The document discusses the growing acceptance and integration of mindfulness practices in treating military service members and veterans. It provides the following key points: 1) Mindfulness techniques like meditation and breathing exercises are increasingly being recommended for stress management and used in therapy with clients. The VA has funded studies on using mindfulness for PTSD. 2) Within the military, mindfulness has been incorporated into training programs to build resilience. The Army has a Master Resiliency Training program that teaches skills like tactical breathing. 3) The author advocates tapping into service members' existing familiarity with mindfulness-related concepts from their military experience. Reframing techniques like "tactical breathing" can help clients engage more readily.

1. STAR PROVIDERS
Community
AUGUST
2016
INSIDE
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Utilizing service member’s strengths
to implement mindfulness
Mindfulness, continued 2
SBHP receives award 2
Coping with suicide 3
National training dates 4
ARIELLE THIBODEAUX, MSW, LCSW
BEHAVIORAL HEALTH PROFESSIONAL CONTRACTOR
INDIANA ARMY NATIONAL GUARD
It seems that a day does not go by where a mindfulness article
pops up in my social media feed. I often hear from my clients
that their doctors are suggesting mindfulness to them. This
was virtually unheard of a decade ago.
Research has been suggesting, “…meditation often induces
relaxation, which may contribute to the management of…
disorders.”1
As clinicians, we have more than likely engaged
our clients in some form of mindfulness through breathing
techniques or progressive muscle relaxation.
Since the mainstream culture has caught on to the benefits
of mindfulness, the Veterans Administration (VA) has also
begun to respond. Recently, alternative therapies, such as
mindfulness, have become recognized as valuable. The “VA
has recently funded studies of the effects of meditation on
PTSD. Areas of current investigation include: The “mantram”
technique of meditation, in which people silently repeat a
word or phrase that holds personal meaning for them, and;
Mindfulness-Based Stress Reduction, a type of meditation
that promotes relaxation and has been shown to relieve pain.”2
Even in the last few months, I had a service member be
referred by the VA to Tai Chi for pain management.
Within the currently serving branches, mindfulness has been
integrated into training. Research suggests, “…fostering better
resiliency in soldiers could not only positively improve their
ability to cope with stress, but also reduces psychological
wounds in the long run and improved their performance
in theaters of operations.”3
Specifically, the Army has been
conducting Master Resiliency Training (MRT). MRT
involves components from multiple therapy modalities. Some
examples include the sections of “Avoid Thinking Traps”
(cognitive distortions in CBT) and “Energy Management”
(mindfulness) which teaches rhythmic breathing.
continued on page 2

2. 2
You may have some service members and veterans who
are resistant to alternative therapies but many of them
have familiarity with the concepts. They may not be aware
that they already have some of this type of training! With this
in mind, I think it is important to tap into the strengths they
already possess from their military training.
Instead of teaching “breathing techniques,” I frame it as
“tactical breathing.” Often times, service members are
already familiar with this terminology and tend to buy in
more frequently. This technique involves a 4-4-4 breathing
method where the service member breathes in for four
counts, holds their breath for four counts and breathes out
for four counts. Some choose to see the number in their
head as they count. I request they practice this skill several
times per day to become acquainted with the method. This
tool has set the foundation for further mindfulness tools to
be integrated throughout treatment.
Ask your service members what types of training they already
have. You may be shocked to find that they are familiar with
the therapeutic concepts you are engaging them in. They may
just be using different language.
To help support your service member outside of treatment,
the VA has the Mindfulness Coach app that is available for
download in the Apple app store. For those with Android,
the Calm app is a great resource as well. For clinicians who
are wishing to integrate mindfulness into their practice, I
recommend reading the book Mindfulness: An Eight-Week
Plan for Finding Peace in a Frantic World by Danny Penman
and J. Mark G. Williams for some more tips and exercises.
REFERENCES
1 Baer, R. A. (2003). Mindfulness Training as a Clinical Intervention: A Conceptual and Emerical Review [Ab-
stract]. American Psychological Association, 10(N2), 125-143. Retrieved February 04, 2016.
2 VA Research on Complementary and Alternative Medicine [PDF]. (2015, March). U.S. Department of Veterans
Affairs.
3 Bouchard, S., Bernier, F., Bolvin, E., & Robillard, G. (2012). Using Biofeedback while Immersed in a Stressful
Videogame Increases the Effectiveness of Stress Management Skills in Soldiers [Abstract]. PLoS ONE, 1-13.
Retrieved February 04, 2016.
continued from page 1
SBHP receives W.K. Kellogg Foundation Award
SBHP has been selected as one of four recipients of
the W.K. Kellogg Foundation Community Engagement
Scholarship Award. Together with the National Guard
and the Department of Defense’s Center for Deployment
Psychology, MFRI created SBHP as a training, referral and
dissemination program that helps service members and those
who care about them find trained civilian behavioral health
professionals who better understand challenges associated
with military service.
“At Purdue we want to do everything we possibly can to help
military members, veterans and their families adjust and
excel once a service member returns home,” said Deba Dutta,
provost and executive vice president for academic affairs
and diversity. “We are proud to offer Star Behavioral Health
Providers so that well-trained help can be found when needed.”
As one of four regional winners of a $2,500 prize, Purdue is
eligible to compete for the national C. Peter Magrath Com-
munity Engagement Scholarship Award at the Engagement
Scholarship Consortium annual conference in October. The
money from the Kellogg Foundation will be used to create
a video, which will be presented for the national award,
highlighting the program. Purdue was chosen as a finalist over
eight other applicants from the North Central Region.
The C. Peter Magrath Award includes a sculpture and
$20,000 for the winner. The three programs not chosen will
receive $5,000. The winner will be announced during the
Association of Public and Land-grant Universities annual
meeting Nov. 13–15 in Austin, Texas.
Since 2006, the APLU and ESC, with support from
the W.K. Kellogg Foundation, have partnered to honor
engagement, scholarship and partnerships of four-year
public universities. The award recognizes programs that
demonstrate how colleges and universities have redesigned
their learning, discovery and engagement missions to
become more involved with their communities.

3. 3
The hilliest course I’ve ever run:
Coping with the suicide of a loved one
CARIN M. LEFKOWITZ, PSY.D.
CLINICAL PSYCHOLOGIST
COGNITIVE BEHAVIORAL THERAPY TRAINER
CENTER FOR DEPLOYMENT PSYCHOLOGY
UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES
My brother, Wayne, would have celebrated his 41st birthday
this month, but he died by suicide 10 years ago. If you’ve
ever doubted that stigma surrounds this topic, consider that
it has taken me (a psychologist who’s spent years working
with trauma and empathizing with clients’ darkest moments)
a decade to acknowledge his suicide in a public, uncensored
venue. My CDP colleagues have written powerful blogs about
coping in survivors of suicide (view those posts by Dr. Lisa
French here and Dr. Regina Shillinglaw here) that inspired to
me to reflect both on how I’ve coped with Wayne’s death, and
how it has influenced my clinical work.
Wayne was always a complicated person who defied descrip-
tion. He routinely got suspended from school, but was also
the most charismatic person I’ve ever known. It’s impossible
to travel around NY without running into someone who
wants to share their memory about Wayne making them
laugh or helping them out. In many ways, he was a typical
older brother: he teased me mercilessly, but would physically
threaten anyone else who tried to do the same (I still feel
a little bad for that guy in the bowling alley). You can add
him to the list of people whom you’d never expect to die by
suicide. Much like Robin Williams (the legendary actor who
died by suicide in 2014), Wayne always seemed like he was
having more fun than anyone else in the room.
As it so often happens with loss, Wayne’s death feels both like
it happened just yesterday, but also like it happened eons ago.
I’m sure I passed through each of the “five stages of grief”
–– denial, anger, depression, bargaining, and acceptance ––
though I remember some more clearly than others. It seems
ridiculously trite to say, but being a sibling survivor of suicide
was and is the hardest thing I’ve ever had to do. Even 10 years
later, I am always trying to find a balance between processing
my own emotions and being a rock for my parents. I am
forever grateful for the outpouring of support that my parents
received from friends, neighbors, and family. However, I also
understand why sibling survivors are called “the forgotten
mourners,” often receiving less support than parents or
significant others. That said, the benefit of having many
friends who are also mental health professionals ensured that
I did not fall into that category. Some friends knew exactly
what to say, sent brownies, and then came over to eat them
with me. Other friends were clearly less comfortable and
seemed to have developed a sudden interest in my thoughts
on the weather. In a funny way, that latter group of conversa-
tions was equally powerful; the fact that people reached out
even when they were uncomfortable ensured that I was not a
forgotten mourner.
As with any loss, I have found ways to honor my brother’s
memory. Some ways are more obvious and easily shareable,
like me writing this blog or running a suicide awareness and
prevention 5k in his honor. Other forms of remembrance
can only be appreciated if you understand our complicated
relationship and shared dark sense of humor. Like the fact
that when I ran that 5k, the hilliest course I’ve ever run, I
cursed him for continuing to be the quintessential older
brother and finding a way to torture me from beyond the
grave. I like to imagine him laughing harder and harder as
each new expletive bounced around my brain.
On a professional level, Wayne’s suicide had a profound
impact on my work. I’d like to say it made me a better
clinician, but I’m not sure that’s wholly true. On the one
hand, I have become a very cautious clinician. I spend a lot
of time assessing suicide risk factors, discussing safety plans,
and consulting with treatment teams. My documentation is
always thorough and timely, and I teach my students to ask
very difficult questions about suicide. It’s as if my mantra has
become, “Not on my watch!”
continued on page 4

4. 4
National training dates
MICHIGAN
TIER ONE
Aug. 11 Grand Rapids
GEORGIA
TIER ONE
Aug. 17 Douglasville
Sept. 7 Augusta
TIER TWO
Sept. 14–15 Atlanta
TIER THREE
Oct. 19–20 Macon
INDIANA
OHIO
NEW YORK
DATES COMING SOON
But on the other hand, Wayne’s suicide has made me doubt
my clinical skills. I was already working as a psychologist
when Wayne died and I’ve always been plagued by guilt-laden
thoughts such as “What should I have done differently?”
and “What warning signs did I miss?” I’ve accepted that I’ll
probably always entertain those thoughts to some extent, even
if all of my education and experience point to these being
unanswerable, unhelpful, and unfair questions. And despite
all of my clinical caution, I have had patients who made
suicide attempts while under my care; it has happened “on
my watch.” Because I was lucky to work with a supportive
group of colleagues and supervisors who shared their own
experiences, I felt sadness and a desire to deliver even better
clinical care without the accompanying burden of guilt or
shame. But I did often fear what other providers would think
of me. If they knew about my brother’s suicide, would they
think I was incompetent? What if my patients found out?
Would they also think I was incompetent? Or would they try
to protect me from emotional pain by censoring their own? I
worried about my ability to handle the emotional burdens of
being a clinical psychologist. What if a patient presented with
a similar story to my own? Would I have enough emotional
fortitude and professionalism to stay engaged without becom-
ing overwhelmed or vicariously traumatized?
Fortunately, over time, I have figured out what I need to
stay healthy and effective as a psychologist. Of course, my
needs have changed over the past decade. Initially, I avoided
working with clients who presented with grief. Within a
few months I felt able to work with grief as long as I could
consult with trusted colleagues. This process of what I’ll call
“professional recovery” continued over the years with me
regaining confidence in my abilities. I still set a limit for
myself in working with patients whose traumas remind me of
my brother’s suicide. Twice in the past six years I’ve referred
new patients to colleagues because I did not feel that I could
remain objective or engaged. I don’t know if my professional
limits will continue to change over time, but I know having
a small group of trustworthy colleagues to consult with has
been the most important factor in my professional recovery.
It is my hope that this post is received less as a self-indulgent
memoir and more as my personal attempt to reduce the
stigma associated with suicide. I wish to end with some
eloquent guidance for survivors of suicide and maybe title it
“My 10-Point Plan for Coping with Suicide and Overcoming
Stigma and Still Being a Super-Awesome Clinician.” I would
design a pastel-hued pamphlet and include stock photos of
a puppy and people holding hands. But the reality is that,
like many survivors, I’m making up my 10-point plan as I
go along. Today it includes writing this blog, but it has also
included periods of blasting emo rock in my car (a long, long
time ago…I swear!). My own patience and acceptance of this
process waxes and wanes over time, but all of my psychology
training tells me that this is normal and expectable. Perhaps
the only constant in this process for me has been the presence
of a handful of trustworthy, empathic friends and colleagues
who admitted that they didn’t always know the “right” thing
to say, but who sent brownies, talked about the weather,
shared their own stories, and made room on their caseloads
for my referrals.
continued from page 3
DID YOU KNOW?
The United States
Military is one of the
world’s largest providers
of international aid and
disaster relief.
Learn more about
the ongoing
humanitarian project
in Cambodia.
To find out more
information or register
for trainings visit
www.starproviders.org
This article is being reprinted with the permission of the Center for Deployment Psychology. To read other interesting posts, please visit: http://deploymentpsych.org/blog