Maintaining Peak Performance

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Maintaining Peak Performance

SFC Bandy Hyatt, 18D

[email protected]

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Role of the SOF Medic

• We treat more than just trauma

• Keep as many guns in the fight…FOR AS LONG AS POSSIBLE!!!

• Humans are more important than hardware

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Truths About Suicide

“There are two basic, albeit contradictory, truths about suicide: (a) Suicide should never be committed when one is depressed (or disturbed or constricted); and (b) almost every suicide is committed for reasons that make sense to the person who does it.”

—E. S. Shneidman, “Suicide as Psychache”

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Our Patient

• Deployments: 5 combat; 8 JCETs

• Divorce 2010; Problems with current marriage

• 15‐40 Drinks/week; BH AUG 2015 for “sleep”

• 24 AUG 15: Brother commits suicide

• AUG 15 – APR 16: Various Treatments

• Guilt/Shame; Stigma; Drinking = Medication

• FEB 16: Prior SI/HI; SSRIs; Danger to World

• Symptoms worsen; Alcohol 30‐50+ drinks/wk

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Our Patient

• 14‐15 APR 16: >50 drinks; Plans Suicide

• 18 APR 16: Current SI/HI; Month off; Therapy

• May 16: Full Disclosure; Improves treatments

• JUN 16: Addiction brief; Peer support

• OCT 16‐APR 17: Returns to an ODA; POTFF invite

• APR‐OCT 17: Friend suicide; JCETs; Tampa/DC

• MAR 18‐JAN 19: AFG; PTSD; Alcohol/Family issues

• JAN‐MAY 19: Refocus on treatment; AA

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Our Patient

• Graphical Data of PCL scores APR – AUG 16

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The Truth about Suicide

• Anyone can be suffering

• Nickolas Taylor• Struggled from numerous unaddressed BH problems

• Hx of severe financial, legal, and relationship problems

• Used alcohol to cope with unresolved issues

• Died from suicide 24 AUG 15

• Brother of our Patient

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The Truth about Suicide

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Stigma

“There is no health without mental health. One out of five of us is living with a mental illness, but most people are too embarrassed to admit it. That is because of stigma. Only by making it completely acceptable to discuss issues relating to mental illness in public, can we ever hope to fully eradicate the scourge of stigma.”

—Senator Michael J. Kirby

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The Truth

• My security clearance was never affected.

• No one took my guns away.

• BH Providers never notified my command.

• I returned to an ODA in October 2016.

• I was still able to deploy.

• I still struggle and continue to seek help.

• I chose to take a break.

• My marriage never fully recovered.

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Takeaways

• Suicide IS preventable.

• There IS help.

• There IS hope.

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Common Misconceptions

• “I’m going to lose my security clearance”• EXORD 12968, Access to Classified Information, 7 AUG 95

• You cannot be denied a clearance solely based on seeking mental health treatment.

• SECDEF memo, DOD Guidance on Question 21, SF 86, 4 SEP 2012 • “Your decision to seek mental health Care will NOT in and of itself adversely impact your ability to obtain or maintain a national security position. In fact, seeking personal wellness and recovery may favorably impact your eligibility for a national security position.”

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• “I will become non‐deployable”• Only your CoC can determine your deployability status. Profiles are recommendations to your commander only.

• As a leader, you should look at the mental health of your soldiers the same way you look at their physical health. If a soldier is “injured”, then he should focus on treatment until ready to deploy again.

• Waivers may be needed for prior medical history or medications

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• “They’ll take my guns away”• 18 U.S. Code § 922 (g) (4)

• It shall be unlawful for any person who has been ADJUDICATEDas a mental defective or who has been committed to a mental institution to ship or transport in interstate or foreign commerce, or possess in or affecting commerce, any firearm or ammunition.

• http://www.ncsl.org/research/civil‐and‐criminal‐justice/possession‐of‐a‐firearm‐by‐the‐mentally‐ill.aspx

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• “They’ll notify my chain of command”• Medical providers are bound by confidentiality laws and HIPPA.

• Unless you are an IMMEDIATE threat to yourself or others, or are admitting to actively committing serious crimes, your BH provider will not notify your chain of command, law enforcement, or any other entity.

• Leaders, and friends, should go to any extreme to prevent loss of life…including notifying the chain of command.

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Advanced Schooling

• A history of suicidal ideation, mental illness, or other behavioral health problem will most likely not stop you from attending any advanced training.

• Waivers must distinctly show your history of the problem, treatment, and STABILIZATION AFTERWARDS.

• Ensure to submit all waivers at least 30 days before course start date.

• Consult with school/SWCS providers prior to school

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The Best Predictors

• How can we tell when someone is struggling?

“…lethality combines with desire for death to result in serious suicidal behavior, and that desire for death stems from feeling a burden on loved ones and others, and feeling disconnected and alienated from others.“

—Thomas Joiner, “Why People Die by Suicide”

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Thoughts are not Actions

“There is nothing intrinsically wrong in thinking about suicide; it is abnormal only when one thinks that suicide is the only solution.”

—E. S. Shneidman, “Suicide as Psychache”

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Don’t Make Assumptions

“They’re just having a hard time right now. Things will get better for them...they always do.”

Sometimes they don’t...

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Shame and Guilt

• I am a shitty (insert title here)…• Husband, father, brother, operator, medic, person, etc...

• Morality• Concrete parameters for personal standards

• Can you live with what you’ve done?• Can you learn to?

• Don’t let it control your life!

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The Truth About PTSD

• PTSD is a psychological disorder resulting from a traumatic event.• Persistent re‐experiencing of the traumatic event

• Numbing of emotional responsiveness

• Persistent symptoms of increased arousal

• Impairment in social/occupational functioning

• Often delayed manifestation after event (~90 days)

• PTSD=Increased Divorce/Substance Abuse/Suicide

• 1996: 3x more suicides after Vietnam than KIA

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Grossman, D., & Siddle, B.K., "Psychological Effects of Combat," in Encyclopedia of Violence, Peace and Conflict, Academic Press, 2000

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Psychological Effects of Combat

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• Psychiatric breakdown • Remains one of the most costly items of war

• More likely than being killed by enemy fire

• Mental debilitation=Not able to participate in combat

• Swank and Marchand's World War II study• Beaches of Normandy; 60 days continuous combat

• 98% psychiatric casualties• 2% "aggressive psychopathic personalities."

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Grossman, D., & Siddle, B.K., "Psychological Effects of Combat," in Encyclopedia of Violence, Peace and Conflict, Academic Press, 2000 23


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• WIA and the fear of dying

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Why do we do it then?

“…it’s about the men next to you…”

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Peak Performance

• How do we maintain, or return to, peak performance?

• Simple things done with consistency

• Stress and Bandwidth

• Maximize being a minimalist

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Operator Syndrome

• TBI

• Endocrine dysfunction

• Sleep disturbance

• Obstructive sleep apnea

• Chronic joint/back pain, orthopedic problems, and headaches

• Substance abuse

• Depression and suicide

• PTSD

• Anger

• Worry, rumination, and stress reactivity

• Marital, family and community dysfunction

• Problems with sexual health and intimacy

• Being “on guard” or hypervigilant

• Memory, concentration, and cognitive impairments

• Vestibular and vision impairments

• Challenges of the transition from military to civilian life

• Common existential issues

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Frueh BC, Madan A, Fowler JC, Stomberg S, Bradshaw M, Kelly K, Weinstein B, Luttrell M, Danner SG, Beidel DC."Operator Syndrome": A unique constellation of medical and behavioral healthcare needs of military special operations

forces. The International Journal of Psychiatry in Medicine, in press. 28

Operator Syndrome

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Frueh BC, Madan A, Fowler JC, Stomberg S, Bradshaw M, Kelly K, Weinstein B, Luttrell M, Danner SG, Beidel DC."Operator Syndrome": A unique constellation of medical and behavioral healthcare needs of military special operations

forces. The International Journal of Psychiatry in Medicine, in press.

Bandwidth Cloggers

• mTBI

• Pain

• Sleep

• Relationship issues

• Work stuff

• Positive stress

• Environmental ADHD

• Nutrition

• Deployment stuff

• Bad habits

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Ways to Unclog Bandwidth

• Sleep

• Exercise

• Positive Meaningful Connections

• Nutrition

• Attention development5/7/2020 31

Sleep

• 7‐9 hours of quality sleep

• Testosterone production increases with more time slept• 6 vs. 8 hours

• Clears neurotoxins

• Prolactin increase – insulation for the brain

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Sleep Deprivation

• Emotional: short fuse with less restraint • Brain firing differently

• Physical: 3x more likely to get sick if <6 hours

• Cognitive: decrease in reaction time, accuracy, and attention• Working memory decrease

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Sleep Tips

• High protein snack 1‐2 hours before bed

• Limit stimulants• Caffeine half‐life 5 hours

• Avoid sugar before bed

• Bedroom=Sleep/Sex

• Screen time after dark• Blue light glasses

• Limit Alcohol• Stop 3‐5 hours before bed

• 0, 1, 2, 3 Drinking

• Don’t work out before bed (<3 hours)

• Keep room cold

• Dark as possible

• No Electronics

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Exercise

• Consistent cardio (>30mins at least 4x/wk)

• Work on mobility

• Brain‐Derived Neurotrophic Factor (BDNF)• Physical activity increases neurogenesis‐boosting signaling factor

• Higher levels correlate with improved cognitive performance

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Meaningful Connections

• Need at least one person you can go to with your doubts and concerns• Interdependency• Not your spouse or significant other

• Develop home environment• Family meeting

• Date night• 10 second kiss

• Three Main Relationships• God, Self, Others

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Nutrition

• Higher the quality, better off you are.

• Variety is important.

• Anti‐inflammatory diet

• Save money through plan and prep.• Traveling nutrition; HelloFresh; Clean Eatz; Mealime

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Attention

• Failure in high pressure situations is always a problem of focus.

• Right place, right time, right amount.

• “Operate subconsciously”

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Attention Development

• Heart Rate Variability• High HRV linked to greater situational awareness, longer life, lower cortisol, and higher adaptability

• Can consistently raise HRV with simple breathing techniques

• Diaphragmatic breathing• <10 breaths/min

• 5‐10 minutes/day of breathing techniques will increase HRV• 5 minutes anytime of the day

• 5 minutes before you get home

• Will cause you to be more adaptable and feel more awake

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Attention Development

• Train yourself for sustained focus• During breathing practice, be mindful of wandering thoughts.

• Leads to increased reaction times and better attention span

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Resiliency

• What is resiliency?• The ability to bounce back

• How can you tell that resiliency is failing?• Deviations from baseline

• Can resiliency be learned? Trained?

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Resources

• SOF Embedded Behavioral Health

• Military Family Life Consultant

• Chaplain

• Medical Providers

• Friends and Family

• Teammates

• Non‐military Organizations/Providers

• YOU!

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In Closing

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Questions

Takeaways

• Suicide IS preventable.

• There IS help.

• There IS hope.

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Documents

Maintaining Peak Performance