Program not currently included in IDF mental resilience unit

Computerized prevention program could lower PTSD to 1% of former combat troops

Tel Aviv University scientist says peer-reviewed research shows a fivefold reduction in symptoms among soldiers who participate in new protocol, 18 months on

A new study has found that a series of specialized computer-based training exercises can significantly reduce the risk of post-traumatic stress disorder (PTSD) among IDF combat soldiers.

The peer-reviewed study by Tel Aviv University (TAU), the IDF Medical Corps, and the US Department of Defense is one of the first PTSD prevention programs in the world that was tested and replicated in randomized controlled trials.

The research was developed by Prof. Yair Bar-Haim, professor of psychology and neuroscience at TAU and director of the National Center for Traumatic Stress and Resilience, and doctoral student Chelsea Gober Dykan.

It found that out of more than 500 soldiers, just one percent of those who participated in the attention-training program developed PTSD, compared to 5.3% in the control group — an almost fivefold reduction in risk.

“It’s a simple program that shifts a soldier’s attention towards the threat on the screen,” Bar-Haim told The Times of Israel.

The research comes as the Defense Ministry’s Rehabilitation Department reported on Monday that it has treated some 22,000 wounded soldiers since October 7, 2023, of whom some 58% are suffering from PTSD and other mental health conditions.

Bar-Haim said he believes the program works because “attention to threat is a basic mechanism in human survival.”

Surprisingly, people “who do not pay enough attention to threats are at risk for PTSD during deployment and after deployment,” he said. “When trauma hits them, they probably do not have enough attentional resources allocated to process the trauma.”

The training program was adopted by the IDF in 2018, but it was ended shortly before the outbreak of the Israel-Hamas war in October 2023.

The results recently appeared in the top-tier American Journal of Psychiatry.

Threat-related attentional bias

The research began with very large-scale studies on PTSD that Bar-Haim conducted in the IDF 17 years ago with more than 1,000 soldiers.

PTSD is a mental health condition that might develop after soldiers experience terrifying attacks, explosions, or see others injured or killed. Although they’re no longer on the battlefield, they might have flashbacks, nightmares, and a constant feeling of threat.

“We wanted to measure those who ended up developing PTSD,” Bar-Haim said.

One factor that increases PTSD is what’s known as threat-related attentional bias, when soldiers continue scanning for danger and perceiving threats even after the danger has passed.

Therefore, the scientists designed what Bar-Haim called a “computer intervention” to shift soldiers’ attention toward the danger to get them accustomed to threats. He said the intervention “manifests in the brain, in the neural systems.”

The first study, led by postdoctoral fellow Ilan Wald, was conducted in 2012 and tested the computer-based training program among some 800 soldiers in one of the IDF’s infantry brigades during their basic training and through their first deployment.

“The training is very simple, delivered on laptops and computers and takes about seven minutes per session,” Bar-Haim explained. “You need to only do it four times over separate days.”

In the first study, soldiers were shown both neutral and threatening pairs of words. In the second study, they were shown neutral and threatening faces. In both studies, targets then appeared near the images with arrows pointing to the left or right. The soldiers had to respond by pressing the relevant key on a keyboard as quickly as possible without compromising accuracy.

There were 160 repetitions per training. “It was a kind of game,” Bar-Haim said.

The process gradually trained the soldiers to direct more attention toward potential threats in their environment.

Shortly thereafter, in the summer of 2014, most of the soldiers saw combat during Israel’s Operation Protective Edge.

Four months after the fighting ended in August 2014, Bar-Haim and his team found that among those who participated in the training program, just 2.6% had PTSD compared to 7.8% of the soldiers who had not had the training, considerably reducing the risk for PTSD.

“Even though these results were promising, I was not completely convinced that it was not just by chance,” Bar-Haim said. “I felt that it needed a good replication with better control.”

Bar-Haim, along with Dykan and their research team, slightly modified the study and conducted it in 2022–2023.

Of the soldiers, one-third received the original protocol, one-third underwent a revised protocol, and the remaining third, the control group, received placebo training.

“We tried the original version of the intervention and a new version that we were hoping would be better,” Bar-Haim said.

The scientists found that 2.7% of the group that received the revised attention-training protocol had PTSD compared to 5.3% in the control group. Notably, less than 1% of troops who were given the original version this time around developed PTSD symptoms by around the 18-month mark.

“The original version is really the best one,” Bar-Haim said.

The Defense Ministry forecasted that by the end of 2026, its rehab centers will take in another 10,000 wounded veterans, most of whom will be suffering from PTSD or other mental health conditions.

The rehab department’s budget stands at NIS 8.3 billion ($2.57 billion), of which NIS 4.1 billion ($1.27 billion) is dedicated to treating those with mental health conditions, the ministry said.

In a reply to The Times of Israel, Dr. Dennis S. Charney, dean emeritus of the Icahn School of Medicine at Mount Sinai, who has done extensive research on PTSD and was not involved in the study, wrote that Bar-Haim’s research “demonstrates that attention bias modification can have robust preventative effects in reducing the effects of combat on the development of PTSD.”

Although there are no universally accepted methods to completely prevent PTSD, Charney said that Bar-Haim’s “practical method” can be integrated into a comprehensive resilience-building program.

An IDF spokesperson told The Times of Israel that over the past two years, the field of mental health in the military has “expanded following the widening of existing frameworks and the opening of significant new frameworks.”

The IDF established a mental resilience branch in March 2024, where “tools are developed and implemented to strengthen the resilience of service members,” the spokesperson said. At this time, however, Bar-Haim’s program is not included.

“There are very clear results now about the efficacy of this program,” Bar-Haim said. “The  IDF implemented it in the past, and they should implement it again.”