For Sarah, a retired combat medic who served over two decades in the Israeli Air Force, the ghosts of war did not arrive immediately. For years, she carried the memory of high-level missions and the visceral trauma of treating the wounded under fire. It was only after her retirement and while working as a nurse practitioner in a high-pressure intensive care unit, that her post-traumatic stress disorder (PTSD) fully surfaced.
The onset was debilitating. Sarah struggled with basic daily tasks, plagued by severe anxiety, sleep disturbances, and flashbacks of burned children. The trauma manifested in physical avoidance; she stopped eating meat because the act of pulling chicken off a bone triggered distressing memories. Despite trying talk therapy and selective serotonin reuptake inhibitors, she found herself in the category of patients with treatment-resistant PTSD.
At 60 years old, Sarah was referred to the Aviv Clinic for hyperbaric oxygen therapy (HBOT). According to a 2024 case study published in Annals of Case Reports, the results were transformative. Her nightmares ceased, and her CAPS-5 score—a clinical scale used to measure PTSD severity—dropped from 34 to 10. Brain imaging later revealed increased activity in the frontal, parietal, and temporal regions, correlating with improved working memory and cognitive flexibility.
Sarah’s recovery is part of a broader shift in how medical professionals are approaching trauma. By treating Israel’s HBOT therapy for PTSD not as a psychological ailment but as a physical brain injury, researchers are opening new doors for the millions of veterans and civilians worldwide who do not respond to conventional care.
Addressing the Physical Root of Trauma
The traditional approach to PTSD relies heavily on cognitive behavioral therapy (CBT) and medication. However, these methods often hit a ceiling. A 2013 report in Advances in Psychiatric Treatment noted that roughly one-third of patients do not respond to standard treatments, with up to 50% showing resistance specifically to CBT. In Israel, data from the IDF Unit for Treatment of Combat-Related PTSD suggests that only Israeli Defense Forces patients experience significant clinical improvement using conventional approaches.
Dr. Keren Doenyas-Barak, head of the Post-Traumatic Stress Disorder Unit at Shamir Medical Center, argues that the reason for this resistance lies in the physical architecture of the brain. Trauma can cause long-term alterations in the frontolimbic circuit and a reduction in the volume and activity of the hippocampus.
If PTSD is rooted in physical damage, the solution may be regenerative. HBOT, which has long been used to treat decompression sickness in divers and non-healing diabetic ulcers, is being repurposed to “restart” malfunctioning regions of the brain. By increasing the amount of oxygen dissolved in the blood plasma, the therapy allows oxygen to reach damaged tissues that red blood cells might otherwise bypass.
The Science of the ‘Oxygen Fluctuation’ Protocol
The Israeli protocol, developed by Professor Shai Efrati at the Sagol Center for Hyperbaric Medicine and Research, differs from standard HBOT in its delivery. Rather than a steady stream of oxygen, the treatment relies on a cycle of “relative hypoxia” to trigger the body’s repairing mechanisms.
Patients undergo a rigorous 60-day regimen consisting of 60 daily sessions. Each 90-minute session involves entering a pressurized chamber—typically set to 2 atmospheres—and breathing 100% oxygen through a mask for 20 minutes, followed by a break where the mask is removed. This cycle is repeated four times per session.
“We cause a fluctuation in oxygen level in each of our cells,” Doenyas-Barak explained. “We are moving from a remarkably high level of oxygen back to normal. … This generates repairing mechanisms, and these mechanisms can contribute to better healing of any wound that needs to be healed.”
The efficacy of this method was tested in a placebo-controlled trial published in the Journal of Clinical Psychiatry in November 2024. The study followed 56 male veterans. Those receiving the active HBOT treatment saw their average CAPS-5 scores drop from 42.57 to 25.08 by the follow-up period. Conversely, the control group, which received a “sham” treatment of 21% oxygen at lower pressure, saw their scores actually increase to 49.22.
Comparison of Treatment Outcomes (HBOT vs. Control)
| Group | Baseline CAPS-5 Score | Post-Treatment Score | Follow-up Score |
|---|---|---|---|
| HBOT Group | 42.57 | 25.8 | 25.08 |
| Control Group | 42.57 (Avg) | 47.75 | 49.22 |
Scaling Care from Veterans to Civilians
While the research began in 2017 focusing on military personnel, the events of October 7 brought an urgent require to expand these services to civilians. Through philanthropic support, the Shamir Medical Center scaled its operations to treat survivors from Gaza border communities and the Nova music festival.
The clinic expanded its capacity from treating 50 patients at a time to cohorts of 200 every 60 days, aiming to reach approximately 800 people per year. This expansion was supported by validation from both the Israeli Ministry of Health and the Ministry of Defense.
However, Doenyas-Barak emphasizes that the oxygen chamber is not a standalone cure. The “system” surrounding the therapy is what ensures stability. The comprehensive care model at Shamir includes:
- Psychotherapy and social work support.
- Trauma-focused yoga.
- Physiological movement and sports-based interventions.
- A support staff of approximately 50 professionals.
The Future: Moving Toward Objective Diagnosis
The ultimate goal for the team at Shamir is to remove the subjectivity from PTSD diagnosis. Currently, diagnosis relies on patient self-reporting and clinician impressions. Doenyas-Barak is now leading research to identify biological markers—measurable indicators via MRI and autonomic nervous system activity—that could allow doctors to diagnose PTSD objectively.
While the ability to diagnose individuals based on these biomarkers is not yet fully realized, the progress in neuroplasticity suggests that the biological “scars” of trauma can be treated as physical injuries, potentially reshaping global standards of psychiatric care.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Please consult a healthcare professional for the diagnosis and treatment of PTSD.
If you or a loved one are struggling with trauma, help is available. In the U.S., you can call or text the 988 Suicide & Crisis Lifeline. International resources can be found via the Befrienders Worldwide network.
The research team continues to analyze data from their current cohorts to refine the global model for regenerative trauma care. We invite you to share your thoughts or experiences with emerging mental health technologies in the comments below.
