JULY 15, 2026 – In combat operations, every second counts. A momentary loss of function on the battlefield can affect individual safety, team performance and mission success.
A combat-related acute stress reaction can occur when exposure to a traumatic event prompts a warfighter to freeze and their ability to function temporarily stops, said Dr. Amy Adler, clinical research psychologist with the Center for Military Psychiatry and Neuroscience at the Walter Reed Army Institute of Research.
ASRs can present in different ways, but they all share one critical characteristic: the impediment of function.
An individual experiencing an ASR may appear frozen, become dissociated or display agitated behavior. In operational environments, those reactions can place both the warfighter and teammates at greater risk if they are unable to move to safety or carry out mission-essential tasks.
“What all three of these expressions of an acute stress reaction have in common is that the individual isn’t functioning,” Adler said. “They’re not engaging in purposeful action.”
How are ASRs relevant to the warfighter?
Adler said that operational impact is why ASRs have become an area of greater interest in military research.
Since 2018, the U.S. armed forces have been collaborating with WRAIR researchers to develop iCOVER, a peer-based intervention to mitigate the effect of ASRs in combat environments. Adapted from an initiative originally developed by the Israeli Defense Forces, the practice is designed to restore a warfighter’s ability to function during an acute stress reaction.
“It’s so important to pay attention to it, to recognize it, to develop an intervention that’s very quick and easy to use, and to make sure that people understand and feel comfortable using that approach,” she said.
The six-step approach focuses on recognizing loss of function from a fellow warfighter, establishing connection, providing reassurance, orienting the individual to the situation and encouraging a simple, purposeful action that helps reengage cognitive function.
WRAIR research has shown that one-in-six service members surveyed after deployments to Iraq and Afghanistan reported experiencing a moment during combat when they became so overwhelmed they temporarily stopped functioning.
This highlights the operational relevance of preparing the force to recognize and respond to ASRs, Adler said. Additional WRAIR research exhibited that iCOVER training significantly improves service members’ confidence in recognizing and responding to acute stress reactions.
DAF-specific efforts to support ASR prevention, training
In March 2026, the U.S. Air Force and Space Force Surgeon General mandated iCOVER as a pre-deployment training requirement for all Air Force Medical Service personnel, according to Lt. Col. Tekia Jones, mental health contingency and readiness operations chief for Air Force Medical Command.
This mandate came after the Mental Health Leadership and Readiness Symposium where DAF mental health leaders and partners emphasized iCOVER’s importance in developing psychological regeneration and peer support on the battlefield.
Currently, iCOVER material is introduced during Ready Airmen Training as part of the Air Force Force Generation Cycle, and included in Comprehensive Medical Readiness Program requirements for medical career fields. Efforts are underway to formalize iCOVER training as a core Category II requirement, Jones said.
As the DAF continues integrating iCOVER into readiness initiatives, the service is also developing Air Force-specific training materials for nonmedical personnel to expand awareness and equip Airmen and Guardians with practical skills they can apply in operational environments.
Outlined in DoDI 6490.05, the expansion is rooted in the commander’s responsibility to maintain psychological readiness through initiatives that serve as early detection and management for combat and operational stress. Jones said she continues to work with mental health consultants at the major command and installation levels to advocate for all service members to receive iCOVER training.
Adler said continued research and realistic training will be essential to strengthening Total Force readiness.
“By integrating mental skills into realistic, difficult training scenarios and applying the military’s crawl, walk, run approach to the psychological skills that support resilience under demanding conditions, we have a huge potential to improve as an organization,” she said.
Story by Maristela Romero
Air Force Medical Service