Section XII: Combat and Operational Stress Reaction
Normal Reactions in Extreme Situations
Goals of the Exercise
1. Describe the various symptoms that have developed in response to the combat/operational stress.
2. Return to full mission capability.
3. Restore confidence in combat abilities.
4. Acknowledge that combat/operational stress symptoms are transient and that full recovery is expected.
Additional Problems for which this Exercise may be Useful
- Adjustment to Killing
- Anxiety
- Insomnia
- Nightmares
- Physiological Stress Response—Acute
- Posttraumatic Stress Disorder (PTSD)
Suggestions for Processing this Exercise with Service Members
The “Normal Reactions in Extreme Situations” is designed for use with service members experiencing combat and operational stress reactions (COSRs) as the result of trying events in combat, training, or other duties. COSRs are a common occurrence in service members who are faced with difficult and dangerous jobs. Unlike psychiatric disorders, COSRs are generally viewed as transient and an expected consequence of serving in a hostile or dangerous environment. Therefore, focus in treatment should be on the transient nature of the symptoms and helping the service member normalize his or her reactions with the expected outcome of a return to previous level of functioning. It is crucial that the service member not be placed into the role of “patient.” This only reinforces the symptoms and halts the service member's natural process of recovery and adjustment. Follow-up for this activity could include a reading assignment from Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner.
EXERCISE XII.A Normal Reactions in Extreme Situations
Being exposed to difficult and dangerous situations in either deployed or garrison settings can put you at risk of experiencing a combat and operational stress reaction (COSR). This is a normal, expected, and predictable emotional, physical, and behavioral reaction to a stressful event. Although generally viewed as a consequence of serving in a war zone, COSRs may also develop during training operations, peacekeeping missions, and/or humanitarian missions. Symptoms of the COSR can range from mild to severe. However, in most situations, the symptoms will disappear on their own or with some brief help from a mental health professional, chaplain, or leader within your chain of command. The important message to take from this is that you can expect this to pass. This exercise will help you identify and understand the typical symptoms associated with COSRs and help get you back on track.
1. Please circle the different reactions you've been experiencing since the stressful event:
| Physical | Emotional | Behavioral |
| Fatigue Jumpiness Difficulty sleeping Irregular heartbeats Dizziness Nausea, vomiting, or diarrhea Slow reaction time Muscle tension Weakness and paralysis Impaired vision, hearing, and touch |
Anxiety Grief Inability to concentrate Nightmares Self-doubt Anger Excessive concern with minor issues Loss of confidence in self and unit Loss of trust in superiors Loneliness |
Indecisiveness Inattention Carelessness Hyper-alertness Lack of motivation Irritability Crying Argumentative Fighting Tardiness |
2. Listed below are some ways to address these responses that many others have found helpful. In addition to these, you can probably think of some more ideas that will work well for you. Please use the empty lines to list things you'll do during the next week:
Addressing physical reactions: Exercise moderately, stretch, get some extra sleep (relax and rest if you have trouble sleeping), take a hot shower, hydrate, eat something you like. For nausea, vomiting, or diarrhea, see a medic/corpsman.
a. _____
b. _____
c. _____
d. _____
e. _____
f. _____
Addressing emotional reactions: Talk to trusted friends and/or a chaplain or counselor; remember past stressful times and how you got through them; watch a comedy or talk with a friend who makes you laugh; pray; write in a journal; remind yourself this will pass; remember your accomplishments and skills; engage in a hobby; read something interesting; listen to upbeat music; think about plans for five years from now; meditate.
a. _____
b. _____
c. _____
d. _____
e. _____
f. _____
Addressing behavioral reactions: Look for ways to stay organized; focus on practical tasks and do them as well as possible; acknowledge feelings and thoughts to yourself and/or a trusted friend, chaplain, or counselor but remind yourself that you choose how to act on them; use methods friends have used to cope with temporary upsets (though not drinking or using other mood-altering substances, except under a doctor's instructions.)
a. _____
b. _____
c. _____
d. _____
e. _____
f. _____
3. (Answer this question one week after the first two questions.) Please answer the following:
a. How many of the activities you chose in question 2 did you end up doing during the past week?
_____
b. Which ones do you think were most useful in helping you relax and feel better?
_____
_____
_____
c. What changes do you see in the reactions you circled for question 1?
_____
_____
_____
Be sure to bring this handout back to your next meeting with your counselor or chaplain, and be prepared to discuss your thoughts and feelings about the exercise.
Healthy Ways to Handle Stress Fast
Goals of the Exercise
1. Return to full mission capability.
2. Restore confidence in combat abilities.
3. Eliminate physical and emotional factors that impede mission performance.
Additional Problems for which this Exercise may be Useful
- Adjustment to Killing
- Anger Management and Domestic Violence
- Anxiety
- Borderline Personality
- Brief Reactive Psychotic Episode
- Insomnia
- Nightmares
- Panic/Agoraphobia
- Phobia
- Physiological Stress Response—Acute
- Posttraumatic Stress Disorder (PTSD)
- Pre-Deployment Stress
- Separation and Divorce
- Sexual Assault by Another Service Member
- Suicidal Ideation
Suggestions for Processing this Exercise with Veterans/Service Members
The “Healthy Ways to Handle Stress Fast” activity is designed for service members experiencing combat and operational stress reactions (COSRs). The best “treatments” for COSRs are simple stress-reduction strategies and staying active in a stable and structured routine. These approaches, especially when integrated, help limit the impact COSR symptoms have on the service member and bolster confidence in his/her abilities. Remember to set an expectation of rapid recovery for service members and not lead them to see themselves as patients. Follow-up can include reading assignments from Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner.
EXERCISE XII.B Healthy Ways to Handle Stress Fast
This exercise has two parts. First is a list of ways to handle stress fast; the second part is about making sure we actually use those stress-management strategies by including them in a structured schedule for our daily routine (and having more structure is a stress reduction strategy in itself). When you're going through a combat and operational stress reaction, these will help you get through it and back to your usual self as quickly as you can. For the scheduling portion, please ask your chaplain or counselor to make seven copies of the daily schedule for you so that you can fill out one for your routine each day of the week.
1. Stress management tools: Basically, we'll divide these into different categories depending on whether they're activities that take more than one person or ones you can do solo and whether they're mainly physical or mainly mental. This handout lists some in each category, but you'll think of more that work well for you and add them to this list.
| With Other People—Mainly Physical | Solo—Mainly Physical |
| Team sports Running Working out |
Stretching Running Working out Sleep Hot shower |
| With Other People—Mainly Mental | Solo—Mainly Mental |
| Conversation Watching a comedy Games—cards, chess, etc. Computer/video games |
Reading Writing in a journal Watching a comedy Computer/video games Listening to music Playing music Calling, emailing, or writing home Meditation Prayer |
2. Scheduling and structure: Following is a sample page for your daily schedule. Please ask your chaplain or counselor to make enough copies to cover a week.
Be sure to bring this handout back to your next meeting with your counselor or chaplain, and be prepared to discuss your thoughts and feelings about the exercise.
| Day/Date _____ | ||
| Time | Activity | Completed? |
| 0500 to 0530 _____ | ||
| 0530 to 0600 _____ | ||
| 0600 to 0630 _____ | ||
| 0630 to 0700 _____ | ||
| 0700 to 0730 _____ | ||
| 0730 to 0800 _____ | ||
| 0800 to 0830 _____ | ||
| 0830 to 0900 _____ | ||
| 0900 to 0930 _____ | ||
| 0930 to 1000 _____ | ||
| 1000 to 1030 _____ | ||
| 1030 to 1100 _____ | ||
| 1100 to 1130 _____ | ||
| 1130 to 1200 _____ | ||
| 1200 to 1230 _____ | ||
| 1230 to 1300 _____ | ||
| 1300 to 1330 _____ | ||
| 1330 to 1400 _____ | ||
| 1400 to 1430 _____ | ||
| 1430 to 1500 _____ | ||
| 1500 to 1530 _____ | ||
| 1530 to 1600 _____ | ||
| 1600 to 1630 _____ | ||
| 1630 to 1700 _____ | ||
| 1700 to 1730 _____ | ||
| 1730 to 1800 _____ | ||
| 1800 to 1830 _____ | ||
| 1830 to 1900 _____ | ||
| 1900 to 1930 _____ | ||
| 1930 to 2000 _____ | ||
| 2030 to 2100 _____ | ||
| 2100 to 2130 _____ | ||
| 2130 to 2200 _____ | ||
| 2200 to 2230 _____ | ||
| 2230 to 2300 _____ | ||
| 2300 to 2330 _____ | ||
| 2330 to 2400 _____ | ||
| 2400 to 0500 _____ | ||