10 Things You Can Do If You Only Have 10 Minutes: Healing Interventions That Can Be Done with Veterans Anytime, Anywhere by Alison Lighthall, RN, MS Founder, HAND2HAND CONTACT

FEAR+ High need for relief + High need for EMOTIONAL SAFETY =

INTERVENTIONS 1. Willingly offer your time 2. Provide acceptance, kindness, empathy, and if possible a little humor to relieve his/her strain 3. Listen actively 4. Help organize the experience 5. Help shift from living the problem to examining it (objectivity, distance) 6. Depathologize, normalize 7. Teach, educate 8. Give hope 9. Offer further contact options 10. Provide physical human touch (hand shake, touching the arm, etc.)

It’ll start something like this…

“Hey, Doc… Can I ask you somethin’?”  Unscheduled, unexpected meeting— a “hallway consult”  At the end of a session  Phone call  During group work

ALERT!  You may be the only person this service member ever reaches out to.  It MUST be a positive interaction that makes him or her feel better at the end, or he/she may never seek care again.

“Sure, what’s on your mind?” INTERVENTION #1: Willingly offering your time  Start moving to a more private location  Casual attitude but active listening  Open, relaxed, confident body language  Friendly eye contact (if face to face)  Observe body language

“You’re gonna think I’m nuts…”  Telling you his worst fear, so address it immediately

“Oh, I doubt you could convince me that you’re nuts, but go ahead and try…” INTERVENTION #2: Acceptance, kindness, empathy and a little humor to relieve his strain  Using the same word for mirroring  Reassuring him of your acceptance  Bonding and relieving tension w/ humor  Showing him simple human kindness  Inviting him to continue, indicating time and willingness to listen in the moment

“Well, (fill in the blank…e.g., I’ve been having trouble sleeping.”)  Often starts with physical complaint because it’s safe  Problem is considered within normal limits  Testing to see if you’re going to engage

“Falling asleep? Staying asleep?...” INTERVENTION #3: Clarifying shows active listening  Showing that you care  Gathering more information about the complaint  Making no assumptive leaps

“Both, really.”  They often resist telling the whole story initially  Still sizing you up, seeing if you’re trustworthy  Still getting comfortable talking about their issues

“Well, that stinks.” (INTERVENTION #2 again)  Nonclinical, friendly conversation  Maintain eye contact, but stay relaxed and confident  Acknowledge that it’s a real problem for him, without indicating it’s outside the realm of “normal”  Remember: “normal” is VERY different for combat vets than for civilians

“Yeah, it does. I’m really struggling with it.”  Once comfortable, they’ll start to admit to the scope of the problem  They start to get a little more serious  A drop in eye contact is a cue that it’s getting uncomfortable—i.e., closer to the issue they’re really worried about

“I can see that. But I don’t think you’re nuts for having sleep problems.” (INTERVENTION #2 again)  Again, acknowledging the issue  Seeking clarification will push the issue  Remind him of his original fear and make him connect it to what he’s really there to talk to you about

“Well, I have some pretty bad dreams…”  He has now opened the door to his real fears.  This is the springboard into doing a quick assessment

(Nod, show concern, maintain eye contact) “OK.”  He’ll be looking for signs of alarm on your face

“Yeah, usually about (fill in the blank)”  His guard may go up after he says this, because he is starting to tell his truth  Increasing discomfort may trigger him or just make him feel vulnerable

“So you’re having a lot of bad dreams about (experience) and it’s really disrupting your sleep.” INTERVENTION #4: Help organize the experience  Classic rephrasing—an oldie but a goodie  Helping him to hear it in one statement helps him organize the experience  Seeing your calm, understanding reaction reassures him that this can be managed

“Yeah, exactly. And they can get pretty intense, you know? Like, my wife says sometimes I thrash around and shout.”  Giving more detail, but from someone else’s perspective  Will often avoid talking about their own experience of it or how distressing it is for them  Trying to talk about it while still staying emotionally safe

“Have you noticed if anything makes this better or worse?” INTERVENTION #5: Shift from living the problem to examining it  Helping him to think outside the experience itself, get some distance  Showing that you are now engaged in helping  Low key assessment might yield a lot of information

“It’s gotten a whole lot worse since…(trigger)” OR “No, not really. It’s pretty much all the time.”  Fork in the road: you can start educating or continue with further assessment…both are helpful, neither is wrong

“Any problems with stuff like feeling keyed up all the time, having a really intense startle reaction, feeling preoccupied, angry or sad a lot…stuff like that?” (INTERVENTION #5 again) :  One or two of these will almost certainly be present.  Saying them for him makes it easier for him to identify the symptoms and admit to them as problems.

“All the time.”  He or she is starting to trust you.  Admitting the problem is not so simple as first described.

“I’m not surprised. A lot of guys coming home tell me they struggle with those kinds of things.” INTERVENTION #6: Depathologize and normalize  Starting to address his unspoken fear: “Am I crazy?”

“Yeah? Really?”  Huge relief.  Turning point for them.

“Let’s talk about what you can do to make things better. How much caffeine do you take in every day?”  Every question furthers the engagement  Communicates your growing commitment to help  Remember to stay with safe topics, especially while in public places  Work on the easily fixable things first, the things that are within their control

(Laughs, then gives what will likely be a staggering quantity) {AS AN ASIDE…}  Military personnel are not only big coffee drinkers by nature (and sometimes necessity), the Army also formally endorses the use of caffeine for alertness during combat to override massive fatigue  Physiologic dependence  Caffeine intake is rapidly rising in this country (Starbucks, Jolt, Red Bull, gum, “energy” drinks of all kinds, etc.)

“You’re not going to like this, but you’d probably sleep a lot better if you weaned yourself off the caffeine.” INTERVENTION #7: Teach, educate Caffeine Tutorial:  Central nervous system stimulant  Caffeine-induced panic disorder  It is chemically similar to, and has trace amounts of, theophylline (respiratory stimulant used medically)  Increases 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 tired

The conversation has progressed… “OK, so let’s review. You can slowly bring down your caffeine intake, talk to your doc about starting on medication, and get back to working out daily. Right? Good, that’s a start. These should help your sleep issue. But don’t worry; if they don’t help, we’ll keep working the problem until we find a solution, OK?” All previous interventions + THE SINGLE MOST IMPORTANT INTERVENTION: INTERVENTION #8: GIVE HOPE

“Here’s my business card, I want you to call me in a couple of weeks and let me know how you’re doing. If you have any other problems, just give me a call. If I can’t help, I’ll find someone who can. Deal?” INTERVENTION #9: Further contact options, referrals

“Hey, I’m glad you reached out. Hope this was helpful.” (Extend hand for handshake) INTERVENTION #10: Physical touch

QUICK!! What were those 10 interventions again?? 1. Willingly offer your time 2. Provide acceptance, kindness, empathy, with a little touch of humor if possible 3. Listen actively 4. Help organize the experience 5. Help shift from living the problem to examining it (objectivity, distance) 6. Depathologize, normalize 7. Teach, educate 8. Give hope 9. Offer further contact options 10. Provide physical human touch (hand shake, touching the arm, etc.)

OH! And one last thing… THANK THEM FOR SERVING…