By Lieutenant Colonel Dr Andrew Cohn MAPS, National Coordinator, Prevention and Resilience Team, Colonel Dr Stephanie Hodson MAPS, Director and Monique Crane, Senior Researcher, Prevention and Resilience Team
Directorate of Mental Health in Defence
Fundamental to being employed within the Australian Defence Force (ADF) is the requirement to be able to respond effectively to adverse, potentially dangerous and high risk situations, whether personnel are in a war zone or disaster relief situation. In response to such requirements, a significant amount of research and development is occurring in the field of psychological resilience.
The Defence Directorate of Mental Health, established in 2002, provides oversight and direction for the ADF Mental Health Strategy. Of particular relevance to the present article are the series of resilience-focused initiatives currently managed by the Directorate of Mental Health. These include the Longitudinal ADF Study Evaluating Resilience (Project LASER), and the development and evaluation of psychological resilience programs for ADF members. These two major initiatives were part of the ADF Mental Health ‘Lifecycle' scheme promoted by the Government in 2007 and strongly supported by Professor David Dunt in his Review of Mental Health Care in the ADF and Transition to Discharge, which was released in May 2009.
This article focuses specifically on the resilience training programs being developed to enhance the coping abilities of ADF personnel. The resilience training program, dubbed BattleSMART (Self-Management and Resilience Training), is a cognitive-behavioural based program that aims to develop both arousal reduction techniques (i.e., the Self-Management component) and adaptive cognitive coping strategies. ADF personnel are taught to identify adaptive from maladaptive responses to stressful situations and adjust their responses as necessary. The article also outlines the origins and empirical support for psychological resilience training in the ADF.
The Stress and Coping Model (Lazarus & Folkman, 1984) emphasises that coping is the ability to manage internal and external demands appraised as adverse or exceeding one's ability. Strategies for resolving these demands need to be congruent with the event's actual level of controllability, and the degree of impact of the event on the individual's wellbeing. Thus, in order to deal with the broad variety of stressors encountered in modern life, no single style of coping strategy is adaptive across all stressful situations. In contrast, it is flexibility in the use of these strategies that contributes to resilience (e.g., Bun Lam & McBride-Chang, 2007).
Recent research demonstrates that flexibility in coping strategies allows an individual to attain such adaptability and resilience. Bun Lam and McBride-Chang (2007) examined whether coping flexibility would buffer the adverse effects of stressful life events. The findings demonstrated that coping flexibility mitigated the impact of stressful life events on psychological distress. In other words, individuals who were able to use a broader range of coping strategies experienced less psychological distress after the onset of a stressful life event, compared to those who did not employ coping flexibility.
Dawson (2000) demonstrated a link between coping strategy use and levels of emotional distress amongst trainees in recruit training at the Army Recruit Training Centre (ARTC). Specifically, ‘avoidant' coping styles (i.e., self-blame, denial, rumination and venting) were predictive of poorer psychological adjustment and failure to complete recruit training. Alternatively, recruits who engaged in problem-focused coping strategies (i.e. planning and problem-solving) reported less emotional distress, and were more likely to complete training. On the basis of these findings, Dawson (2000) recommended that cognitive-behavioural interventions be implemented in the initial weeks of ADF recruit training to teach recruits adaptive styles of coping in the recruit training context.
The resilience training currently being trialled in the ADF is an attempt to capitalise on the idea that people with a broad range of coping strategies display greater adaptability and resilience in the face of adversity.
A study conducted in 2003, and reported in Cohn and Pakenham (2008), evaluated the efficacy of a brief cognitive behavioural program in modifying causal attributions, expectancy of control, coping strategies and psychological adjustment in a sample of Australian Army soldiers undergoing the 45-day recruit training program at ARTC. The results indicated that, compared to the control group, those who received the brief coping skills intervention reported more helpful and realistic attributions for their problems during training, showed less use of self-blame, and reported better psychological adjustment at the end of training. The coping skills program, developed by Cohn and Pakenham (2008) was introduced for delivery to Army recruits as of July 2006.
The ADF has in place psychological screening processes that monitor the wellbeing of personnel on deployment. In late 2007, these processes highlighted the need to enhance the stress management or arousal reduction training to allow ADF personnel to deal effectively with the complex demands of modern operational environments. This requirement was briefed to senior leadership in Defence who directed that arousal reduction be implemented across the training continuum.
In January 2009, the coping skills program was enhanced with the teaching of arousal reduction skills (i.e., controlled breathing and grounding). The importance of arousal reduction during and immediately after a stressful event has been highlighted in recent empirical work (e.g., Bryant, Creamer, O'Donnell, Silove, & McFarlane, 2008). These authors found that elevated physiological arousal (i.e., heart and respiration rate), at the time of and immediately following a traumatic event, was a significant positive predictor of the later development of posttraumatic stress disorder. In mid-2009, the enhanced coping skills training program was redeveloped and branded as BattleSMART.
The cornerstone of the BattleSMART (Self-Management and Resilience Training) program is the evidence-based approaches of attributional retraining and cognitive behaviour therapy. The aim of the program is to encourage optimal emotional and behavioural outcomes in response to adverse events that are considered to promote resilient psychological functioning. BattleSMART highlights several important lessons in adjusting one's coping strategies to fit the adverse situation.
The training identifies four key response areas (i.e., physical, thoughts, emotions and behaviours) that may indicate and promote poor or optimal performance in a stressful situation. The program teaches personnel to test whether their initial response to a situation is the best response, and then identifies a series of ways to change or adjust the response if required.
Brief overview of the BattleSMART program
Individuals are taught to ‘test' their initial responses in the four domains and to ‘adjust' if the initial response is not going to achieve optimal performance in the specific situation. The theme ‘test' and ‘adjust' is central to the BattleSMART program.
Researchers within the ADF have commenced trials evaluating the efficacy of the BattleSMART program in specific training establishments. This research is being conducted in collaboration with Dr Amy Adler, a senior researcher in the US military who is involved in similar trials with the US Army recruits at Fort Jackson (Kappler, 2009). The data from these trials will be used to determine the effectiveness of the training and direct future modifications in areas where the training is unsuccessful. Further, Project LASER will identify the predictors that lead to long-term healthy adjustment to service in the ADF and will be used to guide the priorities for resilience training.
In addition to the introduction of BattleSMART in the initial period of an ADF member's career, other versions are being developed in 2010 for delivery to members at other important career points (i.e., embarking on and returning from deployment, and during preparation for transition out of the ADF into civilian life).
This article has reviewed some of the theoretical and empirical contributions that have informed the ADF's present approach to resilience training. Currently, the ADF is utilising psychological theory and research to attempt to develop an evidence-based and comprehensive resilience building program that will enhance personnel's ability to cope effectively with potentially adverse, dangerous and high risk situations. The goal of the program is to give the personnel both protecting and representing Australia the broadest repertoire of coping strategies and the ability to psychologically adjust to the sometimes challenging roles faced by ADF members.
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Bun Lam, C., & McBride-Chang, C. A. (2007). Resilience in young adulthood: The moderating influences of gender-related personality traits and coping flexibility. Sex Roles, 56 (3-4), 159-172.
Bryant, R.A., Creamer, M., O'Donnell, M., Silove D., & McFarlane, A.C. (2008). A multisite study of initial respiration rate and heart rate as predictors of posttraumatic stress disorder. Journal of Clinical Psychiatry, 69(11), 1694-1701.
Cohn, A., & Pakenham, K. I. (2008). Efficacy of a cognitive-behavioural program to improve psychological adjustment among soldiers in recruit training. Military Medicine, 173(12), 1151-1158.
Dawson, K. J. (2000). Psychological adjustment to basic military training: application of a stress and coping model. Unpublished thesis.
Kappler, S. (2009, July 31). Chief of Staff previews new Army program aimed at combating stress. US Army News. Retrieved 1 March 2010 from www.army.mil/-news/2009/07/31/25291-chief-of-staff-previews-new-army-program-aimed-at-combating-stress/
Lazarus R.S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.