In a recent round of grant awards, the STRONG STAR Consortium based at The University of Texas Health Science Center at San Antonio (UT Health San Antonio) was selected by the U.S. Department of Defense for a total of $17 million in funding to launch eight new research projects focused on traumatic brain injury and psychological health.
The combined projects will enable the consortium to take a big step forward in its mission to advance the care of military personnel and veterans recovering from war-related trauma and the psychological wounds it inflicts.
STRONG STAR, or the South Texas Research Organizational Network Guiding Studies on Trauma and Resilience, is a national research group led by UT Health San Antonio that brings together the expertise of military, civilian and VA institutions and investigators from across the country. Its network of clinical trials, funded by the DOD, Department of Veterans Affairs and other agencies, takes a synergistic approach to better propel advances in military psychological health.
“As a group, these new projects will help us better understand and better assess, treat and prevent chronic problems with the two signature wounds of post-9/11 wars – traumatic brain injury and post-traumatic stress disorder – along with a variety of related conditions that stem from them or that contribute to their complexity,” said Alan Peterson, PhD, professor of psychiatry and behavioral sciences at UT Health San Antonio and director of the STRONG STAR Consortium.
“Some of these related conditions are suicide risk, sleep disorders and chronic pain, including post-traumatic headache, or chronic headaches that develop from or worsen following a traumatic brain injury,” he said. “Another is tinnitus, which is a persistent ringing in the ears that can develop after a brain injury. Tinnitus is also commonly comorbid with PTSD, and it both contributes to and is impacted by psychological distress.”
The new studies will address these problems through a variety of approaches as part of six randomized clinical trials, one treatment development project and one longitudinal follow-up project with previous research participants. Some of these projects will be led by UT Health San Antonio investigators and others by STRONG STAR collaborators at other institutions, with research participants from a variety of military and VA study sites.
Following is an overview of the new research projects:
Combining PTSD treatment and suicide prevention therapies to improve outcomes. This clinical trial will examine whether PTSD symptoms and suicide risk can both be significantly reduced by combining two evidence-based treatments: one a leading PTSD therapy called Cognitive Processing Therapy and the other a suicide-prevention approach known as Crisis Response Planning. This trial will involve both active-duty military personnel and veterans.
Rapid-acting intervention for severe suicide risk. This clinical trial will involve patients treated in an emergency department setting prior to a psychiatric hospitalization for severe suicide risk. Investigators will look for two main outcomes they hope to achieve: (1) Does an intramuscular injection of ketamine result in the rapid reduction of suicidal ideation? (2) Does the addition of Crisis Response Planning, a brief intervention to reduce suicide risk following a crisis, help maintain that improvement long term?
Prevention program to decrease suicide risk after brain injury. Because a traumatic brain injury can elevate a person’s suicide risk, this clinical trial will evaluate Crisis Response Planning as a secondary suicide prevention intervention. Service members already receiving care related to a brain injury will be invited to enroll in this study, which will offer brief training in self-selected actions and activities they can use in times of crisis. At the end of the study, researchers will determine whether the intervention effectively decreased risk among those who received it compared to those who did not.
Adaptive PTSD treatment to personalize care and maximize effectiveness. This clinical trial will test tailored intervention strategies to optimize treatment response and reduce drop-out among veterans with PTSD. The project seeks to determine if outcomes can be improved by: (1) changing the therapy type early on for non-responders, (2) daily digital prompts to help improve homework completion, and (3) reducing therapy intensity for patients who respond well early in treatment.
Improving understanding and treatment of PTSD and tinnitus following a brain injury. Working with military and veterans who have PTSD and tinnitus after a brain injury, investigators will evaluate whether combining therapies for each disorder improves patient outcomes with both. The study will use Cognitive Processing Therapy, a leading PTSD treatment, and Progressive Tinnitus Management, a cognitive-behavioral approach to managing tinnitus and the distress it causes. Some participants also will undergo neuroimaging before and after the treatment program. This can illuminate the brain networks involved in PTSD and tinnitus and how they are impacted by treatment, which could guide future research and approaches to care.
Brain games and stimulation: Improving executive function after a concussion. This clinical trial with service members and veterans will evaluate the effectiveness of a computer game designed to improve cognitive functioning following a mild traumatic brain injury, or concussion. It also will look at whether adding brain stimulation through a technique called electrical transcranial magnetic stimulation leads to further improvements in post-concussive symptoms.
Expanding an effective headache treatment to an alternative approach to PTSD recovery. In a previous consortium trial, researchers discovered that a non-medication treatment they designed for post-traumatic headache not only significantly reduced headache-related disability; it also reduced co-occurring PTSD symptoms as effectively as a gold-standard PTSD therapy. Now they will update the therapy and its treatment manual to specifically focus on PTSD symptoms. They will then test the approach with service members who suffer from PTSD following a brain injury. The aim is to identify an alternative approach to PTSD care that patients may prefer to traditional therapies that focus on the person’s trauma.
Long-term follow-up with previous study participants to inform the research field. A large longitudinal study will enable STRONG STAR to conduct long-term follow-ups with thousands of individuals who participated in the consortium’s previous research studies. Participants from clinical trials will be contacted to assess how well they are doing years later. Researchers are particularly interested to see if treatment responders have maintained their treatment gains over time, which would provide valuable information about the long-term efficacy of the therapies they received. They also are interested to learn if non-responders found subsequent, alternative treatments helpful or if their conditions have remained chronic, which also would inform the field. In another arm of the project, STRONG STAR will follow up with service members who participated in a longitudinal study that involved various assessments before and after a combat deployment to shed light on the deployment’s long-term consequences.
