May 15, 2012
Adapting to stress
Fit in body and mind
From student to teacher
Banishing the stigma
By Mark Cantrell
Anyone who has been through basic training knows the Army is and always has been a strong proponent of physical fitness. In combat, endurance and strength are vital, and the sometimes-grueling regimen recruits must endure in their first few weeks is designed to build those attributes. But until recently, basic training placed less emphasis on something just as important: a soldier’s mental and emotional fitness.
Beginning in World War I, the surgeon general established personality tests for prospective recruits designed to pinpoint those likely to crumble under fire. In World War II, 14 million inductees were tested for psychological problems. Fourteen percent of them were rejected, a situation that led directly to the National Mental Health Act of 1946.
But it wasn’t until after the Vietnam War that PTSD, once known as “shell shock” or “battle fatigue,” was recognized as a bona fide aftereffect of combat and other highly stressful situations. As research continued, it became clear that, even when exposed to the same battlefield conditions, some veterans developed PTSD while others did not. What could explain the difference?
Adapting to stress
A study of veterans who served in operations Enduring Freedom and Iraqi Freedom revealed some soldiers seemed to have an innate ability to bounce back from adversity, an attribute known as resilience. By then, a psychological technique called cognitive-behavioral therapy (CBT), popularized by psychologists such as Dr. David Burns, had proven thoughts lead directly to feelings and behavior. What’s more, experiments with CBT showed thought patterns could be changed, leading to nearly immediate improvements in outlook — and resilience.
By 2008, the wars in Iraq and Afghanistan had been raging for several years, and incidents of PTSD and all of its negative outgrowths were increasing rapidly. With an all-volunteer force, the old methods of simply weeding out those deemed unfit no longer were enough. It was clear the Army was paying the price for having ignored mental and emotional health in favor of physical health for a very long time. Fortunately, tools to ameliorate and even prevent many psychological problems had been developed. In 2009, the Army implemented the Comprehensive Soldier Fitness (CSF) program.
“In 2008, we were really having an issue with suicides,” says Army Brig. Gen. James Pasquarette, who inherited command of CSF from Army Brig. Gen. Rhonda Cornum after her recent retirement. “They were really starting to spike at that time, and the incidence of PTSD and other adverse outcomes were beginning to overwhelm the Army’s resources. We realized that trying to treat this problem after the fact was no longer the answer. Rather than just throwing hundreds of millions of dollars worth of treatment at the problem like we used to do, we’re now doing preventive things … that will not only lower the amount of treatment necessary but, in the long run, will also save a lot of money for taxpayers.”
Former Army Chief of Staff Gen. George W. Casey Jr. approached officials at the University of Pennsylvania to enlist their aid in putting the program together. Psychologists Dr. Karen Reivich and Dr. Martin E.P. Seligman of the university’s Positive Psychology Center were tapped to create tools and techniques the Army could use to teach soldiers how to be more resilient. The resulting program comprises four major components: assessment, universal resilience training, individual training, and master resilience trainers.
Fit in body and mind
While discerning someone’s level of physical fitness is straightforward, that’s not always the case with his or her psychological state. To measure a soldier’s emotional, social, family, and spiritual fitness, University of Pennsylvania researchers developed the global assessment tool (GAT), a 105-question online survey. “Every soldier, regardless of rank, must take it once a year,” says Pasquarette. “The key is that it’s personal — nobody can see your scores.”
Pasquarette estimates about 93 percent of soldiers are being honest with themselves on the GAT, mostly because of the anonymous nature of the test. Though many commanders would like to know which soldiers score low on the test, if the information were to be released “that [percentage] would plummet,” Pasquarette says. “Soldiers will not be honest if they think their chain of command is going to see their results, so we hold a hard line on that. There are other command surveillance tools they can use, but we want the GAT to remain just between the soldier and the computer.”
If the GAT reveals room for improvement, a soldier can continue on with several comprehensive resilience modules (CRMs) designed to build the values and skills that lead to resilience. The interactive modules contain information, quizzes, and games to engage and test the user in the same four areas the GAT measures. The CRMs contain exercises that can be done at the user’s own pace, helping to increase emotional, social, family, and spiritual strength. A separate GAT is available for Army family members as well.
From student to teacher
The sheer number of soldiers in today’s Army precludes the possibility of them all attending resilience classes at the University of Pennsylvania, which led to the concept of master resilience trainers (MRTs). In this train-the-trainer strategy, NCOs attend a 10-day class at either the University of Pennsylvania or Victory University in Fort Jackson, S.C., learning the 12 basic CSF skills they’ll need to teach soldiers once they return to their units.
Army Sgt. 1st Class Michael Ballard became an MRT in 2009. “My commander told me there was a comprehensive soldier fitness course they wanted to send me to,” he says, “so I took my running shoes and got some pushups in, but it was totally different than I imagined.” Since then, Ballard has trained upwards of 2,000 soldiers how to be more psychologically resilient in the face of adversity. “I've never had anyone come up to me after training and say, ‘This isn’t going to work,’ ” says Ballard. “In fact, it’s just the opposite. Some older soldiers ask me why we weren’t doing this 20 years ago.”
Not everyone welcomes the program with open arms. The Army has never been particularly touchy-feely, and many students arrive thinking the course will be just psychobabble. “That’s OK — I want them to be skeptical,” says Ballard. “But usually by the third day, they’re leaning forward and engaged. One of the things we teach is ‘hunting the good stuff’ on a daily basis, [meaning] looking for something positive that has happened. The first time I explained this to them, they were rolling their eyes and wondering what they’d gotten into. A week later, I couldn’t get them to put their hands down. When people are optimistic and positive, others are drawn to them. It becomes contagious energy.”
Like CBT, resilience training is about metacognition: thinking about your thinking. It’s about challenging negative thoughts that might have been with us for nearly a lifetime. Soldiers learn not to “catastrophize” when things go wrong but rather to keep matters in perspective and act rationally to correct the problem. They learn to recognize every event, even a negative one, contains something positive — even if it’s just the knowledge of how to avoid it in the future. They’re encouraged to strengthen their social networks, which provide a vital means of support when things go south.
MRTs are quick to point out they are not psychologists or counselors; they’re simply handing soldiers a set of tools they can use to improve their lives, not just within their units but also at home with their families as well. It seems to be working. A recent study of eight brigades over an 18-month period showed soldiers who had taken resilience training were “happier with who they were, more optimistic about the future, and generally more positive,” says Ballard.
Banishing the stigma
Still, roadblocks remain. As Casey told American Psychologist, “The prevailing view among many within our ranks is that having problems with stress or seeking help is not only inconsistent with being a warrior but also a sign of weakness. This way of thinking has led to a stigma associated with receiving help and, therefore, an aversion across much of the Army to seeking behavioral health care.”
A recent report released by Mental Health Advisory Team 6 underscores the problem. In polling soldiers serving in Afghanistan, the team found nearly half believed commanders would treat them differently if they sought psychological help, and nearly 34 percent thought it would harm their careers. Forty percent believed leaders would blame them for their problems, and more than half thought they’d be seen as weak. Cultural changes tend to be more evolutionary than revolutionary for the Army, but change it must, says Casey. “CSF will serve as a catalyst for changing Army culture from a culture in which behavioral health was once stigmatized to a culture in which psychological fitness is recognized as every bit as important as physical fitness.”
In his years teaching soldiers the tenets of resilience and emotional intelligence, Ballard has seen significant changes in how his students react to adversity. “It’s amazing that no matter where we are and what’s happening to us, no matter how short we believe our lives to be at a certain moment in time, we can always find that grain of positivity,” Ballard says. “I think that’s what keeps the human spirit going.”
Copyright Mark Cantrell and Military Officers Association of America. All rights reserved.