U n i f o r m e d S e rv i c e s U n i v e r s i t yCenter for the Study of Traumatic Stress2012 Annual ReportC e l e b r at i n g 2 5 Y e a r s : 1 9 8 7 – 2 0 1 2

1

Partnerships

U.S. Department of Defense
U.S. Department of Energy

As 2012 marks the 25th year of our Center, wewant to acknowledge the following institutions
that have supported and continue to support ourwork through research and educational collaborations, through funding and importantly throughsharing our mission: to better understand theimpact of trauma and inform interventions thatcan prevent and mitigate its effects on the healthof individuals, families, communities and nations,ours and those around the globe.
American Academy ofChild and Adolescent
Psychiatry

District of Columbia
Department of Mental
HealthAmerican Gold Star Mothers

Dover Air Force Base

American Gold Star Wives

Drexel University

American Psychiatric
Association

Embassy of Italy

American Psychological
Association

Federal Bureau of
Investigation

American Red Cross

Florida Department of
HealthArchitect of the Capitol

Ft. Bragg, NC

Armed Forces Retirement
Home

Ft. Hood, TX

Catholic University ofAmerica
Center for Health Care
Research Medical
University of South
Carolina
Centers for Disease Control
and Prevention
Columbia University
Columbia University
Mailman School of Public
HealthCornell University
Dartmouth University
Defense Centers of
Excellence for
Psychological Health andTraumatic Brain Injury
Deployment Health ClinicalCenterFt. Lee, VA
Ft. Stewart, GA
Geological Survey ofCanada, Natural
Resources Canada

U.S. Department of Healthand Human Services
U.S. Department ofHomeland Security
U.S. Department of Justice
U.S. Department of State
U.S. Department of Veterans
Affairs
Massachusetts General
Hospital
Military Child Education
Coalition
Miller School of Medicine of
the University of Miami
National Association ofState Mental HealthDirectors
National Center for Post
Traumatic Stress Disorderof the Department of
Veterans Affairs
National Committee for
Employer Support of theGuard and Reserve
National Fallen Firefighters
Foundation

George C. Marshall Center
for European Security

National Institute for
Occupational Safety and
HealthHarvard University Medical
SchoolNational Institute of Mental
HealthHarvard University School of
Public HealthNational Institutes of
HealthInstitute of Medicine

National Military Family
Association

International Society forTraumatic Stress Studies
Joint Base Lewis-McChord
Joint Mortuary AffairsCenter and School, Fort
Lee, VA
Las Vegas Psychiatric
Association

Office of the First Lady, The
White House
The Alfred P. Sloan
Foundation
The Carter Center

The Henry M. JacksonFoundation for the
Advancement of Military
Medicine
The National Child
Traumatic Stress Network
RAND Corporation
Rutgers University Cell and
DNA Repository
Rutgers University School ofSocial Work
Sesame Workshop
Substance Abuse andMental Health Services
Administration
Syracuse University andSyracuse VA Medical
Center

U.S. Navy
U.S. Postal Service
U.S. Public Health Service
University of California, Los
Angeles
University of California, San
Diego
University of Michigan
University of Michigan
Institute for Social
Research
University of Pennsylvania
University of Virginia
University of Virginia’s
Critical Incident Analysis
Group
University of Washington

Tragedy Assistance Programfor Survivors

Veterans Administration
Medical Center of DC

Tulane School of Social Work

Walter Reed Army Instituteof Research

Union Pacific Railroad
U.S. Air Force
U.S. Army
U.S. Army Family Advocacy
Program
U.S. Army Family Programs
U.S. Army Installation
Management Command
U.S. Army Medical Researchand Materiel Command
U.S. Coast Guard

Walter Reed National
Military Medical Center
World Health Organization
Wright State University
Yale School of Medicine
and VA Connecticut
Healthcare System
Yellow Ribbon
Reintegration Program
Zero to ThreeFrom the Director of CSTS
Dear CSTS Colleagues and Friends,
In 2012, the Center for the Study of Traumatic Stresscontinued to demonstrate its unique commitment toimproving the psychological health of those people andpopulations exposed to trauma
and traumatic events. While agreat deal of our work continues
to focus on research and outreach
related to the mental health andresilience of our service members
and their families, our Center
responded to two tragic community shootings in Colorado andConnecticut. We provided expertise in community behavioral health and recovery, and the provision of real time,educational resources to help leadership and families in
the aftermath of these events. Our Center’s focus on translational research and knowledge — from the laboratory to
the bedside, field, clinic and public policy — has enabled
us to assist the Department of Defense and the nation inbetter responding to and preparing for the psychologicaland behavioral health effects of traumatic exposure.
Our 2012 Annual Report also marks the 25th anniversary of the Center for the Study of Traumatic Stress. This
milestone presents an opportunity to reflect on our Center’s history in the context of our ongoing contributions totrauma research, education, consultation and training. We
present a special section on the Vision Behind the Center
provided to us by the distinguished Dr. Harry Holloway, Professor, Department of Psychiatry of Uniformed
Services University. Dr. Holloway’s many experiences andcontributions both to the University and the Department
laid the groundwork for what is now the Center for the
Study of Traumatic Stress.
Since July 2009, our Center has been involved as partof a collaborative research network in the largest study ofmental health risk and resilience ever conducted among
military personnel, Army Study to Assess Risk and Resil-

ience in Servicemembers (Army STARRS). In the fall, we
briefed the Secretary of the Army, the Chief of Staff of theArmy, the Vice Chief of Staff of the Army, and the Deputy Undersecretary of the Army on this research project
whose findings will be applied to the Army’s ongoinghealth promotion, risk reduction, and suicide prevention
efforts. At the end of 2012, the Army STARRS team hadcollected data at 70 different Army locations throughout
the U.S. and abroad, and more than 100,000 Soldiers had
participated.

In 2012, the Center for the Study ofTraumatic Stress continued to demonstrate
its unique commitment to improving thepsychological health of those people andpopulations exposed to trauma and traumatic
events.
The Center’s research in neuroscience and the neurobiology of stress has resulted in the discovery of potential
biomarkers for PTSD, potential biomarkers for suicide
risk, increased understanding of gene expression patterns
that underlie biomarkers, and the role of fear memory
consolidation and extinction. These studies continue tohelp us identify and inform new treatments that have thepotential to not just alleviate symptoms of trauma-induced disorders, but to prevent and treat those whose
symptoms have been resistant to current interventions.
We are integrating these research methodologies to support the mental health and resilience of diverse populations from our nation’s Guard and Reserve to our researchon bereavement with military families and children.
The Center’s Child & Family Program continues to2012 Annual Report | 1

…CSTS will continue working with themany organizations whose collaborations
have strengthened our work and its value tothe fields of military psychiatry and disastermental health, and our nation’s public healthand national security.
provide leadership around the impact of combat stress on
military children and families. In 2012, Associate Director
and Child and Family Program head, Dr. Stephen Cozza, served as an expert panelist, along with Chairman of
the Joint Chiefs of Staff General Martin Dempsey, Mrs.
Patty Shinseki and others at ‘Helping Military Families
Through Challenging Transitions’, presented by Sesame
Street and moderated by Bob and Lee Woodruff. Workon the Center’s groundbreaking study on Military Family
Bereavement continues to shed light on this traumatic
aspect of combat.
In 2012, CSTS received approval to commence a new
project with the U.S. Department of Homeland Security in which the two organizations will collaboratively
research, recommend, develop, present, and implement
cutting-edge training on Psychological First Aid, Decision
Making in High Stress Environments, and Resiliency
Assessments for DHS employees.
Unfortunately, 2012 also saw two tragic mass shooting episodes in a movie theatre in Aurora, Colorado andSandy Hook Elementary School in Newton, Connecticut.
In both instances, the Center and its Associate Director,
Brian Flynn provided expertise in the form of consultation and public health resources to mitigate the behavioral
health consequences of such traumas on individuals,
families and communities.
The Center also seeks to extend its trauma expertiseto educate and bridge the entire medical community, especially primary care and internal medicine. I am pleased
to have been the recipient of the 2012 American Collegeof Physicians William C. Menninger Memorial Award for
2 | Center for the Study of Traumatic Stress, USU

Distinguished Contributions to the Science of Mental
Health. This award is bestowed for distinguished contributions to the science of mental health and was originally
supported by the Menninger Foundation. The year ended
with our Center receiving the Joint Service Meritorious
Unit Award as one of the recognized centers of the Defense Centers of Excellence for Psychological Health andTraumatic Brain Injury (DCoE).
As we complete 25 years of service, The Center for
the Study of Traumatic Stress looks forward to fulfilling
its ongoing commitment to bring scholarly and researchoriented problem solving to the psychological and behavioral health challenges of the Department of Defense
and the nation, and to continue working with the manyorganizations whose collaborations have strengthened ourwork and its value to the fields of military psychiatry anddisaster mental health, and our nation’s public health andnational security.
Robert J. Ursano, M.D.
Professor of Psychiatry and Neuroscience
Chair, Dept. of Psychiatry, USU
Director, Center for the Study of Traumatic Stress

Robert J. Ursano, M.D., and Carol S. Fullerton, Ph.D., cut acake celebrating CSTS’ 25th Anniversary.

Vision Behind the Center
The Center for the Study of Traumatic Stress(CSTS) was officially established in 1987 to addressconcerns of the U.S. Department of Defense aroundthe psychological impact and health consequences
resulting from the traumatic impact of: 1) the possibility, or actual use, of weapons of mass destruction(WMD) during combat, acts of terrorism or hostage
events; 2) combat, peacemaking, peacekeeping, andoperations other than war; 3) natural disasters such as
hurricanes, tornadoes, or floods; and, 4) more common stress producing events such as physical assaults
and motor vehicle, shipboard, or airplane accidents inboth the uniformed and civilian communities.
At its quarter century mark, the Center continues
to be on the forefront of translational research inneuroscience and the neurobiology of stress, childand family trauma, especially focused on militarychildren and families, education in military anddisaster psychiatry, consultation and public education to help individuals, families, communities andthe nation prepare for, respond to and recover fromtraumatic events.

The vision behind the Center is greatly attributable toDr. Harry C. Holloway, Professor, Department of Psychiatry, Uniformed Services University (USU), and reflects his
relationship and work with Dr. David McKay Rioch, his
mentor. Dr. Rioch was the first Director of the Divisionof Neuropsychiatry (Division of NP), Walter Reed Army
Institute of Research (WRAIR) and the first to initiate
study of the human response to stress using experts in thevarious neurosciences, behavioral analysis and the social
sciences. These experts, among who included Dr. Holloway, had collaborated in work that would characterize howorganisms, including human organisms, would respondHarry C. Holloway, M.D.
to extreme environmental challenges and demands. This
work also led to the development of an operational language that could be reliably and validly used to describe,study and respond to the problems created by stress. After
serving at WRAIR and its affiliated overseas labs for sevenyears, Dr. Holloway became the Director of the Divisionof the NP following Dr. Rioch’s retirement. Seven years
later in 1978, USU recruited Dr. Holloway as Director of
Research in the Department of Psychiatry.

Dr. Holloway’s goal and vision was toestablish a multidisciplinary group of basic
researchers and clinicians in a Center of StressResearch to address the array of open issues
concerning prevention of the developmentof chronic disabilities in response to extreme
environmental demands.

2012 Annual Report | 3

This early work also led to a pattern that
underlies CSTS’s disaster model and work:
to understand the impact of disasters, one
can study the impact as a whole, or one cantake its different parts and study these partsintensively.

Dr. Holloway’s Goal and Vision
Dr. Holloway’s goal and vision was to establish amultidisciplinary group of basic researchers and cliniciansin a Center of Stress Research to address the array ofopen issues concerning prevention of the development ofchronic disabilities in response to extreme environmental
demands. The Center was also created to train medical
students, house staff and graduate physician fellows toappreciate the risks associated with exposure to horror,
overwhelming environmental demands, and injury, andto do so within the organizational context of the medical school’s collaborators: trauma surgery, emergency
medicine, neurology, epidemiology, pathology, internal
medicine and its specialties, preventive medicine, medical
psychology, and various basic scientists. Initial problems
related to the limitation of mechanisms at the University
for funding and staffing research grants. These problems
were resolved with the establishment of The Henry M.
Jackson Foundation for the Advancement of Military
Medicine, Inc. (HJF) to support military medical research
programs.
Soon thereafter, Dr. Holloway was chosen to be Chairof the Department of Psychiatry. Dr. James Barrett, a research experimental psychologist, joined the department.
He initiated a set of laboratory studies that investigatedfundamental issues in behavior, neuroscience and neuropharmacology. He and Dr. Holloway worked with others
to create an interdisciplinary Department of Neuroscience.

4 | Center for the Study of Traumatic Stress, USU

The Stress Center Team Evolves
Dr. Robert Ursano, a psychiatrist and Flight Surgeon,
was recruited in 1979 from the USAF School of Aerospace Medicine in Texas. He had been responsible forthe psychiatric follow up on U.S. Air Force POWs fromthe Vietnam War, and he had completed a Fellowship inMedical Education at Yale University School of Medicine.
In 1982, Dr. Holloway created the precursor to CSTS
referred to as the ‘Stress Center’ with Dr. Ursano as chief.
Dr. Ursano soon took over leadership of a couple ofdisaster events and Dr. Holloway knew he had realized
his dream — to establish a Stress Center — as Dr. Ursano
created and led the field teams. These early teams hadcollaborators from the Division of NP, WRAIR. Dr. Ursano’s first hire was Dr. Carol Fullerton whose training inhuman development was viewed as highly valuable to Dr.
Holloway’s perspective of a Stress Center. According to
Dr. Holloway, people who study human development are
multi-variable people. “They look from multiple domains
when they try and look at a problem rather than eliminate
them, which many laboratories do, calling them noise.”
In fact, Dr. Holloway insisted that the overall teaching of
medical students be developmental because risk is critically determined by age and social status.
Dr. Fullerton’s credentials in human development andpsychology aligned with changing risk with changing age
and development.
In the spring of 1985, the Stress Center team wasworking with WRAIR in response to the crash of Arrow
Air Flight 1285 carrying U.S. troops from Cairo, Egypt via
Germany and Newfoundland to their home base in Fort
Campbell, Kentucky. Shortly after takeoff from Gander enroute to Fort Campbell, the aircraft crashed and burned
killing all 256 passengers and crew on board. Responding
to this disaster involved collaboration with WRAIR who
introduced the Center to a new approach and tool thatwould inform CSTS’s disaster work for years to come.
An assembled group deploying to the disaster called theepicon team, following a model previously developed at
WRAIR’s Department of Epidemiology, would collectdata in the field by observation as well as by questioning,surveying, and measuring.
This early work also led to a pattern that underliesIn the spring of 1985, the Stress Center team worked with
WRAIR in response to the crash of Arrow Air Flight 1285,
killing all 256 passengers and crew (stock photograph).
CSTS’s disaster model and work: to understand theimpact of disasters, one can study the impact as a whole,or one can take its different parts and study these partsintensively. The Stress Center began looking at what happened to people who stood guard over the remains; what
were the effects of dead bodies on them? The Stress teamalso looked at the community and what it meant to get areal surge in terms of what happened to its adolescents,
its families as they used up resources and became volunteers. Another principle that developed in 1987 out of
the Center’s chemical/biological warfare studies was theidea of bringing together “thought groups” from multiple
disciplines. The Center began having meetings of experts— usually about 50 people from cross-disciplinary areas.
It was not uncommon for an individual to ask, “Why am I
here to study chemical warfare when I study astronauts?”
The answer reflected the multidisciplinary purpose: that
attendee understood how people behaved in contained
environments.
Information into Action
In addition to science and research, the Center has
always been focused on application or what might today
be referred to as information that is ‘actionable’ — thepurpose of ‘application’ is to produce something that canbe used, e.g. the Center shares its observations with seniorleadership to help them understand how to minimize trau-

matic stress. This is the public health approach, which is
looking for interventions that can be used at the community level, at the family level and at the individual level before,
during, and after a traumatic event.
Central to the CSTS and integral to Dr. Holloway’s
legacy is a vision of interdisciplinary studies and multidisciplinary collaborations organized to address critical researchquestions using techniques from the bench to observational studies of field operations. The vision behind the Center
is a dynamic vision that continues today as dedicatedindividuals address complex problems that require complex science and an ability to communicate across diverse
disciplines and organizations.
The Center’s Work
The Center:■■ Develops and carries out research programs toextend our knowledge of the medical and psychiatricconsequences of war, deployment, trauma, disaster andterrorism, including weapons of mass destruction.
■■

Educates and trains health care providers, leaders,
individuals and public and private agencies on how toprevent, mitigate and respond to the negative consequences of war, deployment, traumatic events, disasters, and terrorism.

■■

Consults with private and government agencies
on medical care of trauma victims, their families andcommunities, and their recovery following traumatic
events, disasters and terrorism.

■■

Maintains an archive of medical literature on thehealth consequences of traumatic events, disasters andterrorism for individuals, families, organizations, andcommunities.

■■

Provides opportunities for post-doctoral trainingof medical scientists to respond to and research thehealth consequences of trauma, disaster, and terrorism.
In addition to science and research, the Centerhas always been focused on application.

2012 Annual Report | 5

Military Psychiatry
The Center, through its affiliation with the Department of Psychiatry of Uniformed Services University,
has since its establishment in 1987, institutionalized ournation’s knowledge of military psychiatry as a field of
academic and medical study. The Center has expanded
its contributions over a quarter of a century to strengthen
the performance, the health and mental health of our
troops in combat and in operations other than war, and tofoster the resilience of military families and children.
Neuroscience and the Neurobiology of Stress
The Center conducts pioneering, translational research in neuroscience and the neurobiology of stress. A
major focus of this research, which applies basic science
to clinical populations, is improving the lives of our nation’s service members post deployment around militaryunique health issues, especially posttraumatic stressdisorder (PTSD), mild traumatic brain injury (mTBI)
and suicide. 2012 saw expansion of the Center’s laboratory-based research in the neurobiology of stress, and also
its clinical and epidemiologic studies, which encompass
psychopharmacology, the application of cutting-edge
medical technology and studies that address the modifiable risk and protective factors of suicide and suicide
ideation.

Biomarker Research
The Center’s neuroscience research has resulted
in the discovery of potential biomarkers for PTSD,
potential biomarkers for suicide risk and increased
understanding of gene expression patterns that
underlie biomarkers. These findings may ultimately
be used to diagnose diseases promptly and accurately, toidentify individuals at high-risk for certain diseases, and tofollow the course of response to treatment. As new candidate biomarkers are identified, access to large collectionsof bio samples from persons exposed to trauma (withand without PTSD or other diseases) will be importantresources for scientists attempting to replicate and validate
initial studies.
In 2012, Center neuroscientists found that certain
gene families are involved in human brain development aswell as altered fear behavior in animals. Research utilizing
data from postmortem animal brain tissue and an animalmodel of high and low fear demonstrated that endocanabinoid receptor 1 (CBI) expression levels gradually
decrease in the prefrontal cortex (PFC) during development, and altered in the brains of mice selectively bred forhigh and low fear. These studies also found that a group of
mitochondrial genes undergo a consistent up-regulationin the PFC during development and play a role in thefear-related behavior. The development and use of highand low-fear animals models in order to understand theneuro-molecular basis for resilience, and the ability torecover from highly stressful or traumatic experiences, hasbeen pioneered by Center scientist, Luke Johnson. Dr.
Johnson’s work was featured in an article in Nature, International Weekly Journal of Science, which was distributed at
the Society for Neuroscience conference in New Orleans.
INTRuST Consortium Research
The Center plays an important research role throughparticipation and leadership in The National Capital Area
Integrated Clinical Study Site, an established network of

6 | Center for the Study of Traumatic Stress, USU

The Center’s neuroscience research has
resulted in the discovery of potential
biomarkers for PTSD, potential biomarkers
for suicide risk and increased understandingof gene expression patterns that underlie
biomarkers.
clinician-researchers at Walter Reed National Military
Medical Center (WRNMMC), the D.C. Veterans Administration Hospital and the Armed Forces Retirement
Home. This research is initiating clinical trials for novel
medications and psychotherapy treatment for PTSD andother combat-related disorders. The site is one of 10such study sites across the nation which comprise the
INTRuST Consortium for Psychological Health and TBI.
2012 saw advances in some of the network’s important projects. Enrollment was completed for the Consortium’s Transcranial Magnetic Stimulation (TMS) study(described below) and its Acceptance and Commitment
Therapy (ACT), a mindfulness-based psychotherapy for
combat veterans with deployment-related mental illness.
The Consortium’s biorepository enrolled subjects with
PTSD, TBI and healthy controls in an ongoing effort
to identify biomarkers for these diseases. The National
Capital Area site’s Brain Indices protocol, which seeks to
identify electrophysiological test, psychological test andbrain imaging predictors of PTSD risk in persons with
TBI, continued enrollment at Walter Reed National Military Medical Center and expanded to a second enrollment
site and testing laboratory at Fort Belvoir’s Army Hospital.
The Veterans Administration’s Office of Research andDevelopment has recognized the importance of a PTSD
biorepository—a collection of various biological specimens such as blood and saliva from donors with PTSD
and other deployment-related illnesses, as well as healthy
controls, and a larger national biorepository for all neuropsychiatric illnesses. In 2012, as part of its TraumaticStress & Biomarkers in a Military Population Study, theCenter continued to collect survey data, blood and saliva
from active duty soldiers returning from and deploying
to Afghanistan, as well as expanded collections to include activated Reserve populations from California andGuam. The Center also continued with scientists at the
NIMH and the Stanley Foundation to identify and collect
post-mortem brain tissue from persons with PTSD.
Reserve Component Research
The Center is engaged in extensive research with theReserve Component. In collaboration with Dr. Sandro
Galea of Columbia University, CSTS is conducting anationwide longitudinal research project on the healthand mental health of National Guard and Reserve service
members, an at risk population that has been understudied. The study addresses the epidemiology and the trajectory of posttraumatic stress, deployment stress, health risk
behaviors and health care utilization in National Guard
and Reserve. The third wave of annual data collection was
finished in 2012, and a fourth wave is planned for 2013.
Innovative Medical Technologies
The Center is conducting research that involves theuse of innovative medical technologies. In collaboration
with the Medical University of South Carolina and the
INTRuST Consortium, the Center has been working
on a Pilot Safety and Feasibility Study of High Dose Left
Prefrontal Transcranial Magnetic Stimulation (TMS) for
the rapid stabilization of acute suicidal behavior. TMS,
an FDA-approved therapy for treatment of depression,
involves the application of a strong, pulsing magnetic field

2012 Annual Report | 7

to an individual’s head, thus reaching his or her cerebral
cortex. This study will examine the effectiveness of TMS
for treatment of PTSD and suicidal behaviors. Enrollment
at both sites continued through 2012 and has recently
been completed.
Using an animal model of drug addiction, intravenous
drug self-administration, in combination with a stateof-the-art technology, non-invasive positron-emission
tomography (PET) and magnetic resonance (MR) brain
imaging, Center scientists are attempting to identify molecular and cellular markers that may characterize co-morbid substance abuse and anxiety disorders. Utilizing otherbehavioral measures such as Pavlovian fear conditioning
and acoustic startle reflex/pre-pulse inhibition in rodents,
they are investigating the interaction between morphinedependence and fear learning/extinction. In 2012 theyfound that spontaneous withdrawal from chronic morphine might have opposite effects on anxiety and fear
behavior. Understanding the effects of drug abuse on thevarious symptoms of PTSD has implications for clinicians
treating patients with substance use disorders and PTSD.
In 2012 CSTS launched a research study, Daily Diary
Assessment of Post Traumatic Stress Symptoms in US
Military Service Members. This study provides information in real time on the relationship of posttraumaticstress symptoms and psychiatric disorders (e.g., PTSD,
depression), sleep, pain, health risk behaviors (e.g., alcoholand tobacco use), and other areas of health and functioning in active duty service members. This study will
provide a new perspective on identifying PTSD and othersymptoms and behavioral patterns and the environmental
influences that may foster more effective treatments.
This important project will increase ourunderstanding of the relationship between
the daily variability of posttraumatic stresssymptoms and mental health conditions aswell as their trajectory of illness in soldiers.

8 | Center for the Study of Traumatic Stress, USU

In the pilot phase approximately 50 service members
will be recruited and complete daily assessments using
paper questionnaires. In phase II, approximately 350 service members will complete assessments using electronic
tablets programmed with sophisticated applications developed through the collaboration of CSTS and the National
Center for Telehealth and Technology (T2). Completedassessments are instantaneously uploaded to a secured
server for real time monitoring of assessment complianceand data retrieval.
This important project will increase our understandingof the relationship between the daily variability of posttraumatic stress symptoms and mental health conditions
as well as their trajectory of illness in soldiers. The study
has implications for the feasibility and benefits of using
electronic EMA methods in psychiatric research, and inparticular with soldiers.
Army STARRSThe Army Study to Assess Risk and Resilience inServicemembers (Army STARRS) is a five-year project toinvestigate risk andprotective factors for
suicide, suicide-related behaviors,and other mental health issues. Army STARRS involves
several studies whose goals are the same — to identify
factors that help protect a soldier’s mental health, andfactors that put a soldier’s mental health at risk. Since theproject began, the research team has successfully recruited
more than 100,000 soldiers at 70 different Army locations
throughout the U.S. and abroad. At the end of 2012, datacollection activities for the two largest studies were wrapping-up. One involved approximately 55,000 new soldiers
who completed questionnaires, performed neurocognitive
tests, and provided blood samples during their first weekof Army service. The other involved questionnaires from
more than 40,000 soldiers at various stages of their careers
across the entire Army. Researchers also conducted 460
clinical interviews with soldiers at eight locations for astudy to calibrate the accuracy of diagnostic measures usedin other Army STARRS studies. Data collection continues
for a longitudinal study of approximately 10,000 soldiersArmy STARRS will not only enhance the healthand resilience of our soldiers, but also will
benefit our nation as a whole…
who completed questionnaires and provided blood samples shortly before deployment and who will be re-contacted at three time-points after deployment. Recruitment
continues for two case-control studies: one involving
soldiers who committed suicide and the other involving
soldiers who were hospitalized for a suicide attempt. The
research team also has been conducting an historical studyof more than 1.6 million soldiers on active duty from 2004
to 2009 by compiling and analyzing complex data from
more than 1.1 billion de-identified health and administrative records. As data collection winds down in 2013, theresearch team will shift its focus to the equally-challenging
phase of preparing and analyzing the complex data-sets foreach study based on a wide array of variables created fromthe many different types of data collected. As findings
become available, they are being reported to senior Armyleadership so that the Army may apply them to its ongoinghealth-promotion, risk-reduction, and suicide-prevention
efforts. Army STARRS will not only enhance the healthand resilience of our soldiers, but also will benefit our nation as a whole because the findings will have widespread
public and behavioral health implications.
Mortuary Affairs Soldiers: Early Intervention andAltering Barriers to Care for Traumatic Stress and
PTSD (the TEAM Study)
Mortuary Affairs Soldiers: Early Intervention andAltering Barriers to Care for Traumatic Stress and PTSD
(known as TEAM; Troop Education for Army Morale)
is a novel stress management and resilience building
early intervention program designed to improve post-deployment readjustment in U.S. Army Mortuary Affairs(MA) soldiers—a group at high risk for psychologicalproblems. An educational intervention, TEAM is basedon the principles of Psychological First Aid (PFA), an
evidence-informed framework for behavioral health inter-

vention to reduce the initial distress caused by traumatic
events and to facilitate positive adaptation. PFA promotes
the following five principles: safety (physical and psychological), calming, connectedness, self-efficacy, and hope/
optimism.
TEAM is a group intervention offered to MA soldiers
as well as their spouses to foster an integration of support
resources within the unit (buddy care) and home (spousesupport) environments. Recruitment is conducted withinweeks after return from deployment and participation isvoluntary. Soldiers who agree to participate in the study
are randomized into either the intervention (workshop)
group or the control group, which receives “usual services” offered to soldiers. The intervention group receives
monthly 2-hour workshops at 2, 3, 4, and 7 months
post deployment, educational handouts, and access to a
specially designed intervention website. Assessments are
made in both groups at 2, 3, 4, 7, and 10 months post deployment. Study aims include assessment of the effectiveness of TEAM on distress, disorder (e.g., PTSD, depression), psychological well-being, health risk behaviors (e.g.,
alcohol or tobacco use), work function, marital conflict,and barriers to health care utilization.
Research establishing the effectiveness of TEAM
began in 2008 and will continue into 2014 making TEAM
one of the longest continuous research studies, and oneof the few intervention studies at CSTS. Findings fromTEAM will inform other early interventions with militaryand civilian populations.
Joining Forces Joining
Families is a quarterly
newsletter published by The
Center’s Family Violence andTrauma Project (FVTP).
In its seventeenth year,
FVTP provides support
via briefings, papers andstaff studies to inform Army leadership and the U.S.
Army’s Family Advocacy Program of the scientificand medical aspects of child and spouse abuse.

2012 Annual Report | 92012 Child and Family Program Activity
and Achievements
Since its establishment in 2006, the Child and Family
Program (CFP) of the Center for the Study of Traumatic Stress has distinguished itself as a national leader inadvancing scientific and clinical knowledge, as well as
educational resources that address the needs of children
and families affected by trauma, especially our nation’s
military families and children. Throughout 2012, Dr. Stephen J. Cozza, Associate Director, CSTS Child & Family
Program, provided his expertise to DoD leadership andnational organizations and stakeholders in military family
health and trauma.
Among the many highlights of 2012, Dr. Cozza
served as an expert panelist, along with Chairman of
the Joint Chiefs of Staff General Martin Dempsey, Mrs.
Patty Shinseki and others at ‘Helping Military Families
Through Challenging Transitions’, presented by Sesame
Street Workshop and moderated by ABC’s Bob Woodruff
and his wife, Lee. Key findings were announced on the

Dr. Cozza served as an expert panelist, along with Chairmanof the Joint Chiefs of Staff General Martin Dempsey, Mrs.
Patty Shinseki and others at ‘Helping Military Families
Through Challenging Transitions’, presented by Sesame Street
Workshop.
10 | Center for the Study of Traumatic Stress, USU

impact of Sesame Street’s Military Families Initiative, anda compelling analysis conducted by The Military Families Research Institute, Russell Research and CSTS was
unveiled. Dr. Cozza and his research team also provided
briefings throughout the year to Four-Star Wives, and theGold Star Wives Annual Convention in Fairborn, Ohio on
topics including the Center’s role in the National Intrepid
Center of Excellence (NICoE) and the Military Family
Bereavement Study described below.
The National Military Bereavement Study
In 2011, CFP received funding to conduct the National Military Family Bereavement Study, the first rigorous
scientific study to examine the impact of a U.S. service
member death on surviving family members. The National Military Family Bereavement Study (NMFBS) is anationwide study that aims to describe the population ofservice members who have died since 9/11, and to identify experiences of the service member’s bereaved family.
The study examines the psychological, physical and/or
behavioral outcomes of the grieving process, and how
family members’ pre-existing psychological and physicalhealth, support or resources (family, community) and/or genetic factors serve as risk or protective factors in thegrieving process.
This study uniquely combines psychosocial measuresand neuroscience methodologies. An optional part of thestudy allows interested participants to provide a saliva
sample for biomarker analysis. In 2012, data collection
for all areas of the study started. Some 519 participants
have completed the Phase 1 questionnaire; 191 saliva kits
have been returned for analysis; 62 families have been
identified as eligible for Phase 2 interviews and 22 of theseinterviews have been conducted; 14 focus groups havealso been conducted. During 2013, data collection forPhase 1, Phase 2 and Focus Group data will continue, anda manuscript that describes the deceased service member
population will be submitted for publication. Over theresources has been completed for 26 installations and 184neighboring communities.
Much of the activity during the 2012 calendar year
was related to advancing the completion of manuscripts
to be submitted for publication. The first manuscript(currently in preparation) will describe characteristics ofChild Neglect in the U.S. Army, including demographics
of offenders, children and families, as well as classificationof neglect using the Modified Maltreatment Classification
System.

The website home page and portal to the National Military
Family Bereavement Study (www. militarysurvivorstudy.org).
next three years, CSTS researchers will continue to work
actively with researchers from other academic institutions, including Columbia University, Harvard University,
University of Michigan, and the University of California,
Los Angeles.
Deployment Family Stress: Child Neglect and
Maltreatment in U.S. Army Families
Another key CFP study underway is Deployment
Family Stress: Child Neglect and Maltreatment in U.S.
Army Families. The goal of this in-depth study of childmaltreatment and neglect among Army personnel is todescribe the characteristics of substantiated child neglect
cases in the Army, and to identify factors within the family, the military community and the civilian communitythat contribute to family health or child maltreatment.
This 4-year study has made significant progress during
2012, culminating in the completion of all data collection
across 26 Army installations in the United States.
Data from 400 closed and substantiated child neglect
records has been collected from 4 Army installations. A
total of 1,088 questionnaires have been completed by telephone, online, or in person. These questionnaires include
information from Army Community Services (ACS)
staff and/or other service providers, and from voluntary
participants at the commissary. A review of community

FOCUS-CI: A Preventive Intervention withChildren and Families of the Combat Injured
Families OverComing Under Stress - Combat Injury(FOCUS-CI) is a randomized controlled trial that tests
the effectiveness of a newly developed family-centered,strength-based intervention for severely combat injured
service members and their families. The FOCUS-CI
intervention provides families support through integrated
instruction, coaching and skill-building in the areas ofemotion regulation, problem-solving, communication,and goal-setting. The study is conducted at Walter Reed
National Military Medical Center (WRNMMC), San
Antonio Army Medical Center (SAAMC), and is expand-

The website home page and portal to the Families
OverComing Under Stress – Combat Injury (FOCUS-CI)
study (www.cifamilies.org).
2012 Annual Report | 11

Families OverComing Under Stress – Combat
Injury (FOCUS-CI) is a randomized controlled
trial that tests the effectiveness of a newly
developed family-centered, strength-based
intervention for severely combat injured
service members and their families.
ing to The University of North Carolina at Chapel Hill.
Families are followed for two years to assess intervention
impact on key aspects of the long-term recovery trajectory: child distress and functioning, parent distress andfunctioning, and family functioning and injury communication. December 2012 marked the successful launchof the study into the field, as active family enrollment isunder way. Findings of this study are expected to validate
the usefulness of the FOCUS-CI model in the context ofthe complex dynamic that often exists uniquely within
military families, and particularly relating to those challenges resulting from combat injuries, including traumatic brain injury (TBI). The FOCUS-CI intervention
is designed to engage the injured service members andtheir families as early as in-theater hospitalization.

12 | Center for the Study of Traumatic Stress, USU

The innovation of the FOCUS-CI model incorporates customizable modularized family care management
sessions, remote access to web-based, interactive tools,
and building connections to a strong network of community resources — all of which have been developed toassist each participating family member (including children) in understanding and managing his/her psychological health during what can be an extremely difficult
period of transition. This study will help define newpathways to stay connected with combat-injured militaryfamilies post-deployment and offer innovative tools to
promote and sustain total quality of life.
CSTS Child and Family Program continues todemonstrate its commitment to improving the psychological and behavioral health of our nation’s militaryfamilies and children through its research, educational
activities and products and extensive consultative outreach to all levels of DoD, the federal government, anddiverse stakeholders. CFP work and impact is strengthened by its collaborations with National Child TraumaticStress Network (NCTSN), Zero to Three, Military Child
Education Coalition (MCEC) and National Military
Family Association (NMFA), The Tragedy Assistance
Program for Survivors (TAPS), Army Survivor Outreach
Services (S.O.S), and its interface and proximity to the
National Intrepid Center of Excellence (NICoE) andWRNMMC.

Disaster Behavioral Health Response,
Education, Planning
Since its establishment in 1987, the Center for the
Study of Traumatic Stress (CSTS) has played an important role nationally and internationally in helping communities respond to and recover from the psychologicaland behavioral health effects of exposure to many typesof traumatic events. These events range from natural
disasters such as hurricanes, earthquakes and tsunami, tohuman made disasters such as the Gulf Oil Spill, terrorist
attacks such as 9/11, and community violence. During
2012, the Center provided consultation and public
education around two tragic community events — themovie theatre shootings in Aurora, Colorado and themass school shooting at Sandy Hook Elementary School
in Newton, Connecticut.
Drawing upon his expertise in helping communities
respond to and recover from traumatic events, CSTS
Associate Director for Health Systems, Dr. Brian Flynn,
reached out to the National Association of State Mental
Health Program Directors in the aftermath of the Aurora,
Colorado movie-theater shooting that occurred on July20, 2012.
CSTS published and disseminated the following
information to support responders to this tragic event:
Predictable Reactions to Trauma/Resilience, What Do We
Know about Mental Illness and Violence?, Restoring a Sense
of Safety in the Aftermath of a Mass Shooting: Tips for Parents and Professionals. The latter fact sheet was featured on
the American Medical Association website. Dr. Flynn also
assisted in the production of the CSTS fact sheet on Grief
Leadership that was widely disseminated and continues tobe a valued document for community disasters.
Dr. Flynn actively consulted with the State of Connecticut following the Sandy Hook Elementary School
shootings that occurred on December 14, 2012 in
Newtown, Connecticut. He provided phone consultation
around preparation and process for official death notification, advised the State on management of the influx ofvolunteers, and leadership interaction with grieving fami-lies and the media. It was later reported that these consultations were very helpful; the Center’s resources and his
expertise were used extensively. The Center’s expertiseis also informed by compassion, often from direct exposure to disaster. A Capital Gazette article, “Anne Arundel
Schools Respond to Tragedy in Connecticut,” quotes Dr.
Flynn as saying, “This brought me back, right back to
Columbine, especially after hearing reports about parents
being notified. It’s such a tragedy. I’ve seen the faces of
those parents before. I know I can’t even imagine.”
In response to Superstorm Sandy that occurred in thefall of 2012, LCDR Jennifer Bornemann deployed as amember of one of the United States Public Health Service
Access Teams to help hurricane victims. LCDR Bornemann assisted the case management and social services
staff at Bayshore Community Hospital in Holmdel, NJ
with patient assessments, discharge planning and staff
resiliency.
National security is another area in which the Center provides its expertise in disaster behavioral health.
In September, CSTS received approval to begin a new
project with the U.S. Department of Homeland Security(DHS) in which the two organizations will collaboratively
research, recommend, develop, present, and implement
cutting-edge training for DHS employees.

2012 Annual Report | 13

Public Education Activities and Resources
The Center for the Study of Traumatic Stress provides
a wide range of educational activities and resources that
advance its expertise in disaster and military psychiatry.
The Center hosts professional conferences, develops fact
sheets, often in real time, in response to national andinternational disasters, creates innovative health education campaigns that address timely trauma needs, andworks with cutting edge technologies and organizations to
produce podcasts and distance learning products, and tocommunicate via social media outlets.
In collaboration with the USUHS Neuroscience Program, the Center hosted the 7th Annual Amygdala Stressand PTSD Conference featuring Dr. Sumantra Chattarji
from the National Center for Biological Science, India, Dr.
JoAnn Difede from Cornell Medical College, Dr. Sheena Josselyn from Toronto’s Hospital for Sick Children,
Dr. Jordan Smoller from Harvard Medical School, andDr. Eric Vermetten from the University Medical Center,Utrecht, The Netherlands. Over 300 scientists, leadersand professionals attended the conference, Recovery fromStress.
The Center also published an important report fromits Forum on Health and National Security conference,
Stigma and Barriers to Care: Caring for Those Exposed toWar, Disaster and Terrorism, which was widely distributed.
2012 saw a number of fact sheets developed anddisseminated by the Center. Its Courage to Care series,
in its 8th year of continuous publication, included The
Doctor-Patient Relationship: Opportunities and Risks of New
Communication Technologies. Researchers at the National
Defense University used a number of Courage to Careresources in a workshop on Military Psychology at theAmerican Psychological Association meeting.
The Center responded with public health education
resources to three community tragedies: two mass shootings and one, major natural disaster. The Center disseminated a number of fact sheets in the aftermath of the mass
shootings in Colorado and Connecticut including two
14 | Center for the Study of Traumatic Stress, USU

important resources to support community leaders: Grief
Leadership: Leadership in the Wake of Tragedy and Leadership In Disasters. In response to Hurricane Sandy, the Center distributed these important fact sheets: Safety, Recovery
and Hope After Hurricane Sandy: Helping Communities andFamilies; Sustaining Caregiving and Psychological Well-Being While Caring for Disaster Victims, and; Information for
Relief Workers on Emotional Reactions to Human Bodies in
Mass Death.
The Center’s public health education resources arehighly regarded by local and national organizations thatrecognize the Center’s expertise in the psychological effects and health consequences of traumatic events in boththe military and civilian communities.
The Center published an
important report fromits Forum on Healthand National Security
conference, Stigma andBarriers to Care: Caring
for Those Exposed to War,
Disaster and Terrorism,
which was widelydistributed.

F O RUM O N H E A LT H A N D N AT I O N A L S E CURI T Y

Stigma and Barriers to Care
Caring for Those Exposed to War,
Disaster and Terrorism
Conference Report

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University of the Health Sciences
and Defense Centers of Excellence

DEFENSE CENTERS
OF EXCELLENCEFor Psychological Health& Traumatic Brain Injury

Center for the Study of Traumatic Stress
The Center for the Study of Traumatic Stress (CSTS) is part of the Uniformed Services University’s Department of Psychiatry, located in
Bethesda, Maryland, and a partnering center of the Defense Center of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury.

In response to Hurricane
Sandy, the Center
distributed threeimportant fact sheets,
including Safety,
Recovery and Hope
After Hurricane Sandy:
Helping Communities andFamilies.

Safety, Recovery, and Hope After Hurricane Sandy:
Helping Communities and Families
Complex disasters such as Hurricane
Sandy often present a cascade of impacts to
those affected —individuals, families andcommunities. These disasters often promote
feelings of fear, confusion, grief, helplessness,anxiety, anger, guilt and even diminishedconfidence in self or others. In order tocounter these effects, disaster experts endorse
an approach called Psychological First Aid(PFA), which can help reduce negative
feelings and foster one’s sense of safety,
recovery and hope.

Psychological First aid
Psychological First Aid (PFA) also
promotes a sense of neighborhood stability
during periods of challenge. PFA seeks
to restore: (1) safety, (2) calming, (3)connectedness to others, (4) empowerment,and (5) hopefulness.

DON’T:■■ Force people to share their stories withyou (this may decrease calmness inpeople who are not ready to share theirexperiences).

DO:■■ Help people meet basic needs for food & shelter, andemergency medical attention. Provide repeated, simple
and accurate information on how to obtain these(safety).
■■ Listen to people who wish to share their stories andemotions; remember there is no wrong or right way tofeel (calming).
■■ Be friendly and compassionate even if people are being
difficult (calming).
■■ Continue to provide accurate information about thedisaster or trauma and the relief efforts to help people
understand the situation (calming).
■■ Help people contact friends or loved ones
(connectedness).
■■ Keep families together -- children with parents or otherclose relatives whenever possible (connectedness).
■■ Give practical suggestions that encourage people to meettheir own needs (empowerment).
■■ Find out and direct people to the types and locationsof available services (government and non-government(hopefulness).
■■ Remind people (if you know) that more help andservices are on the way (hopefulness).

■■ Give simple reassurances like “everything will be ok”

or “at least you survived” (statements like these tend todiminish calmness).
■■ Tell people what you think they should be feeling,

thinking or doing or how they should have acted earlier(this decreases self-efficacy).
■■ Make promises that may not be kept (un-kept promises

decrease hope).
■■ Criticize existing services or relief activities in frontof people in need of these services (this may decrease
hopefulness or decrease calming).
imPortant inFormation For recovery
What do I do in a power outage?
■■ Disconnect appliances to protect from surges■■ Consume food from refrigerator first, then freezer, andthen non-perishables. Open the refrigerator and freezer
as little as possible.
■■ If your home is cold, only use heating units approved
for indoor use.
■■ Keep your cell phone charged and let family and friends
know how you are doing■■ Do not run portable generators inside home
Continued

2012 Funded Grants
Study

Funding Institution

Family Violence and Trauma Project III

U.S. Army

Clinical Study Site for PTSD and TBI (sub-award)

UC San Diego

Addressing the Needs of Children and Families of Combat Injured

CDMRP

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

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

CDMRP
Columbia University

PTSD Trajectory, Co-morbidity, and Utilization of Mental Health Services among National Guard Soldiers
CSTS — Program Grant 2013

CDMRP
DCoE

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

CDMRP

Brain Indices of Risk for PTSD after Mild TBI

CDMRP

Initial Randomized Controlled Trial of Acceptance and Commitment Therapy (ACT) for Distress andImpairment in OEF/OIF Veterans

CDMRP

A Pilot Safety and Feasibility Study of High Dose Left Prefrontal Transcranial Magnetic Stimulation

UC San Diego

A Proof-of-Concept, Double-blind, Randomized, Placebo-Controlled Study of Ganaxolone in PTSD

UC San Diego

Modifiable Risk and Protective Factors for Suicidal Behaviors in the U.S. Army

NIMH

Modifiable Risk and Protective Factors for Suicidal Behaviors in the U.S. Army — ARRA

NIMH

Modifiable Risk and Protective Factors for Suicidal Behaviors in the U.S. Army — Supplement

NIMH

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

CDMRP

The Injury and Traumatic Stress(INTRuST) CONSORTIUM Biorepository
Riluzole Augmentation Treatment for Complicated PTSD (MOMRP)
Resilience Building for Homeland Security
Personally Owned Firearms
Behavioral-Based Predictions of Workplace Violence in The Army STARRSUC San Diego
U.S. Army
DHS
H.A./DOD
Harvard University
2012 Annual Report | 15

2012 Publications
Allen KJD and Gabbay FH. The amphetamine response
moderates the relationship between negative emotionality and alcohol use. Alcoholism: Clinical and Experimental
Research. 2012;37: 348–360.
Biggs QM, Guimond JM, Fullerton CS, Ursano RJ, and
ASD Workgroup (Gray C, Goldenberg MN, Reissman D,
McCarroll JE, Santiago P, Tyler MP). The epidemiology ofacute stress disorder and other early responses to trauma
in adults. In: Beck JG & Sloan DM, eds. The Oxford Handbook of Traumatic Stress Disorders. New York, NY: Oxford
University Press. 2012; 69–83.
Call J, Pfefferbaum B, Jenuwine M, and Flynn B. Practicallegal and ethical considerations for the provision of acutedisaster mental health services. Psychiatry. 2012;75(4):305–322.
Cantilena L, Kahn RC, Duncan CC, Li SH, Anderson A,
and Elkashef A. Safety of atomoxetine in combination
with intravenous cocaine in cocaine-experienced participants. Journal of Addiction Medicine. 2012;6(4): 265–273.
Choi KH, Le T, McGuire J, Xing G, Zhang L, Li H, Parker
CC, Johnson LR, and Ursano RJ. Expression pattern ofthe cannabinoid receptor genes in the frontal cortex ofmood disorder patients and mice selectively bred for highand low fear. Journal of Psychiatric Research. 2012;46(7):882–889.
Choi KH, Le T, McGuire J, Coyner J, Higgs BW, Diglisic
S, Johnson LR, Benedek DM, and Ursano RJ. Expression
profiles of mitochondrial genes in the frontal cortex andthe caudate nucleus of developing humans and mice selectively bred for high and low fear. PLoS One. 2012;7(11):e49183.
Choi, K, Im HJ, JH Kim, Choi KH, Jon DI, Hong H,
Hong N, Lee L, and Seok JH. Relationship of early-lifestress and resilience to military adjustment in a young
adulthood population. Social Psychiatry and Psychiatric
16 | Center for the Study of Traumatic Stress, USU

Epidemiology. 2012;(e-pub ahead of print).
Conway KP, Vullo G, Nichter B, Wang J, Compton WM,
Iannotti RJ, and Simons-Morton B. Prevalence and patterns of polysubstance use in a nationally representative
sample of 10th graders in the United States. Journal of
Adolescent Health (in press).
Duncan CC, Summers AC, Massey AT, Mirsky AF,
Gabbay FH, Benedek DM, and French LM. Evaluation ofmild traumatic brain injury: ERP processing in auditory
and visual novelty oddball tasks. International Journal of
Psychophysiology. 2012;85: 413.
Elhai JD and Naifeh JA. The missing link: A call for more
rigorous PTSD assessment procedures. Clinical Psychology: Science and Practice. 2012;19: 276–282.
Flynn B. Review of The Immortal Life of Henrietta Lacks
by Rebecca Skloot. Psychiatry: Interpersonal and Biological
Processes. 2012;75(2): 107–112.
Gabbay FH. An American woman and the right to health.
[Review of the book The Immortal Life of Henrietta Lacks
by Rebecca Skloot.] Psychiatry: Interpersonal and Biological Processes. 2012;75(2): 113–119.
Gabbay FH and Stern RM. A quiet voice: Roland Clark
Davis and the emergence of psychophysiology. Psychophysiology. 2012;49: 443—453.
Gadermann AM, Engel CC, Naifeh JA, Nock MK, Petukhova M, Santiago PN, Wu B, Zaslavsky AM, and Kessler
RC. Prevalence of DSM-IV major depression among U.S.
military personnel: Meta-analysis and simulation. Military
Medicine. 2012;177: 47–59.
Goldenberg MN, Benedek DM, and Ursano RJ. Disastervictims and the response to trauma. In: McQuistion HL,
Sowers WE, Ranz JM, & Feldman JM, eds. Handbook ofCommunity Psychiatry. New York, NY: Springer; 2012:
435–445.

Goldenberg MN, Hamaoka D, Santiago PN, and McCarroll J. Basic training: A primer on military life andculture for health care providers and trainees. Associationof American Medical Colleges. 2012. www.mededportal.org/
publication/9270
Howe EG. An ethical priority greater than life itself. Journal of Clinical Ethics. 2012;23(3): 195–206.
Howe EG. What legal risks should mental health careproviders take during disasters? Psychiatry. 2012;75(4):323–330.
Howe EG. How should careproviders respond to patients’requests that may be refused? Journal of Clinical Ethics.
2012;23(2): 99–109.
Howe EG. Informed consent, participation in research,and the Alzheimer’s patient. Innovations in Clinical Neuroscience. 2012;9(5–6): 47–51.
Howe EG. How careproviders can acquire and apply
greater wisdom. Journal of Clinical Ethics. 2012;23(1):
3–12.
Jia M, Meng F, Smerin S, Xing G, Zhang L, Su DM, Benedek DM, Ursano RJ, Su YA, and Li H. An animal model of
PTSD for revealing biomarkers and behavioral correlates.
Journal of Visual Experiments. 2012;68: e3361.
Johnson LR, McGuire J, Lazarus R, and Palmer AA.
Pavlovian fear memory circuits and phenotype models of
PTSD. Neuropharmacology. 2012;62(2): 638–646.
Lang AJ, Schnurr PP, Jain S, Raman R, Walser R, Bolton
E, Chabot A, Benedek DM. Evaluating transdiagnostic
treatment for distress and impairment in veterans: A
multi-site randomized controlled trial of Acceptanceand Commitment Therapy. Contemporary Clinical Trials.
2012;33(1): 116 – 123.
Luk WJ, Wang J, and Simons-Morton BG. The co-occurrence of substance use and bullying behaviors among U.S.
adolescents: Understanding demographic characteristics
and social influences. Journal of Adolescence. 2012;35(5):1351–1360.
McGuire JL, Coyner MJ, and Johnson LR. Rodent

models of conditioned fear: Behavioral measures of fear
and memory. In: Szallasi A& Biro T, eds. TRP Channels
in Drug Discovery. New York, NY: Humana Press; 2012:
187–202.
Mirsky, AF, Bieliauskas L, Duncan CC, and French LM.
The Genain quadruplets: A 55-year follow-up of two offour monozygous sisters with schizophrenia. Schizophrenia Research (in press).
Naifeh JA, Tull MT, and Gratz KL. Anxiety sensitivity,
emotional avoidance, and PTSD symptom severity among
crack/cocaine dependent patients in residential treatment.
Cognitive Therapy and Research. 2012;36: 247–257.
Ogle AD, Bradley D, Santiago PN, and Reynolds D.
Description of combat and operational stress control inregional command east Afghanistan. Military Medicine.
2012;177(11): 1279–1286.
Pfefferbaum B, Schonfeld D, Flynn BW, Norwood AE,
Dodgen D, Kaul RE, Donato D, Stone B, Brown LM, Reissman DB, Jacobs GA, Hobfoll SE, Jones RT, Herrmann J,
Ursano RJ, and Ruzek JI. The H1N1 crisis: A case study ofthe integration of mental and behavioral health in publichealth crises. Disaster Medicine and Public Health Preparedness. 2012;6(1): 67–71.
Pfefferbaum B, Flynn BW, David Schonfeld, Brown LM,
Jacobs GA, Dodgen D, Donato D, Kaul RE, Stone B, Norwood AE, Reissman DB, Herrmann J, Hobfoll SE, Jones
RT, Ruzek JI, Ursano RJ, Taylor RJ, and Lindley D. The
integration of mental and behavioral health into disaster
preparedness, response, and recovery. Disaster Medicine
and Public Health Preparedness. 2012;6(1): 60–66.
Russell CA, Russell DW, and Neijens PC. Evidence ofcountry-based prejudices in the marketplace. In: Russell
DW and Russell CA, eds. The Psychology of Prejudice.
Hauppauge, NY: Nova Science Publishers; 2012: 113–127.
Russell CA and Russell DW. Alcohol messages in television series: Content and effects. In: Shrum LJ, ed. The Psychology of Entertainment Media: Blurring the Lines Between
Entertainment and Persuasion, 2nd edition. New York, NY:
Taylor and Francis; 2012.
2012 Annual Report | 17

Sharma P, Su YA, Barry ES, Grunberg NE, and Zhang L.
Mitochondrial targeted neuron focused genes in hippocampus of rats with traumatic brain injury. International
Journal of Critical Illness and Injury Science. 2012;2(3):172–179.
Simons-Morton BG, Ouimet MC, Chen R, Klauer SE,
Lee SE, Wang J, and Dingus TA. Peer influence predicts
speeding prevalence among teenage drivers. Journal of
Safety Research (in press).
Ursano RJ, Benedek DM, and Engel CC. Trauma informed care for primary care: The lessons of war. Annals ofInternal Medicine. 2012;157(12): 905–906.
Wang J and Iannotti RJ. Bullying among U.S. adolescents.
The Prevention Researcher. 2012;19(3): 3–6.
Wang J, Iannotti RJ, and Luk WJ. Patterns of adolescentbullying behaviors: Physical, verbal, exclusion, rumor andcyber. Journal of School Psychology. 2012;50: 521–534.
Xing G, Carlton J, Jiang X, Jia M, Sharma P, Choi KH, and
Li H. Delayed effects of repeated inescapable severe stresson brain cannabinoid receptor expression and acoustic
startle response in adolescent male rats: Relevance tothe development of posttraumatic stress disorder andstress-related brain atrophy. Post-Traumatic Stress Disorder:
New Research. NOVA Science. 2013;4: 83–107.

Photograph by Brian Flynn

Ye T, Lipska BK, Tao R, Hyde T, Wang L, Li C, Choi KH,

18 | Center for the Study of Traumatic Stress, USU

Straub R, Kleinman JE, and Weinberger DR. Analysis of
CNVs in brain DNA from patients with schizophrenia andother psychiatric disorders. Biological Psychiatry. 2012;72:
651–654.
Zakrajsek JS, Shope JT, Greenspan AI, Wang J, Bingham,CR, and Simons-Morton BG. Effectiveness of a parent-directed brief teen driver safety intervention (checkpoints)
delivered by driver education instructors. Journal of Adolescent Health (in press).
Zhang L, Hu XZ, Li H, Li X, Smerin S, and Ursano RJ.
Potential biomarkers of suicide risk. In: Lavigne JE, ed.
Frontiers in Suicide Risk: Research, Treatment and Prevention. NOVA Science. 2012.
Zhang L, Ursano RJ, and Li H. P11: A potential biomarker
for posttraumatic stress disorder. In: Kobeissy FH, ed. Psychiatric Disorders: Methods in Molecular Biology. Human
Press; 2012: 453–468.
Zhang L, Ursano RJ, and Li H. P11: A potential biomarker
for posttraumatic stress disorder. Methods in Molecular
Biology. 2012;829(5): 453–468.
Zhang L, Li H, Hu X, Li X, Smerin S, and Ursano RJ.
Glucocorticoid-induced chromatin remodeling: A novel
molecular mechanism of traumatic stress? In: Simpson
NM & Stewart VJ, eds. New Developments in Chromatin
Research. NOVA Science. 2012.

CSTS Directors, Scientists and Scientific
Advisory Board
CSTS Directors
Robert J. Ursano, M.D.
Professor and Chair, Department of Psychiatry
Uniformed Services University
Director, Center for the Study of Traumatic Stress
Col David M. Benedek, M.D. MC, USA
Professor and Deputy Chair, Department of Psychiatry
Uniformed Services University
Associate Director, Consultation and Education
Center for the Study of Traumatic Stress

Recognition

Dr. Goldenberg, Lt Col Hamaoka, LCDR
Santiago and Dr. McCarroll’s iCollaborative
submission was selected as a winner of the MedEdPORTAL-sponsored Call for Culturally Competent
Training/Learning Modules for Treatment of U.S.
Service Members and their Families at the 2011
Association of American Medical Colleges Annual
Meeting. Their winning submission was titled, “Basic
Training: A Primer on Military Life and Culture for
Health Care Providers and Trainees.”
As the recipient of the 2012 American College ofPhysicians William C. Menninger Memorial Award
for Distinguished Contributions to the Science ofMental Health, Dr. Ursano presented a lecture at the
ACP Annual Meeting. This award is bestowed for
distinguished contributions to the science of mental
health and was originally supported by the Menninger Foundation.
Dr. Duncan’s paper, “Evaluation of traumaticbrain injury: Brain potentials in diagnosis, function,and prognosis,” was one of 2011’s 25 top download-

Stephen J. Cozza, M.D.
Professor, Department of Psychiatry
Uniformed Services University
Associate Director, Child and Family Program
Center for the Study of Traumatic Stress
Brian W. Flynn, Ed.D.
Adjunct Professor, Department of Psychiatry
Uniformed Services University
Associate Director, Health Systems
Center for the Study of Traumatic Stress
Carol S. Fullerton, Ph.D.
Research Professor, Department of Psychiatry
Uniformed Services University
Scientific Director, Center for the Study of Traumatic Stressed articles from papers published in all years in theInternational Journal of Psychophysiology.
Nancy Vineburgh, an invited military healthcommunications expert who heads up the Center’s
Office of Public Education and Preparedness, took
part in the assessment panel and process that led to
the recently announced RAND publication of “Assessment of the Content, Design, and Disseminationof the Real Warriors Campaign.”
CSTS, along with DHP, DHCC, T2, DVBIC,
received the Joint
Service Meritorious Unit Award for
DCoE for January
2010–December
2012. Each center
received a copy of
the award signed by
Defense Secretary
Panetta.

2012 Annual Report | 19

Robert K. Gifford, Ph.D.
Assistant Professor, Department of Psychiatry
Uniformed Services University
Executive Officer, and Associate Director, Homeland Security
Studies
Center for the Study of Traumatic StressJohn A. Stuart, Ph.D.
Assistant Professor, Department of Psychiatry
Uniformed Services University
Director, Resource Management
Center for the Study of Traumatic Stress
Nancy T. Vineburgh, M.A.
Assistant Professor, Department of Psychiatry
Uniformed Services University
Associate Director, Public Education and Preparedness
Center for the Study of Traumatic Stress

CSTS Scientists
Col Daniel J. Balog, M.D., USAF, MC, FS
Assistant Professor and Assistant Chair
Department of Psychiatry
Uniformed Services University
COL David M. Benedek, M.D., MC, USA
Professor and Consultant to the U.S. Army Surgeon General for
Forensic Psychiatry
Department of Psychiatry
Uniformed Services University
Quinn M. Biggs, Ph.D., M.P.H.
Research Assistant Professor
Department of Psychiatry
Uniformed Services University

Maria Braga, D.D.S., Ph.D.
Associate Professor
Department of Anatomy, Physiology and Genetics
Uniformed Services University
Kwang Choi, Ph.D.
Research Assistant Professor
Department of Psychiatry
Uniformed Services University
Daniel W. Cox, Ph.D.
Research Psychologist
Department of Psychiatry
Uniformed Services University
Stephen J. Cozza, M.D.
Professor
Department of Psychiatry
Uniformed Services University
Brian Crowley, M.D.
Clinical Assistant Professor
Department of Psychiatry
Uniformed Services University
Catherine L. Dempsey Ph.D., M.P.H.
Research Psychologist
Department of Psychiatry
Uniformed Services University
Connie Duncan, Ph.D.
Research Associate Professor
Department of Psychiatry
Uniformed Services University
Richard S. Epstein, M.D., P.A.
Clinical Professor
Department of Psychiatry
Uniformed Services University
Col Charles Engel, M.D., M.P.H., MC, USA
Associate Professor
Department of Psychiatry
Uniformed Services University

Photograph by Brian Flynn

Joscelyn E. Fisher, Ph.D.
Project Director/Research Psychologist
Department of Psychiatry
Uniformed Services University
Brian W. Flynn, Ed.D.
Adjunct Professor
Department of Psychiatry
Uniformed Services University

20 | Center for the Study of Traumatic Stress, USU

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

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

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

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

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

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

Col Gary Gackstetter, USAF
Associate Professor
Department of Preventive Medicine/Biometrics
Uniformed Services University

Xianzhang Hu, M.D., Ph.D.
Department of Psychiatry
Uniformed Services University

Robert K. Gifford, Ph.D.
Assistant Professor
Department of Psychiatry
Uniformed Services University
Matthew N. Goldenberg, M.D.
Assistant Professor of Psychiatry
Department of Psychiatry
Uniformed Services University

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

Kristie Gore, Ph.D.
Research Assistant Professor
Department of Psychiatry
Uniformed Services University

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

Lt Col Derrick Hamaoka, M.D., USAF, MC, FS
Assistant Professor
Department of Psychiatry
Uniformed Services University

He Li, M.D., Ph.D.
Associate Professor
Department of Psychiatry
Uniformed Services University

Jill Harrington-LaMorie, DSW, LCSW
Senior Field Researcher
Department of Psychiatry
Uniformed Services University

Xian Liu, Ph.D.
Research Assistant Professor
Deployment Health Clinical Center
Walter Reed Army Medical Center

Harry C. Holloway, M.D.
Professor
Department of Psychiatry
Uniformed Services University

David Marlowe, Ph.D.
Senior Lecturer
Department of Psychiatry
Uniformed Services University

Marjan G. Holloway, Ph.D.
Assistant Professor
Department of Medical & Clinical Psychology
Uniformed Services University

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

2012 Annual Report | 21

James E. McCarroll, Ph.D., M.P.H.
Research Professor
Department of Psychiatry
Uniformed Services University

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

Jodi McKibben, Ph.D.
Research Assistant Professor
Department of Psychiatry
Uniformed Services University

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

Lt Col Kristina Money, M.D.
Assistant Professor
Department of Psychiatry
Uniformed Services University

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

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

Anthony Woodson, D.H.A.
Associate Administrator, Center for the Study of TraumaticStressDepartment of Psychiatry
Uniformed Services University

Claudio Ortiz, Ph.D.
Research Psychologist
Department of Psychiatry
Uniformed Services University
CAPT Dori B. Reissman, M.D., M.P.H., USPHS
Medical Director, World Trade Center Responder Health
Program
Senior Medical Advisor, National Institute of Occupational
Safety and Health
Department of Psychiatry
Uniformed Services University
LCDR Patcho Santiago, M.D., M.P.H., MC, USN
Assistant Professor
Department of Psychiatry
Uniformed Services University
John A. Stuart, Ph.D.
Research Assistant Professor
Department of Psychiatry
Uniformed Services University
E. Fuller Torrey, M.D.
Executive Director
Stanley Medical Research Institute
Bethesda, MD
Robert J. Ursano, M.D.
Professor and Chair
Department of Psychiatry
Uniformed Services University

22 | Center for the Study of Traumatic Stress, USU

Kathleen Wright, Ph.D.
Deputy Chief
Department of Military Psychiatry
Division of Neuropsychiatry
Walter Reed Army Institute of Research
Guoqiang Xing, M.D.
Research Scientist
Department of Psychiatry
Uniformed Services University
Lei Zhang, M.D.
Assistant Professor
Department of Psychiatry
Uniformed Services University

Scientific Advisory Board
James E. Barrett, Ph.D.
Department of Pharmacology and Physiology
Drexel University, College of Medicine
245 N. 15th Street
Mail Stop 488, Room 8213
Philadelphia, PA 19102-1192
Col Charles W. Beadling, USAF, MC
Academic Division Director
Department of Military and Emergency Medicine
F. Edward Hebert School of Medicine
Uniformed Services University
4301 Jones Bridge Road
Bethesda, MD20814-4799
M. Richard Fragala, M.D.
P.O. Box 182
Malverne, NY 11565
Matthew J. Friedman, M.D.
Executive Director
National Center for Posttraumatic Stress Disorder (116D)
VAM & ROC
215 North Main Street
White River Junction, VT 05001-3833
Carol S. Fullerton, Ph.D.
Research Professor, Department of Psychiatry
Scientific Director, Center for the Study of Traumatic Stress
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
CAPT Paul S. Hammer, MC USN
Director,
Defense Centers of Excellence (DC0E) for Psychological
Health and Traumatic Brain Injury
David S. Krantz, Ph.D.
Chair, Department of Medical and Clinical Psychology
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
Larry W. Laughlin, M.D., Ph.D.
Dean
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799

Craig H. Llewellyn, M.D.
Professor
Department of Military and Emergency Medicine
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
David H. Marlowe, Ph.D.
Senior Lecturer
Department of Psychiatry
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
Robert M. Post, M.D.
Head, Bioplar Collaborative Network
3502 Turner Lane
Chevy Chase, MD 20815
CAPT Gerald V. Quinnan, Jr., MC, USN
Professor and Chair, Preventive Medicine & Biometrics
RADM, USPHS (Ret)
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
Arieh Y. Shalev, M.D.
Professor and Chairman
Department of Psychiatry
Hadassah University School of Medicine
Jerusalem, Israel
CAPT Trueman Sharp, MC, USN
Department Chair, Military and Emergency Medicine
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
Robert J. Ursano, M.D.
Professor and Chairman, Department of Psychiatry
Director, Center for the Study of Traumatic Stress
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
Lars Weisaeth, M.D.
Professor and Chairman
Division of Disaster Psychiatry
University of Oslo
Oslo, Norway2012 Annual Report | 23

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

24 | Center for the Study of Traumatic Stress, USU

CSTS Partners
1987–2012

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

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