VA’s National Center for PTSD is focused on research, education and developing strategies to reduce veteran suicide.
Dr. Paula Schnurr guides the staff, research and clinical work at the Department of Veterans Affairs (VA) National Center for PTSD. The center aims to support veterans and others who have experienced trauma, or who suffer from PTSD, through research, education and training in the science, diagnosis and treatment of PTSD and stress-related disorders.
“The center works to understand the relationship between PTSD and suicide and develop strategies to predict and prevent suicide among veterans with PTSD,” says Schnurr, who is the center’s executive director and had previously served as deputy executive director since 1989.
She has investigated risk and resilience factors associated with the long-term physical and mental health outcomes of exposure to traumatic events. She is an expert on psychotherapy research and has conducted clinical trials of PTSD treatment, including multi-site trials of prolonged exposure for female veterans and active-duty personnel with PTSD and of group psychotherapy for PTSD in Vietnam veterans.
Her work ties in directly with The American Legion’s Be the One mission to prevent veteran suicide.
In this Q&A, Schnurr gives an overview of the center, trends in PTSD research and more.
Question: Tell me about what the National Center for PTSD is, its scope or work, and its role in preventing suicide.
Answer: The National Center for PTSD’s mission focuses on improving clinical care and social support for veterans and others affected by trauma or PTSD through research, education and training. The center ensures the latest scientific research findings are applied to clinical care, leveraging expertise from various fields to address PTSD’s complexities. Its research, education, and consultation activities center on five operational priorities: biomarkers; PTSD and suicide; treatment efficiency, effectiveness and engagement; systems of care; and implementation.
Question: Can you assess/compare the volume of cases of PTSD today in a historical context?
Answer: PTSD wasn’t formally recognized until 1980, making it difficult to track its prevalence across eras. Most early research studies focused on veterans sometimes 10 to 15 years after their service, which complicates comparisons with more recent conflicts. However, my interpretation of the evidence is that there are more similarities than differences across the various war eras.
What has significantly improved is our recognition and understanding of PTSD. We know it’s a treatable condition, benefiting both veterans and non-veterans alike.
Question: If someone believes that a loved one, friend, or even themselves might have PTSD, what should they do?
Answer: Education on PTSD is crucial for everyone, especially veterans. The National Center for PTSD website offers valuable resources to help understand this condition. Our video series, AboutFace, shares inspiring stories of veterans who turned their lives around by getting treatment. If anyone has experienced a traumatic event and thinks they may have PTSD, we recommend taking a brief screening test. A positive result should lead you to talk to a health care provider. Veterans in crisis can get immediate help by calling 988 then pressing 1, or by texting 838255.
Question: There are numerous ways for those with PTSD to address their symptoms. What does the center recommend for those seeking relief from PTSD?
Answer: The Clinical Practice Guideline for PTSD, developed by VA and the Department of Defense, recommends talk therapies (psychotherapies) as the most effective treatment options for PTSD. These include Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing, and Prolonged Exposure. Medications like paroxetine, sertraline and venlafaxine are also beneficial. Additionally, Mindfulness-Based Stress Reduction has the most substantial evidence of effectiveness. Veterans can use our PTSD Decision Aid to explore treatment options and choose the one that is best for them.
Question: What recent research is reshaping how the center looks at PTSD and may lead to more solutions for veterans and their families?
Answer: The ongoing research aimed at making treatment even more effective for veterans is extremely exciting. While there are no definitive findings that point to a new therapy or combination of therapies that are definitively more effective than existing therapies, there are signs of progress.
One study, for example, combined transcranial magnetic stimulation (TMS) with Cognitive Processing Therapy and found that veterans who received TMS had much better outcomes than veterans who received a placebo version of TMS that did not deliver the magnetic stimulation.
Question: You have experience in psychotherapy research, including clinical trials of PTSD treatment such as prolonged exposure for female veterans and active-duty personnel with PTSD and of group psychotherapy for PTSD in Vietnam veterans. What are some lessons learned from one or both of those studies, and how those takeaways play a role in suicide prevention today?
Answer: These studies strengthened the case for treating PTSD, particularly through prolonged exposure. Initially, many clinicians were concerned that the trauma focus would be too upsetting for veterans. However, we found that veterans were able to participate and complete the therapy, which proved to be more effective than a therapy that avoided focusing on trauma. The study led to a national VA training initiative for VA clinicians to help disseminate the treatment more broadly.
While my work did not focus on suicide prevention, the evidence from others’ research shows that effective PTSD treatment reduces suicidal ideation.
Question: What advice do you have for family members of those with PTSD? Other than being supportive, how should family members assist their loved one? And how should family members protect their own mental health?
Answer: For family members of veterans with PTSD, it’s important to know that you can help in meaningful ways:
• Educate yourself: Learn about PTSD and how it affects people to better understand their experiences.
• Attend appointments: Offer to go to doctor visits to provide support and help keep track of medicine and therapy.
• Be there to listen: Tell your loved one you want to listen and that you also understand if it's not the right time to talk.
• Plan activities: Engage in family activities together, like having dinner or going to a movie.
• Encourage physical activity: Take a walk, go for a bike ride. Exercise is important for health and helps clear your mind.
• Promote connections: Encourage contact with family and close friends. A support system will help your loved one get through difficult changes and stressful times.
• Be patient: Your family member may not want your help. If this happens, keep in mind that withdrawal — or pulling away — can be a symptom of PTSD. Give them space, but let them know you’re ready to help when needed.
More resources for families are available here.
Question: How can members of The American Legion best support the National Center for PTSD and its work?
Answer: I encourage The American Legion to continue its valuable work in fostering compassion and assisting the VA in reducing stigma. This will help more veterans feel comfortable seeking the help they need. At VA, our goal is for every eligible veteran to access our health care services. By raising awareness of the services and benefits VA offers, we can ensure that more veterans receive the necessary support. The American Legion will remain a vital partner in ensuring veterans receive the care they deserve.
- Be the One