Stories - Blogs

8.6%

The percentage of Ukrainians who "had probable PTSD three years into the war" following Russia's full-scale invasion, according to an article in the European Journal of Psychotraumatology -- Moral injury and PTSD among Ukrainians exposed to full-scale war.

• PTSD severity correlated moderately to strongly with moral injury (r = .47–.58).
   
• Probable PTSD predicted higher shame (η²p = .09) and trust-violation (η²p =  .13) moral injury outcomes.
   
• Trust-violation moral injury notably exceeded shame-related moral injury in this sample.
   
• Ukrainian PCL-5 and MIOS Part 2 showed strong validity and excellent reliability.

By Justin Tash, MSW

“I Must Not Fear. Fear Is The Mind Killer.”
To anyone who has even a passing interest in the genre of science fiction, these words likely ring a bell. They are the opening lines of the Litany Against Fear from American author Frank Herbert’s 1965 sci-fi masterpiece DUNE. This book is, to this day, the best-selling science fiction novel, with well over 20 million copies sold worldwide. The saga has influenced everything from Star Wars to Avatar, offering readers a sprawling universe of political intrigue, ecological philosophy, and deeply human struggle. However, beneath the sandworms, spice, and shifting dunes of Arrakis, lies something far more grounded: a remarkably accurate portrait of what trauma does to children.

I have had this fact proven to me again and again as a social worker who works with adolescents and military families. Unfortunately, many of my clients have faced difficult situations that individuals their age should never have to go through. But, the power of human storytelling teaches us about what is happening internally for all of us and our clients. Even though trauma affects everyone differently, by examining these incredible worlds and characters, we can take away important, universal lessons. 

Paul Atreides and the Burden of the Parentified Child 
When Paul Atreides, the main character in many ways of DUNE, is introduced, he is a teenager who has already begun to carry weight no adolescent should bear. The fall of his Great House and the death of his father, the Duke, strips away his childhood overnight. These events thrust him into a leadership role among the planet's indigenous population, the Fremen, molding him into a de facto father figure for an entire people. 

Clinicians can easily recognize this dynamic because they are often faced with young clients who are being subjected to a similar situation, although not usually on such a grand scale. When a family experiences a loss, or abuse that leads to absence of one parent in some way, the child can become the caretaker or the protector and thus shoulder the responsibility and expectations of holding it all together. 

Children who experience early loss or abuse frequently develop what we call "parentification." They learn to read the emotional temperature of a room, suppress their own needs, and derive their sense of worth from how well they manage the people around them. Paul believes, with complete sincerity, that he is destined for greatness and uniquely equipped to bear this burden that has been thrust on him. This is not an uncommon reaction or complex to develop for trauma victims, especially young victims. Trauma has an insidious way of convincing the victim that they are capable of handling something that will ultimately cause intense harm. The gap that is created between that perceived resilience and a person’s actual capacity is one of trauma’s most dangerous distortions. 

Alia of the Knife and Memories Out of Order 
Paul's sister Alia presents an even more striking clinical metaphor. Born later in the story with the full ancestral memory of every generation before her, she enters the world already saturated with experiences she did not live, has no context for, and cannot process in any developmentally appropriate sequence. 

This is, in an extreme and fantastical form, what trauma does to the brain. Trauma packages memories incorrectly. Traumatic events are stored as present threats rather than being filed as past experiences due to how the amygdala interrupts the regular memory processing that occurs between the frontal cortex, hippocampus, and cerebellum. These memories are often intrusive, disorganized, and stripped of context. Much of trauma-focused therapy is about carefully pulling those neural pathways apart and rebuilding them in a safer, more coherent order, in an environment where the body finally understands it is no longer in danger. It turns out fear truly is the mind killer. 

What Adolescents (and these Children of Dune) Keep Teaching Me 
One of the most important lessons I have learned from my work with adolescents is that trauma affects every child differently. After all, the adolescent brain is still actively developing, still redistributing and consolidating information across its architecture. In many cases, that neurological flexibility allows young people to process difficult experiences before they calcify into symptomatic patterns. They moved through something hard before the brain had the context to commit to storing the experience as a wound. Due to this, there is no guaranteed response to these experiences, there is not even a guarantee that PTSD will manifest. I consistently encounter young people who have experienced events that meet the clinical definition of trauma but do not develop any symptoms. 

Children and adolescents are often seemingly unbothered by experiences we assume must be devastating because they are seeing all of this for the first time. Paul nor Alia responded to their experiences as if they were traumatic, although, objectively, they very much were. Frequently, it is the fear, the alarm, and the urgency in the reactions of the adults around them that teaches a child that what happened was catastrophic. Confusion and fear are often learned responses and not inherent ones. 

Voices from an Outer World 
Paul “Muad’Dib” Atreides and his sister Alia, however fictional they may be, are excellent, microcosmic examples of childhood trauma and adverse childhood experiences. These masterful characterizations can offer an up-close-and-personal perspective on what it means to exist as a young person who has experienced trauma. Impactful clinical lessons like these can be found in unlikely places, even from outer worlds like DUNE, but if we as providers listen to these voices, we can gain access to a deeper understanding of the human condition that no textbook could ever hope to provide.

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.

Justin Tash, MSW, is a Military Behavioral Health Social Worker at the Consortium for Defense Psychology (CDP) at the Uniformed Services University for the Health Sciences in Bethesda, Maryland and the Project Lead/Instructor and for the Prevention of Harmful Behaviors in the Military Project. Mr. Tash completed his Bachelor of Arts in Communications at Texas A&M University in 2015 and his Masters of Social Work at the University of South Florida in 2025. He is now working toward the goal of becoming a Licensed Clinical Social Worker (LCSW).

84
The number of military members killed in motorcycle crashes in FY 25, according to an article in Stars and Stripes -- US military’s rate of motorcycle accidents proves costly in lives, care and lost duty time. By service branch, the fatality numbers were:

• Navy: 45 deaths (30 sailors, 15 Marines)
• Army: 28 deaths
• Air Force: 11 deaths

The weekly Research Update contains the latest news, journal articles, and useful links from around the web. Some of this week's topics include:

● Identifying Priorities in Behavioral Health for Military Youth and Families.
● Alcohol Consumption Per Capita and Suicide: A Meta-Analysis.
● Cognitive Behavioral Therapy for Insomnia in People With Chronic Disease: A Systematic Review and Meta-Analysis.
● Eye Movement Desensitization and Reprocessing Therapy in Persons With Personality Disorders: A Randomized Clinical Trial.

PARTs I & II: Biology and History
As a Suicide Prevention Subject Matter Expert, most of my time these days is spent learning and sharing information to prevent suicide among military-connected individuals. That focus means I’m not always up to date on the evolving landscape of substance use disorders (SUDs), risk management, and treatment.

At one point in time, I provided SUD treatment across levels of care in a range of settings in both DC and Baltimore. It should be noted that that “point in time” started last century and ended 15 years ago. So when I volunteered to write this blog, I initially thought, “I could write this with my eyes closed.” (Ah, the hubris of doctorate-level providers, amirite?) My wake-up call was as swift as it was humbling—the field has changed as much as the neighborhood I grew up in.

After overthinking it, I narrowed the list to three possible topics:

• “Being a Substance Use Disorder Treatment Provider Ain’t for the Faint of Heart” – The Importance of Self-Care for SUD Treatment Providers
• “They Used to Prescribe Narcotic Painkillers Like Pez Dispensers—Now All I Got After Surgery Was Acetaminophen and Lidocaine Patches” – Navigating the Balance Between Pain Management and Reduced Opioid Access
• “Who Can? We Can, Narcan!” – A Naloxone Primer

While all three could be informative, I landed on the third—because it allows me to both learn and teach something. So, without further ado…

Let’s Plug In: Science Lesson: How Opioids Work in the Brain

Receptors, Agonists, and Antagonists
Before we can talk about policies, treatment, or even naloxone, we have to understand the science. Opioids don’t just change behavior — they literally rewire the brain. This first part of the “Who Can? We Can, Narcan!” series breaks down what happens inside the nervous system when opioids enter the body. Whether you’re a clinician, a prevention specialist, or someone supporting military-connected individuals, knowing some basics will lay the foundation for understanding both addiction, the dangers of overdose, and a path to recovery.

Picture your brain as a wall covered in power outlets. These outlets control different functions in the body—they are receptors. They are activated when they get “plugged in”. Below are the “plug” options that determine power flow:

• Agonists: Both sockets have plugs = full power
• Partial Agonists: one socket is plugged in = partial power
• Antagonists: outlet is covered = No power + blocks other plugs

Now, the brain has different types of “outlets” that power all sorts of things. Today, we’re going to focus on one type: μ-(Mu) opioid receptors (MOR). They regulate pain relief, improve mood, and decrease breathing to restore homeostasis after stress or injury. The plugs that provide power to these receptors are called opioid agonists, opioid partial agonists, and opioid antagonists–clever, huh? (Kosten & George, 2002)

Tolerance
Your brain naturally produces endogenous opioid agonists (e.g., endorphins) that plug into MORs. But if the pain is chronic, your body may habituate to the effect over time. When that happens, the opioid agonist is still plugged in, but the power provided is no longer strong enough to alleviate pain or improve mood–this is tolerance (DuPen, Shen, & Ersek, 2007). Tolerance occurs for both endogenous and exogenous opioid agonists (opioids from an external source).

Dependence and Withdrawal
With tolerance comes repeated/increased use; subsequently, the brain adapts, reducing its own endorphin production and increasing other endogenous chemicals to maintain relative balance in affected brain systems. Now, the body relies on opioids just to feel normal, which is considered physical dependence (Kosten & George, 2002).

When the exogenous opioid is removed, the resulting chemical imbalance can lead to agitation and anxiety, severe muscle and bone pain, diarrhea and vomiting, chills and/or sweats, insomnia, not to mention increased breathing, blood pressure, and heart rate. That’s withdrawal, and the lived experience is even worse than the description sounds. While not considered life-threatening in most cases, it is agonizing. People experiencing it have reported “feeling like they were dying” or “wishing they would die.” A person in this position is no longer taking opioids to “feel good,” they are taking them to prevent themselves from feeling wretched (Kosten & George, 2002).

Overdose
Quick reminder, the opioid receptors that manage pain and boost mood also suppress breathing. The pattern of increased frequency/strength of opioid use eventually can lead to too much activation → oxygen deprivation → opioid overdose (Bateman, Saunders, & Levitt, 2023). If oxygen deprivation lasts several minutes, it can cause brain/organ damage, which can be fatal. While increased use to offset tolerance and withdrawal can lead to eventual overdose, an overdose can occur with just one use if the opioid is potent enough. This is especially relevant in today’s fight to prevent opioid overdose deaths. The introduction of such potent opioids, such as fentanyl, into the drug market, sometimes mixed with or disguised as less potent opioids, has skyrocketed overdose rates (Bateman et al., 2023).

The way opioids act on the brain helps explain why they’ve followed us through history — from the battlefield to the bedside. Next, we’ll trace how America’s wars and public policies turned medical innovation into recurring opioid epidemics, setting the stage for the crisis we face today.

PART II: History

Wars and Waves: The Interconnected History of Opioid Use and Wars in the US

In Part I, we explored the neurobiology of opioids and how easily the brain’s reward system can be hijacked. But the opioid epidemic isn’t just a story of molecules — it’s a story of people, policy, and history. Each major U.S. conflict has left behind not only physical and psychological scars but also a trail of opioid dependence. This section of the series follows the timeline of how war, medicine, and public perception intersected to create wave after wave of opioid crises.

It Actually Began with Flowers
Opioid use has been around for a long time…like a really long time. There’s evidence that opium from the poppy flower (an exogenous opioid agonist) was first cultivated in ancient Europe close to 8000 years ago (Salavert et al., 2020). That said, opioids didn't really start showing up in American History until the 1600s. From there, our wars turn everyday use into epidemics.

We’ll start in the 1770s, when the US was fighting its first war —the war for its independence…

Wars

Revolutionary War
During the Revolutionary War (1775-1783), laudanum (a mix of opium and alcohol) gained popularity as a go-to for pain relief by American soldiers (Committee on Prevention, Diagnosis, Treatment, and Management of Substance Use Disorders in the U.S. Armed Forces [CPDTM-SUD], 2013). Laudanum and opium use continued following the war as common household remedies, prescribed especially to women for “nervous complaints” and to infants as sleep aids (Levitt, 2013). In the early 1800s, morphine was discovered and was quickly embraced by the medical community as a “miracle drug” for pain and anxiety (Dormandy, 2012).

Civil War
The Civil War (1861-1865) is, to date, the bloodiest war in American history, so it’s not surprising that morphine and laudanum use surged during this time (Courtwright, 2001). Of note, immediately before the Civil War, the invention of the hypodermic syringe and needle enabled direct injection of morphine, revolutionizing pain control — and unfortunately accelerating opioid dependence (Dormandy, 2012). These advances, in conjunction with the devastating mental and physical injuries of the war, resulted in the nation’s first opioid epidemic; it was during this time that Opioid Use Disorder was coined “the soldier’s disease”(CPDTM-SUD, 2013).

In Germany, shortly thereafter, a chemist at Bayer Pharmaceutical Company developed heroin, deemed a safe, non-addictive alternative to morphine (DEA Museum). This proved to be untrue with dire and enduring consequences; as it turns out, heroin is cheaper, more potent, and more addictive than morphine (Murrin, 2008).

Vietnam War and the “War on Drugs”
The Vietnam War era (1950s-1970s) was the next time opioid use reached epidemic levels, fueled by the intersection of returning soldiers and increased availability of heroin in marginalized neighborhoods (Bergen-Cico, 2015). Although this epidemic was less severe than the one following the Civil War, it led to another type of war, the “War on Drugs,” criminal justice-based policies designed to limit drug supply and use (Farber, 2022). The criminalization of drug use/dependence led to limited access to treatment, an increase in overdose deaths, and spikes in co-occurring infectious disease epidemics such as Hepatitis C and HIV/AIDS through the 1980s into the 1990s (Gostin, 1991).

“The War on Terror” and the Waves of the Current Epidemic
In the mid-1990s, deceptive marketing of prescription opioids (POs) ushered in today’s opioid epidemic (Kolodny, 2015; Van Zee, 2009). This epidemic is unique in that it has been marked by distinct waves and persisted for close to 30 years, making it the longest and deadliest in U.S. history (Jenkins, 2021). The first wave began around 1999, and from 1999 to 2011, the PO overdose death rates nearly quadrupled (Chen, Hedegaard, & Warner, 2014).

It is within this opioid wave that the “War on Terror” Takes place. By 2008, more than 10% of active duty service members were taking opioids either legally or illegally, and between 2000 and 2009, PO overdose deaths among Veterans Health Administration patients nearly doubled (Bohnert et al., 2014; CPDTM-SUD, 2013).

After peaking in 2010, prescriptions for POs declined due to efforts to limit access. Heroin use rebounded in 2010, sparking the 2nd wave in the epidemic with heroin overdose deaths peaking in 2016 (CDC, 2025; Rudd et al., 2016). In 2013, however, a more potent opioid drug hit the illicit drug market, marking the 3rd wave and quickly surpassing all other opioids in terms of potency and mortality: fentanyl (CDC, 2025; Ciccarone, 2017).

Fentanyl (and its analogs) and the 4th Wave
Fentanyl was initially synthesized by pharmaceutical companies in the 1950s for hospital use in surgery and treating severe pain (U.S. Drug Enforcement Administration [DEA], 2020). As such, it is 50 times more potent than heroin and 100 times more potent than morphine (DEA, 2020). In 2013, illicitly manufactured fentanyl and its analogs entered the U.S. drug supply, often passed off as heroin, prescription opioids, and/or benzodiazepines, exposing new, unsuspecting users to the highly potent drug (Schueler & Toner, 2017). In terms of impact, by 2016, Fentanyl surpassed both heroin and prescription drugs as the leading cause of opioid-involved overdose deaths in the U.S. (Ciccarone, 2021; NIDA, 2024).

After a slight decline in Opioid overdose deaths from 2017 to 2018, a new pattern in the epidemic has emerged. Described as the “4th wave,” it is unique as it is not due to the decline in one substance as another increases. It is instead due to polydrug use and overdose deaths, specifically fentanyl with methamphetamine and/or cocaine (Ciccarone, 2021). While COVID-19 did not cause the 4th wave, it did exacerbate its impact, further increasing use and related deaths (Manchikanti et al., 2022).

As of 2023, opioid overdose deaths were nearly ten times as high as it was in 1999 (NIDA, 2024). Today, fentanyl-related substances are thought to be responsible for ~75% of opioid overdose deaths in the US (NIDA, 2024).

History shows that with every war, our understanding of opioids evolves — and so does the toll they take. But the story doesn’t end with despair. In Part III, we’ll meet the new heroes in this fight: the scientists, clinicians, and military health professionals driving lifesaving change through education, innovation, and access to medications like naloxone.

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.

Adria Williams, Ph.D., is a Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) with the Uniformed Services University of the Health Sciences. Dr. Williams is a suicide prevention subject matter expert and trainer.

Part I & II References
Bateman, J. T., Saunders, S. E., & Levitt, E. S. (2023). Understanding and countering opioid-induced respiratory depression. British Journal of Pharmacology, 180(7), 813–828. https://doi.org/10.1111/bph.15580

Bergen-Cico, D. K. (2015). War and Drugs: The Role of Military Conflict in the Development of Substance Abuse. United Kingdom: Taylor & Francis. https://doi.org/10.4324/9781315631226

Bohnert, A. S., Ilgen, M. A., Trafton, J. A., Kerns, R. D., Eisenberg, A., Ganoczy, D., & Blow, F. C. (2014). Trends and regional variation in opioid overdose mortality among Veterans Health Administration patients, fiscal year 2001 to 2009. The Clinical journal of pain, 30(7), 605–612. https://doi.org/10.1097/AJP.0000000000000011

Centers for Disease Control and Prevention. (2025, June 9). Understanding the opioid overdose epidemic. https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html

Chen LH, Hedegaard H, Warner M. ( 2014). Drug-Poisoning Deaths Involving Opioid Analgesics: United States, 1999–2011. NCHS Data Brief No. 166. Hyattsville, MD: Natl. Cent. Health Stat. [Google Scholar]

Ciccarone, D. (2017). Fentanyl in the U.S. heroin supply: A rapidly changing risk environment. International Journal of Drug Policy, 46, 107–111. https://doi.org/10.1016/j.drugpo.2017.06.010

Ciccarone D. (2021). The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. Current Opinion in Psychiatry, 34(4):344-350. https://doi.org/10.1097/YCO.0000000000000717

Committee on Prevention, Diagnosis, Treatment, and Management of Substance Use Disorders in the U.S. Armed Forces, Board on the Health of Select Populations, Institute of Medicine, O’Brien, C. P., Oster, M., & Morden, E. (Eds.). (2013, February 21). Substance use disorders in the U.S. armed forces. National Academies Press. https://doi.org/10.17226/13441

Courtwright D. T. (2001). Dark paradise: A history of opiate addiction in America. Cambridge, MA: Harvard University Press. https://www.hup.harvard.edu/books/9780674005853

DEA Museum. (n.d.). Heroin bottle: Bayer & Co. Retrieved from https://museum.dea.gov/museum-collection/collection-spotlight/artifact/heroin-bottle

Dormandy, T. (2012). Opium: Reality’s Dark Dream. Yale University Press. https://yalebooks.yale.edu/book/9780300175325/opium/

DuPen, A., Shen, D., & Ersek, M. (2007). Mechanisms of opioid-induced tolerance and hyperalgesia. Pain Management Nursing, 8(3), 113–121. https://doi.org/10.1016/j.pmn.2007.02.004

Farber, D. ed. (2022). The War on Drugs: A History. NYU Press Scholarship Online. https://doi.org/10.18574/nyu/9781479811359.001.0001

Gostin, L. O. (1991). The interconnected epidemics of drug dependency and AIDS. Harvard Civil Rights–Civil Liberties Law Review, 26, 114–184. https://scholarship.law.georgetown.edu/facpub/761

Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual Review of Public Health, 36, 559–574. https://doi.org/10.1146/annurev-publhealth-031914-122957

Jenkins, R. A. (2021). The fourth wave of the US opioid epidemic and its implications for the rural US: A federal perspective. Preventive Medicine, 152, 106541. https://doi.org/10.1016/j.ypmed.2021.106541

Kosten, T. R., & George, T. P. (2002). The neurobiology of opioid dependence: implications for treatment. Science & Practice Perspectives, 1(1), 13–20. https://doi.org/10.1151/spp021113

Levitt, R. (2013). Unsafe Medicine: Laudanum in the 19th Century. Wellcome History, (51), 24-25. https://kclpure.kcl.ac.uk/ws/portalfiles/portal/14660527/Pages_from_Levitt_Wellcome_History_Feb_2013.pdf

Manchikanti, L., Singh, V. M., Staats, P. S., Trescot, A. M., Prunskis, J., Knezevic, N. N., Soin, A., Kaye, A. D., Atluri, S., Boswell, M. V., Abd-Elsayed, A., & Hirsch, J. A. (2022). Fourth Wave of Opioid (Illicit Drug) Overdose Deaths and Diminishing Access to Prescription Opioids and Interventional Techniques: Cause and Effect. Pain Physician, 25(2), 97–124. https://pubmed.ncbi.nlm.nih.gov/35322965/

Murrin, L. C. (2008). Heroin. In S. J. Enna & D. B. Bylund (Eds.), xPharm: The comprehensive pharmacology reference (pp. 1–9). Elsevier. https://doi.org/10.1016/B978-008055232-3.63891-7

National Institute on Drug Abuse (NIDA). (2024). Overdose death rates. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates

Rudd, R. A., Seth, P., David, F., & Scholl, L. (2016). Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015. MMWR. Morbidity and mortality weekly report, 65(50-51), 1445–1452. https://doi.org/10.15585/mmwr.mm655051e1

Salavert, A., Zazzo, A., Martin, L., Antolín, F., Gauthier, C., Thil, F., Tombret, O., Bouby, L., Manen, C., Mineo, M., Piqué, R., Rottoli, M., Rovira, N., Toulemonde, F., & Vostrovská, I. (2020). Direct dating reveals the early history of opium poppy in western Europe. Scientific Reports, 10(1), 1-10. https://doi.org/10.1038/s41598-020-76924-3

Schueler, H. E., & Toner, B. B. (2017). Emerging synthetic fentanyl analogs: A review. International Journal of Drug Policy, 46, 150-157 https://doi.org/10.23907/2017.004

U.S. Drug Enforcement Administration. (2020, June). Drug fact sheet: Fentanyl [PDF]. https://www.dea.gov/sites/default/files/2020-06/Fentanyl-2020_0.pdf

Van Zee, A. (2009). The promotion and marketing of OxyContin: Commercial triumph, public health tragedy. American Journal of Public Health, 99(2), 221–227. https://doi.org/10.2105/AJPH.2007.131714

1.9 Million
The number of children who receive care in the Military Health System, according to an article in the journal Alcohol: Clinical and Experimental Research --Diagnosing prenatal alcohol exposure and fetal alcohol syndrome in military-connected children: Insights from US military data claims, 2016–2023.

One thousand four hundred seventy six unique children had any diagnosis between 2016 and 2023 (PAE (Prenatal Alcohol Exposure) only: 301; FAS (Fetal Alcohol Syndrome) only: 1061; both: 114). Period prevalence was 0.42 cases per 1000 children. Cumulative incidence was 0.34 cases per 1000 children for 2017–2023 using 2016 as a 1-year washout. Average age at any diagnosis was 8.3 years. Factors associated with increased likelihood of diagnosis were male sex; being in guardianship; sponsor of senior officer rank; and sponsor affiliated with the Air Force or Other Service branch. Factors associated with decreased likelihood of diagnosis included Black or Other race; being a stepchild; sponsor of junior enlisted or junior officer rank; and sponsor in the Marine Corps.

The Center for Deployment Psychology’s Research Team is excited to introduce a new effort to improve our assessment of disturbing dreams.

The Big Picture
The existing measures of negative dreams often utilize a specific term such as bad dreams, nightmares, or disturbing dreams to assess the severity or frequency of the dreams. Just as assessments use various terms for negative dreams, so do individuals. It is not surprising that individuals report different levels of negative dreams across the various measures. We suggest that there are two reasons that reports may vary. First, the term utilized in the measure may not align with the individual’s preferred term or definition for their negative dream. For example, some individuals consider bad dreams to be less severe than nightmares, so they may not report nightmares if they consider their dreams to not be severe. Additionally, bad dreams and nightmares are often stigmatized, and individuals may not be comfortable using these terms. We suggest a new approach may improve our ability to identify individuals experiencing disturbing dreams.

Participant Eligibility and Study Activity
We are seeking subject matter experts (clinicians and doctoral researchers) in dreams and/or nightmares to take part in a Lawshe study informing the development of a new measure. Participation includes reviewing the current version of the measure and providing feedback on the included items. We estimate this will take approximately xx minutes. You may be asked to provide feedback at a second time point.

Get Involved
To learn more or to take part in this exciting project, please email cat-research.cdp@usuhs.edu with a brief description of your professional experience with dreams and/or nightmares.

8%
The percentage of the incarcerated population in the U.S. comprised of veterans, according to an article in the journal Federal Practitioner -- Examining Moral Injury in Legal-Involved Veterans: Psychometric Properties of the Moral Injury Events Scale.

One hundred veterans with a history of incarceration completed the MIES (Moral Injury Events Scale) and an adapted version for legal-involved persons (MIES-LIP). More than 90% of participants reported potentially morally injurious experiences in the legal context. While confirmatory factor analysis did not support the proposed factor structure of the MIES-LIP, an exploratory factor analysis supported a 2-factor solution characterized by self- and other-directed moral injury.

By: Linda Thompson, Jaime Rodden, Maegan M. Paxton Willing

This Suicide Prevention Month, CDP’s research team is taking a proactive approach to one of the most pressing challenges facing the military community. Suicide among service members and veterans remains a public health concern, with rates far exceeding those seen in the general population. Although many factors are associated with suicide risk, sleep problems have emerged as a critical, yet under-recognized factor. Prior work consistently demonstrates that poor sleep is not only common among military personnel, but also closely linked to worsening mood, hopelessness, and suicidal thoughts.

View the DREAMSS Study Flyer

In recognition of this, our team is collaborating with researchers at San Diego State University and the National Center for PTSD to utilize sleep health interventions to reduce suicide risk through a population health approach. This study recognizes the many ways in which we can support service members’ sleep and mental health by teaching health sleep habits as a proactive strategy, providing specific training to leaders regarding the importance of sleep for the military mission, and providing individual recommendations for problematic sleep using mobile health applications (Insomnia Coach). Our team hopes that by improving sleep health that we may also improve their mental health. Learn more about this study at https://cdp.usuhs.edu/blog/research-cdp-introducing-sleep-ed-mc-study.

Additionally, one of the greatest challenges with suicide prevention is that suicidal thoughts can change rapidly, often over a matter of hours. Traditional research methods typically rely on participants recalling their experiences over the past week or month, but this retrospective approach prevents identification of important warning signs and patterns. While we raise awareness, we also know that effective prevention relies on better understanding the problem. One way to address this is through the use of ecological momentary assessments, which assess suicidal thoughts and related symptoms several times throughout the day within an individual’s daily life. Inclusion of common wearables, such as Fitbits, allow us to observe the effects of sleep on suicide risk. By pairing physiological data with participants’ self-report, we gain a clearer picture of how disrupted sleep and changes in mood and suicidal thoughts are interwined.

This approach allows us to 1) detect early warning signs of suicidal crisis that might otherwise be missed, 2) identify specific times of heightened vulnerability, such as after poor sleep, and 3) pinpoint critical intervention windows when support could be more effective. Learn more about this study at https://cdp.usuhs.edu/blog/research-cdp-introducing-dreamss-study.

Ultimately, we hope these efforts will contribute to building targeted, scalable interventions for the broader military and veteran communities. If we can understand when suicide risk escalates and why, we can help develop tools that deliver support in the moments when service members and veterans need it the most.

Get Involved
To learn more about our current research efforts examining this important relationship, visit our website at cdp.usuhs.edu/research.

by Ariana Bazzi and Jaime Rodden

An exciting collaboration between the Uniformed Services University Department of Medical and Clinical Psychology and the Center for Deployment Psychology is investigating a standardized training program for eating disorders within military settings.

About the PreparED Study
The PreparED study centers around a standardized online educational program on eating disorders. The 85 minute course consists of an introduction by Dr. Tanofsky-Kraff describing the unique presentation of eating disorders in military populations followed by modules on Assessment, Medical Complications, Treatment, and Military-Relevant Considerations. Ultimately, the PreparED curriculum is intended to give healthcare providers a clear and comprehensive all-in-one guide to understanding eating disorders in the military.

The Big Picture
Eating disorders appear at higher rates among our service members compared to the general population. This increased vulnerability is often tied to the unique pressures of military life, such as constant exposure to high-stress environments, and the significant impact of conditions including, but not limited to posttraumatic stress disorder and major depressive disorder. To address this critical need, Columbia University Medical Center, has developed a publicly accessible online course and partnered with our study team to train military providers. The curriculum is designed specifically for future healthcare professionals, including students and trainees to provide them with the essential knowledge and practical tools to better understand, identify, and support individuals affected by eating disorders, ultimately aiming to improve care for those who have served.

Participant Eligibility and Study Activities
Medical providers and providers from the Defense Health Agency (DHA) serving as a primary care or other direct care provider to military-connected patients are eligible to participate in the study. Participants are provided with a SurveyMonkey link to take a pre-survey. Participants are then asked to complete the online 70 minute course and post-course survey within a month from completion of the pre-survey.

Get Involved
For more information about the PreparED study, visit our website at https://cdp.usuhs.edu/Eating-Disorders-Base or reach out to the Research Assistant Ariana at Ariana.Bazzi.ctr@usuhs.edu To participate in the study, review the informed consent document: https://www.surveymonkey.com/r/QXSTNH2