Dr Robert London

Will the U.S. Army's new resiliency training prevent mental distress?

Clinical Psychiatry News - Volume 37, Issue 10, Page 10 (October 2009)

Congratulations to Gen. George W. Casey Jr. and to the Army for offering its members resiliency training. Recognition on the part of the Army's top brass that steps can be taken to avoid PTSD, anxiety disorders, and depression represents a huge step forward for mental health care.

However, in order for this training to “work,” those leaders must accept that mental disorders, like physical disorders, are often rooted in biology. If the generals can come to understand and believe that PTSD has a biological origin and if those generals are able to communicate that message to the young soldiers, the training can have a profound impact. Such a change in military culture could be transformative.

One of the key questions, according to a New York Times article about this new initiative, is whether military personnel will accept educational techniques or whether they will perceive this training as too “emotional or touchy feely” (New York Times, Aug. 18, 2009, p. A1).

If the perception is too “emotional or touchy feely,” the program will suffer and enjoy only limited success.

It is essential that any PTSD prevention program explain why some people are more vulnerable than others to experiencing the disorder. In life, as in medical care, some people have clear vulnerabilities to certain problems. Over the years in treating PTSD, I have been successful using relaxation techniques and behavior modification techniques, such as reciprocal inhibition and systematic desensitization, coupled with guided imagery. I wrote about my success in using these techniques many times over the years in The Psychiatrist's Toolbox column. One of those columns focused on treating veterans (“For Vets With PTSD, Try Behavior Modification,” November 2007, p. 23).

I understand that the military has been quite successful in using virtual reality techniques, a more technologically sophisticated method of visualization and desensitization. Many concepts of cognitive-behavioral therapy can be successfully integrated into the process.

In educating soldiers about anxiety, depression, and PTSD, the cognitive therapies [“thinking therapies,” as I like to tell those I have taught this to] will be very helpful in preventing these stress-related disorders.

For example, teaching thinking that avoids the pitfalls of “all or nothing” or either “this or that” type of thoughts will be helpful in combating some of the stressors that lead to the disorders that many have suffered.

Another concept I use is the idea of possibilities and probabilities, where a person can think anything is possible, but going from extremes, to the simple “what are the probabilities?”

When perspectives are challenged and widened, many times stress and anxiety over certain issues are controlled or stopped.

I am optimistic that the military's focus on developing coping skills in advance of the stress will help some soldiers avoid many stress disorders. Such an emphasis will help soldiers develop multiple perspectives on events of life that, with one-dimensional thinking, lead to internalization and personalization—which in turn, can lead to stress and stress-related disorders.