By Nancy Montgomery, Stars and StripesFebruary 17, 2009
HEIDELBERG, Germany - New training intended to reduce post-combat psychological distress provides "small but significant" improvements in soldiers' mental health, according to a study.
Among soldiers who returned from Iraq and participated in "Battlemind Training," fewer reported sleep problems, and there were less-severe post-traumatic stress disorder symptoms, compared with soldiers who had received either no post-deployment mental health training or a briefing about stress, according to research psychologists with the Walter Reed Army Institute of Research.
"We've completed three groups of randomized trials which have demonstrated that Battlemind training has a positive impact on soldiers' mental health months later," said Amy Adler, a lead researcher on the project. "The effects are not huge. We're not curing disorders."
The study found that in soldiers who had seen extensive combat, Battlemind training resulted in a 14 percent reduction in severity of post-traumatic stress disorder symptoms.
And while 60 percent of soldiers without the training reported sleep problems, just 30 percent of those who'd had the Battlemind class said they were having trouble sleeping after returning home.
Adler said the study validates the efficacy of the training, which aims to prevent or reduce pychological problems by giving soldiers detailed information about what to expect, how to deal with problems and assurance that their experiences are both shared and manageable.
"It's not just the events you might be exposed to," she said. "It's also the thoughts you might have, feelings you might have...it helps put the experience in perspective."
Adler did not say whether the study had determined the training's effects on other commonly reported difficulties, such as irritability or depression.
The Battlemind material was developed after years of gathering data about deployments and reintegration. More than 80,000 troops filled out surveys since at least 2003 providing data on the typical effects of combat and the typical problems after coming home. "What's normal, what you can expect," Adler said.
Battlemind Training was devised by psychologist Col. Carl Castro, along with a colleague. It is based on the psychological theory of expectation, said Castro, now director of the Medical Research and Materiel Command's Military Operational Medicine Research Program.
"Everyone does better when they know what to expect," Castro said. "So we said, 'What would be useful to know, based on evidence we had already collected'"
Reducing or preventing combat impacts on mental health is an important effort. Studies show PTSD and depression affect large numbers of troops - an estimated 20 percent or more - and treatment often is not sought.
It is also a relatively new idea. "What we had first was nothing," Castro said. "We had soldiers coming home - we thought, 'What are going to do to help them reintegrate'' "
The first Battlemind focused on easing soldiers' adjustment to their families and communities. That training is framed in transitioning combat skills into regular life. So the operational secrecy soldiers learned in combat, for instance, might mean they've learned not to tell their wives where they're going, even though actually, they probably should. Likewise, combat driving in the middle of the road, or always being armed, needs to be transitioned into following driving and gun possession laws - and understanding that the danger has passed.
And, while keeping yourself and your buddies alive is your job in combat, "Recognize that there are human limits to preventing death and injuries. Do not allow 'survival guilt' to destroy you. Your buddy would want you to drive on," according to Battlemind.
That the study of the training's effectiveness, conducted in 2005 and 2006 on some 2,000 soldiers in combat brigade teams, showed modest mental health gains was expected, Castro said.
"These are just one-hour lectures, basically," Castro said. "It opens up the door," he said, to more psychological health training throughout an Army career and, eventually, larger mental health gains.
The training has broadened, with pre-deployment and post-deployment classes now mandated for all troops as well as training for family members. A related "resilience" training session is to begin next in basic training. Additionally, Adler said, the training is tweaked and improved as more data is available.
"One of the things I think Battlemind does - it starts a dialogue about issues we have not historically talked about," said Maj. Dennis McGurk, who, like Adler works in Heidelberg for the Walter Reed research institute and worked on the study.
"We train soldiers tactically, technically, but we don't have a great history of training them mentally to go to combat. And we're getting better at that."
McGurk said it's now clear that some veterans of all wars - not only Vietnam - had problems after returning home.
"People will say, 'How come there was no PTSD in World War II'' " McGurk said.
There was, but there was no name for it or recognition that it affected a broad swath of people, and not just, for example, your eccentric, perhaps alcoholic relative. "You just called him Crazy Uncle Joe," McGurk said.
Previous studies have indicated that the risk of developing psychological problems rises with the amount of exposure to disturbing combat experiences: being shot at, handling human remains, being ambushed, killing. In the Battlemind study, soldiers surveyed had had 19 or more combat experiences, McGurk said.