Combat and Operational Stress 101

Part II – Taking Action for Yourself and

Your
Buddy

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 Goals of This Training
- This training focuses on:
- Part I (review)
- Combat and Operational Stress (COS):
- What it means
- How it affects you
- What to do about it
- Interventions: Increasing self awareness, focusing on the here-and-now,
challenging negative thinking, using tactical breathing and muscle relaxation.
- Part II:
- How to use the stress continuum to take care of yourself and your buddies
- The overall goal of this training is to encourage you to enhance total fitness by
optimizing physical, mental, and emotional wellbeing
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 Success Requires Some Stress
Performance
Point of
Strong Optimal Performance
Concern
Impaired Performance
Under
Performance Severely Diminished
Performance

Burnout
Wea Ready
Stress
k Idle Ill
Level
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Stress Continuum Model - Be Aware of You r
Current Zone and Alert to Changes
Idle Ready Reacting Injured Ill
- Lethargic - Good to go - Distressed or impaired - More severe or - Experiencing
- Unfocused, not - Well-trained - Decrease in function persistent distress orange zone
thinking clearly - Fit and focused or performance - Serious suicidal symptoms for more
- Unmotivated, - Cohesive units - Mild & temporarily or homicidal than 60 Days
apathetic - Ready families anxious, irritable thoughts - Stress injuries that
- Bored - Personal & social or sad - Experiencing don’t heal
- Slow, life is good - Physical or panic attacks or without help
unproductive - Optimal behavioral changes rage - Symptoms persist,
- Time goes performance - Trouble sleeping - Disruption of get worse
slowly - Difficulty moral - Feeling depressed
- Not contributing concentrating values or anxious
to the unit - Increase in alcohol - May leave lasting - Feeling suicidal
related incidents memories, and/or homicidal
reactions, and with a plan
impressions
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 Stress Management:
Using the Stress Continuum Model for
Self-Care

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The Blue Zone (Idle)

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 Be Aware of Blue Zone Indicators
Examples of Blue Zone Indicators

- Low energy level - Not moving much; body slumped

Physical
- Not working - Eyes unfocused

- Unfocused - Not very productive

Mental - Not thinking clearly - Preoccupied and distracted

- Unmotivated
Emotional - Apathetic; doesn’t care
- Bored

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 Taking Action in the Blue
Zone
- Look around to find tasks that are more challenging
- Talk with a trusted NCO about career development
- Consult Military OneSource for career advice
- Look for outside career development opportunities (e.g., getting a new certification or
going to school)
- Ask your buddies if they have ideas
- Ask your leadership for more challenging tasks/responsibilities

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The Yellow Zone (Reacting)

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 Be Aware of Yellow Zone Indicators
Examples of Yellow Zone Indicators
- Too pumped up or tired
- Muscle tension or headaches
Physical - Diarrhea or constipation
- Trouble sleeping
- Difficulty concentrating
Mental - Difficulty remembering or performing calculations
- Difficulty following complex instructions
- Mild & temporarily anxious, irritable or sad
Emotional - Being short-tempered
- Apathy or complacency
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 Taking Action in the Yellow
Zone
- Take a knee: take an hour break or request leave
- Get enough sleep [7-8 hours]. To problem solve obstacles to good sleep, talk with family,
buddies, or command; practice sleep hygiene tips
- Practice: focus attention on here and now, challenge your negative thinking, tactical
breathing, progressive muscle relaxation
- Check your activities: decrease unhealthy coping behaviors and increase healthy
coping behaviors
- Manage home-front stressors (e.g., speak to a financial counselor, marriage counselor)
- Ask for help from family, buddies, or command if needed
- Call Military OneSource for help (800-342-9647); it’s confidential and free support available
24/7.
- Additional confidential resources: Military & Family Life Counselling (MFLC) program
and Chaplaincy

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The Orange Zone (Injured)

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 The Orange Zone
Examples of Orange Zone Indicators
- Heart pounding, even at rest
Physical - Shaking, even when not in danger
- Sweating, even at rest and when not feeling hot
- Loss of ability to recall memories
Mental - Memories that are so vivid they seem like they are happening now
- Painful thoughts that keep popping into awareness
- Intense and uncharacteristic anger
Emotional - Intense and uncharacteristic fear
- Intense and persistent sadness

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 Taking Action in the Orange
Zone
- Try short-term stress reducing approaches used in Yellow Zone
- Talk to a buddy or trusted mentor
- Notify leadership and request support:
- Inform leadership that you would like to see a provider
- Keep safe and calm, rest and recuperate for 24-72 hrs
- Schedule an appointment or walk into the BAS or behavioral health clinic, or visit
a chaplain
- Call the Psychological Health Resource Center for support and comprehensive list
of resources (866-966-1020)

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The Red Zone (Ill)

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 Be Aware of Red Zone Stress Indicators
Red Zone Stress Conditions
Red Zone Stress Indicators
Arising From Untreated Stress
- Suicidal or homicidal thoughts, intentions, Reactions
or plans - Acute stress disorder (ASD)
- Alcohol or drug abuse - Posttraumatic stress disorder (PTSD)
- Persistent feelings of hopelessness - Panic disorder
- Excessive, constant worrying - Major depression
- Severe fatigue, insomnia or other trouble - Generalized anxiety disorder
sleeping (includes nightmares) - Drug/Alcohol misuse or dependence
- Intense anger and lashing out - Disorders of impulse control (especially
- Disruptive attention and memory aggression)
problems
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 Taking Action in the Red
Zone
- If you believe that you are a danger to yourself or others, seek immediate assistance
from the emergency department, or the chain of command, or call the Military Crisis
Line (800-273-8255, Press 1)
- If you are experiencing any other Red Zone indicators:
- Notify leadership and request support:
- Inform leadership that you would like to see a provider (“I am having a difficult
time right now. I have thoughts about harming myself but haven’t acted on
them. I would like to see BH before things get worse.”
- Schedule an appointment or walk into the BAS or behavioral health clinic
- Contact the Military Crisis Line for support via phone (800-273-8255, Press 1) or
text 838255
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 Summary: Examples of Speaking to
Leadership
Zone Examples of things to say to leadership
Blue “I’m feeling idle right now. What other responsibilities can I take on?”
Yellow “I feel like I’m not at the level I used to be and I think I need to talk to someone
to get back to myself.”
Orange “Hey sir/ma’am, I am not suicidal but I am having a really rough time. I need
some help getting stuff off my plate.”
“I am having a difficult time right now with some personal things. I am not
thinking of hurting myself but I want to talk to BH before things get worse.”
Red “I am having a difficult time right now. I have thoughts about harming myself
but haven’t acted on them. I would like to see BH before things get worse.”
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 Pros and Cons of Seeking Help: Possible
Barriers
What prevents you from seeking help when experiencing high levels of stress?
Stigma Perceived as being weak by co-workers
Trust in leadership Perceived as being weak by leadership
Self-reliance Lack of support by command leadership
Access to care Everyone is stressed
Understanding of mental health Fear of reprisal
Command climate not conducive to care Not having awareness of how or
resources Being a burden Pride, uncomfortable
Time, too busy Other barriers?
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 Pros and Cons of Seeking Help: Motivators
Factors that encourage you to seek help when
experiencing high levels of stress
Personal responsibility Self preservation
Good leadership Family/friends
When I am having Co-workers Photo Credit: US Department of Defense

trouble coping
Realizing I could handle The desire to contribute
stress and challenges to the mission
differently effectively
Photo Credit: US Army Photo by Maj. Addie Leonhardt

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 Buddy Care

Photo Credit: US Marine Corps Photo Credit: US Army

Photo Credit: US Navy Photo Credit: officercandidatesschool.com

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 What is Buddy Care?
- Buddy care is being aware of and taking care of your buddy
- If you notice your buddy is having a tough time, talk to them
- Know your buddy’s regular behavior + Notice big changes = Take action

Outline of three action steps for buddy care:

1. Observe and be aware. You must notice buddy issues in order to take action!
Pay attention to Blue, Yellow, Orange, and Red Zone Indicators
2. Talk and listen to your buddy (Connected Listening)
3. Choose appropriate action plan

Photo Credit: US Air Force photo

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 Step 1: Be Aware of Blue Zone Stress
Indicators
Examples of Blue Zone Indicators (Idle)
To Identify: Watch For: Listen For:
Current - Very light workload
- Boring and repetitive report “I’m very bored with my job.”
Stressors
- Constantly playing on cell
Level of “I feel like my work doesn’t make much
phone, sitting idle
- Feels bored, of a difference.”
Distress underappreciated
- Slow
Changes in - Unproductive “I’m feeling useless at work.”
- Unmotivated
Functioning
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 Step 1: Be Aware of Yellow Zone Stress
Indicators
Examples of Yellow Zone Indicators (Reacting)
To Identify: Watch For: Listen For:
Current - High operational tempo - “My head feels foggy all the time.”
Stressors - Unit mission unclear - “Some of the members in the unit hate me.”

Level of - Increased conflicts in unit - “Everything makes me angry lately.”

- Outbursts of temper - “Can I get transferred to another unit?”
Distress
Changes in - Loss of mission focus - “I am not sleeping very well.”
- Difficulty getting sleep - “There’s something wrong with me.”
Functioning
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Step 1: Be Aware of Orange Zone Stress
Indicators
Examples of Orange Zone Indicators (Injured)
To Identify: Watch For: Listen For:
Current - Close brush with death - "I almost got killed by an IED."
Stressors - Death/illness of friends/relatives - "My son is very sick."
- Uncharacteristic outbursts of anger, - "I keep waking up from the
Level of anxiety, or fear same nightmare."
- Loss of interest in work, hobbies, - "I don't have any energy
Distress or socializing anymore."
Changes in - Significant changes in personality - "I haven't slept in weeks."
- Poor hygiene or grooming - "My appetite is gone.”
Functioning
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 Step 1: Be Aware of Red Zone Stress
Indicators
Examples of Red Zone Indicators (Ill)
To Identify: Watch For: Listen For:
Stressors are similar to those of the
Current “I don’t want to get out of bed
Orange zone, but the level of distress
Stressors anymore.”
is worse than the Orange zone
Clinical mental disorders, e.g., major
Level of “I’m getting blackout drunk every
depression or substance abuse or
night.”
dependence
Distress
Changes in Symptoms and disability persist over “I haven’t slept for months.”
many weeks or worsen over time
Functioning
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 Step 2: Connected Listening
-Demonstrate awareness by listening to the other person and respecting their opinions:
-Perspective taking – Appreciate another person's reality
-Stay out of judgement – Listen in an active and nonjudgmental way
-Recognize emotion – Be aware of the other person’s feelings
-“Reflect” your understanding – Express your understanding of what is
being said
-Refer to the Stress Continuum to start a conversation (e.g., “Are you in the orange
zone today? You looked stressed.”)
-Be sure to follow up with further conversations or actions, as needed

Photo Credit: US Army photo by Spc. Matthew J. Marcellus

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 Step 3: Buddy Action Plan – Blue
Zone
- Encourage your buddy to:
- Look around to find tasks that are more challenging
- Talk with a trusted NCO about career development
- Consult Military OneSource for career advice (800-342-9647)
- Look for outside career development opportunities (e.g., getting a new certification
or going to school)
- Ask his/her buddies if they have ideas
- Ask his/her leadership for more challenging tasks/responsibilities

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 Step 3: Buddy Action Plan – Yellow
Zone
- A buddy in Yellow Zone may benefit from:
- Talking with you, so that your buddy feels heard and understood (“I’ve noticed that
you’ve been down lately. What’s going on?”)
- Guiding them through tactical breathing, progressive muscle relaxation, focusing
attention on here and now, and checking/challenging their negative thinking
- Taking them to visit a chaplain or MFLC for non-emergency concerns
- Sharing what resources are available to help with certain concerns (financial,
marital, etc.)
- Contacting Military OneSource (800-342-9647) with your buddy; it’s confidential
and free support available 24/7
- Continue to follow up with your buddy

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 Step 3: Buddy Action Plan – Orange Zone
- Guide your buddy through the short-term stress reducing approaches used in Yellow
Zone
- Go with your buddy to the BAS or the mental health clinic (make an appointment or
walk in immediately), or visit a chaplain
- Suggest that your buddy inform leadership that they would like to see a mental
health provider or to request leave for 24-72 hours for recuperation
- Call the Psychological Health Resource Center with your buddy for guidance,
support and a comprehensive list of resources (866-966-1020)

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 Step 3: Buddy Action Plan – Red
Zone
- If you believe that your buddy is a danger to themself or others, seek immediate
assistance from the emergency department, the chain of command, or call the Military
Crisis Line (800-273-8255, Press 1)

- If your buddy is experiencing any other Red Zone indicators:

- Notify leadership and request support:
- Inform leadership that you would like to take your buddy to see a provider
- Schedule an appointment or walk into the BAS or mental health clinic with
your buddy
- Contact the Military Crisis Line with your buddy for support via phone (800-
273- 8255, Press 1) or text 838255
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 Summary: Starting the Conversation
Zone Examples to start a conversation with your buddy
Blue “You have looked bored lately. What’s your workload like these days?”
Yellow “I’ve noticed that you’ve been down lately. What’s going on?”
Orange “Hey, I really think you should visit a chaplain or go to the BAS. I’ll go
with you.”
“Look, I’ll call the Psychological Health Resource Center for you and
put the call on speaker phone. Will that work?”

Red “Hey, I really think you need to go to the BAS. I’ll go with you.”
“Hey, there’s Chaplain Smith. Let’s go talk to her.”

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 Buddy Care Trust and Privacy

- Buddy care is about building relationships, not therapy or counseling

- Trust is the foundation upon which these relationships are built
- Keep your buddy’s personal information private; don’t spread rumors, gossip, or
reveal damaging information! However, for their own safety, consider notifying the
chain of command if your buddy is suicidal or in the Red Zone.
- Encourage (but do not pressure) your buddy to seek help from specific resources
if they are struggling with problems such as sexual assault, legal problems,
thoughts of suicide, or discrimination
- Offer to go with your buddy if they are reluctant to seek help

Photo Credit: US Army photo

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 Wrap-Up
- Remember that some stress is necessary to perform optimally
- Stress tells your mind and body, “Danger is near and we need to prepare!”
- Too much stress can lead to stress reactions which can hurt your performance
- Awareness of your stress zone can help you realize when you need to take action
- The earlier you take action the more likely your stress levels will improve as well
as your performance
- Keep an eye on your buddy; take action if you see signs of Blue, Yellow, Orange,
or Red Zone reactions

Photo Credit: US Army photo

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