From Battlefield to Breakthrough: Integrating a Theoretical Strategic Military Approach into EMDR to Enhance Therapeutic Outcomes

From Battlefield to Breakthrough: Integrating a Theoretical Strategic Military Approach into EMDR to Enhance Therapeutic Outcomes (From Battlefield to Breakthrough: Integrating a Theoretical Strategic Military Approach into EMDR to Enhance Therapeutic Outcomes)

Regent University

Jessica Behne (LMFT), Miya Moore-Felton (LMFT/LPCC), Olya Zaporozhets (PhD)

Translated by: Specialist Psychologist Gizem Pozam

 

Background

• The War on Terror has led to an increase in complex trauma among surviving service members (SMs)


• 20–30% of Iraq/Afghanistan veterans have PTSD, and mental health problems are increasing significantly


• 6,392 veteran suicides in 2021, the second-leading cause of death among veterans under 45


• Those who died by suicide included individuals with the following diagnoses:

Adverse Childhood Experience (ACE)

83 report experiencing one ACE

41.5 reported four or more ACEs

For every one-point increase, the risk of suicidal ideation (SI) or a suicide attempt (SA) increases by 24%

• The intense and prolonged nature of military trauma, combined with trained cognitive processing, makes for a complex client.

The Military Mind

• Stress inoculation is a standard military term for cognitive and behavioral techniques used to create conditioned responses and accelerate adaptation to military combat environments.

Initial entry training, such as boot camp and Officer Candidate Schools

Advanced training, such as Ranger School and Survival, Evacuation, Resistance, and Escape (SERE),

Advanced specialized training, such as special operations selection and weapons and tactics schools.

• Stress inoculation training can enhance performance in stressful environments, reduce performance anxiety, regulate the cardiovascular system, lower heart rate, reduce blood pressure, and decrease symptomatic nervous system modulations.


• Traumatic stress causes long-term changes in brain circuitry, such as reduced prefrontal cortex activity, a smaller hippocampus, and increased amygdala activity.

Military training may mitigate stress-induced cognitive decline and increase stress resilience during distress.

Chronic stress exposure can impair mood and cognitive performance.

• Amygdala hijacking is a potential complication in the treatment and diagnosis of service members.

Treatment Challenges

• According to various studies.

23% of mental health professionals will treat a military patient

High dropout rate of 34%

Stigmas

Lack of cultural awareness

• Poorer treatment outcomes

50% of veterans showed no symptom remission.

SSRIs are only 20–30% effective

During a life-threatening or perceived life-threatening event, service members' cognitive responses differ from those of civilians because of their training. This can sometimes lead to misdiagnosis

• Various types of trauma:

Developmental, complex, single-incident

Differentiating factors:

Combat experiences

Military sexual assault

Grief

Physical injuries, including TBI

Many of the studies cited stated that further research on EMDR for the treatment of combat veterans was needed because of its lack of efficacy.

Treatment protocols for PTSD have plateaued.

The Strategic Military Approach

A culturally aware approach model for integration into treatment modalities

• Step 1: Develop an Understanding of Military Culture

Avoid the outsider stigma to reduce dropout rates.

• Step 2: Build Therapeutic Rapport

Simulate unit camaraderie and the sense of safety inherent in it.

Become a Battle Buddy, ultimately preventing a hijacked response.

• Step 3: Sensory Grounding Techniques During
  Treatment

43.5% of service members are under 25.

83 reported having an unhealthy home environment before joining the military.

Many service members do not know healthy coping skills. The skills they do know are culturally centered.

• Step 4: Take the SM/Veteran's History

Vital for understanding the service member's trauma (Developmental, Complex, Single-Incident)

SMs are conditioned to feel nothing when faced with a threat. If they have an emotional reaction, it may indicate that developmental trauma has been triggered.

• Step 5: Cognitive Restructuring Methods with Emotion Regulation

Preferred modality

• Recommend bilateral stimulation

Empower SMs/veterans to work through past and present events that trigger emotional responses.

• Step 6: Gradual Discharge from Therapy.

The goal is to effectively manage and process emotions such as grief, fear, separation anxiety, and loss.

 

"PTSD is full of contradictions. Virtually every reaction that mental health professionals label a "symptom," and which indeed can create distress in daily life after returning home from combat, is an essential survival skill in the war zone" (Hoge, 2010, p. xii).

Designed for Service Members and Veterans

 

 

 

 

 

From Battlefield to Breakthrough: Integrating a Theoretical Strategic Military Approach into EMDR to Enhance Therapeutic Outcomes

 

Regent University

By: Jessica Behne (LMFT), Miya Moore-Felton (LMFT/LPCC), Olya Zaporozhets (PhD)

 

 

Background

War on Terror has seen increasing complex trauma among surviving service members (SMs)

20-30% of Iraq/Afghanistan veterans have PTSD, and mental health issues are rising significantly

6,392 veteran suicides in 2021, the second-leading cause of death among veterans under the age of 45

Of those suicides, the below had these diagnoses:

 

Adverse Child Event (ACE)

83% experience a report One ACE

41.5% report four or more ACE

For every one-point increase, the risk of SI or SA increases by 24%

The intense and prolonged nature of military trauma coupled with trained cognitive processing creates a complex client.

The Military Mind

Stress Inoculation is a standard military term for the cognitive and behavioral techniques employed to create conditioned responses and expedite adaptation to military combat environments.

• Initial entry training such as boot camp and Officer Candidate Schools


• Follow-on advanced training such as Ranger School and survival, Evacuation, resistance, and escape (SERE),


• Advanced special training such as special operations selections and weapons & tactics schools.


• Stress-inoculated training can enhance performance in stress-induced environments, lower performance anxiety, regulate the cardiovascular system, decrease heart rate, decrease blood pressure, and decrease symptomatic nervous system modulations.


• Traumatic stress induces long-term changes in brain circuitry, such as a decreased prefrontal cortex, smaller hippocampus, and heightened amygdala activity.


• Military training may mitigate stress-induced cognitive decline, enhancing stress resilience during distress.


• Chronic stress exposure may degrade mood and cognitive performance


• Amygdala Hijacking is a potential complication for treating and diagnosing service members.

 

Treatment Challenges

According to various studies...

• 23% of Mental Health workers will treat a military client


• HIGH drop-out rate of 34%


• Stigmas


• Lack of cultural awareness

Poorer treatment outcomes

• 50% of veterans showed no symptom remission

 

• SSRIs are only 20-30% effective


• Military cognitive responses during a life-threatening or perceived life-threatening event are different from a civilian's due to their training. This can sometimes cause misdiagnoses

Various types of trauma:

• Developmental, complex, singular

Differentiating factors:

• Combat experiences


• Miltary sexual assault


• Grief


• Physical injuries, including TBI

Many studies cited stated that EMDR needed more research about the treatment of combat veterans due to the lack of efficacy.

• Treatment protocols for treating PTSD have plateaued.

 

The Strategic Military Approach

 

A culturally aware approach model for integration

into treatment modalities

• Step 1: Develop Military Cultural Understanding

Avoid Outsider stigma to lower dropout rates.

• Step 2: Therapeutic Rapport Building

Simulate unit comradery and the normative safety therein.

To become a Battle Buddy, ultimately preventing a hijacked response.

• Step 3: Sensory Grounding Techniques During
  Treatment

43.5% of service members are under the age of 25.

83% reported having an unhealthy home before joining the military.

Many service members do not know healthy coping skills. Skills they do know are culturally centered.

• Step 4: Gather the SM/Veterans History_

Vital in understanding the service member trauma (Developmental, Complex, Singular)

SMs are conditioned to feel nothing when faced with a threat. If they have an emotional reaction, it may be a trigger to a developmental trauma.

• Step 5: Cognitive Restructuring Methods with Affect Regulation

Modality of choice

• Recommend bilateral stimulation

Empower SM/veterans to navigate past and present events that trigger emotional responses.

• Step 6: Gradual Discharge from Therapy.

The goal is to effectively manage and process emotions such as grief, fear, separation anxiety, and loss.

"PTSD is full of contradictions. Virtually every reaction that mental health professionals label a "symptom," and which indeed can create distress in daily life after returning home from combat, is an essential survival skill in the war zone" (Hoge, 2010, p. xii).

 

Designed for Service Members & Veterans