Psychological Effects of Combat Stress and

Potential Problems in Transitioning Skills Learned in Combat after Returning Home

Matthew J. Reinhard, Psy.D.War Related Illness & Injury Study Center

(WRIISC) US Department of Veterans Affairs

Office of Public Health and Environmental Hazards

Reactions to serving in a combat zone

Reactions to being in a combat zone usually decrease and normalize after return home

For some, these reactions persist even when there is no longer danger and they may interfere with employment, relationships, quality of life and physical health

Serving in a combat zone can change worldview The world isn’t safe Others want to harm me I must be ready for danger at all times I had a sense of purpose while working in a combat zone–

now what?

Conditions Following A Traumatic Event (not Just

PTSD) PTSD Depression (Highly co-morbid) Substance abuse (usually ETOH) Panic Disorder Phobias Adjustment Disorder Dissociative Disorders Somatic Symptoms

PTSD and Substance Abuse

Substance abuse can be used to: Avoid Aid with sleep Block out memories Help “fit in” Help “have fun”

Continuous Assessment

Why the need for continuous assessment?• Mental health symptoms may not appear initially—

they may appear with time.• Greiger, et.al. (American Journal of Psychiatry, 2006)

Veterans who were wounded or injured in the line of duty

• PTSD • One month, 4.4%• Four months, 8.9%• Seven months, 9.3%

• Depression• One month, 4.2%• Four months, 12.2%

Treatment at VA includes “Non-Traditional” Options

Non-Traditional” Treatment Options• Strategies that might help with stress reduction

Army 10 Miler Outward Bound, Wilderness Adventures designed for

OIF/OEF Veterans in Rocky Mountains Team River Runners, kayaking Yoga and Tai Chi Acupuncture WWII Veterans as “mentors”

Treatment(PTSD)

• BATTLEMIND as example of PTSD treatment Developed at Walter Reed Army Institute of

Research Combat skills and battle mindset let you survive in

a war zone This “Battlemind” may be hazardous to social and

behavioral health back home if it is not transitioned Battlemind video; www.battlemind.org

Post-Deployment Battlemind: Soldiers

Buddies (cohesion) vs. Withdrawal Accountability vs. Controlling Targeted Aggression vs. Inappropriate Aggression Tactical Awareness vs. Hypervigilance Lethally Armed vs. “Locked and Loaded” at Home Emotional Control vs. Anger/Detachment Mission Operational Security (OPSEC) vs. Secretiveness Individual Responsibility vs. Guilt Non-Defensive (combat) Driving vs. Aggressive Driving Discipline and Ordering vs. Conflict

Treatment Battlemind: Soldiers

B Buddies (Cohesion) vs. Withdrawal In combat: no one understands your experience

except your buddies who were there with you. At home: may prefer to be with battle buddies rather

than with spouse family or other friends. May avoid speaking about yourself to friends and family. Have thoughts such as: others will die on me like my military friends, so why should I bother getting close?

Potential Concerns: feeling alone, isolation, not connecting with loved ones

Treatment Battlemind: Soldiers

A - Accountability vs. Control In combat: maintaining control of weapon and gear is

necessary for survival At home: become angry when someone moves or

messes with your stuff, even if insignificant. Nobody cares about doing things right except for you.

Potential Concerns: Overreacting to minor events? Still having trouble letting family and friends share in making decisions? Trying to control things that don’t really matter?

Treatment Battlemind: Soldiers

T - Targeted vs. Inappropriate Aggression In combat: soldiers make split second decisions that

are lethal in a highly ambiguous environment, which keeps you alert and alive

At home: overreactions to minor insults. Inappropriate aggressiveness, assault, spousal abuse, snapping at the kids or buddies

Potential Concerns: are you snapping at others? Getting into fights or heated arguments? Avoiding people?

Treatment Battlemind: Soldiers

Tactical Awareness vs. Hypervigilance In Combat: survival depends on being aware at all

time of your surrounding and reacting immediately to sudden changes

At Home: you may feel keyed up or anxious

Potential Concerns: jumping at loud noises… then staying revved up? Having trouble with sleep or nightmares? Drinking to calm down or to help you sleep?

Treatment Battlemind: Soldiers

L – Lethally Armed vs. Unarmed In Combat: carrying your weapon at all times was

mandatory and necessary At Home: need to have weapons on you, in your

home and or car at all times, believing that you and your loved ones are not safe without them.

Potential Concerns: Threatened someone with a weapon? Carry a loaded weapon in your car? Keep an unsecured, locked and loaded weapon at home?

Treatment Battlemind: Soldiers

E – Emotional Control Vs. Anger or Detachment In Combat: controlling your emotions during combat

is critical for mission success. At Home: failing to display emotions, or only showing

anger, around family and friends will hurt your relationships. You may be seen as detached or uncaring.

Potential Concerns: can you only show anger? Feeling numb? Friends and loved ones tell you that you have changed? Having relationship problems?

Treatment Battlemind: Soldiers

M – Mission & OPSEC vs. Secretiveness In Combat: talk about mission only with those who need to

know. Can only talk about combat experiences with unit members. In the chaos of war, you learned not to trust anything or anybody except your buddies (unsure who was the enemy and who was an ally)

At Home: soldiers may avoid sharing their deployment experiences with spouse or significant other.

Potential Concerns: Haven’t shared your deployment experiences with those closest to you? get angry when someone asks you about your deployment experiences? Can be a Win-win to share with your family – you feel heard and cared for and your loved ones feel needed

Treatment Battlemind: Soldiers

I – Individual Responsibility vs. Guilt In Combat: your responsibility in combat is to survive

and to keep your buddies alive At Home: you may feel you have failed your buddies

if they were killed or seriously injured. You may be bothered by memories of those wounded or killed.

Potential Concerns: Certain memories of the deployment keep bothering you? still feeling guilt about things that happened in combat? Recognize that guilt is a common reaction

Treatment Battlemind: Soldiers

N – Nondefensive (combat) driving vs. Aggressive Driving In Combat: unpredictable, fast, rapid lane changes,

straddling the middle line, keeping other vehicles at a distance. To survive convoy runs, had to drive as fast as possible and be alert to every pedestrian and car that could be a bomber.

At Home: aggressive driving leads to speeding tickets, accidents, fatalities. Today, slowing traffic produces anxiety

• Potential Concerns: Chasing adrenalin highs by driving fast? Involved in driving accidents?

Treatment Battlemind: Soldiers

D- Discipline & Ordering Vs. Conflict In Combat: Survival depends on discipline and

obeying orders At Home: inflexible interactions (ordering and

demanding behaviors) with your spouse, children and friends often lead to conflict

Potential Concerns: Relationships aren’t going well? Ongoing conflicts over decisions? Does family say they feel as if “walking on eggshells?”

Mild TBI and PTSD have many smiliarities

Postconcussion Syndrome (PCS) Insomnia Impaired Memory Poor concentration Depression Anxiety Irritability Headache Dizziness Fatigue Noise/Light intolerance

Post Traumatic Stress Disorder Insomnia Memory Problems Poor concentration Depression Anxiety Irritability Emotional numbing Avoidance Intrusive symptoms

+ PTSD Re-experiencing

Avoidance Social withdrawal

Memory gapsApathy

? Mild TBIResidual

Difficulty with decisionsMental slowness

ConcentrationHeadaches

DizzyAppetite changes

FatigueSadness

Arousal

Sensitive to noise Concentration

InsomniaIrritability

+ Depression From presentation by R. Vanderploeg 2007

Moss, King, Blackman (2009). Phys. Review letters, 103 issue 10.

Simulation Geometry: A spherical high-explosive charge is located 4.6 m (15 feet) from a head consisting of three components—the skull, CSF layer, and brain tissue—that are supported by a low detail body structure.

Moss, King, Blackman (2009). Phys. Review letters, 103 issue 10.

Questions?