Post-traumatic stress disorder risk and witnessing team members in acute psychological stress during combat.

BACKGROUND: Occupational groups operating in dangerous environments may witness the development of acute stress reaction (ASR) in team members. Witnessing ASR in team members may increase the risk of developing subsequent post-traumatic stress disorder (PTSD) symptoms. AIMS: To describe ASR symptoms that individuals witness, assess the relationship between witnessing a team member exhibiting ASR symptoms and an individual's own PTSD symptoms, and describe common intervention responses by peers. METHOD: Cross-sectional, anonymous surveys were conducted with US soldiers who were previously deployed (sample 1; n = 176) and currently deployed sample 2; n = 497). Surveys assessed combat experiences, PTSD (PTSD Checklist-5), ASR exposure and intervention responses. Analyses included frequencies and binary logistic regression. RESULTS: Witnessing at least one ASR symptom during a combat-related event was reported by 51.7% in sample 1 and 42.4% in sample 2; the most commonly observed symptoms were being unable to function or being detached. Controlling for combat experiences, high levels of witnessing a team member exhibit ASR symptoms was associated with increased risk of subthreshold PTSD or PTSD in sample 1 (odds ratio (OR) = 8.69, 95% CI 2.29-42.60) and approached significance in sample 2 (OR = 1.67, 95% CI 0.98-2.81). Common intervention responses included providing a directive or yelling; many also reported being unsure how to respond. CONCLUSIONS: Witnessing team members who exhibit ASR symptoms appears to be associated with screening positive for subthreshold PTSD or PTSD. Results suggest the need for further research into how to prepare individuals to manage ASR in team members and to examine ASR in other high-risk occupations.

Witnessing Acute Stress Reaction in Team Members: The Moderating Effect of Peer-Based Training.

Individuals who witness team members exhibiting symptoms of an acute stress reaction (ASR) in the middle of a high-stress operational event may be negatively affected; ASR-related training may moderate this impact. In the present study, 560 Israeli soldiers were surveyed about ASR exposure, posttraumatic stress disorder (PTSD) symptoms, public stigma, and whether they had received ASR-related training. This training, called YaHaLOM, is a Hebrew acronym that outlines steps for managing ASR in team members. Controlling for combat exposure, greater exposure to ASR symptoms was associated with more overall PTSD symptoms, PTSD cluster symptoms, and public stigma. YaHaLOM training buffered these relationships for PTSD, intrusion and avoidance symptoms, and public stigma. The findings suggest that such training may help teams in high-risk occupations better manage ASR exposure.

YaHaLOM training in the military: Assessing knowledge, confidence, and stigma.

Under conditions of profound stress, individuals in high-risk occupations may experience an acute stress reaction (ASR). Given that ASRs may interfere with functioning, placing the team in danger, the Israel Defense Forces developed YaHaLOM training to teach service members how to manage ASRs in team members. YaHaLOM is a novel, rapid, peer-based intervention specifically designed for use in the midst of a high-stress event. In all, 904 Israeli combat soldiers participated in the study; 76% reported having received YaHaLOM, and 24% reported that they had not. In addition to measures of knowledge about managing ASRs, confidence in managing ASRs, and stigma-related attitudes toward ASRs, questions also addressed training approach, including the use of a video and instructor type. Participants who reported receiving YaHaLOM also reported more knowledge about managing an ASR, more confidence in managing an ASR, less external stigma, and more normative views of ASRs. Being trained with a video was associated with more confidence and less self-stigma than being trained without a video. Instructor type was not associated with differences in knowledge, confidence, or stigma-related attitudes. The study is limited by cross-sectional self-report data. Nevertheless, results suggest YaHaLOM may prepare soldiers to manage ASRs in team members; future studies are needed to assess intervention efficacy and to expand this research to other high-risk occupational contexts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Rapid response to acute stress reaction: Pilot test of iCOVER training for military units.

OBJECTIVE: The purpose of this study was to pilot the iCOVER curriculum-a training product designed to teach service members how to recognize and respond to acute stress reactions (ASRs) using a simple, 6-step procedure, iCOVER. Three goals guided the pilot: (a) assess training acceptability, (b) assess impact of training on knowledge and performance of the iCOVER procedure, and (c) explore the effects of in-person and computer-simulated practical exercises. METHOD: Six military squads (N = 66) were randomly assigned to 3 conditions: iCOVER Standard (iCOVER instruction with an in-person practical exercise), iCOVER Tech (iCOVER instruction with a computer-simulated practical exercise), or Control (no iCOVER instruction). Squads in the iCOVER conditions received iCOVER instruction, completed a knowledge test and practical exercise to which they were assigned (i.e., Standard or Tech), demonstrated their iCOVER skills in live-action scenarios, and reported their perceptions of the training. RESULTS: iCOVER training was acceptable to most participants and associated with improved knowledge about iCOVER (Mpre = 3.33 vs. Mpost = 5.15; t[42] = -7.61, p < .001, d = 1.41); iCOVER Standard resulted in more iCOVER behaviors during a live-action scenario compared with the other conditions, F(2, 35) = 13.36, p < .001, η2 = 0.43. Compared with iCOVER Tech, iCOVER Standard had greater acceptability and resulted in better performance of iCOVER. CONCLUSIONS: This is the first U.S. demonstration of a training program designed to address ASRs during high-risk operations and offers a potential way ahead for preparing military teams to manage ASRs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Does It Help? The Contribution of Wives' Ways of Giving Support to Their Veteran Husbands' Posttraumatic Stress Symptoms and Functional Impairment.

In this study, we aimed to understand female partners' ways of giving support to their male military veteran partners' adjustment. Specifically, we examined the direct and moderating contributions female partners' ways of giving support-active engagement, protective buffering, or overprotection-make on their male partners' posttraumatic stress symptoms (PTSS) and functional impairment. Our hypotheses were that (a) female partners' active engagement would be negatively correlated with male veterans' PTSS and positively associated with veterans' functioning, (b) female partners' protective buffering and overprotection would be positively correlated with veterans' PTSS and negatively associated with veterans' functioning, and (c) female partners' ways of giving support would moderate the association between their secondary PTSS and male partners' adjustment. Participants were 300 male Israeli veterans of the 2006 Israel-Lebanon War and their female partners, all of whom completed self-report questionnaires. Active engagement did not contribute to female partners' or veterans' adjustment. In addition, whereas the correlations showed both female partners' protective buffering and overprotection were associated with male veterans' adjustment, the regression analysis showed only protective buffering made a direct, η2 = .040 and .053, and moderating contribution to veterans' adjustment, η2 = .019 and .016. Results revealed that when the level of protective buffering was high, female partners' secondary PTSS was associated more positively and strongly with veterans' PTSS than when protective buffering was low. The discussion reviews the complexity of giving support in couples when the veteran has PTSS.

The double-edged sword: The role of empathy in military veterans' partners distress.

OBJECTIVE: The existing literature has shown that war veterans' posttraumatic stress symptoms (PTSS) are associated with high levels of distress in their female partners. According to the literature, spouses' empathy for their spouses can be a risk factor for their own mental health. However, this subject has not been examined among veteran couples. The current study therefore investigated both the direct and moderating contribution of females' cognitive and affective empathy to their own PTSS and depression symptoms, above and beyond the preexisting traumatic events of the women's own lives and the veterans' PTSS. METHOD: Participants were 300 Israeli men who had served in the 2006 Israel-Lebanon War and their female partners, all of whom completed survey questionnaires. RESULTS: Results revealed that although cognitive empathy can play a positive role for the female in the aftermath of a traumatic event, affective empathy can potentially make a negative contribution to her distress. Women's education, in number of years, and their own previous traumatic life events, as well as veterans' levels of PTSS, were all found to make a direct contribution to females' PTSS and depression symptoms. CONCLUSION: Findings support the theory that although higher empathy can play a positive role in military couples in which the male partner displays symptoms of PTSS symptoms, it can also contribute negatively to her distress. (PsycINFO Database Record

Secondary traumatization of partners of war veterans: The role of boundary ambiguity.

The existing literature has shown that war veterans' posttraumatic stress disorder (PTSD) symptoms are associated with a higher level of distress in their female partners. However, less agreement exists regarding the sources of this distress and the mechanism by which this process occurs. The current study examined the consequences of Israeli war veterans' PTSD on their female partners, as manifested by the females' PTSD symptoms, mental health status, and functioning, while taking into account females' earlier traumatic events. Using the theory of ambiguous loss, it also suggested boundary ambiguity as a mediating variable by which the PTSD of the male veteran is transmitted to his female partner. Participants were 300 men who had served in the 2006 Israel-Lebanon War and their female partners. Results revealed direct associations between males' PTSD and their female partners' PTSD, functioning, and mental health. In addition, boundary ambiguity mediated the association between males' PTSD and females' adjustment. Finally, females' own earlier traumatic events were directly associated with their own PTSD symptoms. Implications of this model for intervention and research are further discussed.