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The Stress Continuum Model
Stress affects everyone, and especially those who are serving our country and their families. However, people vary in how they respond to stress; responses to stress are called stress reactions. Stress reactions are normal, expected and predictable. They are usually temporary and mild and are easy to identify, comparable to a tree limb bending but not breaking in the wind. For most people, the stress reaction ends when the stressful event has ended. however, unmanaged stress from prolonged or repetetive stress reactions may lead to more serious problems, similar to an injury that is left untreated.
Why should you, as a leader, care about the psychological health of your Sailors and organization? A recent poll conducted through the Navy's Personnel Command indicated that 82% of the 2,800 respondents said they had "some" or "a lot" of stress in their jobs, compared with 74% in 2009 and 58% of respondents in 2005. The biggest increase was in the percentage of Sailors who said they had "some" stress - 44% this year, as compared with 30% in 2005. Sea/shore differences were also significant; 86% of sea-based enlisted Sailors report stress in the "some" or "a lot" categories compared to 74% shore-based enlisted. Pay group distribution shows the largest increases in stress in the E7 - E9 ranks; further investigation or focus groups are needed for clarification of their stressors.
Leaders need to understand that:
Successful completion of a command's mission requires that all members of the command contribute to the fullest of their capabilities. Sailors under stress or experiencing psychological health issues are operating at reduced capacity and cannot fully support the mission. Leaders need to be aware of the psychological wellness of their organization, as they are in a unique position to observe and influence it, which is essential for the success of the mission.
Rick West, Master Chief Petty Officer of the Navy discusses Operational Stress in the Navy:
According to the MCPON, "The important thing is to intervene and take action. Don't stand by and allow a problem to become worse." As a leader, it is also your job to reduce stress as much as possible for your Sailors and Commands.
We are in a demanding profession, and while it is impossible to remove every stressor from a Sailor's life, leaders can do more to lessen or mitigate the effects of stress by applying sound, attentive leadership practices such as:
Even the strongest Sailor can have a stress injury. Leaders are responsible for taking care of their Sailors' psychological health as well as their physical health. To accomplish this, leaders must be able to prevent stress as much as possible, identify responses to stress, and treat stress according to the severity of the response. After reading the information presented in this guide, you should be able to explain your responsibilities as a leader towards operational stress control, as well as the resources and tools that are available to help you.
The Navy's definition of stress is "the process by which we respond to challenges to the body or mind." How people respond to the things that cause them stress is a stress reaction. Since not everyone is affected by the same stressors, it is important for leaders to continually monitor their Sailors for signs of stress.
Stress is inevitable, and in operational and combat settings it is expected. It is important to note that stress is not all bad; sometimes working through stressful issues makes you stronger and more resilient, and learning how to be resilient is an important life skill. However, too much stress can seriously degrade performance and mission success. If there is too much stress for too long it can injure the brain and change how it functions, such as its ability to focus, regulate emotions, and memory. This is why it is not uncommon to hear family members and friends remark that the Sailor "is not the same person as they were before deployment."
What causes stress? The short answer is just about anything! And what really stresses one person out may not bother the next person, so it is a very individual problem, which is why there is not a single solution. But, some stressors are much more common than others; a quick poll conducted by Navy Personnel Command in 2010 indicated that top stressors for Navy personnel were:
(click on the heading to display the individual stressors)
A good place to start is with The Five Core Leader Functions Section, which explains how you, as a leader, can help your Sailors navigate stress.
There are some proactive strategies you can take, and tools you can use, to help keep them mission-ready and in a healthy "Green" stress zone. Do you know what it means to be in the Green "Ready" Zone? The Navy has created the Stress Continuum Model that anyone can use to help them understand and identify different levels of stress, because if you can't identify stress responses then you can't help when help is needed. Find out more about how to identify stress levels in the Tools: Stress Continuum Model (SCM) section.
Even if you know what the Stress Continuum Model is, do you know what to do if one of your Sailors is overly stressed and acting out? The Tools: COSFA Model Section explains what to do step by step, and provides some examples. The Tools: Decision Matrix Section will also help you determine the best course of action.
Leaders are also responsible for ensuring, as much as possible, that their Sailors get exercise, adequate amounts of sleep, and understand the importance of a healthy diet. A lack of any of these things can lead to serious mission degradation. However, there are limits to what you can do to help alleviate your Sailors' stress, and you should be able to recognize when they need more help than you can give them. That is why it is crucially important that you are aware of the many resources that exist to help Sailors in distress, which are reviewed in the Resources Section.
Sometimes, despite your efforts to get help for a Sailor, he or she may resist because they are afraid it will make them look weak, bad or crazy. This is a powerfully entrenched stigma that the Navy is working to eradicate, as there is little difference between getting help for a physical ailment and getting help for a stress-related ailment. Learn about stigma and how to prevent it the section on Barriers to Navigating Stress.
Each core function represents a set of actions you need to take on behalf of your Sailors to promote their resilience or ability to cope with challenges they face every day, and to promote the achievement of the two primary objectives of Operational Stress Control:
While these five functions form a continuous cycle, they are not always performed in order. This diagram serves as a way to show the relationship between the five core functions. Click on each section of the diagram to learn about that function.
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One of the main goals of Navy OSC is to change the culture so that taking care of stress issues becomes the way we do business every day. OSC is NOT fire and forget; Leadership must get on board and use the tools. Your Sailors will be getting OSC Awareness Training, so you need to understand OSC concepts and be able to speak the same language.
The Stress Continuum Model (SCM) is an OSC tool. It is a color coded chart with four zones representing different levels of stress. The four zones are the Green "Ready" Zone, the Yellow "Reacting" Zone, the Orange "Injured" Zone, and the Red "Ill" Zone. Consider the zones in terms of a traffic light, where green is good to go, and red means stop. Yellow and orange are progressive warning lights, between go and stop. The Stress Continuum Model in the graphic below shows the expected outcomes in each zone, click inside each zone to see a list of behaviors that are characteristic for that zone.
The graph below shows what happens when a Sailor, Fire Controlman Smith, is stressed beyond the point of resilience. It can be compared to a spring that you stretch too far, or a fuse that has been blown.
The left side of the graph is stress level, while the bottom of the graph is time passing. In the beginning, FC Smith is a bit stressed during the start of his first deployment, and he gets into the Yellow Zone, as represented by the blue line on the graph. After awhile, FC Smith gets accustomed to the pace of deployment and he moves back into the Green Zone, thanks to the tough, realistic training he has had, good leadership, and strong unit cohesion.
One day, FC Smith witnesses a Marine friend being brought on board after an IED explosion. The corpsmen do everything they can to save him, but are unsuccessful. FC Smith's stress overloads his brain with stress hormones (represented on the graph by the explosion and the immediate change of stress into the Orange Zone).
The Stress hormones cause changes to the brain that FC Smith cannot quickly overcome, which results in persistent stress symptoms that keep him from returning to his baseline, as represented by the red line on the graph.
Remember that these changes are involuntary and can affect even the strongest Sailor.
By now, the COSFA graphic below should look familiar to you. If a Sailor is experiencing distress or loss of function from a stress reaction or injury, COSFA is a tool leaders can use to help restore the Sailor to readiness. The seven "Cs" of COSFA are:
Remember the Five Core Leader Functions? Which Core Leader Function(s) would COSFA fall under?
The OSC Decision Matrix is a flowchart to help leaders identify stress indicators in their Sailors. As a leader, becoming familiar with this tool and using it on a regular basis will provide you with objective and factual information about the behavior you see in others or yourself.
The Decision Matrix may look complicated, but it's not. All you are doing is deciding what zone you think Sailor is in, and then what you need to do about it. Start by looking at the Yellow Zone indicators, does the Sailor's behavior match any of them? If so, look at the Yellow Zone box and see what you should do; if not, match their behaviors against the indicators for the Orange Zone. If you think they are in the Orange Zone, you need to refer them to a leader, chaplain, or medical personnel. If you suspect they are in the Red Zone, they should be referred to medical staff immediately.
For example, imagine you are working on evaluations while your LPO is yelling at the staff. You ask the LPO to keep it down and you go on with your work. The following week the LPO is yelling at the staff again because of something else. By this time you might say, "Okay, this guys is not acting normally," so you take your decision matrix out and go through the questions:
Are there signs of distress or loss of function? (YES) Is the distress or loss of function severe? (No, so LPO is probably in Yellow Zone, read the Yellow Zone suggestions) Has the distress or loss of function been persistent? (Yes, it has lasted for two weeks now, so you may want to check Orange Zone indicators just in case.)
Consider this analogy: It's no different than doing quals on a piece of equipment. If you work on the same piece of equipment day in and day out then you know what is likely to be the problem. You know how to troubleshoot it and you step through that process until you figure out where the problem is and fix it. Using the decision matrix is like troubleshooting for people.
Navy leaders have many options for additional resources to help Sailors who are dealing with operational stress. Whether they are helping Sailors find strategies to mitigate stressors, or treating those with stress problems, leaders should use the resources available to them within the command, in the local military community, and on the web. Some of these resources are:
Bottom Line - it is important that you are aware of resources so that you can refer your Sailors when needed.
In the Potential Barriers Section of this Leader's Guide, it was explained why barriers exist in the battle to keep our troops mission ready and resilient. It is every leader's job to help Sailors understand that it is okay to seek help, and to reintegrate Sailors that have received treatment back into the unit. Some leaders may question this, but ask yourself which person you would rather have working beside you, the person who has received help for their stress issues or the person who needs help but is not getting it or is self-medicating in other ways (substance abuse)?
You may think that by taking action you'll hurt their career, but not taking action can be even worse. We need to care about them as a person, not just worry about their career. Getting help will not necessarily negatively impact their career, but poor job performance will.
If Sailors do get help for a stress-related problem, sometimes they feel there is stigma about returning to their unit. They may lack confidence in themselves, or may be worried about what others might say or think about them. It is very important that you consider carefully how you send your Sailors away for help as it can affect whether they can be reintegrated back into the unit, and if a Sailor isn't accepted back, no one will come forward and ask for help again.
There have been several advances in DoD policies concerning security clearances, including revision of the question concerning mental health treatment on the SF-86, and waiting 90-120 days to identify and work on issues with an individual rather than pulling clearances as soon as the problem is identified. Get the message out to Sailors that it is okay to seek help.
Bottom Line - Sailors can get better, even from severe stress injuries, and getting treated for a stress injury is not the kiss of death for a Sailor's Career. It is your job as a leader to reduce stigma, create an atmosphere that is conducive to returning wounded Sailors, establish a no hazing policy, monitor fitness for duty, connect returning Sailors with a Navy OSC-Lead Mentor, and give them every opportunity to demonstrate competence.
Bureau of Medicine and Surgery
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