Management of Acute Stress Reactions in the Military: A Stepped Care Approach

The Reconsolidation of Traumatic Memories Protocol's adjustments to the remote treatment of injured Ukrainian military personnel in hospital settings

Background: Due to the Russian invasion of Ukraine and the intense battlefield combat, many Ukrainian defenders have severe gunshot and explosion injuries, which result in broken bones, spinal damage, limb loss, and more. This physically and emotionally intensive experience often leads to acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD). During post-surgical recovery, injured military personnel need trauma-centred psychotherapy, which is often unavailable because of the hospital's setting limitations.Objective: The article aims to present adjustments of the Reconsolidation of Traumatic Memories (RTM) (US Patent Pending Number US-2024-0148297-A1) Protocol, a structured non-pharmaceutical neuro-based treatment that targets traumatic memory, to the remote treatment of injured Ukrainian military personnel in hospital settings.Method: This clinical practice paper presents two cases of online administration of the RTM Protocol in hospital settings to demonstrate the main adjustments made for remote work with physically injured military personnel.Results: The patients were referred to receive online RTM Protocol treatment by a surgeon due to the psychiatrist-assigned ASD diagnosis, presenting in repetitive flashbacks and sleep disturbances interfering with the post-surgical recovery. Initial and post-treatment screenings using the PCL-5 showed a significant drop in scores: from 36 to 12 points for the first case and from 41 to 7 points for the second case. The patients reported improvements in their mood and sleep, as well as the disappearance of flashbacks. The main adjustments involved on-site adaptations (using the procedure room, utilising nurse assistance, ensuring a stable Internet connection) and modifications to the procedure (conducting shorter sessions, up to 45 min), delegating some Protocol administration steps to patients, and using military jargon and commands.Conclusions: The online administration of the RTM Protocol shows promise for treating combat-related ASD in hospital settings, providing a structured intervention for recovering military personnel, and ensuring accessibility and effectiveness in resource-limited settings.

ABCDE-Psy: Primary assessment scale of acute stress response to critical and potentially traumatic events

Objective: The focus of this paper is to present the psychometric validation of the ABCDE-Psy, an hetero-administered psychological assessment scale for measuring people's acute stress response to critical and potentially traumatic events. Method: An item bank is proposed based on a literature review and expert opinion. Its psychometric validation follows the usual scheme of classical test theory. The scale was administered to two samples, the first watching simulated cases (n = 60) and the second participating in real environments (n = 213). Results: The ABCDE-Psy scale shows solid psychometric properties in terms of both reliability (α = .793; 95 % confidence interval 0.764 - 0.822) and validity. Construct validity was supported by a univariate model of the scale based on confirmatory factor analysis (CFI: 0.956, TLI: 0.976, χ2: 2.567, p = .784, R2: 0.681). Conclusions: The results demonstrate that the ABCDE-Psy scale can be used as a reliable and valid hetero-administered measure for primary psychological assessment of the acute stress response to potentially traumatic events. This has important practical and clinical implications and opens up a new area of research in emergency psychology.

Peer-based intervention for acute stress reaction: adaptations by five militaries

Military service members need to be able to operate under conditions of extreme stress to ensure the success of their team's mission; however, an acute stress reaction (ASR) can compromise team safety and effectiveness by rendering an individual unable to function. Building on an intervention originally developed by the Israel Defense Forces, several countries have developed, tested, and disseminated a peer-based intervention to help service members manage acute stress in others. This paper reviews how five countries (Canada, Germany, Norway, the UK and the USA) adjusted the protocol to fit their organisational culture while retaining essential elements of the original procedure, suggesting there can be interoperability and mutual intelligibility in the management of ASR by military allies. Future research should examine the parameters of effectiveness for this intervention, the impact of intervention on long-term trajectories, and individual differences in managing ASR.

A novel intervention for acute stress reaction: exploring the feasibility of ReSTART among Norwegian soldiers

Background: Soldiers in combat may experience acute stress reactions (ASRs) in response to trauma. This can disrupt function, increasing both immediate physical danger and the risk for post-trauma mental health sequelae. There are few reported strategies for managing ASRs; however, recent studies suggest a novel peer-based intervention as a promising approach.Objectives: This study assesses the feasibility of ReSTART training, a peer-based course designed to prepare soldiers to manage ASRs. ReSTART builds on programmes established by US and Israeli militaries. The current study evaluates the ReSTART programme in a Norwegian setting, across distinct groups of soldiers, professionals and conscripts.Methods: Participants included professional soldiers deploying to Mali and conscripts with 6 months of service, who completed the ReSTART training course and surveys administered pre- and post-training. These surveys assessed attitudes and programme acceptability. Analyses included 74 soldiers who provided complete survey responses.Results: ReSTART training received high ratings in terms of usefulness, relevance, and importance in managing ASRs. From pre- to post-training, respondents had significant increases in positive attitudes towards ASR management and confidence in handling ASRs personally, and at the unit level; decreases in stigma-related attitudes associated with ASRs; and increased perception of leadership emphasizing ASR management.Conclusions: ReSTART training shows potential as an effective tool when preparing soldiers to manage ASRs in high-risk environments, enhancing military units' capacity to support each other and effectively respond to stress-induced functional disruptions. This study adds evidence supporting the utility of peer-based ASR management in operational settings and highlights the need for broader implementation and systematic evaluation.

Optimising Combat Readiness: Practical Strategies for Integrating Physiological and Psychological Resilience in Soldier Training

This narrative review examines the intricate psychophysiological interplay between cognitive functions and physical responses within military personnel engaged in combat. It elucidates the spectrum of responses elicited by symmetric and asymmetric warfare alongside specialised combat scenarios, including close-quarters and subterranean warfare. Central to this discourse is the emphasis on integrating training programs beyond physical conditioning to encompass psychological resilience and decision-making efficacy under duress. The exploration further ventures into applying advanced technologies such as virtual reality and wearable devices, highlighting their pivotal role in augmenting training outcomes and supporting soldier health. Through a detailed analysis of psychophysiological variations across different military branches of service, the narrative review advocates for bespoke training regimens and support frameworks tailored to address the unique exigencies of each service branch. Concluding observations stress the importance of evolving military training paradigms, advocating for adopting realistic, immersive training simulations that mirror the complexities of the contemporary battlefield. This synthesis aims to contribute to the ongoing discourse on optimising military training protocols and enhancing the operational readiness and well-being of armed forces personnel. This narrative review is essential for military psychologists, trainers, and policymakers, aiming to bridge the gap between theoretical knowledge and practical implementation in military training programs.

User experiences of an online therapist-guided psychotherapy platform, OPTT: A cross-sectional study

Introduction

In the last few years, online psychotherapy programs have burgeoned since they are a more accessible and scalable treatment option compared to in-person therapies. While these online programs are promising, understanding the user experience and perceptions of care is essential for program optimization.

Methods

This study investigated the experiences of end-users who had previously received online psychotherapy through a web-based platform. A 35-item multiple-choice survey was developed by the research team and distributed to past users to capture their perceptions of the program.

Results

The survey yielded 163 responses, with a 90 % completion rate. Participants were predominantly white and female, with an average age of 42 years. While most participants preferred in-person therapy, they also reported the benefits of the online psychotherapy program. Participants had positive perceptions of the platform, the quality and interaction of their therapist, and the homework assignments and skills covered. Lack of motivation to complete weekly homework assignments was cited as a common struggle.

Discussion

The findings support online psychotherapy as a beneficial digital mental health tool and highlight some areas for improvement. Scalability and accessibility are key benefits of the platform. At the same time, improvements in participant engagement, including those from equity-seeking and equity-deserving groups, may enhance the efficacy of the programs offered.