U.S. Army photo by Jasmine Chopra-Degadillo

Dr. James Bender is a former Army psychologist who deployed to Iraq as the brigade psychologist for the 1st Cavalry Division 4th Brigade Combat Team out of Fort Hood, Texas. During his deployment, he traveled through Southern Iraq, from Basra to Baghdad. He writes a monthly post for the DCoE Blog on psychological health concerns related to deployment and being in the military.

I spent a few days this month in Orlando, Fla., attending the 127th annual American Psychological Association (APA) Convention, which is the largest gathering of psychologists and psychology students in the world. The convention allows health care providers from all areas of specialization in psychology and from research, practice, education and policy to get together for four days to learn about the latest advances in psychology. For the third year, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) subject matter experts presented at this convention to increase psychologists’ knowledge of the unique needs of the military population, including treatment options for psychological health conditions and traumatic brain injury (TBI).

	U.S. Air Force photo by Tech Sgt. Barry Loo

This blog post was written by Dr. Shelley Carson, a psychologist with the National Center for Telehealth and Technology (T2), a Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury center. For more blog posts written by subject matter experts at T2, visit the ‘blog section’ of afterdeployment.org.

Most everyone has experienced the blues: a few days now and then when you feel mopey, sad, a little off your game, or just tired of it all. This is part of the normal ebb and flow of emotions. Life has its ups and downs. However, when these “off” periods begin to string together for a month or longer, you may have more than just the blues: you may be almost depressed. This is not a “clinical” level of depression, but it’s more than a period of the blues that you can’t just snap out of.

Jagged debris lacerates the Marine’s face and hands as he dives behind the jeep seeking cover from an improvised explosive device blast 50 meters away. He’s not sure how long it is before the unit corpsman reaches him and finds him conscious with superficial wounds. Things seem a little fuzzy at first but he believes he’s ready to move back to his patrol. The corpsman asks him the first two questions from the Military Acute Concussion Evaluation (MACE) card he carries and that yields a clear decision — the next move for this Marine is a full MACE screening.

This all-too-common scenario illustrates the need for MACE, the Defense Department’s standard for clinical assessment of mild traumatic brain injury (TBI), also known as concussion, in deployed settings. It’s the most widely-used clinical interview tool for early detection of concussion, the most common form of TBI sustained in the military. This year, the Defense Department redesigned MACE and the “Concussion Management in Deployed Settings” clinical algorithms, two critical tools used in conjunction with clinical judgment to help first-tier health care providers—combat medics, corpsmen and initial providers—improve cognitive and symptom screening, and neurological evaluation in theater.

	PE Coach mobile app

Prolonged Exposure (PE) therapy is a treatment where patients approach trauma-related memories, feelings and situations to help emotionally process an intense or uncomfortable experience. It’s considered one of the most effective treatments for post-deployment psychological concerns. “PE Coach” is a new mobile application featuring a variety of tools to help users advance their prolonged exposure therapy. It was developed by National Center for Telehealth and Technology (T2), a Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury center, and the Department of Veteran Affairs National Center for PTSD.

“While prolonged exposure therapy is the gold standard for treating posttraumatic stress disorder, patient’s engagement in homework is important. This valuable between-session homework involves revisiting their memory and confronting uncomfortable situations, such as going to the mall for 45 minutes when one may typically avoid crowds,” said Dr. Greg Reger, T2 lead clinical psychologist. “The tools offered by the ‘PE Coach’ app help users stay proactive with their homework and track progress.”

	U.S. Army photo by Sgt. Harold McGill

Dr. James Bender is a former Army psychologist who deployed to Iraq as the brigade psychologist for the 1st Cavalry Division 4th Brigade Combat Team out of Fort Hood, Texas. During his deployment, he traveled through Southern Iraq, from Basra to Baghdad. He writes a monthly post for the DCoE Blog on psychological health concerns related to deployment and being in the military.

If you follow this blog or periodically visit the DCoE website, you’ve heard many times that you should seek treatment for mental health concerns. But what do you do when you’re in treatment and it isn’t working? Unfortunately, that situation occasionally comes up. Sometimes the provider isn’t doing everything needed, or the patient isn’t fulfilling their responsibilities. Personality conflicts and other issues can arise, and sometimes it’s no one’s fault. Don’t despair if you’re in that situation; you have options. And don’t let this problem keep you from getting the help you need.

Here are a few steps to take if you’re in mental health treatment and unhappy with the way things are going: