Stress Management and Resilience Training for Stress in Air Force Personnel

Recruiting at 4 trial locations

Overseen By Yiliang Zhu, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of New Mexico

Disqualifiers: Non-active personnel, BMTs, prisoners, others

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

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 4

Duration: 6-8 weeks

500 Participants Needed

Trial Summary

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your healthcare provider.

What data supports the effectiveness of the treatment Stress Management and Resilience Training (SMART) for stress in Air Force personnel?

Research shows that the SMART program has been effective in building resilience and reducing stress and anxiety in academic physicians and healthcare personnel, suggesting it could be beneficial for Air Force personnel as well. ^{1 2 3 4 5}

Is Stress Management and Resilience Training (SMART) safe for humans?

The available research does not provide specific safety data for the Stress Management and Resilience Training (SMART) program, but it has been used in various settings, such as with physicians and military personnel, without reported safety concerns. ^{1 2 3 6 7}

How is the Stress Management and Resilience Training (SMART) treatment different from other treatments for stress in Air Force personnel?

The SMART treatment is unique because it focuses on building resilience and stress regulation skills, which helps individuals handle stress more effectively. Unlike some treatments that require in-person sessions, SMART can be delivered through self-directed written materials, making it more accessible. ^{1 2 3 8 9}

What is the purpose of this trial?

This trial examines the effectiveness of the SMART program in helping U.S. Air Force personnel manage stress and build resilience. The program includes practices like gratitude and mindfulness and can be delivered in-person, via video calls, or through computer-based training. The study aims to find out which delivery method is most effective. The SMART program has been previously tested in various settings, including healthcare workers and employees at a medical center, showing significant improvements in stress, resilience, and mindfulness.

Research Team

Stephen Hernandez, PhD

Principal Investigator

University of New Mexico

Eligibility Criteria

This trial is for active U.S. Air Force personnel at specific bases who are over 18 years old and can give informed consent. It's not open to those on temporary duty, civilians at the base, trainees in basic military training, prisoners, or anyone under 18.

Inclusion Criteria

Active Component Air Force personnel assigned or attached to specific medical wings and groups at various Air Force bases

Able to provide informed consent

Exclusion Criteria

Personnel at the specified locations who are not Active Component Air Force personnel (e.g. individuals on temporary duty [TDY] at the location or civilian personnel)

Unable to provide informed consent

Basic Military Trainees (BMTs)

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-intervention

Participants complete a pre-intervention survey to collect demographic information and baseline measurements of resilience, stress, anxiety, and quality of life

1 week

1 visit (virtual)

Treatment

Participants complete the assigned modality of SMART (in-person/VTC or CBT)

6-8 weeks

Multiple sessions (in-person/VTC or online)

Follow-up

Participants are monitored for changes in resilience, stress, anxiety, and quality of life at 12, 24, and 36 weeks post-intervention

36 weeks

3 follow-up surveys (virtual)

Treatment Details

Interventions

• Stress Management and Resilience Training

Trial Overview The trial tests Stress Management and Resilience Training (SMART) delivered either in-person/video-teleconference or via Computer-Based Training to see if it boosts resilience and reduces stress among participants over time up to 36 weeks post-training.

Participant Groups

Group I: Randomization Experimental Treatment 1 Intervention

At two study sites, we will randomly assign participants to the VTC/in-person group or CBT group using a ratio of 2:1 to assign participants to the VTC/in-person or CBT training modalities. We anticipate 84 participants (42 per site) will be assigned to the CBT modality and 168 (84 per site) will be assigned to the VTC/in-person modality.

Group II: Self-selection Active Control 1 Intervention

At two study sites, participants will be able to self-select which SMART training modality they will complete (VTC/in-person or CBT).We aim to recruit 250 participants in the self-selection arm.

Stress Management and Resilience Training is already approved in United States for the following indications:

Approved in United States as SMART for:

• Increasing resilience in U.S. Air Force personnel
• Decreasing stress in U.S. Air Force personnel

Who Is Running the Clinical Trial?

University of New Mexico

Lead Sponsor

Trials

393

Recruited

3,526,000+

Wright-Patterson Air Force Base

Collaborator

Trials

1

Recruited

500+

Joint Base San Antonio-Lackland

Collaborator

Trials

1

Recruited

500+

Johns Hopkins University

Collaborator

Trials

2,366

Recruited

15,160,000+

University of Nevada, Las Vegas

Collaborator

Trials

81

Recruited

14,700+

Nellis Air Force Base

Collaborator

Trials

1

Recruited

500+

Joint Base Andrews

Collaborator

Trials

1

Recruited

500+

TriService Nursing Research Program (Funder)

Collaborator

Trials

1

Recruited

500+

Findings from Research

The Stress Management and Resilience Training (SMART) program significantly improved resilience and reduced perceived stress among 49 Air Force healthcare personnel, with notable increases in resilience scores and decreases in stress scores observed at 12, 18, and 24 weeks post-training.

Participants showed a 14% to 21% increase in resilience and a 22% to 35% decrease in perceived stress, indicating that SMART can be an effective intervention for enhancing mental well-being in military personnel.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Resiliency in U.S. Air Force Healthcare Personnel: A Randomized Preventive Trial. Hernandez, SHA., Killian, J., Parshall, MB., et al.[2023]

The SMART program, designed to enhance resilience in physicians, did not show statistically significant improvements in resilience, happiness, stress, or anxiety at 3 and 6 months, based on a study of 40 academic physicians.

Despite the lack of statistical significance, the intervention group reported clinically relevant improvements in resilience, stress, and anxiety, suggesting potential benefits that warrant further investigation in larger trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of Stress Management and Resailience Training (SMART) on academic physicians during the implementation of a new Health Information System: An exploratory randomized controlled trial. Spilg, EG., Kuk, H., Ananny, L., et al.[2022]

A self-directed Stress Management and Resiliency Training (SMART) program using only written materials was effective in improving stress, resilience, mindfulness, anxiety, and quality of life among 37 employees over a 12-week period.

Out of the 37 participants, 34 completed the study, showing that the program can be successfully implemented without in-person training, making it accessible for wider use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bibliotherapy to decrease stress and anxiety and increase resilience and mindfulness: a pilot trial. Sharma, V., Sood, A., Prasad, K., et al.[2014]

The military medical system has seen a 167% increase in costs over the past decade, largely due to behavioral health issues and physical ailments, highlighting the need for improved resilience among medical professionals.

A study of 172 medical professionals who participated in the Provider Resiliency Program showed that nearly all attendees found the training valuable and plan to apply the mind-body resiliency techniques learned, indicating a positive impact on their ability to cope with stress and burnout.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resiliency training for medical professionals. Adams, S., Camarillo, C., Lewis, S., et al.[2010]

The pilot-tested resilience skills training program for pediatric residents resulted in 76% of participants rating the skills as important and 60% expressing satisfaction with the training.

Post-training, 82% of residents reported a change in their response to patient-related grief and trauma, indicating increased awareness of stress signs and improved coping strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adaptation and Evaluation of Military Resilience Skills Training for Pediatric Residents. Bursch, B., Lloyd, J., Mogil, C., et al.[2022]

The article provides guidelines for implementing Critical Incident Stress Debriefing (CISD) interventions specifically tailored for Air Force and aviation personnel after fatal aircraft mishaps, based on experiences with several hundred military members and their families.

Lessons learned from two specific mishaps highlight the importance of structured debriefing to support mental health and recovery in high-stress environments, emphasizing the efficacy of the CISD model in these situations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Critical incident stress intervention following fatal aircraft mishaps. Cigrang, JA., Pace, JV., Yasuhara, TT.[2004]

The implementation of the Critical Incident Stress Management (CISM) Program for air traffic controllers in Germany showed that after five years, the program's fiscal benefits exceeded its costs, indicating economic efficiency.

The program significantly improved the safety culture within the German Air Traffic Control Services, with even those who did not use the services recognizing its value as a supportive resource.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Economic evaluation of CISM--a pilot study. Vogt, J., Leonhardt, J., Köper, B., et al.[2019]

The Stress Resilience Training System (SRTS) has been shown to effectively engage users in managing stress, reducing stress symptoms, and improving job performance through a series of seven evaluations, including usability studies and controlled experiments.

SRTS provides an individualized training approach that not only mitigates the negative effects of stress but also teaches users to leverage stress positively, making it applicable to various professions such as law enforcement, athletics, and healthcare.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Building resilience with the Stress Resilience Training System: Design validation and applications. de Visser, EJ., Dorfman, A., Chartrand, D., et al.[2019]

A systematic training program is essential for military personnel to enhance unit-level resilience in preparation for crises, emphasizing the need for structured support.

Mental health professionals in the military, such as nurses and social workers, are crucial in educating personnel about resilience and supporting effective pre-combat training, leveraging their expertise to improve overall mental health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhancing Resilience in Active Duty Military Personnel. Crabtree-Nelson, S., DeYoung, LP.[2017]

References

1. England pubmed.ncbi.nlm.nih.gov

Improving Resiliency in U.S. Air Force Healthcare Personnel: A Randomized Preventive Trial. [2023]

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

The impact of Stress Management and Resailience Training (SMART) on academic physicians during the implementation of a new Health Information System: An exploratory randomized controlled trial. [2022]

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

Bibliotherapy to decrease stress and anxiety and increase resilience and mindfulness: a pilot trial. [2014]

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

Resiliency training for medical professionals. [2010]

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

Adaptation and Evaluation of Military Resilience Skills Training for Pediatric Residents. [2022]

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

Critical incident stress intervention following fatal aircraft mishaps. [2004]

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

Economic evaluation of CISM--a pilot study. [2019]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Building resilience with the Stress Resilience Training System: Design validation and applications. [2019]

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

Enhancing Resilience in Active Duty Military Personnel. [2017]