Treatment efficacy of virtual reality distraction in the reduction of pain and anxiety during cystoscopy.

OBJECTIVE: Assessment of virtual reality (VR) distraction for alleviating pain and anxiety during flexible cystoscopy. Cystoscopy is a common ambulatory procedure performed in Urology and can be associated with moderate pain and anxiety. Sophisticated distraction techniques are not used with cystoscopy and VR has not been studied for this procedure. We designed a prospective, randomized, controlled trial assessing the efficacy of VR for alleviating pain and anxiety during flexible cystoscopy. METHODS: Adult men referred for cystoscopy were randomized into a control or VR group. Subjects were given preprocedure and postprocedure questionnaires addressing anxiety, pain, and time spent thinking about pain. Vitals signs and galvanic skin monitors were used as objective measures. The control group underwent routine cystoscopy and the VR group underwent cystoscopy with VR. Physicians answered a postprocedure questionnaire assessing the difficulty of the exam. All questionnaires used a visual analog score for assessment. RESULTS: 23 patients enrolled in the control group and 22 in the VR group. Mean scores and Student's t-test were employed to analyze the data. No data endpoints showed a statistically significant difference between the 2 groups. CONCLUSIONS: We concluded no benefit to VR distraction mitigating pain in male patients during cystoscopy.

Mission, physical, and war stressors' impact on aircrew psychological strain.

BACKGROUND: Little is known about the relative impact of the organization of missions on aircrew well-being. Using an occupational stress model we investigate a previously little studied concept of mission stressors and determine its relative impact in comparison to physical and war stressors in the prediction of four strains in deployed aircrews. METHOD: Questionnaires were completed by 272 deployed in-aircraft crewmembers. Three new stressors were developed for this study: mission stressors, physical stressors, and war stressors. In addition, four strains were measured: PTSD, depression, sleepiness, and nervousness. Regression analyses were used to examine the relative impact of each stressor on the four strain measures while controlling for age and occupation. RESULTS: All three stressors played a significant role in the prediction strains with the total explained variance in the analyses ranging from 15% and 39%. Interestingly, mission stressors played the most important role in the prediction of strains possessing the largest partial eta squared in each analysis. The second most important stressor was physical stressors followed by war stressors. CONCLUSION: The importance of mission stressors may be because current training is designed to inoculate crewmembers to stressors such as the physical/environmental conditions and violent war actions, but there is no training or acknowledgment of the importance of dealing with mission stressors. Our findings suggest it might be beneficial for commanders to address these stressors, as it may improve short-term psychological well-being, which may ultimately impact mission success and safety.

Technology complementing military psychology programs and services in the Pacific Regional Medical Command.

The Tripler Army Medical Center is the only federal tertiary care hospital serving the Pacific Regional Medical Command. Due to Tripler's large area of responsibility, many behavioral health professionals are starting to employ more technology during their sessions. As explained in this article, virtual reality and telepsychology efforts are proving to benefit military service members and their families in the Pacific Rim.

The effectiveness of technology-enhanced relaxation techniques for military medical warriors.

Combat zones can be very stressful for those in the area. Even in the battlefield, military medical personnel are expected to save others, while also staying alive. In this study, half of a sample of deployed military medical warriors (total n = 60) participated in technology-assisted relaxation training. Learning relaxation skills with a video clip of virtual reality relaxing scenes showed a statistically significant impact on the anxiety levels of the Experimental Group.

Technology complementing military behavioral health efforts at tripler army medical center.

The purpose of this article is to provide a short narrative on the ways that behavioral health professionals and their patients are currently benefitting from the use of technology. Examples stem from applications of technology to patients/research participants at the Tripler Army Medical Center. The paper also discusses how current use of this technology has made it possible to serve individuals in their own cultural environment, providing a cost-effective means of providing mental health services.

CyberStudies: lessons from the trenches.

Many individuals suffer from anxiety, stress, and depression and those serving in the U.S. military are no exception. Warfighters keep returning from theater with combat stress. Several of these military service members are also technology oriented and tend to prefer performing their daily life activities with and/or near computerized systems. Fortunately, some researchers specialize in helping warfighters via gaming or virtual reality technologies. Nevertheless, a dearth of literature is published about challenges researchers face when conducting these types of studies. This article shares the experiences of a research team, under a uniformed Army Research Psychologist (Stetz), who runs research studies (a) with warfighters, (b) with technological equipment, and (c) in nonstandard laboratory settings.

The receptiveness of stress management techniques by military personnel.

Many military service members suffer from stress. Sixty Soldiers participated in a study designed to test receptivity to stress management techniques. Preliminary analyses of surveys and a focus group suggested that participants not only liked practicing relaxation techniques but would also continue practicing these after completion of the present study.

The impact of deactivation uncertainty, workload, and organizational constraints on reservists' psychological well-being and turnover intentions.

This study assessed the impact of the activation of U.S. Army reservists after terrorists attacked the United States on September 11, 2001. A total of 263 soldiers completed a survey and participated in focus groups. The model's stressors were deactivation uncertainty, workload, and organizational constraints. The outcomes were well-being and turnover intentions. In general, most stressors did predict the proposed outcomes. That is, with high deactivation uncertainty, workload, or organizational constraints, reservists reported low psychological well-being and high turnover intentions. Commanders and policymakers can use our findings when addressing ways to improve reservists' psychological health and to decrease turnover intentions. Specifically, reservists need more predictability and the needed organizational conditions (i.e., proper workload levels and equipment) while activated and deployed to protect our country.

Stress, mental health, and cognition: a brief review of relationships and countermeasures.

Today's network-centric battlefield environment is highly stressful and cognitively demanding. Many warfighters are feeling overwhelmed and end up being medically evacuated from theater due to mental health problems [i.e., post traumatic stress disorder (PTSD) and depression]. Of a sample of troops evacuated for psychiatric reasons, 21% (106 out of 509) had psychiatric histories prior to deploying to the theater of operations. Most cases were either related to stress (i.e., PTSD, n - 33, 310%) or to depression (n = 72, 66%). Stress disorders and depression predominate among the psychiatric causes for medical evacuation. This review paper discusses stress theories as they pertain to warfighting, the types of stress and stress disorders most prevalent on modern battlefields, the relationships among stress, psychiatric disease, and cognitive performance, and potential methods to decrease some types of stress-related acute and chronic disorders (i.e., virtual-reality stress inoculation training).

The effects of prior combat experience on the expression of somatic and affective symptoms in deploying soldiers.

OBJECTIVE: Deployment to a combat zone is undoubtedly an extremely stressful experience. It was hypothesized that, when faced with an impending wartime deployment, soldiers with prior combat experience would report minimal emotional problems accompanied by high rates of somatic complaints compared with combat-naive soldiers. METHODS: Self-reports of posttraumatic stress disorder (PTSD) and affective and somatic complaints were collected from 2068 U.S. soldiers just prior to combat deployment during Operation Iraqi Freedom. RESULTS: Although the percentage of soldiers scoring positive for PTSD was nearly identical for the experienced and inexperienced groups, scores on the Affective and Somatic scales differed as a function of prior combat history. Previous combat experience was associated with lower affective and greater somatic complaints relative to combat-naive soldiers. CONCLUSIONS: Consistent with theories of stress reaction, repression, and somatic amplification, combat-experienced soldiers reported limited affective complaints but greater somatic complaints relative to soldiers without combat experience.

Psychiatric diagnoses as a cause of medical evacuation.

The U.S. military is one of the best trained military organizations in the world. However, war-zone stressors may compromise the psychological resilience of even the most conditioned U.S. service members. The purpose of this study was to investigate the contributing causes for medical evacuation (medevac) during the present war on terrorism. We studied 5,671 cases of medevac reports during Operations Enduring and Iraqi Freedom (OEF and OIF). Our data indicated that psychiatric problems were among the leading causes of medevacs during this period of time. In fact, during March to September 2003, psychiatric problems accounted for 7% of the medevac cases during OEF and 6% during OIF, ranking among the top five reasons for evacuation from each theater. With the use of the International Statistical Classification of Diseases and Related Health Problems (ICD-9), we found that "Top Level Mental Disorders" and "Persons without reported diagnosis encountered during examination and investigation of individuals and populations" were the two main psychiatric reasons for the medevacs. Consequently, mental health researchers, operational commanders, and policy makers should continue developing procedures to mitigate psychiatric problems that translate to personnel loss and readiness decrements on the battlefield.

Monitoring and predicting cognitive state and performance via physiological correlates of neuronal signals.

Judgment, decision making, and situational awareness are higher-order mental abilities critically important to operational cognitive performance. Higher-order mental abilities rely on intact functioning of multiple brain regions, including the prefrontal, thalamus, and parietal areas. Real-time monitoring of individuals for cognitive performance capacity via an approach based on sampling multiple neurophysiologic signals and integrating those signals with performance prediction models potentially provides a method of supporting warfighters' and commanders' decision making and other operationally relevant mental processes and is consistent with the goals of augmented cognition. Cognitive neurophysiological assessments that directly measure brain function and subsequent cognition include positron emission tomography, functional magnetic resonance imaging, mass spectroscopy, near-infrared spectroscopy, magnetoencephalography, and electroencephalography (EEG); however, most direct measures are not practical to use in operational environments. More practical, albeit indirect measures that are generated by, but removed from the actual neural sources, are movement activity, oculometrics, heart rate, and voice stress signals. The goal of the papers in this section is to describe advances in selected direct and indirect cognitive neurophysiologic monitoring techniques as applied for the ultimate purpose of preventing operational performance failures. These papers present data acquired in a wide variety of environments, including laboratory, simulator, and clinical arenas. The papers discuss cognitive neurophysiologic measures such as digital signal processing wrist-mounted actigraphy; oculometrics including blinks, saccadic eye movements, pupillary movements, the pupil light reflex; and high-frequency EEG. These neurophysiological indices are related to cognitive performance as measured through standard test batteries and simulators with conditions including sleep loss, time on task, and aviation flight-induced fatigue.

The impact of National Guard activation for homeland defense: employers' perspective.

Data gathered from a study of reserve component (RC) soldiers who were activated during the spring of 2002, following the terrorist attacks of September 11, 2001, suggested that they were concerned about how the effects of their activation affected their civilian employment. Therefore, the purpose of this study was to obtain this information from the civilian employers of these RC soldiers. Most civilian employers who participated in this study (N = 28) were male (89%) and working in law enforcement (39%). Fifty-six percent of employers gave consent to be interviewed by telephone. Although supervisors reported difficulties in several areas of operation and aspects of the RC activation, they still supported the activation of their RC employees and their military mission. This study is a significant start to illuminating the important roles that both RC employees and their civilian employers play in homeland defense.