Traumatic Brain Injury and Post-Traumatic Stress Disorder in Military Veterans: When Two Problems Collide

Caitlin Kennedy, PHD and Sandy Wang , National Center for Health Research

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can occur as a result of experiencing a traumatic event. The symptoms of PTSD may include being constantly on-edge, frequently having a short temper, reliving the traumatic event through flashbacks or bad dreams, avoiding things related to the traumatic event, or losing interest in previously enjoyable activities.[1] In people with PTSD, these symptoms last for more than a few weeks and become disruptive to the person’s daily living.

One of the largest groups of people who are diagnosed with PTSD consists of recent members of the U.S. military forces. An estimated 17%, or almost 142,000,[2] of the living U.S. military veterans of the Iraq and Afghanistan wars currently have Post-Traumatic Stress Disorder (PTSD), and experts estimate that 35% may develop PTSD over time.[3]

Members of the military are also at risk for Traumatic Brain Injury (TBI). TBI is caused by a hit, bump, or other injury to the head. However, not all hits or bumps to the head are considered TBIs. A TBI may range from a “mild” injury, where the person has a short change in mental state or consciousness, to a “severe” injury, where the person has an extended period of unconsciousness or memory loss. TBI is common in military veterans, with almost 288,000 U.S. veterans having suffered one from 2000-2015.[4] An estimated 10-20% of U.S. veterans who fought in Iraq or Afghanistan have experienced a TBI.[5] Most of those veterans have the mild form of TBI, which is also known as a concussion. Concussions have symptoms such as headaches, changes in sleep patterns (sleeping too much or too little), mood changes (feeling sad/angry for no reason), and memory issues (forgetfulness, concentration difficulties, or struggling to make decisions).[6] Concussions may have occurred in a dangerous environment where the soldier was at risk of his or her life, adding to the emotionally traumatic nature of the injury.[7] These veterans may be at particular risk of PTSD because of the wartime experiences that caused the TBI.

A study in JAMA Psychiatry, a publication of the American Medical Association, found a connection between TBI and PTSD.[8] The study evaluated 1648 Marine and Navy servicemen one month before, one week after, and three months after a deployment. Those who reported little to no PTSD symptoms before deployment and who experienced a mild TBI during deployment had nearly twice the probability of having PTSD after deployment than what was predicted. Those who had the highest risk for post-deployment PTSD (34% likelihood) were those that reported PTSD symptoms before deployment and experienced high combat intensity and a TBI during deployment.

It’s likely that the events that cause a deployment-related TBI are emotionally traumatic and contribute to PTSD. Additionally, even a mild TBI can cause damage to areas of the brain that process fear memories – and thus make PTSD symptoms even worse.[9] TBI has been connected to increased risk of suicide, and those with mental health problems, such as PTSD or depression, are particularly at risk.[10][11][12]

Treatments

When members of the military return home with concussions, TBI, or PTSD, they are likely to be constantly on edge, easily irritated, very anxious, and likely to overreact. This makes it harder for veterans to function in daily activities such as eating in a crowded restaurant. Is there something they can do to cope with their symptoms and live a normal life? A 2016 study examined 74 active-duty military service members with PTSD or anxiety disorder for six months. Researchers assigned half to do Transcendental Meditation (TM) in addition to their psychotherapy and medications. The other half, the control group, also had psychotherapy and medications, but no TM. After one month, 11% of the TM group increased their use of psychotropic drugs, compared to 41% increased of the control group. Neither group was likely to decrease their medications, but the TM group was more likely to keep the same level of medication. For the following months, the percentages were similar. After 6 months, the control group was more likely to have an increase in symptoms from the start of the study compared to the TM group. These findings suggest that practicing Transcendental Meditation helps prevent PTSD from worsening, although few of the patients actually improved.[7]

Why is transcendental meditation helpful? Transcendental meditation is a practice where you sit comfortably for about 20 minutes, once or twice a day. It involves using a mantra or a sound that allows you to concentrate and enter a state of deep relaxation.[13] By reducing the levels of active thinking and replacing it with a focused, inner peace, stress hormones are reduced as is the activation of the sympathetic nervous system, which stimulates the fight-or-flight response. The study shows that meditation could be beneficial for members of the military who have TBI or PTSD or experience concussions.[7]

If a military veteran you know is suffering from TBI and/or PTSD, visit this website on PTSD and this website for TBI for information and help. You can visit this website for more information on how to practice Transcendental Meditation. There is also an information page about both TBI and PTSD among veterans here. In the case of an urgent situation, call the Veterans Crisis Line at 1-800-273-8255.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff

  1. National Institute of Mental Health. Post-traumatic stress disorder. http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder ptsd/index.shtml. Accessed December 18, 2013.
  2. Department of Veterans Affairs. Report on VA facility specific Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans coded with potential PTSD – revised. http://www.publichealth.va.gov/docs/epidemiology/ptsd-report-fy2012-qtr3.pdf. Accessed December 19, 2013.
  3. Stanford Graduate School of Business. Research: High PTSD rates for Iraq war veterans. http://www.stanford.edu/group/knowledgebase/cgi-bin/2009/09/19/high-ptsd-rates/. Accessed December 19, 2013.
  4. Defense and Veterans Brain Injury Center. DoD Worldwide Numbers for TBI. (2012). Retrieved January 22, 2016, from http://dvbic.dcoe.mil/dod-worldwide-numbers-tbi
  5. Iraq and Afghanistan Veterans of America. Traumatic brain injury (TBI). http://iava.org/content/traumatic-brain-injury-tbi. Accessed December 19, 2013.
  6. What You Need to Know: Symptoms of Concussion. (2012). Retrieved February, 2016, from http://www.brainline.org/content/2012/06/what-you-need-to-know-symptoms-of-concussion.html
  7.  Medical College of Georgia at Georgia Regents University. “Transcendental Meditation may reduce PTSD symptoms, medication use in active-duty personnel.” ScienceDaily. ScienceDaily, 11 January 2016. www.sciencedaily.com/releases/2016/01/160111121344.htm
  8.  Yurgil KA, Barkauskas DA, Vasterling JJ, et al. Association between traumatic brain injury and risk of Posttraumatic Stress Disorder in active-duty marines. JAMA Psychiatry 2013; online publication; E1-E9. doi:10.1001/jamapsychiatry.2013.3080
  9. Bryant RA. Disentangling mild traumatic brain injury and stress reactions. N Engl J Med. 2008;358(5):525-527.
  10.  Brenner LA, Betthauser LM, Homaifar BY, et al. Posttraumatic stress disorder, traumatic brain injury, and suicide attempt history among veterans receiving mental health services. Suicide Life Threat Behav. 2011;41(4):416-423.
  11.  Bryan CJ, Clemans TA, Hernandez AM, Rudd MD. Loss of consciousness, depression, posttraumatic stress disorder, and suicide risk among deployed military personnel with mild traumatic brain injury. J Head Trauma Rehabil. 2013;28(1):13-20.
  12. Bryan CJ, Clemans TA. Repetitive traumatic brain injury, psychological symptoms, and suicide risk in a clinical sample of deployed military personnel. JAMA Psychiatry. 2013;70(7):686-691.
  13. Borchard, T. (2013). Transcendental Meditation: What Is It and How Does It Work?. Psych Central. Retrieved on January 22, 2016, from http://psychcentral.com/lib/transcendental-meditation-what-is-it-and-how-does-it-work/