Deliver Psychological First Aid with the Help of New Mobile App

By DCoE Strategic Communications

The new mobile app “Psychological First Aid” or “PFA Mobile,” supports providers and other response workers who provide psychological care to adults, families and children affected by natural or man-made disasters and emergencies. Developed through a collaborative effort among the Department of Veterans Affairs National Center for PTSD, National Child Traumatic Stress Network and National Center for Telehealth and Technology (T2), the app was designed to meet the challenges faced by first responders by making information and resources associated with response efforts readily accessible to them.

Materials in this application are adapted from the Psychological First Aid Field Operations Guide (2nd Edition), which has been used for successful disaster response around the world for the past six years.

Features of the app include:

■Summaries of psychological first aid fundamentals

■Intervention strategies for specific concerns and needs of survivors

■Mentor tips for applying psychological first aid in the field

■A self-assessment tool

■Easy forms for collecting data and making referrals

“PFA Mobile,” is free and currently only available for Apple users (iPhone, iPad and iPod touch). It will be available for Android devices in 2013. To learn more, read this article written by Dr. Julie Kinn, a clinical and research psychologist with T2 who leads the center’s mobile health application development.

T2 is a Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury center and serves as the primary Department of Defense office for cutting-edge approaches in applying technology to psychological health. Information about other mobile apps available for health professionals and the military community is at t2health.org.

Psychological First Aid? There’s An App For That

Written by Dr. Julie Kinn

I’m not alone in saying my heart goes out to those impacted by Hurricane Isaac. As a clinical psychologist, I have treated many children and adults who carry trauma symptoms long after danger has passed from natural or man-made disasters. We health care providers are keenly aware that disasters happen many times a year, and that those treating the survivors rarely have a surplus of resources.

To help support providers on the frontlines of care in emergencies, the VA’s National Center for PTSD and the DoD’s National Center for Telehealth & Technology (T2) have released PFA Mobile . This free mobile application assists providers in putting Psychological First Aid (PFA) into practice in the field. The app includes a brief refresher on the main components of PFA, assists with mentorship of other providers, and allows providers to self-assess and develop insight into readiness to provide PFA.

Some primary features that make the app so appropriate for disaster situations include:

 ■Easy forms for collecting data in difficult circumstances

 ■Intervention strategies tailored to unique conditions

 ■No requirement for internet or phone connectivity to run

PFA Mobile is currently available for iOS (Apple) devices and will deploy for Android devices in 2013. If you are a first responder or frontline care provider, I suggest you take it for a test drive and become familiar with this excellent resource.

Dr. Julie Kinn is a clinical and research psychologist. She leads mobile health application development for the DoD’s National Center for Telehealth & Technology (T2).

PE COACH Mobile App Supports Prolonged Exposure Therapy

By Robyn Mincher

DCOE Strategic Communications

The Departments of Defense and Veterans Affairs (DoD/VA) have released “PE Coach,” a smartphone mobile application for use with posttraumatic stress disorder (PTSD) treatment.

PE Coach is a form of “prolonged exposure” therapy available to all past and present service members — including the more than 10,000 Wisconsin Soldiers and Airmen who have deployed since 9/11 — as a way to help diagnos and treat symptoms of PTSD.

“As technology grows – our ability to find new ways to get information out to our service members and their families needs to grow as well. This new technology is another great tool for our service members and their families to use while transitioning back into their normal routines following a mobilization.” said Vicki Cushman Edgren, director of the Wisconsin National Guard Badger Yellow Ribbon program.

“In addition to our three phases of reintegration, PE Coach can be a valuable tool for our Soldiers and Airmen to use when returning from deployment and beyond. It especially speaks to the younger generation who already utilize phone apps in many other areas of their lives,” she continued.

Both the DoD and DVA use prolonged exposure (PE) therapy as an effective treatment for PTSD.

Psychologists at the Defense Department’s National Center for Telehealth and Technology, known as T2, and VA National Center for PTSD, developed the mobile app to specifically help patients with their therapy.

“‘PE Coach’ is a helpful tool that assists our service members and veterans who are between visits and in treatment for posttraumatic stress disorder,” said Dr. Jonathon Woodson, assistant secretary of defense for health affairs. “We have shared this app with our military health care providers as well, and hope that many individuals who are receiving PE therapy will find it useful.”

Prolonged exposure therapy helps a patient process a trauma memory to reduce the distress and avoidance caused by the trauma. The patient revisits the memory with a therapist and as the memory is emotionally processed, anxiety decreases. The therapy also helps the patient confront avoided situations that trigger memories of the trauma.

“We worked with a broad and diverse group of psychologists in the DoD and VA who are treating PTSD patients with prolonged exposure therapy,” said Dr. Greg Reger, clinical psychologist with the T2 Innovative Technology Applications division. “We wanted to help our patients in the therapy and make it easier for providers to deliver this treatment. PE Coach does both.”

Many psychologists who provide prolonged exposure therapy acknowledge it could be more effective if patients could better adhere to their assignments between sessions.

The patient installs “PE Coach” on their smartphone and can record the therapy session for playback between sessions. The app also provides an explanation of exposure therapy, assignments, explanations of PTSD and its symptoms, and a convenient way to write notes about typically avoided locations, situations and events for later discussions with their therapist.

Reger said that writing in a notebook in public places may make people feel uncomfortable. However, tapping a note on a smartphone is much easier and a more personal way to capture those in-the-moment feelings.

“PE Coach” will help users successfully adhere to PE treatment, which could improve the quality of treatment. Reger said it was not designed to be used as a self-help tool and should not replace professional counseling.

The Defense Department and VA released a similar mobile app last year; “PTSD Coach” is a reference tool for education, tracking symptoms, self-assessments and connections to support individuals with PTSD.

“PE Coach” is available for Apple and Android mobile devices. Find more information about the app at t2health.org/apps/pe-coach.

The National Center for Telehealth and Technology, located at Joint Base Lewis-McChord, Wash., serves as the primary Department of Defense office for cutting-edge approaches in applying technology to psychological health. More information about T2 is at t2health.org.

T2, a Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury center, designs, tests and evaluates available and emerging technologies in support of psychological health and traumatic brain injury recovery for service members, veterans and their families. To learn more, read “About T2.”

Social Media and Suicide Prevention

What would you do if a Facebook friend updated that they were depressed and thinking of ending their life?

What would you do if you observed a group of individuals bullying another person on a social media site? Would your actions be the same if the person was a friend or a complete stranger?

Your answers to these questions may have important implications for how these scenarios turn out. Fortunately, there are resources in social media to help you reduce the risk for suicidal behavior and to get help.

Suicide is a serious but preventable public health problem.  According to the World Health Organization , more than one million suicides occur in the world every year.

Social media, such as chat rooms, blogs, video sites like YouTube, and social networking sites such as Facebook, Twitter, and Google+, have become important ways that many people communicate and share information about a variety of topics, including suicide.

Two colleagues and I recently discussed the role of social media in suicidal behavior in an article published in the American Journal of Public Health  called “Social Media and Suicide: A Public Health Perspective.” In the article, we examined the evidence for how social media can have both negative as well as preventative influences on suicidal behavior.

There are several ways social media is used that can negatively influence suicidal behavior, some examples are:

 ■Pro-suicide forums offering “how-to” information or encouraging suicide pacts.

 ■Cyberbullying and cyber-harassment directed through social networking sites

 ■The “media contagion effect” where reports of things like a celebrity suicide influence suicidal behavior.

It is important to be aware of how your friends and family may interact with or be exposed to these types of social media. Your understanding of these risks and your knowledge of where to go for help may prevent a suicide.

Social media can also be used to increase awareness and provide information on suicide prevention programs, crisis help lines, and other educational resources. Check out the Facebook and Twitter accounts of the Substance Abuse and Mental Health Services Administration (SAMHSA)  or the National Suicide Prevention Lifeline  to find information and share personal stories about suicide prevention and coping. You might also want to watch the suicide survivor stories on the National Suicide Prevention Lifeline’s www.lifeline-gallery.org  website.

There are hundreds of support and prevention groups on Twitter, as well video-based public service announcements geared toward suicide prevention on popular social media sites such as YouTube. Several social networking sites such as Facebook, and Bebo even provide a “panic button” feature to report cyberbullying.

Facebook also works with the Samaritans charity to provide a suicide-alert reporting system for Facebook users to report individuals they believe are expressing suicidal thoughts or intent.

The Department of Defense  is also using social media to address the problem of suicide. For example, the Afterdeployment.org  Facebook and Twitter accounts provide education and prevention information tailored for the military community. Other suicide prevention sites for the military and veteran community include suicideoutreach.org , Realwarriors.net , and the Wingman Project .

There are ways that social media can influence suicide behavior, both positively and negatively. I hope that by reading this blog you have become more aware of the issue and have learned what to look out for as well as what options there are for finding support, learning more, and helping others.

If you or someone you know is in an emotional distress or suicidal crisis, please seek help immediately. If an emergency, contact 911.

Some available resources:

National Suicide Prevention Lifeline  is there to help 24/7, or give them a call at 1-800-273-TALK (8255) or check out their Facebook page.

Want to talk in 140 characters or less?  Check out their Twitter feed.

Suicide.org has an international listing of hotline numbers that could help you or someone you know.

The Substance Abuse and Mental Health Services Administration (SAMHSA)  has some great resources available; Take a look at the AfterDeployment.org  website.

Dr. David Luxton is a Research Psychologist and Program Manager at the National Center for Telehealth and Technology (T2).

DCoE February Webinar – Treating Sleep Problems in PTSD and TBI

The Defense Centers of Excellence (DCoE) presents:

Title: DCoE February Webinar – Treating Sleep Problems in PTSD and TBI

Date: Feb. 23, 2012, 1-2:30 p.m. (EST)

Purpose: The DCoE February webinar will focus on evidence-based and empirically-supported treatments for sleep problems (e.g., trouble getting to sleep, trouble staying asleep, nightmares and excessive daytime sleepiness) that are common in patients with post-traumatic stress disorder (PTSD) and/or traumatic brain injury (TBI). Both behavioral and pharmacological treatments will be presented, with a special emphasis on prazosin. Prazosin is a medication that has been found to be effective in reducing combat-related nightmares.

Presenters: 

 ■Anthony Panettiere, MD

 National Intrepid Center of Excellence

■Murray Raskind, MD

 VA Puget Sound Health Care System

Continuing education units (CEUs) and continuing medical education (CMEs) credits from Saint Louis University will be available for this webinar. Pre-registration is required to receive CEUs/CMEs.

Now available through Adobe Connect and Defense Connect Online

In an effort to support all guests whose network security settings may limit access to various internet sites, we are simultaneously hosting this webinar via two technical platforms. The primary site is via Adobe Connect and Defense Connect Online is the optional site. You need only to sign on to either one of the sites to fully participate in the webinar.

To register, please visit: http://es.adobeconnect.com/dcoewebinar/event/registration.html. Please note, if you would like to obtain CEUs/CMEs, you must register. Some network security settings (e.g., Department of Veterans Affairs) limit access to the registration page. If this occurs, please access the registration page from a different network.

View the webinar

The webinar will be simultaneously hosted on two technical platforms. The primary site is via Adobe Connect and Defense Connect Online is the optional site. You need only to sign on to either one of the sites to fully participate in the webinar. Visithttp://www.dcoe.health.mil/Training/MonthlyWebinars.aspx for instructions on how to access the webinar room and dial-in information for the audio portion of the webinar. Audio will not be provided via Adobe Connect or DCO.

If you have any questions, please email DCoE.MonthlyWebinar@tma.osd.mil

Annual Trauma Spectrum Conference Day One: TBI, Technology, Sleep Discussed

By Robyn Mincher and Emily Deck, DCoE Strategic Communications

Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) hosted the fourth annual Trauma Spectrum Conference at the National Institutes of Health (NIH) in Bethesda, Md., Dec. 8-9. The conference brought together top minds from DCoE, NIH, Department of Veterans Affairs (VA), health care providers and military health care advocates to discuss a key issue: how to bridge the gap between clinical research and military systems of care for psychological health and traumatic brain injury (TBI).

“This is an important conference because we have a lot of creative people out in the world doing excellent work,” said Navy Capt. Paul S. Hammer, DCoE director, who gave opening remarks. He stressed the need to provide greater care to wounded warriors by translating information from the research world into clinical reality, and reminded the audience of the importance of keeping the patient at the center of what they do every day.

After encouraging the audience to introduce themselves to neighboring attendees, Hammer remarked that one of the first steps in bridging this gap was to reach out “and get to know people from other agencies.”

Keynote speaker Dr. Ramon Diaz-Arrastia, Center for Neuroscience and Regenerative Medicine, Uniformed Services University for the Health Sciences, outlined the modern epidemiology of TBI and gave an overview of TBI in the military and modern battlefield. He discussed diffusion-tensor imaging, an advanced technique that scans white matter in the brain. The technique is valuable because it can help clinicians diagnose a TBI months after the trauma.

Technology to improve diagnosis and treatment became a focal point of the conference, as new imaging techniques and technology from National Center of Telehealth and Technology (T2) were presented.

Dr. Greg Gahm, T2 director, took the audience on a virtual tour of the center’s mobile applications, websites, telehealth units and the future of its efforts to help service members manage care.

He praised suicideoutreach.org and afterdeployment.org as key resources for improving military psychological health care and noted the success of the popular Mood Tracker mobile application. He also discussed the use of virtual worlds for treatment, including demonstrating the T2 Virtual PTSD Experience, which provides information about PTSD causes, symptoms and resources for care.

“We at T2 believe the best way to predict the future is to create it, and we will continue to do that,” Gahm said.

Dr. Anthony Panettiere, a neurology and sleep physician at National Intrepid Center of Excellence, talked about sleep concerns. The center treats service members with post-combat sleep disorders in its sleep lab.

“Most troops do not look forward to going to bed,” he said as he discussed ways the center treats a service member with wartime experiences that turn into nightmares.

“We have a patient take a dream or nightmare they’re having, write it down and then [encourage them to] change the beginning or the end to something less emotional,” said Panettiere.

Afternoon workshops provided attendees with opportunities to gain more information and resources and ask questions about psychological health topics such as co-occurring disorders, cognitive rehabilitation, substance use disorders, among other subjects.

Day one of the conference ended with encouragement for attendees to embrace what they learned to help improve the system of military health care.

“We can rapidly translate what we’re learning from our investment into clinical practice,” said Dr. Alison Cernich, VA Maryland Health Care System and VA senior liaison for TBI with DCoE. “Above all, the service member and veteran is our focus. For all of us, the responsibility, and the charge, is clear.”

A first-time poster session was held later that afternoon where 26 researchers highlighted current and emerging findings and best practices focused on bridging the gap between research and clinical practice of psychological health and TBI. Award recognition went to Susanne W. Gibbons, Ph.D., assistant professor, Graduate School of Nursing, Uniformed Services University of the Health Sciences, for her poster about “Gender Differences in Response to Deployment Among Military Healthcare Providers in Afghanistan and Iraq.”

Frontline Psych with Doc Bender: Use Technology to Your Benefit

By Dr. James Bender, DCoE psychologist

Dr. James Bender is a former Army psychologist who deployed to Iraq as the brigade psychologist for the 1st Cavalry Division’s 4th Brigade Combat Team out of Fort Hood, Texas. During his deployment, he traveled through Southern Iraq, from Basra to Baghdad. He writes a monthly post for the DCoE Blog on psychological health concerns related to deployment and being in the military.

Technology has dramatically changed our world during the past 20 years, including how we approach psychological health care, and mostly for the better. Twenty years ago, if you wanted to find out about post-traumatic stress disorder (PTSD), you could either make an appointment with a psychologist or spend countless hours at a library reading books and professional journals. Now, great information is just a click away.

If you have a smartphone for example, you can instantly download free mobile applications such as the PTSD Coach, and learn about PTSD and ways to help you manage its symptoms. There are apps to track your mood during a period of time and give you and your provider information to help diagnose a possible mood or anxiety disorder. Treatment guidelines to help providers manage patients with mild traumatic brain injury (TBI) are even available on a smartphone. There are lots of good online assessment tools, and although they don’t give a clinical diagnosis of a disorder, they can get you thinking about your well-being and help start a conversation with a mental health care provider if needed.

When I was seeing patients, it impressed me when someone came to my office with a printout from a website describing a particular problem or topic. It showed me that they cared enough to seek out information and were proactive in their care.

But here are a few points to keep in mind when you’re educating yourself on psychological health concerns:

 ■Make sure to get your info from credible sources: DCoE, American Psychological Association, afterdeployment.org and Department of Veterans Affairs are great sources for info on TBI, PTSD, depression and other military-related mental health concerns

■While many sources are good, a few are poor. Be wary of sites that try to sell you something, make outlandish claims or offer quick results. Treatment for mental health conditions works, but it takes time and effort
■While these resources can educate you and give you things to talk about with your provider, they should not serve as a substitute for professional help

Another example of how technology is improving the way people can access information is being able to connect with someone instantly and at any time. The DCoE Outreach Center is available through online chat and whether you’re a service member, veteran, family member or provider, you can speak to a health resource consultant who can provide guidance and resources 24/7.

I often participate in webinars. I can sit at home and virtually attend a TBI symposium across the country given by great researchers. This makes me a better psychologist and allows me to do my job better. If you find a topic that interests you, why not take advantage of all this technology to learn more about it?

After all, it is clear that technology is here to stay, and I encourage you to embrace it as a tool that can help you improve your psychological health. Thanks for reading and for your service.