Discovering Novel Treatments for Service Members with PTSD

Kristine Rae Olmsted, a senior research epidemiologist, describes her career by a series of kismet events. Growing up she experienced the challenges of her father’s severe posttraumatic stress disorder (PTSD) from fighting in the Vietnam War. 

“We’re super close now, but I always wondered as a child what was wrong with my dad that he wasn’t around much,” she stated. “As I got older, I learned that he was in the war and saw some really terrible things.”

Her father’s experience influenced Kristine to pursue a career that helps military service members with PTSD. 

Pursuing a Masters in Epidemiology 

After receiving her bachelor’s in psychology from the University of Tampa, Kristine applied for neuropsychology and biological psychology PhD programs. “I got rejected from every last one of them, so I did a little recon and figured out that it was because I was competing against a bunch of people who had master’s degrees,” Kristine explained. 

While Kristine describes psychology as her first love, following the PhD rejection, she immediately pursued a master of science in public health with a concentration in epidemiology at the University of South Florida. She had just missed the deadline for the school’s psychology program. 

She went on to study the physiological effects of military service with her thesis on skin cancer in Vietnam veterans exposed to defoliants. Then, in 1999, while finishing her program, Kristine bumped into a friend at the American Public Health Association (APHA) conference. Her friend was waiting for a job interview with RTI. 

“I asked him, ‘how did you get the interview? And he said, you just sit here. They’ll interview whoever wants to wait,’” Kristine stated.

After interviewing at the conference, RTI offered Kristine a job as a health analyst where she supported epidemiologic studies of substance abuse, mental health, and pain in active-duty military populations. 

“The folks who interviewed me at APHA saw my interest in psychology and the military on my resume,” she explained. “Being placed with RTI’s military behavioral health folks was a happy accident.”

Stellate Ganglion Block to Treat PTSD

During her tenure at RTI, Kristine mentioned one project that stands out. In 2014, Kristine received funding from the United States Army Medical Research and Materiel Command to investigate whether a procedure called stellate ganglion block (SGB) could treat PTSD. The procedure consists of a local anesthetic injected into the stellate ganglion, a nerve cluster in the neck. The injection resets the body’s “flight-or-flight” response. SGB emerged more than a century ago as a treatment for certain types of pain. In the early 1990s, a case report was published illustrating improvements in PTSD symptoms in a woman being treated with SGB for pain. Around 2008, researchers started finding signs of effectiveness specifically for PTSD. 

In November 2019, the results of a randomized controlled trial led by Kristine and her team [5] revealed that SGB is a powerful tool for treating PTSD. This led to several follow up studies, and now SGB treatment for PTSD is available nationwide. Kristine has been told by several providers that her team’s work has directly led to an increase in SGB being offered not only to military populations, but also to veterans and civilians.

“Finding that the treatment worked was really cool,” she said. “Several media outlets interviewed me, such as 60 minutes, NPR, and the Wall Street Journal. It was a lot of fun because your average research geek, like me, doesn’t normally get to do that. I’m really thankful for the experience and my team that put together the study that is still moving forward today.”

Kristine further described why SGB is such a special treatment for PTSD. Talk therapy can be hard, and it hurts people to relieve their trauma, resulting in a lot of people dropping out. Also, there is a stigma within the military culture when a service member seeks mental health treatment. SGB is discreet, and while talk therapy has been proven effective, SGB addresses a biological and neurochemical component to PTSD as well.

“If you treat both the psychological and biological symptoms that cause PTSD, I think you have the best chance of getting better,” Kristine explained. 

Currently, SGB is available for free for any active-duty service member in the United States. Treatment can be received at a military hospital that offers it. 

Limitations to Receiving SGB Treatment for PTSD                              

Kristine mentioned that as more studies illustrate SGB’s effectiveness, she’d like to see SGB available as a recommended treatment for PTSD that is covered by insurance companies. Right now, the treatment can cost anywhere from $800 to $3,500, making it inaccessible for some. Her team recently submitted a proposal to investigate the cost effectiveness of SGB compared to other PTSD treatments, in the hopes that commercial insurance will agree to pay for the treatment in the near future. 

RTI Team Contributes to Success of SGB for PTSD Studies

Kristine attributes the success of SGB for treating PTSD to her team at RTI. She explained the joy of working with people who she respects and are rockstars at their job. Her team was able to fill in the gaps of expertise that were needed beyond her training in epidemiology to carry out their studies of SGB for PTSD. “You know, I am not an expert in statistics, so we had statisticians,” she said. “I am not an expert in logistics, so we had somebody for that. I felt like the opportunity to work in teams is a real gift.”

In the past, Kristine was involved in studies evaluating novel interventions for PTSD in the military population, including web-based interventions and centrally assisted collaborative care. Moving forward, plant-based medicines and psychedelics are a promising area that Kristine is currently following. She is also pursuing work in traumatic brain injury (TBI) research, including co-authoring a recently submitted proposal to evaluate the effectiveness of SGB in treating symptoms associated with TBI. PTSD and TBI are invisible wounds faced by many military service members with overlapping symptoms like sleep disturbance and cognitive deficits. As she thinks about what’s next for PTSD treatments, Kristine remains focused on her north star of helping service members and veterans like her father.