transition workbook for combat veterans - Navy Medicine - Navy.mil

Loading...

POSTDEPLOYMENT USER GUIDE

TRANSITION WORKBOOK FOR COMBAT VETERANS

CREATED BY Valerie A. Stander, PhD Heidi S. Kraft, PhD Linda Xiong, MPH Gerald E. Larson, PhD

CONTRIBUTORS Alphabetical List of Major CONTRIBUTORS

Angela B. Anderson, Esq. Donald Bal, 1stSgt, USMC

POSTDEPLOYMENT USER GUIDE

TRANSITION WORKBOOK FOR COMBAT VETERANS

Jim Bauman, PhD Christopher W. Dyslin, PhD Rebekah W. Francis, Esq. Evan C. Johnson, MA Wayne Jones, LtCol, USMC George Mangual, MSW Courtney A. May, MS Joel S. Milner, PhD Joanne Piedra, LCSW Todd C. Sander, CDR, MSC, USN Kenneth J. Thompson, MLA, LtCol, USMC (Ret.) Cynthia J. Thomsen, PhD Nathan Woellhof, Capt, USMC

Naval Health Research Center 140 Sylvester Road San Diego, CA 92106-3521

The development of this workbook was made possible through US Congressional support.

ACKNOWLEDGMENTS

Sincere appreciation is expressed to the US Marine Corps and US Navy personnel who assisted in reviewing the content for this guide. We further acknowledge the exceptional Department of Defense photography in many of the images used throughout this book (www.defenselink.mil/multimedia). The views expressed here are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government. Correspondence concerning this workbook should be addressed to Dr. Valerie Stander, Behavioral Science and Epidemiology, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521, e-mail: valerie. [email protected]

We hope this workbook is useful to you, and we would appreciate your recommendations for improving it. You can e-mail us your comments or suggestions at [email protected] Also, we would specifically like to know: 1. Overall, how helpful was this workbook to you on a scale from 1–10? (1, not all helpful; 10, completely helpful).

SEND YOUR COMMENTS

2. How likely are you to recommend any of the information in this workbook to a friend or colleague? (1, never would; 10, already have) 3. What sections or activities were most helpful? 4. Do any sections or activities need improvement? 5. Other comments:



The 7 months I spent in Iraq were the best and worst of my life. People who have been there understand that. Although the horrible experiences were really bad, there was something comforting about the simplicity of our jobs there. We knew exactly what we were there to do, and no one questioned us about it. We put blinders on, we did our jobs. It was black and white. Simple…. Sometimes I miss that. 1



For some time now, you have been on a mission. That mission has been the driving force in your life. It provided meaning and direction for you on a daily basis. Coming home and leaving that behind can be difficult. While you were away, there were probably people and things at home that you kept in mind, and they were meaningful to you as well. But now they need to become the daily meaning and focus for your life, once again.

i

INTRO

While you were deployed––for half a year, a year, or more––the thought of finally being able to go back home probably helped you get through difficult times. It was something to look forward to, which is very important. Going home may have felt like the light at the end of the tunnel. However, one of the mistakes we often make is to think of returning home as “going back.” Especially when you have been deployed for a long time, you are not “going back.” You are “going forward.” You may return to new circumstances in your life. You may return to family and friends who have changed. You too may be changed. You are returning to a new life you must create. Transitions can be challenging. This program is a returning veteran’s self-help guide to support you through this transition. The primary purposes of this guide are, first, to help you take advantage of unique opportunities you might have in this moment. You can use this transition as a stepping stone in your life. Second, as a combat veteran you are a role model, and many people will look up to you. This guide suggests ways that you can maximize your positive influence on others. Third, this guide can help you deal with the challenges and reduce the stresses that frequently come with any transition. Although there are many things you cannot completely control in life, there are always things you can do to improve your overall happiness and general well-being. This book includes information on a broad variety of topics that affect everyone. The demands of all of these aspects of life must be managed jointly and balanced for overall wellness. Stress in one area can make things difficult in many others, because these aspects of life are all connected. As you return from deployment, this book can hopefully be useful in regaining or maintaining that sense of overall balance in your life.

HOW TO USE THIS BOOK

This workbook was not written to be read from cover to cover. It was designed to be used as a reference book. The following paragraphs briefly describe each of the chapters to help you decide which of them might be helpful to you. Read through these paragraphs and then look at the chapters that seem most related to your life right now. This book can be something you come back to later when you are interested in other topics. It can also give you information about how to support other Marines or Sailors who may be going through difficult times.

Setting Goals While you were deployed, you were dedicated to a mission directed by your chain of command, with little opportunity to focus on yourself. Now you have to jump into another life with new personal priorities. What should you work toward? How should you manage your time? One important purpose of this book is to help you make new plans in important areas of your life. Each chapter includes a menu of activities that might be helpful to you right now. The information in the goal-setting chapter can help you create a workable plan to complete any of the activities in this book or to work toward other goals you may set.

Personal Growth How have you grown as a result of your deployment? A transition is a moment of opportunity when it may be easier to redefine who you are than at other times in your life. This chapter is an invitation to assess your strengths and review the skills you may have gained or improved during deployment. It includes activities to help you think about how you might use your strengths more often and more effectively.

Personal Thoughts The way you think about your life can have a very powerful effect on how you feel. This chapter discusses some ways your habits of thought may be influencing your life. The activities in this chapter are designed to help you think about and document your own successes and focus on positive things in your life. The chapter also includes an activity to help you challenge unhelpful self-talk that you may not now recognize.

ii

Personal Relationships While you were deployed you relied on people from your unit for friendship, recreation, and personal support. It can be very helpful when you return home to maintain those relationships. However, you also need to take conscious steps to reinvest your time and emotions in friends and family at home. This chapter addresses some ways that you can reconnect with your family and friends. It suggests ways you can manage the anger and frustration that you may experience in reaction to the stress of returning home so that these feelings do not create problems in your relationships.

Mental Health Your mental health is heavily influenced by many other aspects of your life including your personal thoughts, feelings, physical health, substance use, and relationships. In fact, all of the chapters and activities in this book are intended to be helpful in improving your life and your sense of general wellbeing. However, the chapter on mental health in particular includes some activities and tips to help you deal with uncomfortable feelings or reactions to your combat experiences and to help you feel more relaxed.

III

Grief and Guilt Returning veterans are often dealing with difficult losses, and grieving can be a lifelong journey. This chapter explains some typical feelings and emotional stages that people go through in reaction to a serious loss such as death, injury, divorce, or job loss, and it discusses some things you can do that might help you move through the stages of grief. The chapter also includes an activity to help you think through and challenge any feelings of guilt or blame you might hold against yourself for things that happened during your deployment.

Recreation and Relaxation Having more fun and playing more often may not seem like something you need to consciously practice. However, recreation is a critical component of personal well-being. It is also key in building relationships with others and becoming a well-rounded person. The purpose of this chapter is to remind you to do things regularly that you enjoy and find relaxing and recreational. It also encourages you to consider how your recreational interests might have changed as a result of your deployment.

Physical Health Most military people have relatively good physical health habits. However, it may seem harder to stay in good shape at home than it was while you were deployed. To help you stay on top of your game, this chapter reviews dietary guidelines for an active

lifestyle and for optimal mental health. It recommends focusing on form in your workout and improving the effectiveness of your stretching and cool down. Finally, it provides guidelines for good sleep habits, particularly if you are having trouble sleeping regularly.

Substance Use People use different substances for various purposes. These might include over-the-counter medications for pain or alcohol for recreation and socialization. They might be prescriptions for specific health conditions. These substances can be miraculously helpful when used correctly, but they can destroy lives when abused. This chapter lists guidelines and strategies for using substances, particularly alcohol, responsibly. It also lists information on being a role model and a part of the solution in helping others who may be having a problem.

Personal Finance Good financial management can relieve a lot of stress and give you peace of mind for the future. Financial stability also can ease burdens on family relationships. This chapter offers some basic advice about managing your finances. The chapter encourages you to think about your financial goals and make plans for your money. Finally, if you are not used to budgeting, this chapter includes three simple activities to help you get started.

Career As you return from deployment, you may be deciding whether to remain in the service or not. You may be deciding whether to continue in your current occupational specialty. Within the military environment, it may feel like there are many limits on your choices and opportunities. However, whether your future career is military or civilian, there are always choices you can make that will improve your morale and work satisfaction. This chapter discusses some simple things you can do to make work more meaningful and enjoyable.

Legal Affairs If you are on active duty and have access to free legal assistance, you should always seek help with any legal matter. At the very least, all of us will sign a number of binding legal documents throughout our lives, from home mortgages or rental agreements to marriage licenses. Getting good advice and guidance on important legal decisions such as these is a must. This chapter lists some practical information about how and when to seek assistance.

TABLE OF CONTENTS

Introduction.......................................................................................i How To Use This Guide......................................................................ii

CHAPTERS Setting Goals....................................................................................1 Mental Health.................................................................................45 Grief and Guilt................................................................................56 Recreation.....................................................................................67 Physical Health...............................................................................75 Substance Use...............................................................................87 Finance........................................................................................102 Career..........................................................................................114 Legal Affairs..................................................................................121 Charting Forms.............................................................................129 References...................................................................................134

iV

1

SETTING GOALS



It’s just goals, lifetime goals that will allow you to look toward the future, not what I went through and what’s going on now. I have educational goals. I have financial goals. There are places I want to visit. I think if we allow ourselves to look to the future, you can see yourself in the future and I guess devise a plan in order to meet these 2 goals. It will eventually take you out of your combat mindset.





How much success do you want? Many athletes achieve some success without using formal goal setting, but virtually every great 3 athlete who consistently wins uses some form of goal setting.



The second quote above is from a manual written by the United States Olympic Committee’s Sports Psychology Team. This chapter borrows specifically from the recommendations given to Olympic athletes about setting goals. The team advises Olympic athletes that “using goal setting is as necessary as having a coach.”3 As a returning veteran, you are no stranger to setting and achieving goals, even if you are not someone who thinks about goals a lot. In theater you accomplished some of the most difficult and important goals of your life. In fact, you may feel like you were never better and never more successful than during the time you were deployed. For many veterans, deployment has been the peak experience of life so far. Now that you are home, the assignments you have in garrison may not seem nearly as important or exciting. You may be thinking about what you are going to do next in your personal life, and that may not seem as exciting as combat either. You may feel that combat has changed the way you look at life and maybe even what you want out of life. Many of these changes are likely to be positive. For instance, you may feel more confident to take on a goal that you would not have attempted before. It is also possible that life presents you with a whole different picture now. If you were gone for a very long time, if a lot changed in your life while you were away, or if you were seriously injured in combat, you may be creating a whole new identity––a whole new set of dreams and plans. The more your life has changed recently, the more challenging it may be to focus on setting new goals. Furthermore, if you are redeploying soon, you may feel like it is difficult to accomplish very much right now. It is important to realize that these very challenges make it all the more important to choose your goals carefully. It is important to decide where you want this transition to take you. Your goals can help take your life to a new level of success. They can also help you change course if you have decided you do not like your current heading. Just the process of working toward an important goal can change how you feel about your life during this time of transition. One important objective of this book is to help you choose and set goals in important areas of your life. Each chapter includes activities that might be useful to you right now in your transition home. The following facts and exercises are intended to help you complete any of the goal activities in this guide. They also can help you with other goals that you may set.

2

FACTS ABOUT GOALS

3-6

• Effective goals change your behavior. Great hopes and good intentions are useless if you do not take action. • You are more likely to take action if you have a clear plan for exactly what you will do and exactly when you will do it.

• You are more likely to take action if you focus on the little goals rather than the big ones. You must break your long-range goals down into specific, short-term tasks.

• You are more likely to take action if your goals are doable, but still challenging. If your goal is too hard, you will get discouraged. If it is too easy, you will become bored.

• You are more likely to complete goals that you want to accomplish rather than goals that other people think you should accomplish.

3

• It is important to set goals that match the resources and personal strengths that you have. Working with your best strengths will be the most productive.

• Goals focused on accomplishing specific tasks, improving relationships, building character, or finding meaning and spirituality will most likely promote well-being. Goals such as avoiding problems, being better than others, or controlling other people are generally unsatisfying and difficult to accomplish.

• There are times you may think you would like to change your basic personality. Some core aspects

of your personality will be very difficult to change, and in the long run they are important to who you are. Other things such as personal habits, investment in important relationships, education, and personal attitudes or thoughts will be much more controllable, and improving these will be more helpful to your general well-being.

• Flexibility is important. It is better to adjust or switch your goals and then feel excited about them than to halfheartedly work toward something you do not really want to do.

ACTIVITIES

3-7

SET A SHORT-TERM GOAL. Sometimes it can be difficult to make your daily habits and tasks support your long-term goals. Answer the following questions and think about what short-term goals you might want to set that could better help you work toward your overall plans.

1. What is one long-term goal you have right now, or one way that you would like your life to be different right now? Make sure that this goal is something doable, but important to you. ________________________________________________________________________________________________ ________________________________________________________________________________________________ 2. What are three things that you may need to do in order for this goal to become a reality? (a) _____________________________________________________________________________________________ (b) _____________________________________________________________________________________________ (c) _____________________________________________________________________________________________ 3. Which of these three things do you think makes the most sense to work on first? ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 4. What could you do in the next 6 months to work on this? ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 5. What could you do in the next month to work on this? ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 6. What could you do in the next week to work on this? ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________

4

MAKE A PLAN. In the following table write the short-term goal or task you chose to accomplish in question 6 of the “Set a Short-Term Goal” activity on the previous page. Make sure you are as specific as you can be about what you want to do. Then list the steps you will take to accomplish this. For each step, make sure you include specific times to do things (eg, before or after specific events during the day, at certain times on certain days of the week, or on specific dates at certain times). Next write out exactly what you will do at those times. You can go to the supplement at the end of this chapter for examples of goal plans.

Goal Definition My goal is to: __________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

Goal Plan 5

Step

Time and Place

Action

1.

________________________________

________________________________________________________



________________________________

________________________________________________________

2.

________________________________

________________________________________________________



________________________________

________________________________________________________

3.

________________________________

________________________________________________________



________________________________

________________________________________________________

4.

________________________________

________________________________________________________



________________________________

________________________________________________________

5.

________________________________

________________________________________________________



________________________________

________________________________________________________

TROUBLESHOOT. Imagine what the biggest challenges might be that would

prevent you from following your goal plan. What may get in the way? What may tempt you to quit? In the first column below, write at least three challenges that could interrupt your plan. Next, see if you can think of one or two possible solutions for each of those challenges. Write the solutions in the second column. The supplemental materials at the end of this chapter include examples of troubleshooting for two types of action plans.

Goal Troubleshooting Challenge 1: ____________________________________

Solution 1: __________________________________________

_______________________________________________

____________________________________________________

_______________________________________________

____________________________________________________

Challenge 2: ____________________________________

Solution 2: __________________________________________

_______________________________________________

____________________________________________________

_______________________________________________

____________________________________________________

Challenge 3: ____________________________________

Solution 3: __________________________________________

_______________________________________________

____________________________________________________

_______________________________________________

____________________________________________________

6

REWARD YOURSELF. Decide ahead of time on some reward you will give

yourself for sticking to your goal plan. For example, you could try dropping a quarter or a dollar (why not five dollars?) in a jar each time you do something on your goal plan. Better still, talk your spouse or a good friend into donating the quarters! After a preset amount of time working toward your goal or after you have finished your goal depending on what will work best, take yourself out to dinner.

What will you do? Each time I complete a step on my goal plan, I will reward myself by: _________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ When I miss a step on my goal plan, the consequence will be: _________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

7

How will you keep track? In planning your rewards, it can be helpful to have a way of tracking your progress toward your goal. You can use the goal charts in the appendix to keep track of your progress if those are helpful to you. Alternatively, if you are putting quarters in a jar, you can choose to reward yourself whenever you reach a certain amount of money. However you do it, as you chart your progress, remember: 1. Your progress will have some ups and downs. You should expect this to happen. 2. Dropping back to baseline at some point or having a particularly bad stretch does not mean you have to start again. It just means you may need to add some more challenges and solutions to your troubleshooting plan and then keep going. 3. Plan some celebrations along the way. What benchmarks may be particularly important? Try to include other people in your celebrations. Share your successes.

Copeland ME. (2002). Developing a recovery and wellness lifestyle. http://mentalhealth.samhsa.gov/publications/allpubs/SMA-3718/default.asp.

ONLINE RESOURCES

Pychyl TA. (2008). Goal progress and happiness. http://www.psychologytoday.com/blog/dont-delay/200806/goal-progress-andhappiness. Pychyl TA. (2008). Procrastination: A strategy for change. http://www.psychologytoday.com/blog/dont-delay/200804/procrastinationstrategy-change

SUPPLEMENT

GOAL ACTION PLAN EXAMPLES. The following

are examples of goal plans for two different types of goals. The first example shows a possible plan of action to accomplish a specific task. The second suggests a plan of action to develop a new habit.

ACCOMPLISHING A TASK

Goal Definition My goal is to be supportive of the family of a Marine in my unit who was KIA (killed in action) by bringing them a card and some pictures of their son/daughter in theater.

Goal Plan Step

Time and Place



Action

1.

This Friday when I have a short workday

Buy a card with a large envelope. Print out some pictures I have of my colleague and write a brief note about my memories of him/her on the back of each picture.

2.

Sunday evening after dinner

Call the family of this Marine and introduce myself. Schedule a time to stop by the next weekend.

3.

Monday morning

Bring my pictures in and ask some other work colleagues who knew him/her if they have any pictures of the Marine that they could add.

4.

Collect any pictures other people want to contribute and put them into the envelope with the card. Give people a chance to sign the card.

Friday at work

5.

Drive to visit the family and give them the card.

At time of scheduled appointment

Goal Troubleshooting Challenge 1 If the thought that what I am doing is not really that important crosses my mind



Solution 1 Then I will remind myself of how much their son/ daughter meant to this family

8

GETTING INTO A HABIT

Goal Definition My goal is to give my children at least 1 hour per day of my undivided attention.

Goal Plan

9

Step Time and Place

Action

1.

Right now

Set an alarm on my cell phone to go off every weeknight at 7:00 PM.

2.

Weeknights an hour before bedtime (7:00 PM)

I will read to my kids from their favorite books or play some games with them before they have to go to bed.

3.

Friday night at 7:00 PM

I will ask my kids to choose an activity they would like to do together on Saturday and schedule it on our weekend calendar.

4.

Saturday at prescheduled time on calendar

Take my kids out to do the activity we have planned.

5.

Sunday at 4:00 PM

Help my kids make dessert for dinner.

Goal Troubleshooting Challenge 1



Solution 1

If I have to be out of town for work

Then I will still call the kids at 7:00 PM to talk

Challenge 2

Solution 2

If I am engrossed in a TV show after dinner and I do not want to miss it

Then I will record the show and watch it later

Challenge 3

Solution 3

If the kids do not have their homework done by 7:00 PM

Then I will help them finish their schoolwork instead of reading or playing

PERSONAL GROWTH

10



For some, it [deployment] is the most important thing they’ve ever done. It’s the defining moment of their life and their Marine Corps career. 8 ‘That’s the best I’ve ever been.’





There is a validation of your ability. You’ve been practicing the game, but now you’ve done it and held your own. You gain a degree of confidence in that. 9 There’s a degree of satisfaction in that. I now know I can face the fire.



It is very likely that you improved or developed new skills while you were deployed. In the aftermath of combat, returning veterans often report positive changes in themselves.10, 11 Many say they have gained a greater sense of personal strength. For instance, while you were away, you may have experienced life at a much more intense level. That may have given you an increased sense of experience, maturity, or confidence. Your deployment also may have given you a greater sense of competence, decisiveness, or independence. Returning veterans have also reported a fresh focus on their relationships.10 You may have come to value your close friends and family more than you did before. Your priorities in life may be clearer. You may have become confident that you can rely on others to have your back, and you may have learned the importance of relying on others in a tough situation. You may also have come to a stronger sense of your own thoughts and feelings and that may make you feel more ready to share who you are with others.

11

Some veterans further notice that deployment helped them to develop a vision of new goals and possibilities for their lives, a new sense of spirituality, or a greater appreciation of the value of life.10 Again, you may notice some of these changes in yourself. You may find you are ready to take advantage of opportunities in your path, and deployment may have opened up doors to options that were not open to you before. You may feel more motivated to make every day of your life count and have a stronger sense of your own values and beliefs. As you adjust to life at home, you must continue to rely on the strengths that have carried you so far. You may find yourself in very different situations, but your greatest strengths can still play an important role in helping you to overcome obstacles and get you where you want to go. What are your best strengths and talents, and what goals will they be most helpful in achieving? How can you continue to use the abilities you tapped into and developed on the battlefield? This chapter focuses on the choice of which strengths and skills you want to rely on in different situations. What abilities do you have that may help you on the stretch of road ahead?

FACTS ABOUT PERSONAL GROWTH

4, 12, 13

• Character strengths are basic building blocks of your personality. Character strengths such as honesty, courage, or creativity can be helpful both to you and others.

• Talents are abilities that you have developed over the years. Your character strengths have aided you in building your talents. Talents may include managerial skills, musical ability, or social charisma.

• You are likely to be more successful whenever you are able to put your best foot forward. It is important to identify your greatest character strengths and then look for ways to use them in all areas of your life.

• Knowing when and where to use each of your character strengths is like being a great musician. You have to figure out which keys to play and when to play them to create the melody you want.

• It is important to know which of your strengths work well together. Like a great coach, you need to know which of them are team players and which of them will just compete with one other.

• It is important to figure out the best way to use your strengths in each situation. As every great comedian knows, it is all in the delivery.

12

ASSESSMENTS

VIA SURVEY OF CHARACTER14 The following table lists important character strengths. Which of these do you believe are strengths for you? To explore your own personal strengths, we encourage you to complete the VIA Survey of Character online at http://www.viasurvey.org/.14 Once you have completed that online measure, write your top five strengths in the following spaces.

Creativity

Social intelligence

Humor

Curiosity

Fairness

Spirituality

Open-mindedness

Leadership

Perspective (wisdom)

Love of learning

Forgiveness

Integrity (honest/genuine)

Bravery

Humility

Vitality (enthusiasm/energy)

Persistence

Appreciation of beauty

Citizenship (teamwork/loyalty)

Love

Gratitude

Prudence (careful/discretion)

Kindness

Hope

Self-regulation (self-control)

13

Strength 1: __________________________________________________ Strength 2: __________________________________________________ Strength 3: __________________________________________________ Strength 4: __________________________________________________ Strength 5: __________________________________________________

Deployment and Modified Post-Traumatic Growth Inventory10, 11, 15 Underline each of the following statements that are true for you because of your deployment. Then write down the top three ways your life improved because of your deployment.

Personal Development

Relationships

I I I I I

I more clearly see that I can count on people in times of trouble. I have a greater sense of closeness with others. I am more willing to express my emotions. I have more compassion for others. I better accept needing others. I put more effort into my relationships.

know I can better handle difficulties. have a greater feeling of self-reliance. am better able to accept the way things work out. have discovered I am stronger than I thought I was. have greater courage in the face of fear.

I have more confidence in my wisdom and judgment in a difficult situation. I have a greater feeling of independence. I have a greater sense of self-discipline. I am more reliable and dependable.

I learned a great deal about how wonderful people are. I am better able to work together with others. I value my friends and family more.

New Meanings

New Possibilities

I have a better understanding of spiritual matters. I have a stronger religious faith.

I established a new path for my life.

I have a broader perspective, a better sense of the big picture. I can better appreciate each day. I have more pride in being an American.

I am able to do better things with my life. I developed new interests. New opportunities are available that would not have been otherwise. I am more likely to try to change things that need changing.

I changed my priorities about what is important in life. I have a greater appreciation for the value of my own life.

Growth Area 1: __________________________________________________ Growth Area 2: __________________________________________________ Growth Area 3: __________________________________________________

14

ACTIVITIES

4, 10, 12, 13, 16

WHAT CHANGED YOU? Can you think of specific things that happened to you during deployment that helped you to grow in each of the following areas? You should at least write one experience down for each of the top three growth areas you listed at the end of the deployment growth assessment on the previous page. If you have not already done this assessment, you should do so before you complete this exercise.

PERSONAL DEVELOPMENT (eg, maturity, confidence, competence, decisiveness, independence, and assertiveness) ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

RELATIONSHIPS 15

(eg, valuing relationships more, greater respect for others, better understanding and empathy, better able to express thoughts and feelings, believing others will be there for you, and feeling it is okay to need help sometimes) ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

NEW MEANINGS (eg, stronger sense of moral values, greater faith, sense of meaning in life, valuing your own life, enjoying the moment, living life to the fullest, and better priorities in life) ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

NEW POSSIBILITIES (eg, ready to take advantage of opportunities, change in goals, and deployment opened new doors to you) ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

Share Your Deployment Successes. As a veteran, you have

successfully experienced challenges that many people cannot imagine. Keeping a record of your successes, and even difficult experiences that changed you for the better, can help you maintain that growth and change. It also can be helpful to others. People who have never experienced combat can come to understand, at least to some degree, what that was like for you. You can help them understand the new insights you learned through your experiences. You are the only one who can share your successes. Take the time to do it.

You could write your story down in a journal or type it up on a computer and give it to your friends and family to read. You could also use an Internet networking site such as MySpace17 or Facebook18 to share your experiences with friends, family, and members of your deployment unit. If you choose to use the Internet, make sure that you alone have control over what is posted there and that you control who can access the site. There are plenty of news stories and blogs about the controversial and the negative but never enough about the positive.19

16

TAKE STOCK. If you have not already done the VIA Survey of Character14

described in the beginning of this chapter, you should do it before you complete this activity. In this exercise you will explore how you may expand the ways you use your most important character strengths in your life. You can complete any of the following modules that you believe will help you explore this.

WHAT WORKS WHEN? When do you find that each of your strengths is most useful in your life? Choose a specific character strength from your top 5 VIA Survey strengths and describe at least one recent incident when you found it helpful. First, describe the context briefly. Then try to be specific about what you did that made use of your strength. Then explain how that strategy made a difference in the situation.

Character strength: ____________________________________________________________________________________ Context: ______________________________________________________________________________________________

17 Actions: ______________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Benefits: ______________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

A SHORT QUIZ Ask yourself the following questions about your personal strengths. 1. Is there a character strength that you identified using the VIA Survey that surprised you? Why do you think you did not recognize it in yourself before? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 2. Is there a particular character strength that did not quite make your top 5 on the VIA Survey that you believe is also a very important strength for you? Which of the VIA character strengths would you add to your top 5? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

18 3. If someone asked you to describe yourself, which of your strengths would come to mind first? Is there a certain strength you have that is a particularly important aspect of your personal identity? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 4. Are there times in the past that you did not use a particular strength when it may have helped? What held you back from showing this part of who you are in that situation? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 5. Is there a particular character strength that you would like to use more in your life? What opportunities may give you the best chance to do that in the near future? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

ROLE MODELS Sometimes it may be tempting to see others who have similar character strengths as competitors. However, they are really your best resource. The people you admire can help you improve yourself. Who do you know who has similar character strengths to your own? Choose one of your top 5 VIA character strengths and see if you can write down the name of at least one person you admire for this characteristic. Next, think about the times that you have been most impressed or inspired by his/her use of this strength. Describe one particular incident when you were impressed by his/her actions. What did he/she do? When did he/she do it? Try to be specific. Then, how may you adapt that person’s approach so that it fits your personality and your circumstances? Can you think of a particular time, place, or situation that you deal with regularly or that may be coming up in the near future when you could adopt a similar strategy? See if you can write down at least one specific time when this would be possible. Strength area ____ : ____________________________________________________________________________________ Name of role model: ___________________________________________________________________________________ Context: ______________________________________________________________________________________________ Actions: ______________________________________________________________________________________________ ______________________________________________________________________________________________________

19 ______________________________________________________________________________________________________ Adaptation for you: _____________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Future application: _____________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

American Psychological Association Practice Organization. (2008). Posttraumatic Growth Inventory. http://www.apapractice.org/apo/public/resilience/ presentation/ptgi.html.

ONLINE RESOURCES

Gallup Incorporated. (2007). Clifton Strengths Finder 2.0. http://sf2. strengthsfinder.com/. Manuel D. and Rhoda Mayerson Foundation. (2008). VIA Institute on Character. http://www.viastrengths.org/. Monster Worldwide Inc. (2009). MILblogging.com. http://www.milblogging.com/ listingDetail.php?id=1551.

PERSONAL THOUGHTS

20



I worked with a Marine who had a serious head injury in combat and afterwards he was really hard on himself about the fact that he didn’t make a full recovery. He told me, ‘It’s unacceptable to me to be anything other than what I was.’ He tried really hard to get back to his infantry unit, but he was ultimately transferred to a Wounded Warrior Battalion. One day, we were talking and out the window we saw a young Marine, an amputee with a prosthetic leg, doing wind sprints across a track. I said, ‘Do you think that Marine out there is going to be one of your Marines now in the Wounded Warrior Battalion? Do you think that Marine might come to you and tell you he is grieving for what he used to be? What would you tell him?’ He said, ‘I’d 1 tell him he’ll never be what he used to be but he’ll be better.’





These are experiences that are going to cause me to live life to the fullest…. I now realize how precious my life is and my family. I turned the negative experiences into opportunities to feel grateful for what I have.

21



9

Your mind is constantly moving. There is never a moment when you are actually not thinking of anything. There may be moments your thoughts seem trivial as you are choosing a brand of cereal or playing a mindless game. But the apparently trivial can be important, like the thoughts crossing your mind after you spill your milk at the morning breakfast table or your hopes as you check your watch for the time at the end of a morning run. These simple thoughts add themselves up to create your life story. You are telling yourself that story every minute of every day. Add them all up and you will find yourself somewhere between the lines of the biography you did not realize you were writing. But how often do you pay attention to the dialogue or the script of the story in your head? The truth is that the choices you make in explaining your own actions and the events of your life affect how you feel about the past, how you feel about yourself in the present, and how you look toward the future.20 The activities in this chapter are designed to help you choose what you want to focus on and the attitudes you want to have about your life. In particular, they can help you document your successes and appreciate the important things in your life. The chapter also includes an activity to help you challenge some self-defeating thought patterns that you may have without being very aware of them.

FACTS ABOUT THINKING STYLES

4, 21, 22

• Positive thinking can be learned, and it will improve your happiness and well-being. • Contrary to what you may believe, many people do not take enough responsibility for their achievements and successes in life. At the same time, they take too much responsibility for bad things that happen.

• When faced with a risk, the possible consequences of failure may loom larger in your mind than the possible benefits of success.

• Remember, you are more resilient than you may believe. If things do not work out as you hope, your plan B may actually end up being better than plan A.

• What you do not have may always seem a little more obvious than what you do have. Regularly taking the time to thank yourself and others for things you do have can help you refocus.

• Having high expectations of yourself can be a strength, unless you take it to the point of perfectionism, and criticize yourself every time you do not live up to your standards or you become extremely competitive with others.

• Life is complex. When making sense of it in your own mind, avoid black and white thinking (eg, deployment was bad for me, I do not like that person, I can or cannot do this or that). In everything and everyone, you will find good, bad, strength, and weakness.

• Living in the past is useless if you are focusing on regrets. But thinking of the past is helpful if you are remembering good times or reviewing your successes.

• It is important to look forward toward good things coming up in the future. They are always there.

22

CREATE A PRIVATE RESUME.

ACTIVITIES

4, 20-24

You can create a resume to document your personal successes and strengths in more aspects of your life than just your career. Going through this exercise may help you think of things you should add to your professional resume. However, it will certainly help you to remember and focus on your personal achievements. As you face new challenges, it is important to keep past successes in mind. Thinking about your success stories also can help you in shaping your goals and identifying your best talents and skills.

This should be a collection over your whole life. You can simply write things down as you think of them, or you could actually get a container to hold important documents and objects, such as certificates, trophies, letters of appreciation, pictures of events, or things you have made. As you collect, think in the following broad areas or beyond: 1. What awards or accomplishments did you receive both before and after entering the military? 2. Do you have any thank-you notes or letters of appreciation to include? 3. Are there choices you have made in your life that you believe have been particularly important, changing your life for the better? 4. What personal goals have you accomplished that you are glad about?

23

5. Are there things you have done that you believe family members or friends have particularly appreciated? 6. What recognitions have you received for service to others in your community? 7. In what ways are you kind or helpful to others? 8. What mental or physical abilities do you have that you feel are above average? (Complete the personal growth chapter assessments for help here.) 9. Do you have a particular personality trait or skill that others admire or enjoy? 10. You should also include brief descriptions or pictures of times in your life that have been particularly positive and enjoyable.

START A THANK-YOU LIST. You can use a thank-you list to focus on the positive as well as to improve your relationships. Make an effort to acknowledge what others do for you. Try to work on your list once a week or at least every 2 weeks. In keeping your list, make sure that you keep track of (a) facts about your life that make you happy, (b) good things that happen in the world or around you that you can bring up in conversations, and (c) favors and small or large acts of kindness for which you can specifically thank someone.

24

ARGUE WITH YOURSELF. In the middle of a battle, if the enemy started

dropping leaflets from the air telling you that you were completely outnumbered, you could not possibly succeed, and the best thing you could do was surrender now, what would you do? You may have no trouble arguing with discouraging or critical comments and suggestions when they come from the enemy. But unfortunately, when they come from within yourself, you may not even question them. That is when you become your own worst enemy.

Why would you think you were always correct, justified, and trustworthy in your judgments of yourself? Many people are not always consciously aware of their self-critical thoughts. This exercise is designed to help you become more aware of what you tell yourself, especially when the going gets tough. It also is designed to give you some ideas of alternative arguments you could learn to use to combat your own self-defeating thoughts.

WARNING: watch out for these three traps: It’s all my fault! (personalizing) It’s my fault all the time! (overgeneralizing) It’s always going to be my fault! (fortune-telling)

25

DOCUMENT Carry a notebook with you for a week. When you find that you are feeling discouraged or unsuccessful at something, pull out your notebook and write down your immediate thoughts. You could use the following format as a guide for each entry. Date: ___________ Time of day: ___________

Situation: _____________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

Thoughts: _____________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

REVIEW At the end of the week, choose the event that was most upsetting. Use the following matching worksheet and the definitions on the next two pages to evaluate your thoughts about the event. First, write the three main thoughts you had about the situation on the left. Then draw a line to connect each thought to the thinking style(s) they each seem most like on the right. Circle each of these thinking styles. Thought 1: ______________________________________________________ _______________________________________________________________ _______________________________________________________________ Thought 2: ______________________________________________________ _______________________________________________________________ _______________________________________________________________ Thought 3: ______________________________________________________ _______________________________________________________________

Personalizing Overgeneralizing Fortune-telling All-or-nothing thinking Filtering Mind reading Disqualifying Magnifying Emotional reasoning Obligating Labeling Comparing

_______________________________________________________________

STRATEGIZE Finally, for each style of thought you circled, take a look at the alternative arguments suggested on the next two pages. Using these suggestions, think of some statements you can use to argue with yourself the next time you find yourself thinking that way again. Use the following spaces to write down the alternative arguments you choose.

Argument 1: ___________________________________________________________________________________________ ______________________________________________________________________________________________________ Argument 2: ___________________________________________________________________________________________ ______________________________________________________________________________________________________ Argument 3: ___________________________________________________________________________________________ ______________________________________________________________________________________________________

26

27

Style of Thought

Alternative Argument

Personalizing: Blaming yourself completely for problems. You see yourself as primarily responsible rather than considering the impact of the situation, chance events, or other people’s actions.

Contextualizing: Acknowledge to yourself that many things have contributed to this problem. Think of everything that may have played a role, including others’ actions, chance events, the time of day, and what happened yesterday.

Overgeneralizing: Seeing problems in all aspects of your life that are your fault. You ignore examples of your own success and focus on only those instances that fit your “pattern of failure.”

Specifying: Think through times you have been able to successfully handle challenges. Recognize that there are many times when you are capable and successful.

Fortune-telling: Believing your problems will never get better, and they will always be your fault. You will never be able to change or improve your situation. Furthermore, you know all about Murphy’s law. Anything that can go wrong will.

Delimiting: Acknowledge to yourself that the circumstances that created this problem are unique. They will never occur again exactly like this. There may be similarities in challenges that come up in the future, but what you have learned now can help you deal with those future challenges.

All-or-nothing thinking: Frequently using words such as always and never. Judging your own successes and failures in terms of all or nothing. Things either turned out exactly as you wanted or you totally blew it.

Balancing: Realistically estimate what percentage of the situation is going poorly and what is still okay. Force yourself to acknowledge what you have done well despite what you could have done better.

Filtering: Focusing mostly on the negative aspects of the situation even though there may be many good things about it as well.

Problem solving: Try not to focus on the things that are going wrong. Instead, focus on the opportunities you have to make the situation better.

Mind reading: Worrying about the hidden reasons why people say what they say and do what they do. You immediately assume, for example, that they are thinking poorly of you without even asking them for clarification.

Trusting: Accept what other people tell you about why they do what they do. Do not second guess them. If you are really concerned about what they are thinking, ask them about it.

Disqualifying: Discounting your successes and others’ encouragement or compliments and finding a way to interpret even these good things in a negative light.

Appreciating: Take time to think about your successes and value them. Remind yourself of your strengths and talents.

Style of Thought

Alternative Argument

Magnifying: Noticing every little mistake or problem and overestimating their importance. Small problems or criticisms really affect your feelings and you worry about them a lot.

Perspective taking: Go over all of the positive facts about the situation in your mind. You may have some challenges, but you can deal with them.

Emotional reasoning: Judging things based on how you feel, not on the facts. Even though everything appears fine, if you are feeling worried, then there must be a problem.

Grounding: Remind yourself of the facts of the situation. Consider whether there may be any factors that have nothing to do with the situation that are influencing your feelings.

Obligating: Feeling obligated to live up to a lot of “shoulds.” These may be things you believe you need to do or they may be things you believe other people expect you to live up to.

Gauging: Be flexible and recognize that perfection is not the goal. Remember that your best is good enough.

Labeling: Quickly judging and labeling yourself in a negative way (eg, personal name-calling).

Acknowledging: Think of all the different things about yourself that a single label could never capture. Remind yourself how inaccurate and unfair it is to pigeon-hole anyone like that.

Comparing: Measuring how well you are doing by comparing yourself with other people you know. Thinking about how much better they are at everything in comparison with you.

Admiring: If you know someone else who is good at handling problems, admire them for that. Think about what you have learned from them and how that can help you deal with things. Self-respecting: Only compete against yourself. Think of ways you have been able to handle problems better now than you have in the past.

Beck Institute for Cognitive Therapy and Research. (2008). For consumers. http://www.beckinstitute.org/FolderID/223/SessionID/a/PageVars/Library/ InfoManage/Guide.htm.

ONLINE RESOURCES

British Broadcasting Corporation. (2008). The happiness formula. http://news. bbc.co.uk/1/hi/programmes/happiness_formula/. Livingston GS. (2009). Optimism. http://www.psychologytoday.com/blog/ lifelines/200907/optimism. The Trustees of the University of Pennsylvania. (2008). Authentic Happiness. http://www.authentichappiness.sas.upenn.edu/Default.aspx.

28

29

PERSONAL RELATIONSHIPS



You tend to have such a tight bond with other Marines when you are deployed and you lose that when you come back to the states. You lose that relationship with everyone as you come back including spouse and children, because as you come back you feel detached from them. You feel detached from the rest of the world. No one can 2 understand what’s going on in my head.



Americans seem more concerned about who will win the latest reality TV show than they are about the soldiers in Iraq. ‘It seems like the majority of the population doesn’t give a darn. We’ve got men and women overseas dying. See, Americans have always been blessed, they’ve never experienced war on the homeland.…’ Soldiers who do make an effort to interact with civilians after they return are often faced with questions such as, ‘Did you kill anyone over there?’ or 25 ‘Did you ever get shot at?’



Most people would probably say that their closest relationships provide them with the most important meaning in their lives. Although your contributions at work may make the world a safer place for everyone, and this is monumental, the meaning you get from this effort may not surpass the importance of having a loving spouse or good friends. You may have made important new friendships during your deployment. Still, your time away may have taken a great toll on family and friends at home. Some common issues veterans experience in relating to friends and acquaintances once they return home include feeling annoyed, irritated, or angry at people’s opinions of the war or their shallow priorities (eg, shopping, TV, or the latest celebrity gossip). It may be hard to feel understood, and even when civilians try to understand or learn about your experiences they may ask all the wrong questions. When you find it hard to connect with others, it may seem easier to avoid them. Ultimately, you may simply not want to be around very many people. Avoiding family members may not be possible, but relating to them may still be a challenge.26, 27 You may feel detached from them. In fact, you may find it hard to understand emotions such as love or caring. You may lose interest in sex. Anger may be the safest emotion to feel for a while, and that creates its own problems. You may feel like you are in a maze trying to figure out how to fit in now that your spouse has grown more independent and changed household routines. Your children are not used to talking to you anymore and may be shy or afraid around you. Your family and close friends may also be feeling confused about how to relate. They may be trying to figure out why your interests and hobbies have changed, why you do not trust them enough to talk about what happened while you were away, or what you are feeling now. They may be wondering why you cannot sit still and relax. You may be feeling guilty about the fact that they feel shut out of your life and even more guilty for feeling distant from them in the first place. This chapter addresses some ways that you can gradually get to know your family and your friends (and yourself) again. It describes ways for you to reinvest in important relationships and resolve problems that may come up as you readjust to being home. It also focuses on how you can prevent your own anger or frustration from creating additional problems.

30

FACTS ABOUT RELATIONSHIPS

4

• Make your relationships a priority. People can maintain a healthy level of happiness under many challenging circumstances if they have good relationships.

• Relationships with family, friends, and coworkers are all important. None of these types of relationships should be underestimated.

• Quality is more important than quantity. Most people do not actually need to make more close friends. Too many relationships may even spread you too thin. Most of us just need to invest more in the important relationships we already have.

• It is important to actively plan ways to invest in and maintain your relationships. • Relationships where you are primarily helping others (your own children or other family members, volunteer 31

organizations, or church) can lead to a high level of fulfillment and happiness.

• Anger can help motivate you to take action, raise your energy to deal with problems, and help you

act decisively in a crisis. However, it can also lead you to act rashly, get into fights, and even hurt yourself or others. If you think your anger may be causing serious problems for you in your work or personal relationships, or you are afraid you may hurt yourself or someone else, you need to seek professional help.

ASSESSMENTS

A TRUE TEST OF YOUR COURAGE Choose someone you trust, someone who knows you as well as anybody, and who will be honest with you. Ask them to answer the following questions for you. 1. What has been the best event or experience for you since I came home from deployment? ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 2. What is the best thing about having me home from deployment? ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 3. Are there questions you have wanted to ask me since I came home from deployment that you have not asked yet? ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 4. Since I have been home from deployment, is there anything I have done that has really surprised you? ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 5. Since I have been home from deployment, is there anything I have done that has really worried or bothered you? ________________________________________________________________________________________________ ________________________________________________________________________________________________

32

IMPORTANT SIGNS YOU SHOULD SEEK OUTSIDE HELP28 Since you returned from deployment, are any of the following statements true for you? There are problems I would like to talk about that I cannot share with anyone I know.

It is possible that I may purposely hurt or injure someone.

It seems like I am always getting into arguments or fights.

I have made plans to purposely hurt or injure someone I know.

My children, spouse, or closest friends are afraid of me.

I have purposely destroyed or damaged another person’s property or belongings.

Sometimes I think that I may hurt someone.

I have purposefully hurt my child or someone else’s, causing a mark/bruise or injury.

I have threatened to hurt a child with something more than a spanking.

I have purposely hurt a romantic partner, family member, neighbor, friend, colleague, acquaintance, or stranger.

I have threatened to hurt a romantic partner, family member, neighbor, friend, colleague, acquaintance, or stranger.

33 If you honestly must agree with any of these statements, YOU SHOULD CONSULT A HEALTH CARE PROFESSIONAL.

TAKE YOUR TIME. When you come home from

ACTIVITIES

4, 23, 26, 29, 30

deployment, you know you cannot expect everything to be like it used to be with your family and friends. You know it will take some time to reinvent your relationships. While you are taking your time, here are a few things you may do:

1. Make sure you talk to each of your family members and close friends one-on-one. Do not take it for granted that they will come to you. You should go to them. 2. If you are married or in a serious relationship, take a day or two off and spend some quality time together involved in activities you both enjoy. 3. Make the effort to try and explain how you are feeling to your family and closest friends. Especially, try to tell them how they can be most helpful and supportive to you right now. 4. Choose some stories about your deployment that you believe you would be comfortable sharing with your family or closest friends. Make the opportunity to share those stories. 5. Remember to compliment and encourage your family and friends for positive things they have accomplished while you were gone. 6. Be sure to thank your family and friends for the ways they have been supportive of you. 7. Be flexible. You will probably need to adjust your expectations and your role in the lives of your family and friends.

34

BE PROACTIVE. As you came home, family, friends, and acquaintances all have

taken time to tell you how glad they are you are back and how proud they are of what you have done. Most of this has probably been very welcome. You also may have been offended by things friends, family, or acquaintances have said to you about your service or the war. They may not know that they irritated or offended you. If they do know, they may not understand why. You may look back on how you handled the situation and feel you did the best you could under the circumstances; then again, you may wish you had done something differently.

MOST MEANINGFUL MOMENTS List the three things that people have done to welcome you home that meant the most to you. If you have not already thanked your loved ones for what they have done, write down one thing you could do to thank them. Event 1: ______________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Thank you: ____________________________________________________________________________________________

35 Event 2: ______________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Thank you: ____________________________________________________________________________________________

Event 3: ______________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Thank you: ____________________________________________________________________________________________

MOST OFFENSIVE MOMENTS List the three things that people have done that have bothered you the most. Try to be specific about exactly what happened––include both their actions and your reactions. Next, try to describe why each of these events was a problem for you; why did each incident offend you? Finally, compare what you actually did with what you wish you had done. Write down what you would like to do the next time this type of thing happens or what you would like to do to prevent it from happening again in the future. If this event occurred with a close friend or family member, sharing the thoughts you have written down in this exercise may help them to better understand what happened Event 1: ______________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Problem: ______________________________________________________________________________________________ Solution: ______________________________________________________________________________________________

Event 2: ______________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Problem: ______________________________________________________________________________________________ Solution: ______________________________________________________________________________________________

Event 3: ______________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Problem: ______________________________________________________________________________________________ Solution: ______________________________________________________________________________________________

36

GIVE SERVICE. One great way to invest in relationships is to think of ways you

can help out. As a returning veteran, there are a number of new skills and insights that you can contribute. You are a community leader now. You are a role model, and it is important for you to be a visible role model.

Some of the service you could do may be informal among friends and family. This service can be the hardest to accomplish because sometimes people will ask for help and other times they will not. When they ask, it makes your task much easier. Now you know what will be useful. Other times you have to simply listen carefully to others as you go through the day, keeping your goal in mind. As you hear needs that people express, you may see if an offer of help is accepted. If it is not openly accepted, it may be best to look for other opportunities. Helping can be a delicate matter in personal relationships. Some service can be done in formal ways. In every community there are opportunities to get involved in volunteer work. This is also a great way to get to know new people. A few opportunities that may be particularly suited to veterans and your unique skills and leadership abilities as a role model may include community disaster planning teams, fundraising through athletic events, Special Olympics, Habitat for Humanity, Thousand Smiles Foundation, etc. In some cases, it may work well for you to invite other veterans to work with you on community service projects. Some web sites for volunteer opportunities are highlighted in the Online Resources later in this chapter.

37

KEEP AN ANGER DIARY. There are a number of ways that anger can be

helpful, especially in a war zone. While you were deployed you may have relied on your anger to give you the energy and focus to accomplish your mission. Now that you are home, however, you may still find that you get frustrated easily, which can lead to anger. You may still be keyed up and have a hard time sleeping or relaxing. People may not seem to understand you or you may not understand them anymore. Although anger is a normal and natural emotion, uncontrolled anger can be a serious problem in personal relationships.

In this exercise, you will track your anger for a week. The idea is to become more aware of the types of situations that trigger your anger and the types of feelings and sensations you have as you begin to get angry. In other words, this exercise will help you better understand your cycle of anger. Create a new entry and answer the following questions each time you get angry.

1. What was the date and time of the incident? ____________________________________________________________ 2. What was the triggering event or circumstance? _________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

3. What feelings, sensations, and automatic actions did you notice in yourself as you became angry (eg, feeling hot, heart rate going up, breathing faster, muscle tension, stomach knots, finger tapping, or eye twitching). ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

4. How angry did you get? mild frustration

serious threat/use of violence

1

7

2

3

4

5

6

8

9

10

5. Approximately how long did you stay angry? _____________________________________________________________ 6. What did you do in reaction to the situation and your anger? ______________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

38

LEARN SHORT-TERM ANGER MANAGEMENT. This activity guides you

through some ways to deal with anger. Completing the anger diary activity first could help you with the following steps. It may help you recognize more quickly that you are getting angry, understand the types of events that make you most angry, and think about what you could say or do in those situations. This activity has separate modules dealing with thoughts, feelings, and actions.

Short-term anger management is designed for use in the moment you find yourself getting angry. If you find you are frequently angry and you need a more long-term strategy to cope with the problem, you can seek professional assistance for anger management through your local Navy Family Service Centers or Marine Corps Community Services. You can also try the meditation and systematic relaxation techniques in the Mental Health chapter. Practicing these types of techniques regularly can help you reduce your overall level of anger and frustration.

COUNT TO 10 As soon as you identify that you are getting angry, the first step is to take some time and try to rethink the situation. Take some slow deep breaths and try to think of some alternative conclusions. Count each alternative and try to come up with 10. Some possibilities are:

39

1. Under other circumstances, I would probably really like this person. 2. This is just a bad day, it will all look different tomorrow. 3. This situation would be hard for anyone. 4. How much do I really care about this? I really want to forget it and do something else. 5. Just because this person is a jerk does not mean I want to be one. 6. It is not personal; we are all just tired and out of patience. 7. This person is not trying to hurt me; he/she just does not know how to handle the situation any better. 8. My relationship with this person is worth more than this stupid argument. 9. The most important thing is not justice, it is the kind of person I want to be. 10. I am not going to give this person the satisfaction of pushing my buttons.

COUNTERACT YOUR FEELINGS Consciously pay attention to any changes in your emotions and in your body that you are experiencing. Directly try to counteract some of these. For example, if you typically find that your shoulder muscles get tense when you are angry, try to relax those muscles. If you often find yourself clenching and unclenching your hands, try to do something else with them (fold your hands, doodle with a pencil). If you breathe faster when you are angry, try taking deeper and slower breaths. One of the best ways to counteract your feelings is to practice meditative breathing. For example, if you practice meditating during routine tasks as described in the Mental Health chapter, then when you find yourself becoming angry you can slow down your movements, focus on your breath, and apply that meditative skill in the moment.

40

COME UP WITH ONE-LINERS You can decide ahead of time what you will do and say when you get angry. If you are angry with someone you have an important relationship with, learning some assertive problem solving may be important as well (see the Assertive Communication activity at the end of this chapter). However, if the problem really is not that critical or the person you are angry at is not someone you need to deal with often, you may simply need a way to get yourself out of the confrontation. You may try making yourself a list of one-liners to use in just those types of situations. You should think of things that would work with different people such as store clerks, coworkers, friends, and family. The following are a few ideas to start you off. There is also space for you to add your own ideas to the list.

1. I am sure we can work this out. Can we meet in the middle somewhere? 2. Okay, this day has just been too long for all of us. 3. It is not that big of a deal to me, I am happy to go along. 4. Okay, I’ll think about this; we can talk about it later. 5. This is all new to me. I will have to think about it. 6. I know, I really hate this situation; I am sorry about it.

41

7. I had no idea you felt this way. I can see how you feel now. 8. I do not know what to do; let us just go on for now. 9. ___________________________________________________________________________________________________ 10. __________________________________________________________________________________________________ 11. __________________________________________________________________________________________________ 12. __________________________________________________________________________________________________

TAKE A BREAK When you are very angry, sometimes it can be helpful to walk away for a while. Putting a little distance between you and the other person can help you figure out what you really think, what is really important, and how you really want to handle things. Following are some things that you can do ahead of time to make it easier to take a break when you need one. Also, there is a brief set of steps to follow when you actually take a break.

Preparation 1. Use the anger diary activity to identify signs that may tell you that a break would be helpful. How were you feeling and what were you thinking as you were getting angry? How can you recognize when you are feeling and thinking that way again in the future and use that as a cue to take a break? 2. What types of situations do you think are most likely to make you angry in the future? Again, you may consider the events in your anger diary for suggestions. Do you think you could plan ahead to take a break in similar types of situations?

3. Is there a particular person you are very likely to feel angry around? If so, talk with that person at a time when you are not feeling angry and explain to him/her that you want to try taking a break should a big problem arise. Discuss the instructions for taking a break outlined below and adjust them to fit the two of you. 4. Plan ahead where you will go and what you will do during a break. Do not plan to drive or to use alcohol or other substances. Some good options include exercise or any of the systematic relaxation or meditation activities from the chapter on Mental Health. Make sure it is something that helps you calm down. 5. Before the two of you get back together, think about the most important thing you need to accomplish to solve your problem. How important is it to you to keep this relationship healthy? What do you stand to lose or gain in the situation? How will this problem affect your life in a week, a month, or a year?

In the moment 6. Recognize the thoughts and feelings you are having that tell you that a break would be helpful now. 7. Tell the person you are with that you are getting too angry and that you need to take a break. If the two of you have agreed on a signal or a specific statement to use when you need a break, use that. Tell him/her specifically the amount of time you need. You may have agreed on a length of time beforehand (eg, a half hour, 2 hours, or 24 hours). 8. Take your break. Follow the plan you have set for yourself ahead of time. 9. Return in the amount of time you specified. 10. Ask yourself and the other person if you are both comfortable talking at that point. If either of you still does not feel ready or able to work on the problem, agree on another time to discuss it. 11. If either of you feels this topic is too difficult to discuss without a third party, you should seek outside help. In particular, if you are afraid for your safety or his/her safety, or you suspect that things may get physical at all, you should seek professional assistance.

42

USE ASSERTIVE COMMUNICATION. Sometimes you can take care of problems with important people ahead of time so you can avoid angry fights altogether. It is important to be able to communicate effectively when you have a problem rather than ignoring your feelings or avoiding the issue, which can make things worse. Consider the following rules.

1. Tell him/her the topic you would like to discuss and schedule a time to do it. 2. Make sure you think through the problem thoroughly yourself before you have the discussion. That way you can be prepared to clearly communicate your position. • Observations: What exactly is going on? Try to think of very specific objective examples of things that have happened to illustrate the problem. • Feelings: How do you feel about the problem? Are you angry, sad, or frustrated? Now take this process a step further: how do you feel about how you feel? Do you feel justified in your feelings? Do you feel embarrassed you feel that way? Are you surprised by your feelings? • Desires: What do you want? How would you like to see the problem resolved? Try to be very specific about what you would do and what the other person would do to solve it.

43

• Intentions: What is the most practical thing to do? What compromise would work the best in your opinion, and what actions can you take to accomplish this? 3. Take responsibility for your own thoughts and feelings. One good way to do this is to use “I” statements: “I know that you have rescheduled our vacation several times.” “I feel frustrated by this because I wanted to go earlier in the summer, long before school starts or my family comes to visit.” “I would still like to try to go soon.” “I can get a little extra time off from work this month so we can take an extra weekend, and I have some time to make some reservations.” These “I” statements clearly explain the speaker’s observations, feelings, desires, and intentions. They are much more likely to be effective than a “You” statement: “You have been really inconsiderate in putting your summer plans before our family!” 4. Set a goal to stay calm during the conversation. If you are very worried about how hard it will be to remain calm or respectful, you may try having the conversation in a public place such as a park or restaurant. You could also plan some break times into the conversation before you start. 5. Set a goal to focus on what is most important: solving the problem in a way that makes both of you happy. Do not be distracted by other goals such as being right or getting even. 6. Do not purposely push buttons. In every good relationship, both partners usually know what will really upset the other person. In addition to those unique hot spots, it is always critical to stay away from yelling, swearing, insulting, or threatening.

ONLINE RESOURCES Service opportunities are bolded.

American Cancer Society. (2008). Volunteers. http://www.cancer.org/docroot/EMP/EMP_2_Volunteers. asp?sitearea=EMP&level=1. American Academy of Pediatrics. (2009). Support for military children & adolescents. http://www.aap.org/sections/ uniformedservices/deployment/videos.html. American Psychological Association. (2008). Controlling anger – before it controls you. http://www.apa.org/topics/ controlanger.html. American Psychological Association. (2003). Resilience for kids and teens: A guide for parents and teachers. http://www. apahelpcenter.org/featuredtopics/feature.php?id=39. American Red Cross. (2008). Help now: Volunteer. Retrieved http://www.redcross.org/donate/volunteer/. Copeland ME. (2002). Making and keeping friends: A self-help guide. http://mentalhealth.samhsa.gov/publications/ allpubs/SMA-3716/default.asp. Department of Defense. (2009). Military OneSource. http://www.militaryonesource.com/skins/MOS/home.aspx. Habitat for Humanity International. (2008). Habitat for Humanity. http://www.habitat.org/. Hearts Toward Home International. (2009). Hearts Toward Home. http://www.heartstowardhome.com/index.htm. International Association of Chiefs of Police. (2008). Volunteers in Police Service. http://www. policevolunteers.org/. Leukemia & Lymphoma Society. (2008). How to help. http://www.leukemia-lymphoma.org/all_toplevel. adp?item_id=4189. Marine Corps Community Services. (2009). Family Life. http://www.usmc-mccs.org/family/. Military Child Education Coalition. (2009). Militarychild.org. http://www.militarychild.org/. NASAR. (2008). National Association for Search and Rescue. http://www.nasar.org/nasar/. Navy Installations Command. (2009). The Navy Fleet and Family Support Center. http://www.nffsp.org/skins/nffsp/ home.aspx. Sesame Street Workshop. (2006). Talk, listen, connect: Deployments, homecomings, changes. http://www. sesameworkshop.org/tlc/. Special Olympics. (2008). SpecialOlympics.org. http://www.specialolympics.org/ Special+Olympics+Public+Website/default.htm. Texas Council on Family Violence. (2008). National Domestic Violence Hotline. http://www.ndvh.org/. Thousand Smiles Foundation. (2008). TheSmileTrain. http://www.thousandsmiles.org/. Uniformed Services University of the Health Sciences. (2007). Courage to Care Campaign. http://www.usuhs.mil/psy/ courage.html. US Federal Government. (2008). USA Freedom Corps. http://www.usafreedomcorps.gov/.

44

45

MENTAL HEALTH



Marine Lt Col Michael Zacchea, 38, who trained Iraqi troops and was in about 100 firefights, knows [the] paranoia all too well. ‘Every time I get on the road,’ says Zacchea, who commutes from Long Island to Wall Street, ‘it’s like I’m back in the streets of Baghdad in combat, driving and running gun battles, with people throwing 31 grenades at me.’





I don’t feel like I really have any big problems, but hyperawareness is magnified when you come back. You are constantly looking for things to do. You are hyperactive all the time. You can’t just sit around on Sunday. I have to make tasks for myself to do all 32 the time.



During a time of adjustment it is very common to have unexpected feelings. You may miss people and things from your deployment you never thought you would miss. You may have assumed you would be very happy and relieved to be back, and it may be a surprise to find that returning home was not the big release you had hoped it would be. You may have to deal with stressful problems in your personal life that were on hold while you were gone. Now you have to worry about many different things at once, for example, bills, rent, work, and obligations to family and friends. While deployed, the tasks of your life were much more specific and focused. Many returning veterans also report feeling constantly “amped,” unable to relax, having trouble sleeping, or feeling jumpy or easily startled.26 It is common to feel angry more often or to get angry faster with less cause. Many find they are particularly annoyed by shallow people who do not understand what deployment was like and take life for granted. Some veterans find themselves avoiding people, even their close friends and family. It may actually be hard to feel close or loving toward others. It could be hard to get in touch with your feelings at all, enjoy things you used to enjoy, or concentrate on things. Finally, you may want to avoid reminders of the war such as news coverage, especially when it does not seem to accurately show your experience. At the same time, it may be hard not to remember things that happened. It may seem like you are too often reminded of events or images that you would rather forget. This may seem like a long list, but all of these reactions are common. This chapter, and this entire guide, include many activities and tips to help you deal with these issues. For example, the chapter on Personal Relationships is helpful regarding how to deal with anger and reconnect with people. The activities in the chapter on Physical Health focus on managing the effect of diet on your mood and the importance of getting enough sleep and exercise. Even Recreation and Relaxation can be very important in getting you back into your life at home, helping you rediscover things you used to enjoy, or suggesting new things you may enjoy now. This guide is not intended to replace other resources and professional services available to returning military personnel. If you are avoiding people a lot of the time; if you are using alcohol or drugs (even legal medications) in excess to improve your mood; if you find yourself sad, anxious, or extremely angry most of the time...or if you cannot sleep, have nightmares, or flashbacks, or if you feel numb inside for more than 3 months after returning home––and especially if you are considering hurting yourself or someone else––you should seek help.26

46

FACTS ABOUT MENTAL HEALTH

4, 23

• Most people tend to be moderately happy most of the time. • You cannot expect to be completely happy all the time. • You can expect to bounce back from your lows. • Happier people are healthier and more productive at work. • You do not have to make major changes in your life circumstances to be happier. Simply adjusting your routine and habits will be easier and probably more successful.

• Everyone regularly experiences feelings of anxiety and depression, even if only mildly or for brief moments.

47

• Feelings of anxiety and depression can spin out of our control and become overwhelming or even life-threatening.

• Removing huge problems from our lives will not necessarily take away anxiety and depression.

Without big things to worry about, we will often worry about smaller things. However, there are a number of things you can do to reduce your overall levels of anxiety and depression.

• Some anxiety is natural and it can motivate us to protect ourselves or solve problems. However, when your fears are larger than the reality of the problem, when your fears hold you back from solving your problems, or when your fears are constant or overwhelming, you should seek professional help.

• Some feelings of sadness are natural and unavoidable. However, if your feelings are severe or

have been moderately bad for some time or if you have thoughts of hurting yourself or others, you should seek professional help.

ASSESSMENTS

DEPRESSION33 In the past month, how much have you been bothered by either of the problems below? Feeling down, depressed, or hopeless?

Little interest or pleasure in doing things?

If you have had either of these problems half the time or more in the past month, YOU SHOULD BE EVALUATED BY A HEALTH CARE PROFESSIONAL.

SELF-HARM28, 34

48

Since returning from deployment, have any of the following statements been true for you? I frequently feel like life is very hopeless and not worth living.

I have previously attempted suicide and think about trying again.

I frequently think about hurting myself or killing myself.

I have a plan in mind as to how I can kill myself.

I am seriously thinking about hurting myself or killing myself.

I have taken steps to get ready to kill myself (eg, wrote a note, gave away possessions, or chose a method).

I have threatened to kill myself or confided in someone that I feel like killing myself. If any of these statements are true for you, you should be evaluated by a health care professional.

POSTTRAUMATIC STRESS DISORDER CHECKLIST35-37 In the past month, have you been bothered more than just a little by any of the following?

49

Suddenly acting or feeling as if a stressful experience were happening again (as if you were reliving it).

Feeling very upset when something reminded you of a stressful experience from the past.

Repeated, disturbing memories, thoughts, or images of a stressful experience from the past.

Avoiding activities or situations because they remind you of a stressful experience from the past.

Repeated, disturbing dreams of a stressful experience from the past.

Avoiding thinking about or talking about a stressful experience from the past or avoiding having feelings related to it.

Having physical reactions (eg, heart pounding, trouble breathing, or sweating) when something reminded you of a stressful experience from the past.

Feeling emotionally numb or being unable to have loving feelings for those close to you.

Trouble remembering important parts of a stressful experience from the past.

Feeling distant or cut off from other people.

Loss of interest in things that you used to enjoy.

Feeling as if your future will somehow be cut short.

Trouble falling or staying asleep.

Having difficulty concentrating.

Feeling irritable or having angry outbursts.

Feeling jumpy or easily startled. Being “super alert” or watchful on guard.

If you have had moderate or greater difficulty with five or more of these problems, YOU SHOULD BE EVALUATED BY A HEALTH CARE PROFESSIONAL. Diagnosing posttraumatic stress disorder is complex. Only a health care professional can determine whether your symptoms meet the criteria for this illness.

ACT RATHER THAN REACT. If you are bothered by

ACTIVITIES

23, 26, 38-43

lingering thoughts or reminders from deployment or you feel you are reacting to the stress you experienced in combat, sometimes it is helpful to have a plan to act and take some control. Rather than simply reacting to what you feel, you may want to take charge of the situation. The following are some ways to act in response to common experiences that returning veterans report. Notice that certain types of actions or “game plans” are listed as helpful for several different issues.

HAVING UNWANTED MEMORIES OR THOUGHTS ABOUT STRESSFUL EXPERIENCES DURING DEPLOYMENT 1. Remember, this is a common and natural reaction to a very stressful situation or event. 2. Talk to someone you trust about how these unwanted memories are bothering you; if you feel comfortable, actually share the experiences or memories with them. 3. Consider finding a buddy with whom you shared these experiences to talk to––often confiding in someone who was there and understands is extremely helpful. 4. Remind yourself that these are just memories; this is not happening now. Remind yourself that you are safe. 5. Remember that these unwanted memories or thoughts will come less often and be less bothersome in time.

FEELING LIKE YOU ARE SUDDENLY BACK IN THEATER AGAIN 1. Remind yourself of where you actually are. Look around yourself and think of today’s date. Tell yourself that you are safe. 2. Get up, move around, and touch familiar objects such as your clothes or the furniture. 3. See if you can find a pattern to when this feeling may come over you. Do certain places or situations seem to set it off?

50

HAVING NIGHTMARES (for trouble sleeping or insomnia, see Physical Health chapter) 1. Remember, this is a common and natural reaction to a very stressful situation or event. 2. Talk to someone you trust about how this dream is bothering you. If you feel comfortable, actually share the details of the dream with him/her. 3. Remind yourself that these are just dreams; this is not happening now. 4. Remind yourself of where you are. Get out of bed and touch familiar objects such as your clothes or the furniture. 5. Take a little time right then to do something that you find relaxing (eg, listen to music, take a hot shower, or do a crossword puzzle). 6. Make sure you are practicing good sleeping habits (see the sleep activity in the chapter on Physical Health). 7. Spend 10–15 minutes each night practicing the relaxation or meditation activities described next in this chapter. 8. Keep a notebook next to your bed. If a nightmare wakes you up, write down what happened in your dream. The next day, use your notebook to rewrite your nightmare (eg, Who could be there with you to help you feel safer? What alternate ending would you prefer?). Rehearse this rewritten dream in your mind for 10–15 minutes before falling asleep at night.

51

9. If you tend to sleepwalk or act out your dreams in some manner, make sure that your bedroom is safe. Do not leave things in the way of traffic that may hurt you or trip you. Make sure anyone you sleep with is aware of the problem and is going to be safe.

PRACTICE SYSTEMATIC RELAXATION. One of the most common problems

veterans report is feeling too hyped up all the time and having difficulty relaxing. This technique can help you lower your overall anxiety level, help you to fall asleep at night, and help you reduce feelings of frustration and anger. It is important to practice this regularly for a month or so to start really feeling the benefits. For best results, practice once or twice a day for about 20 minutes. Systematic relaxation takes advantage of a rebound effect, one-by-one tensing the muscles and then fully relaxing them. In this exercise it is important to recognize the difference in how each part of your body feels when it is tense versus when it is relaxed.

1. Sit in a comfortable chair in a relaxing position. Do not cross your legs. Your feet should be flat on the floor, and your arms should be lying flat at your sides. Close your eyes. 2. Begin by taking several deep breaths. Think of the way your breathing feels as you are falling asleep and practice breathing like that. As you breathe, pay attention to the air flowing gently in through your nose, into your lungs, and out again. It should take several seconds for you to breathe in and out. Take about 10 or 15 more breaths like this. 3. Flex your right foot up. Clench the muscles tightly, but not to the point of pain or discomfort. Hold your foot like that for about 5 to 10 seconds. Pay attention to how your foot feels with the muscles tensed. Is there some part of your foot that starts to feel tired first? Do your muscles start to feel warm? 4. Now relax your foot as much as you can. Focus on breathing deeply again. Each time you breathe out, try to relax the muscles in your foot just a little bit more. For about 20 to 30 seconds, pay attention to how your foot feels now. Which parts of your foot relax fastest? Does it feel lighter? Is there a point at which you almost cannot feel it anymore? 5. Repeat this exercise for your left foot and then for each of the following parts of your body, tensing them and then relaxing them in order: • Right leg (lift slightly; tighten quads)

• Abs (tighten)

• Left leg (lift slightly; tighten quads)

• Shoulders (shrug)

• Right hand (clench fist)

• Jaw (clench teeth in a big “smile”)

• Left hand (clench fist)

• Forehead (screw eyes tightly shut)

• Right arm (tighten bicep) • Left arm (tighten bicep) 6. After you have gone through your whole body, take some time to continue breathing and relax your entire body. Pay attention to which parts of your body feel the most relaxed. Are there muscles or parts of your body that you cannot feel like they have almost fallen off? Can you feel the pressure of your body lying completely limp? Take as long as you like to feel relaxed.

52

MEDITATE. Meditation is the practice of focusing your attention on a very simple

thought, sound, or image. Whenever you are distracted, simply return your attention to this simple focus. It can also be the practice of being aware or “mindful” of all levels of your current physical and mental experience, starting with awareness of breathing. Like systematic relaxation, meditation is helpful for reducing anxiety, frustration, and anger. There are a number of different ways to meditate, and you may already be doing some meditation. For example, chanting a short song as a group or by yourself while running is meditative. Prayer is a form of meditation. Try spending about 20 minutes daily practicing any of the following methods. As with systematic relaxation, this technique takes a month or two of practice to really start feeling the results.

ROUTINE TASKS

53

You can use routine tasks, such as taking a bath/shower or washing the dishes, as an opportunity to meditate.38 Make this task the most important thing in your life at that moment. Make every movement about twice as slow as usual and use this time to pay attention to your experience and each step in the process. The most important way to begin paying attention to your experience of the moment is to focus on your breath. As you breathe in think about how it feels to breathe in. As you breathe out, think about how it feels to breathe out. When you first start practicing this type of meditation you may try slowly counting your breaths each time you exhale from 1 to 10. Once you get to 10, start counting again from 1. If you lose track of the count, start over from 1. After focusing on your breathing for a few minutes, begin to pay attention to the task. For example, if you are washing the dishes notice how the water feels on your hands, the texture of the dish, and the motion of your muscles as you clean. If a thought about anything other than this task interrupts you, notice what the thought is, acknowledge it, and then refocus on your experience of the task. Generally, the best way to refocus is to pay attention to your breathing again. Some of the thoughts that interrupt your focus may be important to consider later, particularly if they fall into any of the categories that you should “argue with yourself” about from the Personal Thoughts chapter (see activity 4). However, during meditation, you should continue to try to experience the moment and refocus your attention on the task.

TAPES OR SCRIPTS There are a number of tapes or scripts available that you could use to practice meditating. One is available online, posted by the Mayo Clinic (http://www.mayoclinic.com/health/meditation/MM00623).39 This videotaped script is approximately 6–8 minutes long. The transcript of the video clip also is posted and is simple enough that you could go through this brief meditation exercise on your own anywhere you have a moment to sit quietly.

RELAXATION IMAGERY Find a quiet place with dim lighting if possible. While you are going through this exercise, do not worry about other thoughts that may creep in or interrupt you. If other thoughts arise, that is okay––just keep going back to the script and the imagery. You may fall asleep, and this is also okay as long as you do not need to be anywhere soon. Set an alarm on your cell phone or watch if you are worried about that. 1. Sit in a comfortable chair in a relaxing position. Do not cross your legs. Your feet should be flat on the floor, and your arms should be lying flat at your sides. Close your eyes. 2. Choose a safe and relaxing place you would love to be. It may be on an oversized towel at the beach or in the penthouse suite of a five-star hotel. It may be your own bed at home if you are traveling. Close your eyes and imagine you are actually there. Imagine the sounds you may hear and feel the temperature of the air. What colors are around you? 3. Next focus on your breathing. Think of the way it feels the moment when you are falling asleep and practice breathing like that. As you breathe, pay attention to the air flowing gently in through your nose, into your lungs, and out again. It should take several seconds for you to breathe in and out. Take about 10 or 15 more breaths like this.

4. Now imagine that the air you are breathing in is like a warm bath filling your body. You can direct that flowing warmth into each part of your body to melt any tension you may feel. 5. Start with your head. Notice what your muscles feel like in your face and scalp. Take a deep breath in and as you breathe out imagine a flood of warm air flowing through all of those muscles. Each time you breathe out, use that warm air to melt and relax each of the muscles in your face one by one. Be sure to relax the muscles on the top and the back of your head as well. 6. Repeat the process you used with your head and face with each of the following parts of your body, first noticing how your muscles feel. Which of them feel tight? Do you feel pain anywhere? Next, as you exhale use your breath to help you melt and relax those tensions. • Neck • Shoulders • Arms • Hands • Chest and Stomach • Hips • Legs • Feet

54 PRAYER Regardless of whether you are religious you can use prayer to meditate. If you are religious, you may already use some form of prayer. However, it can be very beneficial to lengthen the amount of time you spend praying daily and put some effort into choosing what to think of during prayer. If you are not religious, it can still be helpful to spend quiet time alone thinking through things in your mind that you appreciate from the universe or from a higher power of your choosing. The following are some categories of thoughts you may spend time rehearsing in your mind through meditative prayer. 1. If you have a religious prayer that is meaningful to you, such as the Lord’s Prayer or the 23rd Psalm, you can recite this slowly and repeatedly in your mind. 2. Think of a list of things you are grateful for in your life and slowly rehearse in your mind a statement of gratitude for each of them. 3. Think of a list of good things you wish for, for those whom you love or care about. Rehearse in your mind a request for each of those benefits or blessings to come to each of those people. 4. If you have a goal you are working toward in your life, think of the steps you need to take to complete it. One by one make a simple request in your mind for help and success in your efforts to complete each task. 5. If you are using prayer specifically as a tool to help you relax or feel more peaceful, think of a simple request or phrase asking for that feeling in your mind. Keep repeating that statement slowly in your mind.

ONLINE RESOURCES

American Psychological Association. (2004). Managing traumatic stress: Tips for recovering from disasters and other traumatic events. http://www.apahelpcenter.org/articles/article.php?id=22. American Psychological Association. (2003). Resilience in a time of war: Homecoming. http://www.apahelpcenter.org/ featuredtopics/feature.php?id=56. Copeland ME. (2002). Dealing with the effects of trauma: A self-help guide. http://mentalhealth.samhsa.gov/ publications/allpubs/SMA-3717/default.asp. Copeland ME. (2001). Recovering your mental health: A self-help guide. http://mentalhealth.samhsa.gov/publications/ allpubs/SMA-3504/default.asp. Center for Mental Health Services. (2008). Mental health services locator. http://mentalhealth.samhsa.gov/databases/. Department of Defense. (2008, August 5). After deployment. http://www.afterdeployment.org.

55

Department of Defense. (2008). Military installations: Lookup installations & directories of services. http://www. militaryinstallations.dod.mil/. Department of Defense. (2009). Military OneSource. http://www.militaryonesource.com/skins/MOS/home.aspx. Mayo Clinic Staff. (2007). Relaxation techniques: Learn ways to calm your stress. http://www.mayoclinic.com/health/ relaxation-technique/SR00007. Battlemind Training Office. (2008). Battlemind. Walter Reed Army Institute of Research and the Office of the Surgeon General, Army Medical Command. http://www.battlemind.army.mil/. Pfizer. (2008). Patient Health Questionnaire Screeners. http://www.phqscreeners.com/. Screening for Mental Health Inc. (2007). Mental health self-assessment program. http://www.militarymentalhealth.org/ chooselang.asp. USN Chaplain Corps. (2008). Chaplain care: Self-help tools. http://www.chaplaincare.navy.mil/index.htm. US Department of Health and Human Services. (2008). National Suicide Prevention Lifeline. http:// suicidepreventionlifeline.org/default.aspx.

GRIEF AND GUILT

56



On June 7 Marcus Luttrell was discharged from the Navy, having served with the elite SEALs, survived a fierce battle in Afghanistan, and earned a Navy Cross for combat heroism. Less than a month later ‘Lone Survivor,’ Mr. Luttrell’s memoir of the 2005 battle and his rescue, became a best seller…. Mr. Luttrell was the only one…to survive after a violent clash with dozens of Taliban fighters…. His main goal was to tell the story of his comrades who did not make it out alive. ‘Now I think the American public knows who they are, and now they are forever immortalized,’ said Mr. Luttrell, who added that he has set up a trust with all the proceeds from the book to help the families of the dead and to donate to military charities. ‘Their memory will 44 never die out, and that’s what I wanted.’



Your combat experience may have included some difficult losses. You may have had friends or acquaintances die in combat. You may have come home to find that your friends moved on or your family relationships were in jeopardy. You may have been injured, and if so, you may not be able to return to the same job, your hobbies may have to change, and your personal identity may be in question. You may have moved or left active military service. Any of these could leave you feeling grief and loss.

57

If your unit experienced casualties while you were in theater or if someone you were close to died in combat, you may not have been able to fully grieve while you were deployed.27 You may have been too busy or had too little privacy. The demands of the mission may have made it safer and more sensible to feel anger rather than sadness at the time. If you were not there when your friends or colleagues lost their lives and especially if you were unable to participate in funeral services, it may be hard to accept the reality of their deaths. Conversely, if you were there when you lost a friend, it may be difficult to stop replaying the events and wondering what else you could have done to prevent it. Now that you are home it may still be difficult to grieve. If you are no longer with any members of your unit who went through the experience as well, you may feel that there is no one you can talk to who really understands. Your grief may be complicated by feelings of guilt or regret.45 It is not uncommon to feel guilty for surviving when someone else did not. This chapter addresses some facts about grieving. In particular, it explains some typical feelings and emotional stages that people go through in reaction to a serious loss such as death, injury, divorce, or job loss. It discusses some things you can do that may help you work through the stages of grief. However, if you experience any of the following you should consider professional help: (a) preoccupation with someone who has died or constantly wanting to go places or find things that remind you of him/her, (b) physical pain in the same body area that was injured when a friend/loved one died, (c) systematically avoiding reminders of someone who has died, (d) inability to accept the reality of a death or continuing to feel stunned or shocked even after time has passed, (e) moments when you think you see someone who has died, (g) feeling empty or lonely most of the time, (f) feeling like you should not be alive now that a friend/loved one has died or believing you deserve to be punished in some way, or (g) feeling like you cannot care for other people or respect or trust them anymore.46

FACTS ABOUT GRIEVING

47

• There are five different emotional stages many people go through as they grieve. In order, these are denial, anger, bargaining, depression, and acceptance.

• Immediately after a great loss, most people have a hard time accepting and believing the reality of it. The most common initial reaction is disbelief and shock.

• Anger may follow after denial. Once the reality of the loss has sunk in, you may ask “why me?” Anger could be focused in many directions––God, the universe, yourself, other people, or the situation in general. Anger could be triggered by many things––the time of day, reminders of the loss, daily frustrations, or seemingly nothing at all.

• Bargaining is another common reaction to loss. In this stage you may want to make a deal with God to change the situation. You may find yourself replaying the events leading up to your loss trying to figure out what you could have done to prevent it.

• After the anger and the bargaining, as you begin to accept your loss, you may experience depression. You may only then start to feel the depth of your sadness in reaction to what has happened.

• Although there will always be some sadness over the loss, there is ultimately a stage of acceptance. In this stage, you will have found helpful ways to cope. You will have reorganized your life to fit your new reality. You may also have found ways to promote some greater good in reaction to your loss. • Going through the stages of grief will be somewhat different for every person and for every situation. Each stage may last a longer or shorter amount of time. The stages may follow each other in order sequentially. Alternatively, you may experience more than one stage at once or you may go back and forth between them. All of these reactions are normal.

58

ACTIVITIES

45

GRIEVE WELL. There are a number of things you can actively do to make it easier to go through the stages of grieving if you have lost friends or colleagues. You also can be an important support for others who are grieving. The following are some things that can help.

1. Get together with other people who also knew the friends you lost. 2. Take the time to write down your memories of those you have lost. Share these memories with others who knew them. 3. Use a web site for fallen warriors (see the following online resources) to write about your relationship with those you have lost. 4. Contact the family and express your feelings to them. 5. Start or add to a blog about those you have lost.

59

6. Write letters to their children. Even if they are very young children, they will still be able to read these when they are older. These letters may help them get to know a parent they cannot get to know personally. 7. If at all possible, attend the funeral. If you cannot attend the funeral, visit the grave. If you know others who were unable to attend the funeral, organize a memorial service. 8. Make a donation of money, or better yet your time, to some charity or cause that was important to him/her. 9. Organize a fundraising activity to provide support or help to surviving family members. 10. Take the time to express appreciation to important people in your life who are still with you.

SURVIVE SURVIVOR GUILT. Everyone will feel some guilt and regret during

their lifetime. The mark of a good person and a successful life is not whether you ever made mistakes. It is what you learned from your mistakes and what you did next. Like anger and fear, the negative emotions of guilt, regret, and even shame can be helpful if they motivate you to do something positive in the future. They are unhelpful and pointless if they lead you to live in the past or to continually try to punish yourself or if they discourage you from acting confidently in the present.

ACKNOWLEDGE FEELINGS OF WAR GUILT OR SURVIVOR GUILT Honestly answer the following questions: 1. Do you worry about your responsibility for the death or injury of friendly troops? 2. Do you worry about your responsibility for the death or injury of noncombatants? 3. Do you ever think that it would have been better or more just if you had been injured or died in place of someone else? 4. Do you believe you could have and should have prevented someone else’s injury or death? 5. Do you worry about instances where you believe you failed to follow the rules of engagement?

60 6. Do you feel you must keep a secret about something you did in combat because others may judge you for it if they knew?

WHAT HAPPENED? Briefly describe an impactful deployment experience that has left you with feelings of guilt. In the table on the left side, first write down what happened. Then make some notes about what your thoughts and feelings were at the time. On the right side, describe your current thoughts about this event. Try to be clear about how your thinking may have changed from the time of the experience until now.

Description Action Sequence

61

Thoughts

Feelings

Commentary

ASSESS RESPONSIBILITY Make your best estimate of how much responsibility different people and circumstances had for the experience you described on the previous page. Remember the numbers you choose must add up to 100%. You cannot give 50% responsibility to yourself, the government, your superior officers, and to chance because that would add up to 200%. Enemy action ______% Noncombatant action ______% Yourself ______% Those who were injured or killed ______% Other peers in your unit ______% Unit senior enlisted ______% Unit officers ______% Other involved persons ______% USMC or USN policy ______% US Government policy ______% International policy ______% Chance events ______% Other ______%

Total ____% (must equal 100%)

62

CHALLENGE UNNECESSARY GUILT Answer the following questions and think carefully about how these beliefs may influence your feelings. How do such self-punishing thoughts add to your survivor guilt rather than help you survive your guilt? For each thought that unnecessarily adds to your guilt, write down a way to challenge it. Think of a more realistic thought that allows you to be fair to yourself. You may look at the last activity in the Personal Thoughts chapter for some ideas about how to challenge your thoughts. 1. Based on your responsibility assessment on the previous page, do you sometimes take too much responsibility for the things you feel guilty about? Challenge: ____________________________________________________________________________________________ ______________________________________________________________________________________________________ 2. Do you blame yourself for actions, thoughts, or feelings that many people would have considered reasonable under the same circumstances? Challenge: ____________________________________________________________________________________________ ______________________________________________________________________________________________________ 3. Do you blame yourself for thoughts or feelings that you had at the time even though you did not act on them?

63

Challenge: ____________________________________________________________________________________________ ______________________________________________________________________________________________________ 4. Do you blame yourself for things that you are not sure you could have prevented? Challenge: ____________________________________________________________________________________________ ______________________________________________________________________________________________________ 5. Do you forget to give yourself credit for things you did that may have prevented other problems at the time? Challenge: ____________________________________________________________________________________________ ______________________________________________________________________________________________________ 6. Do you blame yourself for something you could not have changed without knowing more than you knew at the time? Challenge: ____________________________________________________________________________________________ ______________________________________________________________________________________________________ 7. Do you blame yourself for things even though you may still not know exactly what happened or why it happened as it did? Challenge: ____________________________________________________________________________________________ ______________________________________________________________________________________________________

8. Do you blame yourself for not acting perfectly in the situation? Challenge: _____________________________________________________________________________________________ _______________________________________________________________________________________________________ 9. If you had been injured or killed at the time, would that really have prevented what happened? Could it have allowed worse things to happen? Challenge: _____________________________________________________________________________________________ _______________________________________________________________________________________________________ 10. Do you have any other unrealistic thoughts about what happened that you believe may contribute to your feelings of guilt? Challenge: _____________________________________________________________________________________________ _______________________________________________________________________________________________________

64

OWN YOUR MISTAKES AND MAKE A PLAN At the end of this exercise, do you truly feel that you knowingly or unknowingly did things that directly caused harm to someone else? If yes, you may want to follow these instructions to make a constructive plan to make amends, if possible, or to try to avoid this type of outcome in the future. Use the activities in the Goals chapter to set a goal to act on that plan.

1. Is there anything you can do now that may restore or make up for what happened? If so, what? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 2. Is there anything you can do that may make it easier to grieve for those who have been hurt or harmed by what happened? If so, what? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

65

3. Is there anything you are afraid to tell others about what happened? Would you feel more at peace and honest or would it help others to heal if you told them about it? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

4. Can you think of any lessons you have learned from this event in hindsight? Are there specific things you can now do that may prevent problems in the future? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

5. Regardless of whether you can do anything to make amends to those who were affected by your actions, are there things you can do that may help others with similar problems? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 6. Once you have acted on your plan to make amends or take positive action about what you have done, can you forgive yourself? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

ONLINE RESOURCES

USA KIA/DOW Family Foundation. (2008). Your shield. http://www.usakia.org/. Yahoo. (2008). KIA Memorial Yahoo Group. http://groups.yahoo.com/group/kiamemorial/. Military Times Media Group. (2009). Honor the fallen. http://www.militarycity.com/valor/honor.html. Monster Worldwide Inc. (2009). MILblogging.com http://www.milblogging.com/listingDetail.php?id=1551.

66

67

RECREATION & RELAXATION



You go from a pressure-filled environment where you are focused and have a very understandable mission (you are in combat)…. I ran half of Anbar province. I came back and people say nice things like, ‘thank you for your service.’ That’s nice, but what do you do with all that time and energy? What do you do? I’ve run 4 or 5 marathons and a triathlon. You need to develop healthy habits that 8 replace the adrenaline you had in combat.





For some returned [veterans], the biggest challenge is just figuring out what to do with all their free time. ‘Getting up in the morning and not really having something to do, no PT, no formations,’ explained Andrew Davis, an Army Reserve specialist, ‘planning things 25 out was tough.’



While you were deployed, you may have been unable to participate in many of the things you like to do to relax and have fun. Now that you are back, you may be busy with work, family, or school and feel that you do not have time to relax and enjoy life. You may also find that you are having trouble getting interested in some of the things you used to enjoy doing. If you were injured or have health problems, you may actually be unable to participate in some sports you used to love. However, these types of challenges make it all the more important to focus on keeping a healthy balance of recreation and relaxation in your life.48 You should not view participating in recreational activities as an unnecessary perk. It is a key factor in mental health, particularly in managing the impact of trauma, anxiety, and depression.26, 49 It makes a critical contribution to your physical health, protecting against the long-term effects of stress that can increase your risk of heart disease, cancer, and other illnesses.50, 51 Learning to stay active even when you may find it hard to motivate yourself is an important coping skill, particularly during a time of adjustment. Recreation also is important in managing stress when your life is simply busy and hectic.52, 53 Many people, regardless of whether they have recently returned from deployment, feel like the number of things they have to do every day just keeps increasing. To have any chance at managing that stress, you have to remember that life is about balance. You have to be the one to make sure you have time for recreation and relaxation. Recreational activity can further provide great opportunities to spend time with family, friends, and coworkers and to invest in important relationships.50, 54 It is a chance to spend quality time with the people you care about. By engaging in recreational activities, you can also create opportunities to meet new people who have similar interests to your own. The purpose of this chapter is to help you set a goal to do things that you enjoy and that you find relaxing and recreational on a daily basis. This chapter includes some lists of activities that you may try if you are looking for suggestions. It also includes some space for you to write down your thoughts regarding how your recreational interests may have changed as a result of your deployment.

68

FACTS ABOUT RECREATION

24, 26, 50

• When you are feeling down and unmotivated, it is tempting to stop doing things that you used to enjoy. However, becoming less active will lead to a downward spiral where you feel less and less like doing anything.

• If you are feeling down and it is hard to enjoy doing things, forcing yourself to stay active will lead to an upward spiral where you gradually start to enjoy things again.

• Sharing recreational activities with others is a very important part of developing supportive social networks. • Your recreational and leisure time is one aspect of your life where you are completely in control of what you do. It is a time when you can really express who you are and what you enjoy in life.

• The things you do during your recreational and leisure time can help you develop your strengths and interests and increase your energy and ability to deal with other challenges.

69

• Doing things with other people, especially where you feel accepted and respected, is important. • Participating in active recreation is important. Active recreation includes things like creative hobbies, indoor or outdoor sports, and travel.

• Taking the time to relax is important. Relaxing activities may include taking a nap, soaking in a tub, relaxing on the couch with a snack, or watching a funny TV show that makes you laugh.

ACTIVITIES

24, 26

HOW HAVE YOU CHANGED? Which of the recreational activities you used to enjoy before you were deployed are you still interested in? Take the time to think about this for a moment and write down your thoughts. You may also have learned to enjoy some new recreational activities or pastimes while you were gone, or there may be some new things you would like to try.

What recreational activities or pastimes did you participate in before you left for deployment that you still enjoy or that you want to get back into? 1. ____________________________________________________________________________________________________ 2. ____________________________________________________________________________________________________ 3. ____________________________________________________________________________________________________

Are there recreational activities or pastimes you learned to enjoy while you were deployed? 70 1. ____________________________________________________________________________________________________ 2. ____________________________________________________________________________________________________ 3. ____________________________________________________________________________________________________

Are there other recreational activities or pastimes you would like to try now? 1. ____________________________________________________________________________________________________ 2. ____________________________________________________________________________________________________ 3. ____________________________________________________________________________________________________

STAY ACTIVE. If you are having trouble thinking of things you want to do for

recreation and relaxation, take a look at the following list. Which of the following do you think you would enjoy? Do you already participate in any of these activities?

Would you like doing this activity? (check the box)

Activities

Social Activities Visit family or friends Call an old friend Go out to eat with family or friends Join a club or attend a club meeting

71

Participate in military social activities Go to church socials or classes Participate in or coach a community sports team Join a walking or running group Go dancing Babysit Go on a date Have a garage sale or go to one Do volunteer work or community service Play pool or billiards Play board/card games Go golfing with friends Play in a band or sing in a choir Take art lessons Hire a personal trainer

Have you done this in the past month? (check the box)

Would you like doing this activity? (check the box)

Activities

Have you done this in the past month? (check the box)

Active Recreation Camp, hike, rock climb, or fish Garden or do yard work Go motorboating, kayaking, sailing, etc. Visit a national park Take a scenic road trip Plan a day trip or a vacation Water-ski, surf, or swim Play basketball, baseball, soccer, etc. Run, jog, or bike Go horseback riding Go to a fair, zoo, or amusement park Go to the movies Go to a comedy club Go to a museum, theater, or concert Go to a college or professional sports event Try creative writing, blogging, or journaling Fix a car, bike, motorcycle, etc. Play a musical instrument Start a collection Try woodworking, photography, painting, etc. Cook

72

Would you like doing this activity? (check the box)

Activities

Quiet Relaxation Take a bubble bath Sit in a sauna or jacuzzi Take a nap Read scriptures or other sacred works Read a novel Read a newspaper Try yoga Get a massage Eat a snack on the couch

73 Watch a funny TV show Meditate* Practice systematic relaxation* Make a list of movies you want to see Pet a dog or cat Put a jigsaw puzzle together Do a crossword puzzle or other word games Do a Sudoku puzzle or other number games *See Mental Health chapter activities.

Have you done this in the past month? (check the box)

MAKE A PLAN. With a little time for planning and creativity, you can start doing the recreational activities you enjoy or try new ones. Get started by filling out this worksheet. After you fill it out, post the worksheet somewhere like the refrigerator, a bulletin board, or a bathroom mirror to remind you of your plans. Try to include at least some activities from all three categories (ie, socialization, recreation, and relaxation) in your weekly schedule.

Week No. _________ Day

What activity would you like to do?

Did you do it? Check Yes or No

1.

Yes

No

2.

Yes

No

1.

Yes

No

2.

Yes

No

1.

Yes

No

2.

Yes

No

1.

Yes

No

2.

Yes

No

1.

Yes

No

2.

Yes

No

1.

Yes

No

2.

Yes

No

1.

Yes

No

2.

Yes

No

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Marine Corps Community Services. (2009). Recreation and fitness. http://www.usmcmccs.org/fitnessrec/.

ONLINE RESOURCES

Navy Morale, Welfare, and Recreation. (2009). MWR. http://www.mwr.navy.mil/. The Active Network. (2008). Active.com. http://www.active.com/. US Department of the Interior. (2008). Federal recreation, camping, and tour reservation information. http://www.recreation.gov/. US Department of the Interior. (2008). National Park Service, http://www.nps.gov/.

74

75

PHYSICAL HEALTH



Physical fitness is a crucial element of mission performance and must be a part of every Sailor’s life. Mission readiness and operational effectiveness are built on the physical fitness of the individual; therefore, all Navy personnel shall maintain personal 55 physical fitness by regular exercise and proper nutrition.





Every Marine must be physically fit, regardless of age, grade, or duty assignment…. The [Marine Corps Physical Fitness Program] emphasizes the requirement for all Marines to adopt a healthy lifestyle and a lifelong commitment to fitness. This combination has a direct and positive impact on job performance and combat 56 readiness.



On deployment, you had constant access to the care of dedicated corpsmen and you may have had fewer distractions from staying on top of your own fitness. Now that you are home, you may feel it was easier to stay in good physical shape while you were deployed. However, physical health is one of the most important contributing factors to general well-being and quality of life. It is important to stay on top of your own fitness now that you are home. This chapter focuses on three important health issues: diet, exercise, and sleep. A healthy diet can protect you from many problems, including heart disease, stroke, obesity, diabetes, and even some types of cancer.57 As service members, you may be at the height of youth and health. Although a few of you may believe you are already at risk for heart disease or high blood pressure, most of you probably see such problems only as distant possibilities. Since many Navy and Marine Corps personnel are active and healthy, the first activity in this chapter includes helpful dietary suggestions for an active lifestyle and for reducing stress. Regular exercise can help you lose weight, increase muscle and bone strength, prevent heart disease, and improve mood and psychological health.58 A large percentage of these benefits comes from regular moderate exercise (eg, fast walking, biking on flat terrain). However, there are still greater benefits from vigorous exercise (eg, jogging, biking up hill). US military personnel are very active overall.59 Most (61%) manage 30 minutes of moderate exercise at least 3 days per week. However, only 21% report that much vigorous physical exercise. Although you may be training regularly to be prepared for your military mission, this kind of “mission fitness” may not be the same as the kind of “healthy fitness” your body needs to prevent longterm health problems and increase your life span. The second activity in this chapter describes some important ways to exercise in healthy ways. Among deployed personnel and returning veterans, sleep problems may be the most common complaint.60, 61 In dealing with insomnia, some coping strategies will make things worse. These include (a) going to bed too early; (b) drinking alcohol, which can make you wake up at odd hours; (c) becoming addicted to sleep medications; (d) avoiding sleep entirely, which will exhaust you and make it harder to cope in general; and (e) lying in bed awake for long periods of time, which can make you hate and fear going to bed.26 By contrast, the last activity in this chapter includes some recommended strategies that can be helpful in improving sleep.

76

FACTS ABOUT PHYSICAL HEALTH

23, 62- 64

• For long-term cardiac health, moderate exercise (eg, brisk walking, light running, or swimming) for 30 minutes per day is the current recommendation of the US Department of Health and Human Services.

• Focusing on fitness and health is more productive and more likely to be successful than focusing on weight loss. You will reap important physical and mental health benefits from better diet and exercise regardless of whether you lose weight. Furthermore, yo-yo weight loss can be just as harmful to your health as being overweight.

• Being underweight can be just as great a health risk as being overweight. • As part of your military training, you may be working out at the level of a professional athlete on a 77

regular basis. It is important to be aware that heavy training can increase your risk of injury, reduce your overall energy, and lower your immune system. Careful attention to safe exercise practices, diet, and sleep may be even more important.

• One quarter to one third of adults say that they have trouble with chronic or occasional sleeplessness (insomnia). • Insomnia is related to several mental health problems such as depression and alcoholism. It is also a risk factor for poor physical health and shortened life span. If you believe you have a chronic problem with insomnia or some other sleep problem, you should seek professional help.

DIET. Your diet should support your lifestyle and

ACTIVITIES

24, 26, 62, 63, 65-75

health needs. For instance, if you are very physically active, it is important for your diet to support your fitness goals. If you are bothered by anxiety or you are having trouble relaxing, what you eat can make a difference there as well.

EATING TO IMPROVE YOUR MOOD OR RELAX 1. Reduce or eliminate alcohol and caffeine from your diet. With caffeine, for example, at least try to limit yourself to one cup of coffee or one caffeinated soft drink per day. If you have been using a lot of caffeine, make sure you gradually cut back to avoid headaches and other withdrawal symptoms. 2. Cut back on sugar and simple carbohydrates (eg, refined flour) in your diet. Eating a lot of sugar can temporarily raise your blood sugar, but that can be followed by very low blood sugar. Low blood sugar, or hypoglycemia, can lead to symptoms of anxiety such as nervousness, trembling, light-headedness, and irritability. 3. To keep your blood sugar at optimal levels, try to avoid going for long periods of time without eating. Have a healthy snack between meals. 4. Increase complex carbohydrates (eg, whole grains) and starches in your diet. These are metabolized slower and may help raise serotonin levels in the brain. Serotonin is important in improving not only mood, but also sleep patterns. 5. Eat foods high in tryptophan that metabolizes into serotonin (eg, milk products, bananas, oats, soy, poultry, and nuts). 6. Make sure you drink enough liquids to stay well hydrated. Dehydration can affect not only physical performance but also mental ability and mood. 7. Take supplemental vitamins such as B6, C, and zinc to help your body combat stress. 8. Avoid extreme diets. Eliminating any food group from your diet completely may affect your mood.

78

EATING FOR AN ACTIVE LIFESTYLE 1. To improve your energy and stamina, work toward a diet of low-fat, moderate protein, high carbohydrates, and high fluids. 2. FAT • Eat monounsaturated and polyunsaturated fats, particularly omega 3s (eg, vegetable oils, nuts, seeds, avocados, and fish). • Avoid saturated and trans fats as well as cholesterol (eg, fatty meat, butter, processed foods, and fried foods). 3. PROTEIN • Eat poultry (especially skinless white meat), fish, lean meats (eg, choice, select), beans, and low-fat or fat-free milk products. • Avoid red meats, including pork, and especially fatty cuts (eg, prime, chuck). 4. CARBOHYDRATES • Eat whole grains, fresh fruits, and vegetables that are high in fiber (eg, sweet potatoes, squash, apples, bananas, avocados, and grapes). • Avoid foods with added sugar and refined grains (eg, white flour).

79

5. LIQUIDS • Moderately active people may need 3 to 5 liters of water per day while a very active person may need 10 liters. Monitoring your urine color with a urine color chart (http://www.nata.org/statements/ppt/fluid%20replacement. ppt#356,100,Slide 100) can help you know your hydration level.76 • Avoid alcohol and carbonated beverages, which are high in calories and can lead to dehydration.

EATING WHEN YOU EXERCISE 1. About 2–4 hours BEFORE EXERCISE, eat a high carbohydrate, low-fat meal and drink 17–20 fl oz of water or a sport drink. Another carbohydrate snack and 7–10 oz of additional fluids can be helpful within 30 minutes of intense exercise. Avoid candy and foods high in sugar. These can spike your metabolism and actually lower your blood sugar. 2. DURING EXERCISE, drink 7–10 fl oz about every 10–20 minutes. Drink enough fluids so that you do not drop more than 2% of your fully hydrated pre-exercise weight. At the same time, never drink more fluids than your weight loss during exercise; overhydration, particularly during exercise, also can be a serious health risk. During prolonged exercise (over an hour), a 6% carbohydrate drink also is recommended. 3. Within 2 hours AFTER EXERCISE, drink liquids equivalent to 125%–150% of the difference in your pre- versus post-exercise weight. Avoid alcohol and carbonated soda. A carbohydrate snack of about 300 calories also is recommended within an hour of strenuous exercise. 4. Every athlete has a unique sweat rate. KNOW YOURSELF. Monitor changes in your body weight, thirst, and urine color. Watch for signs of dehydration such as feeling thirsty, hot, tired, or lethargic, poor physical performance, flushed skin, cramps, dizziness, headache, vomiting, nausea, or chills.

80

EXERCISE.

Regular exercise can be one of your most important tools in maintaining good health and getting back to a sense of routine and well-being at a time of transition. However, it is important to practice good form and safe exercise habits, especially if you are exercising frequently at a high intensity level.

FOCUS ON FORM

81

Make a habit of focusing the first 15 to 20 minutes of your daily workout on form. Working on your execution can help improve your performance and reduce your risk of injury. For example, if you are running, start out at a slightly slower pace and take the time to pay attention to your body. One of the fastest ways to focus your attention is to monitor your breathing. Notice the pattern of the number of steps you take as you breathe in and breathe out. For about 2 minutes just focus on this rhythm. Next, begin to pay attention to your face. Use your next 2 minutes to focus on releasing any tension you may have there (see step 1). Each time you exhale imagine your face and jaw relaxing just a little more. Then spend a couple of minutes relaxing your neck and shoulders (see step 2). Next, for 2 minutes compare your body posture to the recommendation in step 3. How does it feel to use this posture? Continue taking deep breaths and focusing on each of the seven aspects of running form outlined. Each time, pay attention to the feeling of your own motion as you practice. The online resources at the end of this chapter include some sites with additional information on running form. 1. Face: Your face and jaw should be relaxed. Particularly as you go up hills, make sure you do not tighten your jaw or tense your forehead. 2. Neck and shoulders: Like your face, your shoulders and neck should be relaxed. Make sure you do not hunch your shoulders, especially as you get tired or go up hills. Keep your chest and shoulders open so you can breathe fully. 3. Body posture: As you run you should lean forward slightly but still maintain a tall posture. Your head, body, and hips should be in line with one another. 4. Arms: Your arms should swing easily at your sides with your elbows bent at approximately a 90° angle. Your hands should brush your hips at the bottom of your swing and should not go above your lower chest at the top. Do not allow your hands to swing across the center line of your body. 5. Hands: Your hands should be relaxed in a loose cupping shape not balled into tight fists. Make sure your thumbs are relaxed as well. 6. Legs: Lift your knees straight forward to run. For distance running, you should not lift your knees too high. Take shorter faster steps, with your feet landing directly under your hips. 7. Feet: For distance running, your feet should hit the ground on the ball or the center of your foot. Your heel should not hit the ground first, and you should not push off with your toes. Pay attention to the sensation of feeling the ground under your feet.

Do not forget to stretch Stretching can help you prevent injury, soreness, and stiffness, improve your range of motion, and help you relax and reduce stress. After you finish your workout, try to take about 20 minutes to stretch. When you stretch, it is important to remember that the more you can relax your muscles, the more comfortable, safe, and effective the stretch will become. This is a good opportunity to practice breathing and relaxation techniques (see Mental Health chapter). Breathe deeply and as you exhale imagine your muscles relaxing completely. Be sure that you hold each stretch for 30 seconds without bouncing. You should feel tension in the muscle but not pain. The goal is to feel the tension in the muscle, relax and release. If you experience pain with any particular stretch, you should stop practicing that stretch. There are numerous positions you can use for stretching. The Mayo Clinic Foundation for Medical Education and Research provides some good instructions online (http://www.mayoclinic.com/health/stretching/SM00043) for stretching each of your major muscle groups.77 The following is a series of relaxing stretches that you can try. (Consult a doctor before beginning any exercise or stretching regimen, particularly if you have any injuries, back problems, or medical conditions.)

1. Place the ball of your foot on a step or curb so that your heel hangs off the edge. It is helpful if you have a wall or a handrail for balance. Lift the opposite leg so that your weight presses down on your heel. Hold the stretch for 30 seconds. Focus on taking deep breaths and relaxing your calf muscle a little more each time you exhale. Repeat this stretch three times on each leg.

82

2. Sit cross-legged on the floor. (A) With your right hand, pull the top of your left arm across your body until you feel a gentle stretch in your shoulder. Hold the stretch for 30 seconds. (B) With your right hand, pull your left elbow straight up toward your left ear until you feel a gentle stretch along the back of your arm. Hold the stretch for 30 seconds. Repeat A and B three times on each arm.

3. Sit with your legs spread out as far as they can go (greater than a 90° angle). (A) Lean straight out over the floor and walk your hands forward. Imagine a cord tied to the top of your head pulling you forward and try to lengthen your back as much as you can comfortably. Hold this stretch for 30 seconds and use your breath to relax the muscles where you feel the stretch the most. (B) Now take a deep breath and really relax, letting your arms rest on the floor and your head fall forward. Take 9 more deep breaths, relaxing your body as much as possible in this position. Repeat A and B three times.

83

4. Lie flat on your back next to a door frame or a corner wall that sticks out into the room. Make sure your legs are lying next to the corner along the wall (or through the door frame) and your body and head are pointing away from it. Lift the leg closest to the wall straight up, perpendicular to the floor if you can. Lean your leg on the door frame or corner and rest it there. Keep the other leg straight and flat on the floor. Scoot closer or farther from the corner or door frame so that you get a good stretch but so that you can easily keep both legs straight. Take a deep breath and as you exhale focus on relaxing the hamstring you are stretching. Hold this position and practice deep breathing for 30 seconds. Repeat three times for each leg.

5. Lie on your left side on the floor. (A) Bend your left arm up so that you can rest your head on it as you do this stretch. Bend your right knee and pull your right foot straight up behind you until it touches your buttocks if possible. Try to keep your chest, hips, and right thigh in as straight a line as possible. Hold this stretch for 30 seconds. (B) Release your foot and extend your leg. Take 10 deep breaths as you lie there, relaxing your whole body a little more each time you exhale. Repeat A and B three times for each leg.

6. Lying on the floor, roll onto your stomach. Bend your arms so that they are resting on the floor with your elbows at your sides and your hands on the floor at about shoulder or chin level. (A) Press up with your arms, arching your back just enough to feel a stretch through your body. Hold this stretch for about 15 seconds. (B) Relax back down on the floor to your starting position. Take 10 deep breaths, relaxing your body each time you exhale. Repeat this stretch three times.

7. Lie flat on your back on a carpet or a mat. Bend your knees up at a comfortable angle so that the small of your back is flat on the ground. Raise your right foot and rest it on your left knee. Relax your right knee straight out to the side so that your knee is as far away from your body as is comfortable. (A) Raise your left leg and clasp your hands under your left thigh. Keep your head and shoulders resting on the floor and keep your right foot resting on your left knee. If you cannot reach your left thigh use a towel to pull it up toward you. Breathe deeply and as you exhale relax the muscles you are stretching on the outside of your right leg. Hold this stretch for 30 seconds. (B) Take a really deep breath and stretch both legs flat out on the floor. Take 9 more deep breaths, relaxing your whole body a little more each time you exhale. Repeat three times for each leg.

84

SLEEP.

If you are worried about sleep, it is very important to adopt some healthy habits. Some helpful suggestions in establishing a regular and healthy sleep routine follow.

GOOD SLEEP HYGIENE 1. Stick to a regular schedule. Do not go to bed earlier than usual at night. Do not sleep later in the morning than usual even if you did not get much sleep the night before. 2. If you take a nap during the day, keep it short (15–30 minutes). Do not nap later than the early afternoon. 3. Only use your bed for sleeping and sex. Do not work, use your laptop, or watch TV in bed. 4. If you cannot sleep at night, do not lie in bed awake for long periods of time. After about 15–20 minutes get up and do something quiet and relaxing for a while until you feel tired enough to sleep.

85

5. Have a 30–60-minute regular bedtime routine that includes some relaxing activities such as a hot bath, brushing your teeth, listening to calming music, light reading, or praying. Try to go through your routine in the same order each night at about the same time. During your bedtime routine, avoid things that would make you anxious or keyed up like phone calls, arguments, working, household tasks, and watching TV or movies. 6. Practice 15–20 minutes of meditation or systematic relaxation (see Mental Health chapter) just before you go to sleep. 7. If your bedroom or your bed are not comfortable enough, change things. Get a better bed. Use a fan to cool things down or block out noise. Keep the room dark. 8. Make sure you get some exercise during the day but do not exercise within 2 hours of bedtime. 9. Eat regular meals. Do not go to bed hungry but do not eat a lot right before bed. Try not to drink a lot of fluids close to bedtime. 10. Cut back on or eliminate use of substances that may interfere with sleep, particularly in the late afternoon or evening, including alcohol, caffeine, chocolate, and tobacco. 11. If you find there is a specific task or problem that you are worrying about at night, think through ways that you may be able to solve that problem or complete that task. Get any worries that you can reasonably eliminate off your plate. 12. Be happy and grateful when you do get sleep and do not beat yourself up over it when you do not.

ONLINE RESOURCES

The Active Network. (2008). Active.com. http://www.active.com/. Agricultural Research Service. (2008). Nutrient Data Laboratory. http://www.nal.usda.gov/fnic/foodcomp/search/. Deployment Health Clinical Center. (2008). Veterans and families. http://www.pdhealth.mil/veterans/default.asp. Mayo Foundation for Medical Education and Research. (2008). Health tools. http://www.mayoclinic.com/health/ HealthToolsIndex/HealthToolsIndex. Mayo Clinic Staff. (2009). Nutrition and healthy eating: Nutrition basics. http://www.mayoclinic.com/health/ nutrition-and-healthy-eating/MY00431. Morris R. (2009). Running form for distance runners. http://www.runningplanet.com/training/running-form.html. National Center for Complementary and Alternative Medicine. (2008). NCCAM. http://nccam.nih.gov. Unger Hahn J. (2009). The perfect form: Running better, from head to toe. http://www.runnersworld.com/article/ 0,7120,s6-238-267-268-8210-0,00.html. US Department of Health and Human Services and US Department of Agriculture. (2005). Finding your way to a healthier you (HHS-ODPHP-2005-01-DGA-B). http://www.health.gov/dietaryguidelines/dga2005/document/pdf/ brochure.pdf. US Department of Health and Human Services. (2008). Healthfinder.gov. http://www.healthfinder.gov/. US Department of Health and Human Services. (2008). Health.gov. http://www.health.gov/. US Department of Veterans Affairs. (2008). MyHealtheVet. http://www.myhealth.va.gov/. US National Library of Medicine. (2008). Veterans and military health. http://www.nlm.nih.gov/medlineplus/ veteransandmilitaryhealth.html.

86

87

SUBSTANCE USE



Most nights when Anthony [Klecker], a former Marine, finally slept, he found himself back on the battlefields of Iraq. He would awake in a panic and struggle futilely to return to sleep…. Desperate for sleep and relief, Mr. Klecker, 30, drank heavily. One morning, his parents found him in the driveway slumped over the wheel of his car, the door wide open, wipers scraping back and forth. Another time, they found him curled in a fetal position in his closet. Yet only after his drunken driving caused the death of a 16-year-old cheerleader did 78 Mr. Klecker acknowledge the depth of his problem.





As far as mental health, I was confused all the time, my judgment was cloudy. Your first instinct is to eliminate whatever it is that is putting you in that state. All you know as infantry men is to destroy. That is all you did while you were over there. You have to take lives or your life will be taken. To get rid of these feelings, a lot 2 of Marines end up self-medicating––alcohol, drugs.



Members of the US military are aware of the importance of using alcohol and legal medications responsibly. You rely on each other to be at your best and count on the fact that your buddy will be fully capable of covering your back. Overall, you are a proud, fit, and healthy fighting force, with little patience for those who do not take that seriously. Particularly when it comes to illegal drugs, most of you believe that Marines and Sailors know the policy on drug use and should be discharged if they test positive. In the words of one Marine, “If you get nailed, then you should do time and then get kicked out, because you deserve it.”79, 80 When someone in your unit tests positive, you take it personally. It makes all of you look bad. One Marine who tested positive explained, “the whole platoon looks down on you.” Despite the general attitude that you should all have your lives together and none of you should be the weak link, preparing to leave on deployment and adjusting to being home after you return from deployment are stressful. These are both times when, for some, it may be tempting to use alcohol to lower stress.81 However, excessive drinking; using over-the-counter drugs, prescription medications, or sleeping aids more than directed; and especially the use of illegal drugs, will ultimately make it more difficult to adjust. Using substances like this may help you temporarily avoid your problems or the stress you feel over them. However, it will not solve your problems, and it is likely to make them even worse. Most of you know this, and it is your responsibility to watch for others who may be having difficulty. This chapter discusses general substance use guidelines for optimal health and wellbeing. It describes some ways that you can be a role model and speak out about your opinions regarding substance use. It describes ways you can volunteer and become part of the solution to substance abuse. This chapter also lists signs that you can use to identify those who may be under pressure and to support them before they have a problem. Finally, there is some important information regarding symptoms of addiction that you may recognize in your friends or colleagues, along with some tips for offering support.

88

FACTS ABOUT ADDICTION

23

• Even if you do not have an addiction problem, responsible use of alcohol, prescriptions, and over-the-counter drugs, as well as abstinence from all illegal drugs, is critical, particularly as a member of the US military.

• Like high blood pressure or diabetes, addiction can run in families, and it has many serious long-term consequences: loss of important relationships, unemployment, homelessness, physical dependence, loss of personal control, brain damage, cirrhosis of the liver, depression, legal problems (eg, DUI), financial problems, and suicidality.

• Addiction can be progressive. In this case, addiction becomes stronger over time, use increases, and associated problems get worse.

• Many people can recover from addiction. 89

• You are most likely to be able to recover from an addiction fairly early on before the problem has progressed very far. Unfortunately, many people do not have the motivation to change until the problem has progressed all the way to where they “hit bottom.”

• There are several things that can greatly help you in recovering from addiction, such as getting

involved in healthy activities (eg, a hobby, meditating, or work), finding a sense of meaning and hope (eg, religion, spirituality, or philosophy), and investing in healthy relationships (eg, friends, family, religious/spiritual groups, or substance use support groups).

ASSESSMENTS

82-84

ALCOHOL PROBLEMS Since returning from combat have you: Used alcohol more than you meant to?

Felt guilty after drinking?

Wanted to cut down or quit your use of alcohol?

Driven a car under the influence of alcohol?

Had anyone suggest to you that you may have a problem with alcohol?

Consumed alcohol at a time when it could interfere with work, family, or other responsibilities?

Given up other activities or interests because of your drinking?

Kept drinking even though it is harmful due to your medical condition (eg, ulcers, diabetes, or pregnancy)?

If you answered yes to any of these questions, YOU SHOULD SEEK FURTHER EVALUATION BY A HEALTH CARE PROFESSIONAL. Furthermore, if you have used any illegal substances since returning from deployment, YOU SHOULD SEEK HELP. For the abuse of or dependence on alcohol, over-the-counter medications, or any medications that were legally prescribed to you by a doctor, military policy allows you to seek help through the USMC Substance Abuse Counseling Centers or through the USN Substance Abuse Rehabilitation Program. For a self-referral such as this, without prior incident, your unit will help you without judgment. You can request a referral to your local program through your unit USMC Substance Abuse Control Officer or your Navy Drug and Alcohol Program Advisor. For an illegal substance or the unlawful use of prescription drugs, you are still subject to administrative action even for a self-referral. However, the US Government supports a web site that can help you find a treatment facility at http://dasis3.samhsa.gov/, or you can call the national help line for locating drug prevention treatment programs at 800-662-HELP.85, 86

90

BE A ROLE MODEL.

ACTIVITIES

87-95

Many people look up to members of the US military. As a veteran, you have the opportunity to be an important example to others, especially children and young people. They admire your courage. They want to hear your stories, and they will listen to your advice. Although you can be a role model in any context, we have five ways you can be a leader in the solution to substance abuse among other Marines or Sailors and particularly among other returning veterans.

EDUCATE YOURSELF Take the time to learn the public health guidelines for responsible and healthy use of legal substances such as over-the-counter drugs, prescriptions, and alcohol. For example, the US Department of Health and Human Services recommends 1 drink or fewer per day (a 24-hour period) for women and 2 drinks or fewer for men (1 drink is 12 oz of regular beer, 5 oz of wine, or 1½ oz of 80-proof alcohol).92 Furthermore, it is healthy to have some days that you do not drink at all. If you drink more on certain occasions or days of the week, the National Institute on Alcohol Abuse and Alcoholism indicates that men should have no more than 4 drinks on any given day and a maximum of 14 drinks per week.96 Women should have no more than 3 drinks on any given day and a maximum of 7 per week. Extensive research suggests that drinking beyond these limits can significantly increase your risk for serious social, physical, and mental health problems.97-99 The online resources at the end of this chapter include additional resources for information about responsible substance use, the problem of substance abuse, and substance abuse support services.

91

Responsible drinking 1. Women should keep regular alcohol use at 1 drink or fewer (1 drink is 12 oz of regular beer, 5 oz of wine, or 1½ oz of 80-proof alcohol) per day (a 24-hour period); the recommendation for men is 2 drinks or fewer per day. 2. Women should limit maximum use to 3 drinks on a specific day and a total of 7 per week; men should limit maximum use to 4 drinks per day and 14 per week. 3. Do not drink when you must be responsible for work or the care and safety of others. 4. The DoD standard is that you should never drive after drinking any amount of alcohol.

Photos courtesy of the Young Marines program.

EVALUATE YOURSELF How are you doing as a role model for responsible alcohol use? Are you just okay, or are you an excellent role model? On the following rulers, put an X on the blank where you fall by comparison with the general US population ages 17 to 49 years.95 More information about how your drinking compares with US population norms is available at http:// rethinkingdrinking.niaaa.nih.gov/.100

Typical Daily Drinks: In the past month, on a day when you drank, how many drinks did you usually have?

Men

Women

Healthy Nondrinker

None (46%)

Healthy Drinker 1 or fewer (17%)

At Risk

2-3 (26%)

None (34%)

2 or fewer (29%)

3-4 (18%)

Healthy Nondrinker

Healthy Drinker

At Risk

4 plus (11%)

5 plus (19%)

Maximum Occasional Drinks: In the past month, how often did you have 5 or more drinks (4 or more for women) on one occasion or within a 2-hour period?

Men

Women

Healthy Nondrinker

None (46%)

92 Healthy Drinker

Nonbinge (18%)

At Risk Occasional binge (1-4 times; 27%)

None (34%)

Nonbinge (23%)

Occasional binge (1-4 times; 28%)

Healthy Nondrinker

Healthy Drinker

At Risk

Heavy (9%)

Heavy (15%)

Note: Heavy drinking is defined as 5 or more drinks (4 or more for women) on one occasion (2-hour period) 5 or more times per month. A drink is 12 oz of regular beer, 5 oz of wine, or 1½ oz of 80-proof alcohol. A nondrinker is someone who reports no alcohol use in the past month.

WEIGH YOUR RISKS AND BENEFITS If you are not already doing so, make a list of the pros and cons of following the responsible drinking guidelines listed in the first module of this activity. The supplement at the end of the next chapter on Personal Finance may be helpful with this task. It gives you an example of how much money you would have if you cut back on your drinking and invested the cash you saved instead.

Examples

Possible Risks

Possible Benefits

You may not be included in some activities with friends.

You would be a role model, and people would respect you for it.

You may have a harder time relaxing in some social situations.

You would save money that you could invest or spend on something else.

It may be hard to explain to people that you do not want another drink.

You would lose weight and improve your physical health.

Make your own list 93

Possible Risks

Possible Benefits

MODERATE YOURSELF If you are not following the responsible drinking guidelines listed in the first module of this activity, make a commitment to start. Create a personalized responsible drinking plan for yourself. Better yet, make a shared responsible drinking plan between yourself and other Marines or Sailors in your unit. The following are some steps you may take to set up your plan. As you are working on this, make sure you refer to the supplement at the end of this chapter, which includes some helpful tips for moderate drinking. If you are in a position of leadership, a group goal plan may be an ideal way to work toward substance abuse prevention within your unit.

Individual Plan

Group Plan

1. Write down what you want to do at the top of your goal plan (eg, my goal is to maximize my health by having 2 alcoholic drinks or less per day).

1. Share your goal with others. Agree to work toward the goal together or at least get support with your goal (eg, do something other than specifically go out to drink when you get together).

2. Think about when you will be tempted or likely to over-drink (eg, weekend evenings, at a party, at a restaurant, feeling stressed, or with specific friends).

2. Discuss together when you may be most tempted to over-drink (eg, on weekend evenings, holidays).

3. Brainstorm things you could do instead of overdrinking (eg, workout).

3. For specific situations, think about what you could do instead of going out to drink (eg, play basketball, go to a movie).

4. Write a goal step for each situation you expect to be challenging: • If I am feeling stressed and want a drink, then I will go running instead.

4. Agree on a final list of specific goal steps you will act on: • If we make plans to get together on the weekend, then we will plan something specific to do (eg, play basketball, go to a movie).

5. Troubleshoot. How could you overcome difficult obstacles (eg, if friends ask me out to drink when I am feeling stressed, then I will say, “No I have an early morning; I have to head home.”)

5. Troubleshoot. How could you solve big challenges that are likely to come up (eg, if it is a big celebration like New Year’s Eve then invite people to come who are not heavy drinkers)?

6. Use the charting tools in the Appendices to track your goal success.

6. Use the charting tools in the Appendices to track your goal success.

94

EXPRESS YOURSELF Too often people keep their opinions about tobacco, alcohol, and drug use to themselves. You can be a role model simply by using substances responsibly yourself and looking for opportunities to express your opinion about the importance of responsible use. The following statements are examples of attitudes and opinions that you should share rather than keep to yourself.

What to say 1. Using illegal drugs is just not something you would ever consider doing. 2. Secondhand tobacco smoke does bother you, and you do not want to be around it. 3. It is embarrassing and unpleasant to watch someone drink too much. 4. People who drink and drive risk their own and everyone else’s lives; it is not a small offense, it is criminal.

95

BE A VOLUNTEER. There are opportunities to become more formally involved as a role model and as a proponent of responsible substance use. Military policy encourages volunteerism in drug prevention programming.101 Contact your local program directly to get involved (http://www.usmc-mccs.org/subabuse/poc.cfm?sid=fl&smid=2).102 In addition, you can find information about volunteering online through the Young Marines program (http://www.youngmarines.com/).103 This program provides community outreach to youth, with drug prevention as one major goal.

96

BE A FRIEND. There are a number of symptoms you can watch for that may indicate that someone you know is experiencing a high level of stress and could be at risk. Other symptoms indicate he/she may already have an addiction problem. Some important signs you may notice in a work setting follow. If you notice some of these symptoms in a coworker, we have listed some suggestions as to what you may do.

SIGNS OF STRESS

97

1. Muscle aches or headaches. 2. Upset stomach. 3. Feeling exhausted a lot of the time. 4. Change in appetite. 5. Change in weight (not due to dieting). 6. Sleeping a lot more or less than usual. 7. Irritability or short temper. 8. Problems with relationships or pulling away from relationships. 9. Poorer work quality than usual. 10. Difficulty concentrating. 11. Not enjoying work. 12. Feeling discouraged, low morale.

SIGNS OF ADDICTION IN THE WORKPLACE 1. Frequently being late for work. 2. Long lunch periods, leaving early, disappearing from worksite. 3. Frequent, unplanned, or unauthorized absences from work. 4. Frequent use of sick leave. 5. Patterns in absence from work (after paydays or on Mondays or Fridays). 6. Deteriorating work performance (missed deadlines, incomplete work, sloppy work). 7. Inconsistent work performance. 8. Making excuses for poor work performance. 9. Complaining about vague health problems; using them as excuses. 10. Needing help from others to get work done. 11. Blaming others for problems. 12. Asking others for help in covering up problems, such as being late. 13. Change for the worse in relationships with coworkers. 14. Short-tempered or argumentative, particularly after holidays or weekends. 15. Mood swings. 16. Avoiding people, isolating. 17. Avoiding supervisors, especially after lunch. 18. Frequent use of mouthwash or breath mints. 19. Falling asleep at work, always tired. 20. Poor concentration on tasks, forgetting things. 21. Careless risk-taking and a lack of concern for safety; frequent accidents. 22. Financial problems, needing money. 23. Changes for the worse in personal appearance. 24. Evidence of drinking at work (smell of alcohol, bloodshot eyes, inappropriate behavior). 25. Problems getting worse over time.

WHAT TO DO 1. Be an involved friend or leader; it is hard to offer support when you do not know that there is a problem. 2. If you see warning signs of a problem, you may not be sure whether it is a substance abuse problem or some other type of stress or extenuating life circumstance. 3. List and document (dates, places, and specific examples) the things you have observed that have worried you. 4. Speak confidentially about the problem. Start with concrete facts you have noticed: “I have noticed you have been absent several times lately. Is everything okay?” 5. If someone confides a problem to you, encourage him/her to seek help. Be prepared with information about support services to refer him/her (eg, Corpsman, Sgt. Major, Command Master Chief, XO, CO, Family Support or Service Center, Substance Abuse Counseling Center, Substance Abuse Rehabilitation Program, local military treatment facility, local civilian treatment programs). 6. If he/she refuses help or denies a problem, continue to document any problem behaviors and report any significant problems. 7. If you think someone is endangering the safety of themselves or others, is violating workplace rules, or is impaired by substances or in possession at work, report it to a supervisor immediately. If you are the supervisor, speak with a substance abuse treatment or human resource specialist to discuss how you may best address the problem. 8. DO NOT cover up or ignore problems. Helping someone avoid the consequences of their actions is “enabling” and will only make things worse in the long run. 9. DO NOT make adjustments for him/her, such as shifting workloads to others or taking on work yourself. 10. DO NOT lend him/her money. 11. DO NOT bring up your suspicions of a substance abuse problem unless he/she suggests it first. 12. DO NOT judge or try to diagnose the problem yourself. 13. DO NOT try to counsel him/her yourself.

98

ONLINE RESOURCES

Adult Children of Alcoholics World Service Organization. (2009). Adult Children of Alcoholics. http://www. adultchildren.org/. Al-Anon Family Group Headquarters. (2008). Al-anon.alateen.org. http://www.al-anon.alateen.org/. Alcohol in Moderation. (2002). Drinking&You. http://www.drinkingandyou.com/. Alcoholics Anonymous World Services. (2008). Alcoholics-anonymous.org. http://www.alcoholics-anonymous. org/?Media=PlayFlash. Alcoholics Anonymous World Services. (2009). Meeting Finder. http://www.aa.org/lang/en/meeting_finder.cfm. Join Together. (2009). AlcoholScreening.org. http://www.alcoholscreening.org/. Join Together. (2009). DrugScreening.org. http://www.drugscreening.org/.

99

Marine Corps Community Services. (2008). Substance abuse program. http://www.usmc-mccs.org/subabuse/index. cfm?sid=fl&smid=1. Moderation Management Network. (2009). Moderation Management. http://www.moderation.org/. Nar-Anon Family Groups World Services. (2008). Nar-anon.org. http://nar-anon.org/index.html. National Clearinghouse for Alcohol & Drug Information. (2008). Making your workplace drug free: A kit for employers. http://ncadi.samhsa.gov/govpubs/workit/. National Council on Alcoholism and Drug Dependence. (2009). Hope Line: 800/NCA-CALL (24-hour affiliate referral). http://www.ncadd.org/. National Institutes of Health. (2008). National Institute on Alcohol Abuse and Alcoholism. http://www.niaaa.nih.gov/. National Institutes of Health. (2009). Rethinking drinking: Alcohol and your health. http://rethinkingdrinking.niaaa.nih.gov/. Navy Personnel Command. (2008). Navy Alcohol and Drug Abuse Prevention (NADAP). http://www.npc.navy.mil/ CommandSupport/NADAP/. Partnership for a Drug-Free America. (2008). DrugFree.org. http://www.drugfree.org/. SMART Recovery. (2009). Self-Management and Recovery Training. http://www.smartrecovery.org/. Smoking Cessation. (2005). Smoking-Cessation.org. http://www.smoking-cessation.org/. Substance Abuse and Mental Health Services Administration. (2009). Center for Substance Abuse Treatment. http://csat.samhsa.gov/. Substance Abuse and Mental Health Services Administration. (2008). National Clearinghouse for Alcohol & Drug Information. http://ncadi.samhsa.gov/. Substance Abuse and Mental Health Services Administration. (2008). Substance abuse treatment facility locator. http://dasis3.samhsa.gov/. Waletzky L, Handel MJ (2009). Recovery Programs: Rational and Secular. http://www.addictionrecoveryguide.org/ treatment/recovery/rational_secular.html. Young Marines National Headquarters. (2008). Young Marines. http://www.youngmarines.com/.

WHAT TO DO WHEN. When you are working on a goal, and

SUPPLEMENT

especially if you are trying to change a health habit, it can be helpful to figure out exactly how you want to handle challenging times. Although you are often the best judge of what would be the most helpful, sometimes ideas that work for others can be useful. In the following table, the left-hand column lists situations that may be challenging while working on a responsible drinking plan. On the right side are some solutions some people find helpful. Take a pencil and draw lines to match up the challenges on the left with the best solution on the right that would help you at a time like that.104

Situation

Solution

If I am tempted to over-drink at a restaurant or bar

Then I will remind myself that drinking causes problems with my spouse/partner

If I am tempted to over-drink with friends at a party

Then I will remind myself that I can choose when I drink

If I am tempted to over-drink when I am frustrated or stressed

Then I will do something else relaxing (eg, a hot bath, systematic relaxation*)

If I am tempted to over-drink when I am happy and celebrating

Then I will remind myself that if I over-drink I will feel sick the next day

If I am tempted to over-drink when I am angry at something or someone

Then I will remember that if I over-drink I will not function well the next day

If I am tempted to over-drink when I am depressed

Then I will find someone to talk to that understands my drinking goals

If I am tempted to over-drink with my partner or close friend who is drinking

Then I will remove things from my home or office that remind me of drinking

If I am tempted to over-drink after arguments or conflicts with my family

Then I will remind myself that I want to be a role model of healthy alcohol use

If I am tempted to over-drink when I see someone drinking and enjoying it

Then I will do something that I enjoy that I could not do if I were drinking

If I am tempted to over-drink while talking and relaxing with friends

Then I will go somewhere that people are not drinking

If I am tempted to over-drink because someone offers me another glass

Then I will remind myself of how stupidly drunk people act

If I am tempted to over-drink when I cannot sleep at night

Then I will remind myself of dumb things I have done while over-drinking

*See Mental Health chapter.

100

STRATEGIES FOR MODERATION.

The National Institutes of Health recommend the following strategies to help moderate your drinking (see Rethinking Drinking, pp. 10-11, http://pubs.niaaa.nih.gov/publications/RethinkingDrinking/ Rethinking_Drinking.pdf).96, 105 Any of these suggestions may be useful as part of a responsible drinking plan. For more information on moderate drinking, another good resource is: Miller WR, Munoz RF. Controlling your drinking: Tools to make moderation work for you. New York, NY: Guilford; 2005.

Keeping track: Keep track of how much you drink. Find a way that works for you, such as a 3”x5” card in your wallet, check marks on a kitchen calendar, or a personal digital assistant. If you make note of each drink before you drink it, this will help you slow down when needed. Counting and measuring: Know the standard drink sizes so you can count your drinks accurately. One standard drink is 12 oz of regular beer, 8 to 9 oz of malt liquor, 5 oz of table wine, or 1.5 oz of 80-proof spirits. Measure drinks at home. Away from home, it can be hard to know the number of standard drinks in mixed drinks. To keep track, you may need to ask the server or bartender about the recipe. Setting goals: Decide how many days a week you want to drink and how many drinks you will have on those days. You can reduce your risk of alcohol dependence and related problems by drinking within recommended guidelines (see activity one, module one—Educate Yourself). It is a good idea to have some days when you do not drink.

101

Pacing and spacing: When you do drink, pace yourself. Sip slowly. Have no more than 1 drink with alcohol per hour. Alternate “drink spacers”—nonalcoholic drinks such as water, soda, or juice—with drinks containing alcohol. Including food: Do not drink on an empty stomach. Have some food so the alcohol will be absorbed more slowly into your system. Avoiding “triggers”: What triggers your urge to drink? If certain people or places make you drink even when you do not want to, try to avoid them. If certain activities, times of day, or feelings trigger the urge, plan what you will do instead of drinking. If drinking at home is a problem, keep little or no alcohol there. Planning to handle urges: When an urge hits, consider these options: Remind yourself of your reasons for changing. Or talk it through with someone you trust. Or get involved with a healthy, distracting activity. Or “urge surf”—instead of fighting the feeling, accept it and ride it out, knowing that it will soon crest like a wave and pass. Knowing your “no”: You are likely to be offered a drink at times when you do not want one. Have a polite, convincing “no, thanks” ready. The faster you can say no to these offers, the less likely you are to give in. If you hesitate, it allows you time to think of excuses to go along.

PERSONAL FINANCE

102



If it hasn’t been spent by family or otherwise squandered, a 3- or 4- tour young veteran Marine is sitting on money they would never have envisioned having in their savings account. It’s a kid’s college savings or a future retirement. Among the things that are critical in the after deployment process is financial management. One option is to save and invest. Another is 9 to buy a Porsche or spend it on alcohol.... I chose to invest.





On the battlefield James Roberts saw the perils of war. Two tours in Iraq left him with shin splints, foot problems, migraines, and post-traumatic stress disorder. ‘I’m 70% disabled, there’s not much I can do, I have a lower back injury and I’m trying to do everything I can.’ What’s worse is what’s yet to come. Money to pay for one more month on his [home] loan is drying up and foreclosure is knocking at his door. ‘Words really can’t describe it, my family built this,’ says Roberts…. ‘It doesn’t look good right now but I’m a fighter, I’m 106 willing, I’m trying to do everything I can to provide for my family.’



103

As you come home from combat deployment, you may be in the best financial position ever. You may have a sizable nest egg in your bank account because of your combat pay and tax savings. If you are active duty, you have access to free financial planning and accounting services through your Marine Corps Community Services or Navy Fleet and Family Support Centers. If you are career military, you have the guarantee of a lifetime of retirement pay after 20 years of service. For some, though, returning from deployment may be difficult financially. This may be because you had trouble tracking bills or financial obligations while you were away. It is possible you had family members at home who mismanaged money, bills, or investments. Your life circumstances may have changed, and you may be in transition, moving or changing jobs with no income at the moment. Finally, it may be hard for you and your family to cut back now that you are not receiving tax-free, combat zone benefits anymore. Regardless of whether you are doing well financially or struggling, setting financial goals is important. There are a lot of self-help books on the market that can help you learn about investing and managing money. There is also a lot of financial information available online. However, sitting down with a financial advisor may help you to clarify your goals, and it may help keep you motivated to achieve them. Especially if you work for the military and have free financial advice available, there is no reason not to make an appointment. The first purpose of this chapter is to encourage you to think about your financial goals and perhaps set some new goals. The second is to encourage you to seek financial advice from reliable sources such as the military financial advisement program. This chapter does not offer any surprising or unique information. It simply emphasizes common financial guidelines and budgeting strategies. If you are active duty, it gives you information about the USMC and USN financial management advisement programs; it also includes a number of online resources that may help you in pursuing your goals.

FACTS ABOUT MONEY MANAGEMENT

107, 108

• Use a budget. With each paycheck, plan out what you need to spend your money on and do your best to stick to your plan.

• Live within your means, or even better, live a little below them. If you have so many financial responsibilities that you cannot save some money out of every pay check, then you should do what you can to cut back on spending. One rule of thumb is to regularly save 10% of your income.

• Avoid debt wherever possible (that means bank loans, loans from friends, credit cards, home equity credit, etc.). Try to limit the types of things you do go into debt for to just the important basics, such as a practical car, a modest home, or an education.

• Make sure you have a rainy day fund. You should keep about 3 months worth of living expenses available in a savings account or a short-term CD as insurance against unexpected financial problems.

• Financial experts suggest that to retire you will need an annual payout from your investments, savings, and pension of about 70% to 80% of your working income. You should make plans to have that amount of retirement income for 25 to 30 years.

• Although no investment is without risk, the more reliable ways to make money and prepare for retirement include: (a) living within your means; (b) building up your own career or business; (c) investing in stocks, bonds, or shares in mutual funds, starting with a federal or employee retirement plan, and keeping them for the long haul; and (d) investing money in real estate, starting with your own home.

• The two ways to build your fortune that require the least amount of time and money up front are living within your means and investing in a retirement savings plan.

• Some investments are so risky they should be avoided altogether. Gambling on the lottery, at a casino, on horse races, or anywhere else is rigged for you to lose. Even gambling on futures and options in the stock market is something to steer clear of because they are very high risk.

• Be careful who you turn to for advice. Your friend, relative, or military buddy may think something is a great investment, but if it sounds too good to be true, it probably is not true. Especially if you are active duty, before you invest a lot of money in anything, you should make use of the free services available to you and consult a financial advisor.

104

SET FINANCIAL GOALS.

ACTIVITIES

109, 110

It is fine if you want to spend some of your deployment savings on things you may not otherwise have been able to indulge in for yourself or your family. However, make sure you also set some long-range goals for that money. What could you do with your savings today that you will be grateful for 15 years down the road?

Use the following worksheet both to review the financial goals you already have and to set new goals. Write down one or two goals in each category. Then go back and think about which goals you believe will be most helpful to you 15 years down the road. Rank each goal accordingly. Finally, rank them as to what you really want to spend your money on right now. What are you most excited about? How similar are your two rankings? Can you work toward the top-ranked goals on both lists at the same time? Can you work toward both of these goals within your budget?

Rankings Financial Stability

Excitement Motivation

Financial Goals

Rainy Day Fund/Insurance (prepare for future bills, maintain emergency savings, purchase life/health insurance, home or renters insurance, car insurance, etc.)

105

Goal 1:

Goal 2:

Debts (pay off credit cards, pay off loans, keep bills current, etc.) Goal 1:

Goal 2:

Investments (contribute to a retirement plan, purchase a home, start a Roth or regular IRA, start an education fund, etc.) Goal 1:

Goal 2:

Personal and Family Goals (plan for a future vacation, save for a hobby, save for hopes and dreams, purchase important gifts, etc.) Goal 1:

Goal 2:

106

USE A BUDGET. If you are not already, you should develop a habit of planning out how you will spend your money. You should at least make a monthly plan for regular expenses, and you should make sure you plan ahead for bills that come up unexpectedly or infrequently. There are commercial computer programs available that you can use to help you budget your money (eg, Microsoft Money, Quicken).111, 112 There are also some free downloadable spreadsheets online, primarily for use with Microsoft Excel.113-116 Some of these are listed among the online resources later in this chapter. There are a number of advantages to budgeting electronically. For instance, it is easier to add and subtract correctly, you can make changes easily, you can download banking information directly from your online account access, and electronic budgeting programs allow you to track information about how you spend your money over time. However, the basics of a monthly budget are simple, and it may be easier to start with paper and pencil. The following steps, along with the two modules that follow, can help you begin.

MONTHLY BUDGETING 1. Take a sheet of paper and draw a line down the middle (see example). At the top of the right-hand column write “Expenses.” At the top on the left write, “Income.”

107

2. Using a pencil, list your regular monthly expenses along with any other expected costs for the month in the lefthand column. Start with bills and payments that are a fixed amount each month and end with your more optional and variable costs. (Beforehand, it may be helpful to complete the module described next entitled “Mind Your Money,” so that you have a better idea of how much you typically spend on things.) 3. Add up the amounts for each of your expenses on the left and write the total in pencil at the bottom of the column. 4. Write in all income you expect to have available for the month from regular employment as well as other sources in the right-hand column. Add up all your expected income and write the total at the bottom of the right-hand column. 5. Make sure the total amount on the Expense side is the same as the total on the Income side. If they are NOT, take a red pen and either cut your expenses or think of ways to increase your income so the totals match. (The last module in this activity, “Vet Your Vice” may be helpful in identifying places you could cut expenses.) 6. Now the hard part: stick to your plan. If it is hard to do that, you may find that you need to make changes in your budget for the next month to be more realistic.

Example Budget Expenses

Income

Fixed Bills:

Employment:

Rent

$1,200

Paycheck

$3,000

Car loan

$300

Bonus

$100

Phone bill

$50

Reimbursement

$15

etc….

$250

etc….

Variable Necessities:

Investments:

Groceries

$450

Interest income

$25

Car (gas, maintenance)

$250

Dividends

$10

etc….

$300

etc….

Savings:

108

Other:

Emergency fund

$100

Yard sale

$200

Financial goals

$100

Gifts of money

$25

Future big bills/purchases

$100

Income from hobbies

$100

etc….

etc….

Other: Dining out

$100

Entertainment

$100

etc....

$175

Total $3,475

Total $3,475

MIND YOUR MONEY Try tracking everything you spend for 1 month. If you use an electronic money management program such as Microsoft Money or Quicken, you may already have this information on your computer. If not, use the following categories to get started. Use a separate envelope for each category and collect appropriate receipts in each envelope. Add additional categories if you need them as you go along. At the end of the week, add up the receipts in each envelope and write the total on the outside for week 1. Staple or paper clip receipts for that week so you can continue collecting receipts in the same envelope for the next week without getting them confused. At the end of the month, add up the weekly totals for a grand total, and you will have an idea of how much you spend in each category. Write those amounts in the blanks.

109

1. Food (grocery store bills, restaurant expenses, fast food, etc.)

$_________

2. Household (routine bills such as electricity, gas, or water, repairs, and other purchases, such as cleaning supplies and new furniture, etc.)

$_________

3. Transportation (car maintenance, fuel costs, car payments, car insurance payments, taxi or bus fare, plane fare, etc.)

$_________

4. Health and Medical Care (hospital bills, insurance payments, costs for medication, health club memberships, workout videos, dietary supplements, etc.)

$_________

5. Unreimbursed work expenses

$_________

6. Recreation (movies, theater, hobbies, fairs, museums, gambling, etc.)

$_________

7. Reimbursed expenses (loans to others, reimbursable work expenses, etc.)

$_________

8. Investments (contributions to retirement accounts, real estate investments, stock market purchases, etc.)

$_________

9. Charitable contributions (donations to churches, community service organizations, political funds, disaster relief, etc.)

$_________

10. Personal items (clothing, toiletries, spa treatments, hair cuts, etc.)

$_________

11. Other (specify) ___________________________________________

$_________

VET YOUR VICE Be honest and name one area where you believe you spend too much money on something that you do not really need. Without worrying about changing your habit, keep track of all your receipts in that area for a month. On each receipt make a note of the time of day, who you were with at the time, and any noteworthy thoughts or feelings that influenced your purchasing decisions. At the end of each week, on a piece of paper or in a notebook, summarize your spending using the following format. Then at the end of the month, answer the next four follow-up questions. The supplemental section at the end of this chapter also includes an example of how much money you could save by cutting back on just one expensive habit.

Weekly summary: Most frequent time of day: ______________________________________________________________________________ I was most often: (a) by myself

(b) with someone else, who? ______________________________________________

Most frequent reason for purchase: ______________________________________________________________________ Weekly total spent: $ ___________________________________________________________________________________

Follow-up questions 1. Is there a time of the day or week when you are most likely to spend money on this? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 2. Are there certain people you are usually with when you spend money on this? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 3. Is there a common mood or rationale for your spending? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 4. Are there changes in your routine or schedule you could make that may reduce the number of times you are in a situation where you are likely to spend money on this? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

110

MAKE USE OF MILITARY RESOURCES. The USMC and the USN both have excellent financial assistance programs. If you have never used any of the resources available to you, take the plunge and do it. If nothing else, try making use of the free tax preparation services this next tax season. Better yet, take your list of goals with you for some help in planning.

You can find phone numbers for your local center online from the Fleet and Family Support Center home page (http://www.nffsp.org/skins/nffsp/home.aspx) by choosing “Family Center Locations” from the menu on the lefthand side. Web sites for installation Marine Corps Community Services (MCCS) Centers can be found at http://www. usmc-mccs.org/installation/. These centers can help with many different services, such as career assistance and family counseling, in addition to financial advisement. Financial services are only available to active-duty personnel, retired military personnel, and DoD civilians. The financial management program can specifically help you with: Financial planning Budgeting Debt management Making major purchases

111

Investing Retirement planning Tax planning Tax preparation

ONLINE RESOURCES

Army Times Publishing Company. (2008). Military Times: Financial help. http://www.militarytimes.com/money/ financial_advice/. Cable News Network. (2009). Money 101 lesson 2: Making a budget. http://money.cnn.com/magazines/moneymag/ money101/lesson2/. Consumer Federation of America. (2008). Military saves. http://www.militarysaves.org/. FINRA Investor Education Foundation. (2008). Saveandinvest.org. http://www.saveandinvest.org/Military/index.htm. Crown Financial Ministries. (2008). Calculators. http://www.crown.org/tools/calculators/. In Charge Education Foundation Inc. (2008). Military money: Home, life, success. http://www.militarymoney.com/. Marine Corps Community Services. (2008). MCCS Installation Websites. http://www.usmc-mccs.org/installation/. Microsoft Office Online. (2009). Budgets. http://office.microsoft.com/en-us/templates/CT101172321033.aspx. Military Benefit Association. (2008). Militarybenefit.org. http://www.militarybenefit.org/. Navy Installations Command. (2008). The Navy Fleet and Family Support Center. http://www.nffsp.org/skins/nffsp/ home.aspx. Navy Personnel Command. (2008). Financial Fitness. http://www.npc.navy.mil/AboutUs/NPC/General_Information/ FinancialFitness.htm. Park C, Park S. (2009). The original pearbudget spreadsheet. http://www.pearbudget.com/spreadsheet. US Department of Veterans Affairs. (2008). VA Mortgage Center.com. http://www.vamortgagecenter.com. US Marine Corps. (2008). USMC Financial Fitness Online Resource Center. http://www.humtech.com/Marines/ financial/index.htm. Vertex42. (2009). Personal Monthly Budget. http://www.vertex42.com/ExcelTemplates/personal-monthly-budget.html. Young Money. (2008). Calculators. http://www.youngmoney.com/calculators.

112

SUPPLEMENT

VICE VERSUS INVESTMENT. If you gave up one expensive habit and at the end of each month you invested the money you saved, how much difference would it make? The following are two examples of what the answer may be. Although they do not take inflation into account, there are some sites listed in the online resources that can help you estimate your savings if you changed your spending and savings habits (ie, http:// www.youngmoney.com/calculators).

HOW MUCH MONEY WOULD YOU SAVE If you cut down drinking alcohol by one 12-pack of beer per week? Here, we assume that you invest this money at a rate of 5% interest over 20 years. We assume that a 12-pack costs $10.00 with an annual inflation rate of 3%.

11 3

Year

Invested

Earned

Total

1

$433

$10

$443

5

$3,265

$518

$3,783

10

$6,486

$2,026

$8,512

15

$10,098

$4,928

$15,025

20

$13,336

$8,680

$22,017

HOW MUCH MONEY WOULD YOU LOSE By smoking a pack of cigarettes a day rather than saving that money? In this example, we again assume that you invest this money at a rate of 5% interest over 20 years. We also assume that a pack of cigarettes costs $4.00 today with an annual inflation rate of 3%.

Year

Invested

Earned

Total

1

$1,200

$28

$1,228

5

$9,048

$1,436

$10,484

10

$17,976

$5,615

$23,591

15

$27,984

$13,658

$41,642

20

$36,960

$24,056

$61,016

CAREER

114



Gunnery Sgt. Jack Sigman…spent 3 long, hard years in rehabilitation, learning to live––and continue his military career––with an artificial limb…. In and around Ar Ramadi, he was escorting [a] quick-reaction force as it disposed of improvised explosive devices. While acting as a sentry for the team, Sigman recalled, ‘An insurgent popped up from behind a corner and fired.’ A rocket-propelled grenade tore into the sergeant’s leg. The gunny is now assigned to Marine Corps Systems Command as the Saber fielding officer…. Until that time, there had been no above-the-knee amputees who had stayed in the Corps.… Captain Stephan Karabin, the Saber project officer, noted Sigman’s contagious inspiration…‘I’m motivated on a daily basis by interacting with Gunny Sigman because of the enthusiasm he carries with 117 him.’

” “

Civilian employers and supervisors act as if it’s a matter of life and death if something minor goes wrong on a job. They have never really experienced life. They have never been in a position to understand what really matters. They think a civilian job (other than police/fire/EMS/ surgeon/etc.) is the be-all and end-all. I know better. So does anyone who’s 118 ever carried a loaded weapon and dealt with rules of engagement. 115



Coming home from deployment is a job change for everyone. Even if you will be staying in the same role within your deploying unit, it is a different job back home in garrison. For those who are transferring to a new unit, who are changing occupational specialty, or who are leaving military service entirely, it is really a JOB CHANGE. This level of life change is always somewhat stressful regardless of whether it is welcome or unwelcome. There could be some challenges you face now that you did not face before deployment that make it harder to adjust at work. You may find that nothing is as exciting or interesting as what you did while you were actually doing the mission. Being deployed may have led you to change some of your career goals. If you have been injured, you may have to change your career aspirations to one degree or another. If you are leaving military service you have additional challenges. The services can provide you with support during this transition through the Transition Assistance Program, but leaving military service may still feel like culture shock.119 It can be hard to relate to people and fit in within a civilian work environment. Some civilian employers are more understanding and appreciative of your skills and experience than others. You may have difficulty figuring out how to translate your military training and experience into a civilian job application. If there are times when you are between jobs, finances may be tight until you find the right niche for yourself. This chapter includes some information about job stress. It discusses some ways that you can improve your career satisfaction regardless of your circumstances. It also includes a number of career resources available online that may be helpful in searching for your next career.

FACTS ABOUT CAREER SATISFACTION

4, 87

• If you feel your job is simply about drawing a paycheck, your work is likely to be less meaningful. • Focusing too much on getting ahead or getting promoted can lead to an overly competitive situation and less satisfaction with work.

• People more often report that their work is satisfying when they are able to find ways to make a difference in the lives of their coworkers and clients.

• Work will be more satisfying and less stressful when you clearly know what is expected of you and what your responsibilities are. • Work will be more satisfying and less stressful if you have good relationships and teamwork with your colleagues.

• Work will be more satisfying and less stressful if you are able to organize your work and personal schedules to reduce conflicts.

• Work will be more satisfying if you are able to use your best strengths and skills on a regular basis.

116

WHAT IS YOUR NEW MISSION.

ACTIVITIES

4

Having a vision of the mission of your work is very important. Particularly at a time of transition such as returning from deployment, it is important to reorient yourself to the big picture. This reorientation will be more or less of a challenge depending on whether you are in the same military occupational specialty and you are training to redeploy, your military duties are very different now that you are home, or you are actually leaving or have left the service and you have completely new employment. In any case, it is helpful to ask yourself:

1. Who or what is most impacted by the work I do now? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

2. What part of my job has the greatest impact on the success of my unit or work group? ______________________________________________________________________________________________________

117

______________________________________________________________________________________________________ ______________________________________________________________________________________________________

3. What tasks or aspects of my job are most satisfying or enjoyable to me personally? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

4. In what way can I personally make a difference in support of my new responsibilities? ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

TAKE CONTROL. In different jobs you have very different amounts of control

over what you do and very different amounts of influence over the process of how things are done within your unit or work group. However, in any situation you have some amount of control. Having a sense of control, even a little, is actually a great way to improve your own job satisfaction. It is also a way to increase your own sense that you are making a difference and playing a valuable role. In situations where you have very little control, making the most of the choices you have can sometimes make a big difference. For example, at the beginning of each fiscal year or at the beginning of each new work project, you may consider what choices you have about your job description. On what tasks do you have the freedom to change and improve the way things are carried out? What tasks could you offer to take on that you would enjoy doing and that others would appreciate? What one thing could you personally choose to do that would make the biggest difference in the success of your unit or work group?

118

TAKE TIME.

Having good relationships with people at work is one of the most important keys to job satisfaction. There are a number of ways you can work on improving these relationships. For example, take a look at the Thank-You List activity in the chapter on Personal Relationships. Actually taking the time to thank people, either in person or in writing, is a great way to improve relationships with coworkers, clients, or others with whom you do business. Taking the time to talk with people throughout the day at work is also important. Consider choosing one or two goals from the following list and make a consistent effort to accomplish them.

1. Know the names of the family members of everyone with whom you work. 2. Know at least one hobby or interest of everyone with whom you work. 3. Keep a list of your coworkers’ birthdays and send an e-mail or a card each year. 4. Bring pictures of your family to work and personalize your office space so others know something about you. 5. Make a point of keeping administrative and support personnel, such as information technology, library, clerical, and maintenance personnel, on your thank-you list. Consciously try to treat them with the same respect that you treat supervisors or senior leadership. Occasionally try making it a more formal thank you with an actual handwritten note or a box of doughnuts or bagels.

119

6. Volunteer to participate on work subcommittees like morale, welfare, and recreation. 7. Consider group activities such as a unit baseball team. 8. Are there people you have noticed going the extra mile and doing a little better job? Consider mentioning to them that you have noticed what they do. You may also point it out to supervisors or senior leadership. 9. Pass out cards to everyone you work with during the holidays. 10. Ask one person a week if you can help with some task he/she is working on, whether large or small. 11. Keep a joke calendar on your desk and share the funniest ones with your coworkers. 12. Keep a small candy dish on your desk with inexpensive candy for anyone to take. 13. If you have your own office, keep the door open as often as possible.

ONLINE RESOURCES

American Council on Education. (2009). ACE military programs. http://www.acenet.edu/AM/Template. cfm?Section=Military_Programs. America’s Job Exchange. (2008). Military Spouse JobSearch. http://www.militaryspousejobsearch.org/msjs/app/. Army Times Publishing Company. (2009). Military Times: Careers & Education. http://www.militarytimes.com/ careers/. Collegeboard.com Inc. (2008). CLEP for military personnel. http://www.collegeboard.com/student/testing/clep/ military.html. Defense Activity for Nontraditional Education Support. (2008). Education Support to the DoD - Worldwide. http:// www.dantes.doded.mil/Dantes_web/DANTESHOME.asp. Defense Activity for Nontraditional Education Support. (2009). Troops to Teachers. http:// www.proudtoserveagain.com/. Health Careers Foundation. (2007). Hire Heroes USA. http://www.hireheroesusa.org/. National Veterans Foundation. (2008). Employment center: Veterans job listings. http://www.nvf.org/ resources/job/index.php. US Department of Labor. (2008). CareerOneStop. http://www.careeronestop.org/. US Department of Labor. (2008). Find your state job bank. http://www.jobbankinfo.org/. US Office of Personnel Management. (2008). USAJobs. www.usajobs.gov. US Department of Veterans Affairs. (2008). GI Bill Website. Retrieved http://www.gibill.va.gov/ GI_Bill_Info/benefits.htm. US Department of Veterans Affairs. (2009). VetSuccess. http://www.vetsuccess.gov/.

120

121

LEGAL AFFAIRS



‘We’re subject to state, federal and military law here,’ [one veteran explained].... He feared both other people’s unpredictability and his own reactions, and he was not alone…. One person had received a recent DUI charge, and another had been demoted after a verbal confrontation with a Department of Defense police officer…. ‘You let your guard down in the States…. Anything [can happen]. You 120 just don’t know.’





Last spring, Cpl Levi Bradley’s marriage to his wife, Amber, fell apart. He was a Marine on active duty and spent some time in Iraq. He said his 2-year-old son, Tyler Allen, now lives with his estranged wife. Bradley thought that by invoking the Service Members Civil Relief Act––which can assist active military personnel involved in lawsuits––he wouldn’t lose his son…. Bradley said he’s upset that he lost his son while he was away serving his country. ‘My opinion wasn’t able to be voiced due to the fact that I wasn’t there to actually state it myself,’ Bradley said. ‘The fact that I’m not able to be back just 121 throws everything out of whack.’



Military briefings try to prevent legal problems for you before you leave for deployment by guiding you through the process of assigning power of attorney, making a will, and helping you focus on issues that you need to take care of beforehand. Federal law tries to protect you from problems that may occur while you are away. However, you may still return from deployment facing legal problems. You may be dealing with divorce or custody issues. You may have financial problems that require legal assistance. Again, although the military tries to protect you while you are in harm’s way, you could be returning with an injury and face a Physical Examination Board (PEB). If you are active duty, since you have access to free legal aid, you should make use of it. You should seek counsel before you enter into any binding legal agreement and before you sign any contract involving a significant amount of money, such as a car or home loan.122 Although you are not guaranteed legal counsel during the initial phases of a PEB, you still can and should request legal aid immediately. Do not wait to be assigned a lawyer halfway through your case. With good legal support, most problems can be resolved satisfactorily. Whether it is a problem with military regulations, a criminal case, or a civil matter, the following information can help guide you on your way to resolving your legal problem. Whether you are dealing with divorce, power of attorney, military rights and benefits, employment, family law, writing a will, buying a car, bankruptcy, taxes, or landlord/tenant problems, your concerns are important. This chapter will provide activity worksheets that can help you prepare for your case.

122

FACTS ABOUT LEGAL AFFAIRS

• By planning in advance, you can avoid many legal problems. Make sure you have professional assistance in making important legal decisions and in understanding any legally binding document you sign, particularly those that involve large sums of money.

• Taking care of your personal legal affairs as soon as you realize you have a problem will give you and your family peace of mind.

• To save time, you should keep your personal history, employment records, automobile information, insurance, property ownership, and financial documents organized in a safe place.

• If you are active duty, you are entitled to free assistance from licensed attorneys through the US Navy and Marine Corps legal aid programs.

123

HOW TO FIND A LAWYER. As an active-duty military

ACTIVITIES

122, 123

member, you always have access to free legal assistance through the military legal assistance programs that can be located online (http://legalassistance.law.af.mil/content/ locator.php).124 Under most circumstances, these programs will be the best place for you to seek legal assistance. In the event that you are not comfortable seeking legal aid through military channels, there are resources online that are helpful in finding good legal counsel. For example, within the San Diego area, the San Diego County Bar Association sponsors a nonprofit referral service (http://www.sdcba.org/LRIS).125 Similarly, for the rest of the country, the National Bar Association web site has a tool to help you find local legal assistance (http://www. abanet.org/legalservices/findlegalhelp/home.cfm).126 Under online resources at the end of this chapter, there are some additional sites for organizations specializing in legal aid for military veterans. Remember, whenever you visit legal aid through the military or a civilian service, make sure you either make an appointment ahead of time or that you are going during walk-in hours.

124

WHAT TO BRING. It is very helpful to be prepared when you first meet with your attorney or go to a legal aid office. Start out by collecting all of the paperwork that is relevant to your legal problem(s). This will help you save time and resolve your legal situation more effectively.

CURRENT ISSUES Be prepared to discuss all of the legal issues you currently have. Make a list and bring it with you if you have more than one issue to discuss. Here are some you may be dealing with:

125

____ Bankruptcy

____ Foreclosure

____ Car

____ Domestic violence

____ Family law

____ DUI/DWI

____ Divorce/separation ____ Sexual assault ____ Sexual harassment

____ Estate plans, wills, trusts

____ Name change

____ Landlord/tenant problems

____ Tax

____ Service Members Civil Relief Act

____ Immigration

____ General and special powers of attorney

____ Other: ___________________________________________________________________________________________

LEGAL CONTACTS If you have been assisted or represented by other attorneys in negotiations about your current legal problems, have their contact information handy. Name: ________________________________________________________________________________________________ Address: ______________________________________________________________________________________________ City: ___________________________________ Zip Code: _______________ Phone: (_______)_______________________ Date Contacted: ____________________ E-mail: ____________________________________________________________

OFFICIAL DOCUMENTS Bring along the following types of documents with you. 1. 2. 3. 4. 5. 6. 7. 8.

Military identification, US driver’s license or US state-issued non-driver identity card, or passport for civilians. Any court notices you have received. All relevant contracts and agreements. Letters or notices you have received through the mail regarding your case. Documents prepared for you by other attorneys. For custody cases, the leave and earnings statement (LES) of the military parent(s). For disability cases, all Physical Examination Board decisions and narrative summaries. For disability cases bring medical records and doctors’ letters or recommendations.

PROBLEM SUMMARY If you have not already done so, write a brief summary of the important issues regarding your case. Also, keep a diary of events including dates and information that you believe are important to your case. ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

126

WHAT TO ASK. If you need to retain legal counsel, you should be ready to ask important questions about the services they will provide and the costs you will incur.123 It is important to interview an attorney first to make sure that he/she is a good fit for you and your case. The following are some questions you can ask. These are only suggestions, and you may have more specific questions pertaining to your case.

1. What is your educational background? 2. In what areas of law do you specialize? 3. How much experience do you have in the area I need help with? 4. Given the details of my case, what can you do to help me? 5. Can you give me a general idea of how my case may progress from here? 6. How may this case interfere with my life? 7. What is the estimated duration of my case?

127

8. How will you notify me of the final results of my case? 9. Have you had cases similar to mine? 10. What success have you had in dealing with situations like mine? 11. What percentage of a chance would you estimate that I have of successfully resolving my legal problem? 12. Is there any way to resolve my legal problem through alternatives such as mediation or collaborative law? 13. Will you be the only one handling my case, or are there other people who will assist you? 14. Do you honestly have time right now to work on my case? 15. What can I do to control and limit my legal costs or fees? 16. What factors may increase the costs of my case? 17. May I see your retainer fee agreement (fee structure, billing procedure, is retainer fee refundable, late charges, or other penalties)? 18. Under what circumstances could you choose to terminate your work on my case? If you terminate services, will my file be returned free of charge?

ONLINE RESOURCES

American Bar Association. (2008). Public resources. http://www.abanet.org/public.html. American Bar Association. (2008). FindLegalHelp.org. http://www.abanet.org/legalservices/findlegalhelp/home.cfm. Department of Defense. (2008). US Armed Forces Legal Assistance: Legal Services Locator. http://legalassistance. law.af.mil/content/locator.php. National Veterans Legal Services Program. (2008). Lawyers Serving Warriors. http://www.lawyersservingwarriors. com/. Pro Bono Net. (2008). LawHelp.org. http://www.lawhelp.org/. The Veterans Consortium. (2008). Pro Bono Program. http://www.vetsprobono.org. Yahoo. (2008). Law: Self-help. http://dir.yahoo.com/government/law/self_help/.

128

APPENDICES 129

CHARTING FORMS

GOAL PLAN, ACHIEVING A SHORT-TERM GOAL. Describe your shortterm goal at the top of this form. Be specific about exactly what you want to do. Next, list the steps you will take to accomplish this goal. Identify specific times when you will take action on each step and exactly what you will do at those times. Finally, troubleshoot your plan. What challenges may get in the way? In the first column at the bottom, write at least three challenges that could interrupt your plan. In the second column, write one or two solutions for each challenge.

Goal Definition My goal is to...

Goal Plan Step

Time and Place



Action

1. 2. 3.

130

4. 5.

Goal Troubleshooting Challenge 1

Solution 1

Challenge 2

Solution 2

Challenge 3

Solution 3

GOAL CHART 1, COMPLETING A PROJECT.

Use this chart to list different steps you need to take in completing a short-term project. Make sure you give yourself a date or a time frame within which you hope to complete each step. Then check off each step as you complete it. If necessary, copy this sheet to track a goal that will take more than 5 steps to complete.

131

Done

Done

Done

Done

Date or Time Frame:

Date or Time Frame:

Date or Time Frame:

Date or Time Frame:

Date or Time Frame:

Step 1: ___________

Step 2: ___________

Step 3: ___________

Step 4: ___________

Step 5: ___________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

Project Complete

Done

10 _____ 9 _____ 8 _____ _____ 6 _____ 5 _____ 4 _____ 3 _____ 2 _____ 1 ____ Day/ Week/ Date

_____

1

_____

2

_____

3

_____

4

_____

5

_____

6

_____

7

_____

8

_____

9

_____

10

_____

11

_____

12

_____

13

_____

14

_____

15

_____

16

_____

17

_____

18

_____

19

_____

20

GOAL CHART 2, BUILDING A HABIT. You can use this chart to graph the number of times you have successfully followed your goal plan to perform a specific task either daily or weekly. You can use the numbers provided on the bottom of the chart to track your days/weeks of progress. Alternatively, you can write in the specific dates when you plan to track your performance on this task. On the side of the chart, you can also use the numbers given or add your own benchmark numbers to represent how often you expect to successfully complete your goal task each day/week or by each target date. Then as you work toward your goal, above each number/date at the bottom of the chart, place an X on the line representing the total number of times you actually completed your task.

132

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

_____

Assessment Chart, Tracking Change in Your Well-Being. You can use this chart to track changes in your results on any of the self-assessments you choose to complete in this book or online. Record your first score in the starting square on the baseline down the center of the chart. Each time you retake the assessment, write the date at the bottom of the chart. Then place an X above the date either above or below your baseline to show how much your score has or has not changed. Write in your exact score next to the X.

> +16

+12

+8

+4

Start

-4

-8

- 12 < - 16

Date

133

REFERENCES

1. USN LCDR, MSC. Challenges of returning from deployment: Interview 5. Personal communication received by Stander VA. San Diego, CA: June 18, 2008.

21. Beck AT. Cognitive therapy and the emotional disorders. New York, NY: Penguin Books; 1979.

2. USMC 1st Sgt. Challenges of returning from deployment: Interview 4. Personal communication received by Stander VA. San Diego, CA: June 18, 2008.

22. Burns DD. Feeling good: The new mood therapy. New York, NY: Harper Collins; 1980.

3. USOC Sports Psychology Staff. Sport Psychology Mental Training Manual. Colorado Springs, CO: United States Olympic Committee; 2002.

23. Seligman ME. What you can change and what you can’t: The complete guide to successful self-improvement. New York, NY: Vintage Books; 2007.

4. Biswas-Diener R, Dean B. Positive psychology coaching. Hoboken, NJ: John Wiley & Sons; 2007.

24. Bourne E, Garano L. Coping with anxiety. Oakland, CA: New Harbinger; 2003.

5. Rouillard L. Goals and goal setting: Achieving measured objectives. 3rd edition. Rochester, NY: Axzo Press; 2003.

25. Kipling L. Fighting combat stress, [Internet]. 2005: http://www.military. com/NewContent/0,13190,Defensewatch_020705_Kipling,00.html. Accessed March 12, 2008.

6. Gollwitzer PM. Implementation intentions: Strong effects of simple plans. American Psychologist. 1999; 54(7):493-503.

26. DeCarvalho LT, Whealin JM, Vega EM. Dealing with stress after war: OIF/ OEF returnee’s workbook. Honolulu, HI: National Center for Posttraumatic Stress Disorder, VA Pacific Islands Health Care System; 2006.

7. Armitage CJ. Evidence that implementation intentions promote transitions between the stages of change. Journal of Consulting and Clinical Psychology. 2006; 74(1):141-151.

27. Hart AB. An operators manual for combat PTSD: Essays for coping. Lincoln, NE: Writer’s Digest, iUniverse.com; 2000.

8. USMC LtCol. Challenges of returning from deployment: Interview 1. Personal communication received by Stander VA. San Diego, CA: June 18, 2008.

28. Slade M, Powell R, Rosen A, Strathdee G. Threshold Assessment Grid (TAG): The development of a valid and brief scale to assess the severity of mental illness. Social Psychiatry and Psychiatric Epidemiology. 2000; 35:78-85.

9. USMC LtCol. Challenges of returning from deployment: Interview 3. Personal communication received by Stander VA. San Diego, CA: June 23, 2008. 10. Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress. 1996; 9(3):455-471. 11. Elder GH, Clipp EC. Combat experience and emotional health: Impairment and resilience in later life. Journal of Personality. 1989; 57(2):311-341.

134

29. Miller S, Miller P, Nunnally EW, Wackman DB. Talking and Listening Together: Couple communication I. Littleton, CO: Interpersonal Communication Programs Inc.; 1991. 30. Sonkin DJ, Durphy M. Learning to live without violence: A handbook for men. Volcano, CA: Volcano Press; 1997.

12. Linley PA, Maltby J, Wood AM, et al. Character strengths in the United Kingdom: The VIA Inventory of Strengths. Personality and Individual Differences. 2007; 43:341-351.

31. Streisand B. Treating War’s Toll on the Mind: Thousands of soldiers have post-traumatic stress disorder. Will they get the help they need?, [Internet] 2006: http://health.usnews.com/usnews/health/articles/061001/9ptsd. htm. Accessed September 18, 2007.

13. Seligman MEP, Park N, Peterson C. The values in action (VIA) classification of characters strengths. Ricerche di Psicologia. 2004; 27(1):63-78.

32. USMC Captain. Challenges of returning from deployment: Interview 2. Personal communication received by Stander VA. San Diego, CA: June 18, 2008.

14. Seligman M, Peterson C. VIA Survey of Character (VIA-IS), [Internet]. 2007: http://www.viasurvey.org/. Accessed 2009, May 20.

33. Spitzer RL, Williams JBW, Kroenke K. Patient Health Questionnaire, [Internet]. 2005: http://www.phqscreeners.com/. Accessed November 17, 2008.

15. American Psychological Association Practice Organization. Posttraumatic Growth Inventory, [Internet]. 2008: http://www.apapractice.org/apo/public/ resilience/presentation/ptgi.html. Accessed February 12, 2009.

34. Bryan CJ, Rudd MD. Advances in the assessment of suicide risk. Journal of Clinical Psychology. 2006; 62:185-200.

16. American Psychological Association Practice Organization. The Posttraumatic Growth Inventory: Introduction, Taking stock: Growth through resilience.[Internet]. 2008: http://www.apapractice.org/apo/public/resilience/ presentation/ptgi_intro.html. Accessed February 12, 2009. 17. Fox Interactive Media. MySpace, [Internet]. 2008: www.myspace.com. Accessed July 9, 2009. 18. Facebook Inc. Facebook, [Internet]. 2008: www.facebook.com. Accessed July 9, 2009. 19. Monster Worldwide Inc. MILblogging.com, [Internet]. 2009: http://www. milblogging.com/listingDetail.php?id=1551. Accessed February 12, 2009. 20. Seligman ME. Learned Optimism: How to change your mind and your life. First Vintage Books edition. New York, NY: Random House; 2006.

35. Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at: Annual Meeting of the International Society for Traumatic Stress Studies. October, 1993; San Antonio, TX. 36. Deployment Health Clinical Center. PTSD Checklist: Civilian Version (PCL-C), [Internet]. 1994: http://www.pdhealth.mil/guidelines/appendix3. asp. Accessed June 5, 2007. 37. Bliese PD, Wright KM, Adler AB, Cabrera O, Castro CA, Hoge CW. Validating the Primary Care Posttraumatic Stress Disorder Screen and the Posttraumatic Stress Disorder Checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology. 2008; 76(2):272-281. 38. Hanh TN. The miracle of mindfulness: An introduction to the practice of meditation. Boston: Beacon Press; 1987.

39. Mayo Clinic Staff. Video: Need to relax? Take a break to meditate, [Internet]. 2007: http://www.mayoclinic.com/health/meditation/ MM00623. Accessed June 25, 2008. 40. Forbes D, Phelps A, McHugh T. Treatment of combat-related nightmares using imagery rehearsal: A pilot study. Journal of Traumatic Stress. 2001; 14(2):433-442. 41. Davis JL, Wright DC. Randomized clinical trial for treatment of chronic nightmares in trauma-exposed adults. Journal of Traumatic Stress. 2007; 20(2):123-133. 42. Korn ER. Visualization techniques and altered states of consciousness. In: Sheikh AA, ed. Handbook of therapeutic imagery techniques. Amityville, NY: Baywood Publishing; 2002:41-49. 43. Smith JC. Relaxation, meditation, & mindfulness. New York, NY: Springer Publishing; 2005. 44. Rich M. He lived to tell the tale (and write a best seller), [Internet]. 2007: http://www.nytimes.com/2007/08/09/books/09seal.html?_ r=2&oref=slogin&oref=slogin. Accessed September 3, 2008. 45. Williams MB, Poijula S. The PTSD workbook. Oakland, CA: New Harbinger; 2002. 46. Goulston M. Post-traumatic stress disorder for dummies. Hoboken, NJ: Wiley; 2008.

63. Levy AM, Fuerst ML, eds. Sports injury handbook: Professional advice for amateur athletes. New York, NY: John Wiley & Sons; 1993. 64. US Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. US Government Printing Office; 2000: http://www.healthypeople.gov/Document/pdf/uih/2010uih.pdf. 65. Journal of Family Practice. Managing insomnia: A physician-patient partnership. Journal of Family Practice. 2008; 57(Supplement):S8-S11. 66. Mayo Clinic Staff. Coping with anxiety: Can diet make a difference?, [Internet]. 2007: http://www.mayoclinic.com/print/coping-with-anxiety/ AN01589/METHOD=print#. Accessed November 13, 2008. 67. Depression and Bipolar Support Alliance. Food and mood. Chicago, IL: Author 2005: http://www.dbsalliance.org/pdfs/foodmoode2.pdf. 68. Dreyer D. ChiRunning: A revolutionary approach to effortless, injury-free running. New York, NY: Simon and Schuster; 2004. 69. Green BS. Jogging the mind. Perry, PA: Silverlake Press; 1995. 70. Casa DJ, Armstrong LE, Hillman SK, et al. National Athletic Trainer’s Association position statement: Fluid replacement for athletes. Journal of Athletic Training. 2000; 35(2):212-224. 71. Casa DJ, Clarkson PM, Roberts WO. American College of Sports Medicine roundtable on hydration and physical activity: Consensus statements. Current Sports Medicine Reports. 2005; 4:115-127.

47. Kubler-Ross E. On death and dying. New York, NY: Macmillan; 1969. 48. Kleiber DA, Hutchinson SL, Williams R. Leisure as a resource in transcending negative life events: Self-protection, self-restoration, and personal transformation. Leisure Sciences. 2002; 24:219-235.

135

49. Hutchinson SL, Loy DP, Kleiber DA, Dattilo J. Leisure as a coping resource: Variations in coping with traumatic injury and illness. Leisure Sciences. 2003; 25:143-161. 50. Iwasaki Y, Mannell RC. Hierarchical dimensions of leisure stress coping. Leisure Sciences. 2000; 22:163-181. 51. Iwasaki Y. Counteracting stress through leisure coping: A prospective health study. Psychology, Health & Medicine. 2006; 11(2):209-220. 52. Heintzman P, Mannell RC. Spiritual functions of leisure and spiritual wellbeing: Coping with time pressure. Leisure Sciences. 2003; 25:207-230. 53. Iwasaki Y, Mactavish J, Mackay K. Building on strengths and resilience: Leisure as a stress survival strategy. British Journal of Guidance & Counseling. 2005; 33(1):81-100. 54. Coleman D, Iso-Ahola SE. Leisure and health: The role of social support and self-determination. Journal of Leisure Research. 1993; 25(2):111-128.

72. Morris R. Running form for distance runners, [Internet]. 2009: http:// www.runningplanet.com/training/runningform.html. Accessed April 17, 2009. 73. Unger Hahn J. The perfect form: Running better, from head to toe, [Internet]. 2009: http://www.runnersworld.com/article/0,7120,s6-238-267268-8210-0,00.html. Accessed April 17, 2009. 74. US Department of Health and Human Services and US Department of Agriculture. Dietary guidelines for Americans, 2005, 6th ed. US Government Printing Office; 2005: http://www.health.gov/dietaryguidelines/dga2005/ document/pdf/DGA2005.pdf. 75. Mayo Clinic Staff. Nutrition and healthy eating: Nutrition basics, [Internet]. 2009: http://www.mayoclinic.com/health/nutrition-and-healthyeating/MY00431. Accessed April 20, 2009. 76. National Athletic Trainer’s Association. Health Care for Life & Sport, [Internet]. 2009: http://www.nata.org/. Accessed April 7, 2009. 77. Mayo Clinic Staff. Slide show: How to stretch your major muscle groups, [Internet]. 2007: http://www.mayoclinic.com/health/stretching/SM00043. Accessed November 13, 2008.

55. US Department of the Navy. Physical Readiness Program, OpNavInst 6110.1H: Chief of Naval Operations; 2005.

78. Alvarez L. After the battle, fighting the bottle at home, [Internet]. 2008: http://www.nytimes.com/2008/07/08/us/08vets.html?_r=1&oref=slogin. Accessed July 9, 2008.

56. US Marine Corps. Marine Corps Physical Fitness Program, Marine Corps Order 6100.13: Commandant of the Marine Corps; 2008.

79. Stander VA, Reed C, Olson CB, et al. Marine Corps drug prevention review. San Diego, CA: Naval Health Research Center.; 2003. NHRC 03-06.

57. US Department of Health and Human Services. The Surgeon General’s report on nutrition and health. Public Health Service; 1988. http://profiles. nlm.nih.gov/NN/B/C/Q/G/_/nnbcqg.pdf.

80. Stander VA. Unpublished results from the Marine Corps drug prevention review. San Diego, CA: Naval Health Research Center.; 2003.

58. US Department of Health and Human Services. Physical activity and health: A report of the Surgeon General. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996: http://www.cdc.gov/nccdphp/sgr/pdf/sgrfull.pdf. 59. Bray RM, Hourani LL, Olmsted KLR, et al. 2005 Department of Defense Survey of Health Related Behaviors Among Military Personnel. Research Triangle Park, NC: Research Triangle Institute; 2006. RTI/7841/106-FR. 60. Chong J-R. Sleep is the enemy, [Internet]. 2008: http://www.latimes. com/news/local/la-me-sleep5-2008aug05,0,5736012.story?page=1. Accessed August 6, 2008. 61. Schneider BJ, Bradley JC, Benedek DM. Psychiatric medications for deployment: An update. Military Medicine. 2007; 172(7):681-685. 62. Currie SR. Self-help therapies for insomnia. In: Watkins PL, Clum GA, eds. Handbook of self-help therapies. New York, NY: Routledge; 2008:215-241.

81. Stander VA, Thomsen CJ, McWhorter SK, Milner JS. Tobacco, alcohol, and drug use among deploying U.S. Marines. San Diego, CA: Naval Health Research Center; 2008. NHRC 08-36. 82. Brown RL, Leonard T, Saunders LA, Papasouliotis O. A two-item conjoint screen for alcohol and other drug problems. Journal of the American Board of Family Practice. 2001; 14:95-106. 83. Kypri K, Cunningham JA. Self-help therapies for problem drinking. In: Watkins PL, Clum GA, eds. Handbook of self-help therapies. New York, NY: Routledge; 2008:243-266. 84. Dimeff LA, Baer JS, Kivlahan DR, Marlatt GA. Brief Alcohol Screening and Intervention for College Students (BASICS): A harm reduction approach. New York, NY: Guilford; 1999. 85. Substance Abuse and Mental Health Services Administration. Substance abuse treatment facility locator, [Internet]. 2008: http://dasis3.samhsa. gov/. Accessed September 9, 2008.

86. Substance Abuse and Mental Health Services Administration. Center for Substance Abuse Treatment, [Internet]. 2008: http://csat.samhsa.gov/. Accessed September 10, 2008. 87. Sauter S, Murphy L, Colligan M, et al. Stress... at work: US Department of Health and Human Services, National Institute for Occupational Safety and Health; 1999: http://www.cdc.gov/niosh/docs/99-101/pdfs/99-101.pdf

105. National Institutes of Health. Rethinking drinking: Alcohol and your health: US Department of Health and Human Services; 2009. 09-3770. 106. Cashmere J. Foreclosure hits home for veterans, [Internet]. 2008: http://www.wptv.com/news/local/story.aspx?content_id=fe2e9591-9b054e3b-85be-3a45cffcb68f. Accessed September 8, 2008. 107. Tyson E. Investing for dummies. 3rd edition. Hoboken, NJ: Wiley; 2003.

88. Ranganathan S, Jayaraman R, Thirumagal V, Rao A. Drug addiction identification and initial motivation: A field guide for service providers and trainers. Ministry of Social Justice and Empowerment, Government of India and United Nations International Drug Control Programme, Regional Office for South Asia; 2002: http://www.unodc.org/india/DAIIM_Manual_TTK.html. 89. Working Partners for an Alcohol- and Drug-free Workplace. Fact sheet: Symptoms and intervention techniques, [Internet]. 2008: http://www.dol.gov/ asp/programs/drugs/workingpartners/materials/symptoms.asp. Accessed October 27, 2008.

108. Malaspina MA. Don’t die broke. Princeton, NJ: Bloomberg Press; 1999. 109. Rose L. Winning the war against debt. Springville, UT: Cedar Fort Inc.; 2006. 110. Lawrence J. The Budget Kit. 5th edition. New York, NY: Kaplan Publishing; 2008. 111. Microsoft Corp. Microsoft Money, [Internet]. 2009: http://www. microsoft.com/MONEY/default.mspx. Accessed March 20, 2009.

90. Substance Abuse and Mental Health Services Administration. Making your workplace drug free: A kit for employers. Center for Substance Abuse Prevention, Division of Workplace Programs; 2007: http://ncadi.samhsa. gov/govpubs/workit/ and http://download.ncadi.samhsa.gov/Prevline/pdfs/ SMA07-4230.pdf.

112. Intuit Inc. Quicken, [Internet]. 2009: http://quicken.intuit.com/. Accessed March 20, 2009.

91. US Office of Personnel Management. Alcoholism in the workplace: A handbook for supervisors. Division for Strategic Human Resources Policy/ Center for Employee & Family Support Policy; 2006: http://www.opm.gov/ Employment_and_Benefits/WorkLife/OfficialDocuments/ HandbooksGuides/Alcohol/index.

114. Microsoft Office Online. Budgets, [Internet]. 2009: http://office. microsoft.com/en-us/templates/CT101172321033.aspx. Accessed March 2009, 2009.

113. Microsoft Corp. Mircosoft Office Excel, [Internet]. 2009: http://office. microsoft.com/en-us/excel/default.aspx. Accessed March 20, 2009.

115. Park C, Park S. The original pearbudget spreadsheet, [Internet]. 2009: http://www.pearbudget.com/spreadsheet. Accessed March 20, 2009.

92. US Department of Health and Human Services and US Department of Agriculture. Finding your way to a healthier you. US Government Printing Office; 2005: http://www.health.gov/dietaryguidelines/dga2005/document/pdf/ brochure.pdf.

116. Vertex42. Personal Monthly Budget, [Internet]. 2009: http://www. vertex42.com/ExcelTemplates/personal-monthly-budget.html. Accessed March 20, 2009.

93. Prestwich A, Conner M, Lawton RJ. Implementation intentions: Can they be used to prevent and treat addiction. In: Wiers WW, Stacy AW, eds. Handbook of implicit cognition and addiction. Thousand Oaks, CA: Sage; 2006:455-469.

117. Katzaman J. Wounded Marine keeps leg up on military career, [Internet]. 2008: http://www.dcmilitary.com/stories/011708/ quanticosentry_27932.shtml. Accessed August 4, 2008.

94. Miller WR, Munoz RF. Controlling your drinking: Tools to make moderation work for you. New York, NY: Guilford; 2005.

118. Military.com. Discussion boards: Unemployment problem, [Internet]. 2008: http://forums.military.com/1/OpenTopic?q=Y&a=dl&s=78919038&f =407191012&x_id=166187&x_subject=Discussing%20the%20Veteran%20 Unemployment%20Problem&x_dpp=Y&x_link=http://www.military.com/ opinion/0,15202,166187,00.html. Accessed September 3, 2008.

95. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health, 2007 [Computer File]. Ann Arbor, MI: Consortium for Political and Social Research; 2008. 96. National Institute on Alcohol Abuse and Alcoholism. Helping patients who drink too much: A clinician’s guide. US Department of Health and Human Services, National Institutes of Health; 2005: http://pubs.niaaa.nih.gov/ publications/Practitioner/CliniciansGuide2005/guide.pdf. 97. Sanchez-Craig M, Wilkinson A, Davila R. Empirically based guidelines for moderate drinking: 1-year results from three studies with problem drinkers. American Journal of Public Health. 1995; 85(6):823-828. 98. Rehm J, Room R, Taylor B. Method for moderation: Measuring lifetime risk of alcohol-attributable mortality as a basis for drinking guidelines. International Journal of Methods in Psychiatric Research. 2008; 17(3):141-151. 99. Rehm J, Room R, Graham K, Monteiro M, Gmel G, Sempos CT. The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: An overview. Addiction Research and Theory. 2003; 98:1209-1228. 100. National Institutes of Health. Rethinking drinking: Alcohol and your health, [Internet]. 2009: http://rethinkingdrinking.niaaa.nih.gov/. Accessed May 11, 2009. 101. US Marine Corps. Marine Corps Order 5355.4: Commandant of the Marine Corps; 1990. 102. Marine Corps Community Services. Substance abuse program [Internet]. 2008: http://www.usmc-mccs.org/subabuse/poc.cfm?sid=fl&smid=2. Accessed June 9, 2008. 103. Young Marines National Headquarters. Young Marines, [Internet]. 2008: http://www.youngmarines.com/. Accessed September 9, 2008. 104. Armitage CJ. A volitional help sheet to encourage smoking cessation: A randomized exploratory trial. Health Psychology. 2008; 27(5):557-566.

136

119. Adamchik W. Discussing the veteran unemployment problem, [Internet]. 2008: http://www.military.com/opinion/0,15202,166187,00.html. Accessed September 3, 2008. 120. Blum L. Treating wounds you can’t see, [Internet]. 2008: http:// www.washingtonpost.com/wp-dyn/content/story/2008/06/30/ ST2008063000520.html. Accessed September 10, 2008. 121. Mahoney M. Kansas Marine fights for child custody, state supreme court considers case, [Internet]. 2006: http://www.kmbc.com/news/8971001/ detail.html. Accessed September 10, 2008. 122. Anderson A. Marine Corps Recruit Depot San Diego, Legal Assistance, Officer in Charge. Personal communication received by Stander VA. San Diego: September 4, 2008. 123. San Diego County Bar Association. Questions to ask when hiring an attorney, [Internet]. 2007: http://www.sdcba.org/LRIS/questions.html. Accessed September 10, 2008. 124. Department of Defense. US Armed Forces Legal Assistance: Legal Services Locator, [Internet]. 2008: http://legalassistance.law.af.mil/content/ locator.php. Accessed September 10, 2008. 125. San Diego County Bar Association. Lawyer Referral & Information Service, [Internet]. 2008: http://www.sdcba.org/LRIS/. Accessed September 10, 2008. 126. American Bar Association. FindLegalHelp.org, [Internet]. 2008: http://www. abanet.org/legalservices/findlegalhelp/home.cfm. Accessed April 3, 2008.

POSTDEPLOYMENT USER GUIDE

TRANSITION WORKBOOK FOR COMBAT VETERANS

Loading...

transition workbook for combat veterans - Navy Medicine - Navy.mil

POSTDEPLOYMENT USER GUIDE TRANSITION WORKBOOK FOR COMBAT VETERANS CREATED BY Valerie A. Stander, PhD Heidi S. Kraft, PhD Linda Xiong, MPH Gerald E...

4MB Sizes 9 Downloads 13 Views

Recommend Documents

transition workbook for combat veterans - Navy Medicine - Navy.mil
This program is a returning veteran's self-help guide to support ... difficult in many others, because these aspects of

transition workbook for combat veterans - Defense Technical
This program is a returning veteran's self-help guide to support ... difficult in many others, because these aspects of

AHLTA - Navy Medicine - Navy.mil
Stefani Ruiz, MHS, Epidemiologist. USAFSAM Epidemiology Consult Service/ PHR [email protected] DSN: 798-3205.

6320.94 - Navy Medicine - Navy.mil
Aug 8, 2008 - training for Navy personnel involved with the Emergency Medical Services (EMS) systems aboard United State

tbi - Navy Medicine - Navy.mil
Dec 4, 2007 - Encl: (1) DoD Definition of Traumatic Brain Injury (TBI). (2) Navy Medicine Monthly TBI Tracking Report.

Substance Abuse - Navy Medicine
However, as a result of accumulating clinical experience and continuing laboratory studies, dosage schedules and/or trea

Flight Surgeon's Manual - Navy Medicine
Physiology of Flight. Table l-3 (Continued). Altitude-Pressure-Temperature Relationships Based on the U.S. Standard Atmo

Command News - Navy Medicine - Navy.mil
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – There have been two fatalities directly linked to influenz

US Navy Aeromedical Reference and Waiver Guide - Navy Medicine
19 Apr 2016 - personnel must remain fit for full duty and continue to meet the aviation standards published in the MMD.

Department of the Navy OCCUPATIONAL AUDIOLOGY - Navy Medicine
them how to properly wear their HPD and educate and motivate them on the ..... Other factors that can increase an indivi