Three-Item Dimensions of Anger Reactions Scale

Importance

Problematic anger is prevalent and associated with adjustment difficulties in military populations. To facilitate measurement of problematic anger, a very brief valid measure is needed.

Objective

To reduce the Dimensions of Anger Reactions 5-item (DAR-5) scale to a very brief measure.

Design, Setting, and Participants

This cross-sectional study used survey data collected between 2014 and 2016 in the Australian Transition and Well-Being Research Programme and US Millennium Cohort Study. Participants were service members who were actively serving or had transitioned out of the military (separated). Statistical analyses were performed from September 2021 to June 2023.

Main Outcomes and Measures

The DAR-5 was reduced to the 3 experiential items: frequency, intensity, and duration (the DAR-3). Psychometrics for the DAR-3 and DAR-5 were compared in terms of standardized Cronbach α, positive screening result, mean, and SD. Analyses were stratified by Australian and US military service status cohorts (active duty and separated).

Results

A total of 71 010 participants were included from Australia and the US. Of 10 900 Australian participants (8145 active duty participants [74.7%]; 2755 separated participants [25.3%]), 5893 (55.2%) were aged 40 years or older and 8774 (80.5%) were male; of 60 110 US participants (24 706 active duty participants [41.1%]; 35 404 separated participants [58.9%]), 28 804 (47.9%) were aged 30 to 39 years and 43 475 (72.3%) were male. The DAR-3 demonstrated good internal consistency in the active duty (Australia: mean [SD] score, 4.97 [2.5]; α = 0.90; US: mean [SD] score, 5.04 [2.6]; α = 0.87) and separated (Australia: mean [SD] score, 6.53 [3.4]; α = 0.92; US: mean [SD] score, 6.05 [3.2]; α = 0.91) samples. The cutoff score of 8 or greater on the DAR-3 had optimal sensitivity and specificity across all samples. DAR-3 and DAR-5 were associated with posttraumatic stress disorder (PTSD), depression, aggression, and relationship conflict. While the scales did not significantly differ in their associations with PTSD, depression, and relationship conflict, the magnitude of association for aggression was significantly lower in US samples using the DAR-3 (eg, US active duty sample: DAR-5 OR, 9.96; 95% CI, 9.01-11.00; DAR-3 OR, 8.36; 95% CI, 7.58-9.22).

Conclusions and Relevance

In this cross-sectional study of a very brief measure of anger, each item contributed to the overall strength of the measure without losing psychometric strength compared with the DAR-5. The consistency of these findings across military and veteran samples in Australian and US populations demonstrated the psychometric robustness of the DAR-3.

Impact of mindfulness training and yoga on injury and pain-related impairment: a group randomized trial in basic combat training

Introduction

Service members are at risk for pain-related difficulties in functioning and physical injury. Previous studies suggest that mindfulness training (MT) and yoga may prevent these outcomes. The present study was designed to determine the impact of MT and yoga on the health, pain, and injury of Army trainees completing 10 weeks of basic combat training (BCT).

Methods

Platoons (≈40 trainees per platoon) were randomized to MT and yoga or training-as-usual in October to December 2020 at a large installation in the US. Self-reported outcomes were health, pain level, and pain impact on training, sleep, mood, and stress. Objective outcomes were injury-related medical encounters and number of diagnoses. The trial was registered at ClinicalTrials. Gov (NCT05550610).

Results

Intervention trainees reported significantly better health (OR = 1.05, 95% CI [1.00, 1.10]) and less impact of pain on training (OR = 0.81, 95% CI [0.74, 0.90]), sleep (OR = 0.88, 95% CI [0.81, 0.95]), mood (OR = 0.86, 95% CI [0.78, 0.96]), and stress (OR = 0.88, 95% CI [0.79, 0.98]). There was no significant difference in injury-related medical encounters (AOR = 0.70, 95% CI [0.48, 1.03]), but intervention trainees had fewer diagnoses (OR = 0.67, 95% CI [0.47, 0.95]) and were 30% less likely to have a first medical encounter at any time during BCT. This difference emerged 3 weeks into BCT.

Discussion

A combined MT and yoga intervention resulted in better trainee health. The US Army and other organizations requiring resilience under extreme stress should consider implementing MT and yoga to offset risks to employee health.

Leadership in moral awareness: Initial evidence from U.S. Army soldiers returning from deployment

OBJECTIVE

To determine whether moral awareness leadership moderated the relationship between combat experiences and soldier mental health symptoms following deployment.

METHOD

The Leadership in Moral Awareness Scale (LIMAS) was evaluated using anonymous surveys completed by 177 U.S. Army National Guardsmen. The survey also assessed general leadership, combat experiences, and posttraumatic stress disorder (PTSD), anxiety, and depression symptoms. Following factor analyses of the LIMAS, moderated regression models examined interactions between the LIMAS and combat experiences on mental health symptoms.

RESULTS

Six items were selected to comprise the LIMAS. No main effect of the LIMAS was found for mental health variables after adjusting for general leadership. There were significant interaction effects between the LIMAS and combat experiences for depression and anxiety symptoms. Soldiers with higher levels of combat experiences reported fewer mental health symptoms if their leaders were rated highly on the LIMAS.

CONCLUSIONS

The LIMAS may offer a useful tool for assessing leader behaviors that can counteract negative mental health outcomes associated with combat. Findings provide support for encouraging leaders to focus on moral awareness during deployment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Peer-based intervention for acute stress reaction: adaptations by five militaries

Military service members need to be able to operate under conditions of extreme stress to ensure the success of their team's mission; however, an acute stress reaction (ASR) can compromise team safety and effectiveness by rendering an individual unable to function. Building on an intervention originally developed by the Israel Defense Forces, several countries have developed, tested, and disseminated a peer-based intervention to help service members manage acute stress in others. This paper reviews how five countries (Canada, Germany, Norway, the UK and the USA) adjusted the protocol to fit their organisational culture while retaining essential elements of the original procedure, suggesting there can be interoperability and mutual intelligibility in the management of ASR by military allies. Future research should examine the parameters of effectiveness for this intervention, the impact of intervention on long-term trajectories, and individual differences in managing ASR.

Optimizing Performance and Mental Skills With Mindfulness-Based Attention Training: Two Field Studies With Operational Units

INTRODUCTION

Mental skills such as focusing attention and managing emotions are essential for optimal performance in high-stress occupations. Studies with military samples have demonstrated that mindfulness training (MT) led to improved computer-based cognitive performance.

MATERIALS AND METHODS

To examine the impact of MT on operational performance, mental skills, and psychological health, a short-form program, Mindfulness-Based Attention Training (MBAT), was delivered to active duty soldiers as part of two randomized trials. Participants in study 1 (n = 121) and study 2 (n = 77) were randomized to one of three conditions: MT with proctored practice, MT with unproctored practice, or a waitlist control. Weekly 2-hour MBAT sessions were offered to participants in both MT conditions for 4 weeks. Beyond these sessions, participants also engaged in mindfulness practice that was proctored (within the occupational context) or unproctored (left up to the individual) for four subsequent weeks.

RESULTS

Overall, the frequency of mindfulness practice was generally associated with better performance and improvements in mental skills. In study 1, those who practiced 3 or more days per week performed better on marksmanship under physical stress and reported fewer attentional lapses, less emotion regulation difficulties, greater mental toughness, and higher self-reported mindfulness compared to those who did not practice. In study 2, the frequency of mindfulness practice was associated with fewer attentional lapses and emotion regulation difficulties.

CONCLUSIONS

Consistent with prior findings, results suggest that regular engagement in MT practice may help to optimize operational performance and improve mental skills in military cohorts.

US soldiers and the role of leadership: COVID-19, mental health, and adherence to public health guidelines

Background

Previous studies have documented the impact of domain-specific leadership behaviors on targeted health outcomes in employees. The goal of the present study was to determine the association between specific leadership behaviors addressing COVID-19 and US soldiers’ mental health and adherence to COVID-19 public health guidelines.

Methods

An electronic, anonymous survey was administered to US Army soldiers across three major commands (N = 7,829) from December 2020 to January 2021. The primary predictor of interest was soldiers’ ratings of their immediate supervisors’ behaviors related to COVID-19. The outcomes were soldiers’ mental health (i.e., depression and generalized anxiety) and adherence to COVID-19 public health guidelines. Covariates were rank, gender, ratings of immediate supervisors’ general leadership, level of COVID-19 concerns, and COVID-19 status (e.g., tested positive, became seriously ill). Logistic regressions were used to model the unique association of COVID-19 leadership behaviors with outcomes after adjusting for covariates.

Results

High levels of COVID-19 leadership behaviors were associated with lesser likelihood of soldiers’ screening positive for depression (AOR = 0.46; 95% CI [0.39, 0.54]) and anxiety (AOR = 0.54; 95% CI [0.45, 0.64]), and greater likelihood of frequent adherence to preventive health guidelines (AORs = 1.58; 95% CI [1.39, 1.80] to 2.50; 95% CI [2.01, 3.11]).

Conclusion

Higher levels of COVID-19 leadership behaviors may support soldiers’ mental health and encourage their adherence to COVID-19 public health guidelines. Given the link between these leader behaviors and soldier adaptation to the pandemic over and above general leadership, training for supervisors should focus on targeting specific health-promoting behaviors. Results can inform leader training for the military and other high-risk occupations.

Preparing Soldiers to Manage Acute Stress in Combat: Acceptability, Knowledge and Attitudes

Objectives: iCOVER training is designed to prepare individuals in high-risk occupations to manage acute stress reactions in team members. Building on an initial pilot study, the present study evaluated iCOVER with soldiers just prior to their deployment to combat, documenting their feedback and changes in knowledge and attitudes.Methods: National guardsmen received a 1-hr training in iCOVER in the weeks prior to deploying to Iraq and Afghanistan. Surveys were administered before iCOVER training (i.e., "pre-training") and immediately afterward (i.e., "post-training"). In all, 129 of 146 (88.4%) soldiers consented to participate in the evaluation, and all consenting soldiers completed both surveys.Results: Participants rated iCOVER highly in terms of usefulness, relevance, and importance. Knowledge scores improved significantly from pre-training to post-training. In terms of attitudes, participants were more confident in their ability to handle an acute stress reaction, were more confident in their unit's ability to handle an acute stress reaction, were more likely to report their leaders emphasized the need to address acute stress, and were less likely to report stigma related to acute stress from pre-training to post-training.Conclusions: iCOVER training offers high-risk teams an opportunity to prepare for encountering acute stress in team members, strengthening the ability of teams to provide support to one another and respond effectively.

Acute Stress Reaction in Combat: Emerging Evidence and Peer-Based Interventions

PURPOSE OF REVIEW

This paper highlights the topic of combat-related acute stress reactions (ASRs) in service members. Specifically, we contrast ASRs with related psychiatric conditions, report the estimated prevalence of ASRs for soldiers deployed to combat, and discuss how team members can effectively respond to these reactions.

RECENT FINDINGS

Although not regarded as a clinical disorder, ASRs can have a significant impact on high-risk occupations like the military in which impaired functioning can imperil team members and others. Based on self-report, 17.2% of soldiers who have deployed to combat report having experienced a possible ASR. To our knowledge, this is the first such prevalence estimate. The prevalence of ASRs underscores the need for improved prevention, management, and recovery strategies. Peer-based intervention protocols such as iCOVER may provide a useful starting point to address ASRs in team members.

Post-traumatic stress disorder risk and witnessing team members in acute psychological stress during combat

BACKGROUND

Occupational groups operating in dangerous environments may witness the development of acute stress reaction (ASR) in team members. Witnessing ASR in team members may increase the risk of developing subsequent post-traumatic stress disorder (PTSD) symptoms.

AIMS

To describe ASR symptoms that individuals witness, assess the relationship between witnessing a team member exhibiting ASR symptoms and an individual's own PTSD symptoms, and describe common intervention responses by peers.

METHOD

Cross-sectional, anonymous surveys were conducted with US soldiers who were previously deployed (sample 1; n = 176) and currently deployed sample 2; n = 497). Surveys assessed combat experiences, PTSD (PTSD Checklist-5), ASR exposure and intervention responses. Analyses included frequencies and binary logistic regression.

RESULTS

Witnessing at least one ASR symptom during a combat-related event was reported by 51.7% in sample 1 and 42.4% in sample 2; the most commonly observed symptoms were being unable to function or being detached. Controlling for combat experiences, high levels of witnessing a team member exhibit ASR symptoms was associated with increased risk of subthreshold PTSD or PTSD in sample 1 (odds ratio (OR) = 8.69, 95% CI 2.29-42.60) and approached significance in sample 2 (OR = 1.67, 95% CI 0.98-2.81). Common intervention responses included providing a directive or yelling; many also reported being unsure how to respond.

CONCLUSIONS

Witnessing team members who exhibit ASR symptoms appears to be associated with screening positive for subthreshold PTSD or PTSD. Results suggest the need for further research into how to prepare individuals to manage ASR in team members and to examine ASR in other high-risk occupations.

Who sees the chaplain? Characteristics and correlates of behavioral health care-seeking in the military

Chaplains have a critical role in the military organization and health care. Using the 2015 Health-Related Behavior Survey, we compared Service Members' (SM) use of chaplaincy services to their use of other behavioral health (BH) services: 26.2% used any BH service and 8.0% met with a chaplain/clergyperson for BH. Among the 36.5% of SM who self-identified needing counseling, percentages of SMs receiving counseling were lower among those perceiving stigma associated with BH services (51.0%) than those not perceiving stigma (66.7%). Of SM who sought counseling: many used multiple counseling sources (48.0%), with the most common sources being a BH professional (71.6%), a medical doctor (37.5%), and a chaplain or clergyperson (30.2%). SM who met with a chaplain or clergyperson had more severe histories of abuse, were more likely to have a mental health diagnosis, and had fewer positive health behaviors than SM who sought other sources of counseling.

Religious beliefs and well-being and distress in congestive heart failure patients

Religiousness (typically assessed as service attendance) is often associated with well-being and psychological distress in persons with life-threatening illnesses, but little of this work has focused explicitly on religious beliefs. We examined the longitudinal relationships of religious beliefs (i.e., in God and in the afterlife) with well-being and distress (assessed 6 months later) in a sample of patients with congestive heart failure, a chronic and progressive disease. After controlling for religious service attendance, belief in God was associated with negative affect and spiritual well-being, while belief in the afterlife was associated with physical health, post-traumatic depreciation, and spiritual well-being. However, after controlling for baseline values of well-being or distress, religious beliefs were not associated with nearly all well-being or distress outcomes at follow-up. Over the 6-month duration of the study, participants increased in belief in afterlife but decreased in their belief in God. Increases in religious beliefs across time were associated with higher levels of distress. These results suggest that religious beliefs are neither positively nor negatively associated with well-being and distress independent of religious attendance among seriously ill patients with CHF. Based on these findings, healthcare providers are encouraged to assess religious belief change at the individual level to better understand and inform spiritual care for patients with late-stage CHF.

Sleep problems and functioning during initial training for a high-risk occupation

OBJECTIVES

The current study sought to characterize the sleep problems of soldiers entering Basic Combat Training and to identify the link between sleep problems and subsequent performance, psychological distress, anger reactions, and attention.

DESIGN

Soldiers were surveyed at 4 time points throughout the standard 10 weeks of Basic Combat Training. Surveys were administered at weeks 1, 3, 6, and 9. Sleep problems were identified as either present or absent at each time point using a sleep problem screening questionnaire. Four sleep patterns were identified and then used to evaluate outcomes throughout training (n = 1577).

RESULTS

When compared to those who never had a sleep problem ("healthy "; 60.6%), those who recovered from their initial sleep problem ("recovered"; 12.8%) started training with higher psychological distress and anger reactions and lower attention but steadily improved throughout training. Those who developed a sleep problem during training ("new onset"; 20.0%) and those who had a sleep problem throughout training ("chronic"; 6.6%) also started off significantly worse than the healthy group. The new-onset and chronic groups saw slower psychological distress improvement and a decline in attention throughout the course compared to the healthy group. The chronic group also significantly increased their anger reactions throughout training compared to the healthy group.

CONCLUSION

Sleep problems during Basic Combat Training may be an indicator for difficulties managing entry into the military. These findings highlight the importance of improving sleep health for soldiers throughout Basic Combat Training and for others with similar training in high-risk occupations.

Examining links between posttraumatic stress and gambling motives: The role of positive gambling expectancies

Problem gambling and gambling disorder (GD) are associated with a range of mental health concerns that extend beyond gambling behaviors alone. Prior works have consistently linked gambling disorder with symptoms of posttraumatic stress disorder (PTSD), both cross-sectionally and over time. However, very little work has examined the specific relationships between these 2 disorders. The present work postulated that symptoms of PTSD are likely associated with unique beliefs about gambling behaviors and unique motivations to gamble. Using 2 samples-an inpatient sample of U.S. Armed Forces veterans (N = 332) seeking treatment for GD and a Web-sample of gambling adults (N = 589)-we examined these ideas. Results from both samples indicated that symptoms of PTSD were related to positive gambling expectancies and coping motivations for gambling. Additionally, in both samples, positive gambling expectancies were associated with greater coping motivations for gambling. Structural equation models revealed that positive gambling expectancies were consistently associated with coping motivations for gambling. The findings indicate that symptoms of PTSD are likely associated with unique beliefs about and motivations for gambling behaviors. Given the high comorbidity between symptoms of PTSD and GD, these specific relationships are likely of clinical interest in populations seeking treatment for either PTSD or for problems with gambling behaviors. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A Randomized Trial of Contingency Management for Smoking Cessation During Intensive Outpatient Alcohol Treatment

INTRODUCTION

This randomized clinical trial was designed to evaluate the efficacy of contingency management (CM) for smoking cessation for smokers with alcohol abuse or dependence delivered concurrently with intensive outpatient alcohol treatment. The study also explored the indirect effects of CM smoking treatment and smoking cessation on alcohol and drug use outcomes.

METHODS

Alcohol abuse/dependent smokers were randomized to cognitive behavioral therapy plus nicotine replacement therapy plus contingency management (CBT+NRT+CM) or to cognitive behavior therapy plus nicotine replacement therapy (CBT+NRT) delivered concurrent with a three-week intensive outpatient alcohol treatment program.

RESULTS

Participants in the CBT+NRT+CM condition were significantly more likely to be cigarette abstinent at the end of treatment (χ²(1)=8.48, p=.004) with approximately double the carbon monoxide confirmed quit rate (60%) compared with the CBT+NRT condition (29%). At the one-month and six-month time-points there were nonsignificant differences in smoking abstinence outcomes by condition. Smoking treatment condition did not directly affect alcohol abstinence outcomes, but we observed an indirect effect of smoking treatment on alcohol and drug abstinence at one-month follow-up that was mediated by smoking cessation at the end of treatment.

CONCLUSIONS

Adding CM to an evidence-based smoking cessation treatment that included medication and behavioral counseling doubled the quit rate at the end of treatment. This finding provides strong evidence for the efficacy of CM for helping alcohol dependent smokers reach the milestone of initial smoking abstinence.

Religious socialization in African American families: the relative influence of parents, grandparents, and siblings

The family is the principal context for religious and spiritual socialization. Although religion remains a central force in the lives of most African Americans, research has failed to explore the role and impact of family on religious socialization within this population. This study addresses that gap in the literature by (1) exploring adults' perceptions of the influence of their parents, grandparents, and siblings on their religious and spiritual lives, and (2) examining the extent to which those perceptions are associated with subjective religiosity, subjective spirituality, religious importance, and commitment to religious socialization among a community sample of urban-residing African American adults in the Midwest and Northeast (N = 319). Findings revealed that, on average, parents, grandparents, and siblings positively influenced adults' religious commitment and values. However, mothers had the greatest positive influence on these outcomes. Religious commitment and values were differentially associated with family members as a function of the generation and gender of the family member. The implications of these findings are discussed.