AACC Webinar NOVEMBER 13, 2012

Resiliency, Combat Trauma and Military Suicide: Effective Faith-based Interventions Bob Dees Major General, U.S. Army, Retired AACC Military Director 11/13/2012

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WHY THIS SEMINAR? • AACC – committed to our Nation’s Military and their Families • The NEED is great, and worsening.

• COUNSELORS and CAREGIVERS, and COACHES are in great demand – FAITH-based counseling and programs are highly relevant. • A Process of EDUCATION and MOBILIZATION – Across broad range of CAREGIVERS and CONSTITUENCIES WE, TOGETHER, can accelerate the mental, behavioral, emotional, relational, and spiritual health and healing of generations of our Nation’s Warriors and their Families 11/13/2012

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OUR GAME PLAN – PART 1 Current Status – – – –

HONOR TO WHOM HONOR IS DUE MILITARY CULTURE AND CURRENT REALITIES COMBAT TRAUMA SPECTRUM THE NEEDS OF THE HOUR • MENTAL & BEHAVIORAL HEALTH ISSUES • MILITARY SUICIDE DYNAMICS AND DEMOGRAPHICS • MILITARY SUICIDE RISK FACTORS – ONGOING EFFORTS TO ADDRESS • ARMY RESILIENCY EFFORTS – COMPREHENSIVE SOLDIER AND FAMILY FITNESS • MILITARY SUICIDE PREVENTION – Q & A / DISCUSSION 11/13/2012

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HONOR TO WHOM HONOR IS DUE WHERE WOULD WE BE WITHOUT THE VETERANS, THE WARRIORS, OF OUR NATION? WE WOULD NOT BE THE LAND OF THE FREE,THE HOME OF THE BRAVE

WE ARE THE LAND OF THE FREE BECAUSE OF OUR BRAVE PROTECTORS… PAST, PRESENT, AND FUTURE

GRATEFULLY, WE DO NOT HAVE TO ASK THIS QUESTION THEY HAVE ALWAYS BEEN THERE FOR US 11/13/2012

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MILITARY CULTURE AND CURRENT REALITIES • ETHOS OF SERVICE AND SACRIFICE • CURRENTLY OPERATIONAL TEMPO AND GEOPOLITICAL REALITIES

• HOMEFRONT REALITIES • FAITH DEMOGRAPHICS (RELATED TO HOLISTIC APPROACH, INCLUDING FAITH/SPIRITUALITY) – Christian: 68% – No preference (or atheist): 21% – Other/Unknown/No response: 11% – Jewish, Muslim, Buddhist: < 1% 11/13/2012

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Combat Trauma Spectrum Mild

Severe

Mild

Reintegration Issues

Combat/Operational Stress Reactions

Adjustment Disorders

Acute Stress Disorder

Post Traumatic Stress Disorder

 Everyone returning from deployment falls somewhere on this spectrum, regardless if they were in combat or not.  A similar spectrum of secondary trauma exists for spouses and other family members. It generally parallels the severity and duration of the primary sufferer.  Both can be mitigated through faith and hope, as well as Exposure Therapy

Acute Stress Disorder: 4 weeks or less

Cognitive-Behavioral

 Acute PTSD: 1-3 months

Medical

 Chronic PTSD: > 3 month

11/13/2012

 Delayed RFD LLC Onset PTSD: Symptoms start > 6 months

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The Needs of the Hour PTSD/TBI

Suicide

Divorce

Homelessness

Drug/Alcohol Abuse

Lawlessness

Spouse Abuse Failure to Reintegrate 11/13/2012

Isolation

Incarceration

Sexual Assault RFD LLC

Child Abuse 7

Suicide Realities in the Military • The “suicide crisis” (per CJCS) in the US military is a complex challenge, reflecting societal dynamics and the strains of persistent conflict – Reserve component “not on active duty” and veteran suicides are equally alarming. – Suicides among military spouses and family members are likewise rampant, yet not reliably measured.

• Suicide Prevention has become a top priority for senior military leadership, and the stimulus for significant institutional “soul searching,” resource allocation, and program development • Despite a full court press and “doing everything possible,” the statistics continue to degrade • Suicide Causalities are multiple and complex, with most directly or indirectlyRFDconnected with relationships8 11/13/2012 LLC

Suicide Causalities in the Military • ISOLATION ( “Alone”) • Social Isolation & Loneliness • Intense loss • grief feelings caused by the death of a loved one • break-up of a relationship Four • Survivor guilt Significant • STRESS (“Anxious and Angry”) Clusters: • Severe chronic stress ISOLATION • Family, work, financial, legal, or social problems STRESS • Combat Trauma Spectrum, incl PTSD INJURY • Victim or perpetrator of domestic violence DESPAIR • INJURY/ILLNESS/ADDICTION (“ Overwhelmed“) • Alcohol or other substance abuse/self-medicating • Severe depression or physical/mental injury or illness • DESPAIR (“Hopeless”) • Low self-esteem • Inability to craft life alternatives or view different futures 11/13/2012

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ONGOING EFFORTS TO ADDRESS • Departments of Defense and Veterans Affairs (DOD,DVA) – – – –

WORKING IT HARD EXPENDING BILLIONS GROWING EMPIRICAL UNDERPINNINGS LIMITED INTEGRATION OF FAITH-BASED RESOURCES AND PROGRAMs

• Office of the Chairman of the Joint Chiefs of Staff (OJCS) – Sea of Goodwill Initiatives – Warrior and Family Support – Office of Religious Affairs

• U.S. Army (mirrored in various ways by other Services) – Comprehensive Soldier and Family Fitness – Resilience Training – Health Promotion (reduction of suicide, sexual assault, drug abuse, et. al.)

• Private Sector (academic institutions, medical profession, churches, et. al.) 11/13/2012

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DOD Suicide Prevention Approach • The Department of Defense (DOD) has begun to aggressively address the problem of military suicides.

• Defense Secretary Leon Panetta recently unveiled his plan to combat the rising number of suicides, focusing on 4 key “pillars”: 1. Leadership 2. Improving access to and quality of health care. 3. Elevating mental fitness to the same level as physical fitness is in the military/DOD culture 4. Increasing research into suicide prevention

Read more: http://www.foxnews.com/opinion/2012/09/27/plan-tocombat-military-suicide/#ixzz2AjhLQXyQ Significant effort identifying “at risk” personnel… Need greater “upstream” efforts 11/13/2012

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Comprehensive Fitness leading to RESILIENCE U.S. Army - Comprehensive Soldier Fitness A structured, long term assessment and development program to

BUILD THE RESILIENCE and enhance the performance of every Soldier, Family member and DA civilian

Army

• • • • •

Physical Family Social Emotional Spiritual

Judeo Christian

• • • • •

U.S. Army Comprehensive Soldier Fitness (CSF) http://csf.army.mil 11/13/2012

Physical (Strength) Mental (Mind) Social (“Neighbor”) Emotional (Heart) Spiritual (Soul) Holy Bible Great Commandment Mark 12:30,31 RFD LLC

Marines

• • • • •

Physical Mental Social Emotional Spiritual Marine Operational Stress Surveillance and Training(MOSST) 12

RESILIENCE rĭ-zĭl'yəns n. 1. The ability to recover quickly from illness, change, or misfortune; buoyancy. 2. The property of a material that enables it to resume its original shape or position after being bent, stretched, or compressed; elasticity. American Heritage Dictionary Medical Definition: the capability of a strained body to recover its size and shape after deformation caused especially by compressive stress 10.16.12

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U.S. Army Resilience Program SUMMARY • Systemic Training Program – Command priority with significant resources committed – Mandatory Training aimed at saturation of entire force – Challenges with consistent execution of program in high tempo environment

• 5 key elements: Physical, Social, Emotional, Family, and Spiritual • Resilience Content – based upon U/PENN positive psychology model 11/13/2012

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U.S. Army Resilience Skills Skill 1: Activating Events, Thoughts, and Consequences: Identify your thoughts about an activating event and the consequences of those thoughts.

Skill 7: Real-Time Resilience: Shut down counterproductive thinking to enable greater concentration on the task at hand.

Skill 2: Avoid Thinking Traps: Identify and correct counterproductive patterns in thinking through the use of critical questions.

Skill 8: Character Strengths: Identify your top character strengths and those of others and identify ways to use your strengths to increase your effectiveness and strengthen your relationships.

Skill 3: Detect Icebergs: Identify deep beliefs and core values that fuel out-of-proportion emotion and evaluate the accuracy and usefulness of these beliefs. Skill 4: Energy Management: Enhance self-regulation so that you are able to stay calm and concentrated when facing an adversity or challenge. Skill 5: Problem-Solving: Accurately identify what caused the problem and identify solution strategies.

Skill 9: Strengths in Challenges: Identify the specific actions that flow from your strengths in challenges and in successes. Skill 10: Assertive Communication: Communicate clearly and with respect. Use the IDEAL model to communicate in a confident, clear, and controlled manner. Skill 11: Active Constructive Responding and Praise: Respond to others to build strong relationships and offer praise to build mastery and winning streaks.

Skill 6: Put It In Perspective: Stop catastrophic thinking, Skill 12: Hunt the Good Stuff: Hunt the good stuff to counter reduce anxiety, and improve problem-solving by identifying the negativity bias, to create positive emotion, and to the worst, best, and most likely outcomes of a situation. recognize and analyze what is good. 11/13/2012

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Questions & Discussion

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OUR GAME PLAN – PART 2 Faith-Based Resiliency – RELEVANCE OF FAITH-BASED APPROACHES – REALITY OF TRAUMA – RESILIENCE “GOD STYLE” • COMPREHENSIVE PERSONAL FITNESS • RESILIENCE LIFE CYCLE – RESOURCES • Light University Stress and Trauma Care Course • Resilient Warriors • Military Counseling Initiative Website (coming soon) – Q & A / DISCUSSION 11/13/2012

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Troops & Families are “Warriors”

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SUFFERING “IN THE WORLD YOU WILL HAVE TRIBULATION…. Resulting From: SELF OTHERS SPIRITUAL FORCES INEXPLICABLE TRAJEDY

Greek “thlipsis” Latin

squeezing

“tribulum” threshing

This Tribulation results in Trauma, Pain, Suffering, and Opportunity.

BUT BE OF GOOD CHEER, I HAVE OVERCOME THE WORLD.” 11/13/2012

JESUS -- John 16:33(NKJV) RFD LLC

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RESILIENT & READY – “GOD Style” “We are often troubled, but not crushed; sometimes in doubt, but never in despair; there are many enemies, but we are never without a friend; And though badly hurt at times, we are not destroyed.” 2 Corinthians 4:8, 9 11/13/2012

Source: Spiritual Fitness Handbook RFD LLC

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Addressing Suicide Causalities •ISOLATION ( “Alone”)

CARING COMMUNITIES/CHURCHES

•STRESS (“Anxious and Angry”) RELEVANT “TRUTH”

•INJURY (“Overwhelmed“)

•DESPAIR (“Hopeless”)

FAITH

HOPE

FAITH brings Help, Hope, & Resilience to Wounded Lives and Relationships 11/13/2012

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FAITH is Relevant • Although there are no “silver bullets” to solve these challenges, there is an arena that has not been pursued to full extent: the faith factor related to Spiritual Fitness. • Faith is clearly a relevant dynamic (in society, and in the military demographic which is predominantly Christian) in the arenas of prevention and recovery from trauma (including PTSD), marital/family cohesion, suicide prevention, and RESILIENCE.

• If we are truly going to “get everything in the fight” on behalf of suicide prevention, we need to more robustly investigate and integrate the power of faith into a holistic and comprehensive approach. – This means we must include faith to “set conditions” for spiritual fitness “up stream” to create positive alternatives to suicide, as well as working the downstream symptoms. 11/13/2012

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Faith Makes a Difference in Suicide Risk & Prevention •

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•

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National studies demonstrated that non-participation in religious activities increased suicide risk by almost 400% (Comstock & Partridge, 1972; Nisbet et al, 2000) 57 of 68 studies (84%) that addressed the link between suicide and religion found that there were lower suicide rates among those more actively involved in faithbased activities (Koenig & Larsen, 2001) One landmark study discovered a link between religious beliefs and practices (specifically Christian), reduced rates of depression, and receiving religiouslyoriented cognitive behavioral therapy (Propst et al, 1992) – Participants showed reduced symptoms of post-treatment depression, balanced clinical adjustment, and lower recidivism with this mode of treatment Religion and spirituality have shown to reduce suicide rates for those suffering from Traumatic Brain Injury (Brenner et al, 2009) Chaplains and faith-based counselors are uniquely qualified to serve a large segment of the military population—those who identify with a religious belief system—and especially those who carry the emotional and psychological wounds of war home with them.

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Selected Research Findings Duke University Medical Center Center for Spirituality, Religion, and Health www.spiritualityandhealth.duke.edu Harold G. Koenig, M.D. Professor of Psychiatry & Associate Professor of Medicine

The Research A systematic review of all quantitative research published from 1872-2010 in peer reviewed academic scientific journals in the English language listed in PsychInfo and Medline This research is documented in: Handbook of Religion and Health, (Oxford University Press, 2001) Handbook of Religion and Health, Second Edition (Oxford University Press, 2012) 11/13/2012

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Overview of Challenges Faced by Military

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High stress: before, during and after deployment

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Poor health behaviors, difficulty with self-regulation

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Alcohol and substance abuse

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Fear, anger, violence

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Isolation, lack of support (especially after return home)

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Divorce, domestic abuse, sexual acting out

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Depression, anxiety, PTSD

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Lack of meaning, lack of hope, giving up, suicide Religion is related to every one of the emotional and social challenges our soldiers face. SOURCE: Koenig, Center for Spirituality, Religion, and Health

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Religious Coping During National Stress America’s Coping Response to Sept 11th: 1. 2. 3. 4. 5. 6.

Talking with others (98%) Turning to religion (90%) Checked safety of family/friends (75%) Participating in group activities (60%) Avoiding reminders (watching TV) (39%) Making donations (36%)

Based on a random-digit dialing survey of the U.S. on Sept. 14-16 New England Journal of Medicine 2001; 345: 1507-1512

Note: Hundreds of quantitative and qualitative studies report similar findings in persons under stress, especially in minorities. SOURCE: Koenig, Center for Spirituality, Religion, and Health 11/13/2012

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How Religion Influences Coping 1. Positive world view 2. Meaning and purpose 3. Psychological integration 4. Hope (and motivation) 5. Personal empowerment 6. Sense of control (prayer) 7. Role models for suffering (facilitates acceptance) 8. Guidance for decision-making (reduces stress) 9. Answers to ultimate questions 10. Social support (both human and Divine)

Not lost with physical illness or disability SOURCE: Koenig, Center for Spirituality, Religion, and Health 11/13/2012

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Research on Religion and Mental Health Emotional disorders Depression Suicide Substance use Positive emotions/virtues Well-being and happiness Meaning, purpose, and hope Forgiveness, altruism, gratitude, compassion Social health Social support Social capital Marital stability SOURCE: Koenig, Center for Spirituality, Religion, and Health 11/13/2012

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Religion and Depression in Religion and Depression in Hospitalized Patients Hospitalized Patients Percent Depressed

35%

23%

22% 17%

Low

Moderate

High

Very High

Degree of Religious Coping

SOURCE: Koenig, Center for Spirituality, Religion, and Health Geriatric Depression Scale Information based on results from 991 consecutively admitted patients (differences significant at p