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Program helps airmen deal with combat stress

As the former chief of primary care psychology at Lackland Air Force Base, Texas, Dr. Craig Bryan has seen more than his share of lives shattered by post-traumatic stress disorder.

Insomnia, nightmares, jumpiness, edginess, depression, stress, short tempers — the symptoms present in airmen returning from combat zones became all too familiar.

So when Bryan — then an Air Force captain and now a civilian researcher — deployed to Balad Air Base, Iraq, as the head of the traumatic brain injury clinic there, he decided to be proactive rather than wait for airmen with psychological problems to come to him.

“If I could teach them [coping skills] from the very beginning … theoretically they would not develop the problems in the first place,” said Bryan, now a researcher at the University of Texas Health Science Center at San Antonio. “I knew they were not going to come to me … until they were in really bad shape. If they’re not gong to come to me, I’m going to go to them and get this information to them.”

Out of that simple precept was born Defender’s Edge, a cutting-edge mental health program that seeks to help airmen deal with combat stress on their terms. But getting from the idea to an actual program required innovative thinking and a novel approach.

Bryan’s six-month tour in Iraq began in February, which roughly coincided with the arrival of members of the 532nd Expeditionary Security Forces Squadron. These airmen routinely patrol off base and man the base’s quick-reaction force, which is dispatched to handle security incidents in the area surrounding the sprawling base north of Baghdad.

Because of the dangers inherent in their work, Bryan identified these security forces airmen as those most in need of strategies to cope with combat stress.

“Of the Air Force personnel at the base, this group was at greatest risk of not only head injury but also any psychological health problems associated with combat missions,” he said. “We [at the brain injury clinic] started talking about what we could do to help prevent the onset of significant psychological issues.”

There was only one problem: Despite years of attempts by the Defense Department to remove the negative stigma of counseling and psychology, many military members are still resistant to mental health services. To many, seeking psychological help is a sign of weakness.

Bryan described his conundrum: “How are we going to make a bunch of cops listen to a psychologist? Security forces sure as heck don’t like mental health providers.”

So rather than set up a standard mental health briefing, Bryan immersed himself in the security forces culture to help him understand what makes them tick. He read their field manuals and learned their standard operating procedures and rules of engagement. He spent time just socializing with the airmen and getting to know them.

It took some time. Senior Airman Brian Hafner, a former Marine infantryman and member of the squadron’s quick-reaction force, told an Air Force journalist that the airmen were at first suspicious of this outsider.

“My first impression was, ‘This guy doesn’t know what he’s talking about. I don’t even know why I’m here. At least he brought pizza,’ ” Hafner said, according to a story on Air Force Link. (Hafner is still deployed and Air Force Times was unable to interview him.) The effort paid off, and Bryan soon began earning the airmen’s trust.

“The most important part was I just hung out with them and participated in their unit activities,” he said. “I did battle drills with them, went shooting with them, let them stick IVs in my arm. … I let them beat me up and get me dirty.

“They saw me not as a psychologist but as this officer that was part of their unit and who was invested in their well being.”

After getting to know the security forces culture, he came up with a program that suited them. Instead of using mental health terms, he couched the concepts in operational language they would embrace.

“Everything was geared around security forces combat operations,” Bryan said. “If they went out on patrol and someone got hit by an IED, the very next time I met with them we would talk about that, not as a therapy type of thing but more of … what was your physiological reaction to it? How do you use the [coping] skills to enhance your performance and become a better security forces member?”

The Defender’s Edge program Bryan devised consists of five main modules: fatigue countermeasure, which includes sleep enhancement and alertness strategies; adrenaline management, which teaches stress management and relaxation; mission focus, dealing with goal-setting and performing under adversity; mind tactics, teaching hardiness and resilience; and killing, which includes trauma prevention.

He framed each of these as not only a tool to promote psychological health, but as a way to do your job better. Bryan gave an example: “You do controlled breathing [techniques] not only to help you sleep, but it’s also useful … when you’re in a firefight.”

Hafner, who suffered from post-traumatic stress disorder from a previous deployment, said Bryan’s approach worked. “He really seemed like he had a lot of experience dealing with people who had my problems,” he said.

Bryan said the program was a success and is still being used by the officer who replaced him at Balad. About 80 percent of the airmen in the squadron said the program was helpful, and 20 percent of the airmen who participated approached Bryan individually to ask for help with problems.

“Realistically, none of them would have ever come into the clinic and asked for advice,” he said.

Bryan attributes that success to his efforts to create a program for a specific group of airmen rather than taking a one-size-fits-all approach. He said Defender’s Edge — designed specifically for security forces at Balad — won’t work for all service members, but programs like it can be tailor-made for any group.

The question mental health professionals must ask themselves, he said, is this: “How can I fundamentally alter the way that I go about doing business so I meet the customer’s needs better, as opposed to trying to convince them that their needs are wrong?”