Jennifer Webb-Murphy, PhD, Robert McLay, MD, PhD, Theodore Morrison, PhD, MPH, Susan Fesperman, MPH, Alicia Baird, PhD, Vasudha Ram, MPH, Erin Miggantz, PhD, Bonnie Nebeker, Steven Gerard, Eileen Delaney, PhD, Scott Roesch, PhD & CAPT Scott Johnston, PhD

Introduction Assessment• Standardization of mental health assessments is a high priority for the Navy. • The Psychological Health Pathways (PHP) program was implemented in 2009

as an innovative and standardized way to collect intakes and reassessments for service members in mental healthcare.

• Upon entry into PHP, patients complete a comprehensive mental health intake, including validated outcome measures, and an individual summary is then sent to providers.

• At 10 week intervals, patients are reassessed, summaries are sent to providers and aggregate reports are provided to clinic leadership.

• In 2013, PHP was converted from a paper and pencil system to an electronic data capture system.

• Over 20, 000 intakes and reassessments have been collected on over 13,000 service members, allowing for advancements in treatment planning, resource allocation, program evaluation and population health research.

• Connectivity issues, changing clinic practices and reassessment compliance were the biggest challenges with PHP.

• There is now a mandate to roll-out the Behavioral Health Data Portal (BHDP), a system similar to PHP, across all services.

• The Navy has defined the requirements for the new system, aiming for further improvements in the quality of care and mental healthcare metrics.

Treatment • With an increase in Posttraumatic Stress Disorder (PTSD) cases in the

military, the demand for effective interventions has grown. • Exposure therapy is known to be one of the most effective treatments for

PTSD, but there is still room for improvement. • Augmenting exposure therapies with virtual reality, Virtual Reality

Exposure Therapy (VRET), ls a way to enhance the in-session exposure by allowing the therapist to control aspects of an interactive environment, including auditory, visual, olfactory and tactile stimuli.

• Previous research comparing VRET to treatment as usual produced significant reductions in PTSD. Yet, it is unclear whether VRET success rates are due to a technology halo, the perception that enhanced technology is more effective.

• An RCT was conducted comparing VRET to exposure therapy with a still image on a computer, used as a technology control.

• 85 active duty service members were treated in either of the two conditions with sessions occurring 1-2 times weekly for 9 weeks.

• Assessments were conducted before, immediately after and 3 months following the conclusion of treatment.

• Analysis is underway to evaluate effectiveness and drop-out rates. • Findings will shape the literature describing the effectiveness of

exposure-based treatments for PTSD, identifying if newer, potentially burdensome (e.g., cost, storage for equipment and additional training for providers) technologies provide added benefit.

Prevention• Psychological fitness is key to maintaining a ready fighting force. • The Navy has tested various programs to combat stress and boost

resilience, including the Stress Resilience Training System (SRTS). • SRTS is a heart rate variability biofeedback based resilience training

tool delivered through an application on a tablet.• Utilizing a cohort-randomized study, the feasibility and effectiveness

of SRTS (n=24) was compared to progressive muscle relaxation (PMR, n=21), also supplied through an app on a tablet, and wait-list control (n=17).

• Participants in the SRTS and PMR groups were provided two hours of training when tablets were issued, and all groups were reassessed after two months.

• Participants in the SRTS group (mean=41 sessions) used the application frequently, significantly more often than the PMR group (mean=16 sessions) (p<.01).

• Both groups showed significant reductions in measures of PTSD, depression and stress, but only SRTS was significantly more effective than the wait-list control in reducing perceived stress (p<.05).

• Various symptoms and coping styles were found to be significantly related to more use with the applications.

• Tablet accessibility and scheduling time for training were the biggest barriers to program engagement.

• Findings suggest that despite these barriers SRTS appears to be an encouraging mechanism to help sailors reduce stress.

Successes and Challenges Leveraging Technology for Mental Health Initiatives in the Navy

Naval Center for Combat & Operational Stress Control, San DiegoThe opinions expressed in this article are the author’s own and do not necessarily reflect the view of the United States Government, the United States Department of Defense, The United States Navy, or The United States Navy Bureau of Medicine and Surgery. The study protocol was approved by the NMCSD Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects.I am a military service member (or employee of the U.S. Government). This work was prepared as part of my official duties. Title 17 U.S.C. §105 provides that ‘copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. §101 defines U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

• Enhanced efficiency, cost reduction, and improvements in care have led to the development and implementation of technology-based tools for psychological health in the military.

• Three such initiatives, highlighting both the benefits and drawbacks of integrating technology into the spectrum of prevention, assessment and treatment efforts, are reviewed.