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Israel’s HBOT Therapy for PTSD Is Changing Lives, Could Reshape Global Care
A treatment once associated with divers is now helping trauma survivors reclaim memory, sleep, and stability
By Maayan Hoffman/The Media Line
Sarah (name changed) served for more than 20 years in the Israeli Air Force as a combat medic. During that time, she took part in high-level missions that exposed her to extreme situations—from watching people be blown apart to treating the wounded under fire.
In one particularly horrific moment, she was asked to pull apart the body of a mother clinging to her two severely burned children.
Those images stayed with her long after the missions ended. But it was only after she retired that the symptoms of post-traumatic stress disorder (PTSD) began to surface.
In the years that followed, Sarah trained as a nurse practitioner and joined an intensive care unit. The high-pressure environment appears to have triggered the delayed onset of her PTSD, bringing it fully to the surface.
Suddenly, Sarah, now a mother, struggled with basic daily tasks. She became irritable, her morale dropped, and she described an overwhelming sense of shame. She stopped eating meat because she could not bring herself to pull chicken off the bone. She began experiencing flashbacks and nightmares, especially of the burned children. She also suffered from mild depression, severe anxiety, sleep disturbances, and heightened hyperarousal.
Eventually, she was forced to leave her job, and her husband pushed her to seek help. She tried talk therapy and selective serotonin reuptake inhibitors, but neither provided relief. At 60 years old, she was referred to the Aviv Clinic with what had become treatment-resistant PTSD.
Sarah was offered hyperbaric oxygen therapy, or HBOT. According to her case, published in 2024 by an Israeli medical team in Annals of Case Reports, her nightmares stopped during the course of treatment, and she began to recall happier memories from earlier in her life.
Over time, she reported a growing sense of peace. Three months after completing HBOT, evaluations showed a significant reduction in anxiety and self-blame. Clinical assessments also demonstrated marked improvement. On the PTSD scale known as CAPS-5, her score dropped from 34 to 10, reflecting fewer intrusions, less avoidance, and reduced hyperarousal.
The authors also found that her cognitive flexibility improved, enabling her to adapt to changing demands and suppress habitual responses.
Brain imaging comparing pre- and post-treatment scans showed notable changes, including increased activity in the frontal, parietal, and temporal regions. These changes were associated with improvements in working memory, coordination, attention, and language comprehension.
A growing body of research points to the high prevalence of PTSD among military personnel, with some studies suggesting it affects up to 30% of veterans who were engaged in combat experience worldwide, according to a report published in JAMA Psychiatry in 2015.
PTSD is typically treated with psychological therapies and medications, including cognitive behavioral therapy (CBT). However, a 2013 report in Advances in Psychiatric Treatment found that about one-third of people with PTSD do not respond to standard treatments, and as many as 50% show resistance specifically to CBT.
Data collected by the Israel Defense Forces Unit for Treatment of Combat-Related PTSD paints a similarly concerning picture. Their findings indicate that only 39% of patients experience significant clinical improvement using conventional approaches.
Against this backdrop, researchers are increasingly looking at what is happening inside the brain.
Dr. Keren Doenyas-Barak, who heads the Post-Traumatic Stress Disorder Unit at Shamir Medical Center, said there is mounting evidence that trauma causes physical changes in the brain. These changes are mainly observed in the frontolimbic circuit and can lead to long-term alterations in both brain structure and function. Trauma has also been linked to a reduction in hippocampal activity and even in its volume, which may help explain why some patients respond poorly to existing treatments.
This has led to a shift in thinking. If PTSD is rooted, at least in part, in physical damage to the brain, then repairing that damage and restoring normal function could offer a more effective path forward.
HBOT has already shown promise in treating other conditions involving disrupted brain structure and function, including stroke, traumatic brain injury, and fibromyalgia, Doenyas-Barak said.
In her own research, she has demonstrated that HBOT can promote neuroplasticity and reduce PTSD symptoms, particularly among military veterans.
“Hyperbaric oxygen therapy is not a new technology,” Doenyas-Barak told The Media Line. But the protocols being used in Israel are distinct.
She explained that HBOT has been around for about 100 years and was initially used to treat decompression sickness and air embolism, a potentially fatal condition in which air or gas bubbles enter the bloodstream, often following surgery and diving accidents.
“While historically we used hyperbaric treatment for these urgent indications, we are now familiar with its role in regenerative medicine,” Doenyas-Barak explained, comparing the HBOT chamber to a pressurized vessel in which a person sits.
Professor Shai Efrati, the founder and director of the Sagol Center for Hyperbaric Medicine and Research at Shamir Medical Center, developed the HBOT protocols for regenerative medicine.
“We can increase the pressure from the pressure in which we sit right now, which is 1 atmosphere, to a higher pressure; we usually use the pressure of 2 atmospheres, and increase the amount of oxygen in the blood,” Doenyas-Barak said.
In simple terms, the amount of gas that dissolves in a liquid is directly related to the pressure applied to it. When pressure increases, more oxygen can dissolve into the blood. For example, if pressure is doubled and a patient breathes a high concentration of oxygen, the amount of oxygen dissolved in the blood can increase dramatically.
Under normal conditions, most oxygen is carried by red blood cells. Inside the chamber, however, oxygen can dissolve more readily into plasma and reach tissues that might otherwise receive less oxygen, accelerating healing, fighting infection, and helping the body rebuild damaged areas more efficiently.
Another key effect is the fluctuation in oxygen levels. During treatment, oxygen levels rise significantly and then return to normal. When this cycle is repeated multiple times, it creates what researchers call “relative hypoxia,” a process shown to trigger regenerative responses in the body.
A specialized protocol is now being used not only for veterans with PTSD referred by the Ministry of Defense in Israel but also, with support from Jewish philanthropic donors, for civilians who were affected by the events of October 7. At Doenyas-Barak’s clinic at Shamir Medical Center, patients undergo 60 sessions over 60 days. During each session, they enter the chamber, breathe 100% oxygen through a mask for 20 minutes, and then remove the mask. 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 very 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.”
She noted that this approach was originally used to treat non-healing diabetic ulcers. Patients would enter the chamber, and wounds that had not healed for months would often recover within weeks. At Shamir, the team adapted the same biological mechanisms to target brain injuries.
“We know today that post-traumatic stress disorder is associated with long-lasting or very chronic changes in brain activity and even structure,” Doenyas-Barak reiterated. “By using hyperbaric treatment, we can activate the malfunctioning brain regions and contribute to their recovery.”
Doenyas-Barak and her team began researching this approach in 2017, well before the October 7 Hamas massacre, but after years of conflict on multiple fronts. Their initial study involved 35 veterans with persistent PTSD who had not responded to psychotherapy or medication. After undergoing the protocol, participants showed, as she described it, “significant improvement of symptoms and activation of the malfunctioning brain regions.”
That early work led to additional studies, including a placebo-controlled trial completed shortly before the October 7 attacks. The findings, later published in the Journal of Clinical Psychiatry in November 2024, showed that the Israeli HBOT protocol “may induce neuroplasticity and improve clinical symptoms of patients suffering from PTSD.”
The study focused on male veterans aged 25 to 60 with CAPS-5 scores above 20. CAPS-5 is the Clinician-Administered PTSD Scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. CAPS-5 evaluates four main PTSD symptom clusters: intrusion, avoidance, Negative changes in mood and thinking, and Arousal and reactivity. While there is no strict cut-off, a CAPS-5 score of 25–30 or higher is often used as a research cutoff suggesting likely PTSD.
Participants were randomly assigned to either HBOT or a sham intervention. Both groups completed 60 daily sessions lasting 90 minutes. The HBOT group received 100% oxygen at 2 atmospheres absolute, while the control group received 21% oxygen at 1.02 atmospheres, with five-minute air breaks every 20 minutes.
Resting-state functional MRI was used to assess brain function before and after treatment. The study, spanning more than three years, ultimately included 56 veterans. Those who received HBOT showed a significant drop in CAPS-5 scores, from 42.57 at baseline to 25.8 immediately after treatment and 25.08 at follow-up. In contrast, the control group saw their scores rise, reaching 47.75 after treatment and 49.22 at follow-up.
The imaging data also showed improved connectivity across the brain’s main networks in the HBOT group, a change that was not observed in the control group.
When the October 7 war began, the Shamir team had funding from the Ministry of Defense to treat veterans, but no framework was in place for civilians suffering trauma. Garnering philanthropic support, within a short time, they scaled up treatment for hundreds of civilians, including survivors from Gaza border communities and the Nova music festival. The clinic expanded from treating around 50 patients at a time to groups of 200 every 60 days, reaching about 800 people per year so far, with plans to grow annually.
Doenyas-Barak noted that the protocol has now been validated by both the Ministry of Health and the Ministry of Defense, allowing her center to treat multiple cohorts across Israel. Her next goal is to bring the model to a global stage.
She emphasized that the protocol alone does not set the program apart. The surrounding care is critical, ensuring patients remain safe, supported, and able to complete treatment. Success depends heavily on the system built around the therapy.
That system includes psychotherapy, social workers, trauma-focused yoga, and physiologists who incorporate movement and sports-based approaches. Around 50 staff members support the program at Shamir.
Looking ahead, Doenyas-Barak is leading a broader study aimed at identifying biological markers for PTSD. The goal is to move beyond subjective diagnosis and toward measurable indicators using MRI and other tools.
“Today, we diagnose PTSD based on what the patient reports and based on our impressions. It is very subjective,” Doenyas-Barak explained. “If we can characterize new biomarkers, that will enable objective diagnosis of people.”
She said there are already clear differences visible in brain scans and in autonomic nervous system activity between individuals with and without PTSD, and added that using these differences and state-of-the-art analysis methods, doctors will eventually be able to use objective measures for the diagnosis of PTSD.
“To take this to the individual level, we are not there yet,” Doenyas-Barak admitted. However, she added that she is optimistic that “we will get there.”
This report is part of Traumatech, a series developed and created by Maayan Hoffman and debuting on The Media Line. The series explores how Israel is building and exporting breakthrough mental health technologies that can transform life at home and bring hope to communities worldwide.
Photo: Hyperbaric treatment at Shamir Medical Center. (Screenshot: YouTube)
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