Latest information on COVID-19
Support teaching, research, and patient care.
Debra Kaysen received her PhD in Clinical Psychology from the University of Missouri. She completed an internship at the University of Washington and continued there to complete an NIAAA-funded F32 to study the area of overlap between PTSD and alcohol use disorders. Dr. Kaysen joined the faculty at University of Washington in 2006 in the Department of Psychiatry and Behavioral Sciences. While there she founded a program to develop and test more accessible interventions for individuals suffering from mental health symptoms following traumatic events. Dr. Kaysen joined the Stanford faculty in 2019. Dr. Kaysen’s area of specialty both in research and clinical work is in treatment for those who have experienced traumatic events including treatment of PTSD and related disorders. She has conducted critical studies on treatment of PTSD and/or substance use across a variety of populations (sexual minority women, Native Americans, sexual assault survivors, torture survivors, active duty military) and in a variety of settings (the Democratic Republic of Congo, Iraq, primary care, rural settings). Other research conducted by Dr. Kaysen have focused on increasing our understanding of how PTSD and substance use may influence each other. Dr. Kaysen is currently the Immediate Past-President of the International Society for Traumatic Stress Studies (www.istss.org). Her research has been funded by the National Institute of Alcohol Abuse and Alcoholism, the National Institute of Drug Abuse, the National Institute on Minority Health and Health Disparities, the Department of Defense, PCORI, and USAID.Dr. Kaysen is currently involved in helping develop and implement coping strategies for healthcare workers dealing with mental health concerns related to COVID-19. Dr. Kaysen's clinical work has been featured on This American Life (https://www.thisamericanlife.org/682/ten-sessions).
The unprecedented impact of COVID-19 on frontline healthcare workers has led to increased distress and mental health concerns among those most affected by workplace demands. Based on the scope of the problem, healthcare workers need more accessible approaches to improving their mental well-being, where and when healthcare workers need them. In addition, people’s needs change over time, and they need tools that adapt based on how the healthcare worker engages with the material, and whether their concerns and symptoms improve based on their use of those resources. Through generous support from philanthropic donors, faculty from Stanford and other institutions have been able to create a digital mental health platform (Take a Moment) that uses individual goals and symptoms over time to deliver adaptive tools to address the mental health needs of frontline healthcare workers affected by the stress of the COVID-19 pandemic. This project is led by Drs. Kaysen and Wiltsey Stirman.
The major goals for this project are compare outcomes among patients randomized to initially receive pharmacotherapy or brief psychotherapy; compare outcomes among patients randomized to treatment sequences (i.e., switching and augmenting) for patients who do not respond to the initial treatment; and examine variation in treatment outcomes among different subgroups of patients
The present research proposes to develop and evaluate a brief motivational interviewing intervention designed to increase treatment-seeking among military personnel with untreated PTSD.
PTSD, substance use
University of Washington
IMA WorldHealth, Johns Hopkins, University of Washington
Sexual assault survivors
Much of my current research focus is on the development of testing of accessible, scaleable, and effective treatments for trauma-related disorders and related comorbidities (e.g. substance use disorders, HIV, mood disorders). This work has focused on addressing trauma-related disorders especially in underserved populations and settings. This includes research in rural communities, with Native American communities, and with sexual minorities. My research has had a strong impact on building an evidence base on adaptations of psychotherapies for PTSD and substance use disorders for diverse populations both within and outside the United States. Our findings demonstrate that complex cognitive behavioral psychotherapies like Cognitive Processing Therapy can be culturally adapted and delivered in challenging settings (conflict settings, high poverty environments) with significant and lasting change in PTSD, depression, and functioning. This has led to work adapting CPT for diverse populations within the United States (rural Native Americans, urban Latinos) and outside of it (Iraq, DRC). Other research has focused on treatment for PTSD/SUD. My research has also found support for the use of brief telehealth interventions to build treatment engagement and to reduce drinking among trauma-exposed populations. In addition, my work has been critical in testing the feasibility of novel trauma-focused interventions for use by those with PTSD and SUD, thus paving the road for more rigorous research studies.<br/><br/>Current PI'ed research studies include: 1) developing and evaluating a brief motivational interviewing intervention designed to increase treatment-seeking among military personnel with untreated PTSD; a two-arm randomized comparative effectiveness trial to evaluate prevention of HIV/STI sexual risk behavior by addressing PTSD through Narrative Exposure Therapy or substance use through Motivational Interviewing among Native American men and women with PTSD; and 3) a comparison of outcomes among patients randomized to initially receive pharmacotherapy or Written Exposure Therapy delivered in primary care as well as comparing outcomes among patients randomized to treatment sequences (i.e., switching and augmenting) for patients who do not respond to the initial treatment.
Sequence of Symptom Change During AUD or PTSD Treatment for Comorbid PTSD/AUD
The broad, long-term objective of the current research is to improve treatment outcomes for
individuals with comorbid posttraumatic stress disorder (PTSD) and alcohol abuse and
The purpose of which is to evaluate changes in both PTSD symptoms and alcohol use and
cravings associated with Cognitive Processing Therapy (CPT) or Relapse Prevention (RP)
treatment in individuals with PTSD/AUD, along with mediators and moderators of outcomes.
The study will randomize 235 PTSD/AUD participants recruited from the VA and from the
community to CPT, RP, or Interactive Voice Response (IVR) assessment only (AO). Those in the
AO condition will be re-randomized after the treatment phase to either RP or CPT. Individuals
will be assessed pretreatment, immediately post-treatment, 3-, 6-, 9-, and 12-months
post-treatment and will monitor symptoms daily throughout treatment.
Stanford is currently not accepting patients for this trial.
For more information, please contact SPECTRUM, .
View full details
Study to Promote Innovation in Rural Integrated Telepsychiatry
Background: Community Health Centers care for over 20 million rural, low income and minority
Americans every year. Patients often have complex mental health problems such as
Posttraumatic Stress Disorder (PTSD) and Bipolar Disorder. However, Community Health Centers
located in rural areas face substantial challenges to managing these patients due to lack of
onsite mental health specialists, stigma and poor geographic access to specialty mental
health services in the community. As a consequence, many rural primary care providers feel
obligated, yet unprepared, to manage these disorders, and many patients receive inadequate
treatment and continue to struggle with their symptoms. While integrated care models and
telepsychiatry referral models are both promising approaches to managing patients with
complex mental health problems in rural primary care settings, there have been no studies
comparing which approach is more effective for which types of patients. Objectives: The
central question examined by this study is whether it is better for offsite mental health
specialists to support primary care providers' treatment of patients with PTSD and Bipolar
Disorder through an integrated care model or to use telemedicine technology to facilitate
referrals to offsite mental health specialists. We hypothesize that patients randomized to
integrated care will have better outcomes than patients randomized to referral care. Methods:
1,000 primary care patients screening positive for PTSD or Bipolar Disorder will be recruited
from Community Health Centers in three states (Arkansas, Michigan and Washington) and
randomized to the integrated care model or the referral model. Patient Outcomes: Telephone
surveys will be administered to patients at enrollment and at 6 and 12 month follow-ups.
Telephone surveys will measure access to care, therapeutic alliance with providers,
patient-centeredness, patient activation, satisfaction with care, appointment attendance,
medication adherence, self-reported clinical symptoms, medication side-effects, health
related quality of life, and progress towards life goals. A sub-sample of patients will be
invited to participate in qualitative interviews to describe their treatment experience using
their own words. Likewise, primary care providers will be invited to participate in
qualitative interviews to voice their perspective.
Understanding and Testing Recovery Processes for PTSD and Alcohol Use Following Sexual Assault
Sexual assault can lead to devastating consequences including the development of chronic
conditions including posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD).
Interventions delivered soon after exposure to assault can decrease the long-term negative
consequences of sexual assault but existing interventions are limited in their ability to
target concurrent PTSD symptoms and alcohol use and little is known about how to make best
practice treatment decisions in the early period following sexual assault. A greater emphasis
on transdiagnostic processes that are related to both PTSD and alcohol use, such as fear and
reward systems, can elucidate mechanisms of recovery, lead to the development of more
effective intervention approaches, and guide clinical decision making for patients recently
exposed to sexual assault.
Sequenced Treatment Effectiveness for Posttraumatic Stress
Individuals with PTSD are more likely to engage in unhealthy behaviors such as tobacco use,
drug use, alcohol misuse, and have high rates of morbidity/mortality. PTSD negatively impacts
marriages, educational attainment, and occupational functioning. Some patients with PTSD can
be successfully referred to specialty mental health clinics, but most patients with PTSD
cannot engage in specialty care because of geographical, financial and cultural barriers and
must be treated in primary care. However, policy makers do not know the best way to treat
PTSD in primary care clinics, especially for patients who do not respond to the initial
treatment choice. There are effective treatments for PTSD that are feasible to deliver in
primary care. These treatments include commonly prescribed antidepressants and brief
exposure-based therapies. However, because there are no head-to-head comparisons between
pharmacotherapy and psychotherapy in primary care settings, primary care providers do not
know which treatments to recommend to their patients. In addition, despite high treatment
non-response rates, very few studies have examined which treatment should be recommend next
when patients do not respond well to the first, and no such studies have been conducted in
primary care settings.
This trial will be conducted in Federally Qualified Health Centers and VA Medical Centers,
where the prevalence of both past trauma exposure and PTSD are particularly high. The
investigators will enroll 1,400 primary care patients. The investigators propose to 1)
compare outcomes among patients randomized to initially receive pharmacotherapy or brief
psychotherapy, 2) compare outcomes among patients randomized to treatment sequences (i.e.,
switching and augmenting) for patients not responding to the initial treatment and 3) examine
variation in treatment outcomes among different subgroups of patients. Telephone and web
surveys will be used to assessed outcomes important to patients, like self-reported symptom
burden, side-effects, health related quality of life, and recovery outcomes, at baseline, 3
and 6 months. Results will help patients and primary care providers choose which treatment to
try first and which treatment to try second if the first is not effective.
Tools for Health and Resilience Implemented After Violence Exposure (Project THRIVE)
Sexual assault victimization is a common and particularly harmful form of trauma that is
associated with increased risk for high-risk drinking and other conditions of public health
concern, such as PTSD. Given evidence that sexual assault survivors who have low social
support or receive negative social reactions to sexual assault disclosure are more likely to
experience PTSD and drinking problems, improving social support is a novel target for
intervention. The proposed study will attempt to prevent the onset of high-risk drinking and
PTSD in sexual assault survivors by developing and testing a web-based early intervention
aimed at increasing contact with social supporters and mitigating the harm of negative social
reactions; ultimately, results will contribute to advancing the field's understanding of the
potential for social support to mitigate the harm of trauma.
Cognitive Processing Intervention for Trauma, HIV/STI Risks, and Substance Use Among Native Women
Many American Indian (AI) women never receive services for serious mental health problems
resulting from traumatic events, violence exposure and maltreatment. AI women suffer higher
lifetime rates of Post-traumatic Stress Disorder (PTSD) (20-23%), that often co-occur with
excessive drinking and risky sexual behaviors. These factors magnify risk for human
immunodeficiency virus and sexually transmitted disease (HIV/STI). In full development with
tribal partners, this application, proposes a 3-year project to culturally adapt and pilot an
empirically supported trauma-focused treatment, Cognitive Processing Therapy (CPT) for PTSD,
substance use and HIV/STI sexual risk behavior among 50 AI women. Additionally, the
investigators will assess the feasibility, acceptability and treatment fidelity of delivering
CPT via AI community health workers in a resource-limited tribal reservation. This project
brings a culturally responsive intervention to an understudied and highly vulnerable
population. Its significance lies in its potential to advance science in the area of PTSD,
substance use treatment and HIV/STI prevention among AI women. Study data would benefit
tribal and rural communities and the mental health field. Finally, it is geared toward
developing the research infrastructure and mental health treatment capacity serving AI women
living in rural settings, a group at risk for an expanding HIV/AIDS epidemic. If successful,
findings from this pilot will provide evidence for a larger effectiveness trial.
The AIMS are AIM I. Adapt the evidence-based CPT intervention in full collaboration with
tribal partners. This will be done in accordance with the CDC's Map of Adaptation Process and
involves formative research with tribal leaders, potential consumers, providers, and health
care administrators using qualitative methodology.
AIM 2. Assess this intervention delivered by Native American community health workers for
feasibility and acceptability in a resource-limited rural reservation setting.
AIM 3. Conduct a two-group, single-site waitlist randomized controlled pilot trial of a
12-session, 6-week CPT intervention among 56 (6 pilot) sexually active and substance using AI
women with PTSD or sub-threshold PTSD. Determine preliminary efficacy and estimate an effect
size in terms of three primary outcomes: (a) PTSD symptomatology; (b) substance use; (c) high
risk sexual behavior.
Preventing HIV Among Native Americans Through the Treatment PTSD & Substance Use
Investigators will conduct a two-arm, comparative effectiveness randomized controlled trial
of two culturally adapted, empirically based programs (EBP) - Narrative Exposure Therapy
(NET) vs. Motivational Interviewing with Skills Training (MIST) in terms of lowering HIV
sexual-risk behaviors (HSB) for American Indian / Alaska Native (AIAN) men and women. NET
addresses Posttraumatic Stress Disorder (PTSD) as a pathway to preventing substance use
disorders (SUD) and HSB whereas MIST addresses substance misuse as a way of preventing SUD
Efficacy Trial of Stress Check-Up
Untreated posttraumatic stress disorder (PTSD) is associated with high societal and
individual costs. Effective interventions for symptoms of posttraumatic stress (PTS) exist
but are underutilized by those who could benefit, especially among active duty military. This
study will develop and test a brief telephone-delivered motivational enhancement intervention
(MET) for military personnel (active, reserve, or national guard) serving in the Army, Air
Force, or Navy who are experiencing symptoms of PTS, but who are not currently engaged in PTS
treatment. The goal of the intervention is to decrease stigma around seeking care, increase
knowledge about treatment options, increase engagement in help-seeking behavior, all leading
to reductions in PTS symptoms.