1. 1 Operational Stress

2. Unique Challenges as Reservists Reserves vs. Active Duty Reserves vs. Active Duty Support (medical, admin) Support (medical, admin) Civilian (They don’t understand) Civilian (They don’t understand) Family (isolated from other USCG families) Family (isolated from other USCG families) Financial? Financial? Employment Employment

3. 3 Combat Operational Stress Continuum (COSC) READYREACTINGINJUREDILL Good to go Well trained Prepared Fit and tough Cohesive units, ready families Distress or impairment Mild, transient Anxious or irritable Behavior change More severe or persistent distress or impairment Leaves lasting evidence (personality change) Stress injuries that don’t heal without intervention Diagnosable PTSD Depression Anxiety Addictive Disorder Leader Responsibility Chaplain & Medical Responsibility Individual Responsibility

4. 4 Stress Outcome Spectrum: Reactions Versus Injuries Stress Injuries Stress Reactions – Common – Always temporary – Mild distress or loss of function – Self-correcting – Less common – May leave a scar – More severe distress or loss of function – May heal faster with help

5. TraumaTrauma A life-threat stress injury Close brush with death Terror, horror, helplessness A grief injury Loss of cher- ished people or things Guilt, sadness, longing LossLoss A fatigue injury Accumulation of all stress over time Depression, anxiety Wear & Tear InnerConflictInnerConflict A moral/betrayal injury Violation of deeply held beliefs Anger, shame, revenge, guilt Four Sources of Stress Injury InjuredInjuredReactingReactingReadyReadyIllIll

6. 6 Monitor and be a good observer of stress continuum changes in your peers Leadership (or friendship if peer) “by walking around” Encourage unit cohesion Short informal 1:1 conversations; availability COSC is preventive in nature Be able to identify on the COSC Continuum, and refer Others for stress related problems Encourage to find the appropriate level of assistance COSC Leadership Skills

7. 7 Individual Stress Management Skills Physical Fitness to Maintain Stress Resilience Breathing to Focus and Calm – – Simplest – consciously slow down your breathing, make it deeper – – Methodical Deep Breathing –full exhale/inhale, hold, relax, release, repeat (no more than 3) Prayer or Meditation for Spiritual Resilience – – Meditation Listening – Close eyes, breath deeply, let daily troubles fade, focus on the sounds around you Centering – do above, then imagine descending down into yourself, look for peace and silence, letting negative thoughts fade away

8. 8 Individual Stress Coping Skills Journaling or Expressive Writing to Clear Your Head – – Journaling Writing about your experiences is very healing, and records your personal and family history – – Expressive Writing Writing with the intent to come to terms with the emotions and all the parts of the memories of an event has proven to be very helpful for long-term mental health Writing to Heal, by James Pennebaker Hobbies

9. 9 Suicide Prevention and Awareness

10. 10 Suicide Prevention Warning Signs Suicide Prevention Warning Signs Talks about committing suicide Talks about committing suicide Has trouble eating or sleeping Has trouble eating or sleeping Relationship difficulties Relationship difficulties Experiences drastic changes in behavior Experiences drastic changes in behavior Withdraws from friends and/or social activities Withdraws from friends and/or social activities Loses interest in hobbies, work, school, etc. Loses interest in hobbies, work, school, etc. Prepares for death by making out a will and final arrangements Prepares for death by making out a will and final arrangements Rehearses the suicide Rehearses the suicide Takes unnecessary risks Takes unnecessary risks Has had recent severe losses Has had recent severe losses Is preoccupied with death and dying Is preoccupied with death and dying Loses interest in their personal appearance Loses interest in their personal appearance Increases use of alcohol or drugs Increases use of alcohol or drugs Impulsive anger behavior Impulsive anger behavior Legal or financial trouble Legal or financial trouble Isolation or withdrawal Isolation or withdrawal Gives away prized possessions Gives away prized possessions Previous attempts Previous attempts

11. The Aftermath “ Why did he do this….to me? ” “ Why did he do this….to me? ” “ What could I have done? ” “ What could I have done? ” Pain that has no resolution Pain that has no resolution Spouse, parents, children, friends who bare the stigma Spouse, parents, children, friends who bare the stigma

12. The Aftermath Financial Financial Emotional Emotional Spiritual Spiritual Work Work Memorial? Honors? “ he bailed out on us ” Memorial? Honors? “ he bailed out on us ”

13. Warning Signs/Risk Factors Financial problems Financial problems Relationship problems Relationship problems Access to a weapon Access to a weapon Transitions (PCS, Retirement, Discharge, Post Deployment) Transitions (PCS, Retirement, Discharge, Post Deployment) Prolonged exposure to stress, especially combat Prolonged exposure to stress, especially combat Pending disciplinary action Pending disciplinary action

14. There is no “ Type ” CDR, USN, CHC—PTSD from Vietnam CDR, USN, CHC—PTSD from Vietnam

15. Protective Factors Belief that it is okay to ask for help. Belief that it is okay to ask for help. Optimistic outlook. Optimistic outlook. Effective coping and problem-solving skills. Effective coping and problem-solving skills. Social and family support. Social and family support. Sense of belonging to a group or organization. Sense of belonging to a group or organization.

16. Protective Factors Supportive Marriage. Supportive Marriage. Physical activity. Physical activity. Participation and membership in a community. Participation and membership in a community. A measure of personal control in life and its circumstances. A measure of personal control in life and its circumstances. Religious or spiritual connectedness. Religious or spiritual connectedness. Unit cohesion and camaraderie. Unit cohesion and camaraderie. Peer support. Peer support.

17. What To Do Take threats serious Take threats serious Answer cries for help Answer cries for help Be a listener Be a listener Be direct with the question “ Have you thought about hurting or killing yourself? ” if so “ Do you have a plan/means to do so? ” Be direct with the question “ Have you thought about hurting or killing yourself? ” if so “ Do you have a plan/means to do so? ” Get help—Medical, chaplain, OOD, ER, Work Life Get help—Medical, chaplain, OOD, ER, Work Life

18. What Not To Do Leave them alone Leave them alone Assume they are not the type Assume they are not the type Act shocked Act shocked Keep it a secret Keep it a secret Make moral judgments Make moral judgments

19. How EOD Marines have fun!

20. DON’T WAIT UNTIL IT IS TOO LATE, GET HELP!

21. 21 Stress Management Professional Resources ● ● Chain of Command ● ● Emergency Room/Medical ● ● Chaplains http://www.uscg.mil/chaplains/http://www.uscg.mil/chaplains/ LCDR Mike McConville (910)545-6976 ● ● Vet Centers (www.va.gov/rcs)www.va.gov/rcs ●877-995-5247 ● Safeline 877-995-5247 ● ● CG support (EAP) - www.cgsuprt.comwww.cgsuprt.com 1-855-CGSUPRT (247-8778)