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Murdoch EM, Ayers J, Trihy E, Crane MF, Ntoumanis N, Brade C, Quested E, Gucciardi DF. Stepping back or stepping in: A qualitative investigation of self-distanced versus self-immersed stressor reflections with competitive swimmers. Stress Health 2024:e3434. [PMID: 38822817 DOI: 10.1002/smi.3434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024]
Abstract
High performance sport consists of stressor events which can disrupt an athletes' functioning and negatively influence performance. The way in which one reflects upon stressor events and develops insights regarding how they coped is essential to overcoming similar experiences in the future. We conducted a pilot randomised controlled trial with a qualitative analysis to explore the coping insights among 48 highly trained/national level swimmers in the lead up to major swimming competitions, who reflected on stressor events from self-distanced or self-immersed perspectives over a 3-week period. Using the self-reflection and coping insight framework as a guideline, we captured divers coping insights across both groups. Irrespective of the group to which they were assigned, athletes showed positive signs towards re-interpreting their stressor experience and embracing the stressor event, whereas consideration of individual values and adoption of a future-focus viewpoint were areas lacking. The emotionality described by athletes in their written reflections varied across both groups and influenced the development of coping insights. Our findings indicate a necessity to examine the emotionality associated with unique stressor events and consider integrating reflection strategies, while also enhancing the operational definitions within conceptual models of stress reflection protocols.
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Affiliation(s)
- Elizabeth M Murdoch
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Western Australian Institute of Sport, Claremont, Western Australia, Australia
| | - Joanne Ayers
- Western Australian Institute of Sport, Claremont, Western Australia, Australia
| | - Eoghan Trihy
- Western Australian Institute of Sport, Claremont, Western Australia, Australia
- School of Human Sciences (Exercise and Sport), The University of Western Australia, Perth, Western Australia, Australia
| | - Monique F Crane
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Nikos Ntoumanis
- Danish Centre for Motivation and Behaviour Science, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Norwegian School of Sport Sciences, Oslo, Norway
| | - Carly Brade
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Eleanor Quested
- Physical Activity and Well-being Research Group, enAble Institute, Curtin University, Perth, Western Australia, Australia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Daniel F Gucciardi
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Turliuc MN, Balcan AD. Psychological intervention programme for developing resilience in the military personnel. A randomized controlled trial. Stress Health 2024:e3399. [PMID: 38619082 DOI: 10.1002/smi.3399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/06/2024] [Accepted: 03/20/2024] [Indexed: 04/16/2024]
Abstract
Military gendarmes are frequently exposed to events with traumatic impact, with negative effects on emotional and physical health. The present research aims to analyse the effectiveness of Military Resilience Training (MRTR), a psychological intervention programme developed to reduce perceived stress, increase the perception of adaptive resources and strengthen resilience. Ninety-eight participants who met the inclusion criteria were enroled in a single-blind randomized controlled trial. The psychological training programme was implemented in the intervention group (n = 48) for a duration of 5 months. The participants in the control group (n = 50) were scheduled to start the training later. The levels of perceived stress, adaptive resources and resilience were measured in all participants, from the intervention and the control group, before and after the intervention, and at a 3-month follow-up. The effects of the intervention (Cohen's d) were very high for adaptive resources (d = 0.99), self-schemes (d = 1.33), family support (d = 0.70), and partner support (d = 0.66), average for resilience (d = 0.53) and stress (d = 0.49), with very high effects on military task demands (d = 1.19) and averages for friction with authority (d = 0.51). The effects were obtained only in the intervention group, and all gains were maintained at follow-up. This study provides evidence of the effectiveness of MRTR, a psychological intervention implemented in the military gendarmerie population. In the short and long term, MRTR has significant effects in reducing perceived stress, increasing the perception of adaptive resources and strengthening the resilience of military gendarmes.
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Affiliation(s)
| | - Ana-Diana Balcan
- Department of Psychology, Alexandru Ioan Cuza University of Iaşi, Iaşi, Romania
- The Group of Mobile Gendarmes of "Matei Basarab" Ploiești, Ploieşti, Prahova
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Bucknell KJ, Kangas M, Karin E, Crane MF. A randomized controlled trial comparing the effects of self-reflective writing focused on successful and unsuccessful coping experiences on resilience. Stress Health 2024; 40:e3311. [PMID: 37671436 DOI: 10.1002/smi.3311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/12/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
Evidence supports the effectiveness of self-reflective training approaches for the development of resilience. Building this work, the objective of this study was to investigate the impact of the focus of coping self-reflective activities on resilience by applying a self-reflection approach to a sample of 254 Australian ministry workers. This randomized controlled trial included three attention-matched conditions: (1) self-reflective writing focused on successful coping, (2) self-reflective writing focused on unsuccessful coping or (3) written descriptions of stressor events alone. Participants were assessed across four time points: prior to, immediately post, 3-months, and 6-months after the intervention. Results demonstrated that self-reflective writing was more effective in enhancing perceived resilience than descriptive writing. Analyses also showed greater maintenance of beneficial effects in the successful self-reflection condition, compared to the unsuccessful condition. These findings support the use of self-reflection training to strengthen individuals' psychological resilience, particularly when focused on successful coping situations for those who initially experience more ruminative thought.
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Affiliation(s)
- Kirsten J Bucknell
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Maria Kangas
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Eyal Karin
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Monique F Crane
- Centre for Elite Performance, Expertise and Training, School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
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Van Breukelen GJP. Cluster Randomized Trials with a Pretest and Posttest: Equivalence of Three-, Two- and One-Level Analyses, and Sample Size Calculation. MULTIVARIATE BEHAVIORAL RESEARCH 2024; 59:206-228. [PMID: 37590444 DOI: 10.1080/00273171.2023.2240779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
In a cluster randomized trial clusters of persons, for instance, schools or health centers, are assigned to treatments, and all persons in the same cluster get the same treatment. Although less powerful than individual randomization, cluster randomization is a good alternative if individual randomization is impossible or leads to severe treatment contamination (carry-over). Focusing on cluster randomized trials with a pretest and post-test of a quantitative outcome, this paper shows the equivalence of four methods of analysis: a three-level mixed (multilevel) regression for repeated measures with as levels cluster, person, and time, and allowing for unstructured between-cluster and within-cluster covariance matrices; a two-level mixed regression with as levels cluster and person, using change from baseline as outcome; a two-level mixed regression with as levels cluster and time, using cluster means as data; a one-level analysis of cluster means of change from baseline. Subsequently, similar equivalences are shown between a constrained mixed model and methods using the pretest as covariate. All methods are also compared on a cluster randomized trial on mental health in children. From these equivalences follows a simple method to calculate the sample size for a cluster randomized trial with baseline measurement, which is demonstrated step-by-step.
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Bekesiene S, Smaliukienė R, Vaičaitienė R, Bagdžiūnienė D, Kanapeckaitė R, Kapustian O, Nakonechnyi O. Prioritizing competencies for soldier's mental resilience: an application of integrative fuzzy-trapezoidal decision-making trial and evaluation laboratory in updating training program. Front Psychol 2024; 14:1239481. [PMID: 38374929 PMCID: PMC10875136 DOI: 10.3389/fpsyg.2023.1239481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/07/2023] [Indexed: 02/21/2024] Open
Abstract
Background The development of resilience is of the utmost importance in military training due to the demanding and high-stress nature of combat situations. Although there have been numerous studies on resilience competencies in the military, there is a research gap when it comes to identifying the most essential competencies that should be prioritized in training programs, particularly within compressed timeframes. With the current geopolitical landscape and ongoing military conflicts in Europe, it is necessary to expedite training of soldiers, including resilience training, without compromising the effectiveness of the program. This study aims to address this research gap by using a reductionist approach to resilience training and identifying the critical competencies that senior soldiers need to be trained to coach younger soldiers to maintain psychological strength during deployment. By filling this research gap, the study will contribute to the development of more efficient and targeted resilience training programs that optimize the ability of soldiers to adapt and excel in challenging military environments. Methods To address the issue, this study assessed the competencies comprising the master resilience training (MRT) program, widely recognized as one of the most effective military resilience training programs. Two groups of military experts, totaling 16 individuals, were involved in the evaluation process, representing two military contexts. The first group consisted of Ukrainian military experts whose experiences primarily focused on defending their own country's territory. The second group comprised Lithuanian military experts who had greater expertise in conducting military missions abroad. The assessment of resilience competencies was carried out using a deep analysis approach through the application of effective multi-criteria decision making (MCDM). Specifically, the decision-making trial and evaluation laboratory (DEMATEL) method was used, which is a significant multicriteria technique used to determine relationships among criteria and assign weight coefficients. In this study, the DEMATEL model was extended using trapezoidal fuzzy numbers (TrFN-DEMATEL) to accommodate decision-making under uncertainty conditions. Results The research findings highlight the critical importance of three core resilience competencies: self-regulation, mental agility and strength of character. The importance of each competency varies depending on the specific military context. When defending one's own country's territory, strength of character emerges as the key factor in enhancing soldiers' mental resilience. Conversely, during military operations abroad, self-regulation is the primary factor that promotes psychological resilience. Furthermore, the results show that these three primary competencies form a 'cause group' that influences other competencies through a cause-and-effect dependency. Conclusion Based on the findings, the theoretical conclusion is drawn that the importance of resilience competencies is contextually differentiated. Furthermore, each resilience competency is associated with a set of causes or effects. These are valuable insights for improving resilience competency training programs.
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Affiliation(s)
- Svajone Bekesiene
- General Jonas Zemaitis Military Academy of Lithuania, Vilnius, Lithuania
| | - Rasa Smaliukienė
- General Jonas Zemaitis Military Academy of Lithuania, Vilnius, Lithuania
| | - Ramutė Vaičaitienė
- General Jonas Zemaitis Military Academy of Lithuania, Vilnius, Lithuania
| | - Dalia Bagdžiūnienė
- General Jonas Zemaitis Military Academy of Lithuania, Vilnius, Lithuania
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Peterson AL, Moore BA, Evans WR, Young-McCaughan S, Blankenship AE, Straud CL, McLean CS, Miller TL, Meyer EC. Enhancing resiliency and optimizing readiness in military personnel through psychological flexibility training: design and methodology of a randomized controlled trial. Front Psychiatry 2024; 14:1299532. [PMID: 38250282 PMCID: PMC10797054 DOI: 10.3389/fpsyt.2023.1299532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Background Enhancing resiliency and optimizing readiness in military personnel is a high priority for the U.S. Department of Defense. Most military resiliency-enhancement programs are evidence-informed interventions. However, few randomized studies have demonstrated efficacy of any intervention or training program to enhance resiliency and prevent the development of psychological health symptoms in military personnel when exposed to operational stressors. This manuscript provides an overview of the theoretical foundation, research design, and research methods of a preventive intervention trial designed to evaluate the efficacy of a training program to enhance resiliency and prevent psychological health symptoms in military personnel. The resiliency training intervention is based on Acceptance and Commitment Therapy (ACT), an evidence-based intervention with broad empirical support for improving functioning in those living with psychological and medical conditions. Method/design This study will evaluate the efficacy of a two-day training program based on ACT for fostering psychological flexibility, the central target in ACT, for enhancing resiliency, and for preventing the development of psychological health symptoms. The research participants will be a non-clinical population of active duty military personnel (N = 600). The ACT-based training program (n = 300) will be compared to a military resiliency training as usual, known as Master Resilience Training (n = 300). Assessment measures will be administered at the baseline assessment, after training, prior to a military deployment, and after returning from a deployment. Qualitative interviews will be conducted to provide feedback on the training program.Clinical Trial Registration: NCT05094115.
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Affiliation(s)
- Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, United States
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, United States
| | - Brian A. Moore
- Department of Psychological Science, Kennesaw State University, Kennesaw, GA, United States
| | - Wyatt R. Evans
- VA North Texas Health Care System, Dallas, TX, United States
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, United States
| | - Abby E. Blankenship
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Casey L. Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, United States
| | | | - Tashina L. Miller
- 3rd Security Force Assistance Brigade, Fort Cavazos, TX, United States
| | - Eric C. Meyer
- Department of Counseling and Behavioral Health, University of Pittsburgh, Pittsburgh, PA, United States
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Madhusudan T, Sharma N, Sarkar S, Grover S. Clinical practice guidelines for well-being among security personnel. Indian J Psychiatry 2024; 66:S365-S371. [PMID: 38445277 PMCID: PMC10911320 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_917_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/03/2023] [Accepted: 12/10/2023] [Indexed: 03/07/2024] Open
Affiliation(s)
- T Madhusudan
- Department of Psychiatry, Army Medical Corps, India
| | - Neha Sharma
- Department of Psychiatry, Army Medical Corps, India
| | - Siddharth Sarkar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India E-mail: ,
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Anand U, Schwartz R, Stonnington CM. Using Their Words to Shape Curricula: Targeted Well-Being Programming for Graduate Medical Education Trainees. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023:10.1007/s40596-023-01906-2. [PMID: 38017332 DOI: 10.1007/s40596-023-01906-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023]
Affiliation(s)
- Uma Anand
- University of California Davis Health, Sacramento, CA, USA.
| | - Rachel Schwartz
- University of California San Francisco, San Francisco, CA, USA
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Zueger R, Niederhauser M, Utzinger C, Annen H, Ehlert U. Effects of resilience training on mental, emotional, and physical stress outcomes in military officer cadets. MILITARY PSYCHOLOGY 2023; 35:566-576. [PMID: 37903164 PMCID: PMC10617376 DOI: 10.1080/08995605.2022.2139948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/18/2022] [Indexed: 12/03/2022]
Abstract
Resilience is an important factor in counteracting the harmful effects of stress and is associated with healthy physiological and psychological responses to stress. Previous research has demonstrated the effectiveness of resilience fostering training programs in psychobiological stress response and recovery. Few studies, however, have examined training effects in real-life high-stress situations. In this study, we compare effects of a brief resilience training (RT) and an active control training in diversity management (DMT) on psychobiological stress response to and recovery from an intense military exercise of 81 male officer cadets. Five weeks after training completion, autonomic, endocrine, and subjective state measures of cadets were measured while undergoing stressful military exercise. The RT group perceived the military stressor as more challenging, and showed higher values in motivation and positive affect than the DMT group. Cortisol increased in both groups during stress, but showed a lower cortisol increase in the RT group thereafter. These results suggest that this brief resilience training helped cadets reframe the stressful situation in a more positive light, experiencing more positive emotions, and recovering faster from stress. To strengthen young military leaders in stressful situations, resilience promoting programs should become part of basic or leadership trainings.
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Affiliation(s)
- Regula Zueger
- Department of Military Psychology and Military Pedagogy Studies, Military Academy at ETH Zurich, Birmensdorf, Switzerland
| | - Madlaina Niederhauser
- Department of Military Psychology and Military Pedagogy Studies, Military Academy at ETH Zurich, Birmensdorf, Switzerland
| | - Chantal Utzinger
- Department of Military Psychology and Military Pedagogy Studies, Military Academy at ETH Zurich, Birmensdorf, Switzerland
| | - Hubert Annen
- Department of Military Psychology and Military Pedagogy Studies, Military Academy at ETH Zurich, Birmensdorf, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
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Hyun S, Ku X, Baik J. Tapping your inner psychotherapist: The effects of a growth writing for military cadets on mental health. MILITARY PSYCHOLOGY 2023:1-10. [PMID: 37722833 DOI: 10.1080/08995605.2023.2259780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 09/01/2023] [Indexed: 09/20/2023]
Abstract
Although growth writing has been verified to be effective in addressing psychological maladjustment through sequential shifts in emotion-processing strategies, there have been no further findings extending these preliminary observations to applications in the military field. This study aimed to investigate whether growth writing can serve as a novel intervention in enhancing the mental health of cadets. A total of 103 cadets (Sex ratio: 68.9% male, Age: 20.60± 2.16 years) participated in an 8-week writing program and were randomly assigned to either the growth writing group or the unstructured writing group. The growth writing group wrote structured narratives on the themes of exposure, devaluation, and benefit-finding for 30 minutes per week, focusing on the most stressful event in cadet lives. The unstructured writing group freely wrote about their feelings and thoughts regarding the most stressful event in cadet lives for 30 minutes every week. We found that growth writing resulted in greater benefits compared to unstructured writing, as indicated by a more significant reduction in stress, depression, anxiety, and anger, as well as a stronger increase in life satisfaction at the five-week follow-up. Moreover, significant changes were observed in stress, depression, anxiety, anger, and life satisfaction over the three assessment points among cadets in the growth writing group. Overall, the current findings highlight that the growth writing process can serve as a valuable form of self-psychotherapy for cadets who will face challenging battlefields in the future.
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Affiliation(s)
- Seungju Hyun
- Department of Psychology, Korea Military Academy, Seoul, Republic of Korea
| | - Xyle Ku
- Department of Psychology, Korea Military Academy, Seoul, Republic of Korea
- Department of Psychology, Seoul National University, Seoul, South Korea
| | - Jaewoong Baik
- The 9th Infantry Division, Republic of Korea Army, Goyang, South Korea
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Niederhauser M, Zueger R, Annen H, Gültekin N, Stanga Z, Brand S, Sadeghi-Bahmani D. Effects of Resilience Training on Resilient Functioning in Chronic Stress Situations among Cadets of the Swiss Armed Forces. Healthcare (Basel) 2023; 11:1329. [PMID: 37174871 PMCID: PMC10177788 DOI: 10.3390/healthcare11091329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Research on resilient functioning has gained increasing interest, and some recent studies interpreted resilience in the sense of resilient functioning to stress. In the present study, we investigated the associations between resilient functioning and coping strategies, stress reactivity, self-efficacy, and well-being, and we examined whether resilient functioning could be improved through a training intervention. The participants were 110 male cadets from two infantry officers' schools of the Swiss Armed Forces. The schools were divided into an intervention and control group. The participants in the intervention group took part in the resilience training intervention, whereas the participants in the control group performed military training as usual. Data were assessed before and after the intervention period. Results showed that resilient functioning was positively associated with task-oriented coping and well-being and negatively associated with emotion-oriented coping and stress reactivity. Furthermore, resilient functioning significantly improved in the intervention group from pre- to post-intervention. The results suggested that specific interventions have the power to increase resilient functioning.
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Affiliation(s)
- Madlaina Niederhauser
- Military Academy, Swiss Federal Institute of Technology ETH Zurich, 8903 Birmensdorf, Switzerland; (M.N.); (R.Z.)
| | - Regula Zueger
- Military Academy, Swiss Federal Institute of Technology ETH Zurich, 8903 Birmensdorf, Switzerland; (M.N.); (R.Z.)
| | - Hubert Annen
- Military Academy, Swiss Federal Institute of Technology ETH Zurich, 8903 Birmensdorf, Switzerland; (M.N.); (R.Z.)
| | - Nejla Gültekin
- Centre of Competence for Military and Disaster Medicine, Swiss Armed Forces, 3008 Bern, Switzerland; (N.G.); (Z.S.)
| | - Zeno Stanga
- Centre of Competence for Military and Disaster Medicine, Swiss Armed Forces, 3008 Bern, Switzerland; (N.G.); (Z.S.)
| | - Serge Brand
- Center for Disaster Psychiatry and Disaster Psychology, Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland;
- Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric University Hospital Basel, 4002 Basel, Switzerland
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran;
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran 25529, Iran
- Center for Disaster Psychiatry and Disaster Psychology, Psychiatric University Hospital Basel, 4002 Basel, Switzerland
| | - Dena Sadeghi-Bahmani
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran;
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
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Mavragani A, Deady M, Mead O, Foright RM, Brenneman EM, Yeager JR, Bryant RA, Harvey SB. Web-Based Mind-Body Tactical Resilience Training Program for First Responders: Pre-Post Study Assessing Feasibility, Acceptability, and Usability. JMIR Form Res 2023; 7:e40145. [PMID: 36724011 PMCID: PMC9932877 DOI: 10.2196/40145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/17/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND First responders report elevated rates of mental disorders, including posttraumatic stress disorder (PTSD), yet many are reluctant to seek care. Preventative resilience training programs attempt to proactively address this issue, and there is evidence showing promise for programs targeting cognitive processes. However, these programs rarely address the physical health conditions associated with PTSD. There is emerging evidence of mind-body exercise training improving PTSD symptoms as well as its associated physical health symptoms. However, the feasibility and acceptability of delivering a web-based mind-body resilience training among first responders are not yet known. OBJECTIVE This study aimed to evaluate the feasibility, usability, and acceptability of a web-based mind-body tactical resilience training program designed for first responders. In addition, we explored the preliminary effectiveness of the training program on mental health outcomes, adaptive cognitive strategies, and work productivity. METHODS A total of 42 first responders based in the United States enrolled in the web-based training program. Participants were administered web-based surveys before enrolling in the 6-week web-based program and at the end of the program. The primary outcomes of feasibility were measured using the number of training hours, program adherence rates, and self-reported data on frequency of practice. Acceptability and usability were measured using self-reported data. Secondary outcomes were symptoms of PTSD, psychological distress, emotion regulation, stress mindset, psychological preparedness, and work performance. RESULTS Overall, the training program was feasible based on the median number of training hours spent on the web-based program (7.57 hours out of an expected total of 6 to 9 hours), and 55% (23/42) of the enrolled participants completed more than half of the program. Although acceptability, usability, and frequency of practice were rated as high, this was based on only 29% (12/42) of the respondents who provided follow-up data. Secondary outcomes showed a significant improvement in the adaptive cognitive strategy of the stress mindset, with a mean difference of -5.42 (SD 4.81; 95% CI -8.475 to -2.358; t11=-3.898; P=.002). All other secondary outcomes were not significant. However, the secondary outcomes were exploratory only, and this study was neither designed nor powered to adequately assess efficacy. CONCLUSIONS These findings suggest that a mind-body tactical resilience training program delivered in a web-based format is feasible and acceptable among first responders; however, further refinements may be required to improve adherence rates. Further research using a larger, more rigorous trial design is warranted to examine the effectiveness of this type of training as a possible prevention or treatment strategy for this population.
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Affiliation(s)
| | - Mark Deady
- Black Dog Institute, University of New South Wales, Randwick, Australia
| | - Olivia Mead
- YogaShield Yoga For First Responders, Castle Rock, CO, United States
| | - Rebecca M Foright
- YogaShield Yoga For First Responders, Castle Rock, CO, United States.,Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Eric M Brenneman
- YogaShield Yoga For First Responders, Castle Rock, CO, United States
| | - Jamie R Yeager
- YogaShield Yoga For First Responders, Castle Rock, CO, United States
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Samuel B Harvey
- Black Dog Institute, University of New South Wales, Randwick, Australia
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Nevins NA, Singer-Chang G, Dailey SF, Roche R, Dong F, Peters SN, Thompson T, Ryznar R, LaPorta A. A Mixed Methods Investigation on the Relationship Between Perceived Self-Regard, Self-Efficacy, and Commitment to Serve Among Military Medical Students. Mil Med 2023; 188:usac430. [PMID: 36653876 DOI: 10.1093/milmed/usac430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/01/2022] [Accepted: 12/26/2022] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Routinely faced with potentially traumatizing situations, resilience is critical for military physicians. However, related studies are limited in scope. The current study distinctively combines hyper-realistic immersion training for military medical students with emotional intelligence and hardiness measures. With self-reflection shown to improve performance, qualitative inquiry was concurrently conducted in a mixed methodology approach to provide a uniquely comprehensive perspective on the resilience training needs of this population. MATERIALS AND METHODS Thirty-four osteopathic military medical students participated in a week-long training simulating real-life combat and mass casualty events. The Emotional Quotient-Inventory 2.0 (EQ-i 2.0) and Hardiness Resilience Gauge were administered as pre- and post-test measures. Paired t-tests were used to determine statistically significant gains, and a multiple case study analysis of a six-student focus group allowed for the synchronization of quantitative and qualitative data. Institutional Review Board approval for the study was obtained through Rocky Vista University with a reciprocal agreement with Touro University California's Institutional Review Board. All students participating in the study received written informed consent. RESULTS Qualitative findings for this study aligned with this current year's findings of statistically significant results in the improvement of the Overall EQ-i and Overall Hardiness. Qualitative responses thematically analyzed demonstrated environmental realism, adaptation, increased awareness, and positive interpersonal and clinical outlook. Notable increases occurred in all EQ-i domains except Decision-Making and Stress Tolerance. The Self-Perception domain saw significant increases in Self-Regard and Emotional Self-Awareness while Well-Being and Optimism simultaneously improved. CONCLUSION This unique pilot study showed that quantitative and qualitative results aligned, supporting the finding that a safe trauma-related training environment can improve the confidence and resilience in military medical students. The goal of this training was to promote resilience and mitigate trauma. Results demonstrate improved self-efficacy and enhanced commitment. Increases in self-awareness and confidence made participants more inclined to see their worth and strengthened their sense of duty as described in their qualitative responses. Pervasive gains suggest that the training aligned well with its purpose, and the methods employed enhanced participant experience. Long-term follow-up studies are needed to assess outcome sustainability.
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Affiliation(s)
- Natalie A Nevins
- Department of Family Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- College of Osteopathic Medicine, Touro University California, Vallejo, CA 94592, USA
| | - Gail Singer-Chang
- Department of Family Medicine/Social and Behavioral Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Stephanie F Dailey
- College of Education and Human Development, George Mason University, Fairfax, VA 22030, USA
| | - Rosellen Roche
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine Cleveland Campus, South Pointe Hospital, Cleveland Clinic, Warrensville Hts, OH 44122, USA
| | - Fanglong Dong
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Sara N Peters
- College of Osteopathic Medicine, Touro University California, Vallejo, CA 94592, USA
- Department of Gynecologic Surgery and Obstetrics, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Trevor Thompson
- College of Osteopathic Medicine, Touro University California, Vallejo, CA 94592, USA
- Transitional-Year Residency Program, St. Joseph's Hospital Health Center, Syracuse, NY 13203, USA
| | - Rebecca Ryznar
- Department of Military Medicine, Rocky Vista University, Parker, CO 80112, USA
| | - Anthony LaPorta
- Department of Military Medicine, Rocky Vista University, Parker, CO 80112, USA
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Kho MC, Karin E, Gucciardi DF, Crane MF. Testing a
supervisor‐led
extension of self‐reflection resilience training: A controlled trial randomized by platoon at the Royal Military College. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2022. [DOI: 10.1111/joop.12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Madison C. Kho
- School of Psychological Sciences Macquarie University North Ryde New South Wales Australia
| | - Eyal Karin
- eCentre Clinic, School of Psychological Sciences Macquarie University North Ryde New South Wales Australia
| | - Daniel F. Gucciardi
- Curtin School of Allied Health and Curtin Enable Institute Curtin University Bentley Western Australia Australia
| | - Monique F. Crane
- School of Psychological Sciences Macquarie University North Ryde New South Wales Australia
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15
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Falon SL, Hoare S, Kangas M, Crane MF. The coping insights evident through self-reflection on stressful military training events: Qualitative evidence from self-reflection journals. Stress Health 2022; 38:902-918. [PMID: 35266279 PMCID: PMC10078775 DOI: 10.1002/smi.3141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 12/22/2021] [Accepted: 02/28/2022] [Indexed: 01/01/2023]
Abstract
Research has demonstrated that adaptive forms of self-reflection on stressor events and insight may strengthen resilient capacities. However, the coping insights that emerge during self-reflection are notoriously under-researched. In this research, we sought to explore the evidence for the self-reflective activities and coping insights drawn from the Self-Reflection and Coping Insight Framework and find evidence of new reflections or insights not captured within the framework. Qualitative analysis was used to examine weekly, written self-reflective journals completed by Officer Cadets involved in a randomised-controlled trial of Self-Reflection Resilience Training. Sixty-eight Officer Cadets who submitted their journals for analysis were included. Journals were analysed using a deductive thematic approach. Findings revealed that self-reflective activities occurred frequently over the course of the intervention. Coping insights were comparatively less frequent, but conveyed complex ideas about the self in the context of stressor exposure, broad principles about stress and coping, and nuanced interpretations regarding the interaction between the efficacy of coping approaches and broader contextual and intrapersonal factors. These findings demonstrate the critical role of coping insight during Self-Reflection Resilience Training, with implications for developing a validated self-report measure of self-reflective activity and coping insight.
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Affiliation(s)
- Samantha Leigh Falon
- Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia
| | - Scott Hoare
- Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia
| | - Maria Kangas
- Department of Psychology, Centre for Emotional Health, Macquarie University, North Ryde, New South Wales, Australia
| | - Monique Frances Crane
- Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia
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16
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Riddell H, Crane M, Lang JWB, Chapman MT, Murdoch EM, Gucciardi DF. Stressor reflections, sleep, and psychological well-being: A pre-registered experimental test of self-distanced versus self-immersed reflections. Stress Health 2022. [PMID: 36166756 DOI: 10.1002/smi.3201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/22/2022] [Accepted: 09/18/2022] [Indexed: 11/06/2022]
Abstract
Evidence supports the effectiveness of cuing people to analyse negative autobiographical experiences from self-distanced rather than self-immersed perspectives. However, the evidence on which this expectation resides is limited largely to static snapshots of mean levels of cognitive and emotional factors. Via a pre-registered, randomised controlled trial (N = 257), we examined the differential effectiveness of self-distanced relative to self-immersed reflections on mean levels and within-person variability of sleep duration and quality as well as psychological well-being over a 5-day working week. Except for sleep quality, we found that reflecting from a psychologically distanced perspective, overall, was no more effective for mean levels and within-person variability of sleep duration, well-being, and stress-related factors than when the current self is fully immersed in the experiential reality of the event. We consider several substantive and methodological considerations (e.g., dosage, salience of stressor event) that require interrogation in future research via experimental and longitudinal observational methods.
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Affiliation(s)
- Hugh Riddell
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Monique Crane
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jonas W B Lang
- Department of Human Resource Management and Organisational Psychology, Ghent University, Ghent, Belgium.,Business School, University of Exeter, Exeter, UK
| | - Michael T Chapman
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Elizabeth M Murdoch
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Daniel F Gucciardi
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia.,Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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17
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Duret D, Terron-Canedo N, Hannigan M, Senior A, Ormandy E. Identifying the Barriers to Incorporating Reflective Practice into a Veterinary Curriculum. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022; 49:454-461. [PMID: 34097581 DOI: 10.3138/jvme-2020-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A portfolio with good reflective content can play a large role in learning and setting up the lifelong learning practice required by veterinary surgeons in practice or in research. The aim of this project was to investigate students' experience with their reflective diaries within an electronic portfolio (e-portfolio). Focus groups were conducted with veterinary students at the University of Liverpool in years 1-4 to explore student perceptions of the e-portfolio, with an emphasis on reflection. Three themes emerged from the qualitative analysis: assessment, understanding the assignment (i.e., is it a useful and fair exercise?), and student well-being (i.e., stress, professional accountability, anxiety). Students had clear concerns about the assessment and did not see the relevance of the reflective diaries to their future career and learning. This has led the university's School of Veterinary Science to restructure the reflections on professional skills in the portfolio.
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Does Training Motivation Influence Resilience Training Outcome on Chronic Stress? Results from an Interventional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106179. [PMID: 35627725 PMCID: PMC9140799 DOI: 10.3390/ijerph19106179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022]
Abstract
Resilience is understood as an acquired skill which aids in coping with acute and chronic stress. Accordingly, the present study aimed to determine the effect of resilience training on mental health problems during chronic stress. To this end, we conducted a quasi-experimental study with 127 male cadets (mean age: 21 years) of the Swiss Armed Forces officers' school. Whereas the intervention group (IG) received resilience training in addition to the standard officer's education program, the control group (CG) completed the officers' school as usual. Data assessment included pre- and post- measurement of chronic stress, symptoms of depression, and vital exhaustion in both groups. Motivation for training was collected before the first training session. Those who received the resilience training reported no change in chronic stress, whereas participants in the CG showed a significant increase in chronic stress over time (ηp2 = 0.025). Furthermore, significant differences between IG and CG were only found for symptoms of depression: Participants in the IG reported significantly decreased symptoms of depression, while this was not the case for participants in the CG. Within the IG, participants' training motivation strongly influenced the effectiveness of the resilience training. More specifically, motivated individuals were more likely to benefit from the resilience training than unmotivated ones. Outcome data suggest that resilience training appeared to favorably affect chronic stress and related mental health symptoms; however, the motivation for the training seemed to be an essential prerequisite.
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19
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Kunzelmann A, Rigotti T. Challenge Demands and Resilience. ZEITSCHRIFT FUR ARBEITS-UND ORGANISATIONSPSYCHOLOGIE 2022. [DOI: 10.1026/0932-4089/a000363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract. This study investigates the relationship of challenge demands (i. e., time pressure, job complexity) on employee resilience. We provide insights into potential pathways (i. e., learning, cognitive irritation) for how challenge stressors influence employee resilience. We employed a two-wave, time-lagged design to examine the influences of challenge stressors and explanatory pathways on employee resilience 2 months later. The data from 359 participants (52.1 % male) were analyzed using a Bayesian time-lagged path model. Results indicate that time pressure and job complexity are negatively related to employee resilience via cognitive irritation. In contrast, we found a positive, indirect effect of job complexity and resilience via learning. This paper contributes to existing employee resilience and stress research by highlighting the roles of learning and cognitive irritation to explain the relationships of challenge stressors on employee resilience. Moreover, the results provide us with a deeper understanding of which factors foster or drain employee resilience.
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Affiliation(s)
- Arian Kunzelmann
- Psychological Institute, Department of Work-, Organizational- and Business Psychology, Johannes Gutenberg University Mainz, Germany
| | - Thomas Rigotti
- Psychological Institute, Department of Work-, Organizational- and Business Psychology, Johannes Gutenberg University Mainz, Germany
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
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20
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Merritt VC, Brickell TA, Bailie JM, Hungerford L, Lippa SM, French LM, Lange RT. Low resilience following traumatic brain injury is strongly associated with poor neurobehavioral functioning in U.S. military service members and veterans. Brain Inj 2022; 36:339-352. [PMID: 35171749 DOI: 10.1080/02699052.2022.2034183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the relationship between resilience and self-reported neurobehavioral functioning following traumatic brain injury (TBI) in U.S. military service members and veterans (SMVs). A secondary objective was to examine the interaction between resilience and posttraumatic stress disorder (PTSD) on neurobehavioral functioning. METHOD Participants included 795 SMVs classified into four groups: Uncomplicated Mild TBI (MTBI; n=300); Complicated Mild, Moderate, Severe, or Penetrating TBI (STBI, n 162); Injured Controls (IC, n=185); and Non-injured Controls (NIC, n=148). Two independent cohorts were evaluated - those assessed within 1-year of injury and those assessed 10-years post-injury. SMVs completed self-report measures including the PTSD Checklist-Civilian version, Neurobehavioral Symptom Inventory, and TBI-Quality of Life. RESULTS Results showed that (1) lower resilience was strongly associated with poorer neurobehavioral functioning across all groups at 1-year and 10-years post-injury, and (2) PTSD and resilience had a robust influence on neurobehavioral functioning at both time periods post-injury, such that SMVs with PTSD and low resilience displayed the poorest neurobehavioral functioning. CONCLUSION Results suggest that regardless of injury group and time since injury, resilience and PTSD strongly influence neurobehavioral functioning following TBI among SMVs. Future research evaluating interventions designed to enhance resilience in this population is indicated.
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Affiliation(s)
- Victoria C Merritt
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Bethesda, MD, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Contractor, General Dynamics Information Technology, Falls Church, VA, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Contractor, General Dynamics Information Technology, Falls Church, VA, USA.,Naval Hospital Camp Pendleton, Oceanside, CA, Oceanside, CA, USA
| | - Lars Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Contractor, General Dynamics Information Technology, Falls Church, VA, USA.,Naval Medical Center San Diego, San Diego, CA, USA
| | - Sara M Lippa
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Bethesda, MD, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Bethesda, MD, USA.,Contractor, General Dynamics Information Technology, Falls Church, VA, USA.,University of British Columbia, Vancouver, BCCanada
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21
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Bucknell K, Kangas M, Crane M. Adaptive self-reflection and resilience: The moderating effects of rumination on insight as a mediator. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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22
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Doody CB, Robertson L, Cox KM, Bogue J, Egan J, Sarma KM. Pre-deployment programmes for building resilience in military and frontline emergency service personnel. Cochrane Database Syst Rev 2021; 12:CD013242. [PMID: 34870330 PMCID: PMC8647095 DOI: 10.1002/14651858.cd013242.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Military personnel and frontline emergency workers may be exposed to events that have the potential to precipitate negative mental health outcomes such as depression, symptoms of post-traumatic stress and even post-traumatic stress disorder (PTSD). Programmes have been designed to build psychological resilience before staff are deployed into the field. This review presents a synthesis of the literature on these "pre-deployment resilience-building programmes". OBJECTIVES The objective of this review was to assess the effectiveness of programmes that seek to build resilience to potentially traumatic events among military and frontline emergency service personnel prior to their deployment. These resilience programmes were compared to other interventions, treatment as usual or no intervention. SEARCH METHODS Studies were identified through searches of electronic databases including Ovid MEDLINE, Embase, PsycINFO, Web of Science and Google Scholar. The initial search took place in January 2019, with an updated search completed at the end of September 2020. SELECTION CRITERIA Only studies that used a randomised controlled trial (RCT)/cluster-RCT methodology were included. The programmes being evaluated must have sought to build resilience prior to exposure to trauma. Study participants must have been 18 years or older and be military personnel or frontline emergency workers. DATA COLLECTION AND ANALYSIS Studies that met the inclusion criteria were assembled. Data extracted included methods, participants' details, intervention details, comparator details, and information on outcomes. The primary outcomes of interest were resilience, symptoms of post-traumatic stress and PTSD. Secondary outcomes of interest included acute stress disorder, depression, social support, coping skills, emotional flexibility, self-efficacy, social functioning, subjective levels of aggression, quality of sleep, quality of life and stress. Assessment of risk of bias was also completed. A total of 28 studies were included in a narrative synthesis of results. MAIN RESULTS All 28 included studies compared an experimental resilience building intervention versus a control or no intervention. There was a wide range of therapeutic modalities used, including cognitive behavioural therapy (CBT) informed programmes, biofeedback based programmes, stress-management programmes, mindfulness and relaxation programmes, neuropsychological-based programmes, and psychoeducational-informed programmes. The main outcomes are specified here, secondary outcomes such as depression, social support, coping skills, self-efficacy, subjective levels of aggression and stress are reported in text. No studies reported on the following pre-specified outcomes; acute stress disorder, emotional flexibility, social functioning, quality of sleep and quality of life. Resilience Eight studies reported resilience as an outcome. We narratively synthesised the data from these studies and our findings show that five of these interventions had success in building resilience in their respective samples. Two of the studies that reported significant results utilised a CBT approach to build resilience, while the other three successful programmes were mindfulness-based interventions. Symptoms of post-traumatic stress Our narrative synthesis of results included eight studies. Two of the eight studies produced significant reductions in symptoms of post traumatic stress compared to controls. These interventions used neuropsychological and biofeedback intervention models respectively. PTSD caseness Four studies reported PTSD caseness as an outcome. Our narrative synthesis of results suggests that evidence is mixed as to the effectiveness of these interventions in reducing clinical diagnosis of PTSD. One study of a neuropsychology-orientated Attention Bias Modification Training (AMBT) programme had success in reducing both symptoms of post-traumatic stress and numbers of participants receiving a diagnosis of PTSD. A stress-management programme reported that, when baseline differences in rates of pre-deployment mental health issues were controlled for, participants in the control condition were at 6.9 times the risk of a diagnosis of PTSD when compared to the intervention group. Given the diversity of intervention designs and theoretical orientations used (which included stress-management, neuropsychological and psychoeducational programmes), a definitive statement on the efficacy of pre-deployment programmes at reducing symptoms of post-traumatic stress and PTSD cannot be confidently offered. AUTHORS' CONCLUSIONS While a number of evaluations of relevant programmes have been published, the quality of these evaluations limits our ability to determine if resilience-building programmes 'work' in terms of preventing negative outcomes such as depression, symptoms of post-traumatic stress and diagnoses of PTSD. Based on our findings we recommend that future research should: a) report pre-/post-means and standard deviation scores for scales used within respective studies, b) take the form of large, RCTs with protocols published in advance, and c) seek to measure defined psychological facets such as resilience, PTSD and stress, and measure these concepts using established psychometric tools. This will provide more certainty in future assessments of the evidence base. From a clinical implications point of view, overall there is mixed evidence that the interventions included in this review are effective at safe guarding military personnel or frontline emergency workers from experiencing negative mental health outcomes, including PTSD, following exposure to potentially traumatic events. Based on this, practitioners seeking to build resilience in their personnel need to be aware of the limitations of the evidence base. Practitioners should have modest expectations in relation to the efficacy of resilience-building programmes as a prophylactic approach to employment-related critical incident traumas.
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Affiliation(s)
- Colm B Doody
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Lindsay Robertson
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Katie M Cox
- National University of Ireland Galway, Galway, Ireland
| | - John Bogue
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jonathan Egan
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Kiran M Sarma
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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Ben-Avraham R, Afek A, Berezin Cohen N, Davidov A, Van Vleet T, Jordan J, Ben Yehudah A, Gilboa Y, Nahum M. Feasibility and preliminary effectiveness of mobile cognitive control training during basic combat training in the military. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1969162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Rina Ben-Avraham
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Anat Afek
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Noa Berezin Cohen
- Department of Health and Well-Being, Medical Corps, Israel Defense Forces (IDF), Israel
| | - Alex Davidov
- Medical Branch, Ground Forces, Israel Defense Forces (IDF), Israel
| | - Tom Van Vleet
- Department of Research and Development, Posit Science Corporation, San Francisco, California
| | - Josh Jordan
- Department of Psychology, Dominican University of California, San Rafael, California
| | - Ariel Ben Yehudah
- Department of Health and Well-Being, Medical Corps, Israel Defense Forces (IDF), Israel
| | - Yafit Gilboa
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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24
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Brassington K, Lomas T. Can resilience training improve well-being for people in high-risk occupations? A systematic review through a multidimensional lens. THE JOURNAL OF POSITIVE PSYCHOLOGY 2021. [DOI: 10.1080/17439760.2020.1752783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Tim Lomas
- School of Psychology, University of East London, London, UK
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25
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Falon SL, Kangas M, Crane MF. The coping insights involved in strengthening resilience: The Self-Reflection and Coping Insight Framework. ANXIETY STRESS AND COPING 2021; 34:734-750. [PMID: 33834896 DOI: 10.1080/10615806.2021.1910676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recent theoretical work suggests that self-reflection on daily stressors and the efficacy of coping strategies and resources is beneficial for the enhancement of resilient capacities. However, coping insights emerging from self-reflection, and their relationship to resilient capacities, is an existing gap in our understanding. OBJECTIVES Given that insights come in many forms, the objective of this paper is to delineate exemplar coping insights that strengthen the capacity for resilience. METHODS After providing an overview of self-reflection and insight, we extend the Systematic Self-Reflection model of resilience strengthening by introducing the Self-Reflection and Coping Insight Framework to articulate how the emergence of coping insights may mediate the relationship between five self-reflective practices and the enhancement of resilient capacities. RESULTS We explore the potential for coping insights to convey complex ideas about the self in the context of stressor exposure, an awareness of response patterns to stressors, and principles about the nature of stress and coping across time and contexts. CONCLUSIONS This framework adds to existing scholarship by providing a characterization of how coping insight may strengthen resilient capacities, allowing for a guided exploration of coping insight during future research.
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Affiliation(s)
- Samantha L Falon
- Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - Maria Kangas
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Monique F Crane
- Department of Psychology, Macquarie University, North Ryde, NSW, Australia
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Hruska B, Barduhn MS. Dynamic psychosocial risk and protective factors associated with mental health in Emergency Medical Service (EMS) personnel. J Affect Disord 2021; 282:9-17. [PMID: 33387746 DOI: 10.1016/j.jad.2020.12.130] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/31/2020] [Accepted: 12/23/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND EMS personnel have a heightened risk of developing posttraumatic stress disorder (PTSD) and major depression relative to other occupational populations necessitating a greater understanding of the risk and protective factors that operate each day in relation to this risk. This study examined dynamic psychosocial factors and their relationship with daily mental health symptoms among EMS workers. The psychosocial factors examined consisted of occupational stressors, sleep disturbance, social conflict, meaning made from the day's challenges, recovery activities, social support, and perceived prosocial impact. METHOD Seventy-nine EMS workers recruited from an emergency medical service provider in Central New York completed a daily assessment for 8 days asking questions about occupational stressors encountered, sleep efficiency, social conflicts, meaning made from the day's challenges, recovery activities engaged in, social support received, and perceived prosocial impact. RESULTS Daily occupational stressors were associated with elevated daily PTSD symptom severity (b = 0.13, SE = 0.06, p = .023). Social conflicts were associated with greater depression symptom severity (b = 0.75, SE = 0.14, p < .001); the meaning made from day's stressors (b = -0.17, SE = 0.05, p = .002) and the recovery activities engaged in (b = -0.30, SE = 0.07, p < .001) were associated with lower daily depression symptom severity. LIMITATIONS A relatively modest sample size and small sampling window may constrain the generalizations made from this study. CONCLUSIONS Occupational stressors and social conflicts are key risk factors related to the daily expression of PTSD and depression symptom severity in EMS workers. The meaning made from the day's challenges and the recovery activities engaged in may protect against depression. These results reveal several dynamic psychosocial factors that aid in understanding features of the work day that contribute to the mental health burden observed among EMS personnel.
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Affiliation(s)
- Bryce Hruska
- Department of Public Health, Syracuse University, Syracuse, NY, USA.
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Collins D, Collins L. Developing coaches' professional judgement and decision making: Using the 'Big 5'. J Sports Sci 2020; 39:115-119. [PMID: 32822272 DOI: 10.1080/02640414.2020.1809053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Coaching can be seen, in large part, as a decision-making game in which coaches must decide on and then deploy an optimum blend of tools to best meet the needs of performance and context. Examining this concept through a lens of professional judgement and decision making, research has shown positive benefits for this approach to understanding and enhancing the coaching process and its outcomes. To date, however, there has been less attention paid to the development of simple applied tools which can be used to facilitate these skills. Accordingly, this paper describes the Big 5, a structured approach to critical reflection which can be used to improve coaching. Following its description, we present some preliminary data on the impact of the Big 5 in a sample of professional adventure sports coaches.
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Affiliation(s)
- Dave Collins
- Moray House School of Education and Sport, University of Edinburgh , Edinburgh, UK.,Grey Matters Performance Ltd , Stratford upon Avon, England
| | - Loel Collins
- Plas Y Brenin National Outdoor Centre , Capel Curig, North Wales
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Crane MF, Kho M, Kangas M, Griffin B, Karin E, Earl JK, Harris CB. Strengthening resilience in over 50’s: a nested clustered-randomized controlled trial of adaptive systematic self-reflection. ANXIETY STRESS AND COPING 2020; 33:623-641. [DOI: 10.1080/10615806.2020.1768375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Monique F. Crane
- Department of Psychology, Macquarie University, North Ryde, Australia
| | - Madison Kho
- Department of Psychology, Macquarie University, North Ryde, Australia
| | - Maria Kangas
- Department of Psychology, Macquarie University, North Ryde, Australia
| | - Barbara Griffin
- Department of Psychology, Macquarie University, North Ryde, Australia
| | - Eyal Karin
- eCentre Clinic, Department of Psychology, Macquarie University, North Ryde, Australia
| | - Joanne K. Earl
- Department of Psychology, Macquarie University, North Ryde, Australia
| | - Celia B. Harris
- Department of Cognitive Science, Macquarie University, North Ryde, Australia
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Crane MF, Kangas M, Karin E, Searle B, Chen D. Leveraging the experience of stressors: the role of adaptive systematic self-reflection. ANXIETY STRESS AND COPING 2020; 33:231-247. [DOI: 10.1080/10615806.2020.1732359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Monique F. Crane
- Department of Psychology, Macquarie University, North Ryde, Australia
| | - Maria Kangas
- Department of Psychology, Centre for Emotional HealthMacquarie University, North Ryde, Australia
| | - Eyal Karin
- Department of Psychology, eCentre Clinic, Macquarie University, North Ryde, Australia
| | - Ben Searle
- Department of Psychology, Macquarie University, North Ryde, Australia
| | - Diana Chen
- Department of Psychology, Macquarie University, North Ryde, Australia
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Crane MF, Rapport F, Callen J, Boga D, Gucciardi DF, Sinclair L. Military police investigator perspectives of a new self-reflective approach to strengthening resilience: A qualitative study. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1645537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Monique F. Crane
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Joanne Callen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Danny Boga
- Department of Psychology, Macquarie University, Sydney, Australia
- Directorate of Occupational Psychology, Commonwealth Department of Defence, Canberra, Australia
| | - Daniel F. Gucciardi
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Laura Sinclair
- Directorate of Strategic and Operational Mental Health, Commonwealth Department of Defence, Canberra, Australia
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