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Resiliency program channels returning vets' need for thrills.

BOSTON -- "Outward Bound on steroids" is how psychiatrist Col. Elspeth Cameron Ritchie, MC, USA, describes one of the U.S. Army's most recent initiatives designed to foster resiliency among soldiers with repeated deployments to Iraq and Afghanistan.

Called Warrior Adventure Quest (WAQ), the program uses high-intensity, extreme sports and a debriefing tool "to provide soldier/leader/unit mitigation and coping skills that can address unresolved transition issues, and build unit cohesion and morale, contributing to combat readiness," Dr. Ritchie said at the conference sponsored by the Massachusetts General Hospital Psychiatry Academy.

Through such activities as kayaking, bungee jumping, rock climbing, white-water rafting, skiing, and snowboarding, the program aims to channel the adrenaline rush that becomes second nature to redeploying soldiers and sometimes leads to reckless, dangerous behaviors, said Dr. Ritchie, director of behavioral health proponency in the Office of the Army Surgeon General. She stressed that the rate of deaths that occur within the first year of returning from combat--often as a result of accidents involving high speed, alcohol, or both--"is unacceptably high."

In fact, according to the U.S. Army Combat Readiness/Safety Center, between October 2001 and October 2009, 287 soldiers died as a result of motor vehicle and personal injury accidents within 1 year of returning from deployment. About 21% of these deaths occurred within the first 30 days post deployment and about 67% within 180 days post deployment.

For this reason, WAQ targets soldiers during the reset phase of a deployment cycle, typically within the first 120 days of a unit's return home, according to the Army Family, Morale, Welfare and Recreation Command (FMWRC), which created the intervention.

The most important aspect of the WAQ program is what comes after the adrenaline-pumping activities: the Battlemind After Actions Review (AAR). Battlemind, the Army's psychological resiliency building program, is designed to help soldiers recognize and respond to fear during combat, then mitigate the cumulative effects of a sustained combat environment and become mentally prepared to reintegrate during the redeployment, postdeployment, and reset periods of the deployment cycle, Dr. Ritchie said.

In the WAQ program, the Battlemind principles are implemented through the AAR debriefing process. For example, soldiers discuss the day's events and the connections between the activities and those they experience in the combat environment. Sharing thoughts on their experiences, as well as their feelings about being home, helps soldiers work through the range of postdeployment emotions.

In addition to the physical outlets that they provide, the WAQ activities are designed to bring cohesion to a unit through teamwork, and develop individual and unit resiliency through "horizontal and vertical bonding" with respect to rank structure and "esprit de corps," Dr. Ritchie noted.

The intervention also is meant to enhance soldiers' personal development during "dwell time"--the period between deployments during which their mental health is especially vulnerable, she said. "We have hard data that shows troops need more dwell time--that it takes at least 2 years and optimally 3 years for a soldier to come back to baseline in terms of mental health. Unfortunately, [with the ongoing crises in Iraq and Afghanistan and no withdrawal of troops], soldiers are being redeployed much sooner, she said.

Early indicators suggest that the WAQ program has been well received. 'Analysis from the program's survey data showed a 19.8% increase in the general perception of unit cohesion, a 12.8% increase in the perception that Army leadership cares for its soldiers, a 22.5% increase in the number of soldiers who viewed outdoor recreation as a means of relieving stress, and a 46.5% increase in the number of soldiers who will use the [WAQ] Outdoor Recreation Centers in future outdoor adventure activities," according to Staff Sgt. Brenton Bulrice, FMWRC WAQ representative.

"Although WAQ might not be the answer to all postcombat issues such as [posttraumatic stress disorder] and [traumatic brain injury], its holistic approach should serve as a model as the Army continues to identify and create programs to honor and empower soldiers who are reluctant to reach out for professional help," Staff Sgt. Bulrice wrote in an article for the US. Army MWR Web site.

Importantly, the program provides an informal screening tool by enabling leaders to identify soldiers who might need additional help, Staff Sgt. Bulrice wrote. "WAQ has formed close bonds and working relationships with many Army organizations" such as the Army Medical Command, Combat Readiness and Safety Center, and Army Substance Abuse Program. Through these collaborations, WAQ is able to track statistical data about participants and how WAQ has initiated positive changes in their behavior, he stated.

The WAQ program is one of many recent military initiatives aimed at supporting the mental health needs of servicemen and women, including periodic health assessments, postdeployment health assessments within 30 days of returning from deployment, and reassessments in 3-6 months for every soldier to screen for mental health problems, Dr. Ritchie said.

Dr. Ritchie reported no conflicts of interest.

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Author:Mahoney, Diana
Publication:Internal Medicine News
Geographic Code:1USA
Date:Aug 1, 2010
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