A biologically-based treatment approach is emerging for veterans suffering from long-standing, treatment-resistant posttraumatic stress disorder (PTSD). According to a September 2025 clinical study and expert insights published in Psychiatric Times, hyperbaric oxygen therapy (HBOT) can significantly improve PTSD symptoms and restore brain function – with benefits sustained for years after treatment.
In honor of Veteran’s Day, Dr. Shai Efrati, cofounder of Aviv Clinics’ Medical Advisory Board, and Dr. Keren Doenyas-Barak, head of the PTSD program at the Sagol Center for Hyperbaric Medicine, explained how HBOT targets the underlying biological wound of PTSD rather than treating it as purely psychological.
The key lies in the “Hyperoxic–Hypoxic Paradox.” Patients inside a multiplace chamber breathe 100% oxygen at 2 atmospheres absolute (ATA), then briefly remove their mask every 20 minutes. Although oxygen levels remain well above normal, the brain perceives a sharp drop as a hypoxia signal. This triggers powerful repair pathways – neuroplasticity, stem cell migration, angiogenesis, and reduced inflammation – without causing actual oxygen deprivation. Over a 60-session protocol, the therapy restores connectivity in the fronto-limbic circuit (hippocampus, prefrontal cortex, amygdala), which advanced imaging shows is often disrupted in chronic PTSD.
In a randomized sham-controlled trial of Israeli combat veterans with chronic, treatment-resistant PTSD, HBOT produced clinically meaningful improvements: CAPS-5 scores dropped significantly across all symptom clusters (re-experiencing, avoidance, negative mood, hyperarousal), while the sham group saw no change. Many veterans who had been unable to work or maintain relationships returned to employment and social engagement. Follow-up two years later showed that gains were largely sustained; most had reduced or discontinued psychiatric medications, and the proportion stably employed or in long-term relationships nearly doubled.
Dr. Efrati and Dr. Doenyas-Barak emphasize that PTSD is “a real biological wound in the brain.” For the estimated 50% of patients who do not respond to guideline-recommended therapies, HBOT offers a new path – not as a magic bullet, but as a powerful complement to trauma-focused psychotherapy. They advise clinicians to use evidence-based protocols (60 sessions at ~2 ATA with the hyperoxic-hypoxic approach) and to prepare patients for temporary emotional turbulence as healing networks reconnect.
“The goal of treatment should be the restoration of social and occupational functioning, not merely the suppression of symptoms,” they said. “If the psychiatric community embraces both the psychological and biological dimensions of PTSD, we can significantly improve outcomes for the many patients currently labeled ‘treatment-resistant.’”