- Army Comprehensive Soldier Fitness Program
- Comprehensive Soldier Fitness Program Regulation
- Army Global Assessment Tool
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1. REPORT DATE (DD-MM-YYYY)
27-12-2011
2. REPORT TYPE
Technical Report
4. TITLE AND SUBTITLE
The Comprehensive Soldier Fitness Program Evaluation. Report #3: Longitudinal Analysis of the Impact of Master Resilience Training on Self-Reported Resilience and Psychological Health Data, December 2011
3. DATES COVERED (From - To)
01OCT09-01DEC11
5a. CONTRACT NUMBER
W91WAW-10-D-0086
5b. GRANT NUMBER
NA
5c. PROGRAM ELEMENT NUMBER
NA 6. AUTHOR(S)
CPT Paul B. Lester, Ph.D.; P.D. Harms, Ph.D.; Mitchel N. Herian, Ph.D.; Dina V. Krasikova, Ph.D.; Sarah J. Beal, Ph.D.
5d. PROJECT NUMBER
Partial Fulfillment 5e. TASK NUMBER 5f. WORK UNIT NUMBER
7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES)
8. PERFORMING ORGANIZATION REPORT NUMBER
9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES)
10. SPONSOR/MONITOR’S ACRONYM(S)
TKC Global Solutions LLC, 3201 C St STE 400F, Anchorage, AK 99503-3967
Comprehensive Soldier Fitness, 2530 Crystal Drive, 5th Floor, 5130, Arlington, VA 22203
DAMO-CSF
11. SPONSOR/MONITOR’S REPORT NUMBER(S) 12. DISTRIBUTION / AVAILABILITY STATEMENT
Public distribution / availability
13. SUPPLEMENTARY NOTES
Prepared in cooperation with the University of Nebraska ’s College of Business Administration.
14. ABSTRACT
This technical report is the third in a series of reports evaluating the impact of the Army’s Comprehensive Soldier Fitness (CSF) Program. This report focused on determining the efficacy of the train-the-trainer component of CSF – Master Resilience Trainer (MRT) – in influencing Soldier resilience and psychological health (R/PH) across time. Four Brigade Combat Teams (BCTs) received MRT skills training (Treatment condition), while four additional BCTs did not (Control condition). Measures of R/PH were taken three times across approximately 15 months (baseline, T1, T2), and demographics, quality of unit leadership, and quality of unit cohesion were accounted for. Analyses show that Soldiers in the Treatment condition exhibited significantly higher R/PH scores at T2 than did Soldiers in the Control condition. Also, MRT skills training appears to be significantly more effective for Soldiers 18-24 years old than older Soldiers. Additional contextual analyses are provided. 15. SUBJECT TERMS
Comprehensive Soldier Fitness; Resilience; Efficacy; Effectiveness; Master Resilience Trainer 16. SECURITY CLASSIFICATION OF: None a. REPORT
b. ABSTRACT
17. LIMITATION OF ABSTRACT c. THIS PAGE
18. NUMBER OF PAGES
UU
19a. NAME OF RESPONSIBLE PERSON
CPT Paul B. Lester
19b. TELEPHONE NUMBER (include area
72
code)
703-545-4338 Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std. Z39.18
The Comprehensive Soldier Fitness Program Evaluation Report #3: Longitudinal Analysis of the Impact of Master Resilience Training on Self-Reported Resilience and Psychological Health Data December 2011
COMPREHENSIVE SOLDIER FITNESS STRONG MINDS STRONG BODIES l
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The Comprehensive Soldier Fitness Program Evaluation Report #3: Longitudinal Analysis of the Impact of Master Resilience Training on Self-Reported Resilience and Psychological Health Data December 2011 CPT Paul B. Lester, Ph.D. Research Psychologist Comprehensive Soldier Fitness P.D. Harms, Ph.D. Assistant Professor University of Nebraska–Lincoln Mitchel N. Herian, Ph.D. Research Analyst TKC Global Dina V. Krasikova, Ph.D. Post-Doctoral Research Associate University of Nebraska–Lincoln Sarah J. Beal, Ph.D. Statistical Consultant TKC Global
Corresponding Author: CPT Paul Lester, G-3/5/7, DAMO-CSF [email protected] Desk: 703-545-4338 BB: 703-677-0561 This report was produced in partial fulfillment of contract #W91WAW-10-D-0086-0002.
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TABLE OF CONTENTS TABLE OF TABLES iv TABLE OF FIGURES iv ACKNOWLEDGEMENTS v EXECUTIVE SUMMARY 1 INTRODUCTION 3 COMPREHENSIVE SOLDIER FITNESS AND THE MEASUREMENT OF RESILIENCE AND PSYCHOLOGICAL HEALTH
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DATA AND METHOD
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RESULTS 15 DISCUSSION, IMPLICATIONS, & RECOMMENDATIONS 23 CONCLUSION 27 REFERENCES 28 APPENDIX A 36 APPENDIX B 48
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TABLE OF TABLES Table 1. GAT Scales and Constructs Used to Measure Soldier R/ PH 10 Table 2. MRT Training Skills and Theoretical Bases 11 Table 3. R/ PH Scales and Expectations Regarding MRT Training 14 Table 4. Differences between Treatment and Control Conditions at Time 2 15 Table 5. Comparison of Treatment and Control Conditions by Age 18 Table 6. Significant Relationships between MRT Survey Data and Soldier R/ PH: 21 18-24 Year Old Soldiers Table A1. MRT Training and Global Assessment Tool Crosswalk 37 Table A2. Summary of Penn Resiliency Program (PRP) Evaluations 40 Table A3. Summary of Military Stress Interventions 45 Table B1. MANOVA: Comparison of Means at Time 1 49 Table B2. MANOVA: Change from Time 1 to Time 2 50 Table B3. Regression: Interactions between Age and MRT Training 51 Table B4. Regression: Interactions between Gender and MRT Training 52 Table B5. Regression: Interactions between Leadership and MRT Training 53 Table B6. Regression: Interactions between Unit Cohesion and MRT Training 54 Table B7. Intraclass Correlation Coefficients for MRT Training Survey Data 55 Table B8. Regression: Effect of Formal Training on R/ PH for Soldiers 18-24 Years Old 56 Table B9. Regression: Effect of Perceived Preparedness to Train on R/ PH for 57 Soldiers 18-24 Years Old Table B10. Regression: Effect of Perceived Command Support on R/ PH for 58 Soldiers 18-24 Years Old Table B11. Regression: Effect of Formal Training on R/ PH for Soldiers Over 24 Years Old 59 Table B12. Regression: Effect of Perceived Preparedness to Train on R/ PH for 60 Soldiers Over 24 Years Old Table B13. Regression: Effect of Perceived Command Support on R/ PH for 61 Soldiers Over 24 Years Old
TABLE OF FIGURES Figure 1. Treatment Conditions and Assignment of MRTs Figure 2. Change in Fitness from Time 1 to Time 2: Comparing Treatment and Control Conditions Figure 3. Significant Interactions between Age and MRT Training at Time 2 Figure 4. Effect Sizes for Differences in Time 2 Fitness Scores between Treatment and Control Conditions by Age
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ACKNOWLEDGEMENTS Comprehensive Soldier Fitness would like to thank the men and women of: 11th Armored Cavalry Regiment, Fort Irwin, California 170th Infantry Brigade Combat Team, Baumholder, Germany 2nd Brigade, 1st Infantry Division, Fort Riley, Kansas 3rd Brigade, 1st Infantry Division, Fort Knox, Kentucky 1st Brigade, 4th Infantry Division, Fort Carson, Colorado 2nd Brigade, 4th Infantry Division, Fort Carson, Colorado 3rd Brigade, 4th Infantry Division, Fort Carson, Colorado 1st Brigade, 25th Infantry Division, Fort Wainwright, Alaska
Our research team would like to thank the following people who helped us in this endeavor. This report would not have been possible without their support. Comprehensive Soldier Fitness: Brigadier General Rhonda Cornum – Director, Comprehensive Soldier Fitness Colonel Thomas Vail – Deputy Director, Comprehensive Soldier Fitness Mr. Michael Porcaro – Knowledge Manager Ms. Katherine Nasser – Data Systems Manager Mr. Samuel Goldgeier – Data Systems Manager Mr. Aaron Mack – Research Analyst Ms. Megan McGuffey – Administrative Assistant
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Executive Summary Top Line Message: There is now sound scientific evidence that Comprehensive Soldier Fitness improves the resilience and psychological health of Soldiers. Background: The purpose of this report is to present empirical evidence of the effectiveness of Comprehensive Soldier Fitness (CSF) at improving Soldier-reported resilience and psychological health (R/ PH). More specifically, this report focuses on the effectiveness of the train-the-trainer component of CSF, known as Master Resilience Trainer (MRT). Though program evaluation of CSF will continue into the future, this report represents a significant milestone in a longitudinal analysis effort involving more than 22,000 Soldiers across eight Brigade Combat Teams (BCTs). Methodology: Eight BCTs were randomly selected for participation in this program evaluation (see Figure 1, p. 12). A total of 96 Master Resilience Trainers completed the 10-day MRT course at the University of Pennsylvania, Philadelphia, and each returned to one of four BCTs; these four BCTs comprised the Treatment condition. Due to training throughput constraints at the MRT course, four additional BCTs did not receive MRTs over the life of this program evaluation initiative; these four BCTs comprised the Control condition. Measures of R/ PH––using the Global Assessment Tool (GAT)––were taken three times over approximately 15 months. A baseline measure was taken in early 2010. Another measure of R/ PH was taken again in the latter part of 2010 (Time 1), and this measure coincided with CSF publishing its training guidance to be implemented by all MRTs across the Army. A final measure of R/ PH was taken again approximately six months later in 2011 (Time 2). Demographics (i.e., age, gender) and organizational factors (i.e., quality of unit leadership, unit cohesion) were also assessed in our analyses given that these two variables could moderate the relationship between MRT training and R/ PH. Key Findings: • The Treatment condition (units with MRTs) exhibited significantly higher R/ PH scores at Time 2 than did the Control condition (units without MRTs) (see Table 4, p. 15). Quality of unit leadership and unit cohesion did not significantly impact the effect of MRT training on R/ PH at Time 2. • In some areas of R/ PH, the Treatment condition had a higher rate of growth than the Control condition (see Figure 2, p. 16). • MRT training appears to be significantly more effective for 18-24 year olds than for older Soldiers (see Figure 4, p. 19). • Training provided by MRTs is most effective when the training is conducted in formal settings (e.g., scheduled classes), when Commands select confident leaders to serve as MRTs, and when Commands properly support their MRTs. • There is no evidence that Soldier R/ PH scores decrease or that Soldiers “get worse” due to training provided by MRTs. • The effect sizes reported here are consistent with or better than many other population-wide developmental interventions and public health initiatives.
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Introduction
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n the midst of prolonged military engagements around the globe, U.S. Army’s senior leadership has programmatically sought to assist Soldiers in handling exposure to traumatic events on the battlefield, assist them in coping with stressful events and circumstances in their daily lives, and provide them with training that may help them thrive in the face of a variety of adversities. The purpose of this report is to present the results of an evaluation of the effectiveness of one such effort––the Comprehensive Soldier Fitness (CSF) program. The CSF program involves a range of training interventions designed to increase Soldier resilience and psychological health (R/ PH) across four broad areas of fitness. Drawing on recent scholarly research, CSF teaches Soldiers various ways to improve their ability to respond to stressful events.
members of their unit via a prescribed curriculum. The expectation of this program is that Soldiers who were trained by MRTs will report higher levels of R/ PH than Soldiers who received no training. Accordingly, this report addresses four broad evaluation questions:
This is the third in a series of reports examining the implications and effectiveness of enhancing Soldier R/ PH under the auspices of the CSF program. The first two reports established the nature of the relationship between Soldier resilience and both positive and negative behavioral outcomes. The first report (Lester, Harms, Bulling, Herian, & Spain, 2011a) provided evidence that Soldiers who used illicit drugs, committed violent crimes, or committed suicide reported having lower levels of R/ PH before the event occurred than did Soldiers who did not engage in such behaviors. The second report (Lester et al., 2011b) showed that Officers promoted early and selected for command had significantly higher levels of R/ PH than Officers not promoted early or selected for command. Though the results from these studies were not surprising, together they serve to underscore the relationship between Soldier resilience and behavioral outcomes that have critical implications for the readiness of the Army.
3) Which demographic or contextual variables, if any, enhance the effectiveness of MRT training?
The current report differs from the first two in that it focuses specifically on the effectiveness of the resilience and psychological health enhancement training program developed by CSF. In particular, this report examines the effectiveness of the Master Resilience Training (MRT) program at improving Soldier-reported R/ PH scores over time. MRT is a train-the-trainer program based in part upon a long-standing research initiative conducted at the University of Pennsylvania. Soldiers selected for MRT are trained at a variety of locations and return to their units to then teach MRT skills to other
1) Do Soldiers in units that received training from MRTs report higher R/ PH scores than Soldiers who were not trained by MRTs? 2) Over time, do the R/ PH scores of Soldiers exposed to MRT training improve at a greater rate than Soldiers not exposed to the training?
4) Does the effectiveness of the training depend on whether MRTs formally train their units? Is the training more effective when MRTs feel better prepared to train and when they feel they have the support of their Command? In order to address these questions, a group of Soldiers who were exposed to training provided by MRTs were compared to a group of Soldiers who were not exposed to the training over a 15-month period of time. More specifically, four Brigade Combat Teams (BCTs) received one MRT per roughly 100 Soldiers assigned to the unit (these four BCTs will be referred to as the Treatment condition in this report), while four other BCTs did not receive an MRT due to throughput constraints inherent with a new training course (these four BCTs will be referred to as the Control condition in this report). Data were captured when MRTs were first introduced to the Treatment condition (this wave of data will be referred to as Baseline), then again eight months later when CSF published detailed training guidance to be implemented locally by the MRTs (this wave of data will be referred to as Time 1), and finally six months later (this wave of data will be referred to as Time 2). Demographic and contextual data were also captured across each time point. To assess the potential 3
impact of formal MRT training within units, MRTs were surveyed about whether they actually formally trained MRT skills to Soldiers, about whether they felt they were adequately trained in the MRT course, and whether the Command supported them in delivering MRT training to Soldiers. The results of the program evaluation showed that Soldiers in units with MRT trainers exhibited higher levels of R/ PH. In particular, at Time 2, the Treatment condition’s R/ PH scores were significantly better than the Control condition on various aspects of Emotional and Social Fitness. When measuring the impact of MRT training over time (change in R/ PH from Time 1 to Time 2), the results showed that the Treatment condition improved significantly more than the Control condition on a number of aspects of R/ PH. As noted, additional analyses were conducted in order to determine whether demographic variables (age and gender) and contextual variables (quality of leadership and unit cohesion), might impact the effectiveness of the training. Results showed that the effects of having MRT trainers in their units produced more pronounced effects for younger Soldiers (18-24 year olds). In comparison to older Soldiers (over 24 years old), younger Soldiers demonstrated changes on more aspects of R/ PH and also showed larger effects on dimensions where training enhanced R/ PH across both age groups. That said, it should be noted that older Soldiers typically reported higher R/ PH overall, irrespective of training condition. Gender did not moderate the effectiveness of MRT training. Examining organizational factors that might influence R/ PH scores, we found no evidence that the quality of unit leadership or unit cohesion moderated the effects of MRT training. Finally, we found that the effects of having MRT trainers embedded in units were greater in those units in which MRTs formally trained Soldiers, felt more efficacious regarding their ability to train others, and felt that they had the support of their Command.
April 2011––because prior to that no detailed training guidance existed for MRTs to implement within their units. Consequently, though the current report suggests that MRT training is effective, it remains to be seen what the long-term effects of the program will be, especially on important objective health outcomes. It is possible that the effects of the program may be enhanced as further training is conducted and MRTs become more proficient in their mission. Furthermore, as analyses of similar programs have suggested (e.g., Gillham, Reivich, Jaycox, & Seligman, 1995), the effects of resilience training may actually increase over time as Soldiers encounter more stressful life events. Alternatively, it is also possible that the effects may diminish as the novelty of the program wears off. For these reasons, further monitoring and assessment of the program’s effectiveness is both warranted and advisable, and CSF plans to do so in the future. Beyond this introduction, this report has four distinct sections. In Section 2, further details are provided about CSF and its relationship to recent research regarding psychological resilience. In Section 3, the data, research design, and analytic strategy that drive this evaluation effort are described. This section includes a description of the Global Assessment Tool (GAT)––the online survey instrument used to measure R/ PH. In Section 4, the results of the evaluation are reported in greater detail. Finally, Section 5 provides a discussion of the results and the implications of the findings of the present program evaluation for future efforts to enhance Soldier R/ PH. References and appendices are also provided. Appendix A includes a review of additional research related to interventions designed to enhance resilience. Appendix B includes detailed tables that present the results of all statistical tests included in this evaluation.
In light of these findings, it is noteworthy that the CSF program has only been in the field for short period of time. Though the program evaluation assessment period ran for 15 months, this evaluation focused on assessing the effects of MRT training during a condensed period of time––the six-month period from October 2010 to 4
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CSF & the Measurement of R/PH
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esilience entails the maintenance of normal functioning despite negative events or circumstances, disruptions, or changes in demands (Bonanno, 2004; Luthar, Cicchetti, & Becker, 2000; Masten, 2001). In the context of CSF, resilience refers to overall physical and psychological health, and has been described as the ability to “bounce back from adversity” (Reivich, Seligman, & McBride, 2011). Recent emphasis on resilience in the face of traumatic events (e.g., Bonanno, 2004, 2005), as opposed to emphasis on adverse reactions to trauma (e.g., Breslau, 2001), has begun to shift researchers’ focus toward seeking a broader understanding of adaptive responses to trauma exposure (see Wald, Taylor, Asmundson, Jang, & Stapleton, 2006). This general shift is represented by literature that examines the characteristics of resilient people (e.g., Connor & Davidson, 2003; Kobasa, 1979; Lyons, 1991; Rutter, 1985), explores the intersection of concepts and measures related to psychological resilience (Connor & Davidson, 2003), and analyzes the relationships between resilience training and various outcomes of interest (Cornum, Matthews, & Seligman, 2011). For the purpose of this report, there are two points related to resilience that deserve emphasis. First, research has provided evidence that resilience is potentially a state-like product of a number of developmental, cognitive, and affective psychological processes (e.g., Bonanno, 2004; Connor & Davidson, 2003; Luthans, Vogelgesang, & Lester, 2006; Masten, 2001; Wald et al., 2006; Werner, 1990). Second, and following from the first point, evidence suggests people can learn to be resilient (Connor & Davidson, 2003; Luthans, 2002; Luthans, Norman, & Hughes, 2006; Luthar & Cicchetti, 2000). Each of these points will be considered. Until recently, resilience was considered to be rare (Luthans et al., 2006; Masten, 2001). More recently, researchers have found that resilience is much more common than was once thought (Bonanno, 2004; Masten, 2001). Thus, researchers have sought to discover what characteristics, if any, grant some individuals a strong capacity to handle adverse experiences. Progress has been made in highlighting a number of internal (e.g., coping strategies) and external (e.g., socio-demographic) factors related to resilience
among individuals. These include, but are not limited to, internal factors such as hardiness (Maddi, 2005), optimism (Carver & Scheier, 2002), self-efficacy (Rutter, 1985), coping strategies (Mikulincer & Solomon, 1989), hope (Snyder et al., 1991), the tendency to search for benefits through adversity (Affleck & Tennen, 1996), and positive emotionality (Fredrickson, 2001). External factors include such constructs as community support, friendships, parental influence, opportunity, and education (Masten, 2001; Masten & Coatsworth, 1998; Werner, 1995). Relationships between these psychological constructs and stress resistance have been found within a variety of applied settings. To briefly name a few examples: In a medical setting, Rose, Fliege, Hildebrandt, Schirop, and Klapp (2002) found that active coping behavior and self-efficacy significantly predicted healthrelated quality of life and improved glycemic control levels among Type 2 diabetes patients. Taylor et al. (1992) found that optimism was associated with a higher degree of perceived symptom control, as well as decreased psychological distress, among AIDS patients. In an organizational context, Bartone (1999) demonstrated that hardiness predicted fewer symptoms of combat stress among Army Reserve personnel deployed to the Persian Gulf War. Sharkansky et al. (2000) found active coping strategies to be related to fewer posttraumatic stress disorder (PTSD) symptoms among combat personnel. Avey, Luthans, and Jensen (2009) found that a combination of the traits hope, optimism, resilience, and self-efficacy (labeled positive psychological capital) were related to reduced work stress. Finally, Fredrickson, Tugade, Waugh, and Larkin (2003) found that positive emotions experienced in the wake of the September 11th terrorist attacks buffered against symptoms of depression and aided posttraumatic growth. As previously mentioned, evidence suggests that resilience is a characteristic that can be learned. The association between positive psychological constructs and increased stress resistance implies that increasing such factors could potentially lead to an increase in resilience. Indeed, the results of numerous empirical evaluations of programs designed to increase resilience provide evidence for the efficacy of psycho-educational programs to increase resilience––evidenced by their
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attenuating effect on stress-related outcomes (e.g., depressive symptoms and PTSD). For example, the Penn Resiliency Program (PRP) (Gillham, Jaycox, Reivich, Seligman, & Silver, 1990) utilized methods for increasing resilience-related constructs in an intervention designed to reduce depressive symptoms among children and adolescents. Recently, interventions designed to increase resilience to deployment- and return-related stress and attrition have shown positive results among military populations. Williams et al. (2004, 2007), for example, found that the BOOT STRAP intervention, designed to increase problemsolving coping strategies, perceived social support, and unit cohesion, led to reduced separation for psychiatric reasons and improved performance among Navy recruits in training. Similarly, Adler, Bliese, McGurk, Hoge, and Castro (2009) found that BATTLEMIND debriefing and training, designed to increase resilience through education and cognitive-behavioral based training, led to fewer PTSD and depressive symptoms among Soldiers returning from combat deployment (for a more extensive review and detailed results of the preceding programs, see Appendix A). Taken together, this body of literature provides evidence of the potential for increasing the resilience of individuals through education and/or training. To reiterate, resilience, viewed through the lens of psychological health, refers to both the ability to effectively deal with stressful events and to better cope in the time following a stressful event. Evidence suggests that resilience is related to a number of the psychological and interpersonal constructs measured by the Global Assessment Tool (GAT), many of which are related to effective coping in a number of different contexts. As research has shown, resilience, while exhibited at varying levels across individuals, is something that can be taught and learned. Comprehensive Soldier Fitness (CSF) and Resilience CSF measures Soldier resilience on five dimensions of human health––emotional, family, physical, social, and spiritual––based on the primary dimensions of health as identified by the World Health Organization (1948). While physical fitness is certainly an important component to overall Soldier R/ PH, CSF provides training opportunities for Soldiers that go 6
beyond traditional interventions designed to increase physical health. Specifically, the Army’s CSF program employs interventions that are “designed to increase psychological strength and positive performance and to reduce the incidence of maladaptive responses” (Cornum et al., 2011, p. 4). As Cornum and colleagues note, CSF proactively promotes R/ PH by emphasizing human potential through a focus on positive emotions, traits, institutions, and social relationships. The emphasis of these concepts is based on the recognition that Soldiers with these characteristics are more resilient and have the cognitive resources to deal with challenges; control over emotional fluctuations that are the result of stress; social and familial resources at their disposal; and the ability to find meaning and purpose in their life and work. The primary way in which CSF promotes these characteristics is by helping Soldiers develop metacognitive skills that can enhance resilience. In other words, the program is designed to help Soldiers understand how and why they think a particular way and how certain beliefs might influence their reactions to events. As noted above, a critical assumption of the CSF program is that becoming resilient is a process. While some Soldiers undoubtedly possess more “resilient” traits than others, the development of R/ PH involves a process in which anyone who is willing to work toward improvement can participate. In fact, one of the first lessons given to Master Resilience Trainers (MRTs) is that the development of resilience is a learning process that can be undertaken by anyone. It is also important to clearly state what CSF is not. First, CSF is not simply a program designed to treat certain illnesses or pathologies; that particular mission is the responsibility of the Army Medical Department. In fact, to guard against potential stigma related to behavioral healthcare among Soldiers, CSF purposely distances itself from the Army medical community. Consequently, CSF training is managed and led by unit leadership in order to underscore the importance of R/ PH in Army life. Additionally, CSF is not simply a training program that is employed after a negative event. The Army Medical Command’s Combat Stress Control teams are responsible for providing behavioral healthcare during and after crises. CSF, on the other hand, provides the psychological tools prior to potential crises so that
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Soldiers might be better able to cope with the effects of such crises. To execute the program, the Army utilizes four components of resilience training (see Casey, 2011). The first component of the program consists of the GAT–– the online survey instrument that provides feedback about Soldiers’ R/ PH levels upon completion. For analytic purposes, the GAT also serves as an indicator of overall psychological health and well-being, which can be used to assess Soldier fitness in relation to a number of outcomes (see Lester et al., 2011a, 2011b for examples). Second, Soldiers are able to take online self-help Comprehensive Resilience Modules (CRM), which are computer-based distance-learning modules that take approximately 20 minutes to complete; as of this writing, there are 27 CRMs available to Soldiers. Third, MRTs are trained in a number of strategies that Soldiers can use to practice and promote resilience. The Army’s goal is to embed MRTs within every battalion and brigade in the Army so they can pass along their training to peers and subordinates. Fourth, resilience training has been made mandatory at every Army leader development school. As noted, this evaluation will focus solely on the effects of having MRTs present in individual units. Specifically, the R/ PH levels of the Treatment condition were compared with the Control condition to assess mean differences and to compare rates of change in R/ PH over time. CSF and Population-Based Interventions Before discussing the analytic strategies and the results of the evaluation of the CSF program, it is important to consider the literature regarding community- and population-based interventions in order to more fully understand the methodological issues associated with interventions like CSF and the implementation of the MRT training program. Such an understanding can enhance the interpretation of the results of this evaluation and can provide the necessary background for placing the results one might expect from a broadscale, population-wide intervention like CSF in the proper context. In general, community-based interventions are implemented on specific populations. As the name implies, the populations involved in the interventions
are typically drawn from a specific geographic area (Atienza & King, 2002). While the Army is certainly not bound by geography, the Army should be viewed as a community that spans both domestic and international boundaries. Additionally, within the Army, smaller communities exist in the form of facilities (e.g., Forts), large units (e.g., Divisions), smaller units (e.g., Brigade Combat Teams), and other organizational structures. Implementing interventions across these “sub-communities,” then, is very much like implementing interventions across communities or populations as done by public health organizations. While many of the methodological issues encountered by developers of community-based interventions (see Atienza & King, 2002) are the same as those faced in the implementation of the MRT program, there is one distinction that deserves note. That is, in communityand population-based studies, the community or population serves as the unit of analysis. In these situations, statistical power sometimes becomes an issue since it is usually not feasible to implement a program on a statistically sufficient number of communities or populations (Atienza & King, 2002). The CSF program, in contrast, utilizes the individual Soldier as the unit of analysis, thus providing adequate statistical power for the analysis of results. While initially this distinction might seem to preclude comparison of CSF to other community-based studies, it is important to note that individual R/ PH scores are averaged across individuals in the two study conditions. Consequently, the mean R/ PH scores that are compared across the two conditions come to more closely resemble outcomes that are measured at the community or population levels in community-based interventions. Another critical point to consider is the fact that community-based trials measure the effectiveness of the intervention on all eligible participants in the study. For example, when assessing the impact of smoking cessation programs implemented at the community level (e.g., COMMIT Research Group, 1991), it is necessary to measure smoking cessation rates across the entire community, not just among those who are likely to smoke. Thus, the measurement of the criterion variable captures the effects of the intervention for those individuals that are actually motivated or predisposed to be impacted by the intervention, as well as for individuals that were
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not predisposed to be impacted and who felt no impact whatsoever from the intervention. A similar situation exists within CSF, where the propensity to be impacted by the intervention undoubtedly varies from Soldier to Soldier. According to Sorensen, Emmons, Hunt, and Johnston (1998), this is one of the primary reasons the observed effect sizes tend to be relatively small in community- and population-based studies. This is not a point of concern, however, as the authors note that, “small changes in behavior observed across an entire population are likely to yield greater improvements in the population-attributable risk than larger changes among a small number of high-risk individuals” (p. 380). This relationship has been labeled the prevention paradox in the preventive health literature, since a population-based intervention may yield only small benefits for individuals, but bring much benefit to the population at large (Rose, 1981, 1985). Indeed, a review of effect sizes in the health field and in other domains suggests that small effect sizes are typically found in many lines of research (see Meyer et al., 2001), but that the practical implications of various statistical relationships are sometimes understated by the presentation of small effect sizes.
Key Takeaways • Resilience is the maintenance of normal functioning in the face of adversity. • Resilience can be taught and learned. • Comprehensive Soldier Fitness measures resilience and psychological health (R/ PH) along four dimensions: Emotional, Family, Social, and Spiritual Fitness. • Comprehensive Soldier Fitness is designed to increase Solider R/ PH by enhancing cognitive skills. • Even small increases in Soldier R/ PH can lead to tremendous benefits for the entire Army.
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Data and Method Measuring R/PH: The Global Assessment Tool (GAT)
T
he GAT is administered annually to all Soldiers. The survey is a self-awareness tool that provides a snapshot of R/ PH along four dimensions of health–– Emotional, Family, Social, and Spiritual Fitness. To measure the four dimensions, the GAT contains 16 subscales, the majority of which were adapted from validated measures of psychological constructs previously published in peer-reviewed journals; a small number of scales were authored by the GAT’s developers (see Peterson, Park, & Castro, 2011). In addition to the 16 R/ PH subscales measured by the GAT, two additional scales were included to assess perceptions of leadership and unit cohesion. These scales were used for follow-up analyses in this report. The measurement approach and a description of the scales used to develop each dimension of fitness are provided below in Table 1. From left to right, the table presents the name of the R/ PH dimension/subscale, the number of items used to measure the construct, the scale range, an example question, the source of the scale, and the scale reliability estimates (indicated by coefficient “α”; note that scores of approximately .70 or higher indicate acceptable scale reliability, see Cohen [1988]). The Intervention: Master Resilience Training The MRT component of CSF is a cornerstone of the Army’s resilience and psychological health development initiative. The MRT course is structured as a train-thetrainer course. Here, mid-career Noncommissioned Officers (NCOs), typically holding the rank of Staff Sergeant or Sergeant First Class, are selected by their senior leaders to attend the MRT training course held at the University of Pennsylvania in Philadelphia; at Victory University at Fort Jackson, South Carolina; or at any number of remote locations where training is offered via a Mobile Training Team coordinated by the Comprehensive Soldier Fitness Directorate. The course was modeled, in part, after the Penn Resiliency Program (PRP) (e.g., Gillham et al., 1990), described in Appendix A. The course consists of approximately 80 hours of classroom time, much of which is devoted to teaching trainers how to teach the skills to Soldiers. After MRTs are trained, they return to their units so that they can train others in their units to utilize the same
skills learned during the MRT course via a prescribed curriculum, described below. 1 Within MRT training, Soldiers learn six core competencies: self-awareness, self-regulation, optimism, mental agility, strengths of character, and connection. Together the lessons are designed to develop Soldiers’ ability to understand the thoughts, emotions, and behaviors of themselves and others; help Soldiers identify their top strengths and the strengths of others in order to overcome both individual and team challenges; and strengthen Soldiers’ relationships with others by responding constructively to positive experiences, praising others, and by discussing problems effectively. These competencies are taught via four modules; the detailed descriptions of each module below are drawn from the Master Resilience Trainer Manual (Reivich, 2010). Reivich et al. (2011) provide an additional description of the program. Module One Module One consists of two units. Unit One lays the foundation for the rest of the course by introducing Soldiers to the concept of resilience and to the six MRT competencies described in the preceding paragraph. Specifically, Soldiers are taught that resilience is the ability to grow and thrive in the face of challenges and to bounce back from adversity. Fostering mental toughness, optimal performance, strong leadership and goal achievement does this. One important message contained within Unit One is that resilience is something that can be obtained by all. Unit Two teaches Soldiers to counter the bias toward negativity, to create positive emotions, and to focus on what is good—rather than bad—in one’s life. This is done through activities that focus Soldiers’ attention on positive events in their lives. Rather than focusing on what goes wrong, Soldiers are taught to search for positive experiences by thinking about why things go well, what positive events mean, and how to create 1
Note that one of the components of CSF—Comprehensive Resilience Modules—is not considered in this report. Previous analyses (not included in the current report) show that the CRMs have had no impact on R/ PH scores across the period of time covered in the current report. This component of CSF is undergoing a significant revision at the time of this writing. Therefore, this report focuses solely on the impact of MRT training on R/ PH scores across time.
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Table 1
Table 1. GAT Scales and Constructs Used to Measure Soldier R/PH Dimension/ Subscale Emotional Fitness Adaptability
# of Items 77
Bad Coping
4
Good Coping
4
1 = Not like me at all 5 = Very much like me
Catastrophizing
7
1 = Not like me at all 5 = Very much like me
Character
24
Depression
10
Negative Affect
11
Positive Affect Optimism
10
0 = Never 5 = Always 1 = Not at all 5 = Every day 1 = Never 5 = Most of the time 1 = Never 5 = Most of the time 1 = Strongly disagree 5 = Strongly agree
Family Fitness Family Satisfaction
5 2
Family Support
3
Social Fitness Engagement
18 4
1 = Not like me at all 5 = Very much like me
Friendship
6
Loneliness
3
0 = No 1 = Yes 1 = Never 5 = Most of the time
Organizational Trust
5
3
4
Spiritual 5 Fitness Organizational 35 Context Transformational 14 Leadership Unit Cohesion
10
21
Scale Range 1 = Not like me at all 5 = Very much like me 1 = Not like me at all 5 = Very much like me
Example Question
Author(s)
I can usually fit myself into any situation. I usually keep my emotions to myself.
Developed by Professors C. Peterson and N. Park. Adapted by Professors C. Peterson and N. Park from previous research, e.g., Carver, Scheier, and Weintraub (1989). When something stresses Adapted by Professors C. Peterson and me out, I try to solve the N. Park from previous research, e.g., problem. Carver, Scheier, and Weintraub (1989). When bad things happen to Adapted by Professors C. Peterson and me, I expect more bad things N. Park from previous research, e.g., to happen. Peterson et al. (2001). Bravery or courage Peterson (2007); Peterson and Seligman (2004) Feeling down, depressed, or Kroenke, Spitzer, and Williams (2001); hopeless. Spitzer, Kroenke, and Williams (1999) Anxious/Nervous Watson, Clark, and Tellegen (1988) Joyful
Watson, Clark, and Tellegen (1988)
Overall, I expect more good things to happen to me than bad.
Scheier, Carver, and Bridges (1994)
1 = Not at all satisfied 5 = Extremely satisfied
How satisfied are you with your marriage/relationship?
1 = Strongly disagree 5 = Strongly agree
My family supports my decision to serve in the Army.
Developed by the Directorate of Basic Combat Training’s Experimentation and Analysis Element, Fort Jackson. Developed by the Directorate of Basic Combat Training’s Experimentation and Analysis Element, Fort Jackson.
I would choose my current work again if I had the chance. I have someone to talk to when I feel down. How often do you feel close to people?
Peterson, Park, and Seligman (2005); Wrzesniewski, McCauley, Rozin, and Schwartz (1997) Developed by Professors C. Peterson and N. Park. Russell (1996); Russell, Peplau, and Ferguson (1978)
1 = Strongly disagree 5 = Strongly agree 1 = Not like me at all 5 = Very much like me 1 = Not at all 5 = Frequently, if not always 1 = Strongly disagree 5 = Strongly agree
Overall, I trust my immediate Mayer, Davis, and Schoorman (1995); supervisor. Sweeney, Thompson, and Blanton (2009) My life has lasting meaning. Fetzer Institute/National Institute on Aging Working Group (1999)
Reliability Estimates αT1=.97 αT2=.97 αT1=.68 αT2=.69 αT1=.70 αT2=.71 αT1=.85 αT2=.88 αT1=.78 αT2=.81 αT1=.98 αT2=.98 αT1=.91 αT2=.92 αT1=.79 αT2=.81 αT1=.89 αT2=.91 αT1=.74 αT2=.74 αT1=.76 αT2=.78 αT1=.79 αT2=.81 αT1=.81 αT2=.83 αT1=.88 αT2=.89 αT1=.84 αT2=.84 αT1=.66 αT2=.69 αT1=.76 αT2=.78 αT1=.88 αT2=.89 αT1=.81 αT2=.83
Spends time teaching and coaching.
Avolio, Bass, and Jung (1995); Bass and αT1=.97 Avolio (2000) αT2=.98
Soldiers in this unit have enough skills that I would trust them with my life in combat.
Adapted by Professors C. Peterson and N. Park from previous research, e.g., Griffith (2002)
STRONG MINDS
αT1=.97 αT2=.98
circumstances that enable good things to occur. Module Two
to allow Soldiers to understand how an initial reaction to an event might be rooted in more deeply held beliefs about the world, and to help Soldiers determine whether the deeply held belief is getting in the way of responding to a problem in an appropriate way.
Module Two consists of seven units. Together, the seven units help Soldiers learn skills that make them stronger Soldiers and better leaders by increasing Unit Four moves beyond self-awareness to focus on mental toughness. Unit One focuses on an Activating stress and energy management. Activities include Event, Thought, Consequence (ATC) model of dealing controlled breathing, progressive muscle relaxation, with challenges in one’s life. This approach is based meditation, and distraction techniques. These strategies on the ABC (adversity-belief-consequence) model of are designed to foster self-regulation through the cognitive therapy developed by Ellis (1962). Similar management of emotion and energy levels. The to the training offered in the PRP, the skills fostered by ultimate goal is to allow for critical thinking and optimal ATC help Soldiers identify the links between events, performance. Unit Five focuses on problem-solving. thoughts, and emotions/reactions, so that individuals can The objective of the unit is for Soldiers to accurately identify how their cognitive reactions to events might be recognize the factors that caused a particular problem at least as consequential as the event itself in driving and to identify solutions to the problem. Soldiers are thoughts and behaviors. Focus is placed on emotions taught about confirmation biases and how they might and how to understand emotional reactions to events. interfere with problem-solving in group settings. Unit Unit Two teaches Soldiers to avoid thinking traps, which Six is designed to reduce catastrophic thinking and are common patterns of thinking that occur under stress reduce anxiety, and to improve problem-solving skills. and, if uncontrolled, can lead to a downward spiral Soldiers are taught about the inefficiencies associated into depression. Through various exercises, Soldiers with rumination and the focus on worst-case scenarios in are taught to identify and correct counterproductive response to an event. This is done by having Soldiers patterns in thinking, such as pessimistic explanatory think about worst- and best-case scenarios, in relation to styles. Unit Three teaches Soldiers to detect icebergs— the most likely outcome of an event. Finally, Unit Seven deep-seated personal beliefs and values—in order to focuses on real time resilience, which trains Soldiers to determine whether the icebergs drive an interpretation pull their skills together and use them in the various of, or reaction to, an event that might be out of contexts that Soldiers typically face. proportion or inaccurate. The purpose of the lesson is Table 2. MRT Training Skills and Theoretical Bases MRT Skill Activating Event Thoughts Consequences Thinking Traps Icebergs Problem Solving Put It In Perspective Mental Games Real Time Resilience Character Strengths Active Constructive Responding and Praise Hunt the Good Stuff Assertive Communication Imagery; Goal Setting Energy Management
Theoretical Basis in Psychology Activating Event Beliefs Consequences (Ellis, 1962) Errors in Logic (Beck, 1976; Burns, 1999; Ellis, 1962); Explanatory Style (Peterson & Seligman, 1984) Underlying Assumptions and Core Beliefs (Beck, 1976; Young, 1994) Challenging Beliefs (Beck, 1976; D’Zurilla & Goldfried, 1971); Explanatory Style (Peterson & Seligman, 1984) Decatastrophizing (Beck & Emery, 1985) Distraction Techniques (Wolpe, 1973) Externalization of Voices (Burns, 1999; Freeman, Pretzer, Fleming, & Simon, 2004) Character Strengths (Peterson & Seligman, 2004) Active Constructive Responding (Gable, Reis, Impett, & Asher, 2004; Kamins & Dweck, 1999) Gratitude (Emmons & McCullough, 2003) Assertive Communication (Wolpe & Lazurus, 1966) Behavioral element of CBT (Beck, 1976); Goal Setting Theory (Latham & Locke, 1991; Locke & Latham, 1990) Sports Psychology and Stress Management (Benson, Greenwood, & Klemchuk,1975; Borkovec et al., 1987)
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Module Three Module Three is designed to build Soldiers’ character strengths. In this module, participants are taught to identify their top strengths and the top strengths of others, as well as how to use those strengths to overcome challenges and build teams. This is done through two units. Unit One focuses specifically on identifying character strengths that Peterson and Seligman (2004) have found to be valued across cultures and geography. Knowing and understanding such strengths in one’s self and in others facilitates optimal performance and builds engagement. Unit Two helps Soldiers understand how personal strengths and the individual strengths of others can be used to overcome challenges. This is done through a series of activities that allow participants to identify and describe the talents of themselves and others.
styles should be developed and are appropriate for use at different times. Soldiers are taught strategies that emphasize confident, clear, and controlled communication. Unit Two focuses on sharing positive experiences with others, which is based on communication research that showed how positive events experienced by one person can be used to strengthen relationships with others (e.g., Gable, Reis, Impett, & Asher, 2004). Finally, Soldiers are taught how to properly give and receive praise. Table 2 on the preceding page provides a crosswalk that lists MRT skills and the theory behind each skill. Assignment of MRTs
Once trained, MRTs return to their units and pass along the skills they learned to peers and subordinates. To test program effectiveness, CSF selected eight BCTs to receive different components of the CSF program (see Figure 1). Four BCTs received MRT trainers, while the Module Four other four did not. Note that the GAT was administered Module Four consists of two units and teaches Soldiers three times during the time period under evaluation. to build stronger relationships through communication Soldiers took the GAT in early 2010, late 2010, and strategies. Unit One teaches participants that different early 2011—a time frame spanning about 15 months. communication strategies can help or hinder group Note also that MRT training implementation guidance problem-solving. For example, Soldiers are taught was published in October Figure 1 2010. This guidance that aggressive, passive, and assertive communication manual included lesson plans, more clearly explained Illustration of MRT Training Implementation Figure 1. Treatment Conditions and Assignment of MRTs 2010 2011
Published MRT Training Guidance
Treatment Condition
1 x MRT Per Company (n= 12,529)
BCTs in Study
3/4 IN
Control Condition
0 x MRT Per Company (n= 9,479)
Deployment
1/25 IN Deployment
2/1 IN
Deployment
3/1 IN
Deployment Deployment
170 HBCT
2/4 IN 11 ACR
UNCLASS/FOUO
12
1/4 IN
Deployment
DAMO-CSF
STRONG MINDS
1
the techniques to be used by MRTs, and outlined the frequency of training. It is likely that program fidelity increased as a result of the guidelines being published. Therefore, this report is focused on the effects of the training as measured by the GAT in early 2011 and on changes in GAT scores from late 2010 to early 2011. Throughout the rest of this report, the October 2010 data collection phase will be referred to as Time 1, while the April 2011 data collection phase will be referred to as Time 2. Figure 1 illustrates the number of Soldiers that received MRT trainers within their units, and the number of Soldiers that did not receive MRT trainers. As Figure 1 shows, at baseline there were 9,479 Soldiers in units that did not receive an MRT trainer (Control condition), while 12,529 Soldiers were in units with an MRT (Treatment condition). While these numbers remained consistent through Time 1, there was considerable attrition from Time 1 to Time 2 in the number of Soldiers in the study. Specifically, 6,739 Soldiers remained in the Treatment condition at Time 2, and 3,218 remained in the Control condition. There are a wide range of reasons for the relatively high attrition rates; these include normal assignment rotations that moved individuals in and out of the target BCTs, individuals who may have exited out of the Army, Soldiers who were wounded or killed in combat, etc. To assess whether attrition rates might have impacted the results of the evaluation, a number of steps were taken. First, after applying the screening approach described in the next section, attrition rates between the Treatment and Control conditions were statistically compared from Time 1 to Time 2. The analysis showed that Soldiers in the Control condition (64.7%) were more likely to attrit from Time 1 to Time 2 than Soldiers in the Treatment condition (44.5%), x2(1; n = 21,261) = 854.36, p .05). Analytic Strategy for Evaluation of MRT Training Evaluation of MRT training effectiveness was conducted as follows. First, mean scores on the GAT at Time 2 were compared between the Treatment and Control conditions to evaluate whether MRT training impacted GAT scores after Soldiers had been exposed to it for an extended period of time. Second, changes in mean GAT scores from Time 1 to Time 2 were compared across Treatment and Control conditions; this analysis allowed for an examination of growth in Soldier R/ PH as a result of MRT training. Next, two demographic factors (age and gender) and two contextual factors (quality of leadership and unit cohesion) were examined as potential moderators of the effect of MRT training on GAT scores at Time 2. Finally, three factors specific to the MRT trainers themselves were assessed: the impact of formal training conducted by MRTs, whether MRTs felt they had the necessary preparation, and whether MRTs
STRONG BODIES
13
felt they had support of the Command to successfully implement the training in their units. However, before this major set of analyses was conducted, the following preliminary analytic procedures were performed. Data Cleaning The data were cleaned and screened for invariant responses on the GAT (responses in which the participant entered a constant value across different questions on the GAT, e.g., 1,1,1,1,1,1,1). To do this, questions from the positive affect/negative affect schedule (PANAS) were used. Individuals were screened from an analysis if they used an invariant response pattern at both Time 1 and Time 2. This approach indicated that 744 Soldiers (3.4% of the total sample) used an invariant response pattern throughout the data collection period. A slightly greater proportion of Soldiers in the Control condition (3.8% [357/9,476]) used an invariant response pattern than Soldiers in the Treatment condition (3.1% [387/12,529]), x2(1; n = 22,749) = 6.90, p < .01. Percentage of Maximum Possible Scores Percentage of Maximum Possible (POMP) scores were used to represent R/ PH. POMP scores transform raw mean scores on items and scales into scores that represent the percentage of the overall total possible on a particular item or scale. For example, if an individual had a mean score of 3.5 on Emotional Fitness, which ranges from 1-5, the individual received a POMP score of 62.5 ((observed [3.5]-minimum possible [1])/ (maximum possible [5]-minimum possible [1])*100). This strategy has been advocated for use in evaluation studies such as the present one (Cohen, Cohen, Aiken, & West, 1999), and is appropriate for use in this study for two primary reasons. First, POMP scores standardize the metrics so that all variables range from 0-100, thus
making it possible to make meaningful comparisons across scales that might have different response options. Second, POMP scores allow differences in fitness scores to be described in terms of percentage differences. For example, if the Control condition had an Emotional Fitness score of 62.5, and the Treatment condition had an Emotional Fitness score of 65, POMP scores allow one to say that there was a 2.50% difference between the two conditions. For the purposes of the evaluation, this approach made the interpretation of mean differences more intuitive and meaningful. Reverse Scoring Items and Scales Five scales in the GAT measure “negative” constructs: catastrophizing, bad coping, depression, negative affect, loneliness. For the purposes of computing the four broad fitness dimensions (Emotional, Family, Social, and Spiritual Fitness) these scales were scored so that higher scores represented higher levels of fitness. When these scales are presented as singular constructs within this report, however, they are scored so that they are more intuitive for the reader. Specifically, lower scores on each of the aforementioned variables represent higher levels of fitness. The table below delineates the expectations regarding MRT training and scores on each of the scales included in the analysis. Note that for all scales in the blue section of the table (left hand side of Table 3), the Treatment condition is expected to have significantly higher scores and amounts of growth than the Control condition. For all scales in the red section (right hand section of Table 3), the Treatment condition is expected to have significantly lower scores than the Control condition, as well as greater decreases over time than the Control condition.
Table 3. R/PH Scales and Expectations Regarding MRT Training Positively Scored Scales (Expect Higher Scores in the Treatment Condition) Emotional Fitness Family Satisfaction Adaptability Family Support Character Social Fitness Good Coping Engagement Positive Affect Friendship Optimism Organizational Trust Family Fitness Spiritual Fitness
14
Negatively Scored Scales (Expect Lower Scores in the Treatment Condition) Catastrophizing Negative Affect Bad Coping Loneliness Depression
STRONG MINDS
Results Effects of MRT Training at Time 2
T
his analysis sought to answer the question, “Do Soldiers who received training from MRTs report higher R/ PH scores than Soldiers who were not trained by MRTs?” To make this determination, fitness scores of the Treatment and Control conditions at Time 2 were compared to determine whether significant differences existed. First, however, it was necessary to determine whether significant differences at Time 1 existed; if so, then it would be appropriate to control for Time 1 R/ PH scores in the analysis. The Time 1 analysis did indeed show significant differences between the two conditions. Therefore, it was appropriate to control for Time 1 scores in the analysis of mean differences at Time 2. More detail about the Time 1 analysis and results is presented in Table B1, Appendix B.
was significantly higher on two of the four broad R/ PH fitness dimensions: Emotional Fitness (1.31% higher) and Social Fitness (.66% higher). At the subscale level the Treatment condition was also significantly higher on adaptability (1.08% difference), character (1.63% difference), good coping (1.30% difference), optimism (1.02% difference), and friendship (2.04% difference). As expected, the Treatment condition was significantly lower on catastrophizing, where there was a 1.61% difference between the two conditions. Effect sizes (partial η2) were computed in order to evaluate whether there were meaningful differences between the conditions. The results of that analysis showed that the effects of the MRT training, while statistically significant, were somewhat small practically speaking as the maximum partial η2 was .002. Again, it is important to keep in mind that small effect sizes do not necessarily mean that the treatment had a small impact. A 1.31% increase on Emotional Fitness, for example, can have implications for behavioral outcomes among Soldiers, as evidenced by previous work regarding the GAT and behavioral measures (Lester et al., 2011a, 2011b).
To compare R/ PH scores at Time 2, analysis of variance (ANOVA) with blocking (recommended by Tabachnick and Fidell [2007, p. 222]) was used as an alternative to analysis of covariance (ANCOVA). Table 4 below presents the mean scores for both the Treatment and Control conditions on each of the R/ PH dimensions and subscales. As Table 4 shows, the Treatment condition Time 2 Analysis Table 4 in the report Table 4. Differences between Treatment and Control Conditions at Time 2 Control
†
Treatment
‡
Mean
SD
Mean
SD
Mean Diff.
F
Sig.
Partial η2
Emotional Fitness Adaptability Character Good Coping Positive Affect Optimism Family Fitness Family Satisfaction Family Support Social Fitness Engagement Friendship Org. Trust Spiritual Fitness Catastrophizing Bad Coping Depression Negative Affect Loneliness
66.74 68.15 70.58 62.71 60.74 57.06 71.27 76.90 68.47 65.08 57.46 77.70 59.15 56.99 31.90 55.02 21.40 36.17 35.15
0.23 0.32 0.32 0.34 0.37 0.32 0.35 0.44 0.40 0.28 0.39 0.40 0.39 0.38 0.39 0.39 0.40 0.29 0.35
68.04 69.23 72.21 64.01 61.22 58.09 71.65 76.57 68.80 65.74 58.09 79.74 59.69 57.07 30.29 55.02 20.60 35.91 34.96
0.16 0.22 0.22 0.23 0.25 0.22 0.24 0.31 0.27 0.19 0.27 0.28 0.28 0.26 0.27 0.27 0.28 0.20 0.24
1.31 1.08 1.63 1.30 0.47 1.02 0.38 -0.32 0.32 0.66 0.63 2.04 0.54 0.09 -1.61 0.00 -0.80 -0.27 -0.19
21.19 7.62 18.13 10.27 1.11 6.92 0.80 0.36 0.45 3.83 1.77 17.28 1.26 0.04 11.58 0.00 2.69 0.58 0.19
.000 .006 .000 .001 .293 .009 .372 .551 .504 .050 .183 .000 .263 .852 .001 .997 .101 .445 .666
.002 .001 .002 .001 .000 .001 .000 .000 .000 .000 .000 .002 .000 .000 .001 .000 .000 .000 .000
Negative
Positive
Dimension/Subscale
†n=3215-3218; ‡n=6739
STRONG BODIES
15
Fitness Change between Times 1 and 2 Next, MANOVAs with time as a within-subjects factor and condition as a between-subjects factor followed by simple effects analyses were employed to answer the question, “Over time, do the R/ PH scores of Soldiers exposed to MRT training improve at a greater rate than Soldiers not exposed to the training?” To address this question, changes in fitness scores from Time 1 to Time 2 were examined across the conditions (i.e., the Treatment and the Control conditions). Again, it was expected that the Treatment condition would experience greater rates of improvement than the Control condition on each of the facets of R/ PH measured by the GAT.
2
Figure 2 depicts the percentage change from Time 1 to Time 2 for both the Treatment and Control conditions. The full results of this analysis are presented in Table B2 in Appendix B. The results showed that there were significant differences between the Treatment and Control conditions in rates of change from Time 1 to Time 2 on five dimensions/subscales of R/ PH: Emotional
Fitness, catastrophizing, character, good coping, and friendship. Simple effects analysis conducted on these dimensions/subscales showed that the Treatment condition demonstrated a significant increase on Emotional Fitness (0.54%), good coping (0.71%), and friendship (2.10%) from Time 1 to Time 2, whereas the Control condition experienced no significant change on these dimensions/subscales. Further, the Treatment condition demonstrated a significant decrease on catastrophizing (0.99%) from Time 1 to Time 2, indicating improvement in R/ PH, whereas the Control condition showed no significant change on catastrophizing across the two time points. Finally, the Control condition demonstrated a significant decrease on character (1.82%), while the Treatment condition showed no change on character across the two time points. This last finding provides some evidence that MRT training may be guarding against natural rates of decline in character fitness that may be experienced by Soldiers not exposed to MRT training.
Figure 2. Change in Fitness from Time 1 to Time 2: Comparing the Treatment and Control Conditions
0.10 0.37
Social Fitness
0.34
0.67 0.16
Family Support
1.25 1.55
0.42 0.56
Family Satisfaction
0.48
0.59 0.48
Family Fitness
0.21
0.39 0.55
Optimism
0.12
0.71
0.25
*p
REPORT DOCUMENTATION PAGE
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1. REPORT DATE (DD-MM-YYYY)
27-12-2011
2. REPORT TYPE
Technical Report
4. TITLE AND SUBTITLE
The Comprehensive Soldier Fitness Program Evaluation. Report #3: Longitudinal Analysis of the Impact of Master Resilience Training on Self-Reported Resilience and Psychological Health Data, December 2011
3. DATES COVERED (From - To)
01OCT09-01DEC11
5a. CONTRACT NUMBER
W91WAW-10-D-0086
5b. GRANT NUMBER
NA
5c. PROGRAM ELEMENT NUMBER
NA 6. AUTHOR(S)
CPT Paul B. Lester, Ph.D.; P.D. Harms, Ph.D.; Mitchel N. Herian, Ph.D.; Dina V. Krasikova, Ph.D.; Sarah J. Beal, Ph.D.
5d. PROJECT NUMBER
Partial Fulfillment 5e. TASK NUMBER 5f. WORK UNIT NUMBER
7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES)
8. PERFORMING ORGANIZATION REPORT NUMBER
9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES)
10. SPONSOR/MONITOR’S ACRONYM(S)
TKC Global Solutions LLC, 3201 C St STE 400F, Anchorage, AK 99503-3967
Comprehensive Soldier Fitness, 2530 Crystal Drive, 5th Floor, 5130, Arlington, VA 22203
DAMO-CSF
11. SPONSOR/MONITOR’S REPORT NUMBER(S) 12. DISTRIBUTION / AVAILABILITY STATEMENT
Public distribution / availability
13. SUPPLEMENTARY NOTES
Prepared in cooperation with the University of Nebraska ’s College of Business Administration.
14. ABSTRACT
This technical report is the third in a series of reports evaluating the impact of the Army’s Comprehensive Soldier Fitness (CSF) Program. This report focused on determining the efficacy of the train-the-trainer component of CSF – Master Resilience Trainer (MRT) – in influencing Soldier resilience and psychological health (R/PH) across time. Four Brigade Combat Teams (BCTs) received MRT skills training (Treatment condition), while four additional BCTs did not (Control condition). Measures of R/PH were taken three times across approximately 15 months (baseline, T1, T2), and demographics, quality of unit leadership, and quality of unit cohesion were accounted for. Analyses show that Soldiers in the Treatment condition exhibited significantly higher R/PH scores at T2 than did Soldiers in the Control condition. Also, MRT skills training appears to be significantly more effective for Soldiers 18-24 years old than older Soldiers. Additional contextual analyses are provided. 15. SUBJECT TERMS
Comprehensive Soldier Fitness; Resilience; Efficacy; Effectiveness; Master Resilience Trainer 16. SECURITY CLASSIFICATION OF: None a. REPORT
b. ABSTRACT
17. LIMITATION OF ABSTRACT c. THIS PAGE
18. NUMBER OF PAGES
UU
19a. NAME OF RESPONSIBLE PERSON
CPT Paul B. Lester
19b. TELEPHONE NUMBER (include area
72
code)
703-545-4338 Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std. Z39.18
The Comprehensive Soldier Fitness Program Evaluation Report #3: Longitudinal Analysis of the Impact of Master Resilience Training on Self-Reported Resilience and Psychological Health Data December 2011
COMPREHENSIVE SOLDIER FITNESS STRONG MINDS STRONG BODIES l
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The Comprehensive Soldier Fitness Program Evaluation Report #3: Longitudinal Analysis of the Impact of Master Resilience Training on Self-Reported Resilience and Psychological Health Data December 2011 CPT Paul B. Lester, Ph.D. Research Psychologist Comprehensive Soldier Fitness P.D. Harms, Ph.D. Assistant Professor University of Nebraska–Lincoln Mitchel N. Herian, Ph.D. Research Analyst TKC Global Dina V. Krasikova, Ph.D. Post-Doctoral Research Associate University of Nebraska–Lincoln Sarah J. Beal, Ph.D. Statistical Consultant TKC Global
Corresponding Author: CPT Paul Lester, G-3/5/7, DAMO-CSF [email protected] Desk: 703-545-4338 BB: 703-677-0561 This report was produced in partial fulfillment of contract #W91WAW-10-D-0086-0002.
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TABLE OF CONTENTS TABLE OF TABLES iv TABLE OF FIGURES iv ACKNOWLEDGEMENTS v EXECUTIVE SUMMARY 1 INTRODUCTION 3 COMPREHENSIVE SOLDIER FITNESS AND THE MEASUREMENT OF RESILIENCE AND PSYCHOLOGICAL HEALTH
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DATA AND METHOD
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RESULTS 15 DISCUSSION, IMPLICATIONS, & RECOMMENDATIONS 23 CONCLUSION 27 REFERENCES 28 APPENDIX A 36 APPENDIX B 48
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TABLE OF TABLES Table 1. GAT Scales and Constructs Used to Measure Soldier R/ PH 10 Table 2. MRT Training Skills and Theoretical Bases 11 Table 3. R/ PH Scales and Expectations Regarding MRT Training 14 Table 4. Differences between Treatment and Control Conditions at Time 2 15 Table 5. Comparison of Treatment and Control Conditions by Age 18 Table 6. Significant Relationships between MRT Survey Data and Soldier R/ PH: 21 18-24 Year Old Soldiers Table A1. MRT Training and Global Assessment Tool Crosswalk 37 Table A2. Summary of Penn Resiliency Program (PRP) Evaluations 40 Table A3. Summary of Military Stress Interventions 45 Table B1. MANOVA: Comparison of Means at Time 1 49 Table B2. MANOVA: Change from Time 1 to Time 2 50 Table B3. Regression: Interactions between Age and MRT Training 51 Table B4. Regression: Interactions between Gender and MRT Training 52 Table B5. Regression: Interactions between Leadership and MRT Training 53 Table B6. Regression: Interactions between Unit Cohesion and MRT Training 54 Table B7. Intraclass Correlation Coefficients for MRT Training Survey Data 55 Table B8. Regression: Effect of Formal Training on R/ PH for Soldiers 18-24 Years Old 56 Table B9. Regression: Effect of Perceived Preparedness to Train on R/ PH for 57 Soldiers 18-24 Years Old Table B10. Regression: Effect of Perceived Command Support on R/ PH for 58 Soldiers 18-24 Years Old Table B11. Regression: Effect of Formal Training on R/ PH for Soldiers Over 24 Years Old 59 Table B12. Regression: Effect of Perceived Preparedness to Train on R/ PH for 60 Soldiers Over 24 Years Old Table B13. Regression: Effect of Perceived Command Support on R/ PH for 61 Soldiers Over 24 Years Old
TABLE OF FIGURES Figure 1. Treatment Conditions and Assignment of MRTs Figure 2. Change in Fitness from Time 1 to Time 2: Comparing Treatment and Control Conditions Figure 3. Significant Interactions between Age and MRT Training at Time 2 Figure 4. Effect Sizes for Differences in Time 2 Fitness Scores between Treatment and Control Conditions by Age
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12 16 17 19
ACKNOWLEDGEMENTS Comprehensive Soldier Fitness would like to thank the men and women of: 11th Armored Cavalry Regiment, Fort Irwin, California 170th Infantry Brigade Combat Team, Baumholder, Germany 2nd Brigade, 1st Infantry Division, Fort Riley, Kansas 3rd Brigade, 1st Infantry Division, Fort Knox, Kentucky 1st Brigade, 4th Infantry Division, Fort Carson, Colorado 2nd Brigade, 4th Infantry Division, Fort Carson, Colorado 3rd Brigade, 4th Infantry Division, Fort Carson, Colorado 1st Brigade, 25th Infantry Division, Fort Wainwright, Alaska
Our research team would like to thank the following people who helped us in this endeavor. This report would not have been possible without their support. Comprehensive Soldier Fitness: Brigadier General Rhonda Cornum – Director, Comprehensive Soldier Fitness Colonel Thomas Vail – Deputy Director, Comprehensive Soldier Fitness Mr. Michael Porcaro – Knowledge Manager Ms. Katherine Nasser – Data Systems Manager Mr. Samuel Goldgeier – Data Systems Manager Mr. Aaron Mack – Research Analyst Ms. Megan McGuffey – Administrative Assistant
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Executive Summary Top Line Message: There is now sound scientific evidence that Comprehensive Soldier Fitness improves the resilience and psychological health of Soldiers. Background: The purpose of this report is to present empirical evidence of the effectiveness of Comprehensive Soldier Fitness (CSF) at improving Soldier-reported resilience and psychological health (R/ PH). More specifically, this report focuses on the effectiveness of the train-the-trainer component of CSF, known as Master Resilience Trainer (MRT). Though program evaluation of CSF will continue into the future, this report represents a significant milestone in a longitudinal analysis effort involving more than 22,000 Soldiers across eight Brigade Combat Teams (BCTs). Methodology: Eight BCTs were randomly selected for participation in this program evaluation (see Figure 1, p. 12). A total of 96 Master Resilience Trainers completed the 10-day MRT course at the University of Pennsylvania, Philadelphia, and each returned to one of four BCTs; these four BCTs comprised the Treatment condition. Due to training throughput constraints at the MRT course, four additional BCTs did not receive MRTs over the life of this program evaluation initiative; these four BCTs comprised the Control condition. Measures of R/ PH––using the Global Assessment Tool (GAT)––were taken three times over approximately 15 months. A baseline measure was taken in early 2010. Another measure of R/ PH was taken again in the latter part of 2010 (Time 1), and this measure coincided with CSF publishing its training guidance to be implemented by all MRTs across the Army. A final measure of R/ PH was taken again approximately six months later in 2011 (Time 2). Demographics (i.e., age, gender) and organizational factors (i.e., quality of unit leadership, unit cohesion) were also assessed in our analyses given that these two variables could moderate the relationship between MRT training and R/ PH. Key Findings: • The Treatment condition (units with MRTs) exhibited significantly higher R/ PH scores at Time 2 than did the Control condition (units without MRTs) (see Table 4, p. 15). Quality of unit leadership and unit cohesion did not significantly impact the effect of MRT training on R/ PH at Time 2. • In some areas of R/ PH, the Treatment condition had a higher rate of growth than the Control condition (see Figure 2, p. 16). • MRT training appears to be significantly more effective for 18-24 year olds than for older Soldiers (see Figure 4, p. 19). • Training provided by MRTs is most effective when the training is conducted in formal settings (e.g., scheduled classes), when Commands select confident leaders to serve as MRTs, and when Commands properly support their MRTs. • There is no evidence that Soldier R/ PH scores decrease or that Soldiers “get worse” due to training provided by MRTs. • The effect sizes reported here are consistent with or better than many other population-wide developmental interventions and public health initiatives.
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Introduction
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n the midst of prolonged military engagements around the globe, U.S. Army’s senior leadership has programmatically sought to assist Soldiers in handling exposure to traumatic events on the battlefield, assist them in coping with stressful events and circumstances in their daily lives, and provide them with training that may help them thrive in the face of a variety of adversities. The purpose of this report is to present the results of an evaluation of the effectiveness of one such effort––the Comprehensive Soldier Fitness (CSF) program. The CSF program involves a range of training interventions designed to increase Soldier resilience and psychological health (R/ PH) across four broad areas of fitness. Drawing on recent scholarly research, CSF teaches Soldiers various ways to improve their ability to respond to stressful events.
members of their unit via a prescribed curriculum. The expectation of this program is that Soldiers who were trained by MRTs will report higher levels of R/ PH than Soldiers who received no training. Accordingly, this report addresses four broad evaluation questions:
This is the third in a series of reports examining the implications and effectiveness of enhancing Soldier R/ PH under the auspices of the CSF program. The first two reports established the nature of the relationship between Soldier resilience and both positive and negative behavioral outcomes. The first report (Lester, Harms, Bulling, Herian, & Spain, 2011a) provided evidence that Soldiers who used illicit drugs, committed violent crimes, or committed suicide reported having lower levels of R/ PH before the event occurred than did Soldiers who did not engage in such behaviors. The second report (Lester et al., 2011b) showed that Officers promoted early and selected for command had significantly higher levels of R/ PH than Officers not promoted early or selected for command. Though the results from these studies were not surprising, together they serve to underscore the relationship between Soldier resilience and behavioral outcomes that have critical implications for the readiness of the Army.
3) Which demographic or contextual variables, if any, enhance the effectiveness of MRT training?
The current report differs from the first two in that it focuses specifically on the effectiveness of the resilience and psychological health enhancement training program developed by CSF. In particular, this report examines the effectiveness of the Master Resilience Training (MRT) program at improving Soldier-reported R/ PH scores over time. MRT is a train-the-trainer program based in part upon a long-standing research initiative conducted at the University of Pennsylvania. Soldiers selected for MRT are trained at a variety of locations and return to their units to then teach MRT skills to other
1) Do Soldiers in units that received training from MRTs report higher R/ PH scores than Soldiers who were not trained by MRTs? 2) Over time, do the R/ PH scores of Soldiers exposed to MRT training improve at a greater rate than Soldiers not exposed to the training?
4) Does the effectiveness of the training depend on whether MRTs formally train their units? Is the training more effective when MRTs feel better prepared to train and when they feel they have the support of their Command? In order to address these questions, a group of Soldiers who were exposed to training provided by MRTs were compared to a group of Soldiers who were not exposed to the training over a 15-month period of time. More specifically, four Brigade Combat Teams (BCTs) received one MRT per roughly 100 Soldiers assigned to the unit (these four BCTs will be referred to as the Treatment condition in this report), while four other BCTs did not receive an MRT due to throughput constraints inherent with a new training course (these four BCTs will be referred to as the Control condition in this report). Data were captured when MRTs were first introduced to the Treatment condition (this wave of data will be referred to as Baseline), then again eight months later when CSF published detailed training guidance to be implemented locally by the MRTs (this wave of data will be referred to as Time 1), and finally six months later (this wave of data will be referred to as Time 2). Demographic and contextual data were also captured across each time point. To assess the potential 3
impact of formal MRT training within units, MRTs were surveyed about whether they actually formally trained MRT skills to Soldiers, about whether they felt they were adequately trained in the MRT course, and whether the Command supported them in delivering MRT training to Soldiers. The results of the program evaluation showed that Soldiers in units with MRT trainers exhibited higher levels of R/ PH. In particular, at Time 2, the Treatment condition’s R/ PH scores were significantly better than the Control condition on various aspects of Emotional and Social Fitness. When measuring the impact of MRT training over time (change in R/ PH from Time 1 to Time 2), the results showed that the Treatment condition improved significantly more than the Control condition on a number of aspects of R/ PH. As noted, additional analyses were conducted in order to determine whether demographic variables (age and gender) and contextual variables (quality of leadership and unit cohesion), might impact the effectiveness of the training. Results showed that the effects of having MRT trainers in their units produced more pronounced effects for younger Soldiers (18-24 year olds). In comparison to older Soldiers (over 24 years old), younger Soldiers demonstrated changes on more aspects of R/ PH and also showed larger effects on dimensions where training enhanced R/ PH across both age groups. That said, it should be noted that older Soldiers typically reported higher R/ PH overall, irrespective of training condition. Gender did not moderate the effectiveness of MRT training. Examining organizational factors that might influence R/ PH scores, we found no evidence that the quality of unit leadership or unit cohesion moderated the effects of MRT training. Finally, we found that the effects of having MRT trainers embedded in units were greater in those units in which MRTs formally trained Soldiers, felt more efficacious regarding their ability to train others, and felt that they had the support of their Command.
April 2011––because prior to that no detailed training guidance existed for MRTs to implement within their units. Consequently, though the current report suggests that MRT training is effective, it remains to be seen what the long-term effects of the program will be, especially on important objective health outcomes. It is possible that the effects of the program may be enhanced as further training is conducted and MRTs become more proficient in their mission. Furthermore, as analyses of similar programs have suggested (e.g., Gillham, Reivich, Jaycox, & Seligman, 1995), the effects of resilience training may actually increase over time as Soldiers encounter more stressful life events. Alternatively, it is also possible that the effects may diminish as the novelty of the program wears off. For these reasons, further monitoring and assessment of the program’s effectiveness is both warranted and advisable, and CSF plans to do so in the future. Beyond this introduction, this report has four distinct sections. In Section 2, further details are provided about CSF and its relationship to recent research regarding psychological resilience. In Section 3, the data, research design, and analytic strategy that drive this evaluation effort are described. This section includes a description of the Global Assessment Tool (GAT)––the online survey instrument used to measure R/ PH. In Section 4, the results of the evaluation are reported in greater detail. Finally, Section 5 provides a discussion of the results and the implications of the findings of the present program evaluation for future efforts to enhance Soldier R/ PH. References and appendices are also provided. Appendix A includes a review of additional research related to interventions designed to enhance resilience. Appendix B includes detailed tables that present the results of all statistical tests included in this evaluation.
In light of these findings, it is noteworthy that the CSF program has only been in the field for short period of time. Though the program evaluation assessment period ran for 15 months, this evaluation focused on assessing the effects of MRT training during a condensed period of time––the six-month period from October 2010 to 4
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CSF & the Measurement of R/PH
R
esilience entails the maintenance of normal functioning despite negative events or circumstances, disruptions, or changes in demands (Bonanno, 2004; Luthar, Cicchetti, & Becker, 2000; Masten, 2001). In the context of CSF, resilience refers to overall physical and psychological health, and has been described as the ability to “bounce back from adversity” (Reivich, Seligman, & McBride, 2011). Recent emphasis on resilience in the face of traumatic events (e.g., Bonanno, 2004, 2005), as opposed to emphasis on adverse reactions to trauma (e.g., Breslau, 2001), has begun to shift researchers’ focus toward seeking a broader understanding of adaptive responses to trauma exposure (see Wald, Taylor, Asmundson, Jang, & Stapleton, 2006). This general shift is represented by literature that examines the characteristics of resilient people (e.g., Connor & Davidson, 2003; Kobasa, 1979; Lyons, 1991; Rutter, 1985), explores the intersection of concepts and measures related to psychological resilience (Connor & Davidson, 2003), and analyzes the relationships between resilience training and various outcomes of interest (Cornum, Matthews, & Seligman, 2011). For the purpose of this report, there are two points related to resilience that deserve emphasis. First, research has provided evidence that resilience is potentially a state-like product of a number of developmental, cognitive, and affective psychological processes (e.g., Bonanno, 2004; Connor & Davidson, 2003; Luthans, Vogelgesang, & Lester, 2006; Masten, 2001; Wald et al., 2006; Werner, 1990). Second, and following from the first point, evidence suggests people can learn to be resilient (Connor & Davidson, 2003; Luthans, 2002; Luthans, Norman, & Hughes, 2006; Luthar & Cicchetti, 2000). Each of these points will be considered. Until recently, resilience was considered to be rare (Luthans et al., 2006; Masten, 2001). More recently, researchers have found that resilience is much more common than was once thought (Bonanno, 2004; Masten, 2001). Thus, researchers have sought to discover what characteristics, if any, grant some individuals a strong capacity to handle adverse experiences. Progress has been made in highlighting a number of internal (e.g., coping strategies) and external (e.g., socio-demographic) factors related to resilience
among individuals. These include, but are not limited to, internal factors such as hardiness (Maddi, 2005), optimism (Carver & Scheier, 2002), self-efficacy (Rutter, 1985), coping strategies (Mikulincer & Solomon, 1989), hope (Snyder et al., 1991), the tendency to search for benefits through adversity (Affleck & Tennen, 1996), and positive emotionality (Fredrickson, 2001). External factors include such constructs as community support, friendships, parental influence, opportunity, and education (Masten, 2001; Masten & Coatsworth, 1998; Werner, 1995). Relationships between these psychological constructs and stress resistance have been found within a variety of applied settings. To briefly name a few examples: In a medical setting, Rose, Fliege, Hildebrandt, Schirop, and Klapp (2002) found that active coping behavior and self-efficacy significantly predicted healthrelated quality of life and improved glycemic control levels among Type 2 diabetes patients. Taylor et al. (1992) found that optimism was associated with a higher degree of perceived symptom control, as well as decreased psychological distress, among AIDS patients. In an organizational context, Bartone (1999) demonstrated that hardiness predicted fewer symptoms of combat stress among Army Reserve personnel deployed to the Persian Gulf War. Sharkansky et al. (2000) found active coping strategies to be related to fewer posttraumatic stress disorder (PTSD) symptoms among combat personnel. Avey, Luthans, and Jensen (2009) found that a combination of the traits hope, optimism, resilience, and self-efficacy (labeled positive psychological capital) were related to reduced work stress. Finally, Fredrickson, Tugade, Waugh, and Larkin (2003) found that positive emotions experienced in the wake of the September 11th terrorist attacks buffered against symptoms of depression and aided posttraumatic growth. As previously mentioned, evidence suggests that resilience is a characteristic that can be learned. The association between positive psychological constructs and increased stress resistance implies that increasing such factors could potentially lead to an increase in resilience. Indeed, the results of numerous empirical evaluations of programs designed to increase resilience provide evidence for the efficacy of psycho-educational programs to increase resilience––evidenced by their
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attenuating effect on stress-related outcomes (e.g., depressive symptoms and PTSD). For example, the Penn Resiliency Program (PRP) (Gillham, Jaycox, Reivich, Seligman, & Silver, 1990) utilized methods for increasing resilience-related constructs in an intervention designed to reduce depressive symptoms among children and adolescents. Recently, interventions designed to increase resilience to deployment- and return-related stress and attrition have shown positive results among military populations. Williams et al. (2004, 2007), for example, found that the BOOT STRAP intervention, designed to increase problemsolving coping strategies, perceived social support, and unit cohesion, led to reduced separation for psychiatric reasons and improved performance among Navy recruits in training. Similarly, Adler, Bliese, McGurk, Hoge, and Castro (2009) found that BATTLEMIND debriefing and training, designed to increase resilience through education and cognitive-behavioral based training, led to fewer PTSD and depressive symptoms among Soldiers returning from combat deployment (for a more extensive review and detailed results of the preceding programs, see Appendix A). Taken together, this body of literature provides evidence of the potential for increasing the resilience of individuals through education and/or training. To reiterate, resilience, viewed through the lens of psychological health, refers to both the ability to effectively deal with stressful events and to better cope in the time following a stressful event. Evidence suggests that resilience is related to a number of the psychological and interpersonal constructs measured by the Global Assessment Tool (GAT), many of which are related to effective coping in a number of different contexts. As research has shown, resilience, while exhibited at varying levels across individuals, is something that can be taught and learned. Comprehensive Soldier Fitness (CSF) and Resilience CSF measures Soldier resilience on five dimensions of human health––emotional, family, physical, social, and spiritual––based on the primary dimensions of health as identified by the World Health Organization (1948). While physical fitness is certainly an important component to overall Soldier R/ PH, CSF provides training opportunities for Soldiers that go 6
beyond traditional interventions designed to increase physical health. Specifically, the Army’s CSF program employs interventions that are “designed to increase psychological strength and positive performance and to reduce the incidence of maladaptive responses” (Cornum et al., 2011, p. 4). As Cornum and colleagues note, CSF proactively promotes R/ PH by emphasizing human potential through a focus on positive emotions, traits, institutions, and social relationships. The emphasis of these concepts is based on the recognition that Soldiers with these characteristics are more resilient and have the cognitive resources to deal with challenges; control over emotional fluctuations that are the result of stress; social and familial resources at their disposal; and the ability to find meaning and purpose in their life and work. The primary way in which CSF promotes these characteristics is by helping Soldiers develop metacognitive skills that can enhance resilience. In other words, the program is designed to help Soldiers understand how and why they think a particular way and how certain beliefs might influence their reactions to events. As noted above, a critical assumption of the CSF program is that becoming resilient is a process. While some Soldiers undoubtedly possess more “resilient” traits than others, the development of R/ PH involves a process in which anyone who is willing to work toward improvement can participate. In fact, one of the first lessons given to Master Resilience Trainers (MRTs) is that the development of resilience is a learning process that can be undertaken by anyone. It is also important to clearly state what CSF is not. First, CSF is not simply a program designed to treat certain illnesses or pathologies; that particular mission is the responsibility of the Army Medical Department. In fact, to guard against potential stigma related to behavioral healthcare among Soldiers, CSF purposely distances itself from the Army medical community. Consequently, CSF training is managed and led by unit leadership in order to underscore the importance of R/ PH in Army life. Additionally, CSF is not simply a training program that is employed after a negative event. The Army Medical Command’s Combat Stress Control teams are responsible for providing behavioral healthcare during and after crises. CSF, on the other hand, provides the psychological tools prior to potential crises so that
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Soldiers might be better able to cope with the effects of such crises. To execute the program, the Army utilizes four components of resilience training (see Casey, 2011). The first component of the program consists of the GAT–– the online survey instrument that provides feedback about Soldiers’ R/ PH levels upon completion. For analytic purposes, the GAT also serves as an indicator of overall psychological health and well-being, which can be used to assess Soldier fitness in relation to a number of outcomes (see Lester et al., 2011a, 2011b for examples). Second, Soldiers are able to take online self-help Comprehensive Resilience Modules (CRM), which are computer-based distance-learning modules that take approximately 20 minutes to complete; as of this writing, there are 27 CRMs available to Soldiers. Third, MRTs are trained in a number of strategies that Soldiers can use to practice and promote resilience. The Army’s goal is to embed MRTs within every battalion and brigade in the Army so they can pass along their training to peers and subordinates. Fourth, resilience training has been made mandatory at every Army leader development school. As noted, this evaluation will focus solely on the effects of having MRTs present in individual units. Specifically, the R/ PH levels of the Treatment condition were compared with the Control condition to assess mean differences and to compare rates of change in R/ PH over time. CSF and Population-Based Interventions Before discussing the analytic strategies and the results of the evaluation of the CSF program, it is important to consider the literature regarding community- and population-based interventions in order to more fully understand the methodological issues associated with interventions like CSF and the implementation of the MRT training program. Such an understanding can enhance the interpretation of the results of this evaluation and can provide the necessary background for placing the results one might expect from a broadscale, population-wide intervention like CSF in the proper context. In general, community-based interventions are implemented on specific populations. As the name implies, the populations involved in the interventions
are typically drawn from a specific geographic area (Atienza & King, 2002). While the Army is certainly not bound by geography, the Army should be viewed as a community that spans both domestic and international boundaries. Additionally, within the Army, smaller communities exist in the form of facilities (e.g., Forts), large units (e.g., Divisions), smaller units (e.g., Brigade Combat Teams), and other organizational structures. Implementing interventions across these “sub-communities,” then, is very much like implementing interventions across communities or populations as done by public health organizations. While many of the methodological issues encountered by developers of community-based interventions (see Atienza & King, 2002) are the same as those faced in the implementation of the MRT program, there is one distinction that deserves note. That is, in communityand population-based studies, the community or population serves as the unit of analysis. In these situations, statistical power sometimes becomes an issue since it is usually not feasible to implement a program on a statistically sufficient number of communities or populations (Atienza & King, 2002). The CSF program, in contrast, utilizes the individual Soldier as the unit of analysis, thus providing adequate statistical power for the analysis of results. While initially this distinction might seem to preclude comparison of CSF to other community-based studies, it is important to note that individual R/ PH scores are averaged across individuals in the two study conditions. Consequently, the mean R/ PH scores that are compared across the two conditions come to more closely resemble outcomes that are measured at the community or population levels in community-based interventions. Another critical point to consider is the fact that community-based trials measure the effectiveness of the intervention on all eligible participants in the study. For example, when assessing the impact of smoking cessation programs implemented at the community level (e.g., COMMIT Research Group, 1991), it is necessary to measure smoking cessation rates across the entire community, not just among those who are likely to smoke. Thus, the measurement of the criterion variable captures the effects of the intervention for those individuals that are actually motivated or predisposed to be impacted by the intervention, as well as for individuals that were
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not predisposed to be impacted and who felt no impact whatsoever from the intervention. A similar situation exists within CSF, where the propensity to be impacted by the intervention undoubtedly varies from Soldier to Soldier. According to Sorensen, Emmons, Hunt, and Johnston (1998), this is one of the primary reasons the observed effect sizes tend to be relatively small in community- and population-based studies. This is not a point of concern, however, as the authors note that, “small changes in behavior observed across an entire population are likely to yield greater improvements in the population-attributable risk than larger changes among a small number of high-risk individuals” (p. 380). This relationship has been labeled the prevention paradox in the preventive health literature, since a population-based intervention may yield only small benefits for individuals, but bring much benefit to the population at large (Rose, 1981, 1985). Indeed, a review of effect sizes in the health field and in other domains suggests that small effect sizes are typically found in many lines of research (see Meyer et al., 2001), but that the practical implications of various statistical relationships are sometimes understated by the presentation of small effect sizes.
Key Takeaways • Resilience is the maintenance of normal functioning in the face of adversity. • Resilience can be taught and learned. • Comprehensive Soldier Fitness measures resilience and psychological health (R/ PH) along four dimensions: Emotional, Family, Social, and Spiritual Fitness. • Comprehensive Soldier Fitness is designed to increase Solider R/ PH by enhancing cognitive skills. • Even small increases in Soldier R/ PH can lead to tremendous benefits for the entire Army.
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Data and Method Measuring R/PH: The Global Assessment Tool (GAT)
T
he GAT is administered annually to all Soldiers. The survey is a self-awareness tool that provides a snapshot of R/ PH along four dimensions of health–– Emotional, Family, Social, and Spiritual Fitness. To measure the four dimensions, the GAT contains 16 subscales, the majority of which were adapted from validated measures of psychological constructs previously published in peer-reviewed journals; a small number of scales were authored by the GAT’s developers (see Peterson, Park, & Castro, 2011). In addition to the 16 R/ PH subscales measured by the GAT, two additional scales were included to assess perceptions of leadership and unit cohesion. These scales were used for follow-up analyses in this report. The measurement approach and a description of the scales used to develop each dimension of fitness are provided below in Table 1. From left to right, the table presents the name of the R/ PH dimension/subscale, the number of items used to measure the construct, the scale range, an example question, the source of the scale, and the scale reliability estimates (indicated by coefficient “α”; note that scores of approximately .70 or higher indicate acceptable scale reliability, see Cohen [1988]). The Intervention: Master Resilience Training The MRT component of CSF is a cornerstone of the Army’s resilience and psychological health development initiative. The MRT course is structured as a train-thetrainer course. Here, mid-career Noncommissioned Officers (NCOs), typically holding the rank of Staff Sergeant or Sergeant First Class, are selected by their senior leaders to attend the MRT training course held at the University of Pennsylvania in Philadelphia; at Victory University at Fort Jackson, South Carolina; or at any number of remote locations where training is offered via a Mobile Training Team coordinated by the Comprehensive Soldier Fitness Directorate. The course was modeled, in part, after the Penn Resiliency Program (PRP) (e.g., Gillham et al., 1990), described in Appendix A. The course consists of approximately 80 hours of classroom time, much of which is devoted to teaching trainers how to teach the skills to Soldiers. After MRTs are trained, they return to their units so that they can train others in their units to utilize the same
skills learned during the MRT course via a prescribed curriculum, described below. 1 Within MRT training, Soldiers learn six core competencies: self-awareness, self-regulation, optimism, mental agility, strengths of character, and connection. Together the lessons are designed to develop Soldiers’ ability to understand the thoughts, emotions, and behaviors of themselves and others; help Soldiers identify their top strengths and the strengths of others in order to overcome both individual and team challenges; and strengthen Soldiers’ relationships with others by responding constructively to positive experiences, praising others, and by discussing problems effectively. These competencies are taught via four modules; the detailed descriptions of each module below are drawn from the Master Resilience Trainer Manual (Reivich, 2010). Reivich et al. (2011) provide an additional description of the program. Module One Module One consists of two units. Unit One lays the foundation for the rest of the course by introducing Soldiers to the concept of resilience and to the six MRT competencies described in the preceding paragraph. Specifically, Soldiers are taught that resilience is the ability to grow and thrive in the face of challenges and to bounce back from adversity. Fostering mental toughness, optimal performance, strong leadership and goal achievement does this. One important message contained within Unit One is that resilience is something that can be obtained by all. Unit Two teaches Soldiers to counter the bias toward negativity, to create positive emotions, and to focus on what is good—rather than bad—in one’s life. This is done through activities that focus Soldiers’ attention on positive events in their lives. Rather than focusing on what goes wrong, Soldiers are taught to search for positive experiences by thinking about why things go well, what positive events mean, and how to create 1
Note that one of the components of CSF—Comprehensive Resilience Modules—is not considered in this report. Previous analyses (not included in the current report) show that the CRMs have had no impact on R/ PH scores across the period of time covered in the current report. This component of CSF is undergoing a significant revision at the time of this writing. Therefore, this report focuses solely on the impact of MRT training on R/ PH scores across time.
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Table 1
Table 1. GAT Scales and Constructs Used to Measure Soldier R/PH Dimension/ Subscale Emotional Fitness Adaptability
# of Items 77
Bad Coping
4
Good Coping
4
1 = Not like me at all 5 = Very much like me
Catastrophizing
7
1 = Not like me at all 5 = Very much like me
Character
24
Depression
10
Negative Affect
11
Positive Affect Optimism
10
0 = Never 5 = Always 1 = Not at all 5 = Every day 1 = Never 5 = Most of the time 1 = Never 5 = Most of the time 1 = Strongly disagree 5 = Strongly agree
Family Fitness Family Satisfaction
5 2
Family Support
3
Social Fitness Engagement
18 4
1 = Not like me at all 5 = Very much like me
Friendship
6
Loneliness
3
0 = No 1 = Yes 1 = Never 5 = Most of the time
Organizational Trust
5
3
4
Spiritual 5 Fitness Organizational 35 Context Transformational 14 Leadership Unit Cohesion
10
21
Scale Range 1 = Not like me at all 5 = Very much like me 1 = Not like me at all 5 = Very much like me
Example Question
Author(s)
I can usually fit myself into any situation. I usually keep my emotions to myself.
Developed by Professors C. Peterson and N. Park. Adapted by Professors C. Peterson and N. Park from previous research, e.g., Carver, Scheier, and Weintraub (1989). When something stresses Adapted by Professors C. Peterson and me out, I try to solve the N. Park from previous research, e.g., problem. Carver, Scheier, and Weintraub (1989). When bad things happen to Adapted by Professors C. Peterson and me, I expect more bad things N. Park from previous research, e.g., to happen. Peterson et al. (2001). Bravery or courage Peterson (2007); Peterson and Seligman (2004) Feeling down, depressed, or Kroenke, Spitzer, and Williams (2001); hopeless. Spitzer, Kroenke, and Williams (1999) Anxious/Nervous Watson, Clark, and Tellegen (1988) Joyful
Watson, Clark, and Tellegen (1988)
Overall, I expect more good things to happen to me than bad.
Scheier, Carver, and Bridges (1994)
1 = Not at all satisfied 5 = Extremely satisfied
How satisfied are you with your marriage/relationship?
1 = Strongly disagree 5 = Strongly agree
My family supports my decision to serve in the Army.
Developed by the Directorate of Basic Combat Training’s Experimentation and Analysis Element, Fort Jackson. Developed by the Directorate of Basic Combat Training’s Experimentation and Analysis Element, Fort Jackson.
I would choose my current work again if I had the chance. I have someone to talk to when I feel down. How often do you feel close to people?
Peterson, Park, and Seligman (2005); Wrzesniewski, McCauley, Rozin, and Schwartz (1997) Developed by Professors C. Peterson and N. Park. Russell (1996); Russell, Peplau, and Ferguson (1978)
1 = Strongly disagree 5 = Strongly agree 1 = Not like me at all 5 = Very much like me 1 = Not at all 5 = Frequently, if not always 1 = Strongly disagree 5 = Strongly agree
Overall, I trust my immediate Mayer, Davis, and Schoorman (1995); supervisor. Sweeney, Thompson, and Blanton (2009) My life has lasting meaning. Fetzer Institute/National Institute on Aging Working Group (1999)
Reliability Estimates αT1=.97 αT2=.97 αT1=.68 αT2=.69 αT1=.70 αT2=.71 αT1=.85 αT2=.88 αT1=.78 αT2=.81 αT1=.98 αT2=.98 αT1=.91 αT2=.92 αT1=.79 αT2=.81 αT1=.89 αT2=.91 αT1=.74 αT2=.74 αT1=.76 αT2=.78 αT1=.79 αT2=.81 αT1=.81 αT2=.83 αT1=.88 αT2=.89 αT1=.84 αT2=.84 αT1=.66 αT2=.69 αT1=.76 αT2=.78 αT1=.88 αT2=.89 αT1=.81 αT2=.83
Spends time teaching and coaching.
Avolio, Bass, and Jung (1995); Bass and αT1=.97 Avolio (2000) αT2=.98
Soldiers in this unit have enough skills that I would trust them with my life in combat.
Adapted by Professors C. Peterson and N. Park from previous research, e.g., Griffith (2002)
STRONG MINDS
αT1=.97 αT2=.98
circumstances that enable good things to occur. Module Two
to allow Soldiers to understand how an initial reaction to an event might be rooted in more deeply held beliefs about the world, and to help Soldiers determine whether the deeply held belief is getting in the way of responding to a problem in an appropriate way.
Module Two consists of seven units. Together, the seven units help Soldiers learn skills that make them stronger Soldiers and better leaders by increasing Unit Four moves beyond self-awareness to focus on mental toughness. Unit One focuses on an Activating stress and energy management. Activities include Event, Thought, Consequence (ATC) model of dealing controlled breathing, progressive muscle relaxation, with challenges in one’s life. This approach is based meditation, and distraction techniques. These strategies on the ABC (adversity-belief-consequence) model of are designed to foster self-regulation through the cognitive therapy developed by Ellis (1962). Similar management of emotion and energy levels. The to the training offered in the PRP, the skills fostered by ultimate goal is to allow for critical thinking and optimal ATC help Soldiers identify the links between events, performance. Unit Five focuses on problem-solving. thoughts, and emotions/reactions, so that individuals can The objective of the unit is for Soldiers to accurately identify how their cognitive reactions to events might be recognize the factors that caused a particular problem at least as consequential as the event itself in driving and to identify solutions to the problem. Soldiers are thoughts and behaviors. Focus is placed on emotions taught about confirmation biases and how they might and how to understand emotional reactions to events. interfere with problem-solving in group settings. Unit Unit Two teaches Soldiers to avoid thinking traps, which Six is designed to reduce catastrophic thinking and are common patterns of thinking that occur under stress reduce anxiety, and to improve problem-solving skills. and, if uncontrolled, can lead to a downward spiral Soldiers are taught about the inefficiencies associated into depression. Through various exercises, Soldiers with rumination and the focus on worst-case scenarios in are taught to identify and correct counterproductive response to an event. This is done by having Soldiers patterns in thinking, such as pessimistic explanatory think about worst- and best-case scenarios, in relation to styles. Unit Three teaches Soldiers to detect icebergs— the most likely outcome of an event. Finally, Unit Seven deep-seated personal beliefs and values—in order to focuses on real time resilience, which trains Soldiers to determine whether the icebergs drive an interpretation pull their skills together and use them in the various of, or reaction to, an event that might be out of contexts that Soldiers typically face. proportion or inaccurate. The purpose of the lesson is Table 2. MRT Training Skills and Theoretical Bases MRT Skill Activating Event Thoughts Consequences Thinking Traps Icebergs Problem Solving Put It In Perspective Mental Games Real Time Resilience Character Strengths Active Constructive Responding and Praise Hunt the Good Stuff Assertive Communication Imagery; Goal Setting Energy Management
Theoretical Basis in Psychology Activating Event Beliefs Consequences (Ellis, 1962) Errors in Logic (Beck, 1976; Burns, 1999; Ellis, 1962); Explanatory Style (Peterson & Seligman, 1984) Underlying Assumptions and Core Beliefs (Beck, 1976; Young, 1994) Challenging Beliefs (Beck, 1976; D’Zurilla & Goldfried, 1971); Explanatory Style (Peterson & Seligman, 1984) Decatastrophizing (Beck & Emery, 1985) Distraction Techniques (Wolpe, 1973) Externalization of Voices (Burns, 1999; Freeman, Pretzer, Fleming, & Simon, 2004) Character Strengths (Peterson & Seligman, 2004) Active Constructive Responding (Gable, Reis, Impett, & Asher, 2004; Kamins & Dweck, 1999) Gratitude (Emmons & McCullough, 2003) Assertive Communication (Wolpe & Lazurus, 1966) Behavioral element of CBT (Beck, 1976); Goal Setting Theory (Latham & Locke, 1991; Locke & Latham, 1990) Sports Psychology and Stress Management (Benson, Greenwood, & Klemchuk,1975; Borkovec et al., 1987)
STRONG BODIES
11
Module Three Module Three is designed to build Soldiers’ character strengths. In this module, participants are taught to identify their top strengths and the top strengths of others, as well as how to use those strengths to overcome challenges and build teams. This is done through two units. Unit One focuses specifically on identifying character strengths that Peterson and Seligman (2004) have found to be valued across cultures and geography. Knowing and understanding such strengths in one’s self and in others facilitates optimal performance and builds engagement. Unit Two helps Soldiers understand how personal strengths and the individual strengths of others can be used to overcome challenges. This is done through a series of activities that allow participants to identify and describe the talents of themselves and others.
styles should be developed and are appropriate for use at different times. Soldiers are taught strategies that emphasize confident, clear, and controlled communication. Unit Two focuses on sharing positive experiences with others, which is based on communication research that showed how positive events experienced by one person can be used to strengthen relationships with others (e.g., Gable, Reis, Impett, & Asher, 2004). Finally, Soldiers are taught how to properly give and receive praise. Table 2 on the preceding page provides a crosswalk that lists MRT skills and the theory behind each skill. Assignment of MRTs
Once trained, MRTs return to their units and pass along the skills they learned to peers and subordinates. To test program effectiveness, CSF selected eight BCTs to receive different components of the CSF program (see Figure 1). Four BCTs received MRT trainers, while the Module Four other four did not. Note that the GAT was administered Module Four consists of two units and teaches Soldiers three times during the time period under evaluation. to build stronger relationships through communication Soldiers took the GAT in early 2010, late 2010, and strategies. Unit One teaches participants that different early 2011—a time frame spanning about 15 months. communication strategies can help or hinder group Note also that MRT training implementation guidance problem-solving. For example, Soldiers are taught was published in October Figure 1 2010. This guidance that aggressive, passive, and assertive communication manual included lesson plans, more clearly explained Illustration of MRT Training Implementation Figure 1. Treatment Conditions and Assignment of MRTs 2010 2011
Published MRT Training Guidance
Treatment Condition
1 x MRT Per Company (n= 12,529)
BCTs in Study
3/4 IN
Control Condition
0 x MRT Per Company (n= 9,479)
Deployment
1/25 IN Deployment
2/1 IN
Deployment
3/1 IN
Deployment Deployment
170 HBCT
2/4 IN 11 ACR
UNCLASS/FOUO
12
1/4 IN
Deployment
DAMO-CSF
STRONG MINDS
1
the techniques to be used by MRTs, and outlined the frequency of training. It is likely that program fidelity increased as a result of the guidelines being published. Therefore, this report is focused on the effects of the training as measured by the GAT in early 2011 and on changes in GAT scores from late 2010 to early 2011. Throughout the rest of this report, the October 2010 data collection phase will be referred to as Time 1, while the April 2011 data collection phase will be referred to as Time 2. Figure 1 illustrates the number of Soldiers that received MRT trainers within their units, and the number of Soldiers that did not receive MRT trainers. As Figure 1 shows, at baseline there were 9,479 Soldiers in units that did not receive an MRT trainer (Control condition), while 12,529 Soldiers were in units with an MRT (Treatment condition). While these numbers remained consistent through Time 1, there was considerable attrition from Time 1 to Time 2 in the number of Soldiers in the study. Specifically, 6,739 Soldiers remained in the Treatment condition at Time 2, and 3,218 remained in the Control condition. There are a wide range of reasons for the relatively high attrition rates; these include normal assignment rotations that moved individuals in and out of the target BCTs, individuals who may have exited out of the Army, Soldiers who were wounded or killed in combat, etc. To assess whether attrition rates might have impacted the results of the evaluation, a number of steps were taken. First, after applying the screening approach described in the next section, attrition rates between the Treatment and Control conditions were statistically compared from Time 1 to Time 2. The analysis showed that Soldiers in the Control condition (64.7%) were more likely to attrit from Time 1 to Time 2 than Soldiers in the Treatment condition (44.5%), x2(1; n = 21,261) = 854.36, p .05). Analytic Strategy for Evaluation of MRT Training Evaluation of MRT training effectiveness was conducted as follows. First, mean scores on the GAT at Time 2 were compared between the Treatment and Control conditions to evaluate whether MRT training impacted GAT scores after Soldiers had been exposed to it for an extended period of time. Second, changes in mean GAT scores from Time 1 to Time 2 were compared across Treatment and Control conditions; this analysis allowed for an examination of growth in Soldier R/ PH as a result of MRT training. Next, two demographic factors (age and gender) and two contextual factors (quality of leadership and unit cohesion) were examined as potential moderators of the effect of MRT training on GAT scores at Time 2. Finally, three factors specific to the MRT trainers themselves were assessed: the impact of formal training conducted by MRTs, whether MRTs felt they had the necessary preparation, and whether MRTs
STRONG BODIES
13
felt they had support of the Command to successfully implement the training in their units. However, before this major set of analyses was conducted, the following preliminary analytic procedures were performed. Data Cleaning The data were cleaned and screened for invariant responses on the GAT (responses in which the participant entered a constant value across different questions on the GAT, e.g., 1,1,1,1,1,1,1). To do this, questions from the positive affect/negative affect schedule (PANAS) were used. Individuals were screened from an analysis if they used an invariant response pattern at both Time 1 and Time 2. This approach indicated that 744 Soldiers (3.4% of the total sample) used an invariant response pattern throughout the data collection period. A slightly greater proportion of Soldiers in the Control condition (3.8% [357/9,476]) used an invariant response pattern than Soldiers in the Treatment condition (3.1% [387/12,529]), x2(1; n = 22,749) = 6.90, p < .01. Percentage of Maximum Possible Scores Percentage of Maximum Possible (POMP) scores were used to represent R/ PH. POMP scores transform raw mean scores on items and scales into scores that represent the percentage of the overall total possible on a particular item or scale. For example, if an individual had a mean score of 3.5 on Emotional Fitness, which ranges from 1-5, the individual received a POMP score of 62.5 ((observed [3.5]-minimum possible [1])/ (maximum possible [5]-minimum possible [1])*100). This strategy has been advocated for use in evaluation studies such as the present one (Cohen, Cohen, Aiken, & West, 1999), and is appropriate for use in this study for two primary reasons. First, POMP scores standardize the metrics so that all variables range from 0-100, thus
making it possible to make meaningful comparisons across scales that might have different response options. Second, POMP scores allow differences in fitness scores to be described in terms of percentage differences. For example, if the Control condition had an Emotional Fitness score of 62.5, and the Treatment condition had an Emotional Fitness score of 65, POMP scores allow one to say that there was a 2.50% difference between the two conditions. For the purposes of the evaluation, this approach made the interpretation of mean differences more intuitive and meaningful. Reverse Scoring Items and Scales Five scales in the GAT measure “negative” constructs: catastrophizing, bad coping, depression, negative affect, loneliness. For the purposes of computing the four broad fitness dimensions (Emotional, Family, Social, and Spiritual Fitness) these scales were scored so that higher scores represented higher levels of fitness. When these scales are presented as singular constructs within this report, however, they are scored so that they are more intuitive for the reader. Specifically, lower scores on each of the aforementioned variables represent higher levels of fitness. The table below delineates the expectations regarding MRT training and scores on each of the scales included in the analysis. Note that for all scales in the blue section of the table (left hand side of Table 3), the Treatment condition is expected to have significantly higher scores and amounts of growth than the Control condition. For all scales in the red section (right hand section of Table 3), the Treatment condition is expected to have significantly lower scores than the Control condition, as well as greater decreases over time than the Control condition.
Table 3. R/PH Scales and Expectations Regarding MRT Training Positively Scored Scales (Expect Higher Scores in the Treatment Condition) Emotional Fitness Family Satisfaction Adaptability Family Support Character Social Fitness Good Coping Engagement Positive Affect Friendship Optimism Organizational Trust Family Fitness Spiritual Fitness
14
Negatively Scored Scales (Expect Lower Scores in the Treatment Condition) Catastrophizing Negative Affect Bad Coping Loneliness Depression
STRONG MINDS
Results Effects of MRT Training at Time 2
T
his analysis sought to answer the question, “Do Soldiers who received training from MRTs report higher R/ PH scores than Soldiers who were not trained by MRTs?” To make this determination, fitness scores of the Treatment and Control conditions at Time 2 were compared to determine whether significant differences existed. First, however, it was necessary to determine whether significant differences at Time 1 existed; if so, then it would be appropriate to control for Time 1 R/ PH scores in the analysis. The Time 1 analysis did indeed show significant differences between the two conditions. Therefore, it was appropriate to control for Time 1 scores in the analysis of mean differences at Time 2. More detail about the Time 1 analysis and results is presented in Table B1, Appendix B.
was significantly higher on two of the four broad R/ PH fitness dimensions: Emotional Fitness (1.31% higher) and Social Fitness (.66% higher). At the subscale level the Treatment condition was also significantly higher on adaptability (1.08% difference), character (1.63% difference), good coping (1.30% difference), optimism (1.02% difference), and friendship (2.04% difference). As expected, the Treatment condition was significantly lower on catastrophizing, where there was a 1.61% difference between the two conditions. Effect sizes (partial η2) were computed in order to evaluate whether there were meaningful differences between the conditions. The results of that analysis showed that the effects of the MRT training, while statistically significant, were somewhat small practically speaking as the maximum partial η2 was .002. Again, it is important to keep in mind that small effect sizes do not necessarily mean that the treatment had a small impact. A 1.31% increase on Emotional Fitness, for example, can have implications for behavioral outcomes among Soldiers, as evidenced by previous work regarding the GAT and behavioral measures (Lester et al., 2011a, 2011b).
To compare R/ PH scores at Time 2, analysis of variance (ANOVA) with blocking (recommended by Tabachnick and Fidell [2007, p. 222]) was used as an alternative to analysis of covariance (ANCOVA). Table 4 below presents the mean scores for both the Treatment and Control conditions on each of the R/ PH dimensions and subscales. As Table 4 shows, the Treatment condition Time 2 Analysis Table 4 in the report Table 4. Differences between Treatment and Control Conditions at Time 2 Control
†
Treatment
‡
Mean
SD
Mean
SD
Mean Diff.
F
Sig.
Partial η2
Emotional Fitness Adaptability Character Good Coping Positive Affect Optimism Family Fitness Family Satisfaction Family Support Social Fitness Engagement Friendship Org. Trust Spiritual Fitness Catastrophizing Bad Coping Depression Negative Affect Loneliness
66.74 68.15 70.58 62.71 60.74 57.06 71.27 76.90 68.47 65.08 57.46 77.70 59.15 56.99 31.90 55.02 21.40 36.17 35.15
0.23 0.32 0.32 0.34 0.37 0.32 0.35 0.44 0.40 0.28 0.39 0.40 0.39 0.38 0.39 0.39 0.40 0.29 0.35
68.04 69.23 72.21 64.01 61.22 58.09 71.65 76.57 68.80 65.74 58.09 79.74 59.69 57.07 30.29 55.02 20.60 35.91 34.96
0.16 0.22 0.22 0.23 0.25 0.22 0.24 0.31 0.27 0.19 0.27 0.28 0.28 0.26 0.27 0.27 0.28 0.20 0.24
1.31 1.08 1.63 1.30 0.47 1.02 0.38 -0.32 0.32 0.66 0.63 2.04 0.54 0.09 -1.61 0.00 -0.80 -0.27 -0.19
21.19 7.62 18.13 10.27 1.11 6.92 0.80 0.36 0.45 3.83 1.77 17.28 1.26 0.04 11.58 0.00 2.69 0.58 0.19
.000 .006 .000 .001 .293 .009 .372 .551 .504 .050 .183 .000 .263 .852 .001 .997 .101 .445 .666
.002 .001 .002 .001 .000 .001 .000 .000 .000 .000 .000 .002 .000 .000 .001 .000 .000 .000 .000
Negative
Positive
Dimension/Subscale
†n=3215-3218; ‡n=6739
STRONG BODIES
15
Fitness Change between Times 1 and 2 Next, MANOVAs with time as a within-subjects factor and condition as a between-subjects factor followed by simple effects analyses were employed to answer the question, “Over time, do the R/ PH scores of Soldiers exposed to MRT training improve at a greater rate than Soldiers not exposed to the training?” To address this question, changes in fitness scores from Time 1 to Time 2 were examined across the conditions (i.e., the Treatment and the Control conditions). Again, it was expected that the Treatment condition would experience greater rates of improvement than the Control condition on each of the facets of R/ PH measured by the GAT.
2
Figure 2 depicts the percentage change from Time 1 to Time 2 for both the Treatment and Control conditions. The full results of this analysis are presented in Table B2 in Appendix B. The results showed that there were significant differences between the Treatment and Control conditions in rates of change from Time 1 to Time 2 on five dimensions/subscales of R/ PH: Emotional
Fitness, catastrophizing, character, good coping, and friendship. Simple effects analysis conducted on these dimensions/subscales showed that the Treatment condition demonstrated a significant increase on Emotional Fitness (0.54%), good coping (0.71%), and friendship (2.10%) from Time 1 to Time 2, whereas the Control condition experienced no significant change on these dimensions/subscales. Further, the Treatment condition demonstrated a significant decrease on catastrophizing (0.99%) from Time 1 to Time 2, indicating improvement in R/ PH, whereas the Control condition showed no significant change on catastrophizing across the two time points. Finally, the Control condition demonstrated a significant decrease on character (1.82%), while the Treatment condition showed no change on character across the two time points. This last finding provides some evidence that MRT training may be guarding against natural rates of decline in character fitness that may be experienced by Soldiers not exposed to MRT training.
Figure 2. Change in Fitness from Time 1 to Time 2: Comparing the Treatment and Control Conditions
0.10 0.37
Social Fitness
0.34
0.67 0.16
Family Support
1.25 1.55
0.42 0.56
Family Satisfaction
0.48
0.59 0.48
Family Fitness
0.21
0.39 0.55
Optimism
0.12
0.71
0.25
*p
Comprehensive Soldier & Family Fitness
The Army's Comprehensive Soldier & Family Fitness (CSF2) program represents the Army's investment in the readiness of the force and the quality of life of our Soldiers, their Families and Department of the Army Civilians. It increases their physical and psychological health and resilience, while enhancing their performance in combat and in life.
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Resilience training offers strength-based, positive psychology tools to aid Soldiers, Leaders and Families in their ability to grow and thrive in the face of challenges and bounce back from adversity. Training and information is targeted to all phases of the Soldier deployment cycle, Soldier life cycle and Soldier support system. Institutional (Life-Cycle) Resilience Training Modules provide Initial Military Training (IMT) and progressive Professional Military Education (PME) Resilience Training timed to the specific phases of the Soldier’s career. Soldiers and Leaders are trained in the principles and skills that enhance Soldier and organizational resilience and reduce the barriers to seeking behavioral health care.
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The Ready and Resilient Campaign integrates and synchronizes multiple efforts and programs to improve the readiness and resilience of the Army Family - Soldiers (Active Duty, Reserve, National Guard), Army Civilians and Families. Ready and Resilient creates a holistic, collaborative and coherent enterprise to increase individual and unit readiness and resilience. Ready and Resilient will build upon physical, emotional and psychological resilience in our Soldiers, Families and Civilians so they improve performance to deal with the rigors and challenges of a demanding profession.
Preventive program arms soldiers and families with positive psychology tools.
Brigadier General Rhonda Cornum is a formidable champion of resilience and optimism in the face of adversity. In February of 1991, when she was a flight surgeon during Operation Desert Shield in the Persian Gulf War, Brig. Gen. Cornum survived a harrowing week which included a fiery helicopter crash, bullet wounds, two broken arms, enemy capture and an abusive assault. She was one of three who survived the ordeal: five others did not. She recounts, “I just approached that particular little stressful week as any other event. Events happen: you make every effort for events like that not to happen, but when they do, you just deal with it.”
As her military career progressed, Brig. Gen. Cornum, says, “I realized when I was responsible for the health of large groups of soldiers that not everyone approaches adversity with resilience and optimism and that we should do something to help people realize that how they respond to adversity is really modifiable by them.” Brig. Gen. Cornum, M.D., is a urologic surgeon and holds a Ph.D in nutrition and biochemistry from Cornell University.
In October 2009, she launched Comprehensive Soldier Fitness, a $145 Million U.S. Army program that trains thousands of soldiers, family members and Department of Defense civilians. The goal of the program is preventive: to arm soldiers with psychological fitness tools in advance so they are better able to face high levels of sustained stress.
Army Comprehensive Soldier Fitness Program
The program was designed in consultation with positive psychology experts at the University of Pennsylvania, notably Dr. Martin E.P. Seligman and Dr. Karen Reivich. “The Penn Resiliency Project was demonstrated to be successful in improving performance and preventing negative outcomes in 17 different studies in replications over 20-25 years, so it’s pretty clear it works,” says Brig. Gen. Cornum.
Two of the four pillars of the Comprehensive Soldier Fitness program are the Global Assessment Tool and Master Resilience Trainers. The other two pillars are online Comprehensive Resilience Modules in each area of health based on individual needs, and an Institutional program that seeks to reduce barriers for those seeking help.
1) Global Assessment Tool – the GAT is a mandatory, confidential online test that measures four key dimensions of emotional strength: emotional; social; family; and spiritual. Consisting of 105 questions, the annual test takes about 15 minutes to complete and was developed from measures previously validated in peer-reviewed scientific journals. So far, the test has been taken over 1.4 million times, of which 300,000 times are second assessments. Each person receives a confidential report with their GAT score and recommendations about how to develop strengths and improve weaknesses.
2) Master Resilience Trainers – To date, over 6,000 soldiers have been trained as MRTs, leaders who have taken the comprehensive 10-day training course on building, sustaining and enhancing performance using resilience theory, cognitive behavior therapy and positive psychology principles. Each MRT returns to their unit to deliver training in small group settings.
Is the program working? Brig. Gen. Cornum reports that in a study comparing four brigades with training to four brigades who had not yet received training, results showed a statistically significant improvement in a variety of measures: increased optimism and adaptability; more positive coping skills; greater emotional and social fitness; and less catastrophic thinking.
The key to the CSF program is that it’s preventive. Brig. Gen. Cornum says, “Everybody can improve. It is not just aimed at someone who is clinical, high risk, or floundering. I have taken the 10-day MRT course in order to see what I was sending people to do. I learned some things, and I am pretty stinkin’ resilient to start with.”
CONNECT THE DOTS
Watch a short video where BG explains how CSF builds resiliency. Find out more about the psychological fitness tools used in Comprehensive Soldier Fitness. If you want to learn more about positive psychology, check out Martin E.P. Seligman’s Authentic Happiness site where you can register and take confidential questionnaires to measure your personal character strengths and aspects of happiness. Seligman is Director of the Positive Psychology Center at the University of Pennsylvania and author of bestsellers Authentic Happiness,Learned Optimism and the recently published Flourish: A Visionary New Understanding of Happiness and Well-being. Dr. Karen Reivich is Co-director, Penn Resiliency Project and co-author of The Resilience Factor: 7 Keys to Finding Your Inner Strength and Overcoming Life’s Hurdles.
You may also like this post: New Frontiers of Military Medical Research.
Originally published on GE Healthy Outlook, November 11, 2011. Copyright Jane Langille.
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Home > Public Policy Center > Publications of Affiliated Faculty > 32
Public Policy Center, University of Nebraska
Publications of Affiliated Faculty: Nebraska Public Policy Center
Title
Authors
Date of this Version
12-2011
Abstract
This technical report is the third in a series of reports evaluating the impact of the Army’s Comprehensive Soldier Fitness (CSF) Program. This report focused on determining the efficacy of the train-the-trainer component of CSF – Master Resilience Trainer (MRT) – in influencing Soldier resilience and psychological health (R/PH) across time. Four Brigade Combat Teams (BCTs) received MRT skills training (Treatment condition), while four additional BCTs did not (Control condition). Measures of R/PH were taken three times across approximately 15 months (baseline, T1, T2), and demographics, quality of unit leadership, and quality of unit cohesion were accounted for. Analyses show that Soldiers in the Treatment condition exhibited significantly higher R/PH scores at T2 than did Soldiers in the Control condition. Also, MRT skills training appears to be significantly more effective for Soldiers 18-24 years old than older Soldiers. Additional contextual analyses are provided.
There is now sound scientific evidence that Comprehensive Soldier Fitness improves the resilience and psychological health of Soldiers. Pc themes for windows 7.
Background: The purpose of this report is to present empirical evidence of the effectiveness of Comprehensive Soldier Fitness (CSF) at improving Soldier-reported resilience and psychological health (R/ PH). More specifically, this report focuses on the effectiveness of the train-the-trainer component of CSF, known as Master Resilience Trainer (MRT). Though program evaluation of CSF will continue into the future, this report represents a significant milestone in a longitudinal analysis effort involving more than 22,000 Soldiers across eight Brigade Combat Teams (BCTs).
Methodology: Eight BCTs were randomly selected for participation in this program evaluation (see Figure 1, p. 12). A total of 96 Master Resilience Trainers completed the 10-day MRT course at the University of Pennsylvania, Philadelphia, and each returned to one of four BCTs; these four BCTs comprised the Treatment condition. Due to training throughput constraints at the MRT course, four additional BCTs did not receive MRTs over the life of this program evaluation initiative; these four BCTs comprised the Control condition. Measures of R/ PH––using the Global Assessment Tool (GAT)––were taken three times over approximately 15 months. A baseline measure was taken in early 2010. Another measure of R/ PH was taken again in the latter part of 2010 (Time 1), and this measure coincided with CSF publishing its training guidance to be implemented by all MRTs across the Army. A final measure of R/ PH was taken again approximately six months later in 2011 (Time 2). Demographics (i.e., age, gender) and organizational factors (i.e., quality of unit leadership, unit cohesion) were also assessed in our analyses given that these two variables could moderate the relationship between MRT training and R/ PH.
Key Findings:
• The Treatment condition (units with MRTs) exhibited significantly higher R/ PH scores at Time 2 than did the Control condition (units without MRTs) (see Table 4, p. 15). Quality of unit leadership and unit cohesion did not significantly impact the effect of MRT training on R/ PH at Time 2.
• In some areas of R/ PH, the Treatment condition had a higher rate of growth than the Control condition (see Figure 2, p. 16).
• MRT training appears to be significantly more effective for 18-24 year olds than for older Soldiers (see Figure 4, p. 19).
• Training provided by MRTs is most effective when the training is conducted in formal settings (e.g., scheduled classes), when Commands select confident leaders to serve as MRTs, and when Commands properly support their MRTs.
• There is no evidence that Soldier R/ PH scores decrease or that Soldiers “get worse” due to training provided by MRTs.
• The effect sizes reported here are consistent with or better than many other population-wide developmental interventions and public health initiatives.
• The Treatment condition (units with MRTs) exhibited significantly higher R/ PH scores at Time 2 than did the Control condition (units without MRTs) (see Table 4, p. 15). Quality of unit leadership and unit cohesion did not significantly impact the effect of MRT training on R/ PH at Time 2.
• In some areas of R/ PH, the Treatment condition had a higher rate of growth than the Control condition (see Figure 2, p. 16).
• MRT training appears to be significantly more effective for 18-24 year olds than for older Soldiers (see Figure 4, p. 19).
• Training provided by MRTs is most effective when the training is conducted in formal settings (e.g., scheduled classes), when Commands select confident leaders to serve as MRTs, and when Commands properly support their MRTs.
• There is no evidence that Soldier R/ PH scores decrease or that Soldiers “get worse” due to training provided by MRTs.
• The effect sizes reported here are consistent with or better than many other population-wide developmental interventions and public health initiatives.
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Comprehensive Soldier Fitness Program Regulation
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