Description of Combat and Operational Stress Control in Regional Command East, Afghanistan

Abstract

Combat and Operational Stress Control (COSC) continues to be a vital component of medical operations in support of military forces serving in Afghanistan in Operation Enduring Freedom and elsewhere. Although numerous studies cover postdeployment mental health, and several cover in-theater conditions, data on behavioral health clinical service provision are presented here to elucidate from COSC provider "boots on the ground" how operations have been executed in one part of the Operation Enduring Freedom theater between 2007 and 2010. The most common types of stressors that led to care included combat, mission demands, home front concerns, and relationships with leaders and peers within units. Classes and consultation for sleep difficulties and anger management were of high interest. Frequent behavioral health diagnoses were depressive and anxiety disorders as well as exacerbation of a previously diagnosed condition. Management of suicidality and other psychiatric emergencies are discussed, as well as care outcomes. The authors present lessons learned regarding the importance of Operational Relationships/Tactical Politics, reducing stigma and barriers to care, collaboration with chaplains, and other strategies seen as supporting COSC success.

Treatment for insomnia in combat-exposed OEF/OIF/OND Military Veterans: Preliminary randomized controlled trial

“…From a clinical perspective, sleep disturbances are highly prevalent, expected, and perceived as socially acceptable during and after military deployment (Ogle, Bradley, Santiago, & Reynolds, 2012; Wright et al, 2008). The perceived stigma for seeking help for insomnia may be low compared to the perceived stigma associated with seeking mental health treatment for PTSD, depression, anxiety, or addictive behaviors (Milliken, Auchterlonie, & Hoge, 2007; Warner et al, 2011).…”

Escaping the Clinic: Exposure as Care among Military Medical Professionals at War

“…In this way, the walkabout enables providers to monitor general troop morale and provide in situ para-therapeutic intervention to individuals and small groups. Conceived of as 'taking the treatment to the troops' (Moore and Reger 2006, 401) and a form of 'Help in Place' (Ogle et al 2012(Ogle et al , 1280, the walkabout quite literally brings the provider to the people, facilitating 'out-of-office casual contacts' intended to be 'less intimidating than a clinical setting' (Hung 2008, 39).…”

Out of the classroom, into the field: Piloting an interprofessional experiential exercise.

“…This experience also provided an opportunity to reinforce the prevention and outreach principles of a COSC team. Students had to simultaneously build rapport, address unit morale, and gather relevant data on morale and unit cohesion, which is in line with real-world expectations for deployed psychologists (Ogle et al, 2012). Student-led debriefs occurred after each platoon visit and concluded with a final exercise debrief.…”

“…After internship there may be limited opportunities for deployment-related adaptation of these skills; however, for the majority of psychologists entering the armed services there are no systematic opportunities to learn the specific competencies necessary to function as a clinical psychologist in deployed settings. Clinical psychologists in deployed settings are responsible for a wide array of behavioral health prevention, assessment, consultation, and intervention needs in both formal and informal settings requiring the navigation of multiple complex roles (Ogle, Bradley, Santiago, & Reynolds, 2012). These challenges parallel those experienced by other health services providers in psychology who must adapt to environments postinternship that require modification of skills learned in the predoctoral period.…”