Wishful resilience

The New York Times has an extended article that uncritically dicusses a $125 million US Military programme currently designed to increase resilience against mental illness.

If you’re interested in the effects and treatment of psychological trauma, it’s always worth keeping tabs on what the military are doing. The concept of trauma has largely been driven by the military and they are usually pioneers in developing treatments and interventions.

The Comprehensive Soldier Fitness programme is a US Army programme based on positive psychology and was developed with the help of the field’s guru Martin Seligman.

Rather than aim to treat mental health problems, it aims to prevent them by improving the psychological strength of individual soldiers. Owing to the fact that the US Military has surprisingly high levels of PTSD, it is clearly designed with this in mind.

It involves completing a 110 item questionnaire called the ‘Global Assessment Tool’ that gives scores based on the four domains of programme: emotional fitness, social fitness, family fitness and spiritual fitness (it would be interesting to see how atheists score on this last part).

The idea is that the programme can then be tailored to the GAT profile of each soldier to strengthen vulnerabilities and build on existing strengths.

If you were going to base your programme on a psychometric assessment, most importantly, you would want to know that your assessment predicted problems or coping in particular soldiers.

For example, if a particular soldier had a low score on, let’s say, the emotional fitness part of the scale, it would be important to know that tells us about what sort of problems the soldier is likely to have in real life and during his or her service.

You would also want to know that the assessment told us about the likelihood of the solider getting mental illness. It makes sense, right? If you’ve designed a programme intended to prevent mental illness based on an assessment, the assessment should tell us which soldiers are at higher risk for psychiatric difficulties so we can help with skills and abilities that mitigate the risk.

In psychological jargon, this is known as predictive validity and it can be tested statistically.

It is not known whether the Global Assessment Tool does actually predicts anything useful about US soldiers’ problems because this was never tested.

We know this because the GAT and the other aspects of the Comprehensive Soldier Fitness Programme were the subject of the special issue of American Psychologist that had numerous articles on the development and evidence for the programme by the programme’s creators, including an article on the GAT.

As a whole, it seems the Army implemented the programme wholesale and has since been evaluating it in retrospect, which seems a little bit of an odd way of going about it.

By the way, the New York Times article is really focused on ‘posttraumatic growth’ – the psychological benefits that surviving trauma can bring. In places it seems to imply a sort of split view of the phenomenon where you either are traumatised or experience growth – when in reality, it’s possible to be both disabled in some aspects of life while growing in others.

One of the best things I read on this recently was Stephen Joseph’s book What Doesn’t Kill Us: The Psychology of Post-Traumatic Growth (note: I’m blurbed on the back but I don’t make any money from it) that, as a level-headed look at the concept, comes highly recommended.

Link to NYT article on post-traumatic growth.

11 thoughts on “Wishful resilience”

  1. “it would be interesting to see how atheists score on [spiritual fitness]”

    From http://richarddawkins.net/articles/645331-civilian-pastor-attacks-atheist-soldier-reverend-bryan-griem-claims-atheist-solders-are-big-fat-chickens :

    US Army Sergeant Justin Griffith failed his spiritual fitness test. Griffith said, “The spiritual fitness test is unconstitutional. That’s why when lawyers and journalist are around they say the test is about ‘human spirit’ and ‘team spirit'”….

    Upon his failure, Sgt. Griffith was given the telephone number to a suicide hotline….

    Non-religious soldiers represent the second largest demographic in the military. Currently, atheist groups like the local Military Atheists and Secular Humanists of Fort Bragg are banned by chaplaincy regulations from meeting on post regularly.

    1. RE: gdfalk and the sideline on the relation of bravery and “spiritual fitness” …

      The point you raise and the associated “spiritual fitness” issue is new to me, and very interesting. It seems to be a very common assumption, especially among the faithful of course, that faith is a cornerstone of bravery. Personally this surprises me because my experience has always been that military heroism seems to be more a function of sacrifice for team, not wanting to let team mates down, more than devotion to God.

      Talk of God in the military always seemed to me to be more a device for finding common ground, especially when it could be used as a way to symbollize our difference with our enemies when they could be conceived as “godless” or perceived to be religious but worshipping in an alien way. “This is why we hate them, they are not like us …” Religion seems to contain powerful ways of depersonalizing people outside of the perceived faithful, and the military understandably, whether deliberately or not, adopts it. The question in my mind is whether this also legitimately leads to bravery in some sense?

      Also group committment is one of the the implied selection criteria in most very high risk units, willingness to forego individual glory for the sake of the team. Things become intensely competitive, but in the midst of showing you can overcome and prevail, if you also tend to throw mates under the bus, you aren’t going to be someone others want to serve with. I don’t see any reason to cast atheists in particular into any extreme here.

      I wonder what actual data is available showing potential relationships between some practical measure of bravery (perhaps some measure of demonstrated willingness to act on core values in spite of duress?) and “spiritual fitness.” Is “spiritual fitness” even a reliable proxy of committment to principles of faith? What does it really measure in psychological terms? Why would thay use a measure like this instead of more direct and straightforward measures of stability and best available indicators of the right balance of individual ambition and team committment?

      Is there any data showing some legitimate value to the “spiritual fitness” crierion?

  2. The military appears to be assuming that any changes in psychology and “attitude” were due to either PTSD or Seligman’s program. When in fact many of the soldiers, including Sgt Beltran (pictured in the article), also suffered severe injuries to the brain… so of course their personalities changed! It’s pretty well documented that brain injuries from sports and auto accidents can also create similar marked changes in folks personalities, although they’re not always changes for the “better”, as in Sgt Beltrans case, which might even have been unrelated to either PTSD or the stress program.

  3. I’ve been in the military for over 10 years. I once informed my Sgt that if I had to go to another suicide prevention briefing I would shoot myself. He was amused, but I went to the briefing.

    The military doesn’t have the power to do anything significant about the mental health of its members because it has to send people to do things that cause mental and physical trauma and it can’t decide to outlaw no-fault divorce on its own.

    The research I’ve seen, and my own anecdotal experience, suggest that the only well known markers for suicide are “relationship issues” and disciplinary action… The suicides I’ve seen wouldn’t have happened if:

    1. Marriage was protected as a contract and no-fault divorce was abolished (at least for military members/families).
    2. Gender roles reverted to a pre-Vietnam arrangement (no women in combat MOS’s).
    3. Military action only occurred when/where consistent with just war theory (no more playing policemen/spreading democracy).

    Also anecdotal; atheists (not anti-theists, the distinction matters) are typically more resilient than theists. In fact, the most devout people I’ve met have been the most fragile, though I suspect the causal link is fragility leads to devotion, rather than devotion leading to fragility…

    I DO NOT speak for the military, and a large number (probably a majority) of military members would not agree with what I’ve posted here.

  4. some advice from a non-combatant to any would-be soldier …

    don’t make war in far away places over the bodies of people about whom you know nothing

    don’t prostitute your life and your mental health for a regular paypacket and a smart uniform

  5. I’m not sure why you characterized the NYT article as schisming PTSD and the post-traumatic growth.

    It does a fine job, repeatedly and consistently, of pointing out that they coexist: describing the life of a person in which they coexist, explaining that this is novel approach that deviates from the traditional “bifurcated” view of trauma, talks about the need to “integrate the concept of growth” into a new model of trauma, etc.

    I though that was actually one of the strengths of the article – it doesn’t divide folks into a PTSD box and a sage-survivor box, but rather embraces and, in a rare moment, celebrates the complexity of surviving trauma.

  6. AngGuy’s comment makes some good points. My experience working with Vets–failed or failing relationships are a big factor. Extremely long, multiple deployments lead to many failed marriages, or marriages with cheating and the like–with the soldier gone for extensive periods of time. Of course easily triggered anxiety, bouts of rage, and sometimes severe impulse control brought on by head trauma just add a lot of fuel to a situation that was already burning our of control. It’s pretty hard to create resilience if extended deployments lead to the break down of the family, key losses, and amp up the limbic system to respond quickly and powerfully to any sign of danger. My hunch is that–although well intentioned this program will have minimal success. But perhaps some small percentage of success is still a move in the right direction anyway–but it won’t be a catch all. You need proxemics and time with loved ones, particularly newer relationships. If money wasn’t an issue brain scans for signs of traumatic injury could be mandatory, I believe that a checklist method is still used–before an injured vet would be referred for a scan. Many vets still play down injuries, even if slowly some acceptance seems to be gaining in PTSD and mental struggles w/ at least the former soldiers.

  7. I saw the former head of this programme, Rhonda Cornum, present the initial results a month or so ago at the Young Foundation in London – it may have the results to share.

    Basically, the difference in ’emotional fitness’ between those who’d taken the test and those who hadn’t was very slim – I think it was less than 1% – which seems to me a very small impact for such an expensive programme.

    On the whole, I think its a good idea to teach basic cognitive therapy techniques to people to help them know how to manage their emotions.

    But Im not into this idea that a five minute questionnaire can seriously quantify a person’s ‘spiritual fitness’. That seems ridiculous to me.

    Nor am I into the ‘optimistic thinking’ which I believe this course teaches. CBT doesnt teach optimistic thinking – it tries to teach people to be realistic rather than optimistic.

  8. This is a wonderful blog! I’ve been reading it on and off for the past few hours and reading articles and watching videos that you have recommended. Thank you for this! I’ll be adding this site to my list of things to read.

    I just wanted to point out that it seems there are a few “typos” in this post.

    “For example, if a particular soldier had a low score on, let’s say, the emotional fitness part of the scale, it would be important to know that tells us about what sort of problems the soldier is likely to have in real life and during his or her service.”

    “…important to know that tells us…” ?

    “It is not known whether the Global Assessment Tool does actually predicts anything useful about US soldiers’ problems because this was never tested.”

    “…does actually predicts…” ?

    Feel free to delete this comment of mine. I’m not trying to criticize your writing or be the “grammar police”. You are an excellent writer. I often make these kind of mistakes when I have a lot to say and am writing quickly and I’d would want someone to let me know so that I could go back and edit my work.

    Yes, I just typed, “I’d would”. LOL! I’ll leave it there.

    Thanks again for all of this great information!

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