Center for the Studyof Traumatic Stress2015 Annual ReportGlobal health, an expanding domain for all health including
mental health, is a growing focus for both USU and the DoD. CSTS
has had long standing involvements in global health activities in
the areas of research collaboration, training and education, andconsultation with colleagues around the world.

CONTENTS
From the Director......................................................................................................1
New Collaborations in 2015....................................................................................3
Our Mission.................................................................................................................4
Research.....................................................................................................................5
Education and Training.......................................................................................... 17
Development and Dissemination of Educational Resources........................... 23
Consultation............................................................................................................ 24
Other Activities in Support of the DoD............................................................... 26
Words from Two Center Scientists....................................................................... 26
CSTS Publications in 2015.................................................................................... 30
CSTS Presentations, Briefings, Interviews and Awards in 2015.................... 33
CSTS Directors, Scientists, Scientific Advisory Board and Staff...................... 37
CSTS Funded Grants in 2015................................................................................ 42
CSTS Partnerships.................................................................................................. 43
Faces of CSTS.......................................................................................................... 47

From the Director
Dear Center Colleagues and Friends,
The Center for the Study of Traumatic Stress(CSTS) is part of the Department of Psychiatry in
the School of Medicine of the Uniformed Services
University (USU). The mission of CSTS is to advancescientific and academic
knowledge, interventions,educational resources andoutreach to mitigate theimpact of trauma from exposure to war, disasters, terrorism, community violenceand public health threats.
In accomplishing our mission, we serve an essential
role for the Department of Defense and provide
valuable service to our nation. We have established astrong 28-year track record of successfully fulfilling
our mission and achieving our goals since the Center
began in 1987.
There are three major ways in which the Center is
unique. First, we successfully integrate two separate
but interrelated fields — military psychiatry and disaster psychiatry. Our Center has helped define andadvance the melding of these two fields. Second, weare unique in how we use scholarly and research-oriented problem-solving to address the mental andbehavioral health problems of those exposed to war,disaster and other traumatic events. Third, we arededicated to research in translational studies, neuroscience and the neurobiology of stress and trauma.
The Center identifies effective interventions for anumber of health issues of special interest to the military including posttraumatic stress disorder (PTSD),
mild traumatic brain injury (mTBI), suicide andsuicide-related behavior. Through unity of effort, andclarity of message, our multi-disciplinary team helps
inform our nation’s policies regarding the impact of
traumatic exposure.
The reach of our Center’s research, education,and intervention activities is broad. We work to
support people and institutions locally, nationally,
as well as globally. The impact of our work extends
from laboratory bench, to hospital bedside, and to
populations across the nation and around the world.
The accomplishments and successes of CSTS are
due to our outstanding and dedicated team who provide the research, teaching, outreach, consultation,
problem-solving and leadership skills that advanceour work. Building, maintaining and sustaining a
multi-disciplinary team of well-trained and highly-collaborative scientists, educators and clinicianshas been essential to our success. Our experienced,
responsive, effective, hard-working and highly-productive team functions in a well-coordinatedmanner and in a unified direction. That combined
effort and synergy results in the rapid and efficientachievement of our goals.
2015 was a year of great productivity for CSTS.
Some highlights of the Center’s activities:■■ The National Military Family Bereavement
Study, included in our child and family research
program, is one of the largest studies of griefand bereavement, and the first large, rigorous,
scientific study of the impact of a U.S. Service
member’s death on surviving family members.
■■ Our Service member research program includes
the Army Study to Assess Risk and Resiliencein Servicemembers (Army STARRS) and thefollow-on research program called the Study
to Assess Risk and Resilience in Servicemembers — Longitudinal Study (STARRS-LS). Army

The mission of CSTS is to advance scientific and academic knowledge, interventions,educational resources and outreach to mitigate the impact of trauma from exposure
to war, disasters, terrorism, community violence and public health threats.
2015 ANNUAL REPORT | 1

■■

■■

■■

■■

■■

STARRS was the largest study of suicide, andmental health risk and resilience, ever conductedamong military personnel. The transition of thesix-year Army STARRS project to the five-year
continuation STARRS-LS project is a major step
toward making the STARRS research the Framingham Study of military mental health.
Another important project in our Service member research portfolio is the Reserve Component Study. This study addresses the health andmental health of the Reserve Component (RC)of the United States Armed Forces. In collaboration with Boston University, CSTS continues
to conduct a longitudinal study of members of
the Army, Air Force, Navy and Marine Reserves
and of the Army and Air National Guards. This
study, which has had four waves of data collection, is unique in that it focuses on a nationwide
representative sample of these various membersof the RC.
The Leahy-Friedman National PTSD Brain Bank
officially opened in 2015 as the first brain tissue
repository dedicated to researching the physical impact of stress, trauma and PTSD on brain
tissue. The Brain Bank will advance the scientificknowledge of PTSD and PTSD biomarkers.
The Center continued its clinical work in neuroscience and neurobiology by conducting clinical
trials to improve the treatment of stress, PTSD
and TBI.
The CSTS neuroscience laboratories investigated numerous biomarkers and are producing
exciting findings that will ultimately improve thediagnosis and treatment of PTSD and TBI.
The Center provided rapid consultation, education and knowledge support to personnel who
responded to crises around the nation including
the following mass shootings:»» The El Paso Veterans Affairs Clinic at Ft.
Bliss, Texas»» Emanuel African Methodist Episcopal
Church in Charleston, South Carolina

2 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

The television station WDBJ7 employees in
Roanoke, Virginia»» Umpqua Community College in Roseburg,
Oregon»» The Inland Regional Center in San Bernardino, California■■ The Center developed and disseminated an“Emergency Action Plan,” a template to assist
academic and other organizations in emergency
and disaster planning. The Plan incorporates
lessons learned regarding issues that offsite facilities may encounter when developing disaster
preparation and response plans.
»»Throughout 2015, the Center continued to engage in the important task of furthering and sharing
its unique knowledge and experience in trauma
research, education, consultation and training to our
local community, throughout the nation and acrossthe world. Looking ahead, we continue to train andmentor the next generation of dedicated scientists
who will continue to fulfill our mission.
In this Annual Report, we share some of themany contributions we are making to enhance
psychological health, recovery and prevention of
the consequences of trauma on individuals, families,
communities and the nation in both military and civilian populations. We continue to work in assisting
the Department of Defense and leading the nation in
trauma-informed care.
On behalf of everyone at CSTS, I would like tothank our colleagues and friends who have collaborated with us, and supported our work throughout
the year.
— Robert J. Ursano, MD
Professor of Psychiatry and Neuroscience
Chair, Department of Psychiatry
Director, Center for the Study of Traumatic Stress
Uniformed Services University

New Collaborations in 2015
NATO EXPLORATORY TEAM IN HUMAN
FACTORS AND MEDICINEIn May of 2015, Dr. Gary Wynn was nominatedto represent the U.S. as a member of an Exploratory
Team within the Human Factors and Medicine Panelof the North Atlantic Treaty Organization (NATO).
The team is focusing on leveraging technology
within psychiatry and will evaluate the evidence
for new technologies with significant potential for
supplementing or replacing conventional approaches
to military performance, mental health assessment,
resiliency training, outreach, treatment, rehabilitation and reintegration programs. Topics covered bythis effort will include neuroimaging, neurostimulation techniques, telemental health, virtual reality,
electronic health record and outcome management.
This Exploratory Team will report its findings by theend of 2016.

U.S. DEPARTMENT OF AGRICULTURE
In the spring/summer of 2015, an outbreak ofhighly pathogenic avian influenza (A-H5N1) produced significant adverse consequences in thoseaffected including health care workers responding tothe outbreak. In anticipation of the potential for subsequent outbreaks, CSTS scientists Drs. Brian Flynn
and Joshua Morganstein responded to a request fora consultation to the U.S. Department of Agriculture(USDA), Region V, Emergency Management andHomeland Security Branch to provide guidance forresponse and preparedness. CSTS provided guidance based upon a review of the literature and CSTS
senior staff experience in related events. This was
significant because the USDA is not a typical sourceof consultation requests and this provided both evidence of the visibility and credibility of CSTS as well
as opening opportunities for future relationships.
The response represents an example of how CSTS
expertise can assist other federal entities in challenges they face. The content of this consultation canbe used in a wide variety of situations that involve
agricultural disasters/emergencies, economic impact

of disaster, and stress in atypical emergency/disaster workers and responders (specifically veterinary
health workers). The response adds to a very limited
range of resources specifically related to behavioral
health factors in avian-based agricultural emergencies and disasters. The response is also a model for
future consultations where the product represents
blending limited published literature, adapted publications in related areas and application of lessons
learned from past real-life experience.

COLLABORATIVE HEALTH INITIATIVERESEARCH PROGRAM
The Collaborative Health Initiative Research
Program (CHIRP) is an exciting new joint effort
between the National Heart, Lung, and Blood Institute, part of the National Institutes of Health (NIH),
and USU. The goal of this NIH/DoD collaborative
initiative is to transform patient care by harnessing
genomics, supercomputers and bioinformatics. The
medical outcome is to predict and pre-empt disease,
mitigate and repair traumatic injury, optimize performance and resilience, and generate novel personalized therapeutic options that impact both civilian
and military lives. Dr. Gary Wynn initiated a CHIRP
effort to study whole genome sequences in individuals with PTSD related sleep difficulties compared tothose with non-PTSD related sleep problems fromindividuals receiving care at Walter Reed National
Military Medical Center (WRNMMC). This threeyear initiative seeks to understand the genetic
relationships and differences between various sleep
disorders and sleep problems resulting from traumatic experiences.

CENTER FOR FORENSIC BEHAVIORALSCIENCES
In July of 2015, COL David Benedek was selected
as the Director of the Center for Forensic Behavioral Sciences (CFBS) Walter Reed National Military
Medical Center. The CFBS conducts the only accredited Forensic Psychology and Forensic Psychi2015 ANNUAL REPORT | 3atry Fellowship training programs in the DoD and
conducts forensic assessments for a variety of DoD
stakeholders within the national capital area andwithin DoD jurisdictions around the world. Under
its charter, the CFBS will establish the first database
related to military forensic assessments in the next

year. This database should provide an opportunity
to explore risk and protective factors related to theintersection of criminal behavior and mental illness
within DoD populations along with aspects of DoD
assessments of criminal responsibility.

Our Mission
CSTS is dedicated to understanding the impact of trauma on individuals, families and communities. We strive to advance trauma-informedcare. The Center is part of our nation’s federal
medical school at USU and the Center’s missionis aligned with the DoD and the nation’s needs.
The Center’s work addresses a broad rangeof trauma exposure from combat, humanitarian
operations, terrorism, natural and human-madedisasters, and public health threats. CSTS has
been involved in nearly every major disaster our
nation has faced in the past 28 years. The Centerhas helped ensure that behavioral health is at

4 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

the table during discussions of disaster planning,
public health threats, and disaster response andrecovery.
The Center is well-positioned to respond to
DoD mission relevant activities and to educate
regional, national and global stakeholders ingovernment, industry, healthcare, public health,and academia on mitigating the effects of disasterand trauma in military and civilian populations,to foster community and national resilience.
CSTS contributes to advancing trauma-informed
knowledge through research, education, training,
consultation and leadership.

Research
RESEARCH ON SERVICE MEMBERS
Army Study to Assess Risk and Resiliencein Servicemembers (Army STARRS)
In 2015, the highly-successful and widely-publicized Army STARRS project ended after six years
and transitioned to STARRS-LS. Army STARRS was
the largest
researchstudy ofmentalhealth risk
and resilience ever conducted among military personnel. It
was designed and conducted under the scientificdirection and leadership of the two Co-Principal
Investigators, Center Director Dr. Robert Ursano,and Dr. Murray Stein at the University of California, San Diego (UCSD). Center Associate Director,
Dr. Robert Gifford, was the Army STARRS Senior
Project Director. Center Senior Program Manager,
Paul Hurwitz, MPH, was the Army STARRS Senior
Program Manager. More than twenty other CSTS
scientists and staff supported Army STARRS.
Army STARRS was a collaborative effort between
USU, UCSD, Harvard University, the University ofMichigan, the National Institute of Mental Health(NIMH) and the U.S. Army. Army STARRS was
designed to examine the mental health and resilienceof active duty U.S. Army Soldiers to increase our“The comprehensive nature of these inquiries
has provided a database on behavioral health,social, biological, and potentially genetic pre-knowledge of the risks and protective factors that
underlie vulnerability and resilience in the face of
traumatic exposure for Service members who have
served and will serve our nation for years to come.
The seven separate but integrated epidemiologic andneurobiologic studies that comprised Army STARRS
were designed to be a comprehensive approachto the research questions. The project involved
large and representative samples of Army Soldiers,
including Regular Army, Army National Guard andactivated Army Reserve. The project included longitudinal, cross-sectional, historical, prospective andneurobiological studies. Army STARRS involved thecollection, integration and analysis of very large volumes of data. The research team obtained, organized
and analyzed a data file of more than a billion data
points from existing Army and DoD administrative
records representing more than 1.6 million active
duty Soldiers from 2004 to 2009; collected data fromnearly 200,000 questionnaires administered to morethan 100,000 active duty Soldiers from 2011 to 2014
throughout the United States and at ten locations
overseas; administered questionnaires to Soldiers in
Kuwait as they transitioned into and out of combat
zones for R&R; obtained data from approximately
400,000 neurocognitive tests administered to active
duty Soldiers; collected approximately 77,000 tubesof blood from approximately 52,000 active duty
Soldiers; used the blood samples to perform a widerange of different types of state-of-the-art biomarker
assays (genetic, metabolomic, proteomic, inflammatory, and neurodegenerative) from DNA, RNA andplasma derived from the blood; conducted multiple,
highly technical and complicated neurobiologicaldeterminants of suicide unprecedented in its“The breadth and scope of the Army STARRS

scope and depth of understanding…”

project is unique in the history of psychiatric and—LTG (Ret) Eric Schoomaker, MD, PhD, who served

military research…”

on the Army STARRS Scientific Advisory Board,— Kerry Ressler, MD, PhD, Chair of the Armyand is a former U.S. Army Surgeon General

STARRS Scientific Advisory Board
2015 ANNUAL REPORT | 5analyses of the biomarker assay data; linked theabove data to extensive Army and DoD administrative data records; and performed sophisticated andhighly-complex data analyses using the huge volumeof data.
To date, 28 Army STARRS papers have been published, five papers are in press, six papers are underreview for publication, and 32 additional papers arein various stages of development.
As findings became available, the researchersreported results directly to senior Army leadershipat in-person briefings at the Pentagon that included
the Secretary of the Army, the Army Chief of Staff,
the Army Vice Chief of Staff, the Deputy Under
Secretary of the Army, Office of the Surgeon Generalstaff and other senior Army officials. In this way, theArmy had the ability to apply the findings to ongoinghealth-promotion, risk-reduction and suicide-prevention efforts. The benefit from this extraordinary,groundbreaking, complex and successful undertaking is beginning to emerge and will increase substantially over time as Army STARRS researchers
continue to analyze the large amount of data.

Study to Assess Risk and Resilience inServicemembers — Longitudinal Study(STARRS-LS)
Due to the success of Army STARRS, the Centeris continuing the research that began under Army
STARRS through a DoD-funded project called
STARRS-LS.
The same
consortiumof four universities (USU, UCSD, Harvard University, and the
University of Michigan) that designed and conducted Army STARRS is continuing the collaborative
effort on STARRS-LS.
STARRS-LS is being conducted under the scientific direction and leadership of the two Co-Principal
Investigators, Center Director Dr. Robert Ursano
and Dr. Murray Stein at UCSD. This five-year research project will continue using the Army STARRS
platforms, systems and data to derive further findings and extract additional value. STARRS-LS also
includes longitudinal follow-up studies with a cohort
6 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

of more than 72,000 Army STARRS participants tocollect additional information and extend the timeframe for collecting further outcome information
and allow continued analyses. This will provide further benefit for the Army, the DoD and the nation.
STARRS-LS is being managed by Center Associate Director Dr. Robert Gifford, who is serving as the
Senior Project Director of STARRS-LS, and by Center Senior Program Manager, Paul Hurwitz, MPH. In
addition, there are many other CSTS scientists andstaff working on the project.

Psychological Stress and Resilience in
Mortuary Affairs (MA) Soldiers: Longitudinal
Study
Since 2005, CSTS has conducted research on the
stresses of mortuary affairs operations during thewars in the Middle East. U.S. Army mortuary affairs(MA) Soldiers, who work with the dead of battle,
are exposed to some of the highest stressors of war,
combat death. In addition, MA Soldiers must deal
with the stress of deployment and return home. This
research has examined training and preparation,
stressors specific to working with the dead, andadjustment to family and work after return from
deployment. Empirical and descriptive data arecollected on factors such as psychiatric disorders.
For example, PTSD, depression, distress (symptomsof posttraumatic stress, e.g., somatization, anger andhostility), health risk behaviors including increases
in alcohol and drug use, resilience and psychologicalwell-being, and instrumental and emotional support.
During 2015, we continued collecting surveys andbegan preliminary data analysis. These studies have
implications for early intervention, training, education, leadership and health surveillance.

Troop Education for Army Morale (TEAM)TEAM is a stress management and resiliencebuilding early intervention study with the goal of
improving post-deployment readjustment in MA
Soldiers. TEAM involves a randomized group of MA
Soldiers and a comparison group immediately after
return from deployment. The study is designed tohelp the Soldiers cope with the daily challenges ofpost-deployment life, including re-integration into

“I wish we could incorporate TEAM into the
Army Resiliency Training because it has many
useful skills for both deployed and garrison
experiences.”— Quote from a participant Soldierfamily and garrison life. TEAM is based on the fiveevidence informed principles of Psychological First
Aid (physical and psychological safety, calming,
connectedness, self-efficacy, and hope/optimism)
and delivered through four group workshops,
informational handouts, a dedicated website,and support through concierge phone and email
services. A total of 125 MA Soldiers in 10 cohortsparticipated in the study. New for 2015 was further
in-depth analysis and development of manuscripts
for publication and presentation at professional
meetings. MA Soldiers in our study have a highnumber of traumatic deployment exposures, andrates of probable PTSD and depression, that are
similar to combat troops. While the intervention
did not specifically reduce rates of actual PTSD,TEAM skills training targets were reported to be
helpful. As expected, Soldiers who attended moreworkshops reported fewer symptoms and weremore likely to rate TEAM as helpful. In 2015, we
identified modifications to TEAM suggested byempirical findings and feedback from participantsthat target increased effectiveness for future trials
in MA Soldiers and expansion of TEAM for use
in other military and civilian populations, such as
disaster workers.

“The communication skills I learned from TEAM
can be applied to all areas of my life including
military, personal and other relationships. It gaveme an opportunity to talk among my peers andgave me positive insights on things.”— Participant Soldier feedback on theirexperience with the TEAM intervention

Reserve Component of the U.S. Armed
ForcesThe Center continues to conduct extensive
research with the Reserve Component (RC) of theUnited States Armed Forces, a traditionally under-studied population that experiences uniquestressors when the nation is at war, that are substantially different from those experienced by the Active
Component (AC). In collaboration with Dr. Sandro
Galea at Boston University, CSTS is conducting longitudinal research on the health and mental healthof National Guard and Reserve Service members nationwide. The study addresses the epidemiology andtrajectory of posttraumatic stress, deployment stress,
health risk behaviors and health care utilization in
the National Guard and in the Reserves of the Army,
Navy, Air Force and Marine Corps. There have beenfour waves of data collection to date, and the teamis actively analyzing this rich data set. This research
is unique in that it uses a representative national
cohort and specifically addresses the experiences of
the Guard and Reserve.
Army STARRS and STARRS-LS provide an unprecedented opportunity to examine the health andmental health of RC members. The Army STARRSNew Soldier Study included surveys of approximately 23,000 RC Soldiers during their first week of basic
training. Many participants also provided blood
samples for the examination of biomarkers. This
collection of data at the beginning of Soldiers’ military service provides an opportunity to follow themthrough the course of their military careers andbeyond in order to identify risk factors for healthoutcomes, as well as factors that promote resiliency.
In addition, Army STARRS included RC membersin the All Army Study and in the in-theater studyof Soldiers serving in Afghanistan, again yielding
data that can be used in long-term studies whileproviding a snapshot of current health and mental
health. This creates the opportunity for assessmentof concentrations of risk in order to develop futureinterventions to promote and sustain military health.
In STARRS-LS, both in-depth analysis of existing
data, and collection of new data on members of theRC, are important aims.
The CSTS portfolio of research on the RC is2015 ANNUAL REPORT | 7rounded out by studies of biomarkers conducted in
National Guard units before and after deployment
for combat tours in Afghanistan. Taken together, thiscombination of studies geared specifically to the RC,
along with inclusion of RC members in other CSTS
research including the Child and Family Program,gives CSTS a key role in expanding knowledge of thespecial needs of the Citizen Soldiers on whom ournation relies.

RESEARCH IN THE CHILD AND FAMILYPROGRAMThe Center’s Child and Family Program (CFP) isa national leader in advancing scientific and clinicalknowledge, and providing educational resources addressing the needs of children and families affectedby trauma, especially our nation’s military families
and children. Dr. Stephen Cozza, CSTS Associate
Director, underscores both the strength of thesechildren and families, as well as their vulnerability
resulting from the impact of these experiences. Military and veteran families can benefit from developing skills and strategies to better manage the challenges that they face. The Child and Family Program
addresses these complex issues through pioneeringresearch, by educating professional audiences
including military and government stakeholders

at conferences, through scholarly publications andconsultation to DoD leadership and national media
outlets. CFP projects shed light on combat injured
families, military family bereavement and childneglect and maltreatment in U.S. Army communities
and families.

COMBAT INJURED FAMILIESA Study of Combat Injured Families
This study examines the short- and long-term
impact of severe combat injury on military families
through interviews conducted at Operation Purple
Healing Adventures (OPHA), an annual summer
camp program for combat injured Service members
and their families sponsored by the National Military Family Association (NMFA). Forty families wereassessed and qualitative data were collected fromfocus groups to assess the issues related to combat
injury and family functioning. We are currently
analyzing the collected data to understand the complex effects and challenges experienced by combat
injured Service members and their families.

Addressing the Needs of Children andFamilies of the Combat Injured
This study investigates the impact of combat
injury on military families over time. All information
has been collected from consenting military families
at Walter Reed National Military Medical Center(WRNMMC) and San Antonio Military Medical
Center (SAMMC). The data are currently being
analyzed to identify the short- and long-term effectsof parental combat injury on Service members andtheir families and children and to inform intervention strategies for this population. Data collection
for this study concluded in 2015 and preliminary
analyses of the data has begun.

FOCUS-CI: A Preventive Intervention withChildren and Families of the Combat Injured
The Families Over Coming Under Stress — Combat Injury (FOCUS-CI) study is the first of its kindto pilot a preventive intervention with the children
and families of combat injured Service members,
to examine the feasibility of its use, and to study
8 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

its efficacy in this context. Using a randomized
controlled trial approach, the study was designed
to test the effectiveness of a new family-centered,strength-based, evidence-informed intervention forseverely combat injured Service members and theirfamilies. FOCUS-CI provides instrumental support
to families and teaches emotion regulation, problem
solving, communication, and goal-setting skills. Data
were collected from military families from Washington, DC, San Antonio, TX and Chapel Hill, NC who
participated in the study. We continue to examine
the effectiveness of the intervention by comparing
FOCUS-CI with the existing standard of care on theeffects of key aspects of family functioning. These
data will help us better understand the experienceof combat injury, its impact on Service members
and their families, and to help inform programmaticintervention that can better address the needs ofmilitary families.

FAMILY BEREAVEMENTThe National Military Family Bereavement
Study (NMFBS)
NMFBS is the first scientific study to examine theimpact of a U.S. Service member death on survivingfamily members. It aims to describe the populationof Service members who have died since 9/11 andto identify experiences of the Service member’s

r
Se

vic

m
bia

Uniformed

University✮Ste

For ward in
ing
G
f✮
rie

pp

es U
olu
niversity • C

bereaved family members — how psychological,
physical and/or behavioral outcomes of the grieving
process are influenced by military-unique contributions, as well as family members’ pre-existing
psychological and physical health and support. An
optional part of the study examines saliva samples
for genetic biomarkers associated with outcomes.
The year 2015 saw the end of Phase 1 data collection
culminating in more than 2,200 completed adultparticipant questionnaires. The longitudinal portionof the study, which consists of annual interviews
over three years, continues until 2017. Approximately 850 adults and 120 children are participating in the longitudinal portion of the study. Expert
consultants from Columbia University, UCLA andthe University of Michigan are also collaborating on
study analyses.

Stepping Forward in Grief (SFG)
The National Military Family Bereavement
Study (NMFBS) has found that a sizeable portion ofsurviving military family
members are sufferingfrom high levels of grief
and distress, putting themat risk for harmful longterm changes in physicaland mental health. Recognizing the need to help
these families, the NMFBS
formed a partnership with the Center for Complicated Grief at Columbia University to develop anintervention study for bereaved military families.
Funding for the SFG study was awarded in May
2015. The SFG study involves the development andtesting of a digital intervention (GriefSteps) that isdesigned to lower grief and decrease risk for longterm problems. The GriefSteps intervention is being
adapted from Complicated Grief Therapy (CGT)that has been shown to be helpful in civilian populations. CGT helps to resolve grief complications andpromote wellness. The SFG study is a randomized
controlled trial, which means that participants will
be assigned to one of two groups: either an intervention group to receive GriefSteps, or a control groupto receive WellnessSteps that will focus on building
2015 ANNUAL REPORT | 9tive and negative bereavement outcomes that follow
a terrorism-related death, including grief, traumatic
symptoms, resilience characteristics and posttraumatic growth. More than 400 participants who arefamily members bereaved by the bombing of Air
India Flight 182 on June 23, 1985 or by the events of
September 11, 2001 completed an online questionnaire about their experiences related to the aftermath of these events and the death of their family
member(s). The study will determine predictors of
bereavement outcomes and use findings to develop
preliminary working models for understanding risk
and protective factors for bereaved family membersof terrorism-related deaths. This study will build abasis for ongoing research to inform training andcounsel for disaster and terrorism victims and theirfamilies.
resilience. The study will compare how people in
the GriefSteps intervention group do, compared to
the WellnessSteps control group, in overall improvement in grief severity and adaptation to loss.
All SFG study participants will be able to complete
their programs virtually, either on an app or on theInternet. In addition, both groups will have “guides”
who can help and answer questions about the study.
Through the SFG study, we will learn how to best
assist military family survivors with their grief andreduce the long-term problems that can result aftera loss, resulting in an extremely helpful resource forcurrent and future survivors who suffer the death ofa military loved one. Military Service members may
also be consoled by knowing that such services areavailable to families if they or a close unit member orfriend should die while on active duty.

Study of Long-Term Outcomes of Terrorism
Related Grief
The Child and Family Program has partneredwith Voices of September 11th (VOICES), a not-forprofit organization that provides services for 9/11
families, and the Canadian Resource Centre forVictims of Crime (CRC), an organization that is engaged with, and supportive of, family members who
were bereaved by the Air India Flight 182 bombing.
The study partners are investigating long-term posi10 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

CHILD NEGLECT AND MALTREATMENT IN
U.S. ARMY COMMUNITIES AND FAMILIES
Deployment Family Stress: Child Neglect and
Maltreatment in U.S. Army Families
This study describes the characteristics of substantiated child neglect cases in the Army and identifies factors that contribute to healthy family functioning as well as to child maltreatment. Data werecollected from over 1,000 questionnaires and fromthe records of 400 substantiated child neglect cases
from Army installations across the country. Muchof 2015 was focused on disseminating important
findings that help to better understand the types andseverity of neglect occurring within military families,
to promote healthy child and family functioning inmilitary communities, and to inform the development of effective prevention approaches. For example, in 2015 we published the first reports of types,
subtypes and severities of substantiated child neglect
cases in the U.S. Army, as well as demographic information about child victims and offenders by type andsubtype. Two other manuscripts currently in preparation focus on: (1) understanding military-specificrisk contributions, including deployment-related risk,
associated with different forms of child neglect; and(2) identifying parent and family risk factors associated with distinct types of neglect.

Military-Related Risk for Child Neglect in
DoD Families: A Population Study to Inform
Future DoD Child Neglect Prevention Efforts
At the end of 2015, the Child and Family Program was awarded a grant from the Department of
Defense to complete a two-year study investigating
child maltreatment and neglect across all Service
branches of military families. Using existing datafrom military families with substantiated cases ofchild abuse and/or neglect and matched control
groups for comparisons, the project goals are to:(1) identify risk and protective factors for various
types of child physical abuse, sexual abuse andneglect in military families; (2) ascertain the effectiveness of military family participation in the New
Parent Support Program (NPSP) for reducing childabuse and neglect prevalence; (3) examine the interaction of abuse and neglect correlates and NPSP
participation on child abuse and neglect outcomes;and (4) identify which at-risk families benefit
most from NPSP and where additional preventive
programming may be needed. To date, efforts havebeen focused on reviewing the existing empiricalliterature and identifying data sets and variables toinclude in analyses.

The Family Violence and Trauma Project(FVTP)The FVTP was initiated in 1995 based on joint
interests of the Center and the U.S. Army. This
project approaches the prevention of maltreatment fatalities through a public health model that
promotes strategies at individual, family, community and societal levels to address practices,
policies, and public attitudes and beliefs aboutfamily violence and maltreatment. The project reports the rates of family maltreatment to the Armyleadership and Army installations. Our reports
for Army installations include graphs of victims,
incidents and maltreatments for child and adultmaltreatment by year as well as comparing Armyrates of child maltreatment to the U.S. national
rates. We also monitor ongoing Family Advocacy
Programs (FAP) research and maintain a literature
database of research applicable to the Army FAP.
During 2015, Dr. James E. McCarroll expanded theliterature review
on maltreatment fatalities
examining risk
and protective
factors relevant
for the Army. We
publish papers inmedical journals
on maltreatment
fatalities in orderto educate social
services, healthcare providers,and forensic andlaw enforcement personnel
on this subject.
We support the
Army FAP byproviding consultation, briefings, papers andresearch studies
to answer questions involving
spouse and childmaltreatment.
We have assisted investigatorsin the field with their research related to the Army
FAP. In addition, members of the program consult
within the Army, and the broader federal community, to support Army and civilian investigators
in family maltreatment research, and publish thehighly regarded newsletter Joining Forces Joining
Families. This year we initiated a new publication
for the Army FAP, Research Reviews. This publication provides highlights of current FAP researchin non-technical language to help FAP personnel
grasp current issues in an abbreviated format. Both
Joining Forces Joining Families and Research Reviews
are broadly distributed within the Army, the Department of Defense and applicable civilian agencies
concerned with family maltreatment.

2015 ANNUAL REPORT | 11

RESEARCH IN NEUROSCIENCE AND
NEUROBIOLOGYThe Center’s laboratory and clinical research inneuroscience and the neurobiology of stress is dedicated to finding effective interventions for a numberof military-related health issues including posttraumatic stress disorder (PTSD), mild traumatic brain
injury (mTBI) and suicide.

LABORATORY RESEARCH IN NEUROSCIENCEAND NEUROBIOLOGY
Genetics and Biomarkers
In 2015, CSTS laboratory research on genetic biomarkers included the purification of DNA
from 4,000 saliva samples collected from Soldiers,
and conducting genotyping for research on several
target genes including p11, BDNF and FKBP5. We
also measured telomere length from DNA derived
from more than 1,000 blood samples collected from
Soldiers pre-deployment and again post-deployment for the Army STARRS project.
This year, our laboratory work included researchon the effect of differential dysregulated cytokines
on stress response, onset, risk and resilience for
PTSD. Using blood samples from volunteer Soldiers pre-deployment (n=450) and post-deployment(n=430) during the Iraq and Afghanistan Wars, we
simultaneously measured multiple (n=40) cytokines
using Luminex high-throughput biochip assays.
Our results indicate that chemokines play different roles in PTSD and in stress responses, thereby
contributing to the understanding of the mechanism
12 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

for PTSD and encouraging further investigation ofchemokines as biomarkers for PTSD and traumaticstress response.
Other work in our laboratories this year usedanimal models, such as classical fear conditioning,
acoustic startle reflex, pre-pulse inhibition, pain
responses and intravenous drug self-administration.
We investigated biological and behavioral mechanisms of substance abuse, stress-related disorders,and individual vulnerability to stress.
The importance of the research conducted in
our laboratories is that it can be translated to clinical research. The findings from these laboratory
studies enhance our understanding of the neuroscience of stress, substance use disorders and PTSD.
Importantly, these findings contribute to improved
treatment strategies for stress-related psychiatricdisorders.

Drug Development for the Treatment of PTSD
The Center, in collaboration with the Walter
Reed Army Institute of Research, is undertaking
an exciting new avenue of research led by Dr. Gary
Wynn to examine novel molecular compounds forthe treatment of PTSD using an early and rapid
throughput model. The rapid throughput model being used is the zebrafish, or Danio rerio. The goal ofthis CSTS supported research is better identificationof candidate compounds for the treatment of PTSD.
More specifically, this very early phase evaluation
will allow down selection from a wide array of compounds using in vivo behavioral evaluations. This
down selection process will increase the success rateof subsequent evaluations in higher order animalstudies.

CLINICAL RESEARCH IN NEUROSCIENCE AND
NEUROBIOLOGY
INTRuST National Capital Area Integrated
Clinical Study Site
The Center continued its work in neuroscienceand the neurobiology of stress through continued
oversight and leadership of the INTRuST National
Capital Area Integrated Clinical Study Site. Center
Associate Director COL David Benedek, MD directs

this established network of clinician-researchers at
WRNMMC, the D.C. Veterans Administration Hospital and the Armed Forces Retirement Home. The
site is one of 10 study sites across the nation participating in the INTRuST Consortium for Psychological Health and TBI. The consortium’s longitudinal
study of Indices of Risk for PTSD in patients withmild to moderate TBI is the only longitudinal study
within the consortium’s portfolio and therefore is thelast INTRuST study to complete subject enrollment.
As a clinical site for the consortium’s Acceptanceand Commitment Therapy (ACT) study for patientswith deployment-related psychiatric disorders including depression, PTSD, and TBI and the Ganaxolone (a synthetic neurosteroid) study for PTSD, theCenter contributed to subject recruitment, enrollment and data analyses for these completed clinical
trials with results now pending publication.
Beyond its affiliation with the INTRuST Consortium, the Center also conducts clinical intervention trials to identify modifiable risk and resilience
factors of Service members and their families. COL
Benedek initiated collaboration with the Syracuse
VA Medical Center in a two-site clinical trial ofriluzole (a glutamatergic modulator used to treat
Lou Gehrig’s Disease) for the treatment of PTSD.
Recruitment and enrollment at both sites continued
throughout 2015.

Riluzole Augmentation Treatment forComplicated Combat-Related PTSD
CSTS continues a multi-site clinical trial at
WRNMMC and the Syracuse Veterans Affairs
Medical Center evaluating the efficacy of the medication riluzole in veterans of recent conflicts with
combat-related PTSD who have not achieved reliefof their symptoms from current evidence-based
treatments. Current recommended medications forcombat-related PTSD increase the availability of
selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs)
in the brain, but do not adequately relieve symptoms
for many patients. This study addresses an urgent
need to investigate other medications and othermechanisms that may be more effective. Riluzole
modifies activity of glutamate, a highly prevalentneurotransmmitter in all brain regions. Preclinicalresearch suggests it may help reverse damage toareas of the brain such as the amygdala, anterior cingulate cortex and hippocampus where an excess of
glutamate is believed to contribute to PTSD symptoms. This is a randomized, controlled, double-blind
trial comparing the effect of riluzole against placebo
over eight weeks of treatment. PTSD, depression
and anxiety symptoms are assessed once a week.
An exciting aspect of this study is the incorporationof magnetic resonance spectroscopy comparing
concentrations of neurotransmitters and related
chemicals in specific brain regions associated with
PTSD before and after treatment. We hypothesizethat treatment with riluzole will result in greater
PTSD symptom improvement, greater improvement
in depression and anxiety symptoms, and greater
improvement in overall well-being compared toplacebo. We also hypothesize that spectroscopychanges in the amygdala, anterior cingulate cortex
and hippocampus will associate positively with improvement due to riluzole compared to placebo. This
multiyear study is currently recruiting patients andhas met 45% of total recruitment targets in its firsttwo years.

Enhancing Fear Extinction via Angiotensin
Type 1 Receptor Inhibition: A Randomized
Controlled Trial in Posttraumatic Stress
Disorder
CSTS investigators began work on a multicenter
trial investigating the efficacy of the medication lo-

2015 ANNUAL REPORT | 13

sartan for treatment of PTSD. Losartan is an angiotensin receptor blocker currently in common use asa blood pressure medication. This study adds to ourportfolio of investigations potentially expanding the
medication options for patients with PTSD beyond
the currently recommended SSRIs and SNRIs, which
in many cases do not adequately relieve patients’
symptoms. CSTS is a study site for this multi-siteclinical trial led by Dr. Murray Stein of UCSD. Other
study sites include Massachusetts General Hospital, the Atlanta VA Medical Center, and the George
Washington University. This investigation stems
from earlier preclinical work suggesting improved
fear extinction in animal models, and retrospective
data in humans from the Grady Trauma Project suggesting lower rates of PTSD in traumatized patientstreated with angiotensin receptor blockers. Thisrandomized, controlled, double-blinded trial willcompare the effect of losartan against placebo
over ten weeks of treatment. PTSD and depression
symptoms, as well as side effects of medication areevaluated every two weeks. In addition, this study
will examine the contribution of variations in theangiotensin converting enzyme (ACE) gene to treatment response. This clinical trial will begin recruiting patients in 2016.

The Leahy-Friedman National PTSD BrainBankThe National PTSD Brain Bank was co-founded
by Dr. Matthew Friedman (Dartmouth/VA) and Dr.
Robert Ursano (USU/DoD). The mission to improve
the lives of veterans with PTSD has been strongly
supported by Senator Patrick Leahy (D-VT), whoplayed a major role in leading the effort to obtain
Congressional funding for this project. The Leahy-Friedman National PTSD Brain Bank officiallyopened in the spring of 2015 when enrollment andtissue collection commenced.
While more than 50 brain banks around thenation investigate a variety of neurological disorders,
this is the first brain tissue repository dedicated toresearching the physical impact of stress, trauma and
PTSD on brain tissue. It will advance the scientificknowledge of PTSD, particularly PTSD biomarkers
though intramural studies now initiated by Brain
14 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Bank investigators and by providing tissue for other
VA investigators whose study proposals have been
approved by appropriate review boards.
A great deal has been learned about how thebrain functions, and about structural brain abnormalities, through brain imaging techniques andother research. However, looking at neurons at thecellular and circuit levels in tissue obtained frompersons known to have had PTSD will allow a greater and more detailed understanding of disorder-related brain activity.
Thus far, the National PTSD Brain Bank has collected brain tissue from nearly 50 donors. The majority of donors were diagnosed with PTSD, however
the brain bank is also collecting tissue from persons
without PTSD to be used as controls for initial studies. In addition, nearly 50 living persons are in theprocess of enrolling in the Brain Bank’s longitudinalfollow-up registry as future donors.
This Brain Bank is a critical step toward identifying potential biomarkers of susceptibility anddeveloping new treatments that target PTSD at thecellular level. The National PTSD Brain Bank will
help pave the way for new approaches to the diagnosis and treatment of individuals with PTSD. In
2015, Dr. Benedek was named as the Director of theBrain Bank’s Assessment Core, and Drs. Ursano and
Benedek both serve as members of the Scientific
Advisory Board of the Brain Bank. Dr. Benedek wasinterviewed by Channel 9 News in Oklahoma City,
OK for a segment on the Brain Bank.

The Brain Indices Study
It is estimated that tens of thousands of combat
veterans with TBI will develop PTSD and otheradverse sequelae, including suicide. The goal of theBrain Indices Study is to develop reliable and valid
predictors of negative outcomes to inform targeted
treatments that can be initiated early, and thereby
improve the lives of our wounded warriors and theirfamilies. The study is being conducted in the Brain
Assessment Research Laboratory directed by Dr.
Connie Duncan, and is funded by the DoD Congressionally Directed Medical Research Programs (CDMRP) and the Center for Neuroscience and Regenerative Medicine (CNRM). This longitudinal study

was designed to identify measures of brain structureand function that predict PTSD and other negative
outcomes in Service members with mTBI. We are
examining cerebral consequences of blast versus
impact TBI, as well as the progression of symptoms
over time in injured Service members with mTBI.
The brain measures include neuroimaging, andelectrophysiological, neurocognitive and neurological assessments. Our goal is to identify associations
between the cause of brain injury (i.e., blast versus
impact) and the nature and severity of outcome inorder to ameliorate and/or prevent the debilitatingconsequences of mTBI and PTSD.
We have completed enrollment for the study.
The past year was devoted to completing the final
evaluations of the mTBI and injured control (IC)participants. The focus then shifted to recruiting andtesting subjects to serve as healthy Service members(HSM) matched on demographic variables but withno history of concussion or blast exposure. These
Service members underwent the same assessment
battery at three time points, the last was completedin October 2015. The HSM group is important ininterpreting the results, as preliminary analyses ofsome of the data revealed similar findings between
Service members with mTBI and those with extracranial injuries who screened negative for TBI.
Our current efforts are directed to data processing and analysis. The primary objective is to evaluate
the associations between baseline indices of brain
structure and function, and the course of PTSD
symptoms, post-concussive symptoms and overallmental and physical health status (including headache) in Service members with TBI or other injuries.
Our secondary objective is to characterize brainchanges and clinical outcomes in Service memberswith blast and impact TBI.
The most notable findings to date based on
baseline evaluations (done within a few months of
injury) are the following: (a) mTBI delays cognitive
processing involved in working memory (an effectpreviously identified in severe TBI); (b) Service
members injured by blast explosions who were rated
negative for TBI on standard DoD screening measures show processing delays similar to those seen in
Service members with mTBI. These findings, basedon measures of brain electrical activity (event-related potentials), raise the question of whether current
screening measures for TBI lack sufficient sensitivity
to detect blast effects on brain function in wounded
warriors; (c) mTBI caused by impact and blast is
associated with similar delays in cognitive processing; and (d) processing of novel stimuli appears to be
impaired in Service members with impact but not in
those with blast-induced TBI.
The results suggest that measures from the Brain
Indices investigation could enhance diagnosis,
targeted treatment and, ultimately, recovery from
TBI. As noted, a study of healthy Service members(who have had no history of TBI or significant blast
exposure) was initiated and completed to serve as acomparison group for the injured Service membersin the Brain Indices study. Processing the data fromthe healthy Service member group is underway.
As with our Brain Indices Study, the SAFE-TBI(Structured Assessment For Evaluation of TBI)
study - aimed at developing a more sensitive andreliable instrument to assess TBI — has come to aclose. Data collection was completed in March of
2015, and efforts have shifted to data analysis. This
structured interview was developed by principal
investigators Thomas McAllister (Indiana University) and Nancy Temkin (University of Washington) to
provide a more reliable and valid means of diagnosing TBI. Participants in the Brain Indices protocol
2015 ANNUAL REPORT | 15

served as the gold standard for data collected fromveterans at several sites. The structured interview(i.e., SAFE-TBI) data obtained from these participants will be compared to the clinician-administered
TBI diagnosis and neuroimaging data from the Brain
Indices Study. This will allow evaluation of the psychometric properties of the interview.
Another sub-study of Brain Indices completed
in 2015 evaluated the effect of differential types of
instruction on the performance of prospective memory tasks (i.e., recall required to perform a future
action). A small but significant advantage was foundassociated with enhanced “implementation intentions” as opposed to rote rehearsal of instructions.
These results may have implications for remembering such actions as taking medication and appearing
for appointments.

Ecological Momentary Assessment of
Posttraumatic Stress Symptoms in U.S.
Military Service Members (Daily Diary Study)
This study uses ecological momentary assessment to collect data throughout the day on posttraumatic stress symptoms (PTSS), sleep, pain, substanceuse and other areas of health and functioning in U.S.
military Service members. This “daily diary” methodology allows for detailed assessment of variabilityof symptom patterns as they occur throughout theday, providing important insights into the interaction between symptoms and environment, psycho-social relatedness and brain processes. This cutting-edge methodology provides assessments overthe course of the Service member’s daily routine,four times a day over 15 continuous days. Psychiatric disorders, including PTSD and depression, areassessed at baseline and in one and three monthfollow-up assessments. Recruitment by the end of2015 totaled 80 Service members and recruitment
continues on an ongoing basis. Importantly, in 2015
the scope of the study expanded to include a genetic component through the collection of biogenetic
samples to identify potential genetic biomarkers
and gene-environment interactions that may distinguish and/or mediate traumatic stress responses andresilience to stress-related disorders. Also new for2015 is the use of electronic tablets for data collection using a sophisticated application developed
specifically for use in this study in collaboration with
the National Center for Telehealth and Technology (T2). Feedback from participants indicate that
overall, Service members report that participationin the study is helpful to them by increasing awareness of thoughts, feelings and how they respond to
stress, therefore helping them identify environmental behavioral triggers. This innovative study has
implications for interventions and program development through awareness of posttraumatic symptom
variability. This methodology informs future use oftechnology in psychiatric assessment, treatment, andresearch.

In 2015, the scope of the study expanded to include a genetic
component through the collection of biogenetic samples to identify
potential genetic biomarkers and gene-environment interactions.

16 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Education and Training
A central aspect of the Center’s mission is education and training. The Center has a wide range ofactivities with the goal of disseminating knowledge.
Center scientists educate and train USU medical
students committed to service in our nation’s Army,
Air Force, Navy and Public Health Service. The
Center educates leaders and health care providers inpublic and private agencies. In addition, the Center
sponsors conferences, seminars and symposia thathave educational and training objectives. The Center
advances the field of military and disaster psychiatry
through presentations, outreach and training, as wellas through participation in conferences, collaborations and workshops across the U.S. and internationally. The Center has educated and expanded knowledge through public health efforts and interventions
during and after disasters.

Profile: Commander Jennifer Bornemann
Commander Jennifer Bornemannjoined the Center in March 2010
after being commissioned in the
United States Public Health Service(USPHS). CDR Bornemann spent almost five years at CSTS, and duringthat time she worked on several of
the Center’s major projects. CDR
Bornemann deployed when she wascalled to serve, including volunteering to respond through her DoD
contacts in the immediate aftermath of the Washington Navy Yard shooting. For two weeks following the shooting, she provided group and individual supportive counseling for those directly
affected. CDR Bornemann is a valued member of
the Services Access Team (SAT) 3, and deployedwith them for Superstorm Sandy in New Jersey.
In late 2014, CDR Bornemann transitioned from
CSTS to the Substance Abuse and Mental HealthServices Administration (SAMHSA), and soonafter was deployed to Monrovia, Liberia for twomonths to support the Ebola crisis. In 2015, CDR
Bornemann was deployed to Roseburg, Oregon
for more than two weeks to provide counselingto those directly affected by the Umpqua Community College shooting. The Center has been acritical resource to support these disaster mental

health response efforts.
CDR Bornemann described theimpact of her service at the Center,“As an officer in the United States
Public Health Service, I am occasionally called to deploy in supportof communities affected by natural
or man-made disasters or events. In
the past year, I have deployed as abehavioral health officer to Liberia
as a member of the Monrovia Medical Unit Team 2, as well as to Roseburg, Oregon
in the aftermath of the mass shooting at Umpqua
Community College. While both deployments
were intense and challenging, the missions werevery different in nature. I was able to use theinformation from CSTS research and subject
matter experts to keep my teams informed of theissues including working with Ebola, deployment
challenges, and helping communities cope in theimmediate days and weeks after a mass shooting. CSTS is the first place I turn to prepare forany and all of my deployments with the USPHS.
Working on Army STARRS, I got a look into thelast moments of those who took their own lives
and I use that knowledge in my current work. My
experience at the Center informs the work I do at
SAMHSA every day.”2015 ANNUAL REPORT | 17

Disaster Response and Public Education
Since its inception, the Center has provided
disaster response education and consultation. This
has involved on the ground support to disasterevents such as the 9/11 Pentagon response in 2001,
the mass shooting at Fort Hood, TX in 2009 andthe active shooter incident at the Washington Navy
Yard in 2013. Center scientists provide consultation
to leaders and other personnel involved in disaster
response efforts. The Center emphasizes disaster
preparation and response and former Center personnel are often called upon to provide expert guidanceon disaster preparation and response activities as aresult of the subject-matter expertise they obtained
working at the Center.

Neuroscience Module for Pre-Clerkship USU
Medical Students
The neuroscience module prepares pre-clerkship
medical students for their clerkship period, as wellas providing a foundation of knowledge that will
inform their long-term education. The neuroscience
module covers a breadth of information from basic
neuroanatomy to clinical skills in neurology andpsychiatry. The neuroscience module is co-directedby Dr. Gary Wynn, CSTS, and Dr. David Mears, USU
Department of Anatomy, Physiology, and Genetics. Drs. Wynn and Mears were again given thebest module director award, this time by the Class
of 2018 and representing the fourth consecutive
year the neuroscience module has received such anaward.

CSTS Sponsored Neuroscience Fellowship
The Center has initiated a pre-doctoral fellowshipfor the USU neuroscience doctoral students. The
goal of the fellowship is to foster the developmentof the next generation of scientists and investigators who will tackle problems relevant to the CSTS
mission. We anticipate the first fellowship will beawarded in 2016.

Education in Combat and Operational StressControl: Operation Bushmaster
CSTS faculty directly support combat and operational stress control (COSC) education at USU. As
18 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

part of its annual medical field training exercise,Operation Bushmaster, students are immersed in alarge-scale medical simulation. CSTS faculty develop, implement, and assess student performance on
a collection of realistic COSC scenarios during thefour-day exercise. Important lessons are emerging on
the psychological impact of these large-scale simulations on learners which CSTS faculty are publishingand using as a springboard to further investigations. These lessons learned do not just apply to medical students or military medicine, but to the field of
disaster psychiatry and impact on responders.

Homeland Security
Dr. Benedek, other Center investigators, andpartners from the Army’s Comprehensive Soldier
Fitness program implemented a training programin psychological first aid/team resilience building
for the Department of Homeland Security (DHS)
in 2015. The DHS and the Center collaboratively
developed and pilot tested a cutting-edge resilience
training program that incorporated findings froman initial assessment of existing DHS programs andincluded elements of Psychological First Aid, Decision Making in High Stress Environments, andindividual and team resilience. The Center conducted the assessment of existent resiliency programs for
DHS employees and made recommendations basedon that assessment. The Center will provide ongoing
consultation, specifically related to program evaluation and data collection, as DHS potentially expands
its Responder Resiliency and Decision Making
program.

Mortuary Affairs Officer Education
CSTS has provided officer education at the Joint
Mortuary Affairs Center and School at Fort Lee,
Virginia, assisting the active duty forces and themortuary affairs school as they trained and deployed
new Soldiers in response to changing missions.
The education addresses resiliency, preparedness,training and education of military personnel forthe stresses of deployment and working with thedead. Content experience comes directly from ourresearch findings and intervention with Mortuary
Affairs Soldiers.

Firearm Safety
There are approximately 30,000 firearm fatalities
in the United States each year. The majority of these
deaths are due to suicide or accidental firearm death.
However, evidence suggests that adopting safe
storage practices can
reduce the likelihood of
deaths due to firearms.
The Center partnered with the Yellow Ribbon Reintegration Program (YRRP) and the Defense Suicide Prevention
Office (DSPO) to develop the Personal Firearm
Safety Education Project. The project developed
multimodal educational materials on personal firearm safety. This targeted effort strategically supports
DoD suicide prevention efforts by educating Service members on the importance of personal firearm safety. This training program, implemented inconjunction with pre-and post-deployment events,
promotes evidence-based gun safety practices toenhance the safety of Service members and theirfamilies. Center scientist CAPT Curt West met with
the Director of Personnel Risk Reduction, Undersecretary of Defense for Personnel and Readiness, at thePentagon to discuss ways forward with the PersonalFirearm Safety Education Project.

Upcoming Textbook of Disaster Psychiatry(Second Edition)
Since the publication of the first edition of the
Textbook of Disaster Psychiatry in 2007 (edited byRobert Ursano, Carol Fullerton, Lars Weisaeth andBeverley Raphael), there
has been a proliferationof disasters worldwide,
including natural andhuman-made disasters,
terrorist events and an
escalation of the war in
the Middle East. In 2012,a total of 357 disasters were registered worldwide(Guha-Sapir D., Hoyois P., Below, R. Annual Disaster Statistical Review 2012: The Numbers andTrends. Brussels, CRED, 2013), affecting approximately 124.5 million people, costing approximately$157 billion. The second edition of the Textbook ofDisaster Psychiatry advances the goals of the firstedition by bringing together a distinguished group ofinternational experts providing an updated, comprehensive review of the psychological, biological andsocial processes of response to, and intervention for,disaster mental health needs. The second edition
represents a decade of advances in disaster psychiatry: the epidemiology of disaster response, the neurobiology of disaster exposure, socio-cultural issues,interventions, actionable research and advances inpublic health responses to disaster. The second edition of the textbook has a Scientific Advisory Board,
Section Editors and Associate Editors comprised of
distinguished scientists, scholars, practitioners andresearchers who are leaders on the cutting edge ofthe field of disaster psychiatry. Chapters from thefirst edition have been edited extensively and updated, and fourteen new chapters have been added tothe second edition with an expected publication datein the fall of 2016.

Upcoming Textbook On Complementary andAlternative Medicine (CAM) for PTSD
Drs. Gary Wynn and David Benedek have recently submitted the upcoming textbook Complementaryand Alternative Medicine for Posttraumatic Stress
Disorder for publication. This text, an invited projectfrom Oxford University Press, is a first of its kindcomprehensive look at a variety of complementary
and alternative treatment modalities. Each chapter
reviews a different CAM treatment, its evidence
2015 ANNUAL REPORT | 19

base and the potential clinical utility for those suffering from PTSD. The treatments covered include acupuncture, yoga, meditation, animal assisted therapy,transcranial magnetic stimulation, virtual reality,
smart phone applications, alternative pharmacology
and family therapy. This project includes chapter
contributions by several Center members including
the chapter “Family Therapy” by Dr. Stephen Cozza. The textbook will be available in the summer of2016.

Upcoming Textbook Chapter
Dr. Joshua Morganstein was the lead author for achapter in an international textbook on the Fukushima nuclear disaster, titled “Psychosocial Responses to Disaster and Exposures: Distress Reactions,
Health Risk Behavior, and Mental Disorders.” Thechapter provides a critical overview of the uniquepsychological issues that impact individuals exposed
to chemical, biological, radiological and nuclear
material as well as those responsible for managing
the consequences of these events. It will serve as animportant global academic resource to assist policy
makers, disaster planners, healthcare providers andfirst responders to better understand, plan and prepare for the adverse psychological effects of disasters
that involve exposure and contamination, such as
nuclear disasters.

Training Research Assistants
CSTS is a training ground for our staff, including
our Research Assistants (RAs). Research Assistants
at CSTS support our scientists in many research-related tasks, including literature searches, datacollection and entry, and writing and summarizing
project meeting minutes. In turn, the scientists andleadership at CSTS provide training and professional
development opportunities for the RAs. RAs learn
practical skills and gain experience in conducting
research. They become familiar with the process ofmanuscript preparation and the presentation of research findings to the scientific community and thegeneral public. This training and experience prepares
the RAs for advanced degree programs and careers
in research and other related fields.
CSTS Research Assistants have moved on to
20 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

further their education at prestigious schools, suchas Yale, Notre Dame, Johns Hopkins and otheresteemed institutions. Opportunities our Research
Assistants have pursued following their training andexperience at CSTS include:■■ PhD graduate programs in psychology and related fields.
■■ Medical school.
■■ Master degree programs in counseling, publichealth and social work.
■■ Careers with the FBI.

EDUCATIONAL CONFERENCES
The Center sponsored three conferences in 2015:
the 10th Annual Amygdala, Stress and PTSD Conference; the Artiss Symposium; and the Forum on
Health and National Security: Financial Stress andBehavioral Health in Military Servicemembers: Risk,
Resilience, Mechanisms and Targets for Intervention.

Amygdala, Stress and PTSD Conference: Of
Mice and Man
For the past decade, the Center has sponsoredthe Amygdala, Stress and PTSD Conference at USU
every year in April. In 2015, the Center presented
the “10th Annual Amygdala, Stress and PTSD Conference: Of Mice and Man.” The Center works in collaboration with the USU Department of Psychiatry,
USU Neuroscience Program, USU Department of
Family Medicine, and the WRNMMC Departmentof Psychiatry on this annual conference. In 2015, theconference included more than 400 individuals registered for a day of world class presentations aimed
at bringing together scientists, clinicians and policy
makers working towards solving the biological basisof stress, fear and PTSD. The conference speakers
represented prestigious universities and research
institutions from across the country and internationally including University of Michigan, Johns
Hopkins, Georgetown University and the Universityof Cape Town, South Africa. The speakers presented
and discussed topics such as the use of big data inneuroscience research, the biology of empathy andthe experience of trauma in South Africa. In addition
to the conference, this year was a first in partneringwith the Journal of Neuroscience Research to puttogether a special issue based on the conference andtitled “The Amygdala: Dysfunction, Hyperfunction,
and Connectivity.” The special issue is a collection ofarticles from a number of the presenters along withother experts in the field of the amygdala and should
be in press prior to the “11th Annual Amygdala,Stress and PTSD Conference: The Effects of Stressand Loss” scheduled for April 2016.

Artiss Symposium: Current Concepts in
Psychosomatic Medicine
The Center is a sponsoring partner for the annual
Artiss Symposium. Kenneth L. Artiss, MD (1913—
2001), the namesake of the symposium, was an Army
officer, a research psychiatrist and instructor at Walter Reed Army Medical Center who inspired generations of military psychiatry residents to conduct highquality research. This year’s symposium, “Current
Concepts in Psychosomatic Medicine,” examined arange of topics that addressed the interplay between
complex medical problems and psychological healthfeaturing expert speakers in clinical and researchleadership positions from throughout the Military
Health System.

Forum on Health and National Security:
Financial Stress and Behavioral Health in
Military Servicemembers: Risk, Resilience,
Mechanisms and Targets for Intervention
Since the mid-1980s, the Center has held a seriesof conferences, the Forum on Health and National
Security, bringing together people with a wide rangeof expertise, perspectives and vantage points tothink and talk together about topics of importanceto the military. By bringing together people whohave thought through different parts of a problem,
but who may have never talked together, our goal
is to generate new knowledge, new thoughts andnew ways of thinking about issues. The focus of theforums have addressed diverse topics: individual andgroup behavior in toxic and contained environments— psychological effects of chemical and biological2015 ANNUAL REPORT | 21

“Great team effort, as always. Important work wehave to integrate. Thanks for all you do.”— Anthony J. Stamilio, Deputy Assistant
Secretary of the Army (Civilian Personnel andQuality of Life), U.S. Department of the Army

warfare; military women in combat deployment andcontingency operations; stress and coping with war;
Army family violence; planning for biological events— responses to terrorism and infectious disease
outbreaks; workplace preparedness for terrorism;
stigma and barriers to care — caring for those
exposed to war, disaster and terrorism; military families in transition — stress, resilience, and well-being;
and financial stress and behavioral health in Service
members — risk, resilience, mechanisms and targets
for intervention.
“Thank you for the opportunity to

The 2015 Forum on Health and National Security: Financial Stress and Behavioral Health in Military Servicemembers: Risk, Resilience, Mechanisms
and Targets for Intervention, addressed financial
stress in the lives of Service members to identify knowledge gaps and opportunities for gaining
new knowledge that can lead to new and improved
intervention programs. Financial stress directly
and indirectly affects Service members’ mental andbehavioral health as well as Service member andfamily functioning. Understanding financial stresscan aid in developing effective programs to mitigate
this stress and help Service members and families
in need. The Forum reviewed the complexity ofdefining financial stress and the interplay of financial stress in the “web” of life stressors that impact
Service members and their families. The Forumbrought together military and civilian leaders andscientists with expertise in risk and resilience, behavioral health, economics, models of stress behavior
and suicide to address the financial challenges faced
by Service members and their families. Participants
were challenged to develop new perspectives bysynthesizing knowledge across diverse disciplines
to better understand the complex issues of financial
stress and associated life stressors, and risk and resilience factors moderating this stress.

participate. The forum was excellent andthought-provoking. A lot of great dialogue,“I thoroughly enjoyed participating. You

networking, and ideas for future collaborationassembled a great group of experts and themade the two days very rewarding.”

discussion was fruitful.”— Barbara A. Thompson, Director, Office of— John A. Fedrigo, Deputy Assistant Secretary

Family Readiness Policy, Office of the Secretaryof the Air Force (Reserve Affairs and Airmanof Defense, Military Community and Family

Readiness), Office of the Assistant Secretary of

Policythe Air Force for Manpower and Reserve Affairs

22 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USUDevelopment and Disseminationof Educational Resources
Part of the Center’s central mission is the development and dissemination of educational material
to inform stakeholders including: healthcare providers, first responders, community leaders, families,
teaching professionals and policy makers. For morethan two decades we have created customized, easyto-read, just-in-time educational fact sheets to assist
our stakeholders to effectively manage the adverse
effects of traumatic stress through enhanced preparation and response to disaster events. This year, theCenter provided resources to partners throughout
the Department of Defense, the National Association of State Mental Health Program Directors, theAmerican Psychiatric Association, the U.S. Public
Health Service and others in response to shootings
in San Bernadino, CA, Umpqua Community Collegein Roseburg, OR, and news personnel in Moneta,
VA. The Center provided consultation to the U.S.
Department of Agriculture (USDA) to assist in themental health response in anticipation of outbreaksof avian influenza. Drs. Flynn and Morganstein developed a customized consultation document which
addressed a range of concerns raised by USDA toassist mental health providers in directly supporting
the thousands of individuals whose families and livelihoods were projected to be directly and adversely
impacted by this infectious disease outbreak.

WebsiteThis year, we redesigned the Center website(www.CSTSonline.org). It remains our goal to
make relevant and timely information available toa wide range of stakeholders. Disaster fact sheets,
current research citations, newsletters and conference reports are easily accessible via the website. A“What’s New” section highlights recent disaster fact
sheets, research initiatives, conference summaries
and announcements of upcoming events. In 2015,
the CSTS website had an average of 3,100 hits permonth. These hits came from all 50 states, the District of Columbia, and 146 countries outside the U.S.

Social Media
During the past year, the Center increased its
online presence through social media resources toassist with the distribution of content. CSTS has a
growing following and uses these resources to ensure
timely delivery of relevant content to our partners.
We encourage people to visit and follow our postings
via Twitter and Facebook to stay up-to-date on newcontent from the Center. In addition, “like” us on
Facebook at Center for the Study of Traumatic Stressand follow us on Twitter at @CSTS_USU.

2015 ANNUAL REPORT | 23

Consultation
KEY CONSULTATIVE PARTNERSHIPS
Since its inception, consultative relationships
have been a cornerstone of CSTS’s mission, including a wide variety of partner organizations both
inside and outside government, and internationally.
Such collaborations provide opportunities to contribute our resources and expertise in the service ofothers. Two such consultations during 2015 werewith NASMHPD and SAMHSA.

National Association of State Mental Health
Program Directors (NASMHPD)
NASMHPD is a membership organization
representing state mental health authorities (Commissioners). The Commissioners are responsible fordirecting the public mental health system in theirstates, and address the many challenges inherent inthose systems. There is significant overlap between
the mission of CSTS and NASMHPD: 1) Militarybases within the U.S. are under the jurisdiction of
NASMHPD; 2) NASMHPD is involved in treating
significant numbers of veterans and their families in
response to natural and human-caused disasters andemergencies; and 3) CSTS and NASMHPD share acommitment to understanding and reducing suicide.
CSTS and NASMHPD have sustained a working
relationship over many years. CSTS staff meet regularly with NASMHPD leadership and are frequent
participants in meetings and conference calls with
their membership.

Substance Abuse and Mental HealthServices Administration (SAMHSA)SAMHSA is one of the oldest and most important federal partners for CSTS. Located within the
Department of Health and Human Services (DHHS),
SAMHSA is the lead federal entity responsible forsupporting and improving mental health services in
the nation. Our relationship with SAMHSA involves
disaster mental health issues. SAMHSA administers
the domestic disaster mental health program (funded by FEMA) for major disasters. SAMHSA disaster24 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

program staff regularly consult with CSTS about
the challenges of disaster services organization anddelivery. CSTS provides science-based knowledge to
SAMHSA on disaster and trauma response informedby current evidence. Consultation with SAMHSA is
facilitated by Dr. Flynn, one of the Center’s Associate
Directors, who had a long and distinguished career
as a USPHS Officer responsible for the disaster mental health program at SAMHSA.

GLOBAL HEALTH IMPACT
Global health, an expanding domain for all healthincluding mental health, is a growing focus for both
USU and the DoD. CSTS has had long standing involvements in global health activities in the areas ofresearch collaboration, training and education, andconsultation with colleagues
around the world. Since
its inception, Dr. Brian
Flynn has served as anactive member of the
USU Global HealthWorking Group, andcontinues collaboration with the newly established USU Center on
Global Health Engagement.
CSTS has a publication coming
out in 2016 on the role of mental health in military
global health engagement.
The Center plays an important role in the national and global response to war, disasters, terrorism
and public health threats. The Center partners withnational and international organizations in response
to global health care needs. Some examples from2015 follow:

International PTSD
As part of the commemorations of WWI, Dr.
Ursano was invited to the residence of the Belgian Ambassador, Johan Verbeke, to participate ina panel discussion, “The Trauma Brought Back

Home - A Historical and Sociological Perspective
on Post Traumatic Stress Disorder from 1914 until
Today.” Other distinguished panelists were Professor Kaat Wils, Professor of Modern European
Cultural History at the University of Leuven (KU
Leuven), Belgium, and Sr. Captain Jeroen Van den
Bossche, Head of the Centre for Crisis Psychology
at the Queen Astrid Hospital in Brussels. The panel
moderator was Leo Shane, Congressional Reporterat Military Times.

Global Suicide Prevention Month and Global
Mental Health Day
Dr. Ursano attended a meeting at the WhiteHouse for World Mental Health Day - Partnerships for Suicide Prevention. In commemoration of
Global Suicide Prevention Month and Global Mental
Health Day, the White House Offices of Scienceand Technology Policy and Public Engagement, in
collaboration with Joining Forces, brought together
clinicians, researchers, data scientists, tool developers, advocates and policy makers for a briefing about
new opportunities for strengthening mental healthtreatment and suicide prevention.

PTSD and International Diplomacy
Dr. Benedek participated in a panel at the U.S.
Department of State, “PTSD in the Context of Conducting U.S. Diplomacy.” The conference was attended by more than 50 State Department leaders andother distinguished guests. Other presenters included the Director of Mental Health for the Departmentof State and representatives from the Department’s
Security Program.

The USU Center of Global HealthEngagement
Dr. Flynn attended “Launch of the USU Center of
Global Health Engagement (GHE) and GHE Views
from the Services” held at USU. The event included
presentations about global health programs in theArmy, Navy, and Air Force. GHE is an importantand growing priority for both DoD and USU. The
Department of Psychiatry and CSTS continue tobe active in this growing initiative by continuing its
long-standing international activities with Dr. Flynn

serving as a member on the USU Global HealthWorking Group.

Sendai Framework for Disaster Risk
Reduction 2015–2030
The final approved Sendai Framework for Disaster Risk Reduction 2015-2030 was issued in2015. Following activities begun last year at the International Symposium on Disaster Medical andPublic Health Management, Dr. Ursano, and Dr.
Hiroaki Tomita from the International ResearchInstitute of Disaster Science at Tohoku University
in Japan, led a team of international subject-matter
experts, including Drs. Flynn and Morganstein, inthe development of policy recommendations. These
recommendations will be disseminated globally toUnited Nations member countries that assist with
reducing the risk of adverse psychosocial and mental
health. A call to address mental health issues aspart of disaster risk reduction was included for the
first time in a report with such global impact. Thisis significant in many ways as there had been no
mention of mental health in prior versions, and thisdocument will be used globally for the next 15 years
to guide disaster risk reduction.

Climate ChangeDrs. Ursano and Morganstein co-authored amental health chapter for a multi-federal agency
report being written at the direction of the Presidentof the United States, which details the current stateof scientific knowledge regarding the impacts ofclimate change on health. This document is a follow-up to the National Climate Assessment, released
in 2014, that provided our country’s leaders with ascientific overview of the current state of climatechange. The report “Climate Change Impacts on
Human Health in the United States: A Scientific
Assessment” will be delivered to the President andCongress in early 2016.
Dr. Ursano resumed his leadership role as the
Chair for the American Psychiatric Association(APA) Disaster Committee. Part of his work on thecommittee involves the development and dissemination of an APA position statement on the mental
health impact of climate change.
2015 ANNUAL REPORT | 25

Other Activities in Support of the DoD
In addition to the many scholarly activities at theCenter that support the DoD, our scientists and staff
participate in non-academic activities related to the
DoD. The pictures below and right illustrate examples from 2015. CSTS hosted a team that ran in the
Army Ten Miler, and one individual from CSTS ran
in the Marine Corps Marathon. CSTS collectively
donated funds and a bicycle to the U.S. Marines Toys
for Tots program which plays an active role in thedevelopment of one of our nation’s most valuable
resources — our children.

Words from Two Center Scientists
Patcho N. Santiago, MD, MPH
Commander, Medical Corps, U.S. NavyPatcho Santiago, MD,
MPH, Commander,
Medical Corps, U.S.
Navy, is a board certified psychiatrist andAssociate Professor of
Psychiatry at the Uniformed Services University (USU). Dr. Santiago
earned his medical
degree from Jefferson
Medical College under the Navy’s Health Professions
Scholarship Program. After completing his psychiatry residency at the Naval Medical Center San Diego,
26 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

his first duty assignment was at the Naval HospitalCamp Pendleton, CA. He subsequently completed
a Disaster and Preventive Psychiatry Fellowship at
USU, earning his Masters in Public Health, and ultimately joining the faculty at the university, having
research interests in psychiatric epidemiology andmental health promotion. As billeted faculty at USU,
Dr. Santiago served as the USU program manager
for the Army Study to Assess Risk and Resiliencein Servicemembers (Army STARRS) as well as the
Associate Program Director for the Disaster andPreventive Psychiatry Fellowship. He is currently
stationed at WRNMMC in Bethesda, MD where heserves as the Program Director of the National Capital Consortium Psychiatry Residency.

What have you learned from CSTS?
I first arrived at the Center in 2008 as a first-year
fellow in the Disaster and Preventive Psychiatry
Fellowship at USU. The first year of the fellowship isthe Masters in Public Health (MPH) program, andthe second year focuses on practicum work in federal and other institutions to see how public healthprinciples are applied to real-world behavioral healthissues and concerns. Most of my practicum time
was spent at CSTS working at the forefront of theintersection of public health and behavioral health,which as a Navy psychiatrist, was more frequently
the mission than not.
In 2006, I was a staff psychiatrist at Naval Hospital Camp Pendleton when I first heard of the disaster
psychiatry fellowship, and the timing was fortuitous.
I had recently struggled with an assignment frommy commanding officer to lead a “PTSD summit” asleaders aboard the Marine Corps Base were trying toaddress the rising rates of posttraumatic stress disorder within their units. In addition, earlier that year,
I had just returned from my first deployment, andone of my duties was as the psychiatrist on a Combat
Operational Stress Team, responsible for delivering
the behavioral healthcare on the smaller U.S. military installations in Kuwait. In both of these cases, it
was clear to me that there was an entire field of study
within mental health that was not part of the curriculum in my residency training. I quickly realizedthat my lack of public health knowledge limited myeffectiveness in the larger role of Navy psychiatry. I
had articulated to myself that my medical training
made sure I knew how to “stamp out disease, one patient at a time,” but what happens when the patient is
a community?
The MPH program made me just as quickly realize how much I didn’t know that I didn’t know on thesubject of public health, but CSTS highlighted thatthe “knowing” only got someone so far; that opera-

tionalizing knowledge into a public health intervention was a much higher-order skill and, I would say,something that must be learned outside the classroom, no matter how many case studies one might
examine. It was at CSTS that I saw how an idea
becomes the action, as when cognitive behavioral
therapy was the theoretical nidus to building a resilience intervention for Soldiers working in mortuary
affairs. The intervention that CSTS created, implemented, tested and studied stood in stark contrast to
my own pre-fellowship work four years earlier when
I was responsible for meeting regularly with the U.S.
Army morticians working at Ali Al Salem Air Base,to check on their mental health and well-being. A
psychiatric technician and I would visit those morticians once a week and talk informally with them forseveral hours in their spaces. Had I had my experience at CSTS prior to that assignment, I would havebeen purposefully programmatic: I would have done
a literature review, identified stakeholders, conducted a needs assessment, defined goals, developed ameasure to assess progress, etc.
One of the core functions of the Center for the
Study of Traumatic Stress is spreading knowledge
and expertise, and in my case, because of my timeat CSTS, I have the opportunity to continue thatmission in graduate medical education. Today, I
am the training director for the largest psychiatry
residency in the Department of Defense, and I makesure that our graduates have a sensitivity, awarenessand motivation to address the public mental healthneeds of those in our care. They understand that inasmuch as a great deal of their time is spent in clinic
or on the wards taking care of patients one at a time,
more likely than not, they will at some point have anassignment where their mission is “to maintain thefighting strength” of a battalion, a fleet, a division, ora community of military family members, each with
their own unique challenges.

CSTS highlighted that the “knowing” only got someone so far; that
operationalizing knowledge into a public health intervention was a muchhigher-order skill and, I would say, something that must be learned outside
the classroom…

2015 ANNUAL REPORT | 27

David M. Benedek, MD
Colonel, Medical Corps, U.S. ArmyDavid Benedek, MD, isProfessor of Psychiatry
and Neuroscience, andAssociate Director/Senior
Scientist at the Center.
He is a past president of
the Society of Uniformed
Service Psychiatrists — theMilitary District Branchof the American Psychiatric Association, and
Immediate Past Branch Representative to the APA
Assembly. He is a Distinguished Fellow of the American Psychiatric Association. Dr. Benedek served as
Consultant to the U.S. Army Surgeon General for
Forensic Psychiatry from 2004–2008.
Dr. Benedek received his MD from the Uniformed Services University School of Medicine in
1991. After Internship and Residency in Psychiatryat Walter Reed Army Medical Center, he was assigned as Division Psychiatrist, First Armor Division,Germany. He returned to Walter Reed to complete
forensic psychiatry fellowship training in 1998
and then served as the Assistant Chief of Inpatient
Psychiatry, Walter Reed Army Medical Center. In
1999 he became Chief, Forensic Psychiatry Service,and Director, National Capital Consortium Military
Forensic Psychiatry Fellowship Program at Walter Reed, and he remained in those positions until
joining the USU/CSTS faculty in 2004. In 2002 hereceived the U.S. Army Surgeon General’s “A” Proficiency Designator, and subsequently received theOrder of Military Medical Merit.
Why did you join the Army? How did you becomea physician, a psychiatrist and now a clinicalresearcher?
My parents often made family vacations out of
my mother’s attendance at the Annual Meeting of
the American Psychiatric Association. Seeing thesites and chasing my siblings around the various
conference centers and hotels of Toronto, Chicago,
New York City, etc. are among my fondest childhood
memories. Perhaps that is what sparked my initial
28 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

interest in medicine and in psychiatry. By the time
I attended college, my enjoyment of science and mypersonal experience with physicians who cared forme led to my plan to attend medical school.
While in college I continued to attend the APA
annual meetings and along the way I was introduced
to Dr. Robert Hales. Dr. Hales is a U.S. Military
Academy Graduate, the longtime Editor-in-Chiefof American Psychiatric Press, and now Professor
and Joe P. Tupin Chair of Psychiatry and Behavioral
Sciences at UC Davis. At the time I met him, he wasa Colonel in the U.S. Army and a psychiatrist at Letterman Army Medical Center in San Francisco. He
encouraged me to apply to the Uniformed Services
University for medical school. When I interviewed at
USU, I was so impressed with the faculty and students that I met, that it immediately became my first
choice. Upon receiving my letter of acceptance, there
was no looking back! At USU, I enjoyed many of myclasses and almost all of my clinical rotations, but
none as much as my inpatient psychiatry rotation
at the old Walter Reed. Therefore, when it was time
for me to list choices for residency that, too, was ano-brainer.
While a psychiatry resident, I was fortunate
enough to count among my instructors Dr. Robert
Ursano. Bob was not only a mentor, but a role model
for balancing scholarly pursuits with compassion
and clinical excellence in a military environment.
He was an inspiration “way back then” just as he istoday. Throughout my residency, and again after I
returned to Walter Reed for fellowship training afteran operational tour in Germany and Bosnia, Bob
provided opportunities for me to teach students andhelped me synthesize my experience into lessons,not only for medical students but for residents andmy peers. While I served as Assistant Chief of theInpatient Psychiatry service at Walter Reed, andthen Fellowship Director for Forensic Psychiatry,
the opportunities to teach, to write, to publish andto contribute to research projects within the USU
Department of Psychiatry and the Center for the
Study of Traumatic Stress that Dr. Ursano gave me
challenged and at the same time groomed me for myeventual transition to a faculty position at USU.

What first connected you to CSTS?
Practically speaking, the missions of the USU
Department of Psychiatry and CSTS overlap in many
ways. My connection to the Department of Psychiatry at USU was first and foremost Bob Ursano, andit follows that he would also serve as my connection
to the Center. Other now retired but formerly uniformed Center scientists, most significantly Harry
Holloway, Ann Norwood, Chuck Engel and Tom
Grieger, helped me develop the ability to synthesize
and integrate my interests into those of the Centerand to translate new skills and knowledge into military medical practice.
Has CSTS contributed to your career/growth/knowledge, and accomplishing your goals?
The CSTS mission of development and dissemination of knowledge related to the preparedness
for and response to the stress of disasters, including
war and terrorism, aligns perfectly with my personal
interests. CSTS is full of inspiring and talented scientists, educators, mentors and willing collaborators.
I cannot imagine a better place for me to work, togrow and to contribute.
What are the research activities of your new
Center?
The Center for Forensic Behavioral Sciences,
CFBS, at Walter Reed National Military Medical
Center is the home of the only accredited Forensic
Psychiatry and Forensic Psychology Fellowships in
the Department of Defense. In addition to training
future military forensic psychiatrists and psychologists, the CFBS provides expert assistance forprosecutors and defense counsel, and testimony incourts martial around the world. CFBS also provides
consultation to law enforcement and investigative
agencies, including the Department of Justice andFederal Bureau of Investigation, on the applicationof principles of psychological function to criminal
behavior and other threats to military mission or national security. While the training and consultation

missions are relatively longstanding and ongoing, thedevelopment of a research program within the CFBS
has just begun.
What tasks or interests does your new Center sharewith CSTS?
Both the CSTS and CFBS are invested in promoting the health security of the nation. Both are committed to developing and disseminating knowledge
regarding response to trauma. The CFBS focus onunderstanding precipitants, predictors and consequences of violence may only represent a subset of
the interest of CSTS, but both also share a desire totrain and prepare mental health professionals fortheir roles in mitigating the consequences of disaster,
war and terrorism.
What do you hope to research, understand andlearn more about in the future?
The CFBS’s charter calls for the establishment ofa database regarding forensic assessments conducted
throughout the DoD. Such a database may provide
new opportunities to identify risk and protective
factors associated with arrest, conviction or recidivism for violent criminal behavior. To the extent that
CFBS staff are consulted to assist with investigations
or assessments of perpetrators of crimes whichpose threats to our national security or compromise
military mission capability, further characterizationof risks of insider threat or radicalization are areasof interest for the CFBS. Since CFBS also conducts
psychological autopsies at the request of military
medical examiners or criminal investigative agencies, there should be opportunity to help answer
questions explored by research conducted at CSTS
including Army STARRS and STARRS-LS. I hope
to explore opportunities to collaborate with CSTS
colleagues along these lines. Maybe this sounds likebig plans for a little center, but you can guess where
I have been looking to find my blueprint for growing
research to meet the needs of the nation, and thatmodel has certainly proven successful!

The CSTS mission of development and dissemination of knowledge related to the preparedness for andresponse to the stress of disasters, including war and terrorism, aligns perfectly with my personal interests.
2015 ANNUAL REPORT | 29

CSTS Publications in 2015
(Names in bold text are CSTS personnel)

JOURNAL ARTICLESBomyea, J., Ramsawh, H.J., Ball, T.M., Taylor, C.T.,
Paulus, M.P., Lang, A.J., & Stein, M.B. (2015). Intolerance of uncertainty as a mediator of reductions in worry in a cognitive behavioral treatment
program for generalized anxiety disorder. Journalof Anxiety Disorders, 33: 90-94.
Castro-Gomes, V., Bergstrom, H.C., McGuire, J.L.,
Parkers, C.C., Coyner, J., Landeira-Fernandez,J., Ursano, R.J., Palmer, A.A., & Johnson, L.R.
(2015). A dendritic organization of lateral amygdala neurons in fear susceptible and resistantmice. Neurobiology of Learning and Memory,[Epub ahead of print].
Colpe, L.J., Naifeh, J.A., Aliaga, P.A., Sampson,
N.A., Heeringa, S.G., Stein, M.B., Ursano, R.J.,
Fullerton, C.S., Nock, M.K., Schoenbaum, M.L.,
Zaslavsky, A.M., Kessler, R.C., & On behalf of
the Army STARRS Collaborators. (2015). Mental
health treatment among soldiers with current
mental disorders in the Army Study to Assess
Risk and Resilience in Servicemembers (ArmySTARRS). Military Medicine, 180(10): 1041-1051.
Cozza, S.J. (2015). Meeting the intervention needsof military children and families. Journal of theAmerican Academy of Child & Adolescent Psychiatry, 54(4): 247-248.

30 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Cozza, S.J., Ortiz, C.D., Fullerton, C.S., McCarroll, J.E., Holmes, A.K., Harris, A.M., Wryter,
C.L., & Ursano, R.J. (2015). Types, subtypes,
and severity of substantiated child neglect in U.S.
Army communities. Military Medicine, 180(11):1147-1153.
Dalgard, C.L., Jacobowitz, D.M., Sing, V., Saleem,
K.S., Ursano, R.J., Starr, J.M., & Pollard, H.
(2015). A novel analytical brain block tool toenable functional annotation of discriminatorytranscript biomarkers among discrete regions of
the fronto-limbic circuit in primate brain. Brain
Research, 1600: 42-58.
Fullerton, C.S., Mash, H.B.H., Benevides, K.N.,
Morganstein, J.C., & Ursano, R.J. (2015). Distress of routine activities and perceived safety
associated with post-traumatic stress, depression,and alcohol use: 2002 Washington, DC sniper
attacks. Disaster Medicine & Public Health Preparedness, 9(5): 509-515.
Fullerton, C.S., Ursano, R.J., Liu, X., McKibben,
J.B.A., Wang, L., & Reismann, D.B. (2015).
Depressive symptom severity and community
collective efficacy following the 2004 Florida
hurricanes. PLoS One, 10(6): e0130863.
Howe, E.G. (2015). Reflections on engaging thepotentially “difficult” patient. Medicolegal andBioethics, 5: 7-16.
Jia, M., Smerin, S.E., Zhang, L., Xing, G., Li, X.,
Benedek, D.M., Ursano, R.J., & Li, H. (2015).
Coricosterone mitigates the stress response inan animal model of PTSD. Journal of PsychiatricResearch, 60: 29-39.
Kessler, R.C., Stein, M.B., Bliese, P.D., Bromet, E.J.,
Chiu, W.T., Cox, K.L., Colpe, L.J., Fullerton,
C.S., Gilman, S.E., Gruber, M.J., Heeringa, S.G.,
Lewandoski-Romps, L., Millikan-Bell, A., Naifeh, J.A., Nock, M.K., Petukhova, M.V., Rosellini,
A.J., Sampson, N.A., Schoenbaum, M., Zaslavsky,
A.M., & Ursano, R.J. (2015.) Occupational differences in US Army suicide rates. Psychological
Medicine, 45(15): 3293-3304.

Kessler, R.C., Warner, C.H., Ivany, C., Petukhova,
M.V., Rose, R., Bromet, E.J., Brown III, M., Cai,
T., Colpe, L.J., Cox, K.L., Fullerton, C.S., Gilman,
S.E., Gruber, M.J., Heeringa, S.G., Lewandowski-Romps, L., Li, J., Millikan-Bell, A.M., Naifeh, J.A., Nock, M.K., Rosellini, A.J., Sampson,
N.A., Schoenbaum, M., Stein, M.B., Wessely, S.,
Zaslavsky, A.M., & Ursano, R.J. (2015). Predicting suicides after psychiatric hospitalization in
US Army soldiers: The Army Study to Assess
Risk and Resilience in Servicemembers (ArmySTARRS). JAMA Psychiatry, 72(1): 49-57.
LaFlair, L.N., Fullerton, C.S., Cozza, S.J., Herberman Mash, H.B., McCarroll, J.E., Ortiz, C.D., &Ursano, R.J. (2015). Military families: Measurement of community resource adequacy. Psychological Reports, 117(1): 133-143.
Licznerski, P., Duric, V., Banasr, M., Alavian, K.N.,
Ota, K.T., Kang, H.J., Jonas, E.A., Ursano, R.J.,
Krystal J.H., Duman, R.S., & Traumatic Stress
Brain Study Group. (2015). Decreased SGK1
expression and function contributes to behavioral
deficits induced by traumatic stress. PLoS Biology, 13(10): e1002282.
Liu, X. (2015). Introduction to longitudinal data
analysis in psychiatric research. Shanghai Archives of Psychiatry, 27(4): 256-259.
Liu, X., Freed, M.C., & McCutchan, P.K. (2015).
Correction of retransformation bias in nonlinear
predictions on longitudinal data with generalized
linear mixed models. Journal of Biometrics &Biostatistics, 6(2): 1-7.
Nock, M.K., Ursano, R.J., Heeringa, S.G., Stein,M.B., Jain, S., Raman, R., Sun, X., Chiu, W.T.,
Colpe, L.J., Fullerton, C.S., Gilman, S.E., Hwang,I., Naifeh, J.A., Rosellini, A.J., Sampson, N.A.,
Schoenbaum, M., Zaslavsky, A.M., & Kessler,
R.C. (2015). Mental disorders, comorbidity
and pre-enlistment suicidal behavior among
new soldiers in the U.S. Army: Results from the
Army Study to Assess Risk and Resilience inServicemembers (Army STARRS). Suicide andLife-Threatening Behavior, 45(5): 588-599.
Ramsawh, H.J., Bomyea, J., Stein, M.B., Cissell, S.H.,& Lang, A.J. (2015). Sleep quality improvement
during cognitive behavioral therapy for anxiety

disorders. Behavioral Sleep Medicine, [Epubahead of print].
Regier, D.A. (2015). Potential DSM-5 and RDoC
synergy for mental health research, treatment,
and health policy advances. Psychological Inquiry, 26(3): 268-271.
Rosellini, A.J., Heeringa, S.G., Stein, M.B., Ursano,R.J., Chiu, W.T., Colpe, L.J., Fullerton, C.S., Gilman, S.E., Hwang, I., Naifeh, J.A., Nock, M.K.,
Petukhova, M., Sampson, N.A., Schoenbaum, M.,
Zaslavsky, A.M., & Kessler, R.C. (2015). Lifetime
prevalence of DSM-IV mental disorders among
new soldiers in the U.S. Army: Results from the
Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Depression andAnxiety, 32(1): 13-24.
Rosselini, A.J., Monahan, J., Street, A.E., Heeringa,
S.G., Hill, E.D., Petukhova, M., Reis, B.Y., Sampson, N.A., Bliese, P., Schoenbaum, M., Stein,M.B., Ursano, R.J., & Kessler, R.C. (2015). Predicting non-familial major physical violent crime
perpetration in the US Army from administrative
data. Psychological Medicine, [Epub ahead ofprint].
Rosellini, A.J., Stein, M.B., Colpe, L.J., Heeringa,
S.G., Petukhova, M.V., Sampson, N.A., Schoenbaum, M., Ursano, R.J., & Kessler, R.C. (2015).
Approximating a DSM-5 diagnosis of PTSD
using DSM-IV criteria. Depression and Anxiety,32(7): 493-501.
Russell, D.W., Cohen, G., Gifford, R.K., Fullerton,
C.S., Ursano, R.J., & Galea, S. (2015). Mental
health among a nationally representative sampleof United States military reserve component personnel. Social Psychiatry and Psychiatric Epidemiology, 50(4): 639-651.
Stein, M.B., Kessler, R.C., Heeringa, S.G., Jain, S.,
Campbell-Sills, L., Colpe, L.J., Fullerton, C.S.,
Nock, M.K., Sampson, N.A., Schoenbaum, M.,
Sun, X., Thomas, M.L., Ursano, R.J., & on behalfof the Army STARRS Collaborators. (2015).
Prospective longitudinal evaluation of the effectof deployment-acquired traumatic brain injury
on posttraumatic stress and related disorders:
Results from the Army Study to Assess Risk andResilience in Servicemembers (Army STARRS).
2015 ANNUAL REPORT | 31

American Journal of Psychiatry, 172(11): 11011111.
Street, A.E., Gilman, S.F., Rosellini, A.J., Stein, M.B.,
Bromet, E.J., Cox, K.L., Colpe, L.J., Fullerton,
C.S., Gruber, M.J., Heeringa, S.G., Lewandowski-Romps, L., Little, R.J.A., Naifeh, J.A., Nock,
M.K., Sampson, N.A., Schoenbaum, M., Ursano,R.J., Zaslavsky, A.M., & Kessler, R.C. (2015).
Understanding the elevated suicide risk of female
soldiers during deployments. Psychological Medicine, 45(4): 717-726.
Thomas, M.L., Brown, G.G., Gur, R.C., Moore, T.M.,
Patt, V.M., Nock, M.K., Naifeh, J.A., Heeringa,
S., Ursano, R.J., Stein, M.B., & on behalf of the
Army STARRS Collaborators. (2015). Measurement of latent cognitive abilities involved inconcept identification learning. Journal of Clinical and Experimental Neuropsychology, 37(6):653-669.
Ursano, R.J., Heeringa, S.G., Stein, M.B., Jain,
S., Raman, R., Sun, X., Chiu, W.T., Colpe, L.J.,
Fullerton, C.S., Gilman, S.E., Hwang, I., Naifeh,
J.A., Nock, M.K., Rosellini, A.J., Sampson, N.A.,
Schoenbaum, M., Zaslavsky, A.M., & Kessler,
R.C. (2015). Prevalence and correlates of suicidal
behavior among new soldiers in the U.S. Army:
Results from the Army Study to Assess Risk andResilience in Servicemembers (Army STARRS).
Depression and Anxiety, 32(1): 3-12.
Ursano, R.J., Kessler, R.C., Heeringa, S.G., Cox,
K.L., Naifeh, J.A., Fullerton, C.S., Sampson,
N.A., Kao, T., Aliaga, P.A., Vegella, P., Mash,
H.B.H., Buckley, C.L., Colpe, L.J., Schoenbaum,
M., & Stein, M.B. (2015). Non-fatal suicidal
behaviors in U.S. Army administrative records,
2004-2009: Results from the Army Study toAssess Risk and Resilience in Servicemembers(Army STARRS). Psychiatry, 78(1): 1-21.
Ursano, R.J., Kessler, R.C., & Stein, M.B. (2015).
Suicide attempts in the US Army — Reply. JAMA
Psychiatry, [Epub ahead of print].
Ursano, R.J., Kessler, R.C., Stein, M.B., Naifeh, J.A.,
Aliaga, P.A., Fullerton, C.S., Sampson, N.A.,
Kao, T., Colpe, L.J., Schoenbaum, M., Cox, K.L.,& Heeringa, S.G. (2015). Suicide attempts in the
U.S. Army during the wars in Afghanistan and
32 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Iraq, 2004-2009. JAMA Psychiatry, 72(9): 917926.
Zhang, L., Li, H., Hu, X., Benedek, D.M., Fullerton, C.S., Forsten, R.D., Naifeh, J.A., Li, X., Wu,
H., Benevides, K.N., Le, T., Smerin, S., Russell,
D.W., & Ursano, R.J. (2015). Mitochondria-focused gene expression profile reveals common
pathways and CPT1B dysregulation in bothrodent stress model and human subjects with
PTSD. Translational Psychiatry, 16(5): e580.

BOOK CHAPTERS
Benedek, D.M. & Grieger, T.A. (2015). Legal issues
in psychiatric practice. In A. Tasman, J. Kay,
J.A. Lieberman, M.B. First, & M.B. Riba (Eds.),
Psychiatry (4th edition) (pp. 85-98). Hoboken, NJ:
Wiley-Blackwell.
Gabbay, F.H., Choi, K.H., Wynn, G.H., & Ursano,
R.J. (2015). The role of endocannabinoid function in posttraumatic stress disorder: Modulating
the risk phenotype and rendering effects of trauma. In L. Fattore (Ed.), Cannabinoids in Neurologic and Mental Disease (pp. 247-288). Oxford,
UK: Elsevier.
Ursano, A.M., Sonnenberg, S.M., & Ursano, R.J.
(2015). Physician-patient relationship. In A. Tasman, J. Kay, J.A. Lieberman, M.B. First, & M.B.
Riba (Eds.), Psychiatry (4th edition) (pp. 20-33).
Hoboken, NJ: Wiley-Blackwell.
West, J.C. (2015). Therapeutic alliance in treatmentof combat PTSD. In E. Ritchie (Ed.), Posttraumatic Stress Disorder and Related Diseases in
Combat Veterans (pp. 27-34). New York, NY:
Springer.
West, J.C., Benedek, D.M., Hamaoka, D., & Ursano, R.J. (2015). Managing psychological consequences in disaster populations. In A. Tasman,
J. Kay, J.A. Lieberman, M.B. First, & M.B. Riba
(Eds.), Psychiatry (4th edition) (pp. 2521-2532).
Hoboken, NJ: Wiley-Blackwell.
Zhang, L., Hu, X.Z., Li, H., & Ursano, R.J. (2015).
Posttraumatic stress disorder biomarker — p11.
In F. Durbano (Ed.), A Fresh Look at Anxiety Disorders (pp. 89-100). Rijeka, Croatia: InTech.

CSTS Presentations, Briefings, Interviews
and Awards in 2015
PRESENTATIONS(Names in bold text are CSTS personnel)
Gender Differences in Sustained Attention in Idiopathic Generalized Epilepsy. Mirsky, A.F., Levav,
M., Greenberg, D.A., French, L.M., & Duncan,
C.C. Poster presented at the 43rd Annual Meetingof the International Neuropsychological Society,Denver, CO, February 2015.
Psychological Stress of Mortuary Affairs Operations.
McCarroll, J.E. Presented at the U.S. Army Mortuary Affairs Center and School, Fort Lee, VA,
March 2015.
Psychotherapy Informed from a Trauma Perspective:
Brain Environment Interaction. Ursano, R.J.
Grand Rounds presented at Wright State University School of Medicine, Dayton, OH, March2015.
Identifying and Distinguishing PTSD vs. mTBI.
Wynn, G.H. Presented at the Ft. Leonard WoodTBI Symposium, Ft. Leonard Wood, MO, March2015.
Self-Reporting of Post-Concussive Symptoms in
Those with TBI vs PTSD. Wynn, G.H. Presented
at the Ft. Leonard Wood TBI Symposium, Ft.
Leonard Wood, MO, March 2015.
Prospective Memory in Mild Traumatic Injury.
Duncan, C.C. Poster presented at the National
Capital Area TBI Research Symposium, Bethesda, MD, March 2015.
Deficits in Auditory and Visual Attention after Traumatic Brain Injury. Duncan, C.C. Poster presented at the National Capital Area TBI Research
Symposium, Bethesda, MD, March 2015.
Overview of the Army Study to Assess Risk
and Resilience in Servicemembers (ArmySTARRS). Naifeh, J.A., Dempsey, C.L., Fullerton, C.S., Benedek, D.M., Heeringa, S., Kessler,
R.C., Stein, M.B., Nock, M.K., Cox, K.L., Colpe,
L.J., Schoenbaum, M., & Ursano, R.J. Poster presented at the 10th Annual Amygdala, Stress and
PTSD Conference, Bethesda, MD, April 2015.

Mediation of Deployment Preparedness on the
Association between Augmentee Status and
PTSD Symptoms in Reserve and National Guard
Members. Wang, J., Ursano, R.J., Fullerton,
C.S., Ramsawh, H.J., Russell, D.W., Benfer, N.,
Cohen, G., Sampson, L., & Galea, S. Poster presented at the 10th Annual Amygdala, Stress and
PTSD Conference, Bethesda, MD, April 2015.
Mediation of Deployment Preparedness on the
Association between Augmentee Status and
PTSD Symptoms in Reserve and National Guard
Members. Wang, J., Ursano, R.J., Fullerton,
C.S., Ramsawh, H.J., Russell, D.W., Benfer,N., Cohen, G., Sampson, L., & Galea, S. Poster
presented at the Anxiety and Depression Conference, Miami, FL, April 2015.
PTSD, Suicide, TBI and DSM-5 ‘Other Trauma Disorders’: Complex Clinical Decisions. Ursano, R.J.
Pellegrino Lecture presented at Eastern Virginia
Medical University, Norfolk VA, April 2015.
Stress in Mortuary Affairs Operations. Flynn, B.W.,
McCarroll, J.E. Presented at the National Conference of the Association for Death Education
and Counseling, San Antonio, TX, April 2015.
Understanding Suicidal Behavior among U.S. Army
Soldiers: Intent, Lethality, and Their Prediction. Dempsey, C.L., Naifeh, J.A., Vegella,
P.L., Nock, M.K., Wryter, C.L., Fullerton, C.S.,
Benedek, D.M., Heeringa, S., Kessler, R.C., Stein,M.B., Colpe, L.J., Schoenbaum, M., & Ursano,
R.J. Poster presented at USU Research Days Conference, Bethesda, MD, May 2015.
Understanding Risk and Resilience Factors for
Suicide in the U.S. Army: Army STARRS. Ursano, R.J. Presented at Johns Hopkins University
Military & Veterans Health Institute Symposium,
Baltimore, MD, May 2015.
Trauma and Stressor-Related Disorders: Care of
Military Service Members. Ursano, R.J. Presented at a Workshop at the 168th Annual American
Psychiatric Association Meeting, Toronto, Canada, May 2015.
2015 ANNUAL REPORT | 33

Introduction to a Master Course on the Fifth Edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5). Regier, D.A. Chaired
a presentation at the 168th Annual American Psychiatric Association Meeting, Toronto, Canada,
May 2015.
First Responders: Mental Health and Resilience.
Ursano, R.J. Presented at the Institute of Medicine Standing Committee on Health Threats andWorkforce Resilience, Washington, DC, May2015.
DSM-5 History, Structural Changes, and Transition
to ICD-10-CM, Part I. Regier, D.A. Presented at
the Kansas Psychiatric Society Annual Meeting,
Wichita, KS, July 2015.
DSM-5 Clinical Assessment and Health Policy
Changes, Part II. Regier, D.A. Presented at theKansas Psychiatric Society Annual Meeting,
Wichita, KS, July 2015.
Army STARRS. Ursano, R.J. Presented at the Military Health Systems Research Symposium, Ft.
Lauderdale, FL, August 2015.
Riluzole for PTSD: Efficacy of a Glutamatergic Modulator as Augmentation Treatment for Posttraumatic Stress Disorder. Spangler, P.T., West, J.C.,

Dr. Ursano speaks at the Amygdala Conference.
34 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

Andrews-Shigaki, B., Possemato, K., McKenzie, S.,
Paxton, M., & Benedek, D.M. Poster presented at
the Military Health Systems Research Symposium,
Ft. Lauderdale, FL, August 2015.
An Overview of Army STARRS. Ursano, R.J. Presented to DoD attorneys at a course entitled “Federal/Military Health Law” at the Defense Health
Headquarters, Falls Church, VA, September 2015.
Integrating Public Health and Behavioral Health inEmergencies: Why and How. Flynn, B.W. Keynote
Address presented to the State Health and Mental
Health Authorities, Trenton, NJ, October 2015.
Personal Firearm Safety: What Every Healthcare
Provider Should Know. West, J.C. Grand Rounds
presented at Walter Reed National Military Medical Center, Bethesda, MD, November 2015.
Riluzole for PTSD: Efficacy of a Glutamatergic Modulator as Augmentation Treatment for Posttraumatic Stress Disorder. Spangler, P.T., West, J.C.,
Andrews-Shigaki, B., Possemato, K., McKenzie, S.,
Paxton, M., Tu, T., Engle, K., & Benedek, D.M.
Poster presented at the 31st Annual International
Society for Traumatic Stress Studies Meeting,
New Orleans, LA, November 2015.
Suicidal Behavior in the U.S. Army: Results fromthe Army Study to Assess Risk and Resilience inServicemembers (Army STARRS). Naifeh, J.A.,
Kessler, R.C., Heeringa, S.G., Stein, M.B., Gilman,
S.E., Nock, M.K., Schoenbaum, M., Colpe, L.J.,
Fullerton, C.S., & Ursano, R.J. Poster presented
at the 31st Annual International Society for Traumatic Stress Studies Meeting, New Orleans, LA,
November 2015.
Army STARRS: Review of Recent Findings and theAnalysis of Big Data to Predict Suicide Post-Hospitalization. Ursano, R.J. Grand Rounds presented at Walter Reed National Military Medical
Center, Bethesda, MD, December 2015.
Army STARRS and STARRS-LS. Ursano, R.J. Presented at the Institute of Medicine Board of Advisers Meeting, Washington, DC, December 2015.
Conceptualizing Exposure to Trauma and Trauma
Related Disorders and Symptoms. Ursano, R.J.
Presented at the Institute of Medicine National
Academies Workshop, Washington, DC, December 2015.

BRIEFINGS AND INTERVIEWS
■■

■■

■■

■■

■■

As part of the commemorations of WWI, Dr.
Robert Ursano was invited to the residenceof the Belgian Ambassador, Johan Verbeke, toparticipate in a panel discussion on “The Trauma
Brought Back Home — A Historical and Sociological Perspective on Posttraumatic Stress Disorder from 1914 Until Today.” Other panelists
were Professor Kaat Wils, Professor of Modern
European Cultural History at the University of
Leuven (KU Leuven), Belgium, and Sr. Captain
Jeroen Van den Bossche, Head of the Centre for
Crisis Psychology at the Queen Astrid Hospital in Brussels. The panel moderator was Leo
Shane, Congressional Reporter at MilitaryTimes. There was also a performance by Belgianaward winning artist Jessa Wildemeersch from a
new play, Days Without Dates, about the impact
of war and post-war trauma from 1914 until
today.
Dr. Robert Ursano and other Army STARRS
investigators conducted an in-person briefing ofArmy STARRS findings to Senior Army leadership at the Pentagon on March 30, 2015. The
audience included the Secretary of the Army,
the Army Chief of Staff, the Vice Chief of Staff,
the Deputy Under Secretary of the Army, Officeof the Surgeon General staff, and other Senior
Army officials.
Dr. David Benedek and Dr. Robert Ursano attended the Steering Committee meeting of the
VA-DoD National PTSD Brain Bank at the Jamaica Plains VA Medical Center in Boston, MA.
A magazine article was published in Soldiers(the official U.S. Army Magazine) titled, “The
Mental State of Military Children” that included
an interview with Dr. Stephen Cozza. The article
included a link to a special issue of the journal
The Future of Children about military children
and families that began with an introductoryarticle authored by Dr. Cozza.
Dr. Robert Ursano presented an update andbriefing of recent Army STARRS findings at
the Military Operational Medicine Research
Program (MOMRP) Suicide Prevention Interim
Progress Report (IPR) in Fort Detrick, MD.

■■

■■

■■

■■

■■

■■

■■

Dr. Curt West met with Mr. Len Litton, Directorof Personnel Risk Reduction, Undersecretary of
Defense for Personnel and Readiness, at the Pentagon to discuss ways forward with the PersonalFirearm Safety Education Project; including thepossibility of obtaining a no-cost extension tocontinue using funds for the project, and looking
for different outlets to share the training materials.
Dr. Robert Ursano attended the Army STARRSScientific Advisory Board (SAB) meeting held
at UCSD in La Jolla, CA, and presented recent
Army STARRS findings to the SAB. Paul Hurwitz and Susan Moss also attended the meeting.
Persons from the following media contacted andinterviewed Dr. Robert Ursano and ran stories
about the Army STARRS article published online in JAMA Psychiatry on July 8: AP, Reuters,
CBS News, Mother Earth News (San Francisco),
Military Times, KUOW (Seattle Public Radio),
Health Day, Healthline and Medical Daily.
Dr. David Benedek, Dr. Dale Russell, and Alex
Liu, along with Julie Broad from the Army’s Resiliency Program, delivered a one-and-a-half day“Train the Trainer” curriculum on psychologicalfirst aid, team-based resiliency and decision
making under stress to Peer Support Program
Managers from multiple agencies within the Department of Homeland Security (DHS) as part ofan ongoing collaborative agreement.
Dr. Robert Ursano and the USU Army STARRS
team presented their JAMA article “Suicide Attempts in the U.S. Army during the Wars in Afghanistan and Iraq, 2004 to 2009” to the Defense
Centers of Excellence for Psychological Healthand Traumatic Brain Injury (DCoE) Monthly
Journal Club.
Dr. Robert Ursano consulted with the Texas Senate Committee on Veteran Affairs and Military
Installations on suicide prevention for Service
members and veterans.
Dr. David Benedek (on behalf of Dr. Robert
Ursano) along with Dr. Murray Stein (UCSD),
Dr. Ron Kessler (Harvard), Dr. Steven Heeringa(University of Michigan), and Dr. Kenneth Cox(U.S. Army Public Health Command) presented
2015 ANNUAL REPORT | 35

the latest Army STARRS findings and recommendations at the final Army STARRS Interim
Progress Report (IPR) to Senior Army Leadership at the Pentagon. The audience included
the Secretary of the Army, Army Chief of Staff,
Army Vice Chief of Staff, Army Surgeon General, Deputy Under Secretary, G-1, Director of
Army National Guard, Deputy Chief of Army
Reserve, Chief of Chaplains and others.
■■ Dr. Robert Ursano attended a meeting at theWhite House for World Mental Health Day— Partnerships for Suicide Prevention. In
commemoration of Global Suicide Prevention
Month and Global Mental Health Day, theWhite House Offices of Science and Technology
Policy and Public Engagement, in collaboration
with Joining Forces, brought together clinicians,
researchers, data scientists, tool developers,
advocates and policy makers for a briefing about
identifying new opportunities for strengthening
mental health treatment and suicide prevention.
■■ Dr. David Benedek participated as a panelist at
the U.S. Department of State on “PTSD in theContext of Conducting U.S. Diplomacy.” Other presenters included the Director of Mental
Health for the Department of State and representatives from the Department’s Security
Program.
■■ Dr. Brian Flynn was invited to participate in aprocess to review and make update recommendations on the 2014 National Health Security
Preparedness Index (NHSPI). Dr. Flynn evaluated existing health care delivery items andmade suggestions for additional items in future

36 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

versions. He was asked as a subject matter expert following his involvement with updating the
NHSPI prior to the 2014 version. The NHSPI is afederally sponsored initiative to provide information on relative state preparedness to respondto established federal preparedness priority
scenarios. It is hoped that the reports stemmingfrom this process will provide incentive for states
to prepare and to help target federal initiatives.
■■ CSTS was listed in the Observer, an online newspaper from La Grande, Oregon, as an organization for resources to assist in the aftermath of
the Umpqua Community College shootings.
■■ Dr. David Benedek was interviewed by Channel
9 News in Oklahoma City, OK for a segment on
the VA PTSD Brain Bank. The interview was
broadcast on December 9th 2015 at 10 p.m. andposted online at www.news9.com.

AWARDS
COL David Benedek, MD was elected to
the Academy of Medicine of Washington, DC in
recognition of his contributions to medicine inresearch, education, care and policy.
■■ LTC Gary Wynn, MD received the Best Module Director award for his efforts in leading the
Neuroscience Module for pre-clerkship students
in the USU School of Medicine.
■■ Edmund Howe, MD, JD, Professor of Psychiatry
and Director of Programs in Ethics, School of
Medicine, USU, and Senior Scientist at CSTS,
was nominated to represent USU on the Health
Affairs Medical Ethics Integrated Product Team(MEIPT).
■■

CSTS Directors, Scientists, Scientific Advisory
Board and Staff
CSTS DIRECTORS
Robert J. Ursano, MD
Chair, Professor of Psychiatry and Neuroscience
Department of Psychiatry
Director
Center for the Study of Traumatic Stress
Uniformed Services University
David M. Benedek, MD
COL, MC, USA
Deputy Chair, Professor
Department of Psychiatry
Associate Director, Consultation and Education
Center for the Study of Traumatic Stress
Uniformed Services University
Stephen J. Cozza, MD
Professor
Department of Psychiatry
Associate Director, Child and Family Program
Center for the Study of Traumatic Stress
Uniformed Services University
Brian W. Flynn, EdD
Adjunct Professor
Department of Psychiatry
Associate Director, Health Systems
Center for the Study of Traumatic Stress
Uniformed Services University
Carol S. Fullerton, PhD
Research Professor
Department of Psychiatry
Scientific Director
Center for the Study of Traumatic Stress
Uniformed Services University
Robert K. Gifford, PhD
Assistant Professor
Department of Psychiatry
Executive Officer, and Associate Director, Homeland Security Studies
Center for the Study of Traumatic Stress
Uniformed Services University

John A. Stuart, PhD
Research Assistant Professor
Department of Psychiatry
Director, Resource Management
Center for the Study of Traumatic Stress
Uniformed Services University
CSTS SCIENTISTSDavid M. Benedek, MD
COL, MC, USA
Deputy Chair, Professor
Consultant to the U.S. Army Surgeon General for
Forensic Psychiatry
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
Quinn M. Biggs, PhD, MPH
Research Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
Maria Braga, DDS, PhD
Associate Professor
Department of Anatomy, Physiology and Genetics
Center for the Study of Traumatic Stress
Uniformed Services University
Kwang Choi, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
Stephen J. Cozza, MD
Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
Brian Crowley, MD
Adjunct Associate Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
2015 ANNUAL REPORT | 37

Catherine L. Dempsey, PhD, MPH
Research Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Jill Harrington-LaMorie, DSW, LCSW
Senior Field Researcher
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Connie C. Duncan, PhD
Research Associate Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Harry C. Holloway, MD
Professor of Psychiatry and Neuroscience
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Joscelyn E. Fisher, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Marjan G. Holloway, PhD
Associate Professor
Department of Medical & Clinical Psychology
Center for the Study of Traumatic Stress
Uniformed Services University

Brian W. Flynn, EdD
Adjunct Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Tomoko I. Hooper, MD
Professor
Department of Preventive Medicine & Biostatistics
Center for the Study of Traumatic Stress
Uniformed Services University

Michael C. Freed, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Edmund G. Howe III, MD, JD
Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Carol S. Fullerton, PhD
Research Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Luke Johnson, PhD
Adjunct Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Frances Gabbay, PhD
Research Associate Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Tzu Cheg Kao, PhD
Professor
Department of Preventive Medicine and Biometrics
Center for the Study of Traumatic Stress
Uniformed Services University

Robert K. Gifford, PhD
Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

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

Derrick Hamaoka, MD
Lt Col, USAF, MC, FS
Associate Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

David S. Krantz, PhD
Professor
Department of Medical and Clinical Psychology
Center for the Study of Traumatic Stress
Uniformed Services University

38 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

He Li, MD, PhD
Associate Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Darrel A. Regier, MD, MPH
Adjunct Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Xian Liu, PhD
Research Professor
Deployment Health Clinical Center
Walter Reed Army Medical Center

Dori B. Reissman, MD, MPH
CAPT, USPHS
Medical Director, World Trade Center Responder
Health Program
Senior Medical Advisor, National Institute of Occupational Safety and Health
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Holly B. Mash, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
James E. McCarroll, PhD, MPH
Research Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
Eric Meyer II, MD
Maj, USAF, MC
Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
Joshua C. Morganstein, MD
CDR, USPHSAssistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
James A. Naifeh, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
Claudio Ortiz, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
Holly Ramsawh, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Dale Russell, PhD
Behavioral Science Researcher
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
Patcho N. Santiago, MD, MPH
CDR, MC, USN
Psychiatry Residency Program Director
Walter Reed National Military Medical Center
Associate Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
Patricia Spangler, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
John A. Stuart, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
E. Fuller Torrey, MD
Executive Director
Stanley Medical Research Institute
Robert J. Ursano, MD
Chair, Professor of Psychiatry and Neuroscience
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
2015 ANNUAL REPORT | 39

Jing Wang, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Suzanne Yang, MD, PhD
Research Psychiatrist
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Maree J. Webster, PhD
Research Assistant Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
Director, Laboratory of Brain Research
Stanley Medical Research InstituteLei Zhang, MD
Associate Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Lars Weisaeth, MD
Professor, Division of Disaster Psychiatry
University of Oslo
Oslo, Norway

James E. Barrett, PhD
Chair, Professor
Department of Pharmacology and Physiology
Drexel University, College of Medicine

James (Curt) West, MD
CAPT, MC, USN
Assistant Professor
Clerkship Director
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

Charles W. Beadling, MD
Col (Ret), MC, USAF
Director, Assistant Professor
Center for Disaster & Humanitarian Assistance
Medicine
Department of Military and Emergency Medicine
Uniformed Services University

Gloria Whaley, PhD
Child Psychologist Researcher
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

M. Richard Fragala, MD
Col (Ret), USAF, MC, FS
Professor, Department of Psychiatry
Uniformed Services University

Anthony Woodson, DHA
Associate Administrator
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University
Kathleen Wright, PhD
Former Director (Retired)
Force Health Protection Program
USAMRU-E
Walter Reed Army Institute of Research
Gary H. Wynn, MD
LTC, MC, USA
Associate Professor
Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

40 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

CSTS SCIENTIFIC ADVISORY BOARD

Matthew J. Friedman, MD, PhD
Professor, Department of Psychiatry
Professor, Department of Pharmacology& Toxicology
Dartmouth University, Geisel School of Medicine
Director, Leahy-Friedman National PTSD BrainBank
Senior Advisor, National Center for PosttraumaticStress Disorder
U.S. Department of Veterans Affairs
Carol S. Fullerton, PhD
Research Professor, Department of Psychiatry
Scientific Director, Center for the Study ofTraumatic Stress
Uniformed Services University

David S. Krantz, PhD
Professor, Department of Medical and Clinical Psychology
Uniformed Services University
Craig H. Llewellyn, MD
Professor, Department of Military and Emergency
Medicine
Uniformed Services University
Francis O’Conner, MD, MPH
COL, MC, USA
Chair, Professor, Department of Military & Emergency Medicine
Uniformed Services University
Robert M. Post, MD
Head, Bipolar Collaborative Network
Former Chief, Biological Psychiatry Branch
National Institute of Mental HealthArieh Y. Shalev, MD
Professor, Department of Psychiatry
New York University
Professor, Department of Psychiatry
Hadassah University School of Medicine
Jerusalem, Israel
Robert J. Ursano, MD
Chair, Professor of Psychiatry and Neuroscience, Department of Psychiatry
Director, Center for the Study of Traumatic Stress
Uniformed Services University
Lars Weisaeth, MD
Professor, Division of Disaster Psychiatry
University of Oslo
Oslo, Norway
Distinguished Former Scientific Advisory Board
Members & Emeritus Friends of CSTS

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
Uniformed Services University
Former Chief, Department of Military Psychiatry
Walter Reed Army Institute of Research
Fellow, American Anthropological Association
CSTS STAFF
Deborah Probe Adams
Pablo Aliaga
TSgt Rondricueas Barlow
K. Nikki Benevides
Natasha Benfer
Enryka Christopher
Evelyn Cordero
Thomas Cullerton
Nicole Dacuyan
Amanda Devane
Hieu Dinh
Krista Engle
Alice Fladung
Mackenzie Franz
Katie Grein
Jessica Grom
Helena Hassen
TSgt. Jorge Hastings
MSgt. Syrus Henderson
Michelle Herman

Paul Hurwitz
Gail Kohls
F. Julian Lantry
Alex Liu
Diana Monday
Susan Moss
Stanley Ng
Nichole Nicholas
Kevin NishidaThomas Park
Maegan Paxton
Joseph Piemontese
Stephanie Singer
Natara Strother-Ware
Kelly Todd
Tung Tu
Patti Vegella
Leming Wang
Christina Wryter
Holly Wu
Bailey Zhang
Jing Zhou

Herbert A. Hauptman, PhD (1917-2011)1985 Nobel Laureate, Chemistry
President, Hauptman-Woodward Medical
Research InstituteResearch Professor, Department ofBiophysical Sciences
Adjunct Professor, Department of Computer Science
University of Buffalo

2015 ANNUAL REPORT | 41

CSTS Funded Grants in 2015
GRANT

FUNDING INSTITUTION

Resilience Building for Homeland Security: A Specialized Training and Collaborative Consultation

DHS

Development of an Education Curriculum for Personally Owned Firearms Safety Enhancements Initiative DSPO
Brain Indices of Risk for Posttraumatic Stress Disorder after Mild Traumatic Brain Injury

UCSD

Riluzole Augmentation Treatment for Complicated Posttraumatic Stress Disorder

USAMRMCPTSD/TBI Clinical Consortium Coordinating Center and Clinical Sites Award (INTRuST)

UCSD

Reliability and Initial Validation of the INTRuST Structured Assessment for Evaluation of TBI (SAFE-TBI)

UCSD

Traumatic Stress and Biomarkers in a Military Population

USAMRMC

Education of the Safety and Pharmacokinetics of the FAAH Inhibitor URB597

USAMRMC

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

NIMHStudy to Assess Risk and Resilience in Servicemembers - Longitudinal Study (STARRS-LS)

DHP

Behavioral-based Predictors of Workplace Violence in the Army STARRSHarvard

Family Violence and Trauma Project

IMCOM

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

CDMRP

GREAT-SF (Grief-Focused Resilience Activities and Training for Surviving Families): An Online Selective
Intervention for Bereaved Military Families
CDMRP
Bereavement due to Terrorism: Families of those who died on Air India Flight 182 or on September 11th
Voices of September 11
Center for the Study of Traumatic Stress (CSTS) Program

42 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

DHP

CSTS Partnerships
The Center for the Study of Traumatic Stress would
like to acknowledge and thank our partners andcollaborators. The Center has worked with organizations in the public and private sector throughresearch partnerships, project collaborations, consultations and trainings.
Alfred P. Sloan Foundation
American Academy of Child and Adolescent
Psychiatry
American Gold Star Mothers
American Psychiatric Association
American Psychological Association
Architect of the Capitol
Armed Forces Retirement Home
Broad Institute
The Carter Center
Catholic University of America
Center for Forensic Behavioral Sciences
Center for Health Care Research Medical Universityof South Carolina
Centers for Disease Control and Prevention
Columbia University
Cornell University
Dartmouth University
Defense Centers of Excellence for Psychological
Health and Traumatic Brain Injury
Department of Mental Health, the District ofColumbia
Deployment Health Clinical Center
Dover Air Force Base
Drexel University
Emory University
Federal Bureau of Investigation
Florida Department of Health
Ft. Bragg, North Carolina
Ft. Hood, Texas
Ft. Lee, Virginia
Ft. Stewart, Georgia
George C. Marshall Center for European Security
Gold Star Wives of America
Hadassah Medical Organization, Jerusalem, Israel

Harvard University Medical School
Harvard University School of Public HealthHenry M. Jackson Foundation for the Advancementof Military Medicine
International Society for Traumatic Stress Studies
Inter-university Consortium for Political and Social
Research
Italian Embassy, Washington, DC
Joint Base Lewis-McChord
Joint Mortuary Affairs Center and School, Fort Lee,
Virginia
Las Vegas Psychiatric Association
Massachusetts General Hospital
Medical Research Command at Ft. Detrick
Military Child Education Coalition
Miller School of Medicine of the University of
Miami
National Association for PTSD
National Association of State Mental Health
Program Directors
National Center for PTSD of the Department of
Veterans Affairs
National Child Traumatic Stress Network
National Committee for Employer Support of theGuard and Reserve
National Fallen Firefighters Foundation
National Institute for Occupational Safety and
HealthNational Institute of Mental HealthNational Institutes of HealthNational Intrepid Center of Excellence
National Military Family Association
Psychiatric Genomics Consortium
Rockefeller University
Rutgers University Cell & DNA Repository
Sesame Workshop
Stanford University
Substance Abuse and Mental Health Services
Administration
Syracuse University
Syracuse VA Medical Center
Tragedy Assistance Program for Survivors
2015 ANNUAL REPORT | 43

Tulane School of Social Work
Uniformed Services University
Union Pacific Railroad
University of California, Los Angeles
University of California, San Diego
University of Michigan
University of Pennsylvania
University of Pittsburgh
University of Virginia
University of Virginia’s Critical Incident Analysis
Group
University of Washington
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 Research and MaterielCommand44 | CENTER FOR THE STUDY OF TRAUMATIC STRESS, USU

U.S. Department of Agriculture
U.S. Department of Defense
U.S. Department of Energy
U.S. Department of Health and Human Services
U.S. Department of Homeland Security
U.S. Department of Justice
U.S. Department of State
U.S. Department of Veterans Affairs
U.S. Postal Service
VA Connecticut Healthcare System
Veterans Administration Medical Center of DC
Virginia Commonwealth University
Voices of September 11th
Walter Reed Army Institute of Research
Walter Reed National Military Medical Center
Wright State University
Yale University
Yellow Ribbon Reintegration Program
Zero to ThreeFaces of CSTS

Faces of CSTS photographs by Tung Tu.

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