Samuel McLean found his calling in the chaos of the emergency room. As a doctor, he was often the first to encounter patients in the wake of a life-altering trauma. Car crashes, gun violence, sexual assault survivors — he saw it all. And while he could treat their physical wounds, the psychological toll was a different story.
“It’s a very profound experience,” he reflects. “One that drove me to this work much more than anything else. Just witnessing the suffering of trauma survivors who are in a very, very dark place, where they don’t see how they can ever get back to the people that they once were or have a sense of safety or personal dignity.”
The options for psychological trauma recovery he could offer as a medical professional were meager. Trauma survivors are understudied in research so the interventions available to them are nearly the same as they were in the 1970s. McLean knew they deserved more — and that gap drove him from the ER to research.
Now the director of UNC-Chapel Hill’s Institute for Trauma Recovery, McLean is pioneering new ways to prevent chronic trauma-related symptoms. His research explores how the brain responds to trauma and tests early interventions to stop it from rewiring in ways that trap survivors in cycles of pain and distress.
Impact Report
The UNC Institute for Trauma Recovery is leading groundbreaking research to improve outcomes for survivors, funded primarily by grants from the National Institutes of Health and One Mind.
North Carolina is home to over 600,000 veterans, making trauma recovery research a critical priority for the state.
Neuroscience of survival
To maximize survival during threats, the human brain shifts into a state of heightened alertness. While this sharpens the ability to detect and respond to danger, it can also rewire the brain to remain hyperalert, causing ongoing physical and emotional distress and disrupting sleep.
Some of this rewiring comes from the amygdala, which becomes chronically overactive — like a fire alarm that won’t shut off. At the same time, influence from the prefrontal cortex, the brain’s emotional regulator, weakens. This imbalance makes even harmless stimuli feel threatening, triggering fear and distress.
For many service members, veterans, and other survivors of trauma, this kind of rewiring results in daily suffering. Crowds, confined spaces, and sudden noises — like fireworks — can trigger intense reactions. For with military experience, celebratory bangs may feel like real threats, even in seemingly safe environments.
Trauma doesn’t always result in long-term brain changes. Some individuals experience Acute Stress Disorder, a short-term psychological response that can resolve within weeks. But for others, symptoms persist — including headaches, dizziness, pain, and depression — and lead to Post-Traumatic Stress Disorder (PTSD), where the brain becomes stuck in survival mode.
McLean and his team are interested in both the short and long-term impacts of these changes and are trying to determine why they occur and how to prevent them.
“Our study participants, including sexual assault survivors and veterans, have so much to teach us and so much that we’re trying to learn from them,” McLean explains. “I’m grateful to them, as they have taught me so much. In addition, we believe it’s critical to capture as many components of the survivor experience as we can in our studies.”
Rebooting the brain
McLean’s research is partially focused on interventions for active-duty military personnel and veterans who often experience extreme repeated stress during deployment. The Institute for Trauma Recovery is currently testing the efficacy of a military intervention called iCOVER — a strategy to help service members regain brain function during moments of extreme distress.
iCOVER is a six-step intervention for peers of trauma survivors. The peer is taught a series of tasks to complete with the person experiencing distress. By making eye contact, engaging with direct questions, establishing a clear sequence of events, and requesting immediate action, the intervention activates the rational brain to help soldiers regain control. And it takes less than a minute to complete.
While this intervention is already being used across NATO militaries, especially in Ukraine, there is no empirical data to prove it actually works. McLean’s team is testing it in civilian trauma centers to find out whether the intervention measurably improves neurocognitive function in highly distressed patients.
In these studies, McLean randomizes people who are experiencing distress into two study groups. They either receive the iCOVER intervention or more traditional care like supportive statements. And then, immediately after, they use an iPad to play different brain games that assess things like response time, reaction time, memory, and problem solving — all of which are hard to do when you’re experiencing stress.
“Our service men and women deserve the very best, and that includes receiving interventions to help them stay alive,” McLean says. “It’s honestly such a privilege to try to be useful to these incredible folks in our military.”
Alongside efforts to ease acute distress, McLean and his team are also testing medications and other interventions to prevent the long-term brain changes that lead to PTSD after combat.
A better tomorrow
Beyond military populations, McLean’s research also focuses on sexual assault survivors who face long-term psychological distress but receive little follow-up care. That’s where the Better Tomorrow Network comes in. The initiative from the Institute for Trauma Recovery connects this population with ongoing research, ensuring their voices are heard and that new interventions are tested.
One study is testing a five-session telehealth intervention designed to reduce PTSD symptoms. A similar approach has already proven effective in car crash survivors, so McLean hopes it will do the same for people who have experienced sexual assault.
The intervention uses written exposure therapy to help survivors engage with their experiences through guided writing exercises. This process rewires difficult memories in the brain, moving them away from raw emotional processing and toward more contextualized thinking. Early results suggest this simple intervention could reduce PTSD symptoms and improve general mental health.
“The fact that it is a low-cost telehealth intervention means that it could reach trauma survivors across the state of North Carolina,” McLean remarks. “We are very excited about our preliminary results, and hope that it is also effective in large-scale testing.”
McLean’s work shows that trauma responses can be prevented. He envisions a future where service members and civilian survivors are routinely screened and receive early interventions to stop long-term effects before they take hold.
“This is a massive area, and it needs lots of researchers,” McLean reflects. “UNC-Chapel Hill is doing so much early intervention work for trauma survivors, and I hope we can prevent people from having months, years, or a lifetime of suffering. An ounce of prevention is worth a pound of cure.”