Post-Deployment Operational Stress Workshop for Marine Commanders

Post-Deployment Operational Stress Workshop for Marine Commanders
Leader Transition II Post-Deployment Operational Stress Workshop for Marine Commanders and Leaders Revised: 29 May 2008

Overview and Purpose Review sources of stress since returning home
Review the Combat Operational Stress Control Continuum (Ready, Reacting, Injured, or Ill) Self-assess eight important areas of life and function Relationships Money and finances Work function Physical & mental health Public behavior Life roles Substance use and abuse 8. Spirituality Learn how to improve these areas of life and function Learn how and where to get help when needed These are some of the areas today’s brief will address. Your Marines and family members will be receiving Warrior Transition II briefs as well. This brief is to familiarize and understand you with what they will be receiving, and also help you as a leader address these areas through your own self-assessment. This brief may be done as strictly an overview for familiarization with the topics that your Marines and families will receive, or, you may have the leaders actually go through the exercises in this brief individually or as an assembled group.

Common Sources of Stress After Deployment
Not understanding why sacrifices were made Loss of trust in others • Mistrust in self SPIRITUALITY Family conflicts • Crowds and rude people Being separated from buddies and leaders RELATIONSHIPS Anger over mistakes • Guilt over surviving Shame over perceived failures • Hatred FEELING Boredom, lack of excitement Back to the routines • Disillusionment THINKING Money problems • Vehicles and traffic Not carrying a weapon any more • Alcohol ENVIRONMENT The stressors we experienced upon returning home were different than what we experienced on deployment. These too impact us in the five areas of our lives shown in the left column. You may recognize some of these sources of stress as part of your experience both for yourself and your Marines. [Allow a short period of time for participants to look at this slide]. Remember: it is how we are feeling about these sources of stress and how we are dealing with them now that matter.

Combat Operational Stress Continuum for Marines
READY REACTING INJURED ILL Good to go Well trained Prepared Fit and tough Cohesive units, ready families Distress or impairment Mild, transient Anxious or irritable Behavior change More severe or persistent distress or impairment Leaves lasting evidence (personality change) Stress injuries that don’t heal without intervention Diagnosable PTSD Depression Anxiety Addictive Disorder Ready: the Green Zone The Green Ready zone can be defined as encompassing adaptive coping, effective functioning in all spheres, and personal well-being. The ability to remain in the Green zone under stress, and to return quickly to it once impaired or injured by stress, are two crucial aspects of resiliency. Following are some of the attributes and behaviors characteristic of the Green Ready zone: Remaining calm and steady Being confident in self and others Getting the job done Remaining in control physically, mentally, and emotionally Behaving ethically and morally Retaining a sense of humor Sleeping enough Eating the right amount Working out and staying fit Playing well and often Remaining active socially and spiritually Reacting: the Yellow Zone The Yellow Reacting zone can be defined as encompassing mild and temporary distress or loss of function due to stress. By definition, Yellow zone reacting is always temporary and reversible. The following experiences, behaviors, and symptoms may be characteristic of the Yellow Reacting zone: Feeling anxious Worrying Cutting corners on the job Being short tempered or mean Being irritable or grouchy Having trouble falling asleep Eating too much or too little Feeling apathetic or losing energy or enthusiasm Not enjoying usual activities Keeping to oneself Being overly loud or hyperactive Being negative or pessimistic Having diminished capacity for mental focus Injured: the Orange Zone The Orange Injured zone can be defined as encompassing more severe and persistent forms of distress or loss of function that cannot be fully undone over time. Although stress injuries cannot be undone, as for physical injuries, their usual course is to heal over time. Since stress injuries are not clinical mental disorders, they do not require clinical mental health expertise to recognize them, although operational commanders and small unit leaders rely heavily on their chaplains and organic medical personnel to identify orange zone stress injuries. Stress injuries include: Losing control of one’s body, emotions, or thinking Being frequently unable to fall or stay asleep Waking up from recurrent, vivid nightmares Feeling persistent, intense guilt or shame Feeling unusually remorseless Experiencing attacks of panic or blind rage Losing memory or the ability to think rationally Being unable to enjoy usually pleasurable activities Losing grounding in previously held moral values Displaying a significant and persistent change in behavior or appearance Harboring serious suicidal or homicidal thoughts Ill: the Red Zone The Red Ill zone can be defined as including all mental disorders arising in individuals exposed to combat or other operational stressors. Since Red zone illnesses are clinical mental disorders, they can only be diagnosed by health professionals. However, Marines can and should be aware of the characteristic symptoms of stress illnesses. Common Red zone illnesses include the following: Posttraumatic stress disorder (PTSD) Depressive disorders, especially major depression Anxiety disorders, including generalized anxiety and panic disorder Substance abuse or dependence Signs and Symptoms of these will be discussed in later slides. Individual Responsibility Chaplain & Medical Responsibility Leader Responsibility

Combat Operational Stress Continuum Decision Matrix
READY REACTING INJURED ILL DEFINITION Good to Go Well-Trained Fit and Tough Adaptive Coping SIGNS Effective Functioning Calm and Steady In Control Getting the Job Done ACTION Monitor for signs of distress or stress reactions in future if concern arises Some impairment in job functions or relationships Mild transient distress Some anxiety or irritability Poor sleep; poor mental focus Nightmares; easily startled Loss of social interest Some change from normal behavior Ensure adequate sleep/restoration Refer to Chaplain or Medical if there is no improvement After Action Reviews More severe or persistent distress or impairment More lasting scars on behavior or personality Lost emotional control at some point Can’t sleep Disruptive nightmares or memories/flashbacks Social withdrawal Panic/rage episodes Loss of concern for usual beliefs/values Enforce rest and recuperation ( hours) Refer to Medical if no improvement Stress injuries that won’t heal without medical intervention Diagnosable illnesses (Such as: PTSD; depression; anxiety; substance abuse) Stress problems that last several weeks post- deployment Not getting better or getting worse Impacting work or relationships Refer to Medical Ensure treatment compliance Monitor back to full duty The Definitions for each area describe, in very general terms, the characteristics that a Marine will exhibit for that particular zone. For example, Marines who are in the Green zone, will be well-trained, fit and tough, and can cope through adapting to circumstances. They are good to go. Signs give some of the signs and symptoms that Marines will exhibit if they are in a particular zone. A Marine in the Orange Injured zone will have bad nightmares and flashbacks and will not be able to sleep. He/she may exhibit panic and rage episodes. Actions are what can be done to mitigate or treat signs and symptoms for each zone. A Marine whose signs and symptoms place him/her in the Yellow Reacting zone may only need a good period of rest, sleep, and replenishment and a meeting or two with a Chaplain to restore some lost confidence and hope for getting better. Any Marine whose signs and symptoms place him/her in the Injured or Ill zone should be referred to Medical if there is no improvement in the condition.

Post-Deployment Self-Assessment
Relationships Work function Public behavior Substance use and abuse Money and finances Physical and mental health Life roles Spirituality The following interactive exercises will be presented to your Marines and family members In Warrior Transition II and Family Transition II: If leaders would like to go through the exercise now, notes are available below and on accompanying slides. So now it’s time to see how we are dealing with some of these stressors. It’s time for a short but helpful self-assessment. These are eight areas of our lives where we can take the pulse of how we are doing after being home for three months. An honest and private evaluation of each of these areas will be helpful for everyone here, but even more beneficial for those who have recently experienced a combat deployment. You have received a folded handout for today’s brief. It fits in your pocket. It is private. But it will help us get to the moment of truth in self assessment today as we see how we are doing handling our life at home. Please get the handout out now, and make sure you have a pen or pencil. This guide gives you a low-risk, high-benefit way to evaluate how you’re doing following deployment. Use it honestly during the presentation and you’ll be able to celebrate the progress you’ve made, identify areas for growth, and figure out where you may need help. Make a mark in the appropriate column on the table inside this guide for each indicator mentioned in the brief. Though this is for your use only, consider sharing your results with family and others. In fact, if you find it difficult to talk about yourself, you may find showing your card to another will help them understand you better and may even jump-start an improved relationship. So, when we are done today, put this in your breast pocket. At some point, I am sure you will take this uniform home to launder it. When you do and pull out the card might be the perfect opportunity to share with your significant-other just how you are doing. This is a great opportunity for real growth. When we are finished with this, we will go through a list of resources that are available to assist in each of the eight areas. When we get to that section, you will want to write down the resources on your sheet next to the area where you need some work.

1. Relationships Spouse, significant other, family, friends
Okay Needs Work Needs Help In relationships, what are signs that we are doing OK? What are indicators of good relationships? Let’s brainstorm some of your ideas. (Marines here give their thoughts for these areas and they can be written down on a large piece of butcher block paper taped to the wall). In relationships, what are signs that you are doing OK? What are indicators of good relationships? What are indicators of a relationship that needs a little work? And let’s get honest – we can all use a little work. What are some signs? And what are some signs that our relationships need some outside help? That we need to talk to someone? That we need to do some work quick, or we may be headed for serious problems, if we are not already there?

1. Relationships Spouse, significant other, family, friends
Okay Needs Work Needs Help Good communication Feeling close Looking forward to seeing Cooperating well Playing well Good sex Good conversation Affection Openness Responsiveness Trouble communicating Occasional fights and disagreements Uncomfortable being together Not having fun Staying apart Difficult or rare sex Complaints from partner Ambivalence Guardedness Poor communication Frequent fighting Dreading contact Emotional coldness No sex Irresolvable conflict Criticism Contempt Defensiveness Emotionally numb Thoughts of hurting others or self [Start across the top for the first, then Do Columns] Here are some we identified. Where are you on each? Put a tick-mark in the appropriate column. And if you need to mark some from the ones you added as a group, feel free to add marks for them as well. This is not a test. We will not collect them. They are just for your use. This might be a good thing to take home and talk over with your significant other. So, where are you? Mark it down.

2. Work Function Shop, supervisors, goals, promotion, rewards
Okay Needs Work Needs Help [Do Columns] In your work, or your unit, what are signs that you are doing OK? What are indicators of a properly functioning shop? What are some indicators that you need to do a little work to cope with your work environment? What are some signs? And what are some signs that you need some outside help to deal with your situation?

2. Work Function Shop, supervisors, goals, promotion, rewards
Okay Needs Work Needs Help Achieving Feeling like a team Mentoring subordinates Getting rewarded Career goals progressing Job satisfaction Enjoying going to work Respected by subordinates Cutting corners Needing a lot of supervision Animosity toward peers or leaders Being apathetic or unmotivated Unrewarding Stagnating Indifferent No respect for self or others Defying authority Being a tyrant to subordinates Hostile environment Disorganized/lack of leadership Held back Unsupported Abandoned Abused [Start across the top for the first, then Do Columns] Here are some we identified. Where are you on each? Put a tick-mark in the appropriate column. So, where are you? Mark it down.

3. Public Behavior Driving, waiting, dealing with public, patience
Okay Needs Work Needs Help What are signs that your actions, your behaviors are OK? What are indicators of personal behavior that is acceptable? What are some indicators that you need to do a little work on your behavior, or actions in public? What are some signs? And what are some signs that you need some outside help to deal with your behavior?

3. Public Behavior Driving, waiting, dealing with public, patience
Okay Needs Work Needs Help Comfortable in public Appropriate in public Good and careful driver Patient in frustrating situations Calm, even with rude people Friendly No police involvement Avoiding going out in public Suspicious of strangers Absent minded Getting frustrated easily Impatient Occasionally angry or irritable Driving too fast Driving recklessly Paranoid in public Road rage Picking fights Rage outbursts in public Panic attacks in public Persistent hyperactive startle responses Arrests [Do across] Put tick-marks in the appropriate columns. Which of these apply to you?

4. Substance Use/Abuse Tobacco, alcohol, drugs, sugars, fats
Okay Needs Work Needs Help What are signs that addictions don’t control your life, or affect your life in negative ways? What means you are doing OK? What means you need to take some steps? What are signs you definitely need help?

4. Substance Use/Abuse Tobacco, alcohol, drugs, sugars, fats
Okay Needs Work Needs Help Good control over intake of alcohol Not tempted to use drugs Not smoking chewing more Nobody who knows you thinks you are abusing Others express concern over drinking Got drunk when didn’t intend to Use alcohol to get to sleep Drinking is getting in the way Smoking or chewing more Anger when others complain about drinking Lying to keep drinking Hiding drinking Harm to life from alcohol Using illegal drugs Blackouts Frequent drinking to intoxication I will use alcoholism as the example, but nearly all addictions, tobacco, drugs, sugars, fats, pornography, etc., have direct parallels in behavior. [When you get to Needs Work:] Others expressing concern may be right, or they may be wrong, but you know if you also have some of the Needs Help column, that’s where it goes for you. Getting drunk when you didn’t intend to, and drinking as a response to problems also move into the Needs Help column if you have any of the other symptoms, or have done it more than once. Put marks on all that apply.

5. Money and Finances Budget, purchases, credit, bills, savings
Okay Needs Work Needs Help Check yourself.

5. Money and Finances Budget, purchases, credit, bills, savings
Okay Needs Work Needs Help Saving money Bills paid up to date Keeping to budget Debt under control Working a financial plan Spending in sync with spouse Minimal savings Bills past due Financial worries Uncomfortable debt Vague financial plan Conflict with spouse over spending No savings Collection notices Major financial stress Large debt load Creditors contacting command Total disagreement over spending Financial trouble Mark the areas that are applicable to you.

6. Physical/Mental Health Fitness, wellness, self-esteem, control
Okay Needs Work Needs Help What are some indicators that you are doing OK? What indicates you should do a little work? When do you need help?

6. Physical/Mental Health Fitness, wellness, self-esteem, control
Okay Needs Work Needs Help Sleeping well No bad nightmares Working out regularly Good nutrition Good energy level Good emotional control Able to enjoy life Not troubled by memories Feeling good about self Trouble getting to sleep Keep waking up Out of shape Eating too much or too little Loss of interest in life Feeling anxious or worried Feeling irritable Painful memories Feeling guilty Can’t sleep enough Repeated disturbing thoughts Trouble pushing memories out of mind Panic attacks (heart pounding, shaking) Rage outbursts Depressed mood Keep blaming self Thoughts of suicide or homicide How are you doing?

7. Roles in Life Leader, coach, parishioner, citizen, provider
Okay Needs Work Needs Help What are some indicators that you are doing OK? What indicates you should do a little work? When do you need help?

7. Roles in Life Leader, coach, parishioner, citizen, provider
Okay Needs Work Needs Help Comfortable in roles Meeting your own expectations in roles Able to balance competing demands Fulfilled Energized Some strain in roles Not meeting own expectations in roles Not able to fit the pieces together Out of balance Pressured Drained Pulled apart Too many demands Tension between roles Serious conflict with others over roles Exhausted How are you doing?

8. Spirituality Creativity, order, connection
Okay Needs Work Needs Help What are some indicators that you are OK spiritually? What would indicate that you should do a little spiritual work? That you need to do a little homework? When do you probably need to seek help?

8. Spirituality Creativity, order, connection
Okay Needs Work Needs Help Enjoy worship Happy with fellowship Happy with spiritual expression Able to give and receive love Appreciating beauty Creative Comfortable with your place in world Connected, peaceful Less tolerant of different beliefs Feeling distant from God; want to get closer Don’t know how to love or feel loved Feeling distant from others Struggling to understand others Not sure where you fit in Something’s missing No reverence for anything outside self Alone and wandering aimlessly Spiritually empty Don’t care about others Nothing seems important Feel powerless to change life Out of touch Loss of purpose Lacking a “moral compass” How are you doing in these? These are all a part of being a spiritual person. Mark your cards.

Self-Assessment Summary
Okay Needs Work Needs Help Relationships Open Communication Tension Coldness or Fighting Work function Effective Indifferent Hostile environment Public behavior Patient, calm Aggressive, irritable Risky, hostile Substance abuse Not an issue Could be an issue Is an issue Money and finances Under control Financial worries Financial trouble Physical and mental health Healthy and fit Disturbing thoughts, feelings Roles in life Balanced, comfortable Out of balance Pulled apart Spirituality Connected, peaceful Something’s missing Empty, lack of “moral compass” Using this summary page, where are you? Even if you haven’t completed the previous worksheets, you have a chance to review and summarize. Take a look at the summary words in this chart. And maybe put a mark in any area that describes your life right now. The chart makes it easy to understand areas on a continuum. Green means good to go. You are healthy in this area. Yellow means that it could be an area of caution; an area to slow down on and examine and maybe get some help. Again, if you find yourself in an Orange/Red area in the “Needs Help” column, then it is time to talk to someone. More than likely, most of us will have a lot of check marks in the Yellow “Needs Work” category, because, don’t we all? Now we are going to look at ways to help yourself or get help if it is necessary. Each of the eight areas will be looked at.

Relationships: Resources and Tools
Marriage Enrichment Retreats CREDO Marriage Encounter Personal Growth Retreats Relationship Seminars Time Away Together Date Nights Family Trips Marriage Counseling Marine and Family Services Military One Source Here is what we will be showing your Marines. These slides will be a good resource tool for you in referring Marines for help in these areas. Be sure to write down, or underline, the tools that you think might be helpful to you. These are tools for when these areas need a little work.

Work Function: Resources and Tools
Supervisor Career counselor Leadership training Training or self-improvement courses Stress management seminar Anger management seminar 1stSgt or SgtMaj Request Mast Here are some tools for improving work function and satisfaction. They actually go in order, for most of us, on how to approach problems in your unit.

Public Behavior: Resources and Tools
Anger Management Motorcycle or driver improvement course Sports or clubs or hobbies Volunteer work – get involved Personal Counseling Marine and Family Services Military One Source More tools for improving public behavior.

Substance Use and Abuse Resources and Tools
Get honest with yourself Ask others how they perceive your drinking Trial of sobriety Stop taking substances that may harm you SACO, DAPA Treatment program, SARP AA Al Anon to help family members adjust These are tools, but in this area, they are also for the “Needs Help” category.

Money and Finances: Resources and Tools
Budget counseling Navy/Marine Corps Relief Society Credit Unions Financial Management seminar Marine and Family Services Disciplined savings – even small First for emergency fund, then savings Career and financial planning for future goals Certified financial planners Couples Communication seminar These resources and tools are excellent for getting the basics together for financial planning.

Physical/Mental Health: Resources and Tools
Physical Fitness to Maintain Stress Resilience Get a physical check-up Eat healthier Improve sleep schedule Breathing to Focus and Calm Prayer or Meditation for Spiritual Resilience Journaling or expressive writing to clear your head Personal Growth Retreat – CREDO Chaplains Mental health professionals OSCAR Deployment Health Clinic MTF Here are some resources and tools for improving your physical and mental health.

Roles in Life: Resources and Tools
Don’t miss out on what you enjoy Re-evaluate your priorities Try something different Get out of a rut (comfort zone) Go with your strengths or growing edges Learn new skills Take a parenting course or seminar Take a college course Use Military OneSource: Information on anything and everything Visit a Marine and Family Services counselor Tools and resources

Spirituality: Resources and Tools
Look for a church or fellowship that fits you Read your sacred texts Pray, meditate Get involved in caring for others Find a spiritual director, talk to a chaplain Go on a spiritual retreat Get involved in music, arts Go camping Again, we can take note of the things we might need to explore and get consistent with in our spiritual lives. There are many excellent resources where we can get information, and they have been listed on these slides in the eight areas of our lives.

Where To Get Help Corpsmen Chaplains Unit medical (BAS, RAS, GAS, etc.) Operational Stress Control and Readiness (OSCAR) mental health team, if your unit has one Medical Treatment Facilities (Hospitals and Clinics) MLG Surgical Company Forward Marine and Family Services Counselors Military OneSource ( Vet Centers ( HQMC COSC ( Marine Leaders Guide ( leadersguide) This is the last slide in our brief. This slide gives “Where to Get Help” if problems are more serious and the tools covered in the other slides for each area aren’t enough. Local resources vary from base to base and location to location. These are best used from referrals to assure that the services are of good quality. Don’t we all need some help and assistance from time to time? Again, if any of you found yourself in the Orange/Red zone of the slides that described serious symptoms such as repeated, disturbing memories, thoughts, or images; repeated, disturbing dreams; suddenly acting or feeling as if a stressful experience were happening again; feeling very upset when something reminded you of a stressful experience; having physical reactions (e.g., heart pounding, trouble breathing, sweating) when something reminded you of a stressful experience—then you need to begin to seek assistance from one of these resources.

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