DEFENDER'S EDGE: A New Approach to Combat Stress

Posted 11/6/2009 Updated 11/10/2009



by Senior Airman Andria J. Allmond
332nd Air Expeditionary Wing Public Affairs

11/6/2009 - Airman Magazine November/December 2009 -- Senior Airman Brian Hafner, a 532nd Expeditionary Security Forces Squadron force protection patrolman and former Marine Corps infantryman, was diagnosed with post-traumatic stress disorder after his first deployment to Iraq as a Marine. Airman Hafner knows exactly which event affected him the most.

"I lost a lot of friends that day," said Airman Hafner. "We were told it was supposed to be peaceful there. And then, some friends of mine in the unit right in front . . . they went across the first bridge in Nasiriyah. That was ambush alley."

Symptoms of PTSD include recurrent and distressing nightmares or recollections, extreme physical reactivity, hypervigilance and an exaggerated startle response.

"I knew I was at home and safe," said Airman Hafner, an advanced designated marksman. "Yet, for some reason, I was crawling on the carpet looking for my gun thinking, 'Where could it be?' How could I fall asleep? Is everybody okay?' I didn't know where I was and started feeling panicked. But at the same time, I knew I was in my house."

Airman Hafner finished his tour in the Marines and enlisted in the Air Force in 2006. He kept working and kept going through the motions until he was told that he was going back to Iraq. That's when he decided to seek military PTSD treatment.

"I wanted to make sure that if I was coming back to Iraq, I would be able to do my job," he said. "So, I went and saw (a military mental health provider). They listened, but it didn't seem like they had a whole lot of experience. I couldn't open up when the person I was talking to seemed not to know what I was talking about."

When he returned to Iraq, he was still experiencing psychological distress. Then, one day shortly after arriving, Airman Hafner's unit was rounded up for a briefing. In walked Defender's Edge founder Capt. Craig Bryan, the traumatic brain injury clinic director for the 332nd Expeditionary Aerospace Medicine Squadron at Joint Base Balad.

"I see this skinny Air Force captain roll up, and my first impression was, 'This guy doesn't know what he's talking about. I don't even know why I'm here. At least he brought pizza,'" said Airman Hafner. "But, as he was going through the module, I thought he really seemed like he had a lot of experience dealing with people who had my problems. I approached him afterward and asked if I could meet with him on occasion to help me."

Capt. Bryan began Defender's Edge because he saw a need for change in the standard mental health services. He felt this was especially true for those with combatant duties.

"Stigma toward mental health services is a significant barrier to military members receiving needed treatment," he said. "Servicemembers may also fear negative perceptions from their comrades and leaders, as well as a potentially negative impact on their career if they seek psychological services."

The captain attributes this stigma to a clash between traditional mental health services and the warrior ethos - a vital element of the Air Force Security Forces career field.

"People, especially cops, don't want to go to mental health," said Captain Bryan, who visited the 532nd ESFS quick reaction force compound several times a week and participated in some of their training exercises. "They don't want to think they're broken or damaged. There is a stigma associated with reaching out for psychological help. Some think that if they are seen going to mental health they are weak or somehow letting down their comrades, will have their weapon taken away from them or be sent home."

So, Captain Bryan started Defender's Edge as a customized mental health program for security forces Airmen who conduct missions on or outside the wire. It differs from the Air Force's traditional methods of treating combat stress by taking the counselor to the Airmen and talking to them in language they already understand.

"I want them to know that I am trying to make them bigger, faster and stronger by giving them the skills to make them more resilient," he said. "This way, if they are weakened, it will be less than if they didn't have these skills to fall back on."

Unlike conventional techniques, which adopt a one-on-one approach focusing on emotional vulnerability, Defender's Edge brings the mental health professionals into the group environment, assimilating them into the security forces culture.

"The combatant ethos adopts a collectivist identity and mental health providers are often seen as outsiders," Captain Bryan said. "They are therefore viewed with suspicion since, according to the warrior culture, trusting an outsider with one's safety can put the whole group at risk."

In order to develop shared experiences with program participants, Captain Bryan underwent several training exercises with the group. In one exercise, he was blindfolded, disoriented and then submerged during vehicle rollover training. In another exercise, he worked in some trigger time with the deployed defenders at the firing range.

"That's the beauty of this program," said Capt. Laura Dart, 532nd Expeditionary Security Forces Group medical officer, who is embedded with the quick response force Airmen and lives on the compound. "They see Captain Bryan as a member of the squadron, not a mental health worker. He's always here. So, due to their ability to come to him on their turf, a much more comfortable situation, they have accepted him very well. They trust him and feel very comfortable approaching him with issues, and that has been the biggest help with this program. They appreciate the information he gives them. It's all really helpful and specifically designed for what they do."

The direct participation in the group's daily life also dictated the terminology Captain Bryan chose.

"Traditional mental health approaches are typically delivered in the clinical vernacular of mental health," said the captain, whose stateside job is chief of primary care psychology at Lackland Air Force Base, Texas. "Essentially, this requires the audience to learn a new language. I wanted to learn to speak their language, not have them speak mine."

The program components also rely on using skills the participants have already learned and adopted through their military training. One of the sessions, for example, applies weapon-firing breathing techniques to exercises for stress relief.

Keeping the training focused on job-related skill sets allows the program to emphasize that each security forces member is a human weapons system, which requires routine maintenance for optimal performance.

The mental health specialist teaches specific skills to security forces teams in 30-minute modules; then, the Airmen go outside the classroom and practice the techniques on their own during battle drills and actual missions.

The five core educational modules are: "fatigue countermeasure," which includes sleep enhancement and alertness strategies; "adrenaline management," based on stress abatement and relaxation; "mission focus," dealing with goal-setting and distress tolerance; "mind tactics," encompassing hardiness and resilience; and "killing," which includes trauma prevention.

So far, the results of Defender's Edge are encouraging.

"I would consider this program a triumph," said Captain Dart, adding that 20 percent of the Airmen who were exposed to Defender's Edge have gone on to seek some sort of counseling or treatment for themselves.

Captain Bryan and Airman Hafner both cited the program's unique format as the one reason why it's been successful.

"It's not a mass briefing in a big, dark room," said Airman Hafner. "The worst thing that could happen to the program is to make it dull, computer-based training. Part of the reason it was so good was because of the way Captain Bryan presented it. We felt like he was our (own unit's) captain. This specific program shows people that their military service is really trying to help them."

In the meantime, Airman Hafner's life is starting to get back to normal.
"I've spent my time while deployed here trying to get myself in better shape, to go home to my family at my best," he said. "I gotta do that mentally too, so I can spend more time talking to my wife and daughter and giving them all the attention they deserve."