Nobody knows stress management like the US military. Stress management has been recognized as an important part of ensuring an effective fighting force since the First World War. The US Marine Coprs manual MCRP 6-11C, “Combat and Operational Stress Control” (2010) is one part of this program.
Bite-sized takeaway: Know yourself and your team (whether that’s fellow Marines in a military environment or family and coworkers in a civilian enivronment) and be alert for any sudden, persistent or progressive change in their behaviour
Combat Stress Reactions
A combat stress-reaction (CSR) is the military equivalent to acute stress reaction, the state of agitation seen as a response to combat or other stressful or traumatic situations. These symptoms, if not properly managed, can lead to Post-Traumatic Stress Disorder (PTSD.)
The most common combat stress reaction symptoms include:
- Slow reaction time
- Difficulty with tasks and prioritizing
- Excessive concern with minor issues
- Focus on familiar tasks
- Loss of initiative
It can be hard to recognize when something is a normal reaction to battle or something that requires more intense medical or psychological support. One example given is that mild shaking while being fired upon or mortar rounds are incoming is very normal. On the other hand, intense shaking post-battle can be incapacitating and will require additional support.
Normal reactions to battle can include:
- Loss of appetite
- Abdominal distress
- Frequent urination
Dreams and flashbacks are one area that are commonly associated with PTSD. MCRP 6-11C notes that vivid battle dreams are a totally normal part of working through and processing combat experiences. Additionally, flashbacks are normal as long as they are recognized as flashbacks. These may become part of PTSD if the acute stress reaction is not managed but can be treated.
Some issues that may require more intensive support are stress-related blindness/deafness or partial paralysis. These can improve with reassurance from comrades, unit medical personnel or the batallion physician. As well, a reaction known as a panic run, where the service member rushes about without self-control or awareness (US Army, 1950) also requires evacuation for treatment.
Managing Combat Stress Reactions
If you need to, remove a soldier’s access to his weapon if he is experiencing combat stress reactions and you’re not sure he can keep himself safe. Additionally, give him simple tasks to do when not sleeping, eating, or resting. Strategies to manage combat stress reaction include:
- Treating the service member close to the front (better outcomes happen when the service member is out of danger but still in theatre)
- Utilize the BICEPS Model of Combat Stress Control
- Brief (they should be out of the field no more than 3-4 days)
- Immediate (treatment should be identified and started quickly)
- Centrality (they should be treated out of hospital but close to the front)
- Expectancy (the chain of command should have faith the service member will recover)
- Proximity (keep the service member close to the rest of their unit so they can offer support)
- Simplicity (the treatment should focus on the member’s return to duty)
Night time is the time to retain or gain the initiative, so it is common for operations to occur then. This increases the chance that sleep deprivation affects military member abilities to manage combat stress. Increasing circulation through activities like moderate exercise or drinking hot beverages may shorten start-up time after a short time sleeping.
After 36-48 hours of complete sleep loss, a minimum of 12 hours of sleep will be required to regain functioning. Keep watch for sleep drunkenness, which is the opposite (reduced functioning as a result of sleeping too much.)
Grief and Death
One area that many military members struggle with is grief and death. So-called open grieving, talking about grief and loss with comrades can help alleviate anxiety, whether this is a fear of the military member’s own death or survivor guilt from having lost friends and fellow military members on the battlefield.
Stress Management Techniques
It’s recommended that each service member know two stress management techniques: a slow or long one that can be used for deep relaxation and a quick one that can be deployed on-the-job.
Psychological Stress Management
Confidence is one of the strongest defences against stress. “If men can’t fight back, fear will overtake; as long as they can return fire they will not fear.”
Cognitive exercises include positive self-talk, visualization, rehearsal and meditation. Positive self-talk involves telling yourself that things will work out for you, rather than assuming and thinking the worst. Replacing bad self-talk with good self-talk can help increase your resilience.
Visualization is a cognitive technique that involves imagining good things. When you remember something that made you angry, your body reacts the same (your blood pressure rises and constricts), and you’re “right back there” mentally. By visualizing happy things, your blood pressure reduces and you find yourself more able to cope.
Rehearsal is similar to visualization but specifically involves yourself going over the tasks in your mind that you are about to perform. This helps to give you more confidence that you’re able to perform these tasks. Finally, meditation is a form of deep breathing and relaxation to improve one’s emotional state.
Physical Stress Management
Good nutrition and hydration is important. Remember the acronym HALT, the four items that make regulating our emotions more difficult (HALT is “Hungry, Angry, Lonely, Tired.”) If the service member only drinks when they are thirsty, they’ll become dehydrated.
Increasing your aerobic fitness increases your ability to handle stress
Mastering relaxation techniques allows you to reverse the combat stress process. Physical stress management techniques include deep breathing, and progressive muscle relaxation.
Deep Breathing involves slow, deep inhaling. Deep breathe for 2-5 seconds, then exhale slowly over 2-5 seconds
Perform this exercise 5 times for a quick mind-clearing, or continuously at night to promote sleep. Diaphragmatic breathing (which is deep in the chest, as opposed to shallow) is especially helpful for stress control
Muscle Relaxation is a special form of relaxation where you concentrate on one muscle group at a time, tensing and relaxing your limbs in order to relax your entire body. The quick version involves tensing all your muscles simultaneously, holding this state for 15 seconds, letting your body relax, and shaking out all the tension.
The long version involves starting in your feet and working up, body part by body part until you reach your head, tensing and then relaxing the limbs.
Pre and Post-Deployment Reactions
New members to a unit are more likely to become casualties than experienced members. Keeping this in mind, experienced members can help mentor new ones to build resilience and support. “Startle reactions to sudden noise
or movement, combat dreams and nightmares and occasional problems with sleeping, and feeling bored, frustrated and out of place” wee all identified as being common after deployment, as the service member re-integrates into their community.
US Army. (1950) TM 8-240 Psychiatry in Military Law. Washington, DC: Department of the Army and the Air Force.
US Marine Corps. (2010) MCRP 6-11C, “Combat and Operational Stress Control”. Retrieved on September 5, 2016 from http://www.marines.mil/Portals/59/Publications/MCRP%206-11C%20%20Combat%20and%20Operational%20Stress%20Control.pdfby