Psychological Hardiness Predicts Success in US Army Special Forces Candidates

Prospective associations of psychedelic treatment for co-occurring alcohol misuse and posttraumatic stress symptoms among United States Special Operations Forces Veterans

This study evaluated prospective associations of ibogaine and 5-MeO-DMT treatment for risky alcohol use and post-traumatic stress disorder (PTSD) symptoms among United States (US) Special Operations Forces Veterans (SOFV). Data were collected during standard clinical operations at pre-treatment and 1-month (1 m), 3-months (3 m), and 6-months (6 m) post-treatment in an ibogaine and 5-MeO-DMT treatment program in Mexico. Of the 86 SOFV that completed treatment, 45 met criteria for risky alcohol use at pre-treatment (mean age = 44; male = 100%; White = 91%). There was a significant reduction in alcohol use from pre-treatment (M = 7.2, SD = 2.3) to 1 m (M = 3.6; SD = 3.5) post-treatment, which remained reduced through 6 m (M = 4.0; SD = 2.9; p < .001, partial eta squared = .617). At 1 m, 24% were abstinent, 33% were non-risky drinking, and 42% were risky drinkers. At 6 m, 16% were abstinent, 31% were non-risky drinking, and 53% were risky drinkers. There were no differences between responders (abstinent/non-risky drinkers) and non-responders (risky drinkers) in demographics/clinical characteristics. However, there were significant and very large differences between responders and non-responders in PTSD symptom (p < .01, d = -3.26) and cognitive functioning change (p < .01, d = -0.99). Given these findings, future clinical trials should determine whether psychedelic-assisted therapy holds promise for individuals with complex trauma and alcohol misuse who have not been successfully treated with traditional interventions.

Predictive validity of a selection instrument measuring resilience: The INSPIRE resilience scale

Military personnel needs to be resilient to be able to remain effective, motivated, and in good mental and physical health. Military organizations select on resilience to determine whether candidates are psychologically fit for their job. The INSPIRE Resilience Scale (IRS) is such a selection instrument that aims to assess the psychological resilience potential of candidates in high-risk professions. A longitudinal predictive validity study was conducted in five European Defense organizations and in the Dutch National Police. The IRS was submitted in selection (N = 11,404), and criterion data about performance and health were collected in the second half of the first training year (N = 726). The results based on correlational and regression analyses showed that the IRS scores significantly predicted the criterion measures. Emotional stability, part of the IRS, turned out to be the best predictor. Results also showed that candidates who dropped out of training had significantly lower means on the IRS in selection than candidates who were still in training in the second half of the first training year. Overall, the IRS proved to be a valid instrument to assess resilience potential in candidates for high-risk professions. Selecting on resilience may therefore contribute to training success and reduction of health problems.

Predicting ranger attrition

Elite military programs such as the 75th Ranger Regiment's Ranger Assessment and Selection Program (RASP) see rates of attrition often in excess of 50%, and amplify the need to identify and screen candidates based on their probability of successful matriculation. Models were developed (and cross-validated) to predict attrition from RASP using the physical abilities, cognitive abilities, and personality scores collected during candidate admissions screening. We report both regression weights and standardized odds ratios for optimum models of candidate success over three program timeframes to enable an understanding of the relative importance of each predictor. In spite of physical abilities scores being used to select RASP candidates, they were the strongest predictors of RASP attrition. Personality scores accounted for more variance in predicting candidate success than cognitive ability scores. Personality predictors, especially dimensions related to Openness, were better at predicting week one attrition than attrition in later weeks. The use of a single, aggregated candidate probability score for making admissions decisions is discussed, along with additional practical and scientific implications.

Differences in military personnel's hardiness depending on their leadership levels and combat experience: An exploratory pilot study

Constant challenges and permanently stressful conditions at military workplaces demand high levels of hardiness for military personnel. We aimed to determine possible differences in Ukrainian military personnel's hardiness depending on their leadership levels and existing combat experience. The study involved 543 Ukrainian service members (85.8% male and 14.2% female, aged 18 to 61 years). We used the Professional Hardiness Questionnaire and the Brief Resilience Scale. The obtained data showed that the higher leadership levels the military personnel had, the higher their hardiness was (up to the company commander level in our study). We revealed a significant predominance of professional challenge acceptance in the structure of military personnel's hardiness, followed by professional control and professional commitment. This proportion of professional hardiness components did not differ depending on service members' leadership levels. Additionally, we showed significantly higher hardiness stability after participating in combat operations in military leaders compared to service members without subordinates. Our findings necessitate hardiness examination during military personnel selection and its development during military training, in particular for deployment.

Open-label study of consecutive ibogaine and 5-MeO-DMT assisted-therapy for trauma-exposed male Special Operations Forces Veterans: prospective data from a clinical program in Mexico

Background: Research in psychedelic medicine has focused primarily on civilian populations. Further study is needed to understand whether these treatments are effective for Veteran populations.Objectives: Here, we examine the effectiveness of psychedelic-assisted therapy among trauma-exposed Special Operations Forces Veterans (SOFV) seeking treatment for cognitive and mental health problems in Mexico.Methods: Data were collected from an ibogaine and 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) clinical treatment program for SOFV with a history of trauma exposure. This clinical program collects prospective clinical program evaluation data, such as background characteristics, symptom severity, functioning (e.g., satisfaction with life, posttraumatic stress disorder symptoms, depression symptoms, anxiety symptoms, sleep disturbance, psychological flexibility, disability in functioning, cognitive functioning, neurobehavioral symptoms, anger, suicidal ideation), and substance persisting/enduring effects through online surveys at four timepoints (baseline/pre-treatment, one-, three-, and six-months after treatment).Results: The majority of the sample (n = 86; Mean Age = 42.88, SD = 7.88) were Caucasian (87.2%), non-Hispanic (89.5%), and males (100%). There were significant and large improvements in self-reported PTSD symptoms (p < .001, d = .414), depression (p < .001, d = .275), anxiety (p < .001, d = .276), insomnia severity (p < .001, d = .351), and post-concussive symptoms (p < .001, d = .389) as well as self-reported satisfaction with life (p < .001, d = .371), psychological flexibility (p < .001, d = .313) and cognitive functioning (p < .001, d = .265) from baseline to one-month follow-up.Conclusions: Data suggest combined ibogaine and 5-MeO-DMT assisted therapy has potential to provide rapid and robust changes in mental health functioning with a signal of durable therapeutic effects up to 6-months. Future research in controlled settings is warranted.

Pilot investigation of an activity-based approach to building hardiness

BACKGROUND

The purpose was to describe an activity-based psychological hardiness training programme delivered by an occupational therapist and examine its acceptability and effectiveness in improving hardiness.

METHOD

Participants (N=28) completed the 6-hour programme, which included pre/post-programme completion of the Dispositional Resilience Scale-15 (DRS-15) and a Program Evaluation Form. Paired t-tests were used to determine differences between pre-training and post-training scores on the DRS-15.

RESULTS

Results showed a significant increase (p<0.05) in total hardiness, commitment, and control scores on the DRS-15 from pre-training to post-training and good-excellent ratings for all categories on the Program Evaluation Form.

CONCLUSIONS

This programme evaluation described an occupational therapist's role in providing an activity-based psychological hardiness training programme and provided preliminary support for the acceptability of an activity-based approach to training psychological hardiness for service members.

Improving hardiness among university students: A meta-analysis of intervention studies

Introduction

Increasing the hardiness of students is a crucial objective in higher education. Universities and colleges have created a variety of interventions to improve students' overall hardiness.

Methods

In terms of the effects of such interventions, empirical research has shown inconclusive results. This meta-analysis applies 12 effect sizes from 12 independent empirical studies, with a total of 640 participants, to assess the overall impact of interventions on students' hardiness and to test for moderators, in light of the contradictory findings in prior work. The current meta-analysis calculates the standardized mean differences (SMD) of pre-post interventions. The level of study heterogeneity, represented by I ², was interpreted as small (I ² ≤ 25%), moderate (25% < I ² ≤ 50%), substantial (50% < I ² ≤ 75%), or considerable (I ² > 75%). Twelve studies met the inclusion criteria and were included in the meta-analysis.

Results

The results show that the interventions had a significant positive overall effect on students' hardiness (g = 0.998, k = 12) and show significant heterogeneity among effect sizes. Among the interventions, cognitive-based intervention yielded the largest mean effect size (g = 2.015, k = 5). Furthermore, moderator analyses suggest that the effects of the interventions on students' hardiness are moderated by respondent type, culture, intervention type, research design, years, and duration of intervention.

Discussion

We conclude that interventions that promote students' hardiness are officious. Despite the low homogeneity of the results and limitations of this meta-analysis (e.g., a small number of included studies) which might have influenced the findings, the large fail-safe N suggests that these findings are robust. The study examined potential causes of heterogeneity and emphasized the importance of further research in this area.

Predicting Firefighters' Physical Ability Test Scores from Anaerobic Fitness Parameters & Mental Toughness Levels

Physical ability test (PAT) evaluates firefighters' (FF) occupational capacity. The contribution of anaerobic systems during PAT and mental toughness (MT) relationship to PAT is unexplored. PAT modeling based on anaerobic fitness (AF), MT, and respective relationships were examined. Fourteen male FFs (Age: 29.0 ± 7.0 years) completed a PAT composed of occupationally-specific tasks in full gear. On a separate day, a series of AF assessments were performed (handgrip-dynamometry: HG; vertical-jump: VJ; Margaria-Kalamen: MK; 300-yard shuttle run: 300YD). MT was evaluated using military training MT inventory (MTMTI) and sports MT questionnaire (SMTQ). We tested the PAT model using multiple backward regression and related correlations coefficients at p < 0.05. A 78% proportion of PAT was explained by AF parameters (F_2,13 = 20.2, <0.05). PAT was significantly correlated with HG (r = -0.71, p < 0.01), VJ (r = -0.73, p < 0.01), MK (r = -0.75, p < 0.01), and with 300YD (r = 0.60, p < 0.05). MT did not demonstrate significant correlation with PAT (p > 0.01). Anaerobic system significantly contributes to PAT performance. FFs should optimize AF training, which would allow for enhanced occupational performance in PAT. Further investigation into psychological determinants of FFs is recommended.

Personality Trait Comparison of Pararescue Personnel and Elite Athletes

INTRODUCTION: Pararescue personnel (PJs) deploy in high-risk environments and perform extraordinary missions under intense conditions, requiring an unusual combination of physical and psychological abilities. The rigorous nature of PJ training and the superior levels of fitness and cognitive functioning to perform challenging physical feats in high-pressure, high-intensity environments have prompted military commanders and embedded health care providers to compare successful performance in the PJ mission with the characteristics required of elite, Olympic-level athletes.METHODS: In the current study, we tested this assumption by comparing the social, emotional, and behavioral functioning of 160 U.S. PJ training candidate graduates and 73 elite, Olympic-level track and field athletes using scores on the NEO Personality Inventory-3.RESULTS: Results from this study suggest that although there are physical and psychological challenges inherent in both the PJ and elite athlete career fields, the emotional, social, and behavioral performance of PJs differs in functional ways from the elite athlete population, with PJs scoring significantly lower in Neuroticism and higher in Extraversion and Conscientiousness.DISCUSSION: The results of this study can be used to improve the delivery of embedded mental health services geared toward improving training and enhancing health, recovery, and performance within operational units.Shadle A, Waite L, Chappelle W. Personality trait comparison of pararescue personnel and elite athletes. Aerosp Med Hum Perform. 2022; 93(11):783–790.

Psychological and Physiological Changes during Basic, Underwater, Demolition/SEAL Training

This longitudinal study examines the growth of psychological characteristics and adaptation of physiological markers of stress during a six-month assessment and selection course for U.S. Navy SEALs. Resilience, hardiness, and grit instruments were used to evaluate the psychological characteristics. Blood samples were taken to determine physiological markers related to stress adaptation; specifically, evaluating DHEA, DHEA-to-cortisol ratio, BDNF, NPY, and cortisol. Data was collected at four timepoints throughout the assessment and selection course from 353 students over three classes. Results indicated that resilience and hardiness grow after an initial decline, DHEA and DHEA-to-cortisol increased suggesting physiological adaptation. However, psychological and physiological markers do not exhibit the same growth patterns for participants in the course. This study enhances the understanding of psychological growth and physiological adaptation in a high-stress environment over an extended duration.

Conceptualizing traumatic stress and the structure of posttraumatic psychopathology through the lenses of RDoC and HiTOP

Trauma-related psychopathology, most notably posttraumatic stress disorder (PTSD), poses unique challenges for psychiatric nosology due to the wide range of symptoms and diagnoses associated with trauma and challenges representing the impact of trauma exposure on psychopathology. In this paper, we review the literature on categorical (i.e., Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases systems) versus dimensional conceptualizations of trauma-related symptoms with an emphasis on the Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP) frameworks. We identify strengths of each approach and challenges in accommodating the full range of trauma-related psychopathology and the clinical implications thereof. We discuss several potential approaches for improving the representation of traumatic stress, including the use of PTSD subtypes, trauma-related specifiers for psychiatric diagnoses, and the development of a dimension that we call the traumatic stress spectrum, which spans both adaptive and adverse reactions to trauma. These approaches to representing traumatic stress can be evaluated empirically and further refined. We also discuss how the use of an integrated RDoC-HiTOP approach to reconceptualize traumatic stress might maximize the ability to model valid and reliable trauma-related phenotypes, which would aid in the investigation of clinically relevant biological correlates.

Mindset as a resilience resource and perceived wellness of first responders in a South African context

The global increase in frequency and intensity of disasters and emergency situations has a major disruptive effect on societies that is especially visible in Africa, where conflict, poverty, diseases and social unrest are some of the biggest factors contributing to societal vulnerability. Developing countries such as South Africa are vulnerable to the impact of disaster situations that strain the society’s ability to deal with these emergencies. First responders play an important function responding to disasters but are exposed to work-related stressors that could impact their performance. Several international studies make a link between wellness, performance and resilience and the use of resilience resources in the development and enhancement of wellness, indicating that resilience resources such as a resilient mindset are an indicator of good mental health and performance amongst first responders, despite being exposed to traumatic situations. However, very little research has been carried out on first responders in South Africa, making this study an important stepping stone towards gaining an understanding of the relationship between mindset as a resilience resource and perceived wellness of first responders in a South African context. Data were collected from 52 first responders using a structured questionnaire. The results indicate a statistically significant relationship between mindset and perceived wellness, with all the wellness factors indicating that the mindset of first responders plays a crucial role in their resilience and perception of wellness, necessitating additional research in this specialised field of disaster response.

Development and Validation of an Improved Hardiness Measure

Abstract. Previous research shows that psychological hardiness is an important factor contributing to stress resilience in individuals. Of the various instruments available to measure hardiness, the most commonly used is the Dispositional Resilience Scale (DRS). Despite its demonstrated utility, the DRS-15 still has a number of serious limitations, including low subscale reliability and limited construct validity. The present work aims to create a new hardiness scale that addresses these limitations. A pool of new items plus the original DRS item set was administered to a census-matched stratified sample of N = 2,021 men and women across the United States. Items for the new scale were selected based on item distribution characteristics, item response theory plots, scale reliabilities, item-total correlations, and confirmatory factor analysis (CFA). CFA results showed the best fitting model reflected a hierarchical structure with three factors (commitment, control, and challenge) nested under a broad hardiness factor. This factor structure is replicated in two independent validation samples and also holds invariant across gender and age. The new scale shows much improved reliability coefficients (e.g., Cronbach’s α of .93, .85, .84, and .89 for total hardiness, challenge, control, and commitment, respectively), as well as structural equivalence across gender and age. Validity is demonstrated in multiple samples via predictive associations of hardiness scores with theoretically relevant outcome measures, including coping, life satisfaction, anxiety, and depression. The Hardiness Resilience Gauge (HRG) possesses excellent reliability and validity and appears to be a more effective tool for measuring hardiness in adult populations.

Lessons From Special Forces Operators for Elite Team Sports Training: How to Make the Whole Greater Than the Sum of the Parts

This methodology paper describes the design of a holistic and multidisciplinary human performance program within the Belgian Special Forces Group, the Tier 1 Special Operations unit of the Belgian Defense. Performance management approaches in the military draw heavily on sports science. The key component of the program design described here is its integrative nature, which team sports training might benefit from. The basic rationale behind the program was to bridge several gaps: the gap between physical and mental training; the gap between the curative or preventive medical approach and the performance enhancement approach; and the gap between individual and team training. To achieve this goal, the methodology of Intervention Mapping was applied, and a multidisciplinary team of training and care professionals was constituted with operational stakeholders. This was the first step in the program design. The second step took a year, and consisted of formal and informal consultations, participant observations and task analyses. These two first stages and their conclusions are described in the Method section. The Results section covers the next two stages (three and four) of the process, which aimed at defining the content of the program; and to test a pilot project implementation. The third stage encompassed the choice of the most relevant assessment and intervention tools for the target population, within each area of expertise. This is described extensively, to allow for replication. The fourth and last stage was to "test drive" the real-life integration and implementation of the whole program at the scale of a single team (8 individuals). For obvious confidentiality reasons, the content data will not be reported extensively here. Implications for wider-scale implementation and tie-back to sports team training are presented.

Meaning in life, psychological hardiness and death anxiety: individuals with or without generalized anxiety disorder (GAD)

Generalized anxiety disorder (GAD) is a widespread psychiatric disorder. According to the transdiagnostic approach, death anxiety can underpin predominantly somatic manifestations of GAD. Personal resilience factors such as a sense of a meaningful life, and psychological hardiness, which can protect people from developing clinical symptoms, may be lower in individuals with GAD. So far, there has been no study examining the role of meaning in life dimensions, death anxiety, and hardiness in individuals with GAD in Turkey. Thus, we aimed to investigate to what extent the GAD sample differs from the non-anxious control group in terms of death anxiety, meaning in life dimensions, and hardiness. Secondly, we examined how conceptually predicted death anxiety by meaning in life dimensions and hardiness regardless of diagnosis, age, and gender. Just before the spread of the Covid-19 pandemic, we could only recruit 38 individuals with GAD and 31 non-anxious control subjects. The Death Anxiety Scale, The Meaning in Life Questionnaire and the Psychological Hardiness Scale were administered to all the participants. The one-way MANOVA results with Bonferroni adjustment revealed that individuals with GAD significantly differed from the control group in every way. Hierarchical regression analysis displayed that the presence of meaning made the most significant contribution in predicting death anxiety. In conclusion, existential issues such as death anxiety, hardiness, and meaningful life can be emphasized for the treatment of GAD, and the presence of meaning is the most crucial antidote to avoid death anxiety in all individuals.

Neurobehavioral Symptoms in U.S. Special Operations Forces in Rehabilitation After Traumatic Brain Injury: A TBI Model Systems Study

INTRODUCTION

Special Operations Forces (SOF) personnel are at increased risk for traumatic brain injury (TBI), when compared with conventional forces (CF). Prior studies of TBI in military samples have not typically investigated SOF vs. CF as specific subgroups, despite documented differences in premorbid resilience and post-injury comorbidity burden. The aim of the current study was to compare SOF vs. CF on the presence of neurobehavioral symptoms after TBI, as well as factors influencing perception of symptom intensity.

MATERIALS AND METHODS

This study conducted an analysis of the prospective veterans affairs (VA) TBI Model Systems Cohort, which includes service members and veterans (SM/V) who received inpatient rehabilitation for TBI at one of the five VA Polytrauma Rehabilitation Centers. Of those with known SOF status (N = 342), 129 participants identified as SOF (average age = 43 years, 98% male) and 213 identified as CF (average age = 38.7 years, 91% male). SOF vs. CF were compared on demographics, injury characteristics, and psychological and behavioral health symptoms. These variables were then used to predict neurobehavioral symptom severity in univariable and multivariable analyses.

RESULTS

SOF personnel reported significantly greater posttraumatic stress disorder (PTSD) symptoms but less alcohol and drug use than the CF. SOF also reported greater neurobehavioral symptoms. When examining those with TBIs of all severities, SOF status was not associated with neurobehavioral symptom severity, while race, mechanism of TBI, and PTSD symptoms were. When examining only those with mTBI, SOF status was associated with lower neurobehavioral symptoms, while PTSD severity, white race, and certain mechanisms of injury were associated with greater neurobehavioral symptoms.

CONCLUSIONS

Among those receiving inpatient treatment for TBI, SOF SM/V reported higher neurobehavioral and symptom severity. PTSD was the strongest predictor of neurobehavioral symptoms and should be considered an important treatment target in both SOF and CF with co-morbid PTSD/TBI. A proactive human performance approach towards identification and treatment of psychological and neurobehavioral symptoms is recommended for SOF.

Selection/Interview Criteria for Drafting Players

One important element for forming and cultivating a high performing team in any sport is player selection. For most professional sports, this is an intense period whereby coaching, performance, and administrative staff must work together and use collective wisdom to identify players who have the best probability of consistent high performance. The stakes of a draft are high: the wrong choice can be incredibly costly and impact a team's performance and culture for many years. This article identifies and details common features of the drafting procedure, followed by a discussion of best practices for structuring and executing a draft protocol.

The workplace integration of veterans: Applying diversity and fit perspectives

Military veterans are a valuable part of the human capital resource pool. Nonetheless, veterans often struggle with their transition into civilian life and workplaces. This problem often limits the extent to which work organizations utilize their talents. Here, we briefly review relevant work from outside the management field and nascent work within the field to build a conceptual model for understanding the integration of veterans into the workplace. We do this by applying diversity and person-environment fit perspectives. A diversity standpoint helps us to understand veterans as a social group and their inclusion in the workplace, while the person-environment fit perspective helps us describe veterans’ compatibility with their work environments in terms of organizational demands and veterans’ needs. We intend for this conceptual model to guide future empirical research on veterans as human capital and their transition into civilian organizations as part of their societal reintegration, career development, and personal well-being.

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Management scholars have neglected the study of military veterans at work.

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Veterans’ workplace experiences are part of their societal reintegration.

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Diversity theory explains veterans’ discrimination, stigma, and identity strain.

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Veterans’ attributes, perspectives, and KSAs fit organizational demands.

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Meaningful work can spillover to fit veterans’ life needs.

Medical Students Immersed in a Hyper-Realistic Surgical Training Environment Leads to Improved Measures of Emotional Resiliency by Both Hardiness and Emotional Intelligence Evaluation

BACKGROUND

Burnout is being experienced by medical students, residents, and practicing physicians at significant rates. Higher levels of Hardiness and Emotional Intelligence may protect individuals against burnout symptoms. Previous studies have shown both Hardiness and Emotional IntelIigence protect against detrimental effects of stress and can be adapted through training; however, there is limited research on how training programs affect both simultaneously. Therefore, the objective of this study was to define the association of Hardiness and Emotional Intelligence and their potential improvement through hyper realistic immersion simulation training in military medical students.

METHODS

Participants in this study consisted of 68 second year medical students representing five medical schools who were concurrently enrolled in the United States military scholarship program. During a six day hyper-realistic surgical simulation training course, students rotated through different roles of a medical team and responded to several mass-casualty scenarios. Hardiness and Emotional Intelligence were assessed using the Hardiness Resilience Gauge (HRG) and the Emotional Quotient Inventory (EQ-I 2.0) respectively, at two time points: on arrival (pre-event) and after completion of the course (post-event).

RESULTS

Hardiness and Emotional Intelligence scores and sub scores consistently improved from pre-event to post-event assessments. No difference in training benefit was observed between genders but differences were observed by age where age was more often associated with Emotional Intelligence. In addition, factor analysis indicated that the HRG and EQ-I 2.0 assessment tools measured predominately different traits although they share some commonalities in some components.

CONCLUSION

This study indicates that Hardiness and Emotional Intelligence scores can be improved through immersion training in military medical students. Results from this study support the use of training course interventions and prompt the need for long term evaluation of improvement strategies on mitigating burnout symptoms.

Personal Accomplishment and Hardiness in Reducing Emergency Stress and Burnout among COVID-19 Emergency Workers

During the severe phase of the pandemic, COVID-19 emergency workers were engaged in long and numerous shifts of duty, resulting in exposure to various stress factors. A high stress level is associated with risk of burnout. Resilience and personal accomplishment can effectively help mitigate and reduce emergency stress levels and emotional exhaustion. The main aim of this study was to analyze the relationship of emergency stress and hardiness with burnout among emergency workers. The participants included 494 emergency volunteers from the Red Cross Committee in Veneto, Italy, engaged in various health, emergency, and social activities aimed at COVID-19 patients and people at risk of contracting the virus. Questionnaires used to measure emergency stress, hardiness and burnout were administered on an online platform. We analyzed the influence of age, sex, weekly hours of service, stress risk factors, and use of personal protective equipment. To verify the predictive effects of risk and protective factors on burnout, correlational and multivariate analyses, and regressions were conducted. Hardiness showed an effect in reducing emergency stress levels, emotional exhaustion, and depersonalization and simultaneously increased personal accomplishment.

Tough Teams and Optimistic Individuals: The Intersecting Roles of Group and Individual Attributes in Helping to Predict Physical Performance

This study tested the effects of individual and group-level characteristics on performance during a mandatory and challenging physical education course at the United States Military Academy (USMA). We focused on attributes related to mental toughness, and examined both self-report and utilized an other-rating scale that measures mental toughness-related characteristics and is important to USMA generally. We examined course scores for 5,581 first-year students over five academic years, accounted for background physical fitness, and determined how mental toughness attributes at the group and individual-level contributed to overall course score and scores on constituent events (e.g. obstacle course, rope climbing). Self-reported optimism, self-reported resilience, and mental toughness items from a peer rating scale, but not self-reported grit, significantly improved course performance. The average score across class section on optimism or the peer rating scale also positively covaried with course score, over and above the individual-level impact of that attribute. Analyses of individual events demonstrated that "group-level character" was important for some events, whereas individual attributes were most important for others. Findings suggested an emergent group character capable of influencing individual physical performance scores. Being a member of a tough group may have comparable effects to individual mental toughness.

The Physical Fitness Effects of a Week-Long Specialist Tactical Police Selection Course

Specialist police tactical teams, like special operations military personnel, are tasked with dangerous, high risk missions which are beyond the scope of general police. Consequently, the selection courses for entry into these teams are physiologically and psychologically demanding. The purpose of this study was to examine the physiological effects of a five-day selection course to aid in candidate preparation and course planning. Measures included body mass, grip strength, sit-and-reach flexibility, and a vertical jump assessment. Eleven candidates finished the selection course with significant decreases in body mass (-2.05 kg, p = 0.006 (95% CI = 3.65-0.45)), grip strength in the right (-14.48 kg, p < 0.001 (95% CI = 21.32-7.64)) and left (-14.27 kg, p < 0.001 (95% CI = 21.89-6.66)) hands and in sit-and-reach flexibility (-6.64 cm, p < 0.001 (95% CI = 9.94-3.33)). No significant decreases in power output or peak jump velocity of 669.77 W (95% CI = 1942.92-603.39) and 0.28 m/s (95% CI = 0.69-0.14) were found and a non-significant, overall increase in vertical jump height of 6.09 cm (95% CI = -6.08 to 18.79) was seen. Decreases in body mass, grip strength and lower limb flexibility are evident in a grueling five-day selection course. Individuals planning on attending these courses should plan for these negative effects and build redundancy into their performance to minimize the effects of fatigue, decrease injury risk and maximize chances of completion.

Coping with recruiter stress: Hardiness, performance and well-being in US Army recruiters

Recruiting for military service can be a highly stressful job, but it is one that is essential for success in the all-volunteer force. Military recruiters face a number of job stressors, including pressure to meet monthly production quotas, long work hours and time away from family. They also work in relative isolation, with limited work social support networks. These factors make recruiters vulnerable to burnout and early attrition. The present study examines psychological hardiness and active, problem focused coping as potential stress resilience resources in US Army recruiters. In a stratified random sample of N = 817 recruiters, hardiness was found to predict supervisor-rated performance and psychological well-being. Hardiness also interacted with problem focused coping to predict psychological well-being, suggesting a mediating role for coping. These results can be applied to help improve policy for selecting and training military recruiters.

"Operator syndrome": A unique constellation of medical and behavioral health-care needs of military special operation forces

OBJECTIVE

U.S. military special operation forces represent the most elite units of the U.S. Armed Forces. Their selection is highly competitive, and over the course of their service careers, they experience intensive operational training and combat deployment cycles. Yet, little is known about the health-care needs of this unique population.

METHOD

Professional consultations with over 50 special operation forces operators (and many spouses or girlfriends) over the past 6 years created a naturalistic, observational base of knowledge that allowed our team to identify a unique pattern of interrelated medical and behavioral health-care needs.

RESULTS

We identified a consistent pattern of health-care difficulties within the special operation forces community that we and other special operation forces health-care providers have termed "Operator Syndrome." This includes interrelated health and functional impairments including traumatic brain injury effects; endocrine dysfunction; sleep disturbance; obstructive sleep apnea; chronic joint/back pain, orthopedic problems, and headaches; substance abuse; depression and suicide; anger; worry, rumination, and stress reactivity; marital, family, and community dysfunction; problems with sexual health and intimacy; being "on guard" or hypervigilant; memory, concentration, and cognitive impairments; vestibular and vision impairments; challenges of the transition from military to civilian life; and common existential issues.

CONCLUSIONS

"Operator Syndrome" may be understood as the natural consequences of an extraordinarily high allostatic load; the accumulation of physiological, neural, and neuroendocrine responses resulting from the prolonged chronic stress; and physical demands of a career with the military special forces. Clinical research and comprehensive, intensive immersion programs are needed to meet the unique needs of this community.

Continuous Measurement of Reconnaissance Marines in Training With Custom Smartphone App and Watch: Observational Cohort Study

Background

Specialized training for elite US military units is associated with high attrition due to intense psychological and physical demands. The need to graduate more service members without degrading performance standards necessitates the identification of factors to predict success or failure in targeted training interventions.

Objective

The aim of this study was to continuously quantify the mental and physical status of trainees of an elite military unit to identify novel predictors of success in training.

Methods

A total of 3 consecutive classes of a specialized training course were provided with an Apple iPhone, Watch, and specially designed mobile app. Baseline personality assessments and continuous daily measures of mental status, physical pain, heart rate, activity, sleep, hydration, and nutrition were collected from the app and Watch data.

Results

A total of 115 trainees enrolled and completed the study (100% male; age: mean 22 years, SD 4 years) and 64 (55.7%) successfully graduated. Most training withdrawals (27/115, 23.5%) occurred by day 7 (mean 5.5 days, SD 3.4 days; range 1-22 days). Extraversion, positive affect personality traits, and daily psychological profiles were associated with course completion; key psychological factors could predict withdrawals 1-2 days in advance (P=.009).

Conclusions

Gathering accurate and continuous mental and physical status data during elite military training is possible with early predictors of withdrawal providing an opportunity for intervention.

Does Emotion Regulation Predict Gains in Exercise-Induced Fitness? A Prospective Mixed-Effects Study with Elite Helicopter Pilots

Emotion regulation (ER) is a strong predictor of different aspects of mental health and wellbeing. However, only recently has ER been examined in relation to physical activity and its effects on fitness. In the present study, 26 elite helicopter pilots, serving in the Spanish Air Force, were physically trained for 6 months, and their level of fitness (maximum oxygen consumption and time to exhaustion in a treadmill-running test) was assessed before and after that period. Additionally, two indices of emotion regulation (general adaptiveness of ER strategies, as measured by the Emotion Regulation Questionnaire (ERQ), and negative urgency, as measured by the UPPS-P questionnaire) measured at baseline were used as prospective predictors of fitness improvement. After controlling for individual features, baseline fitness, and type of training, better emotion regulation strategies (more cognitive reappraisal plus less expressive suppression) predicted larger fitness gains (p = 0.028). Incidental emotion regulation, as measured by the negative urgency index, failed to predict pre–post-fitness changes (p = 0.734). These results suggest that fostering emotion regulation skills may improve the effectiveness of fitness training programs.

Mental health, physical health, and health-related behaviors of U.S. Army Special Forces

Objectives

To prospectively examine the health and health-related behaviors of Army Special Forces personnel in comparison with two distinct, but functionally similar Army groups.

Methods

Special Forces, Ranger Qualified, and General Purposes Forces enrolled in the Millennium Cohort Study were identified using data from the Defense Manpower Data Center. Using prospective survey data (2001–2014), we estimated the association of Army specialization with mental health, social support, physical health, and health-related behaviors with multivariable regression models.

Results

Among the 5,392 eligible participants (84.4% General Purposes Forces, 10.0% Special Forces, 5.6% Ranger Qualified), Special Forces personnel reported the lowest prevalence of mental disorders, physical health problems, and unhealthy behaviors. In the multivariable models, Special Forces personnel were less likely to report mental health problems, multiple somatic symptoms, and unhealthy behaviors compared with General Purpose Forces infantrymen (odds ratios [OR]: 0.20–0.54, p-values < .01). Overall, Special Forces personnel were similar in terms of mental and physical health compared with Ranger Qualified infantrymen, but were less likely to sleep < 5 hours/night (OR: 0.60, 95% confidence intervals: 0.40, 0.92) and have 5 or more multiple somatic symptoms (OR: 0.69, 95% CI: 0.49, 0.98). Both Special Forces personnel and Ranger Qualified infantrymen engaged in more healthy behaviors compared with General Purpose Forces infantrymen (OR: 2.57–6.22, p-values<0.05). Engagement in more healthy behaviors reduced the odds of subsequent adverse health outcomes, regardless of specialization.

Conclusions

Army Special Forces personnel were found to be mentally and physically healthier than General Purpose Forces infantrymen, which may in part be due to their tendency to engage in healthy behaviors. Findings indicate that engagement in a greater number of healthy behaviors may reduce odds for subsequent adverse outcomes.

Personal and psychosocial factors of burnout: A survey within the French neurosurgical community

Object

The neurosurgical community is particularly exposed to burnout. The objectives of this study were to report the prevalence and associated factors of burnout within the French neurosurgical community using validated academic and psychologic scales.

Methods

A national survey was sent to 141 French residents and 432 neurosurgeons between April and July 2019. Burnout was surveyed using the Maslach burnout inventory. The survey included demographic data and several academic psychologic scales. A stepwise multiple regression was used to determine factors that are associated with burnout scores.

Results

The response rate was 100% and 23.6% for residents and neurosurgeons, respectively. Prevalence of burnout within the French neurosurgical community was 49%. There were no significant differences between residents and neurosurgeons. Two categories of factors were associated with the main dimensions of burnout during the stepwise multiple regression: personality and factors related with neurosurgical practice. Personality types such as neuroticism were negatively associated with burnout while agreeableness was protective. Work addictive profile with excessive work and absorption at work were negatively associated. Factors associated with neurosurgical practice such as conflict of work into family life, unbalanced effort to reward ratio, work duration were negatively associated. Pleasure at work was protective.

Conclusion

Prevalence of burnout is high among French neurosurgeons. Predictive models can be used to identify and prevent burnout among profiles at risk.

Big Five Personality Profiles in the Norwegian Special Operations Forces

This study is the first to report on Big Five personality traits of employees in the Norwegian military Special Operations Forces (NORSOF). Three research questions were formulated for this study, aiming to investigate (1) whether age, number of combat-deployments and rank (OR/OF) had an impact on the personalities of NORSOF employees, (2) possible personality differences between personnel organized in the underlying departments of the NORSOF, and (3) if there were personality differences between SOF-operators and conventional forces applicants. SOF-operators from the Norwegian Special Operations Commando (FSK) and the Norwegian Naval Special Operations Commando (MJK) constituted 40% of the total NORSOF sample (N = 190), whilst the term SOF-support categorized the larger proportion of non-operators. Results indicated that younger employees tended to be lower on emotional stability than older colleagues, and that those without any combat-deployments were somewhat higher on agreeableness and a bit lower on emotional stability relative to employees with such experience. Additionally, personnel with officer ranks (OF) were higher on extraversion compared to specialists (OR). Results did not show any significant intradepartmental differences in mean personality trait scores. Compared to male applicants for basic officer training in conventional forces (N = 662), SOF-operators (all males) were less extroverted, less agreeable, and slightly more emotionally stable. The authors conclude that the NORSOF attracts and recruits personnel with similarities in their Big Five personalities. Furthermore, we suggest that the personality profile that emerged for the “average” Norwegian SOF-operator is a functional one, especially when considering the desired future image of the Special Forces operative as a Warrior-Diplomat.

A novel theory on the predictive value of variation in the β-endorphin system on the risk and severity of PTSD

Despite growing interest in genetic and psychosocial indicators of heightened susceptibility to posttraumatic stress disorder (PTSD), a predictive model, which explains why some individuals develop PTSD in response to life-threatening traumatic events, while others, when faced with the same or similar experiences, do not, has thus far remained out of reach. In this paper, we review the literature on gene-environment interactions in β-endorphin system functioning with regard to PTSD and suggest that variation, both genetic and with regard to environmental stimuli, in systems which, like the β-endorphin system, distort human perception of life-threatening traumatic experiences may account for some of the variance in resilience to the disorder. Given the role of β-endorphin in both social connections and physical exercise, this becomes especially relevant with regard to military selection, training, and leadership processes.

Longitudinal associations of psychological resilience with mental health and functioning among military personnel: A meta-analysis of prospective studies

BACKGROUND

Military personnel are exposed to severe stressors across different stages of their career that may have a negative impact on mental health and functioning. It is often suggested that psychological resilience plays an important role in the maintenance and/or enhancement of their mental health and functioning under these circumstances.

METHOD

A systematic literature search was conducted using PsycINFO, MEDLINE, PsycARTICLES, Psychology and Behavioral Sciences Collection, Web of Science, and PubMed up to August of 2019 retrieving 3,698 reports. Schmidt and Hunter meta-analytical techniques were used to assess the predictive value of psychological resilience on ten different military relevant mental health and functioning outcomes. Multivariate meta-analysis assessed the origin of heterogeneity among bivariate effect sizes.

RESULTS

The effect sizes of 40 eligible peer-reviewed papers covering 40 unique samples were included in the meta-analysis. Seventy-eight percent of these studies were published after 2010 and were predominantly conducted in western countries. Bivariate effect sizes were low to medium (absolute values: 0.08 to 0.36) and multivariate effect sizes, adjusting for across studies varying sets of covariates, were low to trivial (absolute values: 0.02 to 0.08). Moderator analyses using multivariate meta-analysis on 60 bivariate effect sizes, revealed no significant effect of type of psychological resilience scale, time-lag, and career stage.

CONCLUSIONS

The current review found no indications that different conceptualizations of psychological resilience across a variety of research designs, are strongly predictive of mental health and functioning among military personnel. Future directions (moderator/mediator models, stressor type specifications, and directionality) for prospective studies are discussed. Our results question the usefulness of interventions to enhance the resilience of soldiers to improve their mental health and functioning.

Psychedelic Treatment for Trauma-Related Psychological and Cognitive Impairment Among US Special Operations Forces Veterans

BACKGROUND

U.S. Special Operations Forces Veterans are at increased risk for a variety of mental health problems and cognitive impairment associated with military service. Current treatments are lacking in effectiveness and adherence. Therefore, this study examined psychedelic treatment with ibogaine and 5-methoxy-N,N-dimethyltryptamine for trauma-related psychological and cognitive impairment among U.S. Special Operations Forces Veterans.

METHOD

We conducted a survey of Veterans who completed a specific psychedelic clinical program in Mexico between 2017 and 2019. Questions probed retrospective reports of mental health and cognitive functioning during the 30 days before and 30 days after treatment. A total of 65 people completed treatment during this time frame and were eligible for contact. Of these, 51 (78%) completed the survey and were included in data analyses (mean age = 40; male = 96%; married = 55%; Caucasian/White = 92%; Operation Enduring Freedom/Operation Iraqi Freedom Service = 96%).

RESULTS

Results indicated significant and very large reductions in retrospective report of suicidal ideation (p < .001; d = -1.9), cognitive impairment (p < .001; d = -2.8), and symptoms of posttraumatic stress disorder (p < .001; d = -3.6), depression (p < .001; d = -3.7), and anxiety (p < .001; d = -3.1). Results also showed a significant and large increase in retrospective report of psychological flexibility (p < .001; d = 2.9) from before-to-after the psychedelic treatment. Increases in the retrospective report of psychological flexibility were strongly associated with retrospective report of reductions in cognitive impairment, and symptoms of posttraumatic stress disorder, depression, and anxiety (rs range -0.61 to -0.75; p < .001). Additionally, most participants rated the psychedelic experiences as one of the top five personally meaningful (84%), spiritually significant (88%), and psychologically insightful (86%) experiences of their lives.Limitations: Several limitations should be considered including the retrospective, self-report, survey design of the study, and the lack of randomization and blinding, thus making these finding preliminary.

CONCLUSION

U.S. Special Operations Forces Veterans may have unique treatment needs because of the sequela of problems associated with repeated trauma exposure and the nature of the exposure. Psychedelic-assisted therapy with these under-researched psychedelics may hold unique promise for this population. However, controlled studies are needed to determine whether this treatment is efficacious in relieving mental health and cognitive impairment among U.S. Special Operations Forces Veterans.

Rates of Behavioral Health Conditions and Health Risk Behaviors in Operators and Support Personnel in U.S. Special Operations Forces

Objective: Rates of behavioral health disorders and potential protective factors in U.S. Special Operations Forces (SOF) have not been well studied, including differences between Operators and Support personnel, despite very high levels of combat exposure in these military personnel. The present study examined the prevalence of endorsed behavioral health problems and protective factors within a large sample of SOF personnel. Method: Anonymized data from 16,284 active duty SOF Service members from the 2016 Preservation of the Force and Family (POTFF) needs survey were analyzed. Results: Overall, the prevalence of PTSD (7.6%), depression (8.4%), alcohol misuse (12.8%), and nicotine use (28%) were comparable or lower than reported in conventional military populations. There were significant differences between Operators and Support personnel in a number of demographic and service-related variables. Operators also endorsed more direct combat exposure and scored higher on resilience and social support, and reported better quality and quantity of sleep. There were no significant group differences in rates of PTSD and depression, except lower odds (adjusted OR = 0.81) for alcohol problems in Support personnel (11.6%) compared to Operators (14.0%), p <.001, 95% CI [0.72, 0.91]. Conclusions: SOF personnel experience considerably higher exposure to combat deployments than conventional forces, yet the data from this study showed comparable or lower levels of behavioral health conditions. Although Operators were somewhat more likely than Support personnel to experience alcohol problems, they showed enhanced resilience, social support, and sleep health. Alcohol misuse is one potential target for preventive health efforts.

Personality, Work-Life Balance, Hardiness, and Vocation: A Typology of Nurses and Nursing Values in a Special Sample of English Hospital Nurses

This initial report of a longitudinal study of 192 English hospital nurses measured Nursing Values (the 6Cs of nursing); Personality, Self-Esteem and Depression; Burnout Potential; Work-Life Balance Stress; “Hardy Personality”; and Intention to Leave Nursing. Correlational, component, and cluster analysis identified four groups: “The Soldiers” (N = 79), with medium scores on most measures, who bravely “soldier on” in their nursing roles, in the face of numerous financial cuts to the National Health Service, and worsening nurse–patient ratios; “Cheerful Professionals” (N = 54), coping successfully with nursing roles, and a variety of challenges, in upwardly mobile careers; “High Achievers” (N = 39), senior nurses with strong profiles of a “hardy personality”, and commitment to fundamental nursing values; and “Highly Stressed, Potential Leavers” (N = 20), with indicators of significant psychological distress, and difficulty in coping with nursing role challenges. We have initiated a program of co-counselling and social support for this distressed group, by nurses who are coping more successfully with multiple challenges. We discuss the role of nurse educators in fostering nursing values, developing and supporting a “hardy personality” and emotional resilience in recruits to nursing. This study is framed within the disciplinary approach of Critical Realism, which identifies the value basis for research and dialogue in developing strategies for social change. The importance of this research is that: (a) it is part of the new thrust in nursing research, applying Critical Realist theory and methodology to research on nursing stress; (b) it has established, through network sampling, a group of nurses who can be supportive of each other in their stressful careers; (c) it establishes the reliability and potential validity of a measure of core nursing values; (d) it is among the first studies in research on nursing stress, to use the humanizing methodology of moving from data analysis (description of “things”), to describing a typology of nursing stress and career progress (description of individuals).

Mindfulness training as cognitive training in high-demand cohorts: An initial study in elite military servicemembers

Cognitive ability is a key selection criterion for entry into many elite professions. Herein, we investigate whether mindfulness training (MT) can enhance cognitive performance in elite military forces. The cognitive effects of a short-form 8-h MT program contextualized for military cohorts, referred to as Mindfulness-Based Attention Training (MBAT), were assessed. Servicemembers received either a 2-week (n=40) or 4-week (n=36) version of MBAT or no training (NTC, n=44). Sustained attention and working memory task performance along with self-reported cognitive failures were assessed at study onset (T1) and 8-weeks later (T2). In contrast to both the NTC and 2-week MT groups, the 4-week MT group significantly improved over time on attention and working memory outcome measures. Among the 4-week more so than the 2-week MBAT participants, working memory performance improvements were correlated with their amount of out-of-class MT practice. In addition to these group-wise effects, all participants receiving MBAT decreased in their self-reported cognitive failures from T1 to T2. Importantly, none of these improvements were related to self-reported task motivation. Together, these results suggest that short-form MT, when delivered over a 4-week delivery schedule, may be an effective cognitive training tool in elite military cohorts.