Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment PREVENTION 167 PRETRAUMA PREVENTION EFFORTS Much research related to the prevention of trauma has focused on the prevention of unwanted sexual contact in civilian and military populations (Casey and Lindhorst, 2009; Exner and Cummings, 2011; Langhinrichsen- Rohling et al., 2011; McMahon and Banyard, 2012; Moor, 2011; Moynihan and Banyard, 2008; Rau et al., 2011; Vladutiu et al., 2011). Research has identified modifiable and nonmodifiable risk factors for unwanted sexual contact in these populations. Those data have been used to inform the development of preventive interventions in both civilian and military per- sonnel. Modifiable factors include unit culture, whereby reporting sexual assault by a fellow service member may considered to be “breaking a code” and may result in ostracization; leadership behavior that may implicitly or explicitly condone, tolerate, or ignore sexual assault and harassment; and facilitating situations such as excessive use of alcohol by any of the involved parties (Allard et al., 2011; Sadler et al., 2001; Street et al., 2009; Suris and Lind, 2008). Nonmodifiable risk factors among service members include female sex, young age, low rank, and prior sexual abuse history. Several prevention programs in civilian populations and in the U.S. military have focused on decreasing the likelihood that individuals exposed to trauma will develop PTSD. Many of the programs emphasize the devel- opment of mental or emotional resilience. In this context, mental resilience refers to a person’s capacity to adapt or change successfully in the face of adversity (Pietrzak et al., 2010b). Most importantly, resilience and PTSD appear to be inversely correlated (Nishi et al., 2010). Those who perceive a trauma as a crisis but are able to confront distressing memories and emo- tions and integrate them into a coherent meaning may be resilient, whereas those who cope by avoiding distressing emotions appear to be at risk for PTSD (Larner and Blow, 2011). In a RAND report on resilience factors in military personnel, Meredith et al. (2011) found 20 evidence-informed factors associated with resilience. Individual-level factors were positive cop- ing, positive affect, positive thinking, realism, behavioral control, physical fitness, and altruism. Family-level factors were emotional ties, communi- cation, support, closeness, nurturing, and adaptability. Military unit-level factors were positive command climate, teamwork, and cohesion. And community-level factors were belongingness, cohesion, connectedness, and collective efficacy. Other factors thought to protect against the development of PTSD are social support and confidence in the military mission and training. Pietrzak et al.