Landing Gear:

Manual for Instructors & Students

Landing Gear

Course Overview:
Purpose: Landing Gear serves as a bridge to care designed to increase the recognition of Airmen suffering from traumatic stress symptoms and connect them with helping resources. Introduction: Traumatic stress problems (e.g., PTSD and other mental health problems) remain a constant threat for Airmen in the theater of operations. Landing Gear serves as a bridge to care designed to facilitate recognizing and helping Airmen suffering from traumatic stress symptoms. Landing Gear provides standardized approach to the mental health requirements for pre-exposure preparation training for deploying Airmen and reintegration education for redeploying Airmen. Landing Gear is built around the metaphor that, no matter how powerful an aircraft is in the air, properly functioning landing gear is necessary to safely launch and recover. All Airmen must to be able to recognize the signs of deployment stress and know when to seek help. Effective risk recognition and help seeking are the functional equivalent of landing gear for Airmen. Exposure to battlefield trauma place Airmen at risk for PTSD and other mental health problems. 20% of Airmen exposed to serious traumatic events in theater, but less than 1% develop PTSD. Trauma exposure is the most powerful predictor of problems following deployment. Airmen with history of trauma exposure are 2-4 times more likely to develop PTSD than other Airmen. This data is consistent across the Army, Navy, AF, and Marines. Exposure measured directly through specific items on PDHA, which can be used to identify and track individuals suffering from traumatic stress. Other risk factors (e.g., AFSC, ILO, etc.) usually reflective of increased exposure risk. Most Airmen exposed to trauma will recover without assistance or complications. However, data indicates 60% of Airmen with serious persisting traumatic stress symptoms wont recover without help. The most effective evidence=based interventions are clinical in nature. Prompt medical intervention (i.e., mental health counseling) greatly improves outcomes. There is no evidence that lengthy pre or post deployment training prevents PTSD or improves resiliency. Resiliency is learned over time (e.g., parenting, mentoring, professional training, psychotherapy, etc.). However, the evidence suggests that brief training is effective at identifying those at risk and getting them in for help. Profile of Vulnerability: The profile of vulnerability for PTSD amongst Airmen includes a yes answer to any of these questions on the PDHA represents an increased risk for traumatic stress symptoms: Did the Airman ever feel he/she was in great danger of being killed? Did the Airman ever see anyone wounded, killed, or dead? Did the Airman ever inspect (or were they ever in) a military vehicle that was destroyed? Did the Airman ever engage in direct combat where they discharged their weapon? High risk groups: High risk groups face increased risk for trauma exposure in theater, and include the following groups: Security Forces EOD OSI Intelligence

Medics Transportation Airmen in ILO positions Airmen with multiple deployments Airmen on longer deployments Course Content: Landing gear offers a standardized but flexible lesson plan that can be tailored to audience needs. Each major section of the briefing is linked to an operational metaphor: Introduction Deployment Stress (Pre-Flight Checklist) Deployed Environment (Gear Up) Typical Reactions (In Flight) Reintegration and Reunion (Recovery to Home Station) Prevention (Routine Maintenance & Inspection) Getting Help (Troubleshooting & Repair) Discussion Pre-Deployment Classes: Landing Gear fulfills existing requirements for pre-exposure training (IAW AFI 44-153, para 3), which is intended to prepare Airmen to cope with traumatic events. Base commanders and mental health personnel will determine locally which personnel require training, but, ideally, all Airmen will attend course before deploying. At minimum, deployers from high risk groups should attend. Predeployment Landing Gear classes emphasize the Deployment Stress, Deployed Environment, Typical Reactions, Prevention, and Getting Help sections. The Reintegration and Reunion section is previewed to lay the foundation for what to expect after deployment. The Pre-deployment Landing Gear class can be accomplished at any time prior to deployment. Post-Deployment Classes: Reintegration education required for all Airmen to facilitate reentry into work and family life (IAW AFI 10-403, Chapter 8, para 8.10.2.3.1), and has required mental health, chaplain, and Airman & Family Readiness Center components. The three components can be accomplished independently or can be integrated into one session. Landing Gear fulfills requirements for mental health component of reintegration education. Post-deployment Landing Gear classes review Deployment Stress, Deployed Environment, and Prevention sections, but emphasize the Typical Reactions, Reintegration and Reunion, and Getting Help sections. The Post-deployment Landing Gear class must be accomplished within seven days of returning from deployment. Scheduling: Installation will determine the frequency and scheduling of classes based on local needs. Installations with high rates of deployments will need more classes and those with fewer deployments correspondingly less classes. While Landing Gear effectively addresses needs of both deploying and redeploying Airmen, the concerns of these two groups are different and their classes should be conducted separately. Scheduling options include a fixed recurring schedule (e.g., once or twice a week, etc.), as needed (e.g., when a large group is projected to deploy or return), or impromptu/just-in-time (e.g., for individuals or groups with short notice deployments or unanticipated returns). It is best to schedule special sessions when larger groups of Airmen from high risk groups return from theater (e.g., 20 security forces personnel return at once). Length: The typical length of a Landing Gear class will be 30-60 minutes for both pre and post deployment classes. However, the class length can be expanded or contracted as needed to address audience needs. Instructors should encourage group discussion, and, ideally, the class will continue until the group discussion has run its course and all questions are answered. For extremely short notice deployments, the lesson plan may need to be summarized in a few minutes. For high risk groups, the briefer should encourage discussion with each slide and the workshop will take longer (up to 2-3 hours, if needed).

Reserve and Guard Personnel: AFR and ANG currently receive pre and post deployment services from host base or base of departure. Oftentimes, these are accomplished upon arrival at installation just prior to deployment and immediately after returning from deployment. AFR and ANG personnel will receive Landing Gear from host base personnel in same fashion. Landing Gear can also be taught in Reserve and Guard units by qualified support personnel. Additional Resources: The Army Battlemind Program was developed to help Soldiers cope with the stresses and strains of deployment. This program provides specific materials targeting soldiers, leaders, National Guard, Reserves, spouses, families, and helping professionals. The materials include a website, lesson plans, slide sets, videos, and brochures, and are available at www.battlemind.org. In addition, Airman Battlemind Programs have also been created by several MAJCOMs (e.g., AMC, ACC, AFMC, USAFA, and AFSOC). Instructors: The primary briefers will be mental health personnel, but other IDS members can be utilized. Course Materials: The course materials are available on-line at http:\\afspp.afms.mil, and include the executive briefing slides, the overview slides, the curriculum slides, the bullet background paper, and the training manual. Room Needs & Set-up: The classroom will need to be large enough to accommodate the class size, and can be set up in a traditional classroom style with the students facing forward. Some instructors may prefer to set up the room with the students sitting in a circle facing each other. Equipment Needs: A projector capable of projecting the slides is ideal. However, there may be certain settings where this is not possible and the instructor can decide to teach from hard copy instead. Slide Notes: Every slide is explained in narrative form in this manual. It is not necessary to cover every word or bullet on every slide, because students can see the slides on the screen.

Course Content:
Introduction (Slides #1-5): The course is composed of eight segments, including the introduction and discussion. The six main subjects are linked directly to an appropriate operational metaphor: Introduction Course Content: Deployment Stress (Pre-Flight Checklist) Deployed Environment (Gear Up) Typical Reactions (In Flight) Reintegration and Reunion (Recovery to Home Station) Prevention (Routine Maintenance & Inspection) Getting Help (Troubleshooting & Repair) Questions & Discussion Landing Gear is built around the metaphor that, no matter how powerful an aircraft is in the air, properly functioning landing gear is necessary to safely launch and recover. Effective risk recognition and help

seeking behavior are the functional equivalent of landing gear for Airmen. All Airmen must to be able to recognize the signs of deployment stress and know when to seek help. Be Great Wingmen! Supporting Airmen returning from the AOR is a critical component of the AF Wingman Culture. In his Letter to Airmen on 7 Aug 07, the Secretary of the Air Force said, Smart Airmen seek out help when they need it and great wingmen know when to encourage their peers to get help. In his Sight Picture from 31 August 05, the CSAF said, Being a great wingman means recognizing when other Airmen are in distress and having the courage to care. The Deployment Cycle is continuous process rotating from home station to pre-deployment to AOR to redeployment to reintegration into work and family life to home station again. Airmen have varying needs at each stage of the deployment cycle. Pre Flight Checklist (Slides #6-10): Our pre-flight checklist looks specifically at deployment stress. The military is a demanding profession. Military life can be highly satisfying, but todays military requires coping with multiple demands. High standards of personal conduct expected from Airmen. We move frequently, often far from our home of origin, and we deploy around world to austere and hostile locations. Airmen often work long hours to complete the mission, especially in theater. Other stressors include required travel, shift-work, exercises, and inspections. Despite the challenges, many Airmen find their deployment experiences to be personally and professionally rewarding. It is important to understand that stress is normal, and stress and distress are part of everyones life. It is common to feel stressed or overwhelmed, at times, and everyone needs help at some point in their life. Getting help when youre hurting is the smart thing to do it demonstrates good judgment. Excessive or chronic stress can negatively impact your job performance, relationships, and health. In the end, taking good care of yourself supports the mission. There are many types of Deployment Stress. Operational (work) stress results from the demands of working to accomplish mission tasks. Separation stress results from difficulties being away from home or family. Reunion stress results from the difficulties transition from a wartime environment back to home. Adjustment stress is difficulty adjusting to a new day-to-day environment where all your daily routines are changed, including recreation, socializing, eating, sleeping, showering, laundry, and toileting. Lastly, traumatic stress is a primary focus of this briefing and represents the normal reaction to living through or witnessing horrible events, such as combat. Gear-up! (Slides #11-14): The Gear Up! Section looks at the Deployed Environment, which can be described as the Dirty Dozen: 1. In theater, Airmen live with constant or intermittent sense of danger or threat. 2. Airmen frequently witness (or are exposed to) death, suffering, and severe injuries. 3. Oftentimes, Airmen must cope with insufficient or inconsistent information about what is going on around them, and struggle against the fear and rumors that uncertainty breeds. 4. In general, every theater of operations involves extreme climatic conditions that can be difficult to cope with and adjust to. 5. Depending on the location, the deployed environment can be isolated (Airmen can feel cut off from their world and lonely) or overcrowded (Airmen can struggle to find quiet or private time). 6. The deployed environment offers challenging living and working conditions (noise, lighting, temperature, food, water, hygiene, sanitation, laundry, etc.).

7. Communication with local people or to and from home can be difficult (mail, phone, language) 8. Restrictions are placed on our behavior in theater, including travel, alcohol, and sex prohibitions. 9. Deployments can be exhausting, as Airmen work long hours with few days off. 10. Limited leisure and recreation activities are available in theater, especially in high risk areas. 11. Airmen may worry about problems at home (e.g., with relationships, housing, bills, etc.) or be concerned about the welfare of their family. 12. Stress can result from unpredictable cycles of intense activity followed by boredom that are so common to the mission in the deployed environment. The slide titled The Face of War is included to explicitly remind Airmen that the deployed environment will carry the high risk of exposure to death and injury, and that Airmen must be vigilant to how theyre reacting to these events (and seek help when they need it). In Flight (Slides #15-21): The In Flight section looks at typical reactions to deployment stress and trauma exposure. Typical reactions include having trouble sleeping, feeling irritable, exhaustion (physical, mental, and/or emotional), fear and nervousness, changes in appetite and/or weight, feeling a sense of horror about things that have been witnessed, feelings of helplessness, and feelings of guilt (e.g., why did I survive and not my buddy?). All of these reactions are to be expected and are often quite normal for the situation. Traumatic Stress Symptoms are more serious and much less common. There are four main categories: Intrusion, Avoidance, Hyper-arousal, and Dissociation. If you experience any of these symptoms, its important seek help. We will explain each category in turn. 1. Intrusion can be described as disturbing thoughts and feelings that are constant, repetitive, and/or seem uncontrollable, or as recurring distressful memories, thoughts, dreams, or flashbacks 2. Avoidance involves changing your habits to avoid things that remind you of a traumatic event or to control your symptoms. Often, youll feel distressed in response to things that remind you of the event, or have less interest in participating in your normal activities. 3. Hyper-arousal feels like fight or flight all the time, and you may experience difficulty sleeping, irritability, poor concentration, agitation, feeling tense or constantly on edge, restlessness, or anxiety 4. Dissociation can feel like being disconnected from yourself or other people. You may feel numb, detached, dazed, or like youre dreaming. Sometimes, youll have difficulty remembering things or notice that youre zoning out frequently or uncontrollably. Lastly, this can feel like (or the world around you) are strange or not real. Another possible set of symptoms to be aware of are those of Traumatic Brain Injury or TBI. TBI is defined any blow to the head that disrupts brain function and doesnt require loss of consciousness or visible injury. Symptoms include some or all of the following difficulty remembering or concentrating, confusion or disorientation, slowed thinking, problems organizing, problems planning, impulsivity, or poor judgment. Physical symptoms can include headache, nausea, vomiting, dizziness, balance problems, fatigue, insomnia, drowsiness, sensitivity to light/noise, blurred vision, or ringing in the ears. Emotional symptoms can include mood changes, personality changes, irritability, depression, or anxiety. Recovery to Home Station (Slides #22-24):

The Recovery to Home Station section focuses on Reintegration and Reunion, or helping Airmen adjust successfully to work and family life after spending months away from home. Moving from a combat to a non-combat environment presents many adjustment challenges. While coming home is wonderful, many Airmen are surprised to discover that their homecoming is more stressful than they expected. The wartime skills that kept us safe and alive in theater are no longer quite so relevant and may even get in the way (e.g., imagine the difference between driving the streets of Baghdad versus the streets of your hometown). In addition, things at home are often not be the same as when you left. Your unit and your family may have found new ways of doing things to manage while you were gone. Your roles and responsibilities at work and at home may have been reassigned or changed. It may difficult to accept or adjust to these changes. On the other hand, your family or work center may be eager to hand back your old responsibilities right away, before you feel like youve had a chance to rest and recover. That, too, can create stress. Re-establishing old relationships, redefining roles and responsibilities, and negotiating new patterns of behavior require time, patience, flexibility, and communication. You may need to build relationships with people who joined your work center or your social/family circle while you were away. As we reintegrate into our old lives and adjust to how things have changed, it is quite natural to feel frustrated, irritated, and even overwhelmed at times. The best advice is to take things slowly and give yourself a chance to adjust. Routine Maintenance & Inspection (Slides #25-30): The Routine Maintenance & Inspection section is intended to provide tips for leaders, the unit, and the individual to prevent or minimize deployment stress. Prevention: Leadership Good leadership is good prevention. Leaders should work to build a supportive work environment and encourage help seeking behaviors. Supervisors should ask the tough questions (e.g., about life problems, coping, stress, suicidal ideation, alcohol use, etc.), especially about Airmen theyre worried about. People tend to regret most the questions they dont ask. Leaders need to recognize when help is needed and get it for their airmen. To do that, they need to know the warning signs and know the base resources for help. Lastly, leaders must stay actively involved until they know the Airmens problems are adequately resolved. Too often, in the press of day-to-day mission requirements, we forget to circle back to make sure the Airman is still doing fine. Prevention: Unit Factors Cohesive units with high morale function better and suffer less stress. Airmen who have confidence in their command also tend to perform better and experience less stress. Proper mission preparation and training reduces stress; Airmen feel less anxiety about missions theyre well-prepared for. Units need to provide support for one another and reach out to peers who are hurting; no one should be left to suffer alone. Lastly, leader need to role model healthy self care, emphasize importance of healthy self-care, and publicly encourage help seeking behavior. Prevention: Information Management Providing adequate information to airmen is critical, because uncertainty fuels anxiety and leads to rumors. Leaders should share information with personnel as quickly as reasonably and safely possible without compromising the mission. Leaders and all personnel should base decisions and risk assessments on reliable information to the extent possible. Airmen should verify their sources and their information, and be careful how much credence they give to unconfirmed data. False rumors and bad information lead to unnecessary stress.

Prevention: Home Factors Pre-deployment planning is to minimizing stress while deployed. Airmen should ensure dependents have information about unit contacts and base resources. Good planning involves addressing legal matters before you leave (e.g., powers of attorney, etc.) and making plans for your dependents needs (including healthcare, finances, childcare, housing, transportation, and emergencies). Planning should involve all family members to build the confidence and competence of family members, and promote peace of mind in the deployed Airman. Prevention: Personal Factors While deployed, effective stress management skills will help maintain good spirits. Try to anticipate and manage stress actively (better to deal with things head on than to avoid problems). Stay positive and keep an open mind (negative thinking brings your mood down). Communicate and express yourself (talk out loud about how youre feeling). If you can, establish a stress sanctuary (this can be a peaceful location that you go to physically or you visit mentally). Adjust your expectations about your situation; nothing breeds disappointment faster that missed expectations. A sense of humor and finding personal meaning in your work can both help with dealing with deployment stress; its easier to deal with stress if you can make a joke out of things or if the work is very important to you. Stay connected with your unit and social circle; isolation can bring you down, too. Take care of yourself and make sure to eat healthily, get plenty of sleep and rest, have fun when you can (play), and exercise regularly. A health body really does lead to a healthy mind. Lastly, when the stress gets to be too much, go get help! Troubleshooting and Repair (Slides #31-35): The Troubleshooting and Repair section emphasizes the importance of getting help when stress gets to be too much to handle. The warning lights indicating an Airman is suffering include unusual or sudden changes in behavior, depression, anxiety, agitation, isolation and withdrawal, nightmares, neglecting responsibilities, and loss of interest in work and normal activities. Airmen should seek help when theyre experiencing persistent stress that is interfering with daily life, either at work or at home, or when theyre having difficulty coping or functioning day to day. Escalating alcohol use (or any drug use), feelings of worthlessness or hopelessness, thoughts about suicide, and symptoms of traumatic stress or TBI that arent improving or are getting worse are all signs that help is needed. Airmen need to understand the importance of getting help. Feeling overwhelmed is the normal reaction to traumatic events. However, failing to deal with stress and other emotions during and after deployments can lead to chronic problems. Nearly two-thirds of people with serious persisting traumatic stress symptoms wont get better without professional help (i.e., mental health counseling). Treatment is available and highly effective. Many Airmen worry that seeking mental health care will harm their career. On the contrary, AF data indicates that 97% of Airmen who voluntarily seek treatment at AF mental health clinics experience no negative career impact. Lastly, Airmen have many places to go for help, including their family, friends, supervisors, first sergeants, and commanders, as well as the Chaplains, the Airman and Family Readiness Center, the Mental Health Clinic, the Family Advocacy Program, and the Alcohol and Drug Abuse Prevention and Treatment Program. Conclusion (Slide #36): Thank you all for listening! You were a great audience. Any questions?