Grief has increasingly become a focus of attention within the military, with 80 percent of redeployed soldiers reporting knowing someone who was seriously injured or killed in theater (Thomas et al., 2010; Toblin et al., 2012). Among 15,938 military service members (SMs) who died between 2001-2011, the majority of the deaths were the result of traumatic events, including accidents (34 percent), suicides (15 percent), homicides (3 percent), and terrorism (less than 1 percent) (Cozza et al., in press).

Intranasal oxytocin may be a safe and effective pharmacological mechanism for improving effectiveness of trauma-focused psychotherapies—but caution is warranted.

The hormone oxytocin is well known for its effects on social and reproductive processes. Intranasal oxytocin (IN OT) has made a splash in the media and scientific community because of its potential for treating autism, schizophrenia, social anxiety and posttraumatic stress disorder (PTSD). While sometimes lauded as a panacea, IN OT is not without its critics (Leng & Ludwig, 2016), and for good reasons.

It is clinically well known that olfactory intrusions in PTSD can be a disabling phenomena due to the involuntary recall of odor memories. Odorants can trigger involuntary recall of emotional memories as well have the potential to help diminishing emotional arousal as grounding stimuli. Despite major advances in our understanding of the function of olfactory system, the study of the relation of olfaction and emotional memory is still relatively scarce.

Dr Halvorsen quite rightly draws attention to the various definitions of clinically significant change, which all have their advantages and disadvantages. We especially agree with the comment that the threshold for clinically significant change should at least coincide with the threshold for reliable change (18.66 in our sample).