Principles of Post Captivity Care

COL Bradley Poppen, Ph.D.

Director, Human Factors

Joint Personnel Recovery Agency

UNCLASSIFIED

UNCLASSIFIED

Agenda

• Overview of the US DoD Reintegration process

• Balancing returnee and organizational needs post-isolation/post-captivity

• Principles of Psychological Decompression during post-captivity care and their potential broader relevance

• Potential complicating factors

• Discussion and Questions

UNCLASSIFIED

UNCLASSIFIED

Reintegration

What it is:

Critical task that allows gathering of necessary information while coordinating multiple activities and protecting the health and welfare of recovered personnel.

UNCLASSIFIED

UNCLASSIFIED

Reintegration Who it is for:

Recovered personnel who have been:

• Separated from their unit (as an individual or a group) while participating in a military mission and needed to survive, evade, resist, or escape

Includes those who are:

• Isolated from friendly forces

• Detained by hostile forces (government, military or other actors)

• Prisoner of War

UNCLASSIFIED

UNCLASSIFIED

Reintegration

Goal:

Return the recovered person back to work, family and society with minimal negative physical and psychological effects

UNCLASSIFIED

UNCLASSIFIED

PHASE I

PHASE II

PHASE III

In Country

• MEDICAL TRIAGE

• DEBRIEFING

• DECOMPRESSION

• RTD or TRANSPORT TO

PHASE II FACILITY

In Theater

• NECESSARY

MEDICAL CARE

• DECOMPRESSION

• DEBRIEFING

• SUPPORT

RTD or TRANSPORT

TO PHASE III

FACILITY

CONUS

• DEFINITIVE MEDICAL

CARE

• DECOMPRESSION

• DEBRIEFING

• SUPPORT

ENDS WITH FINAL

DUTY STATUS

DETERMINATION

COMPLEXITY & LEVEL OF SUPPORT

Reintegration Phases

24-48 Hrs 4 to 14 Days 1-2+ Weeks

UNCLASSIFIED

Returnee Needs

• Appropriate medical care and follow-up • Regain the ability to Predict upcoming events and

establish the Perception of Control • Tell their story repeatedly in a healthy manner • Need to have their reactions and emotions normalized • Need to develop a plan of action for dealing with events

common to their circumstances • Reengage in healthy life style

– Family – Social – Work – etc

UNCLASSIFIED

UNCLASSIFIED

Organizational Needs

• Gather time-sensitive and strategic information

• Gather and develop Lessons Learned for training and maintaining the force

• Prosecution of criminals and protection of their citizens

• Maintain viability of witnesses

• Return citizens to duty, family and society

UNCLASSIFIED

UNCLASSIFIED

Psychological Decompression

• Designed to assist recovered personnel in transitioning from isolation or captivity to full duty status while minimizing any lasting harmful psychological side effects.

• The major assumption is that recovered personnel are emotionally health and resilient individuals. They are normal people who have survived an abnormal event.

• The decompression protocol is designed to minimize the impact of their own and others unrealistic expectations and unhealthy reactions as recovered personnel learn healthier ways to adapt and cope with their environment.

UNCLASSIFIED

UNCLASSIFIED

Decompression Components

• Enable them to regain the ability to predict upcoming events and reestablish a perception of control

• Normalize their emotional and behavioral reactions to the isolating/captivity event

• Allowing them to repeatedly tell their story in a positive, healthy manner

• Allow group and individual down time

• Develop action plans that will assist them as they face the challenges of readjusting to “normal” work, family and social life.

• Planned follow-up

UNCLASSIFIED

UNCLASSIFIED

Prediction and Control

• Isolated personnel have lost the ability to predict and control their environment

• First priority is to return ability to predict

– Initially very structured events with limited access

– Review up coming events with recovered personnel repeatedly before events occur

– Handle them in a professional military fashion

• Titrate ability to make choices/take control

UNCLASSIFIED

UNCLASSIFIED

Normalization of Reactions

• Responsibility of all reintegration team members

• Expected reactions are normal reactions

• Regardless of recovered personnel reactions reintegration team must treat them as expected

• Difference between expected and healthy

• SERE psychologist work with recovered personnel to adopt healthy reactions (action planning)

• Repeatedly telling story is part of normalization process

UNCLASSIFIED

UNCLASSIFIED

Healthy Story Telling

• Understand the role of debriefing in emotional recovery

• Recently recovered personnel want to tell their story

• Can give their event meaning, purpose and context • Safe non-judgmental , professional environment • Initial telling of story with minimal interruptions • Detailed professional questioning vs professional

voyeurism • Learn to adapt the story to the audience

UNCLASSIFIED

UNCLASSIFIED

Group Time

• Recovered personnel who were isolated together need time to together – Initially time-limited structured events – Normalization of reaction with people who have been

through the event – Continuation of healthy relationships developed in

isolation – Resolution of unresolved issues from isolation

• Be careful of – Unhealthy power dynamics within the group – Compromising individual debriefs – Pressure not to revel specific isolation events

UNCLASSIFIED

UNCLASSIFIED

Individual time

• Experience the angst their reactions/fears/ worries

• Develop coping strategies with support

• Practice coping strategies

• Recognize personal strengths

• REST

UNCLASSIFIED

UNCLASSIFIED

Action Planning

• Develop Action Plans for events common to reintegration process

• Priority of action plans determined by – Phase of reintegration – Nature of isolation – Physical and psychological condition – Family issues – Political/public pressure – Condition of unit

• Action plans range from warning orders to planned behavioral responses to given situations

UNCLASSIFIED

UNCLASSIFIED

Reintegration Responsibilities

Needs

- Medical Care and Follow-up

- Regain their ability to Predict and Control

- Tell their story repeatedly in a healthy manner

- Need to have their reactions and emotions normalized

- Develop action plans for dealing with common events

- Reengage in healthy life style

Responsibilities

- Appropriate medical care

- Let them know what is going to happen/graduated exposure

- Trained psychologists and debriefers working with them

- Know how to handle returnee’s reactions

- Help them develop plans of action for their specific situation

- Education, support and follow-up

UNCLASSIFIED

UNCLASSIFIED

PHASE I

PHASE II

PHASE III

In Country

• MEDICAL TRIAGE

• DEBRIEFING

• DECOMPRESSION

• RTD or TRANSPORT TO

PHASE II FACILITY

In Theater

• NECESSARY

MEDICAL CARE

• DECOMPRESSION

• DEBRIEFING

• SUPPORT

RTD or TRANSPORT

TO PHASE III

FACILITY

CONUS

• DEFINITIVE MEDICAL

CARE

• DECOMPRESSION

• DEBRIEFING

• SUPPORT

ENDS WITH FINAL

DUTY STATUS

DETERMINATION

COMPLEXITY & LEVEL OF SUPPORT

Reintegration Phases

24-48 Hrs 4 to 14 Days 1-2+ Weeks

UNCLASSIFIED

Potential Complications

• Overwhelming recovered personnel with a show of support

• Providing accolades, medals, public celebrations too early

• Families

UNCLASSIFIED

UNCLASSIFIED

QUESTIONS

AND

DISCUSSION

UNCLASSIFIED

UNCLASSIFIED