Resilience and Fitness Building Techniques

Scott L. Johnston, PhD, ABPPCAPT, MSC, USN, Director NCCOSC

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OSC N170D

Disclaimers• There were no conflicts of interest.

• The opinions expressed in this article are the author's own and do not necessarily reflect the view of the United States Government, the United States Department of Defense, The United States Navy, or The United States Navy Bureau of Medicine and Surgery. 

• The study protocol was approved by the Naval Medical Center San Diego Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects.

• I am a military service member (or employee of the U.S. Government). This work was prepared as part of my official duties. Title 17, USC, §105 provides that ‘Copyright protection under this title is not available for any work of the U.S. Government.’ Title 17, USC, §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

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OSC N170D

Resilience

Comprehensive approaches that focuses on mind, body, spirit and social fitness working together to address a spectrum of wellness that maximizes each service member’s personal readiness to hone the most combat-effective force in the history of the Department of the Defense.

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Total Force Fitness (TFF)

www.nccosc.navy.mil

An initiative from the Chairman of the Joint Chiefs of Staff

(DCoE adapted from Military Medicine, 2010)

Mind• Psychological• Behavioral• Spiritual• Social

Body• Physical• Medical &

Dental• Nutritional• Environmental

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OSC N170D

Army Air Force Marine Corps Navy

Funding Comprehensive Soldier Fitness & Family (CSF2) > $350M

$5.6M+ $5M $5M for N171 OSC and Suicide Prevention programs

Assessment Global Assessment Tool (GAT)/ArmyFit

Developing online assessment

Marine Corps Fitness Improvement Tool (MCFIT) – Web-based tool for “Marine Total Fitness”

• Behavioral Health Quick Poll

• Defense Equal Opportunity Climate Survey

Training & Programs

Institutional resilience training

• Institutional resilience training

• 2 mandatory stand downs

• Small groups or peer-to-peer learning

• Operational Stress Control and Readiness (OSCAR)

• Force Preservation Council

• Operational Stress Control (OSC)-Leader

• Deckplate Leader-OSC

Facilitators Over 25,000 trained as Master Resilience Trainers (MRT)

Trained 640 MRTs: • 1 per Squadron• 1 per Guard/Reserve

Local Command Trainers • Mobile Training Teams• Command Instructors

Program Evaluation

CSF technicalreports 1, 2, 3, 4

None None None

Services Resilience Programs

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ReactingReady Injured Ill

Adaptive coping

Optimal functioning

Wellness

FeaturesWell-trained and prepared

Fit and focused

In control

Optimally effective

Behaving ethically

Mild and transient distress or loss of optimal functioning

Temporary & reversible

Low risk for illness

FeaturesIrritable, angry

Anxious or depressed

Physically too pumped up or tired

Reduced self-control

Poor focus

Poor sleep

Persistent and disabling distress or loss of function

Unhealed stress injuries

Mental disorder

TypesPTSD

Major depression

Anxiety

Substance abuse

FeaturesSymptoms and disability persist

over many weeks

Symptoms and disability get worse over time

More severe and persistent distress or loss

Higher risk for illness

CausesLife threat, loss,

inner conflict, wear and tear

FeaturesPanic or rage

Loss of control of body/mind Can’t sleep

Recurrent nightmares/ bad memories

Persistent shame, guilt or blame

Loss of moral values and beliefs

STRESS

Unit Leader Responsibility

Caregiver Responsibility

Individual, Shipmate, Family Responsibility

The Operational Stress Continuum

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Five Core Leader Functions

StrengthenLeadership that is Firm, Fair, a Source of Courage, Communicates, Plans and Listens

Expose to Tough, Realistic Training

Foster Unit Cohesion

MitigateRemove Unnecessary Stressors

Ensure Adequate Sleep and Rest

Conduct After-Action Review (AAR) in Small Groups

Identify

Know Crew Stress Load

Recognize Reactions, Injuries and Illness

TreatSelf

“Buddy Aid” (Peers)

Chain of Command

Chaplain

Medical

ReintegrateKeep with Unit if Possible

Expect Return to Full Duty

Don’t Allow Retribution or Harassment

Communicate with Treating Professionals (Both Ways)

(US Navy NTTP 1-15M and US Marine Corps MCRP 6-11C, 2010)

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OSC N170D

Operational Stress Control (OSC) and Resilience Secondary Prevention

(Selective or Indicated Treatment)Primary Prevention

(Universal)

ResilienceOSC

vs

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LOW HIGH LOW

STRESS LEVEL

ST

RE

SS

RE

AC

TIO

N

RESILIENT

LESS RESILIENT

Resilience Continuum

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OSC N170D

NCCOSC Proposed Navy Resilience Program

Assessment Training

Command Champion

Evaluation

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Adaptation of cognitive-behavioral principles addresses: concept of resilience, values, cognitive behavioral therapy

Targets evidence-informed resilience factors:

• Optimism• Flexible Thinking• Behavioral Control• Positive Coping • Control & Acceptance

Individual Resilience Training (IRT)

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IRT Training MethodsEmphasizes multimodal learning skills acquisition and application

strategies

• Facilitation

• Large group exercises

• Small group exercises

• Discussion

• Scenarios

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Individual Assessment Sailor Evaluation Tool (SET)

• Self-report and confidential

• Paper-pencil or electronic

• Reliable and valid inventories

• Strength based focus

• Immediate results

• Reports to command leaders

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SET MeasuresResilienceConnor Davidson Resilience ScaleResponse to Stressful Experience Scale

Individual Resilience FactorsFlexible ThinkingControl and ConfidenceOptimismBehavioral ControlPositive Coping

General InformationDemographicsWork/Deployment Variables

Other Related VariablesPerceived StressSocial SupportQuality of LifePersonalityAffectBrief Clinical IndicatorsHealth BehaviorsResilience Practice

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Sample Reports

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NavyFITServicemember Evaluation Tool (SET)

Building and preserving individual resilience for optimal performance.

Search

My SET Results:

HM3 Joe SailorSan Diego CA

Click here to view your profile

Training:

My Nutrition Planning

My Fitness Planning

Resources:

Resilience

Sleep

Real Warriors

Relaxation

Warrior Care Blog

Military OnceSource

Suicide Prevention

SRTS

Resilience Training

Caregiver OSC Training

My 0verall Resilience Scores:

My SET Training Recommendations

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Navy Resilience depends on fitness of the Mind, the Body, the Spirit and Social connections. These four “Resilience Domains” are vital to building, strengthening, and sustaining resilience at work and at home.

RESILIENCE ASSESSMENTSA set of scientific assessments gives you a position in each of the domains, from green to red. Your objective is to get into the green and to stay there.

Choose the “i” symbol for a description of each domain. Select a domain name to take the related assessments. Select “Details” to see the results of each assessment; “Recommendations” offers suggestions to help you build resilience.

i

i

i

i

LEARN GAMES ASSESSMENTS

Leader View

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Resilience Evaluations/Studies

• Navy amphibious assault ship

• Recruit Training Command

• Stress Resilience Training System (SRTS) Randomized Controlled Trial (RCT)

• SRTS/Resilience Pilot and Evaluation at Military Detention Center

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Navy Amphibious Assault Ship• Training included:

− Operational Stress Control− Resilience− Reunion & Reintegration

• Train-the-Trainer• Over 750 Sailors trained

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Training Effectiveness (Percentage of agreement)

Treatment for stress can help

Training made me more open to treatment

I would recommend training

Learned important strategies/resources

I plan to use strategies

Presentations were informative

I would seek help for stress issues

I would help shipmates under stress

75.0% 80.0% 85.0% 90.0% 95.0% 100.0%

6-12 Month Follow-up Survey(Percentage of agreement)

Learned important strategies

Recommend OSC/IRT

OSC/IRT of value to Navy

OSC/IRT will improve Mission Readiness

Plan to use OSC/IRT strategies

OSC/IRT will improve Navy culture

OSC/IRT presentation informative 80%

80%

78%

83%

88%

85%

90%

0% 20% 40% 60% 80% 100%

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Recruit Training Command• Train-The-Trainer

• Sailor Evaluation Tool (SET)

• Individual Resilience Course

• Command Champion

• Program Evaluation

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IRT Course Evaluation: [Percentage of Agreement]I learned important strategies for developing resilience from training.

The strategies learned will help me become more resilient.

I plan to use the strategies I learned from training.

I would recommend this training.

Resilience training will be valuable to the Navy.

Resilience training will fit well in the Navy culture.

Resilience training will improve Mission Readiness.

80% 90% 100%

(98%)

(95%)

(100%)

(95%)

(93%)

(98%)

(95%)

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Program Evaluation

Baseline Recruit Training Follow-Up End of Pilot

Week: 1 14 25   52

Group 1 SET T1Resilience Training

SET T2 SET T3   SET T4

Group 2 SET T1   SET T2

Resilience Training

SET T3   SET T4

Group 3 SET T1   SET T2 SET T3   SET T4Resilience Training

Group 1 = Early Resilience Training (RT), at start of Recruit TrainingGroup 2 = Late RT, at end of Recruit TrainingGroup 3 = Delayed RT, ~9 months after Recruit Training

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Stress Resilience Training System (SRTS)Teaches stress regulation skills through the use of HRV biofeedback

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SRTS Randomized Controlled Trial(CID: NMCSD.2012.0032)

• SRTS condition – Teaches stress regulation skills through the use of HRV biofeedback

• PMR condition – Teaches Progressive Muscle Relaxation (PMR)

• Waitlist control condition – Receive SRTS training after 2 months

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T1 T20

1

2

3

4

5

Depression

PHQ

Sco

re

Depression, Perceived Stress, and Resilience

T1 T26

8

10

12

14

16

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Perceived Stress

PSS

Scor

e

SRTS, n=24PMR, n=21CONTROL, n=17

T1 T2545658606264666870

Resilience

RSES

Sco

re

p<.05 p<.05

p<.05

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SRTS vs. PMR Usage

Before stressful event with iPad

Before stressful event without iPad

During a stressful event without iPad

1 2 3 4 5

2.9

3.1

3.3

2.0

2.3

2.0

How often do you use (PMR or SRTS): PMR SRTS

SRTS

PMR

0 5 10 15 20 25 30 35 40 45

41.3

16.4

Mean total number of sessions:

“Never” “Very Often”

Note. All differences are significant at p < .05

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• SRTS platform is a promising approach to engage Sailors to learn a variety of skills:– Limited training required– Teaches to different learning styles– Self-paced– Information in small bites

• Combining SRTS platform/skills with Resilience curriculum

SRTS and Resilience Pilot at Military Detention Center

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Program Evaluation

Cohort T1 (March) T2 (May) T3 (July) T4 (September) T5 (November)

WAVE1 Assessment & Training

Assessment Assessment

WAVE2 Assessment Assessment & Training

Assessment

WAVE3 Assessment & Training

Assessment Assessment

WAVE4 Assessment & Training

Assessment

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Summary• Resilience is needed to maintain a ready fighting force

– Prevention is key, cannot rely just on secondary treatment

• Military services are evaluating and developing programs addressing mind, body, spiritual and social fitness

• Collaboration of operational, scientific and educational communities

• Resilience training provides the tools needed:– To preserve skills and talents– For growth – To endure the challenges of military service