Psychological Resilience Training for Stress Management in Military Personnel

(R2OE Trial)

Overseen By Stacey Young-McCaughan

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: The University of Texas Health Science Center at San Antonio

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 6

600 Participants Needed

Trial Summary

What is the purpose of this trial?

Security Force Assistance Brigades (SFABs) are specialized United States Army units formed to train, advise, assist, enable and accompany operations with allied and partner nations. Security Force Assistance Brigades are composed of roughly 800 senior military personnel, primarily commissioned and non-commissioned officers selected from regular Army units across a wide range of military specialties. Because of the high operational tempo (OPTEMPO) of these units, individual resiliency is of utmost importance in maintaining readiness to successfully execute critical, high-stress missions. Acceptance and Commitment Training (ACT) is an evidence-based intervention with strong potential to enhance resiliency by bolstering psychological flexibility along with other factors which have been demonstrated to optimize individual and group performance. This project will compare an Acceptance and Commitment Training-based resiliency-enhancement training program as compared to training as usual in 600 3rd Security Force Assistance Brigades soldiers stationed at Fort Hood in Killeen, Texas. Assessment measures related to resilience will be administered before and after training as well as before and after deployment. Assessments will be conducted at baseline, and every 4 months thereafter for a total of 16-months.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Psychological Flexibility Training (PFT), Acceptance and Commitment Therapy, ACT for stress management in military personnel?

Research shows that Acceptance and Commitment Therapy (ACT) helps improve mental health by increasing psychological flexibility, which is linked to reduced stress and better well-being. Studies have found ACT effective in managing stress and improving quality of life across various conditions, including work-related stress and mental health issues in veterans. ^{1 2 3 4 5}

Is Psychological Resilience Training (ACT) safe for humans?

Acceptance and Commitment Therapy (ACT), which is similar to Psychological Resilience Training, has been used in various studies and is generally considered safe for humans. It focuses on improving psychological flexibility, which can help reduce stress and enhance well-being without known harmful effects. ^{1 3 6 7 8}

How is Psychological Flexibility Training (PFT) different from other treatments for stress management in military personnel?

Psychological Flexibility Training (PFT), also known as Acceptance and Commitment Therapy (ACT), is unique because it focuses on helping individuals accept their thoughts and feelings rather than trying to change them, and it encourages commitment to personal values as a way to manage stress. This approach contrasts with other treatments that may focus more on changing thought patterns or behaviors directly. ^{9 10 11 12 13}

Research Team

Alan Peterson, PhD

Principal Investigator

University of Texas Health San Antonio

Eligibility Criteria

This trial is for adult men and women who are part of the 3rd Security Force Assistance Brigades at Fort Hood, Texas. It's focused on soldiers who need to maintain high levels of psychological resilience due to their demanding missions.

Inclusion Criteria

I am 18 years old or older.

I am a soldier assigned to the 3rd SFAB.

Exclusion Criteria

Not applicable.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training

Acceptance and Commitment Training-based resiliency-enhancement program compared to training as usual

2 days

2 visits (in-person)

Follow-up

Participants are monitored for changes in resilience and psychological flexibility

16 months

Assessments at baseline and every 4 months

Deployment

Participants are deployed and monitored for resilience and psychological health

Variable

Treatment Details

Interventions

• Psychological Flexibility Training (PFT)

Trial Overview The study tests a program called Acceptance and Commitment Training (ACT) aimed at enhancing resiliency in military personnel against usual training methods. Participants will be assessed over a period of 16 months, including before and after deployment.

Participant Groups

Group I: Training as usual Active Control 1 Intervention

Training as Usual for the 3rd SFAB is the U.S. Army Master Resilience Trainer (MRT). It focuses on teaching resilience skills and is one of the foundational pillars of the Comprehensive Soldier Fitness program. MRT course is intended to impart training resilience skills, designed to introduce other resilience concepts that soldiers will likely encounter through their careers. Key focus of course are (1) resilience, (2) building mental toughness, (3) identifying character strengths, and (5) strengthening relationships. The 3rd SFAB uses a a team training grounded in strengths-based leadership. The Small Team Development Consultant and Brigade Behavioral Health Provider serves as a consultant to units conducting their own resiliency training as usual. No booster sessions will be offered to Training as Usual.

Group II: Training as usual with psychological flexibility training Active Control 1 Intervention

Training as usual, with psychological flexibility training delivered during a 2-day workshop. Day 1 provides an overview of the training and describes the posture or stance to prepare for response to challenging situations in a psychologically flexible manner. Day 2 provides common coping strategies.

Psychological Flexibility Training (PFT) is already approved in United States, European Union for the following indications:

Approved in United States as Acceptance and Commitment Therapy for:

• Anxiety disorders
• Depression
• Substance abuse
• Psychological resilience enhancement

Approved in European Union as Acceptance and Commitment Therapy for:

• Anxiety disorders
• Depression
• Substance abuse
• Psychological resilience enhancement

Who Is Running the Clinical Trial?

The University of Texas Health Science Center at San Antonio

Lead Sponsor

Trials

486

Recruited

92,500+

Findings from Research

The study evaluated the Comprehensive Assessment of Acceptance and Commitment Therapy (CompACT) in 178 U.S. military personnel, finding that the shorter 18-item version (CompACT-18) had better psychometric properties than the original 23-item version, indicating it is a more effective tool for assessing psychological flexibility.

The CompACT-18 demonstrated good internal consistency and convergent validity with various psychological measures, suggesting it can be reliably used in military populations undergoing weight management interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Confirmatory Factor Analysis of the Comprehensive Assessment of Acceptance and Commitment Therapy (CompACT) in Active-Duty Military Personnel. Tynan, M., Afari, N., Dochat, C., et al.[2023]

Internet-based acceptance and commitment therapy (iACT) has shown small but significant improvements in anxiety, depression, quality of life, and psychological flexibility across various adult populations, based on a meta-analysis of 25 studies.

Therapist-guided iACT was more effective than unguided versions, particularly for individuals with diagnosed psychological conditions, suggesting that support during treatment enhances its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-Based Acceptance and Commitment Therapy: A Transdiagnostic Systematic Review and Meta-Analysis for Mental Health Outcomes. Thompson, EM., Destree, L., Albertella, L., et al.[2021]

A randomized controlled trial involving 91 participants showed that an increase in psychological flexibility during an Acceptance and Commitment Therapy (ACT) intervention significantly reduced work-related stress and increased well-being during the intervention.

While the benefits of increased psychological flexibility were evident during the intervention, they did not persist in reducing stress or enhancing well-being at the 3-month follow-up, suggesting that ongoing support may be needed to maintain these benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The link between stress, well-being, and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention. Wersebe, H., Lieb, R., Meyer, AH., et al.[2022]

A study involving 35 participants found that Acceptance and Commitment Therapy (ACT) did not significantly reduce the acute stress response, as measured by cortisol levels and subjective stress evaluations, compared to a waitlist control group.

Interestingly, participants who were more avoidant experienced a stronger endocrine stress reaction after receiving the ACT intervention, suggesting that ACT may not be beneficial and could potentially worsen stress responses in certain individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychoneuroendocrine evaluation of an acceptance and commitment based stress management training. Gloster, AT., Klotsche, J., Aggeler, T., et al.[2019]

A multi-site randomized clinical trial is currently evaluating Acceptance and Commitment Therapy (ACT) as a treatment for trauma-related mental health issues in military personnel, addressing the need for effective therapies for veterans with high comorbidity.

ACT is considered a promising transdiagnostic treatment approach, which means it can be beneficial for multiple mental health diagnoses, making it potentially more efficient for veterans readjusting after service.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluating transdiagnostic treatment for distress and impairment in veterans: a multi-site randomized controlled trial of Acceptance and Commitment Therapy. Lang, AJ., Schnurr, PP., Jain, S., et al.[2013]

In a study involving 168 parents of children with asthma, an Acceptance and Commitment Therapy (ACT) program significantly improved parental psychological flexibility, which in turn reduced parental psychological distress and childhood asthma symptoms over a 6-month period.

The ACT intervention led to notable decreases in children's daytime and nighttime asthma symptoms, as well as reduced reliance on bronchodilators, highlighting its efficacy in managing asthma through enhancing parental mental health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of parental psychological flexibility in childhood asthma management: An analysis of cross-lagged panel models. Chong, YY., Mak, YW., Loke, AY.[2020]

In a study involving 41 treatment-resistant patients with panic disorder, Acceptance and Commitment Therapy (ACT) effectively increased valued actions and reduced struggle and suffering over eight sessions.

The results suggest that engaging in valued behaviors is crucial for reducing suffering, supporting the idea that changes in behavior can lead to improvements in mental health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increasing valued behaviors precedes reduction in suffering: Findings from a randomized controlled trial using ACT. Gloster, AT., Klotsche, J., Ciarrochi, J., et al.[2018]

Psychological flexibility (PF) is a distinct and important construct in acceptance and commitment therapy, showing a strong correlation with healthy psychological functioning across various help-seeking samples, including those with panic disorder and social phobia (total n = 1171).

The study found that PF, measured by the Acceptance and Action Questionnaire (AAQ-II), not only differentiates patients from healthy individuals but also provides unique insights into symptomatology and functioning, suggesting it may have clinical relevance beyond existing measures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing psychological flexibility: what does it add above and beyond existing constructs? Gloster, AT., Klotsche, J., Chaker, S., et al.[2015]

Resilience Training for US soldiers during Basic Combat Training showed a faster decrease in anxiety symptoms compared to a Military History intervention, indicating its potential effectiveness in improving mental health.

While Resilience Training was positively received and increased confidence in helping others, it did not significantly enhance group cohesion or reduce depression and sleep problems compared to the Military History group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resilience training with soldiers during basic combat training: randomisation by platoon. Adler, AB., Williams, J., McGurk, D., et al.[2015]

The U.S. Army Master Resilience Trainer (MRT) course is a 10-day program designed to equip sergeants with resilience training skills, which they can then teach to their soldiers, promoting mental toughness and well-being.

The curriculum is based on evidence from the Penn Resilience Program and positive psychology, ensuring that the training is grounded in scientifically validated methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Master resilience training in the U.S. Army. Reivich, KJ., Seligman, ME., McBride, S.[2011]

Warrior Resilience Training (WRT) effectively enhances resilience and posttraumatic growth among Soldiers deployed in Operation Iraqi Freedom, utilizing techniques from rational emotive behavior therapy and positive psychology.

Feedback from 1168 participants indicates that WRT is well-received and suggests that integrating behavioral health services with military leadership can improve combat stress resiliency and promote overall force preservation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Warrior Resilience Training in Operation Iraqi Freedom: combining rational emotive behavior therapy, resiliency, and positive psychology. Jarrett, T.[2013]

A study of 1,342 West Point graduates identified that having a sense of purpose in life, strong social support, and grit are key factors that contribute to psychological resilience, explaining a significant portion of the variance in resilience scores.

The research suggests that these factors are modifiable, meaning they can be targeted in interventions to improve resilience, particularly in high-stress professions like the military and healthcare.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychological Resilience in West Point Graduates: Results From a Nationally Representative Study. Thomas, MM., Pietrzak, RH., Nguyen, DR., et al.[2022]

The U.S. Army Comprehensive Soldier Fitness (CSF) program uses the Global Assessment Tool (GAT) to evaluate soldiers' psychosocial strengths and weaknesses, aiming to enhance well-being and prevent psychological issues.

The GAT is a self-report survey that assesses emotional, social, family, and spiritual fitness, and its development involved a thorough review of military psychological assessment history to ensure its effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessment for the U.S. Army Comprehensive Soldier Fitness program: the Global Assessment Tool. Peterson, C., Park, N., Castro, CA.[2015]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

Confirmatory Factor Analysis of the Comprehensive Assessment of Acceptance and Commitment Therapy (CompACT) in Active-Duty Military Personnel. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Internet-Based Acceptance and Commitment Therapy: A Transdiagnostic Systematic Review and Meta-Analysis for Mental Health Outcomes. [2021]

3. Spain pubmed.ncbi.nlm.nih.gov

The link between stress, well-being, and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Psychoneuroendocrine evaluation of an acceptance and commitment based stress management training. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Evaluating transdiagnostic treatment for distress and impairment in veterans: a multi-site randomized controlled trial of Acceptance and Commitment Therapy. [2013]

6. England pubmed.ncbi.nlm.nih.gov

The role of parental psychological flexibility in childhood asthma management: An analysis of cross-lagged panel models. [2020]

7. England pubmed.ncbi.nlm.nih.gov

Increasing valued behaviors precedes reduction in suffering: Findings from a randomized controlled trial using ACT. [2018]

8. United States pubmed.ncbi.nlm.nih.gov

Assessing psychological flexibility: what does it add above and beyond existing constructs? [2015]

9. England pubmed.ncbi.nlm.nih.gov

Resilience training with soldiers during basic combat training: randomisation by platoon. [2015]

10. United States pubmed.ncbi.nlm.nih.gov

Master resilience training in the U.S. Army. [2011]

11. United States pubmed.ncbi.nlm.nih.gov

Warrior Resilience Training in Operation Iraqi Freedom: combining rational emotive behavior therapy, resiliency, and positive psychology. [2013]

12. United States pubmed.ncbi.nlm.nih.gov

Psychological Resilience in West Point Graduates: Results From a Nationally Representative Study. [2022]

13. United States pubmed.ncbi.nlm.nih.gov

Assessment for the U.S. Army Comprehensive Soldier Fitness program: the Global Assessment Tool. [2015]