Summary: Hyperbaric oxygen therapy (HBOT) has shown effectiveness in alleviating symptoms for individuals with PTSD unresponsive to traditional treatments. In a study of combat veterans, HBOT led to significant reductions in flashbacks, irritability, and hypervigilance, and was associated with improved brain connectivity on fMRI scans. The specialized protocol, developed over years, involves 60 sessions of breathing pure oxygen under high pressure.
The findings suggest that HBOT could heal the “biological wound” tied to PTSD, providing a new avenue of hope. Researchers emphasize that treatment must be carried out by professional teams in specialized hyperbaric centers. This therapy could bring relief to millions affected by PTSD globally.
Key Facts:
- HBOT significantly reduced PTSD symptoms in veterans unresponsive to other treatments.
- The therapy promotes brain connectivity and healing, visible on fMRI scans.
- The treatment protocol involves 60 high-pressure sessions with pure oxygen.
Source: Tel Aviv University
Researchers at Tel Aviv University and the Sagol Center for Hyperbaric Medicine and Research at the Shamir Medical Center have demonstrated that hyperbaric oxygen therapy (HBOT) improves the condition of PTSD sufferers who have not responded to psychotherapy or psychiatric medications.
The researchers say, “Our unique therapeutic protocol affects the biological brain ‘wound’ associated with PTSD, and effectively reduces typical symptoms such as flashbacks, hypervigilance, and irritability. We believe that our findings give new hope to millions of PTSD sufferers and their families all over the world.”
The study was led by Prof. Shai Efrati and Dr. Keren Doenyas-Barak from the Faculty of Medical and Health Sciences at Tel Aviv University and the Sagol Center for Hyperbaric Medicine and Research at the Shamir Medical Center. Other contributors include Dr. Ilan Kutz, Gabriela Levi, Dr. Erez Lang, Dr. Amir Asulin, Dr. Amir Hadanny, and Dr. Ilia Beberashvili from the Shamir Medical Center, and Dr. Kristoffer Aberg and Dr. Avi Mayo from the Weizmann Institute.
The paper was published in The Journal of Clinical Psychiatry.
According to Prof. Efrati, “Due to our unfortunate circumstances, Israel has become a global leader in the field of PTSD. Before the Hamas attack on Oct. 7, 2023, approximately 6,000 IDF veterans had been recognized as PTSD sufferers, with many others, both soldiers and citizens, not yet acknowledged by the authorities.
Following Oct. 7 and the ensuing war, these numbers have risen sharply. Tens of thousands of soldiers, and much larger numbers of civilians, are likely to be diagnosed with PTSD.
“The Sagol Center for Hyperbaric Medicine, the largest of its kind in the world, is rising to the challenge—with a comprehensive therapeutic array comprising hyperbaric facilities combined with diverse mental health professionals, psychologists and psychiatrists. At present, we treat hundreds of PTSD sufferers every day, aiming to reach one thousand patients per year.”
Dr. Doenyas-Barak adds, “PTSD (Post-Traumatic Stress Disorder) is defined as the mental outcome of exposure to a life-threatening event. About 20% of those who have undergone such an experience will develop PTSD, which can lead to substantial social, behavioral, and occupational dysfunctions.
In extreme cases, the disorder can severely impact their quality of life, family life, and professional performance. Symptoms include a range of emotional and cognitive changes, nightmares and flashbacks, hypervigilance, irritability, and avoidance—so as not to trigger traumatic experiences.
“In many cases, PTSD is resistant to psychotherapy and common psychiatric medications. Past studies on therapy-resistant sufferers have found changes in the structure and function of brain tissues, or a ‘biological wound’ that explains such treatment resistance. In our study we wanted to determine whether hyperbaric therapy can help these patients.”
The study, which began in 2019 and ended in the summer of 2023, included 98 male IDF veterans diagnosed with combat-associated PTSD, who had not responded to either psychotherapy or psychiatric medications.
Participants were divided into two groups: one group received HBOT treatment, breathing pure high-pressure oxygen, while the other went through the same procedure, but received a placebo treatment, breathing regular air. Twenty-eight members of each group completed the process and the following evaluation.
Dr. Doenyas-Barak explains, “The HBOT was administered in accordance with a unique treatment protocol developed at our center. Every patient is given a series of 60 two-hour treatments in our hyperbaric chamber, during which they are exposed to pure 100% oxygen at a pressure of 2 atmospheres (twice the normal air pressure at sea level).
“Our protocol specifies alternately breathing oxygen and regular air: every 20 minutes the patient removes the oxygen mask and breathes regular air for five minutes. The drop in oxygen level, at the tissue level, activates healing processes and thus enhances the therapeutic effect.”
The results were encouraging, with improvements observed both at the clinical level and in fMRI imaging. The group that received hyperbaric therapy showed improved connectivity in brain networks, alongside a decline in all typical PTSD symptoms. In the placebo group, on the other hand, no change was observed in either the brain or clinical symptoms.
Prof. Efrati adds, “Our study demonstrated that HBOT induces biological healing in the brain of PTSD sufferers. Curing the biological wound also impacts clinical symptoms. We believe that HBOT, based on the special protocol we have developed, can bring relief to numerous PTSD sufferers worldwide, allowing them to resume a normative life in their community and family.”
Prof. Efrati emphasizes, “Patients suffering from PTSD should undergo HBOT only at professional hyperbaric centers, where treatment is delivered by multidisciplinary teams experienced in trauma care. Unsupervised, private hyperbaric chambers are unable to provide the proven, effective protocol.
“Additionally, it is crucial that patients receive a thorough professional evaluation to ensure they are suitable for HBOT and to determine what additional support is needed throughout their treatment journey.”
About this PTSD research news
Author: Shai Efrati
Source: Tel Aviv University
Contact: Shai Efrati – Tel Aviv University
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Hyperbaric Oxygen Therapy for Veterans With Combat-Associated Posttraumatic Stress Disorder” by Shai Efrati et al. Journal of Clinical Psychiatry
Abstract
Hyperbaric Oxygen Therapy for Veterans With Combat-Associated Posttraumatic Stress Disorder
Objective: Cumulative data indicate that new protocols of hyperbaric oxygen therapy (HBOT) may induce neuroplasticity and improve clinical symptoms of patients suffering from posttraumatic stress disorder (PTSD). The aim of the current study was to evaluate the effects of HBOT on veterans with combat-associated PTSD (CA-PTSD) in a randomized, sham-controlled trial.
Methods: Male veterans aged 25–60 years with CA-PTSD, with a Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) score above 20, were included. Exclusion criteria included a history of traumatic brain injury, other psychiatric diseases, or contraindication to HBOT. Participants were randomly assigned to HBOT or sham intervention.
Both interventions involved 60 daily sessions, with 90 minutes of either 100% oxygen at 2 atmospheres absolute (ATA) (HBOT) or 21% oxygen at 1.02 ATA (sham) with 5-minute air breaks every 20 minutes. CAPS-5 score, Beck Depression Inventory-II (BDI-II), the Depression, Anxiety and Stress Scale 21 Items (DASS-21), and resting-state functional magnetic resonance imaging (rsfMRI) were assessed at baseline and posttreatment, with the primary end point defined as a 30% reduction in CAPS-5 score from baseline.
Results: The study was conducted between February 2020 and July 2023. Of 63 veterans who underwent randomization, 56 completed the study protocol (28 in each group). The HBOT group showed a significant decrease in mean CAPS-5 total score, from 42.57 ±9.29 at baseline to 25.8±9.5 following HBOT (P< .001) and 25.08± 13.08 at follow-up (P< .001). The sham group demonstrated a significant increase in CAPS-5 total score from baseline to follow-up, from 45.11 ±8.99 to 47.75± 11.27 following HBOT (P= .069) and 49.22± 10.26 at follow-up (P= .011).
Significant improvements in the depression domain of the DASS-21 questionnaire and BDI-II were demonstrated (F=4.55, P= .03 and F=4.2, P= .04, respectively). The stress and anxiety domains of DASS-21 did not reach statistically significant levels. Analysis of rsfMRI demonstrated improved connectivity within the 3 main networks (default-mode network, central-executive network, salience network) in HBOT vs sham groups.
Conclusions: Dedicated HBOT protocol can improve PTSD symptoms of veterans with CA-PTSD. The clinical improvement was accompanied by enhanced functional connectivity demonstrated by rsMRI.
Trial Registration: ClinicalTrials.gov identifier: NCT04518007
