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40 Biobehavorial Resilience to Stress

Medical Center psychiatrists, Colonel (Ret) Douglas Waldrep and Colonel
(Ret) Raymond Lande. Th e first and most intensive stage of treatment is

administered as day hospitalization (6 h of treatment per day). This level of

treatment normally continues for 2 weeks but can be extended indefi nitely if
indicated. Service members who demonstrate improvement are transitioned
to an intensive outpatient program, where they continue to meet with a
therapist 1–4 times each week and with a team psychiatrist 1–4 times each
month. Service members can be treated at this level for an extended period
of time while they wait for a determination concerning their future disposi-
tion (return to duty versus separation). Eventually, they transition to a less
intensive model of care, with the option to transition back to a higher level
of care if needed.

Conclusions and Recommendations

This chapter has reviewed and described techniques that are currently
employed by military commanders and behavioral health personnel to iden-
tify and manage stress-related mental and behavioral health problems among
members of the U.S. military. Where possible, we have identifi ed relation-
ships between current practice and the goal of promoting psychological resil-

ience to stress. The U.S. military presently has a robust approach to preparing
its service members and their families for the realities of deployment and
to supporting them through the many challenges of the deployment cycle

itself. This approach includes prevention as well as treatment and concludes
by facilitating adaptive return to military or civilian life aft er deployment.
Although military policy and doctrine do not at present make explicit
reference to “resilience” per se, it is certainly a primary and implied concern
of many programs and practices that target service members’ ability to

confront and overcome negative effects of combat-related stress. As our
theoretical and scientific understanding of resilience improves, U.S. military

combat stress control programs will undoubtedly recognize its explicit rel-
evance and applicability to mental health in the context of military service.
Further rigorous research in this area would be helpful but is notoriously

difficult to achieve even without the challenges of continuous combat. In the
meantime, military psychiatrists are continually assessing preparation and
intervention strategies that may be helpful to service members.

Although resilience may be a difficult construct to define and test,
it is clear that military personnel possess very high levels of physical and
psychological resilience. Many of our nation’s soldiers are currently serv-

ing in their second or third deployments to Iraq. They and their families
demonstrate essential resilience every day and so may provide a uniquely
informative and inspiring basis by which to identify and assess resilient

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