Introduction: Helping Military Personnel and Recent Veterans Manage Stress Reactions

We were pleased when Dr. Rogers asked us if we would be interested in guest-editing a special section of this journal on issues relevant to working with Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) military personnel and veterans. As Veterans Affairs (VA) clinician researchers we face the timeliness of these issues on a daily basis and appreciate the many ways in which the mental health community outside of the VA and the Department of Defense (DoD) can play a role in working with the men and women affected by the current conflicts. We therefore solicited original research, theoretical papers, critical reviews, and case reports from a broad cross section of disciplines. In particular, we sought manuscripts that would provide new ideas or timely reviews directly pertinent to the practice of mental health counseling with those who served in Iraq or Afghanistan. The resulting submissions were reviewed by a group of clinical scholars with expertise in the areas covered. We would like to thank our colleagues from the VA VISN 19 Mental Illness Research Education and Clinical Center and Denver VA Medical Center, Drs. Lawrence Adler, Herbert Nagamoto, Beeta Homaifar, and Jennifer Olson-Madden, and from the Zablocki VA Medical Center in Milwaukee, Dr. Michelle Cornette. We believe the articles selected present a range of ideas and techniques that address the goals of this special section. Application of this information can benefit military personnel, veterans, and their families. The common theme of the three articles selected is deployment-related stress and ways to facilitate coping. Potter and colleagues present data on an in-theater intervention for combat stress control. They also review the types of clinical work being done in the field. Besides informing DoD clinicians about a novel means of service delivery, their article can orient VA and community-based mental health counselors to the types of care their clients may have received in-theater. Corso and colleagues have adapted a range of evidence-based PTSD treatments to use in a primary care setting. Their data suggest that integrating mental health and primary care can be effective and that a behavioral health consultation model can decrease symptoms of PTSD in clients who do not seek traditional mental health services. Finally, from a review of the suicide literature as it relates to members of the military, Martin and colleagues highlight similarities and differences in risk and protective factors for military personnel and veterans compared with the general population. Their material can inform case conceptualization and treatment planning, particularly for counselors new to working with suicidal military personnel and veterans. Readers may be asking why a special section on such topics is necessary. Preliminary evidence suggests that the mental health needs of those who have served or are serving in Iraq and Afghanistan are significant (Lineberry, Bostwick, & Rundell, 2006; Milliken, Auchterlonie, & Hoge, 2007; Seal et al., 2008). As such, increased attention to meeting the needs of these individuals is warranted. Ideally, this will be facilitated via DoD, VA, and community partnerships, and can in part be accomplished by collaboratively pooling resources and sharing information across systems. Based on the clinical literature (Lineberry, Ramaswamy, Bostwick, & Rundell, 2006) we expect that the challenges-both physical and psychological--faced by some individuals will require significant intervention, and that the type of care needed will evolve over time. As individuals return from deployments to Iraq and Afghanistan, clinicians will be seeing clients at differing points in their recovery. Corso et al. (this issue) highlight that many individuals are exhibiting symptoms but do not yet meet the full diagnostic criteria for PTSD. Providing treatments which help these individuals more effectively manage their symptoms may indeed lead to fewer clients developing PTSD. …