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Resilience and Military Psychiatry 37

manage stress. The Walter Reed Army Institute of Research has conducted

numerous survey studies to assess the mental health of soldiers during

and after deployment. Consistently these surveys show that about 13% of
soldiers experience symptoms of PTSD, anxiety, and depression while they

are deployed, and about 17% experience symptoms after they return home
(Hoge et al., 2004).
Clinicians deployed in Iraq have observed that a common chief complaint
among service members who have been diagnosed with depression is the
need for increased dosage of antidepressant medication aft er recurrence
or exacerbation of symptoms due to the stress of deployment. Antidepres-
sant medications are extremely useful to correct the neurochemical imbal-
ance associated with depression. However, most antidepressants currently
available must be taken for several weeks before they begin to demonstrate

benefi cial effect. When pharmaceutical intervention is indicated, clinicians
frequently prescribe selective serotonin reuptake inhibitors (SSRIs). Non-
SSRI antidepressants are also available and may be especially useful for
individuals who have comorbid problems such as attention defi cit disorder
(ADD), nicotine dependence, or anxiety.
Numerous other types of therapies have also been demonstrated eff ective
in treating depressive disorders in structured or community mental health

settings. The realities of combat can make it difficult for military clinicians to
offer behavioral therapy in a classical clinical setting. Nevertheless, military

mental health professionals offer variant forms of supportive therapy, relax-

ation training, cognitive behavioral therapy, psychodynamically oriented
therapy, and social skills/coping strategies education to treat depressive and
anxiety disorders in theater. In each case, the goal is to identify and correct
behavioral or cognitive impediments to effective and healthy performance.

Anxiety
Anxiety disorders are the most common and treatable form of psychiatric
illness. Anxiety can be treated by psychological therapy, pharmaceutical
intervention, or a combination of both. Anxiety disorders include generalized
anxiety disorder (GAD), obsessive compulsive disorder (OCD), panic disorder,
phobias, PTSD, and acute stress disorder (ASD). In each case, anxiety is suf-
ficiently severe that it interferes with functioning by causing panic, avoidance,

or hypervigilant behavior.
Not surprisingly, a wide variety of data sources identify an increase in

the prevalence of PTSD during and after exposure to combat in Iraq and
Afghanistan. Hoge et al. (2004) observed a “strong relationship between
combat experiences, such as being shot, handling dead bodies, knowing
someone who was killed, or killing enemy combatants, and the prevalence of

PTSD.” Th eir findings pointed to a direct relationship between the extent of

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