Chaplain Working Group Tackles Tough Warfighter Issues

By Jayne Davis, DCoE Strategic Communications

If the idea of chaplains getting together to discuss their interests makes you think of genteel spiritual conversations, consider the topic discussed at the August bimonthly teleconference of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) Chaplain Working Group — combat and killing in relation to posttraumatic stress disorder (PTSD) and spiritual distress.

The Chaplain Working Group routinely delves into spiritual and behavioral conflicts arising from deployment. It’s the nature of their calling that chaplains grapple with difficult issues, and the nature of war that military chaplains must address constructs that deeply challenge common beliefs. One such example is that spiritual health, behavioral health and the use of deadly force are not necessarily mutually exclusive.

Invited presenter, Lt. Col. Dave Grossman, retired Army Ranger and former professor of psychology and military tactics at the United States Military Academy, West Point, shared his views on the psychology of posttraumatic stress, and support for the idea of posttraumatic growth, which suggests that bad things in life can make you stronger. He offered chaplains a message that held meaning for both chaplains themselves, some of whom have experienced PTSD after deployment, and the service members they counsel: “We are all going to have bad days as we walk our warrior path,” said Grossman. “Do not destroy yourself because of the bad days and never judge yourself by your worst day.”

Grossman offered other insights:

■There’s a wide range of individual responses to trauma and no wrong way to respond to taking a life. But, you can choose how you respond to it.

■Behavioral health care providers and spiritual counselors must communicate to their patients that recovery from PTSD is possible and in some cases may make you stronger. This expectation must be present if there is to be hope for anything other than a lifetime of therapy.

■Rely on your faith in times of stress and seek spiritual help to process acts that may require the lawful use of deadly force.

According to Dr. Jeffrey Rhodes, DCoE spiritual fitness program manager, Grossman’s remarks generated great interest from the participants.

“Lt. Col. Grossman is one of the top authorities on combat stress and violence and has spoken extensively to military groups about the effect of trauma and killing,” said Rhodes. “Chaplains often provide counsel and support to those who have been exposed to violence and trauma, either as victims or perpetrators, so this is an area of great concern and where there's a need and expectation for chaplains to have some level of knowledge and expertise.”

Issues discussed in past working group sessions demonstrate the variety of challenging subjects relevant to military chaplains:

■Care for the care provider

■PTSD and spirituality

■Military sexual assault

■Moral injury as a psycho-spiritual construct

At the next working group teleconference, scheduled 1:30-3 p.m. (EDT) Oct. 3, Dr. Carrie Doehring, a licensed psychologist and associate professor of pastoral care and counseling at Iliff School of Theology, will discuss research on religious and spiritual coping and how it informs spiritual care of service members and veterans. All are welcome. Contact the group for details.

DCoE Releases Clinical Support Tools to Treat Dizziness Symptoms

By Corina Notyce, DCoE Strategic Communications

While most patients with mild traumatic brain injury (mTBI), also known as concussion, completely recover within days to weeks, some individuals experience persistent symptoms such as dizziness. Dizziness is a common symptom following mTBI and if left unresolved or untreated, can have a significant impact on a service member’s quality of life.

Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) developed “Assessment and Management of Dizziness Associated with Mild Traumatic Brain Injury Reference Card and Clinical Recommendation” to give primary care providers a quick and easy way to help evaluate and manage dizziness symptoms in patients who have been diagnosed with mTBI.

“Usually dizziness associated with mild TBI resolves within seven days,” said U.S. Public Health Service Capt. Rita Shapiro, chief of clinical practice guidelines for DCoE TBI directorate. “However, approximately 20 percent of patients can present with chronic or recurring episodes of dizziness symptoms that require additional examination by a provider to determine the cause and make appropriate referrals.”

There are three basic types of dizziness:

■Vertigo: a false sense of motion

■Disequilibrium: being off-balance or unsteady while standing or attempting to walk

■Lightheadedness: feeling faint or other vague sensations such as disconnect with environment

The reference card and clinical recommendation provides differentiation between the different types of dizziness, so providers can accurately categorize a patient’s symptoms and provide a focused assessment.

“When someone is regularly experiencing dizziness symptoms it can make daily activities challenging and for severe cases, almost impossible,” said Shapiro.

The clinical recommendation includes information on red flags that require urgent referral to appropriate specialists, medication side effects, patient management and referral options. According to Shapiro, this resource allows providers to get detailed information and reasoning behind each step in the algorithm card.

The reference card provides a listing of focused diagnostic tests and specific comorbid conditions (e.g., migraines, sleep disorders, psychological disorders and visual disturbances) which should be explored based upon a patient’s symptoms. It is intended for use by primary care providers and can be carried in their pocket for quick reference on the job.

Additionally, training slides corresponding to the clinical recommendation and the reference card are available for providers.

To request hard copies of the “Assessment and Management of Dizziness Associated with Mild TBI Reference Card and Clinical Recommendation,” contact DCoE at DCoEProducts@tma.osd.mil. To download these tools and other TBI resources, visit the Health Professionals section of the DCoE website.

DCoE recently released a clinical recommendation and reference card for neuroendocrine dysfunction screening following mild TBI, and will be releasing similar tools focused on the evaluation and management of prolonged visual disturbances associated with mild TBI next.

DCoE Director Shares Air Force Birthday Message

By Navy CAPT Paul S. Hammer, DCoE director

Most of us are able to easily answer the question, “Where are you from?” However, for some it can be a bit more difficult. Many of us who have trouble answering the question have developed a default reply over the years.

When I’m asked, “Where are you from,” I am proud to say that I was an Air Force brat and grew up all over (yes, this is my default reply). Growing up, I wasn’t fully aware of what my dad did or why. My dad was a fighter pilot and, like many other military kids, I attended multiple schools and identified more with my family than with the locale.

In 1966 my dad went to Vietnam. Although he was a fighter pilot by training, he was assigned to a forward air control (FAC) squadron. As part of a FAC in Vietnam, he flew around in this dinky little Piper Cub-like airplane, dropped smoke and directed airstrikes in support of Army ground troops.

One of my dad’s proudest moments was about this time of year almost 50 years ago. He was engaged with the infantry battalion he supported in a large firefight on the ground. He was getting low on fuel, running out of daylight and yet the fight was still intense and a much smaller Army battalion was at risk of getting overrun. So, he directed two fighter airstrikes in hope of helping the smaller Army battalion. Sometime later, my dad ran into the former Army battalion commander from that day in Vietnam who told him how they were able to wipe out an entire enemy regiment.

I was 9 years old when my dad went to Vietnam. It wasn’t until many years later when I was on active duty myself that we were able to have conversations about his military experiences.

We often take our capability for air supremacy for granted but it’s because of the hard work, dedication to duty, and professionalism of the U.S. Air Force that we have dominance in air, space and cyberspace. Today, no one thinks about going to war without air power.

On behalf of all of us at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, I wish the United States Air Force a Happy 65th Birthday.

Aim High … Fly, Fight, Win!

Frontline Psych with Doc Bender: How Well You Perform Physically May Depend on How Fit You are Mentally

By Dr. James Bender, DCoE clinical psychologist

“Winning is 90% mental, the other half is physical.”

     — Yogi Berra

Dr. James Bender is a former Army psychologist who deployed to Iraq as the brigade psychologist for the 1st Cavalry Division 4th Brigade Combat Team out of Fort Hood, Texas. During his deployment, he traveled through Southern Iraq, from Basra to Baghdad. He writes a monthly post for the DCoE Blog on psychological health concerns related to deployment and being in the military.

When most people hear the words “psychologist,” “mental health” or “shrink,” they think “mental illness.” After all, why should you talk to those guys unless you have posttraumatic stress disorder (PTSD) or depression? It’s unfortunate that some people think that way, because in addition to helping with serious conditions like PTSD and depression, behavioral health specialists can offer much more. A big part of psychology concerns itself with improving physical performance.

All service members are called upon to perform physically throughout their careers. Everyone has to pass a physical training (PT) test, infantry soldiers need to shoot and run, Navy rescue divers need to perform physically in harsh environments, security forces troops have to stay sharp while protecting flight lines and perimeters, and the list goes on. When I was in Iraq, I told my soldiers to think of themselves as athletes because they are.

Anyone who’s endured endless PT knows that the military is very good at training your body to perform, but that’s only part of the solution. A huge part of your physical performance depends on your mindset, and that’s where behavioral science comes in. During the next few months, I’ll spend some time blogging about the mental aspects of human performance. Hopefully, you’ll learn some things that will improve your execution on the job.

Getting Worked Up

 We’ll start by talking about arousal, or how keyed up, excited or motivated you get while executing an action. This has to do with being alert, both physically and mentally. Weightlifters and football players will often psych themselves up before an event and almost work themselves into frenzies, while a concert violinist may breathe deeply or meditate to calm down and lower their level of arousal before a performance. A lot of things happen when you’re at a high level of arousal or “really psyched.”

Generally, we want to be very keyed up, with adrenaline flowing, when we’re trying to perform a simple task that doesn’t require much thought or complex action. Running and doing pushups and sit-ups are activities where you want a high level of arousal. While in this state, you tend to feel pain and fatigue less and blood and oxygen are carried to your major muscles quickly. On the other hand, when you’re performing an action that requires concentration and fine motor skills, like shooting or land navigation, you want less arousal. Being too keyed up will actually decrease performance because the parts of your brain responsible for concentration, visual-spatial skills and creative thinking become less active, essentially shutting down.

How Do You Perform Best?

 Another point to consider is your personality type. Extroverts or thrill-seeking people generally perform better when they’re more aroused while introverts tend to perform better when they’re calmer, or less aroused. So, it’s important to find your optimal level of arousal based on the task at hand and your personality type.

Things get interesting when you have to switch from high-intensity activities to low-intensity activities very quickly. Snipers are good at this. During training, they sprint and then drop to the ground and fire rounds into a target. They perform an activity (running) where a high level of arousal is needed and then suddenly transition to an activity (shooting) where a lower level of arousal is needed. Being in good physical condition lets them sprint without needing too much arousal, and breathing deeply before shooting lets them lower their heart rate and calm down, allowing them to shoot accurately.

Thanks for reading and please post any comments or questions you may have.

Join Doc Bender for a live chat on Twitter to ask questions about the mental aspects of human performance from 11:30 a.m. to 12:30 p.m. (EDT) Sept. 18. Follow DCoE at twitter.com/dcoepage.

9/11: Remember Past, Honor Present, Cherish Future

By Navy CAPT Paul S. Hammer, DCoE director

Each generation of Americans witness, and some personally experience, “a date which will live in infamy.” These specific moments are etched in our minds and in the history of our country. They are periods of time recalled in an instant, by some more vividly than others. Where we were, what we were doing, what we were feeling — these powerful shared experiences bond each generation with the next.

Generations were witness to the attack on Pearl Harbor, the assassinations of President John F. Kennedy and Dr. Martin Luther King, Jr., the attempt on President Ronald Reagan’s life, and the terrorist attacks in the United States on Sept. 11, 2001. Never forgotten, always remembered.

Like others, I too, can recall where I was, what I was doing and what I was feeling on Sept. 11, 2001. I was on the west coast at the time. It was a warm, bright sunny day, like so many others that year in California and I was headed back to the clinic after my workout. When I arrived back at the clinic, it was then that I saw the slowly developing news coverage and the collapse of the Twin Towers. Looking back I just remember thinking, everything has changed.

On the 11th anniversary of 9/11, I urge all Americans to remember the Soldiers, Sailors, Marines, Airmen and Coast Guardsmen who are still at war, and particularly those who gave their lives defending our nation during the last 11 years. We also pay tribute to the veterans, wounded warriors and their families who shoulder the burden of war here at home and will continue to do so for decades to come.

While we will never forget all that was lost on 9/11, I ask that you also remember what we gained as a country. As a part of the National Day of Service and Remembrance, I hope each and every one of us can rekindle the growth of a country sparked by an unspoken bond and once again come together to give back to our communities — today, tomorrow and the next. In doing so we ensure we are honoring the victims, survivors and those who volunteered to serve the days, weeks and years following Sept. 11, 2001.

No matter how you choose to pay it forward, whether it’s through volunteering, charitable organizations or random acts of kindness, your efforts will make a difference.

Godspeed.