Mission Control, Johnson Space Center, Houston, Texas, during the early portion of space shuttle mission STS-95 on October 29, 1998, overlooking the Flight Director (FD) and the Spacecraft Communicator (CAPCOM) consoles. NASA image.

Dr. Paul Stoner (left) and Dr. Jeff Jones, on-duty flight surgeons in Houston’s Mission Control Center during the April 24, 2000, launch attempt of space shuttle Atlantis during mission STS-101. NASA image.



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Safe Passage: Astronaut Care for Exploration Missions Mission Control, Johnson Space Center, Houston, Texas, during the early portion of space shuttle mission STS-95 on October 29, 1998, overlooking the Flight Director (FD) and the Spacecraft Communicator (CAPCOM) consoles. NASA image. Dr. Paul Stoner (left) and Dr. Jeff Jones, on-duty flight surgeons in Houston’s Mission Control Center during the April 24, 2000, launch attempt of space shuttle Atlantis during mission STS-101. NASA image.

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Safe Passage: Astronaut Care for Exploration Missions 5 Behavioral Health and Performance If the planet is ever terraformed, it will be done by Human Beings whose permanent residence and planetary affiliation will be Mars. The Martians will be us. Carl Sagan, Cosmos (1980, p. 135) Advances in the exploration and habitation of space environments over the last half-century have set the stage for long-duration expeditions beyond Earth orbit. A common feature of these initiatives will be extended stays by groups of humans in extraterrestrial habitats. The success of such endeavors depends on the behavioral health and performance effectiveness of multinational microsocieties living and working continuously in confined, isolated, and hazardous environments for extended periods of time. The increasing durations of space missions and human habitation in space environments over the past four decades have presented a range of biomedical and behavioral challenges. These challenges have been met with remarkable success, often under adverse circumstances. The so-called human element, however, remains the most complex component in the design of long-duration missions into space. The imperatives of behavioral health and performance effectiveness therefore present major challenges to mis-

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Safe Passage: Astronaut Care for Exploration Missions sions that involve significant increases in the time spent and the distance traveled in space. The organization of work and living conditions in space environments must be a primary consideration in the operational requirements for such bold endeavors. Closely related considerations focus on the Earth-bound support and recovery systems interacting with the astronauts and the role of astronaut screening, selection, and training. ASTRONAUT PERFORMANCE AND GENERAL LIVING CONDITIONS Background Hundreds of humans have now participated in missions that required the occupancy of spacecraft vehicles or space stations for periods of up to several months or in some cases a year or more under generally adverse environmental and behavioral conditions. Living space is confined, food is restricted in quality and diversity, there is a lack of privacy, and facilities for personal hygiene are limited. The quality of the environment provided by artificial life-support systems, compounded by high noise levels and unpleasant odors, is hardly comparable to that on Earth. Weightlessness requires motor and perceptual readjustments under conditions in which disorientation and motion sickness are common, at least during the initial exposure to space (SSB and NRC, 1987). Social interactions are limited, and sexual activity is constrained. Only distant and remote communication with family and friends is possible. Workloads can be demanding and stressful, with the ever-present danger of a major life-threatening system failure. All of these restrictions occur under conditions that make no provision for escape, at least during missions beyond Earth orbit. Current Practice and Knowledge Base Despite these conditions, neither the National Aeronautics and Space Administration (NASA) nor other agencies of the international space community have documented behavioral health problems sufficient in magnitude to compromise mission objectives, although they may have occurred or on other occasions have nearly reached the point of compromising the mission. It has been reported (Burrows, 1998), however, that three Soviet missions were aborted for reasons partly psychological. Other evidence sup-

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Safe Passage: Astronaut Care for Exploration Missions ports the assumption that emotional or social problems could develop, and over months and years, these problems could grow to the point at which they disable an astronaut and limit crew effectiveness. Such evidence comes from three sources (Box 5–1): (1) anecdotal reports from astronauts and cosmonauts, (2) summary information from NASA on the incidence of adverse behavioral health events during space missions, and (3) findings from analog environments such as crews aboard submarine patrols or wintering over in the Antarctic. The 1998 report, A Strategy for Research in Space Biology and Medicine in the New Century (SSB and NRC, 1998a), also indicates the importance of a number of psychosocial issues. Performance decrements are usually transient, although behavioral data from more extended missions have not been easy to access. The validity and reliability of participant self-reports, anecdotal and otherwise, as well as those of official reports, have been difficult to both access and evaluate, at least in part because of the traditional reluctance of flight-qualified individuals to be forthcoming about such behavioral health events. Moreover, the extent to which available accounts are representative of astronauts’ experiences in general is not easily determined. The available, evidence-based data from space missions are thus clearly insufficient for the committee to make an objective evaluation or projection of the behavioral health issues likely to be involved in long-duration space missions beyond Earth orbit. However, the available database from analog settings such as undersea and polar environments (Box 5–1) may be informative, at least to some ex- BOX 5–1 Evidence of Emotional or Social Problems on Short-Duration Missions Astronaut and Cosmonaut Reports of Personal and Social Problems of Adaptation The diaries of cosmonauts and astronauts who have spent long periods of time in space describe some of the personal and social problems of adaptation that can occur during long-duration space missions. For example, cosmonaut Valentine Lebedev (1988), who usually had a relatively sunny disposition, described his mood turning distinctly sour relatively early during his 211-day space mission on Salyut 7. By the 9th day he had a conflict with his fellow crewmember (p. 39). Just over 2 months into the mission he said, “My nerves were always on edge, I get jumpy at any minor irritation.” About half way through the trip, his anxiety interfered with his sleep (p. 291). As with cosmonauts and astronauts alike, however, he kept his feelings to himself (p. 158).

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Safe Passage: Astronaut Care for Exploration Missions U.S. astronaut Jerry Linenger, who spent nearly 5 months aboard Mir with two cosmonauts, wrote that he “was astounded at how much I had underestimated the strain of living cut off from the world in an otherworldly environment” (Linenger, 2000, p. 151). Even though he had done all he could do to prepare for the mission, he experienced profound feelings of isolation and confinement as well as alienation from his crewmates (p. 152). Cosmonauts and astronauts alike agreed that the most challenging interpersonal problems were not among the crewmembers but, rather, were between the crewmembers in space and the mission controllers on the ground. Lebedev portrayed the largest proportion of his contacts with his ground control negatively (e.g., pp. 96, 102, and 164). For Linenger, because of communication difficulties and his perception of little support from below, his aggravation with ground controllers in both Russia and the United States reached the point that he stopped communicating with them after the first month (pp. 123–127). His feelings are summed up in the title of one of his chapters, “Cosmonauts, Da! Mission Control, Nyet!” (p. 118). It is important to recognize that no recent U.S. or Russian space missions have failed because of behavioral health problems that led to diminished performance. Some astronauts have suffered from space sickness and headaches, anxiety, anger, and depression and have faced sudden, life-threatening emergencies. So far as is known, however, all of them performed their jobs, and the missions were largely successful. Some crews may have gotten along better than others, but they worked effectively as a team when they had to. Adverse Behavioral Health Events During Space Missions NASA has accumulated data on the incidence of adverse behavioral health events from postflight medical debriefings. Among 508 crewmembers who flew a total of 4,442.8 days on board 89 space shuttle missions between 1981 and 1989, 34 “behavioral signs and symptoms” were reported to the medical staff, the most common being anxiety and annoyance (Billica, 2000). This calculates to 0.11 per 14 person-days, or about 2.86 per person-year. Among the seven astronauts who flew on Mir from March 1995 to June 1998, however, there were only two reported psychiatric events, for a yearly occurrence of about 0.77 percent. It could be that the more experienced astronauts on Mir had fewer behavioral health symptoms than some of the crewmembers on the space shuttle missions, but this has not been documented. Also, it is difficult to know how to interpret these discrepant findings since it is not known whether the same criteria were used to diagnose the conditions. Finally, because experienced astronauts as a group are reluctant to report physical and behavioral symptoms to NASA physicians, this figure may underestimate their true incidence (Collins, 1974, 1990). Behavioral Problems in Analog Environments Data from analog settings are instructive since those who have spent considerable periods of time in isolated, confined, and harsh, dangerous environments have confronted many of the external stresses common to long-duration space missions. Two examples are sailors on U.S. submarine patrols and groups wintering over in the Antarctic. Four studies of the incidence of psychiatric disorders severe enough to cause the

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Safe Passage: Astronaut Care for Exploration Missions loss of a day of work or medical evacuation among submariners found rates per manyear ranging from approximately 0.44 to 2.8 (Wilken, 1969; Tansey et al., 1979; Dlugos et al., 1995; Thomas et al., 2000). Among men and women spending 6 months living together during an Antarctic winter, where evacuation was nearly impossible, the Australian National Antarctic Expeditions Health Register estimated the rate of mental disorders to be 2.3 percent. As with the experienced astronauts aboard Mir, the incidence of behavioral problems was dramatically less among seasoned veterans. Two hand-picked six-man crews trekked around the Lambert Glacier Basin in Antarctica for 100 days and recorded their emotional state twice a week. Although there was some variation in mood and occasional increased interpersonal tension, these remained within normal limits, and all completed the treks successfully (Wood et al., 1999). Additional sources of information on behavioral problems in analog environments are provided by long-duration isolation work from hyperbaric chambers and Earth-bound simulators (e.g., the European Space agency’s ISEMNI and EXEMSI projects, the Russian Space Agency’s Mir simulator studies), and the NASA-funded crewmember and ground personnel interactions study that took place during the space shuttle-Mir program. Relevance of Previous Reports to Long-Duration Space Missions It is difficult to confidently predict from these anecdotal reports from astronauts and cosmonauts, previous space missions, or analog environments the likelihood of behavioral health problems among crews of highly selected, experienced, and well-trained astronauts on long-duration missions. The clearest difference is that the missions described above were all of shorter duration than a mission beyond Earth orbit will be. No information exists on the extent to which the individual distress and the interpersonal frictions depicted in the two autobiographies or other anecdotal accounts are representative of the problems that other space crews have had. The overwhelming majority of members of space crews have neither written nor spoken about the behavioral health problems that they might have experienced. Also, the previous space missions did not rate the severity of the symptoms, their durations, the degree of impairment, or whether the less experienced crewmembers, such as payload specialists, suffered more than the astronaut-pilots and mission specialists. The data from missions in analog environments have several obvious limitations as well. These include differences in the environments and the missions, crew characteristics, crew responsibilities, and levels of external support (Palinkas, 1990). Yet, there is reason to consider the possibility that the stresses of long-duration space missions could cause problems in individual and interpersonal adaptation, which could threaten mental health and the success of the mission. Numbers of astronauts have reported psychiatric symptoms associated with shorter space missions. Also, the rates of occurrence of psychiatric problems among sailors on submarine patrols and those wintering over in the Antarctic were similar to the rates of occurrence of other medical problems such as cardiovascular, genitourinary, and ear, nose and throat problems (Tansey et al., 1979; Palinkas et al., 1998; Thomas et al., 2000). Just as NASA should prepare to care for these potential physical problems in astronauts, so too should it ready itself to look after the behavioral health problems of the astronauts on long-duration space missions.

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Safe Passage: Astronaut Care for Exploration Missions tent, with regard to the consequences of prolonged isolation and confinement (Gunderson, 1974a,b; Wood et al., 1999). Although the relevance of studies conducted in analog environments to long-duration space missions may vary (Stuster, 1986), they do appear useful for examination of intrapersonal and interpersonal issues. Such untoward effects as lassitude, apathy, and hygienic neglect, for example, have been reported in studies of unstructured time of variable duration with polar crews in analog environments (Taylor, 1987). Among the more systematic approaches to analysis of the data from studies conducted in analog environments is a reported content analysis of diaries from polar expedition leaders that ranked the salience of behavioral issues (Stuster, 1996). Of the 22 categories ranked, “group interaction” was found to be the most salient, followed by “outside communication,” “workload,” and “recreation/leisure.” More structured studies with recruits from the Australian National Antarctic Research Expeditions have focused on the effects of group composition on the adaptation of individuals to a remote hazardous environment (Wood et al., 1999). The roles of group membership, the degree of isolation, and selected individual characteristics were examined in relation to self-evaluation measures. The reported results indicate that the predominant dimensions by which the participants determined how well they were functioning within the group included work, social life, and internalized emotional state, all of which appear to play an important role in how aspects of life in isolation and confinement are evaluated. Requirements for Additional Knowledge There is an overarching need to enhance the evidence base on the organization of general living conditions and performance requirements for small groups of humans in isolated and confined microsocieties. The objectives of this knowledge-seeking endeavor would be to specify the conditions under which effective work performance of the group can be generated and maintained within the context of productive and harmonious living arrangements that satisfy both individual and group needs for life support (clean air and water, an adequate food supply, waste management and recycling, lighting, adequate clean clothing, and communications) and general living conditions (medical care, sleep and rest, privacy, exercise, social interaction and sex, leisure and recreation, housekeeping and maintenance, education, remote contacts, and useful work). Significant amounts of ground-based as well as specialized space mis-

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Safe Passage: Astronaut Care for Exploration Missions sion research and development will be necessary to generate the knowledge essential to make adequate provision for these requirements for life support and general living conditions. Engineering and Technological Interactions To some extent, systematic studies are under way on specific subsets of the list of requirements for life support and general living conditions, particularly those for life support, which mainly require engineering or technological solutions. Over the past decade, for example, study groups of the National Research Council have been determining spacecraft maximum allowable concentrations of potentially toxic chemicals in the air and water supplies of spacecraft and habitats (NRC, 1992, 2000). The interdependent nutritional (Stein et al., 1999; Lane and Schoeller, 2000) and food supply system (Hunter, 1999) challenges of long-duration space missions have also been the foci of both intramural and extramural research and development support by NASA. In the case of the food supply system, for example, food is not only a key habitability issue but also a biomedical issue, as well as an issue of engineering and systems design. Considering the duration of missions beyond Earth orbit, a bioregenerative life-support system (e.g., crop growth) would be more cost-effective than the physical-chemical regenerative systems (e.g., freeze-dried storage) now in use. Bioregenerative systems, however, require the growing and processing of crops in situ, treatment of food wastes, and preparation of daily meals, all within severe constraints for which space-compatible technologies have yet to be developed. Under such conditions, the behavioral health and habitability challenge resides in the development of a bioregenerative cuisine of nutritious and appealing dishes that chiefly make up a plant-based diet with a range of choices acceptable to a historically omnivorous population. Biomedical and Behavioral Interactions For the group of requirements for general living conditions, relevant intramural investigations (e.g., by NASA laboratories) and extramural investigations (e.g., by the National Space Biomedical Research Institute and university laboratories) have been undertaken with a focus on human performance effectiveness in the technologically rich spaceflight environment. The effects of changes in circadian rhythms and sleep patterns on behavioral

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Safe Passage: Astronaut Care for Exploration Missions health and performance, for example, continue to receive attention in both ground-based simulation studies (Kennaway and Van Dorp, 1991; Ross et al., 1995; Dinges and Van Dongen, 1999; Wright et al., 1999) and experiments conducted in the course of actual space missions (Monk et al., 1998; Czeisler and Wright, 1999). The results of these ongoing sleep studies indicate that a strictly scheduled wake-sleep cycle with dim light levels comparable to those currently provided on space shuttle missions is sufficient to maintain entrainment of the human circadian pacemaker to the 24.0-hour day for most, but not all, study participants. Misalignment of the circadian rhythm results in disturbed sleep, impaired performance alertness, waking-hour melatonin secretion, and reduced levels of nocturnal secretion of growth hormone. The results of these studies suggest that during long-term missions beyond Earth orbit, the use of stronger synchronizers such as brighter lights will be necessary to entrain the longer-than-24-hour intrinsic circadian period of all humans to the 24.0-hour day and to other day lengths such as the 24.65-hour solar day of Mars. Even with appropriate alignment of the circadian period, however, experience from previous space missions suggests the more likely emergence of restricted sleep patterns in the average range of 4 to 6 hours per day. With that restricted sleep comes the risk of development of cumulative homeostatic pressure across consecutive days of inadequate sleep during long-duration missions beyond Earth orbit. Thus, one objective of ongoing simulation studies is determination of the extent to which the duration of sleep per 24 hours and the use of combined “anchor sleep” plus “nap sleep” opportunities each day can prevent or attenuate the development of cumulative fatigue and performance deficits related to sleep deprivation. Interactions in the General Living Environment Behavioral health issues related to privacy and to leisure and recreational requirements have received some attention since the beginning of space missions that have involved multiperson crews in orbital flights of more than a few days’ duration (Frazer, 1968; Kabanoff, 1980; Kelley and Kanas, 1994). The interaction between the structural-physical design and the personal-social organization of space environments is likely to be the most critical in leisure and recreational pursuits as well as those activities related to personal hygiene, exercise, housekeeping, and maintenance. The historical background of human space travel reflects a predomi-

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Safe Passage: Astronaut Care for Exploration Missions nantly empirical and generally successful approach to these matters. The research and development requirement, however, for evidence-based coordination between design engineering, habitability considerations, and behavioral health imperatives assumes ever-increasing importance with extended mission durations. Under the closed-loop conditions of such missions, for example, all waste products (including human excretions, expired gases, fluids, etc.) must be repeatedly recycled. The unique behavioral health factors involved in the toleration and acceptance of such environmental constraints must be investigated and determined. The extent to which behavioral self-management techniques (Beck and Emery, 1985; Beck, 1993; Barlow, 1996; Cautela and Ishaq, 1996) can be expected to provide effective coping procedures for such intrapersonal challenges will depend on the development and testing of individualized self-monitoring and self-assessment methodologies of demonstrated validity and reliability. Group Interactions Perhaps the matter of highest priority in the performance and general living conditions domain is the development of an evidence-based approach to the management of harmonious and productive, small, multinational groups who must live and work together in isolated, confined, and hazardous environments. Although an extensive literature on the functioning of small groups in both analog environments (Helmreich, 1973; Gunderson, 1974a,b; Vinograd, 1974; Palinkas, 1990; Harrison et al., 1991; Taylor, 1991; Weybrew, 1991; Palinkas et al., 1995; Stuster, 1996) and experimental settings (McGrath and Altman, 1966; Emurian et al., 1981; Brady, 1990; Brady and Anderson, 1991; Duffy, 1993; Guerin, 1994; McGrath, 1997) has been generated over the past half century, the available knowledge base is deficient with respect to long-duration missions beyond Earth orbit in several ways. For example, findings from group studies conducted in one setting are often not applicable to groups functioning under other environmental conditions. Empirical results are typically of such limited scope that they lack practical utility and generalizability. The conditions under which such experimental observations or even observations from analog environments are made usually differ considerably from those encountered in operational spaceflight situations. The benefits and disadvantages of traditional approaches to the study of small-group dynamics have been well documented. When observations of the behaviors of small groups are made when the groups are in their natural habitat or in an

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Safe Passage: Astronaut Care for Exploration Missions analog environment, the generally ethnological monitoring and recording of both current and long-term events lack experimental rigor. On the other hand, data gathered on small groups in controlled experimental settings may demonstrate functional relations, but the analysis of progressive changes in external influences and the development of internal group equilibrium is often neglected (Williams, 1974; Brady, 1990; Guerin, 1994). Viewed from the perspective of groups as small social systems operating in multifactorial behavior-specific settings that comprise specific physical situations involving people, the NASA experience over the past four decades has been successful. Mission objectives have been completed at the level of quality desired, and the behavioral interactions among crewmembers on individual flights have enhanced (or at least have not compromised) the viability of the group as a performing unit. Importantly, crewmembers have accomplished their mission objectives without significant deterioration of their individual behavioral or biomedical well-being. Against this background of generally effective group performance in the course of missions of up to a year or more in duration, the issues to be addressed now are how to promote performance effectiveness, group solidarity, and personal well-being in the course of long-duration space missions beyond Earth orbit. The enhancement of this essential knowledge base must begin by identifying those features of small social systems that foster the effectiveness of groups functioning semiautonomously over extended periods of time (Hackman, 1990, 1998). First, there is a need for evidence-based information on the appropriate partitioning of authority between ground-based mission managers and the space crew in accomplishing clear, unambiguous, and engaging objectives that orient and motivate group members to achieve the overall goals (Radloff and Helmreich, 1973; Sandal et al., 1995). The key question is how legitimate authority can be constructive and empowering while setting directions without dictating procedural details. How can the needs of the astronauts for substantial latitude in developing, executing, monitoring, and managing their own performance strategies be best accommodated within the overall direction required? How can relations between astronauts and the authorities on the ground and the inevitable disputes that occur between them be managed in real time? The second challenge in fostering performance effectiveness is to create a well-composed group engaged in well-structured tasks (Nelson, 1965; Gunderson, 1966a, b; Doll and Gunderson, 1970). Collective work productivity in the context of harmonious living conditions requires the right people

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Safe Passage: Astronaut Care for Exploration Missions ups but ground support personnel and monitors as well. Like individual training, group training also appears to focus on the operational aspects of the mission objectives, with little programmed attention to group functioning per se. An individual and group training program is under development, however, with candidates for long-duration missions beyond Earth orbit specially selected as participants. The extent to which this early initiative will take advantage of the availability of significant behavioral health and performance inputs remains unclear. Requirements for Additional Knowledge Screening and Selection The development of effective screening, selection, and training procedures must be driven by performance requirements and by the general living and support system conditions under which long-duration space missions will take place. The first task is a systematic analysis of the validity and reliability of screening and selection procedures as they are currently practiced, beginning with a descriptive collation of the data and an evaluation of the interrelationships between the measures. Access and review of available outcomes-related data may also shed some light on the utilities of current procedures. At the very least, such an undertaking would set the stage for an evidence-based approach to screening and selection for long-duration space missions. A range of newly emerging approaches to the study of intellectual aptitudes and personal traits should be explored for their predictive value in assessing levels of intellectual functioning in candidates for spaceflight. Although current screening approaches appear to involve only limited evaluation of cognitive function, intelligence and aptitude measures have been shown to predict performance more accurately than personality assessments. Specific constellations of abilities including a variety of aptitudes identified as “fluid intelligence” (analytical, creative, and practical intelligence) have been shown to permit individuals to solve novel tasks without using crystallized knowledge involving general information or vocabulary or previously developed problem-solving skills (Sternberg, 2000). Other measures of cognitive function have been shown to predict pilot performances related to information-processing speed and working memory (Salthouse, 1991; Hartley, 1999) as well as multiple-task attention, breaking-set, visual reasoning, and mental rotation skills (Kane and Kay, 1992). The relevance of these

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Safe Passage: Astronaut Care for Exploration Missions advances in cognitive function assessment to the enhancement of astronaut screening, selection, and training as well as intramission monitoring and countermeasure development resides in the results of recent studies conducted during both simulated and actual spaceflights (Manzey et al., 2000). Under such conditions, degradation in manual tracking ability and phasic decrements in cognitive function performance have been reported as a result of fatigue and other factors. The utility of measures that provide an evaluation of personal traits as they may be related to successful participation in long-duration space missions will also require careful examination. Data obtained from actual and simulated space missions, as well as submarine missions, led to the conclusion that individuals strongly motivated for achievement adapted to these environments better than their peers did (Sandal et al., 1999). By contrast, studies of crews that wintered over in Antarctica found that ambitious individuals had lower ratings on some performance measures than peers who had more modest achievement needs (Wood et al., 1999; Palinkas, 2000a,b). Santy (1994) has also reported that selection procedures in other national space programs (e.g., those of Russia, Germany, and Japan) tend to favor candidates for longer-term space missions whose personality characteristics measure more in the middle of the motivational range. A number of promising new developments in the rapidly advancing fields of neuroscience and molecular genetics hold considerable long-range potential for the assessment, evaluation, and training of future astronauts. Neuroimaging procedures involving functional brain scans are continuing to advance knowledge of the relationship between behavioral processes involving both cognitive and emotional interactions on the one hand and well-specified neural systems and regional structures on the other (Damasio, 1994; Kosslyn and Koenig, 1995; Cahill et al., 1996; Alkire et al., 1998). There is reason to expect that future developments in the functional imaging field will provide noninvasive methodologies that could enhance the feasibility of both training and behavioral health monitoring applications. These probable breakthroughs could be of significant use to NASA. Four brief examples of how NASA might use these advances for screening, selection, and training are described in Box 5–4. It is also conceivable that the future of long-duration travel beyond Earth orbit will be significantly affected by the rapidly advancing field of molecular medicine (see Chapter 4), to the extent that its neuroscience dimensions could differentially reflect DNA variations of relevance to adaptation to stressful behavioral and environmental situations. It is important that the

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Safe Passage: Astronaut Care for Exploration Missions BOX 5–4 Potential Uses of Neuroimaging Methods for Astronaut Selection, Training, and Intervention Functional brain scans for cognitive function assessment could considerably enhance the understanding of an astronaut candidate’s neurological potential for handling the mental training requirements. Positron emission tomography scans find that areas of the brain illuminate when certain mental tasks related to astronaut performance are performed, with the occipital lobe lighting up when certain visuospatial tasks are performed or portions of the frontal and parietal lobe being activated during mental rotation tasks (Kosslyn and Koenig, 1995, pp. 133, 149). One screening scenario might include the simultaneous administration of a test of a particular aptitude (e.g., mental rotation) along with a functional brain scan that would show the extent to which particular portions of the brain were illuminated during the period that the problems were being solved. Functional imaging techniques show promise as means of assessing and predicting potentially disruptive mood states and of perhaps monitoring and intervening to soothe potentially disruptive mood states (Damasio, 1994). Present work illustrating those portions of the brain that are differentially associated with strong feelings of sadness and happiness or of fear and anger could well lead to more accurate ways of assessing characteristics that could be used to select out or select in an astronaut, as well as whether an individual has a predisposition to mental illness. Neuroimaging also may have a role in astronaut training. An example might be the use of scans as an adjunct to assessments of cognitive and affective states during simulations to assist in countermeasure development. Imaging may also be useful for inflight monitoring and assessment of changes in brain function from the baseline function as a result of stress, fatigue, or possible exposure to microdoses of toxins. procedures for the screening and selection of astronauts involved in long-duration missions beyond Earth orbit be capable of validly and reliably discriminating effective group interaction skills and competences. Essential developments in this regard will depend on the availability of an expanded knowledge base on the requirements for harmonious and productive group functioning in the unique environment of space. Training Astronauts on long-duration space missions will confront a range of intra- and interpersonal challenges, the nature of which cannot be accurately determined at present. Therefore, substantive features of training must be based on continuously accumulating experiences in actual spaceflight environments and analog settings with specially designed algorithm software

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Safe Passage: Astronaut Care for Exploration Missions packaging technologies (Lipsey, 1993; Newman, 1997). Naturalistic studies on the efficacies of specific training procedures must follow in both simulated and actual space mission settings. Personalized individual training approaches must also incorporate and evaluate countermeasures based on procedures for evaluation of cognitive and behavioral functioning that are adaptable for computerized administration as self-assessment and supportive intervention procedures (Wolpe, 1958; Beck and Emery, 1985; Power et al., 1990; Beck, 1993; Barlow, 1996; Cautela and Ishaq, 1996; Rosen and Schulkin, 1998; Lazarus, 2000). These programs have been designed within a stress management context and have been effective when combined with a range of interventions including biofeedback, relaxation techniques, systematic desensitization, and pharmacological treatments. Empirical observations about the nature of both individual and group behaviors and about how behavior patterns influence performance effectiveness can guide decisions about group composition and training. Training approaches can build on experience gained in simulated flight exercises going as far back as World War II (Office of Strategic Services, 1948) and, more recently, on that gained in the Cockpit Resource Management programs used by airline crews. The development of strategies for conflict resolution should be explored as well (Fisher et al., 1994; Heifetz, 1998). Among the more recent and relevant developments with respect to training for small group performance effectiveness is the distributed interactive simulation methodology. This simulation approach (Box 5–5) uses multiperson computer-generated workstation networks for selection and training in realistic environments (Pratt et al., 1997; Gillis and Hursh, 1999). This method permits the objective recording and evaluation of interpersonal interactions within and between small training groups under conditions that simulate long-duration spaceflights, as well as related ground-based monitoring and support systems. Training for long-duration space missions must involve an integrated approach that includes ground-based monitoring and support groups specifically selected to participate in such operations. NASA behavioral health personnel should be directly involved in crew selection and in training crewmembers and ground control personnel in crisis intervention and problems with interpersonal functioning. In addition, appropriate assessment tools and countermeasure development will be required to address emergencies and technical assistance requirements under conditions that involve multinational crews and the complexities related to cultural and language

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Safe Passage: Astronaut Care for Exploration Missions BOX 5–5 Distributed Interactive Simulation Distributed interactive simulation environments have been developed and are based on multiperson computer-generated workstation networks that represent operational elements consisting of both individuals and functional groups. Such techniques involving real people can be used for selection and training under conditions of simulated mission operations in a realistic environment. Participants communicate via electronic channels to exchange information, discuss work requirements, and evaluate data for decision making; exchange the outcomes of specific actions; and evaluate mission-oriented scenarios. Space mission simulations also permit inquiries of Earth-based mission control for information or instructions, or both. Groups of individuals are trained to interact within the simulation environment for the purpose of engaging with assigned crewmembers and Earth-based mission control. Distributed interactive simulation methodologies with performance tasks requiring repeated exchange of information among participants and between groups provide an automated means for the systematic monitoring and analysis of the effects of experimental variations on psychosocial interactions, decision making, and both individual and group performance effectiveness. The operational performance measures evaluated include pattern analysis, task completion, and timing parameters. differences as well as under conditions that involve crews of mixed sexes and with command structure constraints (Kelley and Kanas, 1992; Holland et al., 1993). It is not enough to have the leader be the buffer, because the leader could be addressing specific problems or could be too involved in a task-oriented emergency. Finally, crew resource management for long-duration missions also requires consideration of technical as well as nontechnical skills (e.g., corporate citizenship, interpersonal skills, and compatibility). Individual differences in personality functioning become important when the job requires corporate citizenship or the use of “people skills” (Borman et al., 1997; Hogan et al., 1998; Mount et al., 1998; Salgado, 1998). STRATEGIC RESEARCH CONSIDERATIONS The conceptual and methodological challenges associated with designing, establishing, and maintaining functional systems that promote performance effectiveness and social and ecological stability for small groups involved in long-term space missions beyond Earth orbit will need to be approached at the most fundamental scientific level. Evidence-based technological developments can be facilitated by research methodologies that incorporate studies in analog settings and simulations of the environmental

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Safe Passage: Astronaut Care for Exploration Missions conditions and behavioral interactions that will exist in space over long durations. The approach should be explicitly experimental and should be dictated by both scientific and pragmatic considerations closely approximating procedures of established effectiveness in other areas of natural science (Biglan, 1995; Lattal and Perone, 1998). Without such a database of experimentally derived data, the overextrapolation of proposals for ecological systems and recommendations for space habitat designs (Sells and Gunderson, 1972; Singer and Vann, 1975; Maruyama, 1978) renders them incapable of ensuring the successful establishment of functional and enduring space habitats. The relevance of such an experimentally derived knowledge base to the success of future space ventures depends in large part on the precision with which required performances can be specified and on how effectively they can be occasioned and maintained in individuals and groups. Despite the abundance of extensively reviewed experiments with small groups conducted over the past several decades (McGrath, 1984, 1997), the technology needed to analyze multiple modes of communication among and between groups and group members has not been available. With the advent of computer-based communications technologies (Duffy, 1993), the interactions of members of small groups and decision making by small groups can now be automated in the context of distributed performance sites. An empirical research base has been established to evaluate the effectiveness (Pinsonneault and Kraemer, 1990) and test the assumptions (Kraemer and King, 1988; Duffy, 1993) that underlie these technological developments. Distributed communication interactions within and between space-dwelling and Earth-bound groups will be an inherent feature of long-duration space missions beyond Earth orbit. The availability of automated group interaction technologies not only opens the door to the enhanced precision of performance measurements but also provides a research approach to determining the correct mix of group interaction-communication modalities that maximize efficiency without overcomplicating the design of the system. Research applications of such computerized distributed interactive simulation systems can permit the specification, with nearly exact precision, of the stream of psychosocial cues and consequences within the interactions of members of a small group. Under such conditions, systematic investigation can determine which of the many potential modes of communication and verbal interaction are most effective in advancing group stability and efficiency. Within the context of both analog and simulation settings, a strong case

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Safe Passage: Astronaut Care for Exploration Missions can be made for a strategy of research to address the challenges related to operational performance and general living conditions associated with long-duration spaceflights. Such a research approach will require the integration of investigative research and organizational management activities in an attempt to establish and pretest effective social systems within small groups under operational conditions that allow controlled experimental analyses. In this way, major applied research questions of direct relevance to enhancing the knowledge base required for spaceflight beyond Earth orbit can be pursued without sacrificing methodological rigor by using the participants of primary interest. A variety of behavioral health and performance research and development opportunities dealing with performance and general living conditions, support and recovery systems, and screening, selection, and training have been described throughout this chapter. These are summarized in Box 5–6. Some will undoubtedly prove to be highly important in contributing to the success of long-duration space missions. CONCLUSION AND RECOMMENDATION Conclusion Behavioral health and performance effectiveness present major challenges to the success of missions that involve quantum increases in the time and the distance traveled beyond Earth orbit. The available evidence-based spaceflight data are insufficient to make an objective evaluation or projection regarding the behavioral health issues that are likely to arise. The analysis of complex individual and group habitability interactions that critically influence behavioral health and performance effectiveness in the course of long-duration missions remains to be planned and undertaken. There is a need for more information about support delivery systems at the interface between ground-based and space-dwelling groups. In the absence of a valid and reliable analysis of the existing database, it is not possible to determine whether the current procedures will be adequate for the screening and selection of candidates for long-duration missions. Although the data from natural analog environments including simulation studies may be helpful, there remains a need to accumulate knowledge based on observations from systematic research observations

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Safe Passage: Astronaut Care for Exploration Missions BOX 5–6 Behavioral Health and Performance Research and Development Opportunities Astronaut Performance, General Living Conditions, and Group Interactions Enhancing the evidence base on the organization of general living conditions and performance requirements for small groups of humans in isolated and confined microsocieties over extended time intervals and developing an evidence-based approach to the management of harmonious and productive, small, multinational groups whose members will have to function effectively in isolated, confined, and hazardous environments. Coordinating the development of design engineering and habitability requirements on the one hand and evidence-based behavioral health imperatives on the other. Identifying and analyzing those features of small social systems that foster the effectiveness of groups functioning semiautonomously over extended periods of time. Analyzing potentially disruptive group influences that adversely affect harmonious and productive performance interactions under the isolated, confined, and hazardous conditions that characterize long-duration space missions beyond Earth orbit. Support and Recovery Systems Developing a technology that will provide an adequate means for assessment of the behavioral health effects of long-duration space missions and that will establish and maintain safe and productive human performance in isolated, confined, and hazardous environments and developing an evidence-based approach to the establishment and maintenance of a system for the delivery of behavioral health support and to the analysis of those internal and external factors that influence the effectiveness of the system. Evaluating and enhancing communication with family, friends, and other ground personnel and onboard recreational activities as means of providing behavioral health support for long-duration missions. Evaluating the validity and reliability of performance-monitoring procedures including the Crew Status and Support Tracker, the Windows Space Flight Cognitive Assessment Tool, and the Space Behavioral Assessment Tool and the extent to which methodologies for intromission performance monitoring are enhanced by online downlink capabilities in studies conducted during long-duration missions. Developing and refining procedures for effective intervention under conditions of potentially disruptive personal interactions both among astronauts and between astronauts and Earth-bound support components and for evaluation of the nature and extent of changes in group interaction patterns.

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Safe Passage: Astronaut Care for Exploration Missions Evaluating the effects of ground-based support system design factors including backup components and personnel changes on group integration and stability as they affect personal coaching and technical support functions. Developing and assessing countermeasure interventions that meet the challenges presented by emergencies and technical assistance requirements under conditions with complexities related to cultural and language differences as well as under conditions that involve crews of mixed sexes. Screening, Selection, and Training Systematically analyzing and evaluating the extensive existing database on the methods and procedures for screening and selection of astronauts used over the past several decades. Evaluating personality measures in the development of valid and reliable procedures for the screening and selection of astronauts and determining the extent to which intelligence and aptitude measures may predict performance more accurately than the more commonly applied personality measures. Developing and evaluating screening and selection procedures that validly and reliably discriminate effective group interaction skills and competences. Developing and refining training technologies including automated training for the preparation of multinational space-dwelling microsocieties as well as their Earth-bound support groups including those related to the interactions of individuals and small groups in the context of distributed ground-based and space-dwelling performance sites. Data Collection, Analysis, and Monitoring Incorporating and enhancing relevant behavioral health factors as an effective contribution to a more comprehensive plan for the collection and management of astronaut health care data. Developing and testing valid and reliable individualized monitoring and assessment procedures to enhance intrapersonal self-management. Refining communication-monitoring techniques and countermeasure interventions for interactions within and between ground-based and space-dwelling groups. Developing and refining technological approaches to the assessment of individual and group behavioral integrity as well as the efficacies of countermeasure evaluations during long-duration space missions. Establishing a systematic approach to the collection and analysis of postmission (recovery), debriefing, and longitudinal follow-up astronaut health data, including data on behavioral health and performance components. Planning and undertaking a systematic collation and relational analysis of the existing archives of astronaut evaluation data to develop an evidence-based approach to valid and reliable means of screening and selection of candidates for long-duration missions beyond Earth orbit.

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Safe Passage: Astronaut Care for Exploration Missions in both natural and simulated extreme terrestrial environments and venues like the International Space Station. Recommendation NASA should give priority to increasing the knowledge base of the effects of living conditions and behavioral interactions on the health and performance of individuals and groups involved in long-duration missions beyond Earth orbit. Attention should focus on understanding group interactions in extreme, confined, and isolated microenvironments; understanding the roles of sex, ethnicity, culture, and other human factors on performance; understanding potentially disruptive behaviors; developing means of behavior monitoring and interventions; developing evidence-based criteria for reliable means of crew selection and training and for the management of harmonious and productive crew interactions; and training of both space-dwelling and ground-based support groups specifically selected for involvement in operations beyond Earth orbit.

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Safe Passage: Astronaut Care for Exploration Missions NOTES