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STRATEGIES FOR BUILDING
RESILIENCE IN MILITARY
MEMBERS, VETERANS AND
THEIR FAMILIES
Presented by:
Jim Messina, Ph.D., NCC, CCMHC, DCMHS
Assistant Professor: Troy University -Tampa Bay
"The pessimist complains about the wind;
The optimist expects it to change;
The realist adjusts the sails."
William Arthur Ward
GOALS OF PROGRAM
At the end of this training, the trainees will be able to:
1. Identify what are the cognitive, behavioral, and
psychological factors contributing to resilience in
individuals, their families, their military units and their
communities
2. Identify strategies for assisting others to develop and
enhance resilience in the face of stressors facing military,
veterans and their families pre - during- and postdeployment
3. Problem solve solutions for developing resilience strategies
in their own clinical settings in which they work with the
military members, veterans and their families; their military
units and their communities
BEFORE WE LOOK AT RESILIENCE WE
NEED TO LOOK AT SUICIDE
Why you ask should we look at suicide first?
 I am a Red Cross Volunteer who works in Military Deployment
Mental Health work with active military and I have heard over
and over again when talking with military: “You aren’t going to
talk about resilience to us today are you? I have had my fill of
that stuff!”
 On Saturday June 22, 2013 I facilitated two groups at a Yellow
Ribbon event and met men and women military members who all
had similar traits to another veteran whose letter to his family I
got in an email on June 27, 2013
 I realized that the folks I have met at all of the Yellow Ribbon
reintegration events I have been to, could just have easily been
the person who wrote the letter to his family which was
broadcast all over the world
 What was the letter you ask?
 It was a suicide letter left by a Veteran of the Iraq War who killed
himself on June 10, 2013
WE ARE KILLING OURSELVES AT AN
ALARMING RATE
By 2010, in the developed world, suicide became the leading cause of death for people age 15 -49
according to the Institute of Health Metrics and Evaluation, Global Burden of disease, 2010.
SUICIDE’S GRISLY TOLL
I n 2 0 1 0 w o r l d w i d e d e a t h s f r o m s u i c i d e o u t n u m b e r e d d e a t h s f r o m w a r ( 17 , 6 7 0 ) , n a t u r a l
disaster s (196,018), and murder (456,268 ). The Institute of Health Metrics and Evaluation,
Global Burden of disease, 2010
WHY DO PEOPLE DIE BY SUICIDE?
ACCORDING TO THOMAS JOINER:
 “Because they want to and because they can”
 “People will die by suicide when they have both the desire to
die and the ability to die.”
 When Joiner broke down “the desire” and “the ability,” he
found what he believes is the one true pathway to suicide. It’s
a “clearly delineated danger zone,” a set of three overlapping
conditions that combine to create a dark alley of the soul
 The conditions are tightly defined, and they overlap rarely
enough to explain the relatively rare act of suicide. But what’s
alarming is that each condition itself isn’t extreme or
unusual, and the combined suicidal state of mind is not
psychotic
 On the contrary, Joiner’s diagram of suicide is composed of
circles we all routinely step in, or near, never realizing we are
in the deadly center until it’s too late. Joiner’s conditions of
suicide are the conditions of everyday life and only resilience
will pull us out
THOMAS JOINER’S MODEL OF
INTERPERSONAL THEORY OF SUICIDE
 Kimberly A. Van Orden et al., "The Interpersonal Theory of
Suicide," Psychol Rev. 117(2) (2010): 575
LET’S TAKE A CLOSER LOOK AT THE
THREE COMPONENTS OF SUICIDE
In getting ready for this program I receive an email link to a suicide letter
from Daniel Somers who killed himself on June 10, 2013
Why is he relevant to this presentation you ask?
1. He was in the Iraq War and completed 2 deployments
2. In 2004-2005, he was assigned to a Tactical Human -Intelligence Team
(THT) in Baghdad, Iraq, where he ran more than 400 combat missions
as a machine gunner in the turret of a Humvee, inter viewed countless
Iraqis ranging from concerned citizens to community leader s and
government of ficials, and interrogated dozens of insurgents and
terrorist suspects
3. In 2006-2007, Daniel worked with Joint Special Operations Command
(JSOC) through his unit in Mosul where he ran the Nor thern Iraq
Intelligence Center. His of ficial role was as a senior analyst for the
Levant (Lebanon, Syria, Jordan, Israel, and par t of Turkey )
4. In 2007 he was diagnosed with PT SD, TBI, and Gulf War Syndrome,
fibromyalgia and a host of other medical problems He sought treatment
through therapy, medication, music and film production
Daniel’s letter shows us the three components of Joiner’s Interpersonal
Theor y of Suicide and teaches us a lesson about the need for us to change
how we work to help our Militar y, Vets and their families to grow in
resilience
DANIEL SOMERS’ JUNE 10, 2013
SUICIDE LETTER QUOTES
“The fact is, for as long as I can remember my motivation for getting up
ever y day has been so that you would not have to bur y me. As things have
continued to get wor se, it has become clear that this alone is not a
suf ficient reason to carr y on. The fact is, I am not getting better, I am not
going to get better, and I will most cer tainly deteriorate fur ther as time
goes on. From a logical standpoint, it is better to simply end things
quickly and let any repercussions from that play out in the shor t term
than to drag things out into the long term .”
“You will perhaps be sad for a time, but over time you will forget and
begin to carr y on. Far better that than to inflict my growing miser y upon
you for year s and decades to come, dragging you down with me. It is
because I love you that I can not do this to you. You will come to see that
it is a far better thing as one day af ter another passes during which you
do not have to worr y about me or even give me a second thought. You will
find that your world is better without me in it .”
Perceived Burdensomeness
“I am a burden”
DANIEL SOMERS’ JUNE 10, 2013
SUICIDE LETTER QUOTES
“I really have been trying to hang on, for more than a decade
now. Each day has been a testament to the extent to which I
cared, suf fering unspeakable horror as quietly as possible so
that you could feel as though I was still here for you. In truth, I
was nothing more than a prop, filling space so that my absence
would not be noted. In truth, I have already been absent for a
long, long time.”
Thwar ted Belongingness
“I am alone”
DANIEL SOMERS’ JUNE 10, 2013
SUICIDE LETTER QUOTES
“My body has become nothing but a cage, a source of pain and
constant problems. The illness I have has caused me pain that not
even the strongest medicines could dull, and there is no cure. All
day, every day a screaming agony in every nerve ending in my
body. It is nothing short of torture. My mind is a wasteland, filled
with visions of incredible horror, unceasing depression, and
crippling anxiety, even with all of the medications the doctors dare
give. Simple things that everyone else takes for granted are nearly
impossible for me. I can not laugh or cry. I can barely leave the
house. I derive no pleasure from any activity. Everything simply
comes down to passing time until I can sleep again. Now, to sleep
forever seems to be the most merciful thing .”
Capability for Suicide
“I am not afraid to die”
DANIEL’S FINAL WORDS
“This is what brought me to my actual final mission. Not
suicide, but a mercy killing. I know how to kill, and I know how
to do it so that there is no pain whatsoever. It was quick, and I
did not suf fer. And above all, now I am free. I feel no more pain.
I have no more nightmares or flashbacks or hallucinations. I am
no longer constantly depressed or afraid or worried
I am free.
I ask that you be happy for me for that. It is perhaps the best
break I could have hoped for. Please accept this and be glad for
me.
Daniel Somers
Capability for Suicide
“I am not afraid to die”
EXPOSURE TO ADVERSE CONDITIONS
FEEDS THE CAPABILIT Y FOR SUICIDE
 Joiner’s research team has posited that military who have
been exposed to combat have an increased capability for
suicide
 Recent research has found that this is not necessarily the
case, in fact many military suicides have been by people who
have not even been deployed (Bryan, Hernandez, Allison &
Clemans, 2013)
 So another source of Adverse Events which might be a
contributory factor to capability for suicide could be the ACE
Factors which are Adverse Childhood Experience Factors
WHAT ARE THE 10 ACE FACTORS?
ACE (Adverse Childhood Experiences)
Abuse
1 . Emotional Abuse
2. Physical Abuse
3. Sexual Abuse
Neglect
4. Emotional Neglect
5. Physical Neglect
Household Dysfunction
6. Mother was treated violently
7. Household substance abuse
8. Household mental illness
9. Parental separation or divorce
10. Incarcerated household member
Any one of these adverse experiences can drain one’s resilience
SO WHAT IS RESILIENCE?
The APA Health Center (APA, 2004) says that:
Resilience is the process of adapting well in the face of:
1. Adversity
2. Trauma
3. Tragedy
4. Threats
5. Significant sources of stress - such as family &
relationship problems, serious health problems, or
workplace & financial stressors
It means "bouncing back" from difficult experiences!
SO WHAT ARE THE EMOTIONAL FEARS IN
TOUGH TIMES?
Fear of personal ineffectiveness or loss of
ability to survive tough times
Fear of loss of job due to possible failure of
one’s personal effectiveness or professional
skills
Fear of impact of losing one’s job on one’s
self-worth and self-esteem
Fear about impact on family & marriage if
not able to meet financial & emotional needs
in tough times
WHAT ARE KEY FACTORS ASSOCIATED
WITH RESILIENCE?
APA Help Center (APA, 2004) identifies them
as:
1. The capacity to make realistic plans & take
steps to carry them out
2. A positive view of yourself & confidence in
your strengths & abilities
3. Skills in communication & problem solving
4. The capacity to manage strong feelings &
impulses
WHY THE NEED FOR RESILIENCE
 You need to build resilience to sustain your
emotional health when faced with: wars, layoffs, life altering events, natural disasters, death, change,
divorce, health issues, financial difficulties, etc.
 Being resilient doesn’t mean you won’t experience
difficulty or distress. Emotional pain, anger, grief &
sadness are common when you have troubles in
tough times.
 Developing resilience involves behaviors, thoughts &
actions that can help you cope with stressful events.
It helps restore balance in your life.
Ashe, L. (2006). In Times of Trouble Build Resilience. Methodist
Healthcare Employee Assistance Well Informed Program: 3.
WHAT ARE THE FACTORS WHICH IMPACT
RESILIENCE
 The Rand Corporation in 2011 identified this
definition “Resilience is the capacity to adapt
successfully in the presence of risk and adversity”
(Jensen and Fraser, 2005), which they utilized in
their study: Promoting Psychological Resilience in
the U.S. Military.
The Rand group identified four distinct contributors
to factors which build resilience in the military:
1. The individuals,
2. Their families,
3. Their military units
4. Their communities
INDIVIDUAL FACTORS WERE:
 Positive coping: The process of managing taxing circumstances,
expending ef for t to solve per sonal and interpersonal problems, and
seeking to reduce or tolerate stress or conflict, including
active/pragmatic, problem -focused, and spiritual approaches to coping
 Positive af fect: Feeling enthusiastic, active, and aler t, including having
positive emotions, optimism, a sense of humor (ability to have humor
under stress or when challenged), hope, and flexibility about change
 Positive thinking: Information processing, applying knowledge, and
changing preferences through restructuring, positive reframing, making
sense out of a situation, flexibility, reappraisal, refocusing, having
positive outcome expectations, a positive outlook , and psychological
preparation
 Realism: Realistic master y of the possible, having realistic outcome
expectations, self-esteem and self-worth, confidence, self -efficacy,
perceived control, and acceptance of what is beyond control or cannot
be changed
 Behavioral control: The process of monitoring, evaluating, and
modifying emotional reactions to accomplish a goal (i.e., self regulation, self-management, self -enhancement)
FAMILY FACTORS WERE:
 Emotional ties: Emotional bonding among family members,
including shared recreation and leisure time
 Communication: The exchange of thoughts, opinions, or
information, including problem -solving and relationship
management
 Support: Perceiving that comfort is available from (and can be
provided to) others, including emotional, tangible, instrumental,
informational, and spiritual support
 Closeness: Love, intimacy, attachment
 Nurturing: Parenting skills
 Adaptability: Ease of adapting to changes associated with
military life, including flexible roles within the family
MILITARY UNIT FACTORS WERE:
 Positive command climate: Facilitating and fostering
intra-unit interaction, building pride/support for the
mission, leadership, positive role modeling,
implementing institutional policies
 Teamwork: Work coordination among team
members, including flexibility
 Cohesion: Unit ability to perform combined actions;
bonding together of members to sustain
commitment to each other and the mission
COMMUNIT Y FACTORS WERE:
 Belongingness: Integration, friendships, including participation
in spiritual/faith-based organizations, protocols, ceremonies,
social services, schools, and so on, and implementing
institutional policies
 Cohesion: The bonds that bring people together in the
community, including shared values and interpersonal belonging
 Connectedness: The quality and number of connections with
other people in the community; includes connections with a
place or people of that place; aspects include commitment,
structure, roles, responsibility, and communication
 Collective ef ficacy: Group members’ perceptions of the ability of
the group to work together
RESILIENCE IS A PERSONAL STRENGTH
WHICH:
1. Is the ability to positively adjust to adversity
2. Can be applied to building personal strengths
3. Is gained through building positive & nurturing
professional relationship
4. Is the maintaining of positivity
5. Develops emotional insight
6. Is the achieving of life balance & spirituality
7. Results in becoming more reflective
Jackson, D., Firtko, A. & Edenborough, M. (2007). Personal
resilience as a strategy for surviving and thriving in the face of
workplace adversity: a literature review. Journal of Advanced
Nursing:60(1):1-9.
RESILIENCE RESULTS IN ADAPTATION
Adaptation is measured by:
 High prevalence in the community of mental &
behavioral health
 Adequate role functioning at work & home
 A high quality of life by all
Norris, F. H.; Stevens, S. P.; Pfefferbaum, B.; Wyche, K.F. &
Pfefferbaum, R.L. (2008). Community Resilience as a Metaphor,
Theory, Set of Capacities, and Strategy for Disaster Readiness.
American Journal of Community Psychology: 41(1–2):127–150.
FACTORS ASSOCIATED WITH RESILIENCE
(APA, 2004)
1. The capacity to make realistic plans & take
steps to carry them out
2. A positive view of self & confidence in one’s
strengths & abilities
3. Skills in communication & problem solving
4. The capacity to manage strong feelings &
impulses
All of these are factors that people can develop
in themselves.
SO HOW DOES RESILIENCE WORK?
Is a reflex & way of facing or understanding
the world
Is deeply etched in a person’s mind & soul
Results in facing reality with staunchness
Makes meaning of hardship instead of crying
out in despair & improvising solutions out of
thin air
Coutu, D. (2002). How Resilience Works . Har vard Business
Review: 80(5):46-51.
WHAT WEAKENS ONE’S RESILIENCE?
Fear of diminution or loss of one’s personal
strength
Fear of displacement in work roles or possible
failure of effectiveness of one’s professional
skills
Fear that one would not be able to cope with
unemployment & would lose sense of identity &
worth when one lost professional or work role
Fears about the anxieties arising in marital &
family relationships if one should lose one’s job
Martindale, B. (2007). Resilience and Vulnerability in
Later Life. British Journal of Psychotherapy: 23(2):205216.
SELF-ASSESSMENT
 Take the Personal Resilience in Tough Times Self - Assessment
 Rate each item for you on a scale from 1 to 10
1 = never
5 = occasionally
10 = frequently
WHAT DOES THIS ASSESSMENT TELL YOU?
 If you rated 10 or more items over 8 or if you rated 15 -20 over
5
 You are most likely to experience some level of resilience in
facing tough times
WAYS TO BUILD YOUR RESILIENCE
(APA, 2004)
 Make connections
 Avoid seeing crises as insurmountable problems
 Accept that change is a part of living
 Move toward your goals
 Take decisive actions
 Look for opportunities for self-discovery
 Nurture a positive view of yourself
 Keep things in perspective
 Maintain a hopeful outlook
 Take care of yourself
SO WHAT CAN YOU DO TO HELP OTHERS
BUILD THEIR RESILIENCE?
 Surprisingly in preparing for this presentation I realized that
my entire career has been focused on building resilience &
helping folks build a sense of “Belonging” while letting go of a
sense of “Being a Burden” while simultaneously developing a
rational perspective on life so as to let go of the “Capacity to
commit Suicide”
 When I retired from private practice in 1999 my wife
reminded me that I was successful in never having a
successful suicide on my watch!
 What did I do then, you as mental health professionals can do
today to help our military, veterans & their families build their
resilience by
 increasing their sense of belonging
 Increasing their feeling needed, wanted & cherished
 wanting to live life to the fullest
USE THE SEA’S MODEL OF RECOVERY
 The Self-Esteem Seekers Anonymous model of
recovery is on www.coping.us
 The model is a set of tools which make recovery a
workable process for anyone committed to making
changes in life so as to grow in self-esteem, build
their resilience and let go of the three major factors
of Joiner’s Interpersonal Theory of Suicide
 The work is most effective in a SEA’s group which is
a 12 Step model weekly program where each week
the participants explore the following TOOLS for
Recovery in the SEA’S System of Recovery
34
SEA’S TOOLS FOR RECOVERY
 TEA System
http://www.coping.us/seastoolsforrecover y/teasystem.html
 ALERT System
http://www.coping.us/seastoolsforrecover y/aler tsystem.html
 ANGER System
http://www.coping.us/seastoolsforrecover y/angersystem.html
 LET GO System
http://www.coping.us/seastoolsforrecover y/letgosystem.html
 CHILD System
http://www.coping.us/seastoolsforrecover y/childsystem.html
 RELAPSE System
http://www.coping.us/seastoolsforrecover y/relapsesystem.html
TEA SYSTEM
 Thoughts
 Emotions
 Actions
36
TEA SYSTEM
37
ALERT SYSTEM
 ASSESS
 LESSEN
 EASE OUT
 RELAX
 TAKE STEPS
38
39
ANGER SYSTEM
 ACCEPT
 NAME IT
 GET IT OUT
 ENERGIZE
 RELEASE
40
41
LET GO SYSTEM
 LIGHTEN NEED
 EXERCISE RIGHTS
 TAKE STEPS
 GIVE UP CONTROL
 ORDER LIFE
42
43
CHIILD SYSTEM
 CALM
 HEAL
 INFORM
 LIGHTEN
 DIRECT
44
45
RELAPSE SYSTEM
 RECOGNIZE
 EXERCISE
 LEARN
 ACT
 PROTECT
 SUPPORT
 EVALUATE
46
RELAPSE SYSTEM
47
SEA’S TOOLS FOR COPING – TOOL CHEST
ON WWW.COPING.US
The SEA's Program Manual
Laying the Foundation
Tools for Handling Loss
Tools for Personal Growth
Tools for Relationships
Tools for Communications
Tools for Anger Work –Out
Tools for Handling Control Issues
Growing Down: Tools for Healing the Inner Child
Tools for a Balanced Lifestyle: A Manual for a Guilt Free System
of Healthy Living
 Pathfinder Parenting: Tools for Raising Responsible Children
and
 A personal journal — a notebook or audio file in which daily
reactions, feelings, and insights are recorded. It is also used to
record the completing the 12 steps Workbook in the SEA's
program.

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WHAT CAN YOU DO?
What can you do to help Military, Vets and
their family members build resilience?
Brainstorm three things which you can do to
help your clients build resilience
Ok Let’s Go!
COACH CLIENTS ON BUILDING RESILIENCE
Have clients assess their own level of
resilience during tough times
Teach them about what are the best ways to
build their own resilience in tough times
Encourage “resilience building lifestyle”
changes in their lives
WHAT CAN ELSE BE DONE FOR CLIENTS TO
BUILD THEIR RESILIENCE
 Get Military, Vets & their families to be task-focused
by making plans of collaborative actions to cope with
the tough times experienced by them all by setting up
SEA’s Groups within Military Units or in their
community
 Use the SEA’s groups for emotion-focused activities to
give them a chance to let out their true feelings
 Keep the SEA’s groups in reality by not allowing them
to fall into avoidant coping style where they refuse to
believe times are tough & that they must change
 Hoge, E. A ., Austin, E. D. & Pollack, M. H. (2007). Resilience:
research evidence and conceptual considerations for
posttraumatic stress disorder. Depression & Anxiety: 24(2):139152.
SO ARE YOU READY TO HELP ACTIVE
MILITARY, VETERANS & THEIR FAMILIES
You can help them
 feel that they belong to a supportive collaborative effort
to gain meaning & worth in their lives
 to not feel like they are a burden to partners, spouses,
families, military units or workplaces due to their post combat experiences
 to let go of the fall back plan of ending their own lives
just because they are capable of doing so
 build their resilience!
 to agree to network together to support one another’s
efforts to grow in resilience so as to survive their tough
times!
REFERENCES
 A PA . ( 2 0 0 4 ) . A PA H e l p C e n t e r : T h e R o a d t o R e s i l i e n c e : h t t p : / / w w w . a p a . o r g / h e l p c e n t e r / r o a d resilience.aspx
 A s h e , L . ( 2 0 0 6 ) . I n T i m e s o f Tr o u b l e B u i l d R e s i l i e n c e . M e t h o d i s t H e a l t h c a r e E m p l o y e e
Assistance Well Informed Program: 3.
 C o u t u , D . ( 2 0 0 2 ) . H o w R e s i l i e n c e Wo r k s . H a r v a r d B u s i n e s s R e v i e w : 8 0 ( 5 ) : 4 6 - 5 1 .
 Harrison, L.H. (2002). Rolling with the Punches. Business West :19(5):54.
 H o g e , E . A . , A u s t i n , E . D . & P o l l a c k , M . H . ( 2 0 07 ) . R e s i l i e n c e : r e s e a r c h e v i d e n c e a n d c o n c e p t u a l
c o n s i d e r a t i o n s f o r p o s t t r a u m a t i c s t r e s s d i s o r d e r. D e p r e s s i o n & A n x i e t y : 2 4 ( 2 ) : 1 3 9 - 1 5 2 .
 I v y, A . ( 2 0 0 3 ) . D e v e l o p i n g R e s i l i e n c e i n t h e F a c e o f D e c l i n i n g M a r k e t s . N e w Z e a l a n d
B u s i n e s s , 17 ( 6 ) : 1 0 - 1 1 .
 J a c k s o n , D . , F i r t k o , A . & E d e n b o r o u g h , M . ( 2 0 07 ) . P e r s o n a l r e s i l i e n c e a s a s t r a t e g y f o r s u r v i v i n g
and thriving in the face of workplace adversity: a literature review. Journal of Advanced
Nursing:60(1):1-9.
 L a v r e t s k y, H . & I r w i n , M . ( 2 0 07 ) . R e s i l i e n c e a n d A g i n g . A g i n g H e a l t h : 3 ( 3 ) : 3 0 9 - 3 2 3 .
 M a r t i n d a l e , B . ( 2 0 07 ) . R e s i l i e n c e a n d Vu l n e r a b i l i t y i n L a t e r L i f e . B r i t i s h J o u r n a l o f
Psychotherapy : 23(2):205 -216.
 N o r r i s , F. H . ; S t e v e n s , S . P. ; P f e f f e r b a u m , B . ; W y c h e , K . F. & P f e f f e r b a u m , R . L . ( 2 0 0 8 ) . C o m m u n i t y
R e s i l i e n c e a s a M e t a p h o r, T h e o r y, S e t o f C a p a c i t i e s , a n d S t r a t e g y f o r D i s a s t e r
Readiness. American Journal of Community Psychology : 41(1–2): 1 27 –150.
 O w e n , M . ( 2 0 0 2 ) . P s y c h o l o g y a t Wo r k : B o u n c i n g B a c k f r o m A d v e r s i t y. E n t e r p r i s e / S a l t L a k e
City: 32(18):11.
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