...and you don't have to read it but I'm kind of excited about this one. My first paper where I was able to use a real bookstore (thank you B&N) and a topic that is so close to me (and so many of you) personally. I guess that personal investment really paid off, I aced it!
I used several great books as references, some might seem like a bit of 'psycho babble' to the everyday reader but others are very reader friendly and focus on military families and/or their returning service member. If you'd like the titles let me know. I highly suggest them for anyone who has been stationed in/near combat zones.
**I can't imagine any of my friend/family readers would try to plagiarize my paper but for anyone who stumbles across this paper and tries, know it will be caught on any plagiarism site your professor runs it through**
Life After Deployment
Living through a combat deployment may be the most stressful situation that a service member can go through but learning to live again after returning home can be a daunting task as well. We see and hear on the news accounts of service members struggling through adjustment issues when returning home after serving an extended period in combat environments; and as recently as today a post deployment health story made headlines. Though, this particular account was of a military working dog who now suffers from post traumatic stress disorder (PTSD) after serving as a bomb sniffing dog in Iraq (Elliot, 2010). While some debate the idea that animals can suffer combat stress reactions (CSRs), this story contributes to the level of incidence of combat stress injuries that occur as result of serving in hostile environments.
Most service members returning home from combat situations will have a period of readjustment that they and/or their families notice and consider disruptive to daily life. This period of readjusting can be short lived, a couple weeks or last up to a year. While many service members that serve in combat environments return home with only minimal adjustment issues as many as 30% of Vietnam veterans have had, or currently suffer with PTSD; veterans of Operation Desert Shield/Storm had an incidence rate of about 10.1%; veterans from the Somalia and Bosnia conflicts had an 8% incidence rate, and currently with the conflict in Iraq and Afghanistan have an incidence rate between 6.2% and 12.9% (Kennedy and Zillmer, 2006). With occurrences of combat stress reactions at these levels extensive research has been, and is currently being done to identify signs and symptoms of combat stress injuries during, and after returning from a deployment, as well as ways to alleviate symptoms allowing for affected service members to transition more smoothly into non-combat environments.
While serving in theater one might be shot at or be witness to the death of a friend, fellow service member, innocent civilian men, women and/or children, and even hostile combatants. Exposure to improvised explosive devices (IEDs), mine and bomb blasts, excessive weaponry, accidents, the constant state of alertness required while in combat environments and even the unfamiliar setting and culture in the combat location can initiate war zone stress reactions also known as combat or acute stress reactions (Sloan and Friedman, 2008).
Combat stress reactions can show up in the form of sleep disturbances, insomnia, restless sleep or nightmares, trembling or shaking, anger or aggression, shortness of breath, heavy chest, dizziness, pounding heart, elevated pulse or blood pressure, nausea, constipation, diarrhea, head or back aches, blurred vision, feelings that no one can relate or understand what you’ve been through or feeling like you’re either hyper vigilant (always alert) or have a delayed startle reaction. Further symptoms can include inattentiveness, memory loss, difficulty reasoning or faulty judgment, loss of hope, flashbacks, delusions or hallucinations (Kennedy and Zillmer, 2006; Slone and Friedman, 2008).
Due to the unnatural events that service members are faced with while forward deployed and the possible ramifications each could face, each branch of service has implemented a system for use during demobilization in hopes of informing service members of what to expect and/or to watch for in themselves and their comrades. During this demobilization process a post deployment heath assessment (PDHA) is conducted to determine post deployment health and to serve as a baseline for a future PDHA that will take place three to six months after returning home from deployment (Kennedy and Zillmer, 2006).
Colonel Carl Castro, PhD and colleagues created the ‘BATTLEMIND’ approach for the US Army at Walter Reed Army Institute of Research. It is utilized during their demobilization process and can be readdressed as needed through brochures, power point presentations and online. The word BATTLEMIND is an acronym that differentiates mental skills used for survival in combat situations but can be problematic if carried over in to day-to-day living. “B” stands for buddies (cohesion) vs. withdrawal; “A” is for accountability vs. controlling; the first “T” for targeted vs. inappropriate aggression; the second “T” represents tactical awareness vs. hyper vigilance; “L” is for lethally armed vs. locked and loaded; “E” stands for emotional control vs. detachment; “M” is for mission operational security vs. secretiveness; “I” represents individual responsibility vs. guilt; “N” stands for non-defensive driving (combat) vs. aggressive driving and the “D” stands for discipline and ordering vs. conflict (Sloan and Friedman, 2006).
In addition to the demobilization BATTLEMIND for service members, the Army has created a BATTLEMIND for loved ones that aims to increase resilience and smooth the integration process. For loved ones the acronym BATTLEMIND stand for Buddies (social support), Adding/subtracting from family roles, Taking control, Talking it out, Loyalty and commitment, Emotional balance, Mental health and readiness, Independence, Navigating the Army (military) system and Denial of the self (Self Sacrifice) (Sloan and Friedman, 2006). Understanding how and being able to mesh both BATTLEMINDs together can help the post deployment transition for the affected service member and his/her family alike.
Reactions to combat stress are normal and in many cases can be reduced through simple techniques and coping strategies, alone or with loved ones; though in some cases a greater intervention is required. Armstrong, Best and Domenici (2006) suggest using relaxation drills where you recall and focus on positive events that occurred while deployed. In addition to the positive thoughts, focused breathing techniques and forced flex and relaxation of muscle groups helps reverse the “fight-or-flight” response. One simple thing many service members forget is that it takes time to adjust to a post deployment mentality. In addition, service members should ease into pre-deployment routines like drinking, as it can intensify emotions or fears, or driving due to different driving styles in combat/civilian life. They are encouraged to reconnect with their social support and talk about their deployment experiences; if not with family or peers, then with a chaplain or counselor (Sloan and Friedman, 2008).
If CSRs continue for more than six to eight weeks, intensify with time, with specific circumstances or begin to interfere with personal or work life to the extent that basic functioning is hindered help from an outside source is recommended (Armstrong, Best and Domenici, 2006; Sloan and Friedman, 2008). Persistent reactions if left untreated can turn into PTSD, depression or other mental health problems (Sloan and Friedman, 2008).
Once a service member realizes either on their own, as result of a PDHA, through the demobilization process or with administrative initiative that his/her transition from combat to normal life is not progressing or if there is an intensification of combat stress reactions an intervention needs to occur. He or she should meet with their primary care physician (PCP) to discuss any physical or mental concerns and combat stress reactions that they have noticed since returning from combat. While at this appointment the service member should inform the doctor of any medications they are taking, be honest about any alcohol or illicit drug use if any, and if comfortable, discuss their wartime experiences and how they feel they are affecting them (Armstrong, Best and Domenici, 2006; Slone and Friedman, 2008). By making the initial step with a PCP, the physician can listen to the service members concerns and if he/she and/or the physician feel that symptoms suggest a diagnosis of PTSD then a Primary Care PTSD Screen (PC-PTSD) can be conducted. The PC-PTSD is a brief, problem focused survey that does not diagnose but rules out or supports that further assessments are necessary. From there, the PCP can either initiate a regular medical treatment plan or refer the service member to a psychologist, social worker or Veterans Center (Slone and Friedman, 2008).
At the initial meeting with a behavioral or mental health provider an assessment is conducted. Along with talking with the service member the counselor may give a written survey or verbally conduct an interview to assist in the diagnosis (Slone and Friedman, 2008). A diagnosis of PTSD comes with very rigid guidelines and is considered acute if the duration of symptoms is less than three months, chronic if the duration lasts three months or more or delayed onset if the symptoms begin to occur six or more months after the trauma has occurred (Grossman, 2008). In order to meet the criteria for PTSD one must have a history of exposure to one or more traumatic events that involve actual or threatened death or serious injury, or a threat to the physical integrity to oneself or others and has a response of intense fear, helplessness, or horror. In addition they must suffer from at least two symptoms (three for avoidant/numbing) from the following criterion: intrusive recollection, avoidant/numbing and hyper-arousal.
“Intrusive recollection, the traumatic event is persistently re-experienced in: Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions; Recurrent distressing dreams of the event; Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated); Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event; and/or Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
Avoidant/numbing, persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following: Efforts to avoid thoughts, feelings, or conversations associated with the trauma; Efforts to avoid activities, places, or people that arouse recollections of the trauma; Inability to recall an important aspect of the trauma; Markedly diminished interest or participation in significant activities; Feeling of detachment or estrangement from others; Restricted range of affect (e.g., unable to have loving feelings); Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span).
Hyper-arousal, Persistent symptoms of increasing arousal (not present before the trauma): Difficulty falling or staying asleep; Irritability or outbursts of anger; Difficulty concentrating; Hyper-vigilance; Exaggerated startle response” (APA, 2000).
Once a clear diagnosis is made the road to recovery can truly begin. The mental health provider will discuss in depth what PTSD is and how it will affect the service member and his/her co workers and loved ones. From there, patient and provider work together to set short and long term goals while mapping out the intended treatment. Treatment can consists solely of talk therapies and medications but often require more in depth teamwork between the patient and provider (Slone and Friedman, 2008).
Treatment may consist of group or individual therapy. With group therapy participants create bonds with others who have experienced similar traumatic experiences and from an individual’s experiences others in the group learn techniques to apply in their lives. Individual therapy can be administered through Cognitive Behavior Therapy (CBT), Cognitive Processing Therapy (CPT) or Exposure Therapy. CBT is the most effective choice of treatment for PTSD as it works with an individual’s thoughts in order to change their emotions, thoughts and behaviors. CPT enables the patient to indentify and examine trauma related thought patterns through cognitive restructuring and encourages replacing those thoughts with balanced and accurate ones. Exposure therapy involves controlled exposure to detailed images that instigate the fear and distress caused by the initial trauma and the memories triggered by the trauma. This process can be effective in disconnecting the memory from the associated fear and/or distress (Slone and Friedman, 2008).
Many people believe a person should avoid events, locations or situations where triggers occur but avoidance like this only reinforces PTSD symptoms because the sufferer fails to learn that these situations are only triggers to uncomfortable memories but are not in any real physical danger (Armstrong, Best and Domenici, 2006). Because of this theory, providers may offer coping techniques in situation avoidance. An example of such coping would be for the service member to write a list of all triggers – people, places and situations and rank them according to the level of stress they invoke. Create another list of ways to reward yourself after tackling a trigger. On a day where you have no other commitments plan to face the least stressful situation. While doing this you might need to resort to breathing and relaxation techniques but upon completion of the challenge, reward yourself with something from your rewards list (Armstrong, Best and Domenici, 2006).
Providers might also offer coping mechanisms for combating panic or unwanted images or memories. They may suggest specific exercises to do when overwhelmed and to pay attention to your “red flag” moments. At those times, the exercises and techniques provided will help calm tense conditions (Armstrong, Best and Domenici, 2006).
Once the service members understands PTSD and the role it plays in his/her life and has the strategies and coping mechanisms in place to combat stressors the only thing left is to heal and reintegrate into their military unit. Kennedy and Zillmer (2006) stated, “Combat stress reactions are normal responses to extremely abnormal conditions.” Even though symptoms may still present themselves, the natural social support within a military unit helps alleviate the perceived threat and increases the service members perception of personal health and well being as well as normalizing reactions (Kennedy and Zillmer, 2006).
Whether the CSRs are minimal and short lived or progress into PTSD or other emotional or anxiety disorders, knowing the signs and symptoms, seeking help when needed and maintaining a sense of belonging and camaraderie between the affected service member and his/her unit can make a world of difference in the recovery process.
