Key Takeaways

From the Authors As published in the article
  1. While data suggest hyperbaric oxygen therapy (HBOT) benefits for veterans with posttraumatic stress disorder (PTSD), there is a significant lack of sham-controlled trials focused solely on military-related PTSD without traumatic brain injury. This study addresses that gap.
  2. HBOT targets the biological impacts of trauma and should be considered for veterans with PTSD who are unresponsive to psychotherapy and pharmacotherapy.
  3. HBOT should be administered only in medical-standard facilities with staff trained in PTSD-specific challenges.
Extended Takeaways
  1. The benefit signal was large despite a highly treatment-refractory sample: 68% of HBOT patients met the predefined CAPS-5 response threshold at treatment end versus 4% with sham, and 61% versus 4% remained responders 3 months later.
  2. Remission was less common than response but continued to increase after the HBOT course ended, rising from 25% at treatment completion to 39.2% at follow-up, while the sham group went from 3.6% to 0%.
  3. Depressive symptoms improved alongside PTSD severity, with significant between-group effects on both BDI-II (F = 4.2 and P = .043) and the DASS-21 depression domain (F = 4.55, P = .034), whereas DASS-21 anxiety and stress did not reach statistical significance.
  4. The sham design appears credible for PTSD trials: after the first session, 64% of participants in both groups believed they were receiving HBOT and 36% believed they were receiving sham treatment (P = 1.0).
  5. The protocol tested was intensive and specific—60 daily sessions, 5 days per week, with 90 minutes of 100% oxygen at 2 atmospheres absolute (ATA) and 5-minute air breaks every 20 minutes—so clinicians should not generalize these results to lower-dose or nonmedical hyperbaric approaches.
  6. HBOT was associated with increased resting-state functional connectivity in the frontoparietal, default mode, salience, and thalamic networks, with no significant group-by-time connectivity decreases, supporting a neuroplasticity-based mechanism for symptom improvement.
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