New Clinical Tool To Help War Veterans With Post-traumatic Stress Disorder

PTSD, which affects an estimated 20 percent of veterans in recent conflicts, is a dysfunction of the brain's fear control mechanisms resulting from a psychologically traumatic experience, such as combat. One of the central features of the disorder is the inability of the brain to distinguish between dangerous and safe situations.

"The sound of a helicopter flying overhead can be enough to trigger anxiety or panic attacks in vets with PTSD," said Tanja Jovanovic, PhD, an Emory and CBN post-doctoral fellow in the laboratory of Erica Duncan, MD, of the Atlanta VAMC, CBN and the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine. "They know that they are not back in combat, but they can't suppress their fear."

The new PTSD testing system determines the extent of the impairment in the brain's fear control mechanisms. A patient is initially conditioned to fear a series of lights by pairing their appearance with an aversive air blast to the throat. A second set of safety lights are then presented without an air blast. Finally, the two sets of lights are displayed together without an air blast to test the patient's ability to inhibit their fear of the lights. Electrodes attached under the eye measure fear responses based on blink size during each of the three tests. Larger blinks indicate a greater fear reaction.

In a preliminary study of Vietnam War veterans, Jovanovic and her colleagues determined PTSD sufferers were more afraid of the lights than control subjects. Veterans with more severe PTSD symptoms also could not inhibit their fear when presented with both sets of lights, indicative of the dysfunction in their fear control mechanisms.

Clinicians typically assess PTSD sufferers based on subjective accounts of their symptoms. "This new system will provide a new way to objectively test their fear control mechanisms," said Jovanovic, "Our hope is that it will lead to the development of effective treatments for relieving fear in PTSD sufferers and others with anxiety-related disorders."

The researchers' next step is to determine whether specific genes are involved in fear inhibition. Other studies are using functional magnetic resonance imaging to examine brain activation patterns involved in fear inhibition.

Development of the human PTSD testing system was based on animal research conducted by Karyn Myers, PhD, and Michael Davis, PhD, of Emory University and CBN. Additional researchers at the Atlanta VAMC and Emory involved in the human studies include Seth Norrholm, PhD, Megan Keyes, PhD, and Ana Fiallos, BSEE.

The research was supported by grants from CBN and an American Psychiatric Association/Glaxo SmithKline Award to Dr. Duncan, a National Institute of Mental Health (NIMH) grant to Barbara Rothbaum, PhD, of the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine, and a Kirchstein Individual Postdoctoral Fellowship from NIMH to Dr. Jovanovic.

About the Center for Behavioral Neuroscience

The Center for Behavioral Neuroscience (CBN), a National Science Foundation (NSF) Science and Technology Center, is a research and education consortium of eight metro Atlanta colleges and universities, including lead institution Georgia State University, Emory University, Georgia Institute of Technology and the five institutions of the Atlanta University Center (Morehouse College, Morehouse School of Medicine, Spelman College, Clark Atlanta University and Morris Brown College). More than 90 neuroscientists lead the research program to understand the neurobiology of complex social behaviors. CBN studies have led to a breakthrough treatment for anxiety-related disorders and new understanding of the neural basis of social bonding between animals. In addition to research, CBN has a comprehensive education program designed to improve science literacy and attract more women and underrepresented minorities to neuroscience programs. The center is supported by more than $53 million in grants from NSF and the Georgia Research Alliance.

About the Atlanta Veterans Affairs (VA) Medical Center

The Atlanta Veterans Affairs (VA) Medical Center is a comprehensive health care provider for nearly 60,000 veterans, offering primary care, tertiary care, and long-term care services. The medical center operates 173 hospital beds, a 100-bed nursing home, and is the parent location for community-based outpatient clinics in Smyrna, Lawrenceville and Oakwood, Georgia. The Atlanta VA is also a referral center for radiation oncology and other specialized services for facilities within the VA Southeast Network, which is comprised of Georgia, Alabama and South Carolina. The Atlanta VA is affiliated with numerous institutes of higher learning, and has maintained an active affiliation with the Emory University School of Medicine for more than 50 years. The facility's $25 million research program involves approximately 400 projects, conducted by more than 140 principal investigators, and is ranked tenth among VA research programs nationwide.