10 Things You Can Do 10 Things You Can Do If You Only Have 10 Minutes:If You Only Have 10 Minutes:

Healing Interventions Healing Interventions That Can Be Done with Veterans That Can Be Done with Veterans

Anytime, AnywhereAnytime, Anywhere

by Alison Lighthall, RN, MSby Alison Lighthall, RN, MSFounder, HAND2HAND CONTACTFounder, HAND2HAND CONTACT

FEAR+FEAR+

High need for reliefHigh need for relief + +

High need for EMOTIONAL SAFETYHigh need for EMOTIONAL SAFETY = =

INTERVENTIONSINTERVENTIONS1.1. Willingly offer your timeWillingly offer your time2.2. Provide acceptance, kindness, empathy, and if Provide acceptance, kindness, empathy, and if

possible a little humor to relieve his/her strainpossible a little humor to relieve his/her strain3.3. Listen activelyListen actively4.4. Help organize the experienceHelp organize the experience5.5. Help shift from Help shift from livingliving the problem to the problem to examiningexamining it it

(objectivity, distance) (objectivity, distance) 6.6. Depathologize, normalizeDepathologize, normalize7.7. Teach, educateTeach, educate8.8. Give hopeGive hope9.9. Offer further contact optionsOffer further contact options10.10. Provide physical human touch (hand shake, Provide physical human touch (hand shake,

touching the arm, etc.)touching the arm, etc.)

It’ll start It’ll start something like something like

this…this…

““Hey, Doc…Hey, Doc…Can I ask you somethin’?”Can I ask you somethin’?”

Unscheduled, unexpected meeting—Unscheduled, unexpected meeting—

a “hallway consult”a “hallway consult” At the end of a sessionAt the end of a session Phone callPhone call During group workDuring group work

ALERT!ALERT!

You may be the only person this service You may be the only person this service member ever reaches out to. member ever reaches out to.

It MUST be a positive interaction that It MUST be a positive interaction that makes him or her feel better at the end, or makes him or her feel better at the end, or he/she may never seek care again.he/she may never seek care again.

““Sure, what’s on your mindSure, what’s on your mind?”?”

INTERVENTION #1INTERVENTION #1: Willingly offering your : Willingly offering your timetime

Start moving to a more private locationStart moving to a more private location Casual attitude but active listeningCasual attitude but active listening Open, relaxed, confident body languageOpen, relaxed, confident body language Friendly eye contact (if face to face)Friendly eye contact (if face to face) Observe body language Observe body language

““You’re gonna think I’m nuts…”You’re gonna think I’m nuts…”

Telling you his worst fear, so address it Telling you his worst fear, so address it immediatelyimmediately

““Oh, I doubt you could convince Oh, I doubt you could convince me that you’re nuts, me that you’re nuts,

but go ahead and trybut go ahead and try…”…”

INTERVENTION #2INTERVENTION #2: Acceptance, kindness, : Acceptance, kindness, empathy and a little humor to relieve his strainempathy and a little humor to relieve his strain

Using the same word for mirroringUsing the same word for mirroring Reassuring him of your acceptanceReassuring him of your acceptance Bonding and relieving tension w/ humorBonding and relieving tension w/ humor Showing him simple human kindnessShowing him simple human kindness Inviting him to continue, indicating time and Inviting him to continue, indicating time and

willingness to listen in the momentwillingness to listen in the moment

““Well, Well, (fill in the blank…e.g., (fill in the blank…e.g., I’ve been having trouble sleeping.”)I’ve been having trouble sleeping.”)

Often starts with physical complaint Often starts with physical complaint because it’s safebecause it’s safe

Problem is considered within normal limitsProblem is considered within normal limits Testing to see if you’re going to engage Testing to see if you’re going to engage

““Falling asleep? Falling asleep? Staying asleep?...”Staying asleep?...”

INTERVENTION #3INTERVENTION #3: Clarifying shows : Clarifying shows active listeningactive listening

Showing that you careShowing that you care Gathering more information about the Gathering more information about the

complaintcomplaint Making no assumptive leapsMaking no assumptive leaps

““Both, really.”Both, really.”

They often resist telling the whole story They often resist telling the whole story initiallyinitially

Still sizing you up, seeing if you’re Still sizing you up, seeing if you’re trustworthytrustworthy

Still getting comfortable talking about their Still getting comfortable talking about their issuesissues

““Well, that stinks.”Well, that stinks.”

(INTERVENTION #2 again)(INTERVENTION #2 again)

Nonclinical, friendly conversationNonclinical, friendly conversation Maintain eye contact, but stay relaxed and Maintain eye contact, but stay relaxed and

confidentconfident Acknowledge that it’s a real problem for Acknowledge that it’s a real problem for

him, without indicating it’s outside the him, without indicating it’s outside the realm of “normal” realm of “normal”

Remember: “normal” is VERY different for Remember: “normal” is VERY different for combat vets than for civilianscombat vets than for civilians

““Yeah, it does. Yeah, it does. I’m really struggling with it.”I’m really struggling with it.”

Once comfortable, they’ll start to admit to Once comfortable, they’ll start to admit to the scope of the problemthe scope of the problem

They start to get a little more seriousThey start to get a little more serious A drop in eye contact is a cue that it’s A drop in eye contact is a cue that it’s

getting uncomfortable—i.e., closer to the getting uncomfortable—i.e., closer to the issue they’re really worried aboutissue they’re really worried about

““I can see that. But I don’t think I can see that. But I don’t think you’re nuts for having you’re nuts for having

sleep problems.”sleep problems.”

(INTERVENTION #2 again)(INTERVENTION #2 again)

Again, acknowledging the issueAgain, acknowledging the issue Seeking clarification will push the issueSeeking clarification will push the issue Remind him of his original fear and make Remind him of his original fear and make

him connect it to what he’s really there to him connect it to what he’s really there to talk to you abouttalk to you about

““Well, I have some Well, I have some pretty bad dreams…”pretty bad dreams…”

He has now opened the door to his real He has now opened the door to his real fears.fears.

This is the springboard into doing a quick This is the springboard into doing a quick assessmentassessment

(Nod, show concern, maintain eye (Nod, show concern, maintain eye contact) contact) “OK.”“OK.”

He’ll be looking for signs of alarm on your He’ll be looking for signs of alarm on your faceface

““Yeah, usually about Yeah, usually about (fill in the (fill in the blank)”blank)”

His guard may go up after he says this, His guard may go up after he says this, because he is starting to tell his truthbecause he is starting to tell his truth

Increasing discomfort may trigger him or Increasing discomfort may trigger him or just make him feel vulnerablejust make him feel vulnerable

““So you’re having a lot of bad dreams about So you’re having a lot of bad dreams about (experience) and (experience) and

it’s really disrupting your sleep.”it’s really disrupting your sleep.”

INTERVENTION #4INTERVENTION #4: Help organize the : Help organize the experienceexperience

Classic rephrasing—an oldie but a goodieClassic rephrasing—an oldie but a goodie Helping him to hear it in one statement Helping him to hear it in one statement

helps him organize the experiencehelps him organize the experience Seeing your calm, understanding reaction Seeing your calm, understanding reaction

reassures him that this can be managedreassures him that this can be managed

““Yeah, exactly. And they can get pretty Yeah, exactly. And they can get pretty intense, you know? Like, my wife says intense, you know? Like, my wife says sometimes I thrash around and shout.”sometimes I thrash around and shout.”

Giving more detail, but from someone Giving more detail, but from someone else’s perspectiveelse’s perspective

Will often avoid talking about their own Will often avoid talking about their own experience of it or how distressing it is for experience of it or how distressing it is for themthem

Trying to talk about it while still staying Trying to talk about it while still staying emotionally safeemotionally safe

““Have you noticed if anything Have you noticed if anything makes this better or worse?”makes this better or worse?”

INTERVENTION #5INTERVENTION #5: Shift from : Shift from livingliving the the problem to problem to examiningexamining it it

Helping him to think outside the Helping him to think outside the experience itself, get some distanceexperience itself, get some distance

Showing that you are now engaged in Showing that you are now engaged in helpinghelping

Low key assessment might yield a lot of Low key assessment might yield a lot of informationinformation

““It’s gotten a whole lot worse since…It’s gotten a whole lot worse since…(trigger)”(trigger)”

OROR

““No, not really. It’s pretty much all the time.”No, not really. It’s pretty much all the time.”

Fork in the road: you can start educating Fork in the road: you can start educating or continue with further assessment…both or continue with further assessment…both are helpful, neither is wrongare helpful, neither is wrong

““Any problems with stuff like feeling keyed up all Any problems with stuff like feeling keyed up all the time, having a really intense startle reaction, the time, having a really intense startle reaction,

feeling preoccupied, angry or sad a lot…stuff feeling preoccupied, angry or sad a lot…stuff like that?”like that?”

(INTERVENTION #5 again)(INTERVENTION #5 again): : One or two of these will almost certainly be One or two of these will almost certainly be

present. present. Saying them for him makes it easier for him to Saying them for him makes it easier for him to

identify the symptoms and admit to them as identify the symptoms and admit to them as problems.problems.

““All the time.”All the time.”

He or she is starting to trust you. He or she is starting to trust you. Admitting the problem is not so simple as Admitting the problem is not so simple as

first described.first described.

““I’m not surprised. A lot of guys I’m not surprised. A lot of guys coming home tell me they struggle coming home tell me they struggle

with those kinds of things.”with those kinds of things.”

INTERVENTION #6: INTERVENTION #6: Depathologize and Depathologize and normalizenormalize

Starting to address his unspoken fear: Starting to address his unspoken fear:

““Am I crazyAm I crazy?”?”

““Yeah? Yeah? ReallyReally?”?”

Huge relief. Huge relief. Turning point for them.Turning point for them.

““Let’s talk about what you can do to Let’s talk about what you can do to make things better. How much make things better. How much

caffeine do you take in every day?”caffeine do you take in every day?”

Every question furthers the engagementEvery question furthers the engagement Communicates your growing commitment to Communicates your growing commitment to

helphelp Remember to stay with safe topics, especially Remember to stay with safe topics, especially

while in public placeswhile in public places Work on the easily fixable things first, the Work on the easily fixable things first, the

things that are within their controlthings that are within their control

(Laughs, (Laughs, then gives what will likely be a then gives what will likely be a staggeringstaggering quantity) quantity)

{AS AN ASIDE…}{AS AN ASIDE…} Military personnel are not only big coffee Military personnel are not only big coffee

drinkers by nature (and sometimes necessity), drinkers by nature (and sometimes necessity), the Army also the Army also formally endorsesformally endorses the use of the use of caffeine for alertness during combat to override caffeine for alertness during combat to override massive fatiguemassive fatigue

Physiologic dependencePhysiologic dependence Caffeine intake is rapidly rising in this country Caffeine intake is rapidly rising in this country

(Starbucks, Jolt, Red Bull, gum, “energy” drinks (Starbucks, Jolt, Red Bull, gum, “energy” drinks of all kinds, etc.)of all kinds, etc.)

““You’re not going to like this, You’re not going to like this, but you’d probably sleep a lot better if you but you’d probably sleep a lot better if you

weaned yourself off the caffeine.”weaned yourself off the caffeine.”

INTERVENTION #7INTERVENTION #7: Teach, educate: Teach, educate

Caffeine Tutorial:Caffeine Tutorial:Central nervous system stimulantCentral nervous system stimulant

Caffeine-induced panic disorderCaffeine-induced panic disorder

It is chemically similar to, and has trace amountsIt is chemically similar to, and has trace amountsof, theophylline (respiratory stimulant used medically)of, theophylline (respiratory stimulant used medically)

Increases neurologic and psychologic irritability, canIncreases neurologic and psychologic irritability, can disrupt sleep significantly, can cause blood glucose to drop,disrupt sleep significantly, can cause blood glucose to drop,

wears off and leaves person feeling tiredwears off and leaves person feeling tired

The conversation has progressed…The conversation has progressed…

“OK, so let’s review. You can slowly bring “OK, so let’s review. You can slowly bring down your caffeine intake, talk to your doc down your caffeine intake, talk to your doc about starting on medication, and get back about starting on medication, and get back to working out daily. Right? Good, that’s to working out daily. Right? Good, that’s a start. These a start. These shouldshould help your sleep help your sleep issue. But don’t worry; if they don’t help, issue. But don’t worry; if they don’t help, we’ll keep working the problem until we we’ll keep working the problem until we find a solution, OK?”find a solution, OK?”

All previous interventions + All previous interventions + THE SINGLE MOST IMPORTANT THE SINGLE MOST IMPORTANT INTERVENTION:INTERVENTION:

INTERVENTION #8INTERVENTION #8: : GIVE HOPEGIVE HOPE

““Here’s my business card, I want you to call Here’s my business card, I want you to call me in a couple of weeks and let me know me in a couple of weeks and let me know how you’re doing. If you have any other how you’re doing. If you have any other problems, just give me a call. If I can’t help, problems, just give me a call. If I can’t help, I’ll find someone who can. Deal?”I’ll find someone who can. Deal?”

INTERVENTION #9INTERVENTION #9: Further contact options, : Further contact options, referralsreferrals

““Hey, I’m glad you reached out. Hope this Hey, I’m glad you reached out. Hope this was helpful.” was helpful.” (Extend hand for handshake)(Extend hand for handshake)

INTERVENTION #10INTERVENTION #10: Physical touch: Physical touch

QUICK!! What were those 10 QUICK!! What were those 10 interventions again??interventions again??

1.1. Willingly offer your timeWillingly offer your time2.2. Provide acceptance, kindness, empathy, with a little Provide acceptance, kindness, empathy, with a little

touch of humor if possibletouch of humor if possible3.3. Listen actively Listen actively 4.4. Help organize the experienceHelp organize the experience5.5. Help shift from Help shift from livingliving the problem to the problem to examiningexamining it it

(objectivity, distance) (objectivity, distance) 6.6. Depathologize, normalizeDepathologize, normalize7.7. Teach, educateTeach, educate8.8. Give hopeGive hope9.9. Offer further contact optionsOffer further contact options10.10. Provide physical human touch (hand shake, touching Provide physical human touch (hand shake, touching

the arm, etc.)the arm, etc.)

OH! And one last thing…OH! And one last thing…

THANK THEM FOR THANK THEM FOR SERVING…SERVING…