Staff Perspective: Military Couples and Relationships
Article Summary:
Snyder, D. K., Balderrama-Durbin, C., Cigrang, J. A., Talcott, G. W., Smith, A. M., and Heyman, R. E. (2016). Help-seeking among airmen in distressed relationships: promoting relationship well-being. Psychotherapy, 53(1), 1-12.
Relationship distress is a common presentation in the military mental health clinic in which I work and is also a frequently seen precipitating factor for combat stress during deployment. Most of the mental health professionals I work with cite relationship woes as the top reason underlying adjustment disorders in theater. We also know that relationship problems of various types (loss of relationship, perceived burdensomeness in relationships) are associated with an elevated risk of suicide and other mental health problems. As is the case among those with individual mental health problems, many military members who are experiencing relationship distress do not seek help. The authors above examine help-seeking behavior among a group of Security Forces Airmen and use their findings to make recommendations about building relationship resilience.
The article initially reviews some of the literature about help-seeking behavior among Service members pointing out these key points:
- Service members experience a wide range of mental health symptoms after deployment, yet a minority seek help
- Those with more fear of negative repercussions from peers and supervisors are often the ones experiencing higher levels of symptoms
- The relationship between stigma and help-seeking behavior is not clear
- Although in civilian samples relationship distress is associated with increased help-seeking, the same is not known to be true among Service members
To better understand the connection between help-seeking behaviors, mental health problems (including relationship problems), and military service, the authors were asked by the US Air Force command to focus on a specific group of deployed Security Forces (SF) members to examine the following questions:
- What individual and relationship problems were SF members at greatest risk for experiencing during deployment?
- What was the course of these symptoms during the reintegration phase of the deployment?
- What mental health services were available after deployment?
- To what extent were these services being used?
- What factors influenced their utilization?
- What other services might be needed, particularly those addressing relationship problems and how could these be made more available?
The SF teams completed one-year deployments to Iraq, and the authors above assessed their functioning in terms of individual mental health and relationship health at several points in time: pre-deployment, in theater, and six to nine months post-deployment. Results suggested significant worsening of individual and relationship health from pre- to post-deployment including increased rates of PTSD, depression, and alcohol use disorders. In addition, over half of the Airmen in a committed relationship at the outset of the deployment reported significant problems in their relationship or that the relationship had dissolved after the deployment (compared to only 25% at pre-deployment).
Regarding help-seeking, it was found that 37% of the SF Airmen reported that they had sought some kind of counseling since returning from deployment. Rates of help-seeking were higher among those who reported problems with PTSD, depression, or alcohol use on screeners—roughly half among these individuals sought help. While that is positive, it also means that the other approximate half were not getting mental health services, perhaps due to not seeking them out. Of note, most Service members who sought counseling did so for problems such as deployment-related symptoms, depression, anger, or anxiety. A much smaller group sought counseling individually for relationship distress and an even smaller group did so with their partner. Interestingly, neither stigma nor negative attitudes toward mental health treatment differentiated those who received treatment from those who did not receive treatment. Also, contrary to the authors’ prediction, help-seeking behavior did not differ among the Airmen in a committed relationship. In other words, neither relationship status (in a relationship vs. not) nor relationship quality were associated with help-seeking behavior.
Based on the findings with the SF Airmen, a need was identified “to develop and deploy a couple-based resiliency and intervention program aimed at identifying Airman at significant risk for intimate partner relationship problems that could contribute to, exacerbate, or maintain individual, emotional, or behavioral dysfunction and thereby compromise Airmen’s duty performance.” The result was the USAF-ARMOR (Unified Strategy of Action for Airmen Resilience and Maintenance of Operational Readiness) program. To develop the components of the program, the authors formed focus groups asking Airmen about their relationship problems during or following deployment and the tools they had (or did not have) to address them. As a result of the focus groups, the authors developed 18 Action Sheets which addressed relationship problems encountered in the deployment cycle, and these Action Sheets include psychoeducational information, helpful empirically-based tips to address the problems, and help with developing an Action Plan to address the problem. Each Action Plan then prompts the user to apply the information to a specific target behavior/problem, assess pros and cons of the status quo regarding that behavior, create a specific plan of implementing change, implement the change, and, finally, review the results. These occur over the course of time, as appropriate.
The next step in the USAF-ARMOR program implementation was a multi-tiered method of distributing the components. The first level involved promoting awareness of common relationship problems among Service members by informing service providers like those at Airmen and Family Readiness offices, chaplain services, and mental health clinics about common relationship challenges around deployment. The Action Sheets could be utilized by providers in any of these settings to promote positive change in the Service member. A mid-level target of intervention suggested is “conversations” between the Service member and “natural helpers” in the unit who have been specifically trained to promote healthy relationship skills. The article did not specify who would train these individuals. The third level of prevention (intervention) involves family life consultants or actual clinical staff providing outreach workshops on relationship topics such as communication skills. The idea of having commander buy-in was mentioned also, with the idea of commanders setting aside time for this kind of relationship training prior to and after deployment.
Within the context of help-seeking behavior and deployment distress, this article highlights the connection of both help-seeking behavior and deployment distress to the importance of relationship resilience. Given that many military mental health clinics do not offer marital therapy (or it is at least not as available as individual or group therapy), and the reciprocal influence of relationship health and individual health in Service members, the authors’ development of a program to address relationship problems is important and timely.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Regina Shillinglaw, Ph.D., is the Center for Deployment Psychology's Senior Military Internship Behavioral Health Psychologist at Wright Patterson Medical Center in Ohio.
Article Summary:
Snyder, D. K., Balderrama-Durbin, C., Cigrang, J. A., Talcott, G. W., Smith, A. M., and Heyman, R. E. (2016). Help-seeking among airmen in distressed relationships: promoting relationship well-being. Psychotherapy, 53(1), 1-12.
Relationship distress is a common presentation in the military mental health clinic in which I work and is also a frequently seen precipitating factor for combat stress during deployment. Most of the mental health professionals I work with cite relationship woes as the top reason underlying adjustment disorders in theater. We also know that relationship problems of various types (loss of relationship, perceived burdensomeness in relationships) are associated with an elevated risk of suicide and other mental health problems. As is the case among those with individual mental health problems, many military members who are experiencing relationship distress do not seek help. The authors above examine help-seeking behavior among a group of Security Forces Airmen and use their findings to make recommendations about building relationship resilience.
The article initially reviews some of the literature about help-seeking behavior among Service members pointing out these key points:
- Service members experience a wide range of mental health symptoms after deployment, yet a minority seek help
- Those with more fear of negative repercussions from peers and supervisors are often the ones experiencing higher levels of symptoms
- The relationship between stigma and help-seeking behavior is not clear
- Although in civilian samples relationship distress is associated with increased help-seeking, the same is not known to be true among Service members
To better understand the connection between help-seeking behaviors, mental health problems (including relationship problems), and military service, the authors were asked by the US Air Force command to focus on a specific group of deployed Security Forces (SF) members to examine the following questions:
- What individual and relationship problems were SF members at greatest risk for experiencing during deployment?
- What was the course of these symptoms during the reintegration phase of the deployment?
- What mental health services were available after deployment?
- To what extent were these services being used?
- What factors influenced their utilization?
- What other services might be needed, particularly those addressing relationship problems and how could these be made more available?
The SF teams completed one-year deployments to Iraq, and the authors above assessed their functioning in terms of individual mental health and relationship health at several points in time: pre-deployment, in theater, and six to nine months post-deployment. Results suggested significant worsening of individual and relationship health from pre- to post-deployment including increased rates of PTSD, depression, and alcohol use disorders. In addition, over half of the Airmen in a committed relationship at the outset of the deployment reported significant problems in their relationship or that the relationship had dissolved after the deployment (compared to only 25% at pre-deployment).
Regarding help-seeking, it was found that 37% of the SF Airmen reported that they had sought some kind of counseling since returning from deployment. Rates of help-seeking were higher among those who reported problems with PTSD, depression, or alcohol use on screeners—roughly half among these individuals sought help. While that is positive, it also means that the other approximate half were not getting mental health services, perhaps due to not seeking them out. Of note, most Service members who sought counseling did so for problems such as deployment-related symptoms, depression, anger, or anxiety. A much smaller group sought counseling individually for relationship distress and an even smaller group did so with their partner. Interestingly, neither stigma nor negative attitudes toward mental health treatment differentiated those who received treatment from those who did not receive treatment. Also, contrary to the authors’ prediction, help-seeking behavior did not differ among the Airmen in a committed relationship. In other words, neither relationship status (in a relationship vs. not) nor relationship quality were associated with help-seeking behavior.
Based on the findings with the SF Airmen, a need was identified “to develop and deploy a couple-based resiliency and intervention program aimed at identifying Airman at significant risk for intimate partner relationship problems that could contribute to, exacerbate, or maintain individual, emotional, or behavioral dysfunction and thereby compromise Airmen’s duty performance.” The result was the USAF-ARMOR (Unified Strategy of Action for Airmen Resilience and Maintenance of Operational Readiness) program. To develop the components of the program, the authors formed focus groups asking Airmen about their relationship problems during or following deployment and the tools they had (or did not have) to address them. As a result of the focus groups, the authors developed 18 Action Sheets which addressed relationship problems encountered in the deployment cycle, and these Action Sheets include psychoeducational information, helpful empirically-based tips to address the problems, and help with developing an Action Plan to address the problem. Each Action Plan then prompts the user to apply the information to a specific target behavior/problem, assess pros and cons of the status quo regarding that behavior, create a specific plan of implementing change, implement the change, and, finally, review the results. These occur over the course of time, as appropriate.
The next step in the USAF-ARMOR program implementation was a multi-tiered method of distributing the components. The first level involved promoting awareness of common relationship problems among Service members by informing service providers like those at Airmen and Family Readiness offices, chaplain services, and mental health clinics about common relationship challenges around deployment. The Action Sheets could be utilized by providers in any of these settings to promote positive change in the Service member. A mid-level target of intervention suggested is “conversations” between the Service member and “natural helpers” in the unit who have been specifically trained to promote healthy relationship skills. The article did not specify who would train these individuals. The third level of prevention (intervention) involves family life consultants or actual clinical staff providing outreach workshops on relationship topics such as communication skills. The idea of having commander buy-in was mentioned also, with the idea of commanders setting aside time for this kind of relationship training prior to and after deployment.
Within the context of help-seeking behavior and deployment distress, this article highlights the connection of both help-seeking behavior and deployment distress to the importance of relationship resilience. Given that many military mental health clinics do not offer marital therapy (or it is at least not as available as individual or group therapy), and the reciprocal influence of relationship health and individual health in Service members, the authors’ development of a program to address relationship problems is important and timely.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Regina Shillinglaw, Ph.D., is the Center for Deployment Psychology's Senior Military Internship Behavioral Health Psychologist at Wright Patterson Medical Center in Ohio.