Hyperbaric oxygen for brain injury and PTSD (contested)

Domain IX · Biomedical, neuro & digital · Shai Efrati · Israel (Tel Aviv University / Shamir Medical Center)

What it is

The proponents' theory of change (attributed, not established). The Efrati group proposes that their HBOT protocol may "activate mechanisms that repair the wounded brain tissue", including stem-cell activity and new blood-vessel formation, and reports changes in brain connectivity on imaging…

Format

• Proponents' trial evidence. Doenyas-Barak, Kutz, … Efrati (2024) randomized 63 male Israeli combat veterans with treatment-resistant PTSD and no TBI history to HBOT or sham (56 completers); they report much higher responder and remission rates with HBOT than sham, plus imaging changes; the authors…
• Inquiry (often one session or part of one): the client raises HBOT. Goal: understand their hopes, sources and stakes. Move on when you know what the client is considering and why.

Who practises it, and how they are trained or regulated

• FDA safety communication (2025). FDA warned of fires in HBOT devices causing serious injuries and deaths and urged facilities to follow manufacturer instructions, fire-safety and grounding measures, staff training and continuous patient supervision.
• Hyperbaric medicine physicians and trained chamber staff in a hyperbaric facility; FDA expects staff training and continuous supervision, and FDA recommends treatment only at accredited facilities. The psychotherapist does not prescribe, schedule or deliver HBOT.
• Version followed: US regulatory and federal positions as of October 2026 (FDA 510(k) clearance of hyperbaric chambers; FDA consumer update on unproven HBOT claims, 2013, as reported; FDA letter to health care providers, 25 August 2025; VA/DoD PTSD guideline 2023 and mTBI guideline 2021 as cited by VA and DoD; VA Community Care Clinical Determination 00075, effective 1 July 2026; DoD TBI Center of Excellence…

Evidence status, as the guide reports it

• VA/DoD PTSD guideline (2023). Does not recommend for or against HBOT for PTSD because evidence is insufficient; its Recommendation 24 lists hyperbaric oxygen therapy among somatic therapies with insufficient evidence for or against use in PTSD; the 2017 edition had said the same. Trauma-focused…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• notes implying you recommended the treatment.
• hopelessness framed as "this was my last chance".
• worsening headache, confusion or new neurological symptoms: urgent medical review.
• pursuit of repeated or escalating unproven treatments, debt, withdrawal from care.
• the client hearing only the positive or only the negative; check understanding with teach-back.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.