Stress reduction techniques for high stress operations (2023) | Hacker News Reader

Stress reduction techniques for high stress operations (2023)

health.mil

131 pointswslh59 comments

I've often wondered if the traditions around warfare that we read about in ancient classics like the Iliad were intended to reduce PTSD. For example, after every military action, there are always games and feasts, with a lot of communal time with fellow survivors and some "play re-enactment" like boxing matches or running races. The soldiers never, ever just demobilize and go home to their homesteads. Mental phenomena like disturbing dreams are taken seriously (albeit through the lens of the religious practice of the time) and openly discussed.

Am I projecting, or did the ancients know a thing or two here?

That's a great insight, I think you're onto something there

That makes a lot of sense. Would seem quite important for people involved in conflict to have time to decompress with others who can relate instead of just being plopped back into normal everyday life unadjusted.

Modern Veterans pubs seem to be something similar.

The Māori Haka (and related polynesian dances) always seemed to me like they take physical manifestations of a severe adrenalin dump and, catlike, turn them into something where one can say "I'm doing this on purpose".

(speaking of the Iliad: who accompanies Ares/Mars? Phobos and Deimos)

Interesting observation, there may be some truth to it!!

A while back I read a really interesting Reddit comment by someone researching PTSD in ancient history. Here it is

https://www.reddit.com/r/AskHistorians/comments/1j6ssm/comme...

This is a really good comment that touches on some thoughts I’ve been pondering for awhile now.

In psychology, there is a concept of “culture-bound disorders”. Traditionally, these seem to be very unusual disorders that are extremely common in some cultures but not in WEIRD cultures. I think maybe the psychologists are getting this backwards; maybe some of the proper disorders in the DSM are actually culture-bound to WEIRD culture, and I think the specific way PTSD is normally described may be one of these. This isn’t to say that other cultures don’t have stress reactions, but they have different stress reactions that crystallize in forms that are more “normal” to their cultures, the way textbook PTSD is effectively “normal” to our culture. I’ve read about cases where well-meaning Western counselors show up to natural disasters expecting the survivors to have textbook PTSD symptoms. At first, people hear these counselors asking about PTSD symptoms and are genuinely confused, but apparently with enough contact, the suggestion from an authoritative sounding western medical practitioner implying that this is how they should be feeling in that situation can end up inducing those very symptoms.

It's really hard to read this comment as anything but a quiet suggestion that perhaps PTSD is a result of mental health workers and not the result of trauma. What seems far more likely is that people trapped in cultures that have not really developed a strong mental health response (e.g., 20th century America) have few if any resources available to help people with their literally invisible condition, and they have been trained through stigma and other "culture-bound" behaviours to keep their problems to themselves and show that stiff upper lip.

> It's really hard to read this comment as anything but a quiet suggestion that perhaps PTSD is a result of mental health workers and not the result of trauma.

I’m sorry you struggled and ultimately failed to understand what I was saying, because I actually clarified this specific point:

> This isn’t to say that other cultures don’t have stress reactions, but they have different stress reactions that crystallize in forms that are more “normal” to their cultures, the way textbook PTSD is effectively “normal” to our culture.

> I think the specific way PTSD is normally described may be one of these

I'm not sure I understand: Are you saying that there is research that says PTSD is WEIRD? Or is this your idea?

One common feature of Western culture, or at least US culture, is to play down PTSD (and other psychological conditions). Suicide rates among veterans is sky-high, in part because PTSD is treated as dubious. Let's be careful about what we say.

There's a common thread in the comment you're replying to and another comment made by the same author, in which they appear to quietly suggest that perhaps it's just TBIs and sleep deprivation. I get the sense it's a theme.

> One common feature of Western culture, or at least US culture, is to play down PTSD

Yes indeed!

I’m suggesting that TBI’s and sleep deprivation probably make things worse instead of better. Would you seriously argue the contrary?

Broader culture plays down all the atrocities and sheer waste of war for its own psycological purposes. Treating PTSD as dubious is simply collateral damage when it comes to pretending that war means anything but exploding living humans over dirt / oil / religion / money / power.

> I'm not sure I understand: Are you saying that there is research that says PTSD is WEIRD? Or is this your idea?

I’m saying that the specific features and symptoms are not necessarily universal across cultures and that we don’t have anything close to a full understanding of the underlying psychology. All people react to stress, but the specific ways they react to stress might be more culturally bound than we expect. It’s hard to tell because our understanding of PTSD is almost entirely based on cases observed inside of WEIRD cultures.

> One common feature of Western culture, or at least US culture, is to play down PTSD (and other psychological conditions).

This was obviously very much the case for some time. I think we’ve made some laudable efforts to improve on this in recent years.

> Suicide rates among veterans is sky-high, in part because PTSD is treated as dubious.

I agree that veteran suicide is a major problem. I also agree with the desire to avoid stigma. That’s actually why I am skeptical about the impulse to address veteran mental health, for lack of a better terminology, almost entirely within a medical and clinical frame. That carries the implication that our culture is completely healthy and it’s only our returning warriors who are sick and mentally unwell. On the contrary, I think our culture is deeply sick and atomized, and that our warriors are more alienated from civil society than ever before.

It’s not just arrogant but outright laughable to assume we have all of this figured out. If we had it all figured out, we would have solved the problem.

> Let's be careful about what we say.

I am. Let’s be careful about making a good faith effort to actually understand and respond to what’s being said instead of misrepresenting it and trying to shut down the conversation.

Probably, yes. There are also case studies from members of American Indian nations who fought in modern wars and, when returning home, participated in their nation’s traditional warrior rituals; this also seems to help.

It should also be mentioned that ancient warfare has a lot of important psychological differences to modern warfare. Most tactics entailed standing literally, physically, shoulder to shoulder with your comrades in common purpose. People instinctively feel safer in the company of other (friendly) people, which is conducive to traditional formation tactics but not conductive to modern dispersal tactics, where you need to stay a safe distance apart from the next guy so you aren’t both killed by the same grenade or landmine.

Speaking of grenades and landmines, ancient warfare was not as loud and concussive and cacophonous as modern warfare. Its hard to say for sure which is worse—much has been written about the primal human fear of cold, sharp steel—but the constant, deafening gunpowder and explosives of modern warfare are certainly very different. In the First World War, the term “shell shock” was coined, based on the theory that the repeated concussive impact of artillery shells landing nearby could cause some soldiers to experience not just psychological symptoms but also the neurological effects of repeated brain trauma. Later on, people assumed shell shock was just PTSD, but my understanding is that they might have been onto something about the traumatic brain injuries all along. On the other hand, I wouldn’t be surprised if people also got a lot of traumatic brain injuries fighting in a phalanx, too. But on the gripping hand, if you’re fighting in a phalanx, you can actually do something! You don’t have time to just sit around thinking about how you might die the way you would sheltering from a modern artillery bombardment. You’re not at the mercy of terrifying forces much bigger than you are, you’re facing off at close range against a bunch of guys fundamentally no different from you, with a bunch of weapons that are fundamentally no different from yours. Unless they have elephants and you’ve never seen an elephant before, but even they weren’t as scary as you’re probably imagining. When I say “elephant” you’re probably thinking of gigantic African elephants, but nobody ever managed to tame and ride into battle. Instead they used smaller elephants; they were bigger than horses and plenty scary but there were ways to deal with them.

If you were a citizen-soldier of a Greek city-state, the comrades you fought shoulder to shoulder with would be fellow members of your peacetime community. You’d probably live your entire life within the same group of people and if you fought, you’d fight alongside them. There seems to be a lot of value in veterans maintaining social bonds with each other. This is what groups like the VFW were for, except for the ancients, there wouldn’t really be a need to go out of your way to join the VFW because the actual, specific men you fought with would still be your peers in your normal social milieu.

Also, modern warfare probably entails a lot more sleep deprivation. Partly to cope with this, modern soldiers are much more dependent on various stimulants; amphetamines and are out of fashion but nicotine and caffeine are very popular.

Modern culture also has much stronger taboos against violence. In earlier times (and I’m talking about even the 20th century or so), fistfighting was a normal part of life, slaughtering animals for food was something many if not most normal people were accustomed to doing from time to time, and people weren’t as squeamish about this sort of thing. I’m not saying this is a better way to live, but if you take a 21st century kid who might have never even squished a bug and then get him to use 21st century technology to kill people and blow things up, that’s a really big leap. Not every culture has our universal violence taboo. I’ve even read that in some nomadic and tribal cultures, men engaged in warfare practically as sport. They didn’t go raiding their enemies out of some sense of duty or competition for resources; it’s just normal behavior in their culture and if anything they enjoy it. In a lot of modern western accounts, people have admitted complicated feelings of guilt for enjoying the thrills of battle. Not every culture has hangups about this sort of thing.

So all in all I would guess that modern wars push people much farther than ancient wars did. They are operating much farther away from the normal parameters human beings evolved for (which probably were extremely violent by modern standards), in alienated and atomized modern cultures that were designed to scale beyond traditional Dunbar-scale bonds of group identity, inside of a value system that categorically taboos the kind of violence inherent to warfare, using modern weapons that have significantly more violent effects, frequently outside of normal circadian rhythms and under the influence of high doses of stimulants.

Interesting!

> earlier times (and I’m talking about even the 20th century or so), fistfighting was a normal part of life, slaughtering animals for food was something many if not most normal people were accustomed to doing from time to time, and people weren’t as squeamish about this sort of thing.

pull up murder rates for times in the past. not talking 1950s, but like 1850s, or 1650s. cities were often dangerous places, and the countryside could be scary if you weren't a local (and maybe if you were).

examples discussing these topics: https://www.nytimes.com/1994/10/23/us/historical-study-of-ho...

https://www.jstor.org/stable/43774059

from the first link:

> Professor Stone has estimated that the homicide rate in medieval England was on average 10 times that of 20th century England. A study of the university town of Oxford in the 1340's showed an extraordinarily high annual rate of about 110 per 100,000 people. Studies of London in the first half of the 14th century determined a homicide rate of 36 to 52 per 100,000 people per year.

This is true and a good point, and I think the past was genuinely more violent, but there is a confounding factor to homicide rates--medical care has also improved over time, and as a result, people today can survive physical attacks that would have been fatal in previous eras.

I think I've read in on Acoup blog somewhere, it's not a given that ancients had PTSD. E.g. Roman writers complain a lot about all aspects of warfare from fear to tedium, so it's not like they are trying to hide their supposedly then-socially-inappropriate feelings, but they never write about PTSD; it might just be a modern phenomenon.

One theory is that warfare was seen as inherently good and proper, "normal" occupation until very recently.

> To reduce stress:

> Exercise regularly. Cardio and strength training reduce stress levels and keep you mission ready.

> Get good sleep. Poor sleep or not enough sleep has a significant negative impact on wellbeing.

> Eat healthy. A good diet helps keep your body and mind in shape.

> Participate in relaxing activities. Breathing-based meditation and yoga, for example, can improve symptoms and reduce anxiety.

> Stay connected. The support of friends and family improves psychological health when facing stress

Seems like you are missing important parts such as:

> Calming physical reactions to stress. Use regular, slow breathing from your diaphragm and progressive muscle relaxation. This reduces your heart rate and anxiety.

Only from the above you can search more stuff such as [1].

[1] https://www.google.com/search?q=box+breathing+site%3Amil

Also can help you fall asleep if unable to.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361823/ ("Self-Regulation of Breathing as an Adjunctive Treatment of Insomnia")

This. Everything in the top level comment is platitudes but this is life changer whenever I remember to do it. I guess life itself is high stress operations for me

Surprised they didn't call out box-breathing. It works for me.

It's so simple:

1. inhale 4 seconds.

2. hold breath for 4 seconds.

3. exhale 4 seconds.

4. hold breath for 4 seconds.

(repeat)

I do this when I encounter any stressful situation (like public speaking, etc.). It seems to work for me.

Generalized anxiety disorder here. It stresses me out to be so square about breathing, as if I'm not allowed to do it when I feel the need to do it. Almost feeling like I'm strangling myself if I keep it up for more than a cycle or two.

Funny how humans work that this can be experienced so differently I guess!

I can relate. A softer approach is to slowly breathe in for a certain amount of time, then breathe out the same amount of time.

https://www.scientificamerican.com/article/proper-breathing-...

> I'm not allowed to do it when I feel the need to do it. Almost feeling like I'm strangling myself if I keep it up for more than a cycle or two.

I can relate.

Maybe I can offer a suggestion?

Coarsely there are two fundamental ways to approach relaxation breathing:

# The "anything goes" way

Comfortable pose, breathe at the rhythm and location your body feels like it wants to. Lay a hand whereever you feel the breathing happening. Observe the breathing, its location, rhythm, airflow.

There is no reference point so anxiety usually pop up with questions like "Am I doing this right? Was that inhale too fast/slow?", answer that with: there is no right or wrong way, there is just what is, right now. Maybe it's faster than last time, maybe it's slower; maybe it happens higher or lower. Doesn't matter, all that does is that you realise it doesn't matter, observe while noting then letting go of parasite thoughts, and go through with the exercise. This distances judgemental thoughts away.

# The structured way

4s box breathing and 4-7-8 breathing fall into that category.

Comfortable pose, one hand on chest - which aims to stay still - and one hand on abs - which aims to move -, the purported goal being to aim for diaphragmatic breathing.

It is also about being observant, it does not really matter if you miss the mark, or if your chest moves. The structure aims to provide a guiding pace, like a tow boat.

Anxiety kicks in in two ways:

a) Since there's a structure to follow, there's a reference point, and when you inevitably veer off, thoughts like "I'm doing it wrong" or "I can't do this".

b) Holding breath triggers physical fight-or-flight response, which the anxious mind is prone to listen to, and thus abort, which makes same mind think "I can't do this, I fail" in a vicious feedback loop.

Again, in both cases it's about being observant and not judgemental, essentially taking a moment to breathe is all that matters, even if it's a few seconds, so really the only way to "fail" is to not do it. Anxiety is some internal compass being off, triggering all sorts of fight-or-flight responses; by learning to be observant, anxiety is not eliminated, instead it takes a backseat, breaking the runaway feedback loop.

It's like you sprained an ankle, were incapacitated for a while, and then when the tissue damage is fixed you can't stand in balance on just that leg. That's normal, of course your ankle is weak, your sensations are off and fuzzy, your muscles can't react, what else to expect! That's where physiotherapy helps, relearning how to stand, move, walk, and it's uneasy at first, and it gets better over time.

Personally I had a very hard time even breathing in then holding my breath for 3~4s (heart pounding, growing panic state), so I found that "anything goes" helped me a lot in achieving 4-7-8, and in turn 4-7-8 helped me a lot in achieving 4s box breathing.

> Personally I had a very hard time even breathing in then holding my breath for 3~4s (heart pounding, growing panic state), so I found that "anything goes" helped me a lot in achieving 4-7-8, and in turn 4-7-8 helped me a lot in achieving 4s box breathing.

Thanks for this. I could 4s box breathing from the start but appreciate that some folks need intermediate steps to ramp up.

Also, if you are not fighting a war and your workplace is so toxic that you have to take military grade advice on stress reduction then you should look for a new job.

You can have a similar impact in your brain and body that fighting a war. Not only in a job.

As you said, one main difference is that you can quit your job but not the war. There is a detail: you can experience these feelings even if your job is not toxic.

My comment was specifically about people stuck in a toxic work environment in a civilian establishment and I made no claims about other situations.

Unfortunately you made it sounds like you deject what the page said, anyone taking the advices there is working in a toxic environment and should leave.

"There are no innocent bystanders in Hell. War is chock full of them - little kids, cripples, old ladies. In fact, except for some of the brass, almost everybody involved is an innocent bystander."

-- Hawkeye Pierce, M*A*S*H

<https://www.quotes.net/mquote/790330>

War is the job you can't quit.

That you can't legally quit.

There are plenty of ways to quit. E.g. deserting, self-wounding. You also got different forms of mutiny and "fragging" officers (not really quiting, but refusing to do the job).

As the M*A*S*H quote notes, war doesn't only involve combatants, but noncombatants, civilians, neutral parties, children, and future generations.

For the last, consider unexploded WWII ordnance routinely uncovered in Germany and the UK (an example of the latter only this week); mines in Vietnam and elsewhere in Southeast Asia, among many other theatres; Agent Orange and other chemicals utilised in various locations (including a sunken trove of mustard gas munitions aboard a US Liberty ship, the John Harvey, lost at Bari, Italy, during WWII); depleted uranium in Iraq and Afghanistan, amongst others; and the political disruptions of national borders drawn either ignorant of or to deliberately exploit local rivalries across the Middle East (Sykes-Picot), Africa, and the Indian subcontinent.

Even barring that, and allowing that there are long-term employment conditions (shipping, remote development, expeditions) which might be difficult to quit on a moment's notice, military service at the least has legal proscriptions on arbitrary quitting not found in civilian service.

Oh ye. In the broader sense. I took it to litteraly about "quiting a job". Like, you can't refuse to be bombed etc.

Bingo.

You can be a civilian and tasked with rerouting | patching the navigation and steer by wire systems of an oversized fishing trawler refitted to perform seismic survey while the majority of the crew fight a fire underneath the kerosene filled cable spools (with kilometers of microphone cables) during a monsoon storm.

That's fun, luckily most people in such situations tend to be pragmatic task solving types and few are loose cannon BP observers bouncing about screaming "I'm a teapot!" and "The pirates will get us if we don't drown!"

You don't have to be in the military to get caught up in surprise popgun atomic testing twixt India and Pakistan - you just have to be the bunny that took on a radiometric survey contract at third hand.

In hindsight these, and other adventures, are all part of the job and not worth quitting over.

As long as you're not the type that gets in a flap about every shipboard fire and runs about like a headless chicken, of course.

"while the majority of the crew fight a fire underneath the kerosene filled cable spools (with kilometers of microphone cables) during a monsoon storm."

That reads like a scene from a distater movie. I am talking regular people with day jobs!

Also, your use of India / Pakistan while you could have used any other nuclear power smells of prejudice.

> That reads like a scene from a disaster movie.

That was my day job, designing building, field testing seismic mapping systems. Lots of coding, lots of firmware, some hardware.

> Also, your use of India / Pakistan while you could have used any other nuclear power smells of prejudice.

Or simply that I'm not old enough to have been over the Monte Bello's test site when it was live, whereas we were contracted to fly radiometric surveys over the Pokhran-II test site on the day of the first explosion, and crew were detained until after the completion of the Chagai-I response.

If it helps, I've flown over many a former test site, many a tailings pond for a uranium mine in many parts of the world. It's a dull fact that the Pokran-II site is the only such place that went 'live' on a work day (in my experience at least).

- Doctor performing surgery.

- Developer building software to process/secure billions of dollars worth of transactions.

- Fire fighter, policeman, judge, etc..

- Driving on the road in a neighborhood with lots of kids.

Many jobs involve direct consequences on other people.

My job as a software dev is usually pretty cushy office job.

Then sometimes I get involved in seagoing expeditions or trials as part of it, and it changes a lot. Still very much a day job. I am not (that much of) a trained mariner. Definitely become witness to (and involved in) high-pressure situations, like "we have to winch this big yellow thing onto the deck, but it's too close to the aft and we can't reach it with the grappling hooks, it's dangerously close to getting sucked into the propellers, please please figure out how to fix the networking so we can send the CHANGE_HEADING command to get it to drift to a safe grappling distance".

It definitely does wonders for honing your Calm Problem Solving mode.

Counterpoint: Trauma is trauma. The brain doesn't care about relative measures to other situations - it responds to your own experience.

https://youtu.be/JBvc7Ny4iUk?si=A-k0KSnNQbT7rB-L

I went to basic training and looking back on it, it's almost funny how easy it was compared to other training and situations I was in, but RELATIVE to my life up to that point it was way harder than anything I had experienced as a high schooler. and relatively speaking it was harder than any other training that came later that was actually more challenging. I'm not sure if that makes sense but i'm agreeing with you.

It’s kinda weird how that works out. You’d think that every time you experienced something that was harder than anything you’d done before it would be a big deal, but apparently, basic training works on a meta-level. Instead of learning how to get through that particular hard experience, you learn that you can always get through a harder experience than you’ve ever dealt with before.

Publishing on .mil website doesn't make it "military grade".

People’s level of anxiety is unrelated to reality, that’s why it’s an anxiety.

I imagine A&E probably can feel like a warzone at times. No doubt there are also other high stakes jobs (being a firefighter?) whom we all rely on so we can enjoy the privilege of not leading such stressful lives.

Just like with space exploration - it's good for the secondary benefits of observing humans at the limits to filter back to everyday life. In this case stress management

Don't take adderall to work on someone else's startup

You are aware of your emotions by their physical impact. Emotions are in fact sensations, bodily sensations.

Observe those, step back from those, try and control those.

Observe your mind as well.

Slow your pace on purpose.

You may notice some body tension. Consciously observe and release those.

When breathing, you should feel the air going from your nostrils to the back of your throat (larynx).

If there is no reason to feel anxious but you still are, go find what is making you feel that way in the depth of your mind and make it stop. Look at what is happening in your brain, take some distance, and often it will stop on its own. Be patient until it does.

What really worked or me is combination of both Short and Long term solution.

Stress Management (Short term) - Ashvagandha medicinal tablet, jogging, breathing exercise like Anulom Vilom

Stress Relief (Long term) -

1. Vegeterian diet, small amount of green tea over coffee or any other stimulants

2.taking regularly couple of days off every month from your mobile, family and friends and do what he hell you want to do, not suppressing your irritation and depression with alcohol or marijuana but gradually helping them find outer expression in terms of any outdoor non-competitive sports activity which you actually like and not what people around you suggests

3.Understanding source of stress by giving equal (VIA POSITIVA, path of faith) or zero (VIA NEGATIVA, path of sceptic) priority to everything and everyone around you to clearly see who is supporting you to live a life you may or may not like but find it worth, this requires great courage as it may have to look beyond and grow out of your current relationship with life partner, business parter, country etc.

Ashwagandha really works well, you don't have to take it every day either. I only take it when stressed and it's like a biohack it works so well.

Strange. Does health.mil block certain IP blocks or why I can not open the article?

My Google snippet is also very peculiar:

Skills That Aid Job Performance Under High Stress

-Controlling emotions. Reduce negative thinking and fear. ...

-Calming physical reactions to stress. Use regular, slow breathing from your diaphragm and progressive muscle relaxation. ...

-Training with repetition. ...

-Visualizing tasks. ...

-Learning prioritization. ...

-Building team skills.

Not the usual people reported (sleep, exercise, taking with loved ones etc.)

Magnesium levels.

The most overlooked and underrated aspect of stress management.

How do you keep them in check?

Magnesium glycinate!

Light and noise sensitivity can be early indicators one needs additional magnesium, especially if preceded by vomiting, fever or sweating.

Effective, but it also reliably messes up my stomach

Magnesium Oxide and Magnesium Citrate also do that to me. Magnesium Glycinate (and especially Magnesium Threonate) seem to be a lot better in that regard. It also seems to help to take 25% RDA in the morning and 25% at night, rather than 100% RDA at any one time.

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