Clinical Summary: Hyperbaric Oxygen Therapy for Veterans With Combat-Associated Posttraumatic Stress Disorder: A Randomized, Sham-Controlled Clinical Trial
Many veterans with long-standing combat-associated posttraumatic stress disorder remain symptomatic despite trauma-focused psychotherapy and pharmacotherapy, with intrusive symptoms especially difficult to remit. This trial tests whether hyperbaric oxygen therapy can deliver clinically meaningful improvement in a treatment-refractory veteran population without known traumatic brain injury.
Key Findings
- Treatment response rates were 68% vs 4% at the end of HBOT/sham treatment (P < .001) and 61% vs 4% at the end of follow-up, respectively (P < .001).
- Seven patients (25%) achieved remission in the HBOT group compared to 1 (3.6%) in the sham group by the end of the treatment (P < .01); at follow-up, 11 patients (39.2%) in the HBOT group achieved remission, whereas none did in the sham group (P < .01).
- A significant group-by-time interaction on CAPS was demonstrated between the groups (F = 27.33, P < .001).
- Depression outcomes favored HBOT on both the BDI (F = 4.2 and P = .043) and the depression domain of the DASS-21 questionnaire (F = 4.55, P = .034), while the stress and anxiety domains of DASS-21 did not reach statistically significant levels.
- Blinding appeared credible: in both the HBOT and sham groups, 64% of the participants assumed they were receiving HBOT while 36% assumed they were receiving sham treatment (P = 1.0).
For veterans with chronic combat-associated posttraumatic stress disorder who have not improved with standard treatment, the tested hyperbaric oxygen therapy protocol produced large gains in PTSD response and remission over sham. The benefit came from a specific, intensive medical-grade protocol rather than from lower-dose or nonmedical hyperbaric exposure.
Practice Implications
- Consider HBOT for veterans with combat-associated posttraumatic stress disorder who still meet CAPS-5 criteria after at least 1 course of trauma-focused psychotherapy and pharmacotherapy, especially when symptoms have persisted for 5 or more years.
- Use the evidence-based protocol that was tested: 60 daily sessions, 5 days per week, with 90 minutes’ exposure to 100% oxygen at 2 atmospheres absolute (ATA) with 5-minute air breaks every 20 minutes.
- Monitor for mild barotrauma and for surfacing of new memories during treatment; 8 events of self remitting barotrauma were documented, and 7 subjects from the HBOT group reported surfacing of new memories accompanied by distress.
- Refer only to medical-standard hyperbaric centers with staff trained in PTSD care, because the article cautions against extrapolating these results to non–medical grade facilities, variations of monoplaces, home used chambers, or clinics without a professional multidiscipline medical team.
