Paper presented at the 34th annual convention
Canadian Psychological Association - Montreal - 28 May 1993
LAND FORCE WESTERN AREA'S COMBAT STRESS REACTION MANAGEMENT
PROGRAMME. Captain Frank Kuschnereit, Major William Lai, Land Force
Western Area Headquarters, CFB Edmonton, Alberta.
Land Force Western Area (LFWA) personnel and their families faced numerous
dangerous and potentially mostly damaging incidents in the course of their
careers. United Nations peacekeeping troops in particular may be exposed to
extremely stressful conditions and potentially combat. The Commander of LFWA
considers it essential that his troops have every advantage in dealing with
such intense stress. In August 1992 he directed the development of a Combat
Stress Reaction Management Programme for LFWA with the priority being given
to the troops deploying to the former country of Yugoslavia for United Nations
peacekeeping duties. The overall programme comprises of four areas:
education/prevention, resource referral, family education support and Critical
Incident Stress Debriefings (CISD). The aim of the programme is to prevent and
mitigate pathological stress reactions as a result of operations, thus reducing
the risk of developing post-traumatic stress disorders. This paper provides an
account of the LFWA programme in general, the combat stress education
programme supplied to the United Nations troops prior to deployment to
Yugoslavia and the deployment of the Combat Stress Intervention Team.
Highlighted is the American Critical Incident Stress Foundations CISD
methodology and its adaptation to the management of combat stress reaction.
I. Introduction
Following a brief to Command Counsel on the subject of Combat
Stress in August 1992, the Commander of Land Forces Western Area (LFWA)
directed the development of a Combat Stress Management Programme for LFWA
with a priority being given to area personnel being deployed to United Nations
peacekeeping duties to the former country of Yugoslavia. The goal of the
programme was to "prevent and mitigate the pathological stress reactions as a
result of operations, thus reducing the risk of developing post traumatic stress
disorders".
This goal was broken down into four specific objectives:
a. To implement pre-operational and primary preventative measures ;
b. To effect mitigative action rapidly following operations or
incidents (secondary prevention);
c. To provide similar stress reaction preventative services to
families of affected units; and
d. To ensure the availability of suitable candidate referral networks
and procedure should further management be required.
The LFWA programme was designed to be a comprehensive programme that
would address the above issues. Combat Stress Reaction is a term which
encompasses an array of reversible effects caused by the stressors of combat
or deployment in an operational zone and encompasses the terms battle fatigue,
battle shock and critical incident stress as well as older terms such as shell
shock and combat exhaustion. LFWA decided to develop a comprehensive
programme based on the principles for management of Combat Stress Reaction as
outlined in QSTAG 909 which is Canadian Army Doctrine.
Prior to deployment, units received Combat Stress management training.
While in theatre, unit teams monitored stress levels and provided debriefings
after critical incidents. A LFWA team debriefed the entire unit in theatre prior
to rotation. Six weeks after their return to Canada, the units received a follow
up visit by the LFWA team. Support was also provided to families. The major
components of the programme are described on the following pages.
II Primary Prevention and Education
Prior to their deployment to Croatia all members of 3 Princess Patricia
Canadian Light Infantry and 1 Combat Engineer Regiment received a one hour
introduction to Combat Stress Management Lecture. The lecture consisted of a
20 minute introduction to the history and elements of combat stress
management. This was followed by a 23 - minute video "The Faces of Combat
Stress" which demonstrated how to prevent, recognize and manage combat stress
casualties in the field. The video was followed by an introduction to the
concept of Critical Incident Stress and debriefing procedures. The soldiers
were told that they may be required to attend a debriefing while in theatre. It
was emphasized at the end of the lecture that Combat Stress Reaction is not an
excuse for misconduct and any incident of misconduct such as not taking
prisoners or shooting prisoners would be dealt with the full measure of military
law.
The one hour introduction to Combat Stress Management lecture was given
to company size groups. At the completion the privates and corporals were
dismissed and the leaders (MCpls and above) remained for a three hour Combat
Stress Management Leader's Workshop which was broken into three fifty -
minute periods with a ten - minute break in between each. The first period
consisted of a lecture and discussion of the topic of Combat Stress Management
and the role that the leader plays. The second period consisted of how leaders
could prevent or minimize stress reaction in their troops, how to recognize the
more serious signs of stress reaction and also how to manage troops who are
displaying the more serious signs of combat stress reactions. During the third
period the group was broken into platoon size syndicates and were given two
scenarios. The scenarios were based on possible incidents that they might
encounter while deployed. The syndicates had fifteen minutes to discuss how
they would handle such a scenario and then each syndicate presented their
solution. After the syndicate discussions, the workshop was concluded.
While the workshop was orientated towards operation deployment general
stress management procedures were incorporated as part of the procedures for
minimizing and preventing stress reaction with the leaders and their troops.
Each soldier received an aide-memoir card and the leaders received more
detailed aide-memoir cards as well as the manual on the Management of Stress in
Army Operations.
II Secondary Prevention
Critical Incident Stress Debriefing is a structured group debriefing
procedure and is based on a theoretical model developed by Dr. Jeffrey Mitchell,
a Clinical Psychologist who has worked for years with emergency measures
personnel in the United States. The basis of the theory is that if personnel
involved in a traumatic incident are allowed to speak about the facts and their
feelings and thoughts on the incident and allow them to be worked through,
rather than being internalized, that this will prevent or reduce the incident of
post-traumatic stress disorder.
The debriefing session was conducted in seven phases:
a. Introduction. During this phase, the purpose and sequence of
the session was outlined. The soldiers were also told what the
ground rules were. It was emphasised that this was not an
operational debriefing and that no notes were to be taken;
b. Fact Phase. As the soldiers had not experienced one discreet
incident, they were asked to describe their most stressful incident
that they had been involved in over the six month tour;
c. Thought Phase. The soldiers were asked what their first
thoughts were during the worst part of their incident. The intent
is to allow them to conceptualize their thoughts;
d. Reaction Phase. After processing the information from the
objective, fact modality to a more personal, cognitive one, the
soldiers were asked to describe their feelings or emotional
reactions to their incident;
e. Symptom Phase. During this phase, the soldiers were
encouraged to discuss any physical or behaviourial reactions they
may have had and to share how they had been coping with the
stress of the incident;
f. Information Phase. During this phase the debriefer provided
information on stress reactions. It was emphasised that these
reactions were normal. Positive coping strategies and stress
management information was provided. As the soldiers were
preparing to return to Canada, information on how to reintegrate
with their families and how to minimize jet lag was also provided;
and
g. Conclusion. This final phase allowed the soldiers to ask any last
questions. The debriefer then concluded by reinforcing the fact
that the soldiers had made a positive contribution.
In order to mitigate the pathological stress reactions resulting from
operations, a number of LFWA personnel received specialized CISD training. Five
members of the units deploying to Croatia received the four day Mitchell CISD
course and were designated as part of their unit debriefing team. These teams
would be responsible for conducting immediate defusings at or near the scene of
the incident. The unit team also conducted debriefings in theatre within 24 - 72
hours. The unit debriefing teams could handle the immediate assistance but an
external team comprised of mental health professionals and skilled CISD
debriefers was also placed on standby. The external team was tasked to provide
assistance to the units prior to returning to Canada. The debriefing procedure
was based on the International Critical Incident Stress Foundation's Critical
Incident Stress Debiefing methodology as outlined above.
On 22 March 1993 the team assembled in Edmonton and on 23 March 1993 the
team departed Edmonton and flew to Zagreb, Croatia. Upon arrival it was
discovered that the unit had a comprehensive debriefing schedule arranged.
During the next 7 days the team conducted 34 debriefings for a total of 741
personnel of 3 PPCLI. The overall reaction of the soldiers was very positive.
During the six-month tour in Croatia, a number of incidents occurred.
Three armoured personnel carriers struck anti-tank mines and another was
damaged by a anti-tank missile. One officer was almost killed by an anti-
personnel mine. There were numerous vehicle accidents. A hand grenade was
thrown at an out post and another into a compound. Many soldiers were fired at
but were not hit. All members of 3PPCLI experienced the stressors of living in a
war zone such as having to wear flak jackets and being in constant danger as
well as being away from their families for an extended period of time.
Six weeks after their return to Canada, the units received a follow up
visit by the LFWA team. Unfortunately less than 400 of the 862 personnel still
remained with the unit. The remainder had been sent on courses, posted to
other units or had been reservists who had completed their contracts. The
commanding officer did state that he was more than satisfied with the
programme. He had predicted prior to the deployment that 10% of his unit would
have to return to Canada during the tour. He noted that only 4% returned and
most were for non stress related reasons. He also was pleased that there was
very few marriage break ups.
III Family Support and Education
The family support and education component of the LFWA programme was
managed through the family support centres located at the various bases.
Personnel Selection Officers provided stress management training for spouses
and significant others. It was recognised that a six-month separation was just
as stressful for the families as it was for the soldiers.
Family members and home unit personnel were also briefed on how to
recognize stress reaction symptoms in the returning soldiers and also how to
help them deal with it.
Contingency plans to provide Critical Incident Stress Debriefings to
family members were developed in the event that there were mass casualties.
Family support centres and units were provided with information on
referral procedures and treatment resources in their communities.
IV Resource Referral Networking
In order to take advantage of non-military resources, a list of community
contacts of professionals trained in Critical Incident Stress Debriefing and
follow-up counselling was created. Referral procedures were developed as well
as contingency plans for isolated communities.
Conclusion
Land Forces Western Area's Combat Stress Management Programme was
implemented in a short period of time but has been well received by the soldiers.
Commanding officers attribute reduced attrition and fewer marriage break ups
Formal programme evaluation has been initiated but the study will not be
completed until next fall. In any event, this programme has shown that
Psychological support to operations can be useful in peacekeeping as well as in
war.