Improving Resiliency in U.S. Armed Forces Personnel

Although the Department of Defense has made substantial efforts to increase service member resilience, there is limited published evidence that these efforts increase resilience.1-3 The purpose of this proposed study is to examine the effectiveness of the Stress Management and Resilience Training (SMART) in increasing resilience in Air Force (AF) healthcare personnel. SMART includes practices that focus on six factors which promote individual-level resilience.1 Participants in civilian samples have reported a 7.7% to 10.6% increase in resilience after SMART completion.4-6
A pretest-posttest, stacked-wedge, quasi-experimental study is proposed to examine the effectiveness of SMART. The proposed study will be guided by the Defense Centers of Excellence (DCoE) Resilience Continuum. Under the DCoE Resilience Continuum, optimal, mission-ready performance is sustained by providing supportive measures to service members and their families.1 After institutional review board approval, the principal investigator (PI) will recruit a sample (n = 110) of active duty AF healthcare personnel (any 4XXX Officer or Enlisted Air Force Specialty Code) assigned to the 59th Medical Wing at Joint Base San Antonio, TX.
Half of the sample will be randomized to receive SMART and half will be in a wait-list control group, which will receive SMART approximately seven months after the first group. However to ensure a sufficient sample is attained, if a participant consents to participate but needs to be included in a specific group due to their availability (e.g. upcoming deployment, permanent change of station), the service member will be included in the study group of their preference. Baseline data will be collected from each participant prior to the delivery of the intervention. The baseline survey will include demographics questions to attain information regarding participant age, gender, marital status, race, ethnicity, previous deployment, military grade/rank, duty location, and military job duty (i.e. Air Force Specialty Code). The Connor Davidson Resilience Scale (CD-RISC) will be used to measure resilience. The CD-RISC has demonstrated reliability and validity, and has been used in past studies to measure service member resilience. Additional measures to assess the effectiveness of SMART will include the Perceived Stress Scale (PSS), Generalized Anxiety Disorder Scale (GAD-7), and a single item Quality of Life (QoL) measure.
IBM® SPSS® Statistics and R will be used for the statistical analysis. Initial data analysis will include descriptive statistics to characterize demographics, military grade, duty location, military occupation, and previous deployment. Cronbach’s α will be calculated to assess the internal consistency reliability of the CD-RISC, PSS, and GAD-7. CD-RISC, PSS, GAD-7, and QoL responses for the intervention and wait-list control group will be analyzed separately, and scores will be pooled to test differences in intervention effects between the two groups. Changes in CD-RISC, PSS, GAD-7, and QoL will be assessed from baseline to week 12 and week 36 in the intervention group and changes from enrollment to pre-intervention and to week 12 for the wait-list control group. Analyses will be reported as point estimates with 95% confidence intervals and estimates of effect size.
This proposed study would build upon the PI’s previous observational study focused on resilience in Air Force nursing personnel. The proposed study is aligned with the TriService Nursing Program’s priorities of Force Health Protection and Leadership, Ethics, and Mentoring. If the SMART program demonstrates comparable efficacy in increasing resilience in Air Force personnel to what has been found in studies with civilians, this study would provide data to support the need for a multi-site clinical trial of SMART with a broader population of U.S. service members.