Treatment of post-traumatic stress disorders: an applied rear-echelon approach.

This paper presents an applied innovative rear-echelon approach for the treatment of recalcitrant soldiers suffering from post-traumatic stress disorder in the 1982 Lebanon-Israel War. This was used as an alternative to psychiatric hospitalization. Use was made of a short-term, goal-directed, multidisciplinary treatment approach within the confines of a clear military setting. Reintegration into military and civilian life was an integral part of the program. Results indicated that at discharge, all soldiers showed a markedly improved clinical picture. Follow-up results 2.5 years later indicated that the percentage of regulars who returned to combat units doubled, whereas the reservists showed a slight tendency toward deterioration. Follow-up 6 years later showed the continuation of the same tendency. Ramifications of our findings are extensively discussed.

Israel defence forces experiences with treatment of POWs and families: an innovative multifaceted treatment model.

This paper attempts to provide an integrative, multifaceted treatment approach for the surviving POW and his family. The model takes into account the individual, family, interpersonal, and community effects of captivity from the time of captivity until 1 year later. Ramifications of this model are discussed.

Israeli psychological casualties of the Persian Gulf war: characteristics, therapy, and selected issues.

The Persian Gulf war in 1991 presented Israel with its first experience of a threat of chemical attack on the home front. Ground-to-ground missiles were aimed directly at civilian populations, threatening death and destruction over a period of several weeks. Uncertainty as to time, place, and nature of the missile attacks affected the civilian population psychologically. The psychological responses of the population were the result of the continuous nature of the emergency which affected the entire population, and the destruction, injury, and displacement which affected those who were the targets of the attacks. The primary psychological effects of the emergency were investigated in several ways: surveys of samples of civilian and rear-echelon military populations, studies of the military personnel who asked for ambulatory psychological treatment as a result of the war, and studies of the specific populations that bore the brunt of the actual physical attacks were conducted. These studies show a high level of distress in the samples, with considerable differentiation between the populations. Levels of functioning generally remained intact even among the displaced or injured. Interventions were based on experience gained in the treatment of combat stress reaction. The issues of evacuation of psychological casualties to hospitals, psychiatric aspects of chemical attacks, and secondary traumatization of therapeutic and other staff are emphasized.

In the shadow of the Gulf war: psychological distress, social support and coping among Israeli soldiers in a high risk area.

This study assessed the sense of safety, psychiatric symptomatology, coping and sources of support among eight groups of soldiers stationed in the region at highest risk for missile attacks during the Persian Gulf war. The sample consisted of 659 regular, reserve, and career soldiers, both male and female. Findings show that elevated levels of distress were associated with a high level of perceived threat, a low level of perceived self-efficacy, a low level of trust in army authorities, and a low level of support from the social network, particularly from commanding officers. Practical implications are discussed.

Malingering in the clinical setting: practical suggestions for intervention.

The complex nature of malingering observed in the military is examined, and a practical approach to the handling of such behaviour in the clinical setting is outlined. The complementary tasks of the mental health professional, the primary care physician, and other community agents are discussed.

Debate reawakened: premorbid factors for soldiers with refractory posttraumatic stress disorder.

Soldiers with severe Posttraumatic Stress Disorder who did not respond favourably to the front echelon treatment units, were treated in a rear echelon treatment centre, named Combat Fitness Retraining Unit, an alternative to psychiatric hospitalization. The soldiers were given individual clinical interviews; their combat potential scores were measured to tap premorbid factors which may have contributed to the development of symptoms. Analysis indicated that (1) in the clinical interview subjects showed clear interpersonal, school, family, and army adjustment problems prior to the trauma, (2) soldiers with Posttraumatic Stress Disorder treated in the rear unit tended to come from the lower end of the military combat potential level. Ramifications of these findings were carefully elucidated.

Collaboration and mental health education for military primary care physicians.

This paper highlights the diverse ways in which army mental health specialists can intervene as therapists, consultants and supervisors to the primary care physician and his team. Various consultation and collaboration approaches are described, as well as the need for army medical staff to participate in ongoing mental health training workshops.