Page 54 - Biobehavioral Resilence to Stress

Resilience and Military Psychiatry 31

hardiness—factors commonly recognized as important to individual and
group resilience—appear to affect emotionally sustaining behavior in

context of military service ( Manning, 1991).
Prevention is a key objective in fostering resilience to stress among
deployed service members. By emphasizing preparation and prevention,
the U.S. military also promotes the view that each individual service member
and each military unit can (and should) claim at least some level of control
over responses and reactions to stresses that are unavoidably associated with
deployment and combat.

COSC on the Battlefi eld

Despite all the best efforts to prepare and train for the stress of combat,

inevitably some individuals will suffer stress-related diffi culties and dis-

orders that interfere with their effective performance on the battlefi eld. In
recognition of this reality, the U.S. Army deploys mental health providers to
combat zones as members of combat units, medical units, and units specifi -
cally designed to provide combat stress control intervention and treatment.
Traditionally, each U.S. Army combat division has included division mental
health (DMH) personnel assigned directly to a unit consisting of three
behavioral health officers (one psychiatrist, one psychologist, and one social

worker) and as many as seven enlisted service members with specialized
training as paraprofessional mental health technicians. Recently, however,
the army unit organization has changed such that mental health personnel
are now assigned at the brigade combat team (BCT) level. Medical units such
as combat support hospitals and area support medical battalions also have
mental health personnel assigned to them, usually including two or three

behavioral health officers and several technicians.

The U.S. Army also trains dedicated combat stress control (CSC) units

whose mission is to provide specific mental health interventions as needed
in the theater of military operation. CSC units are “stand-alone” units that
include a unit commander and unit-assigned vehicles. CSC units may be

configured as a detachment (20–40 active duty personnel) or as a company
(approximately 80 reservist personnel).
Military psychiatry defines interventions as universal, selective, indi-

cated, or treatment (Department of the Army, 2006). These four categories

are analogous to the concepts of primary, secondary, and tertiary prevention
of disease and dysfunction in the field of public health. Universal interven-

tions are preventive in nature, targeting the general military population at the
unit level. For example, combat stress personnel provide psychoeducational
briefings, which they deliver at the unit level to educate unit members about

stress management strategies and resources. Th ese briefings also help to

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