Killing Versus Witnessing Trauma: Implications for the Development of PTSD in Combat Medics

Killing in combat uniquely predicts elevated PTSD symptomatology among military veterans. This study investigated the effects of combat killing in a sample of 345 U.S. Army combat medics who had recently returned from operational deployments to Iraq or Afghanistan. Combat medics provide frontline medical care before, during, and after battles but also fight alongside other soldiers when under attack. Attempting to kill in combat was a significant predictor of PTSD symptomatology even after accounting for passively witnessing trauma in fellow soldiers. Medics may be well prepared to cope with the passive experiencing and witnessing of war-zone trauma, but may benefit from training to cope with the negative consequences of taking actions to kill.     

Mild Traumatic Brain Injury and Posttraumatic Stress Disorder in Returning Iraq and Afghanistan War Veterans: Implications for Assessment and Diagnosis

Mild traumatic brain injury (MTBI) and posttraumatic stress disorder (PTSD) are considered the “signature injuries” of combat soldiers returning from Iraq and Afghanistan. Both disorders can greatly affect the functioning of soldiers, yet the disorders often go undetected or are misdiagnosed by both military and civilian health care providers. This article provides information about MTBI and PTSD in returning combat soldiers along with implications for assessment and diagnosis.     

Combat exposure, psychological symptoms, and marital satisfaction in National Guard soldiers who served in Operation Iraqi Freedom from 2005 to 2006

In current military operations in Iraq and Afghanistan, US National Guard (NG) troops are serving longer deployments than ever before. Little is known, however, about how such deployments affect this population of individuals, relative to active component (AC) troops. This study investigated the extent of combat exposure, severity of post-deployment psychological symptoms, and general interpersonal functioning, as well as the interrelationships of these variables, in 50 NG soldiers who served a 12-month deployment in Iraq from 2005 to 2006. The results indicate that combat exposure and post-deployment post-traumatic stress symptoms in this sample are greater than those in NG veterans of past military operations, and similar to those of full-time soldiers in current operations. Furthermore, the patterns of interrelationships between combat exposure, psychological symptoms, and interpersonal variables were similar to those detected in prior research on AC troops. These results suggest that NG veterans of current military operations may require similar services as active duty veterans. Given that NG troops are less integrated into the military structure, specific outreach efforts may be needed to help NG veterans to receive such services.     

Combat exposure,psychological symptoms,and marital satisfaction in National Guard soldiers who served in Operation Iraqi Freedom from 2005 to 2006

Abstract

In current military operations in Iraq and Afghanistan, US National Guard (NG) troops are serving longer deployments than ever before. Little is known, however, about how such deployments affect this population of individuals, relative to active component (AC) troops. This study investigated the extent of combat exposure, severity of post-deployment psychological symptoms, and general interpersonal functioning, as well as the interrelationships of these variables, in 50 NG soldiers who served a 12-month deployment in Iraq from 2005 to 2006. The results indicate that combat exposure and post-deployment post-traumatic stress symptoms in this sample are greater than those in NG veterans of past military operations, and similar to those of full-time soldiers in current operations. Furthermore, the patterns of interrelationships between combat exposure, psychological symptoms, and interpersonal variables were similar to those detected in prior research on AC troops. These results suggest that NG veterans of current military operations may require similar services as active duty veterans. Given that NG troops are less integrated into the military structure, specific outreach efforts may be needed to help NG veterans to receive such services.     

The Army National Guard in OIF/OEF: Relationships among combat exposure,postdeployment stressors,social support,and risk behaviors

With the continued operations in Iraq and Afghanistan, studies of the prevalence of posttraumatic stress disorder and related symptoms are now common. However, lacking is how these symptoms relate to precipitating conditions and the mitigating effects of social support on these symptoms. This is particularly relevant for reserve military personnel, who have been shown to be greater at-risk for postdeployment problems. The present study examined questionnaire data obtained from Army National Guard (ARNG) units immediately after their return from deployment to Iraq and Afghanistan during 2010 (N = 4329 soldiers in 50 units). Findings showed few soldiers displayed risk behaviors (i.e., daily alcohol use, use of illicit drugs, suicide thoughts, and physically threatening others) during and after deployment. Those most likely to have more postdeployment risk behaviors were also those who showed more risk behaviors during deployment. A substantial percentage of soldiers reported combat exposure, postdeployment negative emotions, and postdeployment loss of a personal relationship. These reported outcomes were all related to increased risk behaviors after deployment. The buffering effect of social support on postdeployment risk behaviors was equally evident when data were examined individually and when grouped by unit memberships. Implications of findings for future research, practice, and policies are discussed.     

Comprehensive soldier fitness: a vision for psychological resilience in the U.S. Army

The stress and strain on the U.S. Army's community due to nearly a decade of protracted war is well documented in the press and in scientific literature. In response, the Army's Comprehensive Soldier Fitness (CSF) program is a preventive program that seeks to enhance psychological resilience among all members of the Army community, which includes soldiers, family members, and Department of the Army civilians. CSF is not a medical treatment program. Rather, CSF helps those community members who are psychologically healthy face life's adversities-including combat and prolonged separation from loved ones-by providing evidence-based training.     

Warrior Resilience and Thriving (WRT): Rational Emotive Behavior Therapy (REBT) as a Resiliency and Thriving Foundation to Prepare Warriors and Their Families for Combat Deployment and Posttraumatic Growth in Operation Iraqi Freedom, 2005–2009

Warrior Resilience and Thriving (WRT) and Warrior Family Resilience and Thriving were the U.S. Army’s first combat Soldier and Family cognitive resiliency training classes based on Rational Emotive Behavior Therapy (REBT). WRT, as a pilot program, was designed to enhance soldier and family resiliency, thriving and posttraumatic growth prior to, during and following combat deployments. WRT alloys REBT self-coaching, Army Warrior Ethos, Stoic, survivor and resiliency strategies to teach and promote advanced resiliency, emotional management and critical thinking to soldiers and their families. This article will describe efforts initiated by the author, who served twice in Operation Iraqi Freedom where he developed WRT, as well as training he conducted for over 12,500 Warriors as the Prevention Team Leader for the 98th Combat Stress Control Detachment serving Baghdad. Risk Factors for Army Warriors and families and the advantages of existential and philosophically-based interventions like REBT are described along with a brief inventory of Army resiliency initiatives.     

Factors Associated With Physical Aggression Among US Army Soldiers

There are a growing number of studies that have approximated levels of aggression and associated outcomes among combat veterans returning from Iraq and Afghanistan using brief screening assessments. However, further research to evaluate the relative role of combat exposures and overt physical behaviors is required to further elucidate potential associations between military service, combat deployment, and overt physical aggression. The purpose of the current study was to assess the prevalence of self‐reported physical aggression in a sample of US Army soldiers using an adaptation of the Revised Conflict Tactics Scale (CTS2), and examine factors associated with higher levels of aggression. A population‐based cross‐sectional study was conducted at a single US Army Installation within a sample of active duty US Army soldiers (n = 6,128) from two large units. Anonymous surveys were collected 6 months following deployment to measure overt aggressive behaviors, posttraumatic stress disorder, anxiety, depression, traumatic brain injury, and misuse of alcohol. There were a relatively higher number of minor and severe physical overt aggressive actions reported among soldiers who previously deployed, notably highest among deployed soldiers reporting the highest levels of combat intensity. Soldiers screening positive for the misuse of alcohol were also significantly more likely to report relatively higher levels of physical aggression. This study quantified overt aggressive behaviors and associated factors, showing increasing combat exposures may result in increased physical aggression. Clinicians treating service members returning from combat may consider assessing relative levels of combat. Aggr. Behav. 38:357‐367, 2012. Published 2012 Wiley Periodicals, Inc.?     

The Army's New Unit Personnel Replacement and Its Relationship to Unit Cohesion and Social Support

A recent concern of the U.S. Army's top leadership has been the deterioration of morale and cohesion in combat arms units. High personnel turnover in U.S. Army units has been viewed as a primary factor contributing to decreased unit cohesiveness. The current and traditional U.S. Army Indi- vidual Replacement (IR) System trained, assigned, and deployed soldiers to units as individuals. As a result, IR units have had as much as 45% personnel turnover annually. The new Unit Replacement (UR) System trained, assigned, and deployed soldiers as intact groups for the entire first-term soldier's enlistment. The objective of the study was to examine the effects of unit replacement on cohesion and to elaborate on the function of cohesion by examining the relationship between cohesion and social support in a sample of 3,245 soldiers in 43 line companies matched by type of replacement, type of combat arms, and stateside/overseas deployment. Soldiers in UR units in which soldiers had previously undergone Basic and Advanced Individual Training together or had their personnel stabilized reported a significantly higher level of cohesion than did soldiers in IR units. This difference persisted even when personal and unit characteristics were held constant in compari- sons. In terms of social support, UR soldiers cited more support providers in their units than did IR soldiers. Perceived satisfaction with social support and perceived helpfulness of social support provided by unit members were significantly and positively correlated with the cohesion measures, irrespective of the type of replacement. Whereas reciprocity was significantly and positively related to cohesion in commonly trained UR and IR units, it was nonsignificantly related to cohesion in personnel-stabilized UR units. Impli- cations of results for the expected effects of cohesion on the quality of interpersonal relations among unit members are discussed.     

Assessment for the U.S. Army Comprehensive Soldier Fitness program: the Global Assessment Tool

Psychology and the U.S. military have a long history of collaboration. The U.S. Army Comprehensive Soldier Fitness (CSF) program aims to measure the psychosocial strengths and assets of soldiers as well as their problems, to identify those in need of basic training in a given domain as well as those who would benefit from advanced training, and then to provide that training. The goals of the CSF program include the promotion of well-being as well as the prevention of problems. Assessment is the linchpin of the CSF program, and the Global Assessment Tool (GAT) is a self-report survey that measures psychosocial fitness in emotional, social, family, and spiritual domains. We review the history of psychological assessment in the military and the lessons taught by this history. Then we describe the process by which the GAT was developed and evaluated. We conclude with a discussion of pending next steps in the development and use of the GAT.     

Value Stability and Change in an ISAF Contingent

Studying an International Security Assistance Force contingent on tour in Afghanistan, the aim of the present study was to test assertions of the relative stability of personal values in a challenging environment. Three hundred twenty Swedish soldiers answered questionnaires on their values before and after a 6‐month tour of Afghanistan. Value change and stability were studied via mean‐level change, rank‐order stability, and individual‐level change methods. Regression analysis was used to study the impact of combat exposure and personality traits on change. The analysis concluded that even when experiencing such a different social context as a military mission to Afghanistan, the soldiers' values remained stable. Some minor changes occurred, in a pattern similar to a regression toward the mean. It was also shown that combat exposure—to a minor extent—predicted changes in values, whereas Big Five scores yielded stronger effects. The present findings suggest that the assertion of the stability of values is a well‐founded proposition, even after radical changes in environment. However, the findings on the effects of combat exposure point to the possibility of severe life events having the power to exert change in values. Personality traits were, however, more important factors in the present context.     

Primary Trauma of Female Partners in a Military Sample: Individual Symptoms and Relationship Satisfaction

Research traditionally has focused on the development of symptoms in those who experienced war trauma directly but overlooked the impact of trauma in the partners of soldiers. The current study reports data from 45 couples where the male partners were Army soldiers who recently returned from deployments to Iraq (Operation Iraqi Freedom) or Afghanistan (Operation Enduring Freedom). Results from this study indicated that female partner primary trauma, particularly trauma related to PTSD re-experiencing and arousal symptoms, has an influence on levels of relationship satisfaction, both for female partners and soldiers.     

Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of U.S. OEF/OIF veterans

Though the broader literature suggests that women may be more vulnerable to the effects of trauma exposure, most available studies on combat trauma have relied on samples in which women's combat exposure is limited and analyses that do not directly address gender differences in associations between combat exposure and postdeployment mental health. Female service members' increased exposure to combat in Afghanistan and Iraq provides a unique opportunity to evaluate gender differences in different dimensions of combat-related stress and associated consequence for postdeployment mental health. The current study addressed these research questions in a representative sample of female and male U.S. veterans who had returned from deployment to Afghanistan or Iraq within the previous year. As expected, women reported slightly less exposure than men to most combat-related stressors, but higher exposure to other stressors (i.e., prior life stress, deployment sexual harassment). No gender differences were observed in reports of perceived threat in the war zone. Though it was hypothesized that combat-related stressors would demonstrate stronger negative associations with postdeployment mental health for women, only one of 16 stressor × gender interactions achieved statistical significance and an evaluation of the clinical significance of these interactions revealed that effects were trivial. Results suggest that female Operation Enduring Freedom/Operation Iraqi Freedom service members may be as resilient to combat-related stress as men. Future research is needed to evaluate gender differences in the longer-term effects of combat exposure.     

Psychological Model of Military Aggressive Behavior: Findings From Population-Based Surveys

The U.S. military has expressed concern about the influence of deployment and combat exposure on the criminal behavior of personnel returning from Iraq and Afghanistan. This study examines the role of behavioral health risk and protective factors associated with combat exposure and criminal and aggressive behavior in active duty Army and Naval personnel. Data from this cross-sectional study are based on two large anonymous, population-based health-related behavior surveys. Findings show that the proportion of all active duty Army and Naval service personnel who reported encounters with law enforcement or committed one or more aggressive acts in the past year increased from 19.41% in 2005 to 22.58% in 2008. Substance use, especially illicit drug use, and mental health problems were significant correlates of criminal and aggressive behavior, as were younger age, male sex, high impulsivity, and work/family stress. Path modeling suggested that several variables, notably combat exposure and history of childhood abuse, appeared to manifest their influence on criminal or aggressive behavior through increases in substance use and mental health problems. The potential mediating influence of substance use and mental health on combat and other trauma experiences has significant implications for preventing criminal and aggressive behavior among U.S. active duty military personnel.     

Minority representation,tokenism, and well-being in army units

Racial and ethnic diversity is increasing in the US Army and women are moving into more combat roles. This puts minority soldiers at risk for being underrepresented in their work units. Tokenism theory predicts that when a work group has less than 15% representation in a social group, the numerically underrepresented minority (i.e., token) members are subject to three disadvantages: higher visibility, informal isolation, and role encapsulation. In the Army, where many companies contain small numbers of women and racial minorities, some soldiers may face additional stressors and constraints. We explored psychosocial, organizational, and health outcomes of all identifiable token women (N = 4,425) and Black soldiers (N = 5,040). Tokens were remarkably similar to non-tokens and majority soldiers on outcomes such as coping skills, adaptability, organizational trust, sleep, substance use, and pain. The intersection of token status in terms of race and gender was not related to any appreciable differences. One potential explanation is the shared Army culture that emphasizes group unity and the importance of the mission above individual characteristics and goals. The Army depends on cohesion, organizational identification, and commitment to the group in order to reduce stress and anxiety, and to maximize combat performance. For soldiers who have internalized this culture, it could be easier to see past individual differences such as gender and race and identify others in the unit as fellow soldiers primarily.     

Combat Stressors Predicting Perceived Stress Among Previously Deployed Soldiers

While combat exposures are considered principle stressors in developing mental health problems, research suggests social support can reduce this risk. Using data from 1,592 previously deployed soldiers, we found five classes of soldiers based on their patterns of responses to items measuring perceived stress. In subsequent analyses, we found increased combat exposure predicted membership in classes with greater combat-related stress, while greater unit cohesion predicted membership in classes with lower perceived stress. Also, greater willingness to report misconduct predicted greater unit cohesion. Results suggest that unit cohesion plays a vital role in the reduction of perceived stress among soldiers.     

Problems with Danforth's Early Diagnosis and Observational Bias in Behavior Management

ABSTRACT

Many children diagnosed with Attention-Deficit/Hyper-activity Disorder (ADHD) experience difficulties in social relations. While psychosocial approaches based on a combination of skills training and contingency management approaches do appear to improve social behavior, evidence that these benefits generalize and persist following training has been limited. We describe a social skills training program designed to help parents promote the display of appropriate social behavior and better athletic performance in sports settings. The program consists of standard psychological assessment, behavioral parent training, functional assessment, parent-mediated social and sports skills coaching, and generalization and maintenance programming. The goals of this intervention are to promote retention of the child in team sports and facilitate friendship acquisition. Training parents to coach their children effectively in sports-related social skills may prove useful in promoting the maintenance and generalization of skills as well as preventing some of the negative effects of social isolation that frequently accompany an ADHD diagnosis.     

The impact of individual trauma symptoms of deployed soldiers on relationship satisfaction.

Research traditionally has focused on the development of individual symptoms in those who experienced trauma directly but has overlooked the interpersonal impact of trauma. The current study reports data from 45 male Army soldiers who recently returned from a military deployment to Iraq (Operation Iraqi Freedom) or Afghanistan (Operation Enduring Freedom) and their female spouses/partners. The results indicated that increased trauma symptoms, particularly sleep problems, dissociation, and severe sexual problems, in the soldiers significantly predicted lower marital/relationship satisfaction for both soldiers and their female partners. The results suggest that individual trauma symptoms negatively impact relationship satisfaction in military couples in which the husband has been exposed to war trauma.     

A Jungian approach to dreams reported by soldiers in a modern combat zone

Treating combat deployed soldiers is becoming more prevalent and needed in psychiatry. Modern combat produces unique psychological challenges, including those without criteria for post-traumatic stress disorder (PTSD). This article will attempt to share the primary author's experience with psychotherapy in a combat zone, along with understanding the general themes of dreams the author encountered while being deployed. Toward that end, the primary author [RW] discusses his personal experiences in Iraq working with soldiers whom he saw and treated while in theatre, with a particular focus on the dreams they reported. The co-authors [EG and MI] afterward collaborated with the primary author to formulate and provide insight into the dreams from a Jungian perspective.     

Project ABLE

This paper describes a proposed model for the management of Army soldiers rendered ineffective due to inadequate skills in coping with life stress. The history of Army mental health programs is reviewed to establish the rationale for program development. The proposed treatment methods and staffing are discussed. The application of this peacetime treaetment model in the management of combat psychiatric casualties is presented. Emphasis is placed on the role of the Army occupational therapist as a professional skilled in the use of task-directed behavior to enhance daily living skills.