for populations
exposed to war, disaster and terrorism. The conference was the first in a planned series that is part of theForum on Health and National Security.

The Center hosts professional conferences,develops fact sheets, often in real time,in response to national and international
disasters, creates innovative healthcampaigns that address timely trauma
needs, and works with cutting edge
technologies and organizations tofacilitate podcasts and distance learning
products, and to communicate via social
media outlets.
14 | Center for the Study of Traumatic Stress, USUHSOn April 26, 2010, CSTS hosted the 5th Annual
Amygdala, Stress and PTSD Conference, Fear in the
Human Mind, at Uniformed Services University that
focused on two major areas of research: Basic Neuroscience: Role of the Amygdala Neurocircuitry in Fear,
Memory and Anxiety and Translational Research:
From Neurobiology to Anxiety, Fear, and PTSD.

Developing Learning Communities through National
Collaboration
Throughout 2010, the Center partnered with the
National Child Traumatic Stress Network (NCTSN)
to develop a “Military Families Learning Community” consisting of educational resources and tools
to enhance provider knowledge and care of militarychildren and families. These resources included:
Podcasts: “Essentials for Those Who Care for MilitaryChildren and Families”: Army, Navy, Air Force, andMarine Corps experts discussing the culture of military children and families — the impact of deploy-

Resilience through Educational Outreach and Resources
ment, programs and services for military children
and families, how to become a TRICARE provider,
Military OneSource resources, and building community capacity to serve military families. Podcasts may
be viewed at: http://learn.nctsn.org/course/category.
php?id=10 (select podcasts/“Essentials for Those Who
Care for Military Children and Families).
Master Speaker Series: Army, Navy, Air Force, andMarine Corps experts discussing the strengths andperspectives of service members and their families,
the impact of polytrauma and traumatic brain injury,
behavior management and a family-centered intervention, called FOCUS. Archived presentations canbe viewed at: http://learn.nctsn.org/course/category.
php?id=10 (select Master Speaker Series).
Military Families Knowledge Bank (MFKB): A database that speeds access to abstracts of timely articles
and web-based resources related to military families
and children at: http://mfkb.nctsn.org/cwis/index.php.

Innovative Health Communication Initiatives
Courage to Care Courage to Talk
In March 2010, the Center’s Child and Family Program launched a unique health campaign, Courage to
Care Courage to Talk (CtT). The campaign’s purpose
is to foster communication around the impact of war
injuries on military families and children, and to connect families to supportive resources and individuals
within the healthcare environment. The CtT resources — posters and brochures in English and Spanish —address topics such as ‘talking to healthcare providers,’ ‘talking to your children about the injury,’ and‘principles of care’ for families of the combat injured.
A number of prominent military treatment centers
participated in the campaign including National
Naval Medical Center, Bethesda, Naval Medical
Center San Diego, Walter Reed Army Medical Center,
Brooke Army Medical Center, Landstuhl Regional
Medical Center, and Madigan Army Medical Center.
In addition, CtT materials were featured at the Pentagon during Suicide Prevention Month in September
and on the Pentagon InfoNet throughout the fall.
Approximately 160, 000 people view the InfoNet during
any given week in the Pentagon and at a number offederal buildings. There is a companion website atwww.couragetotalk.org.

Courage to Care
In its 6th year of continuous publication, Courage
to Care (CtT) is the leading e-health information
campaign that draws
upon Uniformed Services University’s andthe Center’s expertise inmilitary medicine andmilitary unique healthand mental health issues.
In November 2010, theCenter developed anddisseminated two fact
sheets that generated
considerable interest and attention: ‘Asking for Help:
Facilitating Important Behaviors for Health and Family Function’ for providers, and ‘Asking for Help: Do
You Know How?’ for military families. Defense Media
Activity, DoD’s direct line of communication for news
and information to U.S. forces worldwide, featured
Courage to Care’s ‘Asking for Help’ fact sheets on its
service member blog.

A 2010 highlight of theCenter’s Family Violence andTrauma Project (FVTP) was
the publication of Family
Violence Research, Assessment and Intervention: Looking Back, Looking Ahead.
This book is a collectionof interviews by renowned child and family
researchers and practitioners that have appearedin Joining Forces Joining Families, a newsletter published by the CSTS. In its fifteenth year,
FVTP provides support via briefings, papers,
staff studies and its quarterly newsletter toinform Army leadership and the U.S. Army’s
Family Advocacy Program of the scientific andmedical aspects of child and spouse abuse.

Annual Report 2010 | 15

Recognition
Two Center Scientists Deployed to the War Zone
2010 saw the deployment of two Center scientists
who are also Active Duty military psychiatrists.
Maj Derrick Hamaoka, M.D., USAF, MC, FS was
deployed to Iraq and returned home in May. LCDR
Patcho Santiago, M.D., M.P.H., MC, USN deployed to
Afghanistan and is scheduled to return early in 2011
These deployments represent a unique aspect of theCenter’s work — from bench to bedside to community. According to Santiago, “the Center’s work inresearch, education and consultation set me up fora very successful deployment as Officer-In-Chargeof the Navy’s Mobile Mental Health Care Team. We
conducted a public health mission for the Navy in
Afghanistan. The three key elements of that mission
are behavioral health surveillance of expeditionary
Sailors, communicating our findings to leadership,and recommending population-level interventions
based on these surveillance findings. This has been an
opportunity for me to effectively bring ideas from theivory tower to the deckplates — the real world experiences of deployed Naval officers engaged in the war
on terrorism.”
LC DR Patcho
Santiago, M.D.,
M.P.H., MC, USN

Maj Derrick Hamaoka, M.D., USAF, MC, FS

These deployments represent a uniqueaspect of the Center’s work — from bench
to bedside to community.

16 | Center for the Study of Traumatic Stress, USUHS

Hamaoka expresses a similar view. He explains that,“the Center’s training and emphasis on education,
research, and consultation were invaluable to me
as the Officer-In-Charge of COB Adder, one of thelargest combat stress clinics in Iraq. Being a part of
the Center kept me up-to-date on the most pressing
issues of deployed service members, which lead tothe development and implementation of “just-intime” trainings, surveillance, and consultations. Thiswas essential, as the interventions had to be acceptedby commanders and soldiers, as well as support andenhance the mission.”
The Center recognizes these important contributions
to our nation and to the military healthcare of thosein harm’s way. Welcome home Drs. Hamaoka andSantiago!

Outstanding Achievement

Funded Grants and Awards

Center Scientists Recognized for Outstanding
Achievement■■ Family Violence and Trauma Project III■■ Protecting the Health, Safety & Resilience of■■ The Center’s Director, Dr. Robert J. Ursano

was awarded the “Presidential Commendation”
from the Association for Academic Psychiatry
in “recognition of outstanding contributions to
psychiatric education.” Dr. Ursano’s work was also
highlighted as an example of outstanding researchin the Congressionally Directed Medical Research
Programs promotional information materials forfiscal year 2010.

■■ Center Senior Scientist, COL Charles C. Engel,

M.D., M.P.H., MC, USA was elected to the Boardof Directors of the International Society for Traumatic Stress Studies.

■■ Center Associate Director, COL David M. Bene-dek, M.D., MC, USA was appointed as Deputy
Editor of the Journal of Nervous and Mental
Disease. Dr. Benedek was also elected as the Society of Uniformed Services Psychiatrists, Deputy
Assembly Representative to the Assembly of theAmerican Psychiatric Association.

■■ Center Executive Officer, Robert K. Gifford, Ph.D.

and Edmund G. Howe III, M.D., J.D., Director,
Programs for Medical Students in Ethics, Uniformed Services University Medical School, wereappointed as members of the Headquarters (HQ),
United States Army Medical Research and Materiel Command (USAMRMC) Research Ethics
Advisory Panel (REAP).

■■ Center Associate Director, Stephen J. Cozza, M.D.

was named one of Washington D.C.’s top doctors
in Washingtonian Magazine. Dr. Cozza also servedon the Scientific Advisory Board and participatedin the Pentagon launch of Sesame Workshop’s
Talk, Listen, and Connect (TLC)-III “When Families Grieve,” which was nominated for an Emmy in
July, 2010.

■■ The Center received a letter of appreciation from

Major General Jamie Balfour, Director General of
the Winston Churchill Memorial Trust, London,
UK, for the Center’s support of their fellowship
program.

Deployed Staff■■ Amphetamine Challenge: A Marker of Brain

Function that Mediates Risk for Drug Abuse andAlcohol Abuse■■ Clinical Study Site for PTSD and TBI (sub-award)■■ Addressing the Needs of Children and Families of
Combat Injured■■ Mortuary Affairs Soldiers: Early Intervention andAltering Barriers to Care for Traumatic Stress and
PTSD■■ Deployment Family Stress: Child Neglect and
Maltreatment in U S Army Families■■ Mental Health and Service Utilization Among
Reserve and National Guard Forces (sub award)■■ Ptsd Trajectory, Co-Morbidity, and Utilizationof Mental Health Services Among Reserve Forces(sub-award)■■ Ptsd Trajectory, Co-Morbidity, and Utilizationof Mental Health Services Among National Guard
Soldiers■■ Neurobiologic Evaluation of Novel Targets for
Therapeutic Intervention in PTSD■■ Identification of Gene Expression Patterns in
Brain Tissues and Peripheral White Blood Cells of
Rat Model of PTSD■■ CSTS — Program Grant 2008■■ CSTS — Program Grant 2010■■ FOCUS-CI Preventive Intervention with Children
and Families of Combat Injured■■ Brain Indices of Risk for PTSD after Mild TBI■■ Evaluation of Sesame Workshop’s “Talk Listen
Connect■■ Initial Randomized Controlled Trial of Acceptance and Commitment Therapy (ACT) for
Distress and Impainnent in OEF/OIF Veterans■■ A Pilot Safety and Feasibility Study of High DoseLeft Prefrontal Transcranial Magnetic Stimulation(TMS)■■ Modifiable Risk and Protective Factors for Suicidal
Behaviors in the US Army■■ Modifiable Risk and Protective Factors for Suicidal
Behaviors in the US Army — ARRA■■ Differential Dysregulation of Subcortical Plasticity
after TBI

Annual Report 2010 | 172010 Publications

War Psychiatry. Washington, DC: Borden Institute;(In Press).

Department of Psychiatry

Diebold C, Waits W, Brown M, Benedek DM. Military graduate medical education. In EC Richie (Ed.)
Textbook of Combat and Operational Psychiatry. Borden Institute Textbooks of Military Medicine. Officeof the Surgeon General of the United States Army; (In
Press).

Bell NS, Amoroso PJ, Williams JO, Yore MM, Engel CC Jr, Senier L, DeMattos AC, Wegman DH.
Demographic, physical, and mental health factors
associated with deployment of U.S. Army Soldiers
to the Persian Gulf. Military Medicine. 2010;175(4):227–237.
Benedek DM, Wynn GH (Eds.). Clinical Manual forManagement of PTSD. Washington, DC: American
Psychiatric Publishing Inc; 2010.
Biggs QM, Fullerton CS, Reeves JJ, Grieger TA,
Reissman D, Ursano RJ. Acute stress disorder,
depression and tobacco use in disaster workers following 9/11. American Journal of Orthopsychiatry.
2010;80(4):586–592.
Cozza SJ, Guimond JM, McKibben JB, Chun RS,
Arata-Maiers TL, Schneider B, Maiers A, Fullerton
CS, Ursano RJ. Combat-injured service members
and their families: The relationship of child distressand spouse-perceived family distress and disruption.
Journal of Traumatic Stress. 2010;23(1):112–115.

Flynn BW. Commentary on “I don’t know how tofind my way in the world”: Contributions of userled research to transforming mental health practice:Some thoughts on methodology and results from a
non-researcher. Psychiatry. 2010;73(2):118–121.
Flynn BW. Book Review, Columbine by David Cullen,
Psychiatry. 2010;73(4):383–387.
Forbes D, Creamer M, Bisson J, Cohen J, Crow B,
Foa E, Friedan M, Keane T, Kudler H, Ursano RJ.
A guide to guidelines for the treatment of PTSD
and related conditions. Journal of Traumatic Stress.
2010;23(5):537–552.
Ford JM, Roach B, Miller R, Duncan CC, Hoffman R,
Mathalon D. When it’s time for a change: Failures totrack context in schizophrenia. International Journalof Psychophysiology. (In Press).

Cozza SJ. Meeting the wartime needs of militarychildren and adolescents. In JI Ruzek, PP Schnurr, JJ
Vasterling, MJ Friedman (Eds.) Caring for Veteranswith Deployment-related Stress Disorders. Washington,
DC: American Psychological Association; (In Press).

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.

Cozza SJ, Guimond JM. Working with combat
injured families through the recovery trajectory. In
SM MacDermid Wadsworth, D Riggs (Eds.) Risk andResilience in U.S. Military Families. New York, NY:
Springer; (In Press).

Goldenberg MN, Benedek DM, Ursano RJ. Acutestress reactions, acute stress disorder and PTSD:
Treatment and prevention in the aftermath of trauma.
In T Uhde (Ed.) Therapeutic Strategies in Depression
and Anxiety. (In Press).

Cozza SJ, Feerick MM. The Impact of parental combat injury on young military children. In J Osofsky(Ed.) Young Children and Trauma, Intervention andTreatment. New York, NY: Guilford; (In Press).

Goldenberg MN, Benedek, DM, and Ursano, RJ.
Disaster victims and the response to trauma. In Textbook of Community Psychiatry. (In Press).

Cozza SJ, Chun RS, Miller C. The children andfamilies of combat injured service members. In EC
Richie (Ed.) War Psychiatry. Washington, DC: Borden
Institute; (In Press).
Cozza SJ, Lehman DH. The families and children of
fallen military service members. In EC Richie (Ed.)

18 | Center for the Study of Traumatic Stress, USUHSGoldenberg MN, Benedek DM, Ursano RJ. Pharmacology. In Encyclopedia of Trauma. (In Press).
Goldenberg MN, Biggs QM, Flynn BW, McCarroll
JE. Book Essay: The other side of sadness: What the
new science of bereavement tells us about life after
loss, by George A. Bonanno. Psychiatry. (In Press).

Gould NF, McKibben JB, Hall R, Corry N, Amoyal N,
Mason ST, McCann UD, Fauerbach JA. Peritraumaticheart rate and PTSD in patients with severe burns.
Journal of Clinical Psychiatry. (In Press).

Naifeh JA, Richardson JD, Del Ben KS, Elhai JD. Heterogeneity in the latent structure of PTSD symptoms
among Canadian veterans. Psychological Assessment.
2010;22(3):666–674.

Grieger T, Benedek DM, Ursano RJ. Violence andaggression. In DM Benedek, G Wynn (Eds.) Clinical Manual for Management of PTSD (pp.205–225).
Washington, DC: American Psychiatric PublishingInc.; 2010.

Santiago PN, Wilk JE, Milliken, CS, Castro CA, Engel
CC, Hoge CW. Screening for alcohol misuse andalcohol-related behaviors among combat veterans.
Psychiatric Services. 2010;61(6):575–581.

Howe EG. Core ethical questions: What do you dowhen your obligations as a psychiatrist conflict withethics? Psychiatry (Edgemont). 2010;7(4):40–47.
Howe EG. ‘Third generation’ ethics: What careproviders should do before they do ethics. The Journal of
Clinical Ethics. 2010;21(1):3–13.
Jiang XL, Zhang ZJ, Ursano RJ, Gamble E, Zhang S,
Jia M, Li, H. 5-HT2A receptor antagonism by MDL
11,939 during inescapable stress prevents subsequent
exaggeration of acoustic startle response and reduced
body weight in rats. Journal of Psychopharmacology.
2010;25(2):289–297.
Jiang XL, Zhang ZJ, Ursano RJ, Gamble E, Zhang
S, Jia M, Li H. MDL 11,939 administered prior toinescapable stressor blocks subsequent exaggeration of acoustic startle response and sustained bodyweight loss in rats. Journal of Psychopharmacology.
2010;25(2):1–9.
Mansfield AJ, Kaufman JS, Marshall SW, Gaynes BN,
Morrissey JP, Engel CC. Deployment and the use ofmental health services among U.S. Army wives. New
England J Medicine. 2010;362(2):101–109.
McCarroll JE, Newby JH, Benedek DM, Ursano RJ,
Vineburgh N (Eds.). Family violence research, assessment and interventions: Looking back, looking ahead.
Bethesda, MD: Center for the Study of TraumaticStress; 2010.
McDonald CG, Gabbay FH, Reitschel J, Duncan CC.
Evidence for a new late positive ERP component in
an attended novelty oddball task. Psychophysiology.
2010;47(5):809–813.
Milner JS, Thomsen CJ, Crouch JL, Rabenhorst MM,
Martens PM, Dyslin CW, Guimond JM, Stander VA,
Merrill LL. Do trauma symptoms mediate the relationship between child physical abuse and adult childabuse risk? Child Abuse and Neglect. (In Press).

Schneider B, Bradley J, Benedek DM. Psychiatric
medications in military operations. EC Ritchie (Ed.).
Textbook of Combat and Operational Psychiatry. Borden Institute Textbooks of Military Medicine. Officeof the Surgeon General of the United States Army; (In
Press).
Ursano RJ, Goldenberg MN, Zhang L, Carlton J, Fullerton CS, Li H, Johnson L, Benedek DM. Posttraumatic stress disorder and traumatic stress: From bench
to bedside, from war to disaster. Annals of the New
York Academy of Sciences. 2010;1208:72–81.
Ursano RJ, Fullerton CS, Biggs QM, Santiago PN.
Epidemiology of acute stress disorder in adults. In G
Beck, D Sloan (Eds.) Handbook of Traumatic Stress
Disorders. New York, NY: Oxford University Press; (In
Press).
Ursano RJ, Fullerton CS, Benedek DM. What is
psychopathology after disasters? Considerations about
the nature of the psychological and behavioral consequences of disasters. In Y Neria, S Galea, FH Norris(Eds.) Mental Health and Disasters. (pp. 131–142).
Cambridge, UK: Cambridge University Press; 2010.
Xing G, Carlton J, Zhang L, Jiang X, Fullerton CS, Li
H, Ursano RJ. Effects of sex and repeated tail-shockstress on canabionoid receptor expression and phosporylation in rat cerebellum: Implications for PTSD
(submitted).
Zhang L, Li H, Ursano RJ. Heat shock proteins andpost-traumatic stress disorder. In AAA Asea, BKPedersen (Eds.) Heat Shock Proteins and Whole Body
Physiology. (pp.179–192). Netherlands: Springer; 2010.
Zhang L, Su T-P, Choi K, Webster M, Li CT, Chung
MY, Chen Y-S, Bai YM, Chou YH, Barker JL, Barrett, JE, Li XX, Li H, Benedek DM, Ursano RJ. p11(S100A10) as a potential biomarker of psychiatric patients at risk of suicide. Journal of Psychiatric Research.
2010;1–7.
Annual Report 2010 | 19

CSTS 2010—A Snapshot

The Trauma Team meeting (pictured above) is a Center tradition that takes place every Friday at noon. CSTS scientists
and support staff share important projects and their benchmarks, which enhances the Center’s collaborative approach. The
Center also invites visiting scientists to learn about the work and scope of Center research, education and consultation.

Center Director, Robert Ursano, M.D. and Center
Scientific Director, Carol Fullerton, Ph.D. discuss current
research encompassing both military and disaster
psychiatry. Drs. Ursano and Fullerton have worked
together nearly 25 years since the Center’s establishment.
20 | Center for the Study of Traumatic Stress, USUHS

Dr. Michael Stanley delivers
providesaapresentation
presentationtotoCSTS
CSTSscientists
aspart ofas
thepartDisasterPreventative
PsychiatryPsychiatry
Fellowscientistsof theandDisasterand Preventative
Seminar
Series.
The
Centerprovidesthenation’s
only
Fellow Seminar Series. The Center provides the nation’s only
fellowship in Disaster Psychiatry and Public Health.

Brian Flynn, Ed.D.,
CSTS Associate
Director, moderates apanel and discussion
at the 26th Annual
Rosalynn Carter
Symposium on
Mental Health
Policy, “A Veteran’s
Journey Home:
Reintegrating our
National Guard andReservists into Family, Community and Workplace.”
Senior CSTS neuroscientist, Lei Zhang, M.D., is pictured
in his laboratory, which is located at the F. Edward
Hebert School of Medicine, and is part of the Departmentof Psychiatry at the Uniformed Services University.

The Center’s website, www.cstsonline.org, provides
a wide range of resources including fact sheets that
advance trauma knowledge and trauma informedcare. These resources are developed for healthprofessionals and scientists, first responders, military,
government, business and public health leadership,
and for civilian and military families and children.
This website was created to support a study undertakenby the Center’s Child and Family Program on theimpact of parental death using a Sesame Workshop
DVD and resources designed for grieving families.
Participating families used the website to share theirunique experiences and provide feedback for this project.
The Center’s Family
Violence and Trauma
Project publishes a
newsletter, Joining
Forces Joining
Families, that informs
Army leadership andits Family Advocacy
Program of the scientificand medical aspects offamily maltreatment.

The Center for the Study of Traumatic Stress islocated on the 5th floor of Building 6700 A Rockledge
in Bethesda, Maryland. The Center’s neurosciencelaboratories are primarily within the Uniformed
Services University Medical School on the groundsof the National Naval Medical Center.
Annual Report 2010 | 21

CSTS Directors, Scientists and Scientific Advisory Board
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 David M. Benedek, MD, 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

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

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

Quinn M. Biggs, Ph. D., M.P.H.
Research Psychologist (Post Doc)
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

Carol S. Fullerton, Ph.D.
Director, Scientific Research, CSTS
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

Frances Gabbay, Ph.D.
Research Assistant 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

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

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 Crowley, M.D.
Clinical Assistant Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Robert K. Gifford, Ph.D.
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

Matthew N. Goldenberg, M.D.
Assistant Professor of Psychiatry, CSTS
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

Krisitie Gore, Ph.D.
Research Assistant 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

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

COL Charles Engel, MC, USA, M.P.H.
Associate Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Maj Derrick Hamaoka, M.D., USAF,
MC, FS
Assistant 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
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
John A. Stuart, Ph.D.
Director, Resource Management, CSTS
Assistant 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

22 | Center for the Study of Traumatic Stress, USUHSHarry 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
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

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

Xianzhang Hu, M.D., Ph.D.
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

Dori Reissman, M.D., MPH, CAPT, USPHS
Medical Director, World Trade Center
Responder Health Program
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

Patcho Santiago, M.D., M.P.H., LCDR, MC,
USN
Assistant Professor
CSTS
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

Janet A. Schmidt, Ph.D.
Senior Scientist
CSTS
F. Edward Hebert School of Medicine
Uniformed Services University

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

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

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, CSTS
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University
James E. McCarroll, Ph.D., MPH
Research Professor
Department of Psychiatry
F. Edward Hebert School of Medicine
Uniformed Services University

The Center develops and disseminates educational resources that address the
behavioral implications of exposure to natural and human made disasters. The
Center often responds in real time to events such as the earthquake in Haiti
providing fact sheets to help first responders and disaster leadership on the ground.
Annual Report 2010 | 23

CSTS 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
Captain 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

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

The Center’s neuroscience research utilizes a rat model of PTSD to better
understand the effects of traumatic stress in the hopes of developing more effective
treatments for service members affected by PTDS and other trauma related disorders.
24 | Center for the Study of Traumatic Stress, USUHS

evidence-based
substance abuse

Traumadisorders

STARRSInterneurons

brain

CSTS

p11
Traumatic brain injury
Weapons of mass destruction
Deployment stress

Disaster recovery
Combat stress Research
Psychosocial Public healthAmygdala

Psychological first aid Epidemiologic
Training
Military psychiatry
Trauma informed care
Disaster psychiatry
PFA
Child maltreatment
Natural disasters
Human made disasters
Translational research
Research
Education
Consultation

Posttraumatic stress disorder

Terrorism

family violence
5-HT2A

Injurycommunication

prevention
treatment
protective
factors

Resilience

Neuroscience
neurobiology

biomarkers

Behavioral health Disseminate knowledge

Combat injury

Body handlingTraumaSuicide

GABA
mTBI

PTSD
TBI
genes Disaster response
Traumatic exposure

Acute stress disorder
Military children

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

Soldiers
Sailors
AirmenMarinesArmy
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