STEM Shoutout: Drs. Pilar Sanjuan and Julia Stephen

UNM researchers resume study of PTSD in active duty service members and veterans

Drs. Pilar Sanjuan and Julia Stephen are resuming their National Institute of Mental Health-funded study of active duty service members and veterans to better address concentration and attention difficulties associated with Post Traumatic Stress Disorder (PTSD). 

After halting recruitment efforts due to COVID-19, Sanjuan, whose research lies at the intersection of PTSD, substance use, and emotion regulation and Stephen, whose primary focus is functional neuroimaging, are seeking more volunteers for the study. 

“Many prior studies have focused on how people with PTSD respond to fearful or threatening stimuli, but those with PTSD report much broader cognitive complaints like problems with concentration and attention,” Sanjuan said. “And we’re examining how the brain responds to unexpected but not threatening stimuli on a basic level.”

Stephen said their hypothesis is that the brains of people with PTSD become over-reactive to unexpected stimuli, leading to larger than usual responses to those stimuli even in the absence of clear threat.

“This is important from a clinical perspective because the problems they have with attention and memory are extremely common in people with PTSD and this can interfere with daily functioning like holding a job at a level you were previously able to and doing well in school,” Sanjuan said. “A lot of veterans come back and want to go to school but it’s very hard when you’re having problems with concentration and attention and this can also adversely affect interpersonal relations at home. So we’re focusing on that to see what is actually going on in the brain during attention anomalies.”

Sanjuan said while attention and concentration problems are symptoms of PTSD, people can have these problems following a traumatic event even when they do not have full PTSD, thus they can be very impactful consequences of posttraumatic stress.

“Trying to bring attention to these less frequently discussed aspects of mental illness more broadly I think is important because there are ways you can improve your attention potentially if you find the right intervention,” Stephen said. “It can really improve one’s quality of life.”

Sanjuan said the reason the study is focused on veterans and active duty military service members is partly because Stephen and she both personally care deeply for the well-being of our military service members and also, scientifically, because focusing on one group with shared characteristics helps reduce variability in the study. 

“Some people believe that different kinds of traumas have different ways of affecting the brain so the more you reduce variability the more you are able to find the signal you are looking for,” Sanjuan said. “People have all kinds of different traumas and different lives. However, military service members, as a cohort, have several things in common with each other. Also, one of the things that makes people more likely to get PTSD is when the traumatic events are chronic and repeating versus a single incident, and the type of psychological trauma you experience in combat tends to be more chronic.”

Sanjuan said they are passionate about helping military service members and believe this study will help those dealing with PTSD in a broader sense as well. 

Stephen said they have currently worked with 25 participants and seek to work with 25 more and that study involvement for each participant lasts about two half days. 

“When they first come they go through the procedures to make clear the risks and benefits of study participation and verify that they fully qualify for the study and then they do some tasks. For example, an auditory task is included where they hear different sounds and some are frequent and some infrequent. How does the brain respond to infrequent stimuli is the question– for example, does it respond more than for another individual? Then we also collect a brain scan while they are sitting quietly because idling brain activity might look different based on PTSD status,” Stephen said. 

Next, Stephen said the researchers do neuropsychological tests to look at attention and working memory in participants  \relative to the average population. Stephen said the neuroimaging aspect of the study especially helps to understand and eventually treat underlying problems in the brain.

“One of the biggest challenges with mental illness broadly is that there are some interventions that work for some people, but it is difficult to figure out what works best for any one individual except by just trying things. And that’s fine, but it takes time and the time has an impact on those people’s lives,” Stephen said. “So why not try to figure out how to choose the right treatment the first time. People often avoid mental health treatment due to stigma and other factors. It can be very challenging for everyone involved. So if you can use a better tool to target the best treatment for a particular individual, this will have wide-ranging benefits to patients. Neuroimaging helps us see the potential underlying processes and without that deeper understanding we are just guessing at what we need to do to make people’s lives better.”

One of the most rewarding parts of the project is the community outreach aspect they included to get feedback from an advisory panel made up of veterans and active duty military members, Sanjuan said.

“They are an amazing group of people and have given us a lot of really great feedback. I hope the experience has been rewarding for them too,” Sanjuan said.

Along with this, Sanjuan has another neuroimaging study funded by the National Institute on Alcohol Abuse and Alcoholism examining the role of emotion regulation and stress on alcohol craving and use as well as multiple grants involving perinatal mental health with people who have substance use disorders during pregnancy. 

Stephen is in the middle of a five-year, NIH-funded study looking at motor function and attention in developing children. She is also examining attention deficits associated with Fetal Alcohol Spectrum Disorder and has been awarded a recent grant looking at the effects of music training on brain development.