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5
Resilience Programs and Interventions
The September workshop included a session with four speakers out-
lining aspects of existing resilience interventions that might serve as
models for the Department of Homeland Security’s (DHS’s) resilience
initiative. Speakers from military and non-military programs were invit-
ed to present their experience with various resilience interventions.
Speakers were also asked to discuss measuring program effectiveness
and evidence supporting various types of interventions. Lt. Col. Daniel
Johnston from the U.S. Army provided an overview of the Comprehen-
sive Soldier Fitness (CSF) Program. The director of the Military Opera-
tional Medicine Research Program in the U.S. Army Medical Research
Materiel Command, Col. Carl Castro, discussed his perspective on vari-
ous initiatives within the military. Dr. Randall Beaton from the Universi-
ty of Washington in the Schools of Nursing and Public Health
summarized issues he identified as key lessons from resilience programs
in first-responder populations. Dr. George Everly from Johns Hopkins
Bloomberg School of Public Health and the Resiliency Science Institutes
presented an overview of his work on resilience.
While the majority of the presentations focused on military, first-
responder, and law enforcement personnel, aspects of the interventions
could be applied broadly to DHS employees. After the presentations,
speakers participated in a panel discussion that addressed questions for
workshop attendees. Planning committee member Dr. Joseph Barbera
moderated the panel discussion. Themes that emerged from individual
presentations and the panel discussion can be found in Box 5-1.
95
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96 BUILDING A RESILIENT WORKFORCE
BOX 5-1
Themes from Individual Speakers on Resilience Programs
Role of leadership
Relationship between physical and mental well-being in
resilience
Linkages between resilience and family/social support
Addressing organizational cultures within program design and
implementation
Role of evidence and performance measurement in developing
and improving interventions
COMPREHENSIVE SOLDIER FITNESS
The issue of resilience under stressful conditions is particularly
relevant for those serving in the military. Lt. Col. Daniel Johnston stated
that the U.S. Army’s Comprehensive Soldier Fitness Program was born
in response to the prevalence of post-traumatic stress disorder (PTSD)
and an increase in suicides among army personnel. The program also
offers the possibility of improved performance. Johnston indicated that
these increases have been attributed to dramatic changes in the
operational tempo of the military in a post-9/11 world. Prior to 9/11 a
member of the armed services could anticipate being deployed once or
twice during a career. Other stressors such as moves to new duty stations
were fairly predictable. Since 2001, the cycle has become condensed
with multiple deployments and more frequent changes in duty stations.
Johnston noted that it is important to know that suicide victims are
equally divided among those who have been in combat and those who
have not.
While in theater, soldiers are often exposed to traumatic experiences.
As a result, the amount of psychological and physical problems within
the military population has increased. Johnston cited a study on the
prevalence of PTSD, depression, alcohol use, and drug use among
veterans that was carried out by the Department of Veterans Affairs (VA)
from 2003 to 2006. The study found that the combined rate of mental health
disorders among veterans from Afghanistan was about 6 percent. After the
conflict in Iraq started, this rate rose to 37 percent (Seal et al., 2009).
The CSF has defined itself as “a structured, long-term assessment
and development program to build the resilience and enhance the
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RESILIENCE PROGRAMS AND INTERVENTIONS
performance of every soldier, family member, and defense agency
civilian.” The CSF model incorporates five domains of fitness: (1)
physical, (2) family, (3) social, (4) emotional, and (5) spiritual. The CSF
model uses four program components or pillars to measure fitness
domains and to train individuals and groups:
1. The Global Assessment Tool (GAT) is used to assess individual
soldiers and drive the development of interventions. The GAT is
an online assessment tool and currently includes four domains of
fitness: family, social, spiritual, and emotional.
2. The Comprehensive Resilience (Self-Development) Modules are
online training units that are not linked to performance on the
GAT. These modules are designed to increase overall resilience.
However, their effect on individual GAT scores is not known at
the present. The training is currently not tailored to the individu-
al’s performance levels. The modules will be voluntary for fami-
ly members and defense agency civilians.
3. The Master Resilience Trainers (MRTs) is a training program
designed to teach resilience and performance optimization skills
to unit personnel and their families. The MRT courses are taught
at the University of Pennsylvania, the Army’s training program
at Victory University, and at various sites around the country.
The training is held by the Mobile Training Teams at specific CSF-
PREP (Performance Resilience Enhancement Program) sites at 11
installations around the country. The PREP sites specifically focus
on skill sets and training in addition to the core MRT training that
involves mental performance enhancement.
4. The Institutional Military Resilience Training is taught in Training
and Doctrine Command schools, the Noncommissioned Officer
Education System, and the Officer Education System. The training
is progressive, sequential, and targeted to the unit deployment cy-
cle. It has shown to be valuable and well accepted in the Basic
Officer Leader Course.
The U.S. Army is concerned about maladaptive and undesirable
coping mechanisms and responses from soldiers caused by stress and the
rigors of combat. Examples of maladaptive behaviors include drug and
alcohol use, smoking, harming practices such as cutting, domestic
violence, inappropriate and unhealthy eating habits, risk-seeking
behaviors such as reckless driving, and suicidal intentions. The CSF is
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98 BUILDING A RESILIENT WORKFORCE
focused on teaching soldiers positive, desirable, and mature adaptive
responses and behaviors, as well as enhancing mental performance.
Johnston asserted that the CSF model is similar to the military’s physical
training (PT) program. Soldiers are regularly assessed by taking a PT
test. As with PT, the CSF program elements not only make soldiers more
“hardy” or physically resilient, but also enhance their performance in the
“heat of the moment.” The CSF is not intended to be a single course,
event, or requirement, or a “screen” for any physical or psychological
disease or dysfunction, including suicide. The assessment is part of a
long-term process. The program is focused on resilience and performance
enhancement, and the elements taught are more expansive than
interventions that just focus on doing something after an individual has a
negative psychological, physical, social, or professional outcome. The
focus of the GAT, the Comprehensive Resilience Modules, the Master
Resiliency Trainers, and the Institutional Military Resilience Training is
to promote long-term resilience and enhance performance.
The Global Assessment Tool
The GAT is the largest undertaking of the program and is the
backbone of the assessment. The information gathered by the GAT is
used to structure meaningful reports around psychological fitness in
specific areas for individual soldiers. The survey is designed to collect
key pieces of information in a reasonable amount of time. The survey has
105 questions and takes approximately 15 minutes to complete. Soldiers
are required to participate. The survey is voluntary for military family
members and civilians employees. Once an individual has taken the
survey he or she receives his or her score in each of the nonphysical
domains along with some standard language about the results.
Confidentiality of the data is essential. Individual scores are kept
confidential and are not reported to the military command or leadership.
Soldiers need to know that the GAT is for their assessment and is not
shared with their commanders. The minute soldiers feel that this
information will be reported to their commanders or the leadership, they
will stop giving honest and accurate responses.
The psychological fitness score includes measures of family, social,
emotional, and spiritual fitness. Johnston pointed out that the term
spirituality should not be confused with religiosity. He indicated that it is
an important distinction and that the military is not trying to teach
religion. Instead, spirituality is focused on the value of believing in
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RESILIENCE PROGRAMS AND INTERVENTIONS
something greater, which could be the unit, the Army, or the family at
home. This belief helps give soldiers a purpose. On a scale of 1 to 5 with
5 being the highest and 1 the lowest, the mean psychological fitness
score is around 3.8. The distribution is tight, and the distribution between
males and females is fairly equivalent.
Working closely with the Consortium for Health and Military
Performance at the Uniformed Services University of the Health
Sciences, Lt. Col. Johnston is developing the physical fitness component
of the GAT in order to provide a meaningful online physical assessment.
Smartphone applications are also under development. Questions in the
GAT cover the following areas:
Healthy habits: Nutrition, sleep, dietary supplements, hydration,
caffeine, tobacco, alcohol
Physical performance: Score on unit physical fitness test, flexi-
bility, exercise frequency of individual
Physical build: Body fat calculation based on waist, height,
weight
Johnston also pointed out that the data indicate that across the board,
regardless of a soldier’s GAT score, everyone experiences relatively the
same amount of traumatic events. After deployment, people that have
very low GAT scores have a significant increase in reported symptoms in
their post-deployment health assessment.
Master Resilience Trainers
The MRT is a 10-day course intended to teach skills that increase
positive adaptive psychological fitness, and it includes a foundation in
how to deal with conflict, communication problems, and so on. After the
training, individuals serve in several capacities both as a role model and
unit trainer of the core skill sets taught in the MRT. They are expected to
personally use the skills they have been taught, engage in discussions
about work objectives and progress, teach these skills to others, act as the
commander’s advisor regarding issues related to total fitness and
resilience training, and know the referral options for professional
counseling including behavioral health providers, chaplains, and other
appropriate resources.
As part of the training, soldiers receive a skill identifier. A skill
identifier in the Army means they have an additional duty description.
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100 BUILDING A RESILIENT WORKFORCE
Therefore when they go back to their units they are able to use their
MRT-required training and instruction and set of activities with their
unit. The master resilience trainers are soldiers in the E6 and E7 levels
and generally are between 26 and 35 years old. It is this group that is
leading and mentoring younger soldiers, 18-24 years of age. The
participation of the senior enlisted soldiers is critical because they
frequently interact with the younger soldiers who are more likely to
experience problems.
Johnston described the MRT course he participated in at the
University of Pennsylvania. In that course there were approximately 200
students. Many students were initially skeptical. However, after the
course the participants were excited about the training and looked
forward to using it with their units. The training focused on
understanding that resilience is about using critical thinking, gaining
knowledge, and practicing skills in order to overcome challenges, act
mature, and bounce back. The training explored how to deal with
negative patterns of thought and how to develop a set of tools to deal
with hardship, thus enabling the trainees to be better able to bounce back
from adversity. The training enforced the concept that most challenges
are temporary, not permanent; local, not global; and can be changed by
one’s own effort.
Comprehensive Resilience (Self-Development) Modules
Comprehensive Resilience Modules are online video modules
developed by experts in various fields. Many of the video modules are
very similar to the materials taught in the MRT courses. These are
currently not linked to the GAT, and the program is currently developing
its future strategy so that it will be linked with evidence-based resilience
training and the assessment tool to evaluate effectiveness. The modules
are also available to all family members in the Defense Eligibility
Enrollment Reporting System. The family modules are similar to the
military ones but are generally geared for the family members for self-
assessment and are worded slightly differently. To date, more than
900,000 individuals have voluntarily gone through the online modules.
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RESILIENCE PROGRAMS AND INTERVENTIONS
Institutional Military Resilience Training
The Institutional Military Resilience Training (MRT) program has
trainers go into the training and school environment and work with
soldiers during their educational process. This also provides an
opportunity to reach leaders through these schools. It is essential that
leadership is part of the process and engaged with the program from the
four-star level down.
Lesson Learned from the Comprehensive Solider
Fitness Program
Johnston discussed examples of research that examined the importance
of psychological fitness. Studies of psychological fitness show that it
affects soldiers’ ability to complete training as well as their risk of
developing problems such as PTSD. Soldiers whose GAT scores are in
the bottom 25th percentile have a 2- to 10-times higher likelihood of
negative outcomes, are less likely to complete training, and are more
likely to have other types of undesirable behaviors such as drug use and
suicide. Individuals with high psychological fitness are more likely to
complete the training and less likely to develop PTSD after a traumatic
event. Johnston pointed out that even at relatively low levels of combat
there are significantly higher levels of anxiety in people with low
psychological fitness.
The data indicate that emotional fitness is an important measure.
People who score very low in emotional fitness have almost twice as
many primary care visits as an individual with a high score. This finding
is important when looking at the utilization of medical resources and has
implications beyond the military. Soldiers with low emotional fitness
have significantly higher rates of reporting three or four symptoms of
PTSD. Emotional fitness also appears to influence psychosomatic
symptoms associated with memory, balance, ringing in the ears, and
dizziness. Lower rates of emotional fitness are also related to higher rates
of depressive symptoms.
Ongoing performance measurement is a part of the program. A
review of a unit over the course of a year during which the MRT pro-
gram took place, reveals several interesting findings. Of those reporting
suicide gestures, attempts, or ideations, 78 percent had not been trained.
At Fort Leonard Wood, Missouri, the CSF program looked at individuals
who had to leave the Army because of medical reasons. People that
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102 BUILDING A RESILIENT WORKFORCE
received weekly CSF training ended up staying in the Army and had a
much lower chance of being separated out of the Army, even for general
medical reasons. Army units that had Master Resiliency Trainers
experienced improvement in their GAT scores over time.
In a study with Navy recruits, various psychological measures such
as depression and stress were assessed. Recruits with high scores were
put through the normal basic Navy training. Recruits who scored very
low were separated into control and study groups. The control group
went through the normal training. The study group had resilience training
in addition to the normal training. The researchers observed a large
difference in scores for the control group compared to the study group,
with more individuals in the control group being separated from military
service for psychological reasons (Williams, 2004).
One of the emerging areas of research that have resulted from the
Army’s partnerships with different universities and researchers is the
work around post-adversity growth. Much of the Army’s programs have
historically focused on individuals who are experiencing problems and
how to help them. However, it is also important to consider what positive
outcomes can result from adversity. Johnston asserts that it is possible to
help various groups such as disabled veterans to productively deal with
adversity and experience growth under a new set of circumstances.
Although this is outside the scope of the CSF at the moment, it is a
possible new area to explore.
RESILIENCE RESEARCH IN THE MILITARY
Col. Carl Castro is the director of the Military Operational Medicine
Research Program in the U.S. Army Medical Research Materiel
Command at Fort Detrick, Maryland. He works on a broad research
portfolio that includes psychological health and resilience. This research
includes about $40 million in funding for resilience efforts that are not
focused on treatment or recovery. There is also funding for family
resilience research within the Family Transitions in Well-Being Program.
Castro quoted a statement by the Army vice chief of staff Gen. Peter
W. Chiarelli in 2009:
We have a force that is much more resilient than I ever
thought it was going to be, but it is much more stressed.
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RESILIENCE PROGRAMS AND INTERVENTIONS
The challenge facing the Army today is the overall well-
being of the force.
Castro stated that the core of this quote is true and that through self-
assessments and objective measures the force is very resilient. The data
in Johnston’s presentation illustrate the strong coping skills of the force
before deployment. Although they are not optimal, they are good and
show where there is room for improvement.
Castro commented that the Army and the Department of Defense
(DOD) are threat-based organizations. As a result, the mission of his
group is to develop effective medical countermeasures against combat
and operational stressors to maximize warrior health, performance, and
fitness. There are four focus areas:
1. injury prevention and reduction,
2. psychological health and resilience,
3. physiological health, and
4. environmental health and protection.
Importance of Long-Term Thinking
Resilience research began in child psychiatry and child psychology
and is now being applied to adults. Castro asserts that resilience cannot
be a priority just for adults confronted with disasters or potential traumas.
It has to be a priority for the nation, which starts when children are
young, not when they join the military at 18. As an example, the national
school lunch program was launched during World War II because the
military found that a large percentage of the men recruited into the
military were malnourished. The school lunch program was a long-term
effort to build a strong population in order to ensure a strong military in
the future. The nation is faced with a similar long-term problem with
resilience today. This issue requires creative, strategic, and long-term
policy making.
There are many ways to think about resilience. Although disorders
such as PTSD or events such as suicides are the logical conclusions
along a resilience continuum, resilience is not just about them. There are
broader outcomes to consider. Less resilient individuals are more likely
to engage in self-harm or self-destructive behaviors. For example, 67
percent of soldiers who attempted suicide in 2007 self-reported using
alcohol or drugs during the event (U.S. Army, 2008). Many people who
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have no intention of hurting themselves engage in self-destructive or
risk-taking behaviors such as smoking, unprotected sex, binge drinking,
drunk driving, reckless driving, and overeating. The question becomes:
How do people learn to self-regulate and stop these behaviors?
Much of the research on resilience is more in the basic science area.
Research in general shows that people 18 to 24 years old are susceptible
to peer pressure and more likely to engage in risky behaviors. A lot of
work is directed at this age group because it is the most susceptible group
in the military as well as in colleges. Something happens around age 25
that fundamentally changes the outlook. Castro believes that a lot of
work is left to do on this topic at the basic science level.
Comprehensive Solider Fitness Model
Castro added a disclaimer that he was one of the researchers to
develop the GAT discussed in Johnston’s presentation. Although he is no
longer working on the CSF program he believes it is the most
comprehensive resilience development effort in the DOD.
There were no best practices at the time the CSF was developed, and
as a result the CSF was rolled out without being validated. To address
this issue the rollout included in-depth ongoing program assessment. The
program was designed to be recursive. There was initially a lot of
criticism about the evidence base of the program, which may have had
some validity 3 years ago but does not now because of the built-in
assessment.
Castro stated that he questions some of the assumptions within the
CSF program model. In particular, he questioned the sequence of events
and how they are processed to be perceived as traumatic or adverse. He
asserts that the more significant flaw is that this implies an individual
either has growth or is traumatized by the event when both are possible
at the same time. Research in the United States, Israel, and Norway
indicates that individuals can have growth and decrements at the same
time. To illustrate this point he said that some soldiers with combat-
related PTSD report an improved perspective on life as a result of their
combat experiences. This indicates that there is a post-growth curve even
when there are problems. Although the CSF model includes a post-
adversity growth line it is not necessarily an accurate picture.
The concept that resilience is not an all-or-nothing phenomenon is
important particularly in training service members. The important
message to individuals is that resilience is not going to be all good or
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RESILIENCE PROGRAMS AND INTERVENTIONS
bad, and that if they are not enjoying their life, they should seek help.
There are telltale signs of when someone needs to seek help. For
instance, the first sign is often when a soldier’s partner, whether a
spouse, boyfriend, or girlfriend, tells the individual he or she needs help.
Castro does not agree with the view some have that resilience is a
state that people either have or do not have. How resilience is defined
will determine how it is researched scientifically—as a trait, state, or
process. The fields of child psychiatry and psychology view resilience as
a process. Castro supports this approach. He noted that his group funds a
broad range of research that looks at all three approaches.
The Army has adopted a universal prevention approach and does not
focus just on at-risk groups. The whole idea of the CSF is to tell people
what they need to know when they need to know it, so the training
modules are targeted to the deployment cycles. The family trainings are
organized the same way. Some of the modules are lifetime skills, and
others are uniquely applicable to the current deployment.
Physical Health and Recovery
Resilience is the ability to bounce back and recover, and there is a
connection between physical health and resilience. Individuals that are
physically in shape, generally feel better mentally, psychologically, and
emotionally. They are also better able to recover from mental health and
physical health challenges. Although the term the GAT uses is psychological
resilience, Castro prefers emotional resilience. Psychological resilience was
chosen for political and cultural reasons.
The Army operationalized resilience in terms of determining when
an individual is fit to return to duty following an event such as a combat
death in his or her unit. Establishing return-to-duty standards poses
scientific challenges that transcend the specific type of trauma. The
essential requirements of military occupations must be matched to the
soldier’s ability and to the extent of recovery to injury effects. In order to
accurately, safely, and quickly return soldiers to military occupations
post-injury, the military must first identify when a soldier returns to
“normal,” both physically and psychologically. To achieve this goal, the
Army is developing new tools, including mathematical models and
sensors for physiological status, to assist with return-to-duty assessments.
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114 BUILDING A RESILIENT WORKFORCE
and his colleagues, while developing a resilient leadership training
program, used an application framework based on Bandura’s self-
efficacy investigations in social learning (Bandura, 1997). They
ultimately piloted a training course for the Hong Kong government.
More than 600 people registered for the course the first year, 550 the
second year, and 600 the third year. A shortened version of the same
resilient leadership course was used at the FBI National Academy in
Quantico for 3 years.
Resistance, Resilience, Recovery
Everly and his colleagues at Johns Hopkins developed an
overarching framework within which resilience could be better applied.
Historically, resilience was defined as the ability to withstand or adapt to
a rebound from extreme challenges or adversity. Everly’s group at Johns
Hopkins developed a resistance, resilience, and recovery model as an
outcome-driven continuum of care wherein adaptation and rebound were
segregated (Kaminsky et al., 2007). Everly and colleagues developed the
term resistant to describe the person who has developed a sort of
psychological immunity and is not deterred by adversity. Resilience is
then the term used to describe rebounding from adversity’s perturbations.
In order to end the continuum and make it as comprehensive as possible,
the model includes recovery through treatment and rehabilitation.
Everly’s group argues that there are three elements to the overall
construct of resilience.
Where Does Human Resilience Reside?
The Hopkins model emphasizes the importance of cognitions or the
cognitive primacy model. In the words of Hans Selye, “It is not what
happens to you that matters; it is how you take it.” In 300 BC Epictetus
stated, “Men are disturbed, not by things, but the views which they take
of them.” Everly focused on the question “Does the workplace make
people sick, or is it something else?” From there his group developed a
very linear model where stressors lead to an acute stress arousal that
creates psychophysiologic symptoms and then general illness. Everly
looked at physical illness at 1 year. Everly commented that it is possible
to test each of these phases of the model. The analysis measured stressors
on the job such as job control, workload, qualifications, and affiliation.
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His group also used other standard measures from the business
organizational behavior literature.
Using linear models, Everly commented that it is important to note
that the direct effect of job control, workload qualifications, and
affiliation did not have a very powerful predictive effect on illness.
Linear regression assumes linearity, so Everly’s group later analyzed
the data in a simple structural equation model that assumed either
random or elliptical relationships. The group expanded its research from
physical illness and focused more on job satisfaction, desire to leave the
job, turnover intention, and/or performance on the job. Again, there are
no significant direct lines in this model, which suggests that there are
mediating variables.
The next challenge for the researchers was to identify the mediating
variables. It goes back to Selye and “It is not what happens to you that
matters; it is how you take it.”
Some discussions split traumatic stress and burnout into two issues,
which would underscore the pathogenic nature of simple, slow erosion
burnout.
When Everly’s group reanalyzed the data, it found a direct line from
stress arousal to the desire to leave the job. The group was able to
identify the cognitive factors that appear to have the greatest pathogenic
quality. Everly referred to this as the negative reiteration factor that led
to reduced personal accomplishments and perceptions of poor
performance, which leads to poorer performance on the job. Everly
commented that it is important to develop an intervention that affects the
pathogenic core of any debilitating phenomenon.
Everly’s interventions are focused on what most effectively mitigates
the reiterating negative cognitions. He noted that to understand this
component it is necessary to move to qualitative analysis. Everly quoted
Henry Murray: “There is nothing so powerful as a well-phrased
question,” and David McClelland: “The purpose of psychological testing
is to ask a question that uncovers the essence of the person.”
To identify resilient people Everly’s group developed a questionnaire
and fielded it with various groups, including deep undercover federal
agents, members of SWAT teams, and Navy SEALs. The survey
questions were simple, such as “What is the key to being immune to
stress?” The response was positive attitude, training, and a healthy
lifestyle. “What is the key to bouncing back from excessive stress?” The
response was having a positive attitude, an outlet, a hobby, and a support
network that included leadership. “If most people have a weakness that
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makes them vulnerable to excessive stress, what is it?” The responses
were a lack of perspective, tenacity, and preparation, as well as having a
negative attitude. “What is the key to motivating people to help them be
successful?” The responses included leading by example, training, and
experience.
In focus groups with Navy SEALs the themes of the discussions
included attitude, interpersonal support, and training as critical factors.
Everly also noted that the SEALs’ belief that they were part of a greater
mission was important. Based upon this research, Everly asserts that
there are six qualities of resilient people. They are
1. optimism or faith,
2. integrity,
3. social support,
4. decisiveness (attempting to control only those things over which
they have control) and responsibility,
5. perseverance and tenacity, and
6. self-control.
Everly noted that in meta-analyses on human resilience, social
support explains the greatest variance of all the other variables.
Decisiveness was defined as the attempt to control only those things over
which you actually have control and then to take responsibility for them.
Self-control may be the ability of a sniper to control his or her breathing
to reduce anxiety and reduce fine motor discontrol—perhaps similar
physiological interventions can be taught, as well as other interventions
about overcoming impulsiveness and similar issues.
How Is a Resilient Culture Best Cultivated?
Leadership is a mechanism to engender a culture of resilience. When
Everly and his colleagues looked at the role of poor leadership in direct
effects models they found burnout, job dissatisfaction, poor performance,
and turnover intentions were related to the stressors of role conflict, role
ambiguity, suboptimal leadership, and role overload. Role conflict and
role overload contributed minimally to the direct effects models and were
mediated through the leadership. Leadership should be trained because it
dictates organizational culture.
Resilient leadership is defined as behaviors that help others
withstand crisis and adapt to or rebound from adversity. The goal of the
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Resiliency Sciences Institute training program is to teach leaders and
managers to be not only resilient, but also resilient leaders. The
covenants of resilient leadership are strength and honor, which is
consistent with military research that describes resilient leadership as
authentic leadership. Honor in authentic leaders is exhibited by being
confident and optimistic and possessing a high moral character and
ethical reasoning. Strength in leadership provides purpose, motivation,
and the ability to be decisive in highly stressful conditions. Leaders with
these characteristics are the most likely to create loyalty, obedience,
admiration, and respect. Authentic leaders are effective and make their
followers feel safe. Part of this safety is founded on predictability.
Resilient leaders ease fear and provide hope for those who follow; safety
is based in trust, and trust in honor and integrity. The good news is that
all of these factors are behavioral and can be taught.
A Pedagogical Framework for Leaders to Create a “Culture of Resilience”
Albert Bandura asserted that people guide their lives by their beliefs
of personal efficacy. Bandura goes on to say that such beliefs influence
the courses of action people choose to pursue,
how much effort they put forth in given endeavors,
how long they will persevere in the face of obstacles and failures,
their resilience to adversity,
whether their thought patterns are self-hindering or self-aiding,
how much stress and depression they experience in coping with
taxing environmental demands, and
the level of accomplishments they realize.
To build self-efficacy, Everly asserts the following principles:
Resilience by doing—Allow people to have success. Using suc-
cessive approximation, allow people to develop an increasing
sense of self-efficacy realized via their own agency.
Vicarious resilience—Assign people to successful work groups
or projects so they can experience a sense of shared success.
Resilience via interpersonal support (encouragement, coaching,
and mentoring)—Find positive people to provide support. Use a
buddy system. Create surveillance systems and safety nets.
Physiologic self-regulation—Teach people to mitigate stress arousal.
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Everly noted that organizations such as fraternities attempt to
engender self-efficacy by saying that if you are there then you are special,
and therefore they expect special things from you. People often live up to
those expectations. If people are treated like victims, then they will behave
like victims. If people are treated like survivors, then they will behave like
survivors. If people are treated like heroes, then they will act like heroes.
Everly-Strouse Leadership Scorecard
Everly and Douglas Strouse developed a leadership scorecard to
determine if leaders truly exhibit resilient leadership. The quick set of
questions asks:
Are you optimistic?
Are you decisive?
Do you show integrity?
Do you communicate openly?
When leaders are given this short survey, they usually score fours
and fives. The second time they take the test, they are asked to provide at
least two concrete observable behaviors demonstrating the resilient
behavior to others. In general, scores drop down to the twos and threes.
Almost everyone believes they are being self-efficacious and are resilient
and good leaders, but it has to be demonstrated.
The Resiliency Sciences Institute training program is housed at the
University of Maryland, Baltimore County. The certification in resilient
leadership teaches three components of resilient leadership: the resilient
leadership characteristics, the resilient moment communications model,
and how to develop “psychological body armor.”
RESILIENCE PROGRAMS PANEL DISCUSSION
Evidence-Based Approach
Planning committee member and panel moderator Joseph Barbera
noted that several presentations discussed correlations in the data and
potentially implied a direct cause-and-effect relationship. He asked
speakers to comment on the development of an evidence base for this
work. Beaton noted that the fitness and burnout symptoms were
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correlations, and that a potential way to test the direction of influence
would be to show that improved fitness decreases burnout rates in
response to an intervention over a period of time. There are some
nonsignificant changes on burnout scales, but many of the associations
are frustrating because they are multifactorial. Barbera noted that
information can be interpreted in many ways.
Castro noted that he is currently engaged in several group
randomized trials. Group randomized trials are extremely difficult,
expensive, and time consuming, which is why they are rarely done.
Castro added that it is possible to have meaningful outcomes with small
effects. There have been studies of many of the principles presented by
the various speakers. In general, all of the presentations were hitting on
the same principles and the same intervention strategies.
Castro asserted that agencies with multiple offices present a perfect
opportunity to do group randomized trials. Although these studies are
easy to design, hard to do, expensive, and time consuming, they can be
done. The benefit of then having that data is that effectiveness can be
shown. It is also possible to look at competing approaches so
effectiveness does not become personality driven. The reality is that
interventions and their potential effectiveness are often about politics and
salesmanship. Programs should not be about who is the better salesman;
they should be about the evidence.
Core Program Components
Planning committee chair James Peake noted that DHS is developing
a common strategic core for resilience programs and asked the speakers
what program components they felt were required in order to have an
effective resilience program, and how those components could be scaled
up overtime. Castro responded that a chapter he authored with Dr. Amy
Adler in Resilience and Mental Health: Challenges Across the Lifespan
focused on this issue (Castro and Alder, 2011). The chapter lays out the
core and fundamental principles of building a resilience training program
and also lays out how to ensure that it is both scalable and trainable. He
added that the ability to scale the program and train others to implement
them is critical when working with large populations. After all, it is not
reasonable to have a program that only a small number of people can
participate in if the population is large. That was one of the requirements
for the CSF.
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120 BUILDING A RESILIENT WORKFORCE
Beaton noted that with all the various cultures and subcultures within
DHS it would be helpful to have core features that could be tailored to
the different groups in order to ensure that they are appropriate and
suitable. For example, firefighters and medics have a lot in common, but
it is important to recognize that they have significant differences as well.
Participant Engagement and Trust
Planning committee member Karen Sexton noted that soldiers appear
to trust the GAT survey and are participating without fear of retribution.
How has the military been able to assure participants that it is
anonymous? She added that in nursing they have not been successful in
convincing nurses that surveys are anonymous, and as a result the
surveys do not accurately capture all of the issues. Castro replied that it
would be more accurate to think of the survey as confidential rather than
anonymous. After all, the survey responses are linked to soldiers’
medical records. Instead it is made clear that the information is not
shared with the leadership. Additionally, in his experience Castro has
found that soldiers and Marines are very forthcoming with information.
When he has asked them directly about their concerns, he has found their
input to be thoughtful, reflective, and well informed. They have clear
opinions about mission success. Beaton commented that in his work with
the fire service, it took years of working with the fire service, the unions,
and the state council before they trusted the researchers enough to even
allow the surveys to be administered.
Castro commented that there is a perception that soldiers will not
honestly respond to the survey. To address this concern his group
compared self-reported information against the military records. The
study looked at PT scores, awards, sick visits, DUIs, and so on. Castro
found that the self-reported information was generally very accurate.
Soldiers share information about socially undesirable behaviors such as
drug and alcohol use in the survey where there is no incentive for them to
do so. Beaton also added that much of his data is self-reported survey
information. He has found that there are other measures that can be
employed to see if respondents are being honest in their responses or if
they are simply responding in a way that is perceived as socially
desirable. He also found anomalies when he compared the number of
incidents reported by firefighters and their service records. He found that
firefighters were overreporting critical incidents. He added that it is
difficult to precisely know what influences subjective responses.
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Family Outreach and Engagement
Planning committee member David Sundwall commented that based
on the presentations, social support systems—which in a large part is the
family—are a critical core element of resilience programs. DHS has
indicated that there are legal and logistical constraints that make it
impossible to actively reach out to employees’ families. Sundwall
wanted to know if other sectors such as police and fire departments, as
well as private-sector organizations, have the same issue. Beaton added
that he found that in the fire service a significant factor for PTSD was
marital status. Married firefighters had half the rate of PTSD compared
to their single counterparts in the fire service.
Barbera noted that it is important to consider family stressors,
personal stressors, and job stressors, and how they relate to each other.
He noted that improving stressors at work could inadvertently cause
issues in one of the other areas. For example, in his experience he was
able to cope with stressful shifts in the emergency department but found
stressors difficult when he was home. Behavior that was effective at
work did not work in other areas. Beaton agreed and stated that behavior
that can increase efficiency and effectiveness in one area can be very
ineffective and dysfunctional in another.
Program Design and Evidence Building
A workshop participate asked Castro to discuss the development of
the CSF program and the ongoing program evaluation and evidence
development supporting it. Castro noted at the time the Army started
working on the program design there was very little evidence base in this
field. However, there was a sense of urgency that something should be
done in this field, and if they waited for the perfect evidence, then it
would not happen. To get the program approved the design had to
include ongoing program improvements. As a result, evaluation is a core
program component. While it would have been great to have all the
training modules in place for the initial rollout, that was not practical.
The original GAT included about 100 questions, and participants
received their score and a tailored narrative. Various training modules
are gradually being added. In looking at the outcome data, CSF wanted
to see how it related to suicides, promotions, and data, they were already
collecting. Although the program has been criticized, as it matures and
builds more evidence those criticisms will be less of an issue.
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Changing Culture
Kathryn Brinsfield from DHS asked panelists to comment on how to
change aspects of the culture to improve resilience but retain other
components of the culture that support the mission. Beaton responded
that it is possible to change aspects of a culture while leaving other
components intact. Given that within DHS, commitment to the mission is
such a strong and important aspect of the culture, it could be argued that
improving the effectiveness of leadership will increase the probability of
the mission being accomplished. Changing organizational cultures is an
inherently slow process. For instance, an appreciation for the
psychological factors within the fire service has changed overtime.
Everly added that if a culture is toxic, then it needs to change. Beginning
with the leadership is a cost-effective and efficient way to do that. It is
also important to identify and include the informal leaders into the
process. Informal leaders have peer credibility and are the cultural
gatekeepers and conduits. For example, if you wanted to change the
culture in a hospital, then you would start with the nurses, not the
physicians.
Barbera voiced his concern that high-stress situations change the
culture in negative ways overtime. His experience in emergency
departments that suffer from chronic stress and pressure shows that the
staff that cares the most burns out. When they leave, the more resilient
and perhaps toxic people are de facto leaders because of seniority and
can possibly poison the workplace. Is it possible to recognize this
possibility and address it before it reaches a crisis level? Castro
responded that it is important to define the attributes that are desirable in
the culture in order to effectively foster them. In his opinion every
culture has aspects that are unhealthy and need to be changed. The
military is constantly working on improving its culture. It is a conscious
decision to actively change the culture. Although there is still a great deal
of work to do, the military is making progress. Castro agreed with
Beaton that culture change is not an overnight process and requires
ongoing reinforcement and support. He used the example of sexual
harassment in the military. The armed forces continue to do stand-down
trainings and have required topic-specific annual training. There is
constant assessment and evaluation. Change also happens through
attrition as people leave. Castro added that real change takes a lot of
planning up front. He believes that a good place to start is with the junior
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leaders, such as the squad and team leaders in the Army. As they rise
through the ranks they bring long-term change with them.
Everly asserts that it is also important to change the organizational
values and to publicize those values broadly through the cultural
conduits. Once individuals buy in, it is necessary to make it clear that
behavior aberrant or at variance from those values is not rewarded. He
also noted that peer groups, particularly in young adults, are often able to
do things in a culture that policy cannot.
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