Cognitive behavioral therapy for insomnia among active duty military personnel.

Insomnia is one of the most frequent sleep complaints among veterans and military personnel. This retrospective study investigated whether cognitive-behavioral therapy for insomnia (CBT-I) improved sleep and reduced insomnia symptoms in an active duty military population. The study consisted of 98 military personnel (mean age = 31.0, SD = 7.4; 70% male) who experienced insomnia and completed CBT-I in a military sleep disorders clinic. Assessments of sleep were completed analyzing pre- and posttreatment variables from the sleep diary, Insomnia Severity Index (ISI), and Epworth Sleepiness Scale (ESS). At baseline, the mean ISI was 16.63 (SD = 4.36) with a total sleep time (TST) of approximately 5.90 hr (SD = 1.32). After CBT-I, the ISI was 14.50 (SD = 5.19) and TST was 5.62 hr (SD = 1.32). There was no significant change over time for patients who received fewer than 4 sessions, but change over time was significant for patients who received 4 or more sessions. Over the course of treatment, patients' overall sleep improved across metrics with 20% achieving clinically meaningful improvement in insomnia symptoms. CBT-I improves insomnia symptoms in some military personnel. However, everyone does not respond successfully to CBT-I treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Nonrandomized Trial of Prolonged Exposure and Cognitive Processing Therapy for Combat-Related Posttraumatic Stress Disorder in a Deployed Setting.

For many decades, the U.S. military's general operational guideline has been to limit the use of trauma-focused treatments for combat and operational stress reactions in military service members until they have returned from deployment. Recently, published clinical trials have documented that active-duty military personnel with combat-related posttraumatic stress disorder (PTSD) can be treated effectively in garrison. However, there are limited data on the treatment of combat and operational stress reactions or combat-related PTSD during military deployments. This prospective, nonrandomized trial evaluated the treatment of active-duty service members (N = 12) with combat and operational stress reactions or combat-related PTSD while deployed to Afghanistan or Iraq. Service members were treated by deployed military behavioral health providers using modified Prolonged Exposure (PE; n = 6) or modified Cognitive Processing Therapy (CPT; n = 6), with protocol modifications tailored to individual mission requirements. The PTSD Checklist-Military Version (PCL-M) total score was the primary outcome measure. Results indicated that both groups demonstrated clinically significant change in PTSD symptoms as indicated by a reduction of 10 points or greater on the PCL-M. Participants treated with modified PE had significant reductions in PTSD symptoms, t = -3.83, p = .01; g = -1.32, with a mean reduction of 18.17 points on the PCL-M. Participants treated with modified CPT had a mean PCL-M reduction of 10.00 points, but these reductions were not statistically significant, t = -1.49, p = .12; g = -0.51. These findings provide preliminary evidence that modified forms of PE and CPT can be implemented in deployed settings for the treatment of combat and operational stress reactions and combat-related PTSD.

Suicide in the Military: Understanding Rates and Risk Factors Across the United States' Armed Forces.

This paper presents data from the United States Department of Defense Suicide Event Report System for years 2012-2015 to detail descriptive, longitudinal rate data and risk factor profiles associated with military suicide. The annual findings were aggregated from all U.S. military suicide deaths and suicide attempts. Data elements included the most common method of suicide (firearms), most common behavioral health diagnoses (substance abuse/dependence), common life stressors (failed intimate-partner relationships), and an individual's history of operational deployment. Age- and sex-adjusted rates for the Services were compared with rates for the U.S. adult population. Results showed that the current reporting period (2015) is similar to patterns that have been observed over the preceding years and to patterns reported in the overall U.S. adult population. Suicide rates remain elevated but stable for both the Active and Reserve Components of the Military Services compared to historical levels observed prior to 2003. Finally, we discuss common errors and misinterpretations that can occur when analyzing surveillance data.

Smartphone apps for psychological health: A brief state of the science review.

In this brief state of the science review, we provide a synopsis of the literature on psychological health mobile applications (apps) and discuss the impact of mobile technology on psychological health practice. We describe the variety of psychological health app uses from self-management, skills training, and supportive care to symptom tracking and data collection; and we summarize the current evidence for the efficacy and effectiveness of psychological health apps. Finally, we offer some pragmatic suggestions for evaluating psychological health apps for quality and clinical utility. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Postdeployment mental health screening: an application of the Soldier Adaptation Model.

The Global War on Terrorism and its corresponding frequent and long deployments have resulted in an increase in mental health concerns among active duty troops. To mitigate these impacts, the Department of Defense has implemented postdeployment screening initiatives designed to identify symptomatic soldiers and refer them for mental health care. Although the primary purpose of these screenings is to identify and provide assistance to individuals, macrolevel reporting of screening results for groups can assist Commanders, who are charged with ensuring the wellbeing of their soldiers, to make unit-level interventions. This study assesses the utility of a metatheory of occupational stress, the Soldier Adaptation Model, in organizing feedback information provided to Army Commanders on their units' postdeployment screening results. The results of a combat brigade of 2319 soldiers who completed post-deployment screening following return from Iraq were analyzed using Structural Equation Modeling to assess the Soldier Adaptation Model's use for macrolevel reporting. Results indicate the Soldier Adaptation Model did not strengthen the macrolevel reporting; however, alcohol use and reckless driving were found to mediate the relationship between combat exposure and numerous mental health symptoms and disorders (e.g., post-traumatic stress disorder, anger, depression, anxiety, etc.). Research and practice implications are discussed.

The development of narrative identity in late adolescence and emergent adulthood: the continued importance of listeners.

Research on narrative identity in late adolescence and early adulthood has not extensively examined how conversational storytelling affects the development of narrative identity. This is a major gap, given the importance of this age period for narrative identity development and the clear importance of parent-child conversations in the development of narrative identity. The authors present a series of 3 studies (n = 220) examining how late adolescents and early adults construct narrative identity in ways that are shaped by their listeners. The findings suggest that late adolescents and early adults construct more meaning-laden, interpretive accounts of their everyday experiences when they converse with responsive friends. Further, even within this sample's abbreviated age range, the authors found evidence for age-related increases in the factual content of personal memories. Such findings illuminate the importance of friends in the construction of narrative identity during this key developmental period.

Predicting the anticipated emotional and behavioral responses to an avian flu outbreak.

BACKGROUND: The purpose of this study was to develop a model to predict the emotional and behavioral responses to an avian flu outbreak. METHODS: The participants were 289 university students ranging in age, income, and ethnic backgrounds. They were presented with scenarios describing avian flu outbreaks affecting their community. They reported their anticipated emotional responses (positive emotion, negative emotion) and behavioral responses (helping, avoidance, sacrifice, illegal behavior) as if the scenarios were actually occurring. They also were assessed on individual differences expected to predict their responses. RESULTS: Participants were only modestly familiar with the avian flu and anticipated strong emotional and behavioral responses to an outbreak. Path analyses were conducted to test a model for predicting responses. The model showed that age, sex, income, spirituality, resilience, and neuroticism were related to responses. Spirituality, resilience, and income predicted better emotional responses, and neuroticism and female sex predicted worse emotional responses. Age, sex, income, and spirituality had direct effects on behavior. The emotional responses were directly related to each behavior and mediated the effects of individual differences. CONCLUSION: Emotional responses may be important in predicting behavior after an outbreak of avian flu, and personal characteristics may predict both emotional and behavioral responses.