N151-077 TITLE: Developing Psychological Flexibility

TECHNOLOGY AREAS: Biomedical, Human Systems

ACQUISITION PROGRAM: FNC - Accelerating the Development of Small Unit Decision Makers FY15

OBJECTIVE: To develop a psychological flexibility training and education curriculum that furthers the current body of knowledge using non-proprietary materials and information, and integrates within the curriculum physiological sensor and performance metrics to support an understanding and awareness of the impact of psychological stressors on an individual.

DESCRIPTION: There are significant consequences with the psychological stress that warfighters experience during military operations. Psychological stress permeates every aspects of the service member�s life, affecting job, health, relationships, quality of life, etc. Between 2007 and 2012, the Department of Defense (DOD) spent roughly $4.5 billion on mental health treatment for active duty service members and activated National Guard and reserve members [1]. A recent Institute of Medicine report summarizes the numerous resilience and prevention programs that were funded during this time. The report concluded that while some of these programs have demonstrated effectiveness at reducing the effects of stress, many are not evidence-based and are evaluated infrequently [2].

One area of increasing study for mitigating the effects of stress involves techniques related to the mind-body connection/awareness. A variety of methods and techniques relating to mind-body awareness have been developed to prevent and reduce stress (Examples: Mindfulness-Based Stress Reduction (MBSR) [3-6], Integrative Body-Mind Training (IBMT) [7-12], and breathing techniques [10, 13-17]). However, it is unclear which factors/skills/components are critical and most effective at cultivating psychological flexibility when compared against a range of other techniques. Moreover, most training exercises require guidance from certified instructors. With dwindling budgets and reductions in manpower, such requirements cannot be supported. Additionally, military personnel face time constraints that limit opportunities to learn and implement the skills associated with psychological flexibility.

Integration within existing activities, such as Physical Training (PT), could prove to be a beneficial cost and time saving solution. For example, a curriculum of practical short-term meditation/mindfulness techniques could be provided before, during, or after a run or other outdoor exercises. Alternatively, a curriculum and sensor technologies (e.g. heart rate) could be leveraged by an individual at a gym, home, or training facility (e.g. Infantry Immersive Trainer) between exercises or activities. Regardless of the specific application, techniques and technologies are needed to develop cost-effective methods that are sensitive to time and workload of military personnel and able to mitigate stress effects on warfighter performance and health. The results of this effort will yield capabilities that will quantifiably reduce negative outcomes associated with stress injuries, while enhancing the performance and health of military personnel.

The capabilities (techniques and technologies) sought must be non-proprietary, open source, safe, evidence-based, and easily utilized. New components or techniques should enable administration and outcome assessment without substantial manpower or technical knowledge. The primary capability sought must build on a psychological flexibility training and education curriculum as well as integrate human performance metrics and sensor technologies that are transferable between classroom, field, and home environment.

PHASE I: Define and develop a concept for techniques and technologies that are able to mitigate stress effects on warfighter performance and health, and whose methods are cost effective and sensitive to time and workload of military personnel. Required Phase I deliverables will include a final report, Phase II plans, and a proposed psychological flexibility curriculum, human performance metrics, and initial prototype or mockup of sensor technologies. The final report will include evidence-based information, system performance information, and plans for Phase II. Phase II plans should include key components, technological milestones, and plans for at least one operational test and evaluation. Phase I should also include the processing and submission of all required human subjects use protocols, should these be required. Due to the long review times involved, human subject research is strongly discouraged during Phase I.

PHASE II: Required Phase II deliverables will include the construction, demonstration, and assessment of the curriculum and prototype, based on results from Phase I. All appropriate engineering and human research testing will be performed. A critical design/research review will be performed to finalize the design and assessment plans. Additional deliverables will include: 1) final curriculum; 2) training manual and exercises materials (e.g., video) associated with the curriculum; 3) a working sensor technologies and human performance data collection prototype; 4) drawings and specification for its construction; and 5) test data on its performance collected in one or more simulated operational settings, in accordance with the demo success criteria developed in Phase I.

PHASE III: If Phase II is successful, the company will be expected to provide support in transitioning the technology for Marine Corps or Navy use within training. The company will support the Marine Corps with certifying and qualifying the system for Marine Corps use. In addition, other commercial sectors (e.g., athletics) or federal agencies (e.g., FBI) may be interested in the use of the technology and could serve as another avenue for transition the technology.

PRIVATE SECTOR COMMERCIAL POTENTIAL/DUAL-USE APPLICATIONS: This technology will have broad applications in military as well as commercial settings where personnel are exposed to events that have a high probability of inducing stress and stress-related disorders. For the military, psychological flexibility may be integrated into: 1) entry-level training, such as Basic School; 2) pre-deployment training curricula, such as the Infantry Immersive Trainer; 3) deployment to combat zones, administered by Combat Operational Stress Control (COSC) units; and 4) as part of re-acclimation programs at the end of a tour. In commercial settings, these solutions may be similarly integrated into existing programs or as part of daily activities. Commercial applications in which these solutions are expected to be particularly effective include: disaster and crisis management, first responders, law enforcement, and humanitarian relief efforts.

REFERENCES:
1. Blakeley, K. and D.J. Jansen, Post-Traumatic Stress Disorder and Other Mental Health Problems in the Military: Oversight Issues for Congress. 2013, Congressional Research Service: Washington, DC. p. 1-74.

2. Warner, K.E., et al., Preventing Psychological Disorders in Service Members and Their Families: An Assessment of Programs, L.A. Denning, M. Meisnere, and K.E. Warner, Editors. 2014, National Academies Press: Washington, D.C., p. 1-293.

3. Carmody, J.B., Ruth A., Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 2008. 31: p. 23-33.

4. Holzel, B.K., et al., Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res, 2011. 191(1): p. 36-43.

5. MacCoon, D.G., et al., The validation of an active control intervention for Mindfulness Based Stress Reduction (MBSR). Behav Res Ther, 2012. 50(1): p. 3-12.

6. Rosenkranz, M.A., et al., A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation. Brain Behav Immun, 2013. 27(1): p. 174-84.

7. Tang, Y.Y., et al., Short-term meditation training improves attention and self-regulation. Proc Natl Acad Sci U S A, 2007. 104(43): p. 17152-6.

8. Tang, Y.Y. and M.I. Posner, Training brain networks and states. Trends in Cognitive Sciences, 2014. 18(7): p. 345-350.

9. Xue, S.W., et al., Short-term meditation induces changes in brain resting EEG theta networks. Brain Cogn, 2014. 87: p. 1-6.

10. Tang, Y.Y., M.I. Posner, and M.K. Rothbart, Meditation improves self-regulation over the life span. Ann N Y Acad Sci, 2014. 1307: p. 104-11.

11. Fan, Y., Y.Y. Tang, and M.I. Posner, Cortisol level modulated by integrative meditation in a dose-dependent fashion. Stress Health, 2014. 30(1): p. 65-70.

12. Tang, Y.Y., M.K. Rothbart, and M.I. Posner, Neural correlates of establishing, maintaining, and switching brain states. Trends Cogn Sci, 2012. 16(6): p. 330-7.

13. Jouper, J. and M. Johansson, Qigong and mindfulness-based mood recovery: exercise experiences from a single case. J Bodyw Mov Ther, 2013. 17(1): p. 69-76.

14. Kinser, P.A., L.E. Goehler, and A.G. Taylor, How might yoga help depression? A neurobiological perspective. Explore (NY), 2012. 8(2): p. 118-26.

15. Kim, S. and M. Burge, P02.137. Mindfulness-based stretching and deep breathing exercise reduces symptoms of posttraumatic stress disorder. BMC Complementary and Alternative Medicine, 2012. 12(Suppl 1): p. P193.

16. Niemiec, R.M.R., Tayyab; Spinella, Marcello, Strong Mindfulness: Integrating Mindfulness and Character Strengths. Journal of Mental Health Counseling, 2012. 34(3): p. 240-253.

17. Rakel, D., Breathing Techniques, in Integrative Medicine. 2003, W.B. Saunders: Philadelphia, PA. p. 1072.

KEYWORDS: Military health system; warrior resilience; stress inoculation; psychological flexibility; mindfulness; mental health

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