Feature

Mary Smith's* husband, a white collar professional in civilian life, belonged to an Army Reserve unit mobilized to help train Iraqi soldiers near Fallujah. Deployed for 15 months, he suffered a concussion after surviving the near-miss blast of an improvised explosive device (IED) while out on patrol.

The first time they were alone together after he came home, he couldn't stop crying, Smith recalls.

During the day, he has a constant headache, and at night, sleep doesn't come easy, she adds.

"He didn't really sleep the first two months he was home," she says. "We didn't know what to do for him."

What's more, she found she couldn't handle hearing the grim details of his experiences in Iraq.

"What he did tell me, I had to ask him to stop, because I couldn't take it," she says.

Smith was one of five family members who spoke in January about the challenges faced by families living through cycles of deployments brought by Operation Iraqi Freedom and Operation Enduring Freedom in the first of five courses on deployment psychology offered by the Center for Deployment Psychology this year. The center, located at the Uniformed Services University of the Health Sciences near Washington, D.C., is funded by the Defense Graduate Psychology Education (D-GPE) training program, a federal program that APA's Education Directorate Government Relations Office staff urged Congress to establish.

The center's two-week training sessions bring together military and civilian psychologists and psychology interns from Army, Navy and Air Force internship training sites to learn about the psychological issues associated with military deployments, such as the stress experienced by a service member's family while their loved one is away, says David Riggs, PhD, the center's executive director. A clinical and research psychologist, Riggs's work has focused on the impact of post-traumatic stress disorder (PTSD) and other anxiety disorders on the families of those affected.

Given that the number of service members who have experienced death and destruction is increasing, the need for mental health services for them and their families is growing, Riggs says. According to a 2006 study by the Walter Reed Army Institute of Research, one out of six soldiers and Marines returning from Iraq screened positive for PTSD, generalized anxiety or depression. Overall, the number of returning service members eventually requiring mental health treatment is predicted to exceed 100,000.

"You get some pretty high numbers, when you multiply by the total number [who have deployed] for OIF and OEF," Riggs says. Underscoring that point is an APA task force report calling for more military-sponsored research and programs to help meet the mental health needs of service members and their families--adopted by APA's Council of Representatives in February (see "APA council adopts reports on military mental health, sexualization of girls" ).

First-hand lessons

The center's course is built around instruction in four main areas, including the basics of deployment; the impact of psychological trauma and resilience to trauma; the impact of serious physical injuries; and the process of reintegration into family and community life for returning service members.

Instructors include mental health professionals with expertise in the areas being taught, some of whom have themselves deployed, such as Air Force Maj. Anne Dobmeyer, PhD, who in January taught a section on deployment issues faced by female service members. The instructors' students were 13 psychology interns from the Army, Navy and Air Force, two Air Force psychologists and one civilian psychologist.

Course panelists gave them first-hand accounts of deployment's mental health effects on families, noting that for many families, like Mary's, the real struggle begins when the service member comes home. Students learned about families' need for information on what to look for in terms of symptoms of distress and opportunities for counseling. That need is particularly strong among National Guard and Reserve families, who often live far away from major military installations and can't easily seek out assistance from the Army's Family Readiness Groups, notes Riggs.

Students also spent several days going on rounds with medical teams at the National Naval Medical Center at Bethesda and Walter Reed Army Medical Center to become familiar with the adjustment issues faced by seriously injured service members, including multiple amputees and survivors of traumatic brain injury inflicted by the concussive blasts of IEDs.

And students heard advice about meeting mental health challenges on the ground during deployment. Psychologists in Iraq and Afghanistan need to actively try to meet service-members on their turf, such as by joining units' daily physical training drills, panelists suggested.

"There are a lot of folks who need help, but they're not going to knock on your door to get it. A provider needs to reach out," says Riggs. By doing that, psychologists can work against the stigma preventing service members from coming to see them, according to Riggs and course panelists. Moreover, commanders will see them as more effective because they're working to resolve service-members' problems to keep them functioning within a unit.

A surge of need

The idea for the program came from contacts between Nina Levitt, EdD, associate executive director for education government relations at APA who, with the full support of APA Executive Director for Education Cynthia Belar, PhD, asked Victoria Ingram, PsyD, a former Army psychologist, to collaborate with her in 2004.

Ingram was running the psychology internship program at Walter Reed at a time when severely physically wounded service members, injured in Iraq and stabilized in Germany, were increasingly arriving for treatment.

As a group, her four interns came to her and told her they were struggling with compassion fatigue as they tried to help wounded service members deal with the physical and emotional trauma of triple amputations, tremendous abdominal wounds and serious head injuries, she says.

"There was a point in the year when they came to me and said, 'My God, we need help. We need help understanding how we're supposed to deal with this, and how we're supposed to cope with this,'" Ingram recalls.

When Ingram was approached by Levitt, she knew that a psychology training program focusing on returning military personnel and their families was the answer. Working together, they tapped top psychologists from the Army, Navy and Air Force to create a central site for training on deployment issues.

Besides the two-week course, the center also offers one- to three-day seminars on more specialized topics, such as a course for civilian psychologists on helping soldiers with post-deployment adjustment and the use of Prolonged Exposure Therapy, one approach for dealing with PTSD, Riggs says.

Longer term, the center will support work by research fellows on deployment issues, and build up a virtual library for psychologists working with service members and their families to consult online.

Offsite, the center also supports a coordinator at each of the 10 Army, Navy and Air Force psychology internship training sites who offers follow-up training as well as case supervision and consultation.

Capt. Lisa Burroughs, an Army psychology intern at Eisenhower Army Medical Center who was a student at the first two-week course, says she liked the way the course provided a comprehensive approach to deployment issues.

"This training covered everything, how we can prepare for deployment, learning effective communication skills for families and how to use our skills effectively in a combat situation," Burroughs says.

Once Burroughs gets her license this fall, the Army will probably assign her to a combat arms unit or a combat stress control team, with a high likelihood of deploying to Iraq or Afghanistan.

She's already planning to learn more about Prolonged Exposure Therapy, and use it to help patients.

"That's something I can use immediately, and something I can use in combat," she says.

Even though the center has just recently been established, response from both the military and civilian communities has been positive. "We have gotten calls and e-mails from psychologists all over the country wanting to know more about the program," Belar says. "It is enormously gratifying to know that so many individuals are already benefiting from this new program."

* (Mary Smith is a pseudonym.)