Stories - Blogs

By Kathryn Monsey, LCSW

We come together to learn, to teach, to solve problems, and to support one another. Throughout my career, collaboration has taken many forms, but one lesson has remained constant: some of the most meaningful work happens when people come together around a shared mission. There is a certain energy created through gathering that is difficult to replicate in any other way. Whether exchanging ideas or learning from one another’s experiences, these opportunities leave us better equipped to serve our communities. Some of my most important work—both professionally and personally—has happened in those moments of connection.

That spirit is at the heart of the Star Behavioral Health Providers Convening Event. Since its launch in 2022, the event has brought together Directors of Psychological Health (DPHs), Behavioral Health Officers (BHOs), and the SBHP team from across the country to strengthen the partnerships that support Service Members and their families. Because Reserve Component members rely on civilian behavioral health providers at higher rates than their Active-Duty counterparts, strong civilian-military collaboration is essential. To support those connections, SBHP developed a directory of civilian providers who have completed our training and have access to ongoing consultation and support. Through shared learning, professional development, and meaningful collaboration, the Convening Event helps increase awareness of this resource while creating opportunities for partners nationwide to connect, exchange ideas, and unite around our common goal of addressing the unique behavioral health needs of the National Guard community.

One aspect of the Convening Event that I particularly appreciate is our ability to remain responsive to the needs of the field. By listening to the experiences and feedback of our DPH and BHO partners, we can focus on topics that reflect current challenges, emerging trends, and areas of growing interest within military behavioral health. This year's agenda includes discussions on suicide safety planning, lethal means safety counseling, strategic patient management, brief strength-based interventions, structured case management strategies, and skills-based therapies that support readiness and resilience among National Guard members and their families.

Four years later, SBHP remains committed to supporting these dedicated behavioral health staff through a convening event that continues that tradition. At its core, SBHP is built on this collaborative spirit. The DPHs and BHOs of the National Guard are critical collaborators in our shared mission to improve access to high-quality behavioral healthcare for military-connected communities. Convening events like this provide an opportunity to strengthen those relationships, learn from one another, and continue building the connections that help service members, veterans, and their families receive the care they deserve. I am confident that this year's Convening Event will continue to strengthen those relationships and advance behavioral healthcare across the National Guard community.

Interested in learning more about SBHP or have any questions? Please contact us at sbhpsupport_ggg@usuhs.edu.

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.

Kathryn E Monsey, LCSW, LCDC, is a Military Behavioral Health Social Worker for the Consortium for Defense Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. She assists in the implementation and expansion of the Star Behavioral Health Providers Program (SBHP). SBHP trains civilian behavioral health providers to work with service members, veterans, and their families. The mission is to expand the availability of high-quality behavioral health services, especially for those in the National Guard and Reserve Component.

By Dr. Andrew Devendorf

As a therapist, it feels devastating when a patient drops out of treatment. Queue the automatic thoughts, "What did I do wrong?" "What could I have done differently?" "Am I failing my patients?" These thoughts flooded my brain when I was trained in Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) for patients with posttraumatic stress disorder (PTSD) (Foa et al., 2009; Resick et al., 2016).

CPT and PE are both gold-standard treatments for PTSD. They are among the most studied treatments that reduce PTSD symptoms compared to control groups (Lewis et al., 2020; Powers et al., 2010) . In addition to Eye Movement Desensitization and Reprocessing therapy, they are two of the three psychotherapies that are recommended by the Department of Veteran Affairs (VA/DoD CPGs, 2025).

CPT and PE are mostly delivered in 8-15 weekly sessions. CPT involves challenging and modifying unhelpful beliefs related to the trauma, while PE involves repeatedly confronting trauma-related memories and avoidance to habituate fear responses. Each treatment asks patients to do 1-2 hours of daily homework.

I was excited to learn these evidence-based psychotherapies during my graduate training at the VA—rates of PTSD are high in military populations, and they deserve the best care. Before diving in, I prided myself on having a near 0% dropout rate with my previous clients. My specialty was in treating depression and anxiety disorders, which are like cousins of PTSD.

But when I saw my first caseload of veterans with PTSD, my optimism quickly waned. My no-show rate shot up to almost 40%. I’d usually be 3 sessions into CPT or PE—right before really “diving into” the trauma—when patients started to reschedule, cancel, or “ghost” me entirely. Why was this happening? My process to self-reflect, “what could I have done better?” could only take me so far, since my other patients were benefiting from treatment.

Fortunately, some of my patients shared with me why they prematurely ended therapy. Several said that they stopped due to logistical reasons: not having enough time, getting a new job, or not realizing the level of commitment needed until they started. Others said they weren’t ready to confront their trauma (“It’s too much, right now.”), and some even admitted to engaging in avoidance. For patients I didn’t hear from, it’s possible that they didn’t see me, or the treatment, as the “right fit.” Or...maybe something else? Regardless, I felt defeated, and so I consulted the research literature to learn more.

Dropout Rates for CPT and PE

What I found in the research was staggering. Among combat Veterans with PTSD who served in Iraq and Afghanistan, a meta-analysis found that the overall dropout rates for trauma treatments were 36% (Goetter et al., 2015). This number mirrored my own clinical experience! More recently, in a different a meta-analysis of trauma treatments for military and veteran populations, researchers found that dropout rates were 40% for weekly CPT, and 35% for weekly PE (Penix-Smith & Swift, 2025).

These results made me feel validated. I thought, “I wasn’t the problem. The treatment schedule was.” But then, that idea disappointed me—is this really the best we can do? How can we call a treatment “gold-standard” when almost half of patients don’t finish it? Fortunately, there is light in this story. In the same meta-analysis, the researchers found that when CPT and PE were done in rapid care settings (i.e., a few weeks to a month of treatment), the dropout rates plummeted to just 9% and 6%, respectively. Is this for real? Can you actually treat PTSD in just a few weeks? And still have 90% of people complete treatment?

Enter the conversation: "massed delivery" of PTSD treatments. 

What is “massed” PTSD treatment? 

Massed treatment is when an evidence-based psychotherapy is delivered in 3 sessions or more per week. Given the intensity, this delivery is also called “accelerated” treatment. Massed PTSD treatments are usually done in intensive outpatient or partial hospitalization programs (IOP/PHP), as well as residential settings. However, massed treatment can be adapted into an outpatient setting.

Much of what is known about massed treatment has emerged in the last 10-15 years. As a result, there is no primary model, yet, for how to implement massed CPT and PE. For instance, some intensive care settings will bring in “supplemental” treatments for patients. These could include support via exercise programs, yoga, meditation, or seeing a nutritionist; they may also include helping a patient with other mental health difficulties, such as providing supplemental therapy for depression, anxiety, sleep, or substance use disorders.

Does accelerated CPT and PE work?

The short answer—yes, but research is still emerging.

In multiple randomized clinical trials, massed PE was found to be just as effective as weekly PE for reducing PTSD symptoms at 3-months (Dell et al., 2023; Foa et al., 2018) . Importantly, treatment gains are also similar between massed PE and standard PE after 1-year follow-up (Dell et al., 2023).

There is less research on massed CPT, but initial work shows that it is effective for reducing PTSD symptoms (Baez et al., 2026.; Held et al., 2023) . However, there is a soon-to-be published randomized clinical trial that shows massed CPT is, indeed, as effective as standard CPT in a U.S. military population (Wachen et al., in press). One interesting finding is that CPT can be delivered effectively in 1-week, 2-week, and 3 week formats (Held et al., 2022, 2023).

Lastly, interview research shows that providers really enjoy doing massed PTSD treatments—you have the chance to see a patient make improvements in 2-3 weeks vs. waiting 3-4 months. That said, providers emphasize that the healthcare system needs to provide a reasonable infrastructure for massed treatment to be feasible; this includes protected time for preparation, documentation, and having supportive leadership (Wells et al., 2026).

Who is appropriate for massed treatment? 

The inclusion and exclusion criteria are the same as CPT and PE: patients who meet PTSD criteria and have sufficient memory of the traumatic event is appropriate. These treatments are not appropriate for patients with imminent threat of suicidal or homicidal behavior, current and serious self-injurious behavior, current psychosis, or at imminent risk of domestic violence or assault. However, once these conditions or circumstances are addressed, a patient may be appropriate.

Questions to Be Answered

The initial data on massed PTSD therapies are promising. But a few questions remain unanswered before widespread adoption:

• How long are treatment gains maintained?
• How do providers feel about massed compared to standard treatment?
• What are the best ways to implement massed CPT and PE?
• What is the most economical way to implement these treatments?
• How can providers be reimbursed for massed treatment?
• What is the feasibility for community outpatient providers to implement massed treatment?

A Bright Future

Accelerating treatments are...accelerating. There is good reason for patients and providers to be excited about the future. Patients and providers, alike, can now make similar progress in a few weeks, rather than months. If the last decade was focused on innovation PTSD treatments for massed delivery, then I hope the next decade sees the widespread adoption and dissemination of these promising interventions.

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.

Andrew Devendorf, Ph.D., is a Military Behavioral Health Psychologist with the Henry M. Jackson Foundation for the Advancement of Military Medicine. He serves as a subject matter expert in suicide prevention for the VA SAFEGUARD project.

References

Baez, L., Huberty, J., Yourell, J., Jewell, C., Lin, E., Kaysen, D., Cutts, L., Noori, S.,
 Rosenthal, I., & Chard, K. (n.d.). Effectiveness of massed cognitive processing
 therapy for posttraumatic stress disorder: A retrospective analysis. Journal of
 Traumatic Stress, n/a(n/a). https://doi.org/10.1002/jts.70045

Dell, L., Sbisa, A. M., Forbes, A., O’Donnell, M., Bryant, R., Hodson, S., Morton, D.,
 Battersby, M., Tuerk, P. W., Wallace, D., & Forbes, D. (2023). Effect of massed v.
 standard prolonged exposure therapy on PTSD in military personnel and
 veterans: A non-inferiority randomised controlled trial. Psychological Medicine,
 53(9), 4192–4199. https://doi.org/10.1017/S0033291722000927

Foa, E. B., Chrestman, K. R., & Gilboa-Schechtman, E. (2009). Prolonged Exposure
 Therapy for Adolescents with PTSD Emotional Processing of Traumatic
 Experiences, Therapist Guide. Oxford University Press, USA.

Foa, E. B., McLean, C. P., Zang, Y., Rosenfield, D., Yadin, E., Yarvis, J. S., Mintz, J.,
 Young-McCaughan, S., Borah, E. V., Dondanville, K. A., Fina, B. A., Hall-Clark,
 B. N., Lichner, T., Litz, B. T., Roache, J., Wright, E. C., Peterson, A. L., & for the
 STRONG STAR Consortium. (2018). Effect of Prolonged Exposure Therapy
 Delivered Over 2 Weeks vs 8 Weeks vs Present-Centered Therapy on PTSD
 Symptom Severity in Military Personnel: A Randomized Clinical Trial. JAMA,
 319(4), 354–364. https://doi.org/10.1001/jama.2017.21242

Held, P., Kovacevic, M., Petrey, K., Meade, E. A., Pridgen, S., Montes, M., Werner, B.,
 Miller, M. L., Smith, D. L., Kaysen, D., & Karnik, N. S. (2022). Treating
 posttraumatic stress disorder at home in a single week using 1-week virtual
 massed cognitive processing therapy. Journal of Traumatic Stress, 35(4),
 1215–1225. https://doi.org/10.1002/jts.22831

Held, P., Smith, D. L., Pridgen, S., Coleman, J. A., & Klassen, B. J. (2023). More is not
 always better: 2 weeks of intensive cognitive processing therapy-based treatment
 are noninferior to 3 weeks. Psychological Trauma: Theory, Research, Practice,
 and Policy, 15(1), 100–109. https://doi.org/10.1037/tra0001257

Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological
 therapies for post-traumatic stress disorder in adults: Systematic review and
 meta-analysis. European Journal of Psychotraumatology, 11(1), 1729633.
https://doi.org/10.1080/20008198.2020.1729633

Penix-Smith, E. A., & Swift, J. K. (2025). The protocol matters: A meta-analysis of
 psychotherapy dropout from specific PTSD treatment approaches in U.S. service
 members and veterans. Psychological Trauma: Theory, Research, Practice, and
 Policy. https://doi.org/10.1037/tra0002070

Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010). A
 meta-analytic review of prolonged exposure for posttraumatic stress disorder.
Clinical Psychology Review, 30(6), 635–641.
https://doi.org/10.1016/j.cpr.2010.04.007

Resick, P. A., Monson, C. M., & Chard, K. M. (2016). Cognitive Processing Therapy for
 PTSD: A Comprehensive Manual. Guilford Publications.

Wells, S. Y., Kehle-Forbes, S. M., Shapiro, A., Murray, R. D., Dedert, E. A., Woolson, S.,
 Calhoun, P. S., & Jackson, G. L. (2026). Providers’ and administrators’
 perspectives of massed posttraumatic stress disorder (PTSD) treatment in
 Veterans Affairs (VA) PTSD outpatient clinics. Psychological Services.
https://doi.org/10.1037/ser0001018

By David Obergfell, DSW, LCSW, BCD, DAAETS

June is PTSD Awareness Month, and one of the most important things to understand about posttraumatic stress is that it often doesn't look the way people expect. In military service members, veterans, first responders, emergency medical personnel, and others who work in high-pressure environments, PTSD frequently doesn't look like falling apart. It can look like competence.

Hypervigilance, one of PTSD's hallmark symptoms, often resembles professional excellence. The ability to anticipate problems, scan for danger, stay emotionally controlled, and remain prepared for the unexpected can be lifesaving in environments where mistakes carry serious consequences. The body and brain adapt accordingly, tuning their threat-detection systems to meet the demands of the job.

The challenge is that those adaptations do not automatically switch off when the danger is over. A nervous system that has learned to prioritize threats can, through sheer repetition, persist in operating as though risk remains present, even in objectively safe environments. A family gathering, a quiet evening at home, or a conversation with a loved one may trigger the same physiological readiness that was once essential during a deployment, emergency call, or traumatic event.

When this happens, people often find themselves confused by a gap between what they know and what they feel. They know they are safe, yet their bodies continue to respond as though they are not. This can show up as emotional numbing, irritability, avoidance, sleep disruption, or difficulty trusting others. These are not signs of weakness. They are understandable adaptations that have outlived the circumstances that created them.

When Symptoms Become Identity
 For many people in high-stakes professions, another challenge emerges over time: symptoms begin to blend with identity. Hypervigilance becomes "situational awareness." Emotional distance becomes "professionalism." Reluctance to rely on others becomes "self-sufficiency." The overlap is real. Many of these traits were valuable and necessary in the environments where they developed. But when survival strategies become permanent ways of relating to the world, they can quietly narrow a person's life. The internal narrative often sounds like: “I am the one who stays alert, who carries the responsibility, who cannot let their guard down.”

When symptoms become part of how someone defines themselves, the idea of recovery can feel threatening. If I am not constantly vigilant, who am I? If I trust someone else to take the lead, what happens if they fail? These concerns are understandable. Yet they can create an invisible trap, one that slowly erodes quality of life while making relationships increasingly difficult to sustain.

The Long-Range Cost to Relationships
 Relationships are often where the impact of PTSD becomes most visible. Healthy relationships require trust, vulnerability, and the willingness to share responsibility. PTSD can make each of those feel risky. A partner may experience guardedness as distance. Children may sense a parent who always seems braced for impact. Friends may stop reaching out after repeated cancellations or emotional withdrawal.

Over time, isolation grows.

The original trauma often involved a disruption of safety and trust. Without realizing it, many people find themselves recreating that same distance in the relationships that matter most. This is not a personal failing. It is what happens when protective strategies remain active long after they are needed.

Different Possibility: What Recovery Actually Feels Like
 One of the most persistent myths about PTSD is that it is permanent. That is not, however, what research or lived experience tells us. PTSD is treatable, and many people experience substantial symptom resolution. Recovery does not mean forgetting what happened or losing the strengths developed through difficult experiences. The memories remain. The lessons remain. The skills remain. What changes is your relationship to them. The hypervigilance that once ran automatically becomes something you can turn toward when needed and set aside when it is not. The skills that helped you survive no longer have to dominate every moment of your life.

Many people describe recovery not as becoming someone different, but as becoming more fully themselves. We see this when real rest becomes possible, not passive disconnection, but the kind of engaged stillness that comes from feeling genuinely safe. Relationships feel safer. Curiosity, humor, joy, and connection begin to take up more space. Life requires less management and offers more participation.

Perhaps most importantly, recovery often unfolds through small moments that challenge old assumptions. A spouse handles the situation, and things go well. A colleague takes responsibility, and the outcome is fine. Someone else carries part of the burden, and nothing falls apart. These moments may seem ordinary, but they provide something powerful: evidence. Each experience of "I didn't have to be in control, and everything was okay" gives the nervous system new information. Over time, those experiences can reshape long-held beliefs about safety, trust, and responsibility.

What emerges is not weakness, but a broader definition of strength, one that includes the ability to trust, rest, receive support, and remain connected to others.

You Have Changed Before. You Can Change Again.
 There is something worth remembering: you are not the same person you were at twenty-two, fifteen, or during the hardest year of your life. Human beings are not fixed. We are continually shaped by our experiences, relationships, and choices. The symptoms that feel permanent are not character traits. They are patterns. Understandable patterns, often deeply practiced patterns, but patterns, nonetheless. And patterns can change.

PTSD Awareness Month is an opportunity to move beyond awareness and toward possibility. To consider that life after trauma can look different than it does today. Believing that the relationships you want are still available. To recognize that allowing others to help is not a surrender of competence but an expansion of freedom.

Emerging through the other side of this work is not a diminished version of yourself. It can be the renewed ability to feel safe enough to connect, to be present enough to choose, and to be flexible enough to respond to life as you want to. It is the return of your full humanity.

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 War.

David Obergfell, DSW, LCSW, BCD, DAAETS, is a Military Behavioral Health Social Worker and Subject Matter Expert with the Consortium for Defense Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this capacity, he supports military behavioral health faculty on assignments and bandwidth across the center, providing professional development and performance management

Resources
 Treatment & Clinical Information

• Star Behavioral Health Providers: A no-cost tiered training program for providers interested in working with service members, veterans, and their families. And a public, online directory of trained providers that is easily searchable by military- connected individuals seeking mental health care.
• National Center for PTSD: VA’s comprehensive resource for veterans and the public; includes a treatment locator and symptom information
• PTSD Coach App: A free VA-developed mobile app for self-guided symptom management

Evidence-Based Treatments (Learn More)

• Cognitive Processing Therapy (CPT)
• Prolonged Exposure Therapy (PE)
• EMDR International Association: Find a Therapist

For First Responders & Healthcare Workers

• Safe Call Now: 24/7 crisis support line specifically for public safety and healthcare workers: 1 (253) 243-3701
• First Responder Support Network: Residential and outpatient retreat programs for first responders

Crisis & Suicide Response

•  988 Suicide & Crisis Lifeline: Call or text 988; also available via chat online.
• Dial 988 & press 1 for the Service Members, Veterans and Families Crisis Lifeline

By Elizabeth Burgin, Ph.D.

There are military families living quietly among us who carry a weight that most of us can scarcely imagine. They are the spouses whose hearts shattered at the loss of their partner and experienced another shattering as they found words to tell their children that their parent would never come home. They are the children who learned, at ages far too young, to live without their mom or dad. Surviving military families — those who have lost a service member parent or spouse — benefit greatly from a mental health community that understands the unique dimensions of their loss and is equipped to meet their needs.

For the surviving spouse, losing their service member often means losing an identity, a community, and the future they sacrificed everything to build. When a service member is killed while they are serving, it can trigger a cascade of secondary losses — on-base housing, proximity to a supportive military community, the daily rhythms of military family life and can be thrust into civilian communities that do not understand their experiences (Holmes et al., 2013). Veterans’ families face similar experiences in their loss, but may find themselves with even fewer resources to find stability after loss, which often occurs after long and costly battles with mental and/or physical illness. Bereaved spouses navigate grief layered upon grief. Research confirms the magnitude: among military widows, sudden and violent loss has been associated with a two- to five-fold increase in depressive, posttraumatic stress, and adjustment symptoms (Cozza et al., 2020).

A recent needs assessment of surviving military families found that nearly half — 48.5% — met criteria for complicated grief (Burgin et al., 2023). Those experiencing complicated grief were more likely to experience significantly higher anxiety and depressive symptoms compared their non-complicated grieving counterparts (Burgin et al., 2023). Importantly, resilience — so often invoked as the hallmark of military culture — did not differentiate those with complicated grief from those without. These are families who often appear strong, and may even describe themselves that way, but are nonetheless quietly struggling despite their significant efforts to cope.

The surviving parents in this study reported elevated parenting stress — and identified feeling social alienation, guilt, and unsure of how to parent their children amid their grief (Burgin et al., 2023). These are parents who feel isolated, who doubt themselves, and who are trying to raise children through a grief that has no clear roadmap. Further, their children showed elevated ratings for depressed and anxious mood, social withdrawal, and disengagement from achievement (Burgin et al., 2023). These data do not depict a portrait of families falling apart, but of families doing their very best under extraordinary circumstances, quietly asking for something more from the systems meant to support them.

Bereaved military families benefit from both practical and relational support. One of the most valuable contributions a clinician can offer is an understanding that a child’s grief does not resolve; it evolves. As children reach new developmental milestones — starting a new school year, learning to drive, walking across a graduation stage — they may encounter their loss anew, through a lens shaped by who they are now. A bereaved ten-year-old and a bereaved seventeen-year-old are processing the same loss in profoundly different ways, and both deserve care that honors their experience. Holmes et al. (2013) noted that surviving parents often need guidance about how to talk with their children at each stage of development; clinicians who take time to understand the unique features of military grief — including its cultural context, secondary losses, and community disruption — are well positioned to provide this kind of support.

The parent-child relationship is not peripheral to grief care for these families. It is central to it. Research has consistently shown that a surviving parent's functioning and the family's cohesiveness are among the strongest predictors of children's positive adjustment after parental loss (Holmes et al., 2013). Supporting the parent is, in a very real sense, supporting the child.

The providers bereaved families turn to need to be families with the unique contours of military grief. For clinicians working with these families, a few orienting principles can guide effective care. First, take a military-informed history — even when the service member is gone, understanding the family’s military background, branch of service, and community connections can illuminate important sources of meaning, identity, and loss. Second, be attentive to what might be called the “resilience paradox”: because these families have often internalized a culture of strength, they may minimize their distress or delay seeking help. Third, recognize that grief in these families is frequently compounded, layered with the loss of community, financial instability, and role disruption; addressing these practical stressors alongside emotional ones is part of comprehensive care. Finally, treating the parent-child relationship as a direct focus of treatment — not simply a contextual backdrop — supports the whole family system. These are invitations to bring what you already know into a context that rewards informed, curious, and compassionate care.

These families have already given more than most. Clinicians who approach their care with cultural humility, a curiosity about the military experience, and attention to both the emotional and practical dimensions of their loss can make an extraordinary difference. The mental health community has both the tools and the opportunity to meet these families with the depth of care they deserve.

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 War.

Elizabeth Burgin, Ph.D., is a Licensed Professional Counselor serving as a Military Behavioral Health Child Counselor at the Consortium for Defense Psychology (CDP) at the Uniformed Services University for the Health Sciences in Bethesda, Maryland. In this role, she supports the DoD Child Collaboration Study to identify best practices for enhancing and expanding accessibility to care for military-connected children and adolescents.

References
 Burgin, E. E., Prosek, E. A., Shin, K., Cunningham, V. L., & Ponder, W. N. (2023). *Needs assessment of surviving military families: Clinical symptoms and the parent-child relationship*. Manuscript submitted for publication.
 Cozza, S. J., Hefner, K. R., Fisher, J. E., Zhou, J., Fullerton, C. S., Ursano, R. J., & Shear, M. K. (2020). Mental health conditions in bereaved military service widows: A prospective, case‐controlled, and longitudinal study. *Depression and Anxiety, 37*(1), 45–53. https://doi.org/10.1002/da.22971
 Holmes, A. K., Rauch, P. K., & Cozza, S. J. (2013). When a parent is injured or killed in combat. *The Future of Children, 23*(2), 143–162. https://doi.org/10.1353/foc.2013.0017

By William Brim, Psy.D., 

On 1 June 2026, the Center for Deployment Psychology officially becomes the Consortium for Defense Psychology, continuing to use the acronym CDP while embracing a name that better reflects who we are today and where we are headed tomorrow.

While our name is evolving, our mission remains unchanged.

For nearly 20 years, CDP has worked to strengthen the readiness, resilience, and well-being of Service members, veterans, and their families by preparing the mental health professionals, technicians, and leaders who support them. Through training, education, implementation support, consultation, and innovation, we have remained committed to ensuring that military-connected populations receive high-quality, evidence-informed mental health care that reflects the unique realities of military service.

The transition from Center to Consortium recognizes something that has always been true about CDP: our work has never been accomplished alone.

Over the years, CDP has built enduring alliances across the Department of War, the Department of Veterans Affairs, academia, healthcare systems, and nonprofit organizations. Today, these collaborations are more important than ever as military mental health challenges grow increasingly complex and interconnected.

Our work continues in close partnership with organizations including the Department of Veterans Affairs, the Defense Health Agency (DHA), the National Guard Bureau, and the Department of War’s Sexual Assault Prevention and Response Office (SAPRO). We are also proud to collaborate with our Military Child and Family Collaboratory partners, Kennedy Krieger Institute, Georgetown University, the University of Minnesota, Virtua Health, and the Uniformed Services University’s Departments of Pediatrics and Family Medicine, to improve care and support for military-connected children and families.

At the same time, CDP is strengthening its collaboration with the Uniformed Services University’s Department of Medical and Clinical Psychology. This partnership will further enhance our ability to evaluate outcomes, support implementation efforts, translate research into practice, and ensure our training remains grounded in both operational relevance and scientific rigor.

In many ways, the new name reflects both continuity and growth.

Same initials.

Same commitment.

Stronger partnerships.

As we look toward the future, CDP is renewing and expanding its focus on preparing the military mental health workforce to meet emerging operational demands. This includes identifying, developing, and delivering targeted training and implementation support related to operational stress, wartime mental health needs, suicide prevention, resilience, and Combat and Operational Stress Control (COSC).

Military readiness depends not only on the readiness of the warfighter, but also on the readiness of the professionals and leaders who support them. Mental health providers, technicians, chaplains, medics, commanders, and prevention personnel all play a critical role in sustaining force health and operational effectiveness. CDP remains committed to supporting that broader readiness mission through practical, evidence-informed education and collaboration.

As we celebrate 20 years of service in 2026, we are proud of what has been built alongside our many partners and colleagues. From our earliest days as a tri-service training initiative to our current role as a national hub for military mental health education, CDP has consistently evolved to meet the changing needs of the military community.

The next chapter will require innovation, partnership, adaptability, and resolve and we are ready for it.

The Consortium for Defense Psychology represents more than a new name. It reflects a renewed commitment to collaboration, to scientific and operational excellence, and to the people we ultimately serve: Service members, veterans, and their families.

We are grateful to everyone who has been part of the first 20 years of CDP, and we look forward to building the future together.

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.

William Brim, Psy.D., is the executive director of the Consortium for Defense Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. He joined CDP in 2007, initially as a deployment behavioral health psychologist at Malcolm Grow Medical Center and served as deputy director until 2017. Prior to joining CDP, Dr. Brim served on active duty as a psychologist in the United States Air Force from 1997 to 2007.

By Diana Dolan, Ph.D., CBSM, DBSM

Often in Cognitive-Behavioral Therapy for Insomnia workshops, the personal reactions of the providers attending to recommended interventions is palpable in the room – even when the room is virtual. On the surface, so many of the interventions are counterintuitive: Reduce time in bed when a person is that sleep deprived? Don’t go to bed early even if they actually feel sleepy for once? Wake up early on weekends even without any schedule obligations? Don’t relax in bed before bedtime? Of course, once we explain the rationale things seem much more logical. The goals are quite simply to boost sleep drive consistently over time (rather than say focus on one night), facilitate optimal consistent circadian placement of the sleep schedule, and re-condition the bed and bedroom for sleep.

Understanding the rationale helps providers better implement the CBTI protocol with patients as we can explain interventions more clearly. So the reactions of providers learning about CBTI does not necessarily seem to be about hesitation helping patients use it to improve. Rather, in my experience, reactions stem from a personal perspective. Do I need to start making all these changes to my sleep tonight? This sounds miserable! No, we who train CBTI reassure them, only people with insomnia need to use them. If you’re fine with your sleep, no need to change anything.

Except…what happens when I’m not fine with my own sleep? I’m a sleep psychologist, surely that should not happen! Well, unfortunately it does happen, and it probably happens for many of you providers yourselves reading this.

Personally, while I would not whip out a sleep log and start CBTI from the very beginning every time I have a bad night of sleep regardless, I must confess I do not always practice what I preach. Generally, once our patients have mostly good sleep and have learned the skills, after even one night of poor sleep I tell them they should immediately resume stimulus control to prevent a relapse. Instead, for myself I don’t always get out of bed for every awakening, and on occasion I have tried to sleep in or rest in bed on weekend mornings or even shifted back my alarm a few minutes on other days. Worse – gasp – I have indeed doom-scrolled on my phone in bed. I lay there at oh-dark-hundred filled with imposter syndrome thinking How did this happen? I’m supposed to be a sleep expert! What if I’m up for hours? I’m only going to get six hours of sleep…no, five now…maybe four. Ugh.

Whenever these bad nights occur, I accept that they will be miserable and acknowledge to myself they could continue further since I’m actively choosing not to make use of stimulus control skills in the moment. Fortunately, because I do at least limit sleeping in to an hour or less during these episodes and only a day here or there I have been able to build back a high enough sleep drive that bouts of insomnia only last a night or two. If they persisted, I would plan to give in after about five to seven nights and resume stimulus control, and I’d wait a bit longer to move to sleep restriction.

I still wouldn’t recommend this approach to patients. After all, there is a difference between a few bad nights of sleep and Insomnia Disorder. That said, if you too have occasional bad nights of sleep, even if you use CBT-I in your clinical practice for patients, I think it is alright to give yourself some grace in choosing how you handle them. Just remember you’re ultimately in control because you know how to get back to better sleep – and just don’t tell your patients!

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.

Diana Dolan, Ph.D., CBSM, DBSM, is a clinical psychologist serving as an Assistant Director of Training & Education with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland..

By Shantel Fernandez Lopez, Ph.D.

I recall evaluating and treating an adolescent from a military-connected family who had moved frequently over several years. Each relocation meant adjusting to new schools, routines, and peer environments, changes the family navigated with resilience but that made consistency difficult to maintain. He had engaged in treatment with several providers over time, had several diagnoses, and his caregiver continued searching for support as progress felt limited.

During routine screening for sleep, a different picture began to emerge. He was averaging about four hours of sleep per night, napping for long periods after school, relying on energy drinks, and staying up past midnight playing video games. These patterns contributed to tension at home and difficulty adjusting academically after another move.

As we explored how sleep affected his energy, mood, and relationships, he became open to small, realistic changes, refraining from naps, replacing energy drinks with caffeine free alternatives, adjusting his sleep schedule, and decreasing late-night gaming. These adjustments were made collaboratively with his mother. Over time, sleep improved, family conflict decreased, friendships began strengthening, and his school functioning began to shift. Experiences like this remind me and highlight how meaningful clinical change can begin with routine sleep screening and understanding how sleep influences multiple areas of functioning.

An estimated 20–30% of children and adolescents experience sleep problems, yet sleep remains frequently under assessed in clinical care (Owens, 2020). For providers working with military-connected youth, sleep can be an especially meaningful clinical entry point. Within military-connected youth and family systems, contextual factors associated with military life including relocations, changing school environments, shifting caregiver roles, and ongoing adjustment to new communities may shape daily structure, emotional regulation, and family rhythms in ways that influence sleep consistency, even among highly resilient families.

Rather than viewing sleep as secondary to treatment, many providers recognize it as a foundation that supports regulation, learning, and engagement in care.

Why Sleep Matters
 Military-connected families bring strong adaptability and structure, yet transitions such as time zone changes, reintegration periods, or shifting household roles can unintentionally disrupt routines that support sleep (Lester et al., 2016). These disruptions are understandable responses to changing environments. When sleep difficulties persist, providers may notice irritability, concentration challenges, or increased stress responses. When treatment progress slows, sleep is often an important area to revisit.

Common Sleep Concerns
 Sleep difficulties vary developmentally but commonly include:

• Difficulty falling or staying asleep
• Bedtime resistance or delayed schedules
• Nightmares or nighttime fears
• Insufficient sleep duration
• Circadian rhythm shifts during adolescence

Chronic insufficient sleep is associated with challenges in emotional regulation, attention, learning, and behavior (Gregory & Sadeh, 2016; Shochat et al., 2014). Because these concerns overlap with anxiety, mood changes, and trauma-related stress, integrating sleep assessment into routine care can provide valuable clinical insight.

Taking a Systems Approach to Sleep
 Sleep reflects the interaction of developmental factors, family routines, physiological arousal, environmental conditions, and emotional stress (Owens et al., 2014). Within military-connected families, frequent moves or schedule variability may influence sleep patterns, but they do not determine outcomes. Clinically, sleep disruption often maintains existing challenges rather than causes them outright, making it a meaningful target for intervention.

Evidence-Based Strategies
 Behavioral and cognitive-behavioral approaches remain first-line treatments for pediatric sleep concerns (Meltzer et al., 2014; Mindell et al., 2006). Here are some examples of sleep-focused strategies providers can integrate into practice:

• Supporting consistent bedtime routines
• Encouraging predictable sleep and wake schedules
• Teaching relaxation skills
• Addressing bedtime worries or fears
• Using CBT-informed strategies for insomnia and nightmares

A Practical Takeaway for Providers
 For providers working with military-connected youth, sleep may be one of the most helpful places to begin. Integrating brief sleep screening and targeted intervention can improve engagement, reduce caregiver stress, and support resilience across the family system. Sometimes the most impactful clinical shifts come from strengthening routines that help children feel regulated, supported, and ready to grow.

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 War.

Shantel Fernandez Lopez, Ph.D., is a clinical psychologist serving as a Military Behavioral Health Child Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this role, she supports a study focused on the identification and enhancement of evidence-based treatment delivery to youth with neurodevelopmental and behavioral health needs via telehealth and tele-education.

By Jennifer Nevers, MSW, LCSW

“You feel pretty safe.”

It’s a simple statement, but it carries a great deal of meaning and purpose when shared by a military kid reflecting on what it means for them to have a parent in the military.

In honor of the April's Month of the Military Child, I interviewed my son and stepchildren about their experiences being military-connected. These interviews helped me see how my children relate to military culture and the routines of military life. While their views differ, common themes emerged, including meaning, safety, and loss.

Pre-Deployment: The Notification

“I was pretty chill.”

“I was confused why you were leaving.”

“I was like- three straight months! And then you were gone for another two and a half months”.

Telling the kids I was leaving was an achingly difficult moment for my husband and me. It made our path painfully clear, and there was no turning back. I recall our daughter, the oldest, exclaiming, “You can’t leave! I don’t want to eat cereal for breakfast every day!” Her honesty was raw, and the daily impact stood out in that moment.

Her reaction became my guiding light for what I could focus on with her before I left. Leading up to my departure, she learned how to use the oven, determined to bake crescent rolls with chocolate chips in the middle the way I did. This was the most-requested breakfast I made for the kids a couple of times per week, and living without this routine was a step too far. Navigating my departure was a new experience for her and her brother, as they haven’t always been part of a military family.

For my son, our middle child with Autism, he had a very pragmatic response reflecting on his experience during pre-deployment. He described his reaction as shaped by the predictable patterns of a military kid,

“I was pretty fine because sometimes you do that.” As a concrete thinker, it didn’t seem odd for me to leave. “You’re usually gone for three days.” Even though this was months, not days, he felt prepared for the challenge due to practice effects. Having experienced many separations and reunifications, he’s come to see this rhythm as normal. So, while he often struggles with transitions and change, this felt expected and typical for him.

Deployment: Navigating Separation

“I thought I liked being a military kid, but I care when you leave.”

“You missed my birthday.”

For my stepchildren, navigating this separation was their first time really feeling the reality of what it means to be a military family. Another series of missed birthdays, extracurricular activities, and important events. Being in the National Guard, the periodic days away every month were common. Even the occasional two-week obligations were manageable. But the reality of a long separation meant not only time away from me, but also from my son. Our co-parenting routine and schedule were quite different compared to what they were used to.

For our daughter, that meant she was the only girl in the house, and she very seriously suggested that other deploying parents avoid this dynamic by adopting another child. For our youngest son, it was significant because he didn’t get to see his stepbrother as often as he would have liked. “I like playing with my brother, and that was not cool”. He was careful not to hurt my feelings with his words, but it was clear that what felt most disruptive to him was time away from his stepbrother, whom he’s grown so close to. Blended families often face unique challenges during normative military experiences, such as deployment and other separations. For example, in a local family, the mother's deployment means the stepfather struggles to get time with their stepson, even for significant family events. These challenges can disrupt the home environment for other children, affect the parent-child connection, and undermine the deployed parent's family dynamic.

Deployment: Maintaining Connection

My son would probably be shocked to learn that he’s the one I worried about the most. Would he struggle once the reality set in? How would we connect effectively while I was away? My anxieties informed my questions to him, and I wanted to know what was helpful during my deployment that might be helpful for other parents. He had a quick answer: “Play a game with them.” This is very on- brand for him and reflects how we connected while I was away. We had a video-calling app we used that also let us play games and read books together. He shared that this was helpful and wanted other parents to know it might help their kids, too.

What stood out to me most in these conversations wasn’t the exact experiences but, more so, how they so clearly reflected on what mattered. For them, connection looked like small moments of playing games, reading books, and finding creative ways to spend time together from a distance. It wasn’t the trinkets I brought home, or the sharing of stories and pictures about my experiences. Connection was rooted in the normal joys of childhood. My kids reminded me from notification to reintegration with the family, it’s not about perfection. It’s not about leaving behind the perfect gift or saying just the right words on a recording within a doll, but about those small, deliberate opportunities to share an experience, even from afar.

The most meaningful perspectives from these interviews come directly from the kids themselves. Here are some parting thoughts that my children wanted every child preparing for a parent’s deployment to hear:

“Don’t worry, they’ll be back. It’s ok, you can get through it. It might be hard, but it will be just fine.”

“Be calm, because they’re pretty much going to be ok.”

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.

Jennifer Nevers, MSW, LCSW, is the Subject Matter Expert Office Lead for the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

By Amanda McCabe, Psy.D.

Service members, including Active Duty (Army, Navy, Air Force, Marines, Space Force), Reserve Units, and National Guard members, are referred to network providers for a wide range of medical care, including behavioral health services. Receiving care outside of a military treatment facility can be more complex than typical civilian healthcare. This is due to the unique demands of military service, such as strict physical fitness standards, operational responsibilities, and the need to handle weapons and sensitive equipment. As a result, service members must consistently demonstrate fitness for duty through regular readiness evaluations. These assessments are often part of routine medical appointments, though they may also occur separately.

When care is provided outside of the military system, periodic check-ins are required to assess whether the service member can meet military retention standards. These evaluations determine if the service member can continue full duties, requires temporary duty restrictions, or may need permanent restrictions, potentially leading to medical retirement.

This process differs from civilian healthcare practices, even though it shares some similarities with evaluations for pilots or law enforcement officers. To help civilian providers better understand military medical requirements, we have developed a set of tools to clarify these expectations and processes.

We have developed a new frequently asked questions (FAQ) handout for community providers, outlining the process of readiness evaluations, sometimes called Fitness for Duty evaluations, for service members who are seeking behavioral health care in the community.

In addition to our FAQ, we also have two videos (Military Readiness & Military Readiness and Behavioral Health) that walk providers through the background of the assessments, as well as the process of a request for information, and what it might look like for a behavioral health provider.

Finally, there are three blog posts (What is Readiness and Why is it so Important; Overview of Military Readiness Assessments; Private Sector Providers and Readiness) that describe this process in detail, as well as include a step-by-step guide if and when a provider finds that a military official is requesting information about your patient, in the name of a readiness evaluation or fitness for duty.

Again, these can seem like a foreign process if you are working outside a military hospital, military treatment facility, or MTF; however, these are all typical processes within the military medical system, and hopefully, these resources can help clear up some of the ambiguity, mitigate anxiety, and guide providers through this process.

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.

Amanda McCabe, Psy.D., is a Military Behavioral Health Psychologist with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this capacity, she develops and presents trainings on a variety of evidence based therapies. Prior to the CDP, Dr. McCabe served as a clinical psychologist in the Army from 2013 to 2024.

By Jaime Rodden

The Rise of Wearable Health Technology
 Wearables have become increasingly popular over the last few years, and chances are high that you own one yourself, or someone in your close circle does. In fact, over one-third of U.S. adults report using a wearable device, with significant continued growth reported annually. Wearable devices, which include smartwatches, biosensors, and activity trackers, collect physiological data to inform our understanding of health and well-being. Not only can this help individuals better understand their daily health habits and set goals for improvements (cue me immediately Googling ‘walking treadmills’ after seeing my step count following an eight-hour day at my desk), but these devices also possess significant potential for real-time health monitoring and tracking of physical and mental health conditions such as cardiovascular disease, chronic respiratory conditions, anxiety, stress, and insomnia.

Wearables for Sleep Monitoring
 Sleep wearables have gained particular traction in recent years, appealing to those focused on optimizing their physical and cognitive performance from the likes of athletes and service members, and individuals navigating mental health challenges, such as insomnia and anxiety. These devices claim to detect light, deep, and REM sleep phases, and measure sleep metrics such as sleep onset latency, to compile the dataset into a “sleep score” reflecting nightly and average sleep quality. This information can be genuinely useful for understanding sleep habits and making informed changes to optimize health. The potential benefits are promising and initial validation studies show promise, but further exploration into the reliability of these metrics is still needed.

When Data Becomes a Detriment
 The surge in sleep wearable device popularity has also surfaced some potential downsides worth considering. A new term has emerged, orthosomnia, defined as a preoccupation with perfecting one’s wearable sleep data. Initial research suggests that for a subgroup of users, regularly fixating on sleep metrics may actually backfire, exacerbating insomnia and reinforcing their sleep-related anxiety, rather than relieving it. One proposed explanation is that people may feel compelled to spend extended periods of time in bed in order to boost their numbers, but since devices tend to overestimate time spent asleep, this can be counterproductive, leading some people to believe they have a sleep problem when they are, in fact, getting adequate rest.

Wearable Data in the Clinical Setting
 For providers, wearables can serve as a useful tool for objectively understanding patients’ sleep habits when coupled with evidence-based psychotherapy treatment such as Cognitive Behavioral Therapy for Insomnia (CBT-I). That said, it’s crucial to keep in mind that patients may arrive with firmly held beliefs about what their device data means, and those beliefs can be resistant to change. The decision to incorporate wearable feedback into treatment should be individualized, guided by each patient’s relationship with their device and whether engaging with that data seems likely to help or hinder progress. Some patients may even resist traditional treatment altogether, preferring to rely on their wearable data instead. As the science behind sleep wearable accuracy continues to evolve, providers are encouraged to be intentional about positioning wearable data as a supplemental resource for raising awareness, rather than a driver of treatment decisions. For those who are open to it, providers can use the opportunity creatively, for example, having patients track subjective sleep quality and daily functioning both with and without their device, turning it into a meaningful behavioral experiment.

Looking Ahead: Maximizing Benefits While Minimizing Harm
 Overall, wearable technology brings exciting possibilities for physical and mental health monitoring and optimizing. As the market continues to expand rapidly, it’s important that we thoroughly weigh both the benefits and potential drawbacks of weaving these devices into our daily lives and clinical care practices.

CDP’s Research
 The themes explored in this post are ones our CDP team is actively investigating in collaboration with Walter Reed Army Institute of Research-West, Malcolm Grow Medical Clinics and Surgery Center, and Tripler Army Medical Center. The clinical trial study evaluates the effectiveness of an mHealth application and group-based Cognitive Behavioral Therapy for Insomnia (CBT-I) across various provider levels and objectively measures sleep using a Fitbit device. To learn more about the study, visit the one-pager here.

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.

Jaime Rodden is a Clinical Research Manager for the Center for Deployment Psychology (CDP). In her role she works to advance the center's research portfolio, providing management for clinical studies through supervision, administrative oversight, and coordination of research protocols.