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Basic Retraining


For their sacrifices made in the defense of our nation, wounded war veterans hold a special place of honor in America. There is a deep, abiding respect for those who carry the physical reminders of war so that the rest of us need not. They are remembered on national holidays observed in their honor. Seats are given up for them on buses and at ball games. Hollywood makes movies celebrating their deeds.

But for as long as the machinery of war has injured, the psychology of war has exacted a toll of its own, even from those otherwise spared by bullet, blade, or shrapnel. These are the hidden injuries of war. They can be difficult to recognize, and as a result, not only is adulation often absent from the lives of those who suffer from them, but basic understanding as well.

As a nation, we are beginning to understand the severity of psychological and emotional wounds. In the past, names like “shell shock” and “battle fatigue” have been used to refer to the collection of symptoms that medical professionals now refer to as post-traumatic stress disorder (PTSD).

PTSD, along with traumatic brain injury (TBI), are the signature wounds of the Iraq War. They are co-morbid, often appearing together, and frequently accompany physical wounds, particularly blast injuries. The concussive force of an IED (improvised explosive device), the likely combat situation that follows, and the responsibility a soldier feels for the resulting injured and/or dead, creates a perfect storm for profound emotional and physical trauma.

Recognizing the need for new, effective treatments for these wounded soldiers, researchers at East Carolina University are working in cooperation with the United States Marine Corps to develop new best practices for the treatment of PTSD and TBI.


Marines and Navy Corpsmen from nearby Camp Lejeune are participating in the TOP program to help with PTSD and TBI.

In February 2008, the Training for Optimal Performance (TOP) program began at ECU under the direction of Dr. Carmen Russoniello, associate professor in the College of Health and Human Performance and director of ECU’s Psychophysiology Lab and Biofeedback Clinic.

The TOP program is built upon Russoniello’s prior experiences using biofeedback to help hospital patients with stress-related medical disorders such as hypertension, anxiety, depression, and even diabetes and heart disease.

“I found that people have this incredible ability to heal themselves with the aid of technology,” said Russoniello. “And so I started to look at biofeedback as a treatment intervention. I soon found it was also an excellent psychophysiological measurement tool.”

Biofeedback, the real-time recording and playback of the human body’s physiological response signals, together with psychophysiology, the psychological interpretation of those responses, is a unique intervention because it allows the patient to see—via numerical and graphical readings on a computer screen—how the mind and body are connected. Unlike medications that are often used to treat stress disorders by decreasing activation of the nervous system, biofeedback training teaches the patient to decrease the activation themselves.

When Russoniello was approached by the Marine Corps with the opportunity to work with Marines returning from Iraq, he saw an opportunity to not only help soldiers recover from PTSD, but also test the efficacy of biofeedback-assisted autonomic and central nervous system training with an ideal group of subjects.

The United States Marine Corps has the distinction of being the first branch of the military into battle. It is a mantle they not only accept, but take great pride in. As a result, Marines and Navy Corpsmen—the field medics assigned to Marine infantry squads—undergo extensive training to prepare themselves for the rigors of warfare. The ability to train one’s mind and body is crucial to successful biofeedback training.

“These techniques work. We’ve seen them used successfully in primary health care. It was logical that a group that was well trained and understood training would be very good at it,” said Russoniello.



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