Leadership Training on Preparing for

Combat/Operational Stress

Pre-Deployment StressPre-Deployment Stress

Choices• Family again

– Separation: SO/kids/parents

– Financial

• Mission– Safety– Mission objectives

• Fatigue

Coping• Family

– Spend time, talk with family

– Learn from the past, plan

• Mission– More certainty: no WMD,

less unknowns, time frame

– Take pride in your work

• Get Rest, PT, eat right

History of Combat StressHistory of Combat Stress

• Combat stress has been a common enemy

Operational/Combat StressOperational/Combat Stress

• “I look upon the spiritual life of the soldier as even more important than his equipment… The soldier’s heart, the soldier’s spirit, the soldier’s soul are everything. Unless the soldier’s soul sustains him, he cannot be relied upon and will fail himself and his country in the end.”

General George C. Marshall

Operational/Combat StressOperational/Combat Stress

– “The majority of analysts have arrived at the opinion that the course and outcome of modern war in large part, will depend upon the psychological condition of servicemen, their ability to endure an ever-increasing psychological load, overcome fear in battle, and preserve their will to win.”

Russian Officer reflecting on the Chechen Conflict

quoted in U.S. Army Medical Department Journal

Operational/Combat StressOperational/Combat Stress

• “Combat stress reaction… has the potential to disable the most courageous service member and influence the success or failure of a unit in accomplishing its mission. The small unit leader must understand how to recognize, prevent, and personally contend with reactions to combat stress when it occurs in members of his unit. Effective small‑unit leadership reduces the impact of stress. ”Marine Corps Reference Publication (MCRP) 6-11CCOMBAT STRESS

Stresses

Extreme risk and fear

What is Combat/Operational Stress

Ways to Fight ItEffective leadershipUnit CohesionPhysical Conditioning and Realistic TrainingReassure, Instill ConfidenceImpart pride, Lead by example

Stresses

The “fog” of war

What is Combat/Operational Stress

Ways to Fight It

Keep everyone informed

Quell Rumors

Get Facts

Debrief after mission

Clarify misunderstandings

Stress• Discomfort and fatigue

What is Combat/Operational Stress

Ways to Fight It

Hydration and Food

Dry off, cool off, warm up

Wash up, shave, change clothes

Sleep when possible, set sleep schedules

Stress• Combat Casualties

Ways to Fight It• Plan regular debriefings• Use appropriate memorial• Look for stressed Marines• Stress is normal• Allow for feelings then

focus on the mission

What is Combat/Operational Stress

StressBoredomFeelings of IsolationFNGs

Ways to Fight ItKeep Marines focused on the missionEnsure physical fitnessHumor is a flak jacketEncourage unit cohesionKnow your Marines (Birthdays, Families etc.)Welcome new MarinesNO HAZINGDon’t Intimidate, Inspire

What is Combat/Operational Stress

Stress ResponseStress Response

0102030405060708090

100

High

Arousel (Stress) Level

Performance Efficiency

Heavy Muscle Work

Fine Judgement MotorCoord.

Overlearned Drill

InterventionIntervention

• Regardless of the best prevention and leadership efforts serious Dysfunctional Combat Stress Reactions may occur.

• When this happens, Marine leaders (Squad Leaders, Co Gunny, Platoon CO), Medical and Psychiatric personnel and Chaplains work to intervene with simple principles.

Handling StressHandling Stress

Dysfunctional Stress Response

• Muscles• Sleep• Stomach• Cardiovascular• Neurological• Brain• Behavior/Misconduct

Ways to Cope • Take care of yourself:

sleep, eat, talk• Use Relaxation Steps

– Take deep slow breaths

• Think about succeeding• Maintain Discipline• Swift/Form punishment

for misconduct

Principles of Intervention Principles of Intervention

• Proximity– Manage the service member as close to their unit as

possible. Utilize maximum unit cohesion to promote recovery.

• Immediacy– Treat as soon as possible. Prevent mishaps and misconduct.

• Expectancy– Give positive expectations for full recovery and return to duty.

Normalize reactions.

• Simplicity– Use brief, simple methods to restore physical well-being, and

self-confidence. “3 hots and a cot.” Avoid Psychiatric Labels. Segregate from medical patients.

Regimental Recuperation CentersRegimental Recuperation Centers

When stress responses become too great or do notrespond to measures in the unit, refer Marine to theBAS for evaluation and possible referral to theRegimental Recuperation Center

Regimental Recuperation CentersRestores Marine through 24-72 hours of rest, and reassuranceOperated by Marines with assistance from Chaplains and Medical/Mental Health Staff Prevents unnecessary evacuation of Marines past the Regiment where there is little hope of him returning

***THIS MUST MATCH WITH YOUR UNIT PROCEDURES***

***Change this slide as necessary to match your procedures***

ConclusionConclusion

• Preserve Combat Power

• Stress is Normal • Goal is Control • Leadership

Responsibility• Brilliance in the

Basics• Use Support

ResourcesResources

• Medical Personnel/Chaplains/RRCs• FMFM 4-55 Combat Stress

• FM 8-51, Combat Stress Control in a Theater of Operations• FM 22-51, Leader’s Manual for Combat Stress Control

• FM 8-55, Planning for Health Service Support• “A War of Nerves” by Shepherd• “Achilles in Vietnam” by Shay

• Army Pamphlets and Pubs : COL Jim Stokes3151 Scott Road

San Antonio,TX 78234DSN 471-6985 or 210-221-6985

www.armypsychiatry.com• Stress Management Classes at Interventional Treatment Branch

• Division Psychiatrist Combat Stress Briefings• Virtual Naval Hospital Online

• Military Medicine Textbook Series

QuestionsQuestions

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MCFTB ResourcesMCFTB Resources

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