Training During Social Distancing: The Effects of Remote Virtual Psychiatric Readiness Curriculum on Military Behavioral Health Providers.

There is inconsistency in the training of military medical providers on the regulations and procedures outlining US Army-specific psychiatric readiness related competencies. These competencies are necessary to ensure the appropriate categorization of a soldier's psychiatric readiness. There exists a need for a formal, comprehensive training curriculum accessible to all providers that is time- and cost-effective. Due to the COVID-19 pandemic, there is are additional barriers of social distancing, remote virtual healthcare delivery, and geographic dispersion of healthcare personnel. To address these concerns, we developed a curriculum to target these competencies and deliver them virtually. The curriculum was developed and executed based on Kern's six-step approach to curriculum development, and the objective was to train military behavioral health providers on temporary duty limitations, administrative separations, and medical board referrals based on current US Army policies and procedures. The training was implemented virtually and conducted over the course of 3-hour training sessions to two separate groups. Evaluation of training objectives was conducted via a survey of paired before and after questions, analyzing the change in perceived confidence among learners. Among the 58 respondents, training resulted in statistically significant improvement in confidence in recognizing when a US Army soldier needs a temporary profile, writing a temporary e-profile, deciding when it is critical to contact a US Army soldier's commander, executing administrative separation, deciding when a US Army soldier is at medical retention determination point (MRDP), and in referring a US Army soldier to medical board. Results show the feasibility of virtual training to enhance medical readiness-related competencies of healthcare providers at the enterprise-level to help improve medical readiness. Limitations included immediate and subjective aspects of our results. It is unclear whether our training or similar training sessions resulted in changes in behaviors such as increased profiling or medical board referrals.

Psychiatric Care in a Novel Federal COVID-19 Treatment Center: Development of a Consultation-Liaison Psychiatry Service at the Javits New York Medical Station.

At the outset of the 2019 coronavirus disease (COVID-19) pandemic, New York City faced the highest burden of COVID-19 cases in the United States. In response, the U.S. Federal Government deployed medical providers from various uniformed services to treat patients with COVID-19 at the Jacob Javits Convention Center in New York City. There quickly arose a need for psychiatric services for patients with COVID-19 and psychological support for medical staff. Psychiatrists were tasked with establishing a consult-liaison psychiatry service in this unique environment. The authors detail the establishment of a novel consultation-liaison psychiatry service in a large convention center and explore lessons learned from this experience with the aim to empower uniformed psychiatrists to prepare for and deliver patient-focused care in pandemic settings.

Accelerated Resolution Therapy-Based Intervention in the Treatment of Acute Stress Reactions During Deployed Military Operations.

INTRODUCTION: The treatment and resolution of psychological traumas during military deployments directly supports medical readiness and the military mission and potentially prevents symptom progression to post-traumatic stress disorder (PTSD). However, current evidence-based trauma-focused psychotherapies can be difficult to employ during military contingency operations due to various barriers. Deployed military behavioral health providers need an effective, trauma-focused intervention that is suitable for the operational environment. In this retrospective case series, we describe how a therapeutic intervention based on accelerated resolution therapy (ART), an emerging trauma-focused psychotherapy, was pivotal in the treatment of acute stress reactions in eight deployed U.S. Army soldiers. MATERIALS AND METHOD: ART can be conceptualized as a hybrid of several evidence-based psychotherapy techniques. In brief, ART is a manualized, procedural adaptation of eye movement desensitization and reprocessing (EMDR) that incorporates mindful awareness of emotions and sensations, bilateral eye movements, imaginal exposure, desensitization, visual and cognitive rescripting, and gestalt-style interventions for the processing of traumatic experiences. The eight deployed U.S. soldiers in this case series received a single 45 to 60 minute session of an ART-based intervention within 96 hours of a traumatic death. RESULTS: All of the treated soldiers had rapid improvement in both depressive and acute stress symptoms after treatment. Furthermore, the therapeutic benefits were sustained at 1 year postincident despite continued exposure to the stress of deployed military operations for up to 6 months after treatment. CONCLUSION: Based on these encouraging preliminary findings, the authors recommend that behavioral health providers who are preparing to deploy become familiar with ART or related interventions in order to develop the confidence and the skills that are needed to provide timely and effective trauma-focused care for deployed soldiers.

Psychological trauma symptom improvement in veterans using emotional freedom techniques: a randomized controlled trial.

This study examined the effect of Emotional Freedom Techniques (EFT), a brief exposure therapy combining cognitive and somatic elements, on posttraumatic stress disorder (PTSD) and psychological distress symptoms in veterans receiving mental health services. Veterans meeting the clinical criteria for PTSD were randomized to EFT (n = 30) or standard of care wait list (SOC/WL; n = 29). The EFT intervention consisted of 6-hour-long EFT coaching sessions concurrent with standard care. The SOC/WL and EFT groups were compared before and after the intervention (at 1 month for the SOC/WL group and after six sessions for the EFT group). The EFT subjects had significantly reduced psychological distress (p < 0.0012) and PTSD symptom levels (p < 0.0001) after the test. In addition, 90% of the EFT group no longer met PTSD clinical criteria, compared with 4% in the SOC/WL group. After the wait period, the SOC/WL subjects received EFT. In a within-subjects longitudinal analysis, 60% no longer met the PTSD clinical criteria after three sessions. This increased to 86% after six sessions for the 49 subjects who ultimately received EFT and remained at 86% at 3 months and at 80% at 6 months. The results are consistent with that of other published reports showing EFT's efficacy in treating PTSD and comorbid symptoms and its long-term effects.