Prevention of Chronic Psychological Health Problems

Combat and Operational Stress Control (COSC) programs aim to enhance service member health and readiness, and to prevent service members from developing psychological disorders that may arise from the stress of combat and other military operations. Department of Defense data from 2016 indicates that approximately 15 percent of active duty service members meet criteria for a psychological diagnosis.[ Reference 1 ] Service members who deploy to combat areas may be particularly vulnerable to developing a psychological health condition.[ Reference 2 ]

Prevention of Psychological Health Concerns

Extreme or prolonged stress associated with combat and challenging military operations can make individuals vulnerable to developing signs of psychological health concerns. While most combat and operational stress reactions (COSRs) are temporary, psychological disorders can arise when stress is left unchecked. COSC programs strive to bolster service member health and readiness as well as prevent chronic psychological disorders by training peers, leaders, and service members to recognize early indicators of mental health conditions and teaching strategies for early intervention.[ Reference 3 ]

In line with the Institute of Medicine (IOM) model of prevention, military COSC programs employ three types of strategies for prevention of psychological disorders: universal, selected, and indicated.[ Reference 4 ]

Universal Prevention Strategies

Universal prevention strategies can be directed toward all military service members regardless of rank, and encourage healthy habits to boost service member health and readiness and prevent psychological health conditions from arising. Some general research-based tips for preventing a range of psychological health conditions include, but are not limited to:

  • Exercise regularly[ Reference 5 ]

  • Maintain adequate sleep[ Reference 6 ]

  • Find ways to reduce stress[ Reference 7 ]

  • Practice mind-body skills and relaxation techniques[ Reference 7 ]

  • Practice optimism and gratitude[ Reference 8 ]

  • Solicit social support and foster unit cohesion[ Reference 9 ]

  • Identify purpose and meaning in one’s life[ Reference 10 ]

  • Participate in spiritual practices or organizations[ Reference 10 ]

  • Engage in community activities[ Reference 10 ]

  • Identify and re-frame exaggeratedly negative thoughts and beliefs[ Reference 11 ]

  • Practice active problem-solving skills (versus avoiding)[ Reference 12 ]

  • Avoid drugs and alcohol, especially when in a negative mood[ Reference 13 ]

  • Focus attention on a hobby or enjoyable things when anxious or upset[ Reference 13 ]

     

Selected Prevention Strategies

Selected prevention strategies are trainings or interventions that are provided to subsets of service members who are deemed to be at risk for developing psychological health conditions.

At-risk service members might be identified based on biological, psychological, social, or environmental risk factors. Age, gender, or family history may indicate greater risk for developing certain psychological disorders.

While research in the area of selected interventions for the prevention of combat and operational stress is largely in its early phases and inconclusive, research-informed COSC- interventions include:

  • Psychological First Aid: an intervention to help reduce the impact of a traumatic event.[ Reference 14 ] Interventions and meetings can be performed by clinicians or trained non-clinical staff.
  • Pre-deployment trainings to prepare service members for combat or difficult deployments.[ Reference 15 ]

  • Post-deployment trainings to prepare service members for the transition home from combat or difficult deployments.[ Reference 16 ]

  • Cognitive-behavioral psycho-education for at-risk individuals may lower chances of developing psychiatric disorders such as depression and anxiety.[ Reference 11 ]

Indicated Prevention Strategies

Indicated prevention strategies are designed to prevent the onset of psychological disorders in individuals who do not meet DSM-5 criteria for a clinical diagnosis, but who are at high risk for developing a psychiatric disorder based on the duration or number of their indicators. COSC programs train peers, leaders, and service members to recognize indicators of COSRs as well as common psychological disorders in themselves and others and encourage help-seeking when indicators fail to improve.[ Reference 17 ]

Prevention of Specific Psychological Disorders

The sections accessed below contain more information on how to recognize early indicators and prevent three of the most common psychological disorders that can arise from combat and operational stress.

Resources

These resources provide additional information on effects of deployment on psychological health and can assist professionals, leaders, and service members in preventing stress and managing chronic psychiatric disorders.

References

  1. Psychological Health Centers of Excellence. (2017). Mental health disorder prevalence among active duty service members in the Military Health System, fiscal years 2005–2016. Retrieved from: http://www.pdhealth.mil/research-analytics/psychological-health-numbers/mental-health-disorder-prevalence

  2. Thomas, J. L., Wilk, J. E., Riviere, L. A., McGurk, D., Castro, C. A., & Hoge, C. W. (2010). Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq. Archives of General Psychiatry, 67, 614–623.

  3. Department of the Navy (June, 2016). Combat and operational stress. U.S. Navy OPVAVIST 6520.1A. Retrieved from: http://www.navy.mil/local/nccosc/.

  4. Mrazek, P. & Haggerty, R. (1994). Institute of Medicine Report. Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. Washington, DC: The National Academies Press.

  5. American and Depression Association of America (ADAA). (2018). Exercise for stress and anxiety. Retrieved from: https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety.

  6. Luxton, D., Greenburg, D., Ryan, J., Niven, A,Wheeler, G., & Ysliwiec, V. (2011). Prevalence and impact of short sleep duration in redeployed OIF soldiers. Sleep, 34, 1189–1195.

  7. Denning, L., Meisnere, M. & Warner, K. (2014). The Institute of Medicine: Preventing psychological disorders in service members and their families. Washington, DC. National Academy Press.

  8. Lambert, N., Fincham, F., & Stillman, T. (2011). Gratitude and depressive symptoms: The role of positive reframing and positive emotion. Cognition and Emotion, 26, 615-633.

  9. Williams, J., Brown, J. M., Bray, R. M., Anderson Goodell, E. M., Rae Olmsted, K., & Adler, A. B. (2016). Unit cohesion, resilience, and mental health of soldiers in basic combat training. Military Psychology, 28, 241–250.

  10. Substance Abuse and Mental Health Services Administration (SAMHSA) (May,2017). Depression. Retrieved from: https://www.samhsa.gov/treatment/mental-disorders/depression#factors.

  11. Rasing, S.P.A., Creemers, D.H.M., Janssens, J.M.A.M., & Scholte, R.H.J. (2017). Depression and anxiety prevention based on cognitive behavioral therapy for at-risk adolescents: A meta-analytic review. Frontline Psychology, 8, 1066.

  12. Hudson, J. L., Flannery-Schroeder, E., & Kendall, P. C. (2004). Primary prevention of anxiety disorders. In D. J. Dozois & K. S. Dobson (Eds.), The prevention of anxiety and depression: Theory, research, and practice (pp. 101-130). Washington D.C.: American Psychological Association.

  13. Morgan, A.J., Chittleborough, P., & Jorm, A. (2016). Self-help strategies for sub-threshold anxiety: A Delphi consensus study to find messages suitable for population-wide promotion. Journal of Affective Disorders, 206, 68–76.

  14. National Center for PTSD (2006). Psychological first aid: Field operations guide, 2nd edition. Retrieved from: https://www.ptsd.va.gov/professional/materials/manuals/psych-first-aid.asp

  15. Price, M., Gros, D., Strachan, M., Ruggerio, K. & Acierno, R. (2012). Combat experiences, pre‐deployment training, and outcome of exposure therapy for post‐traumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom veterans. Clinical Psychology and Psychotherapy, 20 (4), 277-285.

  16. Adler, A. B., Bliese, P. D., McGurk, D., Hoge, C. W., & Castro, C. A. (2009). Battlemind debriefing and Battlemind training as early interventions with soldiers returning from Iraq: Randomization by platoon. Journal of Consulting and Clinical Psychology, 77, 928–940.

  17. Greenberg, N., & Jones, N. (2011). Optimizing mental health support in the military: The role of peers and leaders. In A.B. Adler, P. D. Bliese, & C. A. Castro (Eds.), Deployment psychology (pp. 69–101). Washington, DC: American Psychological Association.