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CAPT Bill Nash, MC, USN Operational Stress Control and Readiness (OSCAR) Psychiatrist, 1 st MARDIV. Combat Stress Control Coordinator, OIF-II-2, I MEF [email protected] Post-Deployment Mental Health Brief. Goals For This Brief.

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Capt bill nash mc usn operational stress control and readiness oscar psychiatrist 1 st mardiv l.jpg

CAPT Bill Nash, MC, USN

Operational Stress Control and Readiness (OSCAR) Psychiatrist, 1st MARDIV

Combat Stress Control Coordinator, OIF-II-2, I MEF

[email protected]

Post-Deployment Mental Health Brief


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Goals For This Brief

  • Review a few stresses of operational deployment and homecoming

  • Describe the processes of adapting during deployment and re-adapting after coming home

  • Describe the three most common combat-related stress injuries:

    • Traumatic Stress, including Post-Traumatic Stress Disorder (PTSD)

    • Operational Fatigue

    • Grief

  • Offer a few guidelines for how to help stress injuries heal


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“Stress”: What Is It?

  • Stress is any challengeor demand placed on the body or mind

  • Stress is always both:

    • A danger or threat

    • And an opportunity

  • Stress provokes (requires) an adaptive response (we are never indifferent to it)

  • Stress is continuous and necessary

  • Problems arise if stress is too intense or lasts too long

“DANGER”

Chinese pictogram for “STRESS”

“OPPORTUNITY”




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How Do Marines Adapt to Stress?

  • Change ourselves to better suit the environment

  • The goal of all training and education

  • This makes us more tolerant to a particular stress

  • Change theenvironment to better suit us

  • The goal of all leadership

  • This lessens the force and impact of that particular stress

  • Detach mentally from theenvironment, ourselves, or both

  • The least effective but most common tactic

  • Examples: denial, numbness, detachment


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Adapting and Re-adapting

  • So, in order to adapt to deployment, Marines have had to change themselves to meet their many challenges

  • But they have also become numb (detached) to many of their stresses

  • To re-adapt to being back home:

    • They will have to change themselves again to meet the new challenges of being back in CONUS

    • And the numbness and detachment that has built up during the deployment will have to wear off

  • These tasks take time, hard work, and patience


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But Some Marines Also Sustain Stress Injuries while Deployed

  • Some Marines and sailors sustain stress injuries due to either the impact of intense stresses or the wear-and-tear of prolonged stresses

  • Three types of stress injuries to know about:

    • Traumatic stress (including post-traumatic stress disorder)

    • Grief

    • Operational fatigue

  • Most stress injuries of all types heal up just fine on their own

  • But some do not, so it’s important to know how to recognize them


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Traumatic Stress: What Is It?

  • An abrupt injury to the brain, mind, and spirit

  • Due to specific event(s) involving:

    • Terror, horror, or helplessness

      • Actual or threatened death or serious injury

      • To self or others in close proximity

    • Damage to necessary or deeply-held beliefs

      • Belief in one’s own basic safety

      • Belief in being the master of oneself and one’s environment

      • Belief in “what’s right”— moral order, ethics, expectations

      • Belief in one’s own basic goodness

    • Physiological hyper-arousal — “fight or flight”

    • Shame or guilt

      • For failing to meet one’s own expectations

      • For surviving when others did not

      • For failing to save others from harm, especially subordinates


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Traumatic Stresses in OIF

  • Multi-casualty incidents (SVBIEDs, ambushes)

  • Friendly fire

  • Death or maiming of children and women

  • Seeing gruesome scenes of carnage

  • Handling dead bodies and body parts

  • “Avoidable” casualties and losses

  • Witnessed or committed atrocities

  • Witnessed death/injury of a close friend or leader

  • Killing unarmed or defenseless enemy

  • Being helpless to defend or counterattack

  • Injuries or near misses

  • Killing someone up close

  • Adverse media, public opinion


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Traumatic Stress: Symptoms

  • Early symptoms: dissociation

    • Either an abrupt mental numbness, going blank, a trance-like state

    • Or, a change in personality (becoming cruel, fearless or childlike)

  • Later symptoms

    • Re-experiencing

      • Severe (repetitive) nightmares

      • Flashbacks or intrusive memories or mental images

    • Avoidance and emotional numbing

      • Avoidance of reminders of the traumatic experience

      • Or of situations similar in any way to the traumatic experience

      • Feeling “cold”, hard, distant

    • Increased arousal or agitation

      • Can’t calm down or relax, can’t get to sleep or stay sleep

      • Anxiety (panic) attacks or anger (rage) outbursts


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Other Traumatic Stress Symptoms

  • Poor stress tolerance (easily upset, frustrated)

  • Substance abuse and misuse of all kinds

  • Emotional instability, moodiness

  • Short-term memory problems

  • Persisting loss of moral compass, values, impulse control

  • Paranoia (e.g., being afraid to sleep without a weapon)

  • Hallucinations (seeing or hearing things not there)

  • Unintentional aggressive acts (e.g., domestic violence, startle responses to being touched)

  • Aggressive fantasies and intentional aggression (e.g., cruising tough neighborhoods, bar fights)

  • Guilt over and fear of aggressive impulses (not wanting to be around people any more)

  • Self-destructive behaviors

  • Feeling like combat is the only place you fit in any more


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How Traumatic Stress Symptoms Change over Time

  • Many people experience symptoms during and after a traumatic stress

  • Most people heal up quickly and naturally without professional help

  • Only 10-20% continue to experience symptoms long term

HYPERAROUSAL

Anxiety (Dissonance) Level

Time 

TRAUMATIC EVENT


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Operational Fatigue: What Is It?

  • Emotional changes after prolonged exposure to combat/operational stress

    • How soon it sets in depends on how severe and continuous the operational stresses have been

    • Eventually, everyone succumbs if exposure is continuous, even to low-intensity operational stresses

  • Caused by an accumulation of small stresses

    • Danger, hardships

    • Monotony

    • Insufficient rest or recuperation

  • More common in officers and SNCOs than in younger troops

    • “Old Sergeant's Syndrome”


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Operational Fatigue: Symptoms

  • Anxiety and panic attacks

    • Worry, tension, difficulty relaxing

    • Attacks of rapid heart beat:“Soldier’s Heart”

  • Anger and irritability

    • Temper outbursts

    • Difficulties handling frustrations

  • Insomnia

    • Can’t get to sleep

    • Can’t stay asleep

  • Loss of confidence

  • Loss of ability to enjoy life or feel pleasure


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Grief and Traumatic Grief: What Are They?

  • Grief is how we adapt to the stress of losing someone (or something) important to us

  • The work of grieving includes both:

    • Managing and surviving painful emotions

    • Relearning the world now without the lost person

  • “Traumatic grief” is a particular type of grief which includes some symptoms of PTSD:

    • Intrusive and distressing preoccupations with thoughts about the deceased (often associated with feelings of guilt or shame)

    • Dissociative symptoms: feeling dazed, stunned, shocked

    • Loss of trust in one’s own security, trust in the world

    • Shattered world view; inability to make sense out of the death

  • Like PTSD, traumatic grief can become chronic


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Steps to Promote Healing from Stress Injuries

  • Get safe: reduce levels of physiological arousal and intense emotionas soon as possible — slow yourself down

    • Get enough sleep every day (6-8 hours minimum)!

    • Limit alcohol and avoid drugs (including caffeine)—they’re a trap!

    • Avoid thinking or talking about painful memories except when you feel safe

    • Surround yourself with people (buddies, family, ministers, counselors) who make you feel safe as much as you can


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Steps to Promote Healing from Stress Injuries

  • Stay safe: just say “NO” to violence

    • Avoid any situations in which you might become violent or lose your temper

    • Avoid conflict with spouses, family, friends, strangers

    • Don’t let yourself dwell on violent images or impulses if they pop into your head

    • Get away from situations which make you angry, if you can

    • If you need a violence “fix”, try sports or something safe, but only if you can do it without “losing it”

    • Don’t let yourself drive recklessly or too fast


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Steps to Promote Healing from Stress Injuries

  • Take care of yourself

    • Work out regularly; exercise is a natural treatment for stress, anxiety and depression

    • Make time for yourself; try to keep a balance between work, family, and personal time in your life

    • If you are bored, find a new challenge to take on in your life

      • Go to school

      • Learn a new sport or hobby

      • Volunteer to help others


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Steps to Promote Healing from Stress Injuries

  • Remember and talk: once you can recall the details of painful experiences without getting upset, begin telling your story

    • Tell yourself what happened, in detail; write down your experiences

    • Tell others whom you trust what happened

    • Be on guard for twisted, self-destructive thoughts

      • Blaming yourself for something that wasn’t your fault

      • Forgetting that all combat deaths and injuries are uniquely honorable, even if they don’t make sense

    • Your goals for remembering and talking are:

      • To weave your fragments of memory into a coherent narrative

      • To begin to put the puzzle pieces together to make a whole picture

      • To forgive yourself and others — may need to make amends


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Steps to Promote Healing from Stress Injuries

  • See a doctor: consider medical help if any of the following persist for more than a month:

    • Can’t get to sleep or stay asleep

    • Repetitive nightmares that don’t start going away — especially if they wake you up

    • Panic or anxiety attacks that you can’t control

    • Rage or anger attacks you can’t control

    • Thoughts about killing yourself or someone else

    • Difficulties going out in public or sleeping without a weapon

    • Alcohol or drug use that’s out of control

    • Can’t remember and think through the details of what happened because it remains too painful


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Steps to Promote Healing from Stress Injuries

  • Stay connected: don’t isolate yourself

    • Stay connected with a community of other marines, sailors, and veterans if you can

    • Tell your spouse as much as you and your spouse can handle (try to lower the trust barrier between you)

    • Chaplains, counselors

    • Church

    • PTSD groups at Marine Corps Community Services

    • Vet Centers: www.va.gov/rcs (after release from active duty)

      • Vista: 760-643-2070

      • San Diego: 619-294-2040

    • Help others



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