Jim Messina, Ph.D., NCC, CCMHC, DCMHS

1
Strategies for Building Resilience in Military
Members, Veterans and their Families

• Presented by
• Jim Messina, Ph.D., NCC, CCMHC, DCMHS
• Assistant Professor Troy University-Tampa Bay

2

• "The pessimist complains about the wind
• The optimist expects it to change
• The realist adjusts the sails."
• William Arthur Ward

3
Goals of Program

• At the end of this training, the trainees will be
  able to
• Identify what are the cognitive, behavioral, and
  psychological factors contributing to resilience
  in individuals, their families, their military
  units and their communities
• Identify strategies for assisting others to
  develop and enhance resilience in the face of
  stressors facing military, veterans and their
  families pre- during- and post-deployment
• Problem solve solutions for developing resilience
  strategies in their own clinical settings in
  which they work with the military members,
  veterans and their families their military units
  and their communities

4
Before we look at Resilience We need to look at
Suicide

• Why you ask should we look at suicide first?
• I am a Red Cross Volunteer who works in Military
  Deployment Mental Health work with active
  military and I have heard over and over again
  when talking with military You arent going to
  talk about resilience to us today are you? I have
  had my fill of that stuff!
• On Saturday June 22, 2013 I facilitated two
  groups at a Yellow Ribbon event and met men and
  women military members who all had similar traits
  to another veteran whose letter to his family I
  got in an email on June 27, 2013
• I realized that the folks I have met at all of
  the Yellow Ribbon reintegration events I have
  been to, could just have easily been the person
  who wrote the letter to his family which was
  broadcast all over the world
• What was the letter you ask?
• It was a suicide letter left by a Veteran of the
  Iraq War who killed himself on June 10, 2013

5
We Are Killing Ourselves at an alarming Rate

• By 2010, in the developed world, suicide became
  the leading cause of death for people age 15-49
  according to the Institute of Health Metrics and
  Evaluation, Global Burden of disease, 2010.

6
Suicides Grisly Toll

• In 2010 worldwide deaths from suicide outnumbered
  deaths from war (17,670), natural disasters
  (196,018), and murder (456,268). The Institute of
  Health Metrics and Evaluation, Global Burden of
  disease, 2010

7
Why do people die by suicide? According to Thomas
Joiner

• Because they want to and because they can
• People will die by suicide when they have both
  the desire to die and the ability to die.
• When Joiner broke down the desire and the
  ability, he found what he believes is the one
  true pathway to suicide. Its a clearly
  delineated danger zone, a set of three
  overlapping conditions that combine to create a
  dark alley of the soul
• The conditions are tightly defined, and they
  overlap rarely enough to explain the relatively
  rare act of suicide. But whats alarming is that
  each condition itself isnt extreme or unusual,
  and the combined suicidal state of mind is not
  psychotic
• On the contrary, Joiners diagram of suicide is
  composed of circles we all routinely step in, or
  near, never realizing we are in the deadly center
  until its too late. Joiners conditions of
  suicide are the conditions of everyday life and
  only resilience will pull us out

8
Thomas Joiners Model ofInterpersonal Theory of
Suicide

• Kimberly A. Van Orden et al., "The Interpersonal
  Theory of Suicide," Psychol Rev. 117(2) (2010)
  575

9
Lets Take a closer look at the three components
of Suicide

• In getting ready for this program I receive an
  email link to a suicide letter from Daniel Somers
  who killed himself on June 10, 2013
• Why is he relevant to this presentation you ask?
• He was in the Iraq War and completed 2
  deployments
• In 2004-2005, he was assigned to a Tactical
  Human-Intelligence Team (THT) in Baghdad, Iraq,
  where he ran more than 400 combat missions as a
  machine gunner in the turret of a Humvee,
  interviewed countless Iraqis ranging from
  concerned citizens to community leaders and
  government officials, and interrogated dozens of
  insurgents and terrorist suspects
• In 2006-2007, Daniel worked with Joint Special
  Operations Command (JSOC) through his unit in
  Mosul where he ran the Northern Iraq Intelligence
  Center. His official role was as a senior analyst
  for the Levant (Lebanon, Syria, Jordan, Israel,
  and part of Turkey)
• In 2007 he was diagnosed with PTSD, TBI, and
   Gulf War Syndrome, fibromyalgia and a host of
  other medical problems He sought treatment
  through therapy, medication, music and film
  production
• Daniels letter shows us the three components of
  Joiners Interpersonal Theory of Suicide and
  teaches us a lesson about the need for us to
  change how we work to help our Military, Vets and
  their families to grow in resilience

10
Daniel Somers June 10, 2013 Suicide Letter
Quotes

• The fact is, for as long as I can remember my
  motivation for getting up every day has been so
  that you would not have to bury me. As things
  have continued to get worse, it has become clear
  that this alone is not a sufficient reason to
  carry on. The fact is, I am not getting better, I
  am not going to get better, and I will most
  certainly deteriorate further as time goes on.
  From a logical standpoint, it is better to simply
  end things quickly and let any repercussions from
  that play out in the short term than to drag
  things out into the long term.
• You will perhaps be sad for a time, but over
  time you will forget and begin to carry on. Far
  better that than to inflict my growing misery
  upon you for years and decades to come, dragging
  you down with me. It is because I love you that I
  can not do this to you. You will come to see that
  it is a far better thing as one day after another
  passes during which you do not have to worry
  about me or even give me a second thought. You
  will find that your world is better without me in
  it.
• Perceived Burdensomeness
• I am a burden

11
Daniel Somers June 10, 2013 Suicide Letter
Quotes

• I really have been trying to hang on, for more
  than a decade now. Each day has been a testament
  to the extent to which I cared, suffering
  unspeakable horror as quietly as possible so that
  you could feel as though I was still here for
  you. In truth, I was nothing more than a prop,
  filling space so that my absence would not be
  noted. In truth, I have already been absent for a
  long, long time.
• Thwarted Belongingness
• I am alone

12
Daniel Somers June 10, 2013 Suicide Letter
Quotes

• My body has become nothing but a cage, a source
  of pain and constant problems. The illness I have
  has caused me pain that not even the strongest
  medicines could dull, and there is no cure. All
  day, every day a screaming agony in every nerve
  ending in my body. It is nothing short of
  torture. My mind is a wasteland, filled with
  visions of incredible horror, unceasing
  depression, and crippling anxiety, even with all
  of the medications the doctors dare give. Simple
  things that everyone else takes for granted are
  nearly impossible for me. I can not laugh or cry.
  I can barely leave the house. I derive no
  pleasure from any activity. Everything simply
  comes down to passing time until I can sleep
  again. Now, to sleep forever seems to be the most
  merciful thing.
• Capability for Suicide
• I am not afraid to die

13
Daniels Final Words

• This is what brought me to my actual final
  mission. Not suicide, but a mercy killing. I know
  how to kill, and I know how to do it so that
  there is no pain whatsoever. It was quick, and I
  did not suffer. And above all, now I am free. I
  feel no more pain. I have no more nightmares or
  flashbacks or hallucinations. I am no longer
  constantly depressed or afraid or worried
• I am free.
• I ask that you be happy for me for that. It is
  perhaps the best break I could have hoped for.
  Please accept this and be glad for me.
• Daniel Somers
• Capability for Suicide
• I am not afraid to die

14
Exposure to Adverse Conditions feeds the
Capability for Suicide

• Joiners research team has posited that military
  who have been exposed to combat have an increased
  capability for suicide
• Recent research has found that this is not
  necessarily the case, in fact many military
  suicides have been by people who have not even
  been deployed (Bryan, Hernandez, Allison
  Clemans, 2013)
• So another source of Adverse Events which might
  be a contributory factor to capability for
  suicide could be the ACE Factors which are
  Adverse Childhood Experience Factors

15
What are the 10 ACE Factors?

• ACE (Adverse Childhood Experiences)
• Abuse
• 1. Emotional Abuse
• 2. Physical Abuse
• 3. Sexual Abuse
• Neglect
• 4. Emotional Neglect
• 5. Physical Neglect
• Household Dysfunction
• 6. Mother was treated violently
• 7. Household substance abuse
• 8. Household mental illness
• 9. Parental separation or divorce
• 10. Incarcerated household member
• Any one of these adverse experiences can drain
  ones resilience

16
So What is Resilience?

• The APA Health Center (APA, 2004) says that
• Resilience is the process of adapting well in the
  face of
• Adversity
• Trauma
• Tragedy
• Threats
• Significant sources of stress - such as family
  relationship problems, serious health problems,
  or workplace financial stressors
• It means "bouncing back" from difficult
  experiences!

17
So What are the Emotional Fears in Tough Times?

• Fear of personal ineffectiveness or loss of
  ability to survive tough times
• Fear of loss of job due to possible failure of
  ones personal effectiveness or professional
  skills
• Fear of impact of losing ones job on ones
  self-worth and self-esteem
• Fear about impact on family marriage if not
  able to meet financial emotional needs in tough
  times

18
What are Key Factors Associated with Resilience?

• APA Help Center (APA, 2004) identifies them as
• The capacity to make realistic plans take steps
  to carry them out
• A positive view of yourself confidence in your
  strengths abilities
• Skills in communication problem solving
• The capacity to manage strong feelings impulses

19
Why the Need for Resilience

• You need to build resilience to sustain your
  emotional health when faced with wars, layoffs,
  life-altering events, natural disasters, death,
  change, divorce, health issues, financial
  difficulties, etc.
• Being resilient doesnt mean you wont experience
  difficulty or distress. Emotional pain, anger,
  grief sadness are common when you have troubles
  in tough times.
• Developing resilience involves behaviors,
  thoughts actions that can help you cope with
  stressful events. It helps restore balance in
  your life.
• Ashe, L. (2006). In Times of Trouble Build
  Resilience. Methodist Healthcare Employee
  Assistance Well Informed Program 3.

20
What are the Factors which Impact Resilience

• The Rand Corporation in 2011 identified this
  definition Resilience is the capacity to adapt
  successfully in the presence of risk and
  adversity (Jensen and Fraser, 2005), which they
  utilized in their study Promoting Psychological
  Resilience in the U.S. Military.
• The Rand group identified four distinct
  contributors to factors which build resilience in
  the military
• The individuals,
• Their families,
• Their military units
• Their communities

21
Individual Factors were

• Positive coping The process of managing taxing
  circumstances, expending effort to solve personal
  and interpersonal problems, and seeking to reduce
  or tolerate stress or conflict, including
  active/pragmatic, problem-focused, and spiritual
  approaches to coping
• Positive affect Feeling enthusiastic, active,
  and alert, including having positive emotions,
  optimism, a sense of humor (ability to have humor
  under stress or when challenged), hope, and
  flexibility about change
• Positive thinking Information processing,
  applying knowledge, and changing preferences
  through restructuring, positive reframing, making
  sense out of a situation, flexibility,
  reappraisal, refocusing, having positive outcome
  expectations, a positive outlook, and
  psychological preparation
• Realism Realistic mastery of the possible,
  having realistic outcome expectations,
  self-esteem and self-worth, confidence,
  self-efficacy, perceived control, and acceptance
  of what is beyond control or cannot be changed
• Behavioral control The process of monitoring,
  evaluating, and modifying emotional reactions to
  accomplish a goal (i.e., self-regulation,
  self-management, self-enhancement)

22
Family Factors were

• Emotional ties Emotional bonding among family
  members, including shared recreation and leisure
  time
• Communication The exchange of thoughts,
  opinions, or information, including
  problem-solving and relationship management
• Support Perceiving that comfort is available
  from (and can be provided to) others, including
  emotional, tangible, instrumental, informational,
  and spiritual support
• Closeness Love, intimacy, attachment
• Nurturing Parenting skills
• Adaptability Ease of adapting to changes
  associated with military life, including flexible
  roles within the family

23
Military Unit Factors were

• Positive command climate Facilitating and
  fostering intra-unit interaction, building
  pride/support for the mission, leadership,
  positive role modeling, implementing
  institutional policies
• Teamwork Work coordination among team members,
  including flexibility
• Cohesion Unit ability to perform combined
  actions bonding together of members to sustain
  commitment to each other and the mission

24
Community Factors were

• Belongingness Integration, friendships,
  including participation in spiritual/faith-based
  organizations, protocols, ceremonies, social
  services, schools, and so on, and implementing
  institutional policies
• Cohesion The bonds that bring people together in
  the community, including shared values and
  interpersonal belonging
• Connectedness The quality and number of
  connections with other people in the community
  includes connections with a place or people of
  that place aspects include commitment,
  structure, roles, responsibility, and
  communication
• Collective efficacy Group members perceptions
  of the ability of the group to work together

25
Resilience is a personal strength which

• Is the ability to positively adjust to adversity
• Can be applied to building personal strengths
• Is gained through building positive nurturing
  professional relationship
• Is the maintaining of positivity
• Develops emotional insight
• Is the achieving of life balance spirituality
• Results in becoming more reflective
• Jackson, D., Firtko, A. Edenborough, M. (2007).
  Personal resilience as a strategy for surviving
  and thriving in the face of workplace adversity
  a literature review. Journal of Advanced
  Nursing60(1)1-9.

26
Resilience results in Adaptation

• Adaptation is measured by
• High prevalence in the community of mental
  behavioral health
• Adequate role functioning at work home
• A high quality of life by all
• Norris, F. H. Stevens, S. P. Pfefferbaum, B.
  Wyche, K.F. Pfefferbaum, R.L. (2008). Community
  Resilience as a Metaphor, Theory, Set of
  Capacities, and Strategy for Disaster Readiness.
  American Journal of Community Psychology
  41(12)127150.

27
Factors Associated with Resilience (APA, 2004)

• The capacity to make realistic plans take steps
  to carry them out
• A positive view of self confidence in ones
  strengths abilities
• Skills in communication problem solving
• The capacity to manage strong feelings impulses
• All of these are factors that people can develop
  in themselves.

28
So how does Resilience Work?

• Is a reflex way of facing or understanding the
  world
• Is deeply etched in a persons mind soul
• Results in facing reality with staunchness
• Makes meaning of hardship instead of crying out
  in despair improvising solutions out of thin
  air
• Coutu, D. (2002). How Resilience Works. Harvard
  Business Review 80(5)46-51.

29
What weakens ones Resilience?

• Fear of diminution or loss of ones personal
  strength
• Fear of displacement in work roles or possible
  failure of effectiveness of ones professional
  skills
• Fear that one would not be able to cope with
  unemployment would lose sense of identity
  worth when one lost professional or work role
• Fears about the anxieties arising in marital
  family relationships if one should lose ones job
• Martindale, B. (2007). Resilience and
  Vulnerability in Later Life. British Journal of
  Psychotherapy 23(2)205-216.

30
Self-Assessment

• Take the Personal Resilience in Tough Times
  Self-Assessment
• Rate each item for you on a scale from 1 to 10
• 1 never
• 5 occasionally
• 10 frequently

31
What does this Assessment Tell You?

• If you rated 10 or more items over 8 or if you
  rated 15-20 over 5
• You are most likely to experience some level of
  resilience in facing tough times

32
Ways to Build Your Resilience (APA, 2004)

• Make connections
• Avoid seeing crises as insurmountable problems
• Accept that change is a part of living
• Move toward your goals
• Take decisive actions
• Look for opportunities for self-discovery
• Nurture a positive view of yourself
• Keep things in perspective
• Maintain a hopeful outlook
• Take care of yourself

33
So What can you do to help others Build their
Resilience?

• Surprisingly in preparing for this presentation I
  realized that my entire career has been focused
  on building resilience helping folks build a
  sense of Belonging while letting go of a sense
  of Being a Burden while simultaneously
  developing a rational perspective on life so as
  to let go of the Capacity to commit Suicide
• When I retired from private practice in 1999 my
  wife reminded me that I was successful in never
  having a successful suicide on my watch!
• What did I do then, you as mental health
  professionals can do today to help our military,
  veterans their families build their resilience
  by
• increasing their sense of belonging
• Increasing their feeling needed, wanted
  cherished
• wanting to live life to the fullest

34
Use the SEAs Model of Recovery

• The Self-Esteem Seekers Anonymous model of
  recovery is on www.coping.us
• The model is a set of tools which make recovery a
  workable process for anyone committed to making
  changes in life so as to grow in self-esteem,
  build their resilience and let go of the three
  major factors of Joiners Interpersonal Theory of
  Suicide
• The work is most effective in a SEAs group which
  is a 12 Step model weekly program where each week
  the participants explore the following TOOLS for
  Recovery in the SEAS System of Recovery

35
Seas Tools for Recovery

• TEA System http//www.coping.us/seastoolsforrecove
  ry/teasystem.html
• ALERT System http//www.coping.us/seastoolsforreco
  very/alertsystem.html
• ANGER System http//www.coping.us/seastoolsforreco
  very/angersystem.html
• LET GO System http//www.coping.us/seastoolsforrec
  overy/letgosystem.html
• CHILD System http//www.coping.us/seastoolsforreco
  very/childsystem.html
• RELAPSE System http//www.coping.us/seastoolsforre
  covery/relapsesystem.html

36
TEA System

• Thoughts
• Emotions
• Actions

37
TEA System
38
ALERT System

• ASSESS
• LESSEN
• EASE OUT
• RELAX
• TAKE STEPS

39
(No Transcript)
40
ANGER System

• ACCEPT
• NAME IT
• GET IT OUT
• ENERGIZE
• RELEASE

41
(No Transcript)
42
LET GO System

• LIGHTEN NEED
• EXERCISE RIGHTS
• TAKE STEPS
• GIVE UP CONTROL
• ORDER LIFE

43
(No Transcript)
44
CHIILD System

• CALM
• HEAL
• INFORM
• LIGHTEN
• DIRECT

45
(No Transcript)
46
RELAPSE System

• RECOGNIZE
• EXERCISE
• LEARN
• ACT
• PROTECT
• SUPPORT
• EVALUATE

47
RELAPSE System
48
SEAs Tools for Coping Tool Cheston
www.coping.us

• The SEA's Program Manual
• Laying the Foundation
• Tools for Handling Loss
• Tools for Personal Growth
• Tools for Relationships
• Tools for Communications
• Tools for Anger WorkOut
• Tools for Handling Control Issues
• Growing Down Tools for Healing the Inner Child
• Tools for a Balanced Lifestyle A Manual for a
  Guilt Free System of Healthy Living
• Pathfinder Parenting Tools for Raising
  Responsible Children
• and
• A personal journal a notebook or audio file in
  which daily reactions, feelings, and insights are
  recorded. It is also used to record the
  completing the 12 steps Workbook in the SEA's
  program.

49
What Can You Do?

• What can you do to help Military, Vets and their
  family members build resilience?
• Brainstorm three things which you can do to help
  your clients build resilience
• Ok Lets Go!

50
Coach Clients on Building Resilience

• Have clients assess their own level of resilience
  during tough times
• Teach them about what are the best ways to build
  their own resilience in tough times
• Encourage resilience building lifestyle changes
  in their lives

51
What can else be done for Clients to Build their
Resilience

• Get Military, Vets their families to be
  task-focused by making plans of collaborative
  actions to cope with the tough times experienced
  by them all by setting up SEAs Groups within
  Military Units or in their community
• Use the SEAs groups for emotion-focused
  activities to give them a chance to let out their
  true feelings
• Keep the SEAs groups in reality by not allowing
  them to fall into avoidant coping style where
  they refuse to believe times are tough that
  they must change
• Hoge, E. A., Austin, E. D. Pollack, M. H.
  (2007). Resilience research evidence and
  conceptual considerations for posttraumatic
  stress disorder. Depression Anxiety
  24(2)139-152.

52
So Are You Ready to help Active Military,
Veterans their families

• You can help them
• feel that they belong to a supportive
  collaborative effort to gain meaning worth in
  their lives
• to not feel like they are a burden to partners,
  spouses, families, military units or workplaces
  due to their post-combat experiences
• to let go of the fall back plan of ending their
  own lives just because they are capable of doing
  so
• build their resilience!
• to agree to network together to support one
  anothers efforts to grow in resilience so as to
  survive their tough times!

53
References

• APA. (2004). APA Help Center The Road to
  Resilience http//www.apa.org/helpcenter/road-res
  ilience.aspx
• Ashe, L. (2006). In Times of Trouble Build
  Resilience. Methodist Healthcare Employee
  Assistance Well Informed Program3. 
• Coutu, D. (2002). How Resilience Works. Harvard
  Business Review 80(5)46-51. 
• Harrison, L.H. (2002). Rolling with the
  Punches. Business West19(5)54.
• Hoge, E. A., Austin, E. D. Pollack, M. H.
  (2007). Resilience research evidence and
  conceptual considerations for posttraumatic
  stress disorder.Depression Anxiety
  24(2)139-152.
• Ivy, A. (2003). Developing Resilience in the Face
  of Declining Markets.  New Zealand Business, 
  17(6)10-11.
• Jackson, D., Firtko, A. Edenborough, M. (2007).
  Personal resilience as a strategy for surviving
  and thriving in the face of workplace adversity
  a literature review. Journal of Advanced
  Nursing60(1)1-9.
• Lavretsky, H. Irwin, M. (2007). Resilience and
  Aging. Aging Health 3(3)309-323.
• Martindale, B. (2007). Resilience and
  Vulnerability in Later Life. British Journal of
  Psychotherapy 23(2)205-216.
• Norris, F. H. Stevens, S. P. Pfefferbaum, B.
  Wyche, K.F. Pfefferbaum, R.L. (2008).Community
  Resilience as a Metaphor, Theory, Set of
  Capacities, and Strategy for Disaster
  Readiness. American Journal of Community
  Psychology 41(12) 127150.
• Owen, M. (2002). Psychology at Work Bouncing
  Back from Adversity.Enterprise/Salt Lake
  City 32(18)11.