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The STRONG STAR Consortium has taken on a vital mission: inform, develop, and evaluate the best methods of preventing and treating combat-related PTSD so that our nation's warfighters won't have to wage a never-ending personal battle with the disorder after deployment to a combat zone. Ultimately, the aim is to prevent the chronic onset of PTSD in the current generation of war veterans so that they can continue healthy, productive lives, whether they remain in military service or return to civilian life.

The Consortium has designed an array of clinical, exploratory, and preclinical trials in support of this important goal. STRONG STAR's treatment studies are the first to examine the use of evidence-based PTSD treatments with active-duty military personnel. Therefore, in addition to determining the overall efficacy of these treatments in their traditional form, STRONG STAR investigators have developed and are evaluating novel methods of treatment delivery specifically tailored to meet the unique needs of a military population. Complementary investigations are focused on the root causes of PTSD, including biological factors that influence PTSD susceptibility and recovery; the influence of comorbid physical and psychological ailments; and the interaction of cognitive-behavioral therapies and pharmacologic treatments.

The full cohort of STRONG STAR trials include:
  Treatment Studies Active Study
Study Image Prolonged Exposure for PTSD among OIF/OEF/OND Personnel: Massed vs. Spaced Trials
Principal Investigator: Edna Foa, PhD
Site: Fort Hood, TX
Aim:Evaluate the efficacy of PE therapy for combat-related PTSD in an active-duty military population and determine whether a condensed delivery method maintains efficacy while improving efficiency.

Study Image Individual PE vs. Couples' Cognitive-Behavioral Therapy for Combat-Related PTSD
Principal Investigator: Candice Monson, PhD
Site: San Antonio, TX and Ft. Hood, Tx
Aim:Compare the efficacy of traditional
Prolonged Exposure therapy, an evidence-based therapy that involves only the individual service member, to Cognitive-Behavioral Couples Therapy, which involves the service member and spouse and incorporates behavioral communication skills with traditional aspects of Cognitive Processing Therapy to address both individual and couple-level distress.

Study Image Treatment of Chronic Stress Reaction and Chronic Pain after Traumatic Orthopedic Injury
Principal Investigator: Robert Gatchel, PhD
Site: San Antonio, TX
Aim:Identify the comorbidity of orthopedic trauma and traumatic stress in an active-duty military population and evaluate a preventive behavioral health treatment strategy aimed at helping to retard or halt the development of PTSD and chronic pain.

Study Image Brief Cognitive Behavioral Treatment of Deployment-Related PTSD in Primary Care Settings: A Randomized Controlled Trial
Principal Investigator: Lt Col Jeffrey Cigrang, PhD
(US Air Force, Retired)
Site: San Antonio, TX
Aim:Evaluate a condensed cognitive behavioral therapy (CBT) for PTSD that can be implemented by mental health providers working in an integrated primary care setting. Determine whether this treatment delivery method is well received by military personnel; its efficacy in reducing PTSD symptoms; and the level of PTSD severity that is appropriate for this form of treatment.

Study Image Cognitive Processing Therapy for Combat-Related PTSD
Principal Investigator: Patricia Resick, PhD
Site: Fort Hood, TX
Aim:Evaluate the efficacy of CPT for combat-related PTSD in an active-duty military population and determine whether the more efficient delivery of group CPT is as effective as individual CPT.

Study Image SSRI Treatment of Dual Diagnosis PTSD and Alcohol Dependence: A Test of the Serotonergic Hypothesis
Principal Investigator: John Roache, PhD
Site: San Antonio, TX
Aim:Examine how alcohol use disorder impacts the effectiveness of selective serotonin reuptake inhibitor (SSRI) antidepressants used as the only FDA-approved medication for the treatment of PTSD. Specifically, identify patient characteristics predicting the response to SSRI treatment, which would give clinicians a valuable tool to assess who would or would not benefit from such treatment.

Study Image Outcomes of Prolonged Exposure and Cognitive Processing Therapy used in the Treatment of Combat Operational Stress Reactions in Deployed Settings
Principal Investigator: Lt Col Alan Peterson, PhD (U.S. Air Force, Retired)
Site: Iraq and Afghanistan
Aim:Conduct a pilot investigation to evaluate the treatment outcomes of deployed service members who show symptoms of combat operational stress reactions, including PTSD and acute stress disorder, and who receive CPT or PE therapy from military mental health providers in Iraq and Afghanistan. Follow treatment gains over time to provide much-needed insight on the efficacy of the leading non-pharmacologic treatments for stress-related disorders when delivered “in theater” and to guide the development of a larger, randomized clinical trial.

  Biological Studies  
Study Image Genetic and Environmental Predictors of Combat-Related PTSD
Principal Investigator: Douglas Williamson, PhD
Site: San Antonio, TX
Aim:Use assessments and biological data from service members prior to and following deployment to examine the interaction and influence of genetic and environmental factors on PTSD susceptibility. Identify genetic risk factors and determine how they contribute to the development of PTSD with the ultimate aim of improving prevention and treatment efforts.

Study Image Neuroimaging Studies of PTSD and PTSD Treatment among Combat Veterans
Principal Investigator: Peter Fox, MD
Site: Fort Hood, TX and San Antonio, TX
Aim:Apply advanced neuroimaging methods to study PTSD in the context of ongoing treatment trials to address 1) the underlying neuroanatomical pathology of PTSD (changes in the anatomy of the nervous system or nervous tissue that accompany the development of PTSD); 2) the underlying pathophysiology of PTSD (functional changes in the brain that are associated with the disorder); and 3) neurobiological changes corresponding with successful PTSD treatment. The ultimate goal is to shed light on the underlying neurobiology of PTSD in hopes of developing more effective, targeted treatment interventions.

  Epidemiological Studies  
Study Image Prevalence of Fibromyalgia in PTSD Patients and Family Members
Principal Investigator: Col Jay Higgs, MD (U.S. Air Force, Retired)
Site: Fort Hood, TX
Aim:In light of the significant overlap between PTSD and fibromyalgia, determine whether it is important to assess for this painful rheumatic disorder in active-duty military personnel with PTSD. Screen volunteers from other STRONG STAR treatment studies and their spouses to determine the prevalence of fibromyalgia, observe its influence on patients’ prognosis, and look for secondary familial consequences of PTSD.

Study Image Who gets better and why? Predicting Outcome Trajectories in STRONG STAR Trials
Principal Investigator: Brett Litz, PhD
Site: Data collected from all sites
Aim:Utilize the comprehensive dataset developed from all STRONG STAR trials to perform a variety of analyses aimed at providing knowledge to inform decisions about how best to prevent problems in those most at risk for PTSD and tailor treatments for maximum benefit.

Study Image The Impact of the Treatment of PTSD on Comorbid Insomnia and Pain
Principal Investigator: COL Stacey Young-McCaughan, PhD, RN (U.S. Army, Retired)
Site: Data collected from all sites
Aim:Evaluate the interrelation of comorbid insomnia, pain and PTSD as seen in participants of other STRONG STAR randomized clinical trials focused on the treatment of combat-related PTSD. Perform an in-depth analysis to determine if the successful treatment of PTSD in turn reduces comorbid insomnia and pain, and whether comorbid insomnia and/or pain have a negative effect on participants’ response to PTSD therapy, providing insight to help providers tailor patients’ treatment to achieve the best possible outcomes.

Study Image STRONG STAR Repository
Principal Investigator: Alan L. Peterson, PhD
Site: Data collected from all sites
Aim:Establish a comprehensive database of clinical and biological information collected from participants in STRONG STAR clinical trials to address future questions that arise from the research of STRONG STAR investigators.

  Preclinical Studies  
Study Image Mechanisms of Vulnerability to PTSD: The Role of Early Life Stressors
Principal Investigator: Randy Strong, PhD
Site: San Antonio, TX
Aim:Test the hypothesis that early life stressors cause alterations in the expression of genes, specifically genes that regulate hypothalamic pituitary adrenal (HPA) axis activity, and that these genetic changes increase an individual’s susceptibility to PTSD following a traumatic event in later life. Potentially identify a molecular link between early environment, gene expression, and susceptibility to PTSD, a finding that could lead to intervention methods to reverse someone’s increased susceptibility to PTSD, perhaps with the use of medication.

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