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Due 03/22/2019 Elevating your insight and awareness to your own self-care and wellness is critical to maintaining a healthier trauma response that will ultimately reflect in providing better service provision to clients, supervisees, students, and communities. Now that you have explored work practices that inhibit or promote self-care and wellness. In this week’s Discussion, it is now time to delve deeper and study best practices in this area. As a future helping professional, knowledge of these best practices will help you lead programs and supervise students in a way that minimizes environmental contributions to vicarious trauma. For this Assignment, select an interview from the media carousel in this week’s Resources and consider best practices for promoting professional wellness for that work setting (e.g., agency, police or fire station, school). Think of how each practice might be applied and the potential benefits for trauma-response helping professionals to promote self-care and wellness. Select one or more articles that are specific to a work setting from this week’s Resources to inform your answer. Assignment (2–3 pages): Be detailed in response, use 4 APA references Use the video “Media Carousel: Trauma-Response Helping Professionals” to select an interview. Please select a different interview from the previous week. Describe the work setting in the interview you selected.Identify at least three stressors related to this work environment.Explain three best practices for the work setting you chose to promote personal and professional wellness.In your response, provide evidence-based research from current literature for the inclusion of this sort of environmental practice. Be specific. References Adler, A. B., Castro, C. A., & McGurk, D. (2009). Time-Driven Battlemind Psychological Debriefing: A Group-Level Early Intervention in Combat. Military Medicine, 174(1), 21–28. https://doi-org.ezp.waldenulibrary.org/10.7205/MIL… Laureate Education (Producer). (2014b).Mediacarousel: Trauma-responsehelping professionals [Video file].retrieved from https://class.walden.edu Morrissette, P. J. (2004). The pain of helping: Psychological injury of helping professionals. New York, NY: Taylor & Francis. Chapter 7, “Vicarious Traumatization” (previously read in Weeks 2 and 3)
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MILITARY MEDICINE, 174, 1:21, 2009
Time-Driven Battlemind Psychological Debriefing:
A Group-Level Early Intervention in Combat
Amy B. Adler, PhD*; COL Carl Andrew Castro, MS USAf; MAJ Dennis McGurk, MS USA’
ABSTRACT Military personnel who experience combat-related events are more likely to report mental health problems yet few early interventions have been designed to do more than assess those with problems or treat those with diagnoses. Psychological debriefing is one early intervention technique that has been used with military populations to reduce
symptoms across entire groups. Although there are several different kinds of debrieñngs, this article describes timedriven Battlemind Psychological Debriefing procedures for use during a combat deployment. The five phases include:
Introduction, Event, Reactions, Self and Buddy Aid, and Battlemind Focus. The paper reviews implementation guidelines, scientific support for Battlemind Psychological Debriefing, and feedback from military behavioral health providers
in Iraq. Comparisons with other military debriefing models identify unique features and how Battlemind Psychological
Debriefing is integrated into the larger Battlemind Training system.
BATTLEMIND PSYCHOLOGICAL DEBRIEFING:
A GROUP-LEVEL EARLY INTERVENTION
IN COMBAT
It is estimated that between 20 and 30% of US military personnel returning from combat report significant psychological
symptoms.’ Furthermore, evidence suggests that symptoms
may not be evident immediately following a combat-related
experience but may increase over time.’-^ Thus, mental health
interventions for service members on combat deployments
are needed for those with symptoms and for those who may
develop symptoms over time.
Nevertheless, there have been few early interventions developed specifically for supporting mental health during a combat deployment. Two types of interventions that do exist are
Combat Operational Stress Control (COSC)^ and Trauma Risk
Management (TRiM).” These programs support far-forward
psychiatric care, early identification of mental health problems,
brief and immediate interventions, and appropriate follow-up.
Despite the prevalence of mental health problems on deployment, most of the interventions provided by these programs
target individuals. The interventions, whether delivered by a
professional (in COSC) or trained peer (in TRiM), are geared
to providing assessment and clinical services to individuals
with significant symptomatology or functional impairment.
The exceptions to this individual approach include psychoeducation, which is typically taught in groups, command consultation, which can lead to changes that affect the entire unit.
*US Army Medical Research Unit-Europe, APO AE 09042.
tMedical Research and Materiel Command, RAD III, Medical Research
and Materiel Command, 504 Scott Street, Fort Detdck, MD 21702.
Material has been reviewed by the Walter Reed Army Institute of Research.
There is no objection to its presentation and/or publication. The opinions or
assertions contained herein are the private views of the authors, and are not to
be construed as official, or as reflecting true views of the Department of the
Army or the Department of Defense.
This manuscript was received for review in January 2008. The revised
manuscript was accepted for publication in September 2008.
MILITARY MEDICINE, Vol. 174, January 2009
and group-level assessments (e.g., the Unit Behavioral Health
Needs Assessment).^ Another type of group-level intervention
is group psychological debriefing. The focus of the present
paper is time-driven Battlemind Psychological Debriefing, a
new type of group psychological debriefing designed for use
at periodic intervals with deployed units.
PSYCHOLOGICAL DEBRIEFING
Group psychological debriefing is one of the most common
early interventions with military units.* Although there are
several different types of psychological debriefings, they contain similar elements: a structured group discussion designed
to review a stressful experience. Specific debriefing models
vary in terms of number of phases, focus of discussion, and
degree of structure provided to the group.^ Several reviews
have described the development of debriefing in the military context.^’ The military’s debriefing tradition is rooted in
Marshall’s World War II Historical Group Debriefing (HGD).«
These after-action reviews appeared to have the added benefit
of clarifying misperceptions and promoting unit cohesion.'”
Thus, the military developed a tradition of unit-based debriefing, although debriefing techniques differed in terms of focus
on emotional content.
There is some controversy, however, as to whether psychological debriefing is effective, neutral, or even potentially
harmful. Those studies reporting harmful effects have generally misapplied psychological debriefing by debriefing victims of traumatic events such as victims of severe burns,”
motor vehicle accidents,’^ and violent crime,’^ rather than
those exposed to traumatic events as part of their occupational
responsibility, and by conducting psychological debriefings
with individuals (rather than with intact occupational groups).
Despite these limitations (see Litz et al.’ for a review), metaanalyses of these studies”’-‘^ have led some to call for a stop to
debriefing in any form.'”*
Given that these studies involved individual victims of
trauma, it is difficult to discern whether the conclusions are
21
Time-Driven Battlemind Psychological Debriefing: A Group-Level Early Intervention in Combat
relevant for military units. Clearly, however, there is a need
for military-relevant research. Unfortunately, most previous
studies with military samples have been conducted without
control groups’* or random assignment to condition,’^”*
although results from such studies suggest it is worth examining the positive impact of debriefing on military populations.
In an exception, peacekeepers randomly assigned to debriefing
who reported high levels of mission-related Stressors reported
slightly better mental health outcomes compared to those
assigned to stress education. Although effect sizes were small,
subjects reported liking debriefing more than stress education. Although this was the first randomized trial of debriefing
with the military, there were few deployment-related critical
incidents, reducing the degree to which conclusions could be
drawn regarding debriefing efficacy on deployment.”
In a subsequent randomized trial, debriefing, developed
specifically for soldiers returning from combat, was assessed.
Compared to postdeployment stress education, this form of psychological debriefing was associated with better mental health
4 months later for individuals reporting high levels of combat
experiences in Iraq.^° As a result of these findings, Walter Reed
Army Institute of Research (WRAIR) researchers further developed these postdeployment debriefing procedures for use in
theater. These procedures comprise Battlemind Psychological
Debriefing. In this article, we describe the rationale for developing Battlemind Psychological Debriefing, introduce three
Battlemind Psychological Debriefing techniques, detail implementation guidelines for one of these techniques (in-theater
time-driven Battlemind Psychological Debriefing), contrast
it with other debriefing models, and report on feedback from
behavioral health providers using this technique in Iraq.
Developing Battlemind Psychological Debriefing
Besides the empirical support for developing Battlemind Psychological Debriefing, the need to create new debriefing procedures was also driven by anecdotal evidence that existing
models did not meet the demands of a combat deployment.
Although other psychological debriefing models such as
HGD,’« After-Action Debriefing (AAD),^’ Critical Event
Debriefing (CED),^^ and Critical Incident Stress Debriefing
(CISD),^’ have been used with the Army, accounts suggested
that implementation of these procedures was random with
facilitators dropping or modifying phases partly because the
models did not address the deployment-related concerns of
military personnel. Most recently, for example, the Mental
Health Advisory Team (MHAT) V found haphazard implementation of debriefing procedures in Afghanistan.^”
Besides the lack of consistency, published critiques of psychological debriefing have typically focused on the problems
with single-session debriefing. These critiques centered on
the fact that debriefing could potentially lead to harm through
re-exposing individuals to trauma, exposing other team members to trauma, interfering with natural healing processes,
and suggesting negative messages regarding recovery.^^ Up to
now, some debriefing procedures have been delivered within
22
a framework of trauma management but otherwise do not
address the other criticisms of debriefing.
Battlemind Psychological Debriefing was developed to
address shortcomings of previous models, capitalize on the
unique nature of military deployments, and provide a common method across behavioral health providers. Specifically,
Battlemind Psychological Debriefing does not elaborate on
traumatic events. This lack of historical review (or reconstruction) avoids the risk of exposing individuals to details of the
original trauma. In addition, the new procedure emphasizes
personal resilience and avoids sending the implicit message
that participants will develop mental health symptoms. Also,
Battlemind Psychological Debriefing does not subvert natural
recovery but instead encourages the use and provision of social
support. Eurthermore, the procedure is not conducted as a standalone intervention but is part of behavioral health support provided to operational units as well as integrated with Battlemind
Training, the Army’s mental health training program.
The Battlemind Training System
Battlemind Training, developed by the WRAIR for military personnel across the deployment cycle, was mandated in 2007 as
part of the Deployment Cycle Support program. The training is a
strength-based approach designed to enhance soldier skill development, adaptation to the Stressors of combat, and management
of the transition from combat to home.^” It also targets stigma
and help-seeking attitudes related to mental health problems.
Research on Battlemind Training has found high user
acceptability. Eurthermore, although effect sizes were small,
three group randomized trials have demonstrated that Battlemind Training positively affected the adjustment of soldiers
returning from combat.^””-^** Thus, the evidence supports the
value of an integrated mental health training system which
reinforces similar terminology and principles; Battlemind
Psychological Debriefing exemplifies this approach.
BATTLEMIND PSYCHOLOGICAL DEBRIEFINGS
In all, WRAIR researchers have developed three different
types of Battlemind Psychological Debriefing. There are two
in-theater models. Time-driven Battlemind Psychological
Debriefing is designed to occur at intervals during the deployment and addresses the cumulative effects of the deployment. Event-driven Battlemind Psychological Debriefing
can be used when a commander requests support following
a specific traumatic incident. The third type of Battlemind
Psychological Debriefing occurs at postdeployment. Combatrelated events are acknowledged with an emphasis on the
process of transitioning home, adapting specific Battlemindrelated skills for postdeployment, and resetting one’s Battlemind. The present article focuses on time-driven Battlemind
Psychological Debriefing, provides considerations for implementation, outlines each debriefing phase, and identifies
how Battlemind Psychological Debriefing is integrated into
Battlemind Training.
MILITARY MEDICINE, Vol. 174, January 2009
Time-Driven Battlemind Psychological Debriefing: A Group-Level Early Inten’ention in Combat
Time-driven Battlemind Psychological Dehriefing uses a
set of specific questions to guide participants through phases
in which combat events or deployment experiences are acknowledged among unit members. In addition, Battlemind Psychological Debriefing involves a review of common reactions
to combat-related Stressors and actions that can be taken to
facilitate functioning during the deployment. This kind of
approach is not expected to prevent the development of psychiatric disorders but rather to reduce the level of mental
health symptoms for the unit overall. Although the full procedures (e.g., specific phrasing for each phase and transitions
between phases) are available,^’ the next sections highlight
key elements of this approach.
Implementation Guidelines
Participants
Individuals participating in a Battlemind Psychological Debriefing should be members of a platoon or other group that
functions as an equivalent team (e.g., route clearance teams
and personnel security detachments), typically involving
-20-30 individuals. Units with high levels of combat exposure should be prioritized. Individual service members should
include all ranks in that team, including the team leadership.
Facilitators
Battlemind Psychological Debriefings need to have at least
two facilitators: a leader and one cofacilitator.
Qualifications
Ideally, Battlemind Psychological Debriefing leaders should
be behavioral health officers or chaplains with training in
counseling and should be responsible for providing services
to that unit to minimize territorial issues with other behavioral health providers. Cofacilitators should be service members with related specialties (e.g., enlisted mental health
specialist, military personnel who have received Battlemind
Psychological Debriefing training). The facilitators may be
part of the same unit (e.g., battalion or brigade), or they may
be external to that unit (e.g., combat operational stress control team). Regardless, facilitators should have pre-established
relationships with the unit, have worked with the unit prior
to deployment, or at least have visited the unit during the
deployment. The lead facilitator should be able to provide
appropriate follow-up consultation.
Facilitator Role
The facilitator’s job is to establish rapport with the group, set
a tone of respect and confidentiality, and transition the group
through each of the phases. In serving this vital function, the
facilitator should not dominate the discussion, should not
allow one or two unit members to dominate the discussion,
and should avoid allowing the session to turn into a questionand-answer dyad. Lead facilitators and cofacilitators need
to work together to keep the discussion on track with appropriate summary comments and transitions. If participants are
MILITARY MEDICINE, Vol. 174, January 2009
reluctant to respond during one of the phases, the facilitators
can prompt discussion by introducing what other units like
theirs have typically described.
Timing
Time-driven Battlemind Psychological Debriefings should be
scheduled at intervals during the deployment (e.g., 4 and 8
months into a 12-month deployment). These debriefings are
particularly well-suited to long deployments in which there
may be so many serious incidents that units are reluctant or
unable to hold a debriefing after each one and repeated debriefings may lead unit members to perceive the session to be a rote
exercise. In addition, the cumulative effect of deploymentrelated Stressors can be addressed with time-driven debriefing.
Given real-world constraints regarding accessing remote sites,
it is recommended that Battlemind Psychological Debriefings
be prioritized for units experiencing high levels of combat
and for those units distant from other mental health resources.
At minimum, such units should receive one time-driven
Battlemind Psychological Debriefing midway through their
deployment because the 6-month point has been associated
with increased reports of mental health problems.^** Previous
research has also documented the increase in Stressors experienced by military personnel over the course of shorter deployments.^” Thus, for shorter deployments more typical of NATO
and other allied nations, the time-driven method could be
scheduled across shorter intervals (e.g., 2 and 4 months of
a 6-month deployment).
Ideally, Battlemind Psychological Debriefings should be
conducted at the end of the duty day. After the session, individuals may continue to talk with one another or support one
another. If individuals immediately return to duty, they may
be distracted from providing or receiving on-going support.
Battlemind Psychological Debriefing can be expected to take
-60-120 minutes depending on platoon size, participation,
and the range of issues potentially affecting the unit.
Preparation
The facilitator should touch base with the key unit leaders
before the start of the session to find out about significant
unit event(s) (e.g., casualties, combat experiences, changes in
morale). In addition, the leaders should be told what to expect
from the Battlemind Psychological Debriefing. They should
be told that the session provides an opportunity for the leaders to promote unit member resilience by: (1) normalizing
the experience of the significant event or the postdeployment
transition, (2) talking about events and feelings, (3) reinforcing the meaning of the unit’s sacrifice, and (4) preparing the
unit psychologically to return to duty and to have a story with
which they can live when they eventually return home.
Identify Local Resources
Facilitators need to know what mental health resources are
available to service members and to have a plan for what to
do in the unlikely event a unit member needs an immediate
23
Time-Driven Battlemind Psychological Debriefing: A Group-Level Early Intervention in Combat
mental health evaluation. Part of this planning means communicating with mental health resources responsible for the unit
to inform them that the Battlemind Psychological Debriefing
will be occurring and clarifying the way such referrals should
be facilitated.
Know Battlemind Training
Facilitators also need to become familiar with Battlemind
Training (training materials are available through www.battlemind.army.mil). By incorporating language and themes from
Battlemind Training, the facilitators reinforce the key points
of this mental health training program.
Follow Up
After Battlemind Psychological Debriefing is completed, key
unit leaders should be provided a status report, including a
brief description of any pertinent facts and recommendations
as appropriate. In addition, follow-up contact with the leader
should be scheduled to obtain feedback and a status update.
Throughout, standard confidentiality regarding specific unit
members needs to be maintained.
Time-Driven Battiemind Psychoiogicai
Debriefing Procedures
The objectives of each phase, sample prompts for each phase,
and the transition between phases of time-driven Battlemind
Psychological Debriefing are provided in Table I.
Phase I: The Introduction
The introduction should be brief, establish the climate and
ground rules, and provide basic information about the facilitators’ experience with the subject of combat reactions and
TABLE I.
Phase
24
Phase 2: The Events
The goal of the second phase is to establish the kinds of events
that have placed a significant demand on unit members. The
facilitator asks participants to consider one or two deploymentrelated events that have been the most difficult, the ones that
“still stick with them,” The facilitator does not need to repeat
back what each person says. Facilitators must be sure they
know what event service members are describing but not get
In-Theater Time-Driven Battlemind Psychological Debriefing Phases: Goals, Prompts, and Transitions
Goal
Introduction
Introduce facilitators, objectives, and
ground rules.
Event
Establish the kinds of events that have
placed a significant demand on unit
members.
Normalize thoughts and reactions.
Reaction
the transition between critical eve …
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