Combat and Operational Stress reaction COSR

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Combat and Operational Stress reaction(COSR)

• By CPT Alison Crane, RN, MS
• Mental Health Observer-Trainer
• 7302nd Medical Training Support Brigade

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Think of this hour as PMCS (Preventive
Maintenance Checks and Services) for your inner
machine

• LIKE EVERYTHING ELSE, THE HUMAN MIND
  AND BODY NEED PREVENTIVE MAINTENANCE OR THEY RUN
  A HIGH RISK OF
• BREAK DOWN

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The art of war aims to impose so much stress on
the enemy soldiers that they lose their will to
fight. Both sides try to do this and at times
accept severe stress themselves in order to
inflict greater stress on the enemy. To win,
combat stress must be controlled. US Army
Combat Stress Control Handbook, 2005
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What is Combat Stress?

• Stress is the bodys and minds response
• to uncertain change.
• Combat stress is a combination of physical,
  emotional, cognitive, and behavioral stressors in
  the combat zone which can produce changes in any
  Soldier that will impact performance either
  positively or negatively.

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NOT ALL COMBAT STRESS IS BAD OR DAMAGING!
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COSR vs PTSD (Just more alphabet soup?)

• Pretty much everyone comes home from Iraq and
  Afghanistan with COSR. We consider it a normal
  reaction to an abnormal experience.
• Very few have it long enough or bad enough for it
  to be called PTSD, which is a formal diagnosis in
  the DSM IV.

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WHY CARE?

• It will help keep
• YOU and YOUR UNIT
• mission capable
• and therefore improve
• everyones chances
• of survival

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What does it look like?

• Withdrawn, secretive
• Detached, controlling
• Angry, argumentative, impatient
• On alert, tense (hypervigilant)
• Avoids talking about experience
• Speeding tickets (once home)
• Drinking or using illegal drugs to fall asleep

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Whats really going on?

• Withdrawn, Secretive Feels that no one can or
  does understand war experience used to keeping
  all information closely guarded may feel
  damaged, permanently changed American culture
  may seem alien at first, a lot of nonsense
  Others have changed, disorienting.
• ANTIDOTE Spend time alone with each person
  Acclimate slowly Courageously accept and
  provide support

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Whats really going on?

• Detached, controlling Tight control over
  emotions, details, weapon and gear is critical
  during war for survival and mission success.
  But, with enough practice, we get stuck there.
• ANTIDOTE Remember that the small details are no
  longer vitally important. If you overreact,
  forgive yourself, apologize, and explain.

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Whats really going on?

• Angry, argumentative, impatient Lived under the
  premise of Kill or be killed chemical brain
  storm wages its own war May be angry over
  injustices and losses may see American culture
  as being caught up in a lot of nonsense.
• ANTIDOTE Talk about the anger with someone safe
  (clergy, battle buddy, spouse, counselor, MD,
  me) use prayer and/or meditation to help slow
  down brain chemistry medication walk away,
  count to 10, stop speaking and just think.

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Whats really going on?

• On alert, tense, hypervigilant Highly chemical
  and neurological endless stream of shocks crank
  up chemistry, which is tough to shut off can
  show up as intense startle response, difficulty
  sleeping, nightmares, tense or panicky in large
  groups or open spaces.
• ANTIDOTE Gradual elimination of all caffeine
  regular, sustained exercise see MD re sleep
  give yourself time to disengage from war think
  ahead, be proactive about possible trigger (7/4)

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Whats really going on?

• Avoids talking about war deployment Emotions
  from memories may make it too difficult
  anxiety, shame, guilt, regret, anger, fear, pain,
  grief, frustration, etc.
• ANTIDOTE Talk when you feel like talking and
  feel safe to do so write in a journal look
  into TFT or EMDR to help relieve intense
  emotions. (If intrusive thoughts become more
  frequent, call a Vet Center for suggestions on
  what to do.)

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Whats really going on?

• Speeding tickets In Iraq, 100 mph is a Sunday
  drive going 65 mph in America may make soldier
  feel extremely anxious and vulnerable.
  Consequence lots of speeding tickets.
• ANTIDOTE Work consciously to slow driving down
  and to deal with resulting anxietywith a
  counselor, if necessary.

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Whats really going on?

• Drinking, using illegal drugs to fall asleep
  chemical brain storm may be causing significant
  sleep disturbance, but so may the eerie quiet of
  American streets.
• ANTIDOTE If you need help falling and staying
  asleep, get a prescription drug that will be
  managed carefully by a doctor. Alcohol is a
  depressant, pot could be laced with other drugs,
  and the others are just plain dangerousmedically
  and professionally.

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Its time to get outside help when

• youre drinking or using drugs several days a
  week
• youre thinking about committing suicide or
  homicide
• there seems to be a lot of conflict in your
  relationships
• youre having trouble meeting your commitments at
  work or home
• your spouse, buddy, or boss suggests you need
  help
• youre feeling low or unable to enjoy life

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Why Soldiers Didnt Get Help

• Would be seen as weak 65
• Feared that unit leaders would treat them
  differently 63
• Feared other unit members would have less
  confidence 59
• Would get blamed by leader for problem 51
• Would harm career 50
• Too embarrassing 41
• Didnt trust mental health professionals 38
• Did think mental health care would work 25
• Didnt know where to get help 22
• Had no transportation 18

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Quietly Getting Help

• Clergy
• MilitaryOne Source (800-342-9647)
• Vet Centers and VA Hospitals
• Civilian mental health professionals
• Me
• CPT Alison Crane, 7302nd MTSB
• [phone] cell

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QUESTIONS? Comments?