About Combat and Operational Stress Control

DoD requires the services to implement “Combat and Operational Stress Control (COSC) policies and programs to enhance readiness, contribute to combat effectiveness, enhance the physical and mental health of military personnel, and prevent or minimize adverse effects associated with combat and operational stress."[ Reference 1 ]

Core Principles within COSC:

  • Psychological interventions for combat and operational stress reactions (COSRs) implemented by first-responders, similar to those for physical injuries, to mitigate the risk of potential longer-term consequences
  • Policies to identify psychological first-response interventions for COSRs using stigma-reducing terminology (e.g., “psychological first aid”) to differentiate this assistance from clinical treatment or traditional mental health care and follow up
  • Military service COSC policy to emphasize the importance of psychological first aid as a first step in preventing complications from combat and operational stress

COSC Activities:

  • Assess unit morale, cohesion, and stress levels of the unit and individual service members

  • Evaluate combat units on a periodic basis and after exceptionally stressful events

  • Advise and assist commanders to develop courses of action to improve unit effectiveness and unit well-being

  • Conduct training about combat and operational stress

  • Engage in traumatic event management

  • Conduct outreach activities in an effort to reduce stigma related to seeking behavioral health/mental health care

PHCoE’s Role in COSC:

In support of Department of Defense Instruction (DoDI) 6490.05, “Maintenance of Psychological Health in Military Operations,” dated Nov. 22, 2011 (updated 2013), the Psychological Health Center of Excellence (PHCoE) is tasked with overseeing the COSC mission. PHCoE works with representatives across the military services to optimize the efficiency and effectiveness of COSC policies and programs. The center leads the following activities:

  • Develop and standardize required COSC data collection metrics

  • Promote COSC initiatives that prepare service members for military operations, support them during periods of transition, enhance psychological resilience, and reduce stigma associated with seeking mental health care assistance

  • Align COSC policies and programs with related psychological health and readiness policies, practices and systems within the DoD

  • Determine common DoD-wide COSC program goals

  • Identify opportunities for COSC interoperability and joint application

  • Identify evidence-based COSC-related programs and practices for recommended use by the services, as applicable

  • Annual monitoring of the quality and effectiveness of the services’ COSC programs, in coordination with the services’ quality assurance monitors.


  1. Department of Defense. (2011, November 22). Maintenance of psychological health in military operations (DoD Instruction 6490.05). Washington, DC: Author.