19.5 Readiness State of Mind & Resilience
Key Takeaways
- Stress reactions appear in four categories: cognitive, emotional, behavioral, and physical.
- Comprehensive Airman Fitness covers four domains — mental, physical, social, and spiritual — each with four tenets.
- The Ask, Care, Escort model directs Airmen to ask directly about suicide, show care and listen without judgment, and escort the person to help without leaving them alone.
- More than 12 percent of Air Force personnel voluntarily seek mental health services each year, and seeking care is described as a sign of strength.
- Approximately seven to eight percent of the United States population will have PTSD at some point during their lives.
Mental Preparedness and Psychological First Aid
"One of the telltale signs of a military professional is preparation." Most experience "is gained by accepting opportunities as they come, even when conditions are not perfect," through which professionals build the confidence, judgment, courage, and integrity needed to continue developing.
Psychological first aid is "a way of reducing initial and ongoing stress by developing adaptive coping and recovery skills." Airmen who take care of themselves by getting adequate sleep, eating a balanced diet, and making time for rest and relaxation — combined with positive stress management skills — "can reduce actual and perceived stress in their lives."
AFH 1's coping considerations:
- Have a physically and emotionally safe place to recuperate or relax
- Know (or be) someone who understands, listens, and is compassionate
- Find opportunities to connect with others at the gym, dining facility, or local events
- Provide or demonstrate coping skills that empower others to return to a 'normal' state
- Seek supportive services, such as religious affairs, first sergeants, or mental health providers
- Contact Military and Family Life Counselors
Stress Reactions — Four Categories
"All people experience stressors (challenges or problems) and distress (negative feelings associated with stressors)." Stress is both an organizational concern — it "can negatively affect performance, organizational effectiveness, and mission accomplishment" — and a personal concern, since prolonged stress "can lead to health problems and affect overall quality of life."
| Category | How it manifests |
|---|---|
| Cognitive | Memory problems, an inability to concentrate, poor judgment, seeing only the negative, anxious or racing thoughts, or constant worrying |
| Emotional | Apathy, anxiety, depression, irritability, job dissatisfaction, memory problems, or mental fatigue |
| Behavioral | Appetite changes, increased arguments, increased smoking, neglecting self-care, social withdrawal, substance abuse, or violence |
| Physical | Frequent illness, headaches, high blood pressure, increased heart rate, physical exhaustion, sleep disturbances, or weight gain or loss |
Cognitive, emotional, behavioral, physical. The exam tests placement — social withdrawal is behavioral, not emotional; irritability is emotional; sleep disturbance is physical.
Individual Stress Management
"The key to recognizing stress is knowing what feels normal so you can recognize when something feels off. The earlier stress can be identified, the earlier stress reduction techniques can be applied."
| Technique | What it involves |
|---|---|
| Make Adjustments | Identify potential stressors before they arise — AFH 1's example: if crowds and long lines are stressful, adjust plans to minimize exposure |
| Time Management | Developing a task list and prioritizing tasks |
| Overload Avoidance | Identify and avoid busy work, delegate or empower others, learn to say no, and attempt to negotiate unreasonable deadlines |
| Relaxation | Meditation, reading, and listening to music can improve heart rate, regulate blood pressure, and decrease respiratory rate |
| Exercise and Nutrition | Provides an outlet for excess energy and tension, and helps the body become more resistant to the negative results of stress |
| Social Support | Family, friends, social groups, and peers — discussing problems can provide a more positive outlook, suggest solutions, or just listen |
| Prioritize | On the job, determine the importance of each task and eliminate tasks that are not necessary or productive; consider job enrichment elements such as adequate time off or periodic breaks |
Post-Traumatic Stress Disorder
PTSD is "a mental health condition that can occur after someone has gone through a traumatic event, such as war-related combat, sexual or physical assault, or a natural or man-made disaster."
The four symptom clusters:
- Intrusive or unwanted thoughts — distressing memories, nightmares, or flashbacks
- Avoidance behavior — efforts to avoid reminders of the traumatic event
- Negative thoughts and moods — feeling disconnected from others or believing the world is a dangerous place
- Hyper-arousal symptoms — difficulty sleeping and irritability
"Approximately seven to eight percent of the United States population will have PTSD at some point during their lives," and "within the last decade researchers have developed highly effective treatments that can lead to symptom reduction and even loss of the diagnosis."
Helpful actions. AFH 1 recommends practicing empathy — imagining how you would feel in their situation. The specific guidance:
- Don't be afraid to ask about what is going on, using starters such as "What's going on in your life? I've noticed you seem upset," "I'm concerned about you. Can we talk about it?" and "Is there something I can do to help you?"
- Once you've asked a question, allow time and space for the answer — "listening shows you care, will help you understand, and builds rapport"
- Acknowledge the distress. "It is not helpful to tell them they shouldn't feel a certain way. PTSD is a real condition that produces measurable changes in brain function"
- Discuss needs and offer to help make a plan — "offering to accompany them can be a good way to make getting help seem less difficult"
Psychological Services
"Seeking care for a mental health problem is a sign of strength, not a sign of weakness."
"More than 12 percent of USAF personnel voluntarily seek mental health services each year." AFH 1 addresses the career-impact fear directly: "Time has proven that seeking help appropriately often does not have a long-term negative career impact. In fact, seeking help can improve performance and enable people to better solve problems. In many cases, seeking mental health treatment early can actually save one's USAF career."
The 12 percent figure and the "sign of strength" framing are both quotable and testable.
Redeployment support. Deploying Airmen receive just-in-time training on stress reactions, psychological first aid, and referral resources. "Taking leave after arduous duty and deployment can have a beneficial effect on an individual's psychological and physical status," and the redeployment support timeline identifies activities at the redeployment, recovery, reintegration, and reconstitution junctures.
The Suicide Prevention Program
"While suicide prevention is the responsibility of every Airman, the USAF has identified that leadership support and action across all levels of command are critical."
The Limited Privilege Suicide Prevention Program, under AFI 44-172, Mental Health, "provided an added layer of confidentiality that allows Airmen who are under investigation to receive mental health care without the risk of information disclosed during treatment being used to incriminate them in the future." This matters because "Airmen who are under investigation for legal problems are at significantly elevated risk for suicide."
The confidentiality boundary is testable: under DoDI 6490.08, mental health providers are required to disclose safety issues — suicidal or violent thoughts or self-injurious behavior — and fitness for duty issues to commanders, but all other information is confidential.
Recognition. "Anyone can become suicidal, regardless of how well they have previously managed military or personal stress." "Those most likely to spot a person at risk are the ones with whom an individual interacts on a daily basis — friends, coworkers, and immediate supervisors," because they notice changes in behavior, mood, or performance. "If you hear someone comment or indicate they're considering suicide, take it seriously, get involved, and get them the help they need."
| Factor type | Examples |
|---|---|
| Risk factors | Relationship difficulties, problems at work, legal and financial problems, mental health diagnosis, substance misuse, and previous suicide attempts |
| Leader failures to watch for | Tunnel vision on the mission; not engaging with Airmen; difficulty recognizing risk factors and warning signs; lack of knowledge of USAF resources; inappropriately sheltering Airmen from the consequences of their actions or failing to take proper action |
| Protective factors | Social support, connectedness, sense of belonging, sense of purpose, effective individual coping skills, and cultural norms that promote and protect responsible help-seeking behavior |
The Ask, Care, Escort Model
| Step | What to do |
|---|---|
| Ask | When you see warning signs, ask questions to learn more. "If you have any uncertainty about someone's safety, calmly but directly ask the question, 'Are you thinking of killing/hurting yourself?'" Asking "gives people permission to talk about a subject that may otherwise be difficult to bring up." Do not promise to keep thoughts of suicide a secret |
| Care | Listen and allow them to share what is troubling them. "Avoid making judgmental statements, immediately trying to solve their problem, or trying to talk them out of suicide." Determine if they have a plan, what it is, and take reasonable steps to secure the potential means — but do not put yourself in harm's way. "Building time and space between Airmen in distress and access to lethal means (including firearms and medications) can reduce the risk of suicide attempts and deaths" |
| Escort | Escort the person to command or professional support. "Do not leave the person in distress alone." If they will not agree to go and you have significant concern, contact your chain of command, contact emergency services, dial 911, go to the emergency room or mental health clinic, or call the Veterans Crisis Line (1-800-273-8255) |
Three instructions from ACE run against instinct and are therefore the most tested: ask the question directly, do not promise secrecy, and do not try to talk them out of it or immediately solve the problem — listen first.
AFH 1 also lists five supporting actions: (1) know co-workers, their usual moods and behaviors; (2) recognize early signs of risk, stress, and distress; (3) engage with Airmen to determine what may be stressful; (4) assist in choosing the most appropriate resource; and (5) follow up to ensure stressors are resolving and new ones are not taking their place.
Comprehensive Airman Fitness
CAF is "a holistic approach to build and sustain a thriving and resilient USAF Community by taking care of each other and ourselves through wellness in four domains — mental, physical, social, and spiritual." "The Wingman concept is a core element of CAF."
| Domain | Definition | Four tenets |
|---|---|---|
| Mental | The ability to effectively cope with unique mental stressors and challenges needed to ensure mission readiness | Awareness, adaptability, positive thinking, and decision-making |
| Physical | The ability to adopt and sustain healthy behaviors needed to enhance health and wellness | Endurance, strength, nutrition, and recovery |
| Social | The ability to engage in healthy social networks that promote overall well-being and optimal performance | Connectedness, teamwork, social support, and communication |
| Spiritual | The ability to strengthen a set of beliefs, principles, or values that sustain an individual's sense of well-being and purpose | Purpose, core values, perseverance, and perspective |
Four domains, four tenets each — sixteen items total. The most commonly confused pair is social (connectedness, teamwork, social support, communication) versus spiritual (purpose, core values, perseverance, perspective). Note that core values appears as a spiritual tenet, not a mental one.
Key support resources AFH 1 lists: the Air Force Integrated Resilience Program, Military One Source (1-800-342-9647), and the Veterans Crisis Line (1-800-273-8255, Press 1) with chat and text (838255) options.
Which four domains make up Comprehensive Airman Fitness?
Under the Ask, Care, Escort model, what does AFH 1 direct when an Airman discloses thoughts of suicide?
An Airman shows social withdrawal, increased arguments, and neglect of self-care. Which category of stress reaction does AFH 1 place these in?