Battling Operational Stress
Injuries
Ottawa OSI Clinic
Michele Boivin, PhD, CPsych
Jakov Shlik, MD, FRCPC
Operational Stress Injuries
• Psychological injuries caused by combat,
law enforcement or other operational and
service-re...
The effect of war on the mind
 American Civil War -
Soldier’s heart
 WWI – Shell shock
 WWII – Battle fatigue
 Post-Vi...
Modern non-medical terms
 Combat stress reaction
 Combat stress injury
 Operational stress injury
Mechanisms of stress injury
Combat/operational stress
Trauma Fatigue Grief
Impact
injury
Wear and
tear injury
Loss injury
...
Belief injury
 Safety
 Control
 Moral order
 Righteousness
 Value of life
 Goodness of people
Modern warfare factors
• Peacekeeping stressors
• Advanced technology
• Lethality, atrocities
• Lack of frontline
• Land m...
Suicide
Homecoming
 Distress
hypervigilance, memories
fatigue, insomnia, dreams,
 Identity change
 Anger and impulsivity
 Alco...
Adjustment
 Family
 Loneliness
 Work
 Health
 Society
Leaving the service
 Loss of support
 Loss of goals
 Loss of health
 Loss of financial security
 Bureaucracy
 Civili...
Operational stress in law enforcement
• Critical incidents
• Cumulative stress
• Exposure to crime
and depravity
• Interna...
Employee well-being within Canada’s
Police Departments
• Multiple competing
unremitting demands
• Expectations for top
per...
OSI clinical manifestations
• PTSD
• Depression
• Anxiety Disorder
• Pain
• Psychosomatic problems
• Sleep-related conditi...
OSI treatment
• Mental health care
• Social support
• Medical care
• Vocational recovery
• Physical recovery
• Family func...
OSI Clinic
Mandate:
• Standardized Assessment & Diagnosis
• Empirically Supported Treatment
• Networking & Education
• Res...
Population
3% 3%
9%
5%
12%
59%
9%
WorldWar II
KoreaWar
Afghanistan
Domestic
High Frequency, Short Duration
Deployments*
UNPeacekeepin...
Psychiatric diagnoses
15
5
8
12
5
2
67
14
3
10
10
12
69
0 10 20 30 40 50 60 70 80
Other Diagnoses
Pain Disorder
Substance ...
37
5
7
10
12
13
16
18
18
21
60
63
0 10 20 30 40 50 60 70
Other
Cancer
Respiratory
Diabetes
Migraine/Headac…
Arthritis
Gast...
30
7
12
16
19
23
30
39
41
42
0 5 10 15 20 25 30 35 40 45
Other
Housing/Moves
Loss/Bereavement
Military Related
Health
Fina...
Treatment need
• Most officers and vets do not get help for their
symptoms
• Of those who do, treatment is often delayed
•...
Barriers to help seeking
• Stigma
• Impact on career
• Officer/soldier identity
• Belief about treatment outcome
• Ambival...
Effective Treatments are Available
• Based on models of “natural recovery”
• Target maintenance rather than causal factors...
Treatment targets
Behaviours
Emotions
Thoughts
Treatment modalities
• Psychological treatment
• Emotion Regulation
• Cognitive Behavioural Therapy for anxiety/depression...
Treatment modalities - community
• Social & occupational support
• OSISS
• Referral to vocational rehabilitation
• Physica...
Treatment Planning
Stabilization:
•Safety
•Trust
•Emotion
regulation/
coping skills
Symptom
reduction:
•PTSD therapy
•Depr...
Recovery
• Full remission is possible
• Defining Recovery
– Being symptom free
– Coping vs. forgetting
– Reestablising ide...
Bill and Alana
Q & A
Battling Operational Stress Injuries
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Battling Operational Stress Injuries

  1. 1. Battling Operational Stress Injuries Ottawa OSI Clinic Michele Boivin, PhD, CPsych Jakov Shlik, MD, FRCPC
  2. 2. Operational Stress Injuries • Psychological injuries caused by combat, law enforcement or other operational and service-related duties. • Comprised of biological damage to brain systems, psychological damage to beliefs and self-esteem, and social disruption. • Everyone is affected, some injured, many get better.
  3. 3. The effect of war on the mind  American Civil War - Soldier’s heart  WWI – Shell shock  WWII – Battle fatigue  Post-Vietnam syndrome  1980 – DSM-III PTSD “Thousand Yard Stare” 1944
  4. 4. Modern non-medical terms  Combat stress reaction  Combat stress injury  Operational stress injury
  5. 5. Mechanisms of stress injury Combat/operational stress Trauma Fatigue Grief Impact injury Wear and tear injury Loss injury ASD, PTSD Adjustment disorder Depression Anxiety Disorder Grief reaction Depression Nash, PTSD 101
  6. 6. Belief injury  Safety  Control  Moral order  Righteousness  Value of life  Goodness of people
  7. 7. Modern warfare factors • Peacekeeping stressors • Advanced technology • Lethality, atrocities • Lack of frontline • Land mines, IED • Suicide attacks • Extreme environments Richard Johnson: sketches from front lines
  8. 8. Suicide
  9. 9. Homecoming  Distress hypervigilance, memories fatigue, insomnia, dreams,  Identity change  Anger and impulsivity  Alcohol and drugs
  10. 10. Adjustment  Family  Loneliness  Work  Health  Society
  11. 11. Leaving the service  Loss of support  Loss of goals  Loss of health  Loss of financial security  Bureaucracy  Civilian life
  12. 12. Operational stress in law enforcement • Critical incidents • Cumulative stress • Exposure to crime and depravity • Internal and external pressures
  13. 13. Employee well-being within Canada’s Police Departments • Multiple competing unremitting demands • Expectations for top performance • Organizational stressors • Hindrance to help-seeking Duxbury L & Higgins C. Caring for and about those who serve: Work-life conflict and employee well being within Canada`s Police Departments. March 2012
  14. 14. OSI clinical manifestations • PTSD • Depression • Anxiety Disorder • Pain • Psychosomatic problems • Sleep-related conditions • Alcohol and drug abuse • Gambling, risk-taking, aggression • Self-harm and suicide
  15. 15. OSI treatment • Mental health care • Social support • Medical care • Vocational recovery • Physical recovery • Family functioning
  16. 16. OSI Clinic Mandate: • Standardized Assessment & Diagnosis • Empirically Supported Treatment • Networking & Education • Research & Program Evaluation
  17. 17. Population
  18. 18. 3% 3% 9% 5% 12% 59% 9% WorldWar II KoreaWar Afghanistan Domestic High Frequency, Short Duration Deployments* UNPeacekeeping No deployments Deployments
  19. 19. Psychiatric diagnoses 15 5 8 12 5 2 67 14 3 10 10 12 69 0 10 20 30 40 50 60 70 80 Other Diagnoses Pain Disorder Substance Abuse/Dependence FSR Subtance Abuse/Dependence Other Mood Disorder Bipolar Disorder Major Depression Other Anxiety Disorder Obsessive Compulsive Disorder Panic Disorder Generalized Anxiety Disorder Anxiety Disorder NOS Posttraumatic Stress Disorder % of Clients
  20. 20. 37 5 7 10 12 13 16 18 18 21 60 63 0 10 20 30 40 50 60 70 Other Cancer Respiratory Diabetes Migraine/Headac… Arthritis Gastrointestinal Sleep Disorder Hearing/Vision Cardiovascular Chronic Pain Musculoskeletal % of Clients Medical Conditions
  21. 21. 30 7 12 16 19 23 30 39 41 42 0 5 10 15 20 25 30 35 40 45 Other Housing/Moves Loss/Bereavement Military Related Health Financial Marital/Romantic Relationship Employment/School Social Relationships Family % of Clients Psychosocial problems
  22. 22. Treatment need • Most officers and vets do not get help for their symptoms • Of those who do, treatment is often delayed • Untreated OSI’s result in significant personal and societal costs (lost productivity, medical costs, lives lost)
  23. 23. Barriers to help seeking • Stigma • Impact on career • Officer/soldier identity • Belief about treatment outcome • Ambivalence about symptoms
  24. 24. Effective Treatments are Available • Based on models of “natural recovery” • Target maintenance rather than causal factors • Response rate: 85%
  25. 25. Treatment targets Behaviours Emotions Thoughts
  26. 26. Treatment modalities • Psychological treatment • Emotion Regulation • Cognitive Behavioural Therapy for anxiety/depression • PTSD-specific: Prolonged Exposure (PE), Cognitive Processing Therapy (CPT) • Psychiatric treatment • Medication management • Family support • Psychoeducation • Couples therapy
  27. 27. Treatment modalities - community • Social & occupational support • OSISS • Referral to vocational rehabilitation • Physical recovery • Pain management • Sleep study • Adjunct services (yoga)
  28. 28. Treatment Planning Stabilization: •Safety •Trust •Emotion regulation/ coping skills Symptom reduction: •PTSD therapy •Depression •Substance Use •Related concerns Transitioning: •Meaning •Identity •Relationships •Work
  29. 29. Recovery • Full remission is possible • Defining Recovery – Being symptom free – Coping vs. forgetting – Reestablising identity and relationships – Living according to goals, values
  30. 30. Bill and Alana Q & A

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