Maj. Larissa G. Coon developed several stress coping programs as the occupational therapist officer at the Patriot Clinic on Joint Base Balad, Iraq. Photo by Spc. Brian Barbour

In order to be successful in their missions, Soldiers deployed throughout Iraq deal with combat stress daily whether they perform their duties inside or outside the wire.

The 1835th Medical Detachment (Combat Stress Control) helps Soldiers find positive ways to cope with that combat stress and reduce incidence of suicide through their work at the Patriot Clinic here.

Maj. Larissa G. Coon, Patriot Clinic occupational therapist officer describes combat stress as “dealing with one of the top life stressors while in a combat or deployed environment.”

“This combat stress can be identified through dramatic changes in habits or routines,” Coon said.

Coon, a resident of Goodland, Kan., designed and implemented many of the stress coping programs available here.

She said some of the top stressors that people deal with in their lives are: a job change, a divorce or marriage, the birth or adoption of a child, the death of a family member or close friend, or major purchases like a house or a car.

Coon said these stressors are challenging for anyone to cope with, but when the stressor is combined with a deployment, the stressor for a Soldier is magnified many times over.

When these triggers occur, the affects on a Soldier can be seen in several areas. Soldiers may become angry at everything, have a change in sleeping habits or become withdrawn from contact with family, friends, or coworkers, Coon said.

The combat-stressed Soldier may have a change in eating habits, or may no longer be interested in activities that once brought them pleasure, she said.

Coon said battle buddies and unit leaders need to watch for any dramatic and significant changes in a Soldier’s behavior; it could indicate the need for a “buddy check.”

“Change is the main clue – the key,” she said.

Coon explained that combat stress should not be mischaracterized as Post-Traumatic Stress Disorder. PTSD is a long-term mental health diagnosis where dramatic changes in a person’s habits or routines continue for six months or longer.

A 2003 Army Medical Command report on mental health indicated that forward deployed behavioral health units experienced more than a 95% rate of return to duty status for Soldiers who sought combat stress treatment. The report indicated that almost half of the Soldiers surveyed reported not knowing how to obtain their mental health unit’s services.

The presence of combat stress control units here in Iraq now reflects the efforts the Army has taken to make these services readily available to service members.

There are currently five clinics that offer stress coping programs to service members needing them. These clinics in Iraq are located at Joint Base Balad, Contingency Operating Base Speicher, Camp Liberty, Camp Taji and Forward Operating Base Diamondback.

There are behavioral health assets dispersed across Iraq in more than 25 locations.

Coon said an overwhelming majority of the service members visiting the clinic come voluntarily with only 1 percent of Soldiers being command referred.

When a battle buddy accompanies a fellow Soldier to the Patriot Clinic for assistance, the clinic has no obligation to report the visit to the Soldiers command. The only time this happens is when there is a fear for the immediate safety of the Soldier.

Coon said that Soldiers exhibiting combat stress do not all need to be treated as being a risk of suicide.

“Sometimes they just need someone, like their battle buddy, to offer some help,” she said. Coon said the help a Soldier needs might not be anything more than hearing a buddy’s offer of advice or guidance to some of the resources to help them handle an issue.

The Soldier talking about the stressors they are experiencing can do a lot to relieve some of the pressure they are dealing with alone, Coon said.

If a Soldier needs additional help, Coon listed some other resources besides the clinic where Soldiers can turn to. Such resources are the Judge

Advocate General’s office for legal issues; the finance office for pay issues; the chaplain for spiritual guidance; the Army Emergency Relief fund for unexpected financial shortfalls; the Veterans of Foreign Wars or American Legion for support to loved ones back home; and Military OneSource as a gateway to numerous other agencies and organizations who provide military support, counseling, and assistance in the states.

Coon said: “I have the best job in the Army as I get to supply the activities to make people forget about their stress!”

The 1835th Med. Det. is an Army Reserve unit from Aurora, Colo. The fifty Soldiers of this unit will return to the Fitzsimmons Reserve Center in the spring of 2009 at the end of their deployment.

DVIDS
Story by Maj. Christopher Emmons

A revolutionary treatment program here is demonstrating “little miracles” as it gives new hope to soldiers afflicted with post-traumatic stress disorder who want to stay in the Army, its director reports. The new program is the brainchild of clinical psychologist John E. Fortunato, who uses a holistic approach to treating PTSD at the new Fort Bliss Restoration and Resilience Center.

Fortunato conceded that his proposal “wasn’t an easy sell” initially, particularly because it wove yoga, massage therapy and other nontraditional approaches into its treatment program. But driven by the frustration of seeing soldiers with PTSD forced to leave the Army against their wishes, Fortunato pressed forward and won approval for his prototype program.

With $2.2 million in initial funding and a 1940s barracks building to rehab, he set out to launch the Restoration and Resilience Center in June 2006. The center opened last summer.

Fortunato was convinced traditional PTSD treatments weren’t long enough, intense enough or comprehensive enough. “So we set out to create a program to address all aspects of PTSD and treat the whole soldier,” he said.

The participants, all volunteers, take about one-half the doses of medications they’d typically get through community mental-health programs. “That’s because we’re doing a bunch of other things,” Fortunato said.

Many PTSD-afflicted soldiers experience “hyper-arousal,” which the center staff treats with techniques like medical massage and “Reiki,” a Japanese stress-reduction technique. Acupuncture has proven to be “extremely effective” in treating the anxiety, panic, and tension-induced physical pain many experience, Fortunato said.

There’s a big physical component to the program, too. The soldiers must walk at least 10,000 steps a day, including a daily 45-minute “power walk.” They play water polo three times a week, forcing interaction that Fortunato said many would rather avoid.

“That’s another piece of PTSD. They want to socially isolate. They don’t like to interact with other people,” he said. “So we have them interact with the people they feel most comfortable with: other soldiers with PTSD.”

Field trips during the program take the soldiers to the local mall and Wal-mart, “two hells” to many of them because they’re too big, too crowded and too noisy, Fortunato said. “We teach them ways to regulate their stress level so they can handle those kinds of environments.”

Many afflicted soldiers have trouble with concentration and memory, Fortunato said. For them, the program’s mix of physical activity and calming techniques appears to help. They do yoga; tai chi, a Chinese martial art; “Quigong,” a centuries-old Chinese self-healing method; and biofeedback, which uses the mind to heal the body. “We have a meditation room that looks like it came out of a Zen monastery,” Fortunato said.

The program aims to repair the physical damage to the “learning center” in many PTSD sufferers’ brains. That’s caused, Fortunato explained, when the body’s stress hormone is elevated too high and for too long — as it commonly is among combat troops.

“The good news is, [the learning center] is one of only two parts of the brain that can grow new cells,” he said. So his program requires participants to sit at a computer several times a day, doing mental exercises to help them regain their cognitive functioning.

While confronting the physical aspects of PTSD, the program addresses the emotional and spiritual aspects, too.

“Few soldiers come back from war without terrible images and events in their head,” Fortunato said. Many “suck it up and soldier on” in the combat theater because they have no choice. But when they return home, these issues can percolate to the surface as nightmares, flashbacks and other problems.

Fortunato’s program uses “rehearsal therapy” to help participants confront their most painful memories and experiences. “The soldier tells the story, as painful as it is, over and over until you’ve emptied it of its emotional punch,” he said. “They are never going to forget the story, but it doesn’t have to have the grip on their guts that it did before.”

Meanwhile, many soldiers with PTSD find that their combat experience has shaken their core beliefs and values, Fortunato said. A chaplain helps them review “the big organizing things in their life” as they address the spiritual piece of their PTSD struggle. “We weren’t doing much to address this before,” but it’s critical to a soldier’s healing, he said.

Fortunato said there’s nothing monumental about the Recovery and Resilience Center’s approach to treating PTSD. “If you put all of that together, it isn’t magic,” he said. “None of it is magic. And do you know what? None of it is new. All we did is, we looked at the whole soldier and tried to treat all of him.”

The “whole soldier” approach appears to be paying off. Twelve of the 37 soldiers who volunteered for the program have graduated and returned to their units. Among the recent graduates is a soldier who was in a catatonic state in August, but now is free of all signs of PTSD.

“Little miracles are what we are watching happen,” Fortunato said.

So far, only two participants have washed out of the program, both taking medical discharges from the Army.

Fortunato is the first to say his program isn’t for everyone. “This is a hard program,” he said. “[Participants are] in treatment 35 hours a week [with] daily psychotherapy, daily group therapy [and] integrative medicine. They go from 8:30 in the morning until 4:30 every afternoon. You have to be highly motivated to put up with that much treatment.”

There’s no set timetable for completing the program, but Fortunato said he’s finding six months to be optimal for most soldiers. “As long as they are working hard, we are going to hang in with them,” he said.

The soldiers formed their own platoon, which they dubbed, “the Wolf Pack.” It’s a testament, Fortunato said, to the way they take care of each other and the strength they’ve shown in admitting they have PTSD and seeking treatment.

As the soldiers work to overcome their combat stress and return to their units, Fortunato said he’s convinced the program is in the Army’s best interest as well.

The cost alone of treating a soldier — somewhere between $14,000 and $20,000 — is a bargain to the force, he said. By comparison, he said it would cost about $400,000 to recruit and train a new soldier and provide lifetime disability payments and medical care to the discharged soldier.

“So why wouldn’t you do this?” Fortunato said. “I think the numbers are all in our favor.”

Defense Secretary Robert M. Gates appears to agree. He toured the Restoration and Resilience Center on May 1, calling the visit an “extraordinary experience.”

“They are doing some amazing things here in terms of helping soldiers who want to remain soldiers but who have been wounded with post-traumatic stress disorder,” he said. “It is a multi-month effort by a lot of caring people, and they are showing some real success in restoring these soldiers.”

Gates called the center an example of new approaches the military is taking to care for these troops. “This center here is illustrative of what can be done,” he said.

Gates said he’ll consider the idea of possibly replicating Fort Bliss’ prototype program to other posts.

Fortunato said he’s all for duplicating his effort, but emphasized that his program’s small size is a key to its success. The soldiers and staff all know each other, have nicknames for each other, and feel a personal commitment to each other. “We all love these guys,” he said.

DoD
By Donna Miles
American Forces Press Service