Guide to Coping with 

Deployment and Combat Stress

Guide to Coping with 

Deployment and Combat Stress

TG 320 September 2014
>>>>>[2]

For more information:

USAPHC Combat & Operational Stress Control

http://phc.amedd.army.mil/topics/healthyliving/bh/Pages/

CombatOperationalStressControl.aspx

FM 6-22.5 - Combat and Operational Stress Control Manual 

for Leaders And Soldiers

http://armypubs.army.mil/doctrine/DR_pubs/dr_a/pdf/fm6_22x5.pdf 

Army Suicide Prevention Program

http://www.armyg1.army.mil/hr/suicide/

In a crisis, call the National Suicide Prevention Lifeline

1-800-273 TALK (8255)

Press 1 for Military Crisis Line
>>>>>[3]

>>>>>[ Index ]

Sleep Management and Soldier Readiness: Leaders 

and Soldiers ..........................................................[5]

Combat & Operational Stress and Combat 

Operational Stress Reactions ..............................[11] 

Coping with Stress: Stability in Operations ..........[19] 

Providing Support to Soldiers in Distress: 

Battle Buddies .................................................... [23] 

Providing Support to Soldiers in Distress: Leaders 

Guide .................................................................. [29]

Coping with Deployment Separation: Deployed 

Parents and Caregivers ...................................... [33] 

Coping with the Injured and the Dead .................[39]
>>>>>[4]

>>>>>[ ] To sustain performance over the long 

haul, you and your Soldiers need 7-8 

hours of sleep out of every 24. 
>>>>>[5]

Sleep Management and 

Soldier Readiness 

Leaders and Soldiers

Sleep is a biological function that is essential for the 

brain to function properly. As the first element in the 

Army Surgeon General’s Performance Triad (sleep, 

activity and nutrition), sleep is critical for sustaining 

the mental abilities you need for success in training 

and on the battlefield. Healthy sleepers are more 

accurate, more emotionally stable, they react quicker, 

make better decisions, have better memory, and learn 

quicker. 

When we don’t get enough sleep, our performance 

suffers, and we put both ourselves and our fellow 

Soldiers at risk. Our reactions are slower, it’s harder to 

stay focused, it’s harder to think, and we get stressed 

more easily. To make matters worse, the effects of 

sleep deprivation sneak up on us. In other words, 

when we don’t have enough sleep, we are not good 

judges of the impact that sleep deprivation is having 

on our abilities and performance.

Sleep Tactics for Sustained Operations

Sleep is critical for sustaining the mental abilities you 

need for success in during operations. Even simple 

tasks such as communicating, driving, or plotting grid 

coordinates can be impaired by inadequate sleep 

(anything less than 7—8 hours every 24 hours). 

Soldiers can correctly site a target – but they might 

select the wrong target. 
>>>>>[6]

Combat operations can create situations where 

inadequate sleep becomes the norm. Soldiers who 

do not get enough sleep accumulate a sleep debt 

that must be paid off by getting the needed sleep. It’s 

mission-critical to make sleep your top priority.

Inadequate sleep impairs these (and other) 

abilities:

• Detecting and appropriately determining 

threat level

• Requesting indirect fire

Sleep and fatigue countermeasures (in order of 

priority):

1. Shift scheduling to maximize the time available to 

sleep for all soldiers.

2. Use sleep bank/sleep recovery before and after 

continuous operations.

3. Use naps short-term to recapture some sleep debt 

and maintain alertness and performance over 

several days.

4. Protect the sleep environment.

5. Judicious use caffeine to improve alertness in the 

short term (but caffeine use doesn’t replace sleep 

debt. Only sleep can replace sleep debt.)

Before Sustained Operations 

• Get at least 7–8 hours of sleep every 24 hours the 

week before the operation so that you start the 

mission with a full sleep bank.
>>>>>[7]

During Sustained Operations 

• If possible, get 7–8 hours of sleep every 24 hours.

• If 7–8 hours is not possible, take naps when 

mission permits to minimize your sleep debt.

• Use caffeine to temporarily sustain mental 

performance until you can obtain sleep.

After Sustained Operations 

• Get extra sleep each day to pay off your sleep debt 

and resupply your sleep bank.

Using Caffeine

Sustained operations (no sleep)

• 200 milligrams (mg) at about midnight

• Take 200 mg again at 0400 and 0800 hours, 

if needed

• Use during daytime (1200, 1600 hours) only 

if needed

Night Ops with Daytime Sleep

• 200 mg at the start of night shift

• 200 mg again 4 hours later

• Last dose: at least 6 hours before sleep period

Restricted Sleep (< 6 hrs)

• Take 200 mg upon awakening

• Take 200 mg again 4 hours later

• No caffeine within 6 hours of lights out

Note: The caffeine doses listed are for people who ingest caffeine in 

amounts similar to 2-3 cups of coffee per day. If you already regularly 

ingest more than this much caffeine, then the ability of caffeine to 

keep you alert will not be as pronounced.
>>>>>[8]

Caffeine sources

50 mg = 1 16-oz. bottle of Coke®

60 mg = 1 squirt (1/2 tsp) MiO® Energy Water Enhancer

60 mg = 1 16-oz. bottle of Diet Coke®

80 mg = 1 8.3-oz. can of RedBull®

100 mg = 1 piece of Stay Alert® chewing gum

160 mg = Monster® Energy Drink

200 mg = 1 tablet of NoDoz®

330 mg = 1 16-oz. Starbucks PikePlace® Roast coffee

Use of trademarked name(s) does not imply 

endorsement by the U.S. Army but is intended only to 

assist in identification of specific products.

Signs of Insufficient Sleep:

• Struggling to stay awake during mission breaks, 

guard duty, or driving

• Difficulty understanding or tracking information

• Attention lapses

• Irritability, decreased initiative/motivation

Overcoming Sleep Distractors:

• Nap as much as possible to get 7-8 hours of sleep 

every 24 hours

• If tactically permitted, use soft foam earplugs and a 

sleep mask or room fan to block noise and light

• Do not use any drugs (prescription or over-thecounter) to help you sleep unless you are taking 

them under the guidance of your healthcare 

provider
>>>>>[9]

Best Sleep Habits:

• Sleep 7-8 hours every 24 hours

• No caffeine within 6 hours of lights out

• Finish PT 3 hours before lights out

• Establish a wind-down routine starting 30–60 

minutes before lights out. Stop using electronics. 

Read or listen to relaxing music instead.

• Empty your bladder just before lights out so the 

need to urinate won’t interrupt your sleep

• Sleep in a safe, quiet place: if tactically permitted, 

use soft foam earplugs or a fan to block sounds; 

use a sleep mask to block light

• Wake up at the same time every day of the week

• If you still have sleep problems 2 weeks after 

correcting your sleep habits, talk to your healthcare 

provider

• Tips for Leaders

» Develop a unit sleep management program that 

gives Soldiers enough time off so they obtain 7-8 

hours to sleep out of every 24

» Soldiers trying to sleep during the day require 

longer (or more frequent) opportunities to sleep 

to compensate for the body’s normal reaction to 

sleep cycle disruption

» Never put your Soldiers in a position where they 

must choose between adequate sleep and other 

important off duty activities (personal hygiene, 

calling home, etc.) They will always sacrifice 

sleep in these situations.

» Arrange sleep schedules that give Soldiers 

opportunities to sleep at a consistent time.
>>>>>[10]

>>>>>[ ] Know the signs of combat and 

operational stress and how to 

manage the reactions.
>>>>>[11]

Combat & Operational Stress and 

Combat Operational Stress Reactions

Combat is more stressful and unpredictable than any 

training. The enemy will try to stress, confuse and 

demoralize you. Security and support operations can 

also involve heavy stress, even without direct combat. 

Mental, emotional, physical and spiritual fitness will 

help you endure the stress of combat and sustained 

military operations. Know the signs of combat and 

operational stress (COS) and how to manage or 

respond to combat operational stress reactions. 

(COSR), including seeking assistance.

Preventive Actions to Combat Stress: for Soldiers

• Try to stay as calm and self-controlled as possible

• Focus on the mission and your lane

• Recognize what is and is not within your control

• Follow SOPs, and Rules of Engagement

• Practice critical thinking - remain resilient

• Breathe deeply and relax

• Know that COS is normal and COSRs manageable

• Keep open communication with your team

• Gather facts and avoid rumors

• Respond, don’t react

• Avoid alcohol and drink plenty of fluids

• Eat well balanced meals

• Maintain personal hygiene

• Practice quick relaxation techniques

• Sleep at least 7-8 hours in each 24 hours, 

if possible

• Attend or request a Critical Incident debrief after 

unusually stressful events
>>>>>[12]

• Share grief and loss with a friend, a leader, or a 

chaplain

• Focus on why you and the Army are here

• Welcome new team members and build cohesion

Preventive Actions for Combat Operational 

Stress: Leaders

• Be decisive and assertive; demonstrate 

competence and fair leadership.

• Preserve Soldiers’ welfare, safety, and health.

• Model self-control, even when feeling strong 

emotions 

• Enforce sleep discipline.

• Optimize sleep opportunities for your Soldiers and 

yourself. A tired leader makes bad decisions and 

bad decisions kill Soldiers.

• Be aware of environmental stressors such as light 

level, temperature, and precipitation.

• Learn the signs of stress in yourself and others.

• Recognize that fear and anxiety are a normal part 

of combat stress.

• Rest minor stress casualties briefly, keeping them 

with their unit.

• Help Soldiers to address any Family concerns, 

separation, or economic problems. Refer as 

necessary

• Provide an upward, downward, and lateral 

information flow of communication.

• Foster open communication with Soldiers.

• Understand that stress in response to threatening 

or uncertain situations is normal and adaptive up to 

a point, (Adaptive Stress).
>>>>>[13]

• Create a spirit to win under stress and change.

• Conduct tough, realistic training.

• Ensure training includes understanding of COS and 

how to deal with it.

• Look for stress signs and a decreased ability to 

tolerate stress in combat.

• Keep Soldiers well supplied with food, water, and 

other essentials, including shelter.

• Provide mail, news, and information avenues.

• Arrange the best medical, logistical, and other 

support available. Know your resources well.

• Maintain high morale, unit identity, and 

esprit de corps.

• Keep unit members together and build cohesion.

• Encourage experienced unit members to mentor 

and teach new members.

• When operationally feasible, protect the sleep 

environment. Ensure your Soldiers have relatively 

quiet and dark sleeping accommodations. 

• Consider removing or restricting electronic devices 

(games, computers) from sleep environments. 
>>>>>[14]

Common Combat & Operational Stress Reaction (COSR)

Physical Emotional

Tension: Aches, pains Anxiety: Keyed up, 

worrying, 

expecting the 

worst

Jumpiness: Easily startled, 

fidgety, trembling

Irritability: Complaining, 

easily bothered

Cold 

sweats:

Dry mouth, pale 

skin, eyes hard to 

focus

Attention: Poor; unable 

to focus or 

remember 

details

Heart: Pounding; may feel 

dizzy or light-headed

Thinking: Unclear; trouble 

communicating, 

distorted 

or irrational 

thinking

Breathing: Rapid; out-of-breath; 

fingers and toes 

start to tingle, cramp 

and go numb

Sleep: Troubled; 

awaken-ed by 

bad dreams

Stomach: Upset: may vomit Grief: Crying for dead 

or wounded

Bowels: Diarrhea or 

constipation

Guilt: Self-blame for 

errors or what 

had to be done

Bladder: Frequent urination, 

urgency

Anger: Feeling let down 

by leaders or 

others in unit

Energy: Tired, drained; takes 

effort to move

Confidence: Low; loss of faith 

in self and unit

Eyes: Distant, haunted 

“1000-yard” stare
>>>>>[15]

Combat & Operational Stress: 

Adaptive Responses Versus Destructive and Illegal Behaviors

Adaptive Stress 

Management, Resiliency 

and Thriving Responses 

Misconduct Stress 

Reactions and Behaviors

• Unit cohesion

• Loyalty to battle buddies 

and leaders

• Identification with unit 

tradition

• Sense of uniqueness

• Sense of mission and 

purpose

• Thriving response and 

Posttraumatic growth 

(PTG)

• Alertness, vigilance and 

focus

• Strength, endurance

• Tolerance to hardship

• Managing pain and injury

• Increased faith and 

patriotism

• Courage, heroic acts or 

selflessness.

• Greater self-awareness, 

compassion and 

empathy

• Wisdom and maturity 

based on responsibility 

and service

• Apathy, hopelessness, 

resignation

• Fraternization

• Excessive sick call

• Alcohol and drug abuse

• Recklessness, 

indiscipline

• Neglecting injuries or 

medical attention

• Shirking, malingering

• Combat refusal

• Self-inflicted wounds

• Going absent without 

leave (AWOL), desertion

• Mutilating enemy dead

• Killing noncombatants

• Torture, brutality

• Killing animals

• Fighting with allies

• Looting, pillage, rape
>>>>>[16]

Management of Combat & Operational 

Stress Behaviors

Combat Operational Stress is inevitable, but Combat 

Operational Stress Reactions and casualties are 

not. Good leadership counts! COSR casualties can 

be restored to duty if rested close to their units and 

treated quickly with a positive expectation of return 

to duty. Use your behavioral health, medical and 

chaplain resources

Keep with battle buddies if:

Symptoms: The amount or type of combat 

operational stress does not endanger the Soldier or 

others or interfere with the current mission

Actions: Reassure of being normal, focus on 

mission, rest, clean up, feed, sleep, and keep on 

duty with battle buddies. Stay in the fight!

Rest in parent or support unit if:

Symptoms: Signs that the Soldier is not too much 

of a risk or burden to stay with his or her own battle 

buddies, but needs a change.

• Section can provide safe, stable environment 

for recovery before COSR develops.

• Soldier is not disruptive or dangerous

• No urgent medical evaluation is needed

Actions: Assign less critical duty in safer areas.
>>>>>[17]

Take to aid station or medical company

Symptoms: Warning signs that the Soldier needs 

medical attention

• Soldier is experiencing COSR, impairing the 

ability to execute the mission

• Soldier is disruptive or potentially dangerous to 

self, others or the mission

• Soldier could need urgent medical treatment for 

illness or injury

• Soldier does not improve following rest, sleep or 

basic care

Actions: 

• Take to aid station, behavioral health provider, or 

medical treatment facility

• Maintain contact or visit Soldier if not returned 

in hours. Consider Combat Stress Control 

Restoration Center

• Welcome Soldier back into unit upon return (65-

85% return to original unit in 1-3 days; 15-20% 

to limited duty in 1-2 weeks)

• Do not tolerate stigmatization. We are trained to 

seek help when necessary

If things start to feel out of control, contact the unit 

sergeant, chaplain, medic, behavioral health or 

commander immediately.
>>>>>[18]

>>>>>[ ] The day-to-day stress of stability and 

support operations (SASOs) can be 

as bad as that of major combat. 
>>>>>[19]

Coping with Stress: Stability 

in Operations

The day-to-day stress of stability and support 

operations (SASOs) can be as bad as that of major 

combat. The danger may be just as high, the mission 

may be unclear, civilians may be hostile, and the 

rules of engagement may be stricter than in combat 

whether the enemy abides by them or not

Threats can be hard to recognize. Steady progress 

is difficult to see. There is boredom, a lack of privacy, 

restricted movement, and separation from home with 

poor communication. Under these conditions, anyone 

can begin to show signs of distress. Knowing how 

you can help yourself, your battle buddies, and your 

subordinates is important.

Learn effective relaxation techniques:

• play cards or sports • talk with friends

• write a letter or keep a diary • read a book

• take slow, deep breaths • work out

• watch an engaging video • imagine a favorite

• continue spiritual growth place

Relaxation techniques can help you refocus in action, 

recharge you after grueling or boring work, and can 

help you get to sleep. Request training on relaxation 

or mindfulness techniques from Behavioral Health or 

Combat Stress Control Teams or Unit Ministry Teams 

in your area.

What to do for yourself:

• Remind yourself that the way you are feeling is 

normal given the situation;
>>>>>[20]

• Make certain that you get enough sleep, food, 

water, and exercise – if you are physically stressed, 

your ability to deal with the day-to-day SASO 

stressors is reduced;

• Focus on the mission at hand – break down 

objectives into smaller tasks and reward yourself 

with rest breaks after each task is accomplished;

• Stay tied in with battle buddies in your unit;

• Maintain contact with friends and Family at home 

whenever you can – if something at home is 

bothering you, talk about it with your battle buddies, 

your leaders, or a provider like the chaplain or 

behavioral health.

• If things start to feel out of control, contact your 

unit sergeant, behavioral health provider, chaplain, 

medic, or commander immediately.

What to do for your battle buddies:

• Know the members of your team and welcome 

newcomers when they arrive—help them learn the 

skills they will need to thrive

• Be on the lookout for sudden changes in how your 

battle buddies act – if you see such a change, ask 

them about it or bring to another’s attention

• Offer encouragement and recognition when your 

battle buddies do something well;

• If you’re concerned for your battle buddies, talk to 

them about how they’re doing;

• If you think that your battle buddy may be having a 

really hard time and won’t talk to you, contact your 

supervisor or a provider and let them know about 

your concern. If suicidal, use the Ask, Care Escort 

(ACE) Model and refer to behavioral health or 

chaplain.
>>>>>[21]

What to do for your subordinates:

• Keep your team informed of new developments as 

they come up but be careful not to pass on rumors 

– say you don’t know and will tell them when you do.

• Be on the lookout for changes in behavior or 

performance and act to address issues before they 

become problems.

• Organize team events to help your Soldiers relax 

and have some fun; give them some private time 

when you can.

• Check in with team members on how they’re 

handling the deployment and how things are going 

back home.

• Be aware that home front stress may be worse 

than combat.

• Talk with any Soldier you are concerned about and 

listen to them.

• Conduct sensing sessions as frequently as 

possible, and make sure Soldiers’ feelings and 

thoughts are expressed and heard.

• Refer Soldiers to unit chaplains, behavioral health 

or Combat Stress Control team assets for help if 

they need it. 

• Encourage Soldiers to direct Family members to 

Social Work Services, Army Community Services, 

Military OneSource, etc., for help. Let your rear 

Command Team know if your family is “at risk.” 

Immediately. Do not allow a family member to 

suffer!
>>>>>[22]

>>>>>[ ] If you see a battle buddy upset, 

fuming or brooding alone, you can

help and should help
>>>>>[23]

Providing Support to Soldiers in 

Distress: Battle Buddies

In any operation, a Soldier can run into rough 

times. Examples of difficult situations include: seeing 

destroyed homes; dead bodies (including children); 

hostile reactions from civilians; being ambushed; 

small arms fire; IEDs; knowing someone is seriously 

injured or killed; long deployments; lack of privacy 

and personal space; separation from Family, family 

problems, difficult communication back home.

The fact is that all of us can sometimes feel down, 

anxious, or angry. If you see a battle buddy upset, 

fuming or self-isolating, you can help your 

battle buddy through what may be a painful and 

sometimes risky time. Emotionally distracted Soldiers 

can endanger the mission, the unit, and themselves. 

Often, just talking, listening, and focusing on their 

strengths and positive beliefs is all that a battle buddy 

needs to find their own answers. Try the following 

suggestions:

1. Be a good friend, talk with your battle buddy 

and find out what’s wrong. Listen and be 

understanding. Be compassionate. Ask 

questions. For example, say, “Something seems 

to be bothering you. How can I help? I can listen 

actively.”

2. Listen and encourage your battle buddy to talk 

about what is bothering him or her. Listen not 

merely to the words, but the feeling and beliefs. 

Stay calm and objective. Maintain vigilance.
>>>>>[24]

3. Don’t criticize or argue with the Soldier’s ideas 

and emotions, but feel free to ask clarifying 

questions such as, “How do you mean that?” 

Encourage your battle buddy to continue to tell you 

what’s wrong. Allow time for your battle buddy 

to find words. Reframe ideas for clarity.

4. Acknowledge your battle buddy’s grievances

against others, but don’t make it worse by agreeing 

without clarifying, or escalating emotion.

5. Ask questions to understand the problem and 

the feelings. If the talking stalls, summarize what 

has been said and ask if you have it right.

6. Don’t give a lot of advice. It is okay to plant the 

seeds of new ideas but don’t drive them in with a 

hammer. Remember you don’t need to have all 

the answers for the Soldier’s problems. Refer to a 

professional like the chaplain or behavioral health.

7. Praise your battle buddy for the work he/she has 

been doing under such difficult circumstances and 

for talking with you.

If your battle buddy gives any hints or clues of 

thinking about suicide, or seriously harming or 

killing someone else, remember your Suicide 

Prevention Training! 

Signs of Potential Suicide: Soldiers will show a wide 

range of behaviors and emotions. Try to recognize the 

behaviors that are different. Be aware of Soldiers who 

suddenly become quiet and show significant change 

of behavior. Other signs to watch for:

• Recent break-up in a relationship

• Excessive use of alcohol or drugs
>>>>>[25]

• Significant financial problems

• Poor work performance

• Recent administrative or legal action

• Appears depressed: sad, tearful, poor sleep, poor 

appetite, hopeless, or numb

• Threatens suicide or speaks of escape

• Unit adjustment difficulties or isolation

• Talks about wanting to die or stop pain

• Deliberately injures self or acts recklessly

What to do if you’re concerned about suicide 

Follow the acronym ACE.

“Ask” your battle buddy: Ask questions that will 

give you a better idea of what your battle buddy is 

thinking. Ask directly if he or she is having suicidal 

thoughts. Ask, “Are you thinking about killing yourself 

or someone else?” or “I see how distressed you are. 

Do you wish you were dead?” or “Have you thought 

of how you would kill yourself?” Your asking will NOT 

cause them to become suicidal.

• Know the warning signs you might see in yourself 

or battle buddy if he or she is suicidal. 

• Look for any outward sign that shows a deviation 

from your battle buddy’s usual self.

• Talk openly about suicide. Be willing to listen 

and allow your battle buddy to express his or 

her feelings.

“Care” for your battle buddy: Care for your battle 

buddy by understanding that your battle buddy may 

be in pain.
>>>>>[26]

• Active listening may produce relief. Calmly control 

the situation: do not use force.

• Take action by removing any lethal means, such as 

weapons or pills. If your battle buddy is armed, say, 

“Let me unload your weapon and keep it safe for 

you while we talk.” Ask a buddy for help if needed.

“Escort” your battle buddy: Escort your battle buddy 

immediately to your chain of command, chaplain, or 

behavioral health professional.

• After your battle buddy has talked as much as he 

or she wants, say, “I need to get you help for this. 

People here can help you.”

• Don’t keep your battle buddy’s suicidal behavior 

a secret. Never agree to keep silence, or counsel if 

not qualified.

• Adopting an attitude that you are going to help your 

battle buddy, one way or another may save his or 

her life.

• Stay with your battle buddy until he or she receives 

appropriate help. Don’t leave your battle buddy 

alone. 

The Army has fielded other professionals for Soldiers 

with such problems. Beyond the immediate NCO and 

Officer leaders, you can encourage the Soldier to 

talk about problems with the following personnel. 

• Unit Medic

• A Chaplain or chaplain assistant

• Battalion Aid Station, medical unit or health 

care provider

• Behavioral Health or Combat Stress Control

• Behavioral Health officers, NCOs, and Combat 

Stress Control teams in your area
>>>>>[27]

Get help immediately! A suicidal person needs 

immediate attention and immediate escort to a 

professional.

For more information, access the Army Suicide 

Prevention Program website at

http://www.armyg1.army.mil/hr/suicide/

In a crisis call the 

National Suicide Prevention Lifeline

1-800-273 TALK (8255)

Press 1 for Military Crisis Line
>>>>>[28]

>>>>>[ ] Emotionally distracted Soldiers 

can endanger the mission, the unit 

and themselves. 
>>>>>[29]

Providing Support to Soldiers 

in Distress: Leaders Guide

In any operation, a Soldier can run into rough 

times. It could be any combination of:

• Seeing destroyed homes, dead bodies (including 

children), destruction, poverty, environmental 

stressors;

• Hostile reactions from civilians;

• Being ambushed, receiving small arms fire, 

improvised explosive devices;

• Knowing or seeing someone killed or seriously 

injured; having close calls; chronic fatigue

• Long deployments; lack of privacy and personal 

space;

• Separation from Family, difficulty communicating or 

interacting with Family members at home.

All of us can feel badly at times. If you see a fellow 

Soldier who is upset, fuming or self-isolating, you 

can help him or her through a painful and sometimes 

risky time. Emotionally distracted Soldiers can 

endanger the mission, the unit and themselves. 

Often, just talking to a friend (or leader) who listens, 

tries to understand, and praises their strengths, is all 

people need to find their own answers. The following 

can be useful ways for a Soldier to help a battle 

buddy: 

1. Be a good friend. For example, say, “Something 

seems to be bothering you. How can I help? I can 

listen without judgment.”
>>>>>[30]

2. Listen attentively and encourage him or her 

to continue telling you what’s wrong. Stay calm 

and objective. Don’t criticize or argue with the 

Soldier’s thoughts and feelings, but listen and allow 

silent time for them to find words. Clarify beliefs.

3. Acknowledge the Soldier’s grievances against 

others, including Command, but don’t amplify 

them by agreeing with them blindly.

4. Ask questions to help you understand the 

problem, the underlying beliefs and feelings. If the 

talking stalls, try to summarize what has been 

said and then ask if you have it right.

5. Delay offering different perspectives or 

practical advice until you believe your Soldier 

knows that you really know the situation and 

understand why he or she is upset. 

6. Plant the seeds of new, adaptive ideas. 

7. Praise the soldier for the work he or she has been 

doing under such difficult circumstances and for 

talking with you.

Sometimes the problems are too big to resolve 

after one talk or without additional outside help. 

Remember the Army deploys trained professionals 

for Soldiers with such problems. Help for Soldiers, 

beyond yourself and other military leaders includes:

• Unit Ministry Teams in the maneuver battalion, 

brigade HQs, and Combat Support Hospitals.

• The primary medical providers in battalion aid 

stations and medical companies should know 

where these helpers are and how to contact them, 

as well as being helpers, too. 
>>>>>[31]

• Behavioral health officers, and technicians, 

NCOs, and specialists at the brigade, division and 

area support medical units.

• Behavioral health officers and enlisted technicians 

in Combat Stress Control teams that cover 

those areas and can come forward to battalions, 

companies and remote outposts.

If the Soldier seems preoccupied with death, hints 

at having thoughts of suicide, or makes threats 

toward others, remember your Suicide Prevention 

Training! 

• Say something like, “I can see that you feel 

distressed.” “Have you thought of hurting yourself 

or someone else?” or, “Do you wish you were 

dead?”

• Then “Have you thought of how you could kill 

yourself?” (or whomever);

• Don’t act shocked or alarmed! Encourage the 

Soldier to talk. They are tracking your responses, 

so remain calm

• If the Soldier is armed, say, “Let me unload your 

weapon and keep it safe for you while we talk.”

• After the Soldier has talked as much as he or 

she wants, say, “I need to get you help for this. 

There are people nearby who can help you.”

• Don’t leave this person alone. Secure any 

weapons. Immediately take the Soldier to your 

chain of command, behavioral health, chaplain, or 

to medical care. Have a battle buddy assist you but 

do not leave alone unless you are at risk.
>>>>>[32]

>>>>>[ ] Deployment can be an emotionally 

difficult time for all Family members
>>>>>[33]

Coping with Deployment Separation: 

Deployed Parents and Caregivers

Separation from a loved one who is deployed can be 

an emotionally difficult time for all Family members. 

Symptoms resulting from separation can include low 

energy levels, feelings of sadness, anger, excitement, 

restlessness, tension, frustration, resentment, and 

depression. Additionally, there are many challenges 

for military Families to overcome during deployments. 

It is important to recognize, understand, and face 

these challenges in order to effectively cope with the 

separation during deployment:

Avoid the pitfalls that are often associated 

with deployments:

• Realize that arguments or detached behavior prior 

to deployment are common. Generally, this is the 

result of stress due to upcoming separation. Try not 

to take them too seriously. 

• Discuss family concerns such as child rearing, 

financial management, or intimacy issues prior to 

deployment. Attempting to resolve disagreements 

around family concerns from long distance can be 

challenging. Seek an intermediary or telephonic 

counselor if needed. 

• Avoid trying to resolve marital issues that precede 

deployments. This is very difficult over long 

distance and is best left until the Soldier 

returns home. Relationship counseling may 

occur individually in theater or back home. Try to 

schedule collateral sessions when you return.
>>>>>[34]

• Understand that dates of departure and return 

often “slip” forwards and backwards. Do not commit 

to a certain date! You will return when you do.

• Avoid listening to or spreading rumors. It is 

best not to repeat the rumor. Because of rapid 

communication, rumors can spread unchecked 

causing great psychological harm to Soldiers and 

Family members. An example of a rumor is one 

Family Readiness Group (FRG) member spreading 

allegations of infidelity about another group 

member. Such rumors cause harm to Soldiers, 

Family members, FRGs, and unit cohesion. 

• It is important to accept change and growth by all 

Family members. It is unrealistic to be reunited 

and expect everything to be the same as before the 

deployment. Be grateful your Family endured your 

absence with honor.

Some general tips to help the spouse and Family 

cope while the Soldier is deployed:

• If disagreements arise, leaving the issue until you 

are face-to-face with your spouse may help. Try to 

avoid fighting via the internet. 

• Establishing and maintaining a support network 

helps the Family cope. Try to avoid negative 

influences at home and while deployed.

• Include breaks in the daily routine. This may 

include weekly get-togethers with other Family 

members and monthly outings for the children to a 

favorite park, restaurant, picnic, etc.
>>>>>[35]

• The parent at home will need time away from the 

children. A regular “Mommy’s or Daddy’s day out” 

is important to maintain sanity.

• Encourage all Family members to share feelings 

and ideas, reassure your partner of your love and 

commitment, and try to see the deployment as a 

challenging opportunity for growth.

• Communication is important between the Soldier 

and Family member. Use all available avenues of 

communication (telephone calls, e-mails, letters, 

social media). It is important to keep in touch; 

however, try to end phone conversations and 

letters on a positive note.

Some general tips for caregivers to help children 

cope while the parent is deployed:

• Be honest with children about their parent’s 

deployment. Share information about the Soldier’s 

work and what the parent is doing for our country. 

Answer questions openly and honestly using words 

your children can understand. 

• Give children a method of measuring the passage 

of time. Provide a calendar to help your child count 

the days the parent has been deployed. 

• Make sure your spouse’s parents are kept informed 

including if they are not adapting. The Soldier’s 

parents share your concerns about the health 

and welfare of their deployed son or daughter. 

Grandparents and spouses can support each 

other during the deployment. as can their religious 

community if applicable.
>>>>>[36]

• Continue to provide a structured, stable and safe 

environment for your children. Children require 

reassurance that they are loved, cared for, and 

safe while the other parent is away. 

• Make sure the deployed parent is part of everyday 

conversations and decisions.

• Help your children sort out what they hear and 

see in news reports. Find out what your children 

know and understand and talk with them about 

their feelings. Follow your child’s lead. Give a small 

piece of information at a time and see how your 

child responds before deciding what to do next.

• Use school and independent counselors who 

understand military mission and separation.

• Provide your children with a way to communicate 

to the deployed parent such as letter writing, 

e-mailing or live video.

• Try to maintain Family routines and traditions 

during the other parent’s absence.

• Keep children involved with outside activities and 

maintain constant communication with schools

• Remember that we all grow through adversity. 

We call this Post-traumatic growth. Expect that 

challenges will make your Family stronger when 

you resolve them.

• Remember that our families allow us to serve our 

countries and serve themselves. Thank them for 

their service.
>>>>>[37]

For more information, access the 

Army Suicide Prevention Program website at

http://www.armyg1.army.mil/hr/suicide/

In a crisis call the National Suicide Prevention Lifeline

1-800-273 TALK (8255)

Press 1 for Military Crisis Line
>>>>>[38]

>>>>>[ ] These techniques and coping skills 

cannot make a horrible and tragic 

event acceptable or easy, but they 

can help you and your teammates 

better cope with the stress in order to 

complete the mission.
>>>>>[39]

Coping with the Injured and the Dead

In combat or disaster situations, you may see, hear, 

smell, and perhaps have to handle injured and dead 

people. They may be men, and women and even 

children. It is not about fairness.

You may be struck with combinations of feelings 

that include pity, horror, repulsion, and anger at the 

senselessness or malice of the event. You may feel 

guilty because you feel you think you should have 

prevented it, for surviving it, or for not helping enough. 

These reactions are a normal part of being human. 

You may initially blame yourself or the U.S.A. It hurts 

most when a victim reminds you of someone you love 

or yourself. Seek assistance to counter beliefs which 

depress you or create apathy.

Keep in mind that these beliefs and emotions are 

typical and confirm your humanity. At times, however, 

you may feel emotionally numb and may use 

“graveyard humor” to make the suffering and deaths 

seem less terrible. Whatever you feel, remember that 

the mission must continue. 

The following are lessons learned by people who 

faced such intense experiences. These tips can help 

you do the mission and transform the memories 

without being haunted by them. 

1. Remember the larger purpose of what you must 

do. You are acting honorably! You are showing 

care, giving hope, and preventing disease for 

the living. You are recovering the bodies for 

registrations and respectful burials.

2. Limit exposure to the stimuli: don’t sightsee; use 

screens, poncho curtains, partitions, covers, body 
>>>>>[40]

bags, and barriers to keep away anyone who 

does not need to see, yet recall others also grow 

by seeing loss as you will.

3. Wear gloves and disposable uniforms if available.

4. Mask odors with disinfectants, deodorants, airfresheners. Save perfumes or aftershaves for 

afterwards. Do not be surprised when odors 

trigger memories.

5. Be compassionate, but AVOID FOCUSING on 

any individual victims, especially those you most 

identify with. Do not focus on personal effects. 

6. Have people who did NOT search the body 

examine the personal materials collected for 

identification of the body or intelligence.

7. Remind yourself the body is not the person, just 

the remains.

8. Keep humor alive, even “graveyard humor” with 

battle buddies who understand it, but don’t get too 

gross or too personal (no picking on each other). 

9. Don’t desecrate or steal from the victims. These 

are punishable crimes and can place you and 

your fellow Soldiers in grave danger.

10. Say silent prayers; ask unit or local ministers to 

conduct memorial services.

11. Schedule frequent breaks; maintain hygiene, drink 

plenty of fluids, and eat good food. Command 

should arrange facilities for washing hands and 

face, and later for showers and fresh clothes. 

12. Have your team get together for mutual support 

and encouragement. Acknowledge horrible 

aspects, but don’t dwell on these memories of 

details.
>>>>>[41]

13. Help battle buddies or subordinates in distress by 

being a good listener. Do not jump in with “off the 

shelf” answers. Do not mistake his/her feelings 

as weakness. Tell them they are normal and 

honorable. Remind them that the mission must go 

on, and the team needs everyone.

14. If forewarned of the mission, prepare yourself for 

what you will see and do; take the supplies and 

equipment mentioned above. 

15. Use Combat Stress Control, chaplains or 

behavioral health professionals.

16. Afterwards, do not feel guilty about having 

distanced yourself mentally from the suffering or 

tragic deaths of individuals. This is adaptive.

17. Do not be disheartened by horrible dreams, 

feeling tense, or intrusive memories. Those are 

normal, and it is better to have them now than to 

suppress them. Do not keep them hidden. Share 

them with your battle buddies, and keep that 

positive humor alive. Seek help as needed.

18. One to three days after exposure, participate in a 

critical event debriefing with trained people from 

your supporting unit ministry, behavioral health or 

combat stress control team.

These techniques and coping skills cannot make a 

horrible and tragic event acceptable or easy, but they 

can help you and your teammates better cope with 

the stress in order to complete the mission. Be proud 

of what you have done, and use what you’ve learned 

to take care of yourself, your battle buddies, and your 

family when you get home.
http://phc.amedd.army.mil

TG 320 SEPTEMBER 2014

Approved for public release,

distribution unlimited

 http://www.armyg1.army.mil/hr/suicide/

For more information:

USAPHC Combat & Operational Stress Control

http://phc.amedd.army.mil/topics/healthyliving/bh/Pages/

CombatOperationalStressControl.aspx 

http://phc.amedd.army.mil/topics/healthyliving/bh/Pages/

CombatOperationalStressControl.aspx

FM 6-22.5 - Combat and Operational Stress Control Manual 

for Leaders And Soldiers

http://armypubs.army.mil/doctrine/DR_pubs/dr_a/pdf/fm6_22x5.pdf 

Army Suicide Prevention Program

http://www.armyg1.army.mil/hr/suicide/

In a crisis, call the National Suicide Prevention Lifeline

1-800-273 TALK (8255)

e Press 1 for Military Crisis Lin