U.S. soldiers are battling stress on two fronts: at war and at home. Their coping strategies might help you on the home front as well.
At lunch in a hotel in Philadelphia, a fast-talking, slightly rattled, 38-year-old master sergeant in camouflage and combat boots is recalling another lunch a few years back, in Iraq. That meal took place at a forward operating base, and he'd been standing 20 feet away from where an Iraqi soldier triggered the detonator on a vest loaded with explosives. Shrapnel ripped through everything in its path, and the blast flung the sergeant back into tables and chairs. He came to, dazed but alive, amid a scene of blood and chaos. "I was saved by a coffee urn that had just been filled, between me and the bomber," he recalls. "Guys on either side of me were torn to pieces." Twenty-two people died, some while he was performing CPR on them. He spent a month recuperating from a shrapnel wound and then returned to his unit. A few months later, a car bomber hit his armored vehicle; he spent the next 5 months in bed with a broken back. "It took a few years to get over the bad dreams," he says. "I was worried that if I told the army I had mental-health issues, I would lose my security clearance."
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The sergeant ended up with post-traumatic stress disorder (PTSD), a jittery witness to the way the U.S. Army's own leadership says it has mishandled trauma in the past. Now he is in Philadelphia to help as the army tries to remake itself, at a training session focused on teaching soldiers how to cope with their emotions--on the field of combat and back at home.
The basic idea behind "resilience training" is that you can train your mind to become mentally and emotionally fit the same way you train your body to become physically fit. And as with marathon training, it has to happen before you really need it, or in military lingo, "left of the boom." Bad things may still happen, from broken relationships to rocket-propelled grenades. But with the right training, the program's proponents argue, you'll respond better in the moment. Instead of PTSD, they contend, you can come out the other side with "post-traumatic growth."
The initiative is being deployed on the fly, at a cost of $125 million over 5 years, in response to record rates of depression, domestic strife, and suicide in a military worn down by 9 years of warfare. Col. Darryl Williams, the 49-year-old artillery officer organizing the program, is frank about its practical benefits for army brass. When they're grilled by Congress about the mental fitness of combat forces, he says, "they will use this. This is the only thing they have left of the boom to inoculate soldiers."
Reaching everyone who needs that inoculation will be difficult. The U.S. Army is simply too big to quickly reach everyone who needs the training. Also, the military has always prided itself on physical, tactical, and technological training; emotions have generally been viewed as excess baggage. Thinking was mostly something officers did. Now the army wants soldiers not just to think, but also to think about how they think.
In a conference room at the hotel, Karen Reivich, Ph.D., a University of Pennsylvania psychologist in flared pants and patent-leather flats, is teaching soldiers how to thrive in a hostile world, both downrange in the war zone and back home at the dinner table. The soldiers in her audience have seen more than their share of bad stuff, including multiple deployments, suicide bombings, and friends maimed or killed at close range. Many of them are now drill sergeants, those kindly guys at boot camp who use the nostrils of terrified recruits as echo chambers. Reivich is just trying to convince them to do it all more thoughtfully.
She tells them a story about the night she flipped out over a coffee coaster. The audience members have families too, so if there's a disconnect between problems with coffee coasters and, say, improvised explosive devices (IEDs), that doesn't seem to faze them. It's 17 years ago, the morning after her future husband moved into her apartment. Thinking he's scoring points, he has gotten up first to make coffee. But as Reivich wanders into the living room, her bleary eyes pop halfway out of her head in horror: He has set his coffee cup down not on the coaster but beside it. Coasters are sacred for her, and he knows it. So how hard can it be to use one? She winds herself up into such a coaster-compulsive snit that she blows down the door and flies out into the street in a vortex of righteous indignation.
So, um, what just happened here? And why should the U.S. Army, fighting two wars with roughly 154,000 soldiers deployed, actually care? The offense was nothing to get crazy about, Reivich admits. A little vexed, maybe. But the story has become her favorite tool for teaching people how to listen to family members, fellow soldiers, and friends. We all have what she calls "icebergs"--deeply held beliefs that now and then cause us to react out of proportion to circumstances. The trick is to find out what lies beneath.
Reivich gives her soldier-students four techniques that can help reveal a person's iceberg. First, she says, ask open-ended questions that require more than yes/no answers. Second, use the word "what," not "why." ("'What' questions make you stop and think," she says. "'What' brings out facts and events.") Then repeat the answers verbatim. ("You want the other person to hear his or her own thoughts, not your rendition.") Finally, keep asking questions until you arrive at an iceberg that's big enough to explain the overreaction.
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Reivich's iceberg, it turned out, was a belief that her future husband should know her quirks and accommodate them. It was about the relationship, not the coaster. Someone in the audience asks if her husband now uses coasters, 17 years on. "No," she says, beaming. "And neither do I."
What Reivich is teaching is a variation on positive psychology, a popular but controversial movement. Instead of just treating mental illness, as traditional psychology has generally done, positive psychology aims to make average people's lives better--and maybe help them avoid mental illness in the first place--by teaching them ways to improve relationships, cultivate character strengths, and think about the world more effectively. Positive-psychology programs are now common in the corporate world and at colleges, where "Happiness 101" often ranks among the most popular courses.
The controversy comes from critics who wonder if programs intended for corporate team-building and self-improvement can also work in the pressure cooker of a wartime army. But army psychologists say their preliminary test results show that resilience training can help. In a recent study, they trained soldiers in a single 8-hour session on what to expect and how to handle their return from deployment--for instance, how to separate from the "battle buddy" dynamic of the war zone and assimilate back into their own families. Among soldiers with heavy combat exposure, only 12 percent (versus the usual 21 percent) experienced mental-health problems in the following 4 months.
Reivich adds that resilience training is not a happiness program, nor is it about turning everything into good news. "These are critical-thinking skills," she says. "This is about problem solving." And listening to the soldiers talk between sessions, you have to hope she is right.
The chatter is less about combat--they say they have a mission and that they know how to carry it out--and more about relationships. A sergeant wonders how he could have applied some of the resilience lessons to deal with one of his young soldiers who was struggling downrange. "If I'd had the tools, I would have been able to see what his icebergs were. I probably would've pulled him aside and talked to him more, would've seen the withdrawal, would've seen a lot more of the warning signs. I would've put it in perspective." Instead, the soldier "leaned on his M16. He killed himself."
This is the first time in history that soldiers can phone home from the war zone almost daily if they want to. But doing that can often make problems worse, because they know what's going on back home and have so little influence over those events.
A staff sergeant says his wife of 14 years "sometimes just couldn't give a shit about what I say." So he's already trying one of Reivich's techniques on her. When he phones home after the first day of resilience training, his wife tells him she's just had somebody in to fix the broken leg on their couch. He'd normally respond, "Oh, great. What's that gonna cost me?" This is what Reivich calls "active-destructive responding." Or maybe he'd change the subject (passive-destructive) or just say, "That's nice" (passive-constructive). But this time he opts instead for the full-on activeconstructive: "Hey, that's great, honey. How'd you feel about that?" And the conversation immediately goes better--less barking, more wagging.
Encouraging people to relive their little victories helps them open up, says Reivich. In truth, the chatter during breaks suggests that every cellphone in the hotel has been channeling Reivich during the nightly phone calls home, with generally good results. One soldier says his bewildered kid asked, "Is this you, Dad?"
The big question--the "bottom line up front," or BLUF, in army jargon--is whether such lessons will have the staying power and strength to help soldiers deal with the big stuff. With Reivich, a slender, attractive, almost birdlike woman, the soldiers are deferential. But when one of the army's own trainers starts off by asking the soldiers what they did to relieve stress before joining up, voices call out "weed" and "I used to break into peoples' houses." The hapless trainer asks, "Did anybody do anything legal?" to which a soldier earnestly replies, "I used to have sex before I went into the army." And these aren't ordinary bottom-of-the-ladder grunts. They're the frontline managers the army is counting on to relay resilience training to the soldiers they lead.
Still, it's a surprisingly idealistic crowd. One standard resilience exercise is to take an inventory of character strengths. It's a way the soldiers can recognize what they do well, so they can build on their own strengths and those of the people around them. (Find the VIA Survey of Character Strengths at www.authentichappiness.sas.upenn.edu.) When this audience puts up its results, no one's surprised that it ranks dead last in the "caution, prudence, discretion" category. But traits such as honesty, gratitude, and fairness top their lists. They also rank surprisingly high in "capacity to love and be loved."
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On the other hand, all but a dozen of the 180 or so people in the room test poorly on social intelligence. These are guys from broken homes, with troubled pasts--just plain guys, if you accept the gender stereotype--with lots of emotions and no clue about how to process them. They spend their working lives in a "make it happen" culture, often deploying "targeted aggression" in combat and making split-second decisions that can be lethal. Then they come home from work and can't do things differently. It's the male condition, but with M16s thrown in.
So Reivich has them break down scenes from domestic life, much as soldiers in boot camp learn to break down their weapons and name the parts: Here's the activating event, here's the thought it produces, and here's the consequence. In a video, a father just back from war invites his teenage son to play some hoops. "Maybe later," the kid says, without even looking up from his video game. "That's the activating event," says Reivich. Dad sulks off to watch television and drink beer, thinking, He doesn't love me anymore or My brother took my place while I was gone. And the thought leads to the consequence: When the kid comes in to say, "Okay, I'm ready for a game now," the father retaliates. "Go ask your uncle instead," he says.
"Make sure your activating event doesn't include, 'He doesn't love me' or 'He wishes I were still deployed,' " says Reivich. "You need to help people separate out what they felt" from what actually happened. "They tend to be blended." Separating things out opens up space to think about other possibilities and better outcomes: "I've been gone for 15 months; I need to win him back a little." So maybe the father grabs the moment when the kid is finally ready.
Slowing down is also a chance to sidestep what the resilience trainers call "thinking traps"--mental habits that lead a man to resign himself to a problem instead of resolving it. "Let's say it's the first few weeks of boot camp," a trainer suggests. "You're late for formation, and now your squad is down on the ground pushing South Carolina into Georgia. You know you're the cause. What are your thoughts?" In the thinking trap called "mind reading," you figure, They're all gonna hate me. In "jumping to conclusions," you think I'm not going to make it through basic combat training. Instead, you need to restructure your thoughts: "I'm going to learn from this situation and not make the same mistake twice."
When Reivich is running a session, she tends to underscore her points with inspirational stories and even a quotation from Winnie the Pooh.
The army's own trainers, on the other hand, sugarcoat nothing. "Someone you've been downrange with for 9 months just got hit. Right here," the trainer says, meaning that you're now wearing his blood. "What are some of the emotions you might feel?" The audience calls out "anger" and "anxiety." ("Right. Am I going to be next?") Then, from experience, someone adds, "Happy. Happy that it wasn't me." ("Some soldiers feel guilty about that for the rest of their lives. It's normal.") Or maybe you're a medic working hard on a casualty, but the patient dies anyway. "You say, 'What did I do wrong?' You didn't do anything wrong. Casualties sometimes die. If we don't train 'em on that, we're not doing our job."
Then the trainer rattles off a list of things their soldiers may be thinking on deployment in Iraq or Afghanistan: "I'm wasting my life here. They should be fighting for themselves. They don't want us here. There doesn't seem to be a point to this. The sacrifices I'm making are not worth it. No progress is being made here." And the big one: "I'm tired of this shit." It doesn't sound like positive psychology, or even like resilience training. But he's driving toward two or three basic lessons: If you know to expect these thoughts, if you know that they're normal, then you can avoid getting stuck on them. You put it in perspective, and focus on the little things you can actually control.
Will that kind of perspective make soldiers healthier? Will it change the current dire statistics on mental problems? The army brass hopes to avoid having the program judged on factors like the suicide rate. "We're not saying these specific things have to go down for this to be successful," says Colonel Williams. He likens resilience training to physical training, in which the aim is simply to build stronger soldiers--and bloodpressure levels improve as a by-product.
The lesson the army wants to drive home is that going out and doing a difficult, dangerous job can make you stronger, that post-traumatic growth is possible. Or as one of the trainers puts it, "We're not going to be talking about deployment as a negative, or about how you're going to be screwed up for a long time. Resilience training takes a positive approach: 'Here are some of the things you may encounter, here's how you handle them, and here's how you'll grow from the experience.' "
Nobody delivers this message more effectively than Brig. Gen. Rhonda Cornum, M.D., a slight, blue-eyed army surgeon with a rattat- tat manner. When she asks who's run a half marathon, dozens raise their hands. She reminds them that they trained for weeks or months to prepare for the race, "and if you're willing to do that for your legs and your lungs, why not do it for your head, too?"
Then she tells her story, about going "wopping off" in a helicopter to rescue a downed pilot during the first Iraq war, taking heavy fire while flying 140 miles an hour at the height of this room, and knowing in that instant that she was going to die. (But being a perennial optimist, she was comforted knowing that at least she'd die honorably.)
The chopper flipped and landed upside down, killing most of the crew. General Cornum woke up with "two busted arms and a busted leg," in enemy territory. "Even being a POW didn't seem like such a bad deal," she says. "That's cognitive reframing. I wasn't dead." Her captors sexually molested her. While imprisoned in Baghdad, she distracted herself by singing every opera and musical tune she could think of. "Having a plan not to dwell or ruminate on misery is a good thing." Eventually she was rescued, and now she looks out for the mental and physical well-being of the entire U.S. Army.
Even for men half her age and twice her size, General Cornum sets the bar mighty high. It must seem particularly high for a soldier who's working on his second or third deployment, watching his kids grow up on video, and wondering whether some other guy back home is, as they put it gingerly, parking in his space. But General Cornum makes the case that post-traumatic growth of the kind she experienced isn't "just about your genetic background, or your neonatal health, or where your grandparents grew up, and all that kind of crap. Like physical fitness, it's about what you put into it."
A little later in the hotel conference room, Reivich is leading yet another exercise. She asks her audience to write down words that suggest what a soldier needs to become resilient. Most call out predictable stuff like strength and confidence. But after a moment, from the middle of the crowd, one soldier says, "Peace." Heads turn. Then in the awkward silence, reality sets in, and the soldier recalibrates his thinking.
"Peace of mind," he offers.
source: Military.com
writer- members of military.com
