When terrifying battlefield memories come rushing back, causing night sweats, flashbacks or a panic attack, some troops and vets now find comfort by reaching for their smartphones.
Using new-age technology to cope with age-old wounds of war, they tap into mobile phone applications, or "apps," designed to help with post-traumatic stress and brain injuries.
"I'm not going to lie — when this came out, we sort of wanted to slam it," a once skeptical Staff Sgt. Meg Krause said of her group of veteran friends.
"But it surprised us and has been a phenomenal tool," said the 29-year-old reservist and medic, who has had counseling for post-traumatic stress disorder.
A half-dozen apps with names like "T2 MoodTracker," "PTSD Coach" and "Breathe2Relax" have been developed by the Pentagon and Veterans Affairs Department, but not to diagnose illness or replace psychiatric counseling. Rather, the apps offer at-your-fingertips information about what the military calls "invisible wounds" of the wars in Iraq and Afghanistan — and techniques for managing the symptoms.
"Someone who's struggling ... all they have to do is pull out their smartphone or their iPhone and say, 'I can help myself.'" —Staff Sgt. Meg Krause
All but one were the work of the Pentagon, starting with MoodTracker, which lets users rate how they're feeling — worthless, happy, lonely and so on — and keep a record of their ups and downs over time.
The newest, released in May, was a joint Pentagon-VA effort — PTSD Coach. It helps self-assess symptoms, gives step-by-step instructions in muscle relaxation and breathing, helps users create a phone list of people to call when they need support and helps vets contact the National Suicide Prevention Hotline in an emergency.
"Someone who's struggling ... all they have to do is pull out their smartphone or their iPhone and say, `I can help myself,"' Krause said. "To know that there is something that I can pull out and watch, and it will help me go through my breathing techniques so I don't get to that crisis moment, I think is immensely important."
There's also an app for health care providers that includes definitions, causes and severity ratings for mild traumatic brain injury — or concussions — suffered by so many troops from roadside bombs and other explosions. Another for doctors treating PTSD is expected in the coming months. Officials hope the apps for troops, vets and their families will encourage more people to get professional help and will be used by others to supplement professional therapy.
Krause served twice in Iraq and has worked for the "Real Warriors" campaign, a separate defence program in which service members tell their personal stories to encourage other troops to go for counseling.
Finding others to talk about using the apps is hard since the free downloads are anonymous. Preserving that privacy is a big selling point for a military population that hides its problems for fear of appearing weak or being passed over for promotions.
"Engaging veterans on their own terms is especially crucial in the area of mental health," said Dr. Sonja Batten, a clinical psychologist who works on national mental health policy for the VA. Providing services that are safe, reliable and private is a priority for the VA, she said, where the number of vets getting mental health care has increased to 1.2 million from 900,000 in the past four years.
Increased mental health screening
Last year alone, over 400,000 veterans who received mental health treatment had a diagnosis of PTSD, Batten said. Among troops still in the military, officials estimate 1 in 5 has suffered acute stress, anxiety, depression or other mental problems from a war zone deployment.
Some 2.3 million men and women have served tours of duty in Iraq and Afghanistan in the past decade. The apps are among the latest ideas by a government still struggling to prevent, treat and more fully understand the mental health problems that have ballooned over that time.
In a vast and unprecedented wartime effort that has struggled to keep up with troop needs, the government in recent years has increased mental health screening, hired more psychiatric staff, sent mental health survey teams directly to the battlefields, launched new research and started or bolstered myriad programs from suicide prevention to resilience training to family counseling.
They've promoted the efforts with booklets, boot camp training, interactive websites, social media, call-in phone lines and more.
Still, some troops complain that there isn't enough help. And others simply won't go for psychological treatment. Up to half of soldiers in the most recent battlefield survey said they feared it would make them appear weak to buddies and their leaders.
Defence officials in 2008 set up the National Center for Telehealth and Technology, known as T2, to look at leveraging technology against the mental health problems.
"The Defence Department is doing something different, is doing everything, to try and reach the audience instead of trying to simply put out a better-looking brochure," T2 spokesman Joseph S. Jimenez said of the apps and other initiatives started at the T2 center in Fort Lewis, Wash. "Some people don't respond to a better brochure, some people don't respond to being told to go to the doctor."
Aside from the anonymity, the apps virtually put into the pockets of troops a tool that today's young, tech-savvy force can relate to.
"They like portable technology and they are very much into gaming and smartphones," Jimenez said.
Smartphones on the battlefield
Use of smartphones for mental health issues comes amid a larger military effort to incorporate them more on the battlefield. For instance, the Army is testing several iPhones, Androids and computer tablet devices to allow more troops in battle to see real-time images of insurgents taken by drone aircraft.
"Like the old adage about having to fish where the fish are, using online media to reach an online generation will be worth it even if it just helps one veteran," Joe Davis, spokesman for the Veterans of Foreign Wars, said of the phone apps.
Just how many troops and vets are being reached — and helped — is hard to know.
Because of the anonymity, there is little feedback on the program that started last summer with MoodTracker. But officials said they plan to find volunteers in the future to help with a study on the program's effectiveness.
For now, what's known is that MoodTracker was downloaded about 17,000 times since it was introduced. Since PTSD Coach was released in May, it has been downloaded about 11,000 times in 37 countries, including Mexico, Latvia and Japan.
Although the app is particularly tailored to the needs of active-duty troops and veterans, some users may also be PTSD sufferers with no military background. Officials believe it's likely some are civilians who've had other types of trauma, such as from physical or sexual assaults, car accidents or natural disasters.