Combat Stress Reactions During Military Deployments, Case Study Example

Effectiveness of Immediate Treatment during Wartime Settings on Reduced PTSD

Some of the most amazing medical advancements in our history have come from the battlefield during times of war.  One of the best current examples is the war in Iraq in which dozens of medical papers have been published that evaluate treatment methods for those soldiers that have receive battle wounds in combat.  Unfortunately, the military has not taken a similar stand on mental health advancements, so very little information has been published on the efficacy of treatment methods applied during wartimes.

Due to Operation Iraqi Freedom and Operation Enduring Freedom, hundreds of United States military mental health professionals have been deployed to the Middle East since 2003.  Several different treatment methods have been utilized in this region, including combat stress control, outpatient therapy, exposure therapy, and behavioral health consultation.  However, there is very little scientific data that exists to show the benefits and effectiveness of any of these methods.

Three of the most common treatment concepts that are used for combat stress reactions in wartime settings are BICEPS, PIES, and PIE.  BICEPS is a treatment principle that stands for brevity, immediacy, centrality, expectancy, proximity, and simplicity.  Each of these are clearly defined for the medical professionals in order to engage in effective treatment.  PIE and PIES are very similar concepts, except that they are only bound to three or four principles, respectively.  These principles include proximity, immediacy, expectancy, and simplicity.  These approaches offer a general therapeutic model and do not focus on specifically identifying any interventions or techniques to treat combat stress reactions.

Although these approaches are very crucial for treatment, only one study has been performed to evaluate the effectiveness of the approaches in treating combat stress reactions within wartime settings.  This study evaluated the effectiveness of PIE principles for combat stress reaction during the 1982 Lebanon War and followed up with the patients after 1 year and 20 years.  Researchers compared Israeli soldiers that were treated at the front-lines during battle with another group of soldiers that had been evacuated from battle for treatment.  With this evaluation, there was extensive support for PIE treatment used at the frontlines and produced high return-to-duty rates and low percentages of PTSD presence within the first year.  Most of the soldiers were followed up a second time at the 20-year mark to fulfill the longitudinal evaluation study.  Similar findings were produced that supported PIE treatment during battle and fewer patients developed PTSD than those that did not receive treatment immediately at the frontlines.  This study was limited because the subjects were not randomized to frontline or evacuated treatment groups.

Similar studies have not been conducted on this subject.  However, researchers at the Walter Reed Institute for Research have performed seminal epidemiological research on deployed military personnel that were sent to support OIF/OEF.  The results of this studies show that 5-17% of military personnel return to the United States with symptoms of PTSD, and roughly 25% of these individuals have reported psychological problems of some sort.

There has only been one case series of three U.S. military personnel treated in Iraq to receive research findings on treating active soldiers in wartime settings.  According to the researchers of this study, prolonged exposure significantly reduced PTSD symptoms and enabled patients to return to duty to successfully complete their deployments.

One study analyzed the effectiveness of mental health treatment was evaluated for active OIF/OEF veterans that were evacuated from wartime settings.  Records were reviewed for 1,264 consecutive OIF/OEF psychiatric patients that had been evacuated to Landstuhl Army Medical Center in Germany between November 2001 and July 2004.  Most of these patients were treated as psychiatric inpatients.  Results showed that only 5% of the patients treated returned to duty with their original unit after receiving treatment at Landstuhl.  Another large group of patients were medically evacuated because they showed signs of even greater psychological problems that negatively impacted their ability to benefit from treatment.  Nevertheless, these results verify the importance of treating soldiers in their wartime settings instead of evacuating.  Soldiers that are not immediately treated in wartime setting and are required to undergo psychiatric evaluation are not likely to be re-deployed into combat.  Despite the fact that they is limited research in the area of mental health treatment within wartime settings, the results of these studies show that this treatment is extremely beneficial and needs additional examination and research.

CSC units are primarily relied upon by the DoD for its concept of operations for treatment of combat operational stress reactions within wartime settings.  CSCs typically provide a 2-5 day inpatient restoration program based on a restoration model.  This current investigation is the first attempt to report on the effectiveness of CSC treatment for soldiers that have been deployed into wartime settings.

Methods

This study was performed at the Army’s CSC Restoration Center, 113^th Medical Company, Balad Air Base, in Iraq.  The treatment was based on the PIES principles and it consisted of a 2-day program to help soldiers cope with a large range of symptoms, so that they would be able to return to active duty.  The hypothesis stated that outcome measures would actually decrease by a large margin after soldiers performed the treatment program.

The classes for this program were taught by an occupational therapist with a bachelor’s degree or a medically trained mental health technician.  These technicians were actually paraprofessionals that had attended military mental health training school at some point within their career.  Although these technicians held no credentials, they were supervised by a provider that was fully credentialed to ensure there were no errors.  The process group was led by a clinical psychologist with a doctorate degree and underwent a 2-hour group therapy session.  These sessions were provided for the soldiers to discuss their problems, express their feelings, and provide support to one another.  Depending on the severity of the patient’s problems, the individual therapy sessions were conducted by either the fully credentialed provider or one of the technicians.  This decision was determined by the credentialed provider at the initial period that the soldier was admitted into the program.

These CSC activities were military-specific and were designed to provide the soldiers with a continued sense of discipline and the belief that they would eventually return to active duty within their unit.  The participants were required to wear their uniforms and were treated as soldiers instead of mental health patients.  This portion of the study was designed to reduce any biases or flaws within the data and provided a great chance for the soldiers to receive a positive outcome from the CSC services.