⏱ 8 min read
Benjet, C. et al. The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychol. Med. 46, 327–343 (2016).
Atwoli, L., Stein, D. J., Koenen, K. C. & McLaughlin, K. A. Epidemiology of posttraumatic stress disorder: prevalence, correlates and consequences. Curr. Opin. Psychiatry 28, 307–311 (2015).
Schein, J. et al. Prevalence of post-traumatic stress disorder in the United States: a systematic literature review. Curr. Med. Res. Opin. 37, 2151–2161 (2021).
Vogt, D. et al. Consequences of PTSD for the work and family quality of life of female and male US Afghanistan and Iraq War veterans. Soc. Psychiatry Psychiatr. Epidemiol. 52, 341–352 (2017).
Gradus, J. L. Posttraumatic stress disorder and death from suicide. Curr. Psychiatry Rep. 20, 1–7 (2018).
Steenkamp, M. M., Litz, B. T., Hoge, C. W. & Marmar, C. R. Psychotherapy for military-related PTSD: a review of randomized clinical trials. J. Am. Med. Assoc. 314, 489–500 (2015).
Steenkamp, M. M., Litz, B. T. & Marmar, C. R. First-line psychotherapies for military-related PTSD. J. Am. Med. Assoc. 323, 656–657 (2020).
Sripada, R. K. et al. Examining the nonresponse phenomenon: factors associated with treatment response in a national sample of veterans undergoing residential PTSD treatment. J. Anxiety Disord. 63, 18–25 (2019).
Thibodeau, R. & Merges, E. On public stigma of posttraumatic stress disorder (PTSD): effects of military vs. civilian setting and sexual vs. physical trauma. Int. J. Ment. Health Addict. 22, 238–253 (2024).
Morland, L. A. et al. Advances in PTSD treatment delivery: review of findings and clinical considerations for the use of telehealth interventions for PTSD. Cur. Treat. Options Psychiatry 7, 221–241 (2020).
Kazlauskas, E. Challenges for providing health care in traumatized populations: barriers for PTSD treatments and the need for new developments. Glob. Health Action 10, 1322399 (2017).
Pitman, R. K. et al. Biological studies of post-traumatic stress disorder. Nat. Rev. Neurosci. 13, 769–787 (2012).
Sherin, J. E. & Nemeroff, C. B. Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues Clin. Neurosci. 13, 263–278 (2011).
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition https://doi.org/10.1176/appi.books.9780890425787 (American Psychiatric Publishing Inc, 2022).
Rajagopalan, A. et al. Understanding the links between vestibular and limbic systems regulating emotions. J. Nat. Sci. Biol. Med. 8, 11 (2017).
Kumar Goothy, S. S. et al. A randomized, double blind, sham-controlled clinical trial to evaluate the efficacy of electrical vestibular nerve stimulation (VeNS), compared to a sham control for generalized anxiety disorder. Clin. EEG Neurosci. 57, 152–160 https://doi.org/10.1177/15500594251328080 (2025).
Haber, Y. O., Chandler, H. K. & Serrador, J. M. Symptoms associated with vestibular impairment in veterans with posttraumatic stress disorder. PLoS ONE 11, e0168803 (2016).
McKeown, J. & McGeoch, P. D. Vestibular nerve stimulation may treat post-traumatic stress disorder. Med. Hypotheses 199, 111650 https://doi.org/10.1016/j.mehy.2025.111650 (2025).
Yates, B. J., Bolton, P. S. & Macefield, V. G. Vestibulo-sympathetic responses. Compr. Physiol. 4, 851 (2014).
Shin, L. M., Rauch, S. L. & Pitman, R. K. Amygdala, medial prefrontal cortex, and hippocampal function in PTSD. Ann. N. Y. Acad. Sci. 1071, 67–79 (2006).
Koenigs, M. & Grafman, J. The functional neuroanatomy of depression: distinct roles for ventromedial and dorsolateral prefrontal cortex. Behav. Brain Res. 201, 239–243 (2009).
Zink, R., Bucher, S., Weiss, A., Brandt, T. & Dieterich, M. Effects of galvanic vestibular stimulation on otolithic and semicircular canal eye movements and perceived vertical. Electroencephalogr. Clin. Neurophysiol. 107, 200–205 (1998).
Fitzpatrick, R. C. & Day, B. L. Probing the human vestibular system with galvanic stimulation. J. Appl. Physiol. 96, 2301–2316 (2004).
Ratajczak, W., Watson, S., Mckeown, J., Kumar Goothy, S. S. & Mohanty, K. Non-pharmacological management of insomnia through electrical vestibular stimulation (VeNS). Curr. Sleep Med. Rep. 10, 191–198 (2024).
Curry, G. et al. Repeated electrical vestibular nerve stimulation (VeNS) reduces severity in moderate to severe insomnia; a randomized, sham-controlled trial; the Modius Sleep Study. Brain Stimul. 17, 782–793 https://doi.org/10.1016/j.brs.2024.05.010 (2024).
James, K. E., Bloch, D. A., Lee, K. K., Kraemer, H. C. & Fuller, R. K. An index for assessing blindness in a multi-centre clinical trial: disulfiram for alcohol cessation—a VA cooperative study. Stat. Med. 15, 1421–1434 (1996).
Thorp, S. R. et al. A randomized controlled trial of prolonged exposure therapy versus relaxation training for older veterans with military-related PTSD. J. Anxiety Disord. 64, 45–54 (2019).
Peterson, A. L. et al. Massed vs intensive outpatient prolonged exposure for combat-related posttraumatic stress disorder: a randomized clinical trial. JAMA Netw. Open 6, e2249422 (2023).
Brady, K. et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial. J. Am. Med. Assoc. 283, 1837–1844 (2000).
Blanchard, B. E. et al. Minimal important difference metrics and test–retest reliability of the PTSD Checklist for DSM-5 with a primary care sample. J. Trauma. Stress 36, 1102–1114 (2023).
McLean, C. P., Levy, H. C., Miller, M. L. & Tolin, D. F. Exposure therapy for PTSD: a meta-analysis. Clin. Psychol. Rev. 91, 102115 (2022).
Madore, M. R. et al. Prefrontal transcranial magnetic stimulation for depression in US military veterans–a naturalistic cohort study in the veterans health administration. J. Affect. Disord. 297, 671–678 (2022).
Kozel, F. A. et al. Repetitive TMS to augment cognitive processing therapy in combat veterans of recent conflicts with PTSD: a randomized clinical trial. J. Affect. Disord. 229, 506–514 (2018).
Hickson, R., Simonsen, M. W., Miller, K. J. & Madore, M. R. Durability of deep transcranial magnetic stimulation for veterans with treatment resistant depression with comorbid suicide risk and PTSD symptoms. Psychiatry Res. 332, 115690 (2024).
Belsher, B. E. et al. Advances in repetitive transcranial magnetic stimulation for posttraumatic stress disorder: a systematic review. J. Psychiatr. Res. 138, 598–606 (2021).
Rauch, S., Eftekhari, A. & Ruzek, J. I. Review of exposure therapy: a gold standard for PTSD treatment. J. Rehabil. Res. Dev. 49, 679–687 (2012).
Foa, E. B. & Rauch, S. A. M. Cognitive changes during prolonged exposure versus prolonged exposure plus cognitive restructuring in female assault survivors with posttraumatic stress disorder. J. Consult. Clin. Psychol. 72, 879 (2004).
Brockman, C. et al. Relationship of service members’ deployment trauma, PTSD symptoms, and experiential avoidance to postdeployment family reengagement. J. Fam. Psychol. 30, 52 (2016).
Şalcıoğlu, E., Başoğlu, M. & Livanou, M. Effects of live exposure on symptoms of posttraumatic stress disorder: the role of reduced behavioral avoidance in improvement. Behav. Res. Ther. 45, 2268–2279 (2007).
Pugh, L. R., Taylor, P. J. & Berry, K. The role of guilt in the development of post-traumatic stress disorder: a systematic review. J. Affect. Disord. 182, 138–150 (2015).
Balaban, C. D. & Thayer, J. F. Neurological bases for balance–anxiety links. J. Anxiety Disord. 15, 53–79 (2001).
Woodward, E. et al. Effects of psychotherapies for posttraumatic stress disorder on sleep disturbances: results from a randomized clinical trial. Behav. Res. Ther. 97, 75–85 (2017).
Porges, S. W. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation (WW Norton & Company, 2011).
Balaban, C. D. Neural substrates linking balance control and anxiety. Physiol. Behav. 77, 469–475 (2002).
Hitier, M., Besnard, S. & Smith, P. F. Vestibular pathways involved in cognition. Front. Integr. Neurosci. 8, 59 (2014).
Hien, D. A. et al. Lagged effects of substance use on PTSD severity in a randomized controlled trial with modified prolonged exposure and relapse prevention. J. Consult. Clin. Psychol. 86, 810 (2018).
Watanabe, H., Teramoto, W. & Umemura, H. Effect of predictive sign of acceleration on heart rate variability in passive translation situation: preliminary evidence using visual and vestibular stimuli in VR environment. J. Neuroeng. Rehabil. 4, 1–10 (2007).
Colvonen, P. J., Rivera, G. L. & Park, J. Sleep disorders in veterans: prevalence, consequences, and treatment. In Sleep Medicine and Mental Health 315–340 (Springer International Publishing, 2020).
Talbot, L. S. et al. Cognitive behavioral therapy for insomnia in posttraumatic stress disorder: a randomized controlled trial. Sleep 37, 327–341 (2014).
Johnson, D. A., Billings, M. E. & Hale, L. Environmental determinants of insufficient sleep and sleep disorders: implications for population health. Curr. Epidemiol. Rep. 5, 61–69 (2018).
Kalmbach, D. A., Anderson, J. R. & Drake, C. L. The impact of stress on sleep: pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J. Sleep Res. 27, e12710 (2018).
Ito, M. et al. Cognitive processing therapy for posttraumatic stress disorder in Japan: a randomized clinical trial. JAMA Netw. Open 8, e2458059 (2025).
Weathers, F. W. et al. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): development and initial psychometric evaluation in military veterans. Psychol. Assess. 30, 383 (2018).
Weathers, F. W. et al. The PTSD Checklist for DSM-5 (PCL-5). PTSD: National Center for PTSD https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp (2013).
Morin, C. M. & Barlow, D. H. Insomnia: Psychological Assessment and Management (Guilford Press, 1993).
Ware, J. E., Snow, K. K., Kosinski, M. & Gandek, B. SF-36 Health Survey: Manual and Interpretation Guide (1993).
Farivar, S. S., Cunningham, W. E. & Hays, R. D. Correlated physical and mental health summary scores for the SF-36 and SF-12 Health Survey, V. 1. Health Qual. Life Outcomes 5, 54 (2007).
Spitzer, R. L., Kroenke, K., Williams, J. B. & Löwe, B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch. Intern. Med. 166, 1092–1097 (2006).
Zalta, A. K., Bravo, K., Valdespino-Hayden, Z., Pollack, M. H. & Burgess, H. J. A placebo-controlled pilot study of a wearable morning bright light treatment for probable PTSD. Depress. Anxiety 36, 617–624 (2019).
Tang, W., He, H. & Tu, X. M. Applied Categorical and Count Data Analysis (CRC Press, 2023).
R: a language and environment for statistical computing (version 4.4.2). R Foundation for Statistical Computing https://www.R-project.org/ (2024).
Dunlap, W. P., Cortina, J. M., Vaslow, J. B. & Burke, M. J. Meta-analysis of experiments with matched groups or repeated measures designs. Psychol. Methods 1, 170 (1996).
Leave a Reply