Center for the Study of Traumatic Stress

Leaning Into the Future2023 Annual Report

CONTENTS
From the Director..................................................................................1
Our Mission...........................................................................................3
What’s New in 2023..............................................................................4
Research................................................................................................7
Education and Training........................................................................21
Consultation & Partnerships.................................................................29
Publications.........................................................................................37
Presentations, Interviews and Briefings, Awards and Appointments.....41
CSTS Personnel....................................................................................48
Funded Grants.....................................................................................54
Partnerships.........................................................................................55

With its multidisciplinary and collaborative team ofscientists, educators, clinicians, staff and thought
leaders, CSTS advances its mission, helps sustain
the Nation’s readiness and contributes to the global
community as an internationally renowned Centerin trauma and disaster psychiatry.
— Dr. Robert J. Ursano

From the Director
In its 36th year, the Center for the Study ofTraumatic Stress (CSTS) at Uniformed Services
University (USU) remains dedicated to its mission of
supporting the Department of
Defense (DoD) and the Nationby conducting cutting-edge
research and providing education and consultation aimed at
mitigating the impact of trauma. CSTS is at the forefront ofapplying science-based solutions to address the behavioral
health challenges stemming from trauma, disasters,
terrorism, community violence and public healththreats. The CSTS mission is accomplished throughleadership, research, training, education, service,outreach, collaboration, consultation and global
health engagement.
With its multidisciplinary and collaborative teamof scientists, educators, clinicians, staff and thought
leaders, CSTS advances its mission, helps sustain
the Nation’s readiness and contributes to the global
community as an internationally renowned Centerin trauma and disaster psychiatry. Throughout 2023,
CSTS has continued its core programmatic research
activities, while expanding its scope, launching new
initiatives that underscore the Center’s commitment to evidence-based approaches and proactive
responses to current and future needs. In this way,
CSTS leans into the future supporting DoD and the
Nation.
This year, CSTS began a multi-year partnership with the National Guard Bureau (NGB), Army
National Guard (ARNG) and Air National Guard(ANG) to provide state-of-the-art support in integrated primary prevention and behavioral health for
National Guard (NG) personnel. Additionally, a newresearch partnership with the Defense Advanced
Research Projects Agency (DARPA) explores therole of emotion regulation and cognitive flexibility
in health and performance. The Center also initiateda study funded by the Centers for Disease Control
and Prevention (CDC) focusing on World Trade
Center responders and grief from the 9/11 attacks,
continuing the Center’s contributing to the establishment of the Diagnostic and Statistical Manualof Mental Disorders 5, Text Revision (DSM-5-TR)
prolonged grief disorder diagnosis. Stemming fromthe Army Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study (Army STARRS /STARRS-LS), CSTS researchers continue to develop
and demonstrate the role of machine learning risk
models of suicide in assisting the Defense HealthAgency’s (DHA) clinical and research communities.
Continuing the theme of collaboration, CSTS
Scientists, in collaboration with Harvard University colleagues, initiated a pioneering interagency
research fellowship program with the Department of
Veterans Affairs (VA). The Researcher-in-Residence
Program represents one of the inaugural interagency
endeavors between the DoD and the VA focusing on
the behavioral health of Service members and veterans during the critical transition from active duty toveteran status. Additionally, CSTS Scientists forged asignificant collaboration with the American Psychiatric Association to develop an online education andtraining course, “Disaster and Preventive Psychiatry:
Safeguarding Health and Cultivating Community

CSTS is at the forefront of applying science-based solutions
to address the behavioral health challenges stemming fromtrauma, disasters, terrorism, community violence and publichealth threats.
2023 ANNUAL REPORT | 1

From the Director, continued from page 1

Resilience.” Comprising nine interactive modules,
the course, now available, comprehensively addresses topics related to well-being and resilience in thecontext of disasters.
Amidst global and national crises, CSTS has continued its global and national leadership in providing
outreach and support. The Center maintains strong
ties with colleagues in Ukraine and provides consultation and educational resources for those affectedby the war in Ukraine. The Israel-Hamas War, whichbegan in October 2023, also saw CSTS provide
consultation, research and knowledge tools to thoseaffected. Domestically, CSTS also supported multiple agencies in the US at the federal, state and local
levels in responding to the Maui wildfire disaster andthe tragic shootings in Maine.
Internally, CSTS grew its capabilities and capacities. Expanding on the Amygdala Conference, theBrain, Behavior, and Mind Lecture Series was heldin September. Dr. Ned Kalin, Hedberg Professor andChair at the University of Wisconsin and Editor in
Chief of the American Journal of Psychiatry, gave thelecture. Recognizing the influence and relevance ofmachine learning approaches to psychiatry, CSTS
expanded its internal working group on predictive
analytics. CSTS continued as a core lead of the newly
formed Brain and Behavior Hub of the USU Schoolof Medicine and the specific Hub workgroup on
Stress, PTSD and Health. Understanding the importance of strategic thinking in its research, CSTS
founded and launched the CSTS Strategic Directions
Board, which comprises thought leaders in the fieldsof psychiatry, psychology, public health, clinicalcare and disaster response. Chaired by Dr. Terry
Rauch, the Director of Research and Developmentfor Health Readiness Policy and Oversight at the
Office of the Assistant Secretary of Defense (Health
Affairs), the Strategic Directions Board meets biannually to discuss the latest strategic challenges andopportunities that CSTS can address with its uniquecapabilities.
In 2023, CSTS Scientists published 43 peer-reviewed manuscripts in leading national and international journals. CSTS Scientists also gave dozens
of presentations at conferences and professional
meetings to enhance discussions, collaborations andnetworking, as well as science. Matching the growth
in research initiatives over the last year, CSTS hasgrown its multidisciplinary team and partnershipnetwork. Robust and adaptive teams and partnerships help ensure that CSTS delivers solutions to ourstakeholders.
In this Annual Report, you will find summaries
of new and ongoing activities. CSTS leans into the
future, ready to address challenges and needs of thepresent with a watchful and strategic eye for what
is to come. On behalf of CSTS, I extend our gratitude to colleagues and friends for their support. We
eagerly anticipate the challenges and opportunities
that lie ahead.
Robert J. Ursano, MD
Professor of Psychiatry and Neuroscience
Department of Psychiatry
Director, Center for the Study of Traumatic Stress
Uniformed Services University

The CSTS mission is accomplished through leadership, research,training, education, service, outreach, collaboration, consultationand global health engagement.

2 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Our Mission
CSTS supports the USU Strategic Frameworkand the mission of the DoD. The Center is committed to advancing trauma-informed careand is dedicated to furthering the
Nation’s understanding of
the impact of trauma on
individuals, families
and communities. As
part of our Nation’sfederal medical
school (America’s Medical
School) at USU,
the Center’s
mission iswell-positioned
to rapidly respond to DoD
mission-relevant
activities.
The Center’s
work spans a broad
range of trauma exposures, including combat,
terrorism, natural and human-made disasters, public healththreats, such as the COVID-19 pandemic, and humanitarian operations. CSTS has been in-

CSTS CAPABILITIESCSTS is a multidisciplinary
and multifaceted research center
that possesses the capabilities tostudy psychiatric and psychological phenomena and their sequelae
at the molecular, individual, organization, national and international levels. Our core and focused
capabilities illustrate the key
ways that CSTS ensures relevant
research and consultation for our
stakeholders.

volved in nearly every major disaster our Nation has
faced over the past 36 years. The Center works toensure that behavioral health is addressedin the face of public health threats,disaster planning and disasterrecovery.
Mitigating theeffects of disaster andtrauma in militaryand civilian populations builds
community
and national
resilience. The
Center informs
and educatescommunity,
regional, state,national andglobal stakeholders in government,
industry, healthcare, public health andacademia. CSTS advances trauma-informed care byproviding leadership in research,education, training, consultation, global
health and service.

CORE CAPABILITIES
n

n
n
n
n
n
n
n

Rapid Response to
Psychological Impact ofEmerging Threats
Disaster Psychiatry
Public Health
Laboratory Neuroscience
Translational Science
Randomized Clinical Trials
Applied Military Research
Cutting-Edge Statistics &Methodologies

FOCUSED CAPABILITIES
n
n
n
n
n
n
n
n

Big Data & Machine
Learning
Early Emotional Response
to Trauma & Stress
Event-Related Disorders
Mental Health Sequelae
TreatmentChild & Family
Sleep & Performance(Lab & Field)
Genomics

2023 ANNUAL REPORT | 3

What’s New in 2023
International Support in Disaster Psychiatry
In October 2023, Hamas launched an attack on
Israel, sparking the Israel-Hamas Conflict, which
led to the Israel-Hamas war, that has persisted into
2024. There have been numerous casualties on bothsides, displaced citizens and humanitarian crises.
As a result, exposure to trauma has been extensive.
Responding to this crisis, CSTS developed a webpage providing resources to affected populations,
including Service members, families, health care
workers, aid workers and leaders. Additionally, CSTS
provided consultation to current and former Israel
Defence Forces (IDF) personnel on the psychologicalchallenges of death notifications to surviving family
members, impact of exposure to human remains andstrategies for hostage and prisoner of war reintegration. The CSTS website launched a section entitled, “Israel-Hamas War Mental Health Resources”
following the attacks, which was provided in English
and Hebrew.
The ongoing War in Ukraine has necessitatedcontinued support from CSTS to our Ukraine allies.
Numerous and extensive consultations, educationand partner collaborations have been provided tosupport those affected across many communities.
Two publications with the Five Eyes Alliance Advisory Group on Mental Health have brought attention to the mental health consequences of war in
Ukraine as well as strategies for bolstering resilienceamong groups supporting those affected by the war.
CSTS worked with the Defense Institute of Medical
Operations (DIMO) to support the Ukrainian Armywith combat and operational sustainment guidance.
Furthermore, partnerships with the Walter Reed
Army Institute of Research (WRAIR) and Harvard
University have continued to support Ukrainian
mental health leaders and providers.

New Partnerships
An exciting new project commenced in the summer with the Defense Advanced Research Projects
Agency (DARPA). CSTS partnered with DARPA to
4 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

establish the Emotion Regulation and Cognitive
Flexibility Program (ERCFP). Emotional regulationand cognitive flexibility have been shown to bestrong protective factors that bolster psychologicalhealth and performance and ameliorate the negative
impact of trauma. Supporting the DARPA STRENGHTEN (Strengthening Resilient Emotions and Nimble Cognition Through Engineering Neuroplasticity)
initiative, CSTS fulfills the role of the Independent
Verification and Validation (IV&V) team and works
closely with researchers from Columbia University, Harvard University’s McLean Hospital, and the
University of Wisconsin. CSTS provides expertise,
ensuring a cutting-edge research strategy, design andmethodology and milestone achievement. Additionally, CSTS ensures that resulting interventions from
ERCFP are applicable and relevant to military andveteran populations.
CSTS began a multi-year partnership with the
National Guard Bureau (NGB), Army National
Guard (ARNG) and Air National Guard (ANG) to
help develop, maintain, evaluate and consult for
two new large-scale programs designed to bolster
National Guard (NG) members’ psychological healthand resilience. The Integrated Primary Prevention
Workforce (IPPW) program supports last year’s
DoD Instruction 6400.11—DoD Integrated Primary
Prevention Policy for Prevention Workforce andLeaders. CSTS supports the implementation andassessment of Comprehensive Integrated Primary
Prevention plans throughout the NGB and its 54
states and territories in both the ARNG and ANG.
CSTS support of the ARNG Behavioral Health (BH)
program consists of working with ARNG BH leaders
to leverage evidence-based practices that standardize behavioral health practice and policy across the
54 states and territories.
The Army Study to Assess Risk and Resiliencein Servicemembers (STARRS) research team, incollaboration with our partners at Harvard, haspioneered a groundbreaking interagency research
fellowship program with the VA. The VA/STARRS-LS Researcher-in-Residence Program aims to explore
research-based solutions for Service members vulnerable to suicide as they transition from active duty
to veteran status. Notably, this marks the inceptionof the first-ever DoD-VA research fellowship program specifically addressing this critical researchgap. Commencing in 2023, the VA/STARRS-LS
Researcher-In-Residence Program has welcomed two
VA research scientists who will collaborate part-timewith STARRS-LS researchers for a two-year term.
Dr. Emily Edwards from the Bronx, New York VA,
and Dr. Claire Houtsma from the Southeast Louisiana Veterans Health Care System are the inaugural
Researcher-in-Residence fellows. Over the next five
years, this program will annually integrate two new
VA Researchers-in-Residence. For further details,
please refer to the VA’s Health Services Researchand Development website featuring the Researcher-in-Residence Program: VA/STARRS-LS Researcher-in-Residence Program.

video simulations; Brain Hijack podcast on drivers ofsuicide risk; and Supporting Our Shipmates projectwith the US Coast Guard (USCG).

Strategic Directions Board

Suicide Prevention Projects
Last year, CSTS’ Suicide Prevention Program(SPP) implemented unique and evidence-based
resources to address suicide and related risk factors
at the individual, peer, organizational and leadershiplevels. These resources were developed in partnership with the DoD and academia. The SPP deliveredresources that transition research into actionable,easy-to-implement resources for multiple populations affected by suicide and its concomitant risk
factors. These resources include: the Mental PushUps mindfulness application; Safe Is Strong education materials for providers; Warrior Mindset video
on resilience in combat scenarios; Project Safeguardlethal means and voluntary reductions in firearms
access initiative; the Suicide Prevention Essentials
Course; Let’s Talk About Your Guns podcasts; Psychiatry Electronic Modules on suicide risk assessment; Bereavement Adaptation Interactive tool; theFamily Survivor Self-Care toolkit; Finding the Words

In 2023, CSTS established its Strategic Directions Board. The Board assists the Center by
providing strategic guidance to enhance and expand CSTS global leadership in trauma-informed
research, education and consultation relevant to
the DoD and the Nation. The Board meets biannually and reviews current Center activities and its
operational and strategic direction with a focus on
ensuring the Center is prepared to meet emerging
threats, gaps and opportunities. Dr. Terry Rauch
serves as the Board’s Chair. Dr. Rauch is the Director for Medical Research and Development, Health
Readiness Policy and Oversight, Health Affairs, US
Department of Defense. Board members include:
Dr. Amy Adler, Senior Scientist, Center for Military Psychiatry and Neuroscience, Walter Reed
Army Institute of Research; Rear Admiral Matthew
Kleiman, Assistant US Surgeon General, US Public
Health Service Commissioned Corps; Dr. Harvey
Pollard, Department of Anatomy, Physiology andGenetics, Uniformed Services University; Dr. Rudy
Rull, Principal Investigator, Millennium Cohort
Study, Department Head, Deployment Health2023 ANNUAL REPORT | 5

Research, Naval Health Research Center; Dr. Paula
Schnurr, Executive Director, National Center for
Posttraumatic Stress Disorder, Department of
Veterans Affairs; Delores Johnson Davis, Federal
Executive Retired; Rear Admiral (Retired) Dr. Dori
Reissman, US Public Health Service Commissioned
Corps; Dr. David Riggs, Director, Center for Deployment Psychology, Uniformed Services University; and Lieutenant General (Retired) Dr. Eric
Schoomaker, Former US Army Surgeon Generaland Commanding General of the US Army Medical
Command.

Machine Learning & Predictive Analytics
This past year CSTS has expanded its capabilities and capacities in the machine learning and predictive analytics application of precision psychiatry.
Building on the foundational research conductedin the Army Study to Assess Risk and Resiliencein Servicemembers (Army STARRS), CSTS scientists supported calls from military health systemsenior leaders to work with the clinical and research communities to operationalize suicide risk
models that eventually can be utilized in clinicalcare. Specifically, three risk models have been
advanced: high risk—predicting suicide post-psychiatric hospitalization in order to target enhanced
case management for Service members at highest
risk; moderate risk— predicting suicide in Service
members in outpatient behavioral health care whoare diagnosed with suicide ideation but the clinician determines that risk is insufficient to warrant
immediate hospitalization; low risk—predicting
suicide in Service members who screen positive
for suicide ideation in outpatient health care (e.g.,annual physical). Furthermore, recognizing theimportance and utility of machine learning in psychiatry, CSTS established its own internal working
group on machine learning and predictive analytics. The goal of this working group is to train on
and master cutting- edge statistical approaches tomachine learning and predictive analytics. Developing fluency ensures that CSTS can focus stateof-the-art statistical approaches to CSTS research
priorities.

6 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Global Behavioral Health Community ‘Tracks’Initiative
In 2023, the USU Department of Psychiatry andthe CSTS team initiated the DoD Global Behavioral
Health Community initiative, a groundbreaking effort
uniting clinicians, educators, operational leaders andresearchers across the DoD psychiatry community andbeyond. Monthly meetings convene stakeholders fromfour distinct tracks: Clinical, Operational and Leadership, Academia and Teaching, and Research.
The Clinical Track focuses on delivering optimalcare to military personnel and families while fostering resilience and well-being across the armed forces.
Through a collaborative and interdisciplinary approach, participants receive training on critical topics
including posttraumatic stress disorder (PTSD), suicide prevention, disaster psychiatry, and the diagnosis
and treatment of mental disorders in diverse military
settings.
The Operational and Leadership Track provides aplatform for global tri-service operational psychiatry,offering networking, mentorship and education. This
inclusive forum encourages dialogue across ranks andoperational contexts, emphasizing resource maximization and psychological readiness while aligning withmilitary mental health policies and readiness protocols.
The Academia and Teaching Track nurtures excellence, collaboration, innovation and diversity in academic psychiatry. Participants engage in discussions
and workshops focused on teaching, scholarship, career management and diversity, equity, inclusion andjustice (DEIJ) initiatives, fostering an interconnected
network dedicated to educational advancement.
The Research Track fosters collaboration and innovation among researchers within and beyond the USU
network, promoting dialogue between clinical andpre-clinical researchers in DoD psychiatry. Throughhighlighting cutting-edge research and facilitating collaboration opportunities, this track advances scientificdiscourse aimed at enhancing the psychological healthand performance of the warfighter.
To join one or more of our community tracks,
please visit: https://docs.google.com/forms/d/e/
1FAIpQLSeapPq7G2BOYFh52l_qnWPd2gUcO9bsLgsj92U6KQQLAH6EuQ/viewform

Research
RESEARCH ON US SERVICE MEMBERS
Study to Assess Risk and Resilience inService Members — Longitudinal Study(STARRS-LS)[The continuation of the Army Study to Assess Risk
and Resilience in Service Members (Army STARRS)
research]

Since 2009, CSTS has provided scientific leadership, project management and financial oversight for
the STARRS research programs active duty Soldiers.
Army STARRS (2009-2015) and STARRS-LS (2016onward) use state-of-the-art data collection methodologies and machine learning and predictive analytics designed to help the Army and DoD address thelong-standing problem of suicide and understandand predict suicide and suicide-related behavior.
Both Army STARRS and STARRS-LS involve a
collaborative, multidisciplinary effort that includes USU, the University of California, San Diego(UCSD), Harvard Medical School and the Universityof Michigan.
Army STARRS was composed of a series of distinct but integrated studies, including large, representative samples of Soldiers and targeted cohort
studies, designed to comprehensively examine themental health and resilience of active duty Soldiers,
including Regular Army, ARNG and activated Army
Reserve. These studies included the Historical Administrative Data Study (HADS), which uses a vast
range of existing Army/DoD administrative data for
all Soldiers (more than 1.6 million) on active duty
from 2004-2009. Army STARRS also involved collecting data directly from a combined total of morethan 100,000 active duty Soldiers throughout the US
and overseas. The research included administering

questionnaires, conducting neurocognitive tests, collecting blood samples and performing a broad rangeof data and genetic analyses.
Under STARRS-LS, the research team has continued and enhanced the Army STARRS research by
expanding the sample size, extending the follow-up
period, further developing the STARRS platforms
and systems and conducting additional data analysesof Army STARRS and STARRS-LS data. STARRSLS expanded the size and extended the duration of
the HADS historical cohort by including additional
Soldiers and obtaining an additional twelve yearsof Army/DoD administrative data for the period of
2010-2021. This study now includes all active duty
Soldiers (more than three million) across the eighteen-year period of 2004-2021. For the STARRS-LS
longitudinal cohort, the research team has been locating, re-contacting and collecting survey data every
two years from a representative sample of approximately 15,000 Army STARRS participants. A total offour waves of survey data collection were conductedto continue following the cohort over an eight-year
period. Additional waves of follow-up survey datacollection are being planned for 2024 and beyond.
During STARRS-LS, the Army and DoD added
the VA as a partner. Over the long duration of thefollow-up period, a majority of the participants haveseparated from the Army and transitioned to civilian
life. The STARRS research team has been collaborating with VA scientists on subgroups and outcomesof importance to the VA. In 2023, the Army and
DoD continued to use STARRS findings and knowledge to develop products such as reports, publications, leadership tools and risk mitigation strategies.
The STARRS research has informed the VA suicide
outreach program for post-hospitalization intervention. The STARRS research team is also one of theleaders in the nation at demonstrating the value ofmachine learning and predictive analytic models as
clinical care tools.
Approximately every six months, the teamcontinued to brief the progress and findings of the2023 ANNUAL REPORT | 7

research to senior DoD, Army and VA leadership,including the Assistant Secretary of Defense for
Health Affairs, the Assistant Secretary of the Armyfor Manpower and Reserve Affairs and the Deputy
Chief of Research and Development for the VA.
Throughout 2023, the research team published
important and potentially actionable findings forthe DoD, the Army and the VA. At the end of 2023,
the research team had 127 STARRS publications inhigh-impact, peer-reviewed scientific journals.

Psychological Stress and Resilience in
Mortuary Affairs (MA) Soldiers: Longitudinal
Study
US Army MA Soldiers recover, identify and evacuate the remains of the deceased from the theaterof war, disasters and other mission sites. They area unique population of Soldiers who are exposed
to death, deployment-related stress and work in
combat and other extreme environments. CSTS
longitudinal research of MA Soldiers represents thelongest ongoing study to examine the individual,
unit and family stressors, risk factors and resiliencyof MA Soldiers. The study includes quantitative datacollected through questionnaires, qualitative datacollected through semi-structured interviews andsaliva samples, which will be analyzed for potential
DNA- and RNA-related biomarkers of stress andresiliency. Questionnaires are group-administered
to MA detachments approximately one week before
and after deployment to the Middle East. Empirical

MSgt Moore, Nur Bookwala & Dr. Quinn Biggs,
JMAC, Ft Gregg-Adams, VA.
8 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

and descriptive data are collected on factors suchas PTSD, depression, distress (e.g., anger, hostility,
somatization), substance use and instrumental andemotional support.
In 2023, Reserve MA Soldiers from the 673rd
Quartermaster (QM) Company (CO) (Newark,
Delaware) and active-duty MA Soldiers from the54th QM CO (Fort Gregg-Adams, Virginia) participated in the study by completing deployment-related questionnaires. In total, 92 questionnaires werecollected in 2023. Overall, the study questionnaire
has been administered 85 times and 3,972 questionnaires have been collected since the study began in
2005. Data analyses in 2023 included an examinationof change in rates of probable PTSD and depression
over time (15-year period from 2005 to 2019) among
Soldiers who had and had not previously deployed to
the Middle East, as well as an examination of initialemotional responses to exposure to human remains.
A manuscript reporting study findings is in process
for publication in a scientific journal. Findings from
the MA study target resiliency, preparation, training
and education of Soldiers for the stressors of deployment and work with the deceased.

Troop Education for Army Morale (TEAM)TEAM is a novel stress management and resilience-building early intervention program designed
to improve readjustment after deployment. It has
been offered to US Army MA Soldiers, a groupat high risk for psychological distress due to their
exposure to human remains and the combat environment. The TEAM intervention is based on thefive evidence-informed principles of PsychologicalFirst Aid (PFA): safety, calming, connectedness,
self-efficacy and hope/optimism. TEAM is delivered through four group workshops, informational
handouts, a dedicated website and phone and email
support services. A total of 125 MA Soldiers in 10
cohorts participated in a randomized controlled trial
study of TEAM. Although the intervention did not
reduce rates of PTSD, higher workshop participation
was associated with fewer posttraumatic symptoms
and higher satisfaction with the TEAM program. Of
the variety of skills that the trainings offered, calming (relaxation training) and problem solving weretwo of the skills reported to be most helpful. During
the COVID-19 pandemic, TEAM intervention materials were adapted for an online format using videoconferencing and sharing materials electronicallywhen individuals were not able to meet in person.
The online intervention content can be posted ona dedicated website for 24/7 access or delivered
through group sessions at specified intervals (e.g.,
once a week). The online adaptation of TEAM
broadened the application of the intervention foruse in a variety of military and civilian populations,
including first responders, disaster workers, medical
personnel, mortuary personnel and others who areexposed to human remains.

four PTSD subscales (intrusion, avoidance, negative
cognition, hyperarousal) were disseminated in a poster presentation at a national scientific conference. In
addition, findings on time-of-day variation in PTSD
subscales were disseminated in a poster presentation
at the Military Health System Research Symposium. A manuscript reporting study findings of daily
variation in suicidal ideation frequency and intensity
is underway for publication in a scientific journal.
The Daily Diary Study represents the cutting edge in
psychological assessment methodology, measures,
equipment, technology and research design to better
understand posttraumatic stress symptoms and improve the well-being of Service members.

Ecological Momentary Assessment (EMA)
of Posttraumatic Stress Symptoms in US
Military Service Members (Daily Diary Study)

Firearm Behavioral Practices in US Army
Service Members and Veterans

The Daily Diary Study uses a novel EMA methodology to assess in real time the changes in posttraumatic stress symptoms of US Service members.
The research is designed to examine the relationshipbetween variability in posttraumatic stress symptoms and psychiatric disorders, sleep, health risk
behaviors (e.g., alcohol and tobacco use), pain andother areas of health and functioning. Study participants completed daily assessments of posttraumaticstress symptoms four times per day for 15 consecutive days on electronic tablets, using a sophisticatedsoftware application that was developed specificallyfor use in this study. Psychiatric disorders (e.g.,
PTSD, depression) were assessed at baseline and inone- and three-month follow-up assessments. Participants had the option to wear a wrist actigraph toobjectively measure sleep and complement self-reports of sleep during the 15-day assessment period.
Participants also had the option to donate saliva
and/or blood samples for genetic analysis to identify
potential genetic biomarkers and gene-environment
interactions that may distinguish and/or mediate
stress responses and resilience to stress-related disorders. In total, 187 participants have been recruitedsince the study began.
Data analyses in 2023 included examination ofwithin-day variation in posttraumatic stress symptoms. Study findings on within-day variation in the

The annual firearm suicide rate increased 11%
from 2019 to 2022, reaching epidemic proportions in
the US, according to a recent report from the Center
for Disease Control and Prevention (CDC). In 2023,
CSTS Scientists and collaborators from Harvard
University and University of South Florida (USF)
completed an R01 grant funded by the CDC to study
firearm behavioral practices and suicide risk in US
Army Service members. The study objective was todevelop an understanding of Service members’ firearm behavioral practices and suicidal behaviors, andto identify actionable targets for suicide intervention

Daily Diary Study recruitment.
2023 ANNUAL REPORT | 9using data from the Army STARRS and STARRSLS. The broader impact of this study is the development of a comprehensive understanding of risk andprotective factors of firearm-related suicide, thus
improving risk identification capabilities in militaryand civilian populations.
CSTS, the USF and Harvard University Scientists
presented at the 2023 National Research Conference on Firearm Injury Prevention in Chicago, IL, todisseminate research findings. Key findings presented focused on the unsecure (loaded and unlocked)
storage of a personal firearm or other weapon andthe increased lifetime and past-year risk of suicide
ideation. Of note, carrying a weapon other than agun predicted lifetime and past-year risk of suicide
ideation and attempt after controlling for history of mental disorders and lifetime interpersonal
violence. These findings suggest that secure storage
interventions (for firearms and other weapons) may
have the potential to alter suicide risk among Service
members with personal firearms in their homes.
Gun ownership for safety/protection and history ofgeneralized anxiety disorder significantly predictedunsecure storage practices, which may be related
to perceptions of safety. Finally, state-level policies
were significantly associated with lower odds ofsuicide death resulting from a firearm injury. To ourknowledge, this is the most extensive examination todate of the association of firearm variables with bothsuicide attempt and death in a large, longitudinalmilitary sample. Findings from this study have significant public health relevance in terms of improving
our understanding of how and why firearm ownership is related to suicidal behavior
in US Army
Servicemembers.
Further, ourfocus onpsychological variables
that may
impact theassociation
10 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

between suicide and firearm ownership may shedlight on intervention targets in this population andmay generalize to the civilian population as well.

Emotion Regulation and Cognitive Flexibility
Program (ERCFP): Targets for Improving
Psychological Health and Enhancing
Performance
In partnership with DARPA, CSTS establishedthe Emotion Regulation and Cognitive Flexibility
Program (ERCFP) to advance our understandingof emotion regulation (ER) and cognitive flexibility (CF), two key protective factors that promote
psychological health and buffer against the negative
effects of traumatic stress. The ERCFP supports
research investigating the neural, cognitive, affective
and behavioral correlates of ER and CF, with the goalof developing treatments targeting ER and CF to improve psychobiological functioning in Service members. Through this partnership, CSTS is serving as
the Independent Verification and Validation (IV&V)
team for DARPA’s STRENGTHEN (Strengthening
Resilient Emotions and Nimble Cognition ThroughEngineering Neuroplasticity) program, which
launched in 2023. Under STRENGTHEN, threeteams, led by researchers from Columbia University,
Harvard University-affiliated McLean Hospital, andthe University of Wisconsin–Madison, are developing novel hybrid interventions that combine brainbased techniques (e.g., transcranial magnetic stimulation) with behavioral treatments (e.g., cognitive
behavioral therapy) to optimize the neural circuitry
underlying ER and CF.
As the IV&V partner for STRENGTHEN, CSTS
provides ongoing review of each team’s researchstrategy and evaluates their progress toward program milestones. CSTS works closely with DARPA
and the research teams to provide consultation andsupport in study design, methodology and areas ofsubject matter expertise. As the DoD transition partner, CSTS is pursuing efforts to ensure STRENGTHEN interventions can be efficiently researched andscaled in military and veteran populations. To thisend, the ERCFP has established a science panel to facilitate the advancement of STRENGTHEN findings
into future research and clinical efforts.

Research on Reserve Components of the US
Armed Forces
National Guard Programs
In late 2023, CSTS began collaborations with the
National Guard Bureau (NGB) in two project areas:
Warrior Resilience and Fitness-Integrated Primary Prevention (IPP) and ARNG Behavioral Health.
CSTS is supporting these cutting-edge initiatives in
the following areas: strategic planning, data management, training and education, knowledge products
development and dissemination, and consultation to
54 states and territories.
The Integrated Primary Prevention project aims
to shape and implement a full-time integrated primary prevention program within the 54 states andterritories to increase readiness of all people througha holistic approach for primary prevention of self-directed harm and prohibited abusive or harmful acts.
Looking ahead, the CSTS IPP team is preparing
for engagements with the 54 states and territories
regarding their Comprehensive Integrated Primary
Prevention Plans development, implementation andevaluation processes.
The ARNG program aims to optimize behavioral health readiness among the ARNG, increase
access to care and increase quality of care throughstandardization of evidenced-informed practices,
policies and community partnerships. CSTS ARNG
BH team is preparing for engagements with key
stakeholders in the ARNG BH community and forparticipation in the annual BH training event for the
54 states and territories. We look forward to expanding our work in 2024.

National Guard and Reserve Longitudinal
Study
The Mental Health and Service Utilization
among Reserve and NG forces study was conductedin collaboration with Dr. Sandro Galea at Boston
University. It addresses the epidemiology and trajectory of mental health problems, deployment stress,
health risk behaviors and health care utilization overa four-year period among Reserve Component (RC)members. Using a representative national cohort of
2,003 RC members, CSTS has been actively analyz-

ing this comprehensive dataset.
In 2023, the Center examined the associationof suicide risk with a variety of adversities faced by
RC members who transitioned out of the Service.
Five types of adversities were identified: health, job/
employment, interpersonal, financial and healthcare access adversities. Transitioning out of Service
and adversities both increased the risk for suicide
ideation. In particular, experiencing an adversity
increased the risk for suicide ideation regardlessof separation status, and separation from Service
further increased risk among those who experienced
an adversity. These results suggest that transitioning
from military to civilian life may be a critical period
for interventions to address the unique needs of theRC’s citizen-Soldiers and reduce their suicidal risk.

New York National Guard (NYNG) Warfighter
Readiness and Resilience Assessment:
COVID-19 Activation
The US National Guard (NG) served as a critical component of the Nation’s response to the
COVID-19 pandemic. Identifying, monitoring andunderstanding resilience and risk factors associatedwith mental and behavioral health outcomes in NG
Service members who were activated in response to
the pandemic is central to sustaining force readinessand preparing for subsequent disasters. To address
the immediate need for information to promote
force well-being and readiness, CSTS collaborated
with the NYNG to develop a rapid public healthsurveillance assessment, which was completed byalmost 4,000 NYNG Service members between
August and December 2020. The assessment identified high stress work tasks, personal COVID-19-related experiences, stressors and concerns, resilience
factors and psychological and behavioral healthresponses among NG Service members who did anddid not activate during the pandemic.
In 2023, Center Scientists conducted examinations that identified: (1) the association of unit cohesion and leadership support with post-activation
PTSD, clinically significant anxiety and depression
symptoms and problematic anger; (2) COVID-19-related concerns, strategies to help manage stress, theextent of sleep difficulties and increased substance
2023 ANNUAL REPORT | 11use, including alcohol, tobacco and caffeine/energy
drink consumption during the pandemic; (3) the
relationship of high stress COVID-19 disaster worktasks to PTSD, anxiety and depression and anger;and 4) the influence of personal COVID-19 experiences (i.e., the individual or a close friend or family
member testing positive for COVID-19 or experiencing the loss of a close friend or family member
due to COVID-19) on psychological responses.
Study findings will inform recommendations forleadership to promote mental and behavioral healthand readiness among NG personnel during and following disaster response.

identify factors that are important to recovery fromnatural disasters. This important research continues to inform action-oriented recommendations
for disaster responders and community members,
including community-level interventions, programs
focused on social and workplace support and strategies to promote resilience during and following
disaster exposure.

RESEARCH ON DISASTERS ANDTERRORISM
Natural Disasters Health Response toMultiple Hurricanes
In 2023, CSTS Scientists continued to examine
psychological and behavioral responses following
natural disasters, including psychological distress,
posttraumatic disorders, health risk behaviors andfunctional/occupational impairment. In particular,
the Center examined predictive factors that influence recovery and resilience following disaster exposure, which can be targeted for preventive interventions in first responders who are exposed to multiple
disasters. This work is particularly important globally, as the world experienced a wide range of natural
disasters during 2023, with a significant increase inthreats to and loss of life and economic impact. In
the US, these events resulted in the National Oceanic and Atmospheric Association (NOAA) identifying
2023 as a record year for billion-dollar disasters,
including devastating wildfires in Hawaii, Hurricane
Idalia in Florida, Tropical Storm Hilary in southern
California, severe drought in the South and Midwest
and extreme record-breaking heat in several US
states during the summer. Internationally, disaster events, such as Cyclone Freddy in Madagascar,
severe flooding in African, South Asian and SouthAmerican countries, earthquakes in Turkey and Syria and wildfires in Chile were significant indicatorsof extreme weather and natural catastrophes.
During 2023, Center Scientists continued to
12 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

RESEARCH IN THE CHILD AND FAMILYPROGRAM (CFP)The CFP conducts research to better understandthe needs of all children and families affected bytraumatic events, with special emphasis on the needsof US military families. Although military children
and families possess unique strengths, they can beaffected by combat-related illness and injury, bereavement, child maltreatment and family violence.
Currently, there are six CFP project areas: bereavement, child maltreatment, combat-injured families,
family violence, suicide prevention in families andtargeting family risk associated with unsafe firearm
storage practices. In addition to CSTS-based work,
the CFP maintains collaborative relationships withother departments at USU, other academic institutions and community organizations. The products of
CFP’s research program inform scientists, clinicians
and the general public about the impact of stressand trauma on children and families. CFP’s pioneering research is also translated into actionable andeducational materials for military and government
stakeholders, clinicians and community leaders. In
addition, CFP consults with military and government

have informed development of diagnostic criteria
for a condition of impairing grief. CSTS partneredwith colleagues at Columbia University, New York
University, University of Pittsburgh and UCSD todevelop a proposal for criteria for prolonged griefdisorder, a new diagnosis included in the DSM-5-TR.
A recent publication by CSTS Scientists reported
increased rates of both ill-defined conditions andmental health diagnoses and health care utilization
following bereavement. These findings suggest aneed for proactive health monitoring of military widows to identify and treat mental health conditions
and recognize manifestations of physical symptoms.
In addition, another analysis examined the influenceof adverse childhood experiences on grief adaptation
in bereaved military family members.
Dr. Joscelyn Fisher poster presentation at ISTSS
annual meeting.
leadership, informs national media outlets and conducts research that promotes a deeper understandingof children in the US and throughout the world.

Bereavement
Grief and Health-Related Quality of Life inWorld Trade Center 9/11 Survivors Study
An ongoing CFP project examines outcomes
associated with trauma and bereavement in 9/11
Survivors (individuals who worked or lived at ornear the World Trade Center site in New York City
on 9/11). Using existing and newly-collected data,
we are examining the complex inter-relationships
of bereavement burden and physical and mental
health burden in order to better inform World Trade
Center Health Program programming. This projectis being conducted in collaboration with colleagues
at Columbia University, the World Trade Center
Health Registry and Voices Center of Resilience.

The National Military Family Bereavement
Study (NMFBS)
The NMFBS is the first large, systematic study
to examine the impact of US military Service member’s death on surviving family members. Findings

Stepping Forward in Grief (SFG) Study
An online program that addresses grief adaptation may be a helpful resource for bereaved militaryfamily members. CFP formed a partnership with theCenter for Prolonged Grief at Columbia University
to adapt principles from Complicated Grief Therapy(CGT), found to be helpful in civilian populations, for a digital intervention aimed to assist withgrief integration and decreaserisk for long-term problems.
The goal of SFG, a randomized
controlled trial, was to compare
the effectiveness of two digitalprograms (GriefSteps and WellnessSteps) in helping
those bereaved by military service-related death. Results indicated that there were small, but statisticallysignificant, improvements in grief and in functional
impairment among those in the high grief group.
These results indicate that a novel modality, requiring little oversight or cost, can markedly increase theability to reach bereaved family members.

Study of Long-Term Outcomes of TerrorismRelated Grief
The CFP partnered with Voices of September
11 (VOICES), a nonprofit organization that aids
9/11-affected families, and the Canadian Resource
Centre for Victims of Crime (CRC), an organization
2023 ANNUAL REPORT | 13

supporting family members who were bereavedby the Air India Flight 182 bombing, to investigate long-term bereavement outcomes in family
members following a terrorism-related death. The
team published two manuscripts in 2023. The firstmanuscript identified three groups of bereaved
family members that were differentiated according
to patterns of depression, anxiety and grief. The
second manuscript examined the effects of receiving multiple notifications about the identificationof fragmented remains of a family member. Results
indicated that multiple notifications were differentially associated with posttraumatic stress, but notgrief severity. Results from this publication werealso described on the International Society forTraumatic Stress Studies’ (ISTSS) Trauma Blog andwere used to develop an interactive fact sheet for
health care providers about death notification within
health care facilities. A more recent analysis of thesedata examined predictors of co-occurring pain andcomorbid psychiatric conditions in family membersof 9/11 victims.
Bereavement Coping Study
The goal of this study was to determine whether
military family survivors of suicide, accident andcombat deaths use similar or different coping strategies and to examine associations between risk factors, specific coping strategies and grief, depression

and suicidal ideation. This information will identify
actionable targets for intervention programs. A
related publication from this study used data fromthe NMFBS to examine differential contributionsof specific coping strategies and their relationships
with cause of death in contributing to grief severity,
depression and posttraumatic growth.
Disenfranchised Grief
Through its collaborations with Sons and Daughters in Touch (SDIT), an organization of children
whose fathers died or were MIA in the Vietnam War,CFP noted the consistency with which this population felt their loss was unacknowledged or rejected.
This phenomenon is consistent with the concept ofdisenfranchised grief (DG), which refers to the experiences of bereaved persons whose grief was not or
could not be openly acknowledged, publicly mourned or socially supported by others. CFP is conducting research on DG, which includes developing ameasure of DG.
Child Maltreatment in US Military Communities
and Families
Another focus area of the CFP involves the identification of risk factors for child maltreatment inmilitary families. The goal of this work is to informprevention and intervention strategies that promote
military family health, well-being and resilience.
CFP’s initial work in this area primarily focusedon child neglect, the child maltreatment type mostcommonly reported in the US and most frequently
associated with child fatality. CFP Scientists also
conducted a congressionally mandated study designed to advance understanding of risk and protective factors for all types of child maltreatment inmilitary families.

Combat-Injured Families
CFP Scientists conducted three studies to examine the impact of combat injury on military families.
These studies included families participating in
Operation Purple Healing Adventures (OPHA), an
annual summer camp program for combat-injured
Service members and their families sponsored by

14 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

the National Military Family Association (NMFA),
families of patients at Walter Reed National Military Medical Center (WRNMMC) and San Antonio
Military Medical Center affected by combat injury
and families participating in “Families OverComing
Under Stress-Combat Injury” (FOCUS-CI), a family-centered, strength-based and evidence-informed
preventive intervention. A recent publication in Depression and Anxiety described the impact of combat
injury and military deployment on mental healthsymptoms in a sample of military wives. The aim of
CFP’s work in this area is to help us better understand the impact of combat injury on Service members and their families and inform interventions that
more effectively address their needs.

Family Violence
In 2023, CSTS continued its focus on supporting
the Army Office of the Deputy Chief of Staff (DCS)
G-9. We attended the Army Family Advocacy Program (FAP) annual Fatality Review Board (FRB) ofviolence-related deaths in the Army, including suicides, of children and adults and drafted the annual
FRB report. This report summarized the characteristics of child abuse and neglect-related fatalities,
intimate partner violence-related fatalities andlongitudinal analyses of trends. We also reviewed
recommendations for prevention and treatment ofmaltreatment-related fatalities in the Army.
We continued publishing our Research Review,a publication of research-based information for the
Army FAP community. We focused on: (1) Nonfatal
Firearm Violence: Threats and Injuries in Families;(2) Recantation of Adult Domestic Abuse: What it
Means for the Army Family Advocacy Program; (3)Food Insecurity: Effects on Health and Family Stress;and (4) Preventing Ineffective Arguing, Verbal Altercations and Verbal Aggression.
CSTS continued to provide the FAP with quarterly statistical data monitoring of installation-level
FAP report changes throughout 2023. These briefing books are specific to 40 different Army installations and geographic areas with comparisons of
installation/area-level data to the entire Army. Data
reported included the number of incidents of abuse(physical, emotional and sexual) and neglect of chil-dren. Data on adults were provided by the Defense
Manpower Data Center.

Targeting Family Risk Associated with
Unsafe Firearm Storage Practices
Unsafe firearm storage (e.g., maintaining household firearms unlocked and loaded) has been associated with suicides, accidents and family violencein both military families as well as families in thegeneral US population. Continued noncompliancewith safe storage recommendations combined withpersistent rates of firearm-related suicide in military Service members suggest that risk factors for
unsafe firearm storage and effective lethal means
safety strategies have not been fully delineated.
This project proposes that existing efforts to reduce
lethal means access in military and veteran families
have not adequately addressed family-level attitudes
and behaviors that may promote unsafe firearm
storage, including: (1) the intergenerational effectsof firearm storage (or firearm family socialization);(2) general family home safety practices; (3) adultfamily member shared decision-making regarding
firearm storage; and (4) parental misunderstandingof children’s motivations. This study will determine
patterns of family-level behaviors and attitudes associated with unsafe firearm storage practices among
military-connected families with children.
2023 ANNUAL REPORT | 15

RESEARCH IN NEUROSCIENCE AND
NEUROBIOLOGY
Trauma-Related Disorders Research
Genetics and Biomarkers
Post-traumatic stress disorder (PTSD) remains
a complex and devastating trauma-related disorder,
with its exact molecular mechanisms eluding scientific understanding. Emerging research points towards FK506-binding protein 5 (FKBP5) as a crucial
player, functioning as a negative-feedback regulatorof the glucocorticoid receptor (GR). This association
potentially links stress hormone signaling to mitochondria in PTSD, offering a novel avenue for exploration. In 2023, the Center undertook a thoroughinvestigation of this hypothesis, employing a multifaceted approach that integrated pharmacology,
bioinformatics and mass spectrometry techniques.
The primary focus of the investigation was tounveil the intricate molecular interactions involving
FKBP5 within mitochondria, unraveling the potential links between glucocorticoid signaling andmitochondrial functions in the context of PTSD. The
comprehensive analysis delved into diverse aspects,
including the Kyoto Encyclopedia of Genes andGenomes (KEGG) pathways, biological processes
and molecular functions associated with FKBP5. The
findings, derived from the application of fold change
cutoff values, revealed a spectrum of differentiallyexpressed genes within mitochondria. Both upregulated and downregulated FKBP5-associated proteins
were identified, contributing to the delineation of
distinct protein-protein interaction networks within
this crucial cellular organelle. Notably, the investigation identified a significant over-representation of
KEGG pathways, biological processes and molecularfunctions linked to FKBP5, emphasizing its potential
role in mitochondrial dynamics in the context of
PTSD.
A pivotal discovery was the observation of
FKBP5 overexpression in the mitochondria of whiteblood cells in Service members diagnosed with
PTSD. This significant finding not only supports the
hypothesized link between FKBP5 and stress-related
responses, but it also suggests a potential role for
16 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

FKBP5 and its associated proteins as biomarkers for
PTSD. The identification of these molecular markers
could revolutionize diagnostic approaches and contribute to a deeper understanding of the underlying
biological processes associated with PTSD.
The integration of bioinformatics approaches
allowed us to uncover intricate relationships andpatterns that might have remained obscured using
traditional methodologies. The data derived fromthe investigation shed light on the complex interplay
between glucocorticoid signaling and FKBP5 within
mitochondria, providing valuable insights into themolecular landscape of PTSD.
In conclusion, CSTS’s 2023 investigation has
significantly advanced the understanding of themolecular mechanisms underpinning PTSD. The
identification of FKBP5 and its associated proteinsas potential biomarkers marks a crucial step toward
developing targeted interventions and diagnostic
tools for individuals grappling with stress-relateddisorders. The findings not only contribute to thescientific discourse surrounding PTSD, but also
open avenues for further research and therapeutic
development in this critical area of mental health.

Nightmare Deconstruction and Reprocessing
for Treatment of PTSD-Related Nightmares
Nightmares are a highly prevalent re-experiencing symptom after trauma. For many patients,nightmares and insomnia are highly debilitating
re-experiencing symptoms of PTSD, and too often
the symptoms persist even after successful evidence-based treatments. Sleep disturbance and associated fatigue represent a threat to readiness. CSTS
completed a pilot trial of Nightmare Deconstruction and Reprocessing (NDR), an exposure-based
psychotherapy for trauma-related nightmares andinsomnia. NDR is an adaptation of the Hill cognitive-experiential model for working with dreams in
psychotherapy. Working with their therapists, patients recall their most distressing nightmare images
and associate their thoughts and feelings about themin order to facilitate reconsolidation of trauma memories. Results from the pilot study suggest that NDR
may be effective in decreasing the frequency andseverity of nightmares and insomnia, with moderateeffect sizes. NDR was well tolerated by study participants, with 80 percent completing treatment. The
study also evaluated multiple potential biomarkersof treatment response, including genomic and serum
markers at multiple points in treatment. The study
collected continuous physiologic data over eightweeks of study treatment using a wristband sensor
as another potential marker of treatment response.
We detected changes in expression of brain-derived
neurotrophic factor and in cardiovascular and electrodermal activity in response to exposure to nightmare content during NDR sessions. We are currently
starting a follow-on study in which NDR will becompared to NightWare, a non-exposure treatment
for nightmares that uses a wearable device to interrupt nightmares during sleep.

The Veterans Affairs (VA) National PTSD
Brain BankThe Veterans Affairs (VA) National PTSD Brain
Bank was established as a multi-site collaborative
human tissue bank led by the VA National Center for
PTSD. The VA PTSD Brain Bank collects, processes
and stores tissue donations and medical information
for use in future neurophysiological research on
PTSD. This unique resource allows qualified investigators nationwide to use the clinical and biologicalinformation stored in the bank to identify biomarkers that are unique to PTSD, refine diagnostic assessment, improve treatment efficiency and ultimately
develop preventive strategies for this disorder.
CSTS Scientists co-founded the VA PTSD Brain
Bank and continue to serve on its Steering Committee as well as the Tissue Access Committee andDiagnostic Assessment Core. CSTS Scientists also
continued to collaborate with other Brain Bank
investigators on scientific manuscripts. In 2023,
CSTS enrolled its first future donors from their recruitment location at the Armed Forces Retirement
Home in Washington, DC, and CSTS has establisheda second recruitment site at Brooke Army Medical
Center in San Antonio, TX, which will be poised to
begin advertising to veterans in 2024.
To date, the VA PTSD Brain Bank has acquired
356 tissue samples from existing collections anddonors enrolled through the collaborating institu-

tions. The Brain Bank has also enrolled 244 additional future donors to support the project by providing
their antemortem longitudinal assessment data andmedical records to accompany their future postmortem tissue donations.

Riluzole Augmentation Treatment forComplicated Combat-Related PTSD
The Center conducted a study of riluzole augmentation for treatment of veterans who experienced continued PTSD symptoms despite treatment
with evidence-based medications for PTSD. This
study was funded by the Army Military and Operational Medical Readiness Program, and enrolled participants at WRNMMC and the Syracuse Veterans
Affairs Medical Center from 2014 to 2017. Key study
findings indicated that there was greater improvement in hyperarousal symptoms, such as exaggerated startle responses and hypervigilance, with riluzole
treatment compared to placebo. Analysis of proton
magnetic resonance spectroscopy (1H-MRS) of theamygdala and anterior cingulate cortex before andafter treatment as a potential biomarker of illness
and treatment response is ongoing. CSTS Scientists,in collaboration with researchers at Brigham and
Women’s Hospital, identified discernible changes inbrain metabolites in the areas of interest, which areassociated with changes in PTSD symptoms.

Sleep-Related Research
Chronobiology, Light and Sleep Laboratory
From basic science experiments to randomized clinical trials and implementation studies, the2023 ANNUAL REPORT | 17

Chronobiology, Light and Sleep Laboratory research
program focuses on sleep, circadian rhythms and thephysiological effects of light, with the ultimate goalof maximizing human health and well-being. The
specific work in 2023 aimed to better understand theneural mechanisms underlying the modulation of
the physiological effects of light, including circadian
resetting, neuroendocrine regulation, acute alerting
properties and mood enhancement, along with thepractical application of those findings.
In a multi-phase effort, a significant portion ofdata collection was completed for research on the
kinetics of the alerting response to light. Phase 1
includes a rigorous characterization of the acutealerting and mood enhancement properties of lightin a highly controlled laboratory study that varies
the intensity and duration of photic exposure while
holding the dose constant. In parallel to determining
an optimal dosing configuration and describing thedegradation of these effects after extinguishing thelight, Phase 2 of this work was also initiated. In thisoverlapping field study component, the lab began to
examine efficacy, as well as feasibility of usage in domestic and workplace settings, of the portable lightdevices that are being employed in Phase 1. Identifying the various barriers and facilitators to uptake inreal-world settings, including both operational andresidential contexts, will help to guide future refinements and implementation.
In a separate project, two distinct spectrally-engineered architectural lighting technologies
were developed and tested for increasing alertness,
performance and sleep in Service members who necessarily work nightshift schedules on a high-security
watch floor. Analyses revealed increased alertness
and performance, enhanced sleep, improved qualityof life and high overall satisfaction with the intervention conditions.
The successful transition of new, evidence-based
lighting applications in domestic and workplacesettings will require a well-designed educational
component that increases investment and facilitates
adoption of interventions that target sleep, circadian
health and other physiological effects of light. To
that end, an original education program, Circadian,Light and Sleep Skills (CLASS), was initially cre18 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

ated for undergraduate students and subsequently
tailored for military (CLASS-M) and shipboard
Service members (CLASS-SM). CLASS-SM has
been shown to improve sleep quality during a period
at sea, also leading to better mental health outcomes.
A grant proposal to further tailor and test CLASS
in a marine population was put together this year,
in collaboration with colleagues Dr. Maegan Willingat USU and Dr. Emily Schmied at San Diego State
University. Notification of selection for funding near
the end of the year means this work on CLASS willcontinue into the future.
Finally, in 2023, the lab also continued collaborative projects with colleagues across the globe.
One study, conducted with the vaccination programat WRNMMC, examined the effects of melatonin
supplementation on vaccination efficacy. A collaboration with Emory University assessed sleep, circadian rhythms and cardiometabolic health in African
Americans. Another collaboration project, called theLight Exposure Behavior Assessment (LEBA), involved colleagues from the Max Planck Institute for
Biological Cybernetics, Monash University, University of Basel, Eindhoven University and University ofColorado–Boulder. The LEBA project team developed a novel, self-reported and psychometricallyvalidated inventory to capture light exposure-related
behavior. The results of the validation study were
published in Scientific Reports. Additional work
extending the LEBA is also in progress.
Toward Personalized Care for Insomnia: Machine
Learning Algorithms to Predict Response to
Insomnia Therapy
In collaboration with Harvard Medical School,
our team sought to develop machine learning models to predict response to insomnia medication and,separately, response to cognitive behavioral therapy
for insomnia (CBT-I). We constructed two observational longitudinal datasets using data from the Historical Administrative Data Study (HADS), which is
a component of the Army Study to Assess Risk andResilience in (Army STARRS). The first sample comprised more than 7,000 US Army Soldiers diagnosed
with insomnia and treated with medication, while asecond sample comprised more than 4,000 Soldierstreated with CBT-I. All Soldiers in both samples
were assessed before and 6-12 weeks after initiating
treatment.
Parsimonious, and separate, models were developed to predict response to insomnia medication
and CBT-I. We found in both samples that only
a minority of Soldiers responded to treatment,
highlighting the importance of those predictivemodels. The research also identified predictors of atherapeutic response: severe baseline insomnia andyounger age predicted a positive treatment response
to insomnia medication, while suicidal ideation andsevere baseline insomnia predicted a positive treatment response to CBT-I.
The results of this research constitute an important step toward personalized treatment planning for
Soldiers as well as civilians with insomnia. Pending
replication and the development of additional models to compare alternative treatments, the predictivemodels emerging from this research could be partof a patient-centered decision-making process for insomnia treatment. By allowing health care providers
to inform patients of the likelihood they will respondto a therapeutic approach before a therapy is prescribed, the models will enhance clinical decisionmaking.

Central Nervous System (CNS) Correlates ofExtended Sleep Restriction
Chronic sleep restriction (multiple nights inwhich individuals obtain fewer than six hours of
sleep) is extraordinarily common in modern society
and can lead to reduced performance, increased
risk for accidents and death and significant negative
consequences for both psychological and physicalhealth. In the military population, nearly half of allService members suffer significant sleep loss while
in garrison; in the deployed military population,
chronic sleep restriction is observed in virtually
every individual.
The CNS Correlates of Extended Sleep Restriction study is the most comprehensive investigationof the pathophysiological consequences of chronic
sleep restriction conducted to date The study, which
is being conducted in collaboration with investigators at the National Intrepid Center of Excellence(NICoE), National Institutes of Health (NIH; National Institute of Mental Health [NIMH] and National
Institute of Biomedical Imaging and Bioengineering)and consultants at Yale University, utilizes a varietyof complementary neuroimaging methods designed
to track potential pathophysiological processes atbaseline and during the course of sleep restriction
and recovery.

Multimodal Data Collection: CNS Correlates of Extended Sleep Restriction

2023 ANNUAL REPORT | 19

These methods range from positron emission
tomography (PET) studies that document microglial activation and neuroinflammation, changes insynaptic density and beta amyloid deposition andMagnetic Resonance Imaging (MRI) methods thattrack functional neuronal activity, fluid dynamics,
cortical volumetrics and white matter integrity. MRI
spectrographic methods will assess in vivo neurochemistry and high-density electroencephalograms(EEG) will be obtained throughout the study toestablish the electrophysiological correlates of sleep
restriction and recovery.
The present study will evaluate repeated measures in each participant over the course of approximately two and a half months, with ongoing restriction and recovery assessed at the Walter Reed Army
Institute of Research (WRAIR), NIH and NICoE,
with ongoing home monitoring between these visits.
It should be noted that pinpointing the precise
pathophysiological mechanisms involved will suggest interventions (e.g., anti-inflammatory or antioxidant treatments, facilitation of CNS clearance andaugmentation of sleep efficacy) that might mitigate
such effects or reverse them entirely.
Pre-Deployment and Deployment-Related Risk
and Resilience Factors for Insomnia in Military
Personnel
Insomnia is prevalent among Service members,
especially those with combat exposure, affecting performance and well-being and increasing risk for psychological and physical war-related injuries. Many
aspects of deployment (including combat exposure,assigned job, unit cohesion, sleep-wake scheduleand base location) disrupt sleep and increase fatigue,
while pre-deployment factors may amplify or dampen effects of deployment on sleep.
A CSTS team will use data from the Pre/Post
Deployment Study (PPDS), a component of the
Army Study to Assess Risk and Resilience in Service
members (Army STARRS). The PPDS includes one
assessment immediately prior to and three assessments at standard intervals following deployment.
For the approximately 4,500 soldiers who completed
all four surveys, the team will examine the effects ofdeployment-related variables on post-deployment
20 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

insomnia and evaluate the extent to which pre-deployment variables modify those effects.
This research will expand the evidence base on
which military-relevant solutions can be built toprevent or mitigate the effects of deployment-related sleep loss and fatigue. The team will work withmilitary policymakers to transition the study findings to practice, providing guidance: (a) to inform
deployment-related policy, allowing senior leaders
to modify aspects of policy that increase the likelihood of deployment-related fatigue and medical
evacuation risk; (b) to facilitate the identification ofService members at greatest risk for, and those likely
to show resilience to, sleep-related effects of deployment; and (c) to inform clinical practice guidelines
for military health providers in both garrison anddeployed settings. Results from this work will inform
medical screening standards for deployment to areasof responsibility within combatant commands.

Drs. Rachel Shor and Jeff Thomas with canine
friend, Sgt. Grover.

Education and Training
An essential element of the Center’s work is
education and training. Center Scientists provide
education and training to USU medical students
committed to service in the Nation’s Air Force, Navy,
Army and Public Health Service. CSTS educates
health care personnel and community leaders at the
local, state and federal levels, as well as national,
global and private sector settings. One of the Center’s instrumental public health education tools isdevelopment and dissemination of educational materials to inform stakeholders, including health carepersonnel, community and organizational leaders,
responders and public health emergency workers,families, teaching professionals and policy makers.
For nearly a quarter of a century, CSTS has createdjust-in-time, customized, highly actionable, andeasy-to-read educational fact sheets, flyers, pocket
cards and other resources to aid national and global
stakeholders in mitigating adverse effects of disasters
by enhancing efforts at preparedness, response andrecovery.
As noted above, a primary focus at CSTS has
been the war in Ukraine and ongoing efforts insupport of the COVID-19 pandemic, by providing
educational resources to partners throughout the
DoD, other federal agencies, state and local agencies,
professional associations and international partners.

DISASTER RESPONSE AND PUBLICEDUCATION
Since its inception in 1987, the Center has provided disaster preparedness and response consultation and education in many forms and contexts.
CSTS personnel have provided on-the-groundeducation and consultation following extreme
national and global disasters, as well as immediateand long-term remote “reach back” support to assist
response and recovery efforts following numerous
local, national and global disasters. CSTS personnel
have been sought out for guidance on disaster preparedness, response and recovery because of theirexperience and subject-matter expertise. The Center’s
Deputy Director also serves as Chair of the DisasterCommittee for the American Psychiatric Association(APA), the world’s largest professional organizing bodyof psychiatrists.
Throughout 2023, the Center provided global
consultation and education in response to the war in
Ukraine, Hamas terror attacks in Israel and the earthquakes in Turkey, as well as national disasters, such as
the mass shootings in Lewiston, Maine, Monterey Parkand Half Moon Bay, along with other converging disasters. The Center also supported response efforts to arange of climate-related disasters, including Hurricane
Idalia and the severe tornadoes that severely impacted
Mississippi and other Central states. Additionally, theCenter provided extended and ongoing consultation
and resources to local, state and national responder
organizations helping during and after the devastating
Maui wildfires.
In response to these events, the Center developed
and disseminated just-in-time education fact sheets
and distributed them to stakeholders involved indisaster response, including the Office of the Assistant
Secretary for Preparedness and Response, National
Association of State Mental Health Program Directors,
as well as national medical organizations providing
local response support, such as the APA. The Center
also developed and widely disseminated resource pages and worked with partner organizations to support
families, first responders and community leaders in
the wake of these events.
In October of 2023, the worst terrorist attack innearly half a century took place in Israel, with hundreds of people killed and several hundred taken hostage by Hamas. This event resulted in a declaration of
war by Israel on Hamas, which had claimed thousandsof lives and remained ongoing by the end of 2023. The
Center developed resources to support communities impacted by these devastating events, including
ongoing consultation to senior Israel Defense Forces
leadership, as well as mental health education fact
sheets translated into additional languages.
2023 ANNUAL REPORT | 21

SUICIDE PREVENTION PROGRAM
During 2023, CSTS implemented its second yearof the Suicide Prevention Program (SPP). Informedby CSTS research findings from Army STARRS, SPP
translates science into actionable resources for military and non-military populations to reduce suicidal
behavior and promote protective environments.
SPP developed and delivered education and leadership products, including fact sheets that provided
detailed instructions for leaders in preventing andresponding to suicidal ideation and death, and toeducate leaders on suicide prevention strategies pertaining to firearm safety and knowing when and how
to act when concerned for a Service member.
The aims of SPP are to:■ Collaborate with military and non-militarycommunities to address suicide and related risk
factors■ Leverage existing promising practices and data-informed interventions to enhance synergy ofeffort■ Develop data-informed practices, action tools
and resources for pre-, during and post-suicide
events■ Ensure evaluation of at-risk and hard-to-reach
populations, and develop and disseminate resources to support these groups
SPP has a diverse portfolio of twelve projects
summarized below:
Mental Push-Ups: Mindfulness in the Military
Application: In partnership with the WRAIR, thisproject adapted evidence-informed mindfulness
techniques into an easily accessible mobile app toencourage daily engagement and practice of mindfulness. The mobile app was contextualized for the
military as a prevention tool and for improving
mental health and wellness. The app is expected tolaunch in the Summer of 2024.
Safe Is Strong: This project provided educationmaterials for health care providers to: (1) advanceunderstanding of families with members who are at
risk of suicide; and (2) inform providers about available prevention and intervention services to reducesuicide risk in vulnerable families. The goal is to
22 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

identify profiles of family risk for suicide by examining how suicidality clusters with other indicators ofcompromised health and safety within families (e.g.,child maltreatment, domestic abuse, pediatric emergency room visits, accidental pediatric injuries).
Warrior Mindset: Gaining a Tactical Advantage:
In partnership with WRAIR, a video was createdthat modelled resiliency skills and techniques in realistic battle scenarios. The video demonstrated five
key areas: (1) What’s Important Now; (2) Deliberate
Breathing; (3) Acceptance; (4) Grounding; and (5)Self-talk. The video incorporated positive psychology skills to manage real time extreme stress andultimately protect from negative health outcomes
following combat.
Project Safeguard: With our National Guard(NG) partners, Project Safeguard developed a training model for the NG on lethal means and voluntary
reductions in firearm access during at-risk periods.
Peer-to-peer counseling incorporated principles ofmotivational interviewing to encourage secure storage of personal firearms to decrease the risk of deathby suicide or other means. A project manuscript was
submitted to Military Medicine for publication.
Suicide Prevention Essentials Course (SPEC): This
project is designing and will deploy a robust e-learning curriculum to educate researchers within diverse
settings on the topic of suicide risk determinationand management. The course improves knowledge
on how to identify and address suicidal risk identified during human subjects research. The curriculum is expected to launch in the Spring of 2024.
Let’s Talk About Your Guns: This project developed a podcast series that connects listeners withexperts on secure firearm storage. The aim of this
podcast series is to strengthen the communication
skills and confidence of health care providers, military leaders, family members and peers to enable
conversations with Service members about safely
storing their personal firearms to prevent death andinjury. Guests included Dr. Joseph Simonetti, Dr.
Mike Anestis and Dr. Emmy Betz.
Psychiatry Electronic Modules: This project built
and deployed two self-learning electronic modules(titled “Body Dysmorphic Disorder” and “I Am So
Tired”) for training medical personnel. The eMod-ules provide training on suicide risk assessment
and related risk factors for suicide, including body
dysmorphic disorder and eating disorders.
Bereavement Adaptation Learning and Navigating Coping Essentials (BALANCE): This project
created an interactive tool for bereaved individuals
to learn about and practice effective coping strategies. This user-friendly platform allows bereaved
individuals to: (1) inventory current coping skills; (2)learn about various coping strategies and their possible effects; (3) practice skills to manage ineffective
coping; and (4) expand current coping skills in order
to increase sense of control over ability to cope.
The Family Survivor Self-Care Toolkit: This
toolkit promotes positive family safety practices
for military family members who lost a loved one.
The Military Survivor Family Safety Toolkit supports peer-to-peer discussions around family healthand safety, well-being, potential harmful behaviors
and suicidality. The toolkit’s website is expected tolaunch in Spring 2024.
Finding the Words: This project developed aseries of video simulations to demonstrate and teachskills in help-seeking and combat barriers to care.
The videos build confidence in key stakeholders to
select and deliver the best words to encourage people to seek behavioral health care or other support
services.
Brain Hijack: This project developed a podcast
series that provides information for military andnon-military communities regarding drivers ofsuicide risk and presents a public health approach toaction. This series features expert recommendations
for special populations and communities at large.
Guests included Dr. Peter Gutierrez, Dr. Thomas
Joiner, Dr. April Naturale and other speakers. A
manuscript based on this project is currently indevelopment and will be submitted to the Journal of
Creativity in Mental Health for publication.
Supporting Our Shipmates: Gatekeeper Trainer
Project: In partnership with the USCG, this project
facilitated a “LivingWorks” Training for Trainers(T4T) mentoring model within the USCG andconducts evaluation on the impact of mentoring on
trainer candidates’ willingness and readiness to provide interventions to those having thoughts of sui-cide. A manuscript based on this project is currently
in development and will be submitted to Military
Medicine for publication.

NEUROSCIENCE AND BEHAVIORMODULE FOR PRE-CLERKSHIP USU
MEDICAL STUDENTS
The Neuroscience and Behavior Module is aneight-week, annual, required multidisciplinary course
for the first-year USU School of Medicine students.
The module teaches medical students the principlesof neuroscience through integrated content across a
range of disciplines. With a focus on effective management of a variety of neurologic and psychiatricconditions, students learn to recognize, describe anddiagnose common neuroscience-related medical
conditions. Through simulated patient experiences,
effective, safe and patient-centered clinical skills aredeveloped and practiced, including the performanceof neurologic and mental status examinations. Topics related to military medicine, medical history andhealth systems science are integrated throughout themodule. The goal is to foster a robust and well-rounded education for future military medical officers.
In 2023, the University continued to provide
distance and hybrid learning, in addition to in-person classes and simulations. The Neuroscience
module continued to be highly regarded by students
and faculty alike as one of the best modules in the2023 USU On Site Psychiatry Clerkship Site Director
meeting.
2023 ANNUAL REPORT | 23

pre-clerkship curriculum, pioneering new educational techniques and leading students to one of thehighest passing rates in the pre-clerkship period
while absorbing some of the most challenging material. As early as 2019, the module was recognizedfor pre-recording all lectures into a higher-quality
format that was more accessible to students thanrecording live lectures. In preparation for 2024, themodule continued to enhance online lecture delivery by improving and re-recording 38 (27%) of the
137 video lectures. In collaboration with the Dean’s
Office, the module also embedded questions (checks
for understanding) into the content of 114 (83%)
of the 137 video lectures using Panopto’s built-in
quiz feature. Module instructors continued to fully
participate in the expanded hybrid flipped classroom approach for weekly review sessions six times
throughout the module. These flipped classrooms
invited students to attend a case-based review thathighlighted key learning from the week, invited theirprofessors to rephrase important points from theirlectures to illustrate case studies and invited ongoing
discussion between students and professors in the
online chat.
These vignettes, collected from USU graduates and faculty, were intended to demonstrate theoperational importance of the medical material thestudents were learning each week. Based on consultation with the Assessment Sub-Committee andthe Associate Dean for Assessment, every module
exam question continued to be carefully blueprinted,
down to the objectives which were also mapped tothe university objectives. Due to the intensive effort
put into organizing the material to correlate structure and function with anatomy, basic science andclinical lectures, the class of 2025 suffered no failuresduring our 2023 module, with no compromise in the
integrity or complexity of the material.

EDUCATION AND TRAINING IN
COMBAT AND OPERATIONAL STRESSCONTROL: OPERATION BUSHMASTER
In 2023, CSTS Scientists provided annual training in Combat and Operational Stress Control(COSC) as a core component in military medical ed24 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Operation Bushmaster annual medical fieldtraining exercise.
ucation. In line with USU’s mission to prepare uniformed health professionals to support the readinessof the US Armed Forces, CSTS Scientists engaged
in curriculum preparation, faculty development anddirect teaching as part of the annual medical fieldtraining exercise called Operation Bushmaster.
This full-scale training exercise challenged senior
medical and graduate nursing students to operate inforward medical units in a complex battlefield simulation over four days, culminating in a mass casualty
event. Students evaluated and treated a continuous stream of battlefield casualties and non-battle
injuries, and conducted public health and healthoutreach activities while on a simulated combat
deployment. Differentiating the assessment, disposition and treatment of psychiatric illnesses fromcombat and operational stress reactions were coreskills taught and evaluated as part of the exercise.
CSTS faculty collaborated with the psychiatry resi-

dency programs of the National Capital Consortiumand the San Antonio Uniformed Services Health
Education Consortium to provide an opportunity
for resident physicians to develop their teaching andleadership skills and understand COSC as part oftheir core military-unique curriculum.

DISASTER AND PREVENTIVEPSYCHIATRY COURSE
In collaboration with the American Psychiatric
Association, Center Scientists developed the online
education and training course, “Disaster and Preventive Psychiatry: Protecting Health and Fostering
Community Resilience.” This interactive course hasnine modules and covers a broad range of content
related to well-being and resilience in disasters,
including: Psychological and Behavioral Effects; Risk
and Vulnerability; Public Health Approaches to Interventions; Psychological First Aid; Risk and Crisis
Communication; Leadership Consultation; Responders; and Preparedness. The content was designed
to be applicable for a wide range of stakeholders,
including health care professionals, responders andsafety workers and community leaders. The course
is free to the public and includes eight continuing
education credits at no charge. The course is embedded with downloadable, action-oriented and evidence-based resources that participants can use toreinforce their knowledge and skills to foster disaster
preparedness, response and recovery. This course is
the only one of its kind, has been widely lauded byhundreds of course participants on four different
continents and represents a unique and enduringresource to further knowledge, skills and attitudes in
the mental health aspects of disasters.

scientists, whose work spanning neuroscience, psychiatry, psychology and community has advanced
our understanding of brain, behavior and mind, andour ability to sustain mental health. The 2023 distinguished speaker was Ned H. Kalin, MD, Hedberg
Professor and Chair of Psychiatry at the University of
Wisconsin School of Medicine and Public Health, andEditor-in-Chief of the American Journal of Psychiatry.
More than 600 persons registered for the event.

NORWEGIAN FELLOWSHIP
During 2023, CSTS sponsored Ms. Line Rønning,a research Scientist from the Norwegian Armed
Forces. Ms. Rønning’s research interests aligned
well with CSTS as she explored gender differences in posttraumatic growth and depression among
Norwegian Afghanistan veterans. During her timewith CSTS, Ms. Rønning met with Center Scientists,
analysts and staff to further develop her work. She
also attended daily and weekly science and researchmeetings, learning CSTS’s approach to trauma
research through our multiple research projects.
Moreover, Ms. Rønning was able to meet with manyother research Scientists and clinicians at the USU
and in and around the National Capital Region. Ms.
Rønning has maintained strong ties to CSTS and is

BRAIN, BEHAVIOR AND MINDLECTUREIn 2023, the Brain, Behavior and Mind Lecture,sponsored by CSTS in collaboration with the USU
Department of Psychiatry and the USU Brain and
Behavior Hub, was held in a virtual format. The
Brain, Behavior and Mind Lecture is a forum for a
global audience to attend lectures by distinguished

Dr. Robert Ursano presenting Ms. Rønning with acertificate of completion.
2023 ANNUAL REPORT | 25

actively working on several research projects with
CSTS Scientists concerning Norwegian Afghanistan
veterans. These include a project focused on sexual
harassment and bullying, and another project examining different latent profiles of PTSD symptoms,
and how they interact with key predictors of suicide
and mental health care-seeking behaviors.

US DEPARTMENT OF VETERANS
AFFAIRS (VA) RESEARCHER-INRESIDENCE
CSTS STARRS-LS research team, along with ourpartners at Harvard University, established a newinteragency research fellowship program with the
VA. The purpose of the VA/STARRS-LS Researcher-in-Residence Fellowship Program is the pursuitof research-based solutions for Service members at
risk for suicide as they transition from active duty
to veteran status. To our knowledge, this is the first
DoD-VA research fellowship program addressing
this critical gap in research. Beginning in 2023, the
VA/STARRS-LS Researcher-in-Residence Fellowship
Program brought on two VA research scientists whowill work part-time with STARRS-LS researchers
for a two-year tenure. Dr. Emily Edwards, from theBronx, NY VA, and Dr. Claire Houtsma, from theSoutheast Louisiana Veterans Health Care System,
are the first Researchers-in-Residence Fellows.
This program will bring in two new VA Researchers-in-Residence yearly for the next five years. Seelink from the VA’s Health Services Research andDevelopment website showcasing the Researcher-in-Residence Program: VA/STARRS-LS Researcher-in-Residence Program

TRAINING TO SUPPORT RESEARCH
The Center trains and educates research support
staff, such as Research Assistants (RAs). In 2023, ateam of 11 RAs supported research efforts at CSTS.
At CSTS, RAs provide support to team members
on a variety of projects, and learn by working with
CSTS Scientists, biostatisticians and program managers. The RAs often conduct literature searches,participate in study recruitment and data collection,
26 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

CSTS Research Assistants.
assist in data entry and quality control and develop tables and graphics for study findings. RAs also provide
administrative support for meetings, including preparing meeting minutes. While at CSTS, RAs acquire
valuable research skills, including developing posters
for research presentations at professional conferences.
RAs are offered professional development opportunities, including attending workshops and assisting withmanuscript preparation for publication in peer-reviewed scientific journals.
Following their tenure at CSTS, RAs often further their education by pursuing advanced degrees.
Former Center RAs have engaged in graduate study
at institutions including: Yale University, Notre Dame
University, Johns Hopkins University, Duke University, Columbia University, Georgetown University,
London School of Hygiene and Tropical Medicine,
University of Maryland, George Washington University, Catholic University, Florida State University,
University of Nebraska – Lincoln, and USU. Opportunities that RAs have pursued following theirexperience at CSTS have included:■ PhD programs in psychology and related behavioral science fields■ Medical and physician assistant (PA) school■ Law school■ Master’s degree programs in psychology, counseling, public health and social work
■ Training positions at the NIH■ Careers with the FBI
In 2023, CSTS continued its series of within-center professional development workshops designed toeducate and facilitate discussions among the Center
staff on topics critical to success. Workshops thisyear included discussions on different behavioral
health careers in the military, managing psychological consequences in disaster populations andworkplace etiquette.

DISSEMINATION AND
IMPLEMENTATION OF HEALTH AND
RESEARCH KNOWLEDGE
Fact Sheets, Infographics and Pocket Cards
The Center is internati0onally known for thedevelopment and dissemination of mental healtheducation fact sheets, infographics and pocket cards
to support disaster response and recovery. The fact
sheets are actionable, easy to read and understandand topic-focused education resources developed
using expert knowledge, which communicate essential behavioral health content on difficult and/or
crisis-related issues. Fact sheets, infographics andpocket cards address the needs of a broad range ofstakeholders and partners, including responders andemergency workers, health care providers, community leaders, family members and policy makers.
CSTS fact sheets are developed, updated and maintained in an online repository. The content of theseresources covers a wide range of issues in disaster
preparedness and response, such as: climate-related
and other natural disasters; pandemics; terrorism
and war; risk and crisis communication; elements ofcrisis leadership; health risk education; and family
health behaviors. CSTS fact sheets, infographics andpocket cards provide readers with resources tailoredto the unique aspects
of disaster events
that address criticalcontextual factors forvarious communities during any given
disaster. The Center
develops and rapidly
disseminates theseresources in real time
following major disasters and traumaticDrs. Adam Walsh and Brooke Heintz Morrissey,
Suicide Prevention Project presentation, Military
Health System Research Symposium.
events, including floods, hurricanes and wildfires,
public health threats, such as pandemics and chemical
spills and acts of intentional violence, including mass
shootings, terrorism and war.
In 2023, the Center developed a resource page andtranslated fact sheets and pockets cards in responseto the Hamas terror attacks in Israel and the war that
followed to address the impact on military personnel, children and families, aid workers, refugees andcommunity and military leaders. These fact sheets
and pocket cards addressed unique issues, including
talking with children about war; caring for Service
members injured in war; protecting mental healthof military and community members; managing theemotional reactions to human remains exposure; loss
and grief; crisis leadership actions; and reintegrating
into a community after military service. These products served as essential education resources to support
global mental health responses to the war in Ukraine
for the NATO ally nations, United Nations, the Five
Eyes ministries and numerous Non-Governmental
Organizations (NGOs) around the world.

WebsiteThe CSTS website is a primary tool for disseminating relevant and timely information to a wide range ofstakeholders (www.CSTSonline.org). Throughout theyear, CSTS personnel continually added content andmade content more accessible. Material available on the2023 ANNUAL REPORT | 27

The SPP website, launched by CSTS in 2022, now
has two podcasts available: “Brain Hijack” and “Let’s
Talk about Your Guns.” At the end of 2023, there
were 16 episodes available for the “Brain Hijack”
podcast and eight episodes available for the “Let’s
Talk about Your Guns” podcast. The “Brain Hijack”
podcast page had 1,008 views and “Let’s Talk aboutYour Guns” podcast page had 921 views.
A new website called “Safe Is Strong” officiallylaunched in July 2023. This website was viewed by
182 users in 2023.

Social Media

website includes summaries of current research activities, publication citations, newsletters, conference
reports, disaster response pages and a searchable
repository of CSTS disaster mental health education
fact sheets. The website includes a “What’s New” section to highlight recent disaster education materials,
research initiatives, publications, conference summaries and announcements of upcoming events.
In 2023, CSTS continued to create and update
webpages to respond to, and provide mental healthresources for, natural disasters, human-caused disasters (e.g., shootings) and wars overseas. The updated“War in Ukraine Mental Health Resources” page
provides disaster mental health resources in English,
French, Japanese, Polish, Ukrainian and Russian. The
newly created “Israel-Hamas War Mental HealthResources” page provides disaster mental healthresources in English and Hebrew.
The CSTS website saw 30,660 users from 162
countries around the world in 2023. Among theseusers, 22,123 (72%) were from the US. The mostviewed non-main page section in 2023 was theDisaster Event page entitled, “Israel-Hamas War
Mental Health Resources,” created in October, 2023.
This page had a total of 2,556 views, with the mostviews (341) occurring on October 11th. CSTS created more than 20 fact sheets in Hebrew.

28 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

In 2023, the Center continued to grow its online
presence through the use of social media. Social media resources allowed for the timely disseminationof relevant content to CSTS partners and the public.
CSTS social media engaged users from nine different
countries across the globe on X (formerly known
as Twitter), Facebook and LinkedIn. The Center
now has a Social Media team that works to develop
monthly and weekly public health outreach campaigns and other types of communications materials.
Moving forward, the Center is exploring new ways
to increase its social media presence in 2024 acrossmultiple platforms. CSTS encourages people to visit
and follow our postings via X and Facebook to stay
up to date on new activities, resources and publications. “Like” CSTS on Facebook, and follow CSTS on
X (@CSTS_USU) and LinkedIn.

Nur Bookwala & MSgt Moore, Ft Gregg-Adams, VA.

Consultation & Partnerships
Consultation to other organizations, systems
and individuals has long been a primary functionof the Center. Through consultation, we disseminate research in real-world applications. It is also
the means through which the Center leverages theextensive history and experience of CSTS Scientists. These consultations offer reciprocal learning,providing CSTS with real-time visibility, as well as
the opportunity to support a wide variety of partners
and stakeholders facing challenges related to trauma and disaster. The variety, breadth and durationof CSTS consultation and partnerships span an
impressive range. They include many agencies andorganizations throughout the DoD and other federal
agencies, as well as state, local and national agencies,
international organizations and professional associations. The Center is continuously increasing its
consultative activities through emerging partnership
opportunities. In an increasingly connected yet challenging world, maintaining existing partnerships,
while forging new relationships, will remain central
to the CSTS mission.
While CSTS maintains existing consultative
partnerships, as world events change, each year new
events emerge, and new relationships result. Readersof this report will recall past Annual Reports focusing heavily on COVID-19. Although COVID-19
remains a significant public health, medical and behavioral health issue, it is no longer in the forefrontof CSTS’s daily agenda. As deaths from COVID-19
continue to decline, the residual trauma and griefremain and CSTS’s work in this area continues andadjusts.
In last year’s Annual Report, we noted that Russia
had invaded Ukraine on February 22, 2022, and our
involvement in the aftermath of that ongoing war
began in earnest. This conflict continues today andfor the foreseeable future. The war in Ukraine hascreated an ongoing threat to global health security, resulting in the need for extensive and ongoing
consultation, education and establishment of partnerships to support mental health and well-being in

affected communities around the world.
On October 7, 2023, Hamas invaded Israel andthat conflict continues today. This event, along withother disasters, has led the Center to strengthen existing partnerships and provide consultation throughnew relationships to support global communities.
These relationships allow CSTS to make rapid, substantial and creative contributions following a wide
range of high stress and trauma-related events. The
following sections include examples of impactful
long-standing and new CSTS consultations for 2023.

US GOVERNMENT
Department of Defense
CSTS collaborations with the DoD have been
central to the Center’s mission, and this relationshipremains strong and is growing. CSTS leadership andScientists meet regularly with USU partners andleadership, as well as the Defense Health Agency
to identify new challenges and opportunities, share
relevant operational findings and assure adaptation
to new priorities.
A CSTS Associate Director was invited to attend
the Senior Spouse Senior Leader Conference, which
was held in person at the Pentagon and hosted by
the spouse of the Chairman of the Joint Chiefs ofStaff. The topic of discussion was “Supporting the
Mental Well-Being of Military Families as they Face
Uncertainty in Contemporary Life.” Approximately
25 spouses of General Officer commanders were inattendance, as well as the spouse of the Secretary of
Defense.
CSTS Scientists also focused on the needs of specific Services. For example, a CSTS Navy psychiatrist
served as co-chair for the Operational Virtual Mental Health initiative. In this capacity, she assessed
the status of the program for the United States,
including cost-savings for the US Navy, developed
courses of action (COAs) for advancing the programand presented findings and recommendations to theSurgeon General of the Navy.
2023 ANNUAL REPORT | 29

A Center Scientist was selected to be a memberof the joint VA/DoD Working Group for the Clinical Practice Guidelines (CPG) on Headache. In thiscapacity, she was assigned to specifically address thepharmaceutical treatment of headache, particularlyin active-duty members and veterans with Traumatic
Brain Injury (TBI). This Practice Guideline has been
completed and is now available on the VA/DoD CPG
website.
Another Center Scientist served as a work groupmember for the VA/DoD Clinical Practice Guideline on the Assessment and Management of PTSD
and Acute Stress Disorder (ASD), released in theSummer of 2023. This CPG now represents the mostcontemporary global guidance on PTSD and ASD
management.
A CSTS psychiatrist assumed responsibility
as a board member on the Neuromusculoskeletal
Sub-Community Board (US Navy) as the psychiatry/physical medicine and rehabilitation member. In thiscapacity, she has helped develop prospective policies
for the Navy regarding eating disorders, weight standards, pregnancy and post-partum health, exercise
modifications, and vitamin supplementation.

Military Mortuary Affairs (MA)CSTS has maintained a long-standing relationship with DoD’s MA communities, whose personnel
are exposed to human remains. The Center has beena global leader in studying the psychological andbehavioral responses to exposure to human remains,an area that is often overlooked in planning andresponding to disasters and war. Since its beginning,
CSTS has studied and collaborated on the special
needs of military management of death and thedead. As a result, CSTS Scientists are considered experts by DoD and the global community in research,education and training and consultation regarding awide range of events in which individuals are exposed to human remains, including pandemics, war,
terrorism, climate-related and many other disasters.
The Center’s work with MA has helped numerous organizations better understand the potential
adverse effects of exposure to human remains.
As a result, many partners turn to the Center forassistance in helping their personnel prepare and
30 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

respond to these exposures. CSTS Scientists conducted a consultation with researchers from theWalter Reed Army Institute of Research (WRAIR)on educational content that was under development
for a training course on mental skills for handlinghuman remains. The training was being developed
for medics and military personnel who may be
exposed to human remains during current or future
military conflicts.
A CSTS Scientist conducted multiple consultations with the Joint MA Center (JMAC) in 2023. The
JMAC requested the consultations to obtain information about: mental health and resilience aspectsof work with human remains; potential consequences of extending MA Soldiers’ Middle East rotations
from six months to nine months; and changes in MA
company structure, training and field activities.
A CSTS Scientist participated in monthly Defense Support of Civil Authorities (DSCA) MA
Synchronization meetings throughout 2023. The
meeting maintains a strategic partnership with organizations to prepare and synchronize the responsewhen DoD MA assets are deployed for warfighting,humanitarian or disaster missions. CSTS provided
ongoing consultation, guidance and recommendations on the stressors and resilience factors that
affect Service members’ operational readinessand health. Attendees included: the JMAC, North
American Aerospace Defense Command and US
Northern Command/US Army North/377th Theater
Sustainment Command (TSC), CSTS, Army Reserve Engagement Cell, Headquarters, Departmentof the Army (HQDA) Assistant Secretary of theArmy–Manpower and Reserve Affairs, HQDA G4,
US Army South, 451st Expeditionary Sustainment
Command (ESC), 311th ESC, US Central Command,
Indo-Pacific Command/US Army Pacific/8th TSC,
Joint Personnel Effect Depot, Office of the Under
Secretary of Defense for Personnel & Readiness,
NGB/ANG and ARNG MA Program, US Army
Forces Command, and US Army Europe and Africa
Headquarters.

United States Coast Guard (USCG)
CSTS has been working with USCG behavioral
health and medical leadership with efforts to prepareUSCG members for unique exposures when underway and how to support USCG personnel and theirfamilies following return from high stress operations. This year, the Center was asked to help address
the challenges of working with migrants crossing
the US border, including issues of violence toward
women and children, creating unique exposures for
USCG members The Center provides direct consultations and recommends resources to help prepare
USCG members, mental health professionals andleaders addressing a wide range of challenges related
to homeland security.

Defense Institute of Medical Operations(DIMO)A CSTS Scientist was selected for a mission
to Mexico City to teach Mexican Army personnel
about the fundamentals of military mental health.
This mission involved close collaboration between
US personnel and host nation military personnel tobetter understand cultural and contextual factors
in which the host nation military operates, such as
perceptions of trauma exposure, psychological andbehavioral responses as well as available resources,
military organizational structure and challenges toimplementing interventions in support of the hostnation’s military.

Department of Health and Human Services(DHHS)
CSTS has a long and productive relationship with
the Substance Abuse and Mental Health Services
Administration (SAMHSA). 2023 saw an expansion
and formalization of our relationship with SAMHSA. A CSTS Associate Director serves as a representative of the SAMHSA’s Service Members, Veteransand their Families Technical Assistance Center andon the SAMHSA Military and Veterans Technical
Assistance Group. In addition, he represents CSTS
on the SAMHSA-led Interagency Group for Trauma
Informed Care.

State Department
A senior CSTS leader made an invited presentation entitled, “Protecting the Workforce: Crisis
Leadership Beyond COVID-19,” at the Foreign

Service Institute Resilience Conference in Arlington,
VA. Approximately 150 US Department of State
Foreign Service Officers and representatives fromvarious divisions within the State Department werein attendance.

Immigration and Customs Enforcement (ICE)
CSTS’s ongoing consultation with ICE continued
in 2023. CSTS consulted with ICE to examine thehealth impact of Child Exploitation Investigation(CEI) on ICE personnel. This consultative effort culminated at the end of 2023 with a five-year funded
project to conduct health surveillance and develop actionable recommendations for leadership to
inform management of occupational exposures andcreate education resources to aid the workforce andsupport personnel exposed to CEI work.

PROFESSIONAL ORGANIZATIONS
American Psychiatric Association (APA)
The relationship between CSTS and APA is
strong and enduring. CSTS assisted in the initiationof APA’s efforts in disaster psychiatry by establishing
the Committee on the Psychiatric Dimensions ofDisaster in 1992. During 2023, the Center continued to be actively involved in this and other APA
activities to educate and train health professionals
in disaster and preventive psychiatry. In addition,
CSTS consulted with the Public Health Psychiatry
sub-committee of the APA’s Task Force on Social
Determinants of Health to foster Public Health
Psychiatry for training programs and professional
practice. CSTS provided guidance to the APA Officeof Legal Counsel to the Board of Trustees considering DSM-6 on the Conflict-of-Interest Guidelines
used for the DSM-5 Task Force, Workgroups andConsultant members. CSTS Scientists provided thesubject matter content and review, and co-developed
the first interactive online training in Disaster andPreventive Psychiatry.
In 2023, CSTS supported disaster response with
the APA to help communities impacted by the Mauiwildfires through education, training and by providing just-in-time resources. The Center was asked toconsult with the Hawaii Department of Health, the2023 ANNUAL REPORT | 31

University of Hawaii, and the Hawaii District Branchof the APA. Center Scientists also supported disaster
psychiatrists working in Maui through “reach back”
consultation to address challenging patient care,
community partnership and professional practiceissues, in addition to providing peer support.
Following the mass shootings in Lewiston, ME,
CSTS was asked to provide consultation and resources to local and regional health care and law
enforcement organizations responding to the event.
The Center Deputy Director, in his role on the Disaster Committee, provided ongoing consultation to theGovernor of Maine’s Task Force leadership to help
with their exploration and understanding of various
aspects of mass violence, military culture and regulations and challenges related to emergency protective
orders and firearm restrictions.

National Association of State Mental Health
Program Directors (NASMHPD)

developed a revised version of the classic “phases ofdisaster” graphic model. This new model attempts
to articulate the impact of repeated and colliding
disasters more fully, and to account for underlying
stresses within communities. The result has been thedevelopment of the “Chronic Cyclical Disaster Model,” which has been presented at numerous national
and international meetings. The model is continuing
to be refined as an important new resource to help
disaster planners and community members more
fully prepare for, respond to and recover from increasingly complex disaster events.
The Center Deputy Director was invited to serveas the Keynote Speaker at the Vibrant Emotional
Health annual disaster conference and spoke on the
topic of Crisis Leadership in Disasters to Protect
Mental Health and Foster Sustainment. The conference was attended by nearly 100 leaders in regional,
national and global disaster response.

Sesame Workshop

NASMHPD represents the State and Territory
Mental Health Authorities in all states and territories. For over two decades, CSTS has had a mutually beneficial relationship with NASMHPD. Thispartnership has grown through organizational,
personnel, and sweeping changes and challenges
in the public mental health system. Because of thecloseness of this relationship, NASMHPD and its
members can quickly and easily access CSTS consultation and materials. CSTS also benefits from thisstrong relationship, as it facilitates CSTS remaining
current on issues facing the country’s public mental
health system, including trends, innovations andchallenges.
A CSTS Associate Director made a presentationas part of NASMHPD’s Transformation Transfer
Initiative. The purpose was to acquaint participants
with CSTS’s range of activities and products to assist
states in expanding initiatives for trauma-informedcare. Approximately 17 states and territories wererepresented.

CSTS has been active in disaster research,training and education and consultation since its
inception, and during 2023 the Center remained
active in disaster consultation. The Center provided
remote “reach back” consultation to help protect
communities and foster sustainment for leaders andresponders actively working in disaster settings, byhelping to address complex problems, assist leadersin anticipating and planning for future challenges
and providing critical ongoing peer support. Examples of CSTS’s work in response to disasters during2023 are listed below.

Vibrant Emotional Health

Maui Wildfires

CSTS provided ongoing consultation to a groupheaded by Vibrant Emotional Health and the Groupfor the Advancement of Psychiatry. This group

In response to the devastating wildfires on Maui,
CSTS developed a web page with information andresources for families, health care professionals,

32 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

CSTS provided consultation to Sesame Workshop related to supporting socioemotional development in children. This meeting was attended by Dr.
Jeanette Betancourt, Senior Vice President for US
Social Impact at Sesame Workshop.

DISASTER CONSULTATIONS

responders and community leaders that provide
actionable steps to protect mental health, enhance
resilience and foster sustainment during this crisis
event. The Center was sought out for assistance andprovided these resources to the NG, National Guard
Association of State Mental Health Program Directors, Hawaii Department of Health and the American Psychiatric Association.
At the request of senior leadership at the National Child Traumatic Stress Network (NCTSN), an
Associate Director co-presented an internet-based
course on Psychological First Aid (PFA) sponsoredby the Hawaii Psychological Association. The course
taught application and practice of PFA within theunique cultural and contextual factors relevant to
the Maui community after the wildfires. The primarypresenters were from the NCTSN and the National
Center for PTSD, organizations with which CSTS
has had long-standing relationships and partnerships. The Associate Director served as a commenter and discussant, and addressed questions fromparticipants. Nearly 1,000 participants attended thehalf-day course, including behavioral health providers, local service providers and stakeholders primarily from Maui and other Hawaiian Islands, as well as
the US mainland.
The CSTS Deputy Director and other membersof the APA Committee on the Psychiatric Dimensions of Disaster met to discuss the pertinent resources for mental health clinicians involved in the
response to the Maui wildfires. CSTS resources andknowledge products were included in a new blog
posted to the American Psychiatric Association
website, titled “Maui Wildfire Response: Resources
for Mental Health Clinicians Who Are Helping.”
The blog can be found using the following link:
https://www.psychiatry.org/News-room/APA-Blogs/
Maui-Wildfire-Response-Clinician-Resources.

The Deputy Director at CSTS was asked by
the DHA’s Red Hill Task Force to provide subject
matter expert review and recommendations for a
resource being developed to provide education toService members and families at Joint Base Pearl
Harbor-Hickman exposed to JP-5 fuel during the
Red Hill contamination event. This event occurredin 2021, displaced 4,100 Service members and theirfamilies and exposed over 90,000 individuals tocontaminated water. This initial consultation began
longer-term involvement of the Center in support of
DoD’s response to this environmental and ecologicaldisaster.
The Deputy Director served as a presenter for
an online continuing education series designed toprovide health care workers within and beyond theDoD with knowledge about environmental disasters, such as large-scale chemical spills and otherexposure and contamination events. Topics included
understanding unique psychological and behavioral
responses following exposure and contamination andthe importance of using risk and crisis communication principles to optimize community engagement
in health behaviors.
The Center continues to be consulted by senior
medical leadership on the Red Hill Task Force toreview education materials and community-widecommunication and messaging efforts and aid in furthering knowledge on important long-term actions
to protect community mental health.

Mass Shooting in Lewiston, Maine

Kentucky Tornadoes

A CSTS Associate Director provided consultation to leadership at the Office of the DHHS Assistant Secretary for Preparedness and Response(ASPR), prior to and during her deployment. Consultation topics included: responder well-being
and exposure to human remains; needs of special

The Deputy Director was contacted by the Commander of Blanchfield Army Community Hospitalat Ft. Campbell, KY, following tornadoes that rapidly
and intensely moved across multiple states. The Commander requested CSTS consultation on their basewide behavioral health response to the tornadoes that

populations (e.g., people who are deaf and hearing
impaired); preparing for grief rituals and memorials and optimizing opportunities to enhance stateand local behavioral health disaster and emergency
preparedness and response. CSTS materials were
provided and used extensively.

Red Hill Water Contamination

2023 ANNUAL REPORT | 33

adversely impacted many of the system employees
and large portions of the surrounding communities.
The tornadoes caused severe injury to multiple personnel and destruction of dozens of homes occupied
by military personnel. The Deputy Director and an
Associate Director provided CSTS materials and justin-time consultation to the Commander and his Tiger Team who were leading response efforts. A wide
range of topics were discussed, including preparationfor exposure to human remains, educating families
and DoD school personnel on distress responses
in children and adolescents and how to care forthem and the importance of honoring grief and loss
through rituals and memorials.

GLOBAL HEALTH CONSULTATIONS
Since its beginning, CSTS has established, maintained and continued to expand relationships witha multitude of global partners. This priority focus
continued to expand in 2023.

War in Ukraine
The extensive response by CSTS to the war in
Ukraine began immediately following the February 24, 2022, invasion by Russia. As the war andits sequelae have continued to expand, so have theCenter’s involvement in efforts to protect mental
health and sustainment of victims, families, Service
members and those around the world who are caring
for individuals impacted by the war.
CSTS provided a broad range of mental healthand resilience education resources to support the
34 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Defense Institute of Medical Operations in theirwork with the Ukrainian Army through direct engagement with military personnel to foster operational sustainment during the war. These resourceswere translated into Ukrainian and other languages
to facilitate communication and learning.
Two long-standing weekly consultations by
CSTS Scientists, WRAIR, and Harvard University
to support Ukrainian mental health leaders continued in 2023. An ongoing consultative partnershipwith the President of the Association of Neuropsychologists of Ukraine involved addressing issues of
TBI and related mental health challenges in Service
members, civilians and family members. Discussions
included use of evidence-based screening measureswith cultural adaptation, monitoring for comorbid
mental health conditions in individuals impacted by
TBI, and discussion of challenging patients and careissues. A further consultation involved working witha senior mental health provider in the Ukrainian
Armed Forces (UAF) to provide peer support anddiscussion of adapting Combat and OperationalStress Control principles to address cultural factors
for use in the UAF. This resulted in the developmentof the “Combat Pathway” intervention and culminated in a joint publication, “The Combat Pathway,”
published in the Army War College journal, Parameters.
Members of the CSTS Children and Family
Program met with a representative from the National Psychological Association (NPA) of Ukraine to
discuss a series of training seminars being developed
by Center scientists in collaboration with the National Child Traumatic Stress Network (NCTSN).
The training seminars are intended to address thewartime training priorities identified by NPA for
behavioral health providers working with Ukrainianchildren and families. They also conducted training
on youth suicide prevention for Ukrainian psychologists in collaboration with the NPA of Ukraine andthe NCTSN. In addition, the CSTS team met withthe co-founder of Languages of Care to discuss thedevelopment of resources for supporting children
and caregivers impacted by the war in Ukraine.
A CSTS Scientist met with HOME BASE (Veteran and Family Care), Harvard University experts

and representatives from Ukraine to discuss development of educational materials to assist Ukrainian
physicians in the treatment of posttraumatic stress,
pain and TBI. Materials being developed include validated scales to be used in acute combat situations.
In addition, a CSTS Scientist provided consultation
to the Warsaw for the Casualty Care Assessment of
Russo-Ukraine War Rehabilitation Symposium toenhance their understanding of psychological andbehavioral care of Soldiers injured in combat.
CSTS Scientists continued their support for theEuropean College of Neuropsychopharmacology(ECNP) with their delivery of timely and topicaleducation and training to support global mental
health through fostering knowledge about ongoingand emerging issues related to the war in Ukraine,
the Hamas terrorist attacks in Israel and subsequentwar. In a webinar entitled “364 Days of Full-Scale
War,” dedicated to reflections on a full year of war in
Ukraine, the CSTS Director gave a talk and participated in a panel discussion as part of the ECNP
Traumatic Stress Network “Hot Topics” series.
Several seminars delivered in support of ECNP wereselected for inclusion as part of an online continuing
education series to help foster mental health education in disasters, terrorism and war.
A senior CSTS psychiatrist gave a virtual presentation entitled, “Combat Psychopharmacology:
Return to Military Duty vs. Reintegration into Civilian Life” to the Behavioral Health Workshop held in
Rzeszów, Poland. This was a workshop coordinatedby a California NG Unit in response to a requestfrom the Ukrainian Ambassador to the US. This
CSTS psychiatrist was specifically invited to give thepharmacology presentation and anticipates participation in subsequent training missions.
Two Center Scientists were invited to participate
in the development of a global health training event
developed by Darnitsa Pharmaceutical, the largest
pharmaceutical company in Ukraine, as a public service. The goal was to educate primary care providers
and neurologists throughout Ukraine into enhancetheir ability to support Service members and families
impacted by the war. The Scientists recorded lectures on “Fostering Resilience after Combat: Returnto Duty vs Reintegration into Civilian Life” and“Caring for Patients in War and Other Disasters” aspart of this education series. They then attended theinaugural presentations to participate in a Q&A withnearly 3,000 registered attendees. The presentations
are part of an online training series for which the
Ukrainian Ministry of Defense will be sponsoring
continuing education to increase understanding of
the psychological and behavioral effects of war andother disasters in the care and treatment of affected
community members.

Hamas Terrorist Attacks and War with Israel
Immediately following the attack on Israel,
CSTS developed and disseminated a webpage withactionable resources to protect mental health forService members, families, health care personnel,
aid workers and leaders. The Center was consulted
by senior active and former Israel Defense Forces
personnel to help address issues related to psychological and behavioral issues in notifying survivingfamily following an unexpected death and protecting
communities from the adverse effects of exposure tohuman remains. In addition, the Center’s expertise
was sought out to help address the mental healthissues of repatriating hostages and reintegrating
prisoners of war.
An Associate Director participated in a virtual consultation, along with other members of theAmerican Academy of Child and Adolescent Psychiatry Disaster and Trauma Committee, with childpsychiatrists in Israel to discuss how to best support
children’s health in the aftermath of the Hamas terrorist events and ongoing war. Important issues werediscussed, including the ways in which children andadolescents may respond differently to distressing
events and the importance of protecting the well-being of caregivers in ensuring child mental health.
In addition, CSTS provided consultation, resources and educational material to Clexio Biosciences,a pharmaceutical company in Israel, to assist with
their identification and broader public disseminationof resources in response to the Israel-Hamas war.
These efforts support mental health and well-being
through early identification of and promoting interventions that address posttraumatic stress symptoms
in military and civilian communities.
2023 ANNUAL REPORT | 35

International Ministerial Five Eyes Alliance
CSTS, in its ongoing collaboration with the Five
Eyes Alliance Advisory Group on Mental Health(consisting of the US, United Kingdom, Australia,
New Zealand and Canada), coauthored multiple
publications on Service member and family well-being, including one that identified research priorities
related to suicide, transition to veteran status, moral
injury, problematic anger and optimizing pathways
to mental health care. The publications included twocommentaries highlighting key issues related to themental health consequences of war to aid resilienceamong international and US forces in support ofpopulations at risk during the war in Ukraine.

Disaster Psychiatry Canada
Center Scientists again were invited to serveas speakers at the global virtual annual conference
sponsored by Disaster Psychiatry Canada and theCanadian Psychiatric Association. This annual event
attracts over 1,000 attendees from dozens of countries around the world and features speakers acrossfour different continents. This year, the Center delivered a session on approaches to fostering Disasterand Preventive Psychiatry education for medical
students and residents.
The Chair of Disaster Psychiatry Canada is alsoa member of the APA’s Disaster Committee, chairedby the Center’s Deputy Director. This international
collaboration helps to foster ongoing knowledge

Dr. Quinn Biggs, Behavioral Health Clinic Office,Walter Reed National Military Medical Center.
36 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Aaron Weingrad and Alexandra Blumhorst, poster
presentation, Anxiety and Depression Association ofAmerica annual conference.
sharing, information exchange and sharing of bestpractices across North America.

World Psychiatric Association (WPA)The CSTS Deputy Director was co-author of
the WPA position statement, “Mental Health in the
Workplace,” to provide global guidance on actions
recommended for governments, organizations,leaders and health care workers on the importanceof protecting mental health in the workplace toenhance well-being of workers and global economic
productivity.

Australia
The CSTS Director was invited to participate ina Think Tank for the proposed Australian Defense
Force (ADF) Life Course Study (ADFLCS). The study
is designed to measure and monitor the health andwell-being of ADF Service members throughout theirlives, including during and after service. It will support evidence-based changes to policy and programs
aimed at protecting, preserving and enhancing thehealth, well-being and performance of the ADF. The
series of Think Tanks will provide a mechanism for
consultation and will capture a range of perspectives
on the design of the ADFLCS. The Director also
provided consultation to the lead consultant to the
Hadassah Action Health Teams, Dr. David Forbes of
the University of Melbourne, Australia, on sustaining
teams and supporting health care leaders during theongoing stress of war and terrorism.

Publications(Names in bold text are CSTS personnel)

JOURNAL ARTICLESBerman, R., Spencer, H., Boese, M., Kim, S., Radford,K., & Choi, K. (2023). Loss of consciousness
and righting reflex following traumatic brain
injury: Predictors of post-injury development (ANarrative Review). Brain Sciences, 13(5), 750.
Betz, M. E., Stanley, I. H., Anestis, M. D., Bryan, C.
J., Buck-Atkinson, J., Carey, N., GhahramanlouHolloway, M., Morrissey, B. H., Holloway,
K., Houtsma, C., Kennedy, R., Paine, C. M.,
Ramchand, R., Simonetti, J., Walsh, A., & WrightKelly, E. (2023). Firearm suicide prevention in the
US military: Recommendations from a nationalsummit. Military Medicine, 188(9-10), 231–235.
Campbell-Sills, L., Kautz, J. D., Choi, K. W., Naifeh,
J. A., Aliaga, P. A., Jain, S., Sun, X., Kessler, R.
C., Stein, M. B., Ursano, R. J., & Bliese, P. D.
(2023). Effects of prior deployments and perceived
resilience on anger trajectories of combatdeployed soldiers. Psychological Medicine, 53(5),2031-2040.
Campbell-Sills, L., Kautz, J. D., Ray, C., Lester, P. B.,
Choi, K. W., Naifeh, J. A., Aliaga, P. A., Kessler,
R. C., Stein, M. B., Ursano, R. J., & Bliese, P. D.
(2023). Associations of active-duty mental healthtrajectories with post-military adjustment: Resultsfrom the STARRS Longitudinal Study. Journal of
Affective Disorders, 340, 535–541.
Campbell-Sills, L., Papini, S., Norman, S. B., Choi,
K. W., He, F., Sun, X., Kessler, R. C., Ursano, R.
J., Jain, S., & Stein, M. B. (2023). Associationsof polygenic risk scores with posttraumaticstress symptom trajectories following combat
deployment. Psychological Medicine, 53(14), 1–10.
Campbell-Sills, L., Sun, X., Kessler, R. C., Ursano,R. J., Jain, S., & Stein, M. B. (2023). Exposure to
bullying or hazing during deployment and mental
health outcomes among US Army Soldiers. JAMA
Network Open, 6(1), e2252109.
Campbell-Sills, L., Sun, X., Papini, S., Choi, K. W., He,
F., Kessler, R. C., Ursano, R. J., Jain, S., & Stein, M.
B. (2023). Genetic, environmental, and behavioral
correlates of lifetime suicide attempt: Analysis ofadditive and interactive effects in two cohorts of

US Army soldiers. Neuropsychopharmacology:
Official Publication of the American College of
Neuropsychopharmacology, 48(11), 1623–1629.
Chu, C., Stanley, I. H., Marx, B. P., King, A. J., Vogt,
D., Gildea, S. M., Hwang, I. H., Sampson, N. A.,
O’Brien, R., Stein, M. B., Ursano, R. J., & Kessler,
R. C. (2023). Associations of vulnerability tostressful life events with suicide attempts after
active duty among high-risk soldiers: Resultsfrom the Study to Assess Risk and Resilience inServicemembers-Longitudinal Study (STARRSLS). Psychological Medicine, 53(9), 4181–4191.
Cleaves, E. S. (2023) What happened to you?
Conversations on trauma, resilience, and healing.
Psychiatry, 86(1), 80-83.
Cozza, S. J., Ogle, C. M., Fisher, J. E., Zhou, J.,
Walsh, T. R., Zuleta, R., Dempsey, C. L., West,
J. C., Fullerton, C. S., & Ursano, R. J. (2023). The
associations of PTSD and family composition with
firearm ownership and unsafe firearm storagepractices among military Servicemembers andVeterans. Journal of the American Academy ofChild & Adolescent Psychiatry, 62(10), S250.
Dempsey, C. L., Benedek, D. M., Zuromski, K. L.,
Nock, M. K., Brent, D. A., Ao, J., Georg, M. W.,
Haller, K., Aliaga, P. A., Heeringa, S. G., Kessler,
R. C., Stein, M. B., & Ursano, R. J. (2023). Recent
stressful experiences and suicide risk: Implications
for suicide prevention and intervention in U.S.
Army soldiers. Psychiatric Research and Clinical
Practice, 5(1), 24–36.
Docherty, A. R., Mullins, N., Ashley-Koch, A. E.,...&E., Qin, X., Coleman, J. R. I., Shabalin, A., Kang,J., Murnyak, B., Wendt, F., Adams, M., Campos,
A. I., DiBlasi, E., Fullerton, J. M., Kranzler, H.
R., Bakian, A. V., Monson, E. T., Renteria, M. E.,
Walss-Bass, C., ...Ursano, R. J., …& Ruderfer,
D. M. (2023). GWAS meta-analysis of suicide
attempt: Identification of 12 genome widesignificant loci and implication of genetic risks for
specific health factors. The American Journal of
Psychiatry, 180(10), 723–738.
Forbes, D., Adler, A. B., Pedlar, D., Asmundson, G.
J. G., & MHRIC across the Five Eyes Nations[Ursano, R. J.] (2023). Problematic anger inmilitary and veteran populations with and without
PTSD: The elephant in the room. Journal ofAnxiety Disorders, 96, 102716.

2023 ANNUAL REPORT | 37

Gabbay, F. H., Wynn, G. H., Georg, M. W., Gildea,
S. M., Kennedy, C. J., King, A. J., Sampson, N.
A., Ursano, R. J., Stein, M. B., Wagner, J. R.,
Kessler, R. C., & Capaldi, V. F. (2023). Toward
personalized care for insomnia in the US Army:
Development of a machine learning model topredict response to pharmacotherapy. Journal of
Clinical Sleep Medicine, 19(8), 1399–1410.
Howe, E. G., 3rd. (2023). Adolescents, their parents,
and abortions. International Journal of Pregnancy& Child Birth, 9(6), 171-172.
Howe E. G., 3rd. (2023). White noise and questions
regarding death anxiety, forgiveness, andpatient self-disclosure. Innovations in Clinical
Neuroscience, 20(7-9), 27–29.
Howe E. G., 3rd. (2023). When should providers
defer versus impose their views? The Journal of
Clinical Ethics, 34(4), 289–295.
Kearns, J. C., Edwards, E. R., Finley, E. P., Geraci,
J. C., Gildea, S. M., Goodman, M., Hwang, I.,
Kennedy, C. J., King, A. J., Luedtke, A., Marx, B.
P., Petukhova, M. V., Sampson, N. A., Seim, R.
W., Stanley, I. H., Stein, M. B., Ursano, R. J., &Kessler, R. C. (2023). A practical risk calculator for
suicidal behavior among transitioning U.S. Armysoldiers: Results from the Study to Assess Risk andResilience in Servicemembers-Longitudinal Study(STARRS-LS). Psychological Medicine, 53(15),7096–7105.
Kim, S. Y., Soumoff, A. A., Raiciulescu, S., Kemezis,
P. A., Spinks, E. A., Brody, D. L., Capaldi, V. F.,
Ursano, R. J., Benedek, D. M., & Choi, K. H.
(2023). Association of traumatic brain injury
severity and self-reported neuropsychiatric
symptoms in wounded military Service members.
Neurotrauma Reports, 4(1), 14–24.
Kim, S. Y., Yeh, P. H., Ollinger, J. M., Morris, H. D.,
Hood, M. N., Ho, V. B., & Choi, K. H. (2023).
Military-related mild traumatic brain injury:
Clinical characteristics, advanced neuroimaging,and molecular mechanisms. Translational
Psychiatry, 13(1), 289.
Kumer, K. D. (2023). Book Review: The Lost Art of
Listening, 3rd edition, How Learning to Listen Can
Improve Relationships. Psychiatry, 86(4), 374-377.
Lee-Tauler, S. Y., Grammer, J., LaCroix, J. M., Walsh,
A. K., Clark, S. E., Holloway, K. J., Sundararaman,
R., Carter, C. K. M., Crouterfield, C. B., Hazlett, C.
G. R., Hess, C. R. M., Miyahara, C. J. M., Varsogea,
C. C. E., Whalen, C. C., & Ghahramanlou-

38 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Holloway, M. (2023). Pilot evaluation of the online‘Chaplains CARE’ program: Enhancing skills
for United States military suicide intervention
practices and care. Journal of Religion and Health,62(6), 3856–3873.
Luu, A., Campbell-Sills, L., Sun, X., Kessler, R. C.,
Ursano, R. J., Jain, S., & Stein, M. B. (2023).
Prospective association of unmet mental healthtreatment needs with suicidal behavior among
combat-deployed soldiers. Psychiatric Services,74(8), 809–815.
Mash, H. B. H., Fullerton, C. S., Adler, A. B.,
Morganstein, J. C., Biggs, Q. M., & Ursano, R. J.
(2023). National Guard deployment in support of
COVID-19: Psychological and behavioral health.
Military Medicine, usad177. Advance online
publication.
Mash, H. B. H., Morganstein, J. C., Fullerton, C.
S., & Ursano, R. J. (2023). COVID-19 pandemic
responses among National Guard Service
members: Stressors, coping strategies, sleep
difficulties, and substance use. International
Journal of Environmental Research and Public
Health, 20(9), 5731.
Mash, H. B. H., Ursano, R. J., Kessler, R. C., Naifeh,
J. A., Fullerton, C. S., Aliaga, P. A., Dinh, H. M.,
Sampson, N. A., Kao, T. C., & Stein, M. B. (2023).
Predictors of suicide attempt within 30 days of first
medically documented major depression diagnosis
in U.S. Army soldiers with no prior suicidal
ideation. BMC Psychiatry, 23(1), 392.
Meyer, E. G., Cozza, K. L., West, J. C., & Hamaoka,
D. (2023). The effectiveness of online experiential
learning in a psychiatry clerkship. Academic
Psychiatry, 47(2), 181-186.
Montgomery, A. E., Koh, K. A., King, A. J., O’Brien,R., Sampson, N. A., Petriceks, A., Stein, M. B.,
Ursano, R. J., & Kessler, R. C. (2023). Stressful
life events and risk of homelessness after active
duty: An assessment of risk and resilience among
servicemembers. Public Health Reports, 138(6),963–970.
Naifeh, J. A., Ursano, R. J., Stein, M. B., Mash, H.
B. H., Aliaga, P. A., Fullerton, C. S., Shor, R.,
Kao, T. C., Sampson, N. A., & Kessler, R. C. (2023).
Optimism, sociability, and the risk of future suicide
attempt among U.S. Army soldiers. Military
Medicine, usad457. Advance online publication.
Naifeh, J. A., Ursano, R. J., Stein, M. B., Wang,
J., Mash, H. B. H., Aliaga, P. A., Fullerton, C.

S., Dinh, H. M., Kao, T. C., Sampson, N. A., &Kessler, R. C. (2023). Prospective association of
attachment style with suicide attempts among
US Army soldiers. Psychological Medicine, 1–9.
Advance online publication.
Nevo, O. N., Griffin, A. J., Herness, J., Klein, D.
A., & Cozza, S. J. (2023). Youth with sexual or
gender-diverse identities and military connection:
Recommendations to optimize clinical care.
Journal of the American Academy of Childand Adolescent Psychiatry, Sep 29:S08908567(23)02090-7. Advance online publication.
Nievergelt, C. M., Maihofer, A. X., Atkinson, E.
G., Chen, C. Y., Choi, K. W., Coleman, J. R.,
Daskalakis, N. P., Duncan, L. E., Polimanti, R.,
Aaronson, C., Amstadter, A. B., Andersen, S.
B., Andreassen, O. A., Arbisi, P. A., AshleyKoch, A. E., Austin, S. B., Avdibegoviç, E.,
Babic, D., Bacanu, S. A., Baker, D. G., … &Koenen, K. C. (2023). Discovery of 95 PTSD
loci provides insight into genetic architectureand neurobiology of trauma and stress-relateddisorders. MedRxiv : The Preprint Server for
Health Sciences, 2023.08.31.23294915. https://doi.
org/10.1101/2023.08.31.23294915
Ogle, C. M. & Cozza, S. J. (2023). Contemporary
applications of attachment theory: A review
of The Cultural Nature of Attachment:
Contextualizing Relationships and Development.
Psychiatry: Interpersonal and Biological Processes,
86, 91-97.
Quartana, P. J., Beymer, M. R., Gomez, S. A. Q., Adler,
A. B., Jackson Santo, T., Thomas, J. L., & Millikan
Bell, A. (2023). COVID-19 concerns, informationneeds, and adverse mental Health Outcomesamong U.S. Soldiers. Military Medicine, usad350.
Papini, S., Norman, S. B., Campbell-Sills, L., Sun,
X., He, F., Kessler, R. C., Ursano, R. J., Jain,
S., & Stein, M. B. (2023). Development andvalidation of a machine learning prediction
model of posttraumatic stress disorder after
military deployment. JAMA Network Open, 6(6),e2321273.
Pineles, S. L., Ni, P., Pandey, S., Japuntich, S. J.,
Cesare, N., Shor, R., Carpenter, J. K., Gregor, K.,
Joos, C. M., Blumenthal, T. D., & Rasmusson, A.
M. (2023). Tobacco withdrawal-induced changes
in sensorimotor filtering as a predictor of smoking
lapse in trauma-exposed individuals. Addictive
Behaviors, 148, 107868.

Spangler, P. T., & Sim, W. (2023). Working withdreams and nightmares: A review of the research
evidence. Psychotherapy, 60(3), 383–395.
Spencer, H. F., Berman, R. Y., Boese, M., & Choi,
K. H. (2023). Ketamine, a trauma analgesic with
sex-specific immunomodulatory function. Neural
Regeneration Research, 18(6), 1263–1264.
Spencer, H. F., Boese, M., Berman, R. Y., Radford, K.
D., & Choi, K. H. (2023). Effects of a subanesthetic
ketamine infusion on inflammatory and behavioral
outcomes after closed head injury in rats.
Bioengineering, 10(8), 941.
Ursano, R. J. (Collaborator on), Wendt, F. R., GarciaArgibay, M., Cabrera-Mendoza, B., Valdimarsdóttir,
U. A., Gelernter, J., Stein, M. B., Nivard, M. G.,
Maihofer, A. X., Post-Traumatic Stress Disorder
Working Group of the Psychiatric Genomics
Consortium, Nievergelt, C. M., Larsson, H.,
Mattheisen, M., Polimanti, R., & Meier, S. M.
(2023). The relationship of attention-deficit/
hyperactivity disorder with posttraumatic stressdisorder: A two-sample Mendelian randomizationand population-based sibling comparison study.
Biological Psychiatry, 93(4), 362–369.
Wang, J., Ursano, R. J., Dinh, H., Thomas, J.
L., Cohen, G. H., Sampson, L. A., Galea, S., &Fullerton, C. S. (2023). Understanding a time ofhigh risk for suicide: Adversities associated withseparation from military service among National
Guard and Reserve Service members. Psychiatry,86(2), 124–136.
Weingrad, A. B., & Cozza, S. J. (2023). ChatGPT:“To Be or Not to Be” in Bikini Bottom. Psychiatry,86(3), 249–254.
Wilkerson, M. D., Hupalo, D., Gray, J. C., Zhang, X.,
Wang, J., Girgenti, M. J., Alba, C., Sukumar, G.,
Lott, N. M., Naifeh, J. A., Aliaga, P., Kessler, R.
C., Turner, C., Pollard, H. B., Dalgard, C., Ursano,R. J., & Stein, M. B. (2023). Uncommon proteincoding variants associated with suicide attempt in
a diverse sample of US Army soldiers. BiologicalPsychiatry, S0006-3223(23)01783-3. Advanceonline publication.

BOOKS
Reynolds, III, C. F., Cozza, S. J., Maciejewski, P. K.,
Prigerson, H. G., Shear, M. K., Simon, N. M., &Zisook, S. (Eds.). (2023). Grief and Prolonged
Grief Disorder. American Psychiatric Association
Publishing, Washington, DC.
2023 ANNUAL REPORT | 39

BOOK CHAPTERS
Dempsey, C. L., Spangler, P. S., West, J. C., &Benedek, D. M. (2023) Firearm suicide risk andprevention among Service members. In Nicholas
Thomson (Ed.), Handbook of Gun Violence.
Elsevier, New York, NY.
Cozza, S. J. & Fisher, J. E. (2023). Bereavement. In
C. F. Reynolds III, S. J. Cozza, P. K. Maciejewski,
H. G. Prigerson, M. K. Shear, N. Simon, & S.
Zisook (Eds.), Grief and Prolonged Grief Disorder.
American Psychiatric Association Publishing,Washington, DC.
Cozza, S. J. & Ogle, C. M. (2023). Bereavement,
grief, and prolonged grief disorder in children andadolescents. In C. F. Reynolds III, S. J. Cozza, P.
K. Maciejewski, H. G. Prigerson, M. K. Shear, N.
Simon, & S. Zisook (Eds.), Grief and Prolonged
Grief Disorder. American Psychiatric Association
Publishing, Washington, DC.
Fisher, J. E., Zuleta, R. F., Hefner, K. R., & Cozza,
S. J. (2023). Combat-related injuries andbereavement: Effects on military and veteranfamilies and suggested interventions. In Warner,
C.H., & Castro, C.A. (Eds.), Veteran and Military
Mental Health: A Clinical Manual. Springer,
Cham, Switzerland.

Dr. Stephen Cozza, poster presentation, American
Academy of Child and Adolescent Psychiatry annual
meeting.

40 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Pineles, S. L., Pandey, S., Shor, R., Abi-Raad, R. F.,
Kimble, M. O., & Orr, S. P. (2023). Loudness
dependence of auditory evoked potentials(LDAEP): A promising pre-treatment predictorof selective serotonin reuptake inhibitor (SSRI)
response. In G. Pinna (Ed.), Translational Methods
for PTSD Research. Springer Nature, Berlin,
Germany.
Spangler, P. T., & Sim, W. (2023). Dream workand nightmare treatments. In C. E. Hill & J. C.
Norcross (Eds.), Psychotherapy Skills and Methods
that Work. Oxford University Press, Oxford,
England.
West, J. C., Morganstein, J. C., Benedek, D., &Ursano, R. (2023). Managing psychologicalconsequences in disaster populations. In Tasman,A., et al. (Eds.), Tasman’s Psychiatry (5th edition),
Springer, New York, NY.

Presentations, Interviews and Briefings,
Awards and Appointments
PRESENTATIONS(Names in bold text are CSTS personnel)
Baghdadi, S., Walsh, T. R., & McCarroll, J. E. (2023,
May 16-18). A public health approach to childabuse and neglect in the military using the Haddon
Matrix framework [Poster presentation]. USU
Research Days 2023, Bethesda, MD.
Benedek, D. M. (2022, June). Self-care for frontline health care providers [Virtual presentation].
Cognitive Neuroscience and Clinical
Neuropsychology: The Beginning of a New Pathin Ukraine, Virtual Conference, Association of
Neuropsychologists of Ukraine.
Benedek, D. M. (2023, July 15). Combat
psychopharmacology: Return to military duty vs.
reintegration into civilian Life. Behavioral HealthWorkshop, Rzeszów, Poland.
Benedek, D. M. (2023, November 16). Fosteringresilience after combat: Return to duty
vs reintegration into civilian life [Virtualpresentation]. Mental Health Education Series
for National Healthcare Providers, Darnitsa
Pharmaceutical, Ukraine.
Blumhorst, A., Weingrad, A., Mash H. H.,
Fullerton, C. S., Morganstein, J. C., & Ursano,R. J. (2023, April). Association of COVID-19related National Guard deployment stressors withmental health outcomes [Poster presentation].
Anxiety and Depression Association of America(ADAA) Annual Conference, Washington, DC.
Blumhorst, A., Weingrad, A., Mash, H. H.,
Fullerton, C.S., Morganstein, J.C., & Ursano,
R.J. (2023, August 3-5). National Guard members’
feelings of mattering and valuing COVID-19related work: Association with anger and alcoholuse [Poster presentation]. Division 56, American
Psychological Association (APA) Annual
Convention, Washington, DC.
Bossarte, R. M., Dempsey, C. L., Benedek, D.
M., Spangler, P. T., West, J. C., Nock, M. K.,
Zuromski, K. L., Georg, M. W., Ao, J., Haller, K.,
Probe, D. M., & Ursano, R. J. (2023). Associations
between individual and area level factors andfirearm-related suicide among veterans [Poster
presentation]. National Research Conference
for the Prevention of Firearm-Related Harms,
Chicago, IL.
Brenner, G. H., Koyfman, S., Naturale, A., Clegg,
K. A., & West, J. C. (2023, May 24-26). Chronic
cyclical disaster model [Symposium presentation].
Vibrant Disaster Behavioral Health Symposium,
Washington, DC.
Clegg, K. A., West, J. C., Brenner, G. H., & Koyfman,
S. (2023, May 20-24). Chronic cyclical disasters:
A community context-sensitive approach topromoting adaptive disaster response [Oralpresentation]. American Psychiatric Association(APA) Annual Meeting, San Francisco, CA.
Cobb, E., Lee-Tauler, S., Ghahramanlou-Holloway,
M., & Walsh, A. (2023, April 26-28). A peerdelivered cognitive behavioral program for military
life transitions (Mil-iTransition) following medical
separation [Symposium presentation]. Suicide
Research Symposium 2023. Virtual attendance.
Cozza, S. J. (2023, October 23). Fundamentals
of disaster response with children [Oralpresentation]. American Academy of Child &Adolescent Psychiatry Annual Meeting, New
York, NY.
Cozza, S. J., & Ogle, C. M. (2023, July 24-26). Safe
is strong: Enhancing safety in young militaryfamilies [Distinguished lecture presentation].
2023 Military Child Education Coalition Global
Training Summit, Washington, DC.
Cozza, S. J., Ogle, C. M., Fisher, J. E., Zhou, J.,
Walsh, T. R., Zuleta, R. F., Dempsey, C. L.,
West, J. C., Dhanraj, N., Fullerton, C. S.,& Ursano, R. J. (2023, October 23-28). The
associations of posttraumatic stress disorderand family composition with firearm ownershipand unsafe firearm storage practices among
military Service members and veterans [Poster
presentation]. Annual Meeting of the American
Academy of Child and Adolescent Psychiatry,
New York, NY.
Dempsey, C. L., Benedek, D. M., West, J. C., Nock,
M. K., Zuromski, K., Ao, J., Georg, M. W., Probe,2023 ANNUAL REPORT | 41

D. M., Haller, K., Blumhorst, A., Griffith,
L.M., Dhanraj, N., Bossarte, R. M., & Ursano,R. J. (2023, March 9-11). Firearm behavioral
practices and suicidal behaviors among U.S. Armysoldiers and veterans: Implications for suicideintervention and prevention [Poster presentation].
International Convention of Psychological Science(ICPS), Brussels, Belgium.
Dempsey, C. L., Benedek, D. M., West, J. C., Nock,
M. K., Zuromski, K., Georg, M. W., Ao, J., Probe,
D. M., Haller, K., Griffith, L. M., Dhanraj,
N., Bossarte, R. M., & Ursano, R. J. (2023,
August 14-17). Firearm behavioral practices andsuicidal behaviors in U.S. army Service members:
Implications for suicide prevention [Poster
presentation]. 2023 Military Health System
Research Symposium (MHSRS), Kissimmee, FL.
Dempsey, C. L., Benedek, D. M., West, J. C., Nock,
M. K., Zuromski, K., Ao, J., Georg, M. W., Probe,
D. M., Haller, K., Blumhorst, A., Griffith, L. M.,
Dhanraj, N., Bossarte, R. M., & Ursano, R. J.
(2023, April 13-16). Firearm storage and carrying
practices and suicide attempt and ideation among
US Army Service members: Implications for suicide
prevention [Poster presentation]. 2023 Conferenceof the Anxiety and Depression Association ofAmerica (ADAA), Washington, DC.
Dempsey, C. L., Benedek, D. M., Spangler, P. T.,
West, J. C., Nock, M. K., Zuromski, K. L., Georg,
M. W., Ao, J., Haller, K., Probe, D. M., Bossarte,
R. M., & Ursano, R. J. (2023, November 1-3).
Perception of safety, reasons for firearm ownershipand unsafe storage practices: Opportunities for
suicide prevention in US Army Service members[Poster presentation]. National Research
Conference for the Prevention of Firearm-Related
Harms, Chicago, IL.
Dempsey, C. L., West, J. C., Bossarte, R. M.,
Benedek, D. M., Spangler, P. T., Nock, M. K.,
Zuromski, K., Georg, M. W., Ao, J.,Haller, K.H.,
Probe, D. M., & Ursano, R. J. (2023, November
1-3). Firearm behavioral practices and suicidal
behaviors in U.S. Army servicemembers andveterans: Opportunities for suicide intervention
and prevention [Poster presentation]. National
Research for the Prevention of Firearm-Related
Harms, Chicago, IL.
Dhanraj, N., Griffith, L. M., Dempsey, C. L.,
Benedek, D. M., Nock, M. K., Zuromski, K., Ao,
42 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

J., Georg, M. W., Haller, K., Aliaga, P. A., Brent,
D., Heeringa, S. G., Kessler, R. C., Stein, M. B., &Ursano, R. J. (2023, May 16-18). Bullying frommilitary peers, superiors, subordinates, friends
or family members in the month prior to suicide:
Results from the Army Study to Assess Risk andResilience in Servicemembers (Army STARRS)[Poster presentation]. USU Research Days 2023,
Bethesda, MD.
Fisher, J. E. Cozza, S. J., Zhou, J., Skritskaya, N.,
Mauro, C., Ogle, C. M., Bloom, C., Zuleta, R.,
Fullerton, C. S., Ursano, R. J., & Shear, M. K.
(2023, May 25-28). Utilization, acceptability, andgrief-related outcomes following an online selective
intervention in bereaved family members: Proof ofconcept [Poster presentation]. Annual meeting of
the Association for Psychological Science (APS),
Washington, DC.
Fisher, J. E., Ogle, C. M., Zhou, J., Walsh, T. R.,
Zuleta, R. F., & Cozza, S. J. (2023, November 1-4).
Avoidant coping and supportive coping differentiate
patterns of comorbidity in groups in 9/11-bereaved
fifteen years after 9/11 [Poster presentation].
International Society for Traumatic Stress Studies(ISTSS) 39th Annual Meeting, Los Angeles, CA.
Fisher, J. E., Ogle, C. M., Zhou, J., Zuleta, R. F.,
Walsh, T. R., & Cozza, S. J. (2023, August 14-17).
Influence of adverse childhood experiences on grief
adaptation in bereaved military family members[Poster presentation]. 2023 Military Health System
Research Symposium (MHSRS), Kissimmee, FL.
Friedman, S. K., Foley, E., Kelly, B., Atkinson, J.,
Walsh, A. K., Heintz Morrissey, B. A., Baker, J. C.,
Bryan, C. H., Anestis, M. D., & Betz, M. E. (2023,
August 14-17). Project Safe Guard: Evaluating alethal means safety intervention to reduce firearm
suicide in the National Guard [Oral presentation].
2023 Military Health System Research Symposium,
Kissimmee, FL
Gabbay, F. H., Kessler, R. C., Sampson, N. A., Collen, J.
F., Williams, S. G., Robertson, B. D., Ao, J., Georg,
M. W., & Capaldi, V. F. (2023, May 24). Predicting
response to insomnia treatment in individual
patients: The role of PTSD [Paper presentation]. In:
J. C. West (Chair), The Fragmented life: Examining
relationships between PTSD, nightmares, and sleep.
American Psychiatric Association (APA) Annual
Meeting, San Francisco, CA..

Gabbay, F. H., Spangler, P., Colvonen, P., &West, J. C. (2023, May 20-24). The fragmented
life: Examining relationships between PTSD,
nightmares, and sleep moving towards integrated
and personalized care [Symposium presentation].
American Psychiatric Association (APA) Annual
Meeting, San Francisco, CA.
Gabbay, F. H., Wynn, G. H., Georg, M. W., Gildea,
S. M., Kennedy, C. J., King, A. J., Sampson, N.
A., Ursano, R. J., Stein, M. B., Wagner, J. R.,
Kessler, R. C., & Capaldi V. F., II. (2023, August
14-17). Toward personalized medicine in the
US Army: Using machine learning to predict
response to insomnia treatment. In Precision
medicine research: optimizing warfighter
healthcare, readiness, and return to duty [Poster
presentation]. 2023 Military Health System
Research Symposium (MHSRS), Kissimmee, FL.
Gentry, M. T., Villanueva, R., & West, J. C. (2023,
June 22-24). Race and other patient identifiersin the clinical learning environment: “What’s
the harm?” [Poster presentation]. Associationof Directors of Medical Student Education in
Psychiatry Annual Meeting, San Diego, CA.
Ghahramanlou-Holloway, M., Stivers, M., Winters,
A,M., & Heintz Morrissey, B. (2023, April 26-28).
Essentials of ethical research with human subjects
at risk for suicide [Symposium]. Suicide Research
Symposium 2023. Virtual attendance.
Gregory, J., Akadri, S., & Cleaves, E. (2023, May
20-24). Difficulties in evaluating and managing
sedative, hypnotic, and anxiolytic use disorder andwithdrawal in a patient with tardive dyskinesia.
[Poster presentation]. American Psychiatric
Association (APA) Annual Meeting, San
Francisco, CA.
Griffith, L. M., Udayakumar, P. S., Hooke, J. A.,
Blumhorst, A., Weingrad, A. B., Mash, H. H.,& Fullerton, C. S. (2023, May 16-18). Perceived
work importance, COVID-19 activation stress,
and probable PTSD in National Guard members[Poster presentation]. USU Research Days,
Bethesda, MD.
Gutierrez, P. M., Walsh, A. K., Heintz Morrissey,
B. A., Hanson, J., & Morganstein, J. C. (2023,
October 15-18). Impact of trainer mentoring on
suicide prevention gatekeeper training outcomes[Poster presentation]. 2023 International Academy
for Suicide Research/American Foundation for

Ms. Sasha Baghdadi, poster presentation, USU
Research Days.
Suicide Prevention (IASR/AFSP) International
Summit on Suicide Research, Barcelona, Spain.
Gutierrez, P. M., Walsh, A. K., Heintz Morrissey,
B. A., Hanson, J., & Morganstein, J. C. (2023,
September 19-23). Increasing the fidelity of suicide
prevention gatekeeper training [Oral presentation].
International Association for Suicide Prevention
32nd World Congress, Piran, Slovenia.
Heintz Morrissey, B. A. (2023, March 23). Project
Safeguard: Peer-to-peer lethal means safety
evaluation project [Symposium presentation].
First National Guard Primary Prevention
Symposium at the National Guard Professional
Education Center, Little Rock, AR.
Heintz Morrissey, B. A., Walsh, A. K., Weingrad,
A. B., Meyer, M. C., Godin, S., & Morganstein,
J. C. (2023, October 12-14). Safety belts andsuicide: Conceptualizing and addressing suicidefrom a pragmatic safety perspective. [Poster
presentation]. The Mental Health Services
Conference, American Psychiatric Association(APA), Washington, DC.
Hillman, K., Spangler, P., Phares, A., Bolis, M.,
West, J. C., Mochari-Greenberger, H., Cao, L.,
Haase, E., Koyfman, S., Brenner, G., & Vance, M.,& McLean. A. (2023, August 3-5). Coping andoutcomes pandemic effects study (COPES) on
healthcare workers: Qualitative results [Poster
presentation]. 2023 American Psychological
Association Annual Convention, Division 56,
Washington, DC.
Kotlyar, B., Ping Tsao, C., Russo, R. Cleaves, E.
Gluzman, E., West, J. C., Schilling, D., Schatte,
2023 ANNUAL REPORT | 43

D., & Song, X. (2023, June 22-24). Finding
needles in the haystacks: Results of a scoping
review of methods of evaluating medical student
performance [Poster presentation]. Associationof Directors of Medical Student Education in
Psychiatry Annual Meeting, San Diego, CA.
Kumer, K., Cleaves, E. West, J. C., Hamaoka, D.,& Capaldi, V. (2023, June 22-24). Mass casualty
response teaching for medical students using large
scale simulation [Poster presentation]. Associationof Directors of Medical Student Education in
Psychiatry Annual Meeting, San Diego, CA.
La Croix, C. (2023, October). Psychiatrically treating
the war wounded [Virtual lecture]. Ukraine
Rehabilitation Seminar: Rehabilitation Insights:
Translating Success and Addressing the Unique
Challenges in the Ukrainian Health System,
Warsaw, Poland.
Morganstein, J. C. (2023, January). Caring forpatients in war and other disasters [Virtualpresentation]. Mental Health Education Series
for National Healthcare Providers, Darnitsa
Pharmaceutical, Ukraine.
Morganstein, J. C. (2023, April). Finding structurein chaos: Protecting mental health and fosteringresilience in pandemics, tornadoes, war, and otherdisasters [Virtual presentation]. Grand Rounds
for Carillion Care and Virginia Tech School of
Medicine.
Morganstein, J. C. (2023, May 24-26). Disasters
and community mental health: Crisis leadershipbehaviors to foster action, sustainment, andrecovery [Keynote presentation]. 3rd Annual
Disaster Behavioral Health Symposium, Crisis
Emotional Care Team, Vibrant Emotional Health,Washington, DC.
Morganstein, J. C. (2023, May). Psychological andbehavioral effects of CBRN and other disasters:
Impacts, risks, and interventions to foster resilienceand readiness. [Oral presentation]. Medical
Management of Bio/Chem Casualties Course, U.S.
Army Medical Research Institute of Infectious
Diseases, Fort Detrick, MD.
Nicholson, R., Garfinkle, T., Benedek, D. B., Greene,
E., Kumer, K., Williams, J., Best, N., Moret,N., & Paruchabutr, K. (2023, June 4-7). Highanxiety: Intense emotion simulation and safety
for participants [Conference presentation].
Association of Standardized Patient Educators
44 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU(ASPE) Annual Conference, Portland, OR.
Ogle, C. M., Fisher, J. E., Zhou, J., Walsh, T.,
Nemcek, S., Zuleta, R., Fullerton, C. S., Ursano,R. J., & Cozza, S. J. (2023, May 25-28). Child
protective actions in response to specific types ofchild neglect [Poster presentation]. Annual meetingof the Association for Psychological Science (APS),
Washington, DC.
Santiago, N., Shor, R., Arditte Hall, K. A., Smith, B. N.,
Davison, E. H., & Pineles, S. L. (2023, November
1-4). Examining the relationship between history ofinterpersonal trauma and lifetime suicide attemptamong treatment-seeking women veterans [Poster
presentation]. International Society for TraumaticStress Studies (ISTSS) 39th Annual Meeting, Los
Angeles, CA.
Sheth, N. K., Wilson, A., Schilling, D., Rhee, S., West,
J. C, & Napier, T. C. (2023, June 22-24). Words canhurt: How language impacts trainees’ attitudes andactions in treating substance use disorders [Poster
presentation]. Meeting of Association of Directorsof Medical Student Education in Psychiatry, San
Diego, CA.
Spangler, P. (2023, May 24). Results of a pilot of anovel treatment for trauma-related nightmares andinsomnia [Paper in a Panel]. In: J. C. West (Chair),
The Fragmented life: Examining relationships
between PTSD, nightmares, and sleep. American
Psychiatric Association (APA) Annual Meeting, San
Francisco, CA.
Spangler, P. T., Benedek, D. M., Dempsey, C. L.,
Gill, J., Kwasinksi, R., Mills, E., Probe, D., West,
J. C., & Winslow, B. (2023, August 15). How
biomarkers of stress relate to exposure to nightmares
during treatment visits: Results from a pilot trial ofnightmare deconstruction of reprocessing [Poster
presentation]. Military Health Systems Research
Symposium (MHSRS), Kissimmee, FL.
Spangler, P., Benedek, D., Dempsey, C. L., Hilmi,
A., Kwasinski, R., Mills, E., Probe, D., West, J. C.,& Winslow, B. (2023, August 3-5). Pilot results of anovel treatment for posttraumatic nightmares in a
military and veteran sample [Poster presentation].
American Psychological Association Annual
Convention, Division 56, Washington, D.C.
Udayakumar, P. S., Hooke, J. A., Griffith, L. M.,
Blumhorst, A., Weingrad, A. B., Mash, H.
H., & Fullerton, C. S. (2023, May 16-18). Stressmanagement and psychological responses inNational Guard Service members activated during
COVID-19 [Poster presentation]. USU ResearchDays 2023, Bethesda, MD.
Ursano, R. J. (2023, February 23). 364 days of fullscale war: A reflection on a year of full-scale war
in Ukraine [Presentation and panel discussion].
Traumatic Stress Network, European College of
Neuropsychopharmacology.
Walsh, A. K., Meyer, M. C., Heintz Morrissey, B.
A., & Morganstein, J. C. (2023, April 26-28).
Drop the pen and pick up the mic: The creation ofa podcast series that delivers expert and holistic
information about suicide prevention to the
public [Virtual Presentation]. Suicide Research
Symposium 2023.
Walsh, A. K., Morganstein, J. C., Stanley, I., Betz,
E., Heintz Morrissey, B. A., Fullerton, C. S., &Ursano, R. J. (2023, April 26-28). Take the lead:
The development of a leader driven approach tofirearm safety and suicide prevention [Virtual
Presentation]. Suicide Research Symposium 2023.
Walsh, A. K., Weingrad, A. B., Meyer, M. C.,
Morganstein, J. C., Heintz Morrissey, B. A.,
Fullerton, C. S., & Ursano, R. J. (2023, April
26-28). Partnering, implementing and evaluating:
A how to process of developing suicide prevention
tools for the public [Virtual Presentation]. Suicide
Research Symposium 2023.
Walsh, A. K., Gutierrez, P., Heintz Morrissey, B.
A., & Morganstein, J. C. (2023, August 14-17).
A novel mentoring model to increase fidelity ofsuicide prevention gatekeeper training: A pilot
evaluation study of SafeTALK in the United States
Coast Guard. [Poster presentation]. 2023 Military
Health System Research Symposium (MHSRS),
Kissimmee, FL.
Walsh, A. K., Morganstein, J. C., Betz, E., Heintz
Morrissey, B. A., Bryan, C. J., & Anestis, M.
D. (2023, August 14-17). Peer adaptation of anevidence-based approach to firearm safe storage:
A formative evaluation of four training sites in
the national guard. [Poster presentation]. 2023
Military Health System Research Symposium(MHSRS), Kissimmee, FL.

Wang, J., Ursano, R. J., Dinh, H., Thomas, J. L.,
Cohen, G. H., Sampson, L., Galea, S., & Fullerton,
C. S. (2023, August 3-5). Suicide ideation andadversities in separating US National Guard andReserve Service members [Poster presentation].
American Psychological Association Annual
Meeting, Washington, DC.
Wang, J., Biggs, Q. M., Baghdadi, S., Dhanraj,N., Hooke, J., Thomas, A., Fullerton, C. S.,
Amin, R., & Ursano, R. J. (2023, August 14-17).
Time of day variation in posttraumatic stresssymptoms in Service members: Results from anecological momentary assessment study [Poster
presentation]. 2023 Military Health System
Research Symposium (MHSRS), Kissimmee, FL.
Weingrad, A. B., Blumhorst, A., Mash, H. H.,
Udayakumar, P., Griffith, L. M., Fullerton, C.
S., Morganstein, J. C., & Ursano, R. J. (2023,
August 14-17). Personal experience of COVID-19,
training related stress, and PTSD in National
Guard members [Poster presentation]. Military
Health System Research Symposium (MHSRS),
Kissimmee, FL.
West, J. C., & Morganstein, J. C. (2023, June 9).
Growing the tent: Disaster psychiatry education
across the professional spectrum to enhance global
mental health [Oral presentation]. Disaster
Psychiatry Canada Conference, Toronto, Canada.
West, J. C., Dempsey, C. L., Benedek, D. M.,
Spangler, P. T., Nock, M. K., Zuromski, K. L.,
Georg, M. W., Ao, J., Haller, K., Probe, D.
M., Bossarte, R. M., & Ursano, R. J. (2023,
November 1-3). Relationships between firearm
behaviors and suicide risk in a longitudinalsample [Poster presentation]. National Research
Conference for the Prevention of Firearm-Related
Harms, Chicago, IL.
Zuleta, R. F., Udayakumar, P. S., Ogle, C. M.,
Fisher, J. E., Zhou, J., & Cozza, S. J. (2023, May
16-18). Opinions about Gold Star criteria amongchildren of fathers who died or went missing during
the Vietnam War [Poster presentation]. USU
Research Days 2023, Bethesda, MD.

2023 ANNUAL REPORT | 45

INTERVIEWS AND BRIEFINGS
Dr. Morganstein was featured in “Mental Health 101,”a multi-video series on health.mil, the official
website for the Military Health System (MHS)
and DHA. Topics of discussion included helpseeking and adjusting to post-deployment anddifficult conversations, among others. The videoseries was also listed under the Mental Health isHealth section of the website. This is a campaign
from the MHS to make resources available to help
Service members, families and veterans who arestruggling with mental health challenges.
Dr. Gabbay was interviewed to mark the end of her
six-year tenure as Member-at-Large on the Boardof Directors of the Federation of Associations in
Behavioral and Brain Sciences (FABBS). Featured
in FABBS News Highlights, which is distributed
to FABBS member organizations and affiliates,
the interview focused on the role of scientists inthe effort to ensure that science has a voice at thepolicymaking table.

Mr. Paul Hurwitz attending a STARRS researchbriefing to Senior DoD & Army Leadership at thePentagon.

46 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Mental Health News Radio Network, a network of
podcasts focused on mental health, issued a press
release highlighting CSTS SPP podcast “Brain
Hijack.” Additionally, Dr. Heintz Morrissey and
Dr. A. Walsh were invited to be on the Mental
Health News Radio podcast to discuss the show,
how they got into the field of suicide prevention
and the importance of having open discussions
about suicide prevention with your loved ones.
Dr. S. Cozza was invited and participated in an
in-person meeting of the Senior Spouse Leader
Conference, which was held at the Pentagon andhosted by Mrs. Brown, spouse of the Chairman of
the Joint Chiefs of Staff. The topic of discussion
was “Supporting the mental well-being of militaryfamilies as they face uncertainty in contemporary
life.” In addition to Mrs. Brown, approximately
25 other spouses of General Officer commanders
were in attendance, as well as Mrs. Austin, spouseof the Secretary of Defense.
A series of meetings took place throughout the year
between CSTS and multiple partners, focusedon increasing capabilities in predictive analytics.
To finish out the year, COL Capaldi and Dr.
Ursano participated in an in-person meeting at
the Defense Health Headquarters (DHHQ) with
the Assistant Secretary of Defense for Health
Affairs, Dr. Martínez López. Dr. Martínez López
assembled the group to discuss new ideas toimprove the Defense Behavioral Health Program.
The CSTS SPP team participated in USCG Leadership
Brief to RADM Dana Thomas, Director of
Health, Safety and Work-life. The team discussed
progress updates for “Supporting Our Shipmates:
Gatekeeper Training Project,” a featured CSTS
SPP project to evaluate USCG trainer support for
LivingWorks Applied Suicide Intervention Skills
Training and safeTALK programs.
CSTS presented two briefings at the Pentagon thisyear to provide updates on the Army STARRS
research program. Dr. Ursano, Dr. Thomas, Dr.
Naifeh and Mr. Hurwitz met with Senior Leadersfrom the DoD, the Army and the VA in June andNovember to brief them on the status and futureof the Army STARRS research. Each briefing
included approximately 25 participants, including
the Assistant Secretary of Defense for Health
Affairs, the Assistant Secretary of the Army for
Manpower and Reserve Affairs, the Executive

Director of Health Readiness Policy and Oversightfor the Office of the Assistant Secretary of Defense
for Health Affairs and the Deputy Chief ofResearch and Development for the VA.

AWARDS AND APPOINTMENTS
The following Center Scientists were granted USU
faculty promotions:■ Dr. Hamaoka to Professor■ Dr. Glickman to Associate Professor with Tenure■ Dr. Dempsey to Research Associate Professor■ Dr. Meyer to Professor■ Dr. Giordano to Adjunct Professor■ Dr. West to Associate Professor with Tenure
CSTS podcast, “Let’s Talk About Your Guns,” washonored with the Bronze Telly Award. The annual
Telly Awards showcase the best work created bysome of the most respected advertising agencies,
television stations, production companies andpublishers around the world. There were morethan 12,000 entries from 50 states and fivecontinents, with this year having a decade-highnumber of entries. CSTS podcast, produced
by Podville, was honored with the Bronze Telly
Award in the General-Branded Content category.
The podcast features eight episodes and isavailable on CSTS’s website as well as YouTube,
Apple Podcasts, Spotify and Stitcher. Each episodefocuses on various aspects of gun safety.
‘Brain Hijack’ was ranked by FeedSpot.com as oneof the top ten suicide prevention podcasts out
of forty-five selected podcasts. FeedSpot, a
podcast database with over four million registeredmembers and 100,000 podcasts from over 150
countries, received a listener review describing‘Brain Hijack’ as “a captivating podcast… withengaging hosts and expert guests [that] unveils
hidden truths about the brain, consciousness andhuman behavior.” ‘Brain Hijack’ currently has arating of 5 out of 5 stars on Apple Podcasts.
Dr. Fisher won a 2023 American Graphic DesignAward for the Bereavement Adaptation: Learning
and Navigating Coping Essentials (BALANCE)
website. This website is an interactive tool basedon research studies that was created for bereaved
individuals to practice healthy coping strategies.

COL Vincent Capaldi
presenting shadow
box to CAPT Joshua
Morganstein at his
retirement ceremony.
Dr. Ogle was awarded a 2023 American Graphic
Design Award for the Safe Is Strong website. The
website provides resources to strengthen thehealth and safety of military-connected families
with young children.
Dr. Ogle was selected to serve on the National
Academies Forum for Children’s Well-being as
a representative of the American Psychological
Association (APA), Division for Child and Family
Policy and Practice (Division 37).
Two CSTS articles were showcased in separate
Military REACH newsletters. Recent Stressful
Experiences and Suicide Risk: Implications for
Suicide Intervention and Prevention (Dempsey etal., 2023) and Understanding a Time of High Risk
for Suicide: Adversities Associated with Separationfrom Military Service Among National Guard andReserve Service members (Wang et al., 2023) wereshowcased in February 2023 and August 2023,
respectively. The goal of Military REACH is to put
important research into the hands of individuals
to whom it would be useful. The newslettersummarizes newly published studies related to
the well-being of military families, and distributes
them to researchers, helping professionals andothers interested in military family research,
including the DoD Office of Military Communityand Family Policy.
The Suicide Research & Program Evaluation (RPE)team honored 20 “Top Picks” from suicide
prevention publications in peer-reviewed journals.
The publication authored by CSTS Scientist Dr.
Shor (Shor et al., 2022), was titled The Transition to
Civilian Life: Impact of Comorbid PTSD, Chronic
Pain, and Sleep Disturbance on Veterans’ Social
Functioning and Suicidal Ideation. Its selection as a2023 “Top Pick” was out of nearly 800 publications
disseminated by the RPE team in 2022.
2023 ANNUAL REPORT | 47

CSTS Personnel
DIRECTORS
Robert J. Ursano, MD
Col, MC, FS, USAF (Ret.)
Professor of Psychiatry and
Neuroscience
Department of Psychiatry
Director
CSTS, USUDavid M. Benedek, MD
COL, MC, USA (Ret.)
Professor
Department of Psychiatry
Associate Director, Consultationand Education
CSTS, USU
Stephen J. Cozza, MD
COL, USA (Ret.)
Professor of Psychiatry and
Pediatrics
Department of Psychiatry
Associate Director, CFP
CSTS, USU
Brian W. Flynn, EdD
RADM, USPHS (Ret.)
Adjunct Professor
Department of Psychiatry
Special Advisor to the Director
CSTS, USU
Carol S. Fullerton, PhD
Research Professor
Department of Psychiatry
Scientific Director
CSTS, USUPaul E. Hurwitz, MPH
Instructor
Department of Psychiatry
Director, Program Operations(STARRS)
CSTS, USU

Holly H. Mash, PhD
Research Associate Professor
Department of Psychiatry
Assistant Scientific Director
CSTS, USU
Joshua C. Morganstein, MD
CAPT, USPHS (Ret.)
Professor/Assistant Chair
Department of Psychiatry
Deputy Director
CSTS, USUJames A. Naifeh, PhD
Research Associate Professor
Department of Psychiatry
Assistant Scientific Director
CSTS, USU
Jeffrey L. Thomas, PhD
COL, USA (Ret.)
Research Professor
Department of Psychiatry
Executive Director - Center/
Program Operations
CSTS, USU

Professor
Department of Psychiatry
CSTS, USU
Quinn M. Biggs, PhD, MPH
Research Assistant Professor
Department of Psychiatry
CSTS, USU
Robert Bossarte, PhD
Professor
Department of Psychiatry and
Behavioral Neurosciences
University of South Florida
Adjunct Professor
Department of Psychiatry
CSTS, USUMaria Braga, DDS, PhD
Professor
Department of Anatomy,
Physiology and Genetics
CSTS, USUSCIENTISTS

Allen R. Braun, MD
Senior Scientist
Department of Psychiatry
CSTS, USU

Pablo A. Aliaga, MS
Instructor
Department of Psychiatry
CSTS, USU

Oscar A. Cabrera, PhD
LTC, MS, USA
Department of Psychiatry
CSTS, USU

Eric Allely, MD
COL, MC, ARNG
Maryland State Surgeon
Senior Researcher, Health Systems
Management
Department of Psychiatry
CSTS, USU

Vincent F. Capaldi, II, ScM, MD,
DFAPA, FACP, FAASM
COL, MC, USA
Chair, Department of Psychiatry
Professor of Psychiatry, Medicine,and Neuroscience
Senior Scientist, CSTS
Program Director, Combined
Internal Medicine/Psychiatry
Residency, USU
Senior Medical Scientist, WRAIR

David M. Benedek, MD
COL, MC, USA (Ret.)
Consultant to the US Army
Surgeon General for Forensic
Psychiatry

48 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Kwang Choi, PhD
Associate Professor
Department of Psychiatry
CSTS, USU
Elle S. Cleaves, MD
Maj, USAF, MC
Assistant Professor
Director, Psychiatry Clerkship
Department of Psychiatry
CSTS, USU
Kelly L. Cozza, MD, DLFAPA,
FACLP
Professor and Vice Chair(Education)
Director, Departmental Faculty
Appointments, Promotions
and Development
Department of Psychiatry
CSTS, USU
Stephen J. Cozza, MD
COL, USA (Ret.)
Professor of Psychiatry and
Pediatrics
Department of Psychiatry
CSTS, USU
Justin M. Curley, MD
Assistant Professor
Department of Psychiatry
CSTS, USU
Catherine L. Dempsey, PhD,
MPH
Research Associate Professor
Department of Psychiatry
CSTS, USU
Joscelyn E. Fisher, PhD
Research Associate Professor
Department of Psychiatry
CSTS, USU
Brian W. Flynn, EdD
RADM, USPHS (Ret.)
Adjunct Professor
Department of Psychiatry
CSTS, USU

Michael C. Freed, PhD
Chief
Services Research and Clinical
Epidemiology Branch
National Institute of Mental
HealthDepartment of Psychiatry
CSTS, USU
Carol S. Fullerton, PhD
Research Professor
Department of Psychiatry
CSTS, USUFrancie Gabbay, PhD
Research Associate Professor
Department of Psychiatry
CSTS, USUJames Giordano, PhD
Adjunct Professor
Department of Psychiatry
CSTS, USU
Gena L. Glickman, PhD
Associate Professor
Director, Chronobiology, Lightand Sleep Lab
Department of Psychiatry and
Neuroscience
CSTS, USU
Oscar I. Gonzalez, PhD
MAJ, MS, USA
Research Psychologist
Army Resilience Directorate
Headquarters, US Department of
the Army, DCS, G-1
Department of Psychiatry
CSTS, USU
Elizabeth A. Greene, MD
Assistant Professor
Department of Psychiatry
CSTS, USU
Derrick Hamaoka, MD
Col, USAF, MC, FS (Ret.)
Professor
Department of Psychiatry
CSTS, USU

Erin L. Maresh, PhD
Research Psychologist
Department of Psychiatry
CSTS, USU
Brooke A. Heintz Morrissey, PhD,
LCSW
LTC, ARNG
Suicide Prevention Program &Army Behavioral Health andNational Guard Programs
Department of Psychiatry
CSTS, USU
Harry C. Holloway, MD
COL, MC, USA (Ret.)
Professor Emeritus
Department of Psychiatry
CSTS, USU
Marjan G. Holloway, PhD
Professor
Department of Medical & ClinicalPsychology and Psychiatry
CSTS, USU
Edmund G. Howe III, MD, JD
Professor
Department of Psychiatry
CSTS, USU
Xianzhang Hu, MD, PhD
Department of Psychiatry
CSTS, USU
Luke Johnson, PhD
Associate Professor
Department of Psychology
University of Tasmania
Tasmania, Australia
Adjunct Assistant Professor
Department of Psychiatry
CSTS, USU
Tzu Cheg Kao, PhD
Professor
Department of Preventive Medicine
and Biometrics and Psychiatry
CSTS, USU

2023 ANNUAL REPORT | 49

Elie Karam, MD
Professor and Chairman
Department of Psychiatry
American University, Beirut
Beirut, Lebanon

Thomas H. Nassif, PhD
MAJ, MS, USA
Research Psychologist
Department of Psychiatry
CSTS, USUDavid S. Krantz, PhD
Professor
Department of Medical & ClinicalPsychology and Psychiatry
CSTS, USU

Christin M. Ogle, PhD
Research Assistant Professor
Department of Psychiatry
CSTS, USU

Kimberly D. Kumer, MD
Col, USAF, MC
Assistant Professor
Director of Operational
Curriculum
Department of Psychiatry
CSTS, USU
Christina La Croix, DO
CDR, USN
Assistant Professor
Department of Physical Medicine& Rehabilitation andPsychiatry
CSTS, USU
He Li, MD, PhD
Associate Professor
Department of Psychiatry
CSTS, USU
Xian Liu, PhD
Research Professor
Deployment Health ClinicalCenter
WRNMMCJames E. McCarroll, PhD, MPH
COL, USA (Ret.)
Research Professor
Department of Psychiatry
CSTS, USU
Eric Meyer II, MD
Lt Col, USAF, MC, FS
Professor
Department of Psychiatry
CSTS, USU

Darrel A. Regier, MD, MPH
RADM, USPHS (Ret.)
Adjunct Professor
Department of Psychiatry
CSTS, USU
Dori B. Reissman, MD, MPH
RDML, USPHS (Ret.)
Adjunct Professor
Department of Psychiatry
CSTS, USU
Dale Russell, PhD
Director of Research/SeniorResearch Psychologist
Commander, Naval Surface Forces
Behavioral Science Researcher
Department of Psychiatry
CSTS, USU
Patcho N. Santiago, MD, MPH
CAPT, MC, USN (Ret.)
Associate Dean for Diversity &Inclusion
School of Medicine
Associate Professor
Department of Psychiatry
CSTS, USU
Eric Serpico, DO
LCDR, USN
Assistant Professor
Department of Psychiatry
CSTS, USU
Rachel Shor, PhD
Research Assistant Professor
Department of Psychiatry
CSTS, USU

50 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Patricia Spangler, PhD
Research Assistant Professor
Department of Psychiatry
CSTS, USU
Madeline Teisberg, DO
LCDR, MC, USN
Assistant Professor
Department of Psychiatry
CSTS, USU
Faculty, National Capital
Consortium Psychiatry
Residency
WRNMMCE. Fuller Torrey, MD
Executive Director
Stanley Medical Research InstituteMary C. Vance, MD, MSc
LCDR, USPHS
Director, Behavioral Health, PacificArea, USCG
Assistant Professor
Department of Psychiatry
CSTS, USU
Adam Walsh, PhD, LCSW
Adjunct Professor
Department of Psychiatry
CSTS, USU
Tasanee Walsh, PhD, MPH, MSW
Department of Psychiatry
CSTS, USU
Jing Wang, PhD
Research Associate Professor
Department of Psychiatry andMedical & Clinical Psychology
CSTS, USU
Leming Wang, MS
Instructor
Department of Psychiatry
CSTS, USU
Maree J. Webster, PhD
Research Assistant Professor
Department of Psychiatry
CSTS, USU
Director

Laboratory of Brain Research
Stanley Medical Research InstituteLars Weisaeth, MD
Professor
Division of Disaster Psychiatry
University of Oslo
Oslo, Norway
James (Curt) West, Jr., MD
CAPT, MC, USN (Ret.)
Associate Professor and Deputy
Chair
Department of Psychiatry
CSTS, USU
Ronald Whalen, PhD, LMSW
Senior Research Social Worker
Department of Psychiatry
CSTS, USU
Kathleen Wright, PhD
Former Director (Ret.)
Force Health Protection Program
USAMRU-E
WRAIR
Gary H. Wynn, MD
COL, MC, USA (Ret.)
Professor
Department of Psychiatry
Senior Scientist
CSTS, USU
Lei Zhang, MD
Associate Professor
Department of Psychiatry
CSTS, USU

BIOSTATISTICIANS
Pablo A. Aliaga, MS
Instructor
Department of Psychiatry
CSTS, USU
Leming Wang, MS
Instructor
Department of Psychiatry
CSTS, USU

Jingning Ao, MPH
Biostatistician
Department of Psychiatry
CSTS, USU

Amber Hampton, MSN, RN
Clinical Coordinator II
Department of Psychiatry
CSTS, USU

Matthew Georg, MPH
Data Analyst
Department of Psychiatry
CSTS, USU
Katy Haller, MSPH
Data Analyst
Department of Psychiatry
CSTS, USU

Brooke A. Heintz Morrissey, PhD,
LCSW
LTC, ARNG
Operations Director
Suicide Prevention Program, &Army Behavioral Health andNational Guard Programs
Department of Psychiatry
CSTS, USU

Jing Zhou, MS
Biostatistician
Department of Psychiatry
CSTS, USU

Elizabeth Lute, MBA HM, BSN, RN
Clinical Coordinator II
Department of Psychiatry
CSTS, USUPROGRAM
MANAGEMENT

Kristina Medvescek, MPH
Study Coordinator
Department of Psychiatry
CSTS, USU

Wafa Azgugu, MS
Clinical Coordinator II
Department of Psychiatry
CSTS, USU
Sara Bessman, MS
Laboratory Manager
Department of Psychiatry
CSTS, USU
Alexandra Blumhorst, BS
Study Coordinator II
Department of Psychiatry
CSTS, USU
Natasha Dhanraj, BS
Study Coordinator
Department of Psychiatry
CSTS, USU
Leah McGowan Fletcher, MSW,LCSW, BCD
LTC, MS, ARNG
Senior Operations Manager, Army
Behavioral Health and National
Guard Programs
Department of Psychiatry
CSTS, USU

Miranda Meyer, MPA
Senior Program Coordinator
Department of Psychiatry
CSTS, USU
Amila Odeh, BS
Study Coordinator
Department of Psychiatry
CSTS, USU
Joseph Piemontese, BS
Information Technology Specialist
Department of Psychiatry
CSTS, USU
Deborah M. Probe, MA
Project Coordinator
Department of Psychiatry
CSTS, USU
Devinn Searfass, MA
Study Coordinator
Department of Psychiatry
CSTS, USU

2023 ANNUAL REPORT | 51

Aaron Weingrad, BS
Assistant to the Director
Scientific Program Coordinator II
Department of Psychiatry
CSTS, USU
Rafael Zuleta, BS
Associate Program Manager
Department of Psychiatry
CSTS, USUFINANCIALMANAGEMENT
Diana Monday
Administrative Assistant II &Presentations Coordinator
Department of Psychiatry
CSTS, USU
Joshua Ruff, BA
Senior Manager, FinanceOperations
Department of Psychiatry
CSTS, USU

CSTS FELLOWSHIP
AWARD RECIPIENTSWilliam Flerlage
Haley Spencer
Matthew Thompson

MILITARY SUPPORTOPERATIONS
MSgt Jessica Moore

STAFF
Myshak Abdi
Sasha Baghdadi
Kirstin Battles
Rina Berman
Ashley Bernard
Jennifer Bivin
Nur Bookwala
Sama Elmahdy
Shira Godin
Leiana-Mejoi Griffith

Aliya Hilmi
Joseph Hooke
Aamina Khattak
Xiaoxia Li
Carina Martin
Madeleine McGuinness
Hanna Nettles
Rony Ngamliya-Ndam
Rehana Naik Olson
Samuel Nunn
Jessica Simanjuntak
Luke Sumberg
Arrey ThomasPriyanka Udayakumar
Sonia Warrior

Department Head, Deployment
Health Research
Naval Health Research Center

STRATEGIC DIRECTIONSBOARD MEMBERS

Eric B. Schoomaker, MD, PhD
Lieutenant General, US Army
(Retired)
Department of Military andEmergency Medicine
USU
Former US Army Surgeon GeneralandCommanding General of the US Army
Medical Command

Terry M. Rauch, PhD (Chair)Director, Medical Research andDevelopment
Health Readiness Policy andOversight, Health Affairs
DoD
Amy B. Adler, PhD
Senior Scientist, Center for
Military Psychiatry and
Neuroscience
WRAIR
RADM Matthew E. Kleiman,
MSW
Assistant Surgeon General
US Public Health Service
Harvey B. Pollard, MD, PhD
Department of Anatomy,
Physiology and Genetics
USU
David Riggs, PhD
Professor, Director for the Center
for Deployment Psychology
USU
Rudy P. Rull, PhD, MPH
Principal Investigator, Millennium
Cohort Study

52 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Paula P. Schnurr, PhD
Executive Director, National Center
for Posttraumatic Stress Disorder
VA
Delores Johnson Davis, MA, MSW
Federal Executive (Retired)
RADM Dori B. Reissman, MD, MPH
Rear Admiral, US Public HealthService (Retired)

SCIENCE COLLABORATIVEMEMBERSJames E. Barrett, PhD
Emeritus Professor and Former
Chairman
Department of Pharmacology andPhysiology
Drexel University
College of Medicine
Paul D. Bliese, PhD
Associate Professor
Department of Management
University of South Carolina
Darla Moore School of Business
Robert Bossarte, PhD
Professor
Department of Psychiatry and
Behavioral Neurosciences
University of South Florida
Adjunct Professor
Department of Psychiatry
CSTS, USU

David Brody, MD, PhD
Professor
Department of Neurology
Director
Center for Neuroscience andRegenerative Medicine
USU
M. Richard Fragala, MD
COL, USAF, MC, FS (Ret.)
Professor
Department of Psychiatry
USU
Matthew J. Friedman, MD, PhD
Professor
Department of Psychiatry
Professor
Department of Pharmacology &Toxicology
Dartmouth University
Geisel School of Medicine
Director Emeritus
Leahy-Friedman National PTSD
Brain Bank
Senior Advisor
National Center for PTSD
VAHarry C. Holloway, MD
COL, MC, USA (Ret.)
Professor Emeritus
Department of Psychiatry
USU
Ronald C. Kessler, PhD
McNeil Family Professor
Department of Health Care Policy
Harvard Medical School
Craig H. Llewellyn, MD
Professor
Department of Military &Emergency Medicine
USU
Irwin Lucki, PhD
Professor and Chair
Department of Pharmacology &Molecular Therapeutics
USU

Matthew K. Nock, PhD
Edgar Pierce Professor and Chair
Department of Psychology
Harvard University
Francis O’Conner, MD, MPH
COL, MC, USA
Professor
Department of Military andEmergency Medicine
USU
Harvey B. Pollard, MD, PhD
Professor
Department of Anatomy,
Physiology & Genetics
USU
Robert M. Post, MD
HeadBipolar Collaborative Network
Former Chief
Biological Psychiatry Branch
NIMHDavid Riggs, PhD
Professor and Chair
Department of Medical & ClinicalPsychology
Executive Director
Center for Deployment
Psychology
USU
Arieh Y. Shalev, MD
Professor
Department of Psychiatry
New York University Professor
Department of Psychiatry
Hadassah University School of
Medicine
Jerusalem, Israel
M. Katherine Shear, MD
Professor
Department of Psychiatry in Social
Work
Columbia University School ofSocial Work
Columbia University College ofPhysicians and Surgeons
Director, Center for Complicated
Grief
Columbia University

Murray B. Stein, MD, MPH
VA San Diego Healthcare System
Distinguished Professor
Department of Psychiatry andFamily Medicine & Public Health
University of California, San Diego
Lars Weisaeth, MD
Professor
Division of Disaster Psychiatry
University of Oslo
Oslo, Norway

DISTINGUISHED FORMERSCIENCE COLLABORATIVEMEMBERS & EMERITUS
FRIENDS OF CSTS
Herbert A. Hauptman, PhD(1917-2011)1985 Nobel Laureate, Chemistry
President
Hauptman-Woodward Medical
Research InstituteResearch Professor
Department of Biophysical Sciences
Adjunct Professor
Department of Computer Science
University of Buffalo
Joshua Lederberg, PhD, ForMenRS(1925-2008)
1958 Nobel Laureate, Physiology or
Medicine
Professor Emeritus
Department of Molecular Genetics
and Informatics
Rockefeller University
Founder, Department of Medical
Genetics
University of Wisconsin, Madison
David H. Marlowe, PhD(1931-2014)
Senior Lecturer
Department of Psychiatry
USU
Former Chief
Department of Military Psychiatry
WRAIR Fellow
American Anthropological
Association
2023 ANNUAL REPORT | 53

Funded Grants
AWARDS (Jan-Dec 2023)

FUNDING INSTITUTION

Pilot Trial Comparing Exposure and Non-Exposure Treatments for Post-trauma Nightmares and Insomnia:Nightmare Deconstruction and Reprocessing vs. NightWare Wristband

DHP

Brain Bank Project: Consortium for the Translational Neuroscience and Treatment of Stress and PTSD		(VA Biorepository Brain Bank: PTSD Brain Bank Protocol)
VA
Study to Assess Risk and Resilience in Servicemembers – Longitudinal Study (STARRS-LS)

DHP

Family Violence and Trauma Project

IMCOM

Central Nervous System Correlates Study

MOMRP

Army National Guard Behavioral Health Project
National Guard Bureau Joint Staff Prevention Workforce Project

ARNG
NGB

Identifying Predictors of Treatment Response in Service Members with Posttraumatic Stress Disorder Related
Sleep Disturbances: Use of Large Datasets to Improve Treatment Selection over the Military Lifecycle USAMRMC
Center for the Study of Traumatic Stress (CSTS) Program

DHP

Grief and Health-Related Quality of Life in World Trade Center (WTC) Survivors: Associations with
Bereavement, Trauma Exposures, and Mental and Physical Health Conditions

CDC

Identifying Motivations for Service Members and Veterans Owning Firearms, Storing Them in Unsafe
Conditions and Using Them to Hurt Others or Themselves

CDC

Suicide Prevention Program (SPP)

DHP

Targeting Family Risk Associated with Unsafe Firearm Storage Practices

MOMRP

A Phase 2, Multi-center, Multi-Arm, Randomized, Placebo-Controlled, Double-Blind, Adaptive Platform
Trial to Evaluate the Safety, Tolerability and Efficacy of Potential Therapeutic Interventions in
Active-Duty Service Members and Veterans with PTSD
USAMRMC
Emotion Regulation and Cognitive Flexibility Program (ERCFP): Targets for Improving		
​Psychological Health and Enhancing Performance		DARPA
Pre-Deployment and Deployment-Related Risk and Resilience Factors for Insomnia in Military Personnel MOMRP

54 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USUPartnerships
The Center has worked withorganizations in the public
and private sectors throughresearch partnerships, project
collaborations, consultations
and trainings. CSTS would liketo acknowledge and thank ourpartners and collaborators listed
below:
American Academy of Child andAdolescent Psychiatry
American Association for the
Advancement of Science
American Gold Star Mothers
American Psychiatric Association(APA)
American Psychological
Association (APA)
Architect of the Capitol
Armed Forces Retirement Home
Broad Institute
The Carter Center
Catholic University of America
Center for Health Care Research
Medical University of South
Carolina
Centers for Disease Control andPrevention (CDC)
Columbia University
Columbia University Mailman
School of Public HealthCornell University
Dartmouth University
Defense Centers of Excellence
for Psychological Health andTraumatic Brain Injury
Defense Institute of Medical
Operations, Mexico
Department of Mental Health, The
District of Columbia
Deployment Health ClinicalCenterDisaster Psychiatry Canada
Dover Air Force Base
Drexel University

European College of
Neuropsychopharmacology
Federal Bureau of Investigation(FBI)
Florida Department of Health
Ft. Bragg, NC (renamed Ft.
Liberty)
Ft. Hood, TX (renamed Ft.
Cavazos)
Ft. Lee, VA (renamed Ft. Gregg
Adams)
Ft. Stewart, GA
George C. Marshall Center for
European Security
Gold Star Wives of America
Harvard University Medical
SchoolHarvard University School of
Public HealthHenry M. Jackson Foundation for
the Advancement of Military
Medicine (HJF)
Human Performance Resources by
CHAMP
Immigration and Customs
Enforcement
International Initiative on Mental
Health Leadership
International Ministerial Five Eyes
Alliance
International Society forTraumatic Stress Studies(ISTSS)
Italian Embassy, Washington, DC
Joint Base Lewis-McChord
Joint Mortuary Affairs Center andSchool, Ft. Lee (renamed Ft.
Gregg-Adams)
Las Vegas Psychiatric Association
Mass General Brigham
Medical Research Command at Ft.
Detrick, MD
Military Child Education Coalition
Military Mortuary Affairs (MA)Miller School of Medicine of the
University of Miami

National Association of State
Mental Health Program
Directors (NASMHPD)
National Center for PostTraumatic Stress Disorder ofthe VA
National Child Traumatic Stress
Network (NCTSN)
National Committee for Employer
Support of the Guard andReserve
National Fallen Firefighters
Foundation
National Institute for
Occupational Safety and
HealthNational Institute of Mental
HealthNational Institutes of Health(NIH)
National Military Family
Association
The National Association for
PTSD
The National Association ofState Mental Health Program
Directors
National Intrepid Center of
Excellence (NICoE)
National Military Family
Association
Norwegian Military
Rockefeller University
Rutgers University Cell & DNA
Repository
Rutgers University School ofSocial Work
Sesame Workshop
Stanford University
State of California
State of Colorado
State of Texas
State of Maryland
Substance Abuse and Mental
Health Services Administration(SAMHSA)
2023 ANNUAL REPORT | 55

Syracuse University
Syracuse VA Medical Center
The Alfred P. Sloan Foundation
Tragedy Assistance Program for
Survivors
Tulane School of Social Work
Uniformed Services University
Union Pacific Railroad
US Agency for International
Development
US Air Force
US Army
US Army Family Advocacy
Program (FAP)US Army Family Programs
US Army Installation Management
Command
US Army Medical Research &Development Command
US Coast Guard (USCG)US Department of Defense (DoD)US Department of Energy (DoE)US Department of Health andHuman Services (HHS)US Department of Homeland
Security (DHS)US Department of Justice (DOJ)US Department of State (DoS)US Department of Veterans
Affairs (VA)
US Postal Service (USPS)
University of California, Los
Angeles (UCLA)
University of California, San Diego(UCSD)
University of Michigan
University of Pennsylvania
University of Pittsburgh
University of Virginia
University of Virginia’s Critical
Incident Analysis Group

University of Washington
Veterans Administration Medical
Center of DC
Vibrant Emotional Health
Walter Reed Army Institute of
Research (WRAIR)
Walter Reed National Military
Medical Center (WRNMMC)World Psychiatric Association
Wright State University
Yale University
Yale School of Medicine and
VA Connecticut Healthcare
SystemYellow Ribbon Reintegration
ProgramZero to Three

Dr. Carol Fullerton.

Dr. Robert Ursano.

56 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

FACES OF CSTS

Dr. Jeff Thomas and CSTS Research Assistants,
National Museum of Health and Medicine.

CSTS daily noon meeting.

Preparing participant packets for the Daily Diary
Study.

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org