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Stress Reduction 3 be determined that modifiable factors in the social environments of organizational units have powerful stress-inducing effects, it is not prudent to rely on person-based, intrapsychic stress reduction approaches. The organizational mission of the military is combat. That, of course, involves stressful conditions. Consequently, it might seem odd to suggest that stress be lowered for military personnel in their training. A critic here might ask, show can soldiers be prepared for combat if they do not know how to deal with stress, and how can they learn how to deal with stress if they are not exposed to it?" The succinct reply involves a conceptual clarification, namely that stress can be understood as a state of imbalance between environmental demands and resources for coping. Therefore, stress can be mitigated by augmenting coping skills. When environmental demands or pressures are a given inevitability, stress can be reduced nonetheless by enhancing the person's cognitive, behavioral, and social resources for coping with the stressors. An overview of the stress field and an elaboration of the above concept will be set forth in the next section, which will discuss determinants and mediators of stress in environmental, cognitive, behavioral, and social domains. Given the scope of this paper, coverage of these areas will necessarily be abbreviated. The aim will be to provide a basic conceptual background for what is to be presented on stress diagnostic procedures, stress reduction, and prospects for implementation in military se~ctings. OVERVIEW OF THE STRESS FIELD Contemporary research on human stress tracks a number of main areas of investigation, these being (a) conditions of the physical and social environment that function as stressors, (b) stressful life events and the
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Stress Reduction 4 moderating influences of supportive relationships, (c) physiological processes ant health impairments that accompany ant follow from the experience of stress, (a) cognitive ant personality mediators of stress, (e) processes of coping ant adaptation; and (f) stress reduction strategies. Each of these areas is relevant to military settings and the well-being of military personnel. In order to present a coherent synopsis of this vast literature in such a broad field, a theoretical framework will be set forth with its gutting concepts. Human Stress: Conceptual Framework The field of human stress contains many contextually focuses theories or motels. Some examples are those concerned with stressful life crises (Dohrenwent, 1978), attention overload and task performance (Cohen, 1978), perceived controllability of stressors (Glass & Singer, 1972), person- environment congruence (Stokols, 1979), physiological mechanisms and disease (Novaco' 1979), and & Schooler, 1978). stress to adequately in stress research' a the preponderance of (1985)' and the basic (Levi' 1974; Selye, 1976)' the regulation of emotion coping processes (Lazarus & Launier, 1978; Pearlin Although there is no single, all-embracing theory of represent and explain the diversity of phenomena studied basic model can be set forth that is compatible with existing theory. This was attempted by Novaco and Vaux propositions of that model will guide this paper. The concept of stress, as a condition of the organism or system that constitutes a state of imbalance between demands and resources, is defined by relationships between environmental demands (stressors) and adverse health and behavioral consequences (stress reactions) resulting from exposure to those demands. The association between stressors and stress reactions is not
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Stress Reduction uniform, as it is mediated by cognitive, behavioral, and social factors which influence whether environmental demands function as stressors and also influence the course of stress reactions. Importantly, environmental conditions and person characteristics~oehaviors are thought to be reciprocally related in ongoing processes of stress and adaptation. The general model of stress (Novaco & Vaux, 1985) can be understood in terms of its basic postulates given below with brief elaborations. The central propositions pertain to the sources of stress, impact mechanisms, mediational factors, and transactional influence processes. 1. Stress is induced by environmental demands that exceed coping resources,_thus disturbing homeostatic balance. Environmental demands or "stressors~ are elements or conditions of environmental fields that require an adaptive response from the organism or system. The stress inducing potential of environmental demands is a function of their patency and persistence. Potency refers to the degree of disturbance caused to homeostatic balance as a result of a stressor's intensity, severity, and multiplicity. Persistence refers to the temporal exposure to the stressor in terms of its frequency and duration. 2. Stress is manifested by adverse cart lisp behavioral and physiological consequences resulting from the exposure to environmental demands. Stress reactions consist of physiological disturbances, negative affect, and impairments to cognitive ant behavioral functioning. Stress reactions vary in their magnitude and extension, which determine their severity. Magnitude refers to the degree of homeostatic disturbance and impairment to functioning. Extension refers to the temporal duration of the disturbance or impairment.
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Strew Reduction 6 3. Environmental demands operate in transaction with the behavior of persons or systems. Stress is viewed in terms of dynamic influence processes involving reciprocal causal relationships between persons and environments. Transactionality assumes that the organism and the environment are interconnected components of a system in motion over time. 4. The effects of exposure to specific environmental demands are not uniform across individuals or systems but are mediated by cognitive, behavioral and social factors. 4.1 The cognitive representation of environmental demands and of response capabilities, on an initial and ongoing basis, is a primary determinant of stress. The human organism primarily responds to cognitive representations of the environment, not to the environment per se . Attention to environmental demands and response sensitivity to them are a function of expectation and appraisal structures pertaining to both environmental demands and coping resources. 4.2 Behavioral transactions with the environment influence the probability and degree of exposure to environmental demands and the course of stress reactions. While stressors vary in their controlability, some proportion of stressor exposure is a result of the person's behavior. Conditions of stress are often the products of the person's own activities. Similarly, the experience of stress inevitably leads to coping behavior Which may be directed at the environmental circumstances or at the stress reactions resulting from them.
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Strew Reduction 1 4.3 Social relationships moderate stress by reducing exposure to environmental demands, by decreasing sensitivity to them, increasing resources for dealing with them, and by containing subjective distress. . . Supportive social relationships mitigate the impact of environmental demands. Social support insulates the person from otherwise debilitating forces in the environment and facilitates coping with life crises. The importance of social support is such that the loss of supportive relationships is stress-inducing. 5 Stress is a product of contextually linked person-environment impact . mechanisms which determine how environmental demands are experienced . Stress arises in conjunction with clusters of situationally-relevant factors. Behavior occurs in context, and its understanding requires analysis of the ecological setting, identifying the network of variables that are functionally related to the behaving organism or system. The mechanisms by which stress is induced and ameliorated are contextually linked. The implications of this model for the subject of stress reduction are that stress can be prevented, mitigated, regulated, and remedied in a number of ways. In simplified form, the strategies principally involve (1) modifying environmental demands and their context of occurrence, (2) enhancing cognitive-behavioral skills so as to prevent exposure to stressors or moderate their influence, and (3) regulating stress reactions once they have become manifest. It should be noted that this way of understanding stress represents it as an undesirable condition. By definition, it avoids the confusion and inconsistencies routinely found in ideas of positive stress and negative stress. The latter concepts followed from Selye's (1976) late-career notions
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Stress Reduction 8 of "eustress" and "distress," ironic in their ambiguity, because Selye began his distinguished career by advocating clarity in stress concepts. Despite its appeal to management consultants, no one has ever substantively developed the concept of "eustress.~ Quick and Quick (1984), for example, advocate the dual concept, but then throughout their book use the term "stress" to refer almost exclusively to adverse conditions and consequences. This is not to be fussy about definitions, which tell us nothing about the nature of things. Definitions inform us about rules for the use of words, but once the language rules are given, it is important to follow them. Moreover, concept labels like "stress" and "aggressions are shorthand designations for an otherwise long story that cannot be told in a definitional format. The quandary over whether stress can be positive as well as negative results from several conceptual errors: (l) failure to differentiate the concepts of stress and arousal, (2) mixing referents that are categorically different (job demands may be positive, but heart disease is not), and (3) taking a static perspective instead of a transactional one, which would recognize that coping skills can be learned during stressful life experiences. The stress literature is, of course, enormous in volume, and there is an abundance of research in elements of the physical, psychological, and social environment that operate as stressors. Those elements that have direct relevance to military settings will be discussed in the next section. As part of this introductory overview, however, it will be useful to give a brief account of key stress responses that are often studied in stress research. Stress Responses Four main classes of reaction were identified by Lazarus (1966) as stress indexes, these being physiological arousal, emotional distress, motor behaviors, and cognitive functioning, although the emphasis of his work was on
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Stress Reduction 9 cognitive processes. In the time since his landmark book, these general categories still hold true. A central component of stress reactions is physiological arousal. While it is not always the case that arousal is assessed in stress research, it is routinely assumed that patterns of physiological activation underlie illness process. Selye's (1956) formulation of the stress response as a tri-component cluster of bodily reactions and his concept of the general adaptation syndrome' are cornerstones of stress research. His conceptualization of stress is that it constitutes the "non-specific response of the body to any demand,. a physiological common denominator if as.. mile , __ , 1, representing a condition of Swear and tear" in the body. Importantly, he identified adrenocortical enlargement, shrinkage of lymphatic structures, and gastrointestinal disturbances as the triparte response cluster that constitute the stress response. His non-specificity thesis has been strongly criticized by psycho- endocrinologists, especially Mason (1975~. However, Selye's research directed investigators to activation in the autonomic nervous system and to impairments in immunological function. Classic research in the area of psychosomatic medicine by Ax (1954), Schachter (1957), Funkenstein, King, and Drolette (1957), and Wolf and Wolff (1952) directed attention to physiological processes in the study of stress and its mastery. Frankenhauser (1975) was also instrumental in turning attention to catecholamines in particular. Interest in physiology is routine among stress researchers, and military populations have often been studied because they are exposed to extreme environments. For example, an entire volume' has been written on physiological processes associated with parachute jumping (Ursin, Basde, & Levine, 1978). Scientific interest in the physiology of stress was sparked by Cannon (1929), who called attention to bodily states associated with emotional arousal
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Stress Reduction 10 and also to conditions relevant to military environments, such as cold, lack of oxygen, and blood loss . S ince the time of Cannon, the autonomic nervous system (ANS) is generally recognized as central to stress responses. This system regulates the heart and smooth muscles of the body, the digestive system, sweat glands, and certain endocrine functions. While the sympathetic system component of the ANS is activated to mobilize the body's resources in response to threat, the parasympathetic component is also important because of its relevance to digestion, recuperation, and relaxation. Cannon's work on ANS functions and its activation in conjunction with physical and psychological conditions was extended by Seyle, who proposed a general adaptation syndrome (GAS) for stress responses. His non-specificity thesis regarding its activation has not been generally accepted, but he directed attention to sympathetic-adrenocortical activity. Interest in sympathetic- -adrenomedullary functions that Cannon had pioneered soon followed. Research on catecholamine excretion has been studied with regard to many stressful situations, and a leading researcher in this area is Frankenhauser (1975~. In her laboratory in Stockholm, epinephrine and norepinephrine output has been linked to physical work, mental strain, and emotional states. Among those doing psychoendocrine research has been Mason (1975) at the Walter Reed Army Institute, whose work in basic training and combat environments will be discussed later. However, here it can be noted that his laboratory-based research demonstrates that Selye's non-specificity concept does not hold when psychological states (e.g., novelty, apprehension, appraisal) are controlled during stressor exposure. He argued strongly against the view of an indiscriminate action of the pituitary-adrenal cortical system in response to nonpsychological stimuli or stressors as Selye had proposed. Across a large set of laboratory studies, he has found no uniform
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Stress Reduction , 1 pattern for psychoendocrine responses (epinephrine, norepinephrine, 17-OHCS) to a range of stimulus conditions (Mason, 1975~. The significance of physiological arousal as a stress response is threefold. First, pronounced physiological activation constitutes a disturbance of homeostatic balance. The continued onset of arousal, and its prolongation is thought to be related to disease processes that affect the heart, gastro-intestinal system, kidneys, and pancreas, as well as pain and discomfort in the skeletal musculature. For example, acute psychophysiologic reactivity has been linked to cardiovascular disease risk (Krantz & Hanuck, 1984). Second, heightened arousal has been found to impair performance. The empirical generalization that the relationship between arousal and performance is an inverted U function often appears in stress literature and related fields (e.g., sports psychology). This concept originated with Duffy (1932 & 1957) and has been associated with Hebb (1955), as well as being adopted by Spence and his co-workers in their anxiety-drive research. While Duffy focused on muscle tension-performance relationship, Hebb discussed the arousal function in terms of information processing. Importantly, Easterbrook (1959) explained the arousal-caused impairment of performance in terms of cue utilization. Arousal acts to narrow the range of cues that can be used. Hence, for complex tasks, arousal will have a disorganizing effect on performance. Regarding the empirical generalization of an inverted U function, the problems are that "arousal" is not a unitary phenomenon (various indices have low intercorrelation) and that strong arguments have been made for dissociations of electrocortical, autonomic, and behavioral arousal (Lacey, 1967). Moreover, the way in which a particular level of arousal will affect performance will very much depend on the nature of the task and the individual's skill level.
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Stress R educe on 12 A third aspect of the significance of physiological arousal as a stress response component is its involvement in disruptive emotion and its maladaptive consequences. Fear (anxiety) and anger constitute emotional states, defined in part by physiological activation. While these emotional states themselves are unpleasant, they are linked to maladaptive behavior patterns, such as recurrent avoidance and disorganization in the case of anxiety and aggression in the case of anger. Because we are architects as well as victims of our stress experiences (transactionality postulate), these disruptive emotions potentiate continued stress and weigh against adaptive recovery from bans itory s tress experiences . Emotional states that constitute functional disturbances are indeed a major category of stress reactions. In addition to fear/anxiety and anger, guilt, shame, and sadness are relevant stress responses. Conditions of depression and grief are frequently studied by stress researchers in association with processes of coping. Anxiety is of course strongly involved in combat stress, and depression is a prominent feature of wartime -bereavement. Motoric functioning in the sense of behavioral performance, as well as flight and attack responses, are important aspects of stress responses, although attention to overt behavior has been less than to physiology, emotion, or cognitive functioning. Concerns about matters of productivity, work performance on complex tasks, ant behavioral components of problem solving must give attention to motoric dimensions. The adequacy of cognitive functioning is strongly entailed in human performance concerns. There is an abundance of work pertaining to effects of stress on perception, information processing, social judgment, and cognitive elements of coping. Tests of reasoning' signal detection, puzzle-solving)
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Strew Reduction 13 perceptual-motor skills, and memory have long been part of human performance research, and personality-oriented studies have made ample use of measures of expectation, intentions, appraisals, and attributions. With this overview and theoretical framework, the determinants of stress relevant to military contexts will be discussed. Attention will be given to environmental factors, cognitive processes, behavioral performance and coping styles, and social conditions that shape the experience of stress. Among the relevant issues pertaining to the general topic of stress vis-a-vis the military are themes of military socialization. Stress as a Concern for the Militarv The purpose of the military is obviously to fight wars, and the business of war is the destruction of the enemy and of their will to fight. At times, it is naively thought that soldiers are simply taught to follow orders and to be mechanically brutal. Oddly enough, such ideas do seem to underlie Soviet military training philosophy (Gabriel, 1986). But all wars involve being immersed in a hostile atmosphere, where the soldier is enveloped by the sounds, sights, and smells of destruction. Combat environments entail multiple sources of stress that have cumulative effects. As developed in Novaco, Cook, & Sarason (1983), warfare stressors can be thought to fall into two principal classes: (1) harsh physical circumstances that affect tissue needs, and (2) the threatening psychological ambiance of combat. The ability of combat personnel to cope with these powerful stressors has an important bearing on their performance effectiveness. The stress associated with exposure to the extreme environments of warfare has been studied extensively. Among the most notable works are those of Grinker and Spiegel (1945) on air combat units, Kardiner and Spiegel (1947)
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Stress Reduction `4 regarding traumatic neuroses, Bourne (1969 & 1970) on psychological and physiological stress reactions in Vietnam, ant Figley (1978) on combat-related stress disorders among Vietnam veterans. The adverse consequences of stress and the psychiatric casualties that may eventuate are a concern for United States military organizations not only because of the humanistic values at the foundation of our society but because the effectiveness of combat units is seriously impaired. This was a salient lesson of World War II, as reflected in a highly regarded analysis of military behavior by Marshall (1947), who found that less than one-fourth of the men in combat fired their weapons. Going back to the American Civil War Battle of Gettysburg, over 18,000 muskets were found on the battle field that unmistakably had not been fired. The evidence for this conclusion was that 12,000 had two charges, both undischarged, rammed down the barrel; and another 6,000 had three to ten packed charges. The men had panicked and were loading their weapons purposelessly, or they deliberately wanted to appear as though they were firing (Karsten, 1978). Considering such observations, it-must be kept in mind that for World War II the Army rejected about three of every ten men it screened for induction--5 1/4 million out of 18 million. Ginzburg (1959a; l959b) provided a critical review of this ambitious screening operation and the factors associated with the discharge of 470,000 men between 1942 and 1945 for performance ineffectiveness. To be sure, it was not simply a matter of poor initial screening, because ....many educated and strongly motivated men who were properly trained and properly assigned also broke down. The cause of their failure can be found neither within themselves nor within the military organization; but it lies rather, in the excessive stresses to which they were exposed as a result of the exigences of war" (Ginzburg, 1959b, p. 7). Despite
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Stress Reduction induction screening of unstable individuals, the Army came to recognize that even emotionally stable men could become ineffective. Problems at home, casualties in the combat unit, and the strain of protracted battle, such as the Normandy invasion or the push through Italy, could precipitate breakdown (Ginzburg' 1959b, 1959c). Looking at contemporary conflict, Israel is a natural laboratory for the study of warfare-related stress (Milgram, 1982). Since its formal existence nearly 40 years ago, as well as the 75 years of settlement that preceded the establishment of the state, the Israelies have monitored and treated psychological disabilities induced by warfare. Their concerns were made salient by the Yom Kippur par (1973), which in contrast to the Six Day War (1967) had much higher casualties and an unsatisfactory conclusion. The initial success of the Egyptian and Syrian armies was shocking and brought about the realization that the shadow of war and terrorist attack would be perpetual (Milgram, 1982). Coping with war-related psychological distress became a matter for the national consciousness. Moreover, general concern about the disabling effects of combat stress have risen with observations about the recent Lebanon war, as the Israeli army lost nearly twice as many soldiers to "battle shock" as were killed by the enemy (Gabriel, 1986). Despite the nuclear era, conventional warfare continues, and the Soviet's themselves are concerned with how to improve the soldier's ability to withstand stress and trauma. Gabriel's (1986) states that, since the Brezhnev years, the Soviets have believed that conventional operations could be conducted in a nuclear environment and that when nuclear arsenals were exhausted, the conventional forces would be decisive. Soviet behavior in World War II showed a proclivity to continue attacks until the units were nearly decimated -- a willingness to accept staggering numbers of casualties. Gabriel reports that units often fought down to 30% strength. 1-
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Stress R educiLon ; 5 Major causes of stress are the harsh physical circumstances of warfare that affect tissue needs, such as conditions of deprivation (food, sleep, or oxygen), extreme stimulation (temperature and noise), disease-engendering conditions, ant trauma-intucing wounds. But it is the threatening psychological ambiance of combat that is so pervasive. Every soldier must cope with the fear of teeth. Fear has been fount to be greatest before going into action ant to be reported by 7 of 10 men (Dollars ~ Horton, 1944; Stouffer, Lumstaine, Lumsdaine, Williams, Smith, Janis, Star, & Cottrell, 1949). In the Vietnam War, the clandestine nature of the fighting exacerbated the psychological strain, as American troops developed "a sense of helplessness at not being able to confront the enemy in set piece battles. The spectra of being shot at and having friends killed ant maimed by virtually unseen forces generated considerable rage which came to be displaced on anyone or anything available" (DeFazio, 1978, p. 30). The psychological ambiance of combat associated with the Vietnam War hat a particularly negative effect on veterans, who in large numbers manifested "delayed stress responses" (Horowitz & Solomon, 197S). MILITARY SOCIALIZATION AND THE ETHOS OF TRAINING Despite variations across branches of the armed services, military recruit training has a relatively homogeneous process. Basic training is a period of rapid resocialization ant enculturation, occurring under conditions of relative isolation ant confinement (Novaco et al., 1983). Ranging from seven to eleven weeks across service branches, young men are expected to develop new behavior confined to a narrow range of acceptability as shapes by heavy doses of reward ant punishment. In a certain sense, boot camp can be thought to habituate recruits to the unpredictable stresses likely to be encountered in combat. According to Gabriel (1986), Soviet military training
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