resilient responses to trauma: leading edge military care for...

AACC World 2013 Pre-Conference September 11, 2013

Bob Dees Major General, U.S. Army, Retired

AACC Military Director

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Resilient Responses to Trauma: Leading Edge Military Care

For Our Troops and Their Families

SLIDES AVAILALE NOW AT: www.ResilienceTrilogy.com

Our Game Plan 2-5 PM, 9.11.13

Part 1 – Painting the Need

Part 2 – Biblical Principles of Resilience

Break

Part 3 – Military Counseling Applications

and Resources

Part 4 – The Secret Sauce

Discussion

Wrap and Close 9/11/13 RFD LLC 2


9/11/13 RFD LLC 3 www.ResilienceTrilogy.com

PART 1 Painting the Need

Honor to Whom Honor is Due Needs of the Hour

A Day of Infamy

September 11, 2011

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9.11.01 -- A Day of Infamy

“I’ll Take It From Here”

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“THE LORD IS MY SHEPHERD”

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“MY ROCK, FORTRESS, & DELIVERER”

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“THREAT CLEARS A MAN’S HEAD”

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FAITH IN THE FOXHOLE

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HOPE FROM THE HOMEFRONT

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 9/11/13 RFD LLC 13

HONOR TO WHOM HONOR IS DUE

Divorce

Homelessness

Reintegration Challenges

Sexual Trauma

Operational Trauma

Domestic Violence

Substance Abuse

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Military Needs of the Hour

Civilian Transition

Operational Tempo

PTSD/TBI

Suicide

Life Skills, Education & Employment

What is NORMAL???

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“BATTLEMIND”

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“NEW NORMAL”

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REINTEGRATION Challenges

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Brain Physiology

Accelerator (Fight, Flight, Freeze) Brakes

(meaning, purpose, context)

Steering (Planning, Judgment)

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Mild

Reintegration Issues

Combat/Operational Stress Reactions

Adjustment Disorders

Acute Stress

Disorder

Severe

Post Traumatic Stress Disorder

Mild

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

Cognitive-Behavioral (CPT)

EMDR

Medical, et al

Combat Trauma Spectrum

Acute Stress Disorder: 4 weeks or less

Acute PTSD: 1-3 months

Chronic PTSD: > 3 month

Delayed Onset PTSD: Symptoms start > 6 months

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PTSD

Severe

Faces of PTSD

JACOB

ANDY

JOSH

GARY

ALLAN

RAUL

NATE

ROBERT

BOB DAVID

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• 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 indirectly connected with relationships

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SUICIDE Realities in the Military

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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

• Survivor guilt • STRESS (“Anxious and Angry”)

• Severe chronic stress • Family, work, financial, legal, or social problems

• Combat Trauma Spectrum, incl PTSD • Victim or perpetrator of domestic violence

• 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

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Four Significant Clusters:

ISOLATION STRESS INJURY DESPAIR

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• 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)

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ONGOING EFFORTS TO ADDRESS MILITARY SUICIDE

VA Veterans Crisis Hotline: www.Veterancrisisline.net

800-273-8255

http://www.veterancrisisline.net/

Significant effort identifying “at risk” personnel… Need greater “upstream” efforts Trend is still UP, despite $millions to stem the tide.

• 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 in the military/DoD culture

4. Increasing research into suicide prevention

Read more: http://www.foxnews.com/opinion/2012/09/27/plan-to-combat-military-suicide/#ixzz2AjhLQXyQ

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DOD Suicide Prevention Approach

http://www.foxnews.com/opinion/2012/09/27/plan-to-combat-military-suicide/










• Represents latest “spike” in Military Mental & Behavioral Health challenges:

– 19,000 Military sexual “assaults” each year (~50/day)

– Violates the person and erodes essential military trust

– Broad gamut of cases, including “same sex” trauma

• Military Leaders working as a top priority with significant Congressional pressure

• Upcoming Series on MST by Dr. Diane Langberg in next two AACC Military Division Newsletters.

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Military SEXUAL TRAUMA (MST)

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• 40% increase in Army child abuse cases from 2009-2012

• 30,000 Army children abused or neglected over the past decade

– Including 118 child deaths due to beatings, torture, and starvation

– over 1,400 subjected to sexual abuse. (Army Times, August 5, 2013, pages 16-20)

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Military CHILD ABUSE

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This challenge of military child abuse needs to be understood and addressed by Christian counselors across our land.

Are you prepared as a counselor to be confronted by such challenges in the military families who walk in your door?

CIVILIAN TRANSITION

Finding A Job is the Top Priority – The Economy Matters!

• 50% feel navigating the VA system is a 2d priority (support and benefit programs)

• 45% want assistance with re-integrating into civilian culture

• 34% then focus on re-acclimating to civilian family life

• <26% are focused upon finding help with Health issues, and finding a permanent

home

• 4% said they had no challenges in transitioning

View of Military Transition Programs

72% believe TAP programs miss the mark

48% were not prepared/focused for TRANSITION after they took off the uniform

Unemployment and Education

30% under the age of 35 are unemployed, 67% of those are seeking employment

rather than college

56% of the unemployed that are not seeking employment point to being a student

> 50% of those that get accepted to Schools/Jobs … **Depart within the first year**

Culture -- Veterans largely feel respected, yet misunderstood

• Veterans largely feel respected, yet misunderstood ---

Priority: Achieving a good education & career with an employer that values them

Source: Prudential Insurance Veteran Employment Survey – 2012; IVET Independent Research 2013

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29 %

Veteran National Unemployment Under Age 30



PART 2 Biblical Principles of RESILIENCE

Reality of Trauma Resilience Life Cycle©

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THE RESILIENCE TRILOGY

+ Facebook @ Resilience Trilogy

Troops & Families are “Warriors”

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“IN THE WORLD YOU WILL HAVE TRIBULATION….

SELF OTHERS

SPIRITUAL FORCES INEXPLICABLE TRAJEDY

Resulting From: Greek “thlipsis” squeezing Latin “tribulum” threshing

BUT BE OF GOOD CHEER, I HAVE OVERCOME THE WORLD.”

JESUS -- John 16:33(NKJV)

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

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SUFFERING

Defining Trauma

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“Until it happens to you…”

Why Me? Why Now?

How could you let this happen, Lord?

Trauma = Wound, Damage, or Defeat

“A traumatic situation is one involving an actual or threatened death or serious injury.”

A somewhat clinical explanation…

What does a “STORM” look like?

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“At intervals between a bomb falling it sounded like church: voices from nearby slit trenches all chanting the Lord’s prayer together- over and over again.

Louder when the bombs hit closer.” Veteran Army Air Forces Bombardier and Olympic Runner Louie Zamperini as recorded in Unbroken by Laura Hillenbrand, page 117

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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

RESILIENCE

1: Activating Events, Thoughts, and Consequences

2: Avoid Thinking Traps

3: Detect Icebergs

4: Energy Management

5: Problem-Solving

6: Put It In Perspective

7: Real-Time Resilience

8: Character Strengths

9: Strengths in Challenges

10: Assertive Communication

11: Active Constructive Responding and Praise

12: Hunt the Good Stuff

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U.S. Army Resilience Skills

Sources: Positive Psychology Center, U/Pennsylvania, Director: Dr. Martin Seligman U.S. Army Comprehensive Soldier & Family Fitness (CSF2)

Master Resilience Trainer (MRT) Methodology

Preparation Resilience Fundamentals

Enhancement Elevating Performance

Sustainment Education & Operations

Comprehensive Fitness leading to RESILIENCE

• Physical • Mental • Social • Emotional • Spiritual

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Marine Operational Stress Surveillance and Training(MOSST)

U.S. Army -- Comprehensive Soldier & Family Fitness (CSF2) A structured, long term assessment and development program to

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

• Physical • Family • Social • Emotional • Spiritual

• Physical (Strength)

• Mental (Mind)

• Social (“Neighbor”)

• Emotional (Heart)

• Spiritual (Soul)

Army Judeo Christian Marines

U.S. Army Comprehensive Soldier & Family Fitness (CSF2)

http://csf.army.mil

Holy Bible Great Commandment

Mark 12:30,31

“Spiritual” deleted in

Ready &

Resilient Campaign

(R2C)

Source: Spiritual Fitness Handbook

“We are

afflicted in every way, but not crushed;

perplexed, but not despairing;

persecuted, but not forsaken;

struck down, but not destroyed .”

2 Corinthians 4:8, 9 NASB

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RESILIENCE “GOD Style”

Before During After

RESILIENCE LIFE CYCLE©

Source: Resilient Warriors, www.ResilienceTrilogy.com

LEARN & ADAPT

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COACH CRISIS RESPONSE (CRT) CARE & COUNSEL

http://www.resiliencetrilogy.com/

Know Your Calling

(Mission, Purpose)

Know Your Enemy

Know Your Friends

Know Your Equipment

(Armor of God)

Deploy with the Right Mindset

Develop/Rehearse “Actions on Contact”

(Get Ready!)

Call 911

(Ask for help)

Start the IV

(Nurture yourself)

Keep Breathing

(Maintain routines)

Your Well of Courage

(Past strengths)

Remember Your Calling

Guard Primary Relationships

Choose Forgiveness

& Gratitude

Grieve Well

Sing a New Song

Revalidate Your Calling

(Discern/Chart the Future)

Comfort Others

LEARN & ADAPT

SOURCE: Page 200, Resilient Warriors, 2011, Dees 9/11/13 RFD LLC 40

Before During After


Source: Resilient Warriors, Chapter 5, www.ResilienceTrilogy.com

LEARN & ADAPT

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Know Your Calling

(Mission, Purpose)

Know Your Enemy

Know Your Friends

Know Your Equipment

(Armor of God)

Deploy with the Right Mindset

Develop/Rehearse “Actions on Contact”

(Get Ready!)


Before During After


LEARN & ADAPT

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Call 911

(Ask for help)

Start the IV

(Nurture yourself)

Keep Breathing

(Maintain routines)

Draw from your Well of Courage

(Past strengths)


Source: Resilient Warriors, Chapter 6, www.ResilienceTrilogy.com


Weathering the Storm

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Call 911 • Pray to God • Ask for Help from 911 Friends • Ask the “experts” • Graciously accept help from others

Start the IV • God’s WORD in every possible way

Keep Breathing • Count Your Way • Spiritual Breathing • Hit A Knee • Record the Journey

Draw From Your Well of Courage • Remember Past Faithfulness • FEAR + FAITH = COURAGE


“Sharon knew that Faith, Family, and Friends would be the key to living through this nightmarish reality.” Resilient Warriors, page 129, referring to Gold Star Parents Sharon and Deacon Collins

Before During After


LEARN & ADAPT

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Guard Primary Relationships

Choose Forgiveness & Gratitude

Grieve Well

Sing a New Song

Revalidate Your Calling

(Discern/Chart the Future)

Comfort Others

Source: Resilient Warriors, Chapter 7 & 8, www.ResilienceTrilogy.com


• TRAUMA is a Reality… RESILIENCE is a Necessity

• Invest now in yourself and others…

• Before, During, After

• Not merely about human strength or grit

• Faith-based Resilience leads to greater Readiness

• Regarding Christian best practice…

– JESUS was the ultimate Resilient Warrior

• And HE grants that same Resilience to those who follow Him 9/11/13 RFD LLC 45

RESILIENCE SUMMARY

“We are afflicted in every way,

but not crushed;

perplexed, but not despairing;

persecuted,

but not forsaken;

struck down, but not destroyed.”

2 Corinthians 4:8, 9

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RESILIENCE “GOD Style”

Consider JESUS

Calling (John 10:10b) Enemies (Matt 12:14,14a) Friends (Mark 3:13,14) God’s Word (Matt 4:7) Replenishment (Matt 14:13a) Comfort to Others (Luke 23:43) Sing a New Song (2 Corin 5:17)

Even on the Cross!

Always carrying about in the body the dying of Jesus, so that the life of Jesus also may be manifested in our body.

2 Corinthians 4:10

Questions & Discussion

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PART 3 Military Counseling

Applications & Resources

Understand the Culture Know the Stressors

Use Multiple Strategies

• ETHOS OF SERVICE AND SACRIFICE (> Stigma Effect)

• 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%

• Q & A / DISCUSSION

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MILITARY CULTURE AND CURRENT REALITIES

1. Within the current political and cultural environment, integration of faith-based programs is challenging, but essential

2. While Chaplains do great work as counselors and caregivers for troops and families, there are not effective overarching strategies for spiritual fitness which are as mature (or as resourced) as other CSF components (physical, social, emotional, and family). As well, spiritual fitness programs generally need greater command emphasis.

3. Efforts to “not offend” anyone often result in an impotent lowest common denominator (a homogenized approach) which is also not useful to anyone

4. An alternative approach (heterogeneous) is to identify and establish “best practice” programs for each faith group to achieve optimum spiritual fitness

This is a feasible approach which can be implemented within a context of appropriate religious freedoms, religious accommodation and respect for others.

Bottom Line: Implement life cycle integration (accessions, operational, warrior transition, family, spiritual fitness centers) of distinctive faith resources and programs (Christian, Jewish, Muslim, Buddhist, et al) to promote spiritual fitness among troops and families, and minimize conditions for potential suicide (isolation, stress, injury, despair) and other adverse mental and behavioral health trends.

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Political & Cultural Considerations Surrounding Faith

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Analyze one of your life traumas in terms of the Resilience Life Cycle©

Learning and Growing from Trauma

REFERENCE: Resilient Warriors Advanced Study Guide, pages 13,14, 36-39

?

1. My “Body Slam:” ___________________________________ 2. My Feelings: ______________________________________ 3. My Reactions: _____________________________________

BEFORE DURING AFTER LEARN & ADAPT

1. Was I Prepared for this life experience? _______________

2. How could I “Get Ready” for this?

A. __________ B. __________ C. __________

3. Did I have “Actions on Contact” prepared in advance? _______

1. How did I “Weather the Storm?”

A. __________ B. __________ C. __________

2. What/Who were my “life preservers?”

A. __________ B. __________ C. __________

1. Did it get worse? 2. Did I grieve the loss?

(D,A,B,D, Acceptance) 3. Did I get stuck?

A. Guilt? B. Anger? C. Bitterness?

4. Am I still stuck? 5. How do I get unstuck?

A. New Song? B. Forgiveness? C. Renewed Purpose?

1. What did I LEARN? A. Before?_________ B. During?_________ C. After?__________

2. Did I GROW? How? A. __________ B. __________ C. __________

3. Did I ADAPT in order to “Be Ready” for future life traumas?

____________________

Comprehensive Personal Fitness™ The Greatest of Commandments

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“28One of the scribes came and heard them arguing, and recognizing that He had answered them well, asked Him, “What commandment is the foremost of all?”

29 Jesus answered, “The foremost is,

‘HEAR, O ISRAEL! THE LORD OUR GOD IS ONE LORD; 30 AND YOU SHALL LOVE THE LORD YOUR GOD WITH

ALL YOUR HEART(EMOTIONAL), AND WITH ALL YOUR SOUL(SPIRITUAL), AND WITH ALL YOUR MIND(MENTAL), AND WITH ALL YOUR STRENGTH(PHYSICAL).’

The second is this,

‘YOU SHALL LOVE YOUR NEIGHBOR(RELATIONAL) AS YOURSELF.’

There is no other commandment greater than these.” 31

Mark 12: 28-31, NASB, Parenthetical and Bold comments added

COMPREHENSIVE PERSONAL FITNESS™

Comprehensive Personal Fitness™ leading to RESILIENCE

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• PHYSICAL (“Body is Temple of Holy Spirit”)

– Diet, Exercise, Hygiene, Sleep

• MENTAL(“Taking Every Thought Captive”)

– Thought Patterns, Intellectual Curiosity, Acuity

• SPIRITUAL(“To be spiritually minded is life & peace”)

– Connection with God, faith practices

• EMOTIONAL(“Slow to Get Angry”)

– Regulation, Temperament

• RELATIONAL(“Let us LOVE one another”)

– Connectivity, Mutual Support

MY Comprehensive Personal Fitness™ Application Exercise

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PHYSICAL

Diet?

Exercise?

Hygiene?

Sleep?

MENTAL

Thought Patterns?

Intellectual Curiosity?

Acuity?

SPIRITUAL

Connection with God?

Faith practices?

EMOTIONAL

Regulation?

Temperament?

RELATIONAL

Connectivity?

Mutual Support?

Some Leading Questions: 1. How do I assess my status in each of these areas? (1-10) 2. To what degree am I prioritizing these fundamental values in my life? 3. Do I hold myself accountable to these priorities? 4. Have I enlisted others to help? 5. How does success or excess in one area affect the others? 6. What realistic changes/commitments make sense for me now?

A. ____________________________ B. ____________________________ C. ____________________________

Clinical Treatment of PTSD VA & DOD Guidelines

• Three primary treatment options listed: – Prolonged Exposure – Eye Movement Desensitization and Reprocessing

(EMDR) – Cognitive Processing Therapy (CPT)

• U.S. Army Medical Command teaches all 3 • No single protocol works best; all patients are

different – Best to have a number of techniques to apply

• The National Center for PTSD web site – www.ptsd.va.gov

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http://www.ptsd.va.gov/

Leader & Caregiver Self-Care

• Comprehensive Self-Care™

• Disciplines of Replenishment

• Sabbath Rest

• Work Ending Rituals

• Lowering Ambient Noise

• Visualization (“Minute Vacations”)

• Spiritual Meditation

• Sleep Management

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Personal Risk Management™ for Leaders

“HALT”

Hungry

Angry

Lonely

Tired

“Beware the Bubble”

Source: Resilient Leaders, Chapter 8, www.ResilienceTrilogy.com

PUT ON YOUR MASK FIRST!


Self-Care Assessment© (Source: Dr Eric Scalise, AACC, in Resilient Leaders, Appendix 1) A. Three Primary Sources of Stress in my Life???

1. . 2. . 3. .

B. What is causing this stress? 1. Is my profession CAUSING the problems in my life? 2. Is my profession REVEALING the problems in my life?

C. Fundamental Questions: 1. What am I supposed to be doing? (calling, mission) 2. Am I doing the right thing? 3. Am I doing too much? 4. Does what I do really matter? 5. Am I isolated from supportive relationships? 6. Do I seek to control things which are actually beyond my control? 7. Am I employing effective stress reduction techniques?

D. My Personal Commitment: (for personal self-care) 1. . 2. . 3. .

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• RESILIENCE TRILOGY – www.ResilienceTrilogy.com

– www.Facebook.com/pages/Resilience-Trilogy

• AMERICAN ASSOCIATION OF CHRISTIAN COUNSELORS – AACC Military Division

• http://military.aacc.net Military Counseling Initiative (MCI)

• www.Facebook.com/pages/Military-Counseling-Initiative

– AACC “Stress & Trauma Care with Military Applications” Course

• www.aacc.net/courses/biblical-counseling/stress_trauma/

• LIBERTY UNIVERSITY INSTITUTE FOR MILITARY RESILIENCE – www.LUOnline.com/IMR

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RESOURCES


http://www.facebook.com/pages/Resilience-Trilogy



http://military.aacc.net/




http://www.facebook.com/pages/Military-Counseling-Initiative





http://www.aacc.net/courses/biblical-counseling/stress_trauma/





http://www.luonline.com/IMR

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THE RESILIENCE TRILOGY

www.Facebook.com/pages/Resilience-Trilogy

www.ResilienceTrilogy.com





Military Counseling Initiative

• Stress & Trauma Care Video Series

• Christian Counseling Today – Military Edition

• Website w/ BLOG and Facebook connect

• AACC Conferences

– Military Subject Matter Attendees

– Military Counselor Reception

– Military Track – 1st Time – 7 Seminars

• Military Division Formed ~ 400 members

AACC Leadership has made a substantive and relevant commitment to help our nation’s troops and families 9/11/13 RFD LLC 60

“Stress & Trauma Care

with Military Applications”

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www.aacc.net/courses/biblical-counseling/stress_trauma/




Difference between Crisis

and Trauma • Your past is not your past if it

is still affecting your present.

Loss/Grief Cycle and

Complicated Grief

7 Kinds of Abuse

Anxiety and Depression

Trauma and Relationships

Unit 1

Acute Stress & Trauma

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Dynamics of Crisis

Counseling • Lessening the effects of trauma

Peer Support

Survival Guilt and

Fostering Resiliency

High Cost of Caring • “Hurting people hurt people.”

Cultural Differences

Unit 2

Basic Crisis Intervention

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Signs & Symptoms

Risk Factors • Proximity to trauma

• Severity of trauma

• Duration of exposure

• Frequency of exposure

Trauma and Addiction

Scans of the Brain

Suicide Prevention

Unit 3

Post-Traumatic Stress

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Use of Deadly Force • God & the Military: Is it Right

to Bear Arms?

Realities of Service on the Military Member

Realities of Service on the Military Family

Combat Trauma Spectrum • Every solider experiences trauma

on some level

• What can help?

Unit 4

Military Applications

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Theology of Suffering • Opportunity to become bitter

or better

Chaplains

Families • Families need hope!

Churches • Strive to be military friendly

Counselors

Unit 5

Spiritual Solutions

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AACC Military Division

• Expert care & counsel for our nation’s military servants and their families.

– Mobilize AACC membership across the nation

– Augment DOD and VA efforts in every way possible

• Move a nation to care…

• Counselors

• Church/Parachurch

• Communities

AACC can make a huge difference in the mental health of a generation of warriors and their families.

Enlist NOW! 9/11/13 RFD LLC 67

Liberty University

Institute for Military Resilience (IMR) – Curriculum: (both undergrad & grad)

NOTE: Liberty University has 30,000 Military Students with an inventory of over 150 programs of study

– Resilient Warriors & Leaders

– Resilient Military Marriage and Family

– Military Transitions

– Military Mental & Behavioral Health

– Outreach • Existing Military Affairs Office activities

• Share best practices nationwide – Webinars & Conferences

• Training for Universities, Churches, Corporations

– Research • Integration and Assessment of Faith-Based Protocols

“Our nation’s first faith-based program for Military Resilience.”

New Programs focused on

most challenging

military issues of our day.

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LIBERTY UNIVERSITY INSTITUTE FOR MILITARY RESILIENCE

www.LUOnline/IMR

http://www.luonline/IMR

LU IMR RESILIENCE AND MILITARY COUNSELING RESEARCH

More intentional focus on Military Population

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• Primary Purpose: Assess effectiveness of faith-based protocols in addressing the most pervasive and persistent mental and behavioral health issues in the U.S. Armed Forces

• Overarching Research Questions: 1. Do before, during, and after best faith practices (prayer, hope,

encouragement, and life instruction from the Bible; faith community interaction, et al) help to mitigate the impacts of military trauma and the ensuing mental & behavioral health challenges?

2. Does active faith practice (esp Christian) contribute to resilience in military personnel and their families?

3. Does active faith practice (esp Christian) improve outcomes related to key military issues? Specifically,

• Suicide Prevention • Prevention of Sexual Assault and Domestic Violence • Cohesion of Families • Resistance To and Recovery From PTSD, TBI, and other impacts of military

trauma and lifestyle

NEED

: PILO

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assess su

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PART 4 “The Secret Sauce”

Relevance of Faith Research Underpinnings Ultimate Resilient Warrior

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 (incl 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. 71 9/11/13 RFD LLC

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•ISOLATION ( “Alone”) •STRESS (“Anxious and Angry”) •INJURY (“Overwhelmed“) •DESPAIR (“Hopeless”)

FAITH

CARING COMMUNITIES/CHURCHES

HOPE

RELEVANT “TRUTH”

FAITH brings Help, Hope, & Resilience to

Wounded Lives and Relationships 9/11/13 RFD LLC

Addressing Suicide Causalities

Faith Makes a Difference in

Suicide Risk & Prevention • 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 faith-

based activities (Koenig & Larsen, 2001)

• One landmark study discovered a link between religious beliefs and practices

(specifically Christian), reduced rates of depression, and receiving religiously-

oriented 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)

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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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Duke University Medical Center

Center for Spirituality, Religion, and Health

Harold G. Koenig, MD Professor of Psychiatry & Associate Professor of Medicine

SELECTED RESEARCH FINDINGS

The Research (systematic review 1872-2010 of all quantitative research published 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)

Overview of Challenges Faced by Military • High stress: before, during and after deployment

• Poor health behaviors, difficulty with self-regulation

• Alcohol and substance abuse

• Fear, anger, violence

• Isolation, lack of support (especially after return home)

• Divorce, domestic abuse, sexual acting out

• Depression, anxiety, PTSD

• 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. Talking with others (98%)

2. Turning to religion (90%)

3. Checked safety of family/friends (75%)

4. Participating in group activities (60%)

5. Avoiding reminders (watching TV) (39%)

6. 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


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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


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Research on Religion and Mental Health

Emotional disorders (reduced)

Depression Suicide Substance use

Positive emotions/virtues (enhanced)

Well-being and happiness Meaning, purpose, and hope Forgiveness, altruism, gratitude, compassion

Social health (enhanced)

Social support

Social capital

Marital stability

SOURCE: Koenig, Center for Spirituality, Religion, and Health 9/11/13 RFD LLC 78

Religion and Depression in Hospitalized Patients

Geriatric Depression ScaleInformation based on results from 991 consecutively admitted patients (differences significant at p<.0001)

35%

23%22%

17%

Low Moderate High Very High

Degree of Religious Coping

Perc

en

t D

ep

ressed

SOURCE: Koenig, Center for Spirituality, Religion, and Health 9/11/13 RFD LLC

Religion and Depression during Hospitalization

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Religious involvement is related to:

Less suicide and more negative attitudes toward suicide -- 106 of 141 studies (75%)

Suicide (systematic review)

Religious involvement is related to: Less anxiety, less PTSD (125 of 225 studies report significantly less)

Anxiety and PTSD (systematic review)


Spiritual Injury and PTSD Symptoms

1,385 veterans from Vietnam (95%), World War II and/or

Korea (5%) involved in outpatient or inpatient PTSD

programs. VA National Center for PTSD and Yale University

School of Medicine.

Weakened religious faith was an independent predictor of use

of VA mental health services—independent of severity of PTSD

symptoms and level of social functioning.

Investigators concluded that the use of mental health services

was driven more by their weakened religious faith than by

clinical symptoms or social factors.

Fontana, A., & R. Rosenheck. Trauma, change in strength of

religious faith, & mental health service use among veterans treated

for PTSD. Journal of Nervous & Mental Disease 2004; 192:579–

84.


Religious involvement is related to: Significantly greater MEANING AND PURPOSE IN LIFE 42 of 45 studies (93%) [100% of best] Significantly greater HOPE

29 of 40 studies (73%) Significantly great OPTIMISM

26 of 32 studies (81%)

Meaning, Purpose, Hope, Optimism (systematic review)


Religious involvement is related to: Greater well-being and happiness 256 of 326 studies (79%) [82% of best]

Lower well-being or happiness (<1%)

Well-being and Happiness (systematic review)

AND SIMILAR FINDINGS FOR:

Well-Being and Happiness Positive Human Virtues/Character Social Support Marital Stability Self Regulation Et Al


Summary Selected Research Findings - Koenig

• For some, particularly active duty soldiers,

veterans, and their families, religion can be a

powerful coping resource

• Religion is related to better mental health and

better health behaviors

• Religion is related to better physical health,

medical and surgical outcomes, and greater

longevity

• “We cannot ignore this powerful resource for

RESILIENCY at a time like this.” – Dr Harold

Koenig


“The Hope Diamond”

“For God

so loved the world

That He gave his one and only Son,

that whoever believes in Him

shall not perish, but have

eternal life.”

(NIV)

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John 3:16

He Loves &

He Gave

We Believe &

We Live

Courtesy Max Lucado, 3:16: The Numbers of Hope, page 8.

Psalm 31:24 Psalm 38:15 Romans 5:2-5 Psalm 42:15 Psalm 71:5

Romans 15:4,13 1 Corinthians 3:12 Colossians 1:27 Hebrews 6:18-20 1 Timothy 4:10

Questions & Discussion

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NOTES

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