Searching For The Source

Baylor researchers collaborate to treat--and possibly prevent--post-traumatic stress disorder.

As an intern at a Veterans Affairs hospital seven years ago, Matthew Schobert encountered post-traumatic stress disorder (PTSD) for the first time.
A Vietnam veteran had been admitted to the hospital for a routine medication adjustment. Schobert recalls that the man exhibited some of the classic symptoms of the disorder: he was distant and reserved, and he chose to remain silent most of the time, especially about his time in combat. His case made an impression on Schobert, who was then a graduate student at Baylor University's School of Social Work, and sparked an interest in the mental health issues of those who have served in the military.
Schobert earned his Master of Social Work degree in 2002, in addition to his Master of Divinity degree from Truett Seminary (1999), and now works at the Waco Veterans Affairs Medical Center as a licensed clinical social worker in the acute psychiatric unit. He continues to see PTSD patients, including a new influx from the conflicts in Iraq and Afghanistan.
While Schobert sees veterans and active duty personnel with a variety of mental health issues, he often wonders about the causes of PTSD.
"I have some friends who have had three deployments, and they talk about the graphic and difficult things they've seen, but they are just fine," Schobert says. "And there are others who have been deployed once, but when they come back I see symptoms of PTSD and encourage them to talk to someone. It makes you wonder why."
Researchers at Baylor are hoping to help find that answer.
 

Investigating PTSD
Last fall, Baylor, Texas A&M University and the VA received a $2.8 million grant from the U.S. Army Medical Research and Materials Command to study PTSD. A portion of the three-year grant will fund research in neuroscience and computer science at Baylor.
PTSD is an anxiety disorder that can occur after experiencing or witnessing a traumatic event. Although many people associate PTSD with military combat, any kind of life-threatening event can create the trauma. Survivors of natural disasters (such as Hurricane Katrina), terrorist attacks (such as 9/11), and physical or sexual assaults can experience PTSD. Even witnesses to such events, such as first responders or military personnel, can develop PTSD. While it is natural to be stressed and anxious after a traumatic event, people who develop PTSD exhibit chronic symptoms which don't subside and begin to interfere with day-to-day life.
Those suffering from the disorder can exhibit a variety of symptoms. They may have flashbacks of the incident, become hyper-vigilant, suffer from social anxiety, be prone to impulsive behavior, avoid normal activities, be unable to sleep or eat, and/or suffer from depression. They are more likely to abuse alcohol or drugs, become unemployed and have marital problems.
The treatment for the disorder, according to the National Center for PTSD, can include psychotherapy (or talk therapy), medication or both. But it can be difficult to treat.
That's why Baylor researchers are excited about their work. Not only could their research help those already living with PTSD, but it could also help prevent it.
Dr. Matthew Stanford, professor and director of graduate studies in the Department of Psychology and Neuroscience, plans to bring in combat veterans with and without PTSD for the study.
Because people with PTSD have a greater startle reflex, Stanford's team will measure patients' eye blinks. They will also measure the brain activity of both groups using MRIs.
"We're looking for pre-disposing factors," Stanford says. "Looking at the startle response and brain imaging should help us."
Dr. Brad Keele, BS '90, associate professor, and his group will also be looking for things that might make someone more susceptible to developing PTSD. His group will study rats.
"We want to know how animals learn to fear," Keele says. "People with PTSD begin to associate other cues in their environment with fear, and they predict bad things will happen. We're studying what creates that increased fear response."
Keele's team is looking, in particular, at early life stress. By stressing rats prenatally and again immediately after they are born, they can determine if this creates increased fear responses. The rats' brains will be studied to determine what chemical and physiological changes take place. 
"Rats can't truly have PTSD; it's a human disorder," Keele says. "But we hope to learn the role of early life stress in making them more prone to over-learning fear associations."
Once they've established the animal models, says Dr. Jamie Diaz-Granados, chairman of the psychology and neuroscience department, they will begin to assess the animals for substance abuse, particularly alcohol.
Because people with PTSD are more likely to use and abuse alcohol and other substances, Baylor researchers are studying the ways in which alcohol plays a role in the disorder. 
"There are a number of things we'd like to know about how substance use and abuse factors into PTSD," Diaz-Granados says. "In addition to who uses alcohol and how they use it, we think withdrawal might be different for those with PTSD, and recovery might be different."
The bottom line for Diaz-Granados is pre-determining who may be affected.
"We know that if you have two individuals who are exposed to the exact same event, one may develop PTSD and the other may not," he says. "We're trying to figure out which one that will be before it happens. And maybe we can prevent the person from being exposed in the first place, or be more aggressive with early diagnosis and treatment if they are."
 

Translating research to relief
Managing all of the data produced by the researchers will be the responsibility of Dr. Erich Baker, assistant professor of computer science. 
He is currently working on a way to store the electronic data and make it accessible and searchable, and also is in the process of developing a publicly available Web site so other researchers can access the information. When the initial framework is complete, Baker will begin to work on the data analysis portion of the project.
Once the genetic information has been gathered, the tools he develops can help draw conclusions. Although the project is still in the data collection stage, Baker is excited about the potential.
"A lot of times we do so much esoteric research, we forget how good it feels to do something that can be applied in the field," he says. "If we could find a subset of genes that determines PTSD, that could translate to clinical work and could really help people."
Russell Brewer, Baylor's director of sponsored programs, also hopes the research can soon be beneficial to those funding the project: the U.S. government.
"The science of what we are proposing to study is not only so big, but also so relevant in real time, right now," he says. "The research we're doing has immediate results. Because of what we're doing, the VA can grow their program, and in turn, help more people."
The Waco VA Medical Center was recently named a Center for Excellence in Research in Post-Traumatic Stress Disorder, one of only three such centers in the nation.
Because the partnership with the universities and the clinical settings has the potential to create such timely and beneficial research, Brewer is hoping that the grant will be extended.
"Right now we're working on a three-year follow-along grant," he says, "but it looks more and more like it could be a 7-10 year program, so that's what we're hoping for."
Schobert is ready for all the help he can get in his practice. When he thinks about Baylor's research, Schobert thinks about a woman who is currently being treated for PTSD at the medical center.
"She is a victim of military sexual trauma," he explains. "Not all active-duty personnel and veterans are dealing with combat-related PTSD."
The woman was admitted to the center because, although she was able to maintain a fairly normal life during the day, she suffered tremendously during the night.
"When she did sleep, she would have nightmares," Schobert says. "But most of the time she couldn't sleep at all. She was having intrusive thoughts about what happened and would relive it all night. No sleep led to increased levels of agitation, and the problems kept escalating. It was to the point that her family members had become her caregivers. Her symptoms kept her awake at night, and they kept her caregiver awake. And that's what led to her admission."
Other patients he sees say they have such heightened levels of vigilance that they don't feel safe in crowds, create "escape plans" and have to sit near door or windows, and feel the need to withdraw from everyone, even their families.
"Families are caught in an emotional dilemma," Schobert says. "They know they don't understand what their loved one has experienced, but they want to be supportive and don't know how to do that. That's often when they'll bring their son or wife or brother to the mental health clinic. It can be very scary for families, especially when they believe their loved one may be suicidal."
As with any mental health disorder, PTSD is an increased risk factor for attempted or completed suicide, he said. 
"That's why this kind of research is important," he says. "Treating mental health issues is a hidden cost of war, so if we can put more money into researching prevention and early treatment, it's a very proactive thing."