Combat stress en frontlinie interventies

“Nevertheless, the study findings demonstrate the effectiveness of frontline treatment for combat stress reaction even 20 years after combat”(1). Een conclusie van een 20 jaar longitudinale studie! Met als boodschap: zet frontlinie interventies in (proximity, immediacy, expectancy) zoals we ook kennen van bijvoorbeeld TRiM. Ik deel een paar lessen maar lees het zelf kritisch door en ga niet op mijn interpretatie af!

Niet medicaliseren. “Frontline treatment is guided by the notion that the soldier’s response is not evidence of an underlying disorder but a natural, appropriate response to the extreme stress of war”. 

Snel erbij zijn. “ the acute phase of traumatization is a critical period and early intervention should occur during this window of opportunity to prevent the crystallization of combat stress reaction into PTSD . They also suggest that frontline treatment principles, especially immediacy and expectation, might be adopted to the treatment of acute stress reaction stemming from nonmilitary traumatogenic events, such as rape, severe illness, accidents, or natural disasters”.

Controle en Time Out
“Frontline treatment may provide the distressed soldier with temporary relief in relative safety and may thus reduce hyperarousal, which has been found to be associated with risk for chronic PTSD , and may help the soldier regain a measure of control. Together these effects may reduce the risk for maladaptive behavior and possibly limit the generalization of emotional reactivity”. 

Normaliseren van stress-reactie
“A second explanation may be anchored in the communication of the view that combat stress reaction casualties are essentially healthy individuals experiencing a temporary crisis and that they can be expected to have a rapid recovery. These messages, whose absorption may be facilitated by the high level of suggestibility of persons in an acute stress reaction, may help the soldier to see his breakdown as a normal reaction to the pressure of combat and as one that he can overcome”. 

Sociale hulpbronnen: “Frontline treatment may also further recovery by enabling the casualty to continue to enjoy the social support of his comrades and commanders, who can readily visit him during his treatment. This element may help to restore the sense of affiliation that was disrupted by the combat stress reaction…social support has consistently been shown to aid recovery from psychiatric crisis”

“Another possibility is that frontline treatment discourages avoidant coping, which has been shown to predict
PTSD among soldiers with combat stress reaction (e.g., reference 5). Unlike soldiers in the rear echelon treatment
group, soldiers treated on or near the front remain exposed to combat stimuli similar to those that brought about their breakdown. Their gradual reexposure in a supportive and reassuring situation may lead to desensitization, which enables them to cope with the stimuli and reduces their need to avoid them.”

Psychologische eerste hulp

“Finally, frontline treatment may help to stem the cascading loss of resources that occurs with combat stress reaction
(27). Just as traditional first aid stops hemorrhage and saves the wounded soldier’s life, frontline treatment
can be seen as psychological first aid that promotes coping and self-efficacy and minimizes deterioration into the
sick role and incapacity.”

Tot slot: ik ben een geintresseerde leek en hoor graag van deskundigen als Andrea Walraven-ThissenEric VermettenWendy DorrestijnOnno Pouw ea hoe er op dit moment tegen de lessen uit dit onderzoek wordt aangekeken.

1. Solomon, Z., et al. (2005). Frontline treatment of combat stress reaction: a 20-year longitudinal evaluation study. The American journal of psychiatry, 162(12), 2309–2314.