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Results soldiers returning from the Iraq war. JAMA. 2007;298 (18):2141–
2148.
Evaluation 8. Kim PY, Thomas JL, Wilk JE, Castro CA, Hoge CW. Stigma,
barriers to care, and use of mental health services among active
SIT-NORCAL, Human Performance: Preliminary Results duty and National Guard soldiers after combat. Psychiatr Serv.
Quality improvement analyses (Formative, Level 0, and Sum- 2010;61(6):582–588.
mative, Levels 1 and 2) of four versions of half-day and one- 9. Seal KH, Maguen S, Cohen B, et al. VA mental health services
and two-day unit-level human performance optimization utilization in Iraq and Afghanistan veterans in the first year of
trainings were accomplished with USAF Explosive Ordnance receiving new mental health diagnoses. J Trauma Stress. 2010;23
Disposal (EOD) teams from 2017 to 2019. The primary aims (1):5–16.
of the first four analyses were to ensure cultural congruence 10. Hoge CW, Grossman SH, Auchterlonie JL. PTSD treatment
for soldiers after combat deployment: low utilization of mental
and effective reverse-engineering of the core training proto- health care and reasons for dropout. Psychiatr Serv. 2014;65(8):
col for the needs of USAF Special Warfare enablers on active 997–1004.
duty. All four versions resulted in extremely high satisfaction 11. Lu MW, Plagge JM, Marsiglio MC, Dobscha SK. Clinician doc-
among trainees (Training Satisfaction Questionnaire). Notable umentation on receipt of trauma-focused evidence-based psycho-
improvements were observed in the areas of training targeted therapies in a VA PTSD clinic. J Behav Health Serv Res. 2016;43
(1):71–87.
in the protocol as measured pre- and post-training by the Test 12. Chao LL. Evidence of objective memory impairments in deployed
46
of Performance Strategies, emWave Heart Rate Variability Gulf War veterans with subjective memory complaints. Mil Med.
41
Biofeedback, and measurements of adaptability (SASS ). De- 2017;182(5):e1625–e1631.
sign procedures, training targets, outline, and specific results 13. DeViva JC, Bassett GA, Santoro GM, Fenton L. Effects of a
are described in greater detail in Part 2. brief education and treatment-planning group on evidence-based
PTSD treatment utilization and completion among veterans. Psy-
chol Trauma. 2017;9(Suppl 1):35–41.
Conclusion 14. Harmon AL, Goldstein ESR, Shiner B, Watts BV. Preliminary
findings for a brief posttraumatic stress intervention in primary
Previous research has demonstrated that individuals can be mental health care. Psychol Serv. 2014;11(3):295–299.
trained to minimize or overcome the destructive effects of 15. Monson CM, Schnurr PP, Resick PA, Friedman MJ, Young-Xu
stress on their health and performance. 30,31 To address a criti- Y, Stevens S. Cognitive processing therapy for veterans with
cal gap in evidence-based/evidence-driven human performance military-related posttraumatic stress disorder. J Consult Clin Psy-
training, SIT-NORCAL was configured as a tool to address chol. 2006;74(5):898–907.
such application in multiple forms. It has demonstrated early 16. Steenkamp MM, Litz BT, Hoge CW, Marmar CR. Psychotherapy
for military-related PTSD: a review of randomized clinical trials.
utility as an education and outreach tool and as a performance JAMA. 2015;314(5):489–500.
enhancement, health sustainment, and health restoration pro- 17. Watts BV, Shiner B, Zubkoff L, Carpenter-Song E, Ronconi JM,
tocol. It can be deployed fluidly by embedded assets, in commu- Coldwell CM. Implementation of evidence-based psychothera-
nity-based outreach within units and clinics, and individually pies for posttraumatic stress disorder in VA specialty clinics. Psy-
or in groups. Preliminary results have demonstrated promise chiatr Serv. 2014;65(5):648–653.
in group-based implementation of both the SIT- NORCAL (hu- 18. Najavits LM. The problem of dropout from “gold standard”
PTSD therapies. F1000Prime Rep. 2015;7:43.
man performance) modular form and SIT-NORCAL (health 19. Crocker LD, Jurick SM, Thomas KR, et al. Worse baseline ex-
sustainment and restoration) for PTSD/TBI along the full ecutive functioning is associated with dropout and poorer re-
spectrum of need, with minimal resources (i.e., personnel and sponse to trauma-focused treatment for veterans with PTSD and
material) and in naturalistic settings. The protocol provides a comorbid traumatic brain injury. Behav Res Ther. 2018;108:
novel approach to the delivery of psychological performance 68–77.
training that has the potential to overcome barriers to success 20. Britt TW, Jennings KS, Cheung JH, Pury CLS, Zinzow HM. The
in traditional care, but further research is needed to determine role of different stigma perceptions in treatment seeking and
dropout among active duty military personnel. Psychiatr Rehabil
the effectiveness and reach of SIT-NORCAL. J. 2015;38(2):142–149.
21. Steenkamp MM, Litz BT, Marmar CR. First-line psychotherapies
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