In a previous installment in this blog series, I discussed a rapidly growing subset of military psychology, namely Embedded psychology. As a reminder, embedded psychology may be defined as the practice of clinical psychology from within a military unit with the goals of enhancing coping strategies, preventing behavioral and mental health problems, early problem identification and intervention, and provision of a focused amount of traditional mental health assessment and treatment.

I received questions about the concept of embedded psychology, and the most frequent one was: If psychologists aren’t working in a clinic model, what exactly are they doing? Good question.

What follows are three examples that demonstrate the embedded model. Note that embedded practice is only constrained by imagination, expertise, and problem-solving abilities; thus, these examples met service member and Command needs at a given time in a given situation. They should not be regarded as the only types of activities in which embedded assets engage. One of the benefits of the embedded practice is that it adapts and responds in real-time as command needs fluctuate.

Enhancing Coping Strategies

The cultural competence of embedded providers allows for ingenuity in meeting individual and command needs. Take the water survival training required by all Navy and Marine Corps personnel with flight status. The training can be terrifying for some. It involves jumping from heights, swimming, treading, floating face-down in full flight gear with no life jacket, and then learning how to egress from an upside-down, sinking helicopter dunker. Anxiety and fear are normal and intentional components of the training, such that individuals learn that they can be anxious and still have confidence in their ability to save themselves if their aircraft goes down or has to be abandoned. For some Sailors and Marines in flight training, this is the only hurdle keeping them from their dreams of flying. Enter a winged aerospace psychologist and a high-risk water survival instructor, both of whom also have to go through this training routinely to maintain their own skills.

In working with these aspiring aviators and flight officers in the pool, the problems typically stem from low swimming confidence or ability, which makes the training feel truly life-threatening, leading to panic. The solution is a combined approach from the psychologist who teaches basic cognitive-behavioral techniques to manage unproductive and irrational thoughts, monitors anxiety levels during the pool sessions, and titrates the various components of the training, and the instructor who helps people gain confidence by improving technique. This combined instruction occurs exclusively at the survival training pool, not in the psychologist’s office, and is considered training, not treatment, because the anxiety is normative. This program is known to both the training command and the students as a career saver.

Provision of a Focused Amount of Traditional Mental Health Assessment and Treatment

Even traditional services with an embedded Mental Health asset take on a different dynamic. For example, one command managed a number of young service members serving in diplomatic locations overseas. The command’s embedded asset was stationed stateside and traveled to various locations when necessary. There were no other mental health resources where these individuals were stationed.

The command’s need at that time was to determine how to manage poor decisions about alcohol. These had become a pain point for the command, and given the command’s mission, alcohol-related incidents had historically resulted in removal from duty, regardless of the circumstances. To address the problem and avoid unnecessary manning losses, the embedded psychologist implemented a telehealth option for a substance abuse evaluation.

She facilitated the requisite early intervention course for those adjudged to have no substance use disorder (which would require a return to the states) and instead a single incident of poor decision-making. However, she amended the standard responsible drinking curriculum to add information pertaining to the command mission, specific issues related to alcohol in international settings, information about that particular country’s alcohol laws and culture, the impact that individual actions can have on international relations, and morphed the educational intervention into a distance option so that the service member did not have to travel. Feedback from service members indicated that they were grateful they had not been removed from their jobs and that the focused portions of the training allowed them to understand better and consequently accept the stringent alcohol rules necessitated by that particular duty.

Early Problem Identification and Intervention

Designated embedded assets have a window into the functioning of the various components of a given command. For example, when significant numbers of Sailors with mood and motivation problems began to be seen by one embedded mental health team, the team identified the root cause of the problem as an uninformed leader scheduling individuals for duty and watches in a way that prevented consistent sleep. Mounting sleep deficits resulted in frustration, lack of motivation for the job, depressive symptoms, and unhealthy coping strategies (energy drinks to stay awake; alcohol to get to sleep).

Identifying the cause of the immediate problems, as well as a training deficit for the range of leaders at the command, the psychologist was able to provide consultative and educational services, which more effectively solved the problem than seeing Sailors individually in a traditional clinic model. The psychologist provided education to the command leaders on sleep and the mission impact of sleep deprivation and provided consultation about watch and shift schedules applicable to the specific departments of the command. When problems arose with regard to specific mission requirements several months later, the command sought proactive consultation regarding sleep from the embedded team, leading to a satisfactory plan that met the needs of both the individual service members and the military mission.

These are just a few of hundreds of ways that embedded psychologists, working from within a command, are better able to help identify and solve problems, destigmatize interactions with mental health providers while not pathologizing normal issues, and optimize command functioning overall.