Combat Stress Recovery

Heads up: This section discusses combat trauma, PTSD, grief, and emotional reactions to deployment. Some readers may find the material difficult.

If you're already struggling, reach out to a chaplain, Mental Health Services, Military OneSource, or — in crisis — call or text 988 (Veterans Crisis Line: press 1).

A lot of people in the military will never experience actual combat in their careers — but those who do are deeply affected and have to face the consequences that stress carries. As you saw in Mental Preparation for Combat, most deployments are to combat zones, and no matter your job while deployed, you face that stress the same way.

It's easy to fall into your feelings, but you should not feel like you're carrying the weight of the world on your shoulders. Sometimes you'll be able to face this on your own. Sometimes you'll need to seek help if you can't. Combat stress can interfere with your personal life if you let it.

This section helps you identify the signs, what to do, and where to go so your resilience and self-control stay healthy. It's only a weakness if you do nothing.

Overview

Objective: Identify basic facts about resiliency in a deployed environment.

Learning Outcomes

• Define combat stress and how it differs from post-traumatic stress disorder (PTSD).
• Recognize when combat stress may appear.
• Identify reaction symptoms of combat stress and use stress management techniques to control reactions.
• Identify validated treatments for severe or prolonged symptoms — focusing on long-term recovery.
• Identify resiliency activities that create a foundation for minimizing the negative impacts of traumatic exposure.

Foundational Competencies

• Resilience — The process of negotiating, managing, and adapting to significant sources of stress or trauma.
• Self-Control — The ability to keep emotions under control and to restrain negative actions when under stress.

Summary

• What is Combat Stress?
• When to Seek Treatment for Combat Stress
• Treatment for Combat Stress
• What Can Happen if You Fail to Seek Treatment?
• Importance of Resiliency
• Positive Aspects of Deployment

What is Combat Stress?

Combat stress is the typical and normal responses a person may experience after working in a combat zone. It's not a new phenomenon — it's been observed throughout history under different names:

• "Shell shock" — World War I
• "Battle fatigue" — World War II
• "Traumatic stress" — Vietnam War

Whatever we call it, a few things are clear:

• Displaying combat stress symptoms is common, normal, and expected after facing traumatic events.
• It has been — and will continue to be — something experienced by those who face combat.
• It encompasses typical and normal responses to working in a war zone.
• Combat stress is NOT the same thing as PTSD, although some symptoms may overlap. PTSD can be a severe and often debilitating disorder. The prevalence of PTSD among active duty Air Force members is relatively low.

Displaying combat stress symptoms is not a sign of weakness, lack of discipline, or instability. The symptoms and reactions are a normal response to abnormal and stressful situations. They can appear a few hours, days, or even months after a traumatic event.

Combat Stress Reaction Symptoms

These categories include — but are not limited to — the following:

Most physical reactions can be traced to activation of the body's "fight or flight" or "acute stress" response. Relatively simple anxiety-management techniques — such as diaphragmatic breathing or progressive muscle relaxation — can go a long way toward reducing these symptoms.

Many behavioral reactions relate to avoidance of reminders of the traumatic event(s). For example, warriors who have been in combat might associate bridges, trash alongside roads, or loud noises with traumatic events they experienced overseas. They may try to avoid these things to minimize the reaction to those memories.

Avoidance generally worsens anxiety or distress because you're preventing yourself from "learning" that you're now back in a safe environment.

When to Seek Treatment for Combat Stress

So how do you know when professional help is necessary?

"Stress applied to the individual is not necessarily harmful. It is only when stress is prolonged or overwhelming and the individual is not able to cope with it that it becomes harmful physically and/or psychologically." — Davis & Friedman (Grossman, 2004)

Seek help if you have prolonged or overwhelming combat stress that you cannot cope with, or when combat stress reactions interfere with personal relationships, everyday life, or job performance.

The sooner you seek assistance, the easier it may be to resolve issues — and the less likely the combat stress will have long-term, significant effects on your life and the lives of those around you.

As a warrior, make use of all available resources to win the battle. That includes using these resources to aid in your recovery — from state-of-the-art medical and mental health assistance to chaplain support.

Treatment for Combat Stress

The majority of individuals who return from combat with these symptoms will not require formal treatment. Most experience low-level symptoms that resolve over a few months. In these cases, consider the following.

Stay connected

When stressed, people often disengage from activities they previously got pleasure or value from — exercise, going to church, hanging out with friends. It's especially important to remain connected with these sources of support during difficult times. This goes a long way toward reestablishing a sense of normalcy and stability and helps you get back into a "normal rhythm."

Talking about combat stress with others who have been through the same experiences is recommended — it can help normalize or validate thoughts and feelings associated with the traumatic event(s). This doesn't work for everyone and can lead to harm. Nobody should be forced to discuss traumatic events outside of a professional care setting if they aren't ready.

A study by the In-Theater Deployment Transition Center found that opportunities for self-exposure to sharing thoughts — and talking with others who had similar deployment experiences — could be extremely helpful. Journaling about your experiences is also an effective way to process difficult memories and emotions if you aren't yet comfortable sharing with others.

Combat stress can feel like grief

Some compare combat stress to a grief reaction. Being exposed to combat can feel like a "loss of innocence" and make a person question their deepest-held beliefs about the world, self, and others. This may result in a period of grieving.

Time does not heal grief — it's a process that needs to be gone through. Chaplains and mental health staff are trained to help you through this process if needed.

It's important to take time to mourn in the manner you choose. After battle, it's normal to mourn — including crying and feeling a sense of loss. There is no shame in it, and it is necessary. Engaging in mourning and grief rituals (funerals, celebrations of life, memorials) helps the long-term survival of those who served in combat.

Empirically validated treatments

For individuals who experience more severe or prolonged symptoms, there are several treatments that have been proven through research to be effective:

• Cognitive Processing Therapy (CPT)
• Prolonged Exposure (PE)

Research suggests these modalities can result in up to an 85% remission rate for individuals with PTSD. Most Air Force mental health providers are trained to administer CPT and PE.

Psychotropic medications are sometimes used in conjunction with these treatments (e.g., to help improve sleep) — but should never be used alone as a treatment for combat stress or PTSD.

Many military medical facilities offer treatment groups for members who have had similar experiences. There is ample research that group therapy is an effective way to gain social support and treat PTSD. Other recommended methods are reading self-help books, engaging in physical activity, and practicing relaxation methods.

Not all treatments are equally effective. Research has shown "supportive therapy" — just telling a counselor about your problems without a guided treatment approach — is not effective for PTSD and can actually be harmful, because the patient believes they are being helped but aren't.

Be sure to seek information about any diagnosis or treatment you have received and ensure you're receiving the most up-to-date and empirically supported treatment that's available.

What does NOT work

Some ineffective — and dangerous — means of treating combat stress:

• Trying to block combat stress reactions, especially recurring thoughts, dreams, or flashbacks.
  • Time does not heal. Problems cannot be "buried" — they will come out one way or another.
  • Whether it's manifested through substance abuse, relationship difficulties (irritability), sleep difficulties, or chronic pain, among others.
• Trying to numb the pain of combat stress with alcohol or other drugs.
• Not seeking professional help because you fear it will harm your career.

What Can Happen if You Fail to Seek Treatment?

Combat stress should not be a source of shame, embarrassment, guilt, anxiety, fear, grief, denial, anger, irritability, or depression. Anyone who has combat stress should not have a "suck it up and live on" attitude that keeps them from seeking the help they need.

It takes courage to come forward and seek help for emotional problems. It doesn't make sense to struggle alone when so many resources are available.

Combat stress should be looked at the same way as any other medical condition. Think of yourself as a professional athlete: if you had chronic pain in your knee that was slowing you down, you'd want to seek help and fix it. If you didn't, you'd expect the problem to get worse over time. The same is true of emotional difficulties.

Keeping your emotional reactions hidden and not dealing with them will not make the feelings go away. Combat stress will keep rearing its head and wreak havoc on your life — ruining relationships, causing work-related problems, and putting your life into a "downward spiral."

Have the courage to seek help.

Importance of Resiliency

You can engage in activities to help minimize the likelihood of a combat stress reaction. Four areas, taken together, build the foundation:

1. Applying your military training
2. Making healthy lifestyle choices
3. Maintaining strong social and emotional support
4. Having a spiritual foundation

Applying your military training

Your military training is designed to introduce and prepare you for the stress associated with military operations. That's why you receive extensive fitness, educational, and hands-on training to prepare you to perform your job in any environment. The military will do its best to prepare you for the job-related challenges you'll meet in a combat setting.

Making healthy lifestyle choices

Healthy lifestyle choices include:

• Regular exercise
• A healthy, well-balanced diet
• Proper amount of sleep
• Regular medical and dental checkups
• Drinking alcohol in moderation — if at all

A healthy body bounces back faster from physical injury and gives you an extra edge in coping with all types of stress.

Sleep is critical for tissue repair and consolidation of learning/memory — if you're sleep-deprived, your body and mind will NOT function optimally.

Sleep hygiene

Sleep is a highly learned behavior. We can "train" our bodies to sleep efficiently and effectively. Sleep hygiene skills include:

• A regular sleep schedule.
• Using your bed only for sleep.
• Avoiding blue-light-emitting screens (phone, computer, TV) for 30 minutes before bedtime.
• Not looking at a clock or watch overnight.
• Minimizing light, sound, and temperature distractions in the bedroom.
• Using earplugs or "white noise" to minimize ambient noise.
• Diaphragmatic breathing can be used very effectively to induce sleep.

For more information on improving sleep, contact your local Health Promotion team (Health Promotion Coordinator and/or Registered Dietitian).

Maintaining strong social and emotional support

Individuals who create strong social and emotional support during calm periods do better in times of stress because they have established people to turn to when stressful events occur. Those relationships also provide a sense of "value" that helps counterbalance job-related stressors.

Build friendships with people who give you mutual trust, concern, and the willingness to lend a caring hand and heart.

• Make social connections with your peers — you may deploy and spend a lot of time with them.
• Look after and get to know your wingman. You'll most likely have to depend on this person to help you through rough times.
• Rely on family and close friends for love and support, especially during stressful times.

Never isolate or shut yourself off from family, friends, and your wingman. They are all there to help you. Find a way to open up and talk so they can help you deal with your combat stress.

Having a spiritual foundation

A spiritual foundation can help provide value, meaning, and purpose to your life. Spirituality can be defined as some type of feeling or belief that allows you to feel meaningfully connected with the web of life around you.

You can fulfill this foundation by practicing a religious affiliation of your choice or by developing your own spirituality. Either way, it means developing a deep commitment to values that enhance your life and the lives of those connected to you.

Staying true to your beliefs will help you through stressful times and traumatic events.

Positive Aspects of Deployment

For the majority of individuals, deployments do not result in problems with combat stress or PTSD — and can lead to significant personal, professional, and spiritual growth. Life-long bonds of camaraderie and a sense of pride in having served tend to develop.

Even for those who experience a combat stress reaction or PTSD, research on "post-traumatic growth" shows that, after successful treatment, people can find positive aspects in experiences that were initially traumatic.

Get help when you need it

You can reach out to:

• Local Mental Health Clinic
• Chaplain
• Military & Family Life Counseling (MFLC)
• Military OneSource
• Veterans Crisis Line — call or text 988, then press 1

Summary

Know that combat stress symptoms are common, normal, and expected. Sometimes Airmen will be able to handle combat stress on their own — and other times they'll need to seek help. Prolonged or overwhelming stress from combat can interfere with your personal and professional life. Help is there if you need it.

Living a balanced life can help you deal with combat stress more effectively, but failing to get help when you need it can be devastating.

Your Core Value of Integrity First includes taking care of yourself and doing what is right for you.