Page 61 - Biobehavioral Resilence to Stress

38 Biobehavorial Resilience to Stress

exposure to combat and likelihood of developing PTSD symptoms. Specifi -
cally, PTSD prevalence ranged from as low as 4.5% among service members
who were never involved in a fi refight to as high as 19.3% among those who

had been involved in at least fi ve fi refi ghts.
Anxiety disorders may be treated by clinical therapies such as cogni-
tive behavioral therapy, exposure therapy, and eye movement desensitiza-

tion and reprocessing (EMDR) therapy. These methods are particularly

effective in treating ASD and PTSD but may be difficult to perform in a

combat zone as mission or travel requirements may interfere with the need
for weekly therapeutic sessions over a sustained period of time. For service
members who must be treated while serving in the theater of operations,
therapy usually focuses on alleviating specific symptoms that interfere with

performance in the fi eld.
Interestingly, symptoms such as hypervigilance can be seen as highly
adaptive and even essential to survival while in combat and thus may not
indicate the need for intervention or treatment until the postdeployment
phase. If medical intervention is indicated for anxiety disorder, SSRIs are
usually the preferred pharmaceutical approach (APA Practice Guide-
lines, 2004; Ball, Kuhn, Wall, Shekhar & Goddard, 2005; Stahl, 2000).
Benzodiazepines may also be helpful in the treatment of panic disorder.

However, caution is warranted in light of recent findings, which suggest that
benzodiazepines can actually increase the severity of PTSD, especially if
used for a long period of time (APA Practice Guidelines, 2004). Venlafaxine

(Effexor XR) may be useful in treating GAD with depression (Howland &
Thase, 2005; Thase, Entsuah & Rudolph, 2001).

Sleep Disorders
Insomnia has been the most commonly reported symptom of combat-related
stress among service members deployed in Iraq. Since prolonged sleep

deprivation can have a potentially critical effect on performance (see Belenky
et al., 1994), it is a common focus for treatment in a combat zone. In the
absence of other symptoms indicative of underlying medical issues, insomnia

can be treated first by behavioral intervention (e.g., sleep hygiene education).
If pharmaceutical intervention becomes necessary, drug selection must take

into account possible side effects (e.g., drowsiness), personnel occupation and
current duties, comorbid symptoms if any, history of substance abuse if any,

and individual limitations or difficulties that might interfere with eff ective
self-administration of medication according to instructions. Deployment
formulary medications for the treatment of insomnia include trazodone,
zolpidem, lorazepam, clonazepam, prazosin, and quetiapine. As an adjunct
in the treatment of ASD and PTSD, alpha- or beta-blocker medications can
be used to target autonomic symptoms and nightmares.

12/13/2007 6:09:38 PM
CRC_71777_Ch002.indd 38 12/13/2007 6:09:38 PM
CRC_71777_Ch002.indd 38