Moral Injury

Study Coordinator: Mary Nicole Buckley

Moral injury is a syndrome that refers to guilt- and shame-based disturbances often experienced by combat veterans after perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations. It is associated with the consequences of participation in warfare, but different from posttraumatic stress disorder (PTSD) that is related with exposure to life-threatening events and is accompanied with disorders of fear processing. However, killing in combat (a transgressive act in a broader definition) and guilt and shame (key mechanisms in the moral injury model) have been associated with more severe PTSD symptoms. By expanding our investigation into the neuroscience of shame and guilt, which were recently added to DSM-5, we propose to open a new line of research that provides an alternative to fear-based models of PTSD. The knowledge gained may contribute to advancing our understanding of the neurobiology of moral injury and PTSD and in the future may shed light on treatments.

NFL Concussion Study

Study Coordinator: Heather Bouchard

Repetitive head injuries and subconcussive impacts are common among collegiate and professional football players and multiple head injuries have been associated with accelerated aging. Because of the ambiguity of diagnosis and changes in awareness over the years this can be difficult to quantify for individual players. In addition, these athletes are subjected to pressures that lead to both acute and chronic stress that may also be linked to accelerated aging. Therefore, this longitudinal study, in conjunction with George Washington University, aims to use a rate of exposure to the sport of football to assess 1) changes to the brain through diffusion tensor imaging, resting-state functional connectivity, and gray matter volume, 2) changes in cognitive functioning through a comprehensive neuropsychological battery, and 3) changes in blood biomarkers through elevations in proteins and metabolites. This multifaceted assessment will provide a better picture of how a professional football player’s brain and body changes over time. For more information see the Study Website.

Brain Stimulation in Veterans with Mild Traumatic Brain Injury

Study Coordinator: Amanda Watts

Mild traumatic brain injuries (mTBIs), commonly referred to as concussions, are characterized as damage sustained to the brain due to accelerating or decelerating forces. Military personnel are at increased risk for mTBIs during both combat and training exercises, especially from explosive devices. These head injuries have been associated with mental health concerns including sleep disturbances, memory deficits, and suicidal ideation. This study, in collaboration with Teledyne Scientific & Imaging, LLC, aims to investigate the capability of transcranial direct current stimulation (tDCS), a non-invasive brain stimulation, in alleviating mTBI-related clinical symptoms. While Veterans sleep, they will wear a tDCS-emitting headband in the comfort of their own home for a few weeks. Through improvement in sleep, we hope to see a reduction in additional clinical symptoms including memory complaints and suicidal thoughts. The information gained in this study may shed light on possible benefits of tDCS for Veterans living with symptoms from a mTBI.

Fear Generalization and Threat Processing

Study Coordinator: Amanda Watts

Posttraumatic stress disorder (PTSD) is an extreme and sustained maladaptive response to traumatic events. PTSD is a major cause of mental health morbidity and loss of function in affected individuals. Two symptom clusters – re-experiencing symptoms, which include intrusive memories and thoughts, sometimes triggered by environmental cues, and hyperarousal symptoms, characterized by a tonic state of concern and active monitoring of the environment for threat – are particularly debilitating for maintaining effective occupational and social functioning. To gain insight into the pathogenesis of the re-experiencing and hyperarousal symptoms of PTSD, we have developed a series of interactive paradigms of fear learning and threat-based arousal for the fMRI setting that contain features of computer gaming and virtual reality to identify the relevant dysfunction in connectivity patterns within the proposed brain network. These tasks will be conducted in Veterans with PTSD returning from post-9/11 operations in the Middle East and combat-exposed controls, and brain network relationships will be correlated with current PTSD symptoms. The insights gained into the pathogenesis of PTSD will lay the groundwork for developing future therapeutic interventions that are targeted to symptoms.

White Matter Damage from Sub-concussive Blast Exposure

Study Coordinator: Heather Bouchard

Exposure to explosive forces (primary blast) emanating from bombs and other devices is common in recent military personnel from the conflicts in Iraq and Afghanistan. Diffusion Tensor Imaging (DTI) has demonstrated that these symptoms are associated with white matter damage. However, little attention has been given to investigating white matter following asymptomatic exposure to repetitive blast. We will assess the association between spatially distributed injury to white matter and other measures including, gray matter volume, resting-state functional connectivity, cognitive performance, and symptoms of PTSD and depression. If we confirm our key predictions that tissue damage and cognitive impairment result from subconcussive blast exposure, it would argue for an overhaul of the established approach for making clinical symptom-based diagnoses of mild TBI in favor of neuroimaging-based diagnostic criteria. The results would further imply that many blast-exposed individuals with chronic symptoms are being incorrectly diagnosed with other conditions (e.g. depression) in the absence of acute clinical symptoms TBI.

Trauma and Genomics Modulate Brain Structure across Common Psychiatric Disorders

Project Manager: Emily Clarke

Dr. Morey co-leads the PTSD Neuroimaging Workgroup for the Psychiatric Genomics Consortium (PGC) PTSD Workgroup. As part of the wider ENIGMA (Enhancing Neuro Imaging Genetics through Meta-Analysis) network and PGC consortia, the Neuroimaging Workgroup seeks to investigate the neural and genetic underpinnings of PTSD via anatomical and functional MRI imaging and genome-wide association studies. For more information, see

ENIGMA Military Brain Injury

Project Coordinator: Heather Bouchard

Similar to ENIGMA-PGC PTSD, the lab also contributes data to the military subgroup of ENIGMA Brain Injury. See the
ENIGMA Military Brain Injury site for more information.

Predicting the Impact of Climate Change on Mental Health

Contributor: Molly Monsour (Honors Thesis)

As the changing climate intensifies, it is vital that we understand all potential impacts from climate change. While many researchers have considered how climate change will impact natural disaster occurrence, agricultural challenges, and disease prevalence, little research has considered its impact on mental health. Some studies have noted that elevated temperatures lead to an increased prevalence of anxiety, mood disorders, acute stress, PTSD, loss of identity, and depression. Furthermore, the consequences of climate change, including natural disasters, mass exodus, and crop failure, can also contribute to detrimental mental health effects. The current study aims to predict how increases in temperature may impact mental health challenges. Using current data on mental illness prevalence and the relation to previous climate elevations, a projection model will be developed to examine the relationship between mental health and climate change. Our projection model will stress the vitality of providing mental health resources to areas and populations, such as the elderly, farmers, and people experiencing poverty, at greater risk for crop failure, natural disasters, and disease. Additionally, we hope to emphasize how climate change may impact everyone, regardless of their location and socioeconomic status.

Clinical Pathology of Mild Traumatic Brain Injury in Veterans

Contributors: Clare Kehoe (Honors Thesis), Heather Bouchard, & Courtney Haswell

Despite increasing prevalence of mild traumatic brain injury (mTBI) in soldiers exposed to explosive forces (primary blast) in Iraq and Afghanistan, there are still large gaps in understanding both the acute and long-term neurological effects of blast exposures. Previous studies have shown degradation of white matter in patients with mTBI but there has been minimal research examining the effects of impact in the absence of clinical symptoms. This study will assess white matter integrity using diffusion tensor imaging (DTI) and magnetic resonance imaging (MRI) in previously deployed veterans with a history of primary blast exposure with and without clinical symptoms of mTBI at time of exposure. This data can confirm that brain damages can be more accurately predicted by the type of exposure rather than the symptoms the patient reports, arguing for a new approach to diagnosis that utilizes both clinical history and observable acute symptoms in addition to novel imaging-based diagnostic criteria that look below the surface at pathology.

Network Analysis of PTSD Symptomatology

Contributors: Rachel Phillips & Delin Sun

Recent work inspired by graph theory has begun to conceptualize mental disorders as networks of interacting symptoms. Posttraumatic Stress Disorder (PTSD) symptom networks have been investigated in clinical samples of military veterans, natural disaster survivors, civilian survivors of war, and child sexual abuse survivors, but not in samples with subthreshold PTSD. Despite reliable symptom interactions across reported networks, more work is needed to compare central symptoms across trauma types. Networks were estimated using regularized partial correlation models in the R-package qgraph, and robustness tests were performed with bootnet. Frequently co-occurring symptom pairs (strong network connections) emerged between both avoidance symptoms (C1:C2), hypervigilance and startle response (E3:E4), loss of interest and detachment (D5:D6), as well as detachment and restricted affect (D6:D7). With the tools implemented here, researchers can eventually help refine diagnostic criteria for PTSD, develop more accurate measures for assessing PTSD, and eventually inform targeted therapies on symptoms most likely to promote a functional recovery.

Wearable Technology for Anxiety Reduction

Contributors: Arnav Pondicherry

Arnav’s project in the Morey lab is to develop a mobile application that applies machine learning algorithms to predict anxiety from physiologic data collected by wearable sensors. The ultimate goal of the project is to deliver a psychotherapeutic intervention through the application after anxiety is detected in order to provide symptomatic relief. If successful, the project would demonstrate the utility of continuous, real-time physiologic sensing in a real-world setting.