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In May of this year, a group of past presidents of the International Society for Traumatic Stress Studies, the European Society for Traumatic Stress Studies, and the Korean Society for Traumatic Stress Studies, along with more than forty other researchers and clinicians from over a dozen countries, published an editorial in the European Journal of Psychotraumatology that I think every trauma therapist should read. The piece is titled, with the kind of understatement that academic publishing encourages, “Experts in traumatic stress are concerned about global impact of what is happening in U.S.” (Cook et al., 2025). It is a warning. The current U.S. administration’s decisions, the authors argue, are already increasing exposure to trauma worldwide, reducing access to care, and dismantling the research infrastructure that the field has relied on for decades.
I have been thinking about it ever since.
Not because the political commentary surprised me. The cuts to USAID, the withdrawal from the World Health Organization, the $2.3 billion in terminated NIH grants, the layoffs at SAMHSA, the restrictions on what researchers can say about sex and gender, the threats to Department of Veterans Affairs research programs, all of this has been reported exhaustively in the general press. What the editorial does, and what I think has not been reckoned with adequately in our own field, is lay out what those changes mean specifically for the science and practice of trauma treatment. The editorial’s authors are not pundits. They are the people who have spent their careers building the evidence base we now take for granted. When they say the field is in trouble, it is worth stopping to consider what that means for those of us who treat clients every week.
It is also worth considering honestly, because the trauma field has not always been disciplined about its relationship with evidence. I have written before about how popular modalities have outpaced their research support, how the cultural appetite for trauma content has created a marketplace that rewards resonance over rigor, and how the line between what we can demonstrate and what we can narrate has blurred in ways that hurt clients. Those problems are real, and they are internal to the field. What Cook and colleagues describe is something different, and in some ways more alarming. It is the weakening of the very institutions that would, in a healthier ecosystem, correct the drift.
Most therapists, myself included, came to trauma work through a clinical door rather than a research one. We learned the modalities we practice because we studied them, were trained in them, were supervised in them. Behind each of those modalities, though, is a long chain of studies that someone funded, conducted, peer-reviewed, and published. That chain is not a natural feature of the landscape. It is built, deliberately and at considerable public expense, by a small set of institutions. In the United States, the most significant of those institutions are the National Institutes of Health, the Department of Veterans Affairs, and a handful of federally supported academic medical centers. Internationally, bodies like the World Health Organization and bilateral aid programs like USAID have played a complementary role, particularly in low and middle income countries where the majority of the global mental health burden actually sits (World Health Organization, 2024).
What Cook and colleagues document is a rapid and coordinated weakening of this infrastructure. At the time of their writing, roughly 800 NIH research projects representing $2.3 billion had been terminated (Cook et al., 2025). Grants addressing violence against sexual and gender minorities, women, and people of color have been specifically targeted for cancellation under the rationale that they “no longer effectuate agency priorities.” Several former VA leaders have published an opinion piece in JAMA Internal Medicine warning that cuts to VA biomedical research are “counterproductive and wasteful” (Fihn et al., 2025). The VA, for context, is one of the most prolific producers of rigorous trauma research in the world. The prolonged exposure protocol that most of us know, the cognitive processing therapy that is now considered a first line treatment for PTSD, the dissemination science that shaped how evidence based treatments get implemented in real clinics, all of it has VA fingerprints on it.
None of this is abstract. If you have a client who is a veteran, the treatment protocols your clinician is using were almost certainly refined at a VA research site. If you practice EMDR or CPT or PE or STAIR, you are benefiting from decades of NIH funded work. If you read WHO trauma guidelines, you are standing on the shoulders of international coordination that took years to build. When the funding for this kind of work is withdrawn, the effects do not appear immediately. They appear five and ten years from now, as the protocols we currently rely on age out without successors, as the research pipeline for new treatments thins, as the graduate students who would have become the next generation of trauma researchers choose other fields. What Cook and colleagues are describing is a slow motion injury to the field that will show up in clinical practice long after the administration that caused it has left office.
The decision to terminate USAID has, by many accounts, been catastrophic for global health (Rilkoff, 2025). USAID was among the largest aid agencies in the world and has historically supported food security, disaster relief, conflict mitigation, and mental health programming in more than a hundred countries. Much of the trauma related work it funded happened in places where rates of exposure to war, gender based violence, displacement, and community level adversity are orders of magnitude higher than anything we see in U.S. outpatient practice. A 2016 study in Psychological Medicine estimated that more than 70 percent of people worldwide will experience a potentially traumatic event in their lifetime, with the highest burden falling on populations in low and middle income countries (Benjet et al., 2016). The programs USAID supported were, in many cases, the only mental health infrastructure available to those populations.
It is tempting, as a U.S. based clinician, to view this as a distant problem. I want to push back on that instinct. Trauma science is global in a way that many other medical sciences are not. A disproportionate amount of what we understand about complex trauma, war related PTSD, refugee mental health, and intergenerational transmission of trauma has come from collaborations between U.S. researchers and international colleagues whose work has been either directly funded or indirectly supported by these now dismantled programs. The field’s understanding of culturally adapted interventions, which are essential to treating the increasingly diverse populations arriving in U.S. clinics, depends on research done outside the U.S. The withdrawal from the WHO, similarly, removes the U.S. from the primary international body that coordinates treatment guidelines, training materials, and gender based violence frameworks. It is not an exaggeration to say that the flow of knowledge into U.S. trauma practice has been partly severed.
There is also a more immediate domestic consequence. Cook and colleagues note that layoffs at the Health Resources and Services Administration and the Substance Abuse and Mental Health Services Administration, combined with major cuts to the programs those agencies oversee, will directly reduce access to care. Previous research on mass layoffs in the private sector shows associations with increased mental health utilization, medication use, and suicidal behavior among affected workers (Classen & Dunn, 2012; Elser et al., 2019). What the federal workforce is currently experiencing, and what the communities served by these agencies are experiencing, is a large scale reduction in exactly the kinds of services that mitigate trauma and its sequelae. Rural patients, veterans seeking mental health care outside the VA, community health centers operating in marginalized communities, and trauma survivors relying on state contracts funded through SAMHSA will all feel the narrowing.
One of the more specific and clinically consequential changes Cook and colleagues flag is the federal directive that research and research reporting on sex and gender be limited to binary male and female categories. This deserves particular attention because trauma research is one of the fields in which sex and gender differences are most pronounced and most clinically relevant. Women experience PTSD at roughly twice the rate of men following comparable exposure (Haering et al., 2024). Gender diverse individuals experience trauma exposure at elevated rates and face documented barriers to evidence based care (Travers et al., 2020). The interplay of sex, gender, and posttraumatic stress is not a peripheral research topic. It is central to how we understand risk, presentation, course, and response to treatment.
Limiting research reporting to binary categorizations will not change the clinical reality that gender diverse clients exist, are overrepresented among trauma survivors, and present in our practices. What it will do is narrow the evidence base that clinicians draw on to serve those clients, while simultaneously making it harder for gender diverse clinicians and researchers to participate in the field at all. The Centers for Disease Control and Prevention has already removed information on sexual violence and gender based prevention from its website, which means resources that clinicians have relied on for client education and for their own continuing education have been taken down. This is not a political opinion. It is a description of material changes to the research record and the public health knowledge base that therapists use.
I want to be careful not to conflate political commentary with clinical guidance, because those are different things and the field benefits from keeping them distinct. At the same time, the question Cook and colleagues pose is a professional one, not merely a political one. What is our responsibility as trauma clinicians when the institutions that produce the evidence we practice on are being weakened?
The first responsibility, I think, is literacy. Most of us were not trained to read or evaluate research with the depth that rigorous clinical practice actually requires. In ordinary times, this gap is compensated for by the intermediaries we trust to interpret the literature for us, including training institutes, professional associations, continuing education providers, and the peer reviewed journals we occasionally consult. When those intermediaries are themselves under strain, the obligation to read primary literature, and to do so carefully, shifts onto the individual clinician. That obligation is uncomfortable. It is also unavoidable. The clinicians who are best positioned to weather a period of institutional disruption are the ones who have developed the capacity to evaluate evidence directly rather than relying on summaries and promotional material.
The second responsibility is conservatism, in a particular sense of the word. When the research pipeline narrows, we are less able to correct errors, test new claims, or refine existing protocols. This is not the moment to abandon well established treatments in favor of approaches with thin evidence bases. If anything, it is a moment to lean harder on the treatments we know work, precisely because the mechanism by which we would discover better alternatives has been partly disabled. Cognitive processing therapy, prolonged exposure, EMDR, and other treatments with substantial evidence bases did not become well supported by accident. They were tested, retested, compared, and refined over decades of work by the very institutions that are now being defunded. The research that would replace or improve them is now much less likely to happen on the timeline we would want.
The third responsibility is participation. The international trauma community has made it easier than ever to engage across borders. Organizations like the International Society for Traumatic Stress Studies, the European Society for Traumatic Stress Studies, and the Global Collaboration on Traumatic Stress offer memberships, conferences, and publications that give U.S. based clinicians access to research and perspectives that are increasingly difficult to find through domestic channels alone. If the U.S. research ecosystem is narrowing, the international one is the place where U.S. trauma clinicians can most productively maintain their connection to the evolving field. Joining, reading, attending, and contributing are not optional luxuries during a period like this. They are a form of professional insurance.
One of the uncomfortable implications of the editorial is that the trauma field has been more dependent on public investment than it has generally acknowledged. The evidence base that clinicians cite, the training programs that exist, the conferences that happen, the books that get written, all of this sits on top of decades of public funding that made the underlying research possible. When that foundation is weakened, the whole structure becomes more fragile than it appears. The appearance of abundance, of more and more modalities, more and more trainings, more and more books, can disguise the fact that the basic research engine is slowing down.
I do not have a tidy prescription for this. The scale of what Cook and colleagues describe is larger than any individual clinical practice, any single training institute, or any professional association can fully address. What I do think is that the field would benefit from taking their warning seriously and responding in the ways that are available to us. That means reading the editorial itself, which is open access and freely available. It means being more disciplined about our evidence claims during a period when rigorous evidence is going to be harder to produce. It means investing in our own research literacy. It means treating international collaboration as a meaningful part of our professional lives rather than as an optional enrichment. And it means being honest with clients, with trainees, and with ourselves about what we know, what we do not, and what the institutions that once answered those questions are currently able to offer.
The field built something remarkable over the past several decades. It built it slowly, unevenly, and with considerable public support. Whether it continues to grow, or begins to contract, will depend in part on what we do in the next several years to protect what has been built and to find new ways to sustain the work. The first step, as Cook and colleagues have offered, is to notice what is happening. That is what their editorial does. The rest is up to us.
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Rebecca Kase, LCSW, is a trauma therapist, CEO of The Trauma Therapist Institute, and a thought leader at the intersection of neuroscience, trauma, and human performance.
She writes about the intersection of trauma science, clinical practice, and the professional life of the therapist on a regular basis. If you want essays like this one delivered as they are published, along with analysis of the research most relevant to trauma clinicians, you can subscribe at rebeccakase.substack.com. Also check out TTI's training programs in EMDR, IFS, and integrative trauma treatment are also listed there for clinicians who want to deepen their work.
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Fihn, S. D., Atkins, D., O’Leary, T., & Kizer, K. W. (2025). Veterans Affairs research under threat. JAMA Internal Medicine. Advance online publication. https://doi.org/10.1001/jamainternmed.2025.1270
Haering, S., Meyer, C., Schulze, L., Conrad, E., Blecker, M. K., El-Haj-Mohamad, R., Geiling, A., Klusmann, H., Schumacher, S., Knaevelsrud, C., & Engel, S. (2024). Sex and gender differences in risk factors for posttraumatic stress disorder: A systematic review and meta-analysis of prospective studies. Journal of Psychopathology and Clinical Science, 133(6), 429–444. https://doi.org/10.1037/abn0000918
Rilkoff, H. (2025). “Massive retrogression”: USAID cuts affect global morbidity and mortality. British Medical Journal, 388.
Travers, Á., Armour, C., Hansen, M., Cunningham, T., Lagdon, S., Hyland, P., Vallières, F., McCarthy, A., & Walshe, C. (2020). Lesbian, gay or bisexual identity as a risk factor for trauma and mental health problems in Northern Irish students and the protective role of social support. European Journal of Psychotraumatology, 11(1), 1708144. https://doi.org/10.1080/20008198.2019.1708144
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