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Battlefield Physiology:

Resiliency, Recovery,
and Reintegration
Instructor: Anita McCrary

Battlefield Physiology Resiliency, Recovery, and Reintegration


Outline
I. Psychosomatic response to fear
II. Malevolent intent
III. Idiosyncratic perception
IV. Availability of response time
V. Skill/Training and Band of Brothers
VI. Physical and mental fatigue: The Cooper Color Code
VII. Reintegration and Soul Purification
VIII. Case Study
IX. Exam

DESCRIPTION:
Prerequisites for the course include: Situational Awareness: A Primer for SUDs Counselors; Sleep, Memory, and
Recovery; Breathing and Anxiety: Natures Chill Pill; and Perceptual Distortion and Performance. The course
continues a neuropsychological approach by detailing psychosomatic response to psychological and physical
shock, pain, and trauma. The course describes innovative cognitive-behavioral, exposure, and stress inoculation
therapies for anxiety, stress, PTSD, and SUDs.

COURSE GOAL:
The course builds on the previous topics of situational awareness, sleep, attentional breathing, and perception
and uses them to explore traumatic psychosomatic response. The course offers the clinician further explanation of
physiological responses to anxiety and trauma. The course also provides clinicians state-of-the-art approaches to
therapeutic recovery and management of dysfunctional anxiety.

Fear is nonspecific physiological arousal in response to a


threat manifesting as tunnel vision, auditory exclusion, the
Psychosomatic Response to Fear
loss of fine and complex motor control, irrational behavior,
and the inability to think. It is a psychological straight
jacket that binds thoughts and action. A previous course1 My heart pounds in my chest and it drowns
reviews the discharge of cortisol, the hierarchical heart out all other noise. Sweat drips from my
rate zones of the Cooper Color Code (1989), and how the forehead, but I am shaking and cold; freezing.
sympathetic nervous system (SNS) prepares the body for An overwhelming pain settles into my bones
fight-or-flight. This course will further detail the Cooper and I ache to the core. I scream; it does not
Color Code and discuss therapeutic treatments to combat help. I cry; it makes me feel worse. If someone
physiological arousal within the context of battlefield touches me, I jerk away, as if they are poking
physiology. me with a hot steel rod. I can see his/her
mouth moving but cannot not comprehend
You can conquer almost any fear if you will only make
the words. The world around me looks gray
up your mind to do so. For remember, fear doesnt exist
and colorless; foreboding. My mind races with
anywhere except in the mind.
vile thoughts. All I want to do is strike out and
Dale Carnegie hit something or someone, drink, use, cut,
etc. Where is this coming from? What is
happening to me!

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Perceptual Distortion and Performance (McCrary, 2013)

Battlefield Physiology Resiliency, Recovery, and Reintegration


Cortisol; that is what is happening. The massive discharge
of cortisol (the stress hormone) into the bloodstream
Idiosyncratic Perception
activates the sympathetic nervous system (SNS) to There are two core stressors the human brain cannot
prepare the body for fight-or-flight. Individual perception comprehend: the trauma of being a victim of interpersonal
is the key element to SNS activation, ranging from aggression, and the trauma of creating a victim of
anticipatory increases in heart rate and respiration, or interpersonal aggression. Personal acts of malicious
yellow-to-red zone, to extreme catastrophic failure, or zone intent engage the amygdala. Once the emotional centers
black, of vision, thinking, and body control. Activation of of the brain attach significance to external action, the
the SNS dominates cognitive functioning in the presence memory can remain frozen in long-term memory. Human
of a perceived threat; however, control of the physiological aggression and malevolence is especially severe;
responses is possible through training. Variables impacting lasting longer than any other known stressor. Studies of
SNS activation include malevolent intent, idiosyncratic psychiatric casualties confirm civilian and military acts
perception, availability of response time, skill or training of aggression such as hand-to-hand combat, rape, or
confidence, and physical fatigue (Grossman, 1999). psychological degradation in the presence of others
We will review each of these components within the predispose a victim to PTSD. This is true of the warrior
context of battlefield physiology, with a focus on PTSD and victims of domestic violence or bullying.
symptomology and efficacious treatments to restore
cognitive and psychological balance.
Availability of Response Time
Malevolent Intent Years of training and battlefield alertness become
ingrained in the warrior, however maintaining zone yellow
We define malevolence as someone having a harmful alertness exacts a heavy psychological toll. PTSD is
influence on another. Potegal and Stemmler (2010) denote characterized by many in the military and law enforcement
the response to malevolence arises from frustration, as the gift that keeps on giving. Many cases of PTSD
threats to autonomy, authority, or reputation; disrespect result from incidental moments of slipping into zone
and insult; norm or rule violation; a sense of injustice; and white, usually from fatigue, when trauma occurs. When
goal blockage (2010, p. 3). Response to malevolence caught while in zone white, the warrior is unaware and
does not necessarily lead to negative aggression; anger unprepared; leaving him vulnerable to psychiatric casualty.
energizes and motivates a person to solve the problem. The warrior carries this hyper-vigilance back home and
The physiological effects of malevolent intent is an cannot easily revert to zone white.
evolutionary adaptation to increase awareness, activate
aggression, or retreat from the source. Physiological Lee and Cuijpers meta-analysis (2013) shows high
manifestations of anger informs the person that someone efficacy of Eye Movement Desensitization and
has stolen his or her autonomy and they are no longer Reprocessing (EMDR) in stabilizing hyper-vigilance
in control. As any client in recovery can testify, these and removing the cognitive and emotional sting of
subjective feelings can well up without conscious trauma. Francine Shapiros (1989) EMDR addresses the
recognition and can evoke immediate subjective interdependency of mind-brain-body and the accumulative
response. Subjective responses are known as triggers effects of the inescapable stress a warrior endures. The
enticing reactivity instead of proactive response through therapy addresses: Acute Stress reaction (ACR), Combat
idiosyncratic perception. and Operational Stress Reaction (COSR), and spiritual/
moral symptomology.

Skill/Training and Band of Brothers

I know of gangbangers who have sucked


up a dozen 9-millimeter rounds and drove
on to surviveI know of a little old lady who
was stabbed 20 times and then crawled to the
phone, dialed 9-1-1, and lived to tell about it.
Instances of malevolent intent
Never, ever give up...Do not train yourself to
(above) and public humiliation
(below) die and do not train othersto die,
(Grossman, 2003).

Battlefield Physiology Resiliency, Recovery, and Reintegration


The human drive for survival is stronger than the human bringing the body back to homeostasis and extreme
abhorrence to kill another. Severe injury exacts an fatigue occurs. NOTE: A person should not be allowed to
overwhelming survival instinct and searches externally for sleep for an hour following zone red activation.
a reason to fight for life; whether it is for a pet, a child, a
Zone Black: Active involvement and pure survival mode.
spouse, brothers-in-arms, or unmet life-goals. However,
A person is irrational and virtually uncontrollable. There
survival depends on rehearsal. Adaptive outcomes from
is total loss of cognitive functioning, peripheral vision,
combat include: forming close interpersonal relationships
depth perception, and hearing. Memory retrieval is
with comrades (i.e. band of brothers/sisters); enhanced
nearly impossible (total blackout). Conditional training
appreciation of life; and profound pride and sense of
successfully negates zone black.
eliteness.

Physical and Mental Fatigue


In an earlier course2 the Cooper Color Code (Cooper,
1989) explains how fear increases heart-rate and
manipulates physical and perceptual action. Within each
of the principle zones of orange, red, and black certain
physiological failures occur.

Zone White: A person is unprepared and unaware of


a potential attack. Activities in the white zone include
sleeping, bathing, or watching television. The CNS is in
homeostasis and all organs are functioning properly. In a
combat zone, warriors rarely experience zone white.

Zone Yellow: A person is attentive of surroundings and


hand-eye coordination increases. The warrior scans the
environment and is prepared to act. Respiration is normal. Reintegration and Soul Purification
Cognition is clear with fine-motor control in tact. U.S. Air
Force pilots, snipers, bomb-technicians, and athletes A warrior in combat or the police officer do not have the
receive conditioning to maintain mellow-yellow status. luxury of retreat. When facing interpersonal aggression a
warrior instinctually resorts to pre-conditioned responses
Zone Orange: Adrenal glands release cortisol. he or she learns through months of training. Many warriors
Vasoconstriction begins in extremities (hands, arms, feet, comment I did not even think about it; I just did it. Muscle
and legs). The face becomes pale and hands begin to memory and conditioning seize control when the forebrain
tremble and become cold. Severe injury to extremities lacks time to evaluate. The average civilian may fault
may not be consciously felt or bleed. Fine motor control the warrior for his or her lack of emotional connection
decreases and magazine changes, weapon handling, and and sick humor, yet family members and clinicians must
handcuffing are tedious processes. Sleep spindle pruning understand this emotionless reactivity saves lives; and it is
and conditioning result in a hyper-arousal state and a position few civilians encounter. The warrior adopts the
restless sleep. Attentional/focused breathing returns heart- non-personal perception to protect his or her sanity; the
rate to yellow status. same way a victim of abuse adopts learned helplessness.
After months and sometimes years of being in a state of
Zone Red: Cortisol floods the bloodstream. A conditional hypervigilance it takes time for the warrior to adjust;
response is immediate (i.e., cut and run or prepare for some cannot.
impact), whereas level white to red results in surprise
attack and loss of life, because it takes five to six seconds Prior to WWII battles took place only during daylight hours,
to achieve full awareness of a threat and to consider allowing warriors to debrief and relieve the stress of the
a proactive response. Peripheral vision gives way to day around the campfire with his fellow comrades. To a
tunnel vision (i.e., looking down the barrel of the gun). warrior, this is a welcoming back to the tribe. Purification
Muscles twitch from lack of use (i.e., pacing, nail biting, rituals give warriors ample opportunity to recondition the
etc. I know of one soldier who plays air drums to burn off forebrain to non-combative status, gives the individual
this adrenaline rush). Auditory blink occurs (i.e., sirens, a differing perspective of the battle, and allows the
gunshots are muffled or completely blocked). Bladder and parasympathetic system to stabilize (homeostasis) before
sphincter control is lost (i.e. accidents will happen). After sleep lock the horrors of war into long-term memory. This
30 seconds, the parasympathetic system regains control, type of group therapy session allows warriors to praise
one another and defuse the emotional significance of their

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See Perceptual Distortion and Stress (McCrary, 2013)

Battlefield Physiology Resiliency, Recovery, and Reintegration


actions; helping returning warriors deal with their blood care manager. Daves symptoms include dysfunctional
guiltreassuring them that what they did in combat was sleep, fatigue, constant irritability, intrusive thoughts of
good (Grossman, 1996). By the time the warrior hits the past combat experiences and malevolence toward his
sack emotional significance dissipates3, leaving only the fianc, intermittent headaches, chronic constipation,
praise and admiration of leaders and fellow comrades. intense guilt and shame, road rage, suicidal ideation, and
This is also the reasoning behind the awarding of metals problematic alcohol consumption. Significant deployment
and commendations during and after military conflicts. It situations include multiple firefights, the killing of enemy
is a critical component to solidify in the warriors brain that insurgents, one instance of accidental civilian killing, and a
what he has done was right, justified, and necessary. close friends losing a leg from an IED explosion.

After months of deployment, military personnel anxious to Upon conducting a mental status examination (MSE),
see loved ones resent the standard practice of returning the psychologist observes a range of emotional affect,
to stateside home bases for several weeks before being fluctuating speech patterns, and mild hand wringing
released. One solider commented, I do not understand and foot tapping. Scales used to analyze Dave include,
why I cannot go home and report back to my unit. This Subjective Units of Disturbance Scale (SUDS), Validity of
adjustment period assists battle-worn soldiers acclimate Cognition (VoC), Beck Depression Inventory (BDI), and
to non-alert status and is also a period for psychological the PTSD ChecklistMilitary (PCL-M). Upon completion of
evaluation. The science behind this critical debriefing initial testing, Daves scores reveal moderate PTSD and
period reports that PTSD symptoms surface immediately depressive symptomology. Dave is informed of treatment
following removal from the combat zone, when the options including medication trials, follow-up with primary
psyche realizes it is no longer in constant danger. This is care physician, support group contact, and several
known as parasympathetic backlash. Psychologists and therapeutic treatment options. Dave refuses to consider
commanding officers observe soldiers during debriefing medication and elects to try EMDR.
for symptoms including sleeplessness, disorientation,
and aggressiveness. Soldiers having difficulty in this EMDR sessions begin by targeting three of Daves most
adjustment period are referred for further evaluation disturbing memories and designating negative and positive
and therapy. cognitive thought patterns. Initial analysis of negative and
positive cognitions are taken during the first session. In
It is worthy to note, a spouse may come to resent a subsequent EMDR sessions Daves negative cognitions
warriors overwhelming sense of loyalty to his/her unit. are combined with bilateral stimulations such as finger
A spouse may hold the erotica key to a warriors heart tapping, eye movements, or alternating light cues. As
but phila love and security belong to his unit. This is Dave cycles through negative and positive cognitions
something the average civilian cannot comprehend; and combined with bilateral stimulations, he notices the three
probably never will. It should be accepted unconditionally memories beginning to overlap and fade. In place of the
and embraced as a idiosyncratic trait of the warriors negative cognitions, positive cognitions begin to appear.
personality. After three sessions, Daves negative cognitions are
replaced with positive affirmations, subsequently causing
memories of war-time maneuvers to come to the surface.
Case Study His initial negative cognitions become less severe as
Treating Violent Impulses: A Case Study Utilizing Eye reported through follow-up VoC. By session six, Daves
Movement Desensitization and Reprocessing With a lower scores on SUDS, PCL-M and BDI-II are nonclinical.
Military Client His demeanor changes and he no longer feels the acute
anxiety about the initial negative cognitions. During
a four month follow-up, Dave confesses his extreme
Stephanie A. Wright and suicide ideation during his initial consultation, informing
Mark C. Russell the clinician that these negative thought patterns have
ceased. He reports positive life changes including getting
Dave (pseudonym), a 31-year-old Caucasian Marine married and contact with his friend who lost a leg during
Corps Sergeant with 10 years of active-duty service is deployment; violent impulses are no longer a problem.
referred to an Army clinical psychologist by his primary

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See The Need for Sleep (McCrary, 2013)

Battlefield Physiology Resiliency, Recovery, and Reintegration


Exam 6. How long can a person typically sustain a heart rate in
Zone Red?
1. Malevolence is a. As long as required
a. possessing a harmful influence on another. b. 3 minutes
b. public humiliation. c. It depends on conditioning
c. emotional or psychological abuse. d. 30 seconds
d. All of the above.
7. All responses to malevolence lead to negative
2. Total loss of cognitive functioning, peripheral vision, aggression. True or False
depth perception, and hearing occurs in which of 8. A client approaches you and you notice her face is
these heart-rate zones? pale and her hands are cold. Which heart-rate zone is
a. Red Zone the person likely experiencing?
b. Black Zone a. Zone White
c. White Zone b. Zone Black
d. Yellow Zone c. Zone Orange
d. Zone Red
3. Which of these variables impact SNS activation?
a. availability of response time 8. Attaching emotional significance to a traumatic
event
b. malevolent intent
a. Helps a person learn coping strategies.
c. skill or training
b. Makes a person pay attention.
d. all of the above
c. Can cause PTSD.
4. Which of these heart-rate zones is not typical of a
d. Engages a persons fight or flight response.
warrior?
a. Zone Red 8. This increases awareness, activates aggression, or
causes a person to retreat from malevolence.
b. Zone Black
a. Physiological responses
c. Zone White
b. Conditioning
d. Zone Yellow
c. Debriefing
5. Warrior purification rituals or debriefing
d. EMDR
a. reconditions the forebrain to non-combative
status.
b. gives a warrior time to show off and boast about
accomplishments.
c. returns the sympathetic system to homeostasis.
d. Locks trauma into long-term memory.

Battlefield Physiology Resiliency, Recovery, and Reintegration


References:

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Boulder, CO: Paladin Press. of eye movements in processing emotional memories.
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com/schoolattack.htm Lewis, M. (2010). The Development of Anger. In M.E.
Portegals International Handbook of Anger (pp. 177-191).
Grossman, D. &. (2003, November). Practicing to be New York: Springer Science+Business Media, LLC.
Miserable. Signalman, pp. 7-15.
McGraw, P. (2013). Life Code: The New Rules for Winning
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Grossman, D. (2004). On Combat. Warrior Science
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Lazarus, R. (1998). Fifty Years of Research and Theory


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Battlefield Physiology Resiliency, Recovery, and Reintegration