The “Cognitive and Behavioral Health” course will provide education regarding the cognitive and behavioral difficulties that Wounded Warriors with a mild traumatic brain injury experience when returning from combat.  

There are three problem areas for the Wounded Warrior on which this course will focus:  

  • Post-Traumatic Stress Disorder (PTSD)

  • Depression and Suicide

  • Substance Abuse.  

In each of these problem areas, education will be provided about cognitive and behavioral risk factors, symptoms, and brief intervention strategies.  Participants in this course will be provided with education, empirically validated assessment tools, and in-vivo practice for how to identify and briefly intervene with Wounded Warriors who have difficulty with any of these potential problem areas.




Learning Units

Unit 1: Impact of Combat and Military Culture on Mental Health for the Wounded Warrior with TBI.


  • 10 Tough Facts about Combat 
  • Military Culture 
  • Military Customs Vignette 
  • Hyper-arousal in Public Settings Vignette 

Continuing Education Units:  1 Hour

Learning Objectives

1.  Understand the combat zone, which can trigger stress reactions, ASD, and PTSD

2.  Understand military culture as it relates to mental health clinical practice.

3.  Understand various military cultural issues, including:

  • How military-specific language can hinder treatment outcome
  • How the hierarchical system in the military influences mental health issues
  • Shared ideals, beliefs, and views of service members
  • How the importance of the “mission” is given higher priority than the needs/wishes of individual service members. 

4.  Understand the different reasons mental health stigma remains a problem in the military.

5.  Understand the unique psychosocial stressors service members face post-deployment.
  • Identify the various challenges with family reintegration.
  • Identify how sleep, hyper-vigilance, and hyper-startle impact reintegration.
  • Identify the various DSM-IV disorders service members struggle with post-deployment.
  • Recognize the differences between “normal” adjustment issues and more severe problems.

6.  Understand the challenges service members face during the transition from military to civilian life, including:

  • The anxiety and uncertainty surrounding transition
  • Financial and healthcare concerns associated with transition
  • Employment concerns relevant to the transitioning service member.



Unit 2: Stress and Suicide Management in the Wounded Warrior with a Traumatic Brain Injury.


  • Stress Management: Living and Working In Balance
  • Military Suicide Risk
  • Suicidal Ideation Vignette

Continuing Education Units: 1 Hour

Learning Objectives

  1. Understand and apply the following brief interventions with the Wounded Warrior: grounding (for crisis intervention), diaphragmatic breathing, thought stopping, brief muscle relaxation exercise, sleep hygiene principles.
  2. Understand the risk factors for suicide in the Wounded Warrior.
  3. Be able to administer a clinical interview for suicide risk. 
  4. Be aware of and apply 3 forms of empathic response to the Wounded Warrior.



Unit 3:  Assessment and Management of Depression in the Wounded Warrior with a Traumatic Brain Injury.


  • Depression in the Wounded Warrior 

Continuing Education Units:  1 Hour

Learning Objectives

  1. Understand the DSM-IV-TR diagnosis of Major Depression and the symptoms of Minor Depression.    
  2. Understand the risk factors for developing depression in the Wounded Warrior.
  3. Be able to identify, administer, and score an empirically-validated screener for depression symptoms.



Unit 4: Assessment and Management of Post-Traumatic Stress Disorder in the Wounded Warrior with TBI



  • Post-Traumatic Stress Disorder 
  • PTSD Vignette 

Continuing Education Units:  1 Hour

Learning Objectives

  1. Understand Combat/Operational Stress Reactions (COSR) and be able to differentiate them from diagnoses of Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD).
  2. Understand the DSM-IV-TR diagnoses of ASD and PTSD.
  3. Understand the risk factors for developing ASD/PTSD in the Wounded Warrior.
  4. Be able to identify, administer, and score an empirically-validated screener for PTSD symptoms.





Jared L. Skillings, PhD, ABPP, FACHP, is the current President of the Academy of Clinical Health Psychology and currently serves as the Director of Behavioral Medicine at Spectrum Health.





Contributing Author:


Bret A. Moore, Psy. D., ABPP, is a Clinical Psychologist in San Antonio, TX, and former Active Duty Captain and Psychologist with the Unites States Army.


This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Michigan State University and Grand Valley State University. The Michigan State University is accredited by the ACCME to provide continuing medical education for physicians. 

This continuing nursing education activity was approved by the Ohio Nurses Association (OBN-001-91), an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.  Approval valid through 10-28-15.  Assigned ONA# 16321


Page last modified March 22, 2016