Army seeks to overcome depression stigma
FORT SILL, Okla. (Oct. 10, 2013) -- October is National Depression Awareness Month, with the theme "The courage to seek help."
The Army is calling on commanders and leaders to inform Soldiers, dependents and civilian personnel that depression is treatable, and help decrease the stigma associated with seeking treatment.
"We are trying to raise awareness regarding depression and encourage Soldiers and other people to seek help. It involves screening, with efforts to try and reduce the stigma associated with depression, so people will feel more comfortable about seeking help," said David Dodd, clinical psychologist and deputy director of Fort Sill's Behavioral Health program. "This year's theme, "The courage to seek help," is good because it does take a fair amount of courage for people to make that initial contact and admit that they are feeling down or discouraged to the point of being depressed."
Dodd said there are several aspects to the stigma that Soldiers face. The first is a personal or internal perception that most service members feel. When they seek out help and admit there is a problem, they feel that they are seen as weak or inadequate in some way.
"Nobody really likes that feeling. But even if they get beyond that aspect of it, there's a stigma that is reinforce by the system, by people who don't understand and have never experienced depression. Therefore they treat people differently. A lot of people in the military, instead of feeling depressed, express their feelings with anger, frustration and rage. It is more acceptable in the Army to be angry and irritable, and to yell at people than to be sad or depressed. That's part of the system," Dodd said.
He added that it is common for people to come to behavioral health seeking help, because they are finally so miserable they can't function. Often a good friend or battle buddy has suggested they seek help.
"But then they go back to their units and somebody will say they are pathetic, weak, broken or whatever, and that is the other side of the stigma. So battling depression and stigma should be a multi-level approach from different angles," he said.
In addition to the behavioral health clinics here, Fort Sill now has a new resource to help deal with depression - the Army Wellness Center. Stephanie Ryan, the new AWC director, says the center takes a holistic approach to their services, focusing on the mind and body as a whole, through multiple disciplines.
"Our core disciplines are fitness, nutrition, stress management, healthcare, tobacco education and responsible drinking. And those multiple disciplines provide many opportunities to manage depression," Ryan stated. "One of our six programs is stress management and our goal is to increase the number of clients who maintain healthy stress levels. That includes stress evaluation, stress management education classes and biofeedback - with one-on-one sessions with a health educator."
Ryan explained that biofeedback evaluates a person's stress levels using instruments that measure the body's response to external factors. That information teaches a person how to become more in control of their body's responses to those factors.
"We use software that monitors your heart rate variability, and based on that we are able to determine what's called your coherence level. A low coherence level would be a frustrated state, while a high coherence level would be a relaxed state. So it gives the patient a visual picture of what it looks like when they are stressed out, as opposed being calm. It's common for some people to be in a low coherence state and not even realize how stressed they are because they just think that's just the way life is," said Ryan. "It helps you learn to control what you can control and let go of the things that are beyond your control."
Dodd said that behavioral health also uses biofeedback to provides information on what is going on biologically in a person's body. When people have a stress response, it causes things that happen in their bodies.
"Some responses are due to acute stress, such as a threat - someone is trying to kill us, a near-fatal car accident or a dog is chasing us. And your body has that flight-or-fight response in order to get away. And that is natural. But some people develop a more chronic, high level of stress and it becomes so common that people aren't even aware," Dodd said. "So it's not uncommon to put someone on the machine and it shows they are not nearly as relaxed as they think they are. And that's when we begin to educate them and train them to know how to relax and how they feel when they really relax. The biofeedback gives you data and information on how to develop a relaxed response. Once you can control that, you can implement it whenever you need to."
Dodd said that using biofeedback doesn't mean that when a person is being chased by a dog or someone is trying to hurt them that they won't still have that response of fight or flight. It just helps a person be more in control so they can take their emotions down a notch when they want to. "It helps shift the control of my stress response from external to internal. In the biofeedback response, it is just one way of saying I can control my breathing, I can control my thinking and help get myself down to a somewhat mellow state," he said.
"The wellness centers are the wave of the future across our country. It's the way of determining how to prevent illnesses and maintain your health over time. Research says if you are mildly depressed one of the best things you can do is exercise. And so you may not want to go into the wellness center and start with stress management, but you can go and work out. If you exercise regularly during the week, and do it week after week, that can actually modulate stress as well. So the wellness center focuses on those six core areas and it is a great place to start," Ryan said.
But if someone is dealing with moderate or severe depression, they are well past the wellness stage. That's when it is important to pay attention to the moods and behaviors of those around you.
"If someone you know, a Soldier, family member or coworker, shows signs of severe depression and says that they don't feel like living, you shouldn't leave that person alone. You should go with them to get help. And if you have moderate or severe symptoms of depression for over two weeks, and it's impairing your ability to function, then it's probably time to go get some help," Dodd said. "You can get help anywhere at any time. Most behavioral health treatment is not done in behavioral health clinics, it's done in primary care. So people don't need to feel bad that they are going to be labeled or stigmatized.
"We have a system of referral that can put someone in the care of medical personnel. It used to be that you could only get help at behavioral health but now there's help in every direction. You can go to the chaplain, you can go to your commander or you can go to your NCO. At every primary care visit for active duty Soldiers they do screenings to measure for depression, post-traumatic stress disorder and anxiety. The key is -- if you have the courage, seek help somewhere.
If you or someone you know is dealing with depression, seek help by going to your primary care provider at Reynolds Army Community Hospital, or by contacting Fort Sill Behavioral Health at 580-442-4832 or 4833.