The Stress Continuum

Stress Continuum

The stress continuum model was developed by the Department of the Navy in 2007 as a visual tool to promote understanding that there is a range of stress responses, to shift the policies and training from mental disorders to psychological health, and develop interventions that would support service members who were injured but not disordered (Nash, 2010). The stress continuum uses a color schema of green, yellow, orange, and red as visual cues for four stress zones (Stress Continuum Figure). The stress continuum uses a cultural metaphor that used by most industrialized societies. Green lights to represent that things are working well, yellow or amber lights to warn of change, and red to indicate problems or to stop. The stress continuum is used as a metaphor for individual stress responses that considers a range from resilience through illness or disorder. The stress continuum labels the stress zones as Ready (green), Reacting (yellow), Injured (orange), and Ill (red) (Combat and Operational Stress Control (COSC), 2016).

Ready and Reacting Zones

The Ready Zone (green) represents people and workplaces that are rested, well-trained, and have the resources to meet demands. Having robust resources increases the capacity greater capacity to respond to stress events. The Reacting Zone (yellow) include physical and psychological reactions to immediate stressor related to the fight, flight, or freeze response. Reacting Zone (yellow) reactions are transient and resolve quickly when the stressor is reduced or removed.Health care settings regularly expose workers to stressful situations. Experiencing Reacting Zone (yellow)stress reactions can be part of developing competence and confidence as you face work challenges. Most people have sufficient resources and skills to recover from a Reacting Zone (yellow) stress reaction with limited assistance.Because health care workers may commonly experience yellow zone stress reactions, it is important to clarify the difference between Reacting (yellow) stress reactions and Injured Zone (orange) stress.

Injured Zone

Orange Zone stress injuries are not transient and have their origins in exposures to trauma and life threat, loss and bereavement, long-term stress exposure that results in burnout, and un-resolved moral and ethical conflicts.It is important to recognize that people can have stress injury symptoms without having a mental disorder; just as injury is different from disease.The presence of a stress injury means that additional resources are needed to resolve the injury and return to the Reacting and Ready Zones. A key strategy to help people and teams in the orange Zone is to link the right resources to address the sources of the stress injury. A peer support Stress First Aid intervention can be used by peers and family members to augment coping resources for those that present with stress injury behaviors (Combat and Operational Stress Control (COSC), 2016; Watson & Westphal 2020).The concept of Yellow Zone versus Orange Zone stress is similar to the difference between a strained versus a broken ankle. When an ankle or tendon is strained, physical therapy and controlled movement and use are often prescribed. However, when there is an injury like a broken ankle, a cast and rest are needed. In the same way, the support given for Reacting Zone (yellow) stress may need to be different from the support typically given for Injured (orange) Zone stress.

Ill Zone

The Ill Zone (red) includes the stress related mental disorders. These are conditions that exceed normal coping resources and require professional intervention or long-term augmentation with symptom management strategies (e.g., ongoing therapy, medications, lifestyle changes to reduce symptoms.There are many effective treatments for stress related illness. The goal of treatment is not to return to baseline Ready and Reacting zones but to create a new form of resilience that includes positive life changes and expanded coping resources.


Combat and Operational Stress Control (COSC). (MCTP 3-30E/NTTP 1-15M). (2016). Quantico, VA: Marine Corps Combat Development Command Retrieved from

Nash, M. W., Westphal, R. J., Watson, P., & Litz, B. (2010). Combat and Operational Stress First Aid. Washington DC: Department of Defense.

Watson, P. J. & Westphal, R. J. (2020) Stress First Aid for Health Care Workers. National Center for PTSD.