Can Precision Psychiatry Improve PTSD Treatment?

Summary: Yes, based on the results of two recent studies, precision psychiatry has potential to improve PTSD treatment by enabling targeted treatment for distinct symptom profiles identified in people with PTSD.

Key Points:

• PTSD – post-traumatic stress disorder – is a serious mental health condition that can cause significant emotional distress and functional impairment.
• Symptoms of PTSD, which include fear-based symptoms and symptoms associated with emotional pain – can disrupt relationships and have a negative effect on family, school, work, and social life.
• Current treatment for PTSD focuses on resolving fear-based symptoms with exposure therapy, and emotional pain-based symptoms with trauma-informed psychotherapy.
• Precision psychiatry may improve PTSD treatment by identifying which symptoms create the most disturbance for PTSD patients, allowing providers to tailor treatment to specific patient needs.

Precision Psychiatry and PTSD Treatment: Symptom Profiles

In a study published in 2025 called “Dissecting Fear and Emotional Pain in Posttraumatic Stress Disorder: From Symptom Networks to Neural Signatures,” a group of researchers designed a study of two separate datasets on PTSD patients with the following goal:

“…to identify fear- and emotional pain–based PTSD symptom profiles and their neural correlates across 2 independent samples.”

This research is important for overall public health and wellness. As our awareness of trauma increases, and stigma around mental health and mental health treatment decreases, more people are willing to come forward, discuss their mental health challenges, and disclose that those challenges may be related to traumatic experiences during childhood or the recent past.

Here’s the current prevalence of PTSD among adults in the U.S., as reported by the U.S. Department of Veterans Affairs and the National Center for PTSD:

Prevalence of PTSD: Adults 18+

• PTSD diagnosis in past 12 months: 5%
• PTSD diagnosis at any time: 6%
  • Females: 8%
  • Males: 4%

In real figures, that means that 13 million people have PTSD or a recent diagnosis, and over 20 million have received a diagnosis for PTSD at some point during their lives. That means that at any given time in the U.S., millions of people work to manage symptoms of PTSD, which can include flashbacks of the event, fear of typical situations that may evoke memories of the event, and negative emotional states such as depression, anxiety, irritability, and others.

In an online interview about the PTSD study, lead researcher Ziv Ben-Zion, PhD, Yale School of Medicine, offers the following insight into PTSD symptoms and the consequences of trauma:

“For some, trauma inflicts not just fear, but a moral or existential wound, shattering beliefs about oneself, others, or the world. For others, it deepens pre-existing negative schemas, reinforcing guilt, shame, or worthlessness. These internalized and meaning-laden responses often give rise to persistent emotional pain.”

That’s where this new study can add value and potentially leverage precision psychiatry to improve PTSD treatment. When providers can identify which type of symptoms create the most distress for each PTSD patient, they can prioritize treatment for optimal results.

We’ll review the new publication, which synthesizes data from two studies, in the sections that follow. First, however, we’ll briefly discuss why improving PTSD treatment is important, and why exploring using precision to improve PTSD treatment is worth the time and effort.

Consequences of Untreated PTSD

While treatment for PTSD is not new, and effective treatment for PTSD is readily accessible and available in 2026, the PTSD experts from the Veterans Administration (VA) understand the gap between the number of people who need PTSD treatment and the number of people who receive effective PTSD treatment is large, and people attempting to manage their symptoms need to learn they can find symptom relief.

Here’s the message about PTSD treatment they want people to hear:

“Most people who have PTSD don’t get the help they need. Everyone with PTSD needs to know that effective treatments can reduce symptoms and lead to a better quality of life.”

Treatment is critical because the consequences of untreated PTSD can be severe, and may include:

• Excess fear and avoidance
• Withdrawal from daily activities
• Withdrawal from friends and family
• Low mood/depressive states
• Anger/aggression
• Suicidality
• Alcohol and drug use
• Problems with family, peer, and romantic relationships
• Problems navigating work, school, and social situations

Research on PTSD also shows the following negative physical consequences of PTSD:

• Changes in neurological structure and function
• Difficulty/chronic issues with muscles, bones, and joints
• Increased prevalence of chronic heart problems and metabolic disorders
• Increased prevalence of chronic stomach/digestive issues

With that information in mind, which foregrounds the real need for expanding our understanding of PTSD, let’s take a look at this new research.

About the Two Studies: Identifying Symptoms, Relationships, and Predicting Symptom Severity

In the first study, researchers examined responses on the PTSD Checklist for DSM-5 (PCL-5) from 838 patients with a history of trauma and probable PTSD. The PCL-5 is a standard, evidence-based metric that measures subjective experiences of fear and emotional pain. Researchers conducted statistical analyses on participant responses in order to identify primary symptom systems and assess any relationships between them.

Specific items the researchers focused on included:

• Memories
• Nightmares
• Flashbacks
• Emotional reactivity
• Physical reactivity
• Internal avoidance
• External avoidance
• Amnesia
• Negative beliefs
• Blame
• Negative emotions
• Anhedonia
• Disconnection
• Trouble with positive emotions (experiencing, expressing)
• Irritability
• Risk behavior
• Hypervigilance
• Startle
• Concentration
• Sleep

In the second study, researchers recruited 162 patients with a recent history of traumatic experiences and significant symptoms of PTSD. This second study involved three steps:

1. Researchers assessed participants with two types of functional magnetic resonance imaging scans one month after their trauma exposure:

• • • Resting-state scans
    • Scans performed during tasks

2. 14 months after the traumatic experience/trauma exposure, participants received a full PTSD-focused psychiatric assessment.
3. Researchers applied a process called connectome-based predictive modeling (CPM) to predict the severity of symptoms associated with the symptom profiles identified in the first study:

• • • One profile for fear-based symptoms
    • One profile for emotional pain symptoms

Note: CPM is the process of predicting behavioral traits from brain connectivity data.

Another researcher on the team that designed this process, which seeks to disentangle different types of PTSD symptoms from one another, observes:

“Basic science has focused for years on fear learning and safety updating, with minimal attention to the toll of other negative emotions associated with PTSD. We started thinking that fear and emotional pain are potentially driven by two different biological systems that play a critical role in defining how to tailor pharmacological and psychological treatments for PTSD.”

Let’s take a look at what they found.

Fear and Emotional Pain: Separate Sources of Impairment in PTSD

The first, top-line result was unexpected. As mentioned previously, an assumption about PTSD among treatment providers and research scientists was that fear-based symptoms drove most of the disruption and impairment in PTSD, compared to symptoms associated with emotional pain. However, here’s what the data showed:

69% of patients reported symptoms connected to emotional pain caused more impairment than symptoms connected to fear.

That outcome alone is enough for providers to consider recalibrating their overall approach to PTSD treatment, which now focuses more on managing fear than managing emotional pain.

Here’s the second major outcome of the study;

Brain networks associated with the two symptom categories – fear-based, emotional pain-based – showed quantifiable patterns of activity.

Fear was associated with the following PTSD symptoms, listed in order of strength of association:

• Flashbacks
• Nightmares
• Distressing memories
• Exaggerated startle
• External avoidance

In contrast, emotional pain was associated with these PTSD symptoms, listed in order of strength of association:

• Anhedonia
• Negative beliefs
• Negative emotions
• Sleep disturbance
• Emotional reactivity

The final component of the study was designed to determine whether connectome-based predictive modeling (CPM) could predict the severity of PTSD symptoms in the year following exposure to/experience of trauma.

Here’s what they found:

• CPM accurately predicted the severity of symptoms associated with fear.
• CPM did not accurately predict the severity of symptoms associated with emotional pain.

Brain areas and networks associated with fear in PTSD that showed predictive features included the default mode, the central executive network, the salience network, motor-sensory areas, and other subcortical networks.

Here’s how John Krystal, MD, Editor of Biological Psychiatry, the journal that published this study, characterizes these findings:

“This study identifies distinct emotional symptoms that are associated with PTSD: fear and emotional pain. These two experiences are represented by different circuits in the brain, and they are differentially associated with other PTSD symptoms. Fear was associated with increased arousal, nightmares, and intrusive trauma memories, while emotional pain was associated with depression-like symptoms and insomnia.”

We’ll discuss the implication of these results below.

The Role of Precision Psychiatry in PTSD Treatment

The current standard of care for PTSD involves a combination of trauma-informed psychotherapy, medication, education, adjunct treatments, and complementary therapies.

Psychotherapy may include prolonged exposure (PE) therapy, trauma-focused cognitive behavioral therapy (TF-CBT), and eye movement desensitization & reprocessing (EMDR) therapy. Medication may include short-term prescription of anxiolytics such as benzodiazepines, while education may include workshops on the science of trauma, relationship support, and healthy eating.

To maximize treatment results, providers may offer new and emerging treatments such as transcranial magnetic stimulation (TMS), nicotinamide adenine dinucleotide (NAD+) therapy, GeneSight® testing, as well as offer additional support with exercise therapy, stress management techniques, mindfulness, and expressive therapies like music and visual art.

Despite the wide range of effective treatments available, not everyone who receives treatment for PTSD experiences significant symptom relief. The reasons for this are difficult to identify, but it’s a phenomenon that’s not uncommon in mental health treatment. Here’s Dr. Krystal again, on how this study may help us resolve some of the ambiguity in mental health support, and the way precision psychiatry may improve PTSD treatment:

“One of the most challenging aspects of mental health care is simply and accurately characterizing the actual emotional symptoms associated with psychiatric disorders. People may use different words to describe the same experience, and they may apply the same descriptor to different experiences. Neuroimaging may provide a strategy to help to untangle this state of affairs.”

When we use neuroimaging to contribute to diagnosis and treatment in precision psychiatry, we can move toward eliminating unnecessary guesswork and replace elements of subjectivity with objective, quantifiable results that can help patients and providers develop treatment plans that address primary issues first.

In PTSD treatment, this may mean prioritizing exposure therapy over behavioral therapy for patients with a fear symptom profile, and prioritizing behavioral therapy over exposure therapy for patients with an emotional pain symptom profile.

Those are two basic examples related to PTSD. In the future, precision psychiatry may allow us to apply a similar process – less guesswork, more quantifiable data – to the treatment of patients with other mental health disorders, such as major depressive disorder (MDD), anxiety, bipolar disorder, and schizophrenia.