Field Manual No. 22-51: Leaders' Manual for Combat Stress Control: Booklet 1
Chapter 11: Prevention of Battle Fatigue Casualties and Misconduct Stress Behaviors
Headquarters, Department of the Army, Washington, DC
In combat, battle fatigue is inevitable but high battle fatigue casualty rates are
not. History shows that highly trained and cohesive units with good leadership have had
fewer than one such casualty for every ten WIA, even in intensely heavy fighting. This is
significantly fewer than the usual one per four or five in moderate intensity battle and
one per two or three in intense fighting. By knowing what factors in the tactical and
overall situation increase battle fatigue, leaders and unit members can take action to
counteract those factors. They must share the burden, resolve internal conflicts, build
unit cohesion, and reduce stress. The same measures, plus positive adherence to discipline
and the Law of Land Warfare, also prevent misconduct stress behaviors which could defeat
the purpose of the mission. We can overcome the stressors of the battlefield --
11-2. Leader's Role in Training Battle Fatigue Prevention
a. History shows what kinds of situations and stressors tend to produce battle fatigue
casualties. Some are conditions which can be modified or controlled by good leadership.
Other situations or events may be beyond the leader's control; however, knowing which
situations or events increase stress and battle fatigue enables the leader to compensate
by reducing other stressors and taking corrective actions. The leader must also plan for
the care of battle fatigue casualties and still accomplish the mission.
b. Mental health/combat stress control personnel have the mission to give formal
training and consultation on how to reduce stressors. This training and consultation is
provided to both medical and line officers, NCOs, chaplains, and troops.
c. Appendix E elaborates on material which is part of the Advanced NCO Course and
Advanced Officer Course core curricula. The same material is also outlined in GTAs 21-3-4,
-5, and -6. These GTAs are designed to facilitate "hip pocket training" in the
field. They are camouflaged pocket cards which should be available through all Army
Training and Audiovisual Support Centers. The GTAs can serve as training aids in peacetime
and as reminders and checklists in war.
11-3. What the Members of the Unit Can Do to Control Stress
a. Unit leaders and members can control stress by assisting one another. They need to be
able to recognize stress in each other. One important way in which stress can be
alleviated is by talking things out ("ventilation"). This requires encouragement
and listening to the soldier under stress. Realistic reassurance is helpful. Arguing with
the soldier and being critical or disparaging usually is not helpful. Ways which unit
leaders and members can assist one another in controlling stress may include --
All soldiers being assigned or developing "battle buddies" with whom they
share their feelings and ventilate about their experiences.
Officers and NCOs in the same unit encouraging each other to talk things out together,
especially those issues or feelings they cannot share with their troops.
Officers and NCOs in sister units providing ventilation for each other.
Officers and senior NCOs in the chain of command, chain of support, and staff positions
encouraging junior leaders to talk freely about their feelings at suitable times and
places without fear of reprisal. Formal after-action debriefings of the unit leaders after
difficult actions are one example of suitable times. Another example is during change of
command transition workshops.
The unit chaplain being someone that anyone can ventilate to about anything.
b. Should a unit member be in a crisis, a number of actions may be useful. These
actions are to --
Observe and attempt to calm the soldier.
Protect him from danger (restrain only if necessary).
Ensure that someone takes charge of the situation, finds out what is going on, and takes
appropriate action. Specific actions which should be taken by a buddy or junior leader are
outlined in GTA 21-3-4 and -5.
11-4. What the Individual Can Do to Control Combat Stress
a. Individuals must drink enough fluids, eat enough food, and attempt to get rest/ sleep
as often as possible.
b. Everyone should learn at least two relaxation techniques (and preferably more) that
can be used at times when physical exercise is not feasible.
One technique should provide quick reduction of excessive alertness without taking the
mind, eyes, or hands off the task.
A second technique should provide deep relaxation for refreshing sleep even under
c. Care must be taken to use relaxation techniques only at tactically appropriate
times. Mental health personnel can assist in teaching these methods. Useful techniques
which can be used alone or in combination include --
Visual imaging self-relaxation. Imagine yourself in a relaxing situation. Pick your own
relaxing situation, then imagine it with every sense of your body -- colors, shapes,
textures, sounds, smells, temperature, and touch of it.
Brief or progressive muscular relaxation. Tense your muscles for a few seconds
(approximately 5-10) and then slowly release this tension while feeling the warm and heavy
sensation that occurs when you relax. Either tense all your muscles at once or start with
the muscles in your toes and work slowly up the muscles in the rest of your body.
Stretching. Stretch your muscles and joints, move them around, and shake out the
When the soldier must stay alert and be responsive to the environment, special relaxation
techniques can be used that will not disrupt performance. In such situations, deep
relaxation techniques would be tactically inappropriate and unsafe.
Positive self-talk. Say to yourself, "Easy does it," "Take your
time," "I can do it," "OK, go for it!" or any other brief words
Abdominal breathing. Breathe slowly and deeply, using the abdominal muscles (not the
chest muscles) to move the air in and out. Even one slow breath in which you breathe in,
hold for 2-3 seconds, and then exhale slowly (about 5 seconds) can steady the nerves and
Breathing meditation. Focus your attention on your breathing, especially each time you
breathe out. Say the same word or short phrase once each time you exhale (such as the word
"one" or "relax"), over and over, while passively letting all other
thoughts drift out of your mind.
d. Individuals should share feelings constructively ("ventilation").
e. Individuals can also reduce stress by planning ahead, preparing for the mission, and
ensuring readiness. The best way to alleviate stress is to take appropriate action. The
above techniques should be practiced frequently until they become automatic.
11-5. Prevention of Misconduct Stress Behaviors
The measures which reduce battle fatigue and prevent battle fatigue casualties should
also help reduce the incidence of misconduct stress behaviors. However, additional actions
also need to be practiced consistently by leadership at all echelons and by buddies at the
small unit level.
a. Clearly state and teach the Standards of Conduct. United States forces will
faithfully adhere to the Law of Land Warfare and the UCMJ.
b. Reemphasize those standards repeatedly, especially every time they are violated by
the enemy or at the first early signs of slippage by our troops. Some of the early signs
may include talking about breaking the law, stretching the interpretation, or committing
acts in the "gray" areas which cannot be documented for legal action. Let troops
express (ventilate) their frustrations verbally among themselves, but not in action.
c. Emphasize national, Army, and unit pride in living by the standard even under
provocative conditions. "We are American soldiers of the (unit). I know how you feel,
but we do not do that stuff. Those who do have let us down and are no longer part of
d. Explain, as often as necessary, the ethical, legal, practical, and tactical reasons
why we obey the rules. For example, "Provoking us to commit atrocities is exactly
what the enemy is trying to do to achieve his objectives, not ours." Restate the
mission and its objectives clearly.
e. Clearly state and consistently enforce the rules and regulations against substance
abuse, fraternization, and misconduct. Develop a group sense of "family" that
makes such improper behavior morally and spiritually unacceptable as well as illegal and
f. Set the personal example of correct conduct.
g. Report all violations.
h. Prosecute all verifiable violations.
i. Consistently and fairly punish misconduct and violation of the UCMJ in peacetime to
set the standard that misbehavior will not be tolerated.