Leadership Training on PostDeployment Combat Stress

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Leadership Training on Post-Deployment Combat
Stress
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Overview

• Redeployment is a process
• Typical adjustment issues and mental health
  problems seen post-deployment
• Warrior Transition and Return and Reunion
  Principles are healthy reviews
• Leadership interventions
• Resources for assistance

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Overview

• We should pay attention to mental health issues
  after deployment like we do hydration. It is
  every unit leaders responsibility to look after
  their Marines. This should be a campaign.
  BGen Dunford
• Readjustment and mental health problems will
  occur. It is the job of unit leaders and fellow
  Marines to pay attention to this, involving
  chaplains, mental health, and MCCS to assist as
  needed

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Stressor Effects

• Combat Stress Responses should be viewed on a
  continuum
• Body naturally attempts to maintain balanced
  functioning. Real or perceived stressors requires
  movement away from this balance
• Two complimentary arousal systems
• 1) Sympathetic Nervous System (SNS) fight or
  flight response -mobilizes bodys resources or
  energy for action
• -(activates front-line fighters)
• 2) Parasympathetic Nervous System (PNS)
  moderating response -supports the arousal system
  e.g., digestion, recuperation
• -(supportive function like cooks, mechanics,
  logistics)

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Stressor Effects (cont)

• Under stress brain activates fight or flight
  syndrome and directs all available SNS resources
  to the fight. SNS dominates all systems until
  threat eliminated (e.g., if running, no need for
  digestive system functioning)
• Both SNS and PNS will contribute, but under
  prolonged or extreme circumstances, PNS not cut
  out for it (like asking support
  personnelcooks/mechanics to do prolonged
  fighting)
• Effect is that prolonged or extreme stressors
  (even mental stressors) breaks down the PNS and
  you see the loss of recuperation on ones
  thinking/emotions/physiology/behavior
• --Hyper-arousal anger, sleep disruption,
  restless, startle response, aches
• --Hypo-arousal fatigue, daydreaming, decreased
  motivation, withdrawal

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Whats Normal and Whats Not?

• Normal Readjustment
• Most will go through some difficulties the first
  few months upon return
• Spouse/Significant other/Kids
• Readjust to garrison work / Change in
  responsibilities
• General malaise or decrease in motivation
• Dont expect the credit you think you deserve
• Everyone adjusts differently at their own pace
  flexibility is advised
• Although there will be some difficulties, serious
  problems will not necessarily occur

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Whats Normal and Whats Not?

• Operational Fatigue
• Upon return, service member may experience some
  of these normal responses to operational stress
• Sense of restlessness or boredom arousal or
  sensation seeking behavior
• Some decreases in motivation, avoidance of some
  responsibilities, mildly depressed mood, mission
  letdown
• Irritability or less frustration tolerance
• Sleep disruption for a period effects
  mood-outlook
• General medical complaints (fatigue, soreness,
  GI)
• Startle responses re-acclimatizing or
  re-learning

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Whats Normal and Whats Not?

• Operational Fatigue
• Signs of problematic combat stress responses
• Persistent trouble getting to sleep nightmares
• Flashbacks or intrusive images of deployment
• Persistent irritability rage or angry outbursts
• Significant withdrawal avoidance of
  conversations
• Lack of appetite for food, sex, or other pleasing
  things
• Unexplained tearfulness, depression, or suicidal
  thoughts
• Increased alcohol or substance abuse (numbing
  behavior)
• Will be seen in each battalion given human
  nature, deployment, and demands of combat

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Problematic Stress Responses

• Mental
• Poor concentration (forgetful, dissociating,
  vacant stare)
• Apathy (verbalized or seen through
  self-neglect)
• Declining performance (change from baseline,
  poor judgments)
• Indecision / Mental Paralysis (slowed
  thinking, less expressive)
• Emotional
• Irritability (out of place rage,
  hyper-vigilance, jumpiness)
• Depression (guilt, apathy, hopelessness,
  emotional numbing)
• Isolating Self / Detachment (no one else can
  understand)
• Loss of Confidence (in self, unit, mission)
• Prolonged Anxiety/Vulnerability KEY
  SHIFTS

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Whats Normal and Whats Not?

• Operational Fatigue
• Problematic Stress Responses And Treated as
  Misconduct
• Reckless driving / excessive speeding / DUIs
• Misuse or abuse of alcohol and substances
• Domestic Violence or abuse of family members
• Sexual misconduct
• Unauthorized Absence
• Malingering
• GET HELP!

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What Problems Can I Expect to See?

• Survey done 3 6 months post OIF
• Examined mental health symptoms reported by
  Marine battalions
• Examined how Marines felt about receiving mental
  health care and the barriers to care
• 15.6 of Marines had significant mental health
  symptoms (Dep. / Anx. / PTSD)

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What Problems Can I Expect to See?

• Depression
• Feeling down or no longer enjoying things, poor
  sleep and appetite, low energy and activity,
  suicidal thoughts
• 7.1

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What Problems Can I Expect to See?

• Anxiety
• Worrying about multiple things, cant control the
  worry, tense, on edge, poor sleep and
  concentration, irritable
• 6.6

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What Problems Can I Expect to See?

• Post Traumatic Stress Disorder (12.2)
• A traumatic event occurs that overwhelms ones
  sense of control or predictability or sensibility
  (IEDs, graphic loss of life, randomness)
• Creates primitive distrust of your instincts or
  antennaes ability to detect dangercauses
  increased levels of arousal a conditioned
  response
• Mental appraisals of events cause chemical
  changes (cortisol, NPY)
• Different dispositions or thresholds for what
  overwhelms a person, regardless of how others
  evaluate it (e.g., randomness)
• Collection of Symptoms
• --Re-experiencing the event through nightmares /
  day flashbacks
• --Increased arousal (startle response,
  irritability, restlessness, fighting,
• hyper-vigilance in safe places or within
  crowds, sleep disruption, speeding)
• --Numbing emotional responses (alcohol,
  withdrawal, apathy)
• --avoidance of things related to the event or
  talking about it

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What Problems Can I Expect to See?

• Alcohol Problems
• Drinking more than intended 35
• Need to cut back on drinking 29
• Drove after drinking several drinks 19

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What Problems Can I Expect to See?

• Aggressive Behavior
• Got angry, smashed something, punched a wall,
  slammed a door, etc.
• 52
• Threatened a person with physical violence
• 54
• Got into a physical fight
• 29

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How Many Marines Seek Help?

• 86 of Marines who had a serious problem
  recognized it
• However, only 45 of those wanted help
• 33 received help from a professional
• 24 received help from mental health

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Why Dont More Marines Seek Help?

• Stigma
• I would be seen as weak 66
• Leadership would treat me differently 57
• My unit will have less confidence in me 59
• It would harm my career 47
• My leaders discourage the use of mental health
  19
• Access Problems noted (Mental Health/Command)

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Leadership Responses

• Realize that some Marines will have serious
  symptoms that need attention
• Symptoms observed may not just be a phase but
  may increase and further damage performance
• Make yourself available to your Marines. If a
  Marine asks, listen to him/her and take their
  concerns seriously. Sometimes all a Marine wants
  is for someone to listen, understand and not tell
  him/her that they are a coward.
• Let Marines know that it is healthy to get
  assistance when needed, and that asking for help
  will not affect their standing in the battalion

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Leadership Responses

• Regularly visit and informally assess your
  Marines (Leadership by walking around)
• Short informal 11 conversations availability
• 1/2 to 2/3 of psychiatric patients present months
  after combat intensity ends recognize this
• Look for Marines who cant unwind or exhibit
  major shifts in personality (e.g., irritability,
  apathy)
• Address marines who question their efforts or
  losses
• Encourage to find the appropriate level of
  assistance

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Important Considerations

• Key ingredient in individual psychiatric problems
  after combat casualties or critical events is a
  lack of support structure
• Elite units marked by their high morale unit
  cohesion suffer lower incidence of combat stress
  reactions when compared to units exposed to
  similar battle conditions
• Social support mitigates perceived intensity of
  stressors and enhances self-efficacy efforts in
  dealing with them
• In listening to Marines, need normalization of
  reactions to difficult situations. Requires
  leadership and not personal insecurities
  regarding emotions/thoughts

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4 Primary Areas of Combat Stress Prevention

• 1. Unit Cohesion
• Primary reason for individual personality
  disorganization in combat is lack of unit
  cohesion.
• Individual Marine/Sailor who is depleted will
  function vicariously through the strength and
  attitude of his group
• Combat security is feeling trust in a
  commanders tactical proficiency and personal
  oversight of ones own welfare
• Marines/Sailors will keep fighting for their
  comrades longer than against their enemy

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4 Primary Areas of Combat Stress Prevention

• 2. Confidence in Commanders
• Strong inverse relationship between level of
  confidence and trust in commanders leadership
  before combat and combat stress responses
  afterwards
• 3. Confidence in Equipment and Self as User
• Appropriate, dependable, and repairable
• 4. Perceived Legitimacy of Mission
• Must see purpose. Requires Communication /
  Reiteration

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Leadership Resources

• Chaplain Ministry of Presence
• Can utilize Chaplain to visit sections and
  provide informal talks on Return and Reunion
  issues
• Provides understanding of pulse of command
• Address any existing reintegration difficulties
• Provide guidance towards available resources
  (e.g., CREDO, MCCS, etc)
• Chaplain can help gauge difficulties of
  transition
• Chaplain making available counseling sessions
• Management by Walking Around

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Leadership Resources

• List your Mental Health Resources such as
  ..Regimental, Battalion, MCCS One Source,
  Medical Treatment Facility.
• Marine Corps Counseling Services
• Individual or couples treatment Groups
• Prevention and Education
• (Anger/stress management finances parenting)

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RESOURCES

• List contact info for all the local resources
  that can help the Marine reintegrate with family
  and society.

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Questions or Thoughts?What are your needs?
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MCFTB Resources

• Coming soon via HQMC!
• Childrens Deployment Show Video
• L.I.N.K.S. Infomercial
• Standardized Pre-deployment materials
• Beyond the Yellow Footprints
• Updated SLS Curriculum