Page 55 - Biobehavioral Resilence to Stress

32 Biobehavorial Resilience to Stress

identify mental health providers as present, available, and approachable.
Other examples of universal interventions include command consultations,
unit surveys, or “sensing” sessions (similar to focus groups). Th ese initiatives
provide commanders with opportunities to identify and begin to address
unit issues or areas of dysfunction.
Selective interventions are targeted at units or at individual service

members who have already been identified as being at higher-than-average

risk for stress-related problems. This risk category would include units whose
members have been exposed to a traumatic incident and engaged in protracted
operations. In situations of this type, combat stress and trauma specialists are

assigned to provide affected units with targeted service known as traumatic

event management (TEM). This service involves the evaluation and selec-
tion of intervention techniques as warranted by the unit’s specifi c situation.

The TEM approach draws upon the civilian model of critical incident stress
management (CISM) (see Everly & Mitchell, 1997; Mitchell & Everly, 1997).
The TEM doctrine has been modified in response to recent fi ndings that

call into question the effectiveness of critical event debriefing as a strategy to

prevent traumatic reactions. For example, some studies have cautioned that
critical event debriefing may be ineffective as a means to prevent PTSD and

may even increase the risk of PTSD in some individuals (see NIMH, 2002;
Ritchie, Friedman & Watson, 2006). TEM instead emphasizes the need for

a more flexible approach, which includes “psychological first aid” as needed

and as appropriate to each specific or unique situation. TEM specialists may
conclude that formal critical event debriefing is not indicated, but rather

there is a need for other proactive interventions such as personnel rotations
(i.e., to control or limit individual exposure to traumatic stress).
Indicated interventions target individual service members who have
demonstrated behavior that suggests the need for mental health intervention

or treatment. These individuals may be identified by their leaders, colleagues,
mental health or other health care providers, or by self-referral. Indicated
interventions may also target entire units whose performance has been
compromised. Indicated interventions recognize and apply the traditional
military forward psychiatry concepts of PIES, including simple restorative
interventions such as “three hots and a cot” (food and rest).
Service members who display symptoms of stress-related dysfunc-
tion or disorder should be treated as soon as the problem is recognized and
should receive the necessary support as close as possible in proximity to their
assigned unit (support system). These individuals are reassured that their

symptoms are usually “a normal response to an abnormal situation,” and

that with the help of some brief, simple, and often very practical restorative
interventions (sleep, nutrition, hygiene), they will soon return to their
prior level of functioning and will be able to return to their original units.
Although it is recognized on the basis of historical and recent experience that

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