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TBI Pocket Guide from DCoE

HPRC Fitness Arena: Mind Tactics, Total Force Fitness
Traumatic brain injury can be a serious invisible injury. The DCoE provides helpful information about symptoms and treatment.

You’ve probably heard of TBI—the acronym for traumatic brain injury. The Defense Centers of Excellence defines a traumatic brain injury as “a blow or jolt to the head that disrupts the normal function of the brain.” TBI can be mild, moderate, or severe, with 80-90% being mild. The symptoms, treatments, and recovery time are different for mild versus moderate-to-severe TBIs.

Common symptoms associated with TBI are:

Physical: headache, sleep disturbances, dizziness, balance problems, nausea/vomiting, fatigue, visual disturbances, sensitivity to light, ringing in the ears

Cognitive: slowed thinking, poor concentration, memory problems, difficulty finding words

Emotional: anxiety, depression, irritability, mood swings

For more information, including strategies and suggestions for rehabilitation, check out DCoE’s Mild Traumatic Brain Injury Pocket Guide for Warfighters. TBI is a serious physical as well as mental injury, so it is important to consult a health professional before attempting any kind of treatment.

It’s never too late to quit

Are you a smoker, but you’re trying to quit? Have you smoked for so long that you don’t see the point in quitting? Well new research has found that it’s never too late to kick an old habit.

Tobacco use, especially in the military, is still an important health issue in this country. While the negative effects of tobacco use have been well documented, what you may not know is that there’s also a lot research about what happens when you quit smoking—and the news is good, especially if living longer is something you care about. Scientists have compiled information from these studies and have found that it’s never too late to quit, even if you have been a lifetime smoker. The military is committed to keeping its past and present service members ready and resilient. Check out HPRC’s article “Tobacco in the military: Be a quitter!” Live longer and better. Consider quitting, starting today!

Buyer beware! “Brain games” questioned

HPRC Fitness Arena: Mind Tactics, Total Force Fitness
Many commercial “brain exercise” products claim to improve overall cognitive performance, but a large study shows this may not be the case.

A recent American Psychological Association press release focused on the overall effectiveness of brain training programs as explored in a review of research that appeared in the Journal of Developmental Psychology. It turns out that not only are these exercises ineffective for treating cognitive disorders such as ADHD, but their effectiveness on improving brain function and intelligence in healthy adults and children is minimal. In fact, the effects weren’t comprehensive and didn’t last long.

If you’re looking to increase cognitive performance, mindfulness training such as meditation may be a good bet. Although mindfulness meditation is a relatively young field of study, so far studies indicate that regular practice has a positive effect on memory, attention, and mood regulation.

Namaste: Using yoga to manage PTSD and TBI symptoms

Wounded warriors are using yoga as a way to manage stress and other symptoms involved with PTSD and TBI.

Yoga’s popularity is growing in the United States, but many Americans are still not familiar with the details of this ancient practice. Yoga roots are holistic in nature—body and mind are of equal importance, and the asanas, or poses, which define yoga for many of us, are only one aspect of practice. Together with meditation and breath control, yoga promotes strength, flexibility, and awareness of body and mind. Yoga can help achieve wellness through meditation, deep relaxation, stretching, and breathing. Several organizations are now beginning to provide yoga classes tailored to veterans and active-duty service members who suffer from combat stress. VA facilities, Warrior Transition Units, and civilian studios are using it to complement traditional treatment of patients with post-traumatic stress disorder and traumatic brain injury.

Individuals who struggle with PTSD describe it as a feeling of disconnectedness from themselves and others. Yoga, which means “bringing together parts as a whole,” helps people feel connected again. One traditional type of yoga that has been shown to decrease anxiety in the military population is sensory-enhanced hatha yoga, which involves breathing, meditation, and certain poses. A specific benefit reported by participants in sensory-enhanced yoga was a decrease in insomnia. Combat-stressed adults also experienced reduced hyperarousal symptoms such as anxiety, depression, and rage. Integrative Restoration (iRest) is a yoga-based meditative practice that teaches a person to focus on breathing when a negative memory arises. Soldiers and marines have expressed satisfaction in these breathing techniques because of the method’s simplicity and ease. It allows a person to regain control over his/her thoughts whenever symptoms of PTSD present themselves. A study found that iRest decreases rage, anxiety, and emotional reactivity all of which encourage negative thoughts and memories. Those practicing iRest also reported increased feelings of relaxation, peace, self-awareness, and self-efficacy. Walter Reed Army Medical Center (WRAMC) was one of the first military facilities to research the outcomes of yoga for veterans and active-duty warriors suffering from PTSD. WRAMC immediately added iRest to its weekly treatment programs for soldiers suffering from PTSD and TBI after observing its effects: increased calm and peaceful feelings, less severe reactions to situations, and increased outlook on life.

There are many more yoga practices than the ones mentioned here, and each yoga method is different, so you can find the right one for you!

Break down your problems, not yourself

HPRC Fitness Arena: Mind Tactics, Total Force Fitness
When problems seem larger than life, try breaking them down in sections to tackle one at a time.

Dealing with the stress of deployment and re-adjusting to home life post-deployment can be tough. It’s important to focus on managing your stress, finding ways to cope, and building your resilience. According to Real Warriors, you can get “behaviorally fit” by managing stress and reaching out to others. Among several tips offered is how to deal with problems as they come—head on. Don’t avoid discussing tough issues or finding ways to deal with them. For problems that seem too big, try breaking them down into smaller, manageable steps. For issues that you still find yourself struggling with even after breaking them down, the best bet is to get help from a professional, friend, or supportive family member.

The domains of total fitness

HPRC Fitness Arena: Total Force Fitness
What’s a domain, and what does it have to do with fitness?

Even wonder why HPRC refers to the sections of its website as “domains”? They came from an initiative within the Department of Defense that’s outlined in a special issue of Military Medicine titled “Total Force Fitness for the 20th Century: A New Paradigm.” Experts identified eight “domains” of fitness that contribute to the optimal, overall fitness and preparedness of U.S. military forces. With some reorganization (and one exception – medical), these domains are represented on HPRC’s website—Physical Fitness, Environment, Nutrition, Dietary Supplements (originally part of nutrition), Mind Tactics (psychological, behavioral, and spiritual fitness), and Family and Relationships (family and social fitness)—along with a section on Total Force Fitness that addresses how these domains come together to create Human Performance Optimization (HPO) for our military service members.

Buddy up to help maximize performance

Get the most out of your workouts and maximize your performance by using the buddy system.

Working out by yourself is fine if you’re self-motivated, but getting a buddy to tag along can provide the motivation needed to really ramp up your workout. Let’s face it—a bit of friendly competition can help you push harder than if you were alone. In fact, research has consistently shown that performance is substantially improved when you exercise with someone (even a virtual partner)—unless the workout is complex or involves tasks that require coordination, when the performance can degrade (i.e., "choking under pressure"). So, for best results, practice your difficult routines with a trainer, and then engage in healthy competition to optimize your performance. Keep in mind that not just any friend will do. It’s best to get a buddy whose skill level is similar to your own.

Science article asks: Are we winning the war against PTSD?

HPRC Fitness Arena: Mind Tactics, Total Force Fitness
A review on how the military is preventing and addressing PTSD in troops suggests that programs are helping keep rates low.

Post-Traumatic Stress Disorder (PTSD) has been one of the military’s top priorities in the past few years, especially after reports of projected rates as high as 30% in veterans. However, a May 2012 Science article points to new findings that might indicate lower PTSD rates currently across all services—between 2.1 and 13.8%. Taking into consideration under-reporting due to stigma, the authors suggest these low rates might be due to the targeted attention that PTSD has received, along with interest in bolstering Warfighter resilience. The article cites the military’s adoption of resilience programs such as “Battlemind” as possible contributors to these low rates. The authors recommend more in-depth research to determine the effectiveness of such programs.

Learning mental toughness through Army training

HPRC Fitness Arena: Mind Tactics, Total Force Fitness
Can mental toughness be taught? Time magazine interviewed Dr. Martin Seligman on how the Army plans to do it.

In an April 2012 Times article Dr. Martin Seligman, whose work on “positive psychology” influenced Comprehensive Soldier Fitness, explains his stance that soldiers can enhance their mental toughness through optimistic thinking. By seeing situations as temporary—“It will go away soon”—or specific—“It’s just this once”—or changeable—“I can do something about it”—you can make it through adversity and perform optimally. The training also emphasizes how resisting negative thoughts such as “Maybe I don’t have what it takes to be a soldier” while expressing gratitude—“I made it farther than I did last time”—are part of the puzzle to building resilience and becoming mentally tough. To learn strategies that can help build mental toughness, visit OSOK’s Mind Tactics module in HPRC’s Total Force Fitness domain.

Leveraging mindfulness as a performance-optimization tool

HPRC Fitness Arena: Mind Tactics, Total Force Fitness
Practicing mindfulness can improve performance by reducing stress and increasing well-being.

PsychCentral’s March 2012 "Ask the Therapist" article addresses how mindfulness relates to military performance—especially important now that the military has been incorporating mindfulness tactics for enhancing Warfighter mental and physical resilience. Of particular note is a study from the Journal of Clinical Psychology that demonstrated significant improvements in PTSD symptoms, depression, etc. in veterans after completing a Mindfulness-Based Stress Reduction (MBSR) program. The article also noted other studies that showed long-term stress-reduction, well-being, and positive experiences. Simply put, acknowledging emotional pain helps you overcome it. You are then able to focus and communicate with loved ones more effectively.

If you’d like to learn more about meditation and mindfulness, check out the Mind Tactics section of the HPRC website, which contains many resources related to meditation and mindfulness, as well as resources related to mental fitness, mental toughness, and resilience.

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