Grief, Bereavement and Self Care Module 2012 Slide Reference Guide Slide 1

___________________________________ ___________________________________ Department of the Army Casualty and Mortuary Affairs Operations Center

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Grief, Bereavement and Self Care

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Assisting Survivors and Yourself

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Slide 2

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Terminal Learning Objective

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• Action: – Observe grief, bereavement and self care.

• Condition:

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– In a training environment, given instruction, practical exercises and applicable references.

• Standard:

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– Observe grief, bereavement and self care by recognizing normal grief responses; naming the Stages of Grief and Extended Grief Cycle Theory; supporting individuals recovering from loss; recognizing the importance of self care; and applying personal resiliency principles and self care resources. Grief, Bereavement and Self Care

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Slide 3

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References (1 of 2)

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• AR 600-20, Army Command Policy,18 March 2008 • DA PAM 600-24, Health Promotion, Risk Reduction, and Suicide Prevention, RAR 7 September 2010 • DoDI 1300-18 incorporating Change 1, 14 Aug 2009 • FM 4-02.51 (FM 8-51), Combat and Operational Stress Control, July 2006

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Grief, Bereavement and Self Care Module 2012 Slide Reference Guide Slide 4

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References (2 of 2)

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• Military Widow: A Survival Guide, Steen, J. M., and Asaro, R.M., 2006 • On Death and Dying, Kubler-Ross, E., 1969 • When Children Grieve, James, W.J. , and Friedman, R., 2001 • Comprehensive Soldier Fitness Program • Authentic Happiness located at http://www.authentichappiness.sas.upenn.edu • Resilience Training located at http://www.resilience.army.mil Grief, Bereavement and Self Care

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Slide 5

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Setting the Stage

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Slide 6

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Grief

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• Normal physical, emotional, intellectual, and spiritual response to the actual or threatened loss of a person, thing or place to which we are emotionally attached • Includes the conflicting feelings caused by a change or an end to a familiar pattern of behavior

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Grief, Bereavement and Self Care Module 2012 Slide Reference Guide Slide 7

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Bereavement

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• Period of grief and mourning after a death • Part of the normal process of reacting to a loss • Length can depend on how close the grieving Survivor was to the person who died, if the death was expected, and other factors • Two dimensions:

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– Actual loss – Symbolic loss

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Slide 8

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Self Care

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• Personal health maintenance • Any activity of an individual, Family or community, that can improve or restore health, or treat or prevent disease • CNOs/CAOs/Chaplains supporting the Army Casualty Program need to be aware of the potential for personal stress and “burnout”

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Slide 9

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Importance of CNO/CAO Role • • • •

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Calm, reassuring authority Restoration of control Preparation and prediction Ongoing commitment from the Army

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Grief, Bereavement and Self Care Module 2012 Slide Reference Guide Slide 10

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Grief Responses • Cognitive – – – – – – – –

Helplessness Sadness Anxiety Disbelief Apathy Poor concentration Numbness Irritability

Grief, Bereavement and Self Care

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• Behavioral – Difficulty sleeping or sleeping more than usual – Nightmares – Change in appetite – Social withdrawal – Dreams of the deceased – Elevated blood pressure 21 Sep 2012

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Slide 11

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Children’s Grief Responses • • • • •

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Aggressive and/or regressive behavior Guilt and self-reproach Irritability Physical symptoms Difficulties at school

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Slide 12

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Stages of Grief

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• Cycle of emotional states that serves as a common framework for guiding our understanding of how Survivors cope with grief • Not necessarily linear in nature, may occur in any order, and may not be experienced by everyone • Kubler-Ross’ model was refined further to include additional stages Grief, Bereavement and Self Care

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Grief, Bereavement and Self Care Module 2012 Slide Reference Guide Slide 13

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Extended Kubler-Ross Grief Cycle • • • • • • •

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Shock Denial Anger Bargaining Depression Testing Acceptance

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Slide 14

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Shock

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• Typical first reaction • Initially may exhibit no reaction at all • Physical reactions such as paling of the skin and shortness of breath may occur • CNO/CAO actions:

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– Ask the Survivor to sit – Offer a drink of water – Call a friend or relative to stay with the grieving Survivor

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Slide 15

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Denial

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• May continue to live their lives as though nothing has happened • CNO/CAO actions:

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– Tell the CAC staff intervention may be necessary – A professional counselor may:

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• Deliberately and sympathetically provoke to anger through an honest discussion about their future without their loved one • More than likely, individuals will become angry when confronted with the future they cannot avoid or deny

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Grief, Bereavement and Self Care Module 2012 Slide Reference Guide Slide 16

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Anger

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• May occur in an explosion of emotion • CNO/CAO actions:

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– Best response is to give the Survivor “space” and allow them to express their anger – If destructive, remind grieving Survivors of inappropriate behaviors – Attempt to reframe anger into more productive directions

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Slide 17

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Bargaining

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• Is an expression of hope that the “bad news” is reversible, even though in reality, it is not • CNO/CAO actions:

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– Do not offer false hopes to Survivors in the bargaining stage – Offer support for change or new opportunities for healing

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Slide 18

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Depression

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• Slow down considerably and slump into a state of depression • CNO/CAO actions:

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– First response – “be there” for the individual – Tell the CAC staff intervention may be necessary – A professional counselor may:

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• Keep the individual moving forward • Provide a steady stream of support

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– Professional coaching, counseling, and other support can help people recognize their depression and find ways to heal

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Grief, Bereavement and Self Care Module 2012 Slide Reference Guide Slide 19

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Testing

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• See a “light at the end of the tunnel” • Experiment with laughter and enjoyment • CNO/CAO actions:

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– Encourage Survivors to look for realistic things they can do, or “experiments” to see if doing these things help – Allow Survivors to control their own healing – Encourage Survivors to develop their own coping solutions Grief, Bereavement and Self Care

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Slide 20

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Acceptance

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• Take ownership again for both themselves and their actions • Happier and more content as they find their way forward • CNO/CAO actions:

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– Congratulate Survivors on getting through difficult life changes – Let Survivors celebrate the completion of their transition Grief, Bereavement and Self Care

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Slide 21

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Practical Exercise One: Gilliam Video

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Grief, Bereavement and Self Care Module 2012 Slide Reference Guide Slide 22

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Preparing for CNO/CAO Role

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• Get it out before you get there • Be prepared for anything • Join the Survivors in their grief without being overwhelmed by it • Let Survivors know you care

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Slide 23

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Common Myths about Grief

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Children grieve like adults. Grief is the same after all types of death. It takes two months to get over your grief. All bereaved people (men, women and children) grieve in same way. • Your grief is resolved, it never comes up again. • You and your Family will be the same after the death of a loved one. • It’s not okay to feel sorry for yourself.

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Slide 24

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Sudden Loss or Traumatic Death • • • • •

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Combat Homicide Accident Suicide Illness

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Grief, Bereavement and Self Care Module 2012 Slide Reference Guide Slide 25

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Helping Others Cope with Loss • Adults – Most effective help you can provide is to simply “be there” for the grieving Family or individual. – Be a good listener.

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• Children – Allow aggressive/ regressive behavior and offer comfort. – Encourage expression of feelings through writing, art, music, sports, etc. – Answer questions truthfully and age appropriately.

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Slide 26

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Loss Impacts • • • • • •

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Part of the Self Loss of Self-Confidence Family Structure Desired Lifestyle Loss of the Future and Dreams Social Changes

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Slide 27

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Practical Exercise Two: Priestner Video

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Grief, Bereavement and Self Care Module 2012 Slide Reference Guide Slide 28

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Completing/Continuing CNO/CAO Role

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• Let it out after you leave • Take care of yourself

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Slide 29

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Self Care: Introductory Video

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Slide 30

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Self Care (1 of 2)

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• Self care is personal health maintenance: – Focus on things in your life you can control. – Personal life, family, and health situations can unexpectedly change, contributing to additional burdens and stress. – Care is available at every level for all personnel.

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Grief, Bereavement and Self Care Module 2012 Slide Reference Guide Slide 31

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Self Care (2 of 2)

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• Dealing with Survivors is difficult. • Don’t feel that you have to “fix” their problems. • Do feel empathy and concern. • Don’t “cross the line” – you are important, too.

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Slide 32

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Resilience

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• Resilience is one form of self care. • Resilience: – – – –

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Is an ongoing process Requires time and effort Involves multiple, deliberate steps Can be learned and developed in anyone

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Slide 33

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Resilience Factors

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• The capacity to make realistic plans and take steps to carry them out. • A positive view of yourself and confidence in your strengths and abilities. • Skills in communication and problem solving. • The capacity to manage strong feelings and impulses. • Developing a personal strategy.

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Grief, Bereavement and Self Care Module 2012 Slide Reference Guide Slide 34

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Building Resiliency • • • • • • • • • •

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Make connections. Avoid seeing crises as insurmountable problems. Accept that change is part of living. Move toward your goals. Take decisive actions. Look for opportunities for self-discovery. Nurture a positive view of yourself. Keep things in perspective. Maintain a hopeful outlook. Take care of yourself.

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Slide 35

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Building Resiliency: Stay Flexible • Let yourself experience strong emotions. • Step forward and take action to deal with problems and meet the demands of daily living. • Spend time with loved ones. • Rely on others. • Nurture yourself.

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• Realize when you need to avoid strong emotions to continue functioning. • Step back to rest and reenergize yourself. • Spend time alone. • Rely on yourself. • Allow others to nurture you.

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Slide 36

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Building Resiliency: Learn from the Past (1 of 2)

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• What kinds of events have been most stressful for me? • How have those events typically affected me? • Have I found it helpful to think of important people in my life when I am distressed? • To whom have I reached out for support in working through a traumatic or stressful experience?

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Grief, Bereavement and Self Care Module 2012 Slide Reference Guide Slide 37

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Building Resiliency: Learn from the Past (2 of 2)

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• What have I learned about myself and my interactions with others during difficult times? • Has it been helpful for me to assist someone else going through similar experiences? • Have I been able to overcome obstacles? How? • What has helped make me feel more hopeful about the future?

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Slide 38

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Additional Self Care Factors • Self Care Tips – – – – – – – –

Humor Physical fitness Good nutrition Peer support Sleep Music Meditation/Spirituality Volunteer work

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• Self-Awareness – Compassion fatigue • •

Desensitized Overly sensitized

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– Avoid compassion fatigue by: •

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Making time for a significant other or friend to be your sounding board Spending time with your children (if applicable) Having a support system

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Slide 39

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Self Care Resources (1 of 2) • • • • • • • •

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Military or Civilian Clergy Community Self-Help or Support Groups Licensed Mental Health Professionals Tragedy Assistance Program for Survivors (TAPS), www.taps.org, 1-800-959-8277 National Family Caregivers Association (NFCA), www.nfcacare.org, 1-800-896-3650 Army/Military One Source, www.militaryonesource.com, 1- 800-342-9647 Veteran’s Affairs Military Family Life Consultants, www.mhngs.com

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Grief, Bereavement and Self Care Module 2012 Slide Reference Guide Slide 40

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Self Care Resources (2 of 2)

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• National Caregiver Support Line for Family caregivers of veterans who are living with the effects of war, disability, chronic illness, or aging. • Offers emotional support for the caregiver. • Available Monday through Friday from 8:00 a.m. to 11:00 p.m., and Saturday from 10:30 a.m. to 6:00 p.m. Eastern Time. Tollfree number is 855-260-3274. Grief, Bereavement and Self Care

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Slide 41

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Summary

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• Recognize “normal” grief responses in Survivors – both adults and children. • Recognize Kubler-Ross’ five Stages of Grief and the seven-stage Extended Grief Cycle Theory. • Help and support Survivors recovering from loss; make referrals when needed. • Apply self care resources. • Apply personal resiliency principles.

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