Skip to main content
Army Medicine Home Army Medicine Home


Combat Stress Control (1998)

Stress, an inherent part of life, is very intense in combat. Reactions to combat stress vary depending on training and circumstances. However, every Soldier has a limit and can become a combat stress casualty if exposed to intense or long battle. This is not weakness: it's human nature. To protect Soldiers and unit effectiveness, the Army has a comprehensive program to prevent combat stress reactions when possible and deal with them quickly and effectively when prevention is impossible.

Basic principles of combat stress control

  • Combat-like stress reactions are not caused only by combat. They may occur when Soldiers are affected by or witness mass-casualty disasters. They can also be caused by non-violent pressures like loneliness, boredom and discomfort during extended service in isolated, unpleasant places.
  • When combat is light or sporadic or when frustration gets very high, stress may take the form of misconduct stress behaviors—disciplinary problems, drug/alcohol abuse or attacks on fellow Soldiers.
  • Combat stress reactions are a normal response to abnormal circumstances. They are not a sign of weakness or cowardice and are not a cause for shame.
  • Combat stress control is not primarily a medical problem. It is a leadership responsibility at all levels of command, supported by an echeloned array of medical specialists and also chaplains.
  • Combat stress is better prevented than cured. Leaders, aided by medical professionals, identify and correct controllable stressors in the unit, the mission or on the home front, enabling Soldiers to face the unavoidable pressures of battle without other issues on their minds.
  • Leaders help steel Soldiers against unavoidable combat stressors by giving realistic training, building unit morale and cohesion, keeping troops informed and focused on the mission, and inspiring them continuously. Leaders also manage unit assignments and battles to avoid unnecessarily prolonged combat exposure, sleep loss, and physical or emotional depletion.
  • When Soldiers do have combat stress reaction, it is best to treat them as informally and as far forward as possible. Soldiers are never labeled as patients or clients during such treatment.

What is combat stress control?

  • A recognized Army Medical Department functional area.
  • A coordinated program to prevent/treat battle fatigue and other harmful stress-related behaviors.

Who does combat stress control?

  • Leaders at all levels control stressors and train/motivate Soldiers.
  • Medical personnel and chaplains at all levels are alert for combat stress and refer Soldiers for professional support as needed.
  • The Army has an echeloned system of combat stress control specialists drawn from several mental health professions. They advise, assist and supplement leaders and unit medical staffs.
  • Stress control professionals include psychiatrists, social workers, clinical psychologists, psychiatric nurses, occupational therapists and enlisted specialists.
  • Stress control personnel talk with troops to identify problems early, advise unit commanders on prevention, give classes and debriefings, and train units to identify combat stress reactions early and help the over-stressing Soldiers while they continue their duties.
  • The stress control personnel provide one-on-one stress-control "coaching" to stressed Soldiers when they go forward to visit the units or when Soldiers come to them at the medical companies.
  • Specialized combat stress control teams can provide tents and staff where Soldiers who become too stressed to stay in their units get 1–3 days of rest, catch up on nutrition and sleep, do work and regain confidence. The intention is to get the Soldier back to his/her job and comrades.
  • The stress control professionals occasionally identify individuals who need more specialty treatment and arrange their safe transfer to the medical facilities where it is available.

Where combat stress control professionals are found

  • Mental health personnel are integral in the medical elements of separate brigades, divisions and area support medical battalions. Staffing varies, from three enlisted specialists in a separate brigade to a psychiatrist, social worker, psychologist and seven enlisted specialists in a division.
  • Reinforcing "combat stress control teams" are small mobile teams from CSC detachments or companies. They are tailored mixes of the five mental health disciplines, which also include psychiatric nursing and occupational therapy. The teams have their own vehicles to move forward to augment the tactical units or to support combat service support units over a wide area.
  • Each CSC detachment supports one division or two to three separate brigades/regiments. It consists of three four-person combat stress control preventive teams that move forward to brigade support areas when requested, and one 11-person combat stress fitness (restoration) team that can run a "combat fitness center" in the division support area or the corps forward area. The fitness team also provides preventive services to units in their vicinity and can go further forward.
  • Each CSC company includes six combat stress control preventive teams and four combat stress fitness (restoration) teams. It usually distributes teams in the forward corps area or further to the rear. It supports the corps units behind two or three divisions, but can send teams far forward to augment the division rear and even brigades in combat, like the CSC detachments do.