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Stress

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Broad group of experiences, external.internal demands tax/exceed coping capabilities.

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Stress Effects

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Some of the most potent stressors and interpersonal in nature due to conflict in unit/home front.

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Focused stress

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Vital to survival and mission accomplishment but stress to intense or prolonged results in combat operational stress reaction (COSR) impairs ability to function effectively. (bad stress)

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Combat & Operational Stress behavior

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Generic term range of reactions from adaptive to maladaptive to overlapping stress behaviors.

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Adaptive stress behaviors

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combined with effective leadership and good peer relationships, lead to enhance individual and unit performance. (Ex. heightened alertness, strength, endurance, increased tolerance to hardship, discomfort and pain, loyalty to buddies, leaders, and units, courage, heroic acts.)

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Maladaptive stress behaviors

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Combat operational stress reaction (COSR) and misconduct stress behaviors. COSR applied to any stress reaction in military unit environment. Misconduct stress behaviors range from minor breaches of unit orders/regulations to serious violations of UCMJ and law of land warfare. Most likely to occur in poorly trained undisciplined troops, but good and heroic troops, under extreme combat stress may also engage in misconduct.

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Overlapping stress behaviors

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overlapping among adaptive stress reactions, misconduct stress behaviors and COSRs.

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Combat Operational stress reaction (COSR)

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broad group of physical, mental, and emotional symptoms from heavy mental and emotional work of combat. Not a medical or psychiatric illness.

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Post Traumatic Stress disorder (PTSD)

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persistent/recurring stress response after exposure to extremely distressing event. Diagnosis not made in theater unless pre-existing condition (6+ months) Inadequately treated COSR. Often follows misconduct stress behavior. Exhibit no maladaptive responses at time of trauma. Vary from person to person.

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Physical stressor

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has a direct, potentially harmful effect on the body.

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Mental/emotional stressor

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brain receives information about a given threat/demand, but this information results in only indirect physical impact on the body.

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Dysfunctional/maladaptive behavioral symptoms

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substance abuse/misuse, self-inflicted wounds, excessive sick call/malingering, minor to serious violations.

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Focus of combat operational stress control (COSC)

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PREVENTION of stress related casualties and harmful combat stress reaction. Treatment and early return to duty (RTD) or service members suffering from COSR.

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Goals of COSC

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monitor stressors/stress levels in units; advise command to reduce/control stress before cause dysfunction; Reduce combat stress-related casualties by teaching strss coping techniques to leaders, medical personnel, chaplains, and service members; promote positive combat stress behavior; treat battle fatigue and combat stress reactions as close to service member's unit as possible; accomplish earliest possible RTD; reduce development of PTSD through: training and assisting leaders to conduct after action debriefings ; leading traumatic event debriefings.

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BICEPS

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Brevity(less then 72 hours), Immediacy (as soon as syptoms are evident), Centrality (one location, separate physically sick and injured patients), Expectancy (expectation of recovery), Proximity (treatment at or as near the front as possible), and simplicity (use of simple measures such as rest, food, hygiene, and reassurance).

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Combat and operational stress control (COSC)

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prevent, identify and manage adverse combat and operational stress reactions in units

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Combat and operational strss reaction (COSR)

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The expected, predictable, emotional, intellectual, physical, and/or behavioral reactions of service members who have been exposed to stressful events in combat or military operations other than war.

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5 R's

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Reassure of normality; Rest (respite from combat or break from the work); Replensih bodily need (such as thermal comfort, water, food, hygiene, and sleep); Restore confidence with purposeful activities and contact with his unit; Return to duty and reunite service member with his unit. (simple needs we need to make sure pt's have before we can really help them)

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Reconditioning program

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intensice 4-7 day program or replenishment, physical activity, therapy, and military retraining for combat and operational stress control casualties and neuropsychiatric cases (including alcohol and drug abuse) who require successful completion for return to duty or is evacuated for further neuropsychiatric evaluation. (Refresh camp)

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Service member restoration

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24-72 hours (1-3 days) program in which service members with combat and operational stress reactions receive treatment. (same as reconditioning but shorter time period)

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Stabilization

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initial short term management and evaluation of severely behaviorally disturbed service members caused by an underlying combat and operational stress reaction, behavioral health disorder, or alcohol and/or drug abuse reaction

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Traumatic Event Debriefing

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scheduled meeting (approved by leader) where a highly disruptive/traumatic event occured. Facilitative techniques, not therapy or counseling. Discussiong to clarify what happened and help restore full well-being.

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Purpose of traumatic event debriefing

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enhance unit cohesion and effectiveness. Reduce short term emotional and physical stress. Prevent long term distress and burnout.

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Contributing factors of traumatic event debriefing

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death, suffering, handle dead bodies, friendly fire incidents, serous error, injustice, atrocity, evident distress, consensus at the after-action debriefing want to talk more, evident reluctance of unit members, expressed wish for consolidated or combined debriefing.

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Phases of a traumatic event debriefing

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phase 1 introductory phase, phase 2 fact phase, phase 3 thought phase, phase 4 reactive phase, phase 5 symptom phase, phase 6 teaching phase, phase 7 re-entry phase

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Phase 1: Introductory phase (Traumatic event debriefing)

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intrudcue and explain process. no one ever repeat outside group, no notes or recording, no breaks are scheduled but may leave as needed, no one is required to speak but encouraged, speaker speaks only for themself, all persons are equal, fact-finding and personal reactions, TED team members availible after debriefing.

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Phase 2: Fact phase (Traumatic event debriefing)

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Reconstruct event in detail, view facts from all sides and perspectives. Participants start at beginning and work up to event(s), first person involved in event tell: how it started, what their role was, what they saw heard, smelled, and did, step by step. Others are drawn in tell their observations ad actions in detail, asks those who din't come in what they were doing, disagreements about what happened when elicit observations from others resolve the difference and reach consensus, proceed to phase 3 and 4 before event reconstruction is complete. Eventually back fill in timeline.

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Phase 3: Thought phase (Traumatic event debriefing)

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Personalize event, shift forces from factual to emotional. Share thoughts, express themselves.

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Phase 4: Reactive phase (Traumatic event debriefing)

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Identify feelings raised by event, allow ventilation of feelings. Leader emphasizes all emotional reactions deserve to be expressed, respected and listend to. Encouraged reactions. Find commonality of feelings.

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Phase 5: Symptom phase (Traumatic event debriefing)

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Normalize, personalize, physical stress responses. focus back to factual. Describe how their bodies reacted physically before, during, and since the event. Reassured, group members having same symptoms

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Phase 6: Teaching phase (Traumatic event debriefing)

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Reassurance by educating the feelings and stress symptoms are normal. Educate symptoms resolve normally. Teach stress process, stress management training, anger management training, grief process or coping. Avoid predictions of long term disability (such as PTSD)

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Phase 7: Re-Entry phase (Traumatic event debriefing)

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Complete debriefing, closure. Final invitation for comments, summary statement, point of contracts, follow-up, group participants define group self-support activities, be immediately available for one-on-one talks. Say good byes.

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Division Mental Health Section (DMHS)

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assigned to main support medical company, division support command. 3 mental health officers, 7 BHTs. Primary responsibility for assisting the command in controlling combat stress.

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Area suport medical battalion (ASMB)

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primary responsibility assisting units in corps support command in combat stress. (corps= massive unit with many divisions). 2 mental health officers, and 8 BHTs

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Combat stress control, detachment

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Provides comprehensive COSC support to division of to 2-3 separate brigades or regiments. 43 personnel total: 4 COSC prevention teams( 2 mental health officers, 2 BHTs), 2 CSC fitness teams (restoration/Reconditioning teams) (3 mntal health officers and 8 enlisted personnel), HQ section Provides all 9 COSC functional mission areas

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Combat stress control, company

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2 or more divisions and their corps slices. 88 personal total: 8 COSC privation teams, 4 CSC fitness teams, HQ sections Provides all 9 COSC functional mission areas

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Unit Needs assessment (UNA)

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Purposes: identify and describe specific areas. Provide assessments of BH training needs. Develop plans to meet or improve COSC needs. Pre assessment-obtain command support, determine target issues, and select appropriate methods Assessment-gethering, integrating and analyzing information to identify the COSC need of the unit. Post-assessment-determine the courses of action to present to commander which address identified COSC needs, link to plan of action.

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Combat and operational stress control (COSC) consultation

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transmission of information through an interactive relationship between the consultant and consulate.

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Combat and operational stress control (COSC) consultation

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transmission of information through an interactive relationship between the consultant and consulate.

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