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# 									Key Topics							

Deployment Stress Management Program

## 								In This Section							

        - What is Resilience
        - High Stress Assignment Outbrief
        - Post-Traumatic Stress Disorder
        - Take the Four Question PTSD Screener
        - PTSD Workers’ Comp Claims
        - Do You Need Help?
        - Resources

## What Is Resilience?

Resilience refers to the ability to successfully adapt to stressors, maintaining psychological well-being in the face of adversity. It’s the ability to “bounce back” from difficult experiences. Resilience is not a trait that people either have or don’t have. It involves behaviors, thoughts, and actions that can be learned and developed in everyone.

Resilience is about being adaptable. It’s about being flexible. It’s about recognizing that we’ve got strengths that perhaps we never knew we had until we have to use them. And like many things in life – the more we practice, the more we learn. The more we find out about resilience and certainly the more we do of it, then the more resilient we become.

Resilient people are able to adapt to stress, crises, and trauma. They find ways to bounce back from the ups and downs of life and move forward. Some people are born with a strong sense of resilience. Others may need to learn skills and develop resilience. If you would like to become more resilient, these tips and information can help. Remember that resilience is a skill, like riding a bike. The more you practice, the better you’ll be.

**Ways to become more resilient:**Resilience isn’t about “toughing it out” or reacting to every setback with a smile. Resilient people still feel sad, angry, or frustrated when faced with a setback. But they find ways to move forward, to tackle challenges with creativity, hope, and a positive attitude

**Here are some ways to increase your resilience:**
        - *Maintain a sense of perspective.* Ask yourself, “How big is this problem really?” and “What do I need to do?” Remember not to blow things out of proportion or catastrophize, remind yourself of the good in your life and that things really will change
        - *Recognize that you have a choice in how you handle challenges.*  You can’t control what happens to you, but you can choose how you respond. You can choose to react to changes and problems with hope and a positive attitude.
        - *Accept change* .  Change and uncertainty are part of life. When you accept this, you’ll be better able to react to change with flexibility.
        - *Anticipate challenges*  by focusing on the positive ways in which you can meet them rather than possible negative outcomes. This will help you feel more in control and less overwhelmed.
        - *Learn how to calm yourself.*  When you feel yourself reacting to a challenge with escalating stress and anxiety, take steps to calm yourself (deep breathing, replacing negative thoughts).
        - *Overcome your fear* *.*  All of us feel fear, especially when we’re faced with a change. But fear can hold us back from new experiences and opportunities for growth. If you are faced with a challenge that feels scary or overwhelming, start with the simplest thing you can do that takes you in the direction you want to go. Ask yourself, “What’s the smallest thing I can do to get started?” Once you’ve thought about it, do it.
        - *Let go of your anger* *.*  A difficult challenge can cause us to feel angry and upset. These feelings are normal, but they won’t help us move forward. Work through your anger and try to let go of negative feelings by writing about them or talking with a trusted friend.
        - *Take action.*  Avoid dwelling on problems. Focus on solutions instead. Figure out what you can do and then do it, one step at a time.
        - *Laugh.*  Even when things seem to be falling apart around you, try to find time to smile and laugh. It’s very healing and it will help you forget your worries for a few moments. Rent a movie that makes you laugh or spend time with a friend with a good sense of humor.

## High Stress Assignment Outbrief

In order to support our employees returning from challenging assignments ( i.e., High Threat Environments) , the Foreign Service Institute (FSI) and M/MED are partnering to offer a one-day **High Stress Assignment Outbrief Program, MQ-950**, which, is mandatory for all employees serving 90 days or more in Iraq, Afghanistan, Pakistan, Libya and Yemen. Employees who are TDY have the option of attending an outbrief at their post or when they transfer to an onward assignment.

While mandatory for all employees completing 90 days or more of service in Iraq, Afghanistan, Pakistan, Libya and Yemen, the program is highly recommended for employees returning from other high stress/high threat posts (i.e., Sudan, Lebanon and Haiti) as well. Employees of other agencies are welcome to attend MQ-950.

If an employee cannot possibly attend the regularly scheduled group High Stress Assignment Outbrief Program, MQ-950, an individual meeting High Stress Assignment Outbrief – Special Session, MQ-951 can be arranged by coordinating the individuals’ schedules directly through the Transition Center **or** MHS. Employees may also participate in the Outbrief Program with the Health Unit at their onward, non-CONUS assignment.

**The Outbrief Program can help you:**Understand the challenges of returning from a high stress environment and learn how to share information with your loved ones to ensure the kind of reunion you want and deserve.
        - Identify signs and symptoms of possible psychological reactions, including Depression, Anxiety and Post Traumatic Stress Disorder (PTSD).
        - Locate additional resources if desired.
        - Convey to the State Department the full range of difficulties you encountered.

The Outbrief Program is led by experienced staff from the Mental Health Services (MHS) Office and the Transition Center.

**Where:****High Stress Assignment Outbrief Program, MQ-950**: at the George Shultz National Foreign Affairs Training Center (Foreign Service Institute (FSI) Transition Center) in Arlington, VA.

**High Stress Assignment Outbrief Program – Special Session, MQ-951**: at FSI, the Health Unit at their onward non-CONUS assignment or at the Deployment Stress Management Program (DSMP) offices located in Rosslyn, VA.

**How to schedule:**Contact the Foreign Service Institute Transition Center at **FSITCOutbrief@state.gov**or 703-302-7272.

Contact the Deployment Stress Management Program at **MEDDSMP@state.gov** or Call 703-875-4828.

## Post-Traumatic Stress Disorder

**What is PTSD?**Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can occur following the experience or witnessing of a traumatic event. A traumatic event is a life-threatening event such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adult or childhood. Most survivors of trauma return to normal given over a period of time. However, some people will have stress reactions that do not go away on their own, or may even get worse over time. These individuals may develop PTSD.

**PTSD Symptoms**People with PTSD experience three different categories of symptoms:
        - The first set of symptoms involves reliving the trauma in some way such as becoming upset when confronted with a traumatic reminder or thinking about the trauma when you are trying to do something else.
        - The second set of symptoms involves either staying away from places or people that remind you of the trauma, isolating from other people, or feeling numb.
        - The third set of symptoms includes things such as constantly feeling on guard, irritable, or startling easily.

In addition to the symptoms described above, we now know that there are clear biological changes that are associated with PTSD. PTSD is complicated by the fact that people with PTSD often may develop additional disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. These problems may lead to impairment of the person’s ability to function in socially and may result in work problems, marital/relationship problems and family problems.

**Treatment**PTSD can be treated with psychotherapy (“talk” therapy) such as Cognitive Behavior Therapy (CBT), Prolonged Exposure (PE) Therapy and Eye Movement Desensitization & Reprocessing (EMDR), and medicines such as antidepressants. Early treatment is important and may help reduce long-term symptoms. Unfortunately, many people do not know that they have PTSD or do not seek treatment.

**Do you think you may have PTSD?**If you think you have PTSD there are a number of things you can do. You can also explore the **Web Link Resources**; **Take the Four Question PTSD Screener** or **Do You Need Help** pages. You may also want to be evaluated for PTSD by psychiatrist, psychologist, or clinical social worker specifically trained to assess psychological problems. You could also discuss your symptoms with your doctor. Talk to your doctor about the possible treatments for you.

### Take the Four Question PTSD Screener

The 4-item Primary Care Post-Traumatic Stress Disorder screen (PC-PTSD) is a simple and effective tool to identify symptoms of post-traumatic stress disorder (PTSD). The 4-item screen assesses key characteristics of PTSD.

It is not designed to diagnose but rather to help you identify symptoms of PTSD.

**In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you…**
        - Have had nightmares about it or thought about it when you did not want to?                                         Yes    No
        - Tried hard not to think about it or went out of your way to avoid situations that reminded you of it?   Yes    No
        - Were constantly on guard, watchful, or easily startled?                                                                              Yes    No
        - Felt numb or detached from others, activities, or your surroundings?                                                    Yes    No

If you have answered “yes” to three (3) items or more it is considered “positive” and your screening results are consistent with symptoms of PTSD. As this screening is not a substitute for a clinical evaluation and cannot provide an actual diagnosis, it is recommended that you see a health professional for further assessment/evaluation.

**Resources**

There are many options for assistance. If the screening results suggested the need for further assessment/evaluation:
        - Visit a primary care or mental health care provider.
        - If you are not sure about benefits or don’t have a primary care manager.
        - Contact the Employee Consultation Service at  MEDECS@state.gov  or Call 703-812-2257.
        - Contact the Deployment Stress Management Program at  MEDDSMP@state.gov  or Call 703-875-4828.

### PTSD Workers’ Comp Claims

Employees working in high threat environments such as Afghanistan, Iraq, Pakistan, Libya and Yemen may develop symptoms of Post Traumatic Stress Disorder (PTSD) as a result of their performance of duty.

PTSD may be basis for a workers’ compensation claim under the Federal Employees’ Compensation Act (FECA). The FECA is administered by the U.S. Department of Labor, Office of Workers’ Compensation Programs (OWCP). If an OWCP claim is accepted, benefits may include payment of medical expenses and disability compensation for wage loss.

When an employee develops any mental health symptoms, including symptoms of PTSD, he/she is encouraged to make a confidential appointment with a counselor in the Office of Medical Services (MED)’s Employee Consultation Services (ECS**)**office. If the initial evaluation indicates symptoms suggestive of PTSD, ECS will refer the employee to MED’s Deployment Stress Management Program (DSMP) for further evaluation. A psychiatrist designated by DSMP will document the initial symptoms for the OWCP claim form (CA-2) and CA-20 (Attending Physician’s Statement). If the employee requires assistance in completing the OWCP claims package, **HR’s Office of Casualty Assistance (OCA)** will help the employee gather the required documentation, complete the necessary paperwork, and submit the claims package.

OWCP has advised the Department that PTSD claims will be handled expeditiously. PTSD claims from Department employees have been successfully adjudicated by OWCP in the past. The **Office of Employee Relations (HR/ER)** will remain the point of contact with OWCP. HR/ER will provide consultation, advice and guidance on the OWCP process and on issues regarding the employee’s use of leave (annual, sick, and use of FMLA), disability accommodation options, and benefits. HR/ER will manage the employee’s claim after OWCP receives it and continue in its liaison role with OWCP to meet the employee’s needs.

Some PTSD patients may require treatment by a specialist outside of the Department of State. For such cases, MED/DSMP may refer the employee to an outside provider. MED will cover the initial cost of treatment until OWCP accepts the claim, submitted by the employee through HR, and OWCP will reimburse MED once the claim is accepted. If OWCP does not accept the case as work-related, the employee should submit the medical bills to his/her insurance carrier to reimburse MED for the initial treatment costs. Subsequent treatment costs will be the responsibility of the employee’s health insurance provider.

Throughout this process, the Office of Casualty Assistance (OCA) will assist the employee and his/her family as they adjust to the employee’s medical condition and explore various options affecting their career with the Department. OCA’s role is to assist the employee with paperwork and coordinate with other Department offices as appropriate.

**Workers’ Comp Resources:** (* = Intranet Website)

DoL Workers’ Compensation Program WebsiteOWCP Forms: CA-2CA-2aCA-20DoL’s Publication CA-801

**DoS Office of Casualty Assistance (OCA)*********Tel:** 202-736-4302**DoS Office of Employee Relations (HR/ER)*** **Email:****HRWorkersCompensation@state.gov**

## Do You Need Help?

**When Should I Consider Face-To-Face Counseling?**High Stress Posts affect people in many different ways. Of course, seeking professional counseling is your choice. However, there are conditions that occur in people’s lives when it is best to work with a provider.

**We strongly encourage you to get help and support from a trained mental health professional if you are:**
        - Feeling sad or depressed most of the time for more than one week.
        - Feeling anxious or having distressing thoughts you can’t control most of the time for more than one week.
        - Having continuing difficulty working or meeting your daily responsibilities.
        - Having problems in your relationships, or trouble taking care of your family.
        - Increasing your use of alcohol or misuse prescription medications, street drugs, or using them to cope.
        - Having traumatic stress reactions that are not getting better as time passes.
        - Thinking about hurting or killing yourself.
        - Thinking about hurting or killing someone else.
        - Doing things to hurt yourself, like cutting or burning yourself.
        - You are extremely angry most of the time.
        - Other people are saying they’re concerned about you and think you should talk to someone.
        - You are having trouble sleeping most of the time.
        - You are experiencing changes in appetite (significant increase or decrease), most of the time or you’ve lost significant weight without meaning to.

**If you are feeling suicidal or homicidal**, it’s URGENT that you let someone know. You should seek help immediately by calling 911 or going to the closest emergency room or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). If you are overseas you should seek help immediately by calling or visit the health unit, your doctor or visit or call the Military Crisis Line or a local Suicide Hotline.

**It doesn’t have to be an emergency for you to benefit** from talking with a professional. Professionals who have training and expertise in working with military personnel and those deployed to the combat environment can help you with several things:
        - Learn to manage your feelings and thoughts more effectively.
        - Learn to feel more comfortable talking to people in your daily life.
        - Learn to pursue goals that are important to you.
        - Learn to focus on the future.

**Some reactions are very common** in the first week or two following a traumatic event and, do not require in-person consultation with a counselor. Initially you may difficulties with normal activities and responsibilities, avoidance of situations, nervousness, or sleeping problems. If there is no improvement after the first weeks following a stressful or traumatic event, then face-to-face counseling should be strongly considered.

**You may also want to consider counseling if:**
        - The people close to you are not able to support you the way you need them to.
        - You are isolated or without close family or friends.
        - The traumatic experience feels so personal or sensitive (such as rape, assault, domestic violence, loss of a buddy, friendly-fire related incident) that you don’t feel comfortable or safe talking with anyone you may know.

**Remember…**Seeking counseling is not a sign of weakness; seeking support is a sign of strength. Talking to a counselor can improve your ability to help yourself.

**If you’re not sure whether to seek counseling**

Make an appointment for a consultation. This is not a contract for services. You can meet with a therapist and discuss if the services are right for you at this time. Remember that “shopping around” for a counselor is a perfectly acceptable thing to do; in fact many people recommend it.

**State Department Resources**

**Deployment Stress Management Program**(M/MED/MHS/DSMP)Office of Medical Services1800 North Kent StreetArlington (Rosslyn), VA 22209**Tel**: 703-875-4828**Fax**: 703-875-4952**Email**: **MEDDSMP@state.gov****Intranet Website**

**Employee Consultation Service**(M/MED/ECS)Office of Medical Services1800 North Kent StreetArlington (Rosslyn), VA 22209**Tel**: 703-812-2257**Fax**: 703-875-4952Email: **MEDECS@state.gov**

Global Community Liaison Office (M/GTM/GCLO)HST Building, Room 2133(202) 647-1076, or (800) 440-0397Email: **GCLO@state.gov**Internet Website: Global Community Liaison Office

## Resources

**Department of State Resources Web Links** (* = Department of State Intranet Access Required)
        - Alcohol and Drug Awareness Program (ADAP)*
        - Deployment Stress Management Program*
        - Employee Consultation Service (ECS)*
        - Global Community Liaison Office
        - **FSI Transition Center**
        - **Medical Clearances**
        - Office of Casualty Assistance (OCA)*
        - Unaccompanied Personnel Support Page (FSI Transition Center)*
        - USAID LCSW Social Worker and Staff Care*
        - USAID Mental Wellbeing Services for USAID Community*
        - Worker’s Compensation Program*

**Post-Traumatic Stress Disorder Web Links**
        - AfterDeployment.org
        - Center for the Study of Traumatic Stress
        - Deployment Health Clinical Center
        - International Society for Traumatic Stress Studies
        - National Center for PTSD
        - National Child Traumatic Stress Network
        - National Institute of Mental Health

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