Multimodal Image Analysis and Guidance of Neuromodulation for Trauma-Related Symptoms

Eligibility Criteria

• * Veterans will be enrolled in this study if they:
• 1. are aged 18-80;
• 2. have a documented diagnosis of PTSD with evidence of ongoing symptoms as demonstrated by score of "31" or higher on the PCL-5, a measure of posttraumatic stress symptoms;
• 3. are fluent in English (as the neuropsychological testing tools used are only available in English) and
• 4. have been on stable doses of psychotropic medications for the past month.
• * Veterans will be excluded from participation in this study if there is:
• 1. a prior history of other neurological disease beyond mild TBI, as determined by VA/DoD criteria for TBI severity;
• 2. any history of seizures beyond immediate posttraumatic seizure or childhood febrile seizure, so as to reduce risk of exacerbation of epilepsy or other neurological symptoms;
• 3. history of a psychotic disorder, such as schizophrenia or bipolar disorder, so as to reduce risk of psychiatric decompensation;
• 4. active substance/alcohol dependence without ongoing treatment, to reduce confounding effects on diagnosis and brain imaging;
• 5. presence of any implanted electrical device (e.g., pacemaker), to reduce risk of device malfunction from rTMS;
• 6. recent medical hospitalization (within four weeks), to reduce risk of medical decompensation during the study;
• 7. any condition that would prevent the subject from completing the protocol;
• 8. appointment of a legal representative or inability to provide informed consent, to avoid coercion of a vulnerable population;
• 9. any ongoing litigation related to PTSD, TBI, disability determination, or service connection, to prevent interference with legal proceedings;
• 10. any contraindication to MRI;
• 11. pregnant women, so as to prevent complications;
• 12. membership in an identified vulnerable population, including minors and prisoners, so as to prevent coercion;
• 13. Cognitively impaired adults who lack capacity to consent.