Common Ground PROPOSAL This is a 30-page document with many sections Please note the Table of Contents for specifics Page numbers are not attached. Copy Rights reserved 2008 Robert Bornt, MFT
 
Common Ground Honor - Courage – Commitment  A ranch retreat specifically for active duty military, veterans and their families The Antidote to Operational Stress A non-medical approach to building resiliency in family, community and career. Table of Contents Page Introduction 2 Mission Statement 2 Situational Review 3 Common Ground Proposal 4 Additional Review 5 Summary 6 Personal Observation 6 Proposal Brief 8 Benefits to Military Personnel 8 The Training Experience 9 Safety 9 Efficacy 10 Support for Marine Culture and Ethos 10 Costs 10 The Training Process 11 Workshop Flow Chart 12 Overview of Therapeutic Approach 13 The Triage Method 15 The Triage Perspective 20 Operation Recovery History of Service 26 Purpose and Goals 26 Results 26 Conclusion 27 Appendix A 28 References 28    Decompression War Zone - - - - - - - Zone - - - - - - - - Home Zone Introduction Americans have long accepted the need and the cost to provide intense structured training to prepare our brave men and women for wartime service. Recent evidence suggests we must acknowledge there is now an urgent need to provide an equally intense process for our military personnel’s transition back, from combat and grinding deployments, into civilian life. Veterans from the war in Iraq and Afghanistan are struggling from the effects of Combat Operational Stress and traumatic experience labeled PTSD. Rates of veteran suicide, domestic violence, criminality and homelessness make it apparent that new and creative means of support are required for their successful transition from military culture and war to a peaceful civilian culture. A successful transition requires a Common Ground – between cultures. It requires a place of rest, where there is opportunity to make the transition with acceptance and respect, where trust becomes the heart of relationship and support. It takes a special environment, where nature and living things develop and give purpose to lives disorganized by the violence of war and deployment. Common Ground Mission Statement Create a Decompression Zone with self-sustaining enterprises within a beautiful, natural ranch setting where war veterans and their families have the opportunity to earn immediate income and receive the personal counseling and occupational training each requires to assure a successful transition from military duty back into a productive, civilian life. Situational Review There is no shortage of compelling evidence to describe the situation facing our military personnel and their families. Combat Operational Stress, the stress of long and multiple deployments, and the challenges of family and community reunion are creating tremendous challenges for the young men and women who defend our country and freedoms. Domestic violence in veteran families is increasing - becoming more violent and lethal, and rates of suicide, homelessness and addiction are all escalating. Perhaps more disturbing then this immediate crisis is the prescribed response - psychotropic medication - drugs for mental health. The number and variety of prescribed psychiatric medication during deployment and after discharge is staggering. Psychotropic drugs are now the first line of action for most care giving agencies. Funding from the Department of Defense and the Veteran Administration are advancing research on drugs to alter the neuroprocesses of fear, panic and memory in relation to traumatic events. Cocktail mixes of existing drugs for mood, attention, fatigue and depression are being prescribed in record numbers in an attempt to build Warrior resiliency and mitigate PTSD. The prescribed use of psychotropic medication may become the greatest long-term injury of the current war on terror! The spirit of warrior culture may be the antidote to this rush to manage the psychological effects of war through medication. To maintain a culture of Honor, Courage and Commitment it requires trust, emotional regulation and self-attunement, which is the capacity to notice and self-regulate one’s own automatic and reactive emotional process. These are important aspects of a strong, durable culture and it requires trust in one’s self, one’s family and one’s community. Trust is the bond of alliance between and within a culture. Trust is the foundation of resiliency. Developing and maintaining trust requires time and effort. Children develop trust over time in a family and community culture, warriors develop trust over time in military culture – first in boot camp and then through the shared experiences of war. The return home with the lingering effects of war and long deployment is an extreme transition. Successful reunion requires time for decompression and re-attunement to a trusting alliance with self, family and community. Research confirms that an alliance between “living things” is vital. Warrior alliance is based on bonds of trust. Home reunion and a resolution of traumatic stress require an alliance. Building a trusting alliance with psychotropic medication just may not prove beneficial in maintaining a strong and durable culture. The proposed Common Ground Ranch environment offers a Decompression Zone, where military personnel and their families have the time to build alliances, learn vital self-attunement and become self-sufficient without the interruption of military or civilian culture. In the Zone, alliance will be paramount, coming before training and work detail. It will continue throughout the Common Ground experience and is expected to significantly reduce the stigmatic tone of seeking help with transitional stress and PTSD. Common Ground Proposal Farm Hands, Inc. the 501 (c)(3) non-profit organizing Common Ground, requires initial funding to secure a ranch property located in San Diego County. The goals for the ranch are to support military personnel and their families in developing greater self-attunement as a means of increasing their capacity to reunite and integrate after their military experience, and to build a network of professional mental health workers, veterans and community organizers committed to our veteran’s success. The property is secluded yet within easy drive from all points in San Diego County. It is ideally structured, with homes, cabins, shop buildings and fields to meet the program’s need for short-term lodging, abundant areas for job-skill training and the privacy to conduct workshops and meetings anytime day or night. The ranch location offers tremendous potential for job placement and support of veterans in residence as it is less than an hours drive from the majority of participating corporate sponsors. In addition, the ranch offers an abundant water source for food production, animal programs and community social activities. The combination of physical projects, sharing meals and weekend get-a-ways will provide the perfect environment for an ongoing therapeutic alliance between participants, volunteers and staff. Initial funding will secure the property and allow the time necessary to develop micro enterprises, government grants and collaborations. Enterprises include, farm direct fruit and vegetables, animal husbandry, manufacturing/welding, construction and culinary products. Potential grants include Department of Veteran Affairs VA Homeless Providers Grant and Per Diem Program, State of California Veteran Employment Assistance Program Funds, Department of Labor Veteran’s Employment and Training Service programs and other State and Federal grants available for veteran assistance in counseling, housing and career development. Ultimately, the Common Ground development offers several avenues for continuous and long-term funding. Government grants for veteran housing, counseling and job development are expanding due to veteran demand. Funding through corporate sponsorship and private foundations has potential along with community college alliances. In addition, it is expected that micro-enterprises will develop as part of career / job training on the property offering immediate veteran employment and sustainable funding. Your support is greatly appreciated and goes directly to veteran services. Sincerely, Robert Bornt Executive Director Farm Hands, Inc. EIN # 33-0786733 Additional Review Over the last 15 months of serving Military personnel and their families through Operation Recovery’s Garden Project, I’ve had the privilege of meeting with a significant number of Military personnel. Their rank ranged from junior Marine, Noncommissioned Officer and Warrant Officer to Lt. Colonel. All had direct experience with Operational Stress and PTSD. During their participation, the garden environment provided an atmosphere where we were able to confidentially discuss the impact stress has on Marine ethos. These discussions offered an opportunity to compare and contrast their perspectives on Operational Stress with my professional experience. In general, junior Military personnel showed less interest in the concepts of Operational Stress and PTSD. They did express the need for an efficient method of re-situating themselves after deployment, before family reunion. They felt the Marine they had been trained to become collided with the husband or family member they were expected to be. The focus of work with each Marine became that of preserving Marine ethos, while reframing their role and responsibilities within their family. These junior Military personnel received the idea of a Marine spending time in a decompression zone, away from military duties - where they could truly relax and re-organize their emotional selves before reintegrating with their families, as an ideal solution. Jointly, they were optimistic that, given time and a place to decompress the experience of deployment, they could decrease their reliance on medication and alcohol and the emotional disturbance they frequently encountered returning to their families. The older and often more senior Military personnel expressed intense frustration with Operational Stress and the symptoms, which threaten a PTSD diagnosis. They know and respect the effects stress has on them and on their Military personnel. However, their concerns regarded what to do about stress, not so much what it is. They felt the Marine Corps was providing a lot of information on PTSD, particularly the definitions and consequences of the disorder, but was limited on practical direction as to how to address stress within their command and, more importantly, how to minimize the pressure they feel from their superiors to "suck-it-up." Unanimously, they agreed that a confidential program, where they could receive personal attention for their own symptoms and learn what to do about Operational Stress in their command was critical. Collectively, every Marine, participating in Operation Recovery’s Garden Project, asked for relief and resolve of the emotional effects of their active duty experiences. Importantly, they were not asking to be fixed or counseled. They were asking for the tools to manage stress and the associated risk that stress presents, for themselves, their fellow Military personnel, and their families. Situational Summary According to participating Military personnel the most critical issues pertaining to Operational Stress and the preservation of Marine ethos requiring immediate attention are: Decompression after deployment and before family reunion Therapeutic process and education for decompressing their experience Physiological and psychological rest with workshops on self-regulation Reduction of Operational Risk Managing Operational Stress through education and training Maintaining Marine ethos and preserving physical resources Increase Deployability of experienced Military personnel In the context of health related restrictions to capacity for deployment Manage and reduce Operational Stress before diagnosing for PTSD Increase Retention of experienced Military personnel Maintain experience by intelligent vs. emotional choices during FTAP/STAP Manage and reduce Operational Stress before critical career decisions Preserve Trust in Marine Command Overcoming perception that command is acting out of self-preservation Increase understanding of how stress impacts behavior and perception Medication alternatives Learn alternatives to the massive application of drug therapy Increase behavioral self-discipline and self-regulation Personal Observation The situation of resolving the mounting stress in our military resembles a wild goose chase. All the wild goose wants to do is its job - complete the stressful flight from Canada to Mexico and home again. Unfortunately, along the way hundreds of well meaning people insist on chasing it around every time it tries to land for rest. The chasing compounds the goose’s stress and thus the risk of falling from the sky in exhaustion. Our Military personnel are striving to do their job. Combat operations are stressful and there is a need to rest and restore. But, unresolved stress from combat, active duty operations and family, all continue to threaten Marine capacity and erode Marine ethos in both subtle and profound ways. There seems to be a chasing here too. The press, politicians and community therapists are all engaged in trying to help the Military personnel. Recent initiatives to improve mental health care of the American Military by the Department of Defense and the Veteran Administration validate the government's effort to help the Military personnel as well. However, well meaning though ineffective treatment may fuel the fire of resistance to any potential remedy and have the potential to deepen hopelessness and increase suicide ideation. In addition, greater testing for PTSD only exposes the depth of the situation and association with attempts to diagnosis or treat may increase stress. Even the suspicion of a decline in a Marine’s capacity could be threatening. The signature expressions of stress, especially PTSD, appear to be intrinsic in the barriers to care. The stigma of weakness, perceptions of mental health provider inadequacy, and feelings of command neglect, can all be attributed to a systemic stress load in military culture. Efforts to care may present the most critical barriers to resolve. Conversely, research reveals that a therapeutic alliance is vital to effective efforts to reduce or resolve PTSD (Appendix A). The alliance between Military personnel is fundamentally based on a bond of trust. Barbers, even bartenders form alliances with Military personnel through bonds of trust. The combat veteran credo declaring that you can only trust another combat veteran embodies the bond of trust. But, while these bonds can offer stress relief, they are not necessarily resolving. Resolving PTSD requires an alliance with individuals who have an understanding of and respect for the therapeutic process. Marine ethos may hold the answer. Maintaining Marine honor, courage and commitment requires trust, emotional regulation and attunement. It requires individuals and groups to work as a team, Marine for Marine. An environment where Military personnel learn to support themselves and each other - in combat and at home, could significantly reduce the stigmatic tone of handling Operational Stress and its associated risk. The environment in Operation Recovery’s garden has proven very effective in developing trust. Military personnel learned to trust the therapeutic process of self-attunement as a means to resolve issues of stress, including irrational thoughts and physical reactions to environmental triggers. Clinically, there appears to be a direct relationship between resiliency and degree of self-attunement. Most importantly, the therapeutic method utilized in the garden has the potential to be a support tool for Military personnel. Active duty Military personnel supporting Military personnel in the process of stress resolution has the potential to result in reduced Operational Risk, greater Marine retention and decreased PTSD positives showing up in the PTSD screening process. Proposal Brief This proposal requests your support in securing funding, advisors and collaboration to expand and evaluate an effective and efficient decompression training center with programs for active duty military personnel and veterans. The purpose is to reinforce the military culture of honor, courage and commitment as a means of increasing resiliency and reducing Operational Stress, its associated Operational Risk and its potential to develop into PTSD. The goal is to support military personnel and their families in developing greater self-attunement as a means of increasing their self-discipline and self-regulation of behavioral expression, while developing teams of Military personnel who can duplicate a successful training process in the field. The ultimate goal is to increase resiliency, reduce stress with its potential to develop into PTSD, and minimize the stigma of participating in programs to reduce Operational Stress. Programs at the center will utilize The Triage Method, a body/centered therapeutic approach, during training and experiential learning workshops. The Triage Method has proven effective when applied in a contained, open-air garden/woodshop environment, with engagement in physical activities and social interactions. Past participants were able to (a) develop the trust required for an effective therapeutic alliance, (b) experience a sense of control through initiating their own therapeutic process, (c) learn to self-regulate core neuro-processes through education and experiential training in self-attunement, (d) gain trust in their capacity to acknowledge and tolerate emotions, and (e) learn to engage physical and emotional defensive systems in real time. Results of efforts to build resiliency, reduce stress and the development of PTSD symptoms are expected to be formally evaluated using valid assessment tools designed by a selected collaborator. Benefits to Military Personnel Military personnel can expect a reinforcement of military culture and a correlative increase in resiliency with a subsequent decline in the consequences of Operational Stress as Military personnel learn to deepen their capacity to utilize self-attunement to regulate their mental and behavioral expressions. This includes a potential increase in deployability, greater retention of experienced military personnel and a decrease in general misconduct. In addition, military personnel will benefit from the development of active duty teams trained to duplicate the training process in the field. Overall the reinforcement of military culture will stimulate resiliency, reduce Operational Stress and the associated Operational Risk to Military personnel, their families and their provisions. The Training Experience This training experience is designed to compliment the translation of physical toughness into mental toughness, where mental discipline and rigor accentuate combat fitness and combat skills. It has the potential to assist Military personnel in handling any situation they confront, while effectively processing the moral and ethical decisions of war and family life. Training consists of six four-hour workshops designed to accommodate military schedules and may include individual, couple, and/or group workshops. An introductory workshop will assist military personnel in discovering Who they are neurologically - in behavior and physical structure. The discovery will be in relation to the many realms of their life-experience, from active duty to family spouse, parent or friend. The second and subsequent workshops are designed to deepen the understanding and relevance of The Triage Method in personnel capacity to prevent, reduce and resolve Operational Stress and any associated risk. The workshop processes provide opportunities to both learn and train methods of triaging self-discipline and behavioral regulation. Activities may include intense one-on-one interaction, project participation or group process. All education and training pertaining to self-discipline and self-regulation involves noticing and attending to behavior, which is self-attunement, expressed during activities and social interaction. The focus is on behavioral expression in the moment and how it relates to mental functioning. Safety All participants will be expected to comply with rules of confidentiality. Discussions may include historical reference - as in stories of the past or the imagined future. However, while these references may be of value for establishing bonds of trust, the emphasis is on how the past or future is motivating behavior in the present, and how military personnel can influence a change. Personal disclosure and family history may be part of introductory information but it is not critical to the mission of increasing military personnel capacity for self-attunement, self-awareness and behavioral self-regulation. Disclosure in discussions and training remains the individual’s choice, as is the capacity to learn. The training strategy promotes the individual, couple or group potential to manage their own stress and associated risk by utilizing structured information and training. Issues relating to TBI, PTSD, depression and anger and psychotic disorders are expected to be present. To meet the special needs of particular military personnel or their family members a referral network and relationships with military command, military police, military family services, Chaplains and military Hospitals are vital to the projects ethical framework. Efficacy During a 15-month pilot program conducted in Operation Recovery’s Garden Program, participating Military personnel and/or their spouses reported significant change in their understanding of stress and PTSD, and an increase in their ability to cope with stress. Participants included 68% who had been deployed to Iraq within the last four years. Collectively, 94% reported an increase in their ability to self-regulate or control the tension and anxiety associated with active duty - this including intrusive thoughts, dreams and disturbing physical reactions to environmental triggers. At the present, the program’s efficacy has not been evaluated or validated by a scientific method. However, the foundation has been prepared for an extensive scientific evaluation. Support for Military Culture Research reveals that a therapeutic alliance is vital to effective efforts to reduce or resolve PTSD (Appendix A). Military culture is based on an alliance of trust between Military personnel. Alliance is fundamentally based on a bond of trust. Combat veterans, barbers, and even bartenders form alliances with Military personnel through bonds of trust. Maintaining honor, courage and commitment requires trust, emotional regulation and attunement. It requires individuals and groups to work as a team. Thus, Military culture may hold the answer to reducing the stigmatic tone of handling Operational Stress and its associated risk. By developing an environment where Military personnel learn to support themselves and each other with issues of stress, Military personnel themselves can contribute to the reduction of Operational Risk and an increase in deployability and retention. Costs The costs of developing a warrior may range from $13,000 for boot camp to several million as the years of service and experience accumulate. The value of a warrior’s life through death or incapacitation is un-calculable. Thus, the value of proposed collaboration to expand and evaluate the decompression center is only relational to results. Currently results are unknown. However, supported by evidence in neuroscience, the successful experiences in Operational Recovery’s Garden Program, with its existing community involvement and service, insures its expansion will produce an invaluable outcome for military personnel. The Training Process Many individuals and couples spend time in Operational Recovery’s therapeutic garden sessions. The results reported were a more aware participation in their own emotional process and a decrease in anxiety and emotional conflicts. This includes intrusive thoughts, dreams and disturbing physical reactions to environmental triggers. Structurally, the program is divided into six four-hour workshops, with the flexibility to account for individual situations and sensitivities. This may include individual, couple, family and or group workshops. Workshop #1 BT - Basic Tribology - Who’s Who in the Tribe 4 - hours The first workshop begins the process of noticing Who individual is in relation to the many realms of life from active duty warrior to off duty family spouse, parent or friend. It includes: an introduction to The Triage Method’s principals, perspective and process; an overview of the brain and body’s neuro-processes as they relate to expressions of honor, courage and commitment; and a discussion of the potential for those expressions to be challenged or disrupted. Information will be presented within an experiential format where participants are encouraged to notice and become aware of their own neuro-processes and those of others. Military personnel begin with an introduction to mindfulness and learn to track the process of how they create their own life-experience - from thoughts and ideas, to emotions to core nerve mechanisms in response to their current environment. Discussions include: Tri-level brain - thoughts, emotions and instinct Polyvagal nerve – communication between a mindful brain, heart and gut Brain behavior - neurotransmitters and mirrors Innate character – Who’s Who in the tribe and why? Workshops #2 through #6 OT - Optimization and Training 4 - hours each The second and subsequent workshops deepen the understanding and relevance of The Triage Method in the individual’s capacity to prevent, reduce and resolve Operational Stress and any associated risk. The workshop process provides opportunities to both learn and train methods of triaging self-discipline and behavioral regulation through self-attunement and attention. Activities may include a variety of workshops, including intense one-on-one interaction, project participation or group process. Workshop Flow Chart Experiential Self-Attunement Training  Overview of Therapeutic Approach The Triage Method of Emotional Therapy (TMET) is supported by clinical experiences during a15-month pilot program titled, Operation Recovery. The method is influenced by empirical findings from recent neuroscientific research and considered an on-the-ground application of the Hakomi Method of Body/Centered Psychotherapy. In a pilot program titled Operation Recovery, TMET proved effective when applied in a contained, open-air garden/woodshop environment. While engaged in physical activities and social interactions, participants were able to (a) develop the trust required for an effective therapeutic alliance, (b) experience a sense of self-control by initiating their own therapeutic process, (c) learn to self-regulate physical and psychological function through education and experiential training, (d) gain trust in their capacity to acknowledge and tolerate their own feelings, emotions and thoughts, (e) learn to engage and control their own physical and mental defensive systems in real time. With survival as the genetic dictate, organic systems of the body regulate energy and effort in relation to efficiency and effectiveness. Affective Neuroscience, a book authored by Jaak Panksepp, describes how threats to survival, labeled traumatic experiences, activate survival mechanisms in the primitive brain, which increase affect, a pre-emotion neuroprocess, for the primary purpose of stimulating physical movement. As threats to survival increase, the primitive base brain becomes the Supreme Command Center (SCC) and instinctually elevates the production of motivational affect to influence other neuro-centers. Greatly increased affect results in an overload for the central nervous system (CNS) and a decreased capacity in higher brain function - emotion, cognition, language, attention and memory. All three neuro-centers are systematically integrated during (a) the integration of sensory input with motor output, (b) the regulation of physiological arousal, and (c) the capacity to communicate experience in words. However, only the SCC selectively controls the process. Its supreme control is dictated by genetic survival structures. Continuing SCC arousal with a decrease in CNS function - combined with limitations in memory and attention, produces a virtual experience of being lost in space and time. This produces the out of body experience during moments of trauma and may explain the Marine feeling like they are still in Iraq, when they are with family at home. Until the Supreme Command Center is convinced the threat is over it will continue its potential to control with or without reminders or triggers of the original threat. Variations in reactions to trauma and in the persistence of control by the SCC are related to the particular structure of each individual’s genetic coding for survival – suggesting relationship to resiliency. Additional research published by Rauch/Van Der Kolk, Hull, Lanius, and Lindauer supports Panksepp’s work on how threats of survival motivate increased affect in the SCC as a means of generating physical action, while decreasing the CNS and the higher brain’s capacity to regulate that affect - to slow or stop action in threat’s presence. These researchers have all pointed out that popular therapies, which seek to medicate or modulate the higher brain functions of emotion, cognition and language, may find their methods inefficient and/or ineffective in treating trauma. As Van Der Kolk points out, higher brain chemistry and emotions are activated in order to bring about action. They are not what is motivating the activation. In addition, experience in Triage suggests that some of the actions being motivated may be designed to hide and protect the motivator! The SCC is not easily convinced that threat is over. When missing the experience of a return to safety or through physical damage, the SCC appears to be mandated to continue generating affect, which stimulates the chaotic thoughts, intense emotions and irrelevant behavior of PTSD. Any continuing symptoms are evidence that the SCC is actively sorting for safety and not finding it. Nature has not designed the SCC to simply trust the CNS and higher brain functions to make decisions on issues of survival. It is designed to resist and distract any deviation from its dictate to survive. Only by the experience of knowing the threat is over will this system lower its guard and allow the other neuro-centers the opportunity to regulate peace of mind. Van Der Kolk concludes, that effective trauma treatment needs to involve: (a) Creating a safe, controlled environment where trust and the therapeutic alliance can develop organically, (b) learning to tolerate feelings and sensations by increasing the capacity to mindfully observe and track one’s own inner experience, (c) learning to regulate one’s own affect and the resulting emotions, thoughts and actions, (d) learning to re-engage physical defenses and re-build collapsed or overwhelmed systems. Professor Inge Mula Myllerup-Brookhuis at the University of West Georgia, in Carrollton, Georgia, conducted research on stress hot-points in the brain. Utilizing Quantitative Electroencephalography (QEEG) her study documented a decrease in affective tones during and after Hakomi psychotherapy treatments, which focuses on affect rather than cognition. In contrast: There are existing and newly funded research programs testing old, new and a cocktail mix of psychotropic (mental) drugs to artificially regulate and control these same organic neuroprocesses. Most of the new drugs are in addition to the cocktails used for limbic mood and emotion, and frontal lobe attention and stamina enhancement. The goal is to build resiliency during deployment, block memory during traumatic experience and treat active duty and veteran PTSD. However, much is unknown about long-term effects of these cocktails. The prescribed use of psychotropic medication may become the greatest long-term injury of the current war! Professor Eric Kandel, the Nobel Prize-winning neurobiologist, and his group at the Howard Hughes Medical Institute have discovered processes in the brain, which have the capacity to learn safety, especially in the amygdala, the brain’s fear centre. He says this suggests new possibilities for the development of anti-depressant drugs. He also states that the process is “a bit like psychotherapy” and that a psychotherapeutic process that utilizes the biological basis of the brain is as effective as the anti-depressant Prozac. His research shows it. The Triage Method The Triage Method is an on the ground application of the Hakomi Method of Body/Centered Psychotherapy. The Triage Method has been refined over the last five years working with individuals exposed to mild to severe violence, who have lost trust and remain hyper vigilant to mental and physical invasion. The method utilizes the biological basis of the brain and body to affect efficient and lasting change. During the last 15 months, working with Military personnel and their families the method demonstrated very positive outcomes. A garden provided the safe environment to initiate therapeutic relationship in a non-clinical, non-diagnostic way. It provided a space where Military personnel and families could rest, turn their attention inward and notice their own unique organic neuroprocess. Triage principals honor the fact that living organisms were created to ensure selfish longevity and purpose. The best hope for both is that the organism’s design includes a systematic electrical/chemical system at its core - one, which can self-direct communication between all possible participants in its survival, from its simplest gene to its complex social environment. The supreme goal of this selfish system is to maintain an efficient and effective balance - of all things relevant to self-survival, within limits defined by a Window of Tolerance. The practice of Triage involves noticing any activity threatening to take a participant outside their Window-of-Tolerance. This means noticing any subtle thing that disrupts the participant’s present state of balance and theoretically becomes a threat to their survival. Once noticed, choices are made about what to do about the perceived threat. For example: In broad strokes, too long under water, not enough oxygen tips the balance and causes survival systems to ratchet down efficiency (stop thinking and emoting and swim like a fish to the surface), regain balance and survive. Here, noticing someone is drowning - we take action and throw out a preserver. We don’t shout to them the fact that they are drowning. They couldn’t hear you. Prolonged exposure to threat of immediate death and constant surveillance with sleep deprivation informs the Supreme Command Center (SCC) that it must take over and dictate the survival effort. Thinking stops. Emotions cease. Information or affect from the SCC is generated as standard operational procedure and the first-line of motivation for muscle and body organs. Here, noticing someone is sleepless - we throw them a pillow, turn down the lights and help them by turning their attention to the moment-by-moment neuroprocess they may be using to block sleep. We don’t discuss ways of getting to sleep. As long as the affective signals of communication from the SCC continue to prevail other neuro-centers generating emotions, thoughts and ideas will struggle to compete, to regain their stature. This struggle heightens the potential for an individual to feel disordered and malfunctioned. The choice here is, do we join in the struggle or do we support the SCC until it can self-integrate into present real time? In a more specific example: An active duty Marine with two tours of Iraq returned to a church group for Military personnel struggling with PTSD and TBI. He hadn’t looked at me or said anything to me, the visitor, until he suddenly turned and started telling me his traumatic story of war. He persisted, deepening as he went. The church counselor attempted to interrupt by commenting, "Gosh, you haven’t told me any of this stuff before." He never took his eyes off mine. Never blinked. When he was done I simply said, "Damn, I wish that hadn’t happened to you. Seems like you had a lot of responsibility" (the story was laced with gestures of responsibility and distrust for superiors). I used the word responsibility because it seemed to be a core theme in Who this Marine was. In theory, “to be responsible” was a core and innate process of his SCC. As we begin to explore the possibilities of the theory, our connection abruptly ended. He pulled back saying, "I had chores like everyone else when I was a kid." That was it. He turned back to the group. To check, I asked if he wanted to continue. Without looking at me and with assurance he said, "No!" We had arrived at a Window of Tolerance, too close to a vulnerable operating system his SCC utilized to define his World. Responsibleness defined him. It was a core filter he automatically used to efficiently regulate his World. He was using it before the war. He used it during the war. And, he was now using it to define how he carried the war experience. Responsibleness was both motivating his PTSD associated rage (They weren’t/aren’t responsible and I am) and limiting his resolve (It’s all mine to bear). At the end of the meeting, he again turned and said in a voice of authority, "I want to come visit you at the garden on Friday. I need to build a bed frame." Two days later he visited the garden/woodshop and built a bed frame. We didn’t return to the earlier conversation about his combat experience. We stayed in the present moment. He let me assume and direct some of the responsibility for making the bed frame sturdy. I applied my idea of Gorilla Glue and dowels, while he sanded and stained. His agreeing to let me assume some responsibility may have been a test. However, it felt like a shift in his perception of threat, where he was assessing threat to Who he was with present time experience. In theory, when responsibleness was recognized, supported and given time to rest his SCC experienced safety, turned down the protective affect, and allowed trust to develop. The example demonstrates an aspect of the therapeutic process involved in the resolution of Operational Stress, PTSD and other general distractions from efficient and effective regulation of the life experience. The SCC, especially when activated for frequent and prolonged durations, remains hyper-vigilant and active dictating when and how other neuro-centers get to contribute. Intellectually, the Marine in the example may or may not have understood what had been revealed, but somehow he deduced when it was time to stop and how to allow himself to reorient. Research from Damasio, Ledox, Panksepp, Porges, Llinas and Davidson has shown that the internal process he may have used is automatic and systematic. Its function is to stabilize the life-experience by maintaining a predictable environment within a Window of Tolerance. That is the job of the Supreme Command Center. For this Marine, exploring the intimate structure of responsibility in his life-experience was unfamiliar and thus unpredictable territory, posing too much risk. Staying with what I had noticed about the motivating core structure and participating from their perspective was the quickest way to demonstrate predictability. It by-passed all the negotiating involved in the emotional and cognitive neurostructures. Experience has demonstrated that a puffed-up male (or female), one relying on power, ultimately has a vulnerability his SCC is mandated to protect. Survival dictates that he cannot risk exposing or even knowing this vulnerability. It is too unpredictable. Puffing is the unique process by design. John Wayne and General Patton are historic examples. Read Montague, director of the Human Neuroimaging Lab at Baylor College of Medicine in Houston, recently published studies on how the brain codes for predictability as a vital resource and generates social interaction based on rewarding predictable experience. The more predictable life-experiences are, the less effort required to maintain the Window of Tolerance and the less risk to survival. Fortunately, as the intimate processes of the SCC, which frame the life-experience, become more familiar they become more predictable, making them the most efficient systems to engage for the reduction and resolution of stress and disorder. Triage encourages participants to become familiar with their own inner, neuroprocesses. Once core impulses are experienced as predictable they become tolerable and manageable. Talking, planning and medicating can be supportive to this process. However, The Triage Method guides participants to self-discover their own intimate core processes, which support self-directed integration of their life-experience, as a means of empowering self-discipline and control. A Marine who struggles to make sense of two extreme feeling states, the serene, calm feeling he has outside the wire in Iraq and the irrational, chaotic thoughts and emotions he has at home with his wife and children, may be experiencing distortions in space and time and the effects of his brain sorting for predictability. Outside the wire surprise and uncertainty are predictable and expected. At home nothing feels predictable. Over time a Marine and family can sort out who makes breakfast and when, and who will drive. They may even quickly reconnect intimacy, but the overriding question of who will live to return can’t be predicted. The impermanence of life affects predictability. That question looms as unanswerable, yet the answer is vital to calm the impulse to predict. Without the answer nothing is predictable in the family structure because all things depend on continuance. For civilians the question rarely impedes on their life-experience, rarely leads to hanging themselves out of hopelessness. PTSD and Operational Stress make it a real and threatening situation for Military personnel, as with the late Marine Sgt. Boyd "Chip" Wicks, who left his wife and daughters behind in 2004. The Triage Method offers the potential to overcome and decompress these systematic, base brain operational procedures. By directing attention to where, when and which system is activated and or overwhelmed in any particular moment participants begin the process of turning their attention inward. This is the mindfulness of Triage, noticing and tracking inner neuro-processes in action. This is the primary and most critical job for achieving self-directed self-discipline and self-regulation. It is self-attunement. Once operational procedures are noticed they become known and are the general framework for behavioral development and change. Without appreciation for the potential of systems - especially core mechanisms related to survival, a change in life-experience is inefficient and comes with great effort. The result of inefficient effort is usually circular violence within these systems and throughout the individual’s family and social system. Response to this violence is often labeled denial, resistance, bone headedness and/or just Who they are, creating stigma for the individual and hazard for the culture. In the previous example, the church counselor seemed to feel left out regarding information pertaining to the Marine’s traumatic war experience. Her not noticing the system motivating the experience represented violence. The interaction could have been experienced as threatening to his SCC if her desire to connect appeared self-focused. By not noticing the motivator in the war story, driven by her own emotions and thought, she was not truly supporting the Marine. He stayed within his Window-of-Tolerance by distracting her with the story. The expressions of the SCC, those systematic or instinctual base brain directives, can be noticed in physical structure as well as behavior. Core systems that hold the behavioral codes for survival appear to utilize those codes as blueprints to mobilize a body in support. Ron Kurtz and his associates at the Hakomi Institute have spent 30 years utilizing reference to eight generalized physical or character expressions they contend develop in relation to nurtured experiences.  Drawing adapted from Ron Kutrz, “The Body Reveals” These postures illustrate the core neuro-blueprints of physical tendencies of the body. Withdraw - Collapse - Rely on Self - Charm, Manipulate, Seduce - Expand Power, Control - Take on Burden & Responsibility - Distract by Doing and Up the Struggle to stay Attached. In developing The Triage Method, correlations have been researched showing relationship between Kurtz’s eight physical character expressions and behaviors described by Panksepp’s core neuromechanisms, Keirsey's innate temperament types and Bowlby's attachment styles. This is an area offering significant potential for understanding warrior behavior in relation to warrior culture, the codes of war and expression of behavior associated with stress, especially PTSD. Behaviorist may have been duped by the self-fulfilling prophesy of the SCC. Based on the theory utilized in Triage, the parent/caregiver didn’t just reject the baby causing it to develop a tendency to withdraw. The baby came organized, at least in part, to reject the caregiver. Research coming from the field of Genetic Biology is clearly showing that at least 50% of human behavior is genetically directed. If we accept this data, then we must begin to consider the possibility those same genetic codes have influence on the physical structure expected to back up the behavior. A baby born with a frail, alien body may be predisposed to support its own SCC directives to withdraw and carefully regulate energy before any possibility to feel rejected. Genetic directive to express a power attitude, born into a frail body, would be ill matched to survive the generations. Triage treats these character types as physical expressions of neuro-blueprints organized by the same SCC codes that dictate behavior. While aspects of these characters appear to be evident in everyone and usually remain relatively fluid, they do deepen and become more pronounced in relation to increased stress load. Functionally, Military personnel can learn to utilize Hakomi’s eight character types to predict generalized behavior for themselves, their fellow warrior and their adversaries. An individual who has a tendency to stay withdrawn from the social environment usually has an underlying and continuous sense of feeling not welcome. They will also have a supportive body structure, one that is thin, unstructured and undefined - unnoticeable. An individual with a tendency to withdraw may become a warrior but leave duty disappointed in not getting what they were hoping for from the warrior culture. The Marine expressing responsibleness in the example had unique physical resemblance to the illustrated Take on Burdon and Responsibility character above. The tendency to withdraw or be responsible plays a vital role in the experience of trauma and expression of PTSD. Triage maintains its potential when both physical and behavioral expressions are noticed at the point of initial contact. It builds trust and produces a great amount of efficiency. Trust and respect happen at a feeling level and are allowed to deepen in an organic way without effort, reducing tension, stress and ultimately risk. Military personnel who learn to utilize The Triage Method have tremendous potential to mentor fellow warriors at home and during deployment - increasing warrior culture, reducing Operational Stress and Risk, reducing dependence on medication and supporting intelligent career choices rather than automatic or emotional ones. The Triage Perspective New information offers the potential to adapt our ways of viewing, managing and treating Operational Stress and PTSD. A garden/ranch environment and its many activities are unquestionably grounding and therapeutic. However, the proposed Common Ground therapeutic potential and effectiveness is enhanced with therapeutic principals and methods currently successful in Operation Recovery’s Garden Program in Oceanside, CA. The Triage Method of Emotional Therapy (TMET) frames the relational principals and methods utilized. TMET is an adaptation of The Hakomi Method of Body-Centered Psychotherapy, where awareness is always related to and from a loving, heart-centered perspective - one of acceptance and respect. The Triage Method is a relational method of behavioral change, which utilizes an attunement to existing temperament and attachment theories, and empiric neurological findings. Key mentors include: Dr. Jaak Panksepp Distinguished Research Professor Emeritus of Psychobiology at Bowling Green State University (Primal Neuro-Mechanisms motivating behavior). Dr. Stephen W. Porges Professor of Psychiatry and Co-director of the Brain Body Center at the University of Illinois at Chicago (The Polyvagal Neuro-system Theory). Dr. Bessel A. Van Der Kolk Clinical Implications of Neuroscience Research in PTSD, New York Academy of Sciences, 1071: 277-293 (2006). Boston University School of Medicine, The Trauma Center, Brookline, MA. Dr. Marco Iacoboni Neuroscientist at David Geffen School of Medicine, UCLA, Los Angeles. Pioneer in brain imaging studies of the human mirror neuron system. Of primary importance in Triage is Dr. Jaak Panksepp’s Affective Neuroscience. His research is deeply rooted in psychophysiology and behavioral biology - including behavioral genetics. His work offers the conclusion that survival mechanisms or core neuroprocesses, based in the primitive neuro-structures of the human body, generate affective expression or primitive affect from the Basal Ganglia, the reptilian "old school" area of the brain. Dr. Panksepp’s research suggests these mechanisms have ultimate control over the body’s physical affective expression because they potentially frame all behavior with genetic dictation. And that stress, especially extreme stress of combat and long-deployment, activates these survival mechanisms in extreme ways. Fear, anger, panic, and to seek have been empirically identified as the primary core processes by Dr. Panksepp’s research and that of others. It appears that the symptoms of PTSD are motivated by at least one of these four core neuroprocesses. Triage often reveals PTSD symptoms to be a complicated blend of two or more. The supreme dictate of survival is the incentive for these core processes to be inherently continuous, systematic and efficient. They represent the body’s core organizational structure, which Panksepp suggests, provides the information motivating other brain activity and ultimately behavior. This is one foundation for the relational and information gathering aspects of The Triage Method. By noticing which mechanism or combination of them a Marine is utilizing to manage experience in the moment, choices can be made to deconstruct the automatic structure of affect - offering the potential to experience a change in the behavioral outcome.  Core affective mechanisms underlying all emotion, cognition and thus, behavior. They are designed with the ability to regulate each other (turn each other on and off) and bundle affective output to the body and other parts of the brain. In general, Panksepp concludes the core affect originating in the raw nerve structure of the body and brain-stem are used to stimulate the limbic area or mid-brain to regulate, regulate and adapt that affect as a means of surviving in a social context without neurologic overwhelm. This regulation process produces the felt sense of experience known as emotion. The more evolved outer layer of the brain, the neo-cortex, utilizes core affect and mid-brain emotion to generate cognitive function, declarative knowledge, reasoning and logical thought, which are advanced coping, managing and surviving processes utilized when risk is low. All parts of the brain initiate muscle action. However, the instinctual part has supreme control because it has genetic dictate with the ability to shut off or restrict higher brain function under extreme stress. Also, because it is integrated with all areas of the brain and environment the base brain’s creation of affective information is paramount in the creation of moment-by-moment behavior. It is always on-line. When the underlying processes influencing felt emotion and cognition are intensively activated, especially by extreme psychophysiological stress, their structure of influence may become disorganized demanding them to remain persistently on or off. This persistent override thwarts thoughtful emotional action and appears to be related to some of the disorders referred to in PTSD. Rage or panic affect override emotional action. Freezing or taking flight limits the ability to seek. Understanding this process with the experience of self-regulating affect reduces the possibility of system overwhelm and allows emotions and thoughts to regain their status of control. Attention to the possibility that these systems may be exerting inappropriate influence is the primary focus for change provided by TMET. As the affective signal from these mechanisms increases the body and brain experience increased stress, the more stress the closer to the Window of Tolerance the more survival impulses ignite. For example: A Marine with two Iraq tours was diagnosed with PTSD at discharge. His horrendous stories of combat were punctuated with hopelessness for a marriage and a desire to live. He had come to the garden seeking something. Turning attention to the seeking allowed its affect to settle (be regulated) and his whole coping system was discovered. In theory, separation from the Military personnel had created increased panic (Who am I now?), to cope with the intense panic affect his SCC directed an increase in rage affect (I’ll control this), which was mistakenly directed at a mush safer object, his wife. The shame of beating her (Who am I, a monster?) and her leaving him reignited the panic affect. To cope the SCC shut those affect motivators down and collapsed him with flight motivating affect. Here, without available rational thought or emotion, it manifested into a flight to suicide ideation. Once he had the opportunity to notice and feel this unique process loop in real time the overwhelming affect gave way to increased emotions and rational thought. He found a balance when risk declined and more systems were allowed to participate in his life-experience. Survival is assured by nerve circuits systematically informed, organized and motivated by 3-levels of brain function in direct relation to perceived degrees of risk. Base-Brain The Supreme Command Center, (SCC). The instinctual blueprint part uses a core neuro-blueprint to automatically seek/find, panic/connect, flight/freeze or fight/rage as survival risk escalates. Generates continuous affective information. Mid-Brain The emotional part uses base affect to generate emotion as a means to communicate and cope in relationship to the social environment and its associated risk. Executive The thinking, planning, learning (memory) and explaining part. Constructs concepts of reality from base affect and emotions utilizing thoughts and words to communicate, manipulate, cope and survive within an ultra low risk, stable environment. Panksepp’s representation of the tri-functioning brain.  Affective, Biological and Anthropological Neuroscience all offer new understandings of how our nervous systems organize, express and resolve experience. They also honor that individual nervous systems and family and group relational systems organize in much the same way. Within these developments there is evidence supporting methods of prevention, mitigation and resolution of Operational Stress and PTSD. The Triage Method, as an on the ground application of the Hakomi Method, utilizes these developments with respect for the participant’s potential to heal themselves. Yoga, Meditation, EMDR, and Virtual Iraq seem to be affecting core neuroprocesses, only in a more externally directed way. Perhaps the most important finding relevant to the Marine is how the base brain’s neuro-mechanisms produce mental chaos through instinctual processes when internal impulses deviate from the code of a warrior. The dissonance between the way a Marine expects to respond and the actual real time reaction produces stress. This stress represents the emotional/mental disorder in the brain’s function and validates the SCC function. For example: A Marine, who initially knows he is a kind person and a Marine trained to act with morals and integrity in the act of war, may experience something in the line of duty that cannot be reconciled. Perhaps he turns toward incoming fire, trained to make fast decisions to reduce the threat, but momentarily freezes, not able to pull the trigger until it is too late. Or, he snipes a 12-year old at 300 yards. How does his brain make sense of the experience and the difference between instinct and training? Any lasting incongruence holds potential for stress and increased Operational Risk. Science seems to have the mechanism of this process in PTSD understood. It is a disorder in the primitive brain. When the Basel Ganglia’s generation of affective signals to higher brain function is startled into activation or activated for extended periods of time its instinctual structure is reorganized and remains vigilant though not necessarily ordered in its capacity. The Department of Defense’s funding to research experimental drugs this summer, designed to alter the chemical function of the base brain's genetic dictate to freeze or flight, is based on these findings. It is an attempt to cure or limit the structure of PTSD development. An artificial adjustment to this process may have interesting ramifications because these neuro-mechanisms are motivated by genetic dictate for a reason. Survival. Seeking shelter, panicking during separation, raging at intrusion and freezing or flight from threat may serve Military personnel in combat even when they are trained to act otherwise. For example: A pattern of SCC directed action was discovered when a Marine’s curiosity was aroused during a garden experience. He made the statement, “This is weird. I was just remembering a situation I don’t understand. I don’t think I was ever afraid, while it was happening, but I was doing some odd things.” As a Warrant Officer he was leading a crew outside the wire to gather concrete barriers to cover their new base camp’s flank. Standing in open field, under threat of snipers, he calmly directed the loading and transfer of the first barrier with heavy equipment. As his crew moved into the distance, toward base camp, he found himself standing alone next to a pile of barriers. He said he wasn’t afraid. He knew with his training and physical resources he could handle what might come at him. But, he still found himself diving and freezing behind a barrier until his crew returned. In theory, his panic mechanism motivated the anxiety of separation. It increased to a point where his SCC coped with it by directing the activation of muscles to seek shelter, then freeze behind a remaining barrier. Once the crew and heavy equipment returned he was suddenly out from cover and calmly directing the next load. He felt safe and calm again. When the last barrier began to move off with his crew, he surprisingly found himself running and zigzagging to keep up and behind the last barrier as it dangled from the equipment. He described this as odd because his training and beliefs were telling him he wasn’t afraid and that he should stand and be alert to threat. His SCC was overriding his training and the result was disconcerting. If the natural instincts directing his actions were to have been medically altered, could the outcome have changed? Would he have scurried behind the barriers when alone or stood in the open waiting? Would he have run behind the last barrier or walked along side? Did he experience himself as scared and weak or as a warrior? Most importantly, would the difference between his experience and mental expectations have created Operational Risk? In Semper Fidelis: A Psychological Study of Heroic Bravery, an article describes research conducted by Terence W. Barrett, PhD, Department of Psychology, North Dakota State University. Dr. Barrett found that 292 U.S. Military personnel who acted heroically brave and earned the nation’s Medal of Honor shared forty-one behavioral tendencies or characteristics. Each of these characteristics of bravery appears to be motivated by the instinct to seek. Seek challenge, adventure, risk, social unity, approval and more. It is possible that the instinctual mechanism to seek was genetically dominant for these Military personnel. There may have been a predisposition to shut down fear and seek. Had they understood this, those that subsequently died in combat may have survived longer by augmenting their heroic impulse. The capacity to distinguish honorable acts from those that may lead to unnecessary death or be felt as shameful and lead to serious psychological damage is important. Understanding the neuro-mechanisms motivating these seemingly automatic actions may be vital to a Marine’s capacity to optimize self-regulation and change results - of actions and stress. The officer in the example found considerable relief as he came to understand how these instinctual processes work. It allowed him to resolve and integrate an experience where previously he had been bothered by irrational and conflicting thoughts. Had his tendency to seek overridden his other impulses would he have stood in the open and unknowingly risk unnecessary death? By understanding and experiencing these neuro-mechanisms in action, in the garden, the Marine learned techniques of how to participate in his own neurological processes, to make sense of both honorable and potentially shameful action, and minimize the potential for any resulting mental chaos. This training could be paramount to the mitigation of the long-term effects from stress, which can fester into PTSD. Other Military personnel have successfully embodied the art of self-attunement and emotional regulation through participation in an educational training process in Operation Recovery’s garden. It is expected that this training will enhance their capacity to maintain situational awareness under extreme conditions and ensure the Marine makes appropriate decisions with awareness rather than instinctual inclination or habit. Operation Recovery’s Garden Pilot Program www.thegardenproject.us History of Service Operation Recovery’s mission to serve Military personnel began in June 2007. The managing company, Farm Hands, Inc. and its executive director, Robert Bornt, have an agreement with the Franciscan Friars managing Mission San Luis Rey, near Camp Pendleton Marine Corps Base. The agreement provides for the long-term use of an historic barn and two acres on the Mission’s property to develop a pilot program with the goal of addressing stress issues for Military personnel, veterans and their families. Purpose and Goals The purpose of Operation Recovery’s Garden Project is to provide a safe, familiar decompression zone, where the process of stress relief and behavioral/emotional change is possible for active duty Military personnel, veterans and their families. The primary goal is to assist those affected by the extreme traumatic experiences of war and long-term deployments commonly referred to as Combat Operational Stress or when clinically diagnosed, PTSD. An additional goal is to offer a space where mental health professionals and caregivers have the opportunity to experience and learn non-violent treatment alternatives for resolving the stress associated with military life and the violence of war. Results Together Military personnel, veterans and community volunteers have developed the space into a center for Marine support, including a woodshop/storage area; a garden to produce vine ripened tomatoes, bell peppers and melons; and a blue-jean Recovery Quilt program. Many individual Military personnel, Marine couples and recent veterans spend time in therapeutic garden sessions. The results they report are a significant change in their understanding of their personal stress and symptoms of PTSD. 94% have reported an increase in their ability to self-regulate or control tension and anxiety associated with active duty, including intrusive thoughts, dreams and disturbing physical reactions to environmental triggers. Of the program’s participants, 68% report being deployed to Iraq at least once in the last five years. In addition, the program has sold over 2,400 pounds of fresh tomatoes in the Oceanside Farmer’s Market; donated over 1,250 pounds of tomatoes and melons to Marine families on Camp Pendleton; produced and sold 30 blue jean quilts at auction; and delivered 30 fine quilts made by the Covenant Presbyterian Church Quilters to the Wounded Warrior Battalion at Balboa Hospital. Conclusion The pilot program is fulfilling its mission by providing therapeutic service to Military personnel and veterans with a wide range of stress issues and by generating significant community participation. VONS Foundation, Mission Organics Farming Co., Morgan Stanley Financial, Sidney Stern Foundation and other private individuals have provided financial funding. The farming community continues to generously provide supplies. The importance of community involvement is its direct support of the sacrifices our military make. This has significant benefits for building trust and rapport between military and civilian culture. It is recognized that the results reported are not scientifically valid, nor complete. The pilot project lacks the resources to track participants beyond the time spent in the garden and has no mechanism to commit participants to multiple visits. Most participants are brought to the garden by their spouse and are sporadic in attendance due to their ongoing military duties, and decreasing family tension after the initial visit. However, confidential interaction with active duty Military personnel and recent veterans does provide a unique perspective of the issues relating to Military Operational Stress and PTSD. Most importantly, the ongoing experience indicates extraordinary promise for resolving stress related issues for Military personnel, veterans and their families without clinical assessment, diagnosis and psychotropic medication. An expanded program with the capacity to evaluate ongoing programs is in the best interest of both military and civilian communities. According to those who participate in activities at Operation Recovery the most critical issues they feel could be helpful in their transition between home, war and home again are: Decompression after deployment and before family reunion Therapeutic process and education for decompressing their experience Physiological and psychological rest with workshops on self-regulation Reduction of risk associated with the stress of duty Managing stress through education and training Maintaining family connection during transition Managing impulse to self-medicate with drugs and alcohol Increase resiliency and life skills Learn self-attunement and emotional flexibility Medication alternatives Learn alternatives to the massive application of drug therapy Increase behavioral self-discipline and self-regulation w/o medication Appendix A  The relationship between time, the increase in alliance (trust) and the relevant decrease in PTSD symptoms. References KURTZ, R. 1990. 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