Since 2022, more than 10,000 Ukrainian soldiers have undergone this training in Norway. In Trøndelag, Ukrainian medical soldiers have gone through a programme where they have also received training in operational resilience, called ORT (Operational Resilience Training).

"We simulate combat stress with experiences and situations that they may encounter in war, and we try to make them as realistic as possible. You could call it a kind of stress vaccination," says Andreas Espetvedt Nordstrand.

Nordstrand is head of military mental health at the Norwegian Armed Forces Joint Medical Services, and an associate professor at the Norwegian University of Science and Technology (NTNU's) Department of Psychology. In collaboration with American researchers in the US Army, he has developed a training programme that helps the soldiers to incorporate mental techniques they can use in demanding operations.

“We use different scenarios for different types of stress. It can be moral stress, cognitive stress, or emotional stress. While it seems realistic, it never becomes real. This means that you can go deep into it from a psychological standpoint, while at the same time feeling secure that the experience is ‘sort of’,” Nordstrand said.

The training exposes the soldiers to different scenarios for the different types of stress.

"It can be finding a torture chamber, being subjected to a drone attack, an artillery strike or a moral dilemma such as having to leave civilians in distress to fight,” he said.

Nordstrand has now conducted a study that shows that the skills are put to use when the soldiers are back in combat.

"What we see is that the soldiers gain increased confidence that they will master such situations in war. They gain increased confidence that they will be able to handle combat stress, both for themselves and for those around them. They are also able to handle human remains without being so bothered by it, which we simulate with the help of made-up corpse dolls and fermented pig's blood.

He described a course participant who was one of the first to enter the Ukrainian village of Bucha after the Russians withdrew. Hundreds of residents were killed, including several children. They also found alleged torture chambers where the victims, primarily the elderly and children, bore traces of brutal violence.

"She was a civilian nurse and had no experience in situations like this. It completely destroyed her and she was plagued by trauma for a long time. She suffered from recurring memories, not being able to sleep, fear, losing faith in humanity,” he said.

This kind of post-traumatic stress is caused by strong, overwhelming memories based on sensory experiences, which the sufferer is unable to control or dampen.

"She was very happy with the stress training she got from us. After the training, there were a lot of emotions, a lot of tears. She was able to get deeply in touch with what she had experienced. Although stress vaccination is not the same as trauma therapy, this is exactly what we want in trauma treatment," says Nordstrand.

For this soldier, the training became a way to correct what she had experienced at the time, he said.

"Here she is in a completely different situation. She is with other soldiers, has a task to be completed, while at the same time being brought back to what she experienced. The experience with the simulated stress thus became a rewrite of the old trauma experience where she felt completely helpless,” he said.

Here’s how she reprocessed the experience.

"In the days that followed, she experienced increased self-confidence and less anxiety about returning to service in Ukraine,” he said.

The problem with going into these stressful situations without being mentally prepared is that the brain can be overwhelmed by strong impressions. You have nothing to relate the experiences to. The soldiers learn techniques in the ORT course such as controlling their attention, breathing techniques and helping each other.

The training takes place in three stages, with theory, practice and then realistic stress exercises, a progression the researchers compare to learning to walk: First you have to crawl, then you can walk, and then you can run. The entire course is completed in three days, with two full days of theory, and one day of practical exercises in the field.

Nordstrand calls it educating trench psychologists.

"Military medics are often good at bandaging injuries and treating gunshot wounds, but they have no mental health training before they come here. We teach them techniques for managing stress, and how to help people around them,” Nordstrand said.

The soldiers learn to recognize symptoms of various stress reactions during the training.

"We teach them simple conversation techniques, techniques from cognitive behavioural therapy, about suicide risk and simple steps to deal with soldiers with acute stress reactions. They also learn to recognize signs of serious mental health problems, such as psychosis. We teach them simple diagnostics and treatment for mental health problems that can arise in combat,” he said.

Now the ORT program is also being introduced into military training in Ukraine.

"The Ukrainian National Guard has adopted the programme for its 170,000 soldiers, where a day of ORT training is now mandatory for all soldiers. The programme has also been introduced into the Norwegian training of Ukrainian soldiers in Poland,”.

The programme will also become part of the training in the Norwegian Armed Forces.

"We have received the assignment and the funds needed, and we are now in the start-up phase," Nordstrand said.