Session Descriptions
Conference Video Presentations
Wednesday, 13 August 2008
Keynote Speakers
Gen Joseph P. Hoar, USMC(Ret), Former CINC, CENTCOM 
MajGen Michael R. Lenhert, Commanding General, Marine Corps Installations West
Plenary
William P. Nash, M.D., USN–USMC Combat and Operational Stress Consultant and : LTC Mary S. Hull, USA; Director of Resilience and Prevention, DCoE
The June 2007 report of the Congressionally mandated DoD–VA Mental Health Task Force identified the crucial need for operational leaders to assume personal ownership of the programs and processes necessary to build resiliency and promote recovery from operational stress in their service members and families. The partnership in the Marine Corps between its Marine Expeditionary Forces (MEFs) and its mental health and religious ministry professionals has provided a model for other military services to emulate. As the central organizing framework for combat and operational stress control in the USMC and USN, the Combat and Operational Stress Continuum Model shows great promise as a tool for leaders at all levels to promote psychological health in their units and services. This presentation details the current and future efforts of the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) to promote the Continuum Model across DoD.
CAPT Paul S. Hammer, MC USN; Director Naval Center for Combat and Operational Stress Control and CAPT Robert Koffman, Director, Deployment Health and Navy COSC Consultant
It is critical that COSC doctrine, policies and training concepts are consistent as they are being implemented throughout the naval services. This presentation will focus on current COSC doctrine and policy development issues in the Navy as well as to introduce the Naval Center for Combat and Operational Stress Control. Discussion will focus on common doctrinal issues, policies and training standards especially for Sailors who commonly deploy in support of the Marine Corps and the need for them to have a consistent COSC message.
Joseph J. Thomas, Ph.D., Director, John A. Lejeune Leadership Institute, MarineCorpsUniversity
Ethical decision making is a fundamental concern in the conduct of counter-insurgency or irregular warfare. The outcomes of decisions made in the heat of combat not only effect the tactical situation on the ground, but they can have a persistent effect on the warfighter for years to come. It is for this reason that Gen James Conway, Commandant of the Marine Corps, convened the 2007 Values and Ethics Working Group. Nearly 100 combat leaders from the fire team to regimental command level were brought to Quantico to discuss values and ethics and the impact that effective leadership can have. The results of the working group have been far-reaching. A large scale survey on leadership and ethics was developed and administered to nearly 2000 Marines across the operating forces. Curriculum and training tools were developed to support Marines and sailors in the field and efforts continue. The Gen. John H. Russell Leadership Conference has been reinvigorated to gather first-line leaders (primarily Marine NCOs) to help develop leadership, ethics, and core values doctrine, policy, and curriculum. The results of these efforts serve to prepare Marines for the challenges of irregular warfare. Training and education play a vital role in the prevention of combat operational stress. It is known that warriors who perceive themselves to be doing the right thing, for the right reasons, actually do the right thing and are more accepting of their actions, no matter how taxing and stressful.
Once a Warrior: Wired for Life
Bridget C. Cantrell Ph.D, Hearts Toward Home International
The workshop is designed for the OIF/OEF warriors. Their partners are also highly encouraged to attend with them when this is given. Each workshop is a structured awareness course revealing various ways warriors and their partners/family change during military separation. It provides them with effective coping techniques ensuring a smooth transition in regards to their communication and intricate relationship-building methods after returning from a war zone. It is also designed to encourage healthy interactions and discussions in a group setting and help them work together in dealing with critical issues they may face before and after the deployment(s). Other important topics include understanding the signs and symptoms of Combat Operational Stress (COS), Post Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI) and effectively coping with anger issues, substance abuse, sleep disturbances, and other physical and emotional wounds.
MILITARY TRACK
1300 – 1400: Session 1
Chaplain Mark W. Smith, CDR, USN
Warrior Transition II is the one Combat and Operational Stress Control brief in the Marine Corps for which attendance must be reported in MCTF as completed. The brief is intended to be given between 60 and 120 days following return from deployment, depending on unit’s dwell time before deploying again. It is less content oriented and more self-evaluative as participants discuss examples of doing okay, needing a little work, and needing help. Workshop will begin with actual presentation of the brief with attendees acting as participants, followed by ample discussion time.
1400 – 1500: Session 2
Col Gregory Boyle, USMC; Commanding Officer, Wounded Warrior Regiment
This presentation will be geared toward Marine leaders who will have wounded Marines in their command. It will help them understand the intricacies of providing care for these returning injured warriors and will give them an overview of the systematic approaches taken in providing administrative, sometimes legal, and medical care for our injured Marines. Marines who return injured from an operational or combat setting deserve the best focused care that the Marine Corps and Navy medicine can provide. Our Wounded Warrior program provides tailored and specific care for each injured Marine, including life-long follow-up and contact by the Marine Corps through our call center and by our recovery care coordinators. Of particular concern will be the treatment provided to those Marines exhibiting combat stress problems including PTSD. Interplay with traumatic brain injury will also be addressed. Other topics that will be covered include: non-medical case management; accountability and tracking; Pay/Benefits/Charitable support; assistance with employment and vocational rehabilitation benefits; smooth transition from DoD to VA; and, Traumatic Servicemember's Group Life Insurance (TSGLI).
Balancing Risks in Stress Control Policy
LCDR Bonnie R. Chavez, Ph.D., OPNAV Navy Behavioral Health Program Manager
Development of Stress Control policy requires balancing potentially competing demands and risks. Time to recover from stress effects must be balanced with availability for missions. Communication that normalizes stress reactions must be considered with adequate emphasis on needed assistance for stress injury. Communication between Leaders and Care-Givers must be balanced with privacy and confidentiality. Addressing security concerns must be squared with de-stigmatizing treatment. Improved access to care (with imbedded and integrated providers) must be balanced with maintaining therapeutic boundaries. Standardization of care to maintain minimum standards must be weighed versus providing choice and flexibility to address individual needs and preferences. Screening aimed at early identification of potential concerns must be balanced with retention. Navigating the balancing act and reducing the risks associated with any policy choice presents a key challenge in the development of Stress Control policy.
1500 – 1600: Session 3
Matthew A. Yanagi, Research Psychologist; SPAWAR
The proposed workshop will consist of a small panel formed to address the important relationship between stress disorders and their effects on sleep. Looking at the continuum from exposure to treatment, and from combat through post-deployment, three panelists will provide meaningful experiences and insightful information to help identify sleep disorders and their relation to stress disorders. Beginning with a combat veteran, the panel will present personal stories of operational experiences and the effect on sleep both during and after deployment. Next, the Sleep Laboratory Director of the Naval Medical Center San Diego will discuss current practices and experiences that include Marines and Sailors recently diagnosed with PTSD or other stress disorders. The panel’s third presenter will be the Director of the Sleep Disorder Clinic at VA San Diego Medical Center, who will discuss the VA sleep disorders program and treatment for veterans with stress disorders. The panel will conclude with a fifteen minute question and answer forum.
1600 – 1700: Session 4
Steven A. Murray, Ph.D, SPAWAR
This work attempts to establish an empirical database of factors – including stress and fatigue – that contributed to hazardous or lethal events during both Marine Corps (SASO / UWT) training and deployed settings. This method is similar to the approach taken by the NASA/FAA Aviation Safety Reporting System and is used to identify underlying factors in “real world” operations that are difficult to obtain in research conditions. Data were collected from SASO and Mojave Viper training, and from surveys distributed among Marine units in Iraq. Results were analyzed in terms of formal situation awareness models, and showed the relative contribution of stress and fatigue to hazardous events, broken down by individual unit role and mission, and demonstrate the potential analytical value of extracting similar information from current Marine Corps (e.g., MCCLL) databases.
Wayne Y. Ensign, Ph.D. Research Physiologist; Co-Director of the Human Performance Research Group SPAWAR
Prior to deploying to Operation Iraqi Freedom (OIF), Marine battalions undergo a 30-day training evolution referred to as Mojave Viper (MV). The training scenarios during MV are designed to expose Marines to environmental/operational conditions encountered during deployment to OIF. It is unclear however, whether such rigorous training is capable of eliciting stress and fatigue during the course of MV training. Given the operational tempo of MV training coupled with continuous exposure to harsh environmental conditions, it is important to determine any degree of stress and fatigue experienced as a component of MV training since stress and fatigue can influence training effectiveness, physical and cognitive performance, decision making capabilities, and the individual’s physiological and psychological state. Therefore, the purpose of this study was to assess the levels of fatigue and stress experienced by small unit leaders undergoing MV training thus providing insight into their potential impact on performance, situation awareness and training effectiveness.
FAMILY TRACK
1300 – 1400: Session 1
CAPT Edward Simmer, MC, USN, Director for Quality Management, Naval Medical Center, Portsmouth, VA and Ms. Peggy Simmer, MS, Command Ombudsman, Navy Medicine East and Naval Medical Center Portsmouth.
Combat/operational stress can have a significant impact on families, and family stress can, in turn, have a significant impact on the readiness of deployed troops. The presenters are, respectively, the Navy Medicine East and Naval Medical Center Portsmouth Command Family Ombudsman, and a Navy Psychiatrist who recently completed a deployment with an Army Combat Stress Control Unit in Iraq. The presentation will focus on operational stress issues that develop in families and effective (and not so effective) ways that family support personnel, COSC personnel, and commands can address these issues, both from the point of view of the family, and the deployed service member. Specific prevention strategies for families will be discussed. The presenters will also share their personal observations regarding issues for caregivers, especially when the caregivers are themselves facing the stress of a deployment.
1400 – 1500: Session 2
LT Michael D. Howard, CHC, USN; Naval Hospital Camp Lejeune
Most models of treatment for combat stress injury and Post Traumatic Stress Disorder (PTSD) are directed towards the individual. Dr. Sue Johnson has developed a highly researched model of couple therapy called Emotion-focused Therapy (EFT) that has proven extremely effective in treating couples impacted by combat-related PTSD. EFT focuses on the expression of emotion within the framework of adult attachment theory. The couple relationship is restructured to provide the service member with a safe haven and secure base as a foundation for healing. This workshop presents the therapeutic model of Emotion-focused Therapy (EFT) as a means to more effectively treat PTSD. Clinical aspects of PTSD are illustrated through the use of a dynamic case study designed to highlight potential attachment injuries, as well as examine and discuss significant elements of attachment theory and components of the EFT model. Emphasis is placed upon both theoretical and practical issues of treatment.
1500 – 1600: Session 3
Pamela J. McCrory, Ph.D., Psychologist; The Soldier Project
The presentation explores the impact of combat stress on couple relationships from the perspective of attachment theory. Attachment is defined as an innate motivating principle throughout life. Secure attachments offer a “safe haven” or secure base for adaptive development and the capacity for emotional regulation and resilience. There is a wealth of evidence that links the quality of close relationships to physical and mental health. Separation, fear, loss and helplessness are common experiences in the lives of service members and their families. These experiences represent threats which activate attachment needs--the comfort and connection of intimate relationships. Post-traumatic stress disorder and depression intensify the need for protective and supportive attachment experiences while negatively impacting an individual’s capacity to seek and receive this comfort. Symptoms of these disorders increase distress and interfere with communication, responsiveness and trust in relationships. Effective and relatively brief therapy aimed at identifying and altering patterns of interaction can promote healthy attachment bonds, reduce symptoms and facilitate resilience in the family.
1600 – 1700: Session 4
Kim Gates, Section Head Marine Corps Family Team Building, HQMC
The Commandant of the Marine Corps requires that the Marine Corps as an institution, and each Marine and Marine leader individually, undergo a complete shift in the approach to, and execution of, personal and family readiness and support. This workshop will outline the new family readiness programs, which are characterized by the Marine Corps shouldering its responsibility by holding Marines accountable for attaining and maintaining personal and family readiness, expanding the definition of family, appropriately utilizing volunteer support, expanding and refreshing training capabilities, increasing support opportunities, and committing the necessary financial, personnel, and technological resources to enhance former practices. With the changes, Marines and their families will be fully supported by the enduring partnership between the unit's family readiness command team and Marine Corps Community Services (MCCS) team, thus maximizing support.
LCDR Dwight Horn, CREDO Marine Corps West, MCB Camp Pendleton
At this conference, the Warrior Couple Readjustment; and the Warrior Challenge programs will be highlighted. We will uncover the different segments of each seminar to provide understanding of what is accomplished and the impact of each from experience. Videos from each event will be presented to give a visual of the seminars in action. The Warrior Couple Readjustment is a 2-day retreat that is targeted to the warriors who have been involved in live-fire combat. There are three central foci: 1) Uncovering the Warrior Experience; 2) Making connections with Counselors; and 3) Learning ways to facilitate togetherness. The Warrior Challenge is a half day training cycle on ethics and leadership. There are two 50 minute lectures and then, tactical simulations with Airsoft weapons that reinforce the ethics and leadership training.
CAREGIVER TRACK
1300 – 1400: Session 1
CDR Charles K. Springle, Ph.D, CDR, MSC, USN; Director, CommunityCounselingCenter, CampLejeune
Reserve, National Guard, and Active members who separate from service following service in OEF/OIF often return to communities far away from concentrated military support bases and structures. Local community mental health providers often lack an understanding of military culture and struggle to provide appropriate services for returning warriors and their families.
The Citizen Soldier Program at The University of North Carolina, through a pilot national demonstration project, developed a curriculum to respond to the needs of local community providers. Topics include a primer on military culture, identification of war-related stressors, common presenting issues, appropriate interventions, and available resources. Project faculty includes providers from the Veterans Administration, Tri-Care, and MCB Camp LeJeune. Additionally, representatives from N.C. National Guard units participate as “expert” presenters. The project is coordinated by the North Carolina Area Health Education Centers. This workshop will describe the process, lessons learned, and identify issues for future research and development.
1400 – 1500: Session 2
LCDR J. Michael Hakanson, CHC, USN; Deputy Wing Chaplain, 1st Marine Air Wing
This course would examine how the COSC model interplays with the essential element of personhood known as Spirituality. Among Americans, recent Gallop polls indicate that almost 80% profess a belief in the Divine. While many Americans today might not consider themselves religious, their professed beliefs show they have integrated spiritual elements into assumptions about life, morality, right, wrong, and justice and self worth. It follows that this pervasive element of personhood would factor heavily into each stage of the COSC intervention model.
Reasons for this understanding: Chaplains or lay psychological first responders may consider symptoms of stress as primarily a spiritual problem rather than primarily a stress reaction. Conversely clinicians who are not trained in the languages of faith may be looking past vital tools to bring Marines and Sailors back to the ready posture.
A Template for a Community Based Pro-Bono Mental Health Project
Judith T. Broder, M.D; Founder/ Director The Soldiers Project
The extent of the psychological sequelae of the current conflicts in Iraq and Afghanistan has exceeded expectations. It has become increasingly clear that all sectors of our health care system need to be involved in addressing the multiplicity of psychological needs of servicemembers, veterans and their extended families. In response to this growing need for psychological support and education, The Soldiers Project was established several years ago. The mission of the project is to provide free and confidential psychological services to those who have served in Iraq or Afghanistan and their loved ones; provide educational services to military families and the broader community regarding the psychological effects of war; and provide in-depth training on combat stress and the deployment cycle to out volunteer therapists. Based on three years of experience with a not-for-profit pro bono project, we will present a template for the formation of such a project
1500 – 1600: Session 3
Chaplain Mark W. Smith, CDR, USN
Warrior Transition II is the one Combat and Operational Stress Control brief in the Marine Corps for which attendance must be reported in MCTF as completed. The brief is intended to be given between 60 and 120 days following return from deployment, depending on unit’s dwell time before deploying again. It is less content oriented and more self-evaluative as participants discuss examples of doing okay, needing a little work, and needing help. Workshop will begin with actual presentation of the brief with attendees acting as participants, followed by ample discussion time.
1600 – 1700: Session 4
George Mangual, Director, Substance Abuse Counseling Center, Marine Corps Recruit Depot/ Western Recruiting Region
This workshop will discuss the interface of post traumatic stress and substance use disorders as well as the significance of substance use in altering emotional states. We will explore the use of medication in the treatment of physical and mental injuries and the danger of pain management drugs inadvertently being utilized to relieve psychic pain. In describing substance abuse disorders and post traumatic stress we will explore the effects of trauma on psychosocial development. Finally, we will discuss resources to help Marines facing the psychosocial challenges in returning from combat.
PROGRAMS, RESEARCH AND PROJECTS TRACK
1300 – 1400: Session 1
Nader Amir, Ph.D., Associate Professor, Center for Understanding and Treating Anxiety, SDSU/UCSD
Research suggests that individuals with Generalized Anxiety Disorder (GAD) show an attention bias for threat-relevant information. In the current paper, we tested the hypothesis that an eight-session attention modification program would (a) decrease attention bias to threat and (b) reduce symptoms of GAD. We trained attention by including a contingency between the location of the probe and the non-threat word in one group (Attention Modification program, AMP) and not in the other (Attention Control condition, ACC). Participants in the AMP showed change in attention bias and a decrease in anxiety, as indicated by both self report and interviewer measures. These effects were not present in the ACC group. These results are consistent with the hypothesis that attention plays a causal role in the maintenance of GAD and suggest that altering attention mechanisms may effectively reduce anxiety. More importantly, these results may have implication for easy-to-deliver treatment for traumatized individuals.
1400 – 1500: Session 2
Barry Francke, Clinical Supervisor, Marine and Family Services, Counseling Services, MCB Camp Pendleton
EMDR is one of the most effective short term treatment approaches for trauma. The use of EMDR in the treatment of combat stress improves Marines’ and Sailors’ adaptive functioning, thus improving Mission Readiness. Research has shown a rapid decline in self reported distress after only one session of EMDR (Rogers, et al 1999). Additionally, 77.7% of combat veterans treated with EMDR no longer met criteria for PTSD (Carlson et al, 1998). Now more than ever effective short term treatment is available. This presentation will include several case studies highlighting the use of EMDR in treating combat stress symptoms.
1500 – 1600: Session 3
James L. Spira, PhD, MPH; Clinical Professor, Department of Psychiatry, University of California San Diego and Research Scientist, Virtual Reality Medical Center
We will describe the benefits of an Office of Naval Research funded clinical intervention program that uses virtual reality to treat combat-related PTSD. 50 Marines and Navy support personnel diagnosed with recently developed combat-related PTSD were offered this treatment program, that included training patients to relax through biofeedback, and to ‘distance distress’ and focus more fully though Zen meditation, followed by immersion into a virtual reality Iraqi environment, where they were able to move about six different scenarios, including convoy, street combat, house clearing, medical, base camp, and marketplace. Results on those completing 10 sessions reveal that PTSD symptoms and autonomic reactivity reduced significantly. The impact of blast exposure impacted PTSD scores, as well as the inability to control autonomic reactivity at baseline, however these differences disappeared after treatment. Effects sizes were substantially greater than those found for other types of therapy for PTSD, including other forms of exposure therapy
Dr. Douglas Christian Johnson is Assistant Professor in Psychiatry at UCSD and the VA Center of Excellence in Stress and Mental Health (CESAMH).
The Response to Stressful Experiences Scale (RSES) is the result of a 2-year project by researchers at the VA’s National Center for PTSD, and assesses psychological resilience in active-duty military personnel. Scale items draw broadly from research in the areas of optimism, personality, religion & spirituality, psychobiology, emotion regulation, social modeling, fear-conditioning, cognitive flexibility, and coping. Reliability and validity of the RSES was examined in a sample of N = 902 active-duty and reserve personnel, predominantly from the 1st Battalion, 25th Regiment, Marine Expeditionary Unit (MEU), and the US Army 34th Combat Aviation Brigade, Blackhawk Helicopter Assault Battalion. In addition to demonstrating excellent reliability, the RSES is unique in assessing the processes and traits of being resilient rather than the outcome or state of resilience. This presentation will introduce the RSES, as well as provide a conceptual framework for its development and a summary of scale content and preliminary psychometrics.
1600 – 1700: Session 4
Linda Pfeiffer Pauwels, M.S; President, Alas de America Institute for Yoga, Wellness and Lifetime Physical Fitness; Maj Paul Simmonds, Deployment Processing Command; and SSgt Enrique Marin, MCMAP Instructor, Camp Pendleton
Presenter will discuss different types of meditative practices and their historical development (especially as it relates to the world’s warrior cultures) and review current research on meditation, its effects on stress resilience, and how it is being applied for the prevention and/or treatment of PTSD. The presenter will also discuss methods for integrating contemplative and/or meditative practices into USMC education/training schools, such as the Marine Corps Martial Arts Program. Workshop participants will receive instruction in meditative techniques and practice seated meditation.
1800 – 2000: Session 5
Scenes from Sophocles’ Ajax and Philoctetes : A Dramatic Reading
Bryan Doerries, New YorkBbased Writer and Director of Greek and Roman Plays
Discussants: William P. Nash, M.D, retired Captain in the U.S. Navy Medical Corps and former coordinator of Marine Corps Combat Operational Stress Control and Jay Kopelman, LtCol USMC(Ret)
Sophocles wrote plays nearly 2400 years ago, and yet they still speak to us today, perhaps with greater urgency than ever before. In his time, Sophocles wrote for an audience comprised mainly of combat veterans. He had been elected general twice and knew firsthand about the difficulties of war and of soldiers returning to civilian life. Dr. Jonathan Shay argues that, “Athenian theater was created and performed by combat veterans for an audience of combat veterans; they did this to enable returning soldiers to function together in a democratic polity.” Following Shay’s argument, it could be said that Western theater arose out of the therapeutic need to hear and tell the combat veteran’s story. In this presentation, actors will present scenes from Sophocles’ Ajax and Philoctetes, plays that intimately depict soldiers struggling with psychic wounds and chronic illnesses. A panel discussion will follow, featuring combat trauma specialists.