Joint Special Operations University

7701 Tampa Point Boulevard

MacDill AFB, FL 33621

https://jsou.libguides.com/jsoupublications

JOINT SPECIAL OPERATIONS UNIVERSITY

The complexities of transitioning from war to home are myriad, and Jennifer Hazen’s monograph Transitioning from War to Peace: Post-Deployment Support for Special Operations Forces not only describes many of the 

complex factors associated with post deployment adjustment of Special 

Operations Forces (SOF), but elucidates what can be done to improve the 

ways in which the Services reach SOF Service members and families. For 

SOF, the complexities associated with reentering civil society following 

wartime deployments may be exacerbated by the frequency, intensity, 

and unpredictability of special operations deployments. She observes that 

many current programs are designed as “one-size-fits-all” interventions 

and are often of little value to the participants. Consistent with USSOCOM’s 

views on this matter, Hazen suggests that programs need to be tailored 

to accommodate the unique characteristics of individuals and units.

ISBN 978-1-941715-26-0

Transitioning from War to Peace:

Post-Deployment Support for 

Special Operations Forces

Jennifer M. Hazen

Foreword by Donald R. (Rob) Neff, Ph.D., 

USSOCOM Preservation of the Force and Family

JSOU Report 17-8

JSOU Report 17-8 Transitioning from War to Peace: Post-Deployment Support for SOF Hazen 

A 4th Military Information Support Group (MISG) paratrooper reunites with his family 

during a redeployment ceremony on 8 July 2016. About 60 soldiers assigned to 4th MISG 

returned from Qatar following a six-month deployment supporting U.S. Central Command 

missions in the area. PHOTO BY STAFF SGT. KISSTA DIGREGORIO, 4TH MILITARY 

INFORMATION SUPPORT GROUP (AIRBORNE). 
Joint Special Operations University

and the Center for Special Operations Studies and Research

The Joint Special Operations University (JSOU) provides its publications 

to contribute toward expanding the body of knowledge about joint special 

operations. JSOU publications advance the insights and recommendations 

of national security professionals and the Special Operations Forces (SOF) 

students and leaders for consideration by the SOF community and defense 

leadership. 

JSOU is the educational component of the United States Special Operations 

Command (USSOCOM), MacDill Air Force Base, Florida. The JSOU mission 

is to prepare SOF to shape the future strategic environment by providing 

specialized joint professional military education, developing SOF-specific 

undergraduate and graduate level curriculum and by fostering special operations research, analysis and outreach in support of USSOCOM objectives. 

JSOU conducts research through its Center for Special Operations 

Studies and Research (CSOSR) where efforts center upon the USSOCOM 

mission: 

USSOCOM mission. USSOCOM synchronizes the planning of Special 

Operations and provides Special Operations Forces to support persistent, 

networked, and distributed Geographic Combatant Command operations 

in order to protect and advance our Nation’s interests.

Press publications are available for download from the JSOU Library 

web page located at https://jsou.libguides.com/jsoupublications.

Joint Special Operations University

Brian A. Maher, Ed.D., SES, President

Francis X. Reidy, Interim Director, Center for Special Operations Studies and Research

Robert Nalepa, Lieutenant Colonel, U.S. Air Force, Ret., Editor in Chief

Lisa Sheldon, B.A., Advertising, JSOU Press Editor

Cindy Snyder, B.A., Mass Communications/Journalism, Assistant JSOU Press Editor

Resident Senior Fellows

Peter McCabe, Ph.D., Political Science, Colonel, U.S. Air Force, Ret.

Will Irwin, MMAS, Lieutenant Colonel, U.S. Army, Ret.

Paul Lieber, Ph.D., Mass Communication & Public Affairs

David Ellis, Ph.D., International Relations, Comparative Politics

Editorial Advisory Board

Roby C. Barrett

Ph.D., Middle Eastern & South Asian History 

Public Policy Center Middle East Institute and 

JSOU Senior Fellow

James J.F. Forest 

Ph.D., Higher Education Administration

Associate Professor, School of Criminology and 

Justice Studies, University of Massachusetts 

Lowell and JSOU Senior Fellow

Mario Forestier

Chief Warrant Officer, U.S. Army, Ret.

Director, Joint Special Operations Command 

Center for Counterterrorism Studies

Thomas H. Henriksen

Ph.D., History

Hoover Institution, Stanford University

and JSOU Senior Fellow

Bernd Horn

Colonel, Canadian Dept. of National Defence, Ret.

Ph.D., War Studies

Command Historian, CANSOFCOM Education 

and Research Centre

Russell D. Howard

Brigadier General, U.S. Army, Ret.

John D. Jogerst

Colonel, U.S. Air Force, Ret.

James Kiras

Ph.D., History

School of Advanced Air and Space Studies, 

Air University and JSOU Associate Fellow

William W. Mendel

Colonel, U.S. Army, Ret. 

JSOU Senior Fellow

Alvaro de Souza Pinheiro

Major General, Brazilian Army, Ret.

JSOU Senior Fellow

James F. Powers, Jr.

Colonel, U.S. Army, Ret.

JSOU Senior Fellow 

Bryan C. Price

Lieutenant Colonel, U.S. Army

Ph.D., Political Science

Director, Combating Terrorism Center at 

West Point

Richard H. Shultz, Jr.

Ph.D., Political Science

Director, International Security 

Studies Program, The Fletcher School, 

Tufts University and JSOU Senior Fellow

Robert G. Spulak, Jr.

Ph.D., Physics/Nuclear Engineering

Sandia National Laboratories 

and JSOU Senior Fellow 

Jessica Glicken Turnley

Ph.D., Cultural Anthropology

Galisteo Consulting Group 

and JSOU Senior Fellow 

Rich Yarger

Ph.D., History 

JSOU Senior Fellow
JSOU Report 17-8

The JSOU Press

MacDill Air Force Base, Florida

2017

Transitioning from War to 

Peace: Post-Deployment 

Support for 

Special Operations Forces

Jennifer M. Hazen
Comments about this publication are invited and should be forwarded to the 

Director of the Center for Special Operations Studies and Research, Joint Special Operations University, 7701 Tampa Point Blvd., MacDill AFB, FL 33621.

*******

The JSOU Center for Special Operations Studies and Research (CSOSR) is currently 

accepting written works relevant to special operations for potential publication. For 

more information, please contact the CSOSR Director at jsou_research@socom.mil. 

Thank you for your interest in the JSOU Press. 

*******

This work was cleared for public release; distribution is unlimited.

Printed in October 2017.

ISBN 978-1-941715-26-0
The views expressed in this publication are entirely those of the 

author and do not necessarily reflect the views, policy, or position 

of the United States Government, Department of Defense, United 

States Special Operations Command, or the Joint Special Operations 

University.

Authors are granted academic freedom provided their work does not 

disclose classified information, jeopardize operations security, or 

misrepresent official U.S. policy. Such academic freedom empowers 

authors to offer new and sometimes controversial perspectives in the 

interest of furthering debate on key issues.
Recent Publications of the JSOU Press

2017 Special Operations Student Essays, JSOU Report 17-7 

Special Operations Theory, JSOU Report 17-6, Volume 3, edited by Peter McCabe and 

Paul Lieber

Special Operations Contracting: 21st Century Approaches for Service and 

Technology Acquisition, JSOU Report 17-5, Benjamin Tkach 

Outside the Box: A New General Theory of Special Operations, JSOU Report 17-4, 

Volume 2, Tom Searle 

Tunisia, Algeria, and Morocco: Change, Instability, and Continuity in the Maghreb, 

JSOU Report 17-3, Roby Barrett

A Social Marketing Analysis for Suicide Prevention Initiatives in USSOCOM: A 

Framework for Future Research and Success, JSOU Report 17-2, R. Craig Lefebvre 

A Unified Theory for Special Operations, JSOU Report 17-1, Volume 1, 

Richard W. Rubright

On the cover. A communications navigator craftsman with the 4th Special Operations Squadron, holds his newborn for the first time during Operation Homecoming 

at Hurlburt Field, Florida, 6 November 2015. U.S. AIR FORCE PHOTO BY SENIOR 

AIRMAN MEAGAN SCHUTTER.

Back cover. A 4th Military Information Support Group (MISG) paratrooper is 

reunited with his family during a redeployment ceremony on 8 July 2016. About 60 

soldiers assigned to 4th MISG returned from Qatar following a six-month deployment supporting U.S. Central Command missions in the area. PHOTO BY STAFF 

SGT. KISSTA DIGREGORIO, 4TH MILITARY INFORMATION SUPPORT GROUP 

(AIRBORNE).
v

Contents

From the Director.........................................................................vii

Foreword ......................................................................................ix

About the Author...........................................................................xi

Acknowledgements .....................................................................xiii

Introduction: Strain on the Force ................................................... 1

Chapter 1. Common Transition Challenges.................................... 9

Chapter 2. Re-conceptualizing Reintegration as Transition........... 15

Chapter 3. Current Approaches: Overview ................................. 21

Chapter 4. Current Approaches: USSOCOM and Service 

Components................................................................................ 31

Chapter 5. What Works in Current Approaches............................ 43

Chapter 6. Conclusion: Next Steps for Improving 

Transition Support ...................................................................... 51

Acronym List ............................................................................... 61

Endnotes ..................................................................................... 63

vii

From the Director

 Train as you fight.” In this monograph, Jennifer Hazen extends that 

proven admonition to the process of reintegration. Given the duration 

of combat and frequency of stressful deployments, Hazen observes that reintegration is not a single discrete event but a process that must be approached 

with the same attention and training as other military operations. Hazen 

also acknowledges that developing the means and processes is insufficient 

by itself. Overcoming the stigma of seeking assistance, when needed, is an 

exceptional leadership and cultural challenge in the United States Special 

Operations Command (USSOCOM) enterprise. 

Hazen posits that re-conceptualizing reintegration to the notion of transition permits the planning flexibility to develop options for individuals, units, 

and families. Additionally, the fundamental observation, that transition 

affects the individual SOF member as well as spouse and family members, 

is central to developing effective means to foster resiliency and preserve 

readiness. 

The Center for Special Operations Studies and Research is grateful to 

USSOCOM’s Preservation of the Force and Family for their support and 

contribution of a foreword by the deputy director, Rob Neff. It is our hope 

that this monograph, the second JSOU Press title that deals directly with 

issues related to preservation of the force and families, will be a vehicle to 

further conversation among SOF leaders. 

Francis X. Reidy

Interim Director, Center for Special Operations Studies and Research

“

ix

Foreword 

The complexities of transitioning from war to home are myriad, and 

Hazen’s monograph Transitioning from War to Peace: Post-Deployment Support for Special Operations Forces not only describes many of the 

complex factors associated with post-deployment adjustment of Special 

Operations Forces (SOF), but elucidates what can be done to improve the 

ways in which the Services reach SOF Service members and families. 

For SOF, the complexities associated with reentering civil society following wartime deployments may be exacerbated by the frequency, intensity, 

and unpredictability of special operations deployments. Moreover, time 

spent at home is oftentimes punctuated with intensive training requirements 

that remove the Service member from the home in preparation for the next 

mission. In today’s complex global security environment, the pace of operations will remain high for SOF. This high operations tempo demands there 

be concerted efforts to not only address the mission essential training needs 

of SOF, but the social and psychological needs of SOF and their families as 

well. In other words, we must ensure that SOF are able to perform on the 

homefront, as well as on the warfront. The readiness of the SOF operator is 

inextricably linked to that of their families. To understand the impact that 

family relationships have on readiness, one may simply look at military suicide data, where the presence of failed intimate relationships is consistently 

the most common risk factor associated with suicides. 

In chapter 3, Hazen posits that the process of deploying and re-deploying 

should be viewed as transitions rather than reintegration. This is a reconceptualization of how we have traditionally thought of the process of returning 

to family and civil society after wartime deployments. Hazen’s astute observation takes into account that individuals and groups, to include families 

and communities, are in a constant state of flux and the expectation that one 

can simply “reintegrate” may be an unrealistic one. Frequent and lengthy 

separations create situations where changes among individuals and family 

members occur along different trajectories. The Service member returning 

from a deployment is a different person in possession of experiences that 

cannot be understood by those that did not share them. Similarly, the family 

to whom the Service member returns is different than the one he or she left. 
x

Hazen posits that Service members and their families must be trained and 

educated to anticipate and adapt to the uncertainties of human development. 

Much like the training that SOF undergo for their jobs, they and their families must also be highly adaptable when reuniting after combat deployments. 

In chapter 7, Hazen provides an informative review of post-deployment 

family programs done by the Services and the United States Special Operations Command (USSOCOM). She observes that many current programs are 

designed as “one-size-fits-all” interventions and are often of little value to 

the participants. Consistent with USSOCOM’s views on this matter, Hazen 

suggests that programs need to be tailored to accommodate the unique characteristics of individuals and units. Given the sociodemographic characteristics of SOF and its unique mission, it is particularly important that pre- and 

post-deployment programs are attuned to the needs of SOF audiences, and 

that it imparts useful, practical skills.

Donald R. (Rob) Neff, Ph.D. 

Deputy Director, USSOCOM Preservation of the Force and Family
xi

About the Author

Dr. Jennifer M. Hazen currently teaches at the University of North 

Carolina at Chapel Hill. From 2011-2015, she served as a social scientist 

at United States Africa Command (USAFRICOM) in Stuttgart, Germany, 

where she improved senior leadership understanding of Africa through 

research and strategic advising on areas of subject matter expertise. Prior 

to joining USAFRICOM, Hazen served as a research fellow at the University 

of Texas at Austin and at the Center on Conflict, Development and Peacebuilding in Geneva, Switzerland. She also worked as a senior researcher 

at the Small Arms Survey, a political affairs officer at the United Nations 

peacekeeping mission in Sierra Leone, an analyst with International Crisis 

Group, and a research analyst at the U.S. State Department.

She taught at the University of Texas at Austin, Georgetown University, and the United Nations University for Peace and has published several articles and book chapters, as well as a single-authored volume What 

Rebels Want: Resources and Supply Networks in Wartime, and a co-edited 

volume Global Gangs. She has conducted field research in more than a dozen 

countries with a focus on armed groups, conflict dynamics, transnational 

threats, peace processes, post-conflict peacebuilding, and security sector 

reform. She received her bachelor’s in political science from the University 

of Michigan, and her master’s and Ph.D. in international relations from 

Georgetown University.

Hazen’s career has straddled the academic policy nexus. She possesses 

more than a decade of post-doctoral experience conducting policy-relevant 

studies that inform decision makers. Her approach is based on the belief that 

detailed research is at the core of successful policy, and that an understanding of real world dynamics is essential to developing effective strategic and 

programmatic responses to policy challenges.

xiii

Acknowledgements

I would like to thank the men and women, Service members, civilians, 

and contractors of the United States Special Operations Command, Preservation of the Force and Family, United States Army Special Operations 

Command, Air Force Special Operations Command (AFSOC), Marine Corp 

Forces Special Operations Command, and Naval Special Warfare Command 

(NSW), who generously provided their insights, time, and support to this 

endeavor. I am deeply grateful to those at NSW and AFSOC who welcomed 

me during my research visits, arranged numerous interviews, and responded 

to my many follow-up questions. 

I would also like to thank the Joint Special Operations University team, 

the anonymous reviewers who provided critical feedback on the monograph, 

and, in particular, Paul Lieber and Peter McCabe, who provided essential 

support and guidance throughout this process. 
When we get home,

home is still the same,

but something in our minds has changed,

and that changes everything.1
1

Hazen: Post-Deployment Support for SOF

Introduction: Strain on the Force 

Service members experiencing reintegration difficulties may represent the untreated casualties of the longest U.S. war in history.2

In the post-9/11 period, the United States utilized its Special Operations 

Forces (SOF) to carry out numerous missions.3 After more than 15 years 

of war, the forces are showing signs of fatigue and strain. As the wars wind 

down in Iraq and Afghanistan, conventional forces (CF) are able to reduce 

deployments; the same cannot be said of SOF. Although the majority of the 

force is faring well, 15 percent of the force reports severe symptoms related 

to post-traumatic stress (PTS), depression, alcohol-related problems, low 

resiliency, and low levels of social connection.4 Beyond these clinical symptoms, Service members face challenges transitioning from deployments to 

a home environment, and some find it difficult to navigate this transition 

and reconnect to home life. The stress on the force resulting from multiple 

deployments raises questions about how to best enable Service members 

to manage these demands. Currently, transition support is often minimal. 

Improved transition support, including providing essential information and 

transition skills to Service members, could enable SOF to more seamlessly 

transition from war to peace, which in turn would enhance their capacity 

to train and deploy in the future. 

This monograph aims to provide information to SOF leadership and 

behavioral health providers as they continue efforts to understand the strain 

on the force and provide programming to moderate that strain. Given the 

high operational tempo, SOF make numerous transitions as they complete 

multiple deployments. The pace of operations provides little time for reintegration while home. This suggests the need to focus on these transition 

periods, and what can be done to support SOF during these transitions. 

There is no ‘one-size-fits-all’ approach to ensuring Service members make 

this transition as smoothly and successfully as possible—and yet, currently, 

with for a few exceptions, post-deployment programming tends to be standardized and limited. Just as the military provides training to enable Service 

members in combat, support in the post-deployment period could provide 

the information and skills needed to adapt and make these transitions more 
2

JSOU Report 17-8

smoothly. In other words, the military could prepare SOF for coming home 

as much as it prepares them for going to war. 

This introduction provides an overview of the rise in demand for SOF 

deployments since 2001, and the resulting strain on the force, and therefore 

the need to develop support programs to moderate the impact of deployments. It then provides an explanation of why transition assistance is needed 

in particular, and ends with a discussion of the methodology of this study.

Increased Demand for SOF Since 9/11 

The demand for SOF and their deployment overseas dramatically increased 

after the events of 9/11. Military operations in Asia and the Middle East 

increased in number and frequency of deployments, alongside missions in 

other areas of operation across the globe.5 SOF perform a unique mission set. 

Special operations core activities include: “direct action, special reconnaissance, countering weapons of mass destruction, counterterrorism, unconventional warfare (UW), foreign internal defense, security force assistance, 

hostage rescue and recovery, counterinsurgency, foreign humanitarian assistance, military information support operations, and civil affairs operations.”6 

Given their capabilities and operational demands, SOF have “experienced 

shorter but more frequent, and often more violent, deployments” than the 

CF during this time.7

The increase in deployments after 2001 generated sustained high deployment levels and an increase in the size of the SOF enterprise.8

 The average 

number of SOF deployed overseas nearly tripled from 2001-2014.9 The number 

of deployed SOF personnel rose from 2,900 per week to 7,200 in 2014.10 Military personnel increased from 42,800 in FY2001 to 62,800 in FY2014, a 47 

percent increase.11 Civilian personnel increased from 2,800 in FY2001 to 

6,500 in FY2014.12 The Department of Defense (DOD) estimates that personnel levels will remain near this high mark of 63,000 through FY2019 due 

to existing operational requirements.13 As a result of the high operational 

tempo, “at any given time a high proportion of total SOF is either deployed, 

preparing to deploy, or just returning from deployment.”14

The demand for SOF capabilities is unlikely to change in the near future. 

Even as CF are coming home and their pace of deployment is declining, it 

is unlikely that SOF will see a similar decline in their operational tempo.15 

As a result, the number of deployments is not expected to decline.16 While 
3

Hazen: Post-Deployment Support for SOF

the numbers of SOF deployed on a weekly basis is not expected to decrease 

in coming years, where these forces will deploy will continue to change as 

events evolve across the globe.17 Although operations in Iraq and Afghanistan drove both conventional and SOF deployments in the 2000s, as those 

operations come to an end, SOF deployments to those areas decline. However, this change did not decrease the overall demand for SOF. Instead, 

it simply allowed SOF to shift to other areas of the globe where need had 

either increased or was not being met due to the demands of Afghanistan 

and Iraq.18 Requests for SOF already outpace capacity, and such requests 

are projected to increase in the future.19 Unlike the CF, the pressure on SOF 

will continue, including high rates of deployments, highlighting the need to 

maintain attention to the strain on the force and possible ways to support 

SOF through deployment transitions. 

Continued Strain on the Force 

The fast-paced operational tempo increased pressure on SOF to maintain 

demanding deployment schedules. Due to the nature of their missions, and 

the knowledge and training required to perform at this demanding level, 

it takes time to produce SOF. Whereas CF can be quickly recruited and 

deployed, SOF cannot. SOF are highly-specialized, trained forces that go 

through lengthy selection and training processes, meaning that they cannot 

be ‘mass produced,’ nor can they be created after emergencies occur.20 Any 

increase in the number of SOF must be planned and executed ahead of an 

increased demand for their services. If demand spikes, the response cannot 

be the immediate recruitment of more SOF for deployment. Instead, higher 

demand places a heavier burden on existing SOF to conduct repeated highrisk missions.21

During the early years of the increase in deployments, U.S. Special 

Operations Command (USSOCOM) leadership was slow to address how 

the increased operational tempo negatively affected Service members, and 

the detrimental impacts of back-to-back deployments on the force.22 As time 

passed and the strain increased, USSOCOM leadership focused on trying to 

find solutions. Former USSOCOM Commander Admiral Eric T. Olson created the Pressure on the Force and Families Task Force in 2011 to understand 

the challenges SOF faced.23 The task force identified “perpetual absences” of 

Service members from families and home as one of the key stressors.24 By 
4

JSOU Report 17-8

2011, USSOCOM noted the need to improve the “predictability factor” of 

deployments so that operators (and their families) would better know when 

they would be where, and be able to rely on these schedules.25 USSOCOM 

also recognized the need to improve education on and understanding of the 

effects of traumatic brain injury and post-traumatic stress disorder (PTSD).26

Former USSOCOM Commander Admiral (now retired) William H. McRaven continued this program started by his predecessor. McRaven renamed 

the task force Preservation of the Force and Family (POTFF) in 2012, and 

expanded the unit, providing it with additional resources and emphasizing 

a more proactive approach to treatment. USSOCOM emphasized the need to 

properly maintain personnel in line with the SOF ‘key truth’ that “humans 

are more important than hardware.”27

Annual assessments indicate the majority of SOF are managing deployments and the stress on the force well; however, scores on a range of selfreported scales indicate some are experiencing challenges. Of most concern 

are those rating very poorly on these scales: 15 percent of respondents 

reported moderate to high levels of PTS symptoms, 6 percent indicated major 

to severe major depression, roughly 10 percent struggled with alcohol-related 

problems and low resiliency, while more than 20 percent indicated low levels 

of social connection.28 While it is not remarkable that some percentage of 

the force would be facing challenges, what is important to note is that the 

majority of those scoring the worst on these scales are not seeking support 

to manage these challenges, and many of them report not seeking assistance 

because they do not believe they need it.29

After more than a decade of war, there is growing recognition of the strain 

placed on SOF as the signs of ‘fraying.’30 Suicide rates pose great concern, 

but so do high divorce rates, falling 

retention rates, and rising frustrations 

within SOF over salaries, equipment 

quality, and the utility and efficacy 

of their efforts.31 SOF had 10 suicides 

in 2011,32 faced a dramatic increase 

to 23 in 2012, a gradual decline to 18 

in 2014,33 and 12 in 2015.34 While this 

downward trend is positive, concerns 

remain about how best to support the SOF community to continue to bear 

a heavy deployment burden.

Suicide rates pose great concern, 

but so do high divorce rates, 

falling retention rates, and rising 

frustrations within SOF over 

salaries, equipment quality, and 

the utility and efficacy of their 

efforts.
5

Hazen: Post-Deployment Support for SOF

Why Transition Assistance Is Needed 

According to Major General James B. Linder, who assumed command of 

the U.S. Army Special Operations Center of Excellence in May 2015, SOF 

“are adaptable enough to shift as the nature of the threat shifts, fighting 

the kind of asymmetrical warfare that special operators have been fighting 

since World War II. This is what SOF is trained to do; this is why they built 

us.”35 A tremendous amount of time is spent on training for deployments; 

as it should be to ensure SOF are highly-trained and capable of performing 

their demanding missions. However, the skills and training received to be 

excellent warriors may not be the same skills needed to be able to operate 

effectively in a non-deployed setting. 

Existing research indicates the majority of those deployed—both SOF and 

CF—do not exhibit high levels of PTS symptoms when they return home, 

and most make a smooth transition.36 The most common finding in many 

research studies has been resilience, not chronic PTSD.37 However, many 

face readjustment challenges after returning home, including: substance 

abuse, difficulty sleeping, depression, anxiety, and a variety of interpersonal 

challenges (e.g. difficulty connecting, lost social structure, and lack of camaraderie of the deployment environment).38 Insufficient data exists to fully 

explain the nature and extent of these post-deployment challenges, how these 

may differ across Services, occupational specialties, and individuals, and the 

relationship between post-deployment challenges and actual deployments. 

While the majority of Service members studied have transitioned from 

deployment to garrison in a relatively seamless manner, many “struggle to 

find their place in the world they left behind.”39 It is not uncommon to see 

those who deployed claim to have zero problems when they return home (as 

reported on their required, standardized, self-reporting post-deployment 

forms), yet seek support from behavioral health services only a few weeks 

after returning due to experiencing post-deployment challenges. The Naval 

Special Warfare Command (NSW) estimates that 11-16 percent of Service 

members who return from deployments seek additional support in the period 

following deployment.40 Other Service components were not able to provide 

exact percentages, but behavior health providers interviews acknowledged a 

lag between SOF returning home and seeking behavioral health support.41

Since symptoms, whether related to combat or the transition, can increase 

over time, early identification of problems and early interventions are likely 
6

JSOU Report 17-8

to be most successful.42 That being said, it remains unclear whether challenges 

experienced by Service members are purely deployment related or stem from 

the transition home. The latter could account in part for the delayed onset of 

difficulties. Anecdotal reports suggest Service members face some combination of challenges stemming from both deployment stressors and stresses 

from transitioning home. 

Interviews with some of those in charge of managing post-deployment 

care suggest that standardized forms, while perhaps helpful for identifying some individuals with deployment-related concerns, often do not catch 

everyone experiencing trouble transitioning home; in particular those who 

experience these difficulties as a result of the transition home, rather than 

from combat-related experiences. Overall, service providers interviewed felt 

that some form of transition assistance is needed, but they were not certain 

what that assistance should be, nor were they confident that what is currently provided is working.43 One interviewee stated that they know there is 

a problem, and that Service members tend 

to not be fully honest on their post-deployment forms so that they can go on leave, 

but they did not know how to best respond 

to managing these challenges.44 Some care 

providers interviewed indicated they would 

welcome external advice and guidance on 

how to handle such challenges.45 Unfortunately, data is not systematically collected 

and then collated to determine the primary 

post-deployment challenges SOF face, the 

number of Service members affected by 

them, or when and why Service members seek post-deployment behavioral 

health assistance. Combined, this makes it difficult to assess the extent of the 

challenge and the factors that contribute to post-deployment difficulties, and 

then develop effective support to address these factors. 

Not all Service members will experience post-deployment transition in 

the same way. Understanding these challenges, and how they may vary, will 

require more than the standardized post-deployment health assessments 

(PDHAs). Some Service members will have very little difficulty making the 

transition, while others might face significant challenges. For some, these 

challenges will have a quick onset, occurring during deployment or upon the 

One interviewee stated 

that they know there is a 

problem, and that Service 

members tend to not be 

fully honest on their postdeployment forms so that 

they can go on leave, but 

they did not know how to 

best respond to managing 

these challenges.
7

Hazen: Post-Deployment Support for SOF

transition home. Others may experience a delayed onset of challenges, with 

a three-to-six month delay being quite common.46 The types of challenges 

experienced by Service members may vary widely, from difficulty sleeping, 

to an inability to ‘dial down’ one’s intensity, to anxiety resulting from family 

relationships and garrison duties. There is no ‘one-size-fits-all’ approach to 

ensuring Service members make this transition as smoothly and successfully 

as possible—and yet, currently, with a few exceptions, interviewees described 

this as the type of post-deployment programming that exists for many SOF. 

With some describing the military approach as a ‘cookie cutter’ one, several 

service providers emphasized the need for more tailored programming that 

takes into consideration the varying individual needs of Service members.47

A very small percentage of SOF training is spent on transitioning home; 

for some it is a few days, for many it is even less. Support received, i.e. for Air 

Force Special Operations Command (AFSOC) enablers and United States 

Army Special Operations Command (USASOC) forces, is often limited to 

reporting on standardized forms, where there are perceived incentives for not 

being entirely honest, and standardized post-deployment briefing, which are 

repetitive for those with multiple deployments. NSW provides a third location 

decompression (TLD) for its Service members: a 24-to-72 hour stopover at 

a site outside of the continental United States. The purpose of this time is to 

facilitate the Service member’s process of transitioning from deployment to 

home. During this time, NSW SOF receive information on a range of topics 

related to post-deployment transition, have time to acclimate to a non-kinetic 

setting, and receive medical and psychological evaluations to assess potential 

hurdles associated with returning home. Shortly before AFSOC ground forces 

return home, they receive a forward-based evaluation to assess returning 

Service members’ post-deployment needs. This is not a full TLD, but it does 

allow for early identification of SOF facing post-deployment challenges. 

In theory, training could provide some of the skills needed to enable Service members to make an easier transition.48 Research indicates higher levels 

of resilience in those with higher levels of preparedness and training.49 Given 

the level of warfare training that SOF receive, this should boost their resilience during deployments, and reduce lasting impacts of combat trauma. 

However, even the best trained and highly-resilient can be overwhelmed by 

extremely difficult deployments. And it remains unclear whether resilience 

training translates into skills needed to navigate transitioning home; resilience skills designed for surviving combat may not translate well into the 
8

JSOU Report 17-8

demands of home life. SOF may require additional training in transition 

skills to navigate post-deployment challenges.

Methodology 

This monograph marks an initial effort to focus specifically on the postdeployment transition period. This limited study is based on existing literature on post-deployment challenges and reintegration, USSOCOM annual 

survey data, interviews with more than a dozen SOF behavioral health providers or behavioral health support staff at the SOF Service commands, and 

a small survey with NSW. 

Interviews were semi-structured. Common questions focused on what 

the interviewee assessed as the most common challenges during transition; 

whether they had data to confirm those assessments; the type of transition 

assistance provided; whether they assessed that transition assistance to be 

effective, and whether data existed to support those assessments. Follow on 

questions differed across interviewees and focused on the interviewee’s experience and knowledge base. Interviewees are not named in this monograph, 

nor otherwise identified to ensure they remain anonymous and to provide 

them the freedom to speak unhindered. 

A short survey was made available to NSW Service members who returned 

from deployment in 2015. The survey entailed a handful of questions pertaining to the most common challenges faced upon return, whether respondents 

felt the transition training they received enabled them to manage those challenges, and what additional transition training and support they would like 

to receive in the future. The survey was optional and anonymous, and no 

tracking was done to identify who responded. Additional information on 

the survey can be found in chapter 6. 

This initial research highlights the importance of paying more attention to 

the transition period and the support provided during this time, and suggests 

further exploration of the post-deployment transition period would enable 

improvements to current transition programming. The remainder of this 

monograph details the challenges of post-deployment transition (chapter 1), 

the need to focus on transition, rather than reintegration (chapter 2), the current approaches taken (chapter 3), and how these vary across the service components (chapter 4). The monograph also highlights what is working (chapter 

5), and provides suggestions for improving transition support (chapter 6). 
9

Hazen: Post-Deployment Support for SOF

Chapter 1. Common Transition 

Challenges

After nearly 13 years of sustained high operational tempo, our people 

need help with mending their mind, body, and spirit.50

This chapter reviews common transition challenges highlighted in the 

literature and through interviews. These challenges can make the transition from deployment to home potentially difficult to navigate. There are 

the normal residual reactions to combat—e.g. difficulty sleeping, hyperarousal, hypervigilance—that can linger for some time, sometimes several 

months, after returning home. Post-deployment concerns include persistent traumatic stress symptoms, and the possibility of PTSD. In addition, 

SOF encounter challenges resulting not from combat but from the actual 

transition process, including difficulties adapting to the changed operating 

environment, social structure, and required mindset and appropriate behavior when they shift from a deployment setting to being at home. Seeking 

assistance to manage these transitions may be difficult given expectations 

of self-regulation that permeate the community, and the negative stigma on 

seeking help that persists. 

Residual Effects of Combat and Returning to Baseline 

Returning Service members face the normal neuro-physiological reactions 

to high stress environments. They are likely to experience common residual 

effects of the ‘fight or flight’ response activated during deployment, including: hyperarousal, hypervigilance, irritability, anger, anxiety, and panic. 

The fight or flight response is a normal and necessary biological response to 

situations of danger. It is “an adaptive and beneficial response when there is a 

threat to your personal welfare or that of others, and the persistence of these 

reactions is the body’s effort to ensure that you’re immediately ready if the 

danger occurs again.”51 When confronted with a life-threatening danger, the 

body responds by releasing a variety of neurotransmitters and neuropeptides 

(e.g. norepinephrine, serotonin, dopamine), which creates a physical state of 

arousal—hypervigilance—that facilitates the ability to act to survive.52 In this 
10

JSOU Report 17-8

state, the limbic system takes over, relying heavily on reaction and trained 

response, rather than rational thought, which serves to protect the Service 

member in combat.53 Automatic responses to perceived threats are essential 

in combat, but are unlikely to serve Service members well at home, where 

such actions are likely to be interpreted as overreactions. 

Service members, when returning home, need to give their brains and 

biological systems time to adapt to the non-threatening environment. SOF 

will need to manage their elevated senses, enabling them to return to their 

normal baseline, whatever that might be for the individual. This does not 

mean turning these senses completely off; instead the focus is on regulating responses. A key component of regulation is regular sleep; yet difficulty 

sleeping is one of the most common challenges among Service members 

returning from deployments. Service members often turn to alcohol as a 

way to relax and go to sleep. While alcohol can induce sleepiness, it also 

greatly reduces the quality of sleep. This can create a vicious circle of sleep 

deprivation and alcohol consumption.54 While sleep aids can assist a Service 

member in obtaining sleep, the use of prescription medications is only a first 

step toward getting a Service member rested enough to focus on the factors 

that are preventing natural sleep.55

Recurrent deployments with insufficient time to rest and recover in 

between deployments allows “biological systems little time to return to baseline.”56 Service members instead remain at heightened stress levels. Over 

time, without this return to baseline, the constant stress response can lead 

to biological, physiological, and neuroanatomical abnormalities associated 

with PTSD, which can result in neuropsychological impairment.57 To combat 

these negative outcomes, Service members need to self-regulate, and if this is 

not possible, seek assistance to regulate stress levels, enabling them to return 

to their baseline as quickly as possible upon returning home and before the 

next deployment. This ensures both best performance while in the military 

and the most stable long-term outcome. 

PTSD 

Clinical PTSD is a possible outcome for SOF when they return from deployment.58 However, the vast majority of SOF do not exhibit PTSD symptoms. 

This suggests caution in using the PTSD label and protecting against it being 

used “as a catchall [phrase] for the myriad ways that war, peace, genetics, and 
11

Hazen: Post-Deployment Support for SOF

institutions all shape the behavior” of Service members.59 Research indicates 

at least 50 percent of the U.S. population has experienced a traumatic event, 

however, only a small minority of those individuals will develop PTSD.60 

The prevalence of PTSD in the U.S. population is 10 percent in men, and 10 

percent in women.61 Military Service members with combat exposure are 

at higher risk for developing PTSD due to the nature of their service and 

the higher likelihood of experiencing traumatic events. However, even in 

the military, the percentages of PTSD remain relatively low. An estimated 

14 percent of Operation Iraqi Freedom and Operation Enduring Freedom 

(Afghanistan) veterans in the CF experience PTSD.62 The USSOCOM annual 

needs assessment survey indicates roughly 15 percent of respondents experience moderate-to-high PTS symptoms, however, this is only reported symptoms, not a measure of PTSD rates.63 A study of USASOC estimated PTSD 

rates at 16-20 percent;64 although a review of that study argued those rates 

were likely overestimated.65 USSOCOM does not provide publicly available 

statistics on the rate of PTSD in SOF.66 It is important for Service members to 

understand the difference between PTSD and normal transition challenges.

Understanding ‘Normal’

A key challenge for supporting returning Service members is to assist them 

in understanding what is ‘normal’ upon transitioning home, and what can 

be expected in terms of common challenges and recognizable behaviors indicating difficulties transitioning. In other words, it may be helpful to convey 

to Service members that not ‘being normal’ at the time of return and the 

period following a deployment is actually a normal 

response. Perceptions are important: “if you view 

yourself ... as having a disorder according to what 

a professional (or society) says, rather than someone experiencing expected reactions from combat, 

it affects how you feel and think about yourself and 

your loved ones.”67 It often takes time to adjust to 

the transition; for many this may take three or four 

months.68 However, Service members also need 

the knowledge and skills to identify problematic 

behavior and recognize when the post-deployment transition is not going 

smoothly, when symptoms are not abating, or when reactions are so severe 

A key challenge for 

supporting returning 

Service members 

is to assist them in 

understanding what 

is ‘normal’ upon 

transitioning home.
12

JSOU Report 17-8

that they impair daily functioning and/or create the potential for harm to 

oneself or to others. 

Changed Environment 

Returning from deployment requires adjusting to a new environment. Service members must adapt to garrison and home life. The operating environments—deployment versus garrison—present almost opposite conditions. 

Most deployment settings are in developing countries, where living conditions are difficult. The deployment setting is dangerous requiring constant 

vigilance of surroundings and awareness of how people are behaving. The 

community in which SOF operate is likely hostile to the operators. After 

deployments, Service members shift from a setting of danger to one of safety. 

In most instances, this means a transition to a relatively familiar and benign 

environment, but one that requires civilian modes of operation. Transitioning home requires changing one’s behavior to what is appropriate for a 

civilian setting. 

Service members must stow away military behaviors in favor of civilian 

ways when they return home. Military training creates habits that while 

effective in combat and in the military world, may not fit the civilian world, 

including: a focus on safety, trust no one, identify the enemy, mission orientation, decision making, response tactics, predictability and control, emotional control, not talking about the mission, and providing information on 

a need to know basis.69 The changed environment imposes a social demand 

on Service members to alter their behavior; to not respond with intensity, or 

overreact, to what are perceived by society as normal everyday encounters. 

The ways of doing things while on deployment do not always work well at 

home, where these behaviors can alienate friends and family and isolate 

Service members from their support systems. 

It is worth noting the potential ‘dangers’ that can be perceived at home as 

well, such as challenges communicating with family, a strained family life, a 

pending divorce, and other conditions that can act as stressors on returning 

Service members. Even though challenges at home are not usually dangerous, the stress of the situation can prompt the Service member’s system to 

respond as though it is life threatening.70 These stressors produce reactions 

similar to those of combat in that they activate the fight-or-flight reaction, 
13

Hazen: Post-Deployment Support for SOF

and this can hinder the individual’s ability to decompress from the deployment and adjust to a peacetime environment. 

Changed Social Structure 

Equally important is the changed social structure. On deployment, SOF 

operate as a team. The social bonds created in war are often some of the 

strongest; and Service members, regardless of how positive or negative their 

home life experience is, may not feel this same level of cohesion, support, 

and trust at home, as they do when operating with the team on deployment.71 

This can produce a sense of loss of camaraderie and support when returning, which can reinforce the tendency of SOF to gravitate toward their team 

rather than their family members after deployments, which can contribute 

to additional tension at home. This can be exacerbated by the demands of 

home life, whether that is demands on time or additional household responsibilities (e.g. childcare, cleaning, home repairs). Several Service members, in 

casual conversations, have stated they “just 

want to be left alone” when they return 

from deployment. For some, the need to 

be alone includes distancing oneself from 

family members. Family members may perceive the need for space as a rejection of 

the family, rather than the need for solitary 

time to decompress after deployment. Service members also return to more 

independent spouses, different parenting styles, and renegotiated household 

roles, leaving some feeling like guests in their own homes.72

Changing the Mindset 

A changed environment requires an adjustment in mentality and behavior. SOF must change their focus from the mission to training mode; from 

deployment goals to garrison life, and from the team to the family. On 

deployment, SOF are focused on the mission and primed to act. They have 

a mindset for survival that entails hypervigilance, aggressiveness, and often 

a lack of emotion.73 At home, numerous demands on the Service member’s 

time and attention preclude a singular focus, and instead demand multitasking. In casual conversations, Service members have often described being on 

a mission as easier than being home; they are focused on the job, doing what 

Several Service members, in 

casual conversations, have 

stated they “just want to be 

left alone” when they return 

from deployment.
14

JSOU Report 17-8

they have been trained to do, and contributing in a useful fashion. When 

on a mission, they have a sense of purpose, at home they may question what 

they did and how useful it was.74 The pace of action declines precipitously at 

home from a highly kinetic and ‘always on’ tempo to a much slower pace of 

activities, which can lead to boredom and frustration.75

Persistent Stigma 

Despite actions taken by those in military leadership positions to encourage 

Service members to take advantage of support mechanisms when they are 

needed, and to reduce the stigma associated with those having difficulty 

managing combat stress and deployment transitions, the stigma persists.76

For some, the stigma is self-imposed and is the desire to not appear weak; 

for others it is external concerns about being seen as ‘crazy’ or having careers 

negatively impacted by seeking help.77 Those facing challenges do not want 

to admit to ‘having problems’ or to ‘seeking treatment,’ which may inhibit 

SOF from asking for help or self-identifying when they are having trouble.78

Some of this is ingrained in the culture of the military, where any sign of 

weakness is viewed as unacceptable. As one SOF veteran stated: “I can’t 

admit that I have to see a counselor or psychiatrist, that makes me weak.”79

Concerns persist about the impacts of seeking assistance on the Service 

member’s career, including the loss of a security clearance or promotion, as 

well as reactions of team members or letting the team down, which create 

perceived barriers to seeking behavioral health care support.80
15

Hazen: Post-Deployment Support for SOF

Chapter 2. Re-conceptualizing 

Reintegration as Transition

SOF live[s] within a short-term deployment & training cycle that 

result in little or no reintegration period with families ... we are 

always at war.81 

Coming home from deployment is widely viewed as a joyous occasion, 

especially by those at home awaiting the arrival of loved ones. While 

this may hold true for most, this presumption obscures the various challenges of coming home and the difficulties both Service members and family 

members may face during this transition period. This is particularly true 

when there exists a presumption that nothing has changed, except for the 

individual having been gone, and therefore the task of reintegration is to 

enable the deployed Service member to return to ‘normal’ by returning to 

the life he or she had before deployment. Rarely does this presumption hold 

true. Numerous changes take place within the Service member and at home 

while the Service member is deployed. Understanding these changes, and 

their impact, can be essential for the Service member to successfully navigate 

the transition process. In addition, given the nature of SOF and the recurrence of deployments, it may be more helpful to frame homecomings as 

transitions, rather than reintegration. This chapter begins with an overview 

of reintegration in order to set the stage for reframing the post-deployment 

dialogue as one about transition.

Reintegration: Managing Coming Home 

There is no common, widely accepted, or widely used definition of reintegration. Approaches to reintegration may focus on a specific time period when 

reintegration is expected to occur, on the activities entailed in reintegration, 

or on the individual adjustments necessary to transition from one environment to another (e.g. deployment to home). There are pros and cons to each 

approach. A holistic approach to reintegration would incorporate elements 

of all three. 
16

JSOU Report 17-8

One approach to reintegration is associated with events and dates. Postdeployment reintegration is viewed in terms of the ‘return home’ of the 

Service member and his/her reunion with family and community.82 This 

process of returning home can also be framed as reinsertion of the Service 

member into his/her previous context. Reintegration is widely considered 

a long-term process covering various domains of one’s life (e.g. personal, 

family, community). It is unlikely that given current operational demands 

that periods at home between deployments will provide sufficient time for 

full reintegration. Thus, this homecoming could also be viewed as a transition period, since many active duty SOF are returning home with the knowledge that they will be deployed in the future. Understanding reintegration 

in these terms largely focuses attention on the timing of the transition and 

events associated with reintegration beginning with the reunion and ending 

with a new deployment. 

Another approach to reintegration shifts the focus from a certain time 

period to the actual activities involved in reintegration. This approach tends 

to focus on the multiple domains of daily interaction, e.g. home, work, community, and the ways in which reintegration must take place in each domain. 

Here reintegration entails the individual’s reintegration (e.g. ‘feeling like 

oneself again’), reintegration back into family life (e.g. rebuilding spousal and 

familial relationships), work reintegration (e.g. adjusting back into garrison 

life, returning to normal duty), and cultural reintegration (e.g. returning 

from settings of extreme deprivation to a setting of relative abundance).83

This approach implies that these processes may not fit within a certain period 

of time or occur at only a particular time in the deployment cycle. The focus 

is less on when these activities take place, than on what needs to take place 

for reintegration to occur and be successful. 

A third way of considering reintegration is to view it as readjusting to 

a peacetime environment, wherein the change in setting requires different behaviors and approaches. Interacting in this new environment and 

managing conflicts that occur will require different skills than those perceived as effective and necessary during deployments. This requires Service 

members to have the necessary skills to operate in this largely civilian environment, including: communicating effectively, making effective decisions, 

interacting with civilians (versus solely military), and both setting goals 

and engaging in civilian-centric activities.84 The challenge is that while the 

military provides extensive training for deployments, it provides limited 
17

Hazen: Post-Deployment Support for SOF

training for transitioning home; specifically, how to alter behaviors that serve 

them well on the battlefield, but produce negative responses in a peacetime 

environment.

Taken together, these various ways of looking at reintegration suggest that 

post-deployment reintegration should focus on the levels of functioning at 

home, at work, in relationships, and in the community after deployment.85 

This broadens the focus from the individual, and common concerns about 

PTS and the physical health of the individual, to understanding how that 

individual is managing the transition from a deployed setting to home and 

adapting to all of the demands and challenges of this transition. However, 

reintegration also implies remaining within the post-deployment setting for 

an enduring period of time. The operational tempo of SOF usually precludes 

this from happening. Even if the reintegration process begins, deployment 

schedules will likely disrupt it. SOF will not be able to fully reintegrate until 

they stop deploying. 

Service Definitions 

There is no common definition of reintegration used across all U.S. military 

Services.86 The Defense Centers of Excellence defines reintegration as “the 

process of transitioning back into personal and organizational roles after 

deployment” that serves to “return service members to their previous levels 

of function and well-being.”87 While this definition highlights the transition 

that takes place, its emphasis on returning to a previous state of functioning 

suggests there is no allowance for change, which can be challenging. It is rare 

that deployments do not change both the Service member and the Service 

member’s family at home. Creating expectations that there is a ‘normal’ 

that must be returned to when coming home fails to recognize changes that 

likely occurred during the deployment and sets the stage for conflict when 

‘normal’ is difficult, or impossible to achieve. 

The conventional Army uses several terms for the process of coming 

home: redeployment (getting ready to return home), homecoming (physically 

coming home), post-deployment (the time directly following homecoming), 

and the reconstitution phase (the period needed to rebuild relationships at 

home).88 The Army recognizes the importance of reintegration as part of the 

overall cycle of deployment, but views it in terms of getting soldiers ready for 

another deployment. The focus is often on reintegration’s role in individual 
18

JSOU Report 17-8

and unit readiness.89 The conventional Army defines reintegration as “the 

reestablishment of Soldier and civilian readiness, including personal readiness, deployment readiness, and family readiness.”90 This definition rightly 

acknowledges the various spheres of reintegration—personal, work, and 

family—but the focus on the mission on soldier readiness may distort the 

focus of the individual away from non-military spheres of life, resulting in 

only partial reintegration. 

The conventional Navy defines reintegration as “the process and establishment of normalcy as a sailor readjusts to family life, returns to work and 

copes with stress following deployment.”91 The Navy also uses the terms 

‘reunion’ and ‘re-entry’ to characterize the return from deployment.92 The 

definition acknowledges the likelihood of post-deployment stress, and normalizing it, which is a positive aspect. However, the focus on normalcy may 

not serve this population well, as part of navigating the transition home is 

often a reestablishment of what is normal, creating a ‘new’ normal, rather 

than trying to achieve what existed prior to deployment. NSW tends to use 

the terms post-deployment and resiliency, rather than reintegration or other 

related terms.93 NSW SOF operate with the knowledge that the return from 

one deployment is part of the overall deployment cycle, and that they will be 

deployed again. A focus on coming home as part of this cycle helps to set the 

stage for future deployments; indicating an awareness that Service members 

are unlikely to have sufficient time to fully reintegrate between deployments. 

The conventional Air Force defines reintegration as “the process of 

returning Air Force Service members back into a ‘stable and normal environment.’”94 Again, the use of normal as the standard 

can set the bar too high for many who will need to 

define a new normal. The Air Force emphasizes the 

need to recognize, accept and adapt to change in 

order to ensure a smooth transition from deployment to garrison.95 The focus on change as part of 

the transition is essential, however Service members 

may find it difficult to navigate these changes without 

support. The conventional Air Force uses the terms 

redeployment (which is the physical homecoming) 

and post-deployment (the period following a return 

to garrison) as the main terms for the post-deployment period, rather than 

reintegration.96 AFSOC tends to use post-deployment and resiliency, rather 

The focus on 

change as part of 

the transition is 

essential, however 

Service members 

may find it difficult 

to navigate these 

changes without 

support.
19

Hazen: Post-Deployment Support for SOF

than reintegration or other related terms. While some AFSOC behavioral 

health providers use the term reintegration in discussions, this tended to be 

a euphemism for homecoming and reinsertion; a few providers were quick 

to point out that reintegration was a long-term process that could not be 

addressed in a discrete time frame and “wrapped up like a nice package.”97 

The Marine Corps defines reintegration as “the process of the return 

home and reunification with family members following a deployment.”98

The main purpose of reintegration is to “significantly improve the return 

and reunion process, reduce the potential for emotional difficulties and 

marital strife, and ensure Marines are ready for the next mission.”99 Marine 

Corps Forces Special Operations Command uses the phrase “Reintegrate, 

Rest, Refit” to characterize the post-deployment phase. During this phase, 

Marine SOF complete post-deployment training and after action reviews, 

and provide feedback that can be incorporated into future training.100 The 

emphasis in the post-deployment phase is on mission readiness, ensuring 

Marines are fit to deploy again. 

Although the Services have different post-deployment programs, commonalities exist. There is a focus on mission readiness, and forces being 

ready to redeploy. There is a strong focus on change and transition, which 

is essential, but the Services provide limited training for Service members 

on how to manage the transition and navigate these changes. A broader 

recognition of the various spheres of life where difficulties could emerge 

and hamper Service member performance could shift the way the military 

thinks about the post-deployment period to include both deployment readiness and overall Service member health and mental well-being, and family 

health and stability. This would entail considering not only what is needed 

for short-term readiness, but also what is needed for long-term performance 

and sustainability. 

Transition, Not Reintegration 

It may be far more useful to speak in terms of transition rather than reintegration due to the reality that SOF experience numerous homecomings and 

deployments, sometimes with relatively little time in between. This is unique 

to SOF. While conventional forces usually deploy for longer periods of time, 

they also experience longer periods at home between missions, which provide 

time to reintegrate. SOF tend to have shorter deployments, but deploy with 
20

JSOU Report 17-8

more frequency, and often less reliability in terms of scheduling. Reintegration is not possible under these conditions. While coming home will entail 

the challenges of adapting to garrison and home life, it is unlikely that SOF 

will be able to focus on reintegration as long as they have another deployment on the horizon. Under these conditions, setting full reintegration as the 

goal may create unachievable expectations. Former USSOCOM Commander 

Admiral William H. McRaven alluded to this challenge when speaking to the 

House Armed Services Committee in 2012, emphasizing that the revolving 

cycle of home to deployment is just one of the challenges that comes with 

the territory of being SOF and current demand levels for SOF deployments.101

Reintegration is difficult when Service members and their families are also 

thinking about and preparing for another deployment in the near future.102 

Even with more regular deployment schedules and longer dwell times, the 

reality is SOF are coming home only to prepare to leave again. Discussion 

of true reintegration will be hard to achieve until the operational tempo 

declines; but even then, given the nature of SOF, reintegration may only be 

possible once an individual is no longer in a position of deploying. 

Rather than focusing on reintegration, it may be more useful to use the 

term transition. Service members are repeatedly transitioning from warzone to peacetime, from deployment to home, and then in reverse, from 

home to deployment and combat conditions. These transitions entail mental, 

physical, emotional, and social challenges. Navigating these challenges can 

prove difficult, especially for those who lack the necessary skills. Just as the 

military provides training to enable Service members in combat, support 

in the post-deployment period can provide the skills needed to adapt and 

make these transitions more smoothly. In other words, the military could 

prepare SOF for coming home as much as it prepares them for going to war.
21

Hazen: Post-Deployment Support for SOF

Chapter 3. Current Approaches: 

Overview 

Today we have multiple choice, check-the-block training ... we 

throw some safety surveys at the troop and give him a mandatory 

suicide brief.103 

The current approach to maintaining the health of the force relies heavily 

on two measures: efforts to reduce the frequency of deployments and 

a series of pre- and post-deployment questionnaires to track strain on the 

force. Maintaining low deployment-to-dwell ratios is not always possible to 

achieve, or maintain, due to training and operational demands. While standardized forms offer a simplified means of tracking the health of thousands, 

and are perhaps a necessary component of managing personnel, they may not 

be sufficient to ensure the health of the force. Behavioral health care providers interviewed spoke of not having a comprehensive picture of the needs of 

returning SOF, and how these needs vary across components, deployments, 

and individuals; they also indicated concern that current approaches may 

not be effective. This chapter provides an overview of the standard postdeployment efforts and suggests where some possible gaps may exist in current efforts to transition Service members home. 

Deployment-to-Dwell Time Ratios

Having sufficient dwell time in between deployments is essential for Service 

members to have the necessary time to “properly recover physically, socially, 

mentally and spiritually” from deployment.104 In 2005, USSOCOM “issued 

policy requiring active-duty SOF personnel to remain at home for at least 

an equal amount of time as they were deployed for operations and training.”105 This would equate to a deployment-to-dwell ratio of 1:1. However, it 

proved difficult to implement this policy across the command. Not all SOF 

components—Air Force, Army, Marine Corps, Navy—were able to meet this 

target due to operational needs.106 In addition, lack of clear implementation 

guidance led to inconsistent interpretation of the policy across USSOCOM.107

Component commands (e.g. USASOC, AFSOC, NSW, Marine Corps Forces 
22

JSOU Report 17-8

Special Operations Command [MARSOC]108) also lacked reliable data to 

track deployments.109 In 2007, USSOCOM clarified the requirements of the 

deployment-to-dwell policy.110 In 2008, USSOCOM updated the policy, reiterating the need for a 1:1 ratio, but encouraging component commands to 

strive for a 1:2 ratio, and stated a long term goal of reaching a 1:3 ratio.111

As of 2014, the command was striving for a deployment-to-dwell time 

ratio of 1:2; equating to being home twice as long as being operationally 

deployed.112 The aim of this ratio was to acknowledge emerging requirements 

and allow forces time to rest in between deployments. USSOCOM relies on 

component commands to track and report if units are complying with this 

policy.113 Component commands track the readiness of their Service members, including tracking the number of days deployed in a year, and rating 

the health status of individuals. However, deployment demands might still 

win out over concerns about these numbers and ratings, resulting in individuals who are not completely ‘green’ (mentally and physically ‘ready to 

go’) deploying on missions.114

Emerging requirements—more than 100 in FY2014—ensure that not all 

units can meet the deployment-to-dwell guidelines.115 USSOCOM and its 

component commands admit certain units have higher deployment rates 

than prescribed, e.g. USASOC Civil Affairs, Army Ranger units, and some 

MARSOC Support Group forces.116 Others, such as NSW, Air Force Special 

Tactics Squadrons, and MARSOC teams, are able to structure deployments 

on a 1:2 ratio, but this does not take into consideration emerging requirements, which could change demands for deployments and increase them 

beyond this ratio.117

Results from Wave IV of the USSOCOM annual needs assessment survey 

suggests that, on average, the time spent away from home is declining.118

Service members, on average, are spending 4 

months deployed and 5 months on temporary 

duty (TDY) per 24 months, approaching the 1:2 

ratio (9 months away, 15 months at home). While 

this indicates deployment-to-dwell time ratios 

are moving in a positive direction, this overall 

average hides the reality that some units still 

do not meet these guidelines, and additional 

effort is needed to address those units still heavily strained by deployments. Despite efforts to 

Service members, on 

average, are spending 

4 months deployed 

and 5 months on 

temporary duty (TDY) 

per 24 months, approaching the 1:2 ratio 

(9 months away, 15 

months at home).
23

Hazen: Post-Deployment Support for SOF

constrain the amount of time actually deployed, Service members and their 

significant others continue to express concerns that time at home contains so 

many demands—including training, TDY, exercises, and office work—that 

even if dwell times technically fit within Service and command policy, they 

may not provide sufficient time for Service members to recover from their 

deployments.119 Some units, and even some individuals pulled for particular 

expertise for missions, experience less dwell time, and this is where higher 

strain on the forces is likely to occur, and therefore where transition support 

could be most critical. 

Standardized Self-Reporting Forms

“In December 1998, the Joint Chiefs of Staff published uniform, standardized procedures for deployment-related health surveillance and readiness 

which included the requirement to conduct pre-deployment and PDHAs for 

deploying personnel. These health assessments [are] documented using DD 

Forms 2795 and 2796 respectively.”120 Those deploying generally are expected 

to complete the DD 2795 form (a pre-deployment health assessment) and 

the DD 2796 form (a PDHA). These forms are standardized, self-reporting, 

and stored in the Service member’s permanent medical record. The process 

evolved since the late 1990s. While additional forms were added to periodically assess the overall health of a Service member on active duty, e.g. the 

Periodic Health Assessment121 and the Deployment Mental Health Assessment,122 post-deployment transitions still rely heavily on these standardized 

post-deployment assessment forms, or some version of them. 

A PDHA is a commonly used tool in many countries to assess soldiers 

returning from deployments, whether from combat or peacekeeping missions.123 These assessments “review each deployer’s current health, mental 

health or psychosocial issues commonly associated with deployments, special medications taken during the deployment, possible deployment-related 

occupational/environmental exposures,” and any deployment-related health 

concerns.124 The PDHA poses questions about a variety of symptoms related 

to: depression, traumatic stress, alcohol use, relationship problems, anger, 

and sleep.125 The purpose of the assessment is to detect early signs of problems 

to enable the provision of appropriate treatment as soon as possible; early 

treatment is more likely to produce a positive outcome. This assessment 

must be completed in-theater or within 30 days of returning home.”126 In 
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JSOU Report 17-8

practice, Service members are often expected to complete these forms within 

the first two weeks after returning home. Service members are incentivized 

to complete them in a timely fashion; these need to be completed before the 

Service member can take leave. The reason for providing the assessment right 

after deployment return is to address any immediate signs of trouble resulting from the deployment itself,127 as opposed to problems that may emerge 

in the months following a return home. The PDHA process has identified a 

significant number of CF as ‘potential candidates’ for follow up evaluation 

and treatment.128

In response to negative symptoms and recurring challenges observed in 

Service members from Operation Iraqi Freedom and Operation Enduring 

Freedom,129 the military created an enhanced PDHA. These enhancements, 

created in 2003, “included modification of DD Form 2796 to more thoroughly document post-deployment health and mental health status, deployment-related occupational and environmental exposures, and appropriate 

referrals for further evaluation and care.”130 The changes were designed to 

improve post-deployment health screening for all returning Service members, including a screening tool for mental health concerns, and for other 

health and behavioral issues. The enhanced PDHA is to be completed within 

five days of return from deployment, and then filed in the Service member’s 

permanent medical record within 30 days of return.131 The enhanced PDHA 

remains a self-reported assessment, however, policy indicates that it should 

be reviewed during a face-to-face meeting between the Service member and a 

credentialed health care provider.132 Interviews at SOF components indicated 

they require the form to be completed within the first week home, however, 

there was no mention of a standard face-to-face meeting to review the form 

with a health care provider.133 Instead, Service members who screen positive 

for symptoms of PTS, depression, or alcohol-related problems are referred 

for follow-up services, and offered options for follow-up care.134

In March 2005, the DOD mandated the implementation of a second 

post-deployment assessment, the Post-Deployment Health Reassessment 

(PDHRA) (DD Form 2900).135 The purpose of the PDHRA is “to identify 

and address health concerns, with specific emphasis on mental health,” 

that might emerge over time following deployment.136 Service members are 

required to complete the PDHRA within three to six months of coming 

home. Research suggests a follow-up assessment is warranted for a number 

of reasons: the honeymoon period will wear off and symptoms will emerge; 
25

Hazen: Post-Deployment Support for SOF

the stresses of reunions and relationships start to manifest; symptoms that 

are normal at the time of return (e.g. hypervigilance, inability to sleep) may 

persist; and some who are initially asymptomatic will develop symptoms 

between their return home and the 120-day mark.137

While standard assessments can provide an opportunity to identify those 

experiencing difficulties when returning home, and research supports the 

necessity of these multiple assessments,138 there are also challenges to using 

the assessments effectively. Conversations with Service members and interviews with behavioral health care providers suggest standard forms may 

not be the most effective screening tool for a few reasons. The PDHA and 

PDHRA are not anonymous. As a result, Service members are fearful that 

being honest on these forms could lead to negative consequences. In the 

short-term, there is a concern about being held back from going on leave. 

More broadly, there is a concern that anything 

perceived as negative, or weak, in their record 

could affect one’s career and promotion possibilities. As a result, there is an incentive to not disclose problems on these forms.139 Despite efforts 

to reassure Service members they will not be 

penalized for seeking help, fear persists that any 

problems relating to mental health will be used 

against them, and Service members know what 

to report on these forms to avoid getting flagged 

for follow-up services.140 Even when Service members report significant postdeployment symptoms, research indicates few request services to assist in 

managing their symptoms.141

Ultimately the questionnaires do little good if they are not completed. A 

government review of PDHRA completion rates in 2008 found that the DOD 

did not collect sufficient data to identify completion rates.142 In February 

2008, the Armed Forces Health Surveillance System developed a compliance 

assessment methodology.143 A review of NSW compliance rates revealed that 

less than half of those under study had completed a PDHRA, and less than a 

third had completed both a PDHR and PDHRA after a deployment.144 However, when disaggregated by year, completion rates of the PDHRA increased 

over time from 2006-2010, nearing a 75 percent completion rate.145 Additional 

factors may affect PDHA and PDHRA completion rates such as changing 

units, deployments, and discharges.

More broadly, there 

is a concern that 

anything perceived 

as negative, or weak, 

in their record could 

affect one’s career and 

promotion possibilities. 
26

JSOU Report 17-8

Gaps in Current Post-Deployment Approaches

Behavioral health care providers interviewed indicated concerns about being 

able to effectively address the challenges facing returning SOF, and what type 

of support would best enable individuals to make the transition home successfully. Several interlocutors anecdotally mentioned existing challenges: 

they “know” there are problems, but they “don’t know what they are” and 

they “don’t know how to fix them;” some are resistant to research on reintegration despite this awareness, while others are looking for information 

and recommendations on effective methods for supporting the transition 

process.146 Some interviewees offered their thoughts on key problems in the 

community and challenges that seem to arise most often, e.g. hypervigilance, 

sleep problems, and navigating difficult relationships at home, but they did 

not have the data to back up their impressions, nor understand why these 

were the most common challenges.147 There was an expressed recognition 

that alcohol is a common coping mechanism. While this is not a desirable 

or effective coping strategy, it is one that is ingrained in the military culture 

and difficult to tackle.148 The concerns raised by those interviewed suggests 

that additional efforts to understand the needs of Service members, how they 

vary, and how they evolve over time would provide essential information for 

targeting support to enable Service members to successfully manage these 

challenges. 

Understanding Changes during Deployments 

While some individuals may suffer from trauma related to deployments, 

research suggests challenges also arise during the transition process that are 

related to the transition process itself and are not a direct result of trauma 

from war.149 A common saying is that Service members change during 

deployments: 

War changes people. One can argue whether these changes are positive or negative, but the fact that combat deployed soldiers change 

cannot be argued.150

Each soldier returned a very different person, and had to recognize 

this, accept this changed reality, and rediscover who they are.151
27

Hazen: Post-Deployment Support for SOF

My soldiers have been fighting now for 12, 13 years in hard combat—

hard combat, and anybody that has spent any time in this war has 

been changed by it. – Navy Admiral (retired) William McRaven152 

It is not always clear whether these changes are positive or negative. 

Although they are often presumed to be negative, there is also evidence of 

positive changes resulting from combat, including greater maturity, selfconfidence, and self-reliance; acquiring new skills; greater appreciation for 

home and family; and, greater dedication to the military mission.153 Regardless of the nature of these changes, those that take place in the individual 

during deployment will affect the trajectory of the individual’s transition 

home. The question is whether Service members have the necessary skills to 

recognize these changes, accept them, and then manage the transition into 

a home life that likely expects them to be the same person they were when 

they left for war. 

Research has not established what exactly causes changes in individuals 

during deployments. These could result from combat exposure, traumatic 

events whether related to combat or not, and from deployment-related stressors. They also likely result simply from being in very different situations, 

environments, and duties, than is the norm. Some of these factors are modifiable, which could alter the level of impact, while others are not.

Combat exposure is not an easily modifiable factor. It is highly unlikely 

the military will be able to modify how much combat a particular unit will 

experience while deployed. However, knowing that combat exposure is 

an important factor that can influence an individual can help to develop 

pre- and post-deployment interventions that can assist those who have 

experienced combat exposure.154 Combat exposure declined from 2013 to 

2014, as reported by active duty Service members in the USSOCOM annual 

needs survey, but the reported rates of problems increased during this same 

period.155 Possible explanations for this rise in reported problems include: 

different respondents from 2013 to 2014 leading to the variance; active duty 

Service members now having longer dwell times, which can allow for more 

time to experience and be forced to manage problems at home; and the 

response of active duty SOF to not being deployed, and the resulting feelings 

of boredom or ineffectiveness. 

Other factors that affect those on deployments are potentially modifiable. Deployment-related factors include a host of stressors: uncertain 
28

JSOU Report 17-8

redeployment dates; long deployment length; feeling homesick; lack of privacy or personal space; boredom or monotony; concerns or problems back 

home; problems with supervisor(s) or chain of command; lack of time off; 

extremes of heat and/or cold; not having the right equipment or replacement 

parts; and difficulty communicating with home.156 One factor that appears 

to dampen the effects of deployment stressors is unit 

cohesion.157 Preparing Service members for the new 

environments in which they will operate could help 

reduce the shock of working in a developing and 

war-torn country; often a context that is foreign for 

most and overwhelming to many. Increasing access 

to the right equipment, replacement parts, and hotand cold-weather gear could also improve morale and performance.158 Some 

of these stressors may have easier resolutions than others, or at the very least 

are factors that can be considered by leadership for action.

Lack of Data

Currently, no data has been collected on the most pressing challenges, and 

effectiveness of existing programs. This is the result of the lack of welldefined policies, procedures, and assessment metrics to design and assess 

programs that meet the needs of Service members.159 Data collection initiatives could assist in identifying challenges: understanding existing needs, 

changes in trends over time, and the evolution of these trends to assess when 

programs need to be adapted or completely changed. Data collection initiatives could entail monitoring existing programs. This can identify which 

programs, trainings, and procedures exist for each component, and within 

the components (e.g. for those components that provide different assistance 

based on occupational specialty), and assess the impact of these efforts in 

managing Service members’ needs in the post-deployment period. Data 

initiatives would also maintain records. This includes recording what has 

been tried, what has worked and what has not, why there were changes to 

programs, why a certain program was selected to replace a previous one, and 

the measured impacts of the new program. Such information can prevent 

efforts to ‘reinvent the wheel’ with each new program and avoid repeating 

programming that were not successful in the past. 

One factor that 

appears to dampen 

the effects of deployment stressors 

is unit cohesion.
29

Hazen: Post-Deployment Support for SOF

Creating data intensive initiatives may face resistance. The U.S. military 

on the whole seems to have a growing aversion to research studies, with a 

common complaint of being ‘over studied’ or not seeing the utility of ‘academic’ studies.160 More could be done to link academic studies to actionable 

recommendations, which would make such studies more appealing to the 

military, and easier to translate into policy and programming. Currently 

USSOCOM has limited in-house capacity to collect data; this deficiency 

could be addressed by building in data collection to daily operations in ways 

that make the collection streamlined and less burdensome. It would also 

make it internal, which could reduce any concerns about ‘internal problems’ 

being publicly exposed. Data collection is the first step; using that data to 

improve Service member well-being is the second challenge. Wider distribution of study results could reduce resistance to these studies, such that those 

collecting data do not feel the effort is useless and those providing the data do 

not see it as “one more study” that they never see. Participation in research 

could wane if Service members perceive there is no corresponding action to 

address concerns raised in the research. Although USSOCOM circulates the 

summary data from the annual needs assessment survey, this tends to go to 

senior leadership, and it is unclear how much of that information trickles 

down the chain of command. 

Community Engagement

Finally, successful post-deployment transition requires community engagement. Responsibility for supporting the transition of Service members 

cannot fall on USSOCOM and SOF Service members alone, in large part 

because the transition from combat to garrison is only one piece of the transition process.161 A more holistic approach involves the family, the garrison 

community, and the broader community. However, communities may not 

be well placed to understand what is needed or how to provide support.162

Community-based support for transition provides ways for Service members 

to reconnect to their communities, to share their deployment experiences, 

and to bring the war home for all.163 Today’s wars take place outside of the 

U.S. and outside of the everyday experience of the average American. Despite 

the thousands of Service members who have deployed overseas during the 

past decade, that still represents a tiny fraction of the American population. The lack of popular knowledge about these wars, about what Service 
30

JSOU Report 17-8

members are experiencing, can alienate returning Service members from 

their communities.164 In part, this results from the defensive response by 

Service members to shelter family members from the horrors of war and 

to not talk about their deployments, their experiences.165 In part, it is the 

failure of the American public to engage in U.S. foreign policy and bridge 

the civil-military divide that keeps the military separate from the rest of 

society.166 The lack of consensus on the value and morality of recent wars,167

the statements of “we support our troops” that rarely go beyond bumper 

stickers and the national mantra,168 and the lack of validation of Service 

members’ efforts in war169 contribute to the disconnect felt by many returning 

Service members. The ability of Service members to successfully transition 

home after deployment is “closely related to the well-being and successful 

function of their families and communities;” effective transition programs 

will recognize and support this varied population.170
31

Hazen: Post-Deployment Support for SOF

Chapter 4. Current Approaches: 

USSOCOM and Service Components

We obviously have a peer-to-peer stigma, the machismo that ‘I can’t 

admit that I have to see a counselor or psychiatrist, that makes me 

weak and we’re at war, and there can’t be any chinks in the armor.’171 

While USSOCOM supports programs operating across the component commands, such as POTFF, Military & Family Life Counseling 

program (MFLC), and the Families OverComing Under Stress program 

(FOCUS), actual post-deployment programming decisions rest with the 

leadership of the respective SOF components. Each component command 

determines what training and support will be provided, when and by whom, 

to its respective Service members as part of the transition process. While all 

components utilize standardized post-deployment forms, each component 

command takes a different approach to the post-deployment period, based 

on location, unit, or occupational specialty of the individual returning. Thus, 

programs and support offered can vary greatly across component commands, 

as well as within them. 

This chapter begins with an overview of the USSOCOM annual survey 

results that indicate a continuing need for transition support. The chapter 

concludes with an overview of post-deployment programs by USSOCOM 

and the component commands, and indicates efforts that could serve as 

models for other components. 

Continuing Challenges in the Force

USSOCOM’s POTFF conducts an annual needs assessment survey of the 

special operations community.172 While results demonstrate the vast majority of SOF are managing the challenges of Service and deployment without serious debilitating effects, the data indicates some areas of concern 

where Service members are exhibiting signs of stress and need support. 

Importantly, the results also demonstrate that those most in need of support are not seeking it. However, the timing and the wording of the survey 

questions do not distinguish between those who are facing challenges due 
32

JSOU Report 17-8

to a deployment and those experiencing difficulties due to the transition. The challenge 

is understanding why some are experiencing 

significant challenges, while most are not. The 

presumption appears too often that deployment is the cause, and that implies a certain treatment plan; but if it is not, 

if the challenge is the transition home, such responses will be largely ineffective, because they are treating the symptom, not the cause.

The POTFF assessment asks questions about symptoms experienced over 

the past 12 months on five scales: PTS symptoms,173 resilience,174 alcohol abuse 

and dependence,175 depression,176 and social connection.177 The majority of 

respondents in Wave III reported none to low levels of most symptoms, 

with more than 80 percent reporting in the lowest categories except on the 

social connection scale; but the remainder of the population is experiencing symptoms at a moderate to high level, indicating a need for support.178 

The percentage of the population experiencing moderate to high levels of 

symptoms on these scales increased in Wave IV of the survey, indicating a 

negative trend.179

The most common symptoms—those identified by at least 30 percent of 

respondents in Wave III180—included: “trouble falling or staying asleep” (39.9 

percent), “difficulty concentrating” (32.1 percent), “repeated, disturbing, and 

unwanted memories of the stressful experience” (30.9 percent), “being ‘super 

alert’ or watchful or on guard” (30.8 percent), and “irritable behavior, angry 

outbursts, or acting aggressively” (30.1 percent).181 These are normal responses 

to stressful and threatening situations, as well as to the strains of deployments. These symptoms are part of the body’s natural response to danger, 

and are designed to improve the individual’s ability to react and survive.182 

However, they are less useful, and more harmful, in peacetime settings, such 

as in garrison and home life, where they are perceived negatively. While 

these are normal responses, and they often subside over time if stressors are 

absent, if they persist and the individual is unable to successfully manage 

them without assistance, they can disrupt an individual’s ability to function 

normally. Some individuals can learn to cope with high levels of symptoms, 

and may even continue to function at normal levels in the short-term, but 

over time the stress on their system is likely to lead to reduced performance 

and impairment of normal function.183

Importantly, the results 

also demonstrate that 

those most in need of 

support are not seeking it.
33

Hazen: Post-Deployment Support for SOF

Although the majority of SOF reported experiencing no symptoms or 

very mild symptoms across scales measuring PTS, depression, and alcohol 

abuse, a small percentage did report scores in the high ranges for these 

scales. The high scores suggest that Service members would be unlikely to 

manage these symptoms alone, and would likely need external support to 

successfully manage them and any deleterious effects they have on physical 

and mental well-being. Yet, the majority of those experiencing high levels of 

symptoms did not think they needed assistance and therefore were unwilling 

to seek additional support.184 Less than 50 percent of Service members scoring in the high range of symptoms—whether PTS, alcohol abuse, resilience, 

depression, or social isolation—opted to use military-sponsored behavioral 

health care services in the previous 12-month period, and on some measures 

the percentage was far lower.185 The main reasons for not using behavioral 

health services fell into three main categories: lack of need or interest, concerns about the impact of utilizing behavioral 

health services, and lack of access. Lack of trust 

in the provider and a preference for non-military 

externally-provided care, although indicated less 

frequently, are additional barriers to those in need 

seeking care. Given the high score on the measurement scale, choosing not to seek assistance 

when experiencing problems suggests an inability 

by these individuals to recognize that they may 

be having difficulties or choose not to admit that 

they are having difficulties and need assistance. 

Although USSOCOM has made efforts to reduce the stigma of seeking help 

and reassure Service members that seeking help will not automatically result 

in negative consequences, these results suggest that Service members may 

not yet be convinced by this message. 

Clear patterns emerge from the survey data about the characteristics of 

those experiencing high symptom levels. They are mostly male—not surprising given the composition of SOF. They are primarily enlisted. Differences in 

age, education levels, and extent of training could explain why enlisted Service members face greater challenges than officers, who are likely to be older, 

have higher levels of education, and therefore more opportunity to develop 

cognitive and coping skills.186 They are at the beginning of their careers, 

having served less than five years in SOF. Exposure to new experiences and 

Lack of trust in the 

provider and a preference for non-military 

externally-provided 

care, although indicated less frequently, 

are additional barriers 

to those in need seeking care.
34

JSOU Report 17-8

challenges, and being in the process of developing the necessary skills to 

perform on deployments and cope with deployment stressors could explain 

why the group with fewer than five years of SOF service experiences more 

negative symptoms than those with more time in SOF.187 Despite the assumption that operators are ‘invulnerable’ and do not experience difficulties in 

carrying out their missions or recovering from them, there were no significant differences between responses of operators and support personnel; 

both populations are at risk of experiencing post-deployment challenges. 

Likewise, despite the assumption that those who are screened are somehow 

stronger and less vulnerable than those who are CF direct assigned to SOF 

for a specified time, there were no significant differences between responses 

of screened and direct assigned; exposing the misconception that screened 

‘can’t be broken’ or are ‘immune’ to the effects of combat and the difficulties of post-deployment transitions, and that both populations are at risk of 

experiencing post-deployment challenges.188 These findings indicate where 

assistance could be targeted—enlisted and early career—and where certain 

assumptions of invulnerability should be challenged, highlighting that transition assistance and post-deployment support may be needed by a range of 

individuals, across rank, Service, occupational specialty, and time served. 

Common Post-Deployment Programs189

Each component command has a POTFF representative, as well as representatives from a variety of command-common programs aimed at providing 

support for Service members and their families. The POTFF representatives serve as both liaisons with USSOCOM, as well as advocates of the 

needs of the specific component command; this sometimes creates tensions 

between headquarters and the component command, and requires balancing the various interests. POTFF representatives adapt programming efforts 

to their assessments of the needs of the component command, thus there 

is no standardization. This flexibility is useful for targeting programs to a 

component’s specific needs. However, one challenge with respect to transition assistance is that POTFF is not always closely involved with the return 

home of the Service member, but instead provides support after the Service 

member transitions home. In this instance, programming tends to focus 

more on the family than the individual Service member. While this support 

can assist with family-related post-deployment challenges, these programs 
35

Hazen: Post-Deployment Support for SOF

are voluntary, not mandatory, which can leave space for struggling Service 

members unwilling to ask for help to fall through the cracks in the system.

Component commands provide additional support through a variety of 

programs, including the MFLC and FOCUS. MFLC provides short-term, 

non-medical counseling for Service members and their families.190 MFLC 

provides support in a confidential fashion, meaning that these services are 

not part of the Service member’s official record. However, MFLC is limited to non-medical counseling, such that any problems beyond short-term 

counseling related to military life challenges would need to be referred elsewhere. Trust is an important precondition for accessing these services, and 

not easily gained within the SOF population; the routine rotation of MFLC 

counselors can reintroduce barriers with each rotation, as new counselors 

will need to reestablish trust with Service members.191

FOCUS originally centered on the psychological health of families, 

including building resilience and reducing stress within families. The program has since extended its services to single Service members. One interviewee indicated the program has had positive impacts including reducing 

stress and anxiety within families, reducing the number of children experiencing difficulties, and improving the health of marriages and family 

function.192 An early study of the program supports these findings.193 These 

programs provide voluntary services that can complement transition programming, and are designed to achieve this goal. Still they do not provide a 

substitute for focused transition programming for returning Service members to prepare and enable them to transition successfully. 

NSW 

A key component of NSW’s post-deployment transition home is the TLD. 

Deployed Service members spend 24-72 hours in a non-combat location 

outside of the United States between deployment and coming home. This 

time provides an opportunity to decompress individually and as a team. 

This is especially true for those who return to marriages and families; this 

time can provide the space the individual needs to readjust prior to having 

to manage relationship and family matters. The TLD enables a transition in 

stages, slowly readapting to the various challenges of coming off a deployment, adjusting mentally and physically to the change, and then adjusting to 

home life, instead of facing all of these changes at once. TLD also provides 
36

JSOU Report 17-8

an opportunity for the psychological staff to have a first look and assessment 

of Service members. Finally, TLD provides time to hold information sessions 

on what to expect and how to manage the transition.

After returning home, NSW SOF are required to report for a ‘check-up 

from the neck up’ at roughly the three-month post-deployment mark. This is 

an informal meeting with the force psychologist to discuss the post-deployment transition. The service provider does not take notes and the session 

is off-the-record. This meeting is required of everyone—no one is singled 

out—which helps to reduce the stigma of seeing the psychologist. The force 

psychologist believes having this informal and undocumented meeting helps 

to reduce the stigma of seeing a mental health provider, and improves the 

likelihood of Service members sharing honest information about their situation.194 This ‘check-up’ provides the psychologist an opportunity to check 

in with the Service member and to physically see how the person is doing. 

This also builds rapport between the psychologist and the Service members, 

which can help to build trust and keep the door open for the Service member 

to seek future support. 

This raises the question of whether the NSW TLD model should be 

adopted by other SOF components. NSW believes it has developed a good 

model.195 MARSOC reportedly modeled its post-deployment transition on 

the NSW model.196 AFSOC ground forces have a forward-deployed check 

of Service members before they return home, which is similar to the TLD 

model, though not as lengthy or comprehensive.197 USASOC would likely 

face difficulties employing the TLD model simply due to the size of the component, and the costs and logistics entailed.198 A review of TLD indicated it 

was far less successful when conducted inside the U.S., than when conducted 

at a third location, raising doubts about trying to adapt the model to the 

large USASOC population stateside.199 Potentially some elements of TLD 

could be adapted to garrison delivery to provide the transition information 

and psychological support to USASOC, even if the Service members do not 

benefit from the time for decompression. Ultimately, the question is: Does 

it work? And, therefore is it worth figuring out how to fund it and how to 

implement it for all SOF? 

There is some proof that TLD works. Several militaries utilize some form 

of TLD, including Australia, Canada, the United Kingdom, and the Netherlands. NSW requested an independent study of the NSW TLD program to 

assess the program’s effectiveness. This review provided supporting evidence 
37

Hazen: Post-Deployment Support for SOF

that the program helps with the transition from deployment to home. Service 

members were not unanimous in their praise, but the majority found the 

TLD briefings useful, and believed that the TLD program should be continued.200 Positive results seemed to depend largely on how the program was 

run and what was included in the program.201 The review identified areas 

for improvement including: choose a good location, increase the number 

of structured activities provided, streamline travel logistics to avoid delays, 

increase time spent with psychological professionals, and improve the understanding of TLD among spouses.202 One change, that appears to have had an 

impact on both Service members and their loved ones, is to clearly build TLD 

into the deployment schedule, so that it is seen as part of the deployment, 

and not extra days tagged on at the end that extend it. While some Service 

members still view it as deployment extension, building it into the deployment cycle helped increase support and reduce resistance to the program. 

This was especially true among spouses, who initially viewed the program 

as a few days on a drinking holiday before coming home.203 Spouses who 

were initially skeptical or hostile to the program, anecdotally reported seeing 

positive differences in their Service members between deployment with TLD 

and those without, the latter often involving more difficulty in transitioning 

home.204

AFSOC 

AFSOC SOF deploy and return home in various ways. Ground forces are 

more likely to deploy as a small team, whereas support personnel deploy 

in singles or small numbers, and not necessarily return home at the same 

time. This variation in deployment cycles and schedules makes it difficult for 

AFSOC to employ one post-deployment transition strategy. AFSOC behavioral health care and support providers acknowledged they used different 

approaches to the post-deployment transition, but have yet to develop something that they felt worked well for everyone.205

AFSOC ground forces receive a specialized form of post-deployment 

transition. AFSOC recognized that given the nature of deployments, i.e. 

the higher likelihood of engagement with the enemy during deployment, 

these forces needed something more than the standard PDHA form and 

welcome home talk. Although not a full TLD, service providers are forward 

deployed at the end of a mission to assess the team and begin the transition 
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JSOU Report 17-8

process home. While this can provide a short period of decompression, that 

is not the main purpose. The focus is on assessing the Service members 

in a location outside of the United States, i.e. close to the deployment site, 

to ensure preparations are made at home for the return of those with any 

identified special needs so that support is immediately available when the 

Service member arrives to garrison. 

AFSOC support forces, in contrast, are required to complete the PDHA 

self-reporting questionnaire and attend a reintegration talk within the first 

week of return. There is an awareness in AFSOC that this is not very effective 

in terms of identifying those experiencing challenges with the transition, or 

even as a means of providing support. AFSOC Service members expressed 

frustration with the process: “leave us alone; the program is not useful; I 

have heard it all before, this is my 12th deployment; no one is honest on 

forms because they do not want to get stuck in the system if there is a problem, they just want to get home.”206 One much repeated frustration is with 

the transportation delays returning home. Many spoke of being stranded 

waiting on ‘mil-air’ to provide transportation. These long delays could be 

turned into opportunities if they could be used 

to provide TLD-type assessments and information sessions. However, the logistics of doing this 

may make it impossible given the manning of the 

component; specifically, the limited number of 

personnel who are qualified for the task of assessment who would be available to forward deploy monthly.207 Another often 

repeated frustration is the challenge of returning to fast-paced garrison life 

at work, where Service members often have more than one job at work. In 

addition to catching up on what was not done in their billet while they were 

deployed, they are often given additional tasks to manage for those going 

out on deployment. This adds strain to coming home, making it difficult to 

decompress from deployment.208

One measure that appears to have a positive impact on the transition 

process is the presence of a psychologist or licensed social worker within the 

teams. However, the effectiveness seemed to depend on a mix of personality 

and trust. One licensed social worker claimed she had been in her post for 

one month and “the guys were finally talking to her and saying hello.”209 

While she had not yet reached the point where they would have more substantial conversations, she felt this was progress. One AFSOC psychologist 

One much repeated 

frustration is with the 

transportation delays 

returning home.
39

Hazen: Post-Deployment Support for SOF

conducted short, anonymous surveys of returning airmen to determine 

what they needed in order to develop effective responses.210 She found this 

to be an effective method to providing personalized support, rather than 

a one-size-fits-all approach. The psychologist underscored the uniqueness 

of every airman and situation, which is valuable, but this also meant that 

the emphasis was on difference, and not on assessing commonalities across 

airmen. The psychologist did not collect anonymized data over time, making 

it difficult to track common challenges. While this approach seemed to have 

been effective, it was not the standard across AFSOC. 

Interviews suggested two common challenges: the need to develop trust 

and a rapport with Service members over a long and potentially difficult 

process; and, second, the rotation of behavioral health staff at periodic intervals, which leads to a disruption in service or changes in how services are 

provided, and reintroduces the hurdle of building trust. This is especially 

true if certain personalities match well or bring in more effective approaches 

than others.211 Selection of the right people to fit these slots emerges as a 

crucial consideration, however, the military personnel system is not always 

suited to this type of selection process. 

USASOC212 

USASOC approaches post-deployment transition in a fashion similar to 

AFSOC non-ground forces. Returning Service members are required to 

complete the self-reporting, standardized post-deployment forms (PDHA 

and PDHRA).213 Service providers recognized that USASOC did not provide more in terms of training and support specific to the Service member’s transition home. They assessed that what they did provide was not 

sufficient based on the fact that Service members would seek additional 

behavioral health support in the weeks following homecoming. However, 

they acknowledged that they did not know how to tackle the problem more 

effectively.214 One challenge is certainly the larger size and wider dispersion 

of the command—a challenge other components do not face. The size of 

the component could make implementing a TLD-type program difficult, if 

not impossible, and some USASOC service providers were skeptical about 

utilizing such a program.215

The Army has employed a series of trainings aimed at improving the 

health of the force. These programs are intended to increase resilience and 
40

JSOU Report 17-8

optimize performance. This has included Battlemind debriefings and trainings, mandated across the Army in 2007. A review of the Battlemind program 

indicated participants reported fewer PTS and depression symptoms, and 

sleep problems, than those in stress education-only programs.216 The review 

also noted that participants in Battlemind large group trainings reported 

fewer symptoms than those in stress education programs regardless of the 

level of combat exposure.217 In 2009, the Army shifted to use the Comprehensive Soldier Fitness (CSF) program that incorporates elements of Battlemind and Master Resilience Training. There are conflicting reports about 

the effectiveness of the CSF program. Those implementing the program 

report successful outcomes.218 However, there are also numerous critics of 

the program who claim limited evidence exists to support its effectiveness,219 

that the program is largely ineffective,220 that it does not have the necessary 

metrics to demonstrate effectiveness,221 and ultimately that it remains unclear 

whether CSF achieves the goals it sets.222 The CSF program transitioned into 

the Comprehensive Solider and Family Fitness (CSF2) program. Soldiers are 

mandated to complete an annual CSF2 online assessment tool and training.223 The CSF2 program also incorporates a set of metrics to enable senior 

leadership to gauge program results.224

MARSOC225 

MARSOC focuses on its Performance and Resiliency (PERRES) program. 

“MARSOC PERRES incorporates three aspects (mind, body, and spirit) 

into an overarching, principal-based ethos that is laser-focused at giving the 

MARSOC community the tools to obtain and maintain overall resilience of 

the force: the individual and unit’s capacity to withstand mental, spiritual, 

and physical stress and hardship and remain functionally and holistically 

able to self and group renew.”226 “The purpose of PERRES is to provide the 

MARSOC community with an integrated and holistic apparatus capable of 

providing physical, mental, and spiritual optimal performance throughout the individual member and his/her family’s tenure with MARSOC and 

beyond.”227

MARSOC’s approach appears performance based, which could translate 

into difficulties for Marine Corps Special Operations Forces (MARSOF) to 

admit when there are problems, which could be viewed as weakness or an 

inability to perform well. That raises concerns about whether MARSOF 
41

Hazen: Post-Deployment Support for SOF

would seek support if encountering challenges during deployment or upon 

return home. One force psychologist noted that SOF are motivated by the 

notion of improving performance, and therefore behavioral health support 

crafted in these terms may be more effective than that couched in terms of 

mental or spiritual health, which could be seen as admitting weakness.228

MARSOC references the “Warrior Transition,” which for MARSOC can 

involve a third location decompression.229 This TLD is based on the NSW 

model, but adapted to MARSOF.230 The TLD is presented as “an interlude 

between combat and [returning home],” that “can be utilized,” but TLD is 

not stated as a requirement for all forces.231 The purpose of the TLD is to 

assess the well-being of Service members. “This event brings together all 

three PERRES aspects, designed and mentored by both the unit and PERRES 

personnel, to gauge individual posture for the return home.”232 Importantly, it 

also includes an element of family support and preparedness. “Concurrently, 

the family and unit are coached and mentored to anticipate, integrate, and 

execute the changes and transitional hurdles of the return to [the United 

States] and family life.”233

43

Hazen: Post-Deployment Support for SOF

Chapter 5. What Works in Current 

Approaches

My personal mental exercise to think ‘I will keep the frequency, 

intensity, and duration—low, mild, and short,’ allows me to not 

strangle the store clerk, run for the hills, withdraw from life, be 

emotionless, or act or speak in a self-destructive manner.234 

Service members are seeking support services, as described in chapter 5, 

whether to manage deployment-related or transition-related challenges, 

but the USSOCOM annual survey suggests the percentage seeking support 

remains low. More significantly, the percentage remains low among those 

who exhibit high levels of symptoms indicating they are experiencing difficulties. Efforts to reach those most in need but most reluctant to utilize 

services could build upon what some SOF have indicated works: embedded 

unit-level support and post-deployment trainings aimed at developing transition skills. A survey of returning NSW SOF indicates both an interest and 

a need for these transition skills. 

Behavioral Health Services

A key concern, highlighted in the POTFF survey results, is that Service members experiencing the most challenges are also reporting low rates of seeking 

support services to manage those challenges. Less than half of those scoring 

high on the PTS scale sought assistance through behavioral health services 

in the 12 months prior to the survey.235 The selection of service provider 

gives some indication of the type of assistance sought, with the presumption 

that visits with psychologists and psychiatrists would be oriented toward 

the individual, and more likely deployment related, while visits with social 

workers, MFLC, and FOCUS would be oriented toward relationship (couple, 

family, child) issues.236 Those who sought assistance reported more visits to 

individual support services than family-oriented services, but the usage was 

not dramatically skewed toward individual support. The most commonly 

sought service provider was the unit psychologist.237
44

JSOU Report 17-8

Service members who reported utilizing behavioral health services in 

the USSOCOM annual survey also reported finding them useful. A large 

percentage of those seeking assistance reported five or more visits with the 

chosen service provider, indicating some benefit from the service and an 

interest in continued service.238 The ratings of satisfaction and usefulness 

of providers were strong, with unit level providers receiving the highest 

ratings.239 However, it is worth noting that not everyone was satisfied, and 

some service providers received ‘very unsatisfied’ ratings. One challenge in 

the military behavioral health system is that Service members do not have a 

wide selection, and sometimes no choice, in who the mental health provider 

is, and therefore any lack of trust of or discomfort with an assigned service 

provider could lead to reluctance by that Service member to utilize existing 

services.240 Identifying and addressing the concerns underlying some of 

the negative ratings could improve both usage and satisfaction rates among 

Service members. 

Given the rising number of active duty SOF respondents reporting challenges on the annual survey, it is significant that the use of behavioral health 

care increased by 2 percent in the latest survey. 

According to the data, 21 percent of active duty 

respondents sought some form of behavioral 

health support, with embedded behavioral health 

assets receiving the highest ratings on satisfaction 

and usefulness by those who utilized these services.241 This indicates both an increasing willingness to seek support, and a reliance on unit-level 

support systems. SOF tend to trust those in their 

unit, more than outsiders, and are more likely 

to utilize embedded service providers that they 

know and with whom they have had positive interactions.242

One effort that has taken place across component commands is the 

embedding of special operations-specific behavioral health professionals at 

the unit level. In 2013, only 60 behavioral health professionals were embedded at the unit level; in 2015, the number had more than doubled to 131.243 The 

embedded location of these behavioral health professionals assists Service 

members in seeking assistance in three ways: normalizing the presence and 

use of behavioral health professionals, increasing the trust of these individuals through daily interactions, and making it easier to drop in for a 

SOF tend to trust 

those in their unit, 

more than outsiders, 

and are more likely 

to utilize embedded 

service providers that 

they know and with 

whom they have had 

positive interactions.
45

Hazen: Post-Deployment Support for SOF

chat when a Service member wants to discuss an issue. Behavioral health 

providers interviewed indicated they perceived an improvement in the trust 

levels and relationships with Service members.244 These findings suggest 

ensuring access to unit-level resources could be instrumental in increasing 

utilization of that support. 

Pre- and Post-Deployment Retreats 

Overall, in the Wave III assessment, respondents indicated a lack of participation in voluntary pre- and post-deployment retreats. These retreats are 

voluntary and participation is based on interest (of the Service member), 

availability (whether and when they are offered), and accessibility (whether 

the Service member has time to participate). Only 19.2 percent of all survey 

respondents reported having “attended military-sponsored pre-deployment 

and/or post-deployment retreats within the past 12 months.”245 Of the group 

reporting the highest levels of negative symptoms, a slightly larger percentage 

(24.7 percent) reported attending retreats. The low participation rates raise 

questions about the role of pre- and post-deployment retreats in providing 

support to Service members and their families. 

In looking at all respondents, various reasons were provided for why they 

did not participate in pre- and/or post-deployment retreats.246 More than half 

of the respondents expressed that they had “no need” or had “no interest” 

in attending military-sponsored pre-deployment and/or post-deployment 

retreats.247 Another important finding is that those who had an interest in 

attending these retreats were not always able to access them. The reasons for 

not being able to attend included: being “unaware” of retreats (5.5 percent), 

“scheduling conflicts” (8.9 percent), insufficient time due to a demanding 

operational pace (6.1 percent), and retreats not being offered (5.2 percent).248 

The reports of challenges accessing these programs indicates there is interest 

in this type of programming, but not always the ability to participate, which 

suggests that increasing access could facilitate higher levels of participation 

in these programs.

When looking at the entire respondent pool, the results indicate that 

those who reported having no need for retreats, scored lower on the PTS 

scale than those who attended retreats (7.91 mean score versus 10.11 mean 

score).249 Both scores are well within the low range of PTS scale, but the 

difference is significant.250 This suggests those potentially needing support 
46

JSOU Report 17-8

through retreats were utilizing the retreats, while those who reported having 

no need, may have indeed had no need. More importantly from the perspective of providing support to those who need it, when looking at those who 

stated “no need” versus those who stated access problems, those who did 

not attend retreats because they could not access them demonstrated higher 

scores on the PTS scale than those who did not attend because they “did not 

need” the retreat (9.71 mean score versus 6.11 mean score). In addition, those 

who stated access problems also scored worse on the other four assessment 

scales.251 This suggests that improving access to these programs could enable 

SOF to better utilize this support. 

Focusing only on the group of respondents scoring in the high PTS range, 

24.7 percent chose to attend pre- or post-deployment retreats.252 This is not 

necessarily surprising, as those with high levels of PTS symptoms may not 

perceive of retreats as the best forum for asking for help, and might prefer 

more personalized and private care, and might be more likely to seek out psychological support than to attend a retreat. However, of those who chose not 

to participate, 42.7 percent indicated “no need”, “not interested,” or “find no 

benefit in participating,” while 42 percent indicated some challenge accessing 

the retreats in terms of not having the time or retreats not being offered.253

These results raise concerns about the ability to self-identify when they have 

difficulties and take advantage of support programing offered. The results 

suggest, again, that access can pose a significant hurdle to participation, 

and that ensuring information is available on retreats and enabling Service 

members to attend retreats, could enable those with the most need to take 

advantage of these opportunities. 

Of those who attended retreats, their responses indicated the usefulness 

they found in attending these events; more than 70 percent claimed they 

were satisfied or very satisfied with the retreat, and more than 60 percent 

found the retreats useful or very useful.254 These response rates held relatively 

constant regardless of the type of retreat, including both pre- and postdeployment retreats, and a variety of demographic specific retreats, such as: 

couples retreats, family retreats, command or unit retreats, and single soldier 

retreats.255 For most types of retreats, the level of perceived usefulness was 

higher for the post-deployment type than the pre-deployment. This could 

reveal a difference in who attended these retreats. It could also reflect the 

demands on the Service member prior to the deployment and the focus on 

preparing for that deployment. However, it could mean that post-deployment 
47

Hazen: Post-Deployment Support for SOF

retreats provide certain venues and tools for Service members and their 

families to manage the challenges of returning home. The results suggest 

the value of providing post-deployment support. 

NSW Survey on Post-Deployment Challenges 

A survey of active duty NSW Service members who returned from deployments in 2015, and their spouses/significant others, provides insights into the 

challenges Service members faced when returning home from deployment, 

and whether they felt that the training they received from NSW helped them 

manage these challenges.256 Spouses/significant others were asked their views 

on what they saw as the challenges their husbands/significant others faced, 

and whether they seemed to have the skills to manage those challenges. All 

respondents were asked what additional training or support they would like 

to receive to manage post-deployment challenges. The survey included NSW 

active duty SOF with a wide range of experience, ranging from zero to more 

than 14 prior deployments. 

Active duty NSW SOF respondents were asked what challenges, if any, 

they faced when returning home. Respondents could provide more than 

one answer; and were asked to rank those answers. The primary challenges 

respondents faced (indicated by ranking them first) included: difficulty communicating with significant other (and family), difficulty turning down the 

dial (reducing intensity), and difficulty sleeping. The most common challenges faced by the small group of active duty respondents included these 

primary concerns, as well as managing emotions (e.g. anger, irritability), 

managing lack of emotion, and having difficulty enjoying social situations 

with civilians (see fig. 1).

Figure 1. Most Common Post-Deployment Challenges, number of 

respondents (n=66). NSW survey by author.

Difficulty Enjoying Social Situations with Civilians

Lack of Emotion

Difficulty Managing Emotions

Difficulty Dialing Down

Difficulty Sleeping

Difficulty Communicating 

0 5 10 15 20 25 30
48

JSOU Report 17-8

Active duty respondents were also asked whether they felt they had the 

skills and knowledge to manage their challenges, while their significant 

others were asked whether they felt their active duty partners had those 

skills (see fig. 2). 

The two response groups offered different assessments; however, this could 

be the result of the different individuals answering the question. They were 

not matched pairs, and so the significant others were not speaking directly 

about those active duty members who answered the question. It could also 

result from the honesty of Service members on the questionnaire—or those 

same respondents put on a strong façade at home. The answers of the Service 

members suggests that active duty NSW SOF are facing transition challenges 

for which they may not have the necessary skills to manage effectively. This 

is further supported by the answers of the active duty NSW SOF on what 

additional post-deployment training they would like to receive (see fig. 3), 

which largely mirrored the most common challenges reported: improving 

sleep, communication, and self-regulating. 

Figure 2. Assessments of Ability to Manage Post-Deployment Challenges, 

number of respondents. NSW survey by author. 

Service member’s perception 

of ability to use learned skills to 

manage challenges (n=66)

30

25 

20 

15

10

5

0

No

 Rarely

 Sometimes

Most of

the Time

Yes

Significant other’s perception of ability 

of service member to use learned 

skills to manage challenges (n=66)

30

25 

20 

15

10

5

0

No

 Rarely

 Sometimes

Most of

the Time

Yes
49

Hazen: Post-Deployment Support for SOF

Respondents were also given the opportunity to provide any additional 

information about their post-deployment experience that they wanted to 

share. These responses offer additional insight into the concerns and challenges of active duty NSW SOF, although this sample cannot be generalized 

to the entire NSW population. Significant others indicated concerns about 

the lack of post-deployment retreats and workshops, and concern that funding is ending for these programs. Significant others also expressed concern 

about the high operational tempo, and how this reduced time available for 

the family even when active duty Service members return home due to training and other operational demands. 

Active duty Service members expressed concerns about post-deployment 

programs either not being available or not being helpful, with one respondent 

with more than 10 deployments adamant that the post-deployment programs 

were “a joke.” Single active duty Service members noted the lack of support targeted at their demographic, and the discomfort felt when attending 

retreats designed for couples and families. One Service member lamented 

the lack of time to recuperate: “Returning from deployment to a non-stop 

training cycle leaves very little time to even think about unwinding let alone 

taking courses to help with it.” Other respondents reiterated concerns about 

the limited amount of time at home to transition, due to training, the operational tempo, and other requirements. Several respondents, both active 

duty SOF and significant others, commented on how being home was more 

Figure 3. Desired Additional Training, number of respondents (n=66). 

NSW survey by author. 

Stress management techniques

Navigating typical civilian activities

Managing finances

Managing emotions

Improving sleep patterns

Dialing down intensity

Communicating with significant other

Communicating with children 

0 5 10 15 20 25 30
50

JSOU Report 17-8

stressful, or “boring” and “lame,” than being deployed. This is a common 

comment among active duty Service members of all Services.257 Overall the 

results indicate the need for support to assist active duty Service members 

in making the transition from deployment to home, and managing that 

transition successfully.
51

Hazen: Post-Deployment Support for SOF

Chapter 6. Conclusion: Next Steps for 

Improving Transition Support 

All [S]ervice members return changed, but most return uninjured 

physically and without a mental health problem that requires 

psychotherapy.258

A tension exists within SOF between recognizing the struggles and challenges of individuals, and recognizing the overwhelming level of resilience within the force. There are those who lean toward the former, and tend 

to use the language of ‘fraying’ and ‘broken.’ One retired NSW commander 

noted he had never met a retired Special Operations veteran who was not 

at least partly disabled: “We physically crush special operators during their 

careers, and when they retire they are broken. We broke these guys. We 

need to do our best to send them back into the civilian sector as whole as 

possible.”259 For some this language rings true, and may reduce the stigma of 

seeking help. For others, it rankles: “stop assuming everyone is broken,” “stop 

reminding me that the force needs preservation;” instead these SOF want 

to underscore the high level of resilience within SOF.260 While the language 

of ‘broken’ may fit some experiences, this language lends itself to notions of 

defeat and helplessness, at least for some, and therefore may not provide the 

best motivation for admitting a need for help. This language can reinforce 

a sense of weakness, which is largely abhorred by the culture. The language 

used is important because how support is presented may determine who 

ultimately takes advantage of that support. 

Research suggests Service members are more likely to respond positively 

to programs that offer them a competitive advantage, that make performing 

their jobs easier, that make them better 

at doing their jobs, rather than a focus 

on what is broken or bad.261 How postdeployment training and support are 

pitched to the SOF population may be 

just as important as what the training and support entail. This suggests a 

reorientation of what is considered ‘normal’ during the transition period 

How post-deployment training 

and support are pitched to the 

SOF population may be just as 

important as what the training 

and support entail.
52

JSOU Report 17-8

could encourage Service members to seek support. Mental health education 

is most effective when it “normalizes mental health fluctuations, creates an 

expectation of recovery and wellness, and highlights actions that individuals 

can take to maintain or regain their mental fitness.”262 In other words, shifting away from a laser focus on PTSD concerns and away from the language of 

‘fraying’ and ‘broken,’ toward an understanding that fluctuation, not stasis, is 

the norm, and that solutions exist for those facing transition challenges could 

open lines of communication and create opportunities for Service members 

to make the transition more smoothly and with the needed support. 

It should be expected that SOF will return home wired, agitated, and on 

edge; it is unrealistic to expect SOF to turn off these trained reflexes like a 

light switch. Instead, the real questions are: What training can be provided 

to give SOF the skills to self-regulate, to ‘turn the dimmer switch down,’ in 

order to transition more smoothly from deployment to garrison? How can 

Service members learn to recognize when their systems are overwhelmed 

and they need additional support to manage the transition process? And, 

how can the component commands provide support to those who cannot 

self-regulate and need support in the transition process? 

Some Service members have expressed frustration with the post-deployment transition process. There seems to be two competing themes: those 

who complain they are not getting the support they need, and those who 

do not feel they need any special support or attention and therefore do not 

like or are not interested in any post-deployment efforts. At the core of both 

complaints is the sense that the standardized forms and briefings are not 

useful and do not provide good venues for accessing support. One particular source of frustration can come from the evaluation process itself, which 

while scientifically developed, does not “help the warrior understand what’s 

going on,” does not explain why one Service member is experiencing postdeployment challenges, while “fellow unit members seemed to be spared; 

nor does it necessarily help in figuring out the best course of treatment, 

if treatment is even indicated.”263 Service members would likely see postdeployment transition support more favorably if it were tailored to the needs 

of the Service member, provided useful skills (not just repeated briefings 

they have heard several times before), and if there were anonymous venues 

for reporting transition challenges to reduce the hesitancy of reporting for 

fear of negative consequences. 
53

Hazen: Post-Deployment Support for SOF

Targeted Transition Briefings 

The framework for transition could be strengthened by moving beyond filling out the standardized post-deployment form. Additional support could 

include providing information to returning forces about the transition process, what to expect, what is normal, and when they should seek additional 

support. Briefings that are informative, simple, and relevant provide one 

avenue for delivering necessary information. Research indicates that briefings are most effective when they focus on clear requirements and needs; 

emphasize strengths, skills, and abilities, not ‘fraying’ or being ‘broken;’ 

when possible they should be team (or unit) based, which can build cohesion and a stronger support system.264 In addition, briefings that focus on the 

explanatory, answering the question why Service members might be facing 

challenges, highlighting misunderstood reactions (e.g. ‘it is all PTSD,’ or 

someone is ‘broken’), and normalizing the common challenges faced when 

returning home can be most helpful.265

Briefings could incorporate real and relevant examples from Service 

members who have faced transition challenges, e.g. being short-tempered 

with kids, having difficulty communicating with family, having difficulty 

sleeping, etc. Returning Service members can find it easier to relate to these 

real-life examples, and their presentation by active duty Service members 

can reduce the stigma surrounding talking about these challenges. Research 

suggests that military audiences are more receptive to trainings from a pair 

of trainers (one a trained mental health clinician and one a military operator) because these are viewed as more credible, especially when the military 

speaker is persuasive and has a shared similar operational experience of the 

target audience.266 Interviews suggest briefings or discussions with those 

who have deployed and who talk about their challenges upon returning 

home are best received because Service members can relate better to this 

type of storytelling, than to civilians or leadership telling them they might 

have problems and where to seek help if they experience any problems.267

Transition briefings that are adapted to the specific audience and its needs 

are likely to be more effective. Those with multiple deployments noted the 

monotony of transition briefings—that they did not offer anything new—

and so the Service member barely listened and only went because it was 

required.268 Adapting briefings to occupational specialty, particular deployments and anything that may have happened, or simply recognizing the 
54

JSOU Report 17-8

different needs of those returning home for the first time versus those who 

are returning home from their twelfth deployment could improve the utility 

of post-deployment briefings. It is important to understand the specific situations and challenges that each occupational specialty may encounter, and 

to provide support for those specific circumstances.269 Particularly traumatic 

deployments may require additional support. However, each Service member 

will respond uniquely, and support needs to be adaptable to this variance. 

Skills Training 

Skills training offers one track for providing support to Service members and 

enabling them to navigate the transition home. Various options are available, 

but training needs to be built into the overall deployment cycle and program 

of training; it will be far less effective if it is provided as one-off programs 

only during post-deployment transition. Resilience training is one option. 

The challenge is that it is difficult to teach resilience, and there is limited 

evidence that teaching resilience skills en masse has had a significant impact 

on improving outcomes.270 However, having various coping strategies and 

flexibility to adapt strategies to a context has shown the most positive outcomes.271 This suggests that teaching strategies, rather than trying to ‘build 

resilience,’ might be more effective. This training is most effective when it is 

“experiential and action focused, providing tangible skills to build flexible 

and adaptive coping mechanisms, that have real world applications, and can 

be developed through scenarios and situational training.”272 Training could 

also be provided to create and enhance specific skills that would assist in 

managing typical transitional challenges, including skills in: communication, conflict management, and relationship management. 

Additional training is often needed because military training does not 

necessarily translate well to the civilian world. “A warrior’s body knows how 

to respond to threat and danger, and how to handle high anxiety, stress, and 

fear ... to dial up or down their level of alertness, tension, and awareness 

of potential threats.”273 However, these skills do not always span to civilian 

situations. One veteran has noted, “attack, retreat, re-group, close ranks,” is 

part of the mantra of survival in the military; on deployment, the options for 

resolving problems are “shoot it” or “walk away,” but this mantra and these 

options offer limited solutions for navigating typical civilian challenges.274

However, Service members are rarely “instructed (or even reminded) on how 
55

Hazen: Post-Deployment Support for SOF

to let go of our military modus operandi” when they return from deployments.275 “We are indoctrinated into the violence, the selectivity and the 

heritage that is Ranger; we are not, however, taught how to turn it off.”276 In some 

cases, military skills could translate to 

civilian situations, if Service members 

learned how to adjust their approach to a 

civilian setting. One example is patience. 

“Patience is a crucial skill in combat ... 

However, many warriors completely 

forget this skill when they come home. They can’t tolerate the stupid stuff 

people do, and instead of remembering to practice this skill (for example, in 

a supermarket line), they explode at relatively minor things.”277

Post-deployment retreats often provide sessions on building communication and conflict management skills, however developing these skills 

requires repeated practice, and one retreat is unlikely to provide sufficient 

time to fully develop these skills. The NSW survey, discussed in chapter 6, 

indicated such skills training are needed and desired by those returning 

from deployments. FOCUS programs provide another possibility. These 

teach five primary skills to enhance resilience: emotional regulation, problem 

solving, communication, managing reminders (of deployment/trauma/loss), 

and establishing readiness and goal setting.278 Resilience retreats, for family 

members and Service members, and educational workshops offer additional 

opportunities for skills training. 

Identifying Programming Needs and What Works 

Creating effective programs depends largely on knowing what is needed. 

Data collection, however, can seem onerous, or even pointless, for many. The 

requirement of collecting information can be made less daunting by building 

it into existing data collection efforts, such as the pre- and post-deployment 

required forms, annual surveys, and other existing efforts. 

Anonymous surveys can also be made available through secured component portals. NSW used to maintain an anonymous survey online that 

provided the opportunity for Service members and their spouses to provide 

input at any time. This online option was discontinued after USSOCOM 

began their annual survey, the assumption being that the two tools duplicated 

In some cases, military skills 

could translate to civilian 

situations, if Service members 

learned how to adjust their 

approach to a civilian setting.
56

JSOU Report 17-8

efforts.279 However, the NSW option had a different purpose. It was always 

available, which meant it could provide an timely assessment of the environment rather than relying only on annual surveys. Keeping the online version 

short and simple, and focused on reporting both positives and challenges, 

could provide ongoing input about the health of the component; complementing, not duplicating, the larger annual effort. 

The annual survey is a useful tool to provide a general assessment of 

the health of the force, including the component level. Currently, it does 

not provide great insight into the post-deployment transition specifically. 

Adding questions that focus specifically on the post-deployment period 

could be one way of gathering additional information. The shortcoming 

of this approach is that it would make an already lengthy instrument even 

longer. The annual survey findings could be more useful if the findings were 

widely shared across SOF; currently a trickle-down approach seems to be the 

most common, with findings shared with senior leadership, but the information is not necessarily making it down to the unit level.280 One challenge to 

expanding dissemination is the manpower needed to analyze the data and 

put it into an accessible format. 

Input at the unit level may be most useful for creating specialized programming that best fits Service members’ needs.281 USSOCOM survey 

responses indicate a strong level of trust of unit level behavioral health providers among SOF, placing those providers in a unique position to potentially collect sensitive information about 

transition challenges. Anonymous surveys in the post-deployment period provide an opportunity to identify needs and 

provide support that targets the requirements of specific units. One challenge to 

this approach is ensuring there are qualified service providers at this level who can 

collect this data and utilize it to create effective programming. Resource 

constraints could make this challenging to implement across components. 

This approach would also have to guard against any pressure toward standardization; the intent of this approach is to identify specific needs, not to 

produce generic programming to implement across all units.

Efforts can build upon existing data collection tools and capitalize on 

what Service members are willing to admit. For example, most Service 

Anonymous surveys in the 

post-deployment period 

provide an opportunity to 

identify needs and provide 

support that targets the requirements of specific units.
57

Hazen: Post-Deployment Support for SOF

members are willing to discuss sleep-related problems over other problems.282

Yet sleep problems are often the result of an underlying stressor; one that the 

Service member may not understand or be willing to acknowledge. Managing the sleep problem provides an entry point for investigating the underlying stressor, and creating a solution that will address the underlying cause 

of the sleep problem. Another example is communication with spouses and 

children. This is a common challenge for returning Service members, and 

one that appears to be easy for Service members to discuss. The source of 

the problem could be relationship-based, or it could result from the transition home. Tackling the problem as one of communication, rather than any 

problem with the Service member, could provide an avenue to exploring 

transition challenges.

Anonymous and undocumented venues for reporting and discussing 

transition challenges may be an essential element of improved support. 

Despite efforts to destigmatize seeking help, concerns persist among active 

duty SOF that seeking mental health support or other counseling can negatively affect their career trajectory. These concerns can be dampened through 

anonymous surveys, whether at the unit, component, or command level. 

Anonymous surveys are more likely to obtain honest feedback, and this 

information can be used to develop targeted programming at the group 

level. However, this will not enable the identification of individuals who 

need specialized support. One way to encourage these individuals to seek 

support is to offer undocumented (off-the-record) meetings with a behavioral 

health care provider. This is not a replacement for clinical care and on-therecord meetings, but could be used as a confidence building measure to 

build rapport, as well as to check in on Service members in an informal way 

that may create better opportunities for honesty and sharing. While some 

service providers, such as MFLC, can provide undocumented support, not 

all service providers can, which limits the anonymous options available to 

Service members. NSW currently requires undocumented check-ins with 

the force psychologist following return from deployments as a means of 

opening lines of communication and providing a safe venue for reporting 

difficulties. This may be a model for other components to follow to create 

non-threatening opportunities for seeking support. Embedded psychologists 

may offer the best foundation for developing this model. Their role is not to 

find the ‘broken,’ but to provide guidance for improved performance, just 

as sports teams would use sports psychologists to give players a cognitive 
58

JSOU Report 17-8

competitive advantage, and make them better thinkers in all settings; this 

would likely reduce the stigma associated with seeing a psychologist because 

that person is a part of the team and someone to speak with regularly about 

optimizing performance.283

As programs are continued or new ones are developed, it is essential to 

assess these programs to understand what works and why. Program evaluations offer opportunities to assess the effectiveness of programs and retreats, 

to determine what needs to be altered, what is missing from programming, 

and when programs may need to be replaced. Currently there is limited 

evaluation of post-deployment programs, support services, and retreats. 

This makes it nearly impossible to assess whether what is being offered is 

effective. Anecdotal information suggests, at a minimum, programs need 

to be adjusted to improve the positive impact they have. 

Characteristics of Effective Transition Support

Several themes emerged in interviews and over the course of this research 

that could bolster transition support. First, the provision of personalized care 

is essential. Standardized forms are unlikely to be effective in identifying 

and supporting individuals who need assistance. “Instead of strong leaders, 

today we have multiple choice, check-the-block training. In the past, a First 

Sergeant or Platoon Sergeant would have to address a troop who they felt was 

in some trouble. Maybe buy him a beer and offer to hear him out. Today we 

throw some safety surveys at the troop and give him a mandatory suicide 

brief.”284 This example might be the extreme, but for many, standard forms 

and briefings are the norm for coming home, and there is sufficient feedback 

that these are not effective and are viewed more as ‘check-the-block’ requirements than true means of seeking and receiving assistance to question their 

utility for assessment. The Defense Centers of Excellence suggest using the 

total force fitness (TFF) concept as the foundation for transition.285 While 

the TFF highlights various aspects of life that may need to be considered for 

transition programs, it is questionable that creating a standardized one-sizefits-all approach would be most helpful. Instead, TFF probably best serves as 

a reference for remembering the various dimensions of transition and what 

might be considered for a particular unit, team, or individual. Tailoring 

assistance to the needs of specific groups within the population will likely 

be more effective. For example, offering the same retreat for everyone may 
59

Hazen: Post-Deployment Support for SOF

be less effective than offering retreats that target certain ranks, relationship 

status (e.g. single, married, family), or occupational specialty, which would 

enable a focus on the unique challenges faced by these different groups and 

provide more tailored assistance. 

Second, trust is essential. Service members are unlikely to seek support if 

they do not trust the service provider. Trust will be easier to build with those 

who have ‘been there’ and can talk from experience. Incorporating active 

duty or recently retired Service members into post-deployment briefings, 

where they can share their experiences, is one option for creating a 

more open environment. Trust is 

also more likely to develop at the 

unit level where there is already 

familiarity, knowledge, and frequent interactions among Service 

members and behavioral health 

providers. Programs can build upon this existing family setting through 

programming targeted at the unit level, embedding psychologists and social 

workers at this level, and considering ways of maintaining these service 

providers within units for longer periods of time. Local knowledge and daily 

contact will increase the likelihood that both service providers and Service 

members will notice when someone is struggling and be able to respond. 

Third, time and timing are essential. Service members need down time 

when they return from deployment; this requires time to sleep, and time 

away from stressors. Although there may be no life-or-death situations at 

home, this does not mean that coming home is free of stress. Difficult relationships, hectic schedules and work demands, trainings, and TDY can all 

create stress. The body does not distinguish between stressors. Home stressors or combat stressors can produce the same biological response. While the 

stressors at home may not seem as dangerous, our bodies react to threats 

(whether from the threat of a shooter or the threat of a failed marriage) in 

the same way; stressors at home can keep the body at an elevated stress level, 

resulting in prolonged symptoms of stress. This means that even though 

the Service member is home, the Service member is not able to decompress 

from deployment due to the existence of stressors at home; in effect one 

stressor has been replaced by another. In addition, time to decompress can 

often be interrupted by training requirements, bureaucratic requirements, 

Incorporating active duty or recently retired Service members into 

post-deployment briefings, where 

they can share their experiences, 

is one option for creating a more 

open environment.
60

JSOU Report 17-8

and unexpected deployments. Service members need time to seek assistance 

if they need it. One of the reported primary reasons Service members who 

wanted assistance but could not access it, was lack of time to seek help. 

Timing of assistance also matters. Some Service members may not 

develop negative symptoms until several weeks, or months, after returning 

home from deployment. Service members may not immediately recognize 

they are having difficulties transitioning. They may not recognize what they 

are feeling, or not understand what is normal versus what is not. Service 

members may be so happy to be home that initially symptoms are ignored 

or overshadowed by positive feelings about being home.286 Symptoms may 

not result from deployments, but from the transition, and therefore will only 

emerge after being home for some time. The variation in the timing of the 

onset of challenges indicates the importance that opportunities for seeking 

assistance are available when needed, not just immediately upon return from 

deployment. Timing also matters for treatment; the sooner an individual 

seeks support after developing symptoms, the more positive the outcome. 

Fourth, skills for coming home are just as important as skills for deployment. The military provides knowledge, skills, and training for deployments. 

This ensures Service members know what to do in mission-oriented tasks. 

This gives them control while on deployment, which enhances the likelihood 

of survival and mission success. The military does not provide equivalent 

training to enable Service members to operate effectively in the garrison 

environment after deployments. There is limited training to support Service 

members making the transition home. This research indicates a gap in support, suggesting the military could do more to provide Service members 

with the appropriate knowledge and skills to transition home, just as they 

do to ensure Service members are mission-effective.
61

Hazen: Post-Deployment Support for SOF

Acronym List

AFSOC Air Force Special Operations Command

CF conventional forces

CSF Comprehensive Soldier Fitness

CSF2 Comprehensive Soldier and Family Fitness 

DOD Department of Defense 

FOCUS Families OverComing Under Stress Program 

MARSOC Marine Corps Forces Special Operations Command

MARSOF Marine Special Operations Forces

MFLC Military & Family Life Counseling Program

NSW Naval Special Warfare Command

PDHA Post-deployment health assessment

PDHRA Post-Deployment Health Reassessment

PERRES Performance and Resiliency Program

POTFF Preservation of the Force and Family

PTS post-traumatic stress 

PTSD post-traumatic stress disorder

SOF Special Operations Forces

TDY temporary duty

TFF total force fitness

TLD third location decompression

USSOCOM United States Special Operations Command

USASOC United States Army Special Operations Command

63

Hazen: Post-Deployment Support for SOF

Endnotes 

1. Jonah Lehrer, “Why we travel,” The Guardian, 13 March 2010. 

2. Steven J. Danish and Bradley J. Antonides, “The Challenges of Reintegration for 

Service Members and Their Families,” American Journal of Orthopsychiatry 83, 

no. 4 (2013): 551. 

3. By definition, SOF are “those active and reserve component forces of the services 

designated by the Secretary of Defense and specifically organized, trained, and 

equipped to conduct and support special operations.” Andrew Feickert, U.S. 

Special Operations Forces (SOF): Background and Issues for Congress, Congressional Research Service, 6 April 2016, 1. 

4. Wave III, Preservation of the Force and Family (POTFF) Needs Assessment 

2014-2015. Data provided by USSOCOM POTFF. 

5. These operations included: Operation Enduring Freedom (OEF) in Afghanistan, 

which began 7 October 2001 and officially ended 28 December 2014; Operation 

Freedom’s Sentinel, the follow-on mission to OEF in Afghanistan, which began 1 

January 2015 with the purpose to train, advise and assist Afghan security forces; 

Operation Iraqi Freedom (OIF), which began 19 March 2003, and while major 

military combat actions ended 1 May 2003, the Operation officially ended 31 

August 2010; and, Operation New Dawn, the follow-on mission to OIF in Iraq 

which began 1 September 2010, but with the official end of the war in Iraq on 15 

December 2011, U.S. troops were withdrawn from Iraq. Barbara Salazar Torreon, 

U.S. Periods of War and Dates of Recent Conflicts, Congressional Research Services, 27 February 2015, 6-9. 

6. Joint Chiefs of Staff, “Special Operations,” Joint Publication 3-05, 16 July 2014, x. 

7. Thom Shanker and Richard A. Oppel, Jr., “War’s Elite Tough Guys, Hesitant to 

Seek Healing,” New York Times, June 5, 2004. 

8. U.S. Government Accountability Office (GAO), Special Operations Forces: Opportunities Exist to Improve Transparency of Funding and Assess Potential to Lessen 

Some Deployments, July 2015, 23. 

9. Ibid, 22. 

10. Ibid, 23. 

11. Ibid, 9. 

12. Ibid. 

13. Ibid, 13-14. 

14. Ibid, 23. 

15. Ben Watson, “Special Operations Commander Says Burden On Elite Troops Is 

Here to Stay,” Defense One, 10 July 2014. 

16. GAO, “Special Operations Forces: Opportunities Exist to Improve Transparency 

of Funding,” 22. 
64

JSOU Report 17-8

17. Ibid, 24. 

18. Ibid, 22. 

19. Rowan Scarborough, “Obama runs special forces into the ground,” The Washington Times, 11 March 2014. 

20. U.S. Special Operations Command, USSOCOM Fact Book 2015 (MacDill Air 

Force Base, FL: United States Special Operations Command, 2009), 56. 

21. “Special operations require unique modes of employment, tactics, techniques, 

procedures, and equipment. They are often conducted in hostile, denied, or 

politically and/or diplomatically sensitive environments, and are characterized 

by one or more of the following: time-sensitivity, clandestine or covert nature, 

low visibility, work with or through indigenous forces, greater requirements for 

regional orientation and cultural expertise, and a higher degree of risk.” Joint 

Chiefs of Staff, “Special Operations,” Joint Publication 3-05, 16 July 2014, I-1. 

22. Matthew Cox, “SOCOM Commander Says Op-Tempo Stressing Special Operations Personnel,” Military.com, 19 May 2015. 

23. Walter James Wiggins, Generational resilience in support of the global SOF network, Carlisle, Pennsylvania: U.S. Army War College Strategy Research Project, 

2015, presented at the seminar on Resilience Research and Training in the U.S. 

and Canadian Armed Forces, American Psychological Association Convention, 

Toronto, Canada, 7 August 2015, 72. 

24. Donna Miles, “SOCOM Strives to Boost Operators’ Resilience, Readiness,” 

Defense.Gov News, 14 June 2014; Wiggins, 65. 

25. House of Representatives, Subcommittee on Emerging Threats and Capabilities, 

Committee on Armed Services, The Future of U.S. Special Operations Forces: Ten 

Years after 9/11 and Twenty-Five Years after Goldwater Nichols (Washington, D.C; 

U.S. Government Printing Office, 2012), 15.

26. Ibid. 

27. U.S. Special Operations Command, USSOCOM Fact Book 2015, 56. 

28. Wave III, USSOCOM POTFF. 

29. Ibid. 

30. Watson, “Burden on Elite Troops is Here to Stay.” 

31. John Knefel, “Are America’s special operations forces in crisis?,” The Week, 16 

October 2014. 

32. Gregg Zoroya, “Special forces’ marriages on shaky ground, survey shows,” USA 

Today, 11 July 2013. 

33. Jennifer G. Hickey, “High Suicide Rate Prompts Spec Ops Leader to Go Public,” 

Newsmax, 10 March 2015. 

34. Laura Koran, “Special Ops commander tries to lessen the stigma of getting help,” 

CNN, 11 April 2016. 

35. Eliza Griswold. “Can General Linder’s Special Operations Forces Stop the Next 

Terrorist Threat?” The New York Times Magazine, 13 June 2014. 
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Hazen: Post-Deployment Support for SOF

36. Ursula B. Bowling and Michelle D. Sherman, “Welcoming Them Home: Supporting 

Service Members and Their Families in Navigating the Tasks of Reintegration,” 

Professional Psychology: Research and Practice 39, no. 4 (2008): 452. 

37. George A. Bonanno, et al, “Trajectories of trauma symptoms and resilience in 

deployed US military service members: prospective cohort study,” The British 

Journal of Psychiatry 200 (2012): 317–323; Greg M. Reger and Bret A. Moore, 

“Challenges and Threats of Deployment,” in Living and Surviving in Harm’s Way: 

A Psychological Treatment Handbook for Pre- and Post-Deployment of Military 

Personnel, ed. Sharon Morgillo Freeman, Bret A. Moore, and Arthur Freeman 

(New York: Routledge, 2009), 51-52. 

38. Bowling and Sherman, “Welcoming Them Home,” 451. 

39. Joan Beder, Ray Coe, and Darren Sommer, “Women and Men Who Have Served 

in Afghanistan/Iraq: Coming Home,” Social Work in Health Care, 50 (2011): 524.

40. Author interview, 22 June 2016. 

41. Author interview, 16 June 2016. The interviewee’s assessment matches with existing research indicating that delayed onset is not unusual. See Paul D. Bliese et al., 

“Timing of Postcombat Mental Health Assessments,” Psychological Services 4, no. 

3 (2007): 141–148. The results of this study demonstrated “significant increases 

in mental health problems at 120 days post-deployment relative to immediate 

reintegration.” Charles S. Milliken, Jennifer L. Auchterlonie, and Charles W. 

Hoge, “Longitudinal Assessment of Mental Health Problems Among Active 

and Reserve Component Soldiers Returning from the Iraq War,” Journal of the 

American Medical Association (JAMA) 298, no. 18 (2007): 2141-2148. 

42. Amy Adler, Carl Castro, and Dennis McGurk, Battlemind Psychological Debriefings, Report #2007-001, US Army Medical Research Unit – Europe, 2007, 2. 

43. Author interviews, 16 June 2016, 21 June 2016, 13 July 2016. 

44. Author interviews, 16 June 2016. 

45. Author interview, 13 July 2016. 

46. Delayed onset is not unusual. See Bliese et al., “Timing of Postcombat Mental 

Health Assessments,” 141-148; Milliken et al., “Longitudinal Assessment of 

Mental Health Problems,” 46. 

47. Author interviews, 13 July 2016. 

48. One approach to skills training for transitions is Charles W. Hoge, Once A Warrior, Always A Warrior (Guilford, CT: Globe Pequot Press, 2010). The book is 

written for those who have deployed, and their loved ones. “It provides essential 

knowledge on what it means to be a warrior and to transition home from war” 

(x). 

49. Bonanno et al., “Trajectories of trauma symptoms,” 320. 

50. Army Lieutenant General Joseph Votel, “Advance Policy Questions for Lieutenant 

General Joseph L. Votel, USA, Nominee for Commander, United States Special 

Operations Command,” Prepared testimony for U.S. Senate Armed Services 

Committee, 7 July 2014, 5. 
66

JSOU Report 17-8

51. Hoge, Once a Warrior, 35. 

52. Jennifer J. Vasterling et al., “Neuropsychological Correlates of PTSD: A Military 

Perspective,” in Military Neuropsychology, ed. Carrie H. Kennedy and Jeffrey L. 

Moore (New York: Springer Publishing Company, 2010), 338. 

53. Hoge, Once a Warrior, 54-56. Hoge provides a non-technical and clearly written 

description of the how the brain reacts to threats. 

54. Hoge, Once a Warrior, 81. Author interview, 22 June 2016; interviewee commented on seeing this as a frequent problem, and that more needed to be done 

to manage drinking among Service members and to educate them that alcohol 

consumption could worsen their sleep difficulties. 

55. Author interview 22 June 2016; Hoge, Once a Warrior, 75-80. Discussion of sleep 

and sleep medications. 

56. Vasterling et al, 2010, 326. 

57. Vasterling et al., “Neuropsychological Correlates of PTSD,” 328. Hoge, Once a 

Warrior, 58. 

58. PTSD is a clinical diagnosis. It is based on assessing symptoms in four categories: 

re-experiencing the traumatic event; avoidance of reminders or thoughts of the 

event and numbing of emotions; hyperarousal; and negative changes in beliefs 

and feelings. In addition to the presence of symptoms, a person must have experienced a traumatic event, defined as an event in which a person “experienced, 

witnessed, or was confronted with an event or threat to the physical integrity 

of self or others” and had a response that entailed “intense fear, helplessness, or 

horror.” In addition, the symptoms must persist “at least one month and cause 

clinically significant distress or functional impairment.” It is at this point that 

symptoms are assessed as a disorder, and behavioral health intervention is 

recommended. See Vasterling et al., “Neuropsychological Correlates of PTSD,” 

321-322; and, U.S. Department of Veterans Affairs, “Symptoms of PTSD.”

59. Brian Van Reet, “Troubled veterans may suffer from something other than PTSD,” 

The Washington Post, 22 August 2013. 

60. Vasterling et al., “Neuropsychological Correlates of PTSD,” 322. 

61. Ibid. 

62. Ibid. 

63. Wave III, USSOCOM POTFF. 

64. Matthew Hing, Jorge Cabrera, Robert Forsten, and Craig Barstow, “Special 

Operations Forces and incidence of post-traumatic stress disorder symptoms,” 

Journal of Special Operations Medicine 12, no. 3 (2012): 23-35. 

65. Daniel J. Neller and Jimmie J. Butcher, “Prevalence of Posttraumatic Stress Disorder in Special Operations Forces,” Journal of Special Operations Medicine 14, 

no. 1 (2014): 91-92. 

66. Koran, “Special Ops commander tries to lessen stigma.” Koran states USSOCOM 

“does not maintain statistics on post-traumatic stress cases because of privacy 

prohibitions.” 
67

Hazen: Post-Deployment Support for SOF

67. Hoge, Once a Warrior, 9. 

68. Adler, Castro, and McGurk, “Battlemind Briefing,” 21. 

69. Danish and Antonides, “The Challenges of Reintegration,” 552; E. Ann Jeschke, 

“Postdeployment Reintegration: The Ethics of Embodied Personal Presence and 

the Formation of Military Meaning,” Annual Review of Nursing Research 34 

(2016):199-226; RealWarriors.Net, 2016. 

70. Hoge, Once a Warrior, 56. 

71. Mike Stajura, “What Ails Vets Today,” TIME, 9 November 2013. Mike Stajura 

is an Army veteran who wrote this piece to describe his experience and that of 

his friends; Sebastian Junger, “Why veterans miss war.” TED talk, January 2014; 

John R. Christian, James R. Stivers, and Morgan T. Sammons, “Training to the 

Warrior Ethos: Implications for Clinicians Treating Military Members and 

Their Families,” in Living and Surviving in Harm’s Way: A Psychological Treatment Handbook for Pre- and Post-Deployment of Military Personnel, ed. Sharon 

Morgillo Freeman, Bret A. Moore, and Arthur Freeman (New York: Routledge, 

2009), 30-3. 

72. Steven L. Sayers, “Family Reintegration Difficulties and Couples Therapy for 

Military Veterans and Their Spouses,” Cognitive and Behavioral Practice 18 

(2011): 109. 

73. Danish and Antonides, “The Challenges of Reintegration,” 551-552; Sayers, “Family 

Reintegration Difficulties,” 110, 111, 113; RealWarriors.Net, “8 Battlefield Skills 

that make Reintegration Challenging,” 15 August 2016.

74. Danish and Antonides, “The Challenges of Reintegration,” 552-553. 

75. Ibid., 552. 

76. Concerns about the career impacts of seeking assistance are likely also influence 

by anecdotal stories of discharges and studies, such as the one recently conducted 

by the U.S. Army, that upheld its standards for discharges, even though many 

specialists found questionable the discharges of thousands of conventional 

soldiers; soldiers who they say needed behavioral health assistance, not a discharge. National Public Radio, “Senators, Military Specialists Say Army Report 

on Dismissed Soldiers Is Troubling,” 1 December 2016. 

77. Paul N. Pfeiffer, et al, “Peers and Peer-Based Interventions in Supporting Reintegration and Mental Health Among National Guard Soldiers: A Qualitative 

Study,” Military Medicine 177, no. 2 (2012): 1471. 

78. Acosta, et al, Mental Health Stigma in the Military, RAND Corporation: Santa 

Monica, CA, 2014, 11-12. 

79. Shanker and Oppel, “War’s Elite Tough Guys.” 

80. Todd Yosick, et al, A Review of Post-Deployment Reintegration: Evidence, Challenges, 

and Strategies for Program Development, Arlington, VA: Defense Centers of Excellence, 10 February 2012, 61; Thomas W. Britt, et al, “The Stigma of Mental Health 

Problems in the Military,” Military Medicine 172 (2007): 157-161; Charles W. Hoge, 

et al, “Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers 
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JSOU Report 17-8

to Care,” The New England Journal of Medicine 351, no. 1 (2004): 13-22; Author 

interviews, 6/16/2016, 6/21/2016, 6/22/2016, 7/13/2016, 10/11/2016, 11/10/2016. 

81. Votel, “Advance Policy Questions,” 26. 

82. Michael E. Doyle and Kris A. Peterson, “Re-Entry and Reintegration: Returning 

Home after Combat,” Psychiatric Quarterly 76, no. 4 (Winter 2005): 361-370. 

83. Ann-Renée Blais, Megan M. Thompson, and Donald R. McCreary, “The Development and Validation of the Army Post-Deployment Reintegration Scale,” Military 

Psychology 21, no. 2 (2009): 368. 

84. Danish and Antonides, “The Challenges of Reintegration,” 550-558. 

85. Karen-Inge Karstoft, Cherie Armour, Søren B. Andersen, Mette Bertelsen, and 

Trine Madsen. “Community integration after deployment to Afghanistan: a 

longitudinal investigation of Danish soldiers.” Social Psychiatry Psychiatric 

Epidemiology 50 (2015): 654. 

86. Yosick et al., A Review of Post-Deployment Reintegration, 75-76. 

87. Ibid, 6-7. 

88. Department of the U.S. Army, U.S. Army Deployment Cycle Readiness: Soldier’s 

and Family Member’s Handbook, 2008. 

89. Doyle and Peterson, “Re-Entry and Reintegration,” 361-370. 

90. Yosick et al., A Review of Post-Deployment Reintegration, 75. 

91. Ibid, 75. 

92. Ibid. 

93. Author interviews, 21 June 2016, 22 June 2016. 

94. Yosick et al., A Review of Post-Deployment Reintegration, 75. 

95. Ibid. 

96. Air Force Medical Service, “Post-deployment Reintegration,” Fact Sheet, 26 April 

2013; USAF Services, Combat Support & Community Service, “Redeployment,” 

website.

97. Author interviews, 13 July 2016. 

98. Yosick et al., A Review of Post-Deployment Reintegration, 76. 

99. Ibid. 

100. Marine Corps Forces Special Operations Command, MARSOF, MARSOC Pub 

1, Camp LeJeune, NC, 2011, 5-11.

101. House of Representatives, Subcommittee on Emerging Threats and Capabilities, 

Committee on Armed Services, The Future of U.S. Special Operations Forces, 15. 

102. Bowling and Sherman, “Welcoming Them Home,” 454, 456. 

103. Jack Murphy, “Don’t Kill Yourself Briefs: The Army’s Cynical Approach to Skyrocketing Suicide Rates,” SOFREP, 5 August 2012, Accessed 11/11/2016, https://

sofrep.com/10047/armys-cynical-approach-suicide-rates/. 

104. Wiggins, 72. 
69

Hazen: Post-Deployment Support for SOF

105. GAO, “Special Operations Forces: Opportunities Exist to Improve Transparency 

of Funding,” 26. 

106. Ibid. 

107. Ibid. 

108. For a description of component commands see U.S. Special Operations Command, USSOCOM Fact Book 2015. 

109. GAO, “Special Operations Forces: Opportunities Exist to Improve Transparency 

of Funding,” 26. 

110. Ibid. 

111. Ibid. 

112. Ibid. 

113. Ibid. 

114. AFSOC and NSW shared some of their tracking instruments. One such instrument color codes individuals based on their assessed readiness to deploy, resulting 

in green (ready), yellow (potential problems), and red (should not deploy) stick 

figures on a chart. Interviewees admitted that the color coding did not always 

prevent the “yellows” and “reds” from deploying, and that these individuals 

tended to have the most difficulties when returning from deployment. Author 

interviews, 21 June 2016, 13 July 2016. The positive side of this is that at least 

the tracking allows for identifying those at-risk, and could be used to provide 

additional support to those who are most likely to need it upon return. 

115. GAO, “Special Operations Forces: Opportunities Exist to Improve Transparency 

of Funding,” 27. 

116. Ibid. 

117. Ibid. 

118. Neff and Caserta, 2016. 

119. Wiggins, 72-73. 

120. Department of Defense Deployment Health Clinical Center (hereinafter DOD 

Deployment Health Clinical Center), “Background on Programs for Identifying 

Deployment Health Conditions and Concerns.” 

121. “In accordance with HA Policy 06-006, Periodic Health Assessment Policy for 

Active Duty and Selected Reserve Members, Feb. 16, 2006 all active-duty Service 

members and members of the selected reserve (SELRES) are required to receive a 

Periodic Health Assessment (PHA) annually (DD Form 3024) in order to ensure 

medical readiness and help improve the health status of military personnel. The 

PHA includes a current self-reported health status, review of medical records, 

identification and referral for current health and mental health problems, identification and management of occupational health risks and preventive health 

needs, and identification and development of a plan to manage health risks.” 

DOD Deployment Health Clinical Center, “Periodic Health Assessment.” 
70

JSOU Report 17-8

122. “For members of the Armed Forces deployed in connection with a contingency 

operation, a person-to-person Deployment Mental Health Assessment (DMHA) 

is required before deployment and three times after return as prescribed in 

DoDI 6490.12, Mental Health Assessments for Service Members Deployed in 

Connection with a Contingency Operation, Feb. 26, 2013. According to DoDI 

6490.12, “the purpose of the deployment mental health assessment is to identify 

mental health conditions including posttraumatic stress disorder (PTSD), suicidal tendencies, and other behavioral health conditions that require referral for 

additional care and treatment in order to ensure individual and unit readiness.” 

“The required four time frames for DMHA completion are: (a) within 120 days 

of deployment, (b) between 90 and 180 days after return from deployment, (c) 

between 181 days and 18 months (545 days), and (d) between 18 months (546 

days) and 30 months (910 days) after return from deployment.” “The DMHA 

consists of an online self-report assessment completed by the service member 

using validated tools to assess alcohol use and symptoms of PTSD and depression. The assessment is followed by a confidential person-to-person interview 

with a health care provider in order to: assess suicidal ideation and violence risk, 

address specific mental health concerns, provide brief supportive counseling if 

necessary, assess the need and make any referrals necessary for further evaluation and follow-up, and complete the provider portion of the form. The DMHA 

must be conducted in a private setting and include a review of available health 

records. DD Form 2978, Deployment Mental Health Assessment, February 2014 

was created for documenting the DMHA.” “To streamline the implementation 

and tracking process, the DMHA has been integrated into DD Forms 2795, 

2900 and 3024 for administration when the timeframes for completing the first 

two DMHAs overlap with the Pre-DHA and the PDHRA and when the third 

and fourth DMHAs are administered in conjunction with the ensuing two 

PHAs.” DOD Deployment Health Clinical Center, “Deployment Mental Health 

Assessment.” 

123. Bliese et al., “Timing of Postcombat Mental Health Assessments,” 141. 

124. This form is required if “a DD Form 2795 was required during the pre-deployment 

phase or per the decision of the combatant command commander, service component commander, or commander exercising operational control if any health 

threats evolved or exposures (occupational and environmental health (OEH) 

or chemical, biological, radiological and nuclear (CBRN)) occurred during the 

deployment that warrant medical assessment or follow-up.” DOD Deployment 

Health Clinical Center, “Post-Deployment Health Assessment.” 

125. Bliese et al., “Timing of Postcombat Mental Health Assessments,” 141. 

126. DOD Deployment Health Clinical Center, “Post-Deployment Health Assessment.” 

127. Bliese et al., “Timing of Postcombat Mental Health Assessments,” 141-142. 

128. Ibid., 142. 

129. Paula K. Underwood, “Pre- and Post-Deployment Health Assessment Process,” 

Department of Defense, Deployment Health Clinical Center. 
71

Hazen: Post-Deployment Support for SOF

130. DOD Deployment Health Clinical Center, “Background on Programs for Identifying Deployment Health Conditions and Concerns.” 

131. Ibid. 

132. DOD Deployment Health Clinical Center, “Deployment Health Assessments” 

states that “Personnel who are deploying or have deployed must electronically 

complete the deployment health assessment forms within the required timeframes 

listed in the chart below. Following completion of the form, a health care provider 

(i.e., physician, physician assistant, nurse practitioner, advanced practice nurse, 

independent duty corpsman, independent duty medical technician, or special 

forces medical sergeant) must review the form, conduct a confidential face-to-face 

interview, and complete the provider’s section of the form, including indicating 

the need for further evaluation.” 

133. Author interviews, 16 June 2016, 21 June 2016, 22 June 2016, 13 July 2016. 

134. DOD Deployment Health Clinical Center, “Background on Programs for Identifying Deployment Health Conditions and Concerns.” 

135. Bliese et al., “Timing of Postcombat Mental Health Assessments,” 146. 

136. DOD Deployment Health Clinical Center, “Background on Programs for Identifying Deployment Health Conditions and Concerns;” DOD Deployment Health 

Clinical Center, “Post-Deployment Health Assessment.” 

137. Bliese et al., “Timing of Postcombat Mental Health Assessments,” 146. This study 

found that 15.4 percent of Service members in the study developed symptoms 

in the period following the return home; they were initially asymptomatic but 

developed symptoms between return home and 120 days later (145). 

138. Paul D. Bliese, et al, “Validating the Primary Care Posttraumatic Stress Disorder 

Screen and the Posttraumatic Stress Disorder Checklist with Soldiers Returning 

from Combat,” Journal of Consulting and Clinical Psychology 76, no. 2 (2008): 

272. 

139. Bliese et al., “Validating the Primary Care Posttraumatic Stress Disorder Screen,” 

272. 

140. Bliese et al., “Timing of Postcombat Mental Health Assessments,” 141-142; Ibid., 278.

141. Bliese et al., “Timing of Postcombat Mental Health Assessments,” 147. 

142. GAO, Defense Health Care: Oversight of Military Services’ Post-Deployment Health 

Reassessment Completion Rates Is Limited, Report GAO-08-1025R, 4 September 

2008, 6, 16. 

143. GAO, Defense Health Care, 6, 16. 

144. Naval Health Research Center, Program Evaluation of Naval Special Warfare’s 

Third Location Decompression Program, San Diego, CA, n.d., 51. 

145. Ibid., 53. 

146. Author interviews, 16 June 2016, 22 June 2016, 13 July 2016. 

147. Ibid. 

148. Author interviews, 22 June 2016. 
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149. Danish and Antonides, “The Challenges of Reintegration,” 550. 

150. Beder, Coe, and Sommer, “Women and Men Who Have Served in Afghanistan/

Iraq,” 516. 

151. Kristal C. Melvin, Jennifer Wenzel, and Bonnie Mowinski Jennings, “Strong 

Army Couples: A Case Study of Rekindling Marriage After Combat Deployment,” Research in Nursing & Health 38 (2015): 11-12. 

152. Shanker and Oppel, “War’s Elite Tough Guys.” 

153. Danish and Antonides, “The Challenges of Reintegration,” 552; Blais, Thompson, 

and McCreary, 2009, 367; U.S. Department of Veterans Affairs, Returning from 

the War Zone: A guide for families of military members, Washington, D.C., March 

2014, 4. 

154. Bonanno et al., “Trajectories of trauma symptoms,” 321-322. 

155. Discussion with USSOCOM POTFF, 14 October 2016. 

156. Stephanie Booth-Kewley, et al, “Factors Associated with Antisocial Behavior in 

Combat Veterans,” Aggressive Behavior 36 (2010): 336. 

157. Kevin Brailey, et al, “PTSD Symptoms, Life Events, and Unit Cohesion in U.S. 

Soldiers: Baseline Findings from the Neurocognition Deployment Health Study,” 

Journal of Traumatic Stress 20, no. 4 (2007): 500-501. 

158. This challenge may be less applicable to SOF than to conventional forces, where 

accessing appropriate and effective equipment appears to be a larger challenge. 

159. Yosick et al., A Review of Post-Deployment Reintegration, 62. 

160. Author discussions, 16 June 2016, 17 June 2016. 

161. Shirley M. Glynn, “Family-Centered Care to Promote Successful Community 

Reintegration After War: It Takes a Nation,” Clinical Child and Family Psychology Review 16 (2013): 410, 412. 

162. Glynn, “Family-Centered Care,” 410, 412. 

163. Sebastian Junger, “How PTSD Became a Problem Far Beyond the Battlefield,” 

Vanity Fair, 7 May 2015. 

164. Sebastian Junger, “Our lonely society makes it hard to come home from war.” TED 

Talk, November 2015; Doyle and Peterson, “Re-Entry and Reintegration,” 361-370.

165. Leanne K. Knobloch, Aaron T. Ebata, Patricia C. McGlaughlin, and Jennifer 

A. Theiss, “Generalized Anxiety and Relational Uncertainty as Predictors of 

Topic Avoidance During Reintegration Following Military Deployment,” Communication Monographs 80, no. 4 (2013): 453-4; Christina L. Lafferty, Kenneth 

L. Alford, Mark K. Davis, and Richard O’Connor, “Did You Shoot Anyone? A 

Practitioner’s Guide to Combat Veteran Workplace and Classroom Reintegration,” S.A.M. Advanced Management Journal 73 (Autumn 2008): 5. 

166. Junger, “How PTSD Became a Problem.” 

167. Doyle and Peterson, “Re-Entry and Reintegration,” 361-370. 

168. Lafferty, Alford, Davis, and O’Connor, “Did You Shoot Anyone?,” 4-11, 18. 
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Hazen: Post-Deployment Support for SOF

169. Doyle and Peterson, “Re-Entry and Reintegration,” 361-370; Junger, “How PTSD 

Became a Problem.” 

170. Yosick et al., A Review of Post-Deployment Reintegration, 61. 

171. Beder, Coe, and Sommer, “Women and Men Who Have Served in Afghanistan/

Iraq,” 516. 

172. To date there have been four surveys: Baseline Needs Assessment administered 

from 30 October 2012 to 3 December 2012, the Wave II Needs Assessment administered from 13 January 2014 to 21 February 2014, the Wave III Needs Assessment 

administered from 6 January 2015 to 9 February 2015, and, the Wave IV Needs 

Assessment administered from 29 March 2016 to 9 May 2016. Neff and Caserta, 

2016. 

173. The PCL-5 is a 20-item self-reporting measure that assesses symptoms of posttraumatic stress disorder (PTSD) to screen individuals for PTSD, make provisional diagnosis, and monitor symptoms for change. Scores range from 0-80. A 

score between zero and 20 is considered “low PTS” on the scale. Scores ranging 

21-30 are considered “moderate PTS,” and scores ranging 31-80 are considered 

“high PTS.” U.S. Department of Veterans Affairs, “PTSD Checklist for DSM-5 

(PCL-5).” 

174. The Brief Resilience Scale (BRS) is a 6-item self-reporting measure that assesses 

the resilience of an individual. Scores range from 1 (low resilience) to 5 (high 

resilience). Bruce W. Smith, et al, “The Brief Resilience Scale: Assessing the 

Ability to Bounce Back,” International Journal of Behavioral Medicine 15 (2008): 

194-200. 

175. The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item self-reporting 

measure that assesses hazardous alcohol use, dependence, and harmful alcohol 

use. Scores range from 0-40. Scores ranging from 0-7 indicate no problems; 

8-15 suggest potential problems; 16-19 indicate high level problems; and 20-40 

indicate very high level problems. Thomas F. Babor, et al, AUDIT: The Alcohol 

Use Disorders Identification Test: Guidelines for Use in Primary Care, Second 

Edition, Geneva: World Health Organization, 2001, 11, 17. 

176. The Patient Health Questionnaire (PHQ-8) is an 8-item self-reporting measure 

that assesses depression. Scores range from 0-24. Scores ranging from 0-4 indicate no to minimal depression; 5-9 mild depression; 10-14 moderate depression; 

15-19 moderately severe depression; and 20-24 severe depression. Kurt Kroenke, 

et al, “The PHQ-8 as a measure of current depression in the general population,” 

Journal of Affective Disorders 114 (2009): 163-173, appendix has full questionnaire. 

177. The Friendship Scale is a 6-item self-reporting measure that assesses the degree 

of social connectedness and social support perceived (or felt) by the individual. 

Scores range from 0-24, with 0 representing total social isolation and 24 representing social connectedness. Graeme Hawthorne, “Measuring social isolation in 

older adults: Development and initial validation of the Friendship Scale,” Social 

Indicators Research 77, no. 3 (2006): 521-548. 

178. Wave III, USSOCOM POTFF. 
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JSOU Report 17-8

179. Neff and Caserta, 2016. 

180. These respondents reported their level of being affected by the emotion or activity 

as “a little bit,” “moderately,” “quite a bit,” or “extremely.” 

181. Wave III, USSOCOM POTFF. 

182. Lauren M. Conoscenti, Vera Vine, Anthony Papa, and Brett T. Litz, “Scanning for 

Danger: Readjustment to the Noncombat Environment,” in Living and Surviving 

in Harm’s Way: A Psychological Treatment handbook for Pre- and Post-Deployment 

of Military Personnel, ed. Sharon Morgillo Freeman, Bret A. Moore and Arthur 

Freeman (New York: Routledge, 2009), 123-145. 

183. Hoge, Once a Warrior, 11,58. 

184. The failure to recognize a need for service is not uncommon. A study of Canadian 

military Service members found “84-96 percent of those who met criteria for a 

disorder did not perceive a need for services.” Suzanne Bailey, “Road to Mental 

Readiness: Challenges & Opportunities” (PowerPoint slides), Presented at the 

seminar on Resilience Research and Training in the U.S. and Canadian Armed 

Forces, American Psychological Association Convention, Toronto, Canada, 7 

August 2015. 

185. Wave III, USSOCOM POTFF. 

186. These skills, often used in problem-solving approaches, have been found to be 

effective in assisting individuals in managing stress and conflict. Meredith, et 

al, 2011, 24. 

187. Hoge, Once a Warrior, 17. 

188. Email discussion with USSOCOM POTFF, 28 October 2016. 

189. This section is based on existing studies as well as author-conducted research 

including visits to NSW (Coronado) and AFSOC (Hurlburt Field). These components generously provided information about their post-deployment programs. 

USASOC and MARSOC declined to be part of the study. USASOC did provide 

some information on its post-deployment approach. MARSOC did not respond 

to repeated requests for information about post-deployment support. 

190. MHN Government Services, “Military & Family Life Counseling (MFLC) Program,” n.d. 

191. Author interview, 13 July 2016. 

192. Author discussion, 21 June 2016. 

193. Lester, Patricia, et al, “Evaluation of a Family-Centered Prevention Intervention 

for Military Children and Families Facing Wartime Deployments,” American 

Journal of Public Health 102, No. S1 (2012): S48–S54. 

194. Author interview, 22 June 2016. 

195. Author interviews, 21 June 2016, 22 June 2016. 

196. Author interview, 22 June 2016. MARSOC did not reply to requests for 

information. 

197. Author interviews, 13 July 2016. 
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Hazen: Post-Deployment Support for SOF

198. Author interview, 16 June 2016. Interviewee identified TLD as not possible for 

USASOC given size of USASOC. 

199. Naval Health Research Center, n.d.. Components of TLD could be useful in 

stateside post-deployment transition support. 

200. Ibid, 18. 

201. Ibid, 16. 

202. Ibid, 16. 

203. Author interview, 21 June 2016; Naval Health Research Center, n.d., 15. 

204. Author interview, 21 June 2016. 

205. Author interviews AFSOC, 13 July 2016. The interviewees indicated that the 

program was not particularly effective in its current configuration, especially 

for non-ground forces. In addition, interviews revealed that different programs 

had been tried, however, there has been no documentation of these programs, 

what worked and what did not, and why certain new alternatives were chosen 

to replace older programs. 

206. Ibid. 

207. Ibid. 

208. Ibid. 

209. Ibid. 

210. Ibid. 

211. Ibid. 

212. USASOC declined to participate in this study. However, the author did speak with 

POTFF, chaplain, and behavioral health services representatives. The information 

here is based on that discussion and unclassified USASOC and USASOC-related 

publications. 

213. Author interviews, 16 June 2016, 11 October 2016. 

214. Author interviews, 16 June 2016. 

215. Ibid. 

216. Adler et al., “Battlemind Debriefing and Battlemind training as Early Interventions with Soldiers Returning from Iraq: Randomized by Platoon,” Journal of 

Consulting and Clinical Psychology 77, No. 5 (2009): 936. 

217. Ibid. 

218. Paul B. Lester, et al, The Comprehensive Soldier Fitness Program Evaluation. Report 

#3: Longitudinal Analysis of the Impact of Master Resilience Training on SelfReported Resilience and Psychological Health Data, Research Facilitation Team, 

Office of the Deputy Under Secretary of the Army, December 2011; Lester, Paul B. 

Lester, et al, The Comprehensive Soldier and Family Fitness Program Evaluation. 

Report #4: Evaluation of Resilience Training and Mental and Behavioral Health 

Outcomes, Research Facilitation Team, Office of the Deputy Under Secretary of 

the Army, April 2013. 
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219. Dan Sagalyn and Jason Kane, “Army’s Mental Resilience Program: Your Questions Answered,” PBS NewsHour, December 23, 2011; Roy Eidelson, “The Army’s 

Flawed Resilience-Training Study: A Call for Retraction,” Psychology Today, June 

4, 2012; Maria M. Steenkamp, William P. Nash, and Brett T. Litz, “Post-Traumatic 

Stress Disorder: Review of the Comprehensive Soldier Fitness Program,” American 

Journal of Preventive Medicine 44, no. 5 (2013): 507-512. 

220. Eidelson, “The Army’s Flawed Resilience-Training Survey.” 

221. Meredith, et al, 59, 2011. 

222. Roy Eidelson and Stephen Soldz, Does Comprehensive Soldier Fitness Work? CSF 

Research Fails the Test, Working Paper No. 1, Coalition for an Ethical Psychology, 

May 2012. 

223. U.S. Department of the Army, Comprehensive Soldier and Family Fitness. Army 

Regulation 350-53. Washington, DC, 19 June 2014, 6. 

224. U.S. Department of the Army, Comprehensive Soldier, 18. 

225. MARSOC declined to participate in this study. The author’s repeated attempts 

to obtain basic information on the reintegration program were unsuccessful. 

The information here is based on unclassified MARSOC publications. 

226. MARSOC Pub 1, 7-1. 

227. Ibid. 

228. Author interview, 22 June 2016. 

229. MARSOC Pub 1, 7-4. 

230. Author interview, 22 June 2016. 

231. MARSOC Pub 1, 7-12. 

232. Ibid. 

233. Ibid. 

234. Hoge, Once a Warrior, 115. 

235. Wave III, USSOCOM POTFF. 

236. A service provider agreed that this was a relatively accurate way of considering 

service providers and types of services provided. Author interview, 10 November 

2016. 

237. Wave III, USSOCOM POTFF. 

238. Wave III, USSOCOM POTFF. Forty percent or more of the respondents visited 

the following service providers five or more times: unit psychologist, unit psychiatrist, unit social worker, military treatment facility psychologist, military 

treatment facility psychiatrist, military treatment facility social worker, and 

other on-base and off-base counselors. The percentages were slightly lower for 

MFLC (35 percent with five or more visits) and FOCUS (25 percent with five or 

more visits, 50 percent with three or more visits).

239. Wave III, USSOCOM POTFF. 
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Hazen: Post-Deployment Support for SOF

240. Trust is an important factor in seeking out mental health care. If that trust does 

not exist, Service members will not be honest, and are unlikely to seek out services or to continue seeing a provider. Author interviews, 21 June 2016, 22 June 

2016, 13 July 2016, 11 October 2016. 

241. Neff and Caserta, 2016. 

242. Data from the Wave III, Preservation of the Force and Family (POTFF) Needs 

Assessment 2014-2015 and the Naval Health Research Center study of NSW TLD 

support this finding. This was also often mentioned in interviews with service 

providers. Author interviews, 21 June 2016, 22 June 2016, 13 July 2016. 

243. Hickey, “High Suicide Rate.” 

244. Author interviews, 22 June 2016, 13 July 2016. 

245. Of valid responses, 80.8 percent replied “no,” 19.2 percent replied “yes.” Wave 

III, Preservation of the Force and Family (POTFF) Needs Assessment 2014-2015. 

Data provided by USSOCOM POTFF. 

246. Only 77.1 percent provided a reason. 49.7 percent in the “no need/interest” 

category, and 22.9 percent in the “access issues” category. 4.3 percent reported 

“prefer to spend time with family,” and 0.2 percent reported “other.” 

247. Wave III, USSOCOM POTFF. 

248. Ibid. 

249. Although a relatively small difference in terms of what the score means on the 

PCL-5 scale, the difference was statistically significant. 

250. A score between zero and 20 is considered low on the PTS/PCL-5 sum score. 

U.S. Department of Veterans Affairs, “PTSD Checklist for DSM-5 (PCL-5).” 

251. The differences were relatively small, and both groups remained in the low concern 

end of the scales, the differences were statistically significant, suggesting a true 

difference between the groups, and that the group not able to access retreats, but 

that wanted to, may have needed them more than the group that said they were 

not needed. 

252. The attendance rates were even lower for those scoring high on the other four 

scales: Alcohol (21.2 percent), Depression (21.4 percent), Social Isolation (19.4 

percent), Low Resilience (15.9 percent). 

253. Wave III, USSOCOM POTFF. 

254. Ibid. 

255. The scores on pre-deployment retreats for single soldiers fell slightly below 70 

percent. Wave III, Preservation of the Force and Family (POTFF) Needs Assessment 2014-2015. Data provided by USSOCOM POTFF. 

256. NSW POTFF agreed to assist in the distribution of a short electronic survey to 

those who had returned from deployment in 2015 and their significant others. 

The survey was designed in Qualtrix by the author. NSW POTFF sent the survey 

link with a request for participation to four SEAL teams who deployed during 

2015. This included two teams based on the East Coast and two based on the West 
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Coast, with deployments lasting six months. Each SEAL team consists of 225-

250 individuals, resulting in a respondent pool of 900-1000. However, transfers 

to other units and departures from service since deployment would reduce this 

number. Those who were currently in a team, but who had not deployed with that 

team during that time frame, were asked not to respond to the survey. The number 

of eligible active duty NSW respondents was 500-600. POTFF also asked married 

Service members to have their spouses take the survey. An estimated 30% of the 

force is married, which would result in 150-180 significant others being invited 

to take the survey. 160 respondents shared their designation: roughly half were 

AD (79), and half were spouses/significant others (81): SEAL (18, 11.25 percent) 

SWCC (11, 6.88 percent), Enabler (50, 31.25 percent) and Significant Other (81, 

50.63 percent) – of these, only 133 provided answers on most of or all of the 

questions: Significant Other (68), Active Duty (65). The majority of respondents 

(103) was stationed on the East Coast. 

257. Danish and Antonides, “The Challenges of Reintegration,” 552. 

258. Ibid, 550. 

259. Shanker and Oppel, “War’s Elite Tough Guys.” 

260. Wiggins, 79. 

261. Author interview, 22 June 2016; Wiggins, 75. 

262. Suzanne Bailey, “Canadian Forces Health Services Road to Mental Readiness 

Program,” Unpublished working paper, August 2015. 

263. Hoge, Once a Warrior, 8. 

264. Bailey, “Road to Mental Readiness.” 

265. Ibid. 

266. Bailey, “Canadian Forces Health Services Road to Mental Readiness Program.” 

267. Author interviews, 13 July 2016, 11 October 2016. 

268. Ibid. 

269. Author interviews, 21 June 2016, 13 July 2016; Yosick et al., A Review of PostDeployment Reintegration, 64. 

270. George Bonanno and Erica D. Diminich, “Annual Research Review: Positive 

adjustment to adversity--trajectories of minimal-impact resilience and emergent 

resilience,” Journal of Child Psychology and Psychiatry 54, no. 4 (2013): 378-401. 

271. Ibid, 392-393. 

272. Bailey, “Road to Mental Readiness.” 

273. Hoge, Once a Warrior, 90. 

274. Bridget C. Cantrell and Chuck Dean, Once A Warrior: Wired for Life (Seattle, 

WA: WordSmith Books, 2007), 29. 

275. Ibid. 

276. Brandon Young, “Isolation and Relationships after the Military: A Ranger Speaks,” 

The Havok Journal, 20 November 2014. 
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Hazen: Post-Deployment Support for SOF

277. Hoge, Once a Warrior, 100. 

278. William R. Beardslee et al., “Dissemination of Family-Centered Prevention for 

Military and Veteran Families: Adaptations and Adoption within Community 

and Military Systems of Care,” Clinical Child and Family Psychology Review 16, 

4 (2013): 397. 

279. Author interview, 21 June 2016. 

280. Discussion with USSOCOM POTFF, 14 October 2016. 

281. Wiggins, 76; Author interview, 13 July 2016. 

282. Bliese et al., “Timing of Postcombat Mental Health Assessments,” 146. 

283. Wiggins, 77; Author interviews, 22 June 2016, 13 July 2016. 

284. Murphy, “Don’t Kill Yourself Briefs.” 

285. Authors actually use the term reintegration. Yosick et al., A Review of PostDeployment Reintegration, 59. 

286. Bliese et al., “Timing of Postcombat Mental Health Assessments,” 142.