Combat Operational Stress Research Articles

Inclusion of the military in the national social and economic space

Methods. In the course of study, the following methods were used: comparative analysis – in analyzing the inclusion of veterans in the socio-economic space of countries where there is a significant number of military personnel returning from conflict zones or discharged from military service; method of analysis and synthesis – in determining the directions of military inclusion in the national socio-economic space; method of classifications – in identifying the main types of business that may be most favorable for Ukrainian veterans in their integration into the national economy; induction and deductions – when formulating research conclusions. Results. The article defines the need and role of military inclusion in the social environment for the stability and development of the country. The reasons and directions for the inclusion of Ukrainian veterans in the socio-economic space of the country are identified to ensure the psychological and social well-being of veterans, the effective use of human capital, political stability, cultural integration and social justice. It is substantiated that Ukraine should develop measures to fight for a person and for the humanity in working with the military and the population affected by combat operational stress, and create a unified system for the treatment and socialization of war veterans. It is established that the choice of future business depends on the individual skills, interests and experience of veterans, as well as on market conditions and available resources in the country. The author emphasizes the need for support from the state and public organizations to ensure the successful start and development of business by former military personnel. The author summarizes that stimulating business for veterans in Ukraine requires a comprehensive approach that includes financial, educational, consulting, information and infrastructure support. This will help veterans successfully integrate into the economic life of the country and contribute to its development. Novelty. It is proved that the inclusion of former military personnel in the socio-economic space of the country in the context of the social, economic and political plane will shape Ukraine as a country dominated by inclusive development in general, and for veterans will facilitate their integration into civilian life and their active involvement in the development of the country. Practical value. The results of the study can be used by institutions in the process of developing strategies and programs for the inclusion of veterans in the socio-economic space at both the regional and national levels of the country.

Operational Stress Control during a Pandemic: An Army National Guard Perspective on Lessons Learned during the Response to COVID-19

U.S. Army combat operational stress control doctrine and techniques are effective resources for military leaders preparing for prolonged operations in hostile environments. This doctrine provides an understanding of common sources of stress, stress reactions, and effective leader actions to help mitigate the effects. However, it may be less relevant to Army National Guard members activated to support their states during domestic emergencies. This article reviews the observations of one Behavioral Health Officer activated during the novel coronavirus 19 (COVID-19) pandemic and describes the operational stress experienced by Army National Guard members. Adaptive and maladaptive stress reactions to the stress of the COVID-19 operations are reviewed. The author calls for new or revised combat operational stress doctrine that is relevant to part time, citizen-soldiers activated for domestic emergencies. Aggregating Army National Guard lessons learned in the context of COVID-19 may also help support soldiers in the case that unfortunate future waves of the virus occur and to prepare for future pandemics.

Moving Moral Injury Into the Future With Functional Contextualism: A Response to Nash's "Unpacking Two Models for Understanding Moral Injury" (2019).

In his commentary on the Journal of Traumatic Stress special issue on moral injury (Vol. 32, Issue 3), Nash (2019) critiques both Farnsworth's (2019) descriptive-prescriptive framework for differentiating posttraumatic stress disorder (PTSD) from moral injury and Farnsworth, Drescher, Evans, and Walser's (2017) functional contextual definition of moral injury and related concepts. To make his arguments, Nash contrasts these two frameworks with the Navy and Marine Corps Combat Operational Stress Control (COSC) model wherein moral stressors are presumed to cause literal damage to intrapsychic structures. Unfortunately, in drawing his comparisons, Nash makes several misstatements that we feel are important to clarify. We respond to Nash's commentary by first identifying the proper sources for the critiqued frameworks and correctly locate Farnsworth etal.'s functional contextual definition of moral injury within the domain of third-wave cognitive behavioral therapies. We go on to compare and contrast the respective origins of the COSC and functional contextual models, noting important differences in their intended purposes. Next, we defend our model against Nash's critiques by highlighting how a functional contextual approach to moral injury (a) links with evolutionary science, (b) captures multiple levels of analysis, (c) is parsimonious, (d) serves diverse populations, (e) directly informs interventions, (f) promotes moral humility, and (g) decreases stigma while preserving client autonomy. In our conclusion, we recognize the value of the COSC model for its intended purposes while also encouraging deep and respectful dialogue among researchers and clinicians regarding the proposed benefits of the functional contextual model of moral injury.

Reflections on Recent Research Into Animal-Assisted Interventions in the Military and Beyond.

The purpose of the present review was threefold: to address the current state of Animal-Assisted Interactions (AAI) within the military; to summarize recent literature (within the past three years) in the field of AAI; and to discuss trends in AAI research since 2014. With regard to AAI within the military, several canine interaction programs have been utilized to assist service members in coping with various issues. Therapy dogs have been deployed with Combat-Operational Stress Control units; they have been integrated into medical clinics and behavioral health treatment programs in garrison; and policy has been developed to address the use of therapy animals in military treatment facilities. General research in AAI has demonstrated efficacy for certain presenting issues (stress management, trauma, autism spectrum disorder) and specific populations (children, the elderly, acute care patients). Overall trends in research include calls for increased consideration for animal welfare in AAI and increased rigor in research methodology. Current research supports the structured use of therapy dogs in the treatment of various disorders and with specific populations, including military service members and veterans; however, the need for additional research with rigorous methodology remains.

Treating Combat Related PTSD and Combat Operational Stress Reaction A Clinician’s review

Treating Combat Related PTSD and Combat Operational Stress Reaction A Clinician’s review

Combat Social Work During the Surge in Iraq

The military has long recognized the short-term psychiatric effects of war upon soldiers, a significant factor for combat operational readiness and strength (NATO, 2008). Currently referred to as combat stress reaction or combat operational stress reaction (COSR), the condition has debilitating, immediate effects as well as long-term consequences for soldiers and military units. For the wars in Iraq and Afghanistan, commanders expected psychiatric casualties rates equaling physical ones, stemming from the intensity and duration of these conflicts, nonlinear nature of the battlefields, unit morale, and soldier experiences and preparedness. For these recent wars, the concept of behavioral health, combat stress, and its military importance has dramatically changed, as have the protocols dictating the delivery of preventive and restorative combat behavioral health care. This article outlines the conceptual foundation of modern combat stress control, protocols, and the efforts of one social worker–led combat stress prevention team, forward deployed to a small base in a volatile area of Baghdad during the height of the surge in 2006–2007.

Behavioral health leadership: new directions in occupational mental health.

The impact of stress on mental health in high-risk occupations may be mitigated by organizational factors such as leadership. Studies have documented the impact of general leadership skills on employee performance and mental health. Other researchers have begun examining specific leadership domains that address relevant organizational outcomes, such as safety climate leadership. One emerging approach focuses on domain-specific leadership behaviors that may moderate the impact of combat deployment on mental health. In a recent study, US soldiers deployed to Afghanistan rated leaders on behaviors promoting management of combat operational stress. When soldiers rated their leaders high on these behaviors, soldiers also reported better mental health and feeling more comfortable with the idea of seeking mental health treatment. These associations held even after controlling for overall leadership ratings. Operational stress leader behaviors also moderated the relationship between combat exposure and soldier health. Domain-specific leadership offers an important step in identifying measures to moderate the impact of high-risk occupations on employee health.

Combat Operational Stress Control in Iraq and Afghanistan: Army Occupational Therapy

One of the primary roles for U.S. Army Occupational Therapists (OTs) during combat operations is the Behavioral Health (BH) mission. Army OTs have been involved in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) providing BH treatment to service members, serving in Brigade Combat Teams, and Combat Stress Control Units, however, the impact of the OT BH mission has been scarcely documented. Although the theoretical deployment role of OTs in Combat and Operational Stress Control (COSC) operations has been described, the literature provides minimal experiential application of OTs in the COSC role. This article describes the deployed operational roles of three OTs, two deployed during OIF and one in OEF during 2008-2010. Deployed assignments included positions as Officers in Charge of restoration centers, and of prevention centers to include animal-assisted therapy, and disaster response. Occupational therapists play a vital role within the COSC unit as they add the unique perspective of assessing the service member's functional performance in daily living occupations.

Perceived Stigma and Barriers to Mental Health Care in Marines Attending the Combat Operational Stress Control Program

The Department of Defense is aggressively addressing combat stress reactions (CSRs) through comprehensive Combat/Operational Stress Control (COSC) briefings/programs and referral resources for the prevention, identification, and treatment of stress reactions. The purpose of this study was to develop and administer a survey to assess perceptions of CSRs and barriers to care which affect help-seeking behavior in Marines attending the COSC program. A sample of 553 U.S. Marine Corps Officers and Enlisted personnel from Air (44%), Logistics (38%), and Infantry (18%) communities were recruited for the survey. The results suggested that misconceptions and stigma about CSRs still persist in Marines. The findings reinforced the need to facilitate treatment utilization by focusing on mental health-related stigma as well as organizational barriers.

Posttraumatic Stress Disorder and Traumatic Brain Injury in Current Military Populations

The use of unconventional weaponry combined with decreased mortality rates and servicemembers being exposed to intense ground combat during multiple deployments has increased the risk of servicemembers living with the consequences of traumatic brain injuries (TBI) and combat operational stress. The purpose of this article is to perform a critical analysis of the literature to identify current rates of comorbid posttraumatic stress disorder (PTSD) and TBI in military and veteran populations who have served in Iraq or Afghanistan and their combined effects on persistent postconcussive symptoms. A search of the literature with military and veteran populations published after 2001 in Pubmed, OVID/Medline, Cochran Database, Embase, Scopus, CINAHL, and PsychInfo was conducted using keywords. Twenty studies met inclusion criteria. The literature search yielded mixed results for rates of PTSD, TBI, and comorbid conditions. There is some evidence that comorbid PTSD and TBI result in greater reports of postconcussive symptomology than either condition alone. Limitations include lack of consistency of measurements, sampling biases, and lack of experimental design, and these warrant further exploration. Future research is needed to decrease variability in study findings and elucidate relationships between these disorders and their effects on persistent postconcussive symptomology.

Families Overcoming Under Stress: Implementing Family-Centered Prevention for Military Families Facing Wartime Deployments and Combat Operational Stress

The toll of multiple and prolonged deployments on families has become clearer in recent years as military families have seen an increase in childhood anxiety, parental psychological distress, and marital discord. Families overcoming under stress (FOCUS), a family-centered evidence-informed resiliency training program developed at University of California, Los Angeles and Harvard Medical School, is being implemented at military installations through an initiative from Navy Bureau of Medicine and Surgery. The research foundation for FOCUS includes evidence-based preventive interventions that were adapted to meet the specific needs of military families facing combat operational stress associated with wartime deployments. Using a family narrative approach, FOCUS includes a customized approach utilizing core intervention components, including psychoeducation, emotional regulation skills, goal setting and problem solving skills, traumatic stress reminder management techniques, and family communication skills. The purpose of this study is to describe the development and implementation of FOCUS for military families. A case example is also presented.

U.S. Army combat operational stress control throughout the deployment cycle: A case study

As military conflicts around the world persist, a comprehensive approach in managing behavioral health issues will continue to be a key component of military healthcare. Deployed military personnel frequently exposed to trauma are well-known to be at high risk for developing behavioral health disorders, including combat stress reactions and posttraumatic stress disorder. In the U.S. Army, members of combat operational stress control (COSC) units have unique skills to assist soldiers and their families not only throughout all phases of a deployment, but also throughout a soldier's entire career. The purposes of this article are twofold, first to describe the role of COSC operations with an emphasis on interventions in a deployed environment. The second purpose is to present a case study from Operation Iraqi Freedom highlighting the efficacy of the COSC approach to meet a Soldier's behavioral health needs in a deployed environment.

Combat Stress Reactions During Military Deployments: Evaluation of the Effectiveness of Combat Stress Control Treatment

Few studies have evaluated the effectiveness of mental health treatments for the combat stress reactions of military service members treated in deployed locations. The present pilot investigation is the first report on the effectiveness of a Combat Stress Control (CSC) unit treatment for deployed service members. Thirty-eight United States military personnel (33 men and 5 women) completed a 2-day CSC unit program at Balad Air Base, Iraq. The program included individual and group treatments to reduce the symptoms of combat operational stress reactions and to improve coping strategies, stress management skills, and interpersonal relationships. Measures used included the Outcome Questionnaire-45 (OQ-45) and the Posttraumatic Stress Disorder Checklist-Military version (PCL-M). The study found significant decreases on the OQ-45 and the PCL-M. These results provide preliminary data to support the use of CSC units to treat combat operational stress reactions in the field.

Occupational Therapy Role on the Battlefield: An Overview of Combat and Operational Stress and Upper Extremity Rehabilitation

What happens when the stressors of combat, fatigue, separation, and personal conflict affect a Soldier's ability to perform their wartime mission? What happens when an upper extremity injury or a significant trauma impacts a Soldier's ability to fire their weapon or complete their mission? The Army has specialized units known as Combat Operational Stress Control (COSC) Detachments and Combat Support Hospitals (CSHs) deployed on the battlefield to address these issues. Occupational therapists (OTs) work in these units and are responsible for facilitating function when Soldiers are faced with these physical and mental injuries. OTs are involved before, during, and after deployment educating, evaluating, and treating units, leadership, commanders, and Soldiers on a myriad of skills, activities, and tasks that enable Soldiers to optimize their overall performance. The history, functional areas, and specific roles of OT in the COSC unit and in the CSH will be discussed in this article. The effectiveness of occupational therapy intervention in these types of units will be discussed in case studies.

Combat Operational Stress Control in Iraq: Lessons Learned During Operation Iraqi Freedom

The current clinical operations of Combat Stress Control (CSC) teams deployed to Iraq can be informed by the lessons of past deployments and recent empirical research. However, there are few published lessons from Operation Iraqi Freedom (OIF) itself. Two deployed psychologists review 4 lessons learned in the context of deployment in support of OIF III. Specifically, we review the need for CSC providers to anticipate providing commanders rationales for not evacuating some soldiers. Additional lessons include the CSC contributions made by flexible personnel placement, the role of clinical needs assessment, and the ongoing need to educate isolated personnel about CSC mobility. It is hoped that by sharing these lessons, CSCs may continue their history of effective preventive and clinical services within operational environments.