战斗应激反应的研究进展及展望
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摘要
<正>参战人员在战场环境,无论完成什么样的任务,都要出现不同程度的战斗应激反应(combat stress reactions,CSR)。战斗应激反应有积极正向的作用,即促进参战人员儿茶酚胺激增、能量释放、警觉性提升、反应快速、记忆和学习加强,提高军事作业水平和作战能力,称为适应性战斗应激反应;当然重要的是消极负向的作用,参战人员表现出惊恐、视野狭窄与听觉排斥,直接导致非战斗、战斗减员的"显性危害",也间接引起参战人员判断决策失误和技战术水平下降的"隐形危害",最终引起战斗的失利甚至整个战争的失败,称
Soldiers in the combat field may demonstrate such non-adaptive reactions as panic disorder,narrow visual field and hearing disturbance,which potentially cause non-combat attrition and compromise the high-level cognitive functions( reasoning,judgment and decision-making). These non-adaptive reactions,known collectively as combat stress reactions( CSR),can be categorized into different subtypes based on the severity and types of the symptoms. The protective factors against CSR include social support,positive copping style,self-efficacy,strong team leadership and group cohesion,which all help to reduce the impact of stress events. The threat of death,harsh environment and poor health condition are the risk factors that contribute to the occurrence of CSR. Studies of CSR in a neurological perspective revealed that in the event of CSR,catecholamine release might promote the levels of alertness and excitability of an individual to enhance the combat efficacy; excessive alertness in this scenario,however,may cause overestimation of the risk information. Meanwhile, the interaction between the activated amygdala and the prefrontal cortex interferes with the execution control functions,leading to possible irrational behaviors. Long-term stress may even change the brain structure and potentially cause post-trauma stress disorder( PTSD). Based on these observations, military psychologists proposed several intervention principles for CSR, including PIE,IMPRESS and BICEPS. These principles point to the importance of simple and quick handling of CSR with necessary physical,emotional and social support to help the soldiers regain combat abilities soon. The specific measures of CSR control include battle mind debriefing,trauma risk management,eye movement desensitization and reprocessing,and ego-state therapy. Future studies of CSR will focus on developing quick evaluation tools and standards and accurate prediction of CSR occurrence; reinforcement of combat-oriented simulation training and establishment of systemic strategies of countermeasures against CSR; reinforcement of CSR management in combat field and establishment of CSR control unit in the field hospitals; and exploration of the mechanisms of CSR occurrence and the pathways that mediate its effects.
Soldiers in the combat field may demonstrate such non-adaptive reactions as panic disorder,narrow visual field and hearing disturbance,which potentially cause non-combat attrition and compromise the high-level cognitive functions( reasoning,judgment and decision-making). These non-adaptive reactions,known collectively as combat stress reactions( CSR),can be categorized into different subtypes based on the severity and types of the symptoms. The protective factors against CSR include social support,positive copping style,self-efficacy,strong team leadership and group cohesion,which all help to reduce the impact of stress events. The threat of death,harsh environment and poor health condition are the risk factors that contribute to the occurrence of CSR. Studies of CSR in a neurological perspective revealed that in the event of CSR,catecholamine release might promote the levels of alertness and excitability of an individual to enhance the combat efficacy; excessive alertness in this scenario,however,may cause overestimation of the risk information. Meanwhile, the interaction between the activated amygdala and the prefrontal cortex interferes with the execution control functions,leading to possible irrational behaviors. Long-term stress may even change the brain structure and potentially cause post-trauma stress disorder( PTSD). Based on these observations, military psychologists proposed several intervention principles for CSR, including PIE,IMPRESS and BICEPS. These principles point to the importance of simple and quick handling of CSR with necessary physical,emotional and social support to help the soldiers regain combat abilities soon. The specific measures of CSR control include battle mind debriefing,trauma risk management,eye movement desensitization and reprocessing,and ego-state therapy. Future studies of CSR will focus on developing quick evaluation tools and standards and accurate prediction of CSR occurrence; reinforcement of combat-oriented simulation training and establishment of systemic strategies of countermeasures against CSR; reinforcement of CSR management in combat field and establishment of CSR control unit in the field hospitals; and exploration of the mechanisms of CSR occurrence and the pathways that mediate its effects.
引文
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[13] SALMON T W. War neuroses and their lesson[J]. N Y State J Med,1919,109(59):993-994.
[14] SOLOMON Z,BENBENISHTY R. The role of proximity,immediacy,and expectancy in frontline treatment of combat stress reaction among Israelis in the Lebanon War[J]. Am J Psychiatry,1986,143(5):613-617. DOI:10. 1176/ajp.143. 5. 613.
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[16] PETTERA R L,JOHNSON B M,ZIMMER R. Psychiatric management of combat reactions with emphasis on a reaction unique to Vietnam[J]. Mil Med,1969,134(9):673-678.DOI:10. 1093/milmed/134. 9. 673.
[17] HAUSMAN W,RIOCH D M. Military psychiatry. A prototype of social and preventive psychiatry in the United States[J]. Arch Gen Psychiatry,1967,16(6):727-739.
[18] KENTSMITH D K. Principles of battlefield psychiatry[J].Mil Med,1986,151(2):89-96. DOI:10. 1093/milmed/151. 2. 89.
[19] TRUE P K,BENWAY M W. Treatment of stress reaction prior to combat using the“BICEPS”model[J]. Mil Med,1992,157(7):380-381. DOI:10.1093/milmed/157.7.380.
[20] ORSINGHER J M,LOPEZ A T,RINEHART M E. Battlemind training system:“armor for your mind”[J]. US Army Med Dep J,2008:66-71.
[21] VAN EMMERIK A A,KAMPHUIS J H,HULSBOSCH A M,et al. Single session debriefing after psychological trauma:a meta-analysis[J]. Lancet,2002,360(9335):766-771. DOI:10. 1016/S0140-6736(02)09897-5.
[22] BARABASZ A F,BARABASZ M,WATKINS J G. Singlesession manualized ego state therapy(EST)for combat stress injury,PTSD,and ASD,part 1:the theory[J]. Int J Clin Exp Hypn,2011,59(4):379-391. DOI:10. 1080/00207144. 2011. 595349.
[23] BARABASZ A F,BARABASZ M,WATKINS J G. Singlesession manualized ego state therapy(EST)for combat stress injury,PTSD,and ASD,Part 2:the procedure[J].Int J Clin Exp Hypn,2012,60(3):370-381. DOI:10.1080/00207144. 2012. 675300.
[24] CAMPBELL J S,KOFFMAN R L. Ecological systems of combat and operational stress:theoretical basis for the U. S.navy mobile care team in afghanistan[J]. Mil Behav Health,2014,2(4):316-326. DOI:10. 1080/21635781. 2014.963761.
[25] KOBASA S C. Personality and resistance to illness[J]. Am J Community Psychol,1979,7(4):413-423. DOI:10.1007/bf00894383.
[26] MADDI S R. Comment:taking the theorizing in personality theories seriously[J]. Am Psychol,2006,61(4):330-331. DOI:10. 1037/0003-066X. 61. 4. 330.
[27] ANTONOVSKY A. Health,stress,and coping[M]. Son Francisco:Jossey-Bass Publishers,1980.
[28] BANDURA A. Self-Regulation of motivation and action through goal systems[M]. HAMLLTOH V,BOWER G H,FRIJDA N H. Cognitive perspectives on emotion and motivation. Dordecht:Springer. 1988:37-61. DOI:10. 1007/978-94-009-2792-6_2.
[29] SINHA R. The clinical neurobiology of drug craving[J].Curr Opin Neurobiol,2013,23(4):649-654. DOI:10.1016/j. conb. 2013. 05. 001.
[30]李权超,何英强,申国祥,等.我军军人心理应激自评问卷的编制[J].解放军预防医学杂志,2003,21(4):256-258.LI Q C,HE Y Q,SHEN G X,et al. Development of the psychological stress self-evaluation test and its reliability and validity[J]. J Prevent Med PLA,2003,21(4):256-258.
[31]张懿,苏文君,蒋春雷.应激生理指标皮质醇和α-淀粉酶的研究进展[J].军事医学,2017,41(2):146-149.ZHANG Y,SU W J,JIANG C L. Research progress in cortisol andα-amylase as stress biomarkers[J]. Mil Med Sci,2017,41(2):146-149. DOI:10. 7644/j. issn. 1674-9960. 2017. 02. 015.
[32] National Research Council. Opportunities in neuroscience for future army applications[M]. Washington D C:National Academics Press,2009.
[33] ADLER A B,CASTRO C A,MCGURK D. Time-driven battlemind psychological debriefing:a group-level early intervention in combat[J]. Mil Med,2009,174(1):21-28.DOI:10. 7205/milmed-d-00-2208.
[34] GREENBERG N,LANGSTON V,JONES N. Trauma risk management(TRi M)in the UK armed forces[J]. J R Army Med Corps,2008,154(2):124-127. DOI:10. 1136/jramc-154-02-11.
[35] GREENBERG N,LANGSTON V,EVERITT B,et al. A cluster randomized controlled trial to determine the efficacy of trauma risk management(TRi M)in a military population[J]. J Trauma Stress,2010,23(4):430-436. DOI:10.1002/jts. 20538.
[36] HUNT E,JONES N,HASTINGS V,et al. TRi M:an organizational response to traumatic events in cumbria constabulary[J]. Occup Med(Lond),2013,63(8):549-555.DOI:10. 1093/occmed/kqt113.
[37]冯正直.军事心理学[M].北京:人民卫生出版社,2018:187.FENG Z Z. Military psychology[M]. Beijing:People’s Medical Publishing House,2018:187.
[2]肯尼迪C H,左尔莫E A.军事心理学:临床与作战中的应用[M].贺岭峰,高旭辰,田彬,译.上海:华东师范大学出版社,2008:179.KENNEDY C H,ZORMO E A. Military psychology:clinical and operational applications[M]. HE L F,GAO X C,TIAN B, Translated. Shanghai:East China Normal University Press,2008:179.
[3] LAURENCE J H,MATTHEWS M D.牛津军事心理学[M].杨征,译.北京:科学出版社,2014:18.LAURENCE J H,MATTHEWS M D. Oxford military psychology[M]. YANG Z,Translated. Beijing:Science Press,2014:18.
[4] GRINKER R R. Psychiatric disorders in combat crews overseas and in returnees[J]. Med Clin North America,1945,29(3):729-739. DOI:10. 1016/s0025-7125(16)36091-6.
[5] BARTEMEIER L H,KUBIE L S. Combat exhaustion[J]. J Nerv Ment Dis,1946,104:358 passim. DOI:10. 1097/00005053-194610000-00002.
[6] SOLOMON Z,MIKULINCER M,BENBENISHTY R. Combat stress reaction:clinical manifestations and correlates[J].Mil Psychol,1989,1(1):35-47. DOI:10. 1207/s15327876mp0101_3.
[7] SOLOMON Z,MIKULINCER M,HABERSHAIM N. Life-events,coping strategies,social resources,and somatic complaints among combat stress reaction casualties[J]. Br J Med Psychol,1990,63(Pt 2):137-148. DOI:10. 1111/j.2044-8341. 1990. tb01607. x.
[8] SOLOMON Z,BENBENISHTY R,MIKULINCER M. The contribution of wartime,pre-war,and post-war factors to selfefficacy:A longitudinal study of combat stress reaction[J]. J Trauma Stress,1991,4(3):345-361. DOI:10. 1007/bf00974554.
[9] HASSAN A M,JACKSON R J,LINDSAY D R,et al. Combat stress control and prevention:what can be learned from an application of workplace behavioral health in a deployed combat environment?[J]. J Workplace Behav Health,2010,25(3):169-180. DOI:10. 1080/15555240. 2010. 496315.
[10] RAHE R H. Acute versus chronic psychological reactions to combat[J]. Mil Med,1988,153(7):365-372. DOI:10. 1093/milmed/153. 7. 365.
[11] VAN WINGEN G A,GEUZE E,VERMETTEN E,et al.Perceived threat predicts the neural sequelae of combat stress[J]. Mol Psychiatry,2011,16(6):664-671. DOI:10.1038/mp. 2010. 132.
[12] VAN WINGEN GA,GEUZE E,VERMETTEN E,et al.The neural consequences of combat stress:long-term followup[J]. Mol Psychiatry,2012,17(2):116-118. DOI:10. 1038/mp. 2011. 110.
[13] SALMON T W. War neuroses and their lesson[J]. N Y State J Med,1919,109(59):993-994.
[14] SOLOMON Z,BENBENISHTY R. The role of proximity,immediacy,and expectancy in frontline treatment of combat stress reaction among Israelis in the Lebanon War[J]. Am J Psychiatry,1986,143(5):613-617. DOI:10. 1176/ajp.143. 5. 613.
[15] MCDUFF D R,JOHNSON J L. Classification and characteristics of army stress casualties during Operation Desert Storm[J]. Hosp Community Psychiatry,1992,43(8):812-815.DOI:10. 1176/ps. 43. 8. 812.
[16] PETTERA R L,JOHNSON B M,ZIMMER R. Psychiatric management of combat reactions with emphasis on a reaction unique to Vietnam[J]. Mil Med,1969,134(9):673-678.DOI:10. 1093/milmed/134. 9. 673.
[17] HAUSMAN W,RIOCH D M. Military psychiatry. A prototype of social and preventive psychiatry in the United States[J]. Arch Gen Psychiatry,1967,16(6):727-739.
[18] KENTSMITH D K. Principles of battlefield psychiatry[J].Mil Med,1986,151(2):89-96. DOI:10. 1093/milmed/151. 2. 89.
[19] TRUE P K,BENWAY M W. Treatment of stress reaction prior to combat using the“BICEPS”model[J]. Mil Med,1992,157(7):380-381. DOI:10.1093/milmed/157.7.380.
[20] ORSINGHER J M,LOPEZ A T,RINEHART M E. Battlemind training system:“armor for your mind”[J]. US Army Med Dep J,2008:66-71.
[21] VAN EMMERIK A A,KAMPHUIS J H,HULSBOSCH A M,et al. Single session debriefing after psychological trauma:a meta-analysis[J]. Lancet,2002,360(9335):766-771. DOI:10. 1016/S0140-6736(02)09897-5.
[22] BARABASZ A F,BARABASZ M,WATKINS J G. Singlesession manualized ego state therapy(EST)for combat stress injury,PTSD,and ASD,part 1:the theory[J]. Int J Clin Exp Hypn,2011,59(4):379-391. DOI:10. 1080/00207144. 2011. 595349.
[23] BARABASZ A F,BARABASZ M,WATKINS J G. Singlesession manualized ego state therapy(EST)for combat stress injury,PTSD,and ASD,Part 2:the procedure[J].Int J Clin Exp Hypn,2012,60(3):370-381. DOI:10.1080/00207144. 2012. 675300.
[24] CAMPBELL J S,KOFFMAN R L. Ecological systems of combat and operational stress:theoretical basis for the U. S.navy mobile care team in afghanistan[J]. Mil Behav Health,2014,2(4):316-326. DOI:10. 1080/21635781. 2014.963761.
[25] KOBASA S C. Personality and resistance to illness[J]. Am J Community Psychol,1979,7(4):413-423. DOI:10.1007/bf00894383.
[26] MADDI S R. Comment:taking the theorizing in personality theories seriously[J]. Am Psychol,2006,61(4):330-331. DOI:10. 1037/0003-066X. 61. 4. 330.
[27] ANTONOVSKY A. Health,stress,and coping[M]. Son Francisco:Jossey-Bass Publishers,1980.
[28] BANDURA A. Self-Regulation of motivation and action through goal systems[M]. HAMLLTOH V,BOWER G H,FRIJDA N H. Cognitive perspectives on emotion and motivation. Dordecht:Springer. 1988:37-61. DOI:10. 1007/978-94-009-2792-6_2.
[29] SINHA R. The clinical neurobiology of drug craving[J].Curr Opin Neurobiol,2013,23(4):649-654. DOI:10.1016/j. conb. 2013. 05. 001.
[30]李权超,何英强,申国祥,等.我军军人心理应激自评问卷的编制[J].解放军预防医学杂志,2003,21(4):256-258.LI Q C,HE Y Q,SHEN G X,et al. Development of the psychological stress self-evaluation test and its reliability and validity[J]. J Prevent Med PLA,2003,21(4):256-258.
[31]张懿,苏文君,蒋春雷.应激生理指标皮质醇和α-淀粉酶的研究进展[J].军事医学,2017,41(2):146-149.ZHANG Y,SU W J,JIANG C L. Research progress in cortisol andα-amylase as stress biomarkers[J]. Mil Med Sci,2017,41(2):146-149. DOI:10. 7644/j. issn. 1674-9960. 2017. 02. 015.
[32] National Research Council. Opportunities in neuroscience for future army applications[M]. Washington D C:National Academics Press,2009.
[33] ADLER A B,CASTRO C A,MCGURK D. Time-driven battlemind psychological debriefing:a group-level early intervention in combat[J]. Mil Med,2009,174(1):21-28.DOI:10. 7205/milmed-d-00-2208.
[34] GREENBERG N,LANGSTON V,JONES N. Trauma risk management(TRi M)in the UK armed forces[J]. J R Army Med Corps,2008,154(2):124-127. DOI:10. 1136/jramc-154-02-11.
[35] GREENBERG N,LANGSTON V,EVERITT B,et al. A cluster randomized controlled trial to determine the efficacy of trauma risk management(TRi M)in a military population[J]. J Trauma Stress,2010,23(4):430-436. DOI:10.1002/jts. 20538.
[36] HUNT E,JONES N,HASTINGS V,et al. TRi M:an organizational response to traumatic events in cumbria constabulary[J]. Occup Med(Lond),2013,63(8):549-555.DOI:10. 1093/occmed/kqt113.
[37]冯正直.军事心理学[M].北京:人民卫生出版社,2018:187.FENG Z Z. Military psychology[M]. Beijing:People’s Medical Publishing House,2018:187.