FEATURE: Fit for Duty – Building Psychological Resilience

By Jayne Davis, DCoE Strategic Communications

The Military Health System is talking about human performance optimization this month and DCoE is contributing to the conversation by spotlighting the concept of Total Force Fitness, particularly in the domain of psychological health.

Imagine an active-duty service member and what comes to mind? Superior physical fitness may be one thing. Physical fitness is critical to operational success in the military. But military leaders want to see service members both physically and psychologically fit ... a mind-body integration to prepare for continuous optimal performance, enabling both resiliency and recovery.

Traditionally, the military emphasized just the physical – well-trained bodies that meet exacting standards of fitness and preparation for the demands of combat.

Today’s military leaders, aware of the psychological challenges extended and multiple deployments pose, are emphasizing psychological fitness to prepare service members for the rigors of sustained conflict and redeployments.

Psychological fitness is now a focal point for the military to assess a service member’s overall condition pre-, during and post-deployment.

The Office of the Joint Chiefs of Staff “Total Force Fitness” initiative looks at the unique pressures on service members and what they need to both be ready for the mission and maintain personal well-being. It lays out a conceptual framework for service branches to develop their own integrated programs to enhance performance and build comprehensive resilience in service members.

Psychological fitness is one of eight domains of fitness the initiative identifies as necessary for service members to be at their resilient best. The other domains are social, behavioral, physical, nutritional, medical, spiritual and environmental.

The August 2010 issue of Military Medicine, “Total Force Fitness for the 21st Century, a New Paradigm,” describes psychological fitness as “the integration and optimization of mental, emotional and behavioral abilities and capacities to optimize performance and strengthen the resilience of warfighters.”

“In simpler terms, that means giving service members the tools to adapt well to adverse circumstances and perform their unit functions well under a variety of stressful conditions,” said Dr. Mark Bates, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), director of Resilience and Prevention directorate, referring to the definition.

Army Maj. Todd Yosick, deputy director of the directorate, helped develop the Total Force Fitness psychological component and is now helping to create guidelines service branches can use to implement the initiative. According to Yosick, psychological fitness requires training service members to function optimally in the following five areas of assessment remembered as A, B, C, D and E:

Awareness – The capacity to recognize risks in a wide-range of combat and operational environments. Situational awareness is critical for recognizing potential risks to the mission or personnel. For example, a quiet village that’s normally busy may hold hidden risks. Awareness helps one to think about and process the situation and encourages decision-making.

Beliefs – Traumatic events are sometimes an unavoidable part of dangerous missions. Training that addresses the human capability to understand and accept misfortune can strengthen confidence, resolution and ultimately one’s beliefs in their ability to overcome any challenge faced on the battlefield.

Coping – All military personnel will experience challenges that they must overcome to remain psychologically fit and ready. Dangerous missions, feelings of powerlessness, a sense of isolation, increased workload, or in some cases boredom, are prevalent challenges. Support is imperative from leaders, between peers and within the unit. Leadership, communication, cohesion, engagement, flexibility and adaptability are cornerstones of unit fitness and create an environment to enhance and sustain psychological fitness.

Decision-making – Technological advances, developed to help service members make good decisions at the right times, can also overwhelm military personnel with information and inhibit or paralyze decision-making. Training to identify how to select the right information at the right time for the right reason at the lowest levels of leadership informs tactical, operational and strategic decision-making. Decision-making builds mental confidence, which sets the course for a psychologically-fit service member.

Engagement – Engagement is a healthy behavior. Service members should learn to recognize the signs of disengagement in themselves and in others, which builds the collective psychological strength of the unit. At the first signs of disengagement, service members are encouraged to reach out to peers, chaplains, medics, behavioral health officers and other psychological health care providers.

Optimal performance requires rock-solid resilience, which is what the A,B,C,D and E assessment areas and other programs seek to develop in service members during all phases of deployment, with great emphasis on pre-deployment training for both trainers and trainees.

Navy Capt. Paul S. Hammer, DCoE director, told participants at a May 16, 2011, media roundtable discussion on mental health held in Washington, D.C., that the services are now teaching new recruits about post-traumatic stress disorder as part of basic training.

Hammer linked that effort to other service programs that help trainers address psychological fitness when he said, "The Army (incorporates awareness) in resilience training and comprehensive soldier fitness and by training master resilience trainers ... there's a huge effort among the services to really develop a [new] level of resilience."

Comprehensive Soldier Fitness (CSF) is the U.S. Army program for preventative physical and psychological conditioning. It’s a long-term individual assessment and training program for service members, families and Army civilians built on decades of scientific study on performance and readiness.

Total Force Fitness drew from core elements of CSF, such as its five dimensions of strength: physical, emotional, social, family and spiritual. Through CSF’s on-line global assessment tool, or GAT, service members and families can assess and track their “fitness” in each dimension, other than physical, and access tools to improve resilience. The Air Force adapted GAT for its members and families and the Navy and Marines are expected to follow suit.

A major component of CSF is training the trainers. In conjunction with the University of Pennsylvania, CSF offers a 10-day Master Resilience Trainers course to teach resilience skills and how to develop those skills in others. The course is open to Army military and civilian personnel. The expectations are that trainees will return and teach resilience skills to their units, and serve as subject matter experts for their commanders.

In the Association of the United States Army’s January 2011 edition of AUSA News, Maj. Gen. Raymond Carpenter, acting director of the Army National Guard Bureau, said, “The Army should take inspiration from its physical fitness programs that take sometimes out-of-shape recruits and make them physically fit. The Army could do the same thing for mental fitness.”

At the Center for Deployment Psychology (CDP), a DCoE component center, uniformed behavioral health providers including military psychologists, psychiatrists, social workers, physician assistants and clinical nurse practitioners, have the option to take an intensive, eight-day course to learn about a spectrum of deployment psychology issues facing service members, families and providers.

The course, “Topics in Deployment Psychology,” examines what service members and families experience throughout the deployment cycle and what military behavioral health specialists experience in forward operating areas. Psychological trauma and resilience in the context of combat deployment are highlighted and protocols are taught to assess and treat trauma-related responses and build resilience.

Dr. Paula Domenici, head of the division of training programs for CDP, said this about psychological fitness, “In our course, ‘Topics in Deployment Psychology,’ a panel of military behavioral health providers who have been in theater share firsthand how they were able to stay psychologically resilient and take care of themselves so they could help deployed service members with problems down range. We provide military behavioral health clinicians with evidence-based psychotherapies and self-care strategies to build their psychological strength for deployment.”

With this new focus on psychological fitness, the next time you think of a service member, their healthy psyche may be the first thing that comes to mind.

Psychology Course Prepares Military Providers for Deployment Concerns

By Robyn Mincher, DCoE Strategic Communications

During the Center for Deployment Psychology (CDP) course, “Topics in Deployment Psychology,” a panel of five military mental health care providers spoke about their recent deployment. The discussion raised an important question on self-care while deployed: how can a provider stay mentally fit while addressing the psychological health of troops?

For Capt. (Dr.) Tracy Mayfield, a clinical psychologist with the U.S. Air Force deployed to northeast Afghanistan, she found company with the base’s working dog.

“I had to take time out from being a psychologist to have ‘me time’ and relax,” said Mayfield, who was the forward operating base psychologist for about a thousand troops. “Every Sunday, I’d take the dog for a walk. I’m a pet lover, and it really helped.”

CDP is part of the Uniformed Services University of the Health Sciences and a component center of Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE). The course, held at the National Intrepid Center of Excellence from June 7 to June 16, 2011, offered an overview of deployment issues facing service members, their families and providers, geared toward uniformed behavioral health providers from all branches of the military.

Along with the panel, the course started its second week June 13, 2011, with presentations highlighting sexual assault prevention and response, provider self-care and ethical issues in deployment settings.

Retired Lt. Col. Nate Galbreath’s presentation on sexual assault focused on topics such as encouraging bystander intervention to stop assaults, using sexual assault response coordinators when faced with a situation, psychological injury caused by trauma and the potential for the under-reporting of cases.

Dr. David Riggs, CDP executive director, posed ethical questions for students to engage in healthy discussion, raising issues such as dual relationships with service members, managing multiple relationships when supporting many troops at once, and being prepared to cope with cases a psychologist might not be trained in, especially when they are the only mental health support on base.

“Deployed psychologists are expected to diagnose and deal with whatever shows up,” said Riggs. “If you encounter a situation you are not trained to handle, you will have to find ways to learn as much as you can or consult with others who know more than you. You are ethically bound to be as knowledgeable as you can in all areas of deployment mental health.”

Other presentations led by CDP experts throughout the week included ”Cognitive Processing Therapy,” by Laura Copland; “Identification and the Prevention and Treatment of Suicidal Behavior,” by Dr. Augusto Ruiz; and “Prolonged Exposure Therapy,” by Drs. Paula Domenici, William Brim and Riggs.

As the course came to a close, Riggs reflected on the significant impact it had on military providers being deployed.

“This course works to prepare uniformed psychologists for the various psychological health issues they may need to deal with throughout the deployment cycle and issues that might arise among service members and their families. First-hand accounts from recently deployed providers during the course’s panels shed personal light into these issues,” said Riggs. “Military providers leave the course with a pool of knowledge they can tap into to address all kinds of situations while deployed.”

The next CDP “Topics in Deployment Psychology” course for military providers is scheduled for Sept. 20- 29, 2011 in Bethesda, Md. Register here.