Dialectical behavior therapy deployed: an aggressive alternative to traditional mental health on the noncontiguous...

This paper provides a description of the Witmer Wellness Center, the first successful military application of dialectical behavior therapy in a theater of war. Dialectical behavior therapy is a dynamic and provocative evidenced-based modification of cognitive behavioral treatment developed by Dr Marsha Linehan for patients with severe emotional dysregulation. One of the primary concepts of dialectical behavior therapy is that self-harming behaviors are learned, and provide evidence of maladaptive coping that is reinforced in an invalidating environment. Dialectical behavior therapy recommends a hierarchy of goals to effectively address the behaviors associated with dysregulation. Chief among these goals is reducing risk of violence to self or others. Dialectical behavior therapy is especially well-suited for the complex and dynamic environment of the noncontiguous battlefield with its chronic threat of ultraviolence, strain of nonresponse, shifting rules of engagement, and extended duration and frequency of combat deployments. The Witmer Wellness Center program uses an intensive outpatient organizational structure and minimal, but innovative, modifications to standard dialectical behavior therapy designed to meet the special requirements of Warriors in a combat zone. The Wellness Center program was designed and implemented during Operation Iraqi Freedom 07-09, at a time during the troop surge when suicide rates among US forces had reached an unprecedented level.