Psychology Course Prepares Military Providers for Deployment Concerns

By Julie Weckerlein and Robyn Mincher, DCoE Strategic Communications

From www.dcoe.health.mil

During the Center for Deployment Psychology (CDP) course, “Topics in Deployment Psychology,” a panel of five military mental health care providers spoke about their recent deployment. The discussion raised an important question on self-care while deployed: how can a provider stay mentally fit while addressing the psychological health of troops?

For Capt. (Dr.) Tracy Mayfield, a clinical psychologist with the U.S. Air Force deployed to northeast Afghanistan, she found company with the base’s working dog.

“I had to take time out from being a psychologist to have ‘me time’ and relax,” said Mayfield, who was the forward operating base psychologist for about a thousand troops. “Every Sunday, I’d take the dog for a walk. I’m a pet lover, and it really helped.”

CDP is part of the Uniformed Services University of the Health Sciences and a component center of Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE). The course, held at the National Intrepid Center of Excellence from June 7 to June 16, 2011, offered an overview of deployment issues facing service members, their families and providers, geared toward uniformed behavioral health providers from all branches of the military.

Along with the panel, the course started its second week June 13, 2011, with presentations highlighting sexual assault prevention and response, provider self-care and ethical issues in deployment settings.

Retired Lt. Col. Nate Galbreath’s presentation on sexual assault focused on topics such as encouraging bystander intervention to stop assaults, using sexual assault response coordinators when faced with a situation, psychological injury caused by trauma and the potential for the under-reporting of cases.

Dr. David Riggs, CDP executive director, posed ethical questions for students to engage in healthy discussion, raising issues such as dual relationships with service members, managing multiple relationships when supporting many troops at once, and being prepared to cope with cases a psychologist might not be trained in, especially when they are the only mental health support on base.

“Deployed psychologists are expected to diagnose and deal with whatever shows up,” said Riggs. “If you encounter a situation you are not trained to handle, you will have to find ways to learn as much as you can or consult with others who know more than you. You are ethically bound to be as knowledgeable as you can in all areas of deployment mental health.”

Other presentations led by CDP experts throughout the week included ”Cognitive Processing Therapy,” by Laura Copland; “Identification and the Prevention and Treatment of Suicidal Behavior,” by Dr. Augusto Ruiz; and “Prolonged Exposure Therapy,” by Drs. Paula Domenici, William Brim and Riggs.

As the course came to a close, Riggs reflected on the significant impact it had on military providers being deployed.

“This course works to prepare uniformed psychologists for the various psychological health issues they may need to deal with throughout the deployment cycle and issues that might arise among service members and their families. First-hand accounts from recently deployed providers during the course’s panels shed personal light into these issues,” said Riggs. “Military providers leave the course with a pool of knowledge they can tap into to address all kinds of situations while deployed.”

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Stress Relief from Your Smartphone

By Dr. Perry Bosmajian, National Center for Telehealth & Technology

Dr. Perry Bosmajian is a psychologist and project lead for the Breathe2Relax mobile application.

In the growing mobile application marketplace, one of the most promising and rapidly expanding areas is health care and wellness. Here at the National Center for Telehealth & Technology (T2), we design and build high-value mobile applications for the benefit of service members and their families.

Our newest mobile app, Breathe2Relax, is of particular value to people who may be experiencing post-traumatic stress disorder, providing easily accessible relief for stress and anxiety. Breathe2Relax is a diaphragmatic breathing trainer that uses a smartphone’s interactive learning capabilities to teach deep-breathing exercises through video instruction and interactive demonstrations. It’s simple and effective for controlling stress when used either as a stand-alone tool, or in association with face-to-face psychological health care.

Diaphragmatic breathing (belly-breathing) has widely-known benefits for reducing stress, tension and anxiety by calming the “fight or flight” response. From the first time you launch Breathe2Relax, you can immediately begin the breathing exercise and track its beneficial effects through a simple stress results scale. You can easily customize your Breathe2Relax experience, using the app’s preference settings to select breath duration and number of cycles, as well as choice of music and background images.

One of the most interesting parts of Breathe2Relax is the “Body Scanner” feature that allows you to review an image of the human body to learn the effects of stress on its various systems. In understanding the negative and often unseen consequences of stress, users may be more motivated to use the app on a daily basis to develop a beneficial stress relief “habit.”

Breathe2Relax is a free mobile app available now for the iPhone and iPad through iTunes and is scheduled for release for Android devices in late July. For more information about Breathe2Relax and other available apps, visit t2health.org/apps.

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Vycor Medical Inc Features Ground-Breaking Technologies at the Military Healthcare Convention and Conference in San Antonio, TX

Traumatic Brain Injury (TBI) is known as the signature wound of the Iraq and Afghanistan wars and reports show that TBI's increase each year in the US Military. Vycor Medical, Inc. and NovaVision, Inc. present minimally invasive solutions for brain injuries - including a revolutionary neurosurgery device and vision restoration therapy for vision loss due to TBI.

BOCA RATON, FL, June 9, 2011 – In effort to update physicians, caregivers, and our service members dealing with Traumatic Brain Injury – the signature wound of the Iraq and Afghanistan wars, Vycor Medical, Inc. will present at the Military Healthcare Convention and Conference (MHCC) in San Antonio, TX on June 14th.  Vycor Medical is the pioneer behind the minimally invasive ViewSite™ Brain Access System (VBAS) for deep-seated targets in neurosurgery and will introduce NovaVision’s non-invasive Vision Restoration Therapy™ (VRT). NovaVision is wholly owned by Vycor Medical.

According to the Department of Defense (DoD) the worldwide numbers for service members with traumatic brain injury (TBI) since 2000 has reached a total of 212,742 – already reporting 9,861 for 2011Q1. Some of the most common causes of TBI in the military include explosive devices, falls and vehicle or motorcycle accidents, Improvised Explosive Devices, or IEDs, used extensively against Coalition Forces. Results of TBI can vary; such injuries could require surgical removal of shrapnel and result in possible disabilities like vision loss. With statistics of traumatic brain injury (TBI) rising each year within the US military the VBAS minimally invasive surgical device and VRT may provide service members a better chance of regaining a normal life after rehabilitation.

The VBAS is an elliptical access device that allows surgeons to reach some of the deepest targets in the brain, including shrapnel. This access system utilizes a minimally invasive approach by spreading tissue as opposed to cutting it, which in return provides better patient outcome – the most valuable result postoperatively which could lead to reduced cost of care.  Design advantages: made of clear plastic material that allows more accurate visualization of desired target and surrounding tissue; its low profile tubular design minimizes tissue damage when inserted into the brain while optimizing the work area.  Peer Reviewed Studies: recently published in the Journal of Minimally Invasive Neurosurgery and Journal of Neurosurgery: Pediatrics, both of which report less tissue manipulation than with normal resection and several key advantages over the standard blade retractors currently being used for surgery. The VBAS has been used at VA hospitals in the US and was recently used for a case in New York to remove bullet fragments from a patient’s brain.

As more TBI’s occur, the number of patients with vision loss as a result will also increase – leaving our service members with a disability that may severely risk their independence and overall quality of life. NovaVision has developed an FDA cleared, non-invasive rehabilitation program, VRT, which expands a patient’s visual field from deficits including, hemianopia, scotoma, and quadranopia. These deficits can occur as a result from stroke, head trauma or other acquired brain injuries. Design Advantages: The patient performs the therapy on a home-device twice a day for 20-30 minutes a session. The results are evaluated and the therapy is adjusted as the patients progress each month. The patient typically performs the therapy for 6 months but can continue as long as their visual field continues to expand and consults with their physician. Peer Reviewed Studies: The therapy has been proven to be effective regardless of the patient’s age or the time from the damage causing the deficit.  Nearly 3/4th‘s of patients receive a significant increase in their visual field.  The vast majority of patients (88%) responding to a post therapy poll acknowledged significant improvements in their ability to perform daily activities, especially feeling safer in their mobility.

About Vycor Medical, Inc.

With corporate headquarters in Boca Raton, FL, Vycor Medical, Inc. (VYCO.BB) is a medical device company committed to making neurological brain, spinal and other surgical procedures safer and more effective.  The company’s flagship, Patent Pending ViewSite™ Surgical Access Systems represent an exciting new minimally invasive access and retraction system that holds the potential for speedier, safer and more economical brain, spinal and other surgeries and a quicker patient discharge.  Vycor’s innovative medical instruments are designed to optimize neurosurgical site access, reduce patient risk, accelerate recovery, and add tangible value to the professional medical community. Vycor is ISO 13485:2003 compliant, has FDA 510(K) clearance for brain and spine surgeries, and CE marketing and HPB licensing in Canada.

Vycor Medical’s subsidiary NovaVision, Inc. researches, develops and provides science-driven light-based neurostimulation therapy and other medical technologies that help restore sight to patients with neurological vision impairments.  The company’s proprietary, Visual Restoration Therapy (VRT) platform is FDA-cleared and clinically supported to improve lost vision resulting from stroke, brain cancer, traumatic brain injury (“TBI”), or other acquired brain injury. VRT can be prescribed by any ophthalmologist, optometrist, neurologist or physiatrist. NovaVision also provides a device that aids in the early identification of visual field deficits: the Head Mounted Perimeter (HMPTM) - a portable and ADA-compliant instrument to aid in the detection and measurement of visual field deficits even in bed-ridden patients. For the latest information on the company, including media and other coverage, and to learn more, please go online at www.VycorMedical.com or www.NovaVision.com.

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Mobile Applications for Mental Health

Posted by Dr. Julia E. Hoffman, National Center for Telehealth & Technology

As has happened in every era, service members are returning from deployments with combat wounds that affect their mental and physical health. The impact of these problems goes far beyond the service members themselves. Deployment-related mental, behavioral and physical health problems can lead to challenges in military families and communities that last for months or even years. The good news is that there are a variety of treatments that work for post-deployment challenges, and these effective treatments are offered across the Departments of Defense (DoD) and Veterans Affairs (VA) treatment facilities.

However, many service members and families who need treatment will never seek care for a number of reasons like logistical problems getting to treatment because of location, transportation options, work schedules, etc. Others fear the negative perception of seeking help for psychological health concerns as a sign of weakness, and some don’t even realize that treatment would be helpful because they’re trained that reintegration stress is normal.

At National Center for Telehealth & Technology (T2) we’ve been working on solutions to the problem of getting care to service members where and when they need it most. Our focus is on using technology in innovative ways to address concerns such as post-traumatic stress, depression, or traumatic brain injuries. One way we’ve found is through the use of mobile phone applications for mental health, like PTSD Coach and T2 Mood Tracker. Most people who carry smart phones have them within reach and turned on at all times, so the goal of developing these apps is to provide education, skills training, self-assessment and support to service members immediately via their mobile phone.

Mobile Apps Available:

■PTSD Coach: T2 collaborated with the VA’s National Center for PTSD to create PTSD Coach. This mobile app provides users with information on post-traumatic stress disorder, a self-assessment, support resources and tools to help manage stress symptoms. Tools based on evidence-based treatment range from relaxation skills and positive self-talk to anger management and other common self-help strategies. You can customize tools based on your preferences and can integrate your own contacts, photos and music. Download the app for free from iTunes App Store. A version for Android users is expected to be available later this Spring. For more on this mobile app, click here.

■T2 Mood Tracker: This self-assessment app monitors various aspects of your mood over time. Users select what areas they would like to track, and then use simple graphical scales to indicate how they feel. You can also add your own scales to monitor problems that are completely individualized, and enter notes about what’s going on in your environment to help explain mood changes. Download the app for free from iTunes App Store or from Android. For more on this mobile app, click here.

If you’re not sure if treatment is necessary, use these apps to anonymously check your well-being, and then seek routine care if necessary. Even if you’re already in treatment, these apps provide ways to measure stress and offer coping strategies between sessions—when real life happens.

More mobile apps are coming out for service members, veterans, families and providers—stay tuned for Breathe2Relax!

For additional information and resources, visit the DCoE Mental Health Awareness Month page. Learn more about T2 at t2health.org.

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Smartphone App Helps Troops, Vets Manage Stress

From a Department of Veterans Affairs News Release

WASHINGTON, April 19, 2011 – Veterans dealing with symptoms of post-traumatic stress disorder can turn to their smartphones for help any time with the “PTSD Coach” application created by the Veterans Affairs and Defense departments.

“This is about giving veterans and service members the help they earned when and where they need it,” Veterans Affairs Secretary Eric K. Shinseki said. “We hope they, their families and friends download this free app. Understanding PTSD and those who live with it is too important to ignore.”

PTSD Coach lets users track their symptoms, links them with local sources of support, provides accurate information and helpful individualized strategies for managing symptoms, officials said. The app is now available for download from the iTunes Store and will be available for Android devices by the end of the spring.

“This application acknowledges the frequency with which our warriors and veterans use technology and allows them to get help when and where they feel most comfortable,” said Dr. Jonathan Woodson, assistant secretary of defense for health affairs.

PTSD Coach is primarily designed to enhance services for individuals who are already receiving mental health care, though it is helpful for those considering entering mental health care and those who just want to learn more about post-traumatic stress, officials said.

“This is a great service we are providing to veterans, service members, their families and friends, but it should not be seen as a replacement for traditional therapy,” said Dr. Robert Petzel, VA’s undersecretary for health. “Veterans should utilize all of the benefits they have earned with their service, and one of the best things about this app is it will get veterans connected to the places that are out there to provide help.”

The application is one of the first in a series of jointly designed resources by the VA National Center for PTSD and the Defense Department's National Center for Telehealth and Technology to help service members, veterans, their families and friends manage their readjustment challenges and get anonymous assistance, officials said.

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