'Defender's Edge': A new approach to combat stress Published Aug. 26, 2009 By Senior Airman Andria J. Allmond 332nd Air Expeditionary Wing JOINT BASE BALAD, Iraq (AFNS) -- A new customized mental health program is helping security forces Airmen here manage combat stress. The "Defenders Edge" is tailored to those security forces Airmen who conduct missions on or outside the wire. This program is intended to improve Airmen's mental resiliency to combat-related stressors. Senior Airman Brian Hafner, a member of the 532nd Expeditionary Security Forces Squadron's quick reaction force and former Marine Corps infantryman, was diagnosed with post-traumatic stress disorder earlier this year. After a few months of traditional mental health care proved unsuccessful, he found relief in "Defender's Edge". 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." Airmen Hafner enlisted in the Air Force in 2006. Upon being informed he would be deploying to Iraq six months ago, this time as an Airman, he decided to seek treatment from traditional military mental health providers. "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 continued experiencing psychological distress. Then, shortly after arriving, Airman Hafner's unit was rounded up for a briefing. In walked DEFED founder Capt. Craig Bryan, the traumatic brain injury clinic director for the 332nd Expeditionary Aerospace Medicine Squadron here. "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,'" Airman Hafner said. "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 noticed a need for changes in standard mental health services prior to his deployment here, especially 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 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. As a result, Captain Bryan started DEFED which differs from the Air Force's traditional methods of treating combat stress. "People, especially cops, don't want to go to mental health," Captain Bryan said. "They don't want to think they're broken or damaged. There is a negative stigma associated with reaching out for psychological help. Some think that if they are seen going to mental health they are weak or are somehow letting down their comrades, will have their weapon taken away from them or be sent home. Captain Bryan visited the QRF compound multiple times a week and participated in some of their training exercises. "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, DEFED brings the mental health professional into the group environment, assimilating them into the security forces culture. "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." Captain Bryan said it is important for the mental health provider to gain the trust of the participants by being accepted as 'one of them.' This participation in the group's daily life also dictated the terminology he chose. "I wanted to learn to speak their language, not have them speak mine," said the captain, whose stateside job is chief of primary care psychology at Lackland Air Force Base, Texas. 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 breathing techniques for weapon firing to breathing exercises for stress relief. The five core educational modules are: "fatigue countermeasure," which includes sleep enhancement and alertness strategies; "adrenaline management," based on stress management and relaxation; "mission focus," dealing with goal-setting and distress tolerance; "mind tactics" encompasses hardiness and resilience; and "killing," to include trauma prevention. Captain Bryan and Airman Hafner both said the program's unique format is one reason why it's been successful so far. "It's not a mass briefing in a big, dark room," Airman Hafner said. "The worst thing that could happen to the program is to make it a 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 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."