Dr. J. Douglas Bremner says he was fortunate to have served his residency at the National Center for Post-Traumatic Stress Disorder in New Haven, Conn., in the late 1980s. At that time, interest in post-traumatic stress disorder (PTSD) was just beginning, and Bremner — the first medical director of the first inpatient unit for PTSD at the center — became a pioneer in the field.

"The diagnosis was established in 1980 but wasn't really used until 1988," said Bremner, now director of mental health research at the Atlanta Veterans Affairs Medical Center and assistant director in the department of psychiatry and behavioral sciences at Emory University School of Medicine. "When I reviewed charts of our patients and others, I found that people had been given different treatments or none at all.

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Dr. J. Douglas Bremner is studying the effectiveness of using mindful-based stress reduction to treat post-traumatic stress disorder in veterans.

"I knew it was an important problem, and, with brain-imaging studies and other research, we've come a long way in understanding it."

Anyone who has gone through a life-threatening event can develop PTSD. The disorder has affected survivors of natural disasters, accidents and child abuse.

According to the National Center for PTSD, 12 percent to 20 percent of the soldiers returning from active duty in Iraq — and between 6 percent to 11 percent of the soldiers returning from Afghanistan — will suffer from PTSD during their lifetimes. About 30 percent of Vietnam War veterans have the condition.

Of the soldiers who have PTSD, 15 percent will have chronic symptoms that impair their ability to live and work.

Families often see symptoms — such as mood swings, depression, memory loss, anger, and alcohol and drug abuse — as character problems or personality changes, instead of as indicators of a disorder, Bremner said.

"You can't just snap out of it, as some people think. As long as the war in Iraq continues, the stress of being in battle will take its toll on some returning soldiers," he said.

Bremner believes that Veterans Affairs is doing a good job of administering mental health assessments on returning and discharged soldiers and of making sure those who show signs of PTSD get free, high-priority treatment.

"It is critical to intervene early, while the memories of combat are still malleable and the veterans still retain their social and work supports," Bremner said. "We know that, as time goes on, traumatic memories become indelible and resistant to treatment."

With the knowledge that about half of the people who recover from trauma do so by actively changing their thought processes, Bremner's research has looked at the resilience of those who recover.

"We know that certain things facilitate healing," he said. "Social support — being able to talk about their experiences whenever they need to, with family and friends who lend a sympathetic ear — helps people. We can measure that."

In the past, treatment has included antidepressants and anxiety-reducing medications (such as Paxil and Zoloft) as well as psychiatric therapy that allowed veterans to relive painful memories and learn relaxation techniques to deal with them.

"We know that medications can sometimes have unpleasant side effects and that reliving painful events can make some patients more upset," he said.

Bremner is testing a new approach to PTSD, called mindful-based stress reduction (MBSR), that has been shown to work for general anxiety problems.

"The idea is to help people focus on the here and now and live more in the present moment, instead of reliving the past or worrying about the future, which they can't control," Bremner said. "We want to give veterans more control over their thought processes."

For the eight-week MBSR study, half of the randomly selected participants (veterans ages 18 to 50 who are being discharged with two or more symptoms of PTSD) will work with an instructor trained at the Center for Mindfulness in Worcester, Mass. The instructor will teach ways to focus on present-moment experiences using techniques such as yoga and meditation.

The other group will receive conventional supportive psychotherapy. Both groups will undergo brain imaging and assessment of stress hormones before and after treatment to compare brain and hormonal responses to the intervention.

If MBSR works, Bremner hopes to give returning soldiers the skills to control their reactions to trauma without medication and before the stress from memories causes further damage. The early intervention may teach them how to cope not only with war but also with life in general.

"Consciously controlling or accepting intrusive thoughts is considered to be effective in reducing avoidance of distressing thoughts, thus increasing tolerance for those thoughts," Bremner said.

While the study won't be completed until next year, Bremner said he thinks MBSR seems to be helping.

"To me, it makes logical sense to give people something they can actively do to promote their own healing," he said.