Planning for Mental Health Needs During COVID-19.

PURPOSE OF REVIEW: The ability to effectively prepare for and respond to the psychological fallout from large-scale disasters is a core competency of military mental health providers, as well as civilian emergency response teams. Disaster planning should be situation specific and data driven; vague, broad-spectrum planning can contribute to unprepared mental health teams and underserved patient populations. Herein, we review data on mental health sequelae from the twenty-first century pandemics, including SARS-CoV2 (COVID-19), and offer explanations for observed trends, insights regarding anticipated needs, and recommendations for preliminary planning on how to best allocate limited mental health resources. RECENT FINDINGS: Anxiety and distress, often attributed to isolation, were the most prominent mental health complaints during previous pandemics and with COVID-19. Additionally, post-traumatic stress was surprisingly common and possibly more enduring than depression, insomnia, and alcohol misuse. Predictions regarding COVID-19's economic impact suggest that depression and suicide rates may increase over time. Available data suggest that the mental health sequelae of COVID-19 will mirror those of previous pandemics. Clinicians and mental health leaders should focus planning efforts on the negative effects of isolation, particularly anxiety and distress, as well as post-traumatic stress symptoms.

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.

Sleep and the use of energy products in a combat environment.

BACKGROUND: The use of energy products appears to be widespread among deployed personnel, presumably to combat fatigue and sleep deprivation. However, these products have been associated with unpleasant side effects and adverse events, including insomnia, mood swings, fatigue, cardiac arrest, and even death. OBJECTIVE: To quantify the sleep habits and energy products used among deployed service members in Afghanistan from 2010-2011. METHODS: Participants completed an anonymous survey querying their demographic information, sleep habits, combat exposure, and energy product use. RESULTS: Respondent data: 83% experienced some degree of insomnia; 28% were using a prescription or over-the-counter sleep aid; 81% reported using at least one energy product daily. The most frequently consumed energy products were caffeinated coffee and soda. Only 4 energy products were used more frequently during deployment than prior to deployment: Rip-It, Tiger, Hydroxycut, and energy drink powders. On average, respondents who increased their use consumed only 2 more servings per week during deployment than they had prior to deployment. Only degree of combat exposure, not quantity of energy products consumed, predicted degree of insomnia. CONCLUSION: Energy product consumption by service members during deployment was not dramatically different than predeployment and was not associated with insomnia.