Comparing Elite Soldiers Perceptions of Psychological and Physical Demands during Military Training

Transcription

1 MILITARY MEDICINE, 169, 7:526, 2004 Comparing Elite Soldiers Perceptions of Psychological and Physical Demands during Military Training Guarantor: CPT Jeffrey L. Thomas, MS USAR Contributors: CPT Jeffrey L. Thomas, MS USAR*; Amy B. Adler, PhD*; COL Peter Wittels ; 2LT Robert Enne ; Bernd Johannes, PhD This research examined the impact of psychological and physical demands on a group of elite soldiers (N 9) before, during, and after training exercises involving routine and unrehearsed tasks. Based on the psychological concept of toughening, we expected soldier responses to unrehearsed demands to be less resilient than to routine training demands. As hypothesized, soldiers rated their perceptions of physical and psychological demands higher during the unrehearsed training phase of the study. It was also hypothesized that soldiers would recover more from physical demands than from psychological demands after the training exercise. Although a trend in the data marginally supported this hypothesis, a note of caution is warranted because of the small sample size. Limitations and implications of the study are discussed, with particular emphasis on the dual importance of psychological and physical training in preparing soldiers for mission demands. Introduction ll militaries invest a great deal of resources into training A their soldiers to be resilient in the face of extreme mission demands. One common method of preparing soldiers to be resilient is to ensure that they are as physically fit as possible. The civilian and military research communities have consistently demonstrated that physical fitness enhances physical health, 1 3 well-being, 4 and cognitive functioning, 5 and is critical in buffering the impact of stress. 6,7 Along with the scientific literature, military history also teaches us the importance of having physically fit soldiers in a mission-ready status. For example, lack of troop physical fitness was cited as one of the reasons for American losses in the first combat engagement of the Korean Conflict. 8 Thus, one of the costly lessons learned on the battlefield was the importance of physical preparedness. Shortly thereafter, to ensure mission readiness, the U.S. Army bolstered its physical fitness program and incorporated it into its training and evaluation of soldiers. Although all militaries address fitness as a key attribute of combat readiness, another aspect of fitness that has largely been ignored in military training is psychological fitness. This aspect of readiness is surprisingly undertrained in many units, 9 although soldiers in elite units may receive training on the psychological demands of high-intensity missions. 10 Military *U.S. Army Medical Research Unit-Europe, Walter Reed Army Institute of Research, Heidelberg, Germany. Austrian Army, Research Study Group on Physical Performance, Army Hospital, Vienna, Austria. Free University, Berlin. The views expressed in this article are those of the authors and do not necessarily represent the official policy or position of the Department of Defense or the U.S. Army Medical Command. This manuscript was received for review in April The revised manuscript was accepted for publication in September leaders note that there is a lack of focus on psychological preparedness. For example, the American Forces overseas newspaper, Stars & Stripes, 11 reported that the Army s Chief of Infantry, Major General Paul Eaton, said, the Army does a good job preparing soldiers physically, but dedicates the least amount of time to psychological and emotional readiness. In effect, this broadened conceptualization of training calls for the military training and research communities to shift their conceptualization of mission demands to include a psychological component consistent with the train as you fight doctrine. Moreover, this expanded conceptualization must be investigated to assess how physical and psychological demands interrelate over time. Understanding the impact of psychological and physical demands in a training environment can help military leaders and planners apply lessons learned under realistic training simulations to ensure combat readiness for real-world missions. The aim of the present study was to examine the relationship between soldier appraisals of psychological and physical demands before, during, and after a rigorous training exercise involving routinely trained scenarios and unrehearsed scenarios. Before presenting specific hypotheses, we briefly review the effect of physical and psychological demands on health and performance, the relationship between physical and psychological demands, and research on the effects of unrehearsed demands. Effects of Physical and Psychological Demands Not surprisingly, the civilian occupational stress literature overwhelmingly finds that demands adversely affect psychological and physical health and performance. For example, workplace psychological stressors have been associated with an increased use of alcohol, drugs, and cigarettes, 12 general health decline, 13 emotional exhaustion, 14 and impaired decision making. 15 Moreover, psychological stressors have demonstrated an adverse impact on outcomes, including job satisfaction 16 and turnover. 17 To quantify the scope of the problem, Sullivan and Bhagat 18 estimated that stress in the workplace costs U.S. organizations roughly 10% of the entire U.S. gross national product each year. Military researchers have found results very similar to those of their civilian counterparts. 19 For example, Thomas et al. 20 found that training demands were negatively associated with the well-being and performance of Reserve Officer Training Corps cadets participating in an intensive assessment center. Specifically, thay found that role overload, physical training demands, hours spent training, and lack of sleep were strongly and adversely related to the well-being and performance of the cadets. Thus, physical and psychological demands have been linked with negative individual and organizational outcomes in the 526

2 Perceptions of Psychological and Physical Demands military. Interestingly, however, the relationship between the two types of demands is rarely examined. More typically, the impact of these two types of stressors is studied with little attention paid to the comparison between the two types of stressors or the different ways in which individuals respond, recover, and train to meet these challenges. The Role of Training Although several studies have examined the impact of psychological and physical stressors on individuals, few have directly compared their relative impact. In one such study, Spalding et al. 21 examined the extent to which physical fitness affected responses to a physical challenge (i.e., treadmill) and to a psychological challenge (i.e., arithmetic, knowledge quiz, and a modified Stroop test). Results demonstrated that although physically fit individuals responded less intensely to and recovered more quickly from the physical challenge than the unfit group, the impact of the psychological challenge was similar for both fitness groups. In another study, Singh et al. 22 found basic similarities in response patterns to physical and psychological stressors. Specifically, healthy men of similar fitness levels responded to a physical stressor (i.e., high intensity treadmill exercise test) and a psychological stressor (i.e., interview and mental arithmetic). They observed that there tended to be two types of responders: those who were considered high in physiological responsiveness to the physical stressor and those who were considered low. In general, high and low responders to physical stress had correspondingly high and low responses to psychological stressors. In a related study, Wittels et al. 23 examined sympathoadrenal stress responses after exposure to emotionally stressful and unrehearsed military tasks of commando training. In contrast to Spalding et al., 21 Wittels and colleagues found that aerobic fitness was inversely correlated with physiological reactivity to one of the emotionally stressful tasks. The discrepancy between the two studies may be that the psychological challenge in the Wittels et al. 23 experiment was rather strong and was preceded by 3 days of intense commando training. Aerobic fitness was found to influence the physiological response when the emotional stress was preceded by physical strain. In addition, when soldiers had previous experience with comparable stressful tasks, their physiological reactivity was attenuated. In his summary of the literature on the impact of physiological arousal on health, Dienstbier 24 analyzed the implications of stress fitness in toughening an individual. Dienstbier defined toughening as the strengthening of the ability to respond physiologically in an efficient manner to significant stressors and to recover quickly. Toughening occurs through the repeated exposure of the individual to physiological stressors with sufficient recovery time between exposures. Toughening, a concept with a wide range of empirical support cited by Dienstbier, suggests that developing physical fitness is one way to promote efficient response and recovery to physical stressors. Although these studies suggest that physically fit individuals deal effectively with physical demands, it is uncertain how much physical fitness conditions individuals to handle psychological demands. Although Dienstbier does not specifically address the differential impact of physical and psychological stressors, it seems plausible that if the demand, regardless of whether it is physical or psychological, results in a physiological reaction, the concept of toughening would be applicable. This supposition could explain why Spalding et al., 21 who used psychological challenges that were not physiologically intense, did not find that physical fitness improved how individuals responded and recovered from psychological challenges. By expanding the concept of toughening, the development of training in coping with psychological demands can be incorporated into preexisting training programs to ensure that individuals respond and recover optimally from all forms of stress. Unfortunately, a review of the occupational stress literature reveals that much of the research has focused mostly on relatively mundane psychological stressors and thus lacks applicability for toughening individuals for extremely demanding environments. A notable exception to this trend is research that has been conducted with elite military and paramilitary units (such as Wittels et al. 23 ). Personnel in elite units train for highly dangerous missions and contingencies involving intense physical and psychological demands. To understand the effects of extreme stressors encountered by elite military personnel, Morgan et al. 25 examined how military personnel attending a U.S. Army survival training course responded to intense psychological stressors. Findings indicated that exposure to the training resulted in significant physiological changes that predicted psychological dissociation and performance scores. Although all soldiers in the training were physically fit, Morgan and colleagues also compared the responses of elite soldiers with general infantry soldiers. Elite soldiers were found to respond to the acute, uncontrollable training stressors with fewer psychological symptoms of dissociation than did general infantry soldiers. Termed stress hardy, these elite soldiers were regarded as self-selected for their ability to tolerate high levels of stress, well trained and prepared for such stress, or some combination of the two. Unrehearsed Demands 527 It would be expected that when soldiers are trained as they fight and toughened to confront demands consistent with what they experience on real-world missions, the stress response would be accompanied by an efficient physiological and psychological reaction and rapid recovery. However, even highly trained soldiers may find themselves in situations that they have not encountered before in their training that are physically demanding, psychologically demanding, or both. In the case of unrehearsed physical demands, highly trained soldiers would be expected to acclimate quickly because their training and physical fitness generalizes to these demands. For example, physical demands such as prolonged sleep deprivation or intense physical exertion would not necessarily be unrehearsed and are more in line with typical soldier training. Thus, we would expect an effective physiological response and recovery. In contrast, without specific training and preparation, psychological demands such as being taken captive, encountering civilian casualties, or handling dead bodies might not be expected or rehearsed for, and subsequently may elicit intense psychological responses and slower recovery time. In one recent study, Wittels et al. 26 demonstrated that an unrehearsed and stressful commando training task led to a significant emotional activation. This emotional activation declined with repetitions to the task, even though the tasks were

3 528 Perceptions of Psychological and Physical Demands presented after 3 days of intensive survival training. In addition to repetition, there is also evidence that psychological training for extreme psychological stressors can be effective. For example, Strentz and Auerbach 27 conducted a quasi-experimental study in which they were interested in what type of coping technique would be most effective in handling exposure to simulated abduction and 4 days of captivity. Participants who were trained in more emotion-focused coping strategies displayed lower anxiety and distress and exhibited lower levels of behavioral problems during captivity than did participants trained in other coping strategies. This study s results are encouraging because they suggest that it is possible to train individuals to cope emotionally with intense psychological stressors, just as it is possible for physical fitness to be a benefit for those individuals facing physiological stressors. Present Study The present study compared elite soldiers perceptions of physical and psychological demands over the course of an intensive military training exercise. Our research hypotheses were that (1) perceptions of physical and psychological demands during the unrehearsed training phase will be higher than routine training; (2) perceptions of physical and psychological demands during the recovery phase will be lower than during the unrehearsed training phase; and (3) psychological demands at recovery will be higher than at baseline, whereas physical demands at recovery will return to the baseline level. Method Participants The study s sample consisted of nine noncommissioned officers from an elite European commando unit participating in an intensive three-phase training exercise. However, three subjects did not provide complete data for the entire training exercise. Thus, analyses are based on six to nine participants, depending on the phase of the study. All participants were Caucasian men who volunteered to join the commando unit. The mean age of the participants was 24 years with a SD of Two of the soldiers were married, and the mean years of experience in the unit was 5.33 with a SD of The soldiers were physically fit and had a mean physical work capacity of 4 W/kg (SD 0.7) determined by maximal cycle ergometry. 28 In addition, mean job satisfaction 29 was 4.00 (SD 0.50) and mean job engagement 30 was 3.25 (SD 0.53) on a1to5scale, where a 5 indicates a high degree of satisfaction and engagement. The minimal variability in scores indicates that there was agreement in terms of each member s satisfaction and engagement. These mean attitude scores are comparable with those of U.S. Army Rangers. 31 Finally, because the literature reviewed above describes the negative consequences of intense demands, it was necessary to correlate the demands reported by study participants with their rating of distress. Scores on the Subjective Units of Distress Scale 32 correlated significantly with psychological demands. Procedure At the beginning of the study, all participants were informed about the research project and were assured of confidentiality. Informed consent was obtained from each participant. The training consisted of a day of routine training (baseline or T1); a period of intense, unrehearsed training involving a captivity and interrogation scenario that lasted 36 hours (unrehearsed or T2); and a return to routine duty (recovery or T3). The morning of each study phase, participants completed a survey questionnaire. The commando training was similar in intensity to elite military training reported elsewhere in the literature. 25 Research Measures There were two primary variables used in the current analysis. To assess psychological demands, participants were asked, In the past 24 hours, the psychological demands placed on me have been...? To assess physical demands, participants were asked, In the past 24 hours, the physical demands placed on me have been...? Responses were based on a 5-point scale where 1 represented much less than usual and 5 represented much more than usual. Similar items measuring demands have been used in past research 33 and are considered acceptable. 34 Results Means and SDs for physical and psychological demands for each phase of the study are reported in Table I. Study hypotheses were tested using nonparametric statistics where the study variables were treated as ordinal level data because of the small sample size. The Friedman test demonstrated significant ordering of the physical demands across the three phases of the study, 2 (2, N 5) 7.00, p Differences in ordering were also found for psychological demands across the three phases of the study, 2 (2, N 7) 10.64, p These values are graphed in Figures 1 and 2, respectively. Post hoc analyses were conducted using the Wilcoxon signed rank test, a nonparametric within-subject test of significance, to test specific study hypotheses. In hypothesis 1, we expected that there would be an increase in reported physical and psychological demands from the baseline or rehearsed phase to the unrehearsed phase of the study. We found that physical demands during the unrehearsed phase (T2) were significantly higher in their ranked position than during the baseline phase (T1; T 2.04, N 6, p 0.04). Psychological demands during the unrehearsed phase (T2) were also significantly higher in their ranked position than during the baseline phase (T1; T 2.39, N 7, p 0.02). Thus, the intense unrehearsed training scenario (T2) was perceived as more physically and psychologically demanding than the routine training scenario (T1). TABLE I DESCRIPTIVE STATISTICS Measure Mean SD Psychological demands T1 (N 9) T2 (N 7) T3 (N 7) Physical demands T1 (N 9) T2 (N 6) T3 (N 6) The sample size varies due to missing data and attrition.

4 Perceptions of Psychological and Physical Demands Fig. 1. Mean responses to physical demands across training phases. The error bars represent 1 SD from the mean. Fig. 2. Mean responses to psychological demands across training phases. The error bars represent 1 SD from the mean. In hypothesis 2, we expected that there would be a decrease in reported demands from the high intensity and unrehearsed phase of the training (T2) to the recovery phase (T3). Although the drop in demand scores is evident in Figure 1, these decreases in ranked position were not significant for physical demands (T 1.63, N 6, p 0.10) or psychological demands (T 1.86, N 7, p 0.06). Thus, the hypothesis was not supported, although there was a trend for physical and psychological demands to be lower at recovery (T3). Hypothesis 3, that recovery from psychological demands would be less marked than recovery from physical demands during T3, was partially supported in that there was a clear recovery to baseline levels of physical demands. Specifically, there were no significant differences in the ranking order of physical demands from the routine training (T1) to the recovery phase (T3; T 0.38, N 6, p 0.71). For psychological demands, the ranked position was not significantly different from the routine training (T1) to the recovery phase (T3, T 1.90, N 7, p 0.06), although there was a general trend in the expected direction. Thus, psychological demands do not appear to recover as much as physical demands compared with baseline and routine training, but this effect is only a trend that needs to be replicated with a larger sample. Discussion Findings from the current study indicate that soldiers encountering unrehearsed training report heightened physical and psychological demands. Soldiers recovered quickly from the physical demands and tended to recover less from the psychological demands. Consistent with the literature on toughening, 529 the results from this study provide preliminary support for the distinction between physical and psychological demands and the importance of being trained specifically for both. Although both demands tax the resources of elite soldiers, as demonstrated by the peak in their demand ratings during the unrehearsed phase of the training, soldiers recovered more from the physical demands than from the psychological demands. The physical demands of the training were something for which the soldiers had been previously conditioned, whereas the soldiers had no previous conditioning in meeting the psychological demands of the training. The findings in this study are consistent with previous research. Morgan et al. 25 found that elite soldiers recovered rapidly from physical demands. The findings also suggest, consistent with Spalding and colleagues, 21 that physical training alone is not enough to create the same type of recovery pattern from psychological demands. The study findings support the contention that training for psychological demands is valuable. It may be that the stress of extreme physical demands is relatively specific and easy to replicate in training, whereas training designed to address psychological demands is more of a challenge to implement. Psychological training must respect limits created by ethical and legal standards as well as grapple with the inherent difficulty of creating a training scenario that appears realistic. For suggestions about the design of psychological stress training in the military, see Driskell and Salas. 9 Limitations and Implications Given the small sample size, it is critical that the results of this study be interpreted cautiously. Nonetheless, the pattern of the data are informative and can serve as the basis for follow-up studies. Another point to be considered in interpreting the data is that soldiers in this study are from an elite unit. We are unsure about the extent to which recovery after the unrehearsed phase can be generalized to soldiers from nonelite units. Indeed, findings from Morgan et al. 25 indicate that elite soldiers recover more quickly than do nonelite soldiers. This question too can be the basis for follow-up research. In addition to a cautious interpretation of the data, future research should assess several factors that were not specifically addressed in this study. First, the degree of previous physical fitness training and previous psychological training as well as real-world mission experience should be assessed and controlled for in analyses. Second, the effect of psychological and physical demands on other outcomes needs to be explored. For instance, physical health, performance, and cognitive functioning are three other outcome criteria that are important to assess in conjunction with demands. Third, along with the demands measured in this study, multi-method approaches such as physiological stress monitoring would be useful in further understanding the relationship between training and recovery. Finally, to build on the strengths of the present study and more directly assess the relative impact that physical and psychological demands have on soldiers, we suggest that future studies try to disentangle physical and psychological stressors in separate training scenarios. Assessing the separate impact of physical and psychological demands is inherently difficult because of the underlying psychological component to any intense, unrehearsed physical demand and the underlying physical component of many psychological demands. Yet the fact

5 530 Perceptions of Psychological and Physical Demands that training tends to emphasize the physical demands over the psychological demands suggests the need to develop and test training programs that demonstrate the utility of toughening soldiers in both ways. Previous studies show that it is possible to gain positive effects from training in coping style 27 and psychological toughening, 24 indicating the practical benefit of psychological training when applied to intense mission demands. Military researchers must continue to study soldiers reactions to mission demands under various training paradigms to ensure that soldiers have the experience necessary to succeed. The challenge of psychological resilience research is to demonstrate that it contributes above and beyond the training of physical resilience in making soldiers mission-ready and combat effective. It is clear that given the unconventional nature of recent combat operations faced by soldiers, a broad spectrum of preparation is critical. Acknowledgments The data presented here were collected under the Walter Reed Army Institute of Research Protocol 790, Consultation in International Cooperation Project: Stress under Operational Conditions, with Special Reference to Recovery Processes (COL Peter Wittels, Principal Investigator). We thank LTC Carl Castro for his support in the planning and execution of this study. We also thank COL Karl Friedl, CPL Kaisha Haig, Tommy Jackson, Evelyn Golembe, and Ann Huffman for their contributions to the study. This research was funded by the Research Area Directorate for Military Operational Medicine, U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland, and by the Austrian Ministry of Defense. References 1. Nowack KM: Psychosocial predictors of health status. 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