Stories - Blogs

By Timothy Rogers, Ph.D.

We all know that sleep is important. A 2021 congressional report by the Department of Defense (DOD) described sleep as the most important biological factor determining health and combat readiness. 

The report was based on a study required by the National Defense Authorization Act (NDAA) for Fiscal Year 2020 (Public Law 116-92).

The study had four objectives:

1. Provide a standardized definition of sleep deprivation.
2. Conduct an assessment of the prevalence of sleep deprivation among members of the Armed Forces.
3. Assess the relationship between sleep deprivation and medical conditions such as traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and depression.
4. Provide recommendations on efforts to mitigate sleep deprivation based on the study's findings.

The report defines sleep deprivation as “inadequate sleep that negatively impacts a service member’s military effectiveness, evidenced by a reduced ability to execute complex cognitive tasks, communicate effectively, quickly make appropriate decisions, maintain vigilance, and sustain a level of alertness required to carry out assigned duties” (Department of Defense, 2021). A recent review by Rodden et al. (2026) on the impact of sleep deprivation on combat readiness supports the DoD’s definition and created an infographic to summarize key findings from the literature (See figure 1). Prevalence estimates for sleep deprivation among service members were roughly twice as high compared to civilian populations, with 64% reporting getting less than seven hours of sleep per night.

The report notes multiple challenges to obtaining adequate sleep, often related to operational demands. It provides supporting evidence that sleep deprivation is significantly related to mental health conditions such as TBI, PTSD, depression, as well as suicide risk, with 23% of deployed service members screening positive for a mental health disorder when getting four or less hours of sleep per night (Department of Defense, 2021). To address these findings, the report made several recommendations, including adopting duty schedules that ensure eight hours of sleep, implementing sleep-related training for both service members and leadership, the importance of brief interventions, research focused on circadian rhythm issues, and establishing a clearinghouse for military sleep-related resources.

However, a Government Accountability Office (GAO) report in 2024 found that the DoD had no formal plans to implement or monitor the recommendations from that 2021 study. The GAO report noted that between 2015 and 2019, there were 489 reported instances of fatigued-driving related fatalities. Additionally, fatigue has contributed to hundreds of millions of dollars in damage to ships, vehicles, and aircraft (Government Accountability Office, 2024).

Citing the need to address military culture factors that negatively affect sleep and to improve the coordination of research and training, the GAO report serves as a call to action to convene a summit that focuses on addressing sleep and fatigue issues within the Department of War. The Uniformed Services University and its Center for Deployment Psychology, Consortium for Health and Military Performance, Center for the Study of Traumatic Stress, Department of Neurology and Rehabilitative Medicine, along with the Walter Reed Army Institute of Research, and United States Air Force are hosting a 2-day summit for researchers, policy makers, and other key stakeholders to address:

1. Sleep and fatigue challenges in military operations
2. The role of research in advancing sleep intel to support mission readiness
3. Dissemination and implementation strategies to optimize sleep and fatigue management

For more information about the sleep summit, please contact dod-sleep-summit-ggg@usuhs.edu or visit https://sites.google.com/usuhs.edu/sleep-and-fatigue-management/home

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.

Timothy Rogers, Ph.D., is an Assistant Director of Online Training, Technology and Telehealth for the Center for Deployment Psychology (CDP) at the Uniformed Services University for the Health Sciences in Bethesda, Maryland.

References:
 Department of Defense (2021). Study on the effects of sleep deprivation on the readiness of members of the Armed Forces.
https://assets.documentcloud.org/documents/20495233/study-on-effects-of-sleep- deprivation-on-readiness-of-members-of-the-armed-forces-final-report.pdf

Government Accountability Office. (2024) Military readiness: Comprehensive approach needed to address service member fatigue and mange related efforts. (Report No. GAO-24-105917). https://www.gao.gov/products/gao-24-105917

Rodden, J., Rogers, T., Dolan, D., & Paxton Willing, M. M. (2026). Sleep isn’t Optional, it’s
      Operational: The biopsychosocial toll of sleep deprivation in the armed
      forces [Manuscript accepted]. Military Medicine.

By Khristine Heflin, MSW, LCSW-C, LCSW, LICSW

I have served on the Military Child and Family Collaboratory, here at the Center for Deployment Psychology for almost four years now. A part of that work has been the valuable insights that I have gained from, providers, policy makers, advocates and families at our bi-annual convening events. One common theme is that our military families are often described as resilient, even as military youth face unique circumstances and navigate settings and situations marked by constant change. Hearing this theme repeated led me to look more closely at how resilience is supported and defined within military families.

Although there has not been a consensus on the definition of resilience, we can conclude that there are both individual factors and external circumstances that interplay to foster resilience (Skomorovsky & Dursun, 2022). Family resilience research emphasizes that risk and protective factors operate together and the balance of these factors influences a family's ability to be resilient (Sullivan et al., 2020). This framework also underscores how resilience can only fully be understood when providers consider the interaction between a family's stressors, strengths and access to resources (Sullivan et al., 2020).

To bring this framework to life, I want to share some reflections of a recent conversation with my cousin on what sustains her family’s resilience.

Before we get started can you please tell us a little about your family?
 We are the Johnsons. Andrew is 39 and has served on active duty in the U.S. Air Force for 15 years, and I’m Liz, 36, his spouse. We’ve been married for 11 years and are raising two kids—Dylan, our 9-year-old soccer enthusiast, and Amaya, who is 7 and proudly claims the title of gymnastics queen, along with Jefe, our forever puppy, who is either 10 or 70 depending on how you count dog years.

Andrew and I met at his first duty station in Washington, D.C., and since then our family has completed six permanent changes of station and experienced two full deployments. Dylan has already lived through five PCS moves, Amaya four, and Jefe five, each move adding another chapter to our family’s military journey.

-When you think about the term resilience, what does it mean for you in your day-to day life and what is needed to ensure that families maintain resilience?
 Definitely going with the flow and having to be okay with it. With Andrew being active duty, every so often, he’ll get his call-to-duty email and that’s when everything shifts gears with the quickness. When Andrew leaves, I try my best to keep our schedule the same or I may have to add more guidelines to our schedule. My saying for when he’s gone is “we’re all on the same team, we need to 'play' in harmony so that we can make this work”. I try to make sure the kids don’t miss out on their activities and maintain a sense of normalcy. Sometimes, I feel like I’m overcompensating to fill the absence of dad.

It sounds like flexibility is an important component of your family’s ability to maintain resilience. I know your family recently PCS’d. Can you tell us a little about that? How has military life such as deployments, trainings, frequent moves, or changes in routine impacted your family’s sense of connection, adaptability or staying steady during change and what helps your family stay cohesive during these transitions?
PSC-ing is very hard. This particular PSC came with a lot of anxiety for me and sadness for the kids. Andrew and I have open conversations about the upcoming PCS so we can prepare the kids and ourselves. I would schedule more playdates or try to squeeze in that last family vacation to make the idea of leaving less dreadful. We lived overseas and loved every minute of it. Living in Okinawa, I felt safe. My children got to be children (go outside and play without me standing feet away from them, walk alone, not have to worry about active shooters or even having to participate in the drills). I was able to let my guard down and feel human. Once we got the news we were coming back, I started to become stressed, stressed about money, the political climate and not having a job. For the kids, now that they’re older, they’ve expressed sadness because of them having to their friends, schools and teams.

We are a very tight knit family, Dylan and Amaya are each others best friends, they play extremely well together. I’ve had to have a lot of heart-to-hearts with them and remind them that they are always going to be there for each other no matter what. It’s funny to see how they are so different when they interact with their friends. Dylan is more reserved and will have maybe 1 or 2 solid buddies and then there Amaya, she had everyone and their family as a friend. Watching them say goodbye to their friends was hard for me. Amaya and her “besties” cried the whole day and hugged. Dylan gives a quick high-five and a “bye guys” and goes on about his business. Once we landed in the U.S. I saw the excitement and the calmness leave him and he became very sad for a few days. It took him a while to say the words “I’m sad” “I miss my life in Okinawa” “I want to go back”.

Because we PCS-ed during the holiday and the kids weren’t enrolled in school, our schedules were all out of whack, going to bed late, eating out, sleeping in. We talked about how this Christmas didn’t feel like Christmas. Typically right after Thanksgiving, we’re gearing up for Christmas, this year we were gearing up for a move. Dylan reminded me that this year we did not have our traditional movie nights or hot chocolate dance parties. Hearing that made me extremely sad because I am “Mother Christmas" and I feel like as a mom, it’s my duty to help create these traditions and memories.

It’s clear that a move can bring on both excitement and stress, can you share what helps your family maintain stability and a sense of belongingness?
 I try my hardest to keep connections with our family members, cousins and friends to maintain normalcy and consistency for the kids. Thank God for technology, the kids have been able to chat or Facetime their friends and family whenever they want. I try to show them that they don’t have to forget anyone just because we aren’t physically close to them.

What supports, resources, or change within schools, health care, or military systems would support greater resiliency for you and your family?
The process of transferring schools might have be the most nerve wracking for me. During our most recent move, the school we were transferring to needed all of these reports and forms that the kids' current school was not able to give to us until the semester finished, which was bringing us too close for comfort. Having the kids transition right into school was a big goal for me, so that they didn’t have such a big break in their routine, but in true PCS fashion, things just didn’t go as planned. I wish the military would allow/pay for one family member to travel with us during a PCS. This would take a lot off of our minds when we are trying to do our last minute packing or bag check ins. This time around, when we arrived in San Antonio, we had eight large totes, three big suitcases two kids and one dog with a very large travel crate. Having to wrangle everything up, and not have it in the way of the other travelers and keep the kids put, was very hard, especially when we had to walk the entire airport to go to retrieve a rental. Thank God I ran into a longtime friend in the baggage claim, he was willing to sit with our bags and the kids while we got our rental. If we had someone already there with us, we would have gotten out of that airport a lot quicker. Another option might be to have a sponsor ready and waiting for us with a large vehicle to pick us up from the airport and drive us to the hotel. In Okinawa, we drive on the opposite side of the road and car. Coming back and having to immediately remembering how to drive in a state where the minimum speed limit is 80 MPH and it was night (I don’t do well with night driving) was scary. I was terrified, and I kept it 100% honest with my kids, mom was scared. So we drove in silence to help me concentrate. We have a good laugh about it now, but if we could have something like a shuttle service, that would alleviate a lot of stress and added anxiety.

Why are periods of rest or stability important for your family’s resilience?
 This PCS we had a longer period of rest because of the holidays, which for the kids was great, for me, I was burnt out with “Mommmmmm” “Can you charge my ipad?” “Where’s my chargerrrrrr?” “Can I have a snaaaackkkk?”. I think by 12/31 the kids were ready to go back to school and I definitely started that countdown lol. I do, however, like having those moments of rest because it gives us an opportunity to sit with our feelings, good or bad and recalibrate.

Military families and youth experience various risk factors that contribute to challenges, including deployments, reintegration following deployment and frequent moves but their outcomes are shaped not only by these challenges (Sullian et al., 2020). Protective factors like family cohesion, access to resources and support and connection to community serve as a buffer against negative outcomes and contribute to resilience (Sullian et al., 2020).

These experiences of the Johnson family show the work of resilience emerges through the steady and often forgotten moments of connection, flexibility and rest. Sustaining families means not only acknowledging the demands of military life but fostering an environment that promotes coordinated systems of support and opportunities for families to connect, rest and reset.

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.

Khristine Heflin, MSW, LCSW-C, LCSW, LICSW, is a licensed Clinical Social Worker and has been practicing since 2006. Currently, she serves as a Military Child Social Worker with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences located in Bethesda, MD.

References:
 Skomorovsky, A., & Dursun, S. (2022). Introduction: Resilience in military families. Military Behavioral Health, 10(2), 71–73. https://doi.org/10.1080/21635781.2022.2098886
 Sullivan, K. S., Hawkins, S. A., Gilreath, T. D., & Castro, C. A. (2021). Mental health outcomes associated with risk and resilience among military-connected youth. Family Process, 60(2), 507–522. https://doi.org/10.1111/famp.12596

By Annie Layden, LICSW

In military culture, resilience is often framed as endurance — pushing through, carrying on, not slowing down. Strength is measured by how much stress an individual can shoulder without falling apart.

However, stress can become chronic through prolonged work hours, unpredictable schedules, frequent changes, separations from support systems, or exposure to perceived or real threats that keep the nervous system activated for extended periods. This can lead to exhaustion, irritability, sleep disruption, poor communication, and emotional numbing, and eventually a shame spiral for not practicing better self-care. The real challenge is to create opportunities to downshift because the nervous system can better handle chronic stress when it also receives signals of safety and regulation.

Resilience doesn’t require special equipment, extended time off, or perfect conditions — it needs to be practiced daily in small doses through repeatable habits that help the nervous system recover from stress. This is where micro-resilience becomes a clinical tool. Micro-resilience refers to brief, intentional actions that help regulate the stress response throughout the day. Individually, these actions may feel insignificant. Collectively, they create physiological conditions that support emotional regulation, cognitive flexibility, and relational capacity. Think of these strategies as a replenishment tool, like a protein shake after completing a challenging workout. Clients can create a routine that includes many mini-opportunities for recovery for their nervous system.

Framing resilience this way can help reduce all-or-nothing thinking and support clients who feel overwhelmed by traditional self-care recommendations. Clinically, micro-resilience aligns well with trauma-informed and strengths-based approaches.

Micro-resilience strategies are designed to be taught simply and adapted to each client’s individual experience. Providers may find it helpful to offer one or two at a time, and normalize experimenting rather than compliance. The graphic provides examples of six micro-resilience strategies to share with clients.

In families, micro-resilience can be framed as a shared practice, rather than an individual responsibility. This approach reduces pressure on any one family member to “hold it together.” Family-based examples, include:

• Consistent goodbye or reunion rituals
• Naming stress out loud
• One shared moment of calm

Micro-resilience reminds us, and our clients, that meaningful change doesn’t require ideal conditions. It only requires enough moments of safety, connection, and regulation to allow the nervous system to rest.

If you want to further explore the topic of micro-resilience, consider listening to this podcast episode with Bonnie St. John, co-author of Micro-Resilience: Minor Shifts for Major Boosts in Focus, Drive, and Energy, https://www.youtube.com/watch?v=fnMcNQ5mBhc.

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.

Annie Layden, LICSW, is a licensed clinical social worker working as a Military Behavioral Health Social Worker for the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

By Drs. Jessica Strong and Elizabeth Burgin

Military families are ready. Military children are resilient.

These terms - “readiness” and “resilience” - are widely used as compliments, describing the strength, tenacity, and perseverance of military families to adapt and overcome the challenges of military life: family separations, frequent moves, and inherent dangers. And indeed, we celebrate the strength of these families.

But how ready do families need to be?

How resilient is enough?

Do families truly have to be Semper Paratus - always ready?

What does it mean to be “ready” or “resilient”?

This expectation and celebration of readiness and resilience is a dual-edged sword. While the sentiment behind the labels is good, their oversimplification has caused controversy. The core problem lies in the blurred, often contradictory, understanding of what it means to be truly ready for the military lifestyle.

First, let’s look at readiness.

The DoD has defined Family Readiness as:

“The state of being prepared to effectively navigate the challenges of daily living experienced in the unique context of military service” (DoD Instruction 1342.22).

This characterizes “readiness” firmly as a state, something that shifts with time and context. A more nuanced understanding of readiness recognizes that it is not just a state, but a cultivated state —a limited resource that we must actively support and replenish, like a basil plant. If you cultivate it and let it flourish with water, sunshine, and rich soil, you can continuously reap its rewards. You can make pesto today and still have leaves for margherita pizza next week. But if you strip all the leaves clean, or neglect to water it, the plant will not magically produce more leaves on demand. When you know it is finite, but replenishable, you use it more sparingly and be intentional about nurturing it when it’s under stress.

The military family's capacity for readiness is like that basil plant. It requires continuous, systemic nourishment to sustain its strength against the constant, compounding demands of military life.

Now, let’s look at resilience.

Resilience is commonly conceptualized as the ability to bounce back from stress, like a rubber ball. The rubber ball has the inherent ability to bounce back, because of its nature. No matter how often or how hard it is thrown, it will bounce back because it is made to do so.

This definition characterizes resilience as a trait - something a person has or does not have. Defined this way, military family members either have the ability to be resilient, or they fall short. When the system operates under the trait assumption—the label can become a weapon that denies struggling families the necessary aid.

Military spouse and author Jennifer Barnhill highlights this danger, noting that “Military resilience has been reduced to a verbal pat on the back for military families to earn—a label that is awarded, not a skill they develop” (Barnhill, 2025).

This praise feeds the dangerous "superhero" narrative, which gives drowning families a high five instead of a hand up. Being labeled "resilient" can actively block access to care. Barnhill describes an instance in which a spouse navigating serious medical care for their children was denied case management support because they "appeared resilient" and didn’t seem to need the resource.

In these cases, praise without practical support isn't just hollow; it becomes pressure to endure silently. It does real harm; spouses go without health care, including mental health care, for fear of appearing “weak” or not living up to the expectation of resilience. This damages the whole family, as we know the parents’ mental health is one of the best predictors of a child’s wellbeing (Briggs et al., 2020).

Furthermore, labeling families as inherently resilient glosses over the modifiable stressors that required resilience in the first place. It shifts the focus to individual coping skills instead of policies, resources, and sustainable support that could help carry the load.

After rigorously examining how family resilience is defined in the academic literature, Meadows and colleagues concluded: “Readiness is a state and/or condition that focuses on the resources individuals have before experiencing stress, whereas resilience is a process that focuses on the outcome of experiencing stress” (Meadows et al., 2015). They suggest that a definition of resilience should include the following themes: “a process, successfully overcoming adversity or obstacles, being strengthened by an experience, and having resources and utilizing these resources effectively” (Meadows et al., 2015) and further suggest adopting the following definition or family resilience:

“Family resilience can be defined as the ability of a family to respond positively to an adverse situation and emerge from the situation feeling strengthened, more resourceful, and more confident than its prior state.” (Simon et al., 2005).

This definition recognizes that military families can grow stronger through successfully navigating the unique and cumulative stressors of military service, but they require resources and support.

Military family readiness is a context-dependent, cultivated state that must be supported and nurtured.

Military family resilience is a process by which families may recover from adversity and emerge stronger, but it requires the provision or development of resources.

In either case, to conceptualize either readiness or resilience as a trait that families either have or don’t have is problematic and can cause real harm.

It is simply impossible for any human unit to be truly ready at all times and resilient in all circumstances. Striving for constant preparedness and immediate recovery from cumulative stressors is unsustainable and unrealistic. The military family, especially without the benefit of traditional civilian systems of support (extended family, stable employment, local networks), is not a self-contained unit capable of adapting to every stressor at any time with no external support.

True readiness or resilience are not about always bouncing back or being ready for anything at any time, and depend on creating and maintaining sustainable systems of support, not individual grit and bootstraps.

Developing these sustainable systems of support is not the sole responsibility of military families - though they have a big role! It is also not solely the responsibility of the military system. This fabric of support should include strands from families, military systems, and the larger civilian community and society. We need to shift from a demand for military families to be superheroes and instead build stronger, more adaptable support systems that match the magnitude of their sacrifice.

We can start by using the right language.

References:
 Barnhill, J. (2025). The military stories you’ve been told and the ones you need to hear. E.P. House.
 Briggs, E. C., Fairbank, J. A., Tunno, A. M., Lee, R. C., Corry, N. H., Pflieger, J. C., Stander, V. A., & Murphy, R. A. (2020). Military life stressors, family communication and satisfaction: Associations with children’s psychosocial outcomes. Journal of Child & Adolescent Trauma, 13(1), 75–87. https://doi.org/10.1007/s40653-019-00259-z
 McInerney, S.A., Waldrep, E., and Benight, C.C. (2022). Resilience enhancing programs in the U.S. military: An exploration of theory and applied practice. Military Psychology. 36(3). 241-252. doi.org/10.1080/08995605.2022.2086418
 Simon, J., Murphy, J., and Smith, S. (2005). “Understanding and fostering family resilience,” The Family Journal, 13, 2005, 427–436.

By Brian Ludden, Ed.D., LMHC, LPC

I remember being a kid, maybe nine or ten years old, rushing to my best friend’s house after school to play Mario Kart on his Nintendo. We would spend hours racing around 16-bit rainbow tracks, smashing blocks, and throwing bananas. I didn’t realize then that gaming could be more than entertainment, or that for some people it could one day become a healthy way to cope with stress.

For years, I’ve been drawn to survival, crafting, and adventure-style games. Think Minecraft, Conan Exiles, Valheim, or Enshrouded, to name a few. In these games, players gather resources, build shelters, craft tools, and shape the world around them. What I’ve always appreciated is that many of these games allow creativity without urgency. There is often no pressure to perform, no constant combat or repeated restarts after dying, and no demand to move quickly. Instead, there is space to explore, discover, and build at your own pace. For me, that slower rhythm is calming, relaxing, and restorative, rather than the stress that is often associated with gaming.

So it caught my attention when, during a recent therapy session, my client asked, “Is playing video games a good coping skill, or am I just avoiding my issues?”

The client, a woman in her mid-60s, has been struggling with significant anxiety, stress, and worry related to a number of all-encompassing life circumstances. Throughout our time together, we have been working to build coping skills that support the deeper and sometimes difficult work we are doing in session. Recently, she began playing Valheim with her adult son, who lives across the country. It has become a meaningful way for them to connect, but as she noted, it has also served as a powerful distraction from her worries.

Valheim is an open-world survival and crafting game set in a Viking-inspired landscape. Players explore a vast environment with few limits, gathering resources, building homes and settlements, and progressing through the game at their own pace, either solo or cooperatively with others online.

Her concern that gaming might be more avoidance than coping is not unfounded. Healthy distraction, unfortunately, has developed a poor reputation in many therapeutic spaces. Historically, a number of therapeutic models emphasized emotional processing and direct engagement with distress, often cautioning that anything pulling a client away from “doing the work” could be counterproductive.

There has long been a belief that growth requires sitting with distress and acclimating to it. While that approach can be helpful for some, not every person responds well to sustained emotional exposure, especially when their nervous system is already overwhelmed.

The concern that distraction equals avoidance is understandable, but it misses something important. Healthy distraction is not about permanently avoiding unpleasant or distressing feelings. It is about creating enough space for the brain and body to recover from the physical and emotional impacts of stress. When someone is chronically overstressed, their nervous system struggles to self-regulate. Insight narrows, problem-solving becomes harder, and overall well-being declines.

In these moments, healthy distraction can allow anxiety to settle, reduce reactivity, and restore balance. From that regulated place, people often return to their challenges with clearer thinking, renewed motivation, and greater resilience.

Relief is not the enemy of growth. Sometimes, when you are stressed, overwhelmed, and struggling to make sense of the world around you, you don’t need more effort or insight. You may simply need a brief visit to another world, one that allows you to rest, reset, and return.

So the next time you find yourself, or a client you support, feeling overwhelmed and dysregulated, consider stepping into a new world for a while. Harvest a few resources, build something meaningful, and allow yourself time to rest and reset. You might be surprised to find that when you return, the challenges you left behind feel a little more manageable.

If you are curious about where to start, I often recommend Enshrouded as an excellent entry point for those seeking a relaxing gaming experience. It is, by far, my personal favorite. Its emphasis on exploration, building, and creativity allows players to engage at their own pace. There are countless tutorials and creative design videos on YouTube for those who enjoy learning by watching or who simply want a bit of inspiration. It is a great option for exploring whether this kind of play feels restorative for you or the clients you support. You can visit enshrouded.com to learn more about the game, or take some time to explore the other games mentioned here and see which ones spark your curiosity.

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.

Brian Ludden, Ed.D., LMHC, LPC, , is a Military Behavioral Health Counselor at the Center for Deployment Psychology (CDP) within the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

By Debra Nofziger, Psy.D.

Lately, I have found myself speaking a lot with new professionals in our field, all of whom had anxiety about not knowing what to do and experiencing big-time imposter syndrome. It has made me reminisce about my own beginnings and the anxiety I felt being new, looking forward to the day I would feel confident with my cases. I hate to tell all of you new professionals this, but the idea that professional confidence is knowing exactly what to do all the time is an absolute myth.

What is professional confidence made of? How do you get it? Is it knowing how to treat each patient you encounter, or is it something else? The belief that at some point during your training or early years you will suddenly know exactly what you are doing is seriously unhelpful pressure. This idea inevitably causes panic when people realize that they still don’t know what to do with different patients. “I don’t know what I’m doing!” “I’m an imposter!” You can insert any similar statement here and they all ultimately do the same thing – kill our professional self-esteem and confidence. How can you be professionally confident if you don’t “know what you are doing”? How can you develop confidence otherwise? To answer these questions we have to explore what professional confidence really involves.

Is professional confidence achieved by making sure you do treatments “by the book” so you are following an evidence-based path? That does result in you being confident in the evidence base behind the treatment. However, I cannot honestly think of the last time I had an evidence-based treatment go perfectly and without my having to figure out how to adapt it in some way to make it work for the more unusual cases I tend to get. We also know that even when we can follow a specific protocol with absolute fidelity, we still don’t know what the patient will do – if they too will be absolutely faithful to it, how they will apply the learned skills, or what their end results will be.

Does professional confidence mean having lots of different treatment protocols in your toolkit that you can select from? That way, you have something to pull out at the appropriate time. That is part of it, but not all. Variety in your training and the treatment protocols you know does mean you are more likely to have something to apply to your patient. You still have to figure out how to shape that protocol to fit the person sitting in front of you, and that is where things can get dicey. Flexibility in therapy is crucial to meet our patients’ needs. This is where the artwork comes in, and there isn’t a manual for that.

If you can’t know how to treat everything, can you be professionally confident if you simply focus on a specialty area, meaning you only take specific patients and can apply the same tools? This would mean that you become more expert with those treatments and how to apply them to fit your patient’s needs. People who specialize are absolutely more expert in their concentration area than people who remain generalists. But even specialists find many times when they don’t know what to do with a specific case. Does this mean they simply aren’t expert enough yet, and if they continue their study they will gain this confidence? Probably not, because there will always be times when their expertise doesn’t perfectly fit with the presenting patient.

I worked daily with behavioral health interns for many years and continue to work with them intermittently to this day. What I have observed is that for most new professionals, they think being professionally confident means one of the things I’ve already mentioned – being skilled enough treating patients that you know how to treat whatever case presents itself. “I know what I’m doing” equates to knowing a specific treatment plan and knowing you can follow through with it successfully by the time the patient leaves their first appointment. They feel that admitting to not knowing what to do with a patient is some kind of failure as a professional.

In my humble opinion, the bottom line is this: the day you know exactly what you are doing, you need to get out of the profession because you then have a god complex. Feeling confident in this field isn’t always knowing what to do. It is knowing you can figure it out. And that doesn’t have to be in a single session. Do you know the basics – how to check for safety, explain limits of confidentiality, and get enough background information to have a good idea of the presenting problem and the start of a case conceptualization? Are you able to be an active and empathic listener, establish rapport, and ensure the patient feels heard by you? In other words, can you do the very basics that go into every encounter? If the answers are “yes” to these, then I think you indeed know what you are doing overall.

As for knowing the various treatment protocols to address different diagnostic issues, those are things we can consult about, read up on, and get further training for. There will always be times when I am at the end of a session and have no clue what to do next. But I can assure my patient we will figure it out together to get them on the path toward recovery, whatever that might look like for them. That is what professional confidence looks like. I’m not a god. I don’t know everything and I never will, especially when it comes to the immense variety in our patients. There will always be cases that challenge me and treatments I’m not yet sure about. That is what keeps me striving as a professional – not knowing it all, but having the confidence I can learn more and figure it out.

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.

Debra Nofziger, Psy.D., is a Senior Military Behavioral Health Psychologist and certified Cognitive Processing Therapy Trainer with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

By Alessandra Grillo, Ph.D.

The year 2026 is upon us. As we usher in a New Year, for many, this is the opportunity to set a new goal, intention, or resolution. Did you set a New Year’s resolution? If so, statistically speaking, you’re not alone. A recent study by the Pew Research Center found one in three adults made at least one resolution, and over half of this group made more than one goal. Paradoxically, roughly 41% of those adults abandoned at least one goal (or all of them) by the end of the month (Garcia, 2024). In fact, a popular social platform for fitness (Strava) dubbed the second Friday of January as “Quitters’ Day,” based on site data suggesting that fitness-related resolutions or goals are statistically most likely to be abandoned then (Strava, 2025). .

These trends raise an important question: what distinguishes a sustainable goal? While the specific behavior of goal setting around the New Year is surprisingly understudied, we can look to literature on motivation and behavior change to create evidence-based, sustainable goals. As you design your New Year’s resolution, consider the following questions:

Is your goal “Approach” or “Avoidance” oriented?
 Motivational and social psychology often categorizes goals in two buckets: “approach” goals, that is, moving toward positive goals, rewards, or desired outcomes, versus “avoidance” goals, which is moving away from negative, undesirable outcomes including threats or punishments (Elliot, 2013). People who set “approach-oriented” goals (regardless of the goal type) are statistically more likely to complete them versus avoidance-oriented goals (Oscarsson, Carlbring, Andersson, & Rozental, 2020).

For example, a goal of “I am going to engage in 10 minutes of mindfulness each morning” is different from “I am not going to get stressed” because separate cognitive and emotional processes are at play. Approach-oriented goals are associated with greater positive affect and psychological well-being, while avoidance-oriented goals induce negative emotions and can activate fear circuits (Bailey, 2017).

Does your goal connect to your “Why?”: Values-aligned goals
 Both theory and research show that goals aligned with our personal values are more likely to be completed (Sheldon & Elliot, 1999). When establishing a goal, it is useful to reflect on your underlying motivation: what is your “why?” How will achieving this goal add meaningfully to your life? Distinguishing between goals driven by intrinsic motivation (e.g., your “inner drive”) versus perceived obligations (e.g., what others think you “should” do) can be helpful.

Recalibrate your why: A brief values clarification exercise, such as a values card-sorting task grounded in principles of Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999), may help identify core values and guide goal selection.

Is your goal balanced in its level of difficulty?
 Sustainable goals strike a balance of difficulty and attainability. Evidence from organizational psychology shows that goals that are perceived as optimally challenging are more likely to be achieved relative to goals that are “too easy” and require less effort by comparison (Locke & Latham, 2006). This is often termed the “Goldilocks” principle, because goals that are “just right” in their ability to challenge you can induce feelings of confidence and self-efficacy, which are important for completing your goals (Bailey, 2017).

Are you willing to be flexible in your goal?
 Sustainable goals are not rigid, they are naturally adjustable. Humans also have a tendency to overestimate our goals or “bite off more than we can reasonably chew”, known as the planning fallacy (Kahneman & Tversky, 1979). The planning fallacy is based on the principle that people tend to underestimate the time it will take to complete a goal (Buehler, Griffin, and Peetz, 2010). Thus, in addition to daily or weekly tracking of your goal, consider quarterly check-ins, and be willing to adjust as needed to make it more likely to complete your goal.

Does your goal have an “action plan” for both implementation and setbacks?
 Sustainable goals have “implementation intentions” and action plans, including where, when, and how a goal will be implemented. Evidence suggests creating an “if/then” or a coping plan is important for goal setting (Bailey, 2024). Some days you may not be motivated to engage in your goal, or other life commitments can get in the way. Make a gameplan for motivational or logistical barriers.

• If you’re noticing difficulty feeling motivated, try “temptation bundling,” or pairing your goal with something you do enjoy (Milkman, Minson, & Volpp, 2015). For example, call a friend while you go for a walk. Or see if you can do 10 minutes worth of the goal.
• Implement “if/then” logic: If [Situation X] happens, then I will [Response Y].

Does your goal involve a mechanism to track progress?
 Track what you do. Visualization is critical, as getting feedback and tracking your progress are catalysts for hitting your goals (Locke & Latham, 2006).

Write out, color in, or mark, each time you complete your goal. Keeping it in a place you see often (bathroom mirror, office desk, front of refrigerator) is important.

By shifting to these evidence-based, sustainable goals, you aren't just planning for a better January, you're building a foundation for a values-aligned 2026. Happy goal setting!

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.

Alessandra Grillo, Ph.D., is a Postdoctoral Fellow at the Center for Deployment Psychology. Dr. Grillo earned her doctoral degree in Clinical Psychology from the University of North Carolina at Greensboro and completed her pre-doctoral internship at the Boston VA Healthcare System where she provided brief and full-model evidence-based treatments for a wide range of mental and physical health concerns in primary care and outpatient clinics serving Veterans.

References:
 Bailey R. R. (2017). Goal Setting and Action Planning for Health Behavior Change. American journal of lifestyle medicine, 13(6), 615–618. https://doi.org/10.1177/1559827617729634

Buehler, R., Griffin, D., & Peetz, J. (2010). The planning fallacy: Cognitive, motivational, and social origins. In Advances in experimental social psychology (Vol. 43, pp. 1-62). Academic Press.

Elliot, A. J. (2013). Handbook of approach and avoidance motivation. Psychology Press.

Gracia, S. (2024, January). New Year’s resolutions: Who makes them and why. Pew Research Center. https://www.pewresearch.org/short-reads/2024/01/29/new-years-resolutions-who-makes-them-and-why/

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. Guilford Press.

Kahneman, D., & Tversky, A. (1979). Intuitive prediction: biases and corrective procedures. TIMS Studies in Management Science, 12, 313–327

Locke, E. A., & Latham, G. P. (2006). New Directions in Goal-Setting Theory. Current Directions in Psychological Science, 15(5), 265–268. https://doi.org/10.1111/j.1467-8721.2006.00449.x

Oscarsson M, Carlbring P, Andersson G, Rozental A (2020) A large-scale experiment on New Year’s resolutions: Approach-oriented goals are more successful than avoidance-oriented goals. PLoS ONE 15(12): e0234097. https://doi.org/10.1371/journal.pone.0234097

Milkman, K. L., Minson, J. A., & Volpp, K. G. (2014). Holding the Hunger Games Hostage at the Gym: An Evaluation of Temptation Bundling. Management science, 60(2), 283–299. https://doi.org/10.1287/mnsc.2013.1784

Sheldon, K. M., & Elliot, A. J. (1999). Goal striving, need satisfaction, and longitudinal well-being: The self-concordance model. Journal of Personality and Social Psychology, 76(3), 482–497.

Strava (2025, December 31). Conquer Quitter’s Day Challenge. Strava. https://www.strava.com/challenges/5560

By Katrice Byrd, DSW, LCSW

December often evokes a sense of nostalgia, bringing with it cherished childhood memories of family, friends, abundant food, and holiday music, like hearing Silent Night by the Temptations on indefinite repeat. However, for others, the holiday season presents a painful contrast—a constant reminder of losses and distant voices reflecting what is no longer there.

As we navigate this season, it is essential to support our loved ones in delicately balancing their expressions of gratitude while simultaneously acknowledging their grief. So, how do we pay tribute to today without keeping people stuck in yesterday. There are probably one million remedies for this. But life experiences and wisdom have taught me a few tips to support those in need.

First, don’t assume that the holidays are a time of joy for everyone. In fact, those who have lost loved ones may find this time extremely difficult to navigate, especially if the loss is recent. It may be the first time a person has celebrated a holiday without their loved ones. Be gentle with your invitations. Ask, but don’t insist. They may not be ready to walk into the door just yet. As Regina King so eloquently described, “Grief is just love that has no place to go.” The reality is they may not have found their new place in the world just yet.

Secondly, understand that grief is a continual journey. While they may accept your invitation one minute. The next minute may present the smallest reminder that sets them back into a place of pain. If you notice the individual changed their mind, but just a few days ago, they were excited to be part of the festivities, don’t dive into a full-blown interrogation. It probably has nothing to do with you and everything to do with grief. Use this opportunity to practice patience and understanding.

For the person seeking to find gratitude through the teary lens of grief. Start small. Remind yourself of the tiniest reasons to be thankful. Take time to put your feet on the floor before you jump out of bed. Look around. Sit with yourself. As the church elders often say with such conviction, “He woke me up.” Some days, that will be enough to carry you through.

Additionally, acknowledge that you are hurting. This doesn’t mean you have to share your pain if you don’t want to. But be honest with yourself, by honoring your heart. Take scheduled time each day dedicated solely to your grief. Not too long though, just a few minutes will suffice. By doing this, you are learning to co-exist with your grief without letting your grief consume you. Some days, that will be enough to carry you through.

Finally, For every moment of grief you hold on to, grasp on to a moment of hope, a moment of light, a moment of just being. This will look different for everyone. For you, it may look like stepping outside and taking in a deep breath of fresh air. It could also look like a barely cracked smile after that corny joke your co-worker just told. Again, some days, that will be enough to carry you through.

Whether you are the person walking the tightrope of balancing grief and gratitude or the person balancing support for the griever. Remember, holidays can be painful reminders, but they can also be opportunities for new beginnings, new memories, new traditions, and sometimes that is what will carry you through.

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.

Katrice Byrd, DSW, LCSW is a Military Social Worker with the Center for Deployment Psychology (CDP). She is co-chair of the North Carolina National Association of Social Worker’s Legislative Committee and is passionate about serving the village through research, policy, and programmatic changes.

By Kathryn E Monsey, LCSW, LCDC

When we think about alcohol or substance abuse in the military, most of us jump to familiar explanations: PTSD, deployment trauma, combat stress. These are the headline drivers we expect to see on intake forms and clinical assessments. But lurking quietly, often unnoticed and unspoken, is another powerful risk factor, one that rarely makes it onto the paperwork or into clinical interviews: boredom.

Recently, as I was combing through some service member podcasts, a moment caught my ear. A US Marine Corps veteran was asked: “What do frogmen do when there is no war?” He answered plainly: “Well, we drink.” Another vet chimed in, saying, “They pay us to run into gunfire.” He was implying that when the high-stakes action fades, the lingering question becomes: what else is there to do to pass the downtime and dullness of everyday life? That exchange got me thinking deeply about the role boredom and under-stimulation play in hazardous alcohol use among service members.

Military service is inherently intense, whether you’re training for or engaging in combat, your days are structured around high stakes, constant readiness, and high adrenaline. Your hedonic set point, the baseline level of stimulation required to feel engaged, can shift upward in these environments. Living in a near-constant cycle of adrenaline and dopamine recalibrates what “normal” feels like. When the intensity fades, when missions end, deployments slow, or daily life becomes routine, that elevated set point doesn’t immediately reset. The everyday quiet can feel intolerable. From a clinical lens, this is where sensation-seeking and boredom converge: service members may chase stimulation to fill the gap, and alcohol often becomes the most accessible outlet.

This isn’t just a post-deployment issue. Cycles of high intensity followed by prolonged downtime are built into military life. Reserve and Guard members swing between operational tempo and stretches of civilian routine. Veterans transitioning out of service often find their hedonic set points misaligned with the slower pace of civilian life. At each of these junctures, boredom and under-stimulation create vulnerabilities. Without structured, meaningful outlets, the risk of unhealthy substance use rises, not only as a way to cope with stress, but as a way to re-establish a felt sense of aliveness.

If boredom, sensation-seeking, and hedonic adaptation are part of the risk equation, our assessments and interventions need to reflect that. Instead of only asking, “What trauma are you coping with?” we might also ask, “How do you manage periods of low stimulation?” or “What role does boredom play in your drinking or substance use?” or “When do you find yourself seeking intensity, and how do you channel it?” Because sometimes, the clinical task isn’t just treating symptoms of trauma or stress, it’s helping service members discover healthier, sustainable ways to engage when the mission quiets down.

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 Lisa French, Psy.D.

I was recently talking to a civilian community mental health provider, and she asked me if I thought veterans were utilizing mental health care more due to both the VA MISSION Act and the VA COMPACT Act. I thought about it briefly and responded (acknowledging that I had no evidence to support my answer) that it usually takes years for change following laws like these. Then I paused to really think about how much I have heard about either of these veteran-focused acts/laws in my role as a psychologist or as a veteran, and the answer was: not much. So I thought this would be a great topic to share with our community of providers.

For those unfamiliar with them, the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act is a 2018 law that expands community care options for eligible veterans by allowing them to receive VA-approved care in their community (U.S. Department of Veterans Affairs, 2019). It addresses access to care issues such as long wait times for appointments and long drive times for veterans to access VA services. It also allows veterans and their referring clinician to have a say regarding if it is in the best interest of the veteran to receive care in the community.

While measuring the long-term impact of the MISSION Act will take time, the immediate need addressed by the COMPACT Act makes it a vital resource for all community providers to know today. The VA Comprehensive Treatment, Prevention & Access to Care (COMPACT) Act is a 2020 law that specifically provides free emergency suicide care at any VA or non-VA facility for eligible veterans experiencing a crisis, regardless of VA enrollment (U.S. Department of Veterans Affairs, 2023). It also covers related transportation and follow-up care. Both laws were implemented to address barriers to care that many veterans face. 

The VA COMPACT Act was passed in December 2020 and became effective January 2023. The primary goal was to address the critical need of access to care for veterans who are experiencing an acute suicidal crisis by removing financial barriers and by broadening where veterans can seek care (e.g., non-VA facilities). The VA COMPACT Act not only covers emergency suicide care, but it also includes transportation costs as well as inpatient or crisis residential treatment (up to 30 days) or outpatient follow-up care (up to 90 days). It is also important to note that veterans do not need to be enrolled in the VA system to receive care under the VA COMPACT Act.

The steps to accessing the care are relatively straightforward. When a veteran is experiencing a suicidal crisis, they should:

1. Call 911 or if able, go to the nearest emergency room.
2. Notify the staff that they are a U.S. veteran.
3. Contact their local VA Medical Center or the VA patient advocate within 72 hours to begin the process for payment and care coordination.

Although CDP is not directly related to either veteran-related acts, we do serve an important role in training community providers. We offer extensive training and educational materials that are specifically designed for behavioral health providers so that they have the skills, understanding, and resources needed to work with military connected patients, to include veterans.

In addition to more general training focused on improving military cultural awareness, CDP also offers more in-depth training focused specifically on managing suicide risk (e.g., Cognitive Behavioral Therapy for Suicide Prevention, Lethal Means Safety Counseling, etc.). Check out our website where you can find upcoming training events, provider resources, military culture resources, and much more.

It takes a community to help support those who have served. We hope you can be part of that community!

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.

Lisa French, Psy.D., is the Chief of Operations at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.