Главная Manuals FM 6-22.5 COMBAT AND OPERATIONAL STRESS CONTROL MANUAL FOR LEADERS AND SOLDIERS (March 2009)
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Chapter 2
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Death of unit members.
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Accidents.
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Serious injury.
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Suicide and/or homicide.
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Environmental devastation and/or human suffering.
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Significant home front issues.
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Operations resulting in the death of civilians or combatants.
2-103. It is an inevitable fact that all organizations and Soldiers will be affected in some way when
exposed to PTEs. Most organizations and individuals will adjust to these events and successfully transition
through them; capable of continuing the missions and tasks they are assigned. However, some
organizations and/or individuals may show signs of reduced performance and dysfunction as a result of
traumatic exposure. It is the goal of the TEM facilitator to assist leaders in assessing the impact of the PTE
exposure and provide supportive measures as appropriate in an effort to enhance adaptive functioning and
promote PCOS.
2-104. The TEM facilitators include any trained individual designated to assess the potential impact of
PTE exposure to military units and personnel. Traumatic event management facilitators assist in crafting a
support plan and executing measures to enable successful transition through the PTE incident and
promoting resilience, adaptive functioning, and PTG. Specifically, TEM facilitators include all COSC
providers and Army chaplains. Traumatic event management facilitators may also include specially trained
medical and unit personnel designated to provide TEM and UNAs and assist in TEM support activities.
There is no specified restriction on who can be trained to assess and render support to units and individuals
in response to PTE exposure.
2-105. For military units, TEM is active in all phases of the deployment cycle and across full spectrum
operations. It is a process that can and should be used in garrison and in deployed environments.
2-106. The main value of TEM is to quickly restore unit cohesion and readiness to return to action,
through clarifying what actually happened and clearing up harmful misperceptions and misunderstandings.
It may also reduce the possibility of long-term distress through sharing and acceptance of thoughts,
feelings, and reactions related to the PTE.
2-107. In the event a unit experiences a PTE, leadership may request a TEM UNA to assess its potential
impact. When requested, the identified TEM team coordinates a TEM UNA resulting in specific
recommendations to address the identified PTE as effectively and efficiently as required.
2-108. The TEM UNAs differ from COSC UNAs in the scope and tools utilized to gather the required
information. The COSC UNAs are global assessments of the unit, with consideration to multiple variables
that may affect leadership, performance, morale, and combat effectiveness of the organization. The COSC
UNAs are generally not restricted in terms of time or techniques utilized in compiling the necessary data to
obtain the desired results. The COSC UNAs lend themselves to the use of objective measurement tools
such as the UBHNAS.
2-109. The TEM UNAs, however, are a focused assessment of the PTE incident with specific
consideration as to the potential disruption or dysfunction that the event may have caused to individuals or
the entire organization. Collateral data is limited to only information that is relevant to the overall impact
of the PTE exposure (such as previous combat injuries when responding to a unit casualty). The TEM
UNAs are generally time-limited and rely on more subjective data-gathering techniques rather than formal
objective measurements.
2-110. It is recommended that leadership request TEM UNAs as close to the specific PTE as practically
possible. However, there are no time limitations to conducting assessments and implementing TEM
support activities in response to current or past PTE exposure that have had a significant impact on the
performance, morale, and cohesion of the effected unit or organization.
2-111. The TEM process incorporates multiple support exercises to aid the leader in managing and
mitigating the impact of PTE exposure that units and Soldiers may experience while executing military
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Combat and Operational Stress Prevention, Management, and Control
operations. Traumatic event management is tailored to the PTE and operational needs and requirements of
the effected unit or organization. Traumatic event management responses include—
z
Unit needs assessment of the impact of the identified PTE.
z
Command consultation and education.
z
Unit and individual education.
z
Individual supportive intervention and counseling.
z
Psychological debriefs.
2-112. In the event TEM facilitators are not available to assist with TEM, leaders may use alternative
methods to address PTEs, including cool-down meetings and leader-led after-action debriefing (LLAAD),
as described in the proceeding paragraphs.
COOL-DOWN MEETINGS
2-113. An immediate, short meeting when a team or larger unit/group returns from the battlefield or other
mission is referred to as a cool-down meeting. These cool-down meetings are held after heavy/intense
battles with the enemy or a shift in the mission has occurred which is highly arousing and/or distressing.
This is especially important after PTEs. The cool-down meeting is an informal event and occurs before the
participants fully replenish their bodily needs and precedes any other activities including LLAADs, COSC
interventions, or return to the mission.
COMPONENTS OF A COOL-DOWN MEETING
2-114. Components of a cool-down meeting may include—
z
Assembling all of the unit personnel at a safe and relatively comfortable location for a brief
period of time (about 15 minutes).
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Receiving or sharing nonstimulating beverages and convenience food (comfort foods if available).
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Providing personnel the opportunity to talk among themselves.
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Giving recognition and praise for the difficult mission they have completed.
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Providing information to unit personnel on where and how they will rest and replenish.
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Previewing the immediate agenda for the unit on what will happen after the cool-down meeting
including plans for further debriefing and/or other available stress control or morale and welfare
intervention.
z
Providing announcements pertaining to further preparations and expected time of return to the
mission.
LEADER-LED AFTER-ACTION DEBRIEFING
2-115. A LLAAD is led by a platoon, squad, or team leader and is not normally conducted above platoon
level. The LLAAD should be conducted after all missions especially when the maneuvers did not go
according to plan.
2-116. A LLAAD may even be sufficient for PTEs involving injury or death. The best time to conduct
this debriefing is as soon as is feasible after the team/squad/platoon has returned to a relatively safe place
and members have replenished bodily needs and are no longer in a high state of arousal.
2-117. Usually a well-conducted LLAAD is the best option to manage PTEs during a mission. The
exception to this type of debriefing is when the event evoked reactions that seriously threaten unit cohesion
and/or have a high likelihood of arousing disruptive behavior and emotions. In these situations the leader
should ask himself the following:
z
Should I conduct the debriefing?
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Should a trained facilitator be present?
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Should a request for COSC TEM be submitted for his team/squad/platoon?
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Chapter 2
CONDUCTING A LEADER-LED AFTER-ACTION DEBRIEFING
2-118. These debriefings require the leader to extend the lessons-learned orientation of the standard after-
action review. He uses the event reconstruction approach or has the individuals present their own roles and
perceptions of the event, whichever best fits the situation and time available. Refer to Training Circular
(TC) 25-20 for definitive information on after-action reviews. When individuals express or show
emotions, the leader and the teammates recognize and normalize them; they agree to talk with them later
and support the distressed Soldier through personal interactions. The group then returns to determining
the facts. A lessons-learned discussion is deferred until all the facts are laid out. The leader may provide
education about controlling likely reactions or referral information at the end, depending on his knowledge
and experience.
2-119. When a PTE is likely to create individual or collective guilt, distrust, or anger, the unit leader
should be encouraged to request COSC assistance. Either a COSC or a UMT Soldier trained in TEM sits
in with the leader-led debriefing as a familiar and trusted friend of the unit. The COSC or UMT facilitator
helps the unit/team leader rehearse and mentors the leaders on the debriefing process. The leader
conducting the debriefing must be attentive to identify individuals needing COSC follow-up. Leaders in
positions above platoon level also have a role in LLAAD. Company commanders and first sergeants may
conduct after-action debriefings similar to LLAAD with their subordinate leaders. Battalion commanders
may also conduct similar type debriefings with their staffs after distressing actions and may include
subordinate leaders when time allows bringing them together.
COMPONENTS OF LEADER-LED AFTER-ACTION DEBRIEFING
2-120. Do not go it alone. Consult your BH assets or chaplain to discuss the event (PTE) and use of this
guideline before arranging for a LLAAD.
2-121. Give enough advance notice so the unit has time to eat, sleep, and make arrangements to be
present. Leader-led after-action debriefings are best utilized with small groups, specifically at platoon
level and below. Although LLAADs should not be mandatory, it is recommended that the entire unit be in
attendance, regardless if they were directly involved in the incident (such as the entire platoon). It is not
recommended to conduct LLAADs for organizations larger than traditional platoon configurations or
around 30 Soldiers in size. Instead, provide an information briefing to larger organizations focused on
facts and details only. Find a quiet, private room with a door that can be locked to avoid interruptions.
2-122. Conduct a LLAAD using the following:
z
Open the LLAAD with an introduction that—
Identifies the goals of the debriefing and establishes the climate and the ground rules.
Explains that the LLAAD is designed to be given by the leader and focuses on the
emotional impact of a PTE.
Explains that the LLAAD is not intended to be a traditional after-action review or fact-
finding event.
z
Explain that a LLAAD is like a standard after-action review or hot wash with its focus on details
of what happened. It is not a fault finding or an investigation but addresses the human responses
to the event. The purpose of the LLAAD is to—
Provide the most current information, facts, and details so everyone is clear on what
happened and resolve any misperceptions.
Provide an opportunity for those involved to discuss their responses to the event.
Provide emotional support to other group members.
Educate participants about normal physical reactions, feelings, and where to go for help
for any future problems.
z
Share the most current known details regarding the PTE that occurred. The leader should
address issues such as the status of wounded Soldiers and review any specifics that occurred
during the PTE exposure. The focus is on facts and to resolve any developing rumors so
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Combat and Operational Stress Prevention, Management, and Control
everyone is clear, as far as OPSEC permits, on what happened during the PTE. It is a good
opportunity to provide positive feedback for successful actions taken by unit members. Leaders
should point out what was done right according to SOP (quick response time and so forth). Any
real deficiencies can be addressed later.
z
Acknowledge thoughts and reactions resulting from the PTE exposure. Leaders are encouraged
to normalize the range of possible emotions that may occur as a result of the particular incident
(such as feelings of guilt, anger, or sadness). Specifically address the tendency to second guess
alternate actions that may or may not have made a difference. It is common for Soldiers to
review their actions and assign personal blame for events due to perceived inaction or decisions
during the PTE. Leaders should remind Soldiers that this is a common response, combat is not
predictable and sometimes bad outcomes occur. The leader can indicate that the individuals
involved did the best that they could under the circumstances. Leaders should focus on the
realities of the event and the immediate loss.
z
Focus on peer support in managing the PTE impact on both the unit and its individual Soldiers.
Leaders must give permission to their Soldiers that it is acceptable to show reactions to PTEs.
Soldiers are often the best support system available to rely on in transitioning through this
experience. The focus is on supporting each other through a difficult event with the expectation
of continued military operations and execution of assigned missions.
z
Reinforce the Battlemind principles and leave the unit with a healthy, positive perspective to
continue the mission. Leaders should reinforce available resources for continued support such
as chaplains, BH, and COSC assets.
2-123. Leaders should meet with trusted helpers after the LLAAD to review the process and identify
individuals who might need more help or referral right away. Leaders should follow up individually with
group participants within a few days after the LLAAD and periodically thereafter for status check/help as
needed.
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FM 6-22.5
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Chapter 3
Command Leadership Actions and Combat and
Operational Stress Control Programs
SECTION I — UNIT BEHAVIORAL HEALTH NEEDS ASSESSMENT SURVEY
INTRODUCTION
3-1. An effective COSC program starts with early planning and assessment then continues during
deployment and extends beyond the return home. A key instrument in establishing and conducting a
successful unit COSC program is utilizing effective assessment tools to determine the health of the
organization and to identify key components that may require some level of support or intervention to
enhance the overall effectiveness of the unit.
USING AN ASSESSMENT TOOL
3-2. Utilizing a systematic and periodically deliverable assessment tool will allow unit leadership to
monitor the longitudinal health of their organizations and offer the ability to identify and address any BH
or stress-related concerns that may exist within the organization. Such a tool exists and has been
developed specifically for use in the military.
3-3. There are key considerations when utilizing this tool—
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The survey is anonymous. When administering the survey, the anonymity of every Soldier is
maintained by not asking for any identifying information, by not asking to turn in the surveys to
other members of the unit who may read individual responses, and by not looking at the surveys
until all of the surveys have been collected.
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Soldiers need to feel confident that their answers are anonymous or they may not be fully
truthful on the survey.
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Key leaders public efforts to maintain this anonymity will also send Soldiers the message that
leadership takes the situation seriously and can be trusted to maintain this confidentiality if later
needed for personal problems.
3-4. Although the UBHNAS may be a command-directed initiative, completing the survey should always
be voluntary. Units may require Soldiers to attend the survey administration; however, Soldiers may
choose not to complete the survey or to hand it in blank. Leadership should not coerce or order a Soldier to
complete the survey; because they may not answer truthfully, thus making the results less meaningful.
3-5. It is important for leadership to note that the data obtained from the UBHNAS belongs to the
commander of the organization that is being assessed, at the level it is conducted (for example, companies
will have ownership of the individual company and battalions will have ownership of battalion roll up—
not individual companies). These surveys are not for research purposes; there is no institutional review
board oversight or informed written consent process. The data and findings should not be published or
presented in any forum except to the unit commander. Further, the unit commander must give written
permission to utilize the data for any purpose other than to assess and inform the unit leadership about the
unit’s BH needs. Results may be disclosed to military BH personnel for the purposes of consultation
and/or resource allocation. They may also be provided to BH personnel assigned or attached to higher
units for the purposes of rolling up the results as part of a larger UNA.
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Chapter 3
3-6. Only consolidated data from the UBHNAS should be presented to commanders. Brigade
commanders should be briefed on the status of the brigade; battalion commanders should be briefed on the
status of their respective battalions. However, brigade commanders should not be briefed on the results of
individual subordinate battalions without the consent of the respective battalion commanders.
3-7. The survey is solely meant to help BH and unit leaders understand the BH needs of the unit as
a whole in order to develop unitwide BH prevention and early intervention plans targeting identified
problems and allocating limited BH resources. As a rule of thumb, 50 Soldiers per company or 100
Soldiers per battalion should be sufficient, as long as some Soldiers from each subordinate unit are
included in the sample. Examples of when to conduct the UBHNAS would include change of commands,
as part of a quarterly assessment plan, during predeployment/deployment/redeployment operations. For
SECTION II — EFFECTIVE COMBAT AND OPERATIONAL STRESS CONTROL
PROGRAM
MINIMIZE STRESS
3-8. Having an active unit COSC program can have a decisive effect. A sound COSC program can
minimize stress-related reactions and enhance mission accomplishment capabilities. The key element that
COSC programs should focus on is unit morale and cohesion, which can be accomplished by integrating
team-oriented training exercises that are conducted on at least a quarterly basis within the unit training
calendar. Stress protection is achieved by providing realistic training focusing on team building and unit
cohesion. An effective unit COSC program should include all of the different areas of the force projection
process. The force projection process was discussed in Chapter
2.
For definitive information on
deployment and redeployment and the force projection process, see FMI 3-35.
3-9. For current information on the deployment cycle support, see the Army G-1 Deployment Cycle
Support Process Homepage for information and current support documentation and presentations on the
MOBILIZATION
3-10. Mobilization is one of the processes of force projection when units or individuals are alerted for
possible deployment and commence preparation. During the mobilization stage, force projection tasks
consisting of administrative actions, briefings, training, counseling, and medical evaluations are completed
to ensure all Soldiers and their Families are prepared for extended deployments.
3-11. Mobilization stressors experienced by Soldiers include long working hours, preparation for training,
fear of the future, Family worries, and anxiety about the unit’s readiness.
3-12. Signs of poor coping include insomnia, increased use of alcohol, marital problems, and increased
bickering in the unit, irritability, and suicidal feelings. Important preparatory steps to take during the
mobilization phase is to—
z
Conduct unit behavioral needs assessment.
z
Conduct unit training and mission rehearsals.
z
Prepare for changed sleep schedules and jet lag.
z
Attend to task assignments and allocations.
z
Conduct equipment and supply maintenance checks.
z
Attend to personal and Family matters. (Call the ACS.)
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Integrate new members into the unit positively and actively.
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Welcome significant others (not just entitled beneficiaries) in the Family support network
information tree.
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Brief as much information about the operation as possible, consistent with OPSEC measures.
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Command Leadership Actions and Combat and Operational Stress Control Programs
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Familiarize the unit members with the stressors they may encounter.
z
Arrange for mobilization training and education, especially for refresher training of stress
reduction techniques from chaplains, local BH professionals, or COSC team, if available.
UNIT TRAINING
3-13. Because unit leaders have experienced the stressors associated with garrison living and peacetime
training, they should have had the opportunity to better understand their Soldiers and what affects their
performance.
3-14. It is important that Soldiers have a positive perception of their unit’s personnel and equipment
capabilities to accomplish the mission given. This is achieved through the development of realistic training
that fosters unit cohesion and esprit de corps.
3-15. Realistic mission rehearsal helps desensitize Soldiers against potential combat and operational
stressors. For example, wearing and realistically training in protective gear is important. By doing so in
mobilization training, Soldiers may become less distressed in the operational environment, should it be
necessary to wear it.
3-16. Given OPSEC limitations, leadership should make every effort to disclose as much information as
possible regarding mission-specific operational requirements. This includes known enemy tactics and
techniques. Soldiers who are informed and knowledgeable regarding mission specifics tend to exhibit less
anxiety and experience less stress.
3-17. It is important during such training to talk realistically about enemy strengths and weaknesses, as
well as those of their own units. While inspirational pep talks are also important at this time, they should
not include biased, inaccurate information. Leaders earn trust and respect if their troops perceive them as
accurate, dependable sources of information.
Stress-Coping Skills Training
3-18. During preparation for deployment, the leaders should direct the unit to practice stress-coping and
relaxation techniques and can be positive role models by demonstrating use of these techniques. If
necessary, the chaplain and BH personnel available to the unit can provide additional training.
Sleep Discipline
3-19. Before deployment, unit leaders must consider fatigue and sleep loss occurring during combat. The
enforcement of work and rest schedules begins early in mobilization training. During continuous
operations, fatigue caused by lack of sleep is a major source of stress. Breaks in combat are irregular,
infrequent, and unscheduled (refer to Chapter 4).
Task Allocation and Management
3-20. Overloading Soldiers with tasks or responsibilities is another major source of stress. Allocating
tasks fairly among available Soldiers improves unit effectiveness as well as decreases stress. Proper
allocation of tasks include—
z
Selecting the right person for the job. The right person is fitted to the right task according to the
task requirement and the individual’s talents, abilities, and training.
z
Duplicating critical tasks. Two Soldiers are assigned to a critical task requiring behavioral
alertness and complete accuracy. They check each other’s work by performing the same task
independently.
z
Cross-training. Each Soldier (other than medical Soldiers who can only cross-train in positions
with the same MOS requirements) is trained in a secondary duty position to ensure competently
stepping into the position of another.
z
Developing performance supports. Develop SOPs, checklists, or other behavioral aids to
simplify critical tasks during periods of low alertness.
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FM 6-22.5
3-3
Chapter 3
z
Maintaining equipment maintenance and supply. During mobilization, the unit maintains its
equipment and manages needed supplies. Once deployed for combat, Soldiers require
confidence that supplies are ample and equipment is dependable. The following questions are
important:
Does the unit provide ample training in equipment maintenance and troubleshooting?
Has the unit’s equipment been field-tested under realistic conditions?
Have Soldiers fired and cleaned their weapons while wearing full combat gear or protective
clothing?
Does the unit have sufficient ammunition, food, water, and other essential supplies?
Does the unit have contingency plans for procuring and managing critical supplies if normal
channels are disrupted?
PERSONAL AND FAMILY MATTERS
3-21. Family stress adds to combat-imposed stress and causes distraction, interference with performance of
essential duties, and a negative impact on stress-coping abilities. This will result in the unit’s inability to
perform at peak potential.
3-22. The unit should help the Soldiers resolve important Family care matters before deployment and
develop methods for helping Families when Soldiers are deployed. Soldiers are encouraged to—
z
Generate or update their wills.
z
Finalize power of attorney for spouses.
z
Update life insurance policies, including Servicemember’s Group Life Insurance.
z
Ensure Family automobiles are in good repair.
z
Develop lists of telephone numbers of reliable POCs for specific problems
(mechanics,
emergency transportation, babysitters, sources of emergency money, and health care).
z
Resolve major legal issues such as alimony payments, property settlements following divorces,
and child support payments.
ROLE OF LEADERS
3-23. Small-unit leaders should—
z
Brief Families as a group before deployment or as soon as possible after deployment into the
theater. Within the bounds of OPSEC, explain the mission’s nature. Even if a mission is highly
confidential, Families benefit from such a meeting by being told of the support available to them
while separated. They begin to solve problems and form support systems with other Families.
This includes an opportunity to discuss Family questions and concerns. The ACS, post BH
service, or the chaplain’s office assists in staging this briefing.
z
Establish POCs (for example, the key volunteer network) to assist with Family problems. These
volunteers possess good working relations with the chaplain and BH personnel to assist with the
management of complex problems.
z
Establish key volunteer communication and support networks. Commanders’ spouses or
spouses of sergeants majors are often good resources for developing and running such networks;
however, the involvement of junior Soldiers’ spouses is also crucial. Some of the most
enthusiastic participants are tasked to make outreach visits and encourage shy or depressed
spouses to participate.
z
Have BH professionals conduct meetings to discuss mobilization problems. For example, some
children have difficulty adjusting to a parent’s absence. Behavioral health professionals give
Families valuable information on these normal reactions and suggest ways to prepare for them.
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Command Leadership Actions and Combat and Operational Stress Control Programs
DEPLOYMENT
3-24. Deployment occurs when units or individuals deploy from the continental US or outside the
continental US installations into the designated theater. Recurring administrative actions are completed
during the deployment stage.
3-25. During the deployment stage is when units or individuals perform their assigned mission in support
of the joint force commander for a prescribed period of time. Deployment stage tasks include recurring
administrative actions and briefings, training, and counseling for Soldiers departing theater on emergency
leave, rest and recuperation, and medical evacuation.
3-26. In addition to the normal stress associated with moving to a combat zone, Soldiers in these phases
start worrying about their survival and performance under fire. Their thoughts become centered on fear of
the unknown.
3-27. Unit leaders should emphasize that stress under these circumstances and conditions are expected and
are a natural reaction. This will help prevent normal stress reactions from escalating into extreme
reactions.
3-28. Unit leaders should provide as much information as necessary to their survival and mission success,
reinforce stress control techniques, and help their subordinates understand what happens to them when
stressors occur.
DEPLOYMENT VEHICLE
3-29. The deployment vehicle—in most cases, an airplane—is a stressor by itself. If it is a commercial
aircraft, in-flight problems are usually minor. However, if the unit deploys on a military aircraft, leaders
should accomplish the following—
z
Designate areas for light exercise and stretching to counter seating discomfort.
z
Ensure Soldiers drink enough fluids to prevent dehydration and have access to the latrine.
z
Adopt the activity schedule of the new time zone. If the unit is in the sleep cycle or is already in
or about to enter the sleep cycle, cover windows, reduce lighting, and issue earplugs, blankets,
and pillows.
z
Allow uninterrupted sleep. If a stopover occurs during a sleep cycle, do not waken Soldiers to
eat or partake in activities. If the stopover occurs during an activity period, take full advantage
of it by having Soldiers take washcloth baths, stretch, and perform head-and-shoulder rotations.
z
Upon arrival in the area of operations, follow the schedule of the new time zone. Eat the next
meal and go to bed on the new schedule. Doing so helps the Soldiers’ bodies adjust.
KEEP SOLDIERS INFORMED
3-30. Since uncertainty about the future is a major source of stress, timely and accurate information
becomes vital. Lines of communications are clearly defined and kept open. Issuing warning, operation,
and fragmentary orders is critical to ensuring adequate information flow. Informational meetings are
conducted at regular intervals, even when there is no new information to disseminate.
3-31. This reinforces the organizational structure and the importance of unit meetings as the source of
current, accurate information. Reliable sources of information are especially important for countering
rumors.
3-32. Soldiers also need information or performance feedback after mission completion. Engaging in a
firefight or completing a mission without procedural feedback is insufficient with respect to COSC
management. Soldiers must be told how they performed as a group. The knowledge of mission
accomplishment and progress builds unit cohesion, develops a winning attitude, and reduces the effects of
stress. Leaders should consider utilizing routine cool-down meetings and conducting LLAADs as
described in Chapter 2 of this manual.
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FM 6-22.5
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Chapter 3
FAMILY SUPPORT
3-33. The ACS, installation Family Life Chaplain, and Family support groups provide Family support
throughout deployments. The Army Emergency Relief, American Red Cross, ACS, and other community
agencies also provide direct assistance to Family members. Military OneSource provides
24-hour
assistance for Soldiers and Families seeking assistance for a variety to problems at Web site
3-34. The FRG and the American Red Cross continue to function as conduits for emergency information
between Soldiers and their Families.
3-35. Unit leaders need to educate Soldiers about these programs and agencies that are available to serve
the needs of the community.
3-36. Effective communication and caring support networks help to prevent anxiety while Soldiers are
deployed and/or in combat.
FAMILY CARE
3-37. Soldiers entering a full spectrum operational environment with financial worries or Family problems
risk breaking down under the additional operational stress. Even positive but unfinished changes on the
home front, such as a recent marriage or parenthood, can distract the Soldiers’ focus on combat missions
with worries that they will not live to fulfill their new responsibilities at home. Leaders must be aware of
this risk and assist members in handling personal matters before deployment.
3-38. When Soldiers know their Families are cared for, they are better able to focus on their military
duties.
PHYSICAL AND RECREATIONAL ACTIVITIES
3-39. It is imperative that leadership maintain some avenues for physical and recreational activities. Good
physical health in conjunction with routine, team-building activities optimizes individual stress-coping
capabilities and builds unit cohesion. Most current WOT operations have developed extensive physical
fitness facilities and morale, welfare, and recreation activities in almost every location that Soldiers are
deployed. When the tactical situation permits, leadership should maximize the ability for Soldiers to utilize
these services. In fact, units should attempt to organize activities, if possible, in an effort to maintain
cohesion and enhance the bonds formed when deployed.
3-40. The ability to conduct personal hygiene is another key factor in stress protection. If and when
available, Soldiers should be given routine access to these resources. Doing so maximizes the potential
psychological benefits to Soldier and unit.
3-41. Redeployment refers to units/individuals reposturing in theater; transfer forces and materiel to
support other operational requirements; or return personnel, equipment (if it not left in theater for the
incoming unit to use during their deployment), and materiel to the home station or demobilization station.
The redeployment stage continues the process of reintegrating Soldiers and DA civilians into their
predeployment environments. Redeployment stage tasks include administrative actions, briefings, training,
and counseling for Soldiers and DA civilians departing theater and Family members at home station.
3-42. Postdeployment activities occur when personnel, equipment, and materiel arrive at home station or
demobilization station. The postdeployment activities consist of administrative actions, briefings, training,
counseling, and medical evaluations to facilitate the successful reintegration of Soldiers and DA civilians
into their Families and communities.
3-43. Soldiers who have returned from deployments in support of Operation Enduring Freedom and
Operation Iraqi Freedom have often been involved in significant combat experiences. Assimilating back
into their home life and Family routines may be more difficult than expected and may complicate the
reunion process. To ease the transition from the battlefield to home, the Families are provided information
on the stressors and problems they may encounter in readjusting to a normal military family. Soldiers will,
as part of their end-of-tour stress management debriefing and BH screening, receive homecoming-reunion
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Command Leadership Actions and Combat and Operational Stress Control Programs
educational briefings and training to prepare them for their Family reunion and avoidance of domestic
strife. Soldiers with any BH problems are referred for treatment by the installation MTF. All Soldiers and
Families are informed of Family support services available to them.
3-44. The period after combat can be difficult. Today’s rapid transportation enables Soldiers to travel
from the battlefield to their hometowns in as little as 48 to 72 hours. Decompression periods are now
mandatory throughout the Services.
3-45. This short time often does not give them reflection with their comrades. Units should therefore set
aside time in the last few days before leaving the theater to conduct their own end-of-tour debriefing in
which they start at predeployment and talk about whatever stands out in their memories, good or bad, as
they recount the operation up to its end. The Army has developed a postdeployment debriefing process
that may be helpful in achieving this goal. Leaders should consult with existing chaplain and BH assets to
coordinate conducting Battlemind postdeployment psychological debriefings shortly after returning to
home station installations.
3-46. There should also be appropriate memorial ceremonies and rituals that formally bring the operation
to a close. Awards, decorations, and other recognition must be allotted fairly by the commanders.
3-47. Unit officers and NCOs, assisted by the chaplains and BH/COSC teams, prepare the Soldiers for
problems encountered during Family reunion. For example, most Soldiers expect to resume roles and
responsibilities they had prior to separation. However, their spouses often resist giving up their new roles
as decisionmakers and primary home managers.
3-48. Spouses may feel that their sacrifices during the Soldiers’ absence have gone unrecognized. This
feeling becomes an additional source of tension. If at all possible, the Families should receive the same
briefings or written materials.
3-49. Families need to be reassured of their contribution. Key volunteer networks and Family team-
building programs and corresponding organizations for the Army continue to help manage problems with
reunion and adjustment.
3-50. Soldiers are briefed that startle reactions to sudden noises or movements, combat dreams and
nightmares and occasional problems with sleeping, and feeling bored, frustrated and out of place are
common when first returning from operational environment to a peacetime, civilian setting. The leaders,
chaplains, and the COSC team emphasize the normalcy of such reactions. Soldiers are also advised on
resources available to help deal with such symptoms if they are persistent and become upsetting.
3-51. The same leadership skills that apply to troop welfare and warfighting can effectively reduce or
prevent COSRs. Small-unit leaders should take preventive actions and address stress symptoms as they
appear.
3-52. Ignoring the early warning signs can increase the severity of stress reactions.
ARMY FORCE GENERATION CYCLICAL READINESS PROCESS RESET/TRAIN
3-53. Units returning from long-term operations are placed in the reset/train cycle. Active Army units
typically stay in this pool for 6 to 9 months, while RC units will probably stay up to 4 years. It is during
this cycle that replacement personnel are assigned to the unit. The reset/train cyclical readiness process
begins after completing postdeployment recovery and administrative requirements. The reset/train process
involves unit reorganization and the training of individual skills. Administrative actions, briefings,
training, counseling, and medical evaluations are completed during the reset/retrain process to ensure all
Soldiers, DA civilians, and their Families are prepared for extended deployments.
3-54. The reset/train process will also include all organizational and leadership activities that occur in
between deployment orders. Typically this will be located at the installation where the organization is
based or garrisoned during peacetime activities. This includes all BH support activities provided to
Soldiers assigned to the organization, Family support activities, routine assessments, and preventive
activities that occur during routine unit operations
(to include field training and situational training
exercises) not resulting from pending deployment instructions or orders.
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3-7
Chapter 3
3-55. Unit leadership must be familiar with garrison-based BH care resources available to address unit and
individual Soldier concerns while garrisoned.
3-56. There is no better time to utilize BH resources and to refit the organization than when it is garrisoned
awaiting future deployments. Additionally, garrison operations exert unique stressors on the organization
and assigned personnel that are not existent when deployed. Key concerns include routine living problems
experienced by assigned personnel, social, and off-duty activities.
3-57. Unit leaders have a unique opportunity during garrisoned activities to initiate cohesion-building
activities and observe the unique individual traits of each Soldier under them. The bonding and esprit de
corps that is developed during this phase is essential to the unit’s ability to sustain high-stress
environments that exist during deployment operations. Additionally, the small-unit leader can foster a
relationship with his subordinates that will allow the ability to recognize signs of distress exhibited through
behavioral changes.
READY
3-58. Units determined to be at a ready level are capable of beginning their mission preparation and
collective training with other operational headquarters. They are eligible for sourcing; may be mobilized if
required; and can be trained, equipped, resourced, and committed, if necessary, to meet operational
requirements. It is during this cycle that the individual training that could not be accomplished during
reset/train is completed and collective training is undertaken.
AVAILABLE
3-59. Units are capable of conducting a mission under any geographical combatant commander. All
Active Army and US Army Reserve (USAR) units pass through a 1-year available force pool window.
Generally, Active Army units will rotate through this pool 1 in every 3 years; USAR units 1 in every 5
years; and Army National Guard units 1 in every 6 years. Upon notification of a deployment, the unit
begins the force projection process.
SECTION III — COMBAT AND OPERATIONAL STRESS CONTROL
RESILIENCY TRAINING
BATTLEMIND TRAINING—BUILDING SOLDIER RESILIENCY
3-60. Battlemind refers to the US Army psychological resiliency building program. This term describes
the Soldier’s inner strength and courage to face fear and adversity during combat and speaks to resiliency
skills that are developed to survive. It represents a range of training modules and tools under three
categories—the deployment cycle, life cycle, and Soldier support.
3-61. Although war affects all Soldiers, most make a successful transition home after combat duty. Some
Soldiers, however, experience persistent symptoms such as sleep disturbance, hypervigilance, detachment,
anger, or risky behaviors such as alcohol misuse or aggression. These problems can seriously affect their
military duty and Family functioning if not addressed early. Prior to the war in Iraq there were no
empirically validated strategies to build resilience or methods to prevent combat-related BH problems.
Battlemind training is designed to prevent or reduce the severity of combat-related BH problems through a
strength-based approach. This approach focuses on the strengths and the skills that helped Soldiers to
survive in combat instead of focusing on the negative effects of combat.
PREDEPLOYMENT BATTLEMIND
3-62. The predeployment Battlemind training program is designed to build Soldier resiliency by
developing his self-confidence and mental toughness. The training focuses on Soldier strengths and
identifies specific actions that Soldiers and leaders can engage in to meet the challenges of combat and
3-8
FM 6-22.5
18 March 2009
Command Leadership Actions and Combat and Operational Stress Control Programs
address stress reactions that may occur. The predeployment training consists of unique modules for
Soldiers, leaders, and USAR Soldiers. There are also parallel materials for Families.
POSTDEPLOMENT BATTLEMIND
3-63. The postdeployment Battlemind training focuses on transitioning from combat to home. The word
Battlemind when used as an acronym, identifies 10 combat skills that include—
z
Buddies (cohesion).
z
Accountability.
z
Targeted aggression.
z
Tactical awareness.
z
Lethally armed.
z
Emotional control.
z
Mission operational security.
z
Individual responsibility.
z
Nondefensive (combat) driving.
z
Discipline and ordering.
3-64. These Battlemind skills will facilitate the transition home, if adapted. The postdeployment
Battlemind training consists of two training modules to be conducted at different times during
postdeployment. The first training module is intended to be given within the first two weeks of retuning
home. The focus of this initial transition training is on safety, relationships, as well as normalizing
common reactions and symptoms from combat. The second training module is designed to be given at 3 to
6 months postdeployment. This follow up postdeployment training is designed so Soldiers can conduct
their own Battlemind check of themselves, as well as that of their buddies, allowing them to know when to
seek help. The training ends by addressing those barriers which prevent Soldiers from seeking help. The
Battlemind training is designed to be given in small groups to encourage interaction and discussion
requiring approximately 35 to 40 minutes to complete. For additional information on Battlemind training,
SECTION IV — BATTLEMIND WARRIOR RESILIENCY AND COMBAT AND
OPERATIONAL STRESS CONTROL
PEER-SUPPORT PROGRAM
3-65. Management of COSR through peer support is a significant factor in the mitigation of COSR within
the organization. Soldiers identify with peers who are viewed as trusted and needed. A determining factor
in treating COSR is when Soldiers perceive that their peers support them. The higher the level of cohesion
and bonding within a unit, the more likely peers are to support each other thus the more successful the unit
as a whole is in dealing with COSR.
3-66. The US Army has designed a peer-support training program leveraging existing Army BH assets and
health care specialist/combat medics. All health care specialists (military occupational specialty 68W) will
be provided Battlemind Warrior Resiliency training as part of their basic and advanced individual training.
The skills they receive will reinforce the ability to institute peer-support networks within unit structures
and provide the ability to conduct preliminary TEM UNAs and limited support activities in response to unit
and individual PTE exposure. This program is designed to enhance existing buddy aid and battle buddy
support concepts that currently are utilized by the US Army. It specifically addresses unit-level COSBs
that Soldiers and small groups may exhibit while executing military operations. Battlemind Warrior
Resiliency is designed to use a peer-driven psychological risk management and support system with
military personnel and units to provide the earliest possible identification, mediation, and referral for
Family, operational, and combat and operational environment-related BH and stress management.
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3-9
Chapter 3
3-67. A peer-delivered system that operates in concert with more formal BH assets has certain advantages
over one delivered exclusively by the latter. In the military, adequate BH support may be difficult to
deliver because of logistical constraints, difficult terrain, wide dispersal of personnel, combat
contingencies, and a limited number of BH practitioners who may not always be as well-integrated with
their specific brigades.
3-68. Under the Battlemind Warrior Resiliency program, identification of cases and uncomplicated
intervention begin at the unit level, by unit members (health care providers/combat medics), preserving
unit self-reliance and cohesion without the previously mentioned logistical concerns.
3-69. A peer-support program normalizes stressful events at the peer level. This peer-support program
helps neutralize Soldiers’ combat and operational stress responses and also allows for the delivery of vital
services at the earliest possible time. Successful uses of the peer-support program help reduce the potential
of further stressing personnel. The program is a useful extension of effective personnel management.
Leaders may further reduce the added stress of carrying out military operations by incorporating
Battlemind Warrior Resiliency into the organizational structure.
3-70. It is highly recommended that leaders utilize Battlemind Warrior Resiliency-trained medics in
developing and implementing a peer-support program within their organization. Command should contact
local BH assets to consult and establish a peer-support program. Maintaining peer-support programs
internally is a vital part of the command COSC program and is a significant benefit in the normalization of
PTEs and support delivery for Soldiers within an organization.
SECTION V — LEADERSHIP ACTIONS AND INTERVENTIONS FOR COMBAT
AND OPERATIONAL STRESS REACTIONS
LEADER INTERVENTION
3-71. When a Soldier requires medical attention to rule out a possible serious physical cause for his
symptoms or because his inability to function endangers himself, the unit, and the mission, he should be
transported to the battalion aid station or the nearest MTF. Refer to Chapter 1 and DODD 6490.1.
LEADER ACTIONS FOR COMBAT AND OPERATIONAL STRESS REACTION
3-72. Interventions at the small-unit level may be required if a Soldier is upset. The leader should let him
talk about what is upsetting him, listen, and then try to reassure him. Intervention may also be required if a
Soldier’s—
z
Behavior endangers the mission, himself, or others. The leader should take appropriate
measures to control him.
z
Reliability becomes questionable—
Unload the Soldier’s weapon.
Remove the weapon if there is a serious concern.
Physically restrain the Soldier only when safety is a concern or during transport.
Reassure unit members that the signs are probably a normal COSR and will quickly
improve.
3-73. If the COSR signs continue—
z
Get the Soldier to a safer place.
z
Do not leave the Soldier alone. Keep someone he knows with him.
z
Notify the senior NCO or officer.
z
Have the Soldier examined by medical personnel.
3-74. If the tactical situation permits, give the Soldier simple tasks to do when not sleeping, eating, or
resting and assure the Soldier that he will return to full duty as soon as possible.
3-10
FM 6-22.5
18 March 2009
Command Leadership Actions and Combat and Operational Stress Control Programs
3-75. The most effective treatment for COSR is to normalize the symptoms presented by the Soldier. It is
imperative that the small-group leader also verbally and nonverbally illustrate that the expectation is for the
Soldier to improve and rejoin his organization as a fully functioning member. Soldiers need to perceive
that their unit expects and wants them to rejoin the organization and continue to be a part of the team. The
most important thing a small-group leader can do is to project this message. When COSRs are normalized
and the unit demonstrates a desire to retain the individual, there is a significant chance of improvement in
the Soldier.
3-76. When COSR casualties cannot be managed in place, they should be moved to a safer, quieter place
and be provided rest and work for several hours up to one to two days in a place controlled by the unit. If
the unit cannot wait for the Soldier to recover, he must be moved to the Role 1 MTF. From there, every
effort is made to move the Soldiers to a nonmedical unit or area (a tent or building of opportunity could
suffice) for rest, replenishment, and reassurance. Leaders should consider, as an alternative to complete
weapons removal, disabling the weapon system (remove the bolt from the Soldier’s weapon). This will
facilitate the Soldier being able to retain a weapon system without losing the identity associated with being
a Soldier (and carrying a weapon system of issue).
3-77. It should be made clear that the Soldiers are tired and in need of an opportunity to talk, sleep, eat,
and replenish fluids; they are not patients.
3-78. Each Soldier is accounted for and every effort is made to ensure strong lines of communications are
in place and maintained between Soldiers and their original unit.
3-79. Key to successful treatment is the return of the Soldier to his original unit. Actions to be taken for
severely combat-stressed Soldiers are the same as those for the moderately combat-stressed, with one
exception, medical personnel at the battalion aid station level should evaluate severely combat-stressed
Soldiers as soon as possible. Casualties will be treated and released within hours, held for rest and
replenishment, or evacuated for further Soldier restoration. Soldiers who recover from COSR return to
their original units, (same company or platoon) and are welcomed upon their return are less likely to suffer
recurrence. Once rested and returned, they usually become healthy again. Accordingly, risk is reduced
when Soldiers recovering from COSR return to the same unit where their combat experience is known and
welcomed. In rare instances, however, it is in the best interest of the individual to be reassigned to other
jobs or units.
SECTION VI — COMBAT AND OPERATIONAL STRESS REACTION
GUIDELINES FOR THE MANAGEMENT OF COMBAT AND
OPERATIONAL STRESS REACTION
3-80. Guidelines in the treatment and management of COSR are summarized in the memory aid—Brevity,
Immediacy, Contact, Expectancy, Proximity, and Simplicity (BICEPS). Using BICEPS is extremely
important in the management of Soldiers with COSR and/or behavioral disorders.
BREVITY
3-81. Initial rest and replenishment at COSC facilities located close to the Soldier’s unit should last no
more than 1 to 3 days. Those requiring further treatment are moved to the next role of care. Since many
require no further treatment, commanders should expect their Soldiers to RTD rapidly.
IMMEDIACY
3-82. It is essential that COSC measures be initiated as soon as possible when operations permit.
Intervention is provided as soon as symptoms appear.
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FM 6-22.5
3-11
Chapter 3
CONTACT
3-83. The Soldier must be encouraged to continue to think of himself as a Soldier, rather than a patient or a
sick person. The chain of command remains directly involved in the Soldier’s recovery and RTD. The
COSC team coordinates with the unit’s leaders to learn whether the overstressed individual was a good
performer prior to the COSR. Whenever possible, representatives of the unit or messages from the unit tell
the Soldier that he is needed and wanted back. The COSC team coordinates with the unit leaders, through
unit medical personnel or chaplains, any special advice on how to assure quick reintegration when the
Soldier returns to his unit.
EXPECTANCY
3-84. The individual is explicitly told that he is reacting normally to extreme stress and is expected to
recover and return to full duty in a few hours or days. A military leader is extremely effective in this area
of treatment. Of all the things said to a Soldier suffering from COSR the words of his small-unit leader
have the greatest impact due to the positive bonding process that occurs. A simple statement from the
small-unit leader to the Soldier stating that he is reacting normally to excessive stress and that he is
expected back to duty soon will have positive impact. Small-unit leaders should tell Soldiers that their
comrades need and expect them to return. When they do return, the unit treats them as every other Soldier
and expects them to perform well.
PROXIMITY
3-85. Soldiers requiring observation or care beyond the unit level are evacuated to facilities in close
proximity to, but separate from, the medical or surgical patients at the battalion aid station or medical
company nearest the Soldier’s unit. It is best to send Soldiers who cannot continue their mission and
require more extensive intervention to a facility other than a hospital, unless no other alternative is
possible. Combat and operational stress reactions are often more effectively managed in areas close to the
Soldier’s parent unit. On the noncontiguous battlefield characterized by rapid, frequent maneuver and
continuous operations, COSC personnel must be innovative and flexible in designing interventions which
maximize and maintain the Soldier’s connection to his parent unit.
SIMPLICITY
3-86. Indicates the need to use brief and straightforward methods to restore physical well-being and self-
confidence.
3-87. The actions used for COSR control (commonly referred to as the six Rs) involve the following
actions:
z
Reassure of normality.
z
Rest (respite from combat or break from the work).
z
Replenish bodily needs (such as thermal comfort, water, food, hygiene, and sleep).
z
Restore confidence with purposeful activities and contact with his unit.
z
Return to duty and reunite Soldier with his unit.
z
Remind the Soldier as appropriate before, during, and after combat that—
He is an American Soldier here to complete a lawful mission.
An American Soldier behaves honorably because it is the right thing to do.
Harming or killing noncombatants dishonors him and his fellow Soldiers (living and dead).
Stepping down to revenge helps the enemy to discredit him and his unit.
The ultimate objective is to return home with honor.
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FM 6-22.5
18 March 2009
Command Leadership Actions and Combat and Operational Stress Control Programs
SECTION VII — SAFETY CONSIDERATIONS
SOLDIER AND UNIT SAFETY COMES FIRST
3-88. Leaders should be aware of emergency procedures to take in the event that a Soldier presents with
questionable safety concerns. Emergency BH evaluations should be a part of every organization’s SOP.
3-89. Standing operating procedures should include the use of escorts, proper form templates to execute
command referrals, buddy watch protocols, and weapons removal guidelines. If SOPs do not exist, consult
with organic BH assets to establish policies that are compatible with the specific unit structure.
3-90. Confiscation of a Soldier’s weapon should only be considered when it is clearly apparent that the
Soldier is unreliable and a safety hazard to himself and others. Soldiers that have immobilized weapons
systems should not be considered for participation in combat missions.
3-91. A distressed Soldier perceived to be a danger to himself or to unit personnel should always be
escorted until an evaluation is conducted by medical personnel. The escort should be sufficient in grade
and number to successfully stabilize the Soldier if required.
3-92. Consult BH assets immediately in all matters concerning safety assessments and risk management of
unit personnel. Detailed command consultation procedures are provided in Chapter 1; also, refer to a
chaplain, a physician, a physician assistant, a BH professional, the COSC team, or other health care
provider.
18 March 2009
FM 6-22.5
3-13
Chapter 4
Sleep Deprivation
SECTION I — INTRODUCTION AND SLEEPING IN THE OPERATIONAL
ENVIRONMENT
INTRODUCTION
4-1. This sleep guidance is provided by the Walter Reed Army Institute of Research and supported by
extensive research. This guidance is based on current research as of September 2007 and applies to all
levels of military operations, to include both training and tactical environments. Unit sleep plans should be
based on this guidance.
4-2. Sleep is a biological need, critical for sustaining the mental abilities needed for success on the
battlefield. Soldiers require 7 to 8 hours of good quality sleep every 24-hour period to sustain operational
readiness. Soldiers who lose sleep will accumulate a sleep debt over time that will seriously impair their
performance. The only way to pay off this debt is by obtaining the needed sleep. The demanding nature of
military operations often creates situations where obtaining sleep may be difficult or even impossible for
more than short periods. While essential for many aspects of operational success, sheer determination or
willpower cannot offset the mounting effects of inadequate sleep. This concept is applicable for all levels
of military operations including basic training and in all operational environments.
4-3. For this reason, sleep should be viewed as being as critical as any logistical item of resupply, like
water, food, fuel, and ammunition. Commanders need to plan proactively for the allocation of adequate
sleep for themselves and their subordinates.
4-4. Individual and unit military effectiveness is dependent upon initiative, motivation, physical strength,
endurance, and the ability to think clearly, accurately, and quickly. The longer a Soldier goes without
sleep, the more his thinking slows and becomes confused, and the more mistakes he will make. Lapses in
attention occur and speed is sacrificed in an effort to maintain accuracy. Degradation in the performance
of continuous work is more rapid than that of intermittent work.
4-5. Tasks such as requesting fire, integrating range cards, establishing positions, and coordinating squad
tactics are more susceptible to sleep loss than well-practiced, routine physical tasks such as loading
magazines and marching. Without sleep, Soldiers can perform the simpler and/or clearer tasks (lifting,
digging, and marching) longer than more complicated tasks requiring problem solving, decisionmaking, or
sustained vigilance. For example, Soldiers may be able to accurately aim their weapon, but not select the
correct target. Leaders should look for erratic or unreliable task performance and declining planning
ability and preventive maintenance not only in subordinates, but also in themselves as indicators of lack of
sleep.
4-6. In addition to declining military performance, leaders can expect changes in mood, motivation, and
initiative as a result of inadequate sleep. Therefore, while there may be no outward signs of sleep
deprivation, Soldiers may still not be functioning optimally.
SLEEPING ENVIRONMENT INFORMATION AND RELATED
FACTORS
4-7. For optimal performance and effectiveness, 7 to 8 hours of good quality sleep per 24 hours is
needed. As daily total sleep time decreases below this optimum, the extent and rate of performance decline
increase.
18 March 2009
FM 6-22.5
4-1
Chapter 4
4-8. Basic sleep scheduling information for planning sleep routines during all activities (predeployment,
deployment, precombat, combat, and postcombat) is provided in Table 4-1. Basic sleep environment
information and other related factors are provided in Table 4-2.
Table 4-1. Basic sleep scheduling factors
Factor
Effect
Timing of sleep period.
• Because of the body’s natural rhythms (called “circadian” rhythms), the
best quality and longest duration sleep is obtained during nighttime hours
(2300-0700).
• These rhythms also make daytime sleep more difficult and less restorative,
even in sleep-deprived Soldiers.
• The ability to fall and stay asleep is impaired when bedtime is shifted
earlier (such as from 2300 to 2100 hours).
• This is why eastward travel across time zones initially produces greater
deficits in alertness and performance than westward travel.
Duration of sleep period.
• IDEAL sleep period equals 7 to 8 hours of continuous and uninterrupted
nighttime sleep each and every night.
• MINIMUM sleep period—there is no minimum sleep period. Anything less
than 7 to 8 hours per 24 hours will result in some level of performance
degradation.
Napping.
• Although it is preferable to get all sleep over one sustained 7 to 8 hour
period, sleep can be divided into two or more shorter periods to help the
Soldier obtain 7 to 8 hours per 24 hours. Example:
0100-0700 hours plus
nap 1300-1500 hours.
• Good nap zones (when sleep onset and maintenance is easiest) occur in
early morning, early afternoon, and nighttime hours.
• Poor nap zones (when sleep initiation and maintenance is difficult) occur in
late morning and early evening hours when the body’s rhythms most
strongly promote alertness.
• Sleep and rest are not the same. While resting may briefly improve the
way the Soldier feels, it does not restore performance the way sleep does.
• There is no such thing as too much sleep—mental performance and
alertness always benefit from sleep.
• Napping and sleeping when off duty are not signs of laziness or weakness.
They are indicative of foresight, planning, and effective human resource
management.
Prioritize sleep need by
• TOP PRIORITY is leaders making decisions critical to mission success and
task.
unit survival. Adequate sleep enhances both the speed and accuracy of
decisionmaking.
• SECOND PRIORITY is Soldiers who have guard duty, who are required to
perform tedious tasks such as monitoring equipment for extended periods,
and those who judge and evaluate information.
• THIRD PRIORITY is Soldiers performing duties involving only physical
work.
Individual differences.
• Most Soldiers need 7 to 8 hours of sleep every 24 hours to maintain
optimal performance.
• Most leaders and Soldiers underestimate their own total daily sleep need
and fail to recognize the effects that chronic sleep loss has on their own
performance.
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FM 6-22.5
18 March 2009
Sleep Deprivation
Table 4-2. Basic sleep environment and related factors
Factor
Effect
Ambient noise.
• A quiet area away from intermittent noises/disruptions is IDEAL.
• Soldiers can use earplugs to block intermittent noises.
• Continuous, monotonic noise (such as a fan or white noise) also can be
helpful to mask other environmental noises.
Ambient light.
• A completely darkened room is IDEAL.
• For Soldiers trying to sleep during daytime hours, darken the sleep area to
the extent possible.
• Sleep mask/eye patches should be used if sleep area cannot be
darkened.
Ambient temperature.
• Even small deviations above or below comfort zone will disrupt sleep.
• Extra clothing/blankets should be used in cold environments.
• Fans in hot environments (fan can double as source of white noise to
mask ambient noise) should be used.
Stimulants (caffeine,
• Caffeine or nicotine use within 4 to 6 hours of a sleep period will disrupt
nicotine).
sleep and effectively reduce sleep duration.
• Soldier may not be aware of these disruptive effects.
Prescription sleep-inducing
• Sleep inducers severely impair Soldiers’ ability to detect and respond to
agents (such as Ambien®,
threats.
Lunesta®, and Restoril®).
• Sleep inducers should not be taken in harsh (for example, excessively
cold) and/or unprotected environments.
• Soldiers should have nonwork time of at least 8 hours after taking a
prescribed sleep inducer.
Things that do not improve
• Foods/diet—no particular type of diet or food improves sleep, but hunger
or increase sleep.
and thirst may disrupt sleep.
• Alcohol induces drowsiness but actually makes sleep worse and reduces
the duration of sleep.
• Sominex®, Nytol®, melatonin, and other over-the-counter sleep aids
induce drowsiness but typically have little effect on sleep duration and
are, therefore, of limited usefulness.
• Relaxation tapes, music, and so forth may help induce drowsiness but
they do not improve sleep.
SECTION II — MAINTAINING PERFORMANCE DURING SUSTAINED
OPERATIONS/CONTINUOUS OPERATIONS
COUNTERMEASURES TO MAINTAIN PERFORMANCE
4-9. Cold air, noise, and physical exercise may momentarily improve a Soldier’s feeling of alertness, but
they do not improve performance.
4-10. The only countermeasures that effectively improve performance during sleep loss are stimulants
(caffeine and prescription stimulants including Dexedrine® and Provigil®).
However, these
countermeasures are only effective in restoring performance for short periods (2 to 3 days) and they do not
restore all aspects of performance to normal levels. Caffeine is just as effective as the prescription
stimulants.
CAFFEINE COUNTERMEASURES
4-11. Pharmacological countermeasures such as caffeine are for short-term use only (2 to 3 days) and do
not replace sleep.
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FM 6-22.5
4-3
Chapter 4
4-12. Caffeine occurs in varying content in a number of drinks, gums, and nonprescription stimulants such
as—
z
12 ounces (oz) caffeinated soda: 40 to 55 milligrams (mg).
z
No-Doz®: 1 tablet: 100 mg.
z
Vivarin®: 1 tablet/caplet: 200 mg.
z
Caffeine gum (StayAlert®): 1 piece: 100 mg.
z
Jolt® cola: 71 mg.
z
Red Bull® Energy Drink (8.3 oz): 80 mg.
Note. Liquids will increase urine output, which may result in interrupted sleep. To avoid this,
caffeine should be ingested in pill, tablet, or other nonliquid forms.
4-13. Sleep loss effects are most severe in the early morning hours (0600—0800). Countermeasures
against sleep loss, such as caffeine, are often required and are very effective during this early morning lull.
4-14. Table 4-3 below summarizes advice on using caffeine to maintain performance when there is no
opportunity for sleep. Clock times provided are approximate and can be adapted to individual
circumstances.
Table 4-3. Using caffeine under various conditions of sleep deprivation
Condition under which
Guidelines for use
caffeine is used
•
200 mg starting at approximately midnight.
Sustained operations (no
sleep).
•
200 mg again at 0400 hours and 0800 hours, if needed.
•
Use during daytime hours only if needed.
•
Repeat for up to 72 hours.
Night shifts with daytime
•
200 mg starting at beginning of nighttime shift.
sleep.
•
200 mg again 4 hours later.
•
Last caffeine dose: no less than 6 hours before sleep (for example, last
dose at 0400 hours if daytime sleep is anticipated to commence at 1000
hours).
•
200 mg upon awakening.
Restricted sleep.
•
200 mg again 4 hours later.
•
Last caffeine dose: no less than 6 hours before sleep.
SLEEP RECOVERY
4-15. Ultimately, the Soldier must be allowed recovery sleep. Following a single, acute (2 to 3 days) total
sleep loss, most Soldiers will usually recover completely if allowed a 12-hour recovery sleep period,
preferably during the night.
4-16. Following chronic, restricted sleep during continuous operations, Soldiers may need several days of
7 to 8 hours nightly sleep to fully recover.
WORK SCHEDULES
4-17. Usual work schedules are 8 hours on/16 hours off. Sixteen hours off allows enough time to attend to
maintenance duties, meals, personal hygiene, and so forth, while still obtaining 7 to 8 hours of sleep.
4-18. To the extent possible, commanders should attempt to consolidate their own and Soldiers’ off-duty
times into a single, long block to allow maximum sleep time. If the usual 8 hours on/16 hours off schedule
is not possible, the next best schedule is 12 hours on/12 hours off. In general, 12 hours on/12 hours off is
4-4
FM 6-22.5
18 March 2009
Sleep Deprivation
superior to 6 hours on/6 hours off, and 8 hours on/16 hours off is superior to 4 hours on/8 hours off. This
is true because time off is consolidated into a single, longer block.
4-19. On/off shifts should total 24 hours. Shifts that result in shorter or longer days (such as 6 hours on/12
hours off—an 18-hour day) will impair the Soldiers alertness and performance.
Night Shift Work
4-20. In general, Soldiers will not adapt completely to night shift work, even if they are on a fixed night
shift.
4-21. To protect Soldiers’ daytime sleep, the commander should not attempt to schedule briefings, meals,
and Soldiers’ routine maintenance duties during the Soldiers’ sleep time.
4-22. Caffeine can be used during the night shift to improve performance.
4-23. Morning daylight exposure in night shift workers coming off shift should be avoided by wearing
sunglasses from sunrise until the Soldier commences daytime sleep.
Time Zone Travel
4-24. Trying to preadapt sleep and performance to a new time zone by changing sleep/wake schedules
ahead of time to fit the new time zone is of little benefit.
4-25. During travel, Soldiers should not be awakened for meals (for example, while in flight to a new
location). This sleep time should be protected.
4-26. After deploying to a new time zone, sleep and performance will not adapt for several days. During
this time, Soldiers might also experience gastrointestinal disturbances and find it difficult to fall asleep and
stay asleep at night.
4-27. When reaching the new time zone, Soldiers should—
z
Immediately conform to the new time zone schedule (for example, for those on day work, sleep
only at night).
z
Avoid daytime naps. Sleeping during the day will make it more difficult to sleep that night and
to adapt to the new time zone.
z
Use caffeine during the day (morning and only through early afternoon) to help maintain
performance and alertness.
z
Stay on a fixed wake-up and lights-out schedule, to the extent possible.
SECTION III — UNDERSTANDING THE EFFECTS AND MISCONCEPTIONS OF
SLEEP LOSS AND SLEEP LOSS ALTERNATIVES
SPECIFIC SLEEP LOSS EFFECTS
4-28. Sleep loss makes the Soldier more susceptible to falling asleep in an environment with little
stimulation (such as guard duty, driving, or monitoring of equipment). This is especially important when
considering tasking sleep-deprived Soldiers for guard duty during evening and early morning shifts.
Leaders should be aware that putting Soldiers on guard duty that are sleep-deprived or in a sleep deficit,
places those Soldiers at high risk of falling asleep while conducting this mission-critical duty.
Commanders should consider the level of their Soldiers’ sleep deprivation when establishing guard duty
rosters. When significant sleep loss exists, leaders should consider altering the length of duty or manning
guard posts with teams of two or more to maximize security efforts.
4-29. Even in high tempo environments, sleep loss directly impairs complex mental operations such as (but
not limited to)—
z
Orientation with friendly and enemy forces (knowledge of the squad’s location).
z
Maintaining camouflage, cover, and concealment.
18 March 2009
FM 6-22.5
4-5
Chapter 4
z
Coordination and information processing
(coordinating firing with other vehicles and
dismounted elements).
z
Combat activity (firing from bounding vehicle, observing the terrain for enemy presence).
z
Force preservation and regrouping (covering disengaging squads and conducting reconnaissance).
z
Command and control activity (directing location repositioning, directing mounted defense, or
assigning fire zones and targets).
4-30. Soldiers suffering from sleep loss can perform routine physical tasks
(for example, loading
magazines and marching) longer than more complex tasks (for example, requesting fire and establishing
positions), but, regardless of the Soldier’s motivation, the performance of even the simplest and most
routine task will eventually be impaired.
4-31. With long-term (weeks, months) chronic sleep restriction, mood, motivation, and initiative decline.
The Soldier may neglect personal hygiene, fall behind on maintaining equipment, be less willing to work
or less interested in work, and show increased irritability or negativity.
4-32. Sleep-deprived commanders and Soldiers are poor judges of their own abilities.
4-33. Sleep loss impairs the ability to quickly make decisions. This is especially true of decisions requiring
ethical judgment. If given enough time to think about their actions, Soldiers will tend to make the same
decision when sleep-deprived that they would make when fully rested. However, when placed in a
situation in which a snap judgment needs to be made, such as deciding to fire on a rapidly approaching
vehicle, sleep deprivation may negatively impact decisionmaking.
DETERMINING SLEEP LOSS IN THE OPERATIONAL ENVIRONMENT
4-34. Sleep can be measured by having Soldiers keep a sleep log, but compliance is likely to be very low
and reliability is poor.
4-35. The best way to evaluate a Soldier’s sleep status is to observe his behavior. Indications of sleep loss
include, but are not limited to, increased errors, irritability, bloodshot eyes, difficulty understanding
information, attention lapses, decreased initiative/motivation, and decreased attention to personal hygiene.
4-36. Sleep loss can be confirmed by asking the obvious question: “When did you sleep last and how long
did you sleep?” or “How much sleep have you had over the last 24 hours?” The commander or leader
should direct this question not only to his Soldiers, but to himself as well.
4-37. Sleep-deprived Soldiers may be impaired despite exhibiting few or no outward signs of performance
problems, especially in high tempo situations. The best way to ensure that Soldiers are getting enough
sleep is for leaders to establish schedules that provide at least 7 to 8 hours of sleep in 24 hours.
COMMON MISCONCEPTIONS ABOUT SLEEP AND SLEEP LOSS
4-38. It is commonly thought that adequate levels of performance can be maintained with only 4 hours of
sleep per 24 hours. In fact, after obtaining 4 hours of sleep per night for 5 to 6 consecutive nights a Soldier
will be as impaired as if he had stayed awake continuously for 24 hours.
4-39. Another misconception is that Soldiers who fall asleep at inappropriate times (for example, while on
duty) do so out of negligence, laziness, or lack of willpower. In fact, this may mean that the Soldier has
not been afforded enough sleep time by his unit leaders.
4-40. It is common for individuals to think that they are less vulnerable to the effects of sleep loss than
their peers either because they just need less sleep or because they are better able to tough it out. In part,
this is because the Soldier who is sleep-deprived loses the self-awareness of how his performance is
impaired.
Objective measures of performance during sleep loss in such persons typically reveal
substantial impairment.
4-41. Some individuals think that they can sleep anywhere and that they are such good sleepers that
external noise and light do not bother them. However, it has been shown that sleep is invariably lighter
and more fragmented (and thus less restorative) in noisy, well-lit environments (like the tactical operations
4-6
FM 6-22.5
18 March 2009
Sleep Deprivation
center). Sleep that is obtained in dark, quiet environments is more efficient (more restorative per minute of
sleep).
4-42. Although it is true that many people habitually obtain 6 hours of sleep or less per night, it is not true
that most of these people only need that amount of sleep. Evidence suggests that those who habitually
sleep longer at night tend to generally perform better and tend to withstand the effects of subsequent sleep
deprivation better than those who habitually obtain less sleep.
SLEEP LOSS ALTERNATIVES
4-43. Ways to overcome performance degradation include—
z
Upon signs of diminished performance, find time for Soldiers to nap, change routines, or rotate
jobs (if cross-trained).
z
Have those Soldiers most affected by sleep loss execute a self-paced task.
z
Have the Soldiers to execute a task as a team, using the buddy system.
z
Do not allow Soldiers to be awakened for meals while in flight to a new location, especially if
the time zone of the destination is several hours different than that of point of departure.
z
Insist that Soldiers empty their bladder before going to bed. Awakening to urinate interrupts
sleep and getting in and out of bed may disturb others and interrupt their sleep.
z
Allocate sleep by priority. Leaders, on whose decisions mission success and unit survival
depend, must get the highest priority and largest allocation of sleep. Second priority is given to
Soldiers that have guard duty and to those whose jobs require them to perform calculations,
make judgments, sustain attention, evaluate information, and perform tasks that require a degree
of precision and alertness.
18 March 2009
FM 6-22.5
4-7
Chapter 5
Potentially Life-Threatening Thoughts and Behaviors
SECTION I — INTRODUCTION AND THREAT OF SUICIDE
INTRODUCTION
5-1. Soldiers and leaders need to know what changes in behavior to look for when addressing Soldiers
who may be suicidal. The junior leader and battle buddy are the closest on the ground to Soldiers and have
the best visibility to what is happening in their daily lives. Soldiers contemplating suicide tend to be
thinking impulsively and are often not in the best position to help themselves. They are looking for a way
to end the pain. The most common risk factors resulting in suicidal behaviors for Soldiers generally are
some type of relationship problem, closely followed by financial, administrative, or legal problems. These
issues are also highly associated with alcohol abuse and compounded by combat and operational stress
issues.
THREAT OF SUICIDE AND POTENTIAL SUICIDE RISK
5-2. Some of the common symptoms Soldiers may experience relating to suicide are: sleep problems,
impulsivity, and not having the ability to sit still or concentrate. Other indicators are feelings of
worthlessness and guilt and feeling trapped. Often those who commit suicide feel as though the deep
emotional pain or depression they experience will never go away. They feel cornered with no way out.
Soldiers in distress may show a range of behaviors as they struggle with the issues in front of them. What
buddies and leaders need to do is recognize behaviors that are different from the Soldier’s normal behavior.
They must be aware when the Soldier begins to act in ways that are uncommon. When behavior is very
different from what his normal behavior is like and it is know that the Soldier is in the middle of one of the
primary risk factors (divorce or financial or legal difficulties) that leaders and buddies may need to act.
Leaders and buddies must recognize the indicators and make every effort to assist.
5-3. Leaders must establish a command climate which acknowledges that Soldiers may become
overwhelmed with the personal issues they struggle with. One of the tenets of Battlemind is earlier
treatment leads to faster recovery. The only way Soldiers will be open to receive help is if the
environment in which they work endorses getting help is okay. Leaders must create a trusting environment
so Soldiers will feel it is okay to ask for help when needed.
5-4. Leaders and battle buddies have to be willing to talk to Soldiers and listen to what they have to say.
They have to send the message that they are interested in hearing about the problems Soldiers are facing
and dealing with each day. It is important to emphasize that seeking help in times of distress displays
courage, strength, responsibility, and good judgment. These are the cornerstones of Battlemind skill
development. Advise Soldiers to seek needed counseling either through the chaplain’s office or BH
services.
5-5. The Army has developed a tool for Soldiers and leaders to use to provide some guidelines on how to
approach a distressed Soldier. The tool is called ACE (which stands for Ask, Care, and Escort) and
outlines how you can provide buddy aid for Soldiers in distress. You should—
z
Ask your buddy how he is doing and whether or not he feels suicidal. It is a myth that talking
about suicide will make someone more suicidal. Actually, asking someone about suicide is
often what is needed most and serves as a starting point for getting your buddy help. Talking
about suicide may be awkward, intimidating, and difficult. Overcoming this requires every
leader to practice and educate subordinates that your Army strength and courage should guide
18 March 2009
FM 6-22.5
5-1
Chapter 5
you. The best way to ask someone if he is suicidal is to do just that. Ask the question: Are you
suicidal? It is that simple.
z
Care for your buddy. Upon recognition that your buddy is feeling suicidal, calmly remove any
weapons or other items which may increase risk. It is extremely important to remain calm, as
your anxiety will have an impact on your ability to calm the Soldier. Remaining calm will also
increase your effectiveness at intervening. Once any weapons or other potentially dangerous
items are removed, be there for the Soldier. Never leave him alone. Remember, we never leave
a fallen comrade and these situations are no different.
z
Escort the Soldier to help and assistance staying at his side. Failure to stay involved can have a
devastating impact on the Soldier and his ability to drive on. Failure to act increases the risk of
the Soldier impulsively acting on his suicidal intent.
5-6. When a Soldier is experiencing problems, the leaders should not hesitate to refer that Soldier to a
chaplain or BH for intervention before it becomes a larger issue. Remember that earlier treatment leads to
faster recovery. Leaders must—
z
Establish a climate where seeking help is not a character flaw but a sign of strength.
z
Know the chaplain and BH providers. Request outreach BH services for your unit as required.
z
Use ACE to assist Soldiers.
For further information refer to Training Aid
(TA)-059-0107, Soldiers’ Redeployment Information
(Trifold) (https://www.us.army.mil/suite/doc/7374750; TA-056-1206, Soldier Combat Stress Reaction: A
Pocket Guide for Spouse and Loved Ones (Trifold) (https://www.us.army.mil/suite/doc/7374749; Staying
Healthy Guide (SHG) 046-0206, Redeployment Health Guide: A Service Member’s Guide to Deployment-
Related Stress Problems (Trifold) (https://www.us.army.mil/suite/doc/7374862; ACE Suicide Intervention
Card (https://www.us.army.mil/suite/doc/11137929; and Suicide Prevention Training Tip Card located at
https://www.us.army.mil/suite/doc/12786310.
SECTION II — THREAT OF VIOLENCE TO OTHERS AND THE RISK OF
UNLAWFUL BEHAVIORS
DANGEROUSNESS TO OTHERS
5-7. Thoughts of impulsive violent acts, to include injury to others, may be stress reactions that can be
expected during intense combat and other military operations. Horrific Soldier and civilian deaths may
lead Soldiers to feel vengeful and perhaps homicidal. Soldiers may verbalize a desire to kill or harm
civilians they believe to be aiding the enemy or their own leaders they hold responsible for the death of
their friends. Vengeful thoughts and premisconduct behaviors may occur in individuals or groups of
individuals within a unit. Poorly trained and undisciplined Soldiers are at highest risk, but highly cohesive
units and those with high esprit de corps are also susceptible during times of extreme combat and
operational stress.
5-8. Early identification of unit and individual risk factors and behaviors that precede misconduct and
preventive measures can minimize the risk of Soldiers committing acts that are not in conformance with the
Law of Land Warfare and the UCMJ. Soldiers and leaders at every level must be able to identify risk
factors and behaviors that may lead to violent and uncontrolled reactions and employ interventions to
prevent misconduct that must be punished.
UNIT RISK FACTORS
5-9. The unit risk factors are higher for unlawful behaviors and may precede violent inhumane acts or
injuries to unit members when—
z
There is an incidence of multiple Soldier and civilian deaths occurring in the same area of
operation and over a short period of time.
z
There is a high operation tempo with little respite between engagements.
z
There is a rapid turnover of unit leaders.
5-2
FM 6-22.5
18 March 2009
Potentially Life-Threatening Thoughts and Behaviors
z
There is a manpower shortage.
z
There is overly and unreasonably restrictive or confusing ROE.
z
There is an enemy that is indistinguishable from innocent civilians.
z
There is a perception of lack of support from higher command.
INDIVIDUAL RISK FACTORS AFFECTING SOLDIERS
5-10. Individual risk factors that may precede violent acts or injury to others not in conformance with the
Law of Land Warfare and the UCMJ include―
z
Poor social support.
z
Home front or unit problems.
z
History of reacting impulsively in past.
z
History of disciplinary actions and UCMJ proceedings.
z
Suffering a combat loss (friend or a team member who was wounded in action or killed in action).
z
Personally witnessing the injury or death or being involved in the medical evacuation of friend/
unit member.
z
Witnessing a particularly gruesome or horrific loss of life.
INDIVIDUAL BEHAVIORS OF SOLDIERS AT RISK
5-11. Individual behaviors that may precede committing acts not in conformance with the Law of Land
Warfare may include―
z
Verbalization of thoughts about―
Anger toward or lack of support from higher command.
Indiscriminate revenge.
z
Appearance and/or behavior changes which may include―
Lax military dress/bearing.
Appearing on edge.
Being subject to angry outbursts.
Taking excessive and/or intentional risks.
Appearing to be depressed and having minimal or no contact with others.
Changes in sleep patterns and appetite.
Pushing the ROE to the maximum extent.
Alcohol use or substance abuse.
5-12. Leaders are not immune to the individual risk factors, individual behaviors, or hostile thoughts.
They must be alert to and address their own thoughts and feelings and how these may be transmitted to
their Soldiers. In addition to self-awareness and early recognition of risk factors and behaviors that might
indicate future misconduct, small-unit leaders and Soldiers of all ranks can intervene to prevent these types
of thoughts from becoming behaviors that escalate to uncontrolled violence. Specific interventions require
leaders to—
z
Know the Soldier and recognize changes in baseline behavior that seem like more than normal
grieving.
z
Remind the Soldier that horrific injury and death occur in combat.
z
Remind each Soldier after engagements that he is an American Soldier and that―
He is here to complete a lawful mission.
He is required by law to behave honorably and because it is the right thing to do.
To do otherwise dishonors him and his fellow Soldiers (both living and dead).
Stepping down to revenge could not only help the enemy to achieve his goals but could
result in disciplinary action be taken against the Soldier involved.
To return home with honor is his final objective.
18 March 2009
FM 6-22.5
5-3
Chapter 5
z
Remind the Soldier that violent thoughts and thinking about harming or killing is a very
common reaction to the sadness and anger that are part of combat, but acting on those impulses
is misconduct that can and will be punished.
z
Ask the Soldier if he is struggling with violent thoughts or when the leaders suspect that the
Soldier may commit acts that are not in conformance with the Law of Land Warfare and the
UCMJ they should—
Never leave the Soldier alone.
Never permit the Soldier to continue to carry a loaded weapon.
Never keep a dangerous situation with a Soldier a secret. Locate help immediately (NCO,
chaplain, combat medic, health care provider, or COSC/BH personnel).
Always inform the chain of command.
5-13. If the Soldier returns to duty—
z
Obtain advice and ongoing assistance from BH or COSC assets.
z
Consider rotation of individual or small unit (squad) to less intense duties for a period of time.
z
Assign the Soldier a battle buddy.
z
Frequently check back with the Soldier and remind him that he can get help as identified above
throughout the mission.
5-4
FM 6-22.5
18 March 2009
Appendix A
Mild Traumatic Brain Injury and Posttraumatic
Stress Disorder
SECTION I — MILD TRAUMATIC BRAIN INJURY (CONCUSSION)
INTRODUCTION
A-1. Mild traumatic brain injury (also referred to as a concussion) and PTSD have become known as the
signature combat injuries associated with current and ongoing WOT operations. In July 2007, the US
Army released to all Army activities
(ALARACT) 153-2007, date/time group 171457Z July 2007
(available at https://www.us.army.mil/suite/doc/8195435 ) directing all Soldiers (Active Duty, USAR, and
Army National Guard) to participate in training on MTBI and PTSD. This chain-teaching program
provided leaders and Soldiers information and resources on MTBIs (concussions) and PCOS.
CONCUSSION
A-2. This section provides information about MTBI, or concussion, and does not address moderate or
severe traumatic brain injury which is more serious. It is important to recognize that the term MTBI means
exactly the same thing as concussion. The term concussion is commonly used by health care providers
because it is more familiar to most people and is less apt to be confused with more serious traumatic brain
injuries. Concussions are different than other forms of traumatic brain injury. Concussions are mild head
injuries that temporarily affect brain functioning.
A-3. Concussions are most accurately diagnosed as soon as possible after the injury event. A concussion
is defined as a blow or jolt to the head that causes a brief loss of consciousness (being knocked out) or a
change in consciousness (such as feeling disoriented or confused), without any visible brain damage.
Concussions can occur during combat or military training, as well as during sports or as a result of an
accident. Concussions can cause temporary gaps in memory and/or symptoms such as headaches,
irritability, fatigue, nausea or vomiting, slurred speech, balance difficulties, dizziness, ringing in the ears,
blurred vision, and attention or concentration problems starting at or near the time of the injury. The
specific symptoms a leader or his Soldier might experience are hard to predict and it is important to get
evaluated by a health care provider as soon as possible after an injury event.
A-4. The brain heals itself rapidly after a concussion. Concussions from sports injuries or accidents are
common and almost everyone who has had a concussion recovers completely within a few hours or days.
There is no evidence that healing from concussions caused by explosions or improvised explosive devices
are any different than healing from concussions caused by sports or other accidents. Full recovery is also
expected if more than one concussion is experienced during a deployment, although this may take longer.
WHEN TO SEEK MEDICAL ADVICE
A-5. All Soldiers should seek medical advice from the nearest local MTF as soon as possible after any
blow to their head in which there may have been a concussion. It is important to seek care as soon as
possible. Sometimes Soldiers think they are fine after a concussion when they have actually suffered a
more severe brain injury that needs immediate treatment. Also, the health care provider will determine
when it is safe for the Soldier to RTD. Usually this is just a few hours to a few days, but it is important to
let the health care provider decide this because hitting the head for a second time before fully healed from a
18 March 2009
FM 6-22.5
A-1
Appendix A
concussion could place the Soldier at risk for a more serious injury. If a Soldier displays signs of
concussion, make sure he is seen by a health care provider right away.
RECOVERY FOLLOWING A CONCUSSION
A-6. Rest is the best way to heal from a concussion. Recovery usually occurs in a few hours or days.
Some over-the-counter and prescription drugs may relieve headache pain or sleep difficulties, but talk to
your health care provider before taking any medications. Acetaminophen is the best initial treatment for
headaches. Do not take aspirin or ibuprofen without speaking to your doctor, because these medications
may contribute to bleeding. In addition, using drugs or alcohol before your brain has recovered can
complicate healing. A summary of recommendations for treating and managing symptoms of a concussion
is presented in Table A-1.
Table A-1. Healing and management of symptoms
Things that can help
Things that can hurt
Let others know when you have had a
Another concussion before the first one has
head injury so that they can also be on
healed.
the lookout for concussion symptoms.
Aspirin and other over-the-counter medications.
Make sure you are evaluated by a health
Caffeine or energy-enhancing products because
care provider as soon as possible after
they may increase symptoms.
a concussion.
Alcohol and drugs that can slow healing of the
Let your health care provider decide when
injury.
it is time to RTD.
Sleeping aids should be avoided unless instructed
Get plenty of rest and sleep.
by a health care provider since these products
can slow thinking and memory.
A-7. Occasionally, symptoms following a concussion persist longer than a few days or weeks. Common
concussion symptoms such as fatigue, headaches, irritability, concentration difficulties, sleep disturbance,
and ringing in the ears are often experienced after combat and can be due to other injuries or medical
problems, as well as PTSD or depression. If these symptoms persist a Soldier should see a health
care provider to discuss his symptoms and treatment options. For more information, go to Web site
http://www.pdhealth.mil.
SECTION II — POSTTRAUMATIC STRESS DISORDER
POSTTRAUMATIC STRESS DISORDER AND POSTCOMBAT AND
OPERATIONAL STRESS
A-8. All Soldiers have reactions after combat. These reactions are normal and usually resolve quickly.
Some Soldiers go on to have more persistent reactions to combat. Posttraumatic stress disorder is a
medical condition that can develop in some Soldiers after experiencing combat or other life-threatening
events. Soldiers need time to transition home from a combat deployment, but if reactions persist then they
may need to get help. See Table A-2 for common symptoms of PTSD.
A-2
FM 6-22.5
18 March 2009
Mild Traumatic Brain Injury and Posttraumatic Stress Disorder
Table A-2. Symptoms that may be experienced from posttraumatic stress disorder
Soldier experiences the event over and over again:
Cannot put it out of his mind no matter how hard he tries.
Has repeated nightmares about the event.
Has a vivid memory of the event, almost like it was happening all over again.
Has a strong reaction when he encounters reminders, such as the smell of diesel fuel.
Soldier avoids people, places, or feelings that remind him of the event:
Works hard to put it out of his mind.
Feels numb and detached.
Avoids people or places that remind him of the event.
Soldier feels keyed up or on edge all the time:
May be startled easily by loud noises.
May be irritable or angry for no apparent reason.
Is always aware of the possibility of threats.
May have trouble relaxing or getting to sleep.
A-9. It is important for Soldiers to get help if PTSD symptoms are interfering with their ability to live
their lives or do their jobs. Most Soldiers do not develop PTSD. It also is important to remember that a
Soldier can experience some PTSD symptoms without having a diagnosis of PTSD and there are many
other reactions to combat for which he may need counseling (for example, relationship problems or
depression). The good news, however, is that PTSD is treatable. Therapy involving talking to a counselor
has proven to be very effective in reducing and even eliminating the symptoms. Medication can also help.
Early treatment leads to the best outcomes. So, when a Soldier, Family member, or a team member thinks
a Soldier has PTSD, they should seek or request help with referring for treatment right away.
A-10. It is important to note that every Soldier will experience some type of PCOS resulting from their
military experience. Postcombat and operational stress describes the range of possible outcomes along a
continuum of common stress reactions to more serious BH problems. Postcombat and operational stress is
not a BH diagnosis, but a term used to describe the effects of combat and operational exposure experienced
by Soldiers performing military duties. Combat can also lead to personal growth such as increased
confidence, spirituality, relationships with others, and/or ability to appreciate what is important in life.
A-11. Soldiers and leaders should seek help if they are having symptoms that are interfering with their
ability to function at home, at work, or while out with others or if their symptoms are leading to dangerous
thoughts or behaviors. Assistance is available through the unit chaplain, the installation department of BH,
social work service, or the Soldier’s primary care physician. Additional information is also available at
anonymous online survey at http://www.militarymentalhealth.org.
For information on MTBI
(concussions), visit the Defense and Veterans Brain Injury Center Web site at http://www.dvbic.org
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FM 6-22.5
A-3
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Appendix B
Behavioral and Personality Disorders
SECTION I — INTRODUCTION AND MEDICAL READINESS
RESPONSIBILITIES
INTRODUCTION
B-1. Serving in the Army requires the physical and mental fitness necessary to plan and execute missions
involving combat, as well as stability and civil support operations. Any health condition that limits the
physical or psychological ability of a Soldier to plan, train, or execute the mission represents a risk to that
individual, the unit, and mission success. Any condition or treatment for that condition that negatively
impacts on the mental status or behavioral capability of an individual must be evaluated to determine the
potential impact both to the individual Soldier and to the mission.
MEDICAL READINESS RESPONSIBILITIES
B-2. Medical readiness is a shared responsibility of commanders, medical personnel, and Soldiers. It is
essential that this triad work seamlessly in an integrated effort to ensure that our Soldiers are ready to fight
and win our nation’s wars while taking all practical measures to minimize the risk of harm to individuals
and to the mission.
BEHAVIORAL HEALTH POLICY GUIDANCE
B-3. Recovery, amelioration of symptoms, and reduction of behavioral impairment are always goals
associated with BH treatment, as psychiatric disorders, including PTSD, are treatable. Diagnosed
conditions that are not amenable or anticipated not amenable to treatment and restoration to full
functioning within one year of onset of treatment should generally be considered unacceptable or
unsuitable for military duty and referred to a medical evaluation board or to the personnel system.
B-4. Early identification and treatment are keys to continuation of or RTD for Soldiers who experience
BH disorders. All Soldiers, both in the active Army and RC, should be actively encouraged to seek
treatment for BH concerns.
B-5. Leaders and health care providers who conduct Army medical readiness assessments for individuals
with psychiatric disorders must consider the following criteria. These criteria should be applied across
each assessment event in the Army medical readiness/deployment life cycle (periodic/recurring health
assessment/physicals for predeployment, deployment, and postdeployment assessments, and normally after
90 to 120 days for a postdeployment health reassessment [PDHRA]). Leaders and health care providers
who monitor the Army medical readiness for individuals must consider that—
z
All conditions that do not meet retention requirements or that render an individual unfit or
unsuitable for duty should be appropriately referred for a medical evaluation board or for
administrative actions as appropriate.
z
Psychotic and bipolar disorders are considered disqualifying factors for deployment.
z
Soldiers with a psychiatric disorder in remission or whose residual symptoms do not impair duty
performance may be considered for deployment duties.
z
Disorders not meeting the threshold for a medical evaluation board should demonstrate a pattern
of stability without significant symptoms for at least 3 months prior to deployment.
18 March 2009
FM 6-22.5
B-1
Appendix B
z
The availability, accessibility, and practicality of a course of treatment or continuation of
treatment in theater should be consistent with practice standards.
z
Soldiers should demonstrate behavioral stability and minimal potential for deterioration or
recurrence of symptoms in a deployed environment, to the extent this can be predicted by
positive strengths, skills, training, motivation, and previous operational experience. This should
be evaluated considering potential environmental demands and individual vulnerabilities.
z
The environmental conditions and mission demands of deployment should be considered: the
impact of sleep deprivation, rotating schedules, fatigue due to longer working hours, and
increased physical challenges (including heat stress) with regard to a given BH condition.
z
The occupational specialty in which the individual will function in a deployed environment
should be considered. However, when deployed, individuals may be called upon to function
outside their military training, as well as outside their initially assigned deployed occupational
specialties. Therefore the primary consideration must be the overall environmental conditions
and overall mission demands of the deployed environment rather than a singular focus on
anticipated occupation-specific demands.
B-6. Behavioral health disorders are most often treated with either a course of psychotherapy,
pharmacotherapy, or a combined therapeutic protocol. Medications prescribed to treat psychiatric
disorders vary in terms of their effects on cognition, judgment, decisionmaking, reaction time,
psychomotor functioning and coordination, and other psychological and physical parameters that are
relevant to functioning effectively in an operational environment. In addition, psychotropic medications
may be prescribed for a variety of conditions that are not assigned a psychiatric diagnosis.
B-7. Caution is warranted in beginning, changing, stopping, and/or continuing psychotropic medication
for deploying and deployed personnel. Across every assessment event in the medical readiness life cycle
and during routine clinical care both in garrison and in deployed settings, use of psychotropic medication
should be evaluated for potential limitations to deployment or continued service in a deployed
environment.
B-8. There are few medications that are inherently disqualifying for deployment for all military
occupational specialties, to all potential operational locations, and at all times during the conduct of
operations. Clinical care proximity, procedures availability, tempo, and demands of operations at the
deployed location, and time during the deployment rotation must be considered when determining use of
psychotropic medications prior to deployment, as well as in the operational environment.
B-9. A psychiatric condition controlled by medication should not automatically limit deployment.
Soldiers with a controlled psychiatric illness can still deploy. The recommendation on deployability rests
with the clinical judgment of the treating physician or other privileged provider, in consultation with the
unit commander. If there are any questions on the safety of psychiatric medication, a psychiatrist should be
consulted.
B-10. Medical readiness follows the Army force generation (ARFORGEN) model which is a structured
progression of increased unit readiness over time resulting in recurring periods of availability of trained,
ready, and cohesive units. This cyclical readiness allows commanders to recognize that not all units have
to be ready for war all the time and units must build their readiness over time. See Chapter 2 for the force
projection processes and FMI 3-35 for definitive information pertaining to ARFORGEN. Psychological
readiness must be assessed at each phase of the force projection process with determinations made
regarding limitations or restrictions for military occupational specialty requirements or deployment
locations. Special consideration must be given to limitations affecting those under the DOD Personnel
Reliability Program (see DODI 5210.42, DODI 5210.65, AR 50-5, and AR 50-6) and specific operational
standards such as for aviation, Army Special Operations Forces, or other high risk occupational categories.
B-11. Medical readiness assessments are conducted for reconstitution operations, train up, and preparation
period of the ARFORGEN process through the annual periodic health assessment, PDHRA, as well as
routine health care visits. These medical readiness assessments may include—
z
Recurring/periodic health assessment for the predeployment, deployment, and PDHRA
processes which are designed to provide a global health assessment that includes assessment for
B-2
FM 6-22.5
18 March 2009
Behavioral and Personality Disorders
BH disorders, BH risks, and physical health conditions that may impact on mental status or
emotional well-being. Any conditions, concerns, symptoms, or prescribed psychotropic
medications identified through these assessment procedures must be documented. Self-reported
symptoms should be clarified through standard clinical procedures by the reviewing health care
provider to determine clinical significance and the need for further evaluation and treatment. If
the health care provider determines that a concern or condition demonstrates a potential negative
impact on performance in an occupational specialty or fitness for military service, the individual
will be referred for further evaluation. If the concern or condition meets retention standards, but
nevertheless represents a potential risk to health or mission execution in a deployed setting, that
limitation should also be referred to the appropriate health care professional for further
evaluation and definitive recommendation. The reason for the referral and the request for
evaluation for deployment limitations should be clearly documented for future follow up.
z
Health care visits for evaluation of potential deployment-limiting conditions which should
include a thorough assessment of the current status and potential long-term status of the
presenting condition and any associated medications or therapeutic procedures. Any limitations,
either temporary or permanent, should be appropriately documented in the Soldiers official
military personnel file. In addition, notations must be documented in the medical record for
future deployment-related reviews.
z
Recurring/periodic health assessment and PDHRA procedures which are designed to both
identify and facilitate access to care for health risks and conditions. The advantage of these
procedures for medical readiness includes the opportunity and available time to identify,
implement, and conclude a treatment protocol for identified conditions and concerns prior to
deployment. All medications and/or other therapeutic procedures implemented for identified
health concerns that create additional changes to the mental or behavioral status of the individual
should be appropriately noted. Most importantly, at the conclusion of the course of treatment, a
termination notation must clearly document either the removal of deployment limitations or the
initiation of permanent duty limitations.
Mobilization
B-12. The Department of Defense (DD) Form 2795 (Pre-Deployment Health Assessment Questionnaire) is
designed to identify health concerns that would preclude deployment or require a brief course of treatment
immediately prior to deployment. The predeployment health assessment includes self-reported information
of health status, medical record review, and a review of the Soldier’s health concerns by a health care
provider. It is the responsibility of the Soldier to report past or current physical or BH conditions or
concerns and associated treatments, including prescribed medications. The assessing health care provider
must review all medical readiness information and documentation to determine disposition. If the
recommended clinical course of action is not clear, a referral is warranted for further medical evaluation
and disposition. Soldiers followed by nonbehavioral health care providers whose condition fails to
improve after 3 months of management, must have BH specialty review or consultation. This is done to
determine deployability limitations and recommendations.
Deployment
B-13. When personnel are diagnosed with a psychiatric disorder in theater, the provider will assess the
patient’s condition, treatment regimen, and risk level. The clinical decision to maintain or evacuate
personnel diagnosed with psychiatric disorders in theater is based upon: the severity of symptoms and/or
medication side effects; the degree of functional impairment resulting from the disorder and/or
medications; the risk of exacerbation if the Soldier were exposed to trauma or severe operational stress; the
estimation of the Soldier’s ability and motivation to psychologically tolerate the rigors of the deployed
environment; and the prognosis for recovery. Soldiers with conditions that are determined to be at
significant risk for performing poorly or relapse in the operational environment or whose condition does
not significantly improve within two weeks of treatment initiation, will be clinically recommended for
return to their home station, in consultation with their commander.
18 March 2009
FM 6-22.5
B-3
Appendix B
Postdeployment
B-14. The Post-Deployment Health Assessment (PDHA), DD Form 2796, is used to document the
assessment. The PDHA is conducted immediately at the end of a deployment to determine any changes in
health status resulting from deployment. Conditions that require immediate treatment will be stabilized at
the point of administration of the PDHA. Other conditions will be referred back to the servicing MTF at
the Soldier’s station of assignment. Currently established medical processing procedures will be followed
for USAR personnel that are subject to release from active duty upon return. Any resultant treatment and
final disposition will be documented clearly in the military health record for future medical records review.
SECTION II — PERSONALITY DISORDERS
BEHAVIORAL HEALTH STATUS
B-15. Commanders must understand the impact BH status may have on unit readiness. Specifically, the
role personality disorders may play in effecting the organization’s ability to engage in military operations.
Personality disorders are BH diagnoses that reflect long-standing maladaptive behavioral patterns that are
unlikely to adapt to the roles of military service. Personality disorders are not the same as personality
traits. All Soldiers will display various personality traits that are prominent aspects of their personality and
are exhibited in a wide range of important social and personal contexts.
B-16. Personality disorders are clinical diagnoses that characterize the following:
z
Inflexible and maladaptive personality traits which are pervasive across a broad-range of
situations.
z
Deviates from expectations of the individual’s culture.
z
Causes significant impairment in social, occupational, or other important areas of functioning or
causes significant subjective distress.
z
Pattern is stable and of long duration (onset traced back to adolescence or early adulthood).
z
Not due to substance use or general medical condition or another mental disorder.
z
Manifested in two areas of the following: cognition, affectivity, interpersonal functioning, or
impulse control.
B-17. It is imperative that leaders document patterns of misconduct or administrative disturbances resulting
from personality-related maladaptive behavior. Specifically, leaders must document patterns of
maladjustment to military life in order to support a diagnosis of personality disorder so that appropriate
administrative considerations can be determined. For information on administrative considerations for
separation of Soldiers that are unsuited for military life, see AR 635-200.
SECTION III — PERSONALITY DISORDERS AND POSTTRAUMATIC STRESS
DISORDER
DOCUMENTING MALADAPTIVE PATTERNS OF BEHAVIOR AND
PERFORMANCE
B-18. As discussed in earlier chapters of this manual, PTSD is a psychiatric illness that can occur
following a traumatic event in which there was a threat of injury or death to the Soldier or someone else.
The nature of military duty can routinely place a Soldier in situations that expose him to significant
traumatic events. If left unresolved, the negative effects of this exposure can result in degraded
performance and functioning with the ultimate result in a diagnosis of PTSD. It is also important for
leaders to understand that Soldiers having significant personality traits or even personality disorders can
also be affected by PTE exposure. Personality disorders and PTSD can coexist; however, they are not the
same thing.
B-4
FM 6-22.5
18 March 2009
Behavioral and Personality Disorders
B-19. In order to determine which takes priority in providing disposition, it is imperative that commanders
have the appropriate collateral information available to determine the best administrative and treatment
actions available to Soldiers and organizations. Without adequate evidence of maladaptive patterns of
behavior related to personality disorders (such as counseling statements or nonjudicial punishment) that
occurred prior to traumatic event exposure, it is difficult to support a personality disorder diagnosis and
subsequent utilization of appropriate administrative considerations available to commanders resulting from
such a diagnosis.
B-20. Commanders must document service-related maladaptive performance throughout all areas of the
ARFORGEN and force projection processes. This documentation may be used to determine the extent
of personality-related adaptive functioning versus reaction to significant traumatic events. Accurate
documentation and assessment will allow for the appropriate disposition channels and treatment avenues
that Soldiers are entitled to and organizations can leverage.
18 March 2009
FM 6-22.5
B-5
Glossary
SECTION I — ACRONYMS AND ABBREVIATIONS
ACE
ask, care, escort
ACS
Army community services
AMEDD
Army Medical Department
AR
Army regulation
ARFORGEN
Army force generation
BCT
brigade combat team
BH
behavioral health
BICEPS
brevity, immediacy, contact, expectancy, proximity, simplicity
BSMC
brigade support medical company
CDE
command-directed evaluation
COSB
combat and operational stress behavior
COSC
combat and operational stress control
COSR
combat and operational stress reaction
DA
Department of the Army
DD
Department of Defense (official forms only)
DOD
Department of Defense
DODD
Department of Defense directive
DODI
Department of Defense instruction
FM
field manual
FMI
field manual interim
FRG
Family readiness group
G-1
Assistant Chief of Staff, Personnel
LLAAD
leader-led after-action debriefing
mg
milligram
MH
mental health
MRE
meal, ready-to-eat
MTBI
mild traumatic brain injury
MTF
medical treatment facility
NCO
noncommissioned officer
OPSEC
operations security
oz
ounce
pam
pamphlet
PCOS
postcombat and operational stress
PDHRA
postdeployment health reassessment
POC
point of contact
PTE
potentially traumatic event
18 March 2009
FM 6-22.5
Glossary-1
Glossary
PTG
posttraumatic growth
PTSD
posttraumatic stress disorder
RC
Reserve Component
ROE
rules of engagement
RTD
return to duty
SOP
standing operating procedure
TA
training aid
TC
training circular
TEM
traumatic event management
UBHNAS
unit behavioral health needs assessment survey
UCMJ
Uniform Code of Military Justice
UMT
unit ministry team
UNA
unit needs assessment
US
United States
USAMEDDC&S
United States Army Medical Department Center and School
USAR
United States Army Reserve
WOT
war on terrorism
SECTION II — TERMS AND DEFINITIONS
Battlemind
The United States Army psychological resiliency program, based on the Soldier’s inner strength
during combat to face fear and adversity with courage. It speaks to resiliency skills that are developed
to survive and represents a range of training modules and tools under the categories of development
cycle, life cycle, and Soldier support.
Battlemind warrior resilience
Basic traumatic event management and peer-support training to all United States Army
Soldier combat medics/health care specialists and other health care professionals,
allowing for the start of social- and peer-support systems within assigned units, basic
traumatic events management, and assistance to the commander in establishing unit
resiliency programs.
BICEPS
A memory aid used for the management of combat and operational stress reaction:
brevity—usually less than 72 hours; immediacy—as soon as symptoms are evident;
contact—chain of command remains directly involved in the Soldier’s recovery and
return to duty; expectancy—casualties will recover; proximity—treatment at or as
near the front as possible; simplicity—use of simple measures, such as rest, food,
hygiene, and reassurance.
combat and operational stress behavior
The behavioral reactions resulting from exposure primarily experienced while
conducting the full spectrum of operations, reflecting the full range of behavior from
adaptation to combat and operational stress reaction.
Glossary-2
FM 6-22.5
18 March 2009
Glossary
combat and operational stress control
Programs developed and actions taken by military leadership to prevent, identify, and
manage adverse combat and operational stress reactions in units; optimize mission
performance; conserve fighting strength; prevent or minimize adverse effects of combat
and operational stress on members’ physical, psychological, intellectual and social
health; and to return the unit or Service member to duty expeditiously. (JP 4-02)
combat and operational stress control unit needs assessment
Global assessment of the unit with consideration of multiple variables that may affect
leadership, performance, morale, and combat effectiveness of the organization.
combat and operational stress reaction
Negative adaptation to high-stress events and potentially traumatic event exposure.
postcombat and operational stress
Long-term stress reactions resulting from military combat and operational exposure.
posttraumatic growth
The increased functioning and positive change after enduring a trauma, which may
include changes in personal strength, spirituality, relationships with others, and/or
ability to appreciate life.
potentially traumatic event
An event that causes individuals or groups to experience intense feelings of terror,
horror, helplessness, and/or hopelessness. It is an event that is perceived and
experienced as a threat to one’s safety or to the stability of one’s world.
six Rs
Actions used for combat and operational stress control: reassure of normality; rest
(respite from combat or break from work); replenish bodily needs (thermal comfort,
water, food, hygiene, sleep); restore confidence with purposeful activities and contact
with unit; return to duty and reunite Soldier with his unit; and remind Soldier that he
behaves honorably because it is the right thing to do; that harming or killing
noncombatants dishonors him and his fellow Soldiers; that revenge helps the enemy to
discredit him and his unit; that the ultimate objective is to return home with honor.
Soldier restoration and reconditioning program
An intensive program of replenishment, physical activity, therapy, and military
retraining for combat and operational stress casualties, including alcohol and drug
abuse.
stabilization
The initial short-term management and evaluation of Soldiers exhibiting severely
disturbed behavior caused by an underlying combat and operational stress reaction,
behavioral health disorder, or alcohol and/or drug abuse.
traumatic event management unit needs assessment
A focused assessment of a potentially traumatizing event, with specific consideration of
the potential disruption or dysfunction that the event may have caused to an individual
or the entire organization.
18 March 2009
FM 6-22.5
Glossary-3
References
SOURCES USED
These are the sources quoted or paraphrased in this publication.
UNITED STATES CODE
This document is available online at: http://www.ucmj.us
Title 10, Subtitle A, Part II, Chapter 47, Uniform Code of Military Justice, Sections 801 through 940
DEPARTMENT OF DEFENSE DIRECTIVES
These documents are available online at: http://www.dtic.mil/whs/directives/corres/dir.html
DODD 6490.1, Mental Health Evaluations of Members of the Armed Forces, 1 October 1997 (Certified
Current as of 24 November 2003)
DODD 6490.02E, Comprehensive Health Surveillance, 21 October 2004 (Certified Current as of 23
April 2007)
DODD 6490.5, Combat Stress Control (CSC) Programs, 23 February 1999 (Certified Current as of 24
November 2003)
DEPARTMENT OF DEFENSE INSTRUCTIONS
These documents are available online at: https://www.dtic.mil/whs/directives/corres/ins1.html
DODI 5210.42, Nuclear Weapons Personnel Reliability Program (PRP), 16 October 2006
DODI 5210.65, Minimum Security Standards for Safeguarding Chemical Agents, 12 March 2007
DODI 6490.03, Deployment Health, 11 August 2006
DODI 6490.4, Requirements for Mental Health Evaluations of Members of the Armed Forces, 28
August 1997
MULTISERVICE PUBLICATION
This publication is available online at: http://www.usapa.army.mil
FM 21-10/MCRP 4-11.1D, Field Hygiene and Sanitation, 21 June 2000
ARMY PUBLICATIONS
These publications are available online at: http://www.usapa.army.mil , except where otherwise noted.
ALARACT 153-2007, Interim Guidance-Army Mild Traumatic Brain Injury (MTBI)/Post Traumatic
Stress Disorder (PTSD) Awareness and Response Program, DTG: 171457Z Jul 07 (Available at:
AR 30-22, The Army Food Program, 10 May 2005
AR 50-5, Nuclear Surety, 1 August 2000
AR 50-6, Nuclear and Chemical Weapons and Materiel Chemical Surety, 28 July 2008
AR 600-20, Army Command Policy, 18 April 2008
AR 635-200, Active Duty Enlisted Administrative Separations, 6 June 2005
DA Pam 30-22, Operating Procedures for the Army Food Program, 6 February 2007
FM 1-05 (FM 16-1), Religious Support, 18 April 2003
FM 3-90.6 (FM 3-21.31, FM 3-90.3, FM 7-30, and FMI 3-90.6), The Brigade Combat Team, 4 August
2006
FM 4-02, Force Health Protection in a Global Environment, 13 February 2003
18 March 2009
FM 6-22.5
References-1
References
FM 4-02.12, Health Service Support in Corps and Echelons Above Corps, 2 February 2004
FM 4-02.51, Combat and Operational Stress Control, 6 July 2006
FM 90-5, Jungle Operations, 16 August 1982
FMI 3-35 (FM 100-17, FM 100-17-3, FM 100-17-5, and FM 3-35.4), Army Deployment and
Redeployment, 15 June 2007 (Change 1, 15 January 2009)
TC 25-20, A Leader’s Guide to After-Action Reviews, 30 September 1993
DOCUMENTS NEEDED
These documents must be available to the intended users of this publication.
DEPARTMENT OF DEFENSE FORMS
These forms are available online at: http://www.usapa.army.mil
DD Form 2795, Pre-Deployment Health Assessment Questionnaire
DD Form 2796, Post-Deployment Health Assessment (PDHA)
UNITED STATES ARMY CENTER FOR HEALTH PROMOTION AND PREVENTIVE MEDICINE
(USACHPPM) TRAINING GUIDE (TG)
This publication is available online at: http://chppm-www.apgea.army.mil/tg.htm.
USACHPPM TG 320, Guide to Coping with Deployment and Combat Stress, February 2008
RECOMMENDED READINGS
These sources contain relevant supplemental information.
ARMY PUBLICATIONS
These publications are available online at: http://www.usapa.army.mil
FM 6-0, Mission Command: Command and Control of Army Forces, 11 August 2003
FM 6-22, Army Leadership, 12 October 2006
FM 27-10, The Law of Land Warfare, 18 July 1956 (Reprinted with basic including Change 1, 15 July
1976)
DEPARTMENT OF DEFENSE AND ARMY WEB SITES
Center for the Study of Traumatic Stress, Uniformed Services University of Health Sciences, Department of
Psychiatry
and Leadership Stress Management
Defense and Veterans Brain Injury Center, Home of the Defense and Veterans Head Injury Program
(http://www.dvbic.org) and Education: Understanding Traumatic Brain Injury
Deputy Chief of Staff, Army G-1, Deployment Cycle Support Process-(DCS)
Mental Health Self-Assessment Program (Anonymous online Survey)
References-2
FM 6-22.5
18 March 2009
References
My HOOAH4Health, Family Matters
matters/default.htm)
My HOOAH4Health, Army Guidance and Direction on Sleeping, Sleep in Operations
(SIO)
United States Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder
GRAPHIC TRAINING AID (GTA)
GTA 12-01-001, Army Suicide Prevention Program, 15 January 2007
OTHER REFERENCES
World Health Organization (WHO)/SDE/OEH/99.11, International Statistical Classification of Diseases
and Related Health Problems (ICD-10) in Occupational Health
(This document is available online at:
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition—Text Revision
(DSMIV-TR)
(Information on this manual available online at:
UNITED STATES ARMY CENTER FOR HEALTH PROMOTION AND PREVENTIVE MEDICINE
(USACHPPM) TRAINING AIDS (TA)
TA-059-0107 (Tri-fold), Soldiers’ Redeployment Information, January 2007
TA-060-0107 (Tri-fold), A Leader's Guide to Suicide Prevention, January 2007
TA-074-0507, Suicide Prevention Training Tip Card
TA-075-0507, Suicide Prevention: Warning Signs and Risk Factors
TA-056-1206 (Tri-fold), Soldier Combat Stress Reaction: A Pocket Guide for Spouse and Loved Ones
TA-095-0605, ACE Suicide Intervention Card
Staying Healthy Guide (SHG) 046-0206 (Tri-fold), Redeployment Health Guide: A Service Member’s
Guide to Deployment-Related Stress Problems
18 March 2009
FM 6-22.5
References-3
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