At-Length Description of DE-CRUIT Program

DE-CRUIT is an interdisciplinary program designed to help military veterans overcome the obstacles of transitioning from military service back into their communities. Countering the military’s intense indoctrination and training, DE-CRUIT uses routinized techniques derived from principles of classical actor training (e.g., experiential analysis, symbolic representation, spoken verse) to transform military camaraderie into camaraderie among treatment group members to communalize the process of healing from the trauma of war. The DE-CRUIT model combines these techniques with treatment elements from two state-of-the-art therapeutic approaches: Cognitive Processing Therapy (CPT) (which focuses on re-construal of traumatic events and accompanying reactions to enhance an individual’s sense of mastery and safety); and Narrative Therapy (which involves the externalization of previously-internalized narratives and a re-examination of habitual reactions to trauma-based triggers). This integrative model is comprised of three major components, each of which is an extension of existing evidence-based treatment principles that are readily adapted for use with military veterans. These components are as follows:

Unit Cohesion: Unit cohesion is a bond that is formed among members of a military unit. Because this sense of cohesion becomes so engrained in soldiers, returning veterans often feel untethered upon returning to civilian life when their unit members are no longer alongside them. The DE-CRUIT program adopts the notion of military cohesion as a mechanism to foster bonding among group members and creates a sense of connection grounded in the participating veterans’ shared expression of trauma and in their shared goal of adopting the routines of the DE-CRUIT method. These routines include daily breathing exercises, practice in finding and using one’s voice, and accessing the symbolic expression of trauma through dramatic verse. Working together to master the recitation of dramatic verse – a skill that is foreign and often intimidating to most of the veterans in the group – reflects the therapeutic notion of feeling “safe, but not too safe”, a key technique in trauma therapy that fosters support, but also challenges clients to take measured risks.

Communalization of Trauma: Both CPT and narrative therapy include techniques that encourage trauma survivors to relate their stories of trauma. The DE-CRUIT program expands these techniques into a multi- session group process that encompasses progressive phases of narration and sharing. The sharing element finds its foundation in psychiatrist Jonathan Shay’s emphasis on the communalization of trauma as essential in fostering veterans’ reintegration into civilian life. In the DE-CRUIT program, veterans describe and share their first-hand experiences of trauma in the form of a first-person trauma monologue. The method of narration begins by introducing clients to the Shakespearian monologue. The choice of Shakespeare’s work as a therapeutic catalyst for traumatized veterans is specific and deliberate: Among the characters in Shakespeare’s plays are numerous veterans who astutely describe their military trauma through heightened verse that is at once linguistically distinct from the veteran’s own language and experientially close to the veteran’s own traumas. After engaging in a line-by-line experiential analysis of some of Shakespeare’s veterans’ monologues, veterans write their own personal trauma monologues. They then relinquish their monologues to their fellow group members, and each member learns, rehearses, and ultimately performs one of their co-member’s monologues, thereby creating a communal narration of trauma.

Therapeutic Embodiment: A key element in the DE-CRUIT program is a focus on rhythm, embodiment, and breath in the reading, reciting and performing of dramatic verse. This focus is derived in part from scientifically supported relaxation and breathing techniques used in psychotherapy for trauma. Recent research on the neurological effects of relaxation techniques has found significant positive outcomes from the use of these techniques in veterans and in other traumatized populations. The DE-CRUIT program utilizes these techniques and integrates them into a structure that mimics the routines and rituals of military training while also subverting those routines into patterns of emotional self-awareness as opposed to violence- oriented patterns of aggression. The veterans work together on fully inhabiting the spoken verse in passages and monologues, progressively immersing themselves in the patterns of breathing, movement, and rhythm that are required to master the execution of the various texts.

 

IMPLEMENTATION AND EVALUATION OF THE DE-CRUIT PROGRAM

Part of the innovation of this project is that it involves not only the delivery of the DE-CRUIT program, but also the systematic evaluation of the program. This evaluation will draw upon the scientific knowledge and expertise represented in the project team and in the project’s advisory board. The evaluation will allow us to refine the program by identifying those elements that are most efficacious in supporting the participating veterans in their psychological growth and in meeting their goals for reintegration. The evaluation will also allow us to fulfill recent recommendations of the Department of Veterans Affairs which emphasize the need for scientific examination of innovative treatment approaches that may be compatible with existing clinical services for veterans.

The program will be delivered by veterans who will receive extensive training in the DE-CRUIT intervention method. The evaluation of the program will be headed by Alisha Ali PhD, a research psychologist at New York University and member of the project team. Veteran participants for this pilot project will be recruited through the extensive, diverse network of veterans’ organizations that have partnered in various capacities with Bedlam Veterans Outreach over recent years. Male and female veterans of any age will be included. Participation will not be limited to veterans from recent and ongoing wars, so veterans from earlier- era wars (e.g., Korea and Vietnam) will be welcome in the program.

Over the coming three years, the DE-CRUIT program will be delivered in the following four formats: (1) A Weekly DE-CRUIT Program consisting of ten weekly two-hour sessions with a different group of six to ten veterans attending each 10-week program; (2) An ongoing, weekly Open Workshop (open to any veteran who has completed the ten-session weekly DE-CRUIT program) which allows veterans to continue to build and improve their skills, meet new veterans, and attend when it is convenient in their schedule; (3) A series of Weekend Intensives (offered four times per year) which will cover the same content as the weekly DE-CRUIT program, but through a more intense and focused experience; and (4) a fully immersive Residency Program (which will take place outside of New York City) in which the veterans will stay in provided housing and train in the DE-CRUIT program over a period of six consecutive days. Additionally, veterans who take part in any of these four formats will be given access to the DE-CRUIT NETwork: a website that will include videos demonstrating key relaxation techniques and breathing exercises, as well as an online forum that will allow the veterans to stay connected through a supportive online community.

CHANGES TO BE CREATED BY THE DE-CRUIT PROGRAM

The short-term goal of the DE-CRUIT program is to build a supportive community of veterans – forged through the in-person program and sustained through the DE-CRUIT NETwork – which will facilitate veterans’ reintegration by reducing the effects of posttraumatic stress and related conditions, enhancing veterans’ capacities for self-expression and relating to others, and increasing their self-efficacy and confidence in moving forward with their lives. The long-term goal is the wide-spread implementation of the DE-CRUIT program so that it is ultimately provided as an offering to all veterans as they exit military service. This implementation will dramatically reduce rates of homelessness, violence, suicide, and incarceration among veterans by easing veterans’ transition into becoming active, thriving members of their communities.