Hana J. Kim, Ph.D., MSCP, ABPP
Lieutenant Commander, U.S. Public Health Service
One of the most rewarding and demanding careers in the field of mental health is military psychology. The term military psychology is most commonly associated with the treatment of posttraumatic stress disorder related to combat deployments. Perhaps lesser known is that military psychologists—especially those who are board certified or received fellowship training in clinical health psychology—are often prepared to treat a wide breadth of mental health conditions prevalent in military populations as they relate to health. All eight federal uniformed service branches (including the U.S. Public Health Service and the National Oceanic and Atmospheric Administration Corps) expect their members to be in peak physical and mental health condition to perform their occupational duties safely and effectively. Accordingly, as a military psychologist, advanced clinical acumen and rapid but accurate decision-making are key to ensuring service members’ operational readiness and safety.
Because the military is a demanding, fast-paced, and ever evolving environment, occupational stressors can lead to the development of unhealthy coping behaviors such as eating highly processed foods, excessive video gaming, vaping tobacco, and consuming large quantities of energy drinks. These lifestyle behaviors have the potential to interfere with a service member’s ability to be basic ready (e.g., to meet weight retention standards, physical fitness test requirements, and have the physical/psychological fitness to deploy or perform sensitive duties). Common health conditions diagnosed in military service members associated with these behaviors are insomnia, tobacco use, chronic pain, and obesity (Peterson et al., 2012). A trained military health psychologist is able to identify and address these lifestyle behaviors and provide appropriate early intervention to help prevent members from falling out of standards and jeopardizing their careers. Cognitive behavior therapy (CBT) is an especially useful modality for the military population (Ball & Peake, 2006). It offers a concrete, directive and short-term approach generalizable to most psychological problems and is thus the preferred treatment for this population (Ball & Peake) who could deploy at any given time and generally do not have the option of engaging in long-term psychotherapy.
Insomnia, marked by trouble falling asleep and/or waking up in the middle of the night, has sharply increased in military personnel over time (Moore et al., 2021) and is a common issue amongst service members. Military members are particularly at elevated risk for developing sleep dysfunction due to rotational duty shifts (i.e., swing shifts) which could lead to sleep-wake disturbances by disrupting the homeostatic sleep drive and circadian rhythm of alertness (Wickwire et al., 2017). The introduction of energy drinks amongst service members has also reduced sleep quality and duration (Toblin et al., 2012) with many being unaware of the long-term adverse effects of chronically high caffeine intake on sleep architecture. At first glance, insomnia may appear to be a relatively benign diagnosis; however, in severe cases, if a member does not respond to the appropriate interventions and their sleep dysfunction continues to disrupt their occupational duties, it could result in a separation from the service.
Another widespread issue amongst military personnel is tobacco use. While the prevalence of cigarette smoking has declined in the U.S. adult population, the use of electronic tobacco has risen (Cornelius et al., 2023). A common myth is that vaping is a “safer” form of smoking; however, vape products are unregulated and have been implicated in many cases of significant lung injury and even death. Because vaping affects the cardiovascular and pulmonary systems in the body, continued use could have acute and chronic adverse health effects on service members. These effects could contribute to the development of new health conditions that may be discovered during annual medical examinations or lead to poor performance on the mandatory physical fitness test. Service members must meet retention standards and if a tobacco-related health condition is considered incompatible with the occupational demands or is refractory to treatment, a member could be deemed ineligible for retention.
Chronic pain is another common military health condition and is considered to be the leading cause of medical separation in the armed forces (Peterson et al., 2012). Thirty-one to forty-four percent of service members experience chronic pain (Sherry et al., 2021). One of the most challenging aspects of treating chronic pain is helping service members reframe the belief that pain is an acute symptom to be “cured” with a single biomedical modality to a chronic disease that needs long-term multimodal and lifestyle management. Additional critical health domains to address in this population include obesity and weight management, due to strict weight standards for military personnel. Weight gain can be tied to occupational stress and subsequent poor eating habits, or to an underlying medical condition causing metabolic dysfunction. Obesity, like other health conditions, could lead to military separation if a member repeatedly fails to make weight or physical fitness standards.
CBT is a widely accepted and validated treatment framework for various health conditions including chronic pain (Turk & Gatchel, 2018) and sleep disorders (Schutte-Rodin et al., 2008). Many military treatment facilities provide CBT-based group programming to address weight management and tobacco cessation. A military health psychologist aims to conceptualize the service member through the lens of a biopsychosocial framework, with the goal of helping them identify the underlying belief patterns that maintain their unhealthy behaviors, test erroneous assumptions, and empower them to proactively confront their problems. Initial CBT sessions focus on providing the framework and educational foundation of their health conditions, with later sessions prioritizing mood tracking and thought logs that will lead to enhanced self-efficacy and confidence in being able to address their problems. Commonly used health-related measures for military populations include the Insomnia Severity Index (Bastien et al., 2001) and the Pain Catastrophizing Scale (Sullivan et al., 1995). A military health psychologist can also provide consultation to the medical team to help with diagnostic rule outs. For example, rather than assuming a member’s sudden onset of anxiety is an anxiety disorder, a military health psychologist would encourage the primary care provider to consider a full lab work-up first to ensure the absence of a thyroid or cardiac condition.
Military mental health has come a long way from the old mentality of “suck it up” or avoid mental health care at all costs due to fear of negative repercussions on one’s career. Military health psychologists play a critical role in concert with the medical team to prevent the extreme outcome of a military separation, by offering evidence-based psychological interventions such as CBT for health conditions that could impact a member’s fitness for duty if left untreated. Military health psychologists are also responsible for providing education and outreach to commands to reduce the stigma of mental health care and reassure members that the goal of the military is to retain them, not discharge them. Individuals interested in this specialty should consider an APA-accredited clinical health psychology internship or postdoctoral fellowship within a military treatment facility or Veterans Affairs medical center and ultimately seek board certification through the American Board of Professional Psychology (ABPP) in Clinical Health Psychology. This specialty area of mental health provides a demanding but rewarding career with a discernible impact on ensuring the mission readiness of the uniformed services.
References
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