How Mental Skills Training Can Decrease Mental Injuries in the Armed Forces • The Havok Journal

by MSG Alf H. Rodahl, Norweigan Army

The United States (U.S.) government has sent Soldiers to fight the war on terrorism for over two decades, which elevated the concerns for mental health injuries of active military personnel and veterans by the leaders of the military, psychological professionals, and the general population (Inoue et al., 2021). The Department of Defense publishes reports on the overall health of U.S. military servicemembers yearly and reports from 2019 and 2020 showed an increase of 0.3% in military personnel diagnosed with mental health disorders (Kline et al., 2021). Reports also show a high prevalence of Post-Traumatic Stress Disorder (PTSD) and depression among veterans who served in the military, and approximately one of every third of military veterans suffers from PTSD in the U.S. According to Kline et al. (2021), PTSD is an anxiety disorder that typically occurs after a person experience one or several traumatic events, depending on how resilient the person is.

People who suffer from PTSD often develop unwanted distressing memories or flashbacks from a stressful event. They also experience physiological reactions like increased heart rate and shortness of breath when having these memories or flashbacks, affecting their coping ability. PTSD patients can also develop hyperarousal and avoid certain situations which affect daily life routines, relationships, and employment, as well as the risk of developing substance abuse (Kline et al., 2021).

Furthermore, from a psychological perspective, suicide is mostly committed by personnel with mental issues. An average of 21 veterans tried to take their own life every day in 2021. Furthermore, more than 45,000 active military personnel and veterans died from suicide in 2019, with veterans accounting for 14% of the total number (Ravindran et al., 2020). This paper aims to analyze how the armed forces can make Soldiers more resilient by integrating mental skill training (MST) as part of a pre-deployment program to decrease stress-related injuries and enhance Soldier’s performance in stressful and extreme situations within a military context.

A U.S. Army paratrooper assigned to the 20th Engineer Brigade focuses on his mission prior to jumping out of a C-130H Hercules aircraft during a Joint Operational Access Exercise (JOAX) at Fort Bragg, N.C., on June 26, 2013. JOAX was designed to enhance cohesiveness between U.S. Army, Air Force, and allied personnel, allowing the services an opportunity to properly execute large-scale heavy equipment and troop movement. (DoD photo by Senior Airman James Richardson, U.S. Air Force/Released) Source.

The History of Military Psychology

Medical personnel in the military have shown an increased interest in understanding the psychological effects of war on Soldiers since the first World War. During World War One, the military tried out the first intervention for combat stress, which was taking Soldiers from the battleground and giving them rest (Crocq & Crocq, 2000). During World War Two, armed forces around the globe implemented psychologists in the screening and selection of military personnel. Furthermore, the military placed phycologists near the front line to observe which reactions war brought on the Soldiers. Although psychologists developed several screening procedures during that time, it did not prevent Soldiers from suffering from combat fatigue and other mental problems.

During the Korean War from 1950 to 1953, the number of U.S. Service members declared to be phycological casualties was as high as 250 out of every 1000 Soldiers (Kennedy & Zilner, 2012). During the Vietnam War, from 1963 to 1973, the number of phycological casualties decreased, but still many U.S. Soldiers had PTSD caused by a series of compounded stressors. For example, these stressors included long rotations, challenging conditions, a well-trained enemy, and a lack of support from their home country (Tull, 2019). According to Tull (2019), approximately 30% of all Vietnam veterans suffer from PTSD after returning from war.

The wars in Iraq and Afghanistan challenged subject matter experts in psychology to provide a better understanding of combat-related illness. A study including 290,000 veterans treated by the U.S. Veteran’s Administration from 2002 to 2008 found that 37% of those taking part in the study had received mental health diagnoses like PTSD and depression (Baker, 2014). The number of Soldiers defined as mental health casualties during the global war on terrorism was higher than after the Vietnam War. Reports that show an increased number of mental health casualties may result from more focus on the topic, better health care, and less stigma related to mental health. However, an increase in numbers of mental health casualties proves the importance of implementing preventive measures for the mental pressure that young men and women face as Soldiers during combat.

Soldiers of the ArmyÕs 101st Airborne Division (Air Assault) fire a TOW missile at a building suspected of harboring Saddam HusseinÕs sons Qusay and Uday in Mosul, Iraq, on July 22, 2003. Qusay and Uday were killed in a gun battle as they resisted efforts by coalition forces to apprehend and detain them. DoD photo by Sgt. Curtis G. Hargrave, U.S. Army. (Released) Source.

Mental Pressure in Combat

During combat, Soldiers experience life-threatening situations in an environment filled with uncertainty. Warfighters must be able to perform complex and multiple tasks, in an environment where even good tactical decisions can lead to fatalities. Furthermore, their adversaries kill with all means available. Soldiers are still digging holes in the ground and fighting from them, even though modern war is far from the trench warfare of the first World War. Based on the author’s experience while leading a unit fighting in Afghanistan, the characteristics of modern wars are great physical demands, an elevated level of uncertainty, and danger. Despite technological development, Soldiers today have the same primary instinctive responses they had thousand years ago (Evans, 2010). Therefore, preparing Soldiers for combat involves great challenges.

Preparing a Soldier for war is the equivalent of teaching someone to swim without water before throwing them into the sea at night during a storm and expecting them to swim ashore without drowning. This example shows how difficult it is to prepare someone for fighting a war without the opportunity to expose them to the type of environment and stress they will face during battle. For this reason, the effects of combat stress will remain problematic despite technological advantages and new and improved tactics and techniques. Soldiers and leaders also experience increased demands for their cognitive skills because of the complexity of technological advantages. Future Soldiers must be able to conduct close-quarter combat against a deadly enemy while having the cognitive surplus to take advantage of the technological aspect of modern war. Therefore, military personnel must be able to perform at a high physical level and be mentally robust to successfully conduct decision-making in a stressful environment.

How Stress Affects Performance and Decision-Making

Soldiers often find themselves in environments where their life is in danger. To prepare Soldiers for this environment, they undergo endless hours of training and demanding exercises to enable the art of performing at their absolute best under dangerous and stressful conditions. Combat exposes Soldiers to three diverse types of stress. These three types are acute stress, episodic stress, and chronic stress (Chiuwen, 2010). Acute stress appears sudden and is short lasting. According to Chiuwen (2010), acute stress activates the sympathomedullary pathway, which further activates adrenaline secretion to support the fight, flight, or freeze continuum. Examples of scenarios that trigger acute stress are high unexpected noises, near misses during combat, or a sudden and unexpected firefight.

Episodic stress lasts longer, evokes a higher arousal level, and affects how we approach a specific situation afterward. An example can be a Soldier who drives on a dirt road in Afghanistan and has knowledge of the high threat of improvised explosive devices (IED). Here the Soldier will drive carefully and look for signs indicating an IED throughout the entire time spent on the dirt road. Chronic stress is the accumulated version of acute and episodic stress. It is detrimental to a Soldier’s health because of the elevated levels of cortisol, regulated by the hypothalamic pituitary adrenal. Examples of chronic stress are when Soldiers experience life-threatening situations where they fear for their lives regularly over time. As the examples show, something must activate stress to have a stress response, often referred to as stressors. All stressors tend to produce a physiological response which usually acts out through increased heart rate, elevated breathing, increased perspiration, and glucose production (Chiuwen, 2010).

US Army (USA) Lieutenant (LT) Jim Jack, Platoon Leader, 2nd Platoon, Alpha Company, 579th Engineering Battalion, listens to the pleas from the mother of an Iraqi man taken into custody during Operation Grizzly Forced Entry. Operation Grizzly Forced Entry is a battalion-sized cordon, search, and seizure mission to capture High Value Targets who have launched attacks against Logistics Support Area (LSA) Anaconda, during Operation IRAQI FREEDOM. Source.

According to Kiely (2017), psychological stress refers to a mismatch between a person’s perception of a specific task’s demands and their belief in their ability to conduct the task. Furthermore, physical reactions during stress affect the ability to think clearly and make rational decisions. On one hand, knowledge of how mental and physical reactions will affect Soldiers during combat enables a comprehensive approach to mental skills training (MST). On the other hand, reactions caused by stress are far beyond cognitive control and will affect Soldiers to some degree no matter what. Therefore, the primary goal of MST for Soldiers must be to prepare them for extreme environments by teaching them to recognize how to respond to stressful situations, how to obtain cognitive control, and accept that some circumstances are beyond individual control. Preparing Soldiers for these types of situations must be part of the pre-deployment training.

Mental Skill Training as Part of Pre-Deployment Training

In 2019 Norwegian and Swedish Soldiers with combat experience from Afghanistan were involved in a study where Soldiers expressed the need to focus on stress and stress management before deployment during interviews (Waaler et al., 2019). If the Soldier’s level of training is low, and training does not resemble the stress level of combat, they will be unprepared for the stress level they will face when they are on deployment. One of the MST programs in the U.S. is the Master Resilience Trainer (MRT) course, used by the U.S. Army to help Soldiers increase their resilience based on positive psychology. Definitions and viewpoints of resilience vary, but it refers to an individual’s ability to bounce back from adversity.

The American Psychological Association (n.d.) defines resilience as a process where humans adapt well when facing adversity, trauma, tragedy, threats, or other significant sources of stress. Because there are different views of resilience and how to develop it, the MRT program has had some criticism from diverse points of view. Therefore, the skill-based approach would be a better way to prepare Soldiers than MRT. On the other hand, the research of Griffith & West (2013) points to an increased ability to cope with stressful environments by participants of the MRT course, which validates the course.

The Army Centre for Enhanced Performance located at West Point, focuses on intangible mental skills that underlie elite human performance across all domains. In one randomized trial study focusing on cognitive skills training, Soldiers who received cognitive skill training reported greater use of their cognitive skills and better performance on the initial marksmanship tests (Adler et al., 2015). Furthermore, the growth in neuroscience and modern technology results in an integrated understanding of how leaders can prepare Soldiers for extreme environments and how they can mitigate negative consequences. Findings from studies on military pilot trainees and the effects of MST on self-regulation, behavior, self-efficacy, and psychological skill use, depict that MST shows promising effects on several factors, from performance enhancement to anxiety reduction.

U.S. Marines with India Company, 3rd Battalion, 3rd Marine Regiment, respond to a simulated improvised explosive device detonation during counter-IED training at Marine Corps Training Area Bellows, Hawaii, on April 26, 2011. The training was part of a two-week evolution that allowed Marines to learn and practically apply counter-IED techniques under the watchful eye of instructors from the Marine Corps Engineer Center of Excellence. During mounted and dismounted patrols, Marine Corps Engineer Center instructors introduced simulated IED explosions, small arms fire, and casualty scenarios in order to guide Marines on how to mitigate the threat of IEDs and respond to their detonation. DoD photo by Cpl. Reece E. Lodder, U.S. Marine Corps. (Released) Source.

Combined with MST, Soldiers who undergo a system for pre-deployment training called pre-deployment stress inoculation training (PRESIT) can teach practical coping skills to minimize the adverse psychological effects of operational stress before trauma exposure (Hourani et al., 2018). According to Hourani et al. (2018), the PRESIT program emphasizes measuring heart rate variability in real-time, immersed in a virtual reality (VR) setting. VR contributes to simulating the environment that Soldiers meet in combat. By measuring the heart rate, a Soldier will get instant feedback on whether the techniques used to reduce stress are efficient. The PRESIT program follows many ideas initially presented in the Stress Resilience in Virtual Environments (STRIVE) project (Rizzo et al., 2012).

According to Rizzo et al. (2012), the STRIVE project uses knowledge acquired when treating veterans with PTSD through exposure training for Soldiers before deployment. The STRIVE project also uses stress response biomarkers to investigate the allostatic load via physiological and neurohormonal collections before and after STRIVE training. The training is positive due to the direct feedback in a controlled environment, and it is an online tool, meaning that it happens in real time. The STRIVE training program may be too complex, expensive, and demanding to implement across the force. Furthermore, it also requires a support staff trained to provide this type of training. However, building up resources based on an individual unit’s operational needs can be a reasonable way to approach an acceptable solution. For Soldiers, the use of VR alone may have a limited training effect.

However, the U.S. Army Research Laboratory and the University of Central Florida have done studies with large numbers of Soldiers to determine the effectiveness of VR training compared to other methods (Milliner, 2023). According to Milliner (2023), the U.S. Army signed a 22-million-dollar contract with the University of Central Florida in August 2020 for the investment in a Solider perception laboratory. The intent of the Soldier perception laboratory is to create a test bed for developing the theoretical scientific underpinnings for Virtual, Constructive, Gaming, and Augmented Reality (V-C-G-AR) basic research and emerging concepts. The observation of these concepts is currently under rigorous, transparent, and replicable testing to develop theories and prototypes to meet the Army’s Force 2025 vision.

Based on the author’s experience, techniques and tactics changed after using simunition marking cartridges in the weapons during training and exercise. The difference between training in a close-quarter battle with blanks, to taking a simunition bullet in the face, hands, and other body parts evoked a stronger emotional response. Consequently, when such an emotional component is present, Soldiers can train their mental skills in realistic scenarios and to some extent, bridge the gap between training and reality by focusing on individual needs to cope. The expectancy and experience of pain by a shot from a simmunition bullet activate the central nervous system, changing how the Soldiers move and engage the enemy threat during training. As mentioned, VR in training can be valuable as part of training but will never replicate the movement, speed, and physical contact from a real-life exercise.

By providing Soldiers with realistic training that induces stress through simulating a combat environment and giving them the tools to control their stress reactions through MST, Soldiers are more likely to be prepared for what they meet in combat. Also, units who experience combat learn from this experience, and reflecting combat experience is also a form of science. By linking reflected experience through lessons learned with research, the military is likely to produce better prepared and more resilient Soldiers. The combination of different preparations mentioned in this paper will reduce the number of mental casualties among Soldiers. This reduction will be a result of Soldiers who have managed to develop mechanisms to cope with the stress they encounter before it becomes a mental issue.

U.S. Army Soldiers from Company C, 2nd Battalion, 12th Infantry Regiment, watch the surrounding hills for insurgents, while fellow Co. C Soldiers race to their position, dodging heavy sniper fire, during a three-hour gun battle with insurgent forces in Kunar province, Afghanistan’s Waterpur valley, Nov. 3, 2009. The 4th Infantry Division Soldiers have been battling insurgent forces in the Waterpur Valley. Source.

Conclusion

History reveals that the number of Soldiers suffering from mental injuries increased higher than the military’s ability to aid those in need. Some of the reasons for this increase are the growing focus on mental injuries developed through war, better health care, and less stigma related to mental health. However, the increase in mental health disorders results in Soldiers and veterans struggling to cope in job-related situations and on a personal and social level.

The number of military personnel struggling with mental issues proves the importance of finding preventative solutions that can aid Soldiers in reacting, perceiving, and overcoming stressful encounters during combat and other life-threatening events. This paper aimed to illustrate how to mitigate the issue by integrating preventive solutions through MST as part of pre-deployment training. By exposing Soldiers to realistic and stressful environments through VR, use of simunition marking cartridges, demanding exercises, and monitoring their heart rate, SOldiers will get direct feedback when they get stressed and what causes the stress on an individual level.

By combining these diverse types of training, integrated with a focus on MST, the military can teach Soldiers separate and individual ways to cope with stressful situations. A solution like this is likely to make Soldiers more resilient and reduce the risk of developing mental health disorders because of the developed mechanisms to cope with the stress they encounter before it becomes an issue.

References

Adler, A. B., Bliese, P. D., Pickering, M. A., Hammermeister, J., Williams, J., Harada, C., Csoka, L., Holliday, B., & Ohlson, C. (2015, May 25). Mental skills training with basic combat training soldiers: A group-randomized trial. Journal of Applied Psychology. 100((6), 1752-1764. Advance online publication. https://doi.org/10.1037/apl0000021

American Psychological Association. (n.d.). The road to resilience. Washington, DC: American psychosocial association. Retrieved March 30, 2023, from https://uncw.edu/studentaffairs/committees/pdc/documents/the%20road%20to%20resilience.pdf.

Baker, M.S. (2014). Casualties of the global war on terror and their future impact on health care and society: A looming health crisis. Military medicine, 179(4), 348-355. https://pubmed.ncbi.nlm.nih.gov/24690957/

Chiuwen, T. (2010). Psychological and physiological effects on stress. [Research report]. https://cstem.charlotte.edu/sites/cstem.charlotte.edu/files/media/SV/2010/TB/ChiuWen%20Thor-%20Psychological%20and%20Physiological%20Effects%20of%20Str.pdf.

Crocq, M. A. & Crocq, L. (2000). From shell shock and war neurosis to posttraumatic stress disorder: A history of psychotraumatology. Dialogues Clin Neurosci. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181586/.

Evans, J. S. B. T. (2010) Thinking twice: Two minds in one brain. New York, NY, US: Oxford University Press.

Griffith, J. & West, C. J. (2013). Master resilience training and its relationship to individual well-being and stress buffering among army national guard soldiers. https://link.springer.com/article/10.1007/s11414-013-9320-8.

Hourani, L., Tueller, S., Kizakevich, P., Strange, L., Lewis, G., Weimer, B., Morgan, J., Cooney, D., & Nelson, J. (2018). Effect of stress inoculation training with relaxation breathing on perceived stress and posttraumatic stress disorder in the military: A longitudinal study. International Journal of Stress Management, 25(S1), 124-136. https://psycnet.apa.org/record/2017-54509-001.

Inoue, C., Shawler, E., Jordan, C. H., & Jackson, C. A. (2021). Veteran and military mental health issues. StatPearls Publishing, Treasure Island. https://europepmc.org/article/NBK/nbk572092.

Kennedy, C. H & Zilner, Eric. (2012). Military psychology: clinical and operational applications. New York. Guilford Press.

Kiely, J. (2017). Periodization theory: Confronting an inconvenient truth. Sports Med 48, 753-764. https://doi.org/10.1007/s40279-017-0823-y

Kline, A. C., Panza, K. E., Nichter, B., Tsai, J., Harpaz-Rotem, I., Norman, S. B., & Pietrzak, R. H. (2021). Mental health care use among US military veterans: Results from the 2019–2020 national health and resilience in veterans’ study. [Technical report]. https://doi.org/10.1176/appi.ps.202100112

Milliner, M. (2023). Army research laboratory and UCF sign cooperative contract. Team Orlando News. Retrieved February 1, 2023, from https://teamorlando.or g /army-research-laboratory-and-ucf-sign-cooperative-agreement/.

Ravindran, C., Morley, S. W., Stephens, B. M., Stanley, I. H., & Reger, M. A. (2020). Association of suicide risk with transition to civilian life among US military service members. JAMA network open, 3(9), e2016261-e2016261. https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2770538.

Rizzo, A., Buckwalter, J. G., John, B., Newman, B., Parsons, T., Kenny, P., Williams, J. (2012). STRIVE: Stress resilience in virtual environments: A pre-deployment vr system for training emotional coping skills and assessing chronic and acute stress responses. Studies in health technology and informatics, 173, 379-385. https://pubmed.ncbi.nlm.nih.gov/22357022/

Tull, M. (2021, July 08). The long-term impact of PTSD Vietnam veterans. Verywellmind. https://www.verywellmind.com/ptsd-from-the-vietnam-war-2797449.

Waaler, G., Larson, G., Nilsson, S. (2019). Voldsbruk og livsfare, Norske og Svenske soldaters krigserfaringer fra Afghanistan [Violence and danger to life, Norwegian and Swedish Soldiers’ war experiences from Afghanistan]. Cappelen Damm Akademisk.

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Master Sergeant Alf H. Rodahl is an Infantry Senior Noncommissioned Officer in the Norwegian Army. He has served in every leadership position, from Squad leader to Battalion Command Sergeant Major. He currently attends the Sergeants Major Course (Resident) Class 73 at the US Army Noncommissioned Officer Leadership Center of Excellence. His civilian education includes a bachelor’s degree in leadership and a master’s degree in public management. The Norwegian Defense Force established their NCO Corps in 2016, and in 2018, MSG Rodahl transitioned from a Captain to the rank of First Sergeant as one of the first senior NCOs in the Norwegian Army.

As the Voice of the Veteran Community, The Havok Journal seeks to publish a variety of perspectives on a number of sensitive subjects. Unless specifically noted otherwise, nothing we publish is an official point of view of The Havok Journal or any part of the U.S. government.