engleski

Early interventions for individuals with combat- operational stress reactions

Objectives Combat or operational stress reaction (COSR) is an acute stress reaction of service members during Ongoing Military Operations. The objective of this lecture is to discuss the main features of the COSR, review the evolution of the early intervention programs and describe the current state of the art in that field. Methods The early intervention programs evaluated from the concept of the Forward Psychiatry used by the British and Americans in both World Wars. It could be summarized in the principles of proximity, immediacy, expectancy, and simplicity (PIES). Recently, they have been reformulated as BICEPS in US Army. At the end of the last century, the most commonly recommended psychotherapeutic intervention was psychological debriefing and anxiolytics (mostly benzodiazepines) were the primary pharmacological early intervention. Unfortunately, research revealed limited efficacy and also potential harmful effects of these interventions. Results The current recommendation for tretament of CORS relies on the three main principles: Don't Pathologize ; Don't Psychologize ; Don't Pharmacologize as COSR is considered ‘normal’, being socially acceptable, psychologically effective, and self-limited (the first three days after the trauma exposure). After the adequate triage, it is recommended to address the basic needs (“three hots and a cot”) providing the Psychological First aid, to educate person, to normalize observed psychological reactions and provide the expectancy of recovery. Watchful waiting is also recommended for those at-risk for developing negative outcomes following trauma. Specific treatment should not be commenced before 2 weeks after the trauma.

Combat or operational stress reaction ; Early interventions

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