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What is an Operational Stress Injury (OSI)?

An OSI is term used to describe any persistent psychological injury resulting from operational or work-related duties in the military or police service.

What Causes OSI's?

Many situations may cause an OSI, which include:

• Being involved in combat
• Witnessing atrocities
• Coming close to death
• Being assaulted
• Seeing someone killed or killing someone
• Being held hostage
• Natural disasters
• Handling injured bodies and human remains

Canadian Forces and law enforcement personnel are regularly exposed to extreme situations beyond the experience of most people. Similarly to how physical strain may affect the body, an extreme or lasting psychological stress may cause injuries to the brain and mind.

Common Types of OSI’s:

• Post-Traumatic Stress Disorder (PTSD)
• Substance Use Disorders such as problems with alcohol and marijuana
• Anxiety Disorders, such as panic attacks and phobia
• Mood Disorders, such as problems with depression and anger

How Common are OSI’s?

As many as 10-20% of those involved in operational duties may develop OSI.

Symptoms of OSI’s:

There are many possible signs of an OSI, such as:

• Re-experiencing and flashbacks – unwanted vivid recollections of the event
• Disturbed sleep with nightmares
• Irritability or anger
• Decreased concentration
• Exaggerated startle response and hypervigilance
• Avoidance of people, places that remind one of the traumatic event
• Panic attacks and anxiety
• Loss of interest in activities

How Are OSI’s Treated?

There are many types of effective treatments for OSI's that are offered by professionals:

• Cognitive behaviour therapy (CBT): Helps individuals cope with depression and anxiety by focusing on changing their thoughts and behaviours. In CBT, individuals learn to replace negative or worry thoughts with more rational and helpful alternatives..
• Prolonged Exposure (PE): PE is a form of CBT that involves reviewing the traumatic event by recounting it in detail and working with the reminders (triggers) of the trauma rather than avoiding them. This treatment method is very effective for OSI’s and involves individual work with a clinician and homework each week.
• Cognitive Processing Therapy (CPT): CPT involves achieving a better understanding of the traumatic event, processing traumatic experience and acquiring the skills needed for better coping. This treatment method is also CBT-based and may be done individually or within a group.
• Group therapy:  Group therapy involves meeting with a group of people who have also been through trauma and have an OSI, with guidance from a group leader (such as a psychologist or social worker). Group therapy is powerful because you are meeting with others who understand what you've been through. Sharing with the group also can help you build self-confidence and trust. Unlike some therapies which focus on the past, group work focuses on the present.
• Family therapy: Family therapy is a type of counseling that involves your whole family which is important because OSI's can affect the family, and family support is needed to help you cope with an OSI. A therapist helps you and your family to communicate, maintain good relationships, and cope with difficult emotions. In family therapy, each person can express his or her fears and concerns. By doing this, your family will be better prepared to help you.
• Medications: Various medications, such as antidepressants, may be helpful to reduce the symptoms of OSI, such as depression, anxiety and insomnia, and these may be prescribed by a family physician or psychiatrist.

How Can I Help Myself If I Have an OSI?

• Know your limits and triggers.
• Educate yourself
• Confide in someone you trust
• Access resources in your community, your place of work

Getting Help for an OSI

• Speak with your medical doctor.
• Don't keep everything to yourself; chances are, your family and friends have already noticed something is different, and are already concerned about you.
• Set up a support network for yourself, e.g. Tell a trusted friend or family member (e.g. spouse) about your difficulties, so they can understand you and support you. For example, you might say: "Can we talk? I want to tell you about something that's been going on with me. Ever since _____, I've been having troubles with _____. I need your support to help me get through this. This is what I need from you..."
• If you are still serving, you can
  • Speak with Psychosocial Services at your base
  • Speak with a Padre
  • Seek peer support through Operational Stress Injury Social Support (OSISS), 1-800-883-6094, http://www.osiss.ca
  • If you are a veteran, you can contact Veteran's Affairs Canada (VAC) at 1-866-522-2122, http://www.veterans.gc.ca

You are not alone. The sooner you seek assistance, the better.

People commonly delay talking about their symptoms out of fear that it may affect their career and relationships. But it is worse for your work and relationship when OSI symptoms persist and worsen!

How to Support a Friend or Family Member With an OSI

• Seek peer support for family members through Operational Stress Injury Social Support (OSISS), 1-800-883-6094, http://www.osiss.ca
• Listen. You might say: “You don't seem yourself these days... I notice that...  What's up? How are you doing these days?"
• Validate. Regardless of how your friend is feeling, s/he is responding this way to the trauma because this is one of the standard ways that a person may respond. You might simply say, "Yeah, that sounds pretty.... (agreeing with how your friend is feeling)"
• Don't judge or minimize what your friend/family member is going through. Try to avoid statements like "It could have been worse..." Most of the time, this is not helpful; there is ALWAYS someone who has had it worse. Saying that things could have been worse generally makes the person with an OSI feel even more guilty and ashamed about their 'trivial' difficulties, which thus prevents them from opening up and getting help.
• Encourage your friend or family member to get help, and let them know that
  • There are effective treatments that they can access, and
  • The sooner someone with an OSI initiates treatment, the better for that person and their family.
  • You might say: "You don't have to feel this way. It can get better. There are professionals that can help with this. If you want, we can make the call together, and how about I'll drive you to the appointment. And then we can go for a coffee after?"
• Supporting another person can be exhausting, so don't neglect your own health. It’s great to support your loved one, but if you are neglecting your own physical health, and if it is affecting your own work and relationships, then you probably need to set limits.  Example: "I'm here to support you. This is what I can do.... This is what I can't do...  Right now, you need more than I can provide. We have to get you to see someone."
• Seek support from family and/or friends. Whether you prefer to cope by being physical, by talking, or some other way, remember that you need your own support network too.
• Try to set reasonable expectations for both yourself and your family member(s). Until your friend or loved one has healed from the OSI, this usually means that you will have to reduce expectations.

Know that you are also not alone and that supports may be available to you also.

Key Facts About OSI's

• An OSI is a normal response to an abnormal event
• An OSI can happen to anyone; it is not a sign of weakness
• You are not alone
• Effective, researched treatments are available to you
• The sooner a comprehensive assessment and treatment are initiated, the better the future

About This Document

Written by Shelley Hale, RSSW, RSW; Jakov Shlik, MD, FRCPC, Royal Ottawa Operational Stress Injury Clinic; LCdr Rose Collins, RN, BScN, MScN, CPMHN(C), Canadian Forces, Mental Health Directorate; and reviewed by members of the eMentalHealth.ca Editorial Team.

Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.

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