New program to help ISR aircrews cope with different kind of PTSD Published Nov. 29, 2016 By Lori A. Bultman 25th Air Force Public Affairs JOINT BASE SAN ANTONIO–LACKLAND, Texas (AFNS) -- The nature of modern-day warfare has shifted the burden to the intelligence and special operations personnel who identify enemy targets that need to be eliminated. The direct support operators (DSO) and tactical systems operators (TSO) of 361st Intelligence, Surveillance and Reconnaissance Group fly as qualified aircrew members and take the weight of that burden, providing direct threat warning and enhanced situational awareness to aircrews. “Our Airmen are on the front lines of the fight against (Islamic State of Iraq and the Levant), literally,” said Col. Matthew Atkins, the 361st ISR Group commander. “We undergo some very unique stressors that combine the aspects of special operations and intelligence.” The DSOs and TSOs of the 361st ISR Group support and fly with members of Air Force Special Operations Command, as well as U.S. Special Operations Command. They watch and listen to an objective for days on end, learning everything about the intended target. Then, when approval is granted for a strike, they watch the results in high-definition, Atkins said. Exposure to risk or trauma can result in post-traumatic stress for ISR Airmen, according to Col. Paul A. Young, the 25th Air Force command surgeon. Fear-based PTSD is something that combat personnel experience, but there is also a moral injury form of PTSD which can affect ISR cryptology personnel, Atkins said. Dealing with, and treating, fear-based PTSD is different than dealing with the type of PTSD that goes against a person’s beliefs and morals. “There has been a significant amount of research on fear-based PTSD,” Atkins said. “There has also been increasing research on the variety of PTSD associated with remotely piloted aircraft and Distributed Common Ground System crews, where the trauma stems from moral injury after participating in acts over time that might be perceived as transgressive. Some ISR cryptologists share characteristics common to both sets of trauma. “Doing this job with today’s technology brings a whole new perspective to the ISR Airmen who invest their time into determining the validity of a target,” Atkins said. “The human in the loop always bears the consequences of making that life or death decision.” Finding targets by watching and listening is, by nature, intensely personal and can have a long-lasting effect on the ISR Airmen involved, Akins said. To help combat PTSD among the Airmen under his care, he has taken the lead on an initiative to help “Silent Warriors,” both before and after deployment to the field. “Our initial research on this topic led us to believe that modalities of treatment exist that can serve as both rehabilitative and preventative measures for our Airmen,” Atkins said. “We have labeled our goal as a ‘Re-Fit’ program and are seeking help to develop and resource a program that will overcome existing mental health disorders and prevent future problems.” The treatments received through Re-Fit will augment the existing care the DSOs and TSOs currently receive in the form of mental health counseling, therapy from providers under the Preservation of the Force and Family Program, and guidance from military chaplains, Atkins said. Chaplains can assist Airmen who are having difficulties, but sometimes clinical therapies may be needed. “Chaplains are honored to provide spiritual care for 25th Air Force ISR warriors and their families,” said Chaplain (Col.) Bruce Glover, the 25th AF senior chaplain. “When helping Airmen deal with moral or spiritual injuries of war, we are privileged to be compassionate caregivers as Airmen wrestle with complicated issues involving adjustment, grief, relationships, forgiveness or even shame. We are also committed to work with other professionals providing medical and psychological care for Airmen.” In addition to chaplains, Airmen of the 361st ISR Group and their families have access to the SOCOM Preservation of the Force and Family Program. This group builds and implements a holistic approach to address the pressure military members and their families experience. The 361st ISR Group is taking a proactive approach to mentally preparing warriors for the fight in an effort to reduce the psychological effects of modern-day warfare, said Malloree Smith, an embedded psychologist with the Preservation of the Force and Family Program. An initiative such as Re-Fit is an example of leaders getting it right, Smith said. “The focus has shifted from repair to prevent, with a full understanding of the psychological impact produced by the unique position the 361st ISR Airmen are faced with,” Smith said. “This (Re-Fit) is a layered program in that it supports mental strength across the life cycle of the operator.” There are several steps used through Re-Fit to strengthening ISR warfighters. First, the focus is on prevention through building mental toughness, optimizing human performance and increasing introspective awareness and decreasing stigma, Smith said. Second, participants begin building on their strengths with regular maintenance to increase the resiliency innate to the individual and supporting growth areas. Lastly, there is a holistic approach to treatment of clinical and sub-clinical concerns, Smith said. Smith said she hopes Re-Fit will help Airmen cope with their reactions to experiences. “Our Airmen are resilient. They are put in situations that are not typical human experiences. It is expected they will have a response to those situations. A response is normal, but does not need to be persistent,” she said, adding that the key to success is having access to varying support options when reacting to an extreme experience. Atkins said the Airmen of the 361st ISR Group are an extraordinary group and many have experienced more combat hours in less time than Airmen in other specialties. "We have 22-year-old senior airmen who have more than 1,200 combat hours ... that is a lot of stress on a young person,” Atkins said. “They've got their whole career and, more importantly, their whole life still ahead of them. We need to take care of them.” At the end of the day, when these Airmen require assistance coping with the stresses they experience, that help might require multiple avenues and unique methods. Atkins said he knows Re-Fit is the right thing to do to maintain his warrior’s mental health and well-being. “Our airborne operators place themselves in harm’s way all across the globe on a daily basis, and are accumulating a variety of stresses and trauma that span the spectrum of PTSD,” Atkins said. “We are convinced that a rigorous and well-tailored Re-Fit program will assist us in preventing more trauma and will get more Airmen back into the fight.” The 361st ISR Group, part of the 363rd ISR Wing, provides direct support to AFSOC and SOCOM and strengthens analytical and targeting support to the rest of the Air Force.