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Enhancing Human Performance: Background Papers, Stress Management (1988)

Chapter: 4 Determinants and Mediators of Stress in Military Settings

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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Suggested Citation:"4 Determinants and Mediators of Stress in Military Settings." National Research Council. 1988. Enhancing Human Performance: Background Papers, Stress Management. Washington, DC: The National Academies Press. doi: 10.17226/785.
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Stress Reduction 20 "Training is seen as the intentional disruption of civilian patterns of adjustment, replacement of individual gratifications with group goals, inculcation of unquestioning acceptance of authority and development of conformity to official attitudes and conduct" (Yarmolinsky, 1975, p. 158~. These authors, along with Arkin and Dobrofsky (1978) and Dyer (1980), represent basic training as a conversion process that promotes socialization to military norms. Stress has an integral function in this process, but the exposure to this environmental context results in the acquisition of stress coping skills. As one develops commensurate resources for coping, environmental demands that once functioned as stressors can then be appraised as "challenges" that can be handled effectively. In the face of "humanist" criticisms about the nature of basic training, researchers and other social scholars must bear in mind that military institutions indeed have intrinsic defense functions and that training involves preparation for combat with the objective being the destruction of the enemy. Military organizations must therefore utilize methods and techniques of training which provide a realistic test of stress tolerance. "It is more prudent and ultimately more humane, to provide this screening and learning under conditions in which the probability of death due to error is very low than it would be to send ill-prepared troops into combat. This assumption underlies both the process and content of training ant is one often overlooked in discussion of the efficacy of methods used by the military" (Novaco, et al., 1983, p. 392). DETERMINANTS AND MEDIATORS OF STRESS IN MILITARY SETTINGS Those who function in military settings are at high risk for exposure to involved in stressors . Military obj ectives and the nature of the tasks

Strew Reduction 2~ achieving them necessarily entail stress. The concept of stress reduction set forth in this paper, however, asserts that despite the inevitability of stressor exposure, psychological dysfunction and performance impairment can be attenuated if suitable coping skills have been developed and are utilized. So as to better establish this assertion, stress in military settings will be discussed in terms of determinants and mediators. This will be organized in terms of key rubrics in the stress fields, namely environmental context, cognitive factors, behavior patterns/coping, social conditions, and organizational factors. Environmental Context As elaborated in Novaco et al., (1983), combat environments entailed multiple sources of stress that have cumulative effects. Exposure to harsh elements in various environmental fields require an adaptive response from the soldier, including (a) deprivation of food, sleep, or oxygen, (b) extreme stimulation involving aversive temperatures and noise, (c) disease-engendering conditions linked to inadequacies in diet, hygiene, and medical care, and (d) wounds and injuries that induce trauma and confirm the soldiers most basic fear. However, in addition to these harsh physical circumstances that affect tissue needs, there is another pervasive dimension of stress in warfare, which is the threatening psychological ambiance of combat. This psychological dimension has several components: the continuous threat of death and injury, the loss of friends, and the recognition of one's own destructive capacity. Psychological dysfunction in war settings will of course vary with the intensity and duration of combat, as well as with organizational factors such as experience, leadership, unit cohesion, and psychiatric management. Yet it has been estimated that in a high intensity war, approximately one-third of all non-death casualties will be psychiatric (Small, 1984). Such estimates

S=ess Reduction 22 extrapolate from World War II, Korea, Vietnam, and the Arab-Israeli wars, and some estimates run much higher. Battlefield psychiatric disorders include psychoses, psychosomatic syndromes, and acute anxiety reactions. Various forms of withdrawal may also occur, such as drug use and unexcused absences. Treatment policies of immediacy, proximity, and expectancy to return to combat have formed the basis of psychiatric case management (Hilber, 1984; Kormos, 1978). Regarding psychosis, Ginzburg (1959) found that combat exposure did not increase the rate of psychosis among U.S. soldiers, although neuroses rates were clearly affected. Often overlooked in accounts of battlefield psychiatric dysfunction, however, are manifestations of stress in the form of anger, hostility, and aggression. In the earliest work on psychopathy resulting from combat, Kardiner and Speigel (1947) wrote about aggressive impulses as one of the most common aspects of traumatic neuroses. These believed that it was related to the irritability and hypertoxicity of the entire muscular system... Easily aroused to anger, these patients are very prone to motor expression. They -either break or tear objects in these fits of temper, or strike the people who happen to be around them" (pp. 212-213). This is an impulsive aggressiveness related to an incapacity to process information properly. Explosive irritability and unwarranted rage were identified by Kardiner and Spiegel as a stage in the progressive development of incapacitating breakdowns, which begin with poor appetite and carelessness, then involve irritability and exaggerated reactions of rage, and culminate in freezing, sleep disturbances, and being terrified of one's own artillery. While observations during the first and second World Wars led to these ideas of traumatic neuroses as progressive disorders, it was learned in subsequent wars that combat stress reactions are not necessarily progressive and are more dynamic (Bourne, 1970~.

S=e" Reduction 23 Physiological activation, however, should not automatically be expected in combat situations, because psychological defenses can operate to suppress reactivity. Bourne (1969), for example, found in studies of helicopter ambulance crews and of special forces teams of enlisted men that urinary 17- hydroxycorticosteroid (OHCS) levels were relatively low, compared to recruits in basic training, to the population at large, and to the officers in the units. He attributed the low excretion levels to affective denials and the self-perception of invincibility. Recruit training, while hardly analogous to combat, can be seen as having parallel dimensions of stress exposure. That is, the training regimen entails difficult physical challenges and also involves psychological shock associated with isolation, low autonomy, time pressures, ego threat, social comparison, and authoritarian control. To a large extent, boot camp can be viewed as a stress inoculation procedure. Recruit training occurs in an intentionally aversive environment designed to prepare personnel to function effectively under the conditions of overstimulation found in combat (Novaco & Robinson, 1984). The intense demands of the recruit training environment have been found to be associated with both adverse health reactions and psychoendocrine effects. Voors, Stewarts, Gutekunst, Moldow, and Jenkins (1968) identified stress as a precipitant of respiratory infection among Marine recruits, and Poe, Rose, and Mason (1970) viewed stress as one determinant of 17-OHCS excretion among National Guard recruits. Bourne (1967), examining Marine Corps recruit training, reviewed research indicating that during the period of induction, the degree of psychological stress is reflected by 17-OHCS levels comparable to those of patients measured during incipient psychosis.

Stress Reduction 24 Following up a study by Rose, Bourne, & Poe (1969) on basic training and soldiers anticipating combat in Vietnam which found suppressed androgen levels, Krenz, Rose, and Jennings (1972) studied officer candidates at the Army Infantry School at Fort Benning, Georgia. These authors found significantly lower plasma testosterone levels during the stressful part of Officer Candidate School, confirming the hypothesis about androgen suppression as a result of stress. Comparisons were made with non-stressed samples and with the same subjects under conditions of low stress. They also found significant elevations of plasma cortisol during the stressful phase of the training program. Psychiatric interview ratings and questionnaire self- ratings buttressed the analyses. Specialized training, such as for the Navy Underwater Demolition Team, has been found to be highly stressful, with pronounced adrenal cortical activity (Rubin, Rahe, Arthur, and Clark, 1969). The high failure rate in this program (30 to 70 percent) is seen to be stress related, and stressful life events have been found to add to the strain that induces dispensary visits and then training drops. Symptomatology measures of emotional distress have been found to be strongly correlated within dispensary visits among those who ultimately drop voluntarily from training (Rahe, Biersner, Rymen, & Arthur, 1972~. The phasic nature of stress during basic training is easily observed and is commonly reported by training personnel. Empirical studies certainly support such observations. Stewart, Voors, Jenkins, Gutekunst, & Moldow (1969) found that sick calls peak during the second and third week of training for Marine recruits. Similarly, Novaco, Sarason, Cook, Robinson and Cunningham (1979) found that the majority of psychologically categorized attrition occurs during the first two weeks of Marine Corps training.

Stress Reduct:io,. :: Findings by McCabe and Board (1976) for psychiatric admissions among airmen in basic training are also that more than two-thirds of admissions occur during the first 10 days of training. When these authors examined prior illness history, they also found that those airmen having prior illnesses actually completed more training than those who had no illness history, thus supporting a stress reaction view. Cognitive Processes When intense environmental demands are inevitable, as in the case of combat, captivity, or military training, the most accessible form of coping is cognitive. The relatively low levels of cortical steroid excretion found by Bourne (1969) among helicopter ambulance crews and special forces teams in Vietnam was interpreted as a consequence of defensive denial and perceptions of invulnerability. Easily recalled in this regard are the classic experiments by Lazarus and his colleagues (Lazarus, 1966) on denial and intellectualization as cognitive appraisal moderators of anxiety, as reflected in physiological and self-report indices. However, classic military research can be cited here also. Janis' (1951) review of adjustment mechanisms to recurrent air raids found that complete denial of impending danger and "reversion" to beliefs of personal omnipotence were typical psychological defenses. The illusion of personal invulnerability is thought to become reinforced by "remote-miss" as opposed to "near-miss" experiences. While the remote-miss survived emerges unscathed from an intact shelter, the near-miss survivors have had a shocking contact with destruction that shatters their confidence and exposes vulnerability. Assuming that the Vietnam units had some near-misses, they seem remarkably to have become inoculated against fear stimuli and solidified the perceptions of invincibility. Unlike civilians exposed to air raids, combat personnel are engaged in the warfare, and their

Strew Reduction 26 duties may have attention refocusing and task-orienting qualities that facilitate coping with fear, but they also are more recurrently exposed to danger. We have seen that the basic training regimen is an intentional disruption of civilian patterns of adjustment (Yarmolinsky, 1975) and has been described in various ways as a conversion process. O'Neill and Demos (1971) described how stress can operate to effect an ideological conversion. One element is that the recruit becomes aware that overt rewards are rare, while punishment and negative reinforcement (cessation or avoidance of aversive consequences) are the predominant contingencies. Stressors such as yelling and "incentive training" (rigorous calisthenics) are often used to shape attitudes-behavior. In this "conversion process," stress contributes to perceptual "tunnel vision'' and cognitive rigidity. Lazarus (1966) noted that there is a constriction of the perceptual field under stress ant argued from existing research that anxiety resulting from stressor exposure interferes with learning and performance by narrowing the range of attention and by limiting perceptual cue utilization. As discussed earlier with regard to arousal effects, this is Easterbrook's (1959) theory. With regard to basic training environments, stress can be thought to reduce the capacity for critical thinking and for intellectual reflection about the recruit's experience. A third aspect of stress in training regimens is that it heightens suggestibility and thereby can increase receptivity to institutional influences. O'Neill and Demos (1971) make this point as a generalization of Pavlov's principle of transmarginal inhibition. Pavlov discovered that deviation from previously established response tendencies (the ~inhibition" of conditioned behavior) resulted whenever the stimulus situation was sufficient to exceed the "margin" for effective response.

Stress Reduction 2, Pavlov's (1927; 1928) conditioning experiments had been disrupted by the Leningrad flood (Petrograd, September 23, 1924) which threatened the lives of his caged dogs who subsequently failed to exhibit their conditioned responses. His idea of "transmarginal inhibition" was that the animal's upper limit of cortical excitation had been exceeded and the inhibition occurred to protect the brain from overstimulation. Stimuli which had at one time elicited the strongest conditioned responses consequently elicited the weakest ones as the response hierarchy was reversed (Pavlov's "ultraparadoxical phase"). As the transmarginal inhibition dissipated, the original response gradient was restored, and as the overexcited cortex recovered, it could learn to tolerate increasingly greater levels of stimulation. Epstein (1983) speculated that Pavlov's observations of traumatized dogs are related to what Freud saw in traumatized soldiers who exhibited "repetition compulsion," but Pavlov (1941) actually made similar extensions of his concept to war neuroses. For Freud the traumatic neurosis occurred due to excessive stimulation, ant the repetition compulsion was an attempt to retroactively master the stressful experience. Returning to the association with recruit training suggested by O'Neill and Demos (1971), it can be seen that some conditions noted by Pavlov (1928) for the occurrence of transmarginal inhibition are prolonged anticipation of rewards under stress, confusion or inconsistency in the conditions necessary for effective response, and fatigue in the responding subject. Such conditions are indeed part of the early stages of basic training, and stress may thus be utilized to "recondition" civilian behavior (previously established response tendencies). Novaco et al. (1983) presented a cognitive behavioral analysis of recruit training adjustment that suggests a different perspective on the basic

Stress Reduction 28 training experience. Their analysis was organized around the concepts of expectations and appraisals which can be seen to undergo considerable modification as training proceeds. The initial states of disequilibrium and disorientation from unexpected events and stimulus overload are coupled with low efficacy expectations. Similarly, the appraisal systems are commonly those of threat, antagonism, and failure which correspondingly are linked to states of anxiety, anger' and demoralization. Over the course of training, however, these cognitive conditions undergo dramatic change. Repeated exposure to the environment elements over time, success experiences, and the coping efforts utilized by recruits work to alter the expectation and appraisal systems. Recruits have been shown to have strong shifts towards internal locus of control expectancies (Cook, Novaco, & Sarason, 1982) and develop stronger efficacy expectations as they succeed on training tasks. They learn to reappraise their drill instructors' behavior, their pain experiences in physical training, and their role in the social unit. Importantly, they learn to develop a task-orientation and not be distracted by irrelevant stimulation and preoccupation. Very little appears to be known about the cognitive characteristics of successful soliders. The extensive study by Ginzberg et al. (1959) primarily addressed demographic, archival, and managerial factors. More recent works such as the Sarkesian (1980) volume on combat effectiveness, which addresses the Vietnam experience, says little about cognitive dimensions beyond some amorphous reference to the will to fight. While considerable work was done to understand the stress disorders of Vietnam veterans (e.g., Figley, 1978) there is a virtual absence of information about cognitive pre-conditions that heighten susceptibility to trauma. A recent study by Foy, Sipprelle, Rueger, and Carroll (1984) which looked at promilitary adjustment (along with other

Strew Reducers Ha military and combat factors) in the etiology of postraumatic stress disorder (PTSD) found no effects for premilitary measures. This index consisted of items covering family stability, parent relationships, school achievement, disciplinary problems, and social activity. Of course, post-hoc analyses do not lend themselves to the assessment of pre-existing cognitive structures and processes, but given that stress reactions are to a significant degree a function of cognitive mediation, there would seem to be much value in obtaining measures that identify cognitive risk factors. Studies that have sought to differentiate PTSD cases from normal and clinical controls have made physiological and psychometric assessments (Fairbank, Keane, ~ Malloy, 1983; Malloy, Fairbank & Keane, 1983) but have ignored cognitive dispositions. Prisoner of war studies might also be informative about cognitive determinants of stress, but this work as well has given little attention to cognitive dimensions as preconditions. Deaton, Berg, Richlin, and Litrownik (1977) examined the coping activities of Navy POWs in solitary confinement in Vietnam and found that the most useful activities were associated with the captor-captive relationship. This involved the prisoners attempting to stay one step ahead of the captor by anticipating his next move and formulating contingencies for new situations. Communication loaded high on this factor and was accomplished by a variety of methods. Similar accounts were given in the press by interview with those held hostage in Tehran after our embassy-was taken over in November, 1979. Nardini (1952) reported that survival in Japanese POW camps was related to strong motivation to live, intelligence, a sense of humor, controlled fantasy life, and controlled emotional sensitivity. The latter points relate to Spaulding and Ford's (1972; 1977) account of the Pueblo crew's captivity in North Korea, which reported that the men who best tolerated stress were bright, able to isolate their emotions, and able to entertain themselves with fantasy.

Stress Reduction 30 Behavior Patterns and Coping One of the key factors that has emerged in stress research is the coronary prone behavior pattern known as Type A behavior. Characterized by time urgency, competitive drive, and hostility, the behavior pattern has been found to be associated with risk for coronary artery disease. Recent research in this area (cf. Chesney & Rosenman, 1985) has given increased attention to the involvement of anger and hostility as the key risk factor. Longitudinal research by Barefoot, Dahlstrom and Williams (1982) and Williams et al. (1980) linked anger/hostility to subsequent disease and mortality. Coupled with experimental research showing heightened catecholoamine responses among Type As when faced with challenge or provocation (Krantz & Manuck, 1984), the involvement of anger has surely been identified, although the nature of the association remains to be untangled. This behavior pattern should concern the military and its training institutions. Each of the three demarcating dimensions has relevance to military training, particularly for those whose duty it is to train recruits. Longitudinal studies conducted by me and my colleague Irwin Sarason have consistently found significant increases in Type A characteristics among Marine Corps drill instructors. We have found that those men who successfully complete Drill Instructor School are significantly lower on Type A characteristics than are those who are dropped, as well as being low on a variety of other stress risk factors. However, after graduation from Drill Instructor School and when the tour of duty begins, drill instructors progressively increase in Type A behavior, particularly the speed/impatience and anger components. Importantly, these dimensions are inversely related to performance evaluations by their supervisors. The impatient, irritable drill instructors are given poor evaluations. These relationships are both syncronous and predictive (Novaco, Sarason, Cook, Robinson, & Parry, 1983).

Stress Reduction 31 One manifestation of stress and poor coping skills related to anger is child abuse. While military families are not much different than civilian families with regard to abuse (Dubanoski & McIntosh, 1984), several types of stress were found to be related to abuse in military families: family discord, new baby and continuous child care, ant relocation/isolation. Loss of control and lack of tolerance were two major reasons for abuse given by members of the military studied in Hawaii. A study of spousal violence at the Naval Regional Medical Center in San Diego (Uasileski, Callaghan-Chaffee, & Chaffee, 1982) found a high level of reported stress in the families in the preceding twelve months. Low pay, housing problem, and hardship separations are routine characteristics of military life that impose stress on families and have been linked to child abuse and neglect among the military (Roth, 1980). Social Conditions In the stress field, the topic of social support has become a major sub- area. It has involved studies of (1) social resources, including measures of social networks and participation, (2) social behaviors, such as the actual provision of aid, giving advice, or socializing, and (3) perceptions of support, that is the individual's assessment of the quality of relationships, of being cared for and esteemed, and of satisfaction with social relationships. A good example of the measurement of social support and its study in experimental contexts is Sarason, levine, Basham, and Sarason (1983). It is unclear from considerable research how social support operates in ameliorating stress, but it is a good bet that it has both direct effects on stressor exposure and buffering effects in enhancing coping resources. Curiously, in the vast literature accumulating on social support, there is little if any reference to its relevance to military contexts. Given the research done at the time of the second World War, this is indeed suprising.

Stress Reduction 39 Interpersonal strain undermines military organizations, because it is well-established that group cohesion, group identification, and loyalty motivate men to fight. Interpersonal conflict linked to race, gender, or economic class can be a source of organizational stress, but the fact that it disrupts processes of social support constitutes a double risk condition. The concept of te = ark is nowhere emphasized more than in the military, where supportive social relationships indeed have life preserving functions. The importance of social bonds for military functioning is nowhere better emphasized than in Grinker and Spiegel (1945), whose work on air combat units is indeed a historic milestone in the stress field -- e.g., they had a strong influence on Lazarus (1966). Their account of human functioning and psychological adjustment under extreme environmental conditions portrayed the struggle to master the environment, as well as the failures of adaptation. They worked with combat soldiers in theaters of battle and in hospital rehabilitation settings where soldiers were treated for "war neuroses." Regarding the value of social rela~cionships they stated: n It is an interesting fact that, although the members of combat crews are thrown together only by chance, they rapidly become unlaced to each other by the strongest bonds while in combat. The character of these bonds is of the greatest significance in determining their ability to withstand the stresses of the combat situation" (p. 22~. The mutual dependence for protection, the family circle of the combat group, ant the stress associated with the loss of one's brothers-in-arms are vividly described by Grinker and Spiegel, who state that the loss of friends in combat is a major source of emotional stress.

S tress R e auction 3 3 "The men suffer not only from a sense of bereavement but from having seen the anguish of a bloody and painful death . . . ache grief pers is ts and, though i t is dulled by time, new losses may be added to it. In addi tion, the loss of friends s simulates anxiety. . . This double load of grief and anxiety is part of the heritage of emotional stress incidental to combat" (Grinker & Spiegel, 1945, p . 35 ~ . Rachman (1978) in his review of studies on combat fears, including a 17 volume report by Flanagan on U.S. combat air crews during World War II, states that the information testifies to the overwhelming importance of social bonds. "It seems that the most important source of motivation was the small social group of which each soldier or airman became a part" (p. 50~. It is the identification with a group and it history tht provides motivation for combat, and a fighting unit's morale is dependent upon faith in leadership and faith among unit members. nThere is general agreement that a major factor protecting the individual soldier from being overwhelmed by war- related stress is the group cohesiveness of the military unit to which he belongs, the mutual trust of men and officers, and the high morale and confidence in themselves" (Milgram, 1982, p. 134). In a comparison of Yom Kippur War combat units, Steiner and Neumann (1982) attributed differences in posttraumatic stress reactions to differences in cohesiveness of the units, although they did not control for pre-combat variables. Several studies of PTSD Vietnam Veterans have found impairments in social support for this population. Keane, Scott, Chavoya, Lamparski, and Fairbank (1985) compared PTSD veterans to well-adjusted veterans and to VA medical service inpatients. The PTSD group had significant reductions after military

Stress Reduction 34 service in their social network size and in various qualitative dimensions of social support, particularly emotional support. The comparison groups reported either maintained or strengthened support systems. Because pre- military adjustment and support did not differ across groups, Keane et al. speculate that the combat stress and the low levels of subsequent support interact to produce gradual increases in symptomatology. In a less elegant study, Stretch (1985) found significant regressions for returning social support on PTSD symptoms. The retrospective nature of these studies does curtail inferences about causal relationships, especially since it has also been found (Carroll, Rueger, Fry, & Donahue, 1985) that PTSD veterans are less self-disclosing and expressive to their partners, have greater difficulty adjusting to dyatic relationships, and are more prone to hostility than are PTSD-negative combat veterans. An interesting extension is that Stretch, Vail, and Maloney (1985) report PTSD among Army nurses was very significantly attenuated by social support during Vietnam and upon return home. Given that supportive relationships promote adjustment during and after wartime, it is surely a topic that merits attention by the military. Indeed, promoting social bonding, team-work, and group morale receive extensive attention by the military, beginning in basic training. However, it is questionable whether this emphasis gets beyond the "band of brothers" notion that is functionally associated with combat performance. Effective combat units operate with a sense of brotherhood, but a person's overall psychological adjustment is tied to more spheres of activity and responsibility than combat, and the value of supportive relationships in these other domains may be too often ignored or taken for granted.

Stress Reduction 3: Organizational Factors Analyses of stress that are associated with stress reduction strategies often ignore conditions in the social environment that potentiate stress, as well as counteracting forces that can moderate stress reactions and even reduce exposure to stressors. Organizational factors represent contextual conditions that importantly bear on what stress is experienced, how it is experienced, and what is done about it. As Novaco and Robinson (1984) delineate, attention to organizational variables might begin with organizational conflict at an institutional level, dealing with conflict between military and civilean organizations. This, however, is too broad in scope here, but as Novaco and Robinson indicate, the ambivalent attitudes toward the military prevailing throughout large segments of society create a backdrop for tension among military personnel. Members of the armed forces are beset with economic frustrations due to military pay scales, a relatively low social status for enlisted personnel that provides no tradeoff for economic shortcomings, and the fact that a distinct appearance makes soldiers easy targets for the expression of negative sentiment. These conditions of the social fabric were prevalent during the Vietnam era and were the cause of much bitterness. As is well-known, the Vietnam veterans carried the burden of the war's unpopularity, and their resentment followed from their belief that they had been manipulated and betrayed (Bourne, 1970; Shatan, 1978). Such frictions and social strain are by no means unique to Americans. French officers who had spent much of their time after World War II in Indochina began to resent the French people for their lack of sacrifice and support, including criticism in the French press (Hauser, 1973). As Perlmutter (1977) has observed, the military is by no means a cohesive, coherent, monolithic group. There are many divisions and disputes

Stress Reduction 36 between and within military ranks and hierarchies. However, within a given organizational unit, we can identify stress as arising from at least three sources: task generated stress, role-based stress, and stress arising from interpersonal relationships (Novaco & Robinson, 1984). To s = arize briefly about these stress origins, task stress occurs when task demands exceed resources or abilities. This may result from a misfit between Job and worker or because of task multiplicity or because workload is exacerbated by fatigue and debilicacinE Emily mn=1 Chance ~ ~ - person's capabilities, but the Demands of a given cask may be within a overall job context (workload and responsibility) and particular exigencies may deplete resources and thus induce stress. A good example of task-generated stress can be observed in the work of basic training personnel. Drill instructors are responsible for recruits over training cycles of 9-11 weeks. During this period, the drill instructor must cope with the strain imposed by (1) a rigorous training cycle in which activities are tightly programmed, (2) extremely long working hours over extended periods, (3) myriad difficulties associated with managing the behavior of 60-90 eighteen-year-olds, (4) family strain resulting from the heavy workload and recent relocation, (5) the presence of constant supervision and evaluative scrutiny, and (6) competitive pressures among peers and between units . Longitudinal research with Marine Corps drill instructors (Novaco, Sarason, Robinson, & Cunningham, 1982) found stress levels to escalate significantly as a function of length of time as a drill instructor. Our assessments were made prior to the start of duty, after three months, and after one year. Self-repor: physiological, and performance assessment coverage to confirm the stress increases. Moreover, performance evaluations

Strew Reduction by supervisors are inversely related to job stress, as is a more catastrophic outcome, namely being relieved of duty for maltreatment, drug use, or poor judgment. Role-based stress, which was found by Kahn, Wolfe, Snoek, and Rosenthal (1964) to affect five of six men in a national labor force sample, often occurs with regard to conflicts with organizational superiors. In the military, the rank structure, coupled with authoritarian discipline, embodies a system of sharply-defined status differentials. The hierarchical structure of military authority is predicated on the ultimate need to direct troops in battle. Orders emanating from higher organizational levels are presumed to reflect superior information and strategy. Yet role conflict emerges in battle and after fighting has ended, as combat veterans at times are hostile to the military and its leaders (Grinker & Spiegel, 1945; Cartright, 1975). The killing of unpopular officers by their own troops occurred not only in Vietnam but has been recorded in the American Revolution and the Civil War (Walton, 1973). More commonly, role-based stress arises when a set of role demands contain internally contradictory expectations, such as between military obedience and the sense of professional competence or ethics. Another role conflict arena involves the conflicting demands of occupational roles and family roles. Relocations and other routine disruptions of family life constitute very significant sources of stress. The organizational environment of recruit training has been studied with regard to psychological variables of expectations, intentions, role attractiveness, job satisfact on. and motives related to employee turnover. Studies of attrition in recruit training, such as Mobley, Hand, Baker, and Meglino (1979), have generated multiple regression models that account for

S=e" Reduction 38 small but significant proportions of variance. Studies focused on person- centered variables have ignored environmental conditions that may be important determinants of an individual's desire to disengage from the military and/or the organizational actions that result in separation or discharge. The stress perspective leads itself to accounting for environmental factors, and this of course has guided my work with Irwin Sarason which was concerned with Marine Corps recruit attrition, performance, and adjustment. We assumed that the nature of environmental demands or stressors in recruit training are determined not only by the rigorous tasks and challenges specified by Marine Corps training standards but also by the particular way in which the training regimen is operationalized by training unit personnel, specially the drill instructor team. Our conjecture was simply that some training personnel, especially drill instructors, may intensify the stressful nature of recruit training beyond the demands inherent in the training regimen and that this amplification of stress would result in higher rates of attrition, as well as impairment in performance and psychological adjustment. This general proposition involves a complex set of hypotheses about training unit social climates, drill instructor characteristics, unit performance, and recruit psychological variables. The testing of this proposition also involved the evaluation of alternative hypotheses in accounting for attrition, namely one concerning pretraining variables and unit composition, and another which specified the standards of unit leaders as the reason for variation in attrition. Our analyses found virtually no support for the initial composition or the training standards hypotheses, but considerable support was found for our training unit environment hypotheses. This was achieved in several archival investigations and in the testing and tracking of a month's cohort, which was then replicated by a second cohort-

Stress Reduction ~9 testing (Novaco, Sarason, Cook, Robinson, ~ Cunningham, 1979; Sarason, Novaco, Robinson, & Cook, 1981). These studies pointed to the social environment established by drill instructor teams as a key factor determining attrition, adjustment, and performance. STRESS REDUCTION Both individuals and organizations act become victims of it. as architects of stress as well as The objective, traditions, and policies of organizations shape the work social environment, affecting the demands and contingencies that impinge on its members. Correspondingly, the goals, habits, and expectancies of individuals create recurrent behavioral contexts and activate events that cause stressful dimensions. Because of these proactive and transactional aspects of person-environment relationships, strategies of stress reduction should not be preoccupied with after-the-fact intervention. While empirical research on this point is grossly lacking, stress reduction theoretically and pragmatically can be achieved by optimizing environments and behavior patterns. Comprehensively, stress reduction entails remediation procedures, regulatory techniques, and preventive strategies. Remediation Procedures are interventions implemented to curtail and treat stress reactions. Various psychological and medical procedures are available for such therapeutic action. Regulatory techniques are psychological coping tactics utilized to counteract precursors or elements of stress reactions, particularly with regard to tension, emotion, and cognition predisposed to stress. Behavior patterns linked with recurrent stress episodes might also be modified in a self-regulatory effort. Preventive strategies involve proactive personal and oganizational action design Lo reduce exposure to stressors, to develop skills

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