Preventing, Identifying and Treating Combat and Operational Stress Reactions COSRs

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Marine Corps Combat Stress Control Tools for
Rural Healthcare Settings
Geisinger Health System 13 May 2008
William P. Nash, M.D. william.nash_at_cox.net
The views and opinions contained herein are those
of the author, and do not represent the official
views of the USMC, USN, or DoD
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Similar Psychological Health (PH) Challenges,
Similar Solutions?

• Challenges in combat rural settings
• Stoicism reluctance to acknowledge problems
• Self-reliance aversion to asking for help
• Stigma shame and self-blame
• Limited access to specialty mental healthcare
• Solutions for combat rural settings
• Destigmatizing stress injury conception
• Stress Continuum Model a tool for buddies,
  families, and leaders to monitor stress
• Combat and Operational Stress First Aid (COSFA)
  tools to help and heal

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What is the Source of These Challenges and
Obstacles?

• Limited access to specialty care
• Geographic isolation
• Economics
• Stoicism
• Necessary denial
• Adaptive coping with adversity
• Self-reliance
• Cultural norms and expectations
• Adaptive coping with adversity
• Stigma
• Real potential harm from mental health diagnosis
• Prejudice and ignorance

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Conceptions of Combat Stress as Weakness Have
Added to Stigma
1916 Council of Munich
COMBAT STRESS LABELS THEORIES
(Lerner, 2003)
MEDICAL
PTSD, stress injuries
nostalgia
weakness, personality disorder
shell shock
gods, vice, fate
combat stress reaction
railway spine, insanity, soldiers heart
NON-MEDICAL
hysteria, fatigue
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Stress Reactions and Injuries In Between
Normal and Disordered
Stress Injuries
Stress Reactions

• Very common
• Always temporary
• Mild distress or loss of function
• Always self-correcting

• Uncommon
• May leave lasting changes
• More severe distress or loss of function
• May heal faster with help

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What Is Damaged In Stress Injuries?

• In the Mind
• Necessary beliefs can be damaged
• Self-concept and identity can be damaged
• Conscience can be damaged
• In the Brain
• Neurotransmitters can become depleted
• Secondary (allostatic) changes in the brain can
  lead to long-lasting dysfunction
• Neurons that modulate arousal and emotions can be
  damaged
• In the Spirit and Relationships
• Belief in God may be damaged
• Trust and connection to others may be damaged

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USMC Stress Continuum ModelA Tool For Stress
Recognition
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Four Stress Injury Mechanisms
Intense or Prolonged Combat or Operational Stress
BETRAYAL
LOSS
VIOLENCE
WEAR AND TEAR

• A trauma injury
• Due to events provoking terror, helplessness,
  horror, shock

• A grief injury
• Due to loss of people who are cared about

• A beliefs injury
• Due to shaken trust in morals, ethics, values,
  self, others

• A fatigue injury
• Due to the accumulation of stress over time

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Stress Continuum Decision Matrix A Stress
Monitoring Algorithm
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Combat and Operational Stress First Aid (COSFA)
Useful In Any Community
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Questions?