Summary: Hyperbaric oxygen therapy (HBOT) has demonstrated promising results for people with post-traumatic stress disorder (PTSD) who did not improve with standard psychotherapy or psychiatric medications. In a randomized, sham-controlled trial of combat veterans, a specialized HBOT protocol produced marked reductions in core PTSD symptoms—such as flashbacks, irritability, and hypervigilance—and was associated with measurable improvements in brain network connectivity on resting-state fMRI.
The treatment protocol, developed and refined at the Sagol Center for Hyperbaric Medicine and Research, consists of 60 sessions in a hyperbaric chamber during which patients breathe 100% oxygen under increased pressure. Investigators conclude that HBOT may address the underlying biological injury seen in treatment-resistant PTSD and could offer a new therapeutic option when delivered by experienced multidisciplinary teams in specialized centers.
Key Facts:
- HBOT produced significant reductions in PTSD severity among veterans who did not respond to prior treatments.
- Functional MRI showed improved connectivity across major brain networks after HBOT.
- The therapeutic protocol consists of 60 two-hour sessions of high-pressure, 100% oxygen with scheduled air breaks.
Source: Tel Aviv University
A clinical research team from Tel Aviv University and the Sagol Center for Hyperbaric Medicine and Research at the Shamir Medical Center led this trial. Principal investigators included Prof. Shai Efrati and Dr. Keren Doenyas-Barak, with contributions from clinicians and researchers at the Shamir Medical Center and the Weizmann Institute. The study was published in The Journal of Clinical Psychiatry.
The investigators describe PTSD in many sufferers as involving a “biological wound” in brain tissue that may underlie resistance to psychotherapy and medications. Their randomized trial tested whether a targeted HBOT protocol can stimulate neuroplasticity and clinical recovery in veterans with combat-associated PTSD (CA-PTSD) who remained symptomatic despite standard care.
The trial enrolled men aged 25–60 years diagnosed with CA-PTSD and a Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) score above 20. Participants with traumatic brain injury, other psychiatric diagnoses, or contraindications to HBOT were excluded. From 63 randomized veterans, 56 completed the protocol (28 in the HBOT arm and 28 in the sham arm).
Patients in the HBOT group received 60 daily sessions of 100% oxygen at 2 atmospheres absolute (ATA) for 90 minutes per session, with five-minute air breaks every 20 minutes. The sham group underwent an identical schedule but breathed 21% oxygen at 1.02 ATA. The primary clinical endpoint was defined as a 30% reduction in CAPS-5 score from baseline. Secondary measures included the Beck Depression Inventory-II (BDI-II), the Depression, Anxiety and Stress Scale (DASS-21), and resting-state functional MRI (rsfMRI).
Results showed a significant and clinically meaningful decrease in CAPS-5 scores in the HBOT group: mean CAPS-5 fell from 42.57 ± 9.29 at baseline to 25.8 ± 9.5 after treatment (P < .001), with sustained improvement at follow-up (25.08 ± 13.08; P < .001). By contrast, the sham group showed no improvement; CAPS-5 increased slightly from 45.11 ± 8.99 at baseline to 47.75 ± 11.27 after the sham intervention and to 49.22 ± 10.26 at follow-up.
Depression scores improved significantly in the HBOT group as measured by both the DASS-21 depression domain (F = 4.55, P = .03) and the BDI-II (F = 4.2, P = .04). Improvements in anxiety and stress domains did not reach statistical significance. Neuroimaging analysis revealed enhanced functional connectivity in three core brain networks—the default mode network, the central executive network, and the salience network—among HBOT-treated participants compared with the sham group.
Prof. Shai Efrati and colleagues interpret these findings as evidence that the HBOT protocol induces biological healing in brain tissue that correlates with symptomatic improvement. They emphasize that HBOT should be administered only in professional hyperbaric centers by multidisciplinary teams experienced in trauma care, noting that the specialized protocol and clinical oversight are essential for safety and effectiveness.
Given the large and growing number of individuals affected by PTSD worldwide, the authors suggest that HBOT—when delivered with the described protocol—could expand treatment options for patients whose symptoms do not respond to conventional therapies.
About this PTSD research news
Author: Shai Efrati
Source: Tel Aviv University
Contact: Shai Efrati – Tel Aviv University
Image: The image is credited to Neuroscience News
Original Research: “Hyperbaric Oxygen Therapy for Veterans With Combat-Associated Posttraumatic Stress Disorder” by Shai Efrati et al., published in The Journal of Clinical Psychiatry. (Open access)
Abstract
Objective: This randomized, sham-controlled trial evaluated whether a dedicated HBOT protocol could induce neuroplasticity and clinical improvement in veterans with combat-associated PTSD who were resistant to standard treatments.
Methods: Male veterans aged 25–60 years with CAPS-5 > 20 were randomized to receive either 60 daily sessions of HBOT (100% oxygen at 2 ATA) or sham treatment (21% oxygen at 1.02 ATA). Both groups followed a protocol of 90 minutes per session with five-minute air breaks every 20 minutes. Outcomes included CAPS-5, BDI-II, DASS-21, and rsfMRI, assessed at baseline and posttreatment. The primary endpoint was a 30% reduction in CAPS-5 score.
Results: Between February 2020 and July 2023, 56 participants completed the protocol (28 per group). The HBOT group experienced a statistically significant reduction in CAPS-5 scores from 42.57 ± 9.29 to 25.8 ± 9.5 posttreatment (P < .001) and maintained improvement at follow-up. The sham group showed no clinical benefit and a modest increase in CAPS-5 scores over time. HBOT also yielded significant improvements on depression measures, while anxiety and stress domains did not reach significance. rsfMRI demonstrated enhanced functional connectivity across the default mode, central executive, and salience networks in the HBOT group compared with sham.
Conclusions: A dedicated HBOT protocol can improve PTSD symptoms and is associated with enhanced functional brain connectivity in veterans with combat-associated PTSD.
Trial Registration: ClinicalTrials.gov identifier: NCT04518007