��F is the area of concentration (AOC) code assigned by the U.S. Army to the 

specialty of Research Psychology. In terms of numbers, the AOC is a small one, 

with only �� to �� officers serving at any given time. However, the ��F impact 

is far greater than this small cadre suggests. Army research psychologists 

apply their extensive scientific expertise and training toward understanding, 

preserving, and enhancing the health, morale, and performance of Soldiers and 

their families. They do this in many ways and in many areas, but always with an 

empirical, evidence-based approach, and always with an applied focus. 

This book, which grew out of an Army research psychology conference, is the 

first of its kind, intended to provide a comprehensive overview of what Army 

research psychologists do. Chapters cover the diverse activity areas of ��Fs, 

from the neurophysiology of sleep, to traumatic brain injury, to leadership and 

organizational process, as well as several personal and historical accounts. 

Army research psychologists are making a difference. Through their research, 

��Fs provide leaders with new insights and tools for increasing the health and 

performance of military personnel. This is the “��F Advantage.”

Edited by Paul T. Bartone, Ross H. Pastel, and Mark A. Vaitkus, with contributions from:

Gina E. Adam

Gary A. Adams

William F. Blakely

Paul D. Bliese 

Michael W. Boye

Thomas W. Britt

Lolita Burrell 

Joel Carter 

Carl Andrew Castro 

Matthew G. Clark

Michael N. Dretsch 

Doris Durand

Edward N. Edens 

Sandra M. Escolas

Richard V.N. Ginn 

James E. Griffith

Charles W. Hoge 

Steven R. Hursh 

William D.S. Killgore

Thomas A. Kolditz

Gerald P. Krueger

David M. Lam 

Ira H. Levine 

Philip Lewis

Sharon A. McBride 

Dennis McGurk 

Craig A. Myatt

James Ness 

Marek Rewers 

Lyndon A. Riviere 

James A. Romano, Jr. 

Joseph M. Rothberg

Charles A. Salter 

David J. Sandgren 

Maurice L. Sipos

Melba C. Stetz 

Jeffrey L. Thomas 

Michael D. Wood 
The 71F Advantage

The 71F Advantage: 

Applying Army Research Psychology 

for Health and Performance Gains

Edited by Paul T. Bartone, Ross H. Pastel, and Mark A. Vaitkus

Foreword by Major General David A. Rubenstein, USA

Published for the 

Center for Technology and National Security Policy

by National Defense University Press

Washington, D.C.

2010
Opinions, conclusions, and recommendations expressed or implied within are 

solely those of the contributors and do not necessarily represent the views of the Defense 

Department or any other agency of the Federal Government. Cleared for public release; 

distribution unlimited.

Portions of this work may be quoted or reprinted without permission, provided 

that a standard source credit line is included. NDU Press would appreciate a courtesy 

copy of reprints or reviews.

Library of Congress Cataloging-in-Publication Data

The 71-F advantage : applying Army research psychology for health and performance 

gains / edited by Paul T. Bartone, Ross H. Pastel, Mark A. Vaitkus.

p. cm. 

Includes bibliographical references. 

1. Psychology, Military. 2. Soldiers--United States--Psychology. 3. Soldiers-- 

Mental health--United States. 4. Soldiers--Mental health services--United States.

5. Combat--Psychological aspects. 6. Post-traumatic stress disorder. I. Bartone, Paul T., 

1952- II. Pastel, Ross Harvey. III. Vaitkus, Mark A.

U22.3.A25 2010 

355.001’9--dc22 

2010023052

First printing, August 2010

NDU Press publications are sold by the U.S. Government Printing Office. For ordering 

information, call (202) 512–1800 or write to the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402. For GPO publications on-line, access 

their Web site at: http://www.access.gpo.gov/su_docs/sale.html.

For current publications of the Institute for National Strategic Studies, consult the National 

Defense University Web site at: http://www.ndu.edu.
In memory of the 248 Soldiers of Task Force 3–502 who perished

when their plane crashed on December 12, 1985, in Gander, Newfoundland,

as they were returning home from peacekeeping duty in the Sinai.

And in honor of all of those who continue to fight and sometimes die 

 in the cause of world peace and security.

vii

Contents

List of Illustrations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv

David A. Rubenstein

Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii

Hans J. Binnendijk

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix

Paul T. Bartone

Part I: What Is Army Research Psychology?

Chapter 1

U.S. Army Uniformed Research Psychologists: 

Making a Difference Yesterday, Today, and Tomorrow. . . . . . . . . . . 1

Gerald P. Krueger

Part II: Protecting and Enhancing Cognitive 

Performance

Chapter 2

Army Research Psychology: Moving 

from Science to Solutions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Steven R. Hursh

Chapter 3

Asleep at the Trigger: Warfighter Judgment and 

Decisionmaking during Prolonged Wakefulness. . . . . . . . . . . . . . . . . 59

William D.S. Killgore

Chapter 4

Advances in Measuring Higher Order Cognitive 

Performance in Warfighters under Environmental Stress. . . . . . . 79

Gina E. Adam

Chapter 5

Rapid Assessment of Eye Injuries on the Battlefield. . . . . . . . . . . . . 91

Michael W. Boye
Part III: Psychology of Leadership

Chapter 6

New Wine in Old Bottles: Leadership and 

Personality in the Military Organization. . . . . . . . . . . . . . . . . . . . . . . . . 121

Paul T. Bartone

Chapter 7

Development and Fielding of the U.S. 

Army Leader Self-development Portfolio. . . . . . . . . . . . . . . . . . . . . . . . 141

James Ness, Thomas A. Kolditz, Philip Lewis, and David M. Lam

Chapter 8

Understanding and Measuring 

Creative Thinking in Leaders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175

Mark A. Vaitkus

Part IV: Soldier Psychological Health

Chapter 9

U.S. Army Mental Health Advisory Teams. . . . . . . . . . . . . . . . . . . . . . 209

Sharon A. McBride, Jeffrey L. Thomas, Dennis McGurk, 

Michael D. Wood, and Paul D. Bliese

Chapter 10

Military Benefit Finding: Turning Adversity to Advantage. . . . 247

Michael D. Wood and Thomas W. Britt

Chapter 11

Enhancing Operational Readiness through 

Neuroimaging: Mapping the Pathophysiology 

of Mild Traumatic Brain Injury in Warfighters. . . . . . . . . . . . . . . . . . 261

Michael N. Dretsch

Chapter 12

Why Do Soldiers Kill Themselves? 

Understanding Suicide in the Military. . . . . . . . . . . . . . . . . . . . . . . . . . . 283

Sandra M. Escolas, Paul T. Bartone, Marek Rewers, 

Joseph M. Rothberg, and Joel Carter 

viii THE 71F ADVANTAGE
CONTENTS ix

Part V: Applying Psychology to Chemical and 

Biological Defense

Chapter 13

Psychological Effects of Chemical, Biological, 

Radiological, and Nuclear Weapons. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315

Ross H. Pastel

Chapter 14

Mitigating the Medical Consequences of Exposure 

to Chemical Weapons: Contributions of U.S. Army 

Research Psychologists to Chemical Defense. . . . . . . . . . . . . . . . . . . . 341

Maurice L. Sipos and Matthew G. Clark

Chapter 15

New Biodosimetry Tools for Mental Health Support 

in Nuclear/Radiological Accidents or Terrorism. . . . . . . . . . . . . . . . 357

Charles A. Salter, David J. Sandgren, Ira H. Levine, 

and William F. Blakely

Part VI: Psychology and Military Families

Chapter 16

Families Facing the Demands of Military Life: 

New Research Directions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373

Lolita Burrell, Gary A. Adams, Doris Durand, 

and Carl Andrew Castro 

Chapter 17

To Stay or Not to Stay? Family-friendly 

Unit Climate and Career Intentions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395

Edward N. Edens, Lyndon A. Riviere, Charles W. Hoge, 

and Paul D. Bliese

Part VII: Perspectives on Army Research Psychology

Chapter 18

Science in Action: Meeting Urgent Field Requirements 

through Science and Technology on the Ground in Iraq. . . . . . . 413

Matthew G. Clark
Chapter 19

Looking Back: From the Lab to Iraq. . . and to the Clinic. . . . . 425

Melba C. Stetz

Chapter 20

Notes from a Research Psychologist at 

U.S. Special Operations Command. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435

Craig A. Myatt

Chapter 21

The Total Force and the Army Reserve Component: 

Contributions of Research Psychology. . . . . . . . . . . . . . . . . . . . . . . . . . 451

James E. Griffith

Epilogue

Research for the Soldier: The Story 

of an Army Research Psychologist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471

James A. Romano, Jr., as told to Richard V.N. Ginn

About the Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501

Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511

x THE 71F ADVANTAGE
CONTENTS xi

Illustrations

Figures

Figure 4–1. Comparison of Iowa Gambling Task Performance when under 

Caloric Deprivation Diet versus Two Full-calorie Diets. . . . . . . . . . 85

Figure 4–2. Overall Task Performance on SynWin. . . . . . . . . . . . . . . . . . . . . . . 87

Figure 5–1. Blue and Green Plotted in x-y Color Space. . . . . . . . . . . . . . . . . . 112

Figure 5–2. Yellows and Blues in Advanced Aidman 

Vision Screener Plotted in x-y Color Space . . . . . . . . . . . . . . . . . . 112

Figure 5–3. Magentas and Greens in Advanced Aidman 

Vision Screener Plotted in x-y Color Space. . . . . . . . . . . . . . . 113

Figure 7–1. Leader Development Portfolio Major Components. . . . . . . . 147

Figure 7–2. Change in Distribution of Neuroticism Scores 

by Class Year and Compared to “Ideal”. . . . . . . . . . . . . . . . . . . 160

Figure 7–3. Leadership Development Profile Network Clouds 

Showing Connections among User Types and Functions. . . 163

Figure 8–1. Histogram for Mini-markers: Openness. . . . . . . . . . . . . . . . . . 193

Figure 8–2. Histogram for IPIP–NEO: Openness. . . . . . . . . . . . . . . . . . . . 193

Figure 9–1. Soldier Combat and Well-being Model. . . . . . . . . . . . . . . . . . . 211

Figure 9–2. Operation Iraqi Freedom Brigade Combat Team Soldiers 

Reporting Mental Health Problems (adjusted percent). . . . . 213

Figure 9–3. Operation Iraqi Freedom Soldiers Reporting 

Any Mental Health Problem (adjusted percent). . . . . . . . . . . 214

Figure 9–4. Predicted Levels of Individual and Unit Morale 

by Months in Operation Iraqi Freedom Theater. . . . . . . . . . . . 218

Figure 9–5. Predicted Levels of Mental Health Problems 

by Months in Operation Iraqi Freedom Theater. . . . . . . . . . . . 219

Figure 9–6. Predicted Divorce Intent for Officers, Noncommissioned 

Officers, and Junior Enlisted by Months in 

Operation Iraqi Freedom Theater. . . . . . . . . . . . . . . . . . . . . . . . 220

Figure 9–7. Operation Iraqi Freedom Noncommissioned Officer 

Brigade Combat Team Soldiers Reporting 

High Morale (adjusted percent). . . . . . . . . . . . . . . . . . . . . . . . . 222

Figure 9–8. Operation Iraqi Freedom Noncommissioned Officer 

Brigade Combat Team Soldiers with Mental Health 

Problem (unadjusted percent) . . . . . . . . . . . . . . . . . . . . . . . . . . 223

Figure 9–9. Predicted Acute Stress Scores for Operation Iraqi 

Freedom Soldiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226

Figure 9–10. Individual and Unit Morale Rates for Operations 

Enduring Freedom and Iraqi Freedom Soldiers. . . . . . . . . . . . . 232
Figure 9–11. Mental Health Rates for Operations Enduring 

Freedom and Iraqi Freedom Brigade Combat 

Team Soldiers (unadjusted percent). . . . . . . . . . . . . . . . . . . . 233

Figure 10–1. Interaction of Benefit Finding (± 1 SD) and 

Deployment Length by Combat Level on Posttraumatic Stress Disorder Symptoms (± 1 SD). . . . . . . . . . . 255

Figure 12–1. Suicide Rate among Active-duty U.S. Army. . . . . . . . . . . . . . 284

Figure 15–1. Biodosimetry Assessment Tool Flowchart. . . . . . . . . . . . . . . 362

Figure 15–2. Hematology Data Entry Screen. . . . . . . . . . . . . . . . . . . . . . . . 365

Figure 15–3. Summary Screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366

Figure 15–4. Schematic Outline for First-responder 

Radiological Assessment Triage. . . . . . . . . . . . . . . . . . . . . . . . 367

Figure 15–5. Sample First-responder Radiological 

Assessment Triage Entry Screens. . . . . . . . . . . . . . . . . . . . . . . 367

Figure 15–6. First-responder Radiological Assessment 

Triage Dose Assessment Screens. . . . . . . . . . . . . . . . . . . . . . . 368

Figure 17–1. Career Intentions of Soldiers (N = 492). . . . . . . . . . . . . . . . . 399

Figure 21–1. Organization of Army Reserves. . . . . . . . . . . . . . . . . . . . . . . . 452

Tables

Table 5–1. Radiance of Pigments in Colored Target on White 

Background Near Visual Acuity Charts. . . . . . . . . . . . . . . . . . . 111

Table 5–2. Radiance of Pigments in Each Opponent-colored Near 

Visual Acuity Chart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

Table 8–1. Mini-markers Factor Analysis: 40 Item Factor 

Loadings for Five-factor Solution (N = 289). . . . . . . . . . . . . . . 182

Table 8–2. IPIP–NEO Factor Analysis: 30 Facet Factor 

Loadings for Five-factor Solution (N = 174). . . . . . . . . . . . . . . 186

Table 8–3. Mini-markers and IPIP–NEO Big Five Scale 

Intercorrelation Matrix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Table 8–4. Big Five Openness Scale Intercorrelations by Instrument. . . . 189

Table 8–5. Comparative Reliability Analyses of Mini-markers 

and IPIP–NEO (Item Level) for Openness. . . . . . . . . . . . . . . . . 189

Table 8–6. IPIP–NEO Facet Level Reliability Analysis 

for Openness (N = 234). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190

Table 8–7. IPIP–NEO Openness Facet Intercorrelations. . . . . . . . . . . . . . 191

Table 8–8. Mini-markers Openness Item Intercorrelations. . . . . . . . . . . . 191

xii THE 71F ADVANTAGE
ILLUSTRATIONS xiii

Table 8–9. Descriptive Statistics for Openness Measures. . . . . . . . . . . . . . 192

Table 8–10. Descriptive Statistics for Openness Items. . . . . . . . . . . . . . . . . 195

Table 8–11. Multivariate Regression Analysis of Mini-markers Openness on 

Related IPIP–NEO Domain Facets (N = 172; d.f. = [6, 165]). . . . 196

Table 9–1. Reported Stigma-related Rates for Operation Iraqi Freedom

Soldiers Who Screen Positive for Mental Health Problem 

(adjusted percent). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .226

Table 9–2. Reported Barriers to Care for Operation Iraqi Freedom

Soldiers who Screen Positive for Mental Health Problem 

(adjusted percent). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227

Table 9–3. Reported Rates of Ethical Violations for Operation 

Iraqi Freedom Soldiers (adjusted percent). . . . . . . . . . . . . . . . . . . . 228

Table 9–4. Adequacy of Suicide and Stress Training for 

Operation Iraqi Freedom Soldiers (adjusted percent). . . . . . . . 229

Table 9–5. Combat Experiences in Operation 

Enduring Freedom 2005 and 2007 . . . . . . . . . . . . . . . . . . . . . . . . . 236

Table 9–6. Combat Experiences for Brigade Combat Team Soldiers in 

Operations Enduring Freedom and Iraqi Freedom. . . . . . . . . . . . 238

Table 9–7. Reported Barriers to Behavioral Health Care for Operations 

Enduring Freedom and Iraqi Freedom Soldiers who Screen 

Positive for Mental Health Problem (adjusted percent). . . . . . . . 241

Table 9–8. Marital Satisfaction Ratings for Operations Enduring 

Freedom and Iraqi Freedom Soldiers (adjusted percent). . . . . . . 242

Table 11–1. Classification of Traumatic Brain Injury Severity. . . . . . . . . . 264

Table 12–1. Comparison of Self-inflicted Deaths among 

Deployed and Nondeployed Soldiers. . . . . . . . . . . . . . . . . . . . 298

Table 12–2. Observed and Expected Non-battle Deaths 

among Soldiers Deployed to Persian Gulf. . . . . . . . . . . . . . . . 299

Table 12–3. Demographics for Confirmed U.S. Army 

Suicides during Operation Iraqi Freedom. . . . . . . . . . . . . . . . . 302

Table 15–1. Early Clinical Responses Following Radiation Exposure. . . . 364

Table 15–2. Human Databases Used in BAT Dose Assessment Algorithms. . 364

Table 16–1. Indicators of Army Spouse Integration into 

Military Way of Life (in percent). . . . . . . . . . . . . . . . . . . . . . . . 382

Table 16–2. Moderate or Frequent Army Spouse Use 

of Military Resources for Support (in percent). . . . . . . . . . . . 383

Table 16–3. Descriptive Statistics (N = 346). . . . . . . . . . . . . . . . . . . . . . . . . 384
Table 16–4. Regression of Psychological Health on Control 

and Lifestyle Demand Variables (N = 346). . . . . . . . . . . . . . . .385

Table 16–5. Regression of Physical Health on Control 

and Lifestyle Demand Variables (N = 346). . . . . . . . . . . . . . . .386

Table 16–6. Logistic Regression of Integration into the 

Military Community and Retention Preference. . . . . . . . . . . 387

Table 16–7. Regression of Army Life Satisfaction on Control 

and Lifestyle Demand Variables (N = 346). . . . . . . . . . . . . . . .387

Table 16–8. Regression of Marital Satisfaction on Control 

and Lifestyle Demand Variables (N = 346). . . . . . . . . . . . . . . .388

Table 17–1. Measures Affecting Soldiers’ Decision to Remain in Army . . . . 400

Table 17–2. Sample Demographic Variables. . . . . . . . . . . . . . . . . . . . . . . . . 401

Table 17–3. Logistic Regression Analysis on Career 

Intention to Stay in Service (N = 485). . . . . . . . . . . . . . . . . . . . 403

Table 20–1. Special Operations Forces Characteristics. . . . . . . . . . . . . . . . 436

Table 21–1. Types of Reserve Military Service. . . . . . . . . . . . . . . . . . . . . . . 454

Table 21–2. Army Reserve Component throughout History. . . . . . . . . . . 456

xiv THE 71F ADVANTAGE
Foreword

The book you hold in your hands is a powerful tool in the arsenal of our Soldiers’ well-being and, in some cases, very survival. Since 

our nation began putting Soldiers in harm’s way, our forces have experienced the psychological trauma of war. In some cases, the number of 

casualties due to psychological injury approached the rates of physical 

injury. As leaders, we spend countless days training our Soldiers to survive the actual battle. Combat training, battle drills, physical fitness, and 

medical readiness help ensure their physical survival and ultimate victory in the combat zone. Now, we dedicate ourselves to helping ensure 

their psychological survival and victory when the battle is over.

This book grows out of paper presentations and discussions at 

the Army Research Psychology Biennial Conference held April 24–25, 

2008, in Bethesda, Maryland. It provides a snapshot of groundbreaking 

research currently being done by Army research psychologists around 

the globe. The book illuminates the many contributions of Army research psychologists to supporting Soldiers and their families, as well as 

enhancing their performance and well-being. Research breakthroughs 

and updated treatment methods in the areas of human performance, 

psychological and environmental stressors, military and family wellness, personality and organizational factors, and leader and cognitive 

performance are outlined within this volume. The book also serves as a 

valuable historical document, providing a vivid picture of the 71F Army 

research psychology specialty and including a number of personal career stories. It should appeal to a wide range of audiences, including operational commanders, academics, students, and anyone curious about 

what military research psychology is all about.

Today, research psychologists remain true to the fundamental 

principles of Army medicine: to care for those who have the borne the 

perils of battle in the service of the Nation. There is no higher calling.

Major General David A. Rubenstein

Chief, U.S. Army Medical Service Corps

Deputy Surgeon General of the U.S. Army

xv

xvii

Preface

This is a book by and about military research psychologists—behavioral scientists who apply the principles and methods of psychology toward the goal of understanding and improving human health and 

performance in our defense forces. This group of specialists, along with 

their counterparts in the Army’s sister Services and the many civilian 

research psychologists throughout the Department of Defense (DOD), 

forms a critical and essential core asset for our current and future national security. Since World War II, we have relied increasingly on research psychologists within DOD to design better and more efficient 

selection and classification tools and strategies, more effective training programs for military personnel, and improved leader development 

programs. 

In addition, these specialists have applied rigorous research methods to understanding the limits and capacities of human mental and 

physical performance in a range of demanding operational environments. Their work has provided much of the knowledge that has allowed senior national security leaders to design systems and policies 

that appreciate and capitalize on our human talent, rather than ignore 

or frustrate it. Some of this research relies upon the use of animal models, an approach that has proven essential for understanding and developing treatments for chemical defense, stress, and traumatic brain injuries. More recently, military research psychologists have applied their 

expertise to understanding the causes and cures of stress-related injuries 

in troops, such as post-traumatic stress disorder, traumatic brain injury, 

drug and alcohol problems, and even suicide. This work being done by 

research psychologists not only helps with operational effectiveness, but 

it also helps the individuals who are put under great stress during military operations to cope with that pressure; it can save lives and enhance 

well being. Military research psychologists are responsible for significant advances in understanding human resilience and hardiness under 

stress, knowledge that is being applied in the design of more effective 

training and prevention programs. 

As the military operations that we are engaged in as a nation and 

as allies grow in complexity, understanding the human dimension is 

more essential than ever. No matter how good our technologies may be, 

technology alone will not win the day in the challenges before us. It is the 

quality, strength, intelligence, and morality of our human systems that 
ultimately will allow us to realize the shared goal of a world in which 

security and prosperity are the normal state for all inhabitants. The contributions of research psychologists such as those in this volume are critical for moving us toward that goal. The Center for Technology and National Security Policy is pleased to publish this volume in the interest of 

sharing these critical conclusions with all Services, with our allies whose 

personnel face similar situations, and with those dealing with comparable situations in civilian life.

Hans J. Binnendijk, 

Vice President for Research and Applied Learning

National Defense University

xviii THE 71F ADVANTAGE
Introduction

71F, or “71 Foxtrot,” is the AOC (area of concentration) code assigned by the U.S. Army to the specialty of Research Psychology. Qualifying as an Army research psychologist requires, first of all, a Ph.D. from 

a research (not clinical) intensive graduate psychology program. Due to 

their advanced education, research psychologists receive a direct commission as Army officers in the Medical Service Corps at the rank of 

captain. In terms of numbers, the 71F AOC is a small one, with only 

25 to 30 officers serving in any given year. However, the 71F impact is 

much bigger than this small cadre suggests. Army research psychologists apply their extensive training and expertise in the science of psychology and social behavior toward understanding, preserving, and enhancing the health, well being, morale, and performance of Soldiers and 

military families. As is clear throughout the pages of this book, they do 

this in many ways and in many areas, but always with a scientific approach. This is the 71F advantage: applying the science of psychology to 

understand the human dimension, and developing programs, policies, 

and products to benefit the person in military operations.

This book grew out of the April 2008 biennial conference of U.S. 

Army Research Psychologists, held in Bethesda, Maryland. This meeting was to be my last as Consultant to the Surgeon General for Research 

Psychology, and I thought it would be a good idea to publish proceedings, which had not been done before. As Consultant, I’d often wished 

for such a document to help explain to people what it is that Army Research Psychologists “do for a living.” In addition to our core group of 

71Fs, at the Bethesda 2008 meeting we had several brand-new members, and a number of distinguished retirees, the “grey-beards” of the 

71F clan. Together with longtime 71F colleagues Ross Pastel and Mark 

Vaitkus, I also saw an unusual opportunity to capture some of the history of the Army Research Psychology specialty while providing a representative sample of current 71F research and activities. It seemed to us 

especially important to do this at a time when the operational demands 

on the Army and the total force were reaching unprecedented levels, 

with no sign of easing, and with the Army in turn relying more heavily 

on research psychology to inform its programs for protecting the health, 

well being, and performance of Soldiers and their families. 

Everyone present at the 2008 meeting was invited to submit 

a paper for inclusion in the proceedings, and we soon extended this 

xix
invitation to every 71F we could reach. The response was so great that 

the project grew into the present book, with contributions from nearly all 71Fs. It took longer to complete than we planned, but we think 

the result was worth the wait. This book is the first of its kind, providing a detailed overview of research projects and activities of Army research psychologists, as well as several personal and historical accounts. 

It should serve as a valuable resource for anyone curious about research 

psychology in the U.S. Army, and those wanting to know more about 

the kinds of insights and products generated by this group. 

This book is primarily the work of the individual chapter contributors. However, it would never have been finished without the dedication and diligence of my two co-editors, Ross Pastel and Mark Vaitkus. Both are not only top-flight behavioral scientists in their own right, 

but also dedicated public servants. They worked on this project mostly nights and weekends, with no ambition for personal gain, but rather 

with the hope of providing something beneficial to the field, to senior 

leaders, and to junior and future 71Fs. 

Having Center for Technology and National Security Policy 

(CTNSP) Research Assistant Marek Rewers on the project was almost 

like having another editor. In addition to substantive writing contributions, Marek took responsibility for tracking and organizing hundreds 

of files, keeping the different versions straight, and fixing what seemed 

at times like an endless supply of formatting and reference problems. 

The book could not have been completed without Marek’s fine work. 

Also, absolutely stellar editing and review assistance was provided by 

CTNSP Research Assistants Yong-Bee Lim, Simone Erchov, and Anna 

Nelson (whom we borrowed from the Industrial College of the Armed 

Forces). 

We owe a special debt of gratitude to Hans Binnendijk, Director 

of CTNSP, for his unflagging support of the project since it was first proposed. Other colleagues at CTNSP have helped in many ways, especially Bill Berry, Director of the Life Sciences Division, Debra Cagan, a Senior Research Fellow, and Bill Bode, Chief Editor. Paul Strohl and Craig 

Zugschwerdt of NDU Audiovisual services generously helped with the 

illustrations. The professional staff at NDU Press, especially Jeff Smotherman and Lisa Yambrick, handled the many details of finalizing the 

manuscript and getting it ready for print with characteristic efficiency 

and good grace. 

xx THE 71F ADVANTAGE
We also wish to thank our current Medical Service Corps Chief, 

Major General David Rubenstein, and the Deputy Corps Chief, Colonel 

Dawn Smith, for their ongoing encouragement and support on this 

project, and for the 71F AOC more broadly. Former Corps Chiefs Brigadier General (Ret.) Sheila Baxter and Brigadier General (Ret.) Richard 

Ursone also have our collective gratitude for their leadership and support along the way. Finally, the Medical Service Corps Historian, Colonel (Ret.) Richard Ginn, helped not only with key interviews of 71Fs, 

but also with his regular upbeat reminders that it is important for all of 

us to remember and learn from the past.

Paul T. Bartone

INTRODUCTION xxi

Part I

What Is Army Research 

Psychology?

Chapter 1

U.S. Army Uniformed Research 

Psychologists: Making a Difference 

Yesterday, Today, and Tomorrow

Gerald P. Krueger

The United States emerged from the two World Wars as a global economic and military power. During the 65 years since the end of 

World War II, the Nation has deployed its forces around the world to 

serve in numerous smaller, more regionally based military actions ranging from intense regional wars to peacekeeping and to offer humanitarian assistance (Grimmett, 2009). During that time, the weapons available to the U.S. military have become both more precise and lethal, and 

many new technologies have been developed for countering enemy attacks. The military has embraced electronics and computers, developed 

unmanned weapons platforms, military robots, and smart bombs, and 

selected armed systems with longer standoff ranges. It has also determined means to interconnect distributed forces with network-centric 

communication systems, permitting electronic interactions throughout 

the chain of command. Such technological innovations contribute to 

an increasingly complex and stressful working environment for Soldiers 

both during training and in military operations.

Superior technological systems and weapons may help win battles, but they do not ensure winning wars. Machines must be directed, 

operated, controlled, mastered, maintained, and repaired—by people. To 

master the battlefield, the Army continually retains a sizeable manpowerintensive force structure. Despite its thousands of systems, the Army 

is still very much a people-rich organization—a Soldier-centric combat 

force. Since World War II, there have been several large conventional 

but regional battlefield wars: Korea (1950–1953), Vietnam (1967–1973), 

the Persian Gulf War in Iraq and Kuwait (1991), and war in Iraq again in 

2003. However, the more contemporary military missions have involved 

smaller skirmishes and operations such as peacekeeping and nationbuilding (for example, in Bosnia, Haiti, and Somalia, among others). 

Since 2001, heavy participation in antiterrorist missions has produced 

1
2 THE 71F ADVANTAGE

paradigmatic shifts in military tactics. In particular, counterinsurgency (COIN) warfare (initially experienced in Vietnam) has returned to 

the forefront for conducting current military operations in Iraq and Afghanistan (U.S. Army Field Manual 3–24, Counterinsurgency, 2006).

Lower intensity asymmetric battlefields involve both high- and 

low-tech weapons, requiring ever-changing alternative tactics. These 

contemporary skirmishes necessitate more, not less, direct human involvement in fluid battlefield operations in which combatants and support personnel alike are exposed not only to the traditional battlefield 

stressors, but also to new threats conjured up from centuries-old tribal 

animosities that return cruel, crude, but sophisticated guerrilla and terrorist tactics to the forefront (Krueger, 2008).

To help ensure a human-oriented balance in a military milieu 

seemingly driven by technologists, the U.S. Army engages sizeable numbers of behavioral science researchers, among other specialists. Since the 

1950s, without much fanfare, a relatively small coterie of Army Medical 

Service Corps (MSC) uniformed research psychologists has consistently 

played significant roles; and they continue to be called upon in increasingly important ways as military forces restructure to meet the challenges of the new millennium. Currently categorized into the Army’s Military Occupational Specialty (MOS) 71F, these uniformed psychologists 

do research to advance knowledge and develop useful products for enhancing Soldier performance and to prevent, reduce, or cope with neuropsychiatric injuries, including post-traumatic stress disorder (PTSD) 

and traumatic brain injury (TBI). Today’s uniformed psychologists accomplish laboratory-based research in neuroscience and do studies on 

human performance, sleep management, psychosocial and environmental stressors, personality and social/organizational factors affecting 

Soldier health and performance, leader development, and other human 

factors issues. These research psychologists are keenly focused on applying the tools and methods of science to find solutions to the most pressing human problems facing U.S. military forces today, and they communicate research findings quickly and effectively to leaders and decisionmakers throughout the Department of Defense (DOD) (Bartone, 2007).

As social-political climates and the nature of warfare both continually change, uniformed research psychologists face exciting but 

tough new problems. For the past several years, General Robert Scales, 

USA (Ret.), has argued that our forces are already involved in World 

War IV—the social scientists’ war—in which he contends that social 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 3

scientists must assist military leadership in developing smaller teams 

of Soldier-warriors who understand cultural context by training them 

to be skilled in governance, statesmanship, and diplomacy so they can 

thrive in an alien environment and capture the psychocultural rather 

than the geographical high ground (Scales, 2006, 2009). Given that for 

decades the mantra of Army Soldiers has been to “make noise, break 

stuff, blow things up, and kill people,” General Scales presents both the 

Army and social scientists with some very big challenges.

Background

A historian I am not. I write this chapter based on memorable 

impressions stemming from 40 years of involvement, including my 25-

year Active-duty career as a uniformed U.S. Army research psychology officer from 1969 to 1994, and on my 15-year military human factors psychology consultant services for various elements of DOD. This 

chapter presents some of my personal recollections from the exciting research laboratories, programs, and projects I participated in, and from 

other programs my colleagues carried out. All the research was directed toward preserving the health and performance of Army Soldiers, 

but the efforts were also meant for Sailors, Airmen, Marines, and even 

Coast Guard personnel. This brief history recalls only some of the many 

contributions made by U.S. Army MSC uniformed research psychologists—colleagues I had the honor of working for or with, or in some cases officers I might have mentored. They are now the next generation of 

military psychologists proudly wearing the uniform of the U.S. Army.

Personal Experience

While I was an Active-duty graduate student at Johns Hopkins 

University from 1972 to 1975, several professors asked what kind of 

training I expected to obtain to prepare me to do research in an Army 

laboratory. Their faces portrayed quizzical wonderment at my answer: 

I aimed not only to become well versed in experimental design, statistics, and quantitative analysis, but also to learn the fundamentals for 

doing research in perception, cognition, psychological and physiological performance, neuroscience, work-related stress, human factors engineering, ergonomics, information processing, and decisionmaking. The 

professors were accustomed to students specializing in basic research in 

a particular topic, not a panoply of applications of behavioral science. I 
4 THE 71F ADVANTAGE

told them military research psychologists needed to be agile enough to 

do good work on a myriad of Army Soldier performance topics at several military research labs.

Why was my answer to their question so broad? Because in the 

mid-1970s, those Army Medical Department buzzwords described job 

and career opportunities for uniformed Army research psychologists 

participating in the U.S. Army’s MSC officers’ allied sciences research 

career program. After attaining a doctorate, psychology officers were 

expected to serve in a sequence of 3- to 5-year research assignments in 

the above topical areas at different Army laboratories. Soon after graduation, that was how many Army MSC psychologists began their careers as uniformed researchers. Some more than others may have had 

a vision as to how our stints on Active duty would play out; for example, some officers intended to fulfill one 4-year assignment as payback 

for their education and then depart Active duty. However, for many of 

us it seemed that the winds of fate and the Army frequently changed; 

and with the changes, our research careers evolved as opportunities to 

serve in different arenas cropped up one after another. Like many MSC 

colleagues, my own Army career evolved. I gained a superb education 

at Hopkins, and I frequently was called upon to employ my university 

training in most of those topical areas, as well as in additional ones not 

originally envisioned.

What Is Uniformed Army Research Psychology?

Military research psychology might be conceptualized as a specialized sliver of behavioral science in that it deals with topics of human 

behavior and human performance revolving around the work and lives 

of Soldiers, Sailors, Marines, and Airmen. Uniquely, it also involves the 

social psychology of Soldiers’ families. Today, in the post-conscription 

era, Soldiers work in an all-volunteer force—a unique job setting. Those 

Soldiers and uniformed psychologists who devote a career to military 

service participate in a rather select profession in our society—one not 

well understood by psychologists who have not served in the military. 

This, then, speaks volumes about how different the profession of being a 

uniformed military research psychologist is from that of other researchers, such as our colleagues in academia. The focus of military psychology is with Soldiers. This story could therefore be about the psychology 

of soldiering, but it is more about a group of special uniformed research 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 5

psychology officers who are Soldiers themselves. It is about those who 

work hard to preserve the psychological health and performance of our 

troops in everything they do.

As a profession, military psychology is not limited to those wearing the uniform of the U.S. Army. It entails decades of work by thousands of behavioral scientists in the uniformed and civil service sectors. 

Contributions have come from not only the Army, but also the Navy, 

Air Force, DOD, and countless university professors and graduate students, all quietly doing research—a team of scientists fulfilling important roles for the U.S. military over at least seven decades. Modern-day 

military psychology research took on a high level of importance during World War II when it was estimated that more than 2,000 psychologists (researchers and practitioners, uniformed and civilian) worked on 

the war effort (Parsons, 1972). For more complete descriptions of what 

military psychology is and what it has been about since World War II, 

readers are referred to publications such as Wiskoff (1997, 1998), Gal 

and Mangelsdorff (1991), Cronin (1998), Mangelsdorff (2006), Kennedy and Zillmer (2006), and the 21 annual volumes of the American Psychological Association’s Division 19 journal, Military Psychology.

Understanding the Military Milieu

The military services are keen on training people to acquire and 

accentuate skill sets, so the Army pushes opportunities for advanced education in the belief that smarter Soldiers and officers are better members of the force. Accordingly, shortly after graduation with a Ph.D. in 

psychology, new Army officers participate in several months of basic 

MSC officer training, which helps them to assimilate military culture 

and Army values necessary to their jobs as behavioral scientists studying “what makes Soldiers do what they do.” After completing a first or 

second research assignment at an Army laboratory, career progression 

officers receive 5 to 6 months of advanced military officer training. Expectation of additional mid-career training encourages them to take 

correspondence courses in the Army’s intermediate level of education 

(formerly the Command and General Staff College) and other developmental courses to prepare them for higher leadership positions. Very 

occasionally, some psychology officers at higher rank participate in senior service schooling at such institutions as the U.S. Army War College 

to prepare for the highest levels of military leadership.
6 THE 71F ADVANTAGE

Soldier Psychologists: Ready for Action

One of the basic tenets of the Army’s uniformed research psychology program is that psychologist officers are expected to be ready 

to deploy with Soldiers to any environment where the forces are engaged in field training or military operations. After studying and doing 

research in academic settings, uniformed psychology officers deem it 

important to prepare themselves as Soldiers by taking additional military skills training. These endeavors include the physically demanding 

3-week Airborne (parachutist) course, 2 weeks of Air Assault training, 

or other specialized training such as that leading to earning the skillbased Expert Field Medical Badge. After completing such training, it is 

customary to wear on the Army uniform not only the medical caduceus 

of the Medical Service Corps, but also the military skill badges earned.

Such skills training rounds out the Soldier scientist, giving these 

officers a better understanding of what Soldiers undergo in training. 

It provides insights into the stresses entailed in soldiering, and it vividly demonstrates what skill sets and capabilities Soldiers are expected to bring to the battleground—all grist for the psychologist’s study 

of Soldier behavior. Just as important, wearing the specialized skill 

badges gives these psychologists instant rapport with the Soldiers they 

often must entice to volunteer for psychological research projects, or 

with Soldiers they must survey and interview in an attempt to grasp the 

complex nature of unique soldiering tasks and missions being studied. 

Many among us can recall Soldiers in the 82d

 Airborne Division or in 

the Ranger Regiment claiming that a researcher, as a non–badge wearer, 

is not likely to understand the nuances of soldiering jobs because “he’s 

just a leg” (not airborne qualified) and “just doesn’t get it.”

To survey, study, and assist Soldiers, many of our uniformed research psychologists have accompanied large numbers of troops to farforward areas, and some have even deployed with them into combat 

theaters. Such field data collection missions usually last several weeks 

to several months, but they rarely match the lengthy overseas deployments of other Soldiers. Participation by research psychologists in deployments overseas became prevalent throughout the 1990s, and this 

tendency holds true now as research psychologists accompany Mental 

Health Advisory Teams (MHATs) repeatedly deploying to Iraq, Afghanistan, and other conflicts (Gifford et al., 1992; Gifford, 1995; Bartone, 

Adler, and Vaitkus, 1998; Bartone, 2006).
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 7

The Army Uniformed Research Psychology Career Path

While acknowledging General Scales’s challenge, this chapter 

presents a reflective snapshot—an outline of many efforts of the 

Army’s Medical Service Corps research psychologists. Since about 

the mid-1950s, the number of Army uniformed research psychologists at any point in time has ranged from 20 to 40 officers. These psychologists have had a significant impact by shaping the military force; 

informing Army decisionmaking for establishing personnel policies; 

adjusting Army doctrine, troop force planning, and training; and influencing Soldier performance during actual military operations. In an 

abbreviated accounting of how far this elite group of military psychologists has come since the 1950s, this chapter projects the role uniformed 

research psychologists might play in the social scientists’ war—World 

War IV and beyond.

The U.S. Army Medical Research and Materiel Command

For almost 60 years, the U.S. Army’s MSC uniformed research 

psychologists served as key research members, principally at one of 

five research laboratories belonging to the U.S. Army Medical Research 

and Materiel Command (USAMRMC). There has been a smattering of 

other important assignment opportunities, about which more will be 

said. Since the mid-1970s, the laboratories employing uniformed research psychologists have been the Walter Reed Army Institute of Research (WRAIR), the U.S. Army Research Institute of Environmental 

Medicine (USARIEM), the U.S. Army Aeromedical Research Laboratory (USAARL), the U.S. Army Medical Research Institute of Chemical 

Defense (USAMRICD), and the Letterman Army Institute of Research 

(LAIR), which was deactivated in 1995.

Each of the latter four medical laboratories generally had from 

three to five uniformed research psychologists assigned, but WRAIR 

usually had 10 or more. For decades, WRAIR has also maintained a 

small behavioral research lab in Heidelberg, Germany, where typically 

four to six uniformed research psychologists were employed. Army research psychologists, from two to six at a time, also served as research 

program staff officers at Headquarters, USAMRMC, at Fort Detrick, 

Maryland.

Additionally, two Army materiel development laboratories traditionally employed two or three uniformed research psychologists: 
8 THE 71F ADVANTAGE

the U.S. Army Human Engineering Lab (HEL) at Aberdeen Proving Ground, Maryland, and the Natick Research, Development, and 

Engineering Center (Natick RDEC), a materiels research lab at Natick, 

Massachusetts.

The Planned Career Pattern

Typical career patterns for Army Medical Service Corps officers 

have changed over the years. A current generic career path description can be found in Department of the Army Pamphlet 600–4, “Army 

Medical Department Officer Development and Career Management” 

(U.S. Department of the Army, 2007). Here, the career field of 71F, Research Psychologist, is described on pages 74–75 and portrayed graphically on page 96. Within the MSC and U.S. Army Medical Department 

(AMEDD), 71F Research Psychologists are classified as “Medical Allied 

Science” officers, together with 71A, Microbiologists; 71B, Biochemists 

and Research Physiologists; and 71E, Laboratory Science officers.

Whereas most officer assignments in the larger branches of the 

“big Army” are for only 2 to 3 years, the MSC uniformed Ph.D.-level 

psychologist scientist historically has had at least a 4- to 5-year stabilized 

tour of duty at a particular lab. There are several reasons for this difference. The longer tour permits the officer to:

■ become established in a viable lab research program

■ prepare and obtain approved research proposals

■ acquire funding support

■ set up lab equipment and experimental apparatus and recruit 

participants

■ conduct data collection on sizeable projects

■ analyze collected data and document the results

■ present findings at Army decisionmaking forums and scientific and professional meetings en route to publishing the results 

in open literature journals.

After the initial 3- to 4-year assignment, psychology officers were 

generally expected to rotate to another medical research lab, where they 

would take on slightly different research problems, perhaps studying 

other research populations. For example, an officer might be expected to alternate between studies on issues confronting armor forces or 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 9

artillery personnel—or infantry Soldiers, airborne troops, aviators, 

Rangers, or Special Operations forces. Or he might be assigned to a 

basic science laboratory to conduct experiments using animal species as models, where the research is oriented on determining basic 

mechanisms of bodily defense against disease or chemical, biological, or environmental threats. Of course, there were exceptions to that 

general rotational assignment pattern. For example, when an officer 

was identified as having particular expertise related to a hot research 

topic, by agreement he might stay on at that lab for longer than 4 or 5 

years—particularly at WRAIR, where some officers moved about the 

Institute, in some cases into higher managerial roles. Many officers remained affiliated with WRAIR for several consecutive tours and some 

even for their entire military careers.

Staff Officer Work

Like other Army allied scientist officers, research psychologists 

were expected to spend a 2- to 3-year tour in a staff officer role at places like the USAMRMC Headquarters at Fort Detrick. There the staff 

work included assisting in headquarters-level management and administration of large, Federally funded research programs in the labs, 

and enacting and overseeing the command’s extensive extramural research contract program, generally spread out among numerous prestigious universities around the country. This meant staff officers regularly prepared and defended budget outline documents to the Army 

Headquarters at the Pentagon, and to DOD offices where liaison work 

with Congress was carried out to negotiate critical defense research appropriation funding decisions. Such staff work placed young officers in 

the role of shaping the research programs, determining priorities for the 

Army and the labs, and influencing decisions about how millions of precious research dollars would be spent to ensure the Army, the taxpayer, 

and our Soldiers got the best payoff for the country’s investments.

Initially, many young research psychologists looked at being selected for a staff officer assignment as something to be avoided, as it 

normally took a scientist away from the research bench for several 

years at a time, usually at mid-career—just when he was ready to make 

some important research advancement. Thus, a staff assignment could 

be an intrusion. However, unlike no other group of allied science specialists, research psychologists learned to grow into staff officer roles. 
10 THE 71F ADVANTAGE

Army research psychologists excelled in their careers because of their 

staff officer experiences.

Staff officer psychologists gained invaluable understanding of 

the bigger picture—the inner workings of how the Army and DOD do 

business. They learned what works and often what does not. Importantly, they learned how to improve processes, make things work better, increase the likelihood of the labs achieving their research missions, 

and obtain better productivity from research programs for taxpayers 

and Soldiers. Subsequently, when those research psychologists who had 

grown in their staff officer roles returned to the laboratories, they had 

groomed themselves to become the chiefs of multidisciplinary research 

branches, taking on increasing levels of program and personnel management responsibility. Some officers became deputy directors of the 

labs themselves, and a few were even selected as laboratory scientific 

and technical directors, taking command of the institutes and laboratories, attaining perhaps the highest levels of management afforded uniformed scientists in the Army and in DOD.

Army Research Psychology: Often Multidisciplinary

Army research generally is multidisciplinary and involves much 

teamwork. Perhaps as a young Army captain or a junior major, assignment to a research laboratory employing from 85 to 1,100 research staff 

members often meant one had arrived as “the new kid on the block.” 

Initially, that meant “latching on” to extant research programs of senior, more established officers, or working for and with seasoned civil 

service research program directors already entrenched for decades in 

managerial roles. It follows that few uniformed research psychologists 

assigned to laboratories accomplished their high levels of productivity 

alone. Army research experiments, studies, or projects are usually accomplished through group effort. 

Depending on the laboratory and its programs, much of the project 

work involved multidisciplinary studies that called for collaboration 

among researchers from many scientific disciplines, including physiology, neuroscience, biology, chemistry, audiology, anthropology, biomechanics, biodynamics, biophysics, bio-optics, nutritional science, 

microbiology, immunology, and other biological or behavior-related 

sciences. In some labs, doing research projects meant interacting with 

military equipment designers, engineers, and automotive and aviation platform specialists; designers of individual Soldier equipment, 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 11

protective clothing, specialized uniforms, parachutes, tents, and nightvision systems; or military training and doctrine developers and other 

parties. One of the thrills for research psychologists was recruiting, training, and working with Soldier volunteers, who agreed to be subjected to 

behavioral studies in hopes the test results would benefit all Soldiers.

Often it was the military psychologist whose expertise in experimental design and statistics determined the direction taken by research 

programs. Since the goals of large military research projects frequently 

revolve around predictions of equipment operator performance, psychologists were best equipped to guide multidisciplinary research teams 

in accounting for the trickiest of human performance issues: individual differences, motivation, and learning and skill development. Performance studies predicting people’s behavior as it related to experimental 

design issues became the forte of applied military psychologists. The 

most effective and persuasive officer psychologists repeatedly rose to 

the challenge as they took on key leadership roles in designing, running, 

managing, and directing such studies (Krueger, 1998, 2006).

Conducting Research in Military Laboratories

As mentioned above, Army research psychologists conducted 

the bulk of their work at five medical research and two materiel development laboratories. These are outlined here mostly according to the 

organizational missions the labs held and are followed by descriptions 

of assignments at a few other organizations that employed uniformed 

psychologists. The names of many of the MSC psychologists who worked 

in each lab are mentioned, and where possible I listed dates of their assignments. No doubt I missed some names because I retired from Active duty in 1994 and could not keep fully attuned to activities since 

then. I apologize to those Army psychologists I have not mentioned. 

Additionally, providing a short sketch of the contributions of each psychologist would make for a very lengthy chapter. Perhaps that goal can 

be fulfilled in a later effort, as the numerous accomplishments of so 

many colleagues probably warrant a book to do them all justice.

WRAIR Division of Neuropsychiatry

Auspicious beginnings. In 1951, the U.S. Army formally established 

a medical psychology research unit at WRAIR in Washington, DC. 

This unit eventually became known as the Division of Neuropsychiatry 
12 THE 71F ADVANTAGE

(Div. NP). Any history of the Div. NP must include the significant productivity and influence of Joseph V. Brady. After serving as a combat 

infantry platoon leader in World War II, Joe received his Ph.D. from 

the University of Chicago in 1951, and his service as an MSC officer at 

Walter Reed began that same year and lasted two decades. A foundation investigator in the Div. NP, he identified himself as a neurobehavioral scientist. From 1951 to 1963, he was Chief of the Department of 

Experimental Psychology and was Deputy Director of Div. NP from 

1963 to 1970.

Among his many achievements at WRAIR, Joe Brady pioneered 

research into the ties between drug effects and emotional behavior 

(Brady, 1956) and performed the often-cited “ulcers in executive monkeys” experiment, which suggested a link between stress and peptic ulcers (Brady, 1958). That research was significant in establishing the notion that stress can lead to physical illness. His collaborative work with 

M. Sidman, J.W. Mason, and W.J. Nauta produced a classic series of interdisciplinary studies of the relationships between the limbic system, 

the endocrine system, and behavioral stress. Among the many important discoveries of that project was that psychological stress could be 

far more damaging than physical stress. Joe Brady’s work in the 1950s, 

along with that of his colleagues at WRAIR, cast important influences 

into the development of psychology and neuroscience themselves.

In his lengthy, productive stay at WRAIR, Joe Brady was the epitome of a role model. For 20 years, he exuded behavioral science leadership for the Army. His work at WRAIR constitutes a cornerstone for 

the MSC psychology program. He set the pace for many MSC research 

psychologists who followed him in doing neuroscience and behavioral 

biology research at WRAIR and elsewhere. If Joe Brady was not the key 

person in formulating the nucleus of what became known as the MSC 

research psychology program as we know it today, then he certainly was 

the most emulated scientist on whose model career the tenets of the 

program were crafted. Joe retired from the Army in 1970 when he left 

WRAIR to become Professor and Director of Behavioral Biology Research at the Johns Hopkins School of Medicine in Baltimore. Always 

the productive scientist and educator, as recently as June 15, 2008, at age 

86, Joe Brady received the prestigious Mentorship Award from the College on Problems of Drug Dependence.

Over the years, Div. NP traditionally employed about 20 percent 

of the entire WRAIR work force, including as many as 120 full-time 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 13

research and staff members. One of the more prominent MSC psychologists was Frank J. Sodetz, who, in picking up his mentor Joe Brady’s 

mantle, did superb basic neuroscience research, first in the Department of Experimental Psychology, and then as Director of Div. NP. Being recognized for his managerial leadership skills, Frank also served 

for several years as the Deputy Director of the entire WRAIR while he 

was simultaneously the Research Psychology Consultant to the Army 

Surgeon General. Before his Army retirement, Frank also spent several 

years as Commander of the WRAIR’s Armed Forces Institute of Medical 

Sciences, a biological research lab for infectious diseases in Bangkok, 

Thailand. In that assignment, he was the first MSC research psychologist to command a USAMRMC laboratory.

Division NP Headquarters Office. Due to the size of the Division of 

Neuropsychiatry and the number of personnel assigned, a number 

of MSC uniformed research psychologists served in staff officer positions in the Div. NP main office at WRAIR, adjacent to the Walter 

Reed Army Medical Center. Some of the administrative work entailed 

budgeting and preparation of research progress and annual reports. 

In numerous cases, these officers also simultaneously continued their 

active involvement in research projects sponsored by Div. NP. Among 

the many officers who served in that office are John H. McDonough, 

Robert H. Stretch, Kenneth Zych, G. Rufus Sessions, and Thomas G. 

Raslear. After fulfilling leadership roles in the Department of Medical 

Neuroscience, Frederick J. “Rick” Manning had a tour at the Heidelberg research unit and, on his return, became Deputy Director of Div. 

NP (1981–1987), then Director (1987–1992), and for a year Executive Officer of WRAIR (1992). Robert K. Gifford also served a tour as 

Executive Officer of WRAIR.

Department of Medical Neuroscience. Historically, one-third of 

WRAIR’s sizable Div. NP program was dedicated to studies of basic 

neuroscience research (DOD’s 6.1 program funding), including a mix 

of animal and human experiments done to elucidate mechanisms of 

human stress reactions and responses to a wide array of stresses encountered by military personnel. Rick Manning served as Chief of the 

Department of Experimental Psychology from 1976 to 1978 before 

it was combined with the Department of Neuroendocrinology and 

Neurochemistry to become the Department of Neuroscience. 
14 THE 71F ADVANTAGE

An important era in Div. NP started around 1971 and lasted until 1976. Congress mandated a large investment in drug abuse research 

in response to many Vietnam soldiers becoming addicted to heroin 

and facing discharge with an opiate dependence. Div. NP was a center for behavior and physiology research on this problem, and many 

uniformed research psychologists joined the division during that era, 

including Timothy Elsmore, George Rufus Sessions, Steven R. Hursh, 

Thomas G. Raslear, George Koob, Jeffery Witkin, and David M. 

Penetar. The sudden termination of the program in 1976 led to a reduction in force of many civilian employees as well as a restructuring 

of the careers of many uniformed psychologists. Nevertheless, this drug 

research program had a lasting influence on the scientific careers of 

many of these psychologists.

Steven R. Hursh served as Chief of the Physiology and Behavior Branch of Neurosciences (formerly the Department of Experimental Psychology) and Chief of the Medical Neurosciences (1981–1987). 

He was Deputy Director of Div. NP (1987–1992) and succeeded Rick 

Manning as Director (1992–1995). Rick and Steve each served as the 

Research Psychology Consultant to the Army Surgeon General. Steve 

Hursh’s basic research on substance abuse and animal behavior was the 

foundation for what became known as Behavioral Economics, a current theoretical framework for translational research on drug abuse. 

Subsequent studies culminated in a new theory of behavioral motivation. Eventually that work, which descended from his early work at 

Walter Reed with primates, was highlighted in a Psychological Review

article (Hursh and Silberberg, 2008). Steve later directed his research 

efforts to development of Soldier and transportation operator fatigue 

models used in risk management of work schedules in both military and 

civilian work settings.

George Koob became a leader in the discovery of the neurochemistry of drug addiction. His first experiments on reinforcement by electrical brain stimulation in a large and productive animal laboratory in 

Medical Neurosciences became the basis for his highly influential work 

on dopaminergic mechanisms of behavioral reinforcement. After working on the drug research program at WRAIR, Jeff Witkin became a staff 

scientist in the intramural research program at the National Institutes 

for Drug Abuse.

G. Rufus Sessions was a long-time member of the Experimental 

Psychology Department and subsequently the Department of Medical 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 15

Neurosciences. Later in his career, Rufus returned as the Chief, Physiology and Behavior Branch of Medical Neurosciences (1990–1993). 

He then joined Frederick Hegge, a Department of the Army civilian 

(DAC), in a Headquarters USAMRMC–sponsored Tri-service Joint 

Working Group on Drug Dependent Degradation of Military Performance, a program that subsequently funded the research of numerous 

psychologists and physiologists around the command.

David M. Penetar served in Medical Neuroscience and became 

Chief of the Physiology and Behavior Branch, before he served in the 

Department of Behavioral Biology, also in Div. NP. Thomas G. Raslear 

did basic research on animal signal detection and later collaborated 

with Hursh on behavioral economics. Raslear moved to the Department of Microwave Research in Div. NP and conducted studies on the 

behavioral toxicology of electromagnetic radiation. After leaving Army 

research, he became the head of human factors research for the Federal Railroad Administration, where he sponsored studies that validated 

Hursh’s fatigue model for prediction of human error accident risk in 

railroad operations. Other MSC uniformed psychologists who spent at 

least a tour doing research in the Department of Medical Neurosciences 

included Ross H. Pastel and Bruce Hamilton.

Department of Psychophysiology. The second part of WRAIR Div. 

NP constituted applied psychology studies that were conducted in the 

Department of Psychophysiology at WRAIR’s Forest Glen annex near 

Silver Spring, Maryland. Laboratory studies were configured to do 

psychophysiological assessments of Soldier performance in sustained 

duration missions (command and control simulations) that caused 

Soldiers to experience significant loss of sleep and rest. In the 1950s and 

1960s, the department was headed by Harold L. Williams, who gave it 

fame as a center of excellence in sustained performance and sleep loss 

research. It was Williams’s seminal work on the effects of sleep deprivation that first described the Walter Reed Sleep Lapse (microsleeps) 

phenomenon (Williams, Lubin, and Goodnow, 1959).

The department continued sleep deprivation studies for another 

decade under the direction of Dr. Frederick W. Hegge, a well-known 

DAC in our field. In about 1985, Dr. Hegge took a career sidestep to 

work for the Headquarters USAMRMC, where he provided senior 

staff leadership for numerous programs in two premiere research areas: Drug Dependent Degradation of Performance, and Military Operational Medicine. These large research programs both funded the work 
16 THE 71F ADVANTAGE

and challenged the numerous MSC research psychologists and other allied scientists in several of the MRMC labs to take on new and changing 

roles in psychological research applications.

In 1983, under the leadership of Lieutenant Colonel Gregory 

Belenky, a research psychiatrist, the department was renamed the Department of Behavioral Biology. During the 1980s and 1990s, highly 

productive studies continued on Soldier performance during sustained 

military operations, accomplishing both significant sleep deprivation 

studies in the lab and naturalistic studies in the field while the troops 

participated in extensive sustained operations training exercises or in 

large military unit combat readiness test scenarios. Some of that work 

was codirected by this author and included the team leadership work 

of John R. Leu and Harold R. Smith (Krueger 1989, 1991). This field 

test program also included important collaborative work with other 

MRMC uniformed psychologists in efforts that illustrated that wearing 

chemical protective clothing for extended periods has debilitating effects on Soldier performance (Krueger and Banderet, 1997). With novel test instrumentation, including dynamic wrist-activity monitoring 

technology, members of the department configured many of the significant results from the sleep and fatigue research into Soldier alertness/

fatigue and work-rest modeling algorithms. This work, pioneered by 

Colonels Gregory Belenky and Daniel Redmond, USMC, was elaborated on with the involvement of Steven R. Hursh at Div. NP headquarters.

Under the tutelage of research psychiatrists Colonels Gregory Belenky and Paul Newhouse, uniformed psychologists Vincent M. 

O’Donnell and David M. Penetar, and a number of DAC researchers 

(Balkin, Thorne, Wesensten et al.) in the Department of Behavioral Biology accomplished 25 years (1984–2009) of significant in-house exploratory research on stimulant drugs, hypnotic sleep aids, and other pharmaceuticals for use in Soldier fatigue countermeasure programs. That 

work continues today under the direction of Balkin and Wesensten.

Results from decades of research in this highly productive department shaped the Army’s doctrinal planning and operational policies on 

Soldier and unit work-rest scheduling; sleep discipline and fatigue management and countermeasures, including napping; and use of sleeppromoting compounds, stimulant drugs, alertness enhancers, physiological status monitoring, fatigue and performance modeling, and other 

workforce planning measures. For a list of research publications from 

the first 30 years of the Department of Psychophysiology (1958–1986) 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 17

identifying the productivity of numerous MSC research psychologists 

and their colleagues, see Krueger (1986).

Department of Military Psychiatry. The remaining third of WRAIR 

Division NP’s work was carried out in the Department of Military Psychiatry, also housed at the Forest Glen Annex. For decades, those research programs were directed by Dr. David H. Marlowe, a noted Army 

civilian social anthropologist. Marlowe employed numerous uniformed 

research psychologists in examination of more holistic stresses facing 

Soldiers in training and especially while they were deployed to various 

regions of the world. He and his staff pioneered research in stress syndromes associated with the harshness of military occupations and lifestyle. Studies were carried out on the effects of good or poor leadership, 

unit cohesiveness, stress hardiness and resilience, and regimental unit 

replacement policies (Vaitkus and Griffith, 1990); operational stress 

and mental/behavioral effects of stress on Soldiers and their families; 

prevention of mental health problems and performance decrements in 

Soldiers; post-traumatic stress in response to significant events (for example, the Gander Newfoundland airliner crash, Bartone et al., 1989); 

mental health assessments in combat theater deployments; identifying 

factors that impede Soldiers from seeking medical treatment for psychological problems; and related topics.

Some of the department’s work is done collaboratively with military psychologists stationed at WRAIR’s Heidelberg research unit, and 

with other scientists throughout the Army. A contemporary example 

of such work is the support provided in the Army’s deployable MHATs 

to Afghanistan and Iraq; officers from both Forest Glen and Heidelberg have participated in each of the MHATs deployed to combat theaters. Among others, Sharon A. McBride, Paul D. Bliese, Jeffrey Thomas, Dave Cotting, Dennis McGurk, and Michael Wood participated in 

MHAT missions.

Uniformed MSC psychologists who did research with the 

Department of Military Psychiatry reads like a who’s who of the MOS 

for research psychologists. Some worked in the department itself at 

Forest Glen, some in WRAIR’s Heidelberg field research office, and 

others assigned elsewhere working in collaboration. Some of the names 

associated with the Department of Military Psychiatry are Lawrence 

H. Ingraham, Frederick “Rick” J. Manning, Paul T. Bartone, Robert 

K. Gifford, Mark A. Vaitkus, Carl A. Castro, Kathryn Knudson, Robert H. Stretch, J. Edward McCarroll, James A. Martin, James E. Griffith, 
18 THE 71F ADVANTAGE

Sharon A. McBride, Melba C. Stetz, Paul D. Bliese, Scott Killgore, Dave 

Cotting, Paul Wright, Edward Edens, Michael Wood, and Jeffrey Thomas. Robert K. Gifford and Carl A. Castro served stints as Chief of the 

Department of Military Psychiatry.

U.S. Army Medical Research Unit–Europe at Heidelberg 

Since its founding in September 1977, the WRAIR field research lab at Heidelberg, the U.S. Army Medical Research Unit– 

Europe (USAMRU–E), has been closely allied with the Department 

of Military Psychology at Forest Glen. The principal focus in the 

USAMRU–E has been on human dimensions research in the forwarddeployed environment. This lab unit, commanded by a research psychologist, provides a highly responsive and agile research capability 

to field commanders and the European Theater Surgeon on human 

aspects of mobilization, training, and leadership that promote 

Soldier psychological readiness and effective unit performance and aid 

in prevention and treatment of psychiatric casualties.

Initially, USAMRU–E was charged to examine issues of Soldier stress in a large deployed force in Europe (as many as 300,000 

troops and their families). This forward-deployed research lab collects 

psychological and biomedical data with overseas military units to determine the nature and extent of stressors on Soldiers; ascertain the health 

and performance consequences of those stressors; understand factors 

that diminish or enhance morale, cohesion, and psychological wellbeing in Army forces in Europe; and identify mediating factors such as 

stress hardiness that build resiliency in individuals and military units to 

decrease vulnerability to stress.

The psychologists in this highly productive small research unit 

often completed quick response assessments of human dimensions survey data on U.S. Army Europe Soldiers deployed to theaters such as Iraq 

and Afghanistan. The findings identified critical pre- and post-combat stressors for Soldiers and determined their relation to psychiatric 

symptomatology, health, and well-being. From these endeavors, the 

Army’s MHATs were formulated and are used extensively today. As a result of work done in support of these teams, Carl A. Castro led this unit’s 

efforts to develop innovative and effective treatment/training programs 

for returning troops known as Battlemind training that have now been 

adopted Army-wide (Castro, Hoge, and Cox, 2006).
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 19

While the mission of the European research unit has changed 

over the years, there is a continuing focus on applying psychological research and knowledge to protect and preserve the health of the 

force. Prominent MSC psychologists who had one or more tours of 

duty at the Heidelberg lab, and most of whom also served as commander of USAMRU–E, include Lawrence H. Ingraham, Frederick J. 

Manning, Robert K. Gifford, Paul T. Bartone, Mark A. Vaitkus, Jeffrey 

Thomas, Carl A. Castro, James Ness, Dennis McGurk, Paul D. Bliese, and 

Oscar Cabrera.

WRAIR Field Office at Fort Bragg

After a stint directing field work on sustained operations and 

Soldier performance research at WRAIR’s Department of Behavioral 

Biology, John R. Leu rekindled and developed the influential medical 

research liaison assignment at Fort Bragg, North Carolina. Officers 

serving in this position, which was first held by Stanley H. Holgate

(1983–1986), brought about much interchange and collaborative field 

research in the arenas of 18th Airborne Corps and 82d

 Airborne Division. For a time, representing the U.S. Army Research Institute of Environmental Medicine (USARIEM), Lolita Burrell directed this work at 

Fort Bragg as she accomplished multidisciplinary field research with the 

military units located there.

U.S. Army Research Institute of Environmental Medicine

The Army Surgeon General opened USARIEM at Natick, Massachusetts, in 1961. The lab was formed as a merger of elements of the 

Harvard Fatigue Laboratory’s renowned lab of human physiology (Horvath and Horvath, 1973), the Army’s Climatic Research lab at Lawrence, 

Massachusetts, the Quartermaster’s Environmental Protection Research 

and Earth Sciences Divisions at Natick, and portions of the Army Medical Research Lab formerly located at Fort Knox, Kentucky. USARIEM’s 

mission includes basic and applied science in environmental medicine, 

physiology, military nutrition, and Soldier performance research. It features integrated cellular, tissue, animal, and human research programs. 

Multidisciplinary scientists at USARIEM have especially been known 

for their cutting-edge physiological and psychological studies examining Soldier performance and health variables in harsh working environments such as intense heat, extreme cold, and high terrestrial altitudes. 

Over time, USARIEM also became recognized as one of the world’s 
20 THE 71F ADVANTAGE

leading military research laboratories on physical fitness, biomechanics, 

the biophysics of protective clothing, and the health and performance 

effects of military field nutrition.

USARIEM supports a generalized tri-Service research mission in 

preventive, occupational, and environmental medicine, especially as it 

pertains to unique military work tasks and missions. Research psychologists have been an integral part of USARIEM’s research programs every step of the way. An extensive list of 30 years of USARIEM publications (1961–1992) sheds light on the high productivity of the many scientists who worked there (Krueger, Cardinal, and Stephens, 1992).

Researchers have continually worked in world-class climatic and 

environmental research chambers and biomechanics facilities at Natick. 

But USARIEM is also renowned for carrying out numerous large operational and training data collection exercises with hundreds of Soldiers in the field. Its research findings provide products to enhance Soldier capabilities and reduce health risks. The recommendations of the 

lab’s scientists have led to improvements in Army and DOD personnel 

training policies and preventive medicine guidance, decreasing Soldier 

injuries, lost duty time, and medical costs. USARIEM materiel development support programs produce recommendations for design specifications and product improvements for individual Soldier clothing and 

equipment, the nutrition content of military field rations, and pharmaceuticals used as prophylactics for battlefield environmental stressors. 

USARIEM identified strategies for personal physiological and psychological status monitoring systems and developed a variety of algorithms 

to prevent or detect decrements in Soldier health and performance. In 

terms of health hazard assessment of Army developmental materiel systems, USARIEM works closely with the Army’s Center for Health Promotion and Preventive Medicine (CHPPM) to provide expertise on 

thermal and hypoxic conditions.

Research at USARIEM aims to maximize Soldier health and performance in extreme environments and under occupational stress. Over 

the decades, many MSC uniformed psychologists have been assigned 

to USARIEM’s Human Performance Research Directorate, where they 

conducted studies on the cognitive and behavioral decrements related 

to environmental and operational stressors. Typically, the research talents of these psychologists were cross-matrixed to work collaboratively 

with other scientists in the lab and field on numerous multidisciplinary 

studies of the effects of environmental stressors on Soldier performance 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 21

in high heat or extreme cold (Kobrick and Johnson, 1991) and at high 

altitude (Banderet and Burse, 1991), in sustained military operations, or 

while Soldiers wore chemical protective clothing (Krueger and Banderet, 1997). Psychologists examined the effects of various pharmaceuticals 

and nutritional add-ons for inclusion in military food and field rations; 

measured rifle marksmanship as affected by environmental stressors and 

other independent variables; and assessed effects of arduous military 

training—such as Ranger and Special Forces selection programs (IOM 

Committee on Military Nutrition, 1999), injury countermeasures for the 

airborne training program, and U.S. Military Academy at West Point fitness programs. USARIEM scientists conducted special studies of female 

Soldiers in training and operations (Vogel and Gauger, 1993), and so on.

One of the best illustrations of effective transfer of important lab 

research findings to Soldiers in the field was USARIEM’s series of occupational, preventive, and environmental guidance manuals, prepared to 

help deployed Soldiers and commanders to preserve Soldier health and 

performance in harsh environments. These manuals were produced for 

a sequence of overseas deployments beginning with Operations Desert 

Shield/Storm in Southwest Asia in 1990–1991 (Glenn et al., 1990), and 

followed with similar preventive medicine guidance for deployments to 

Somalia, Haiti, Bosnia, Rwanda, and other locales. That highly successful series of manuals (distributed overseas by the tens of thousands) was 

spearheaded predominantly by USARIEM MSC research psychologists. 

After USARIEM set the pace for this program for several years, the mission for technology transfer of such preventive medicine guidance to 

Soldiers in the field was assumed by the CHPPM at Aberdeen Proving 

Ground, Maryland.

MSC psychologists effectively served in upper level management 

positions at USARIEM as well. Mary Z. Mays served as Chief of the Military Performance Division; J. Frazier Glenn was Deputy Commander 

of USARIEM from 1988 to 1992; Gerald P. Krueger served as Scientific Technical Director and military Commander from July 1990 to June 

1994; and David M. Penetar served as Science Director and Commander of USARIEM from October 1997 to August 2000. Following the lead 

of Frank Sodetz as lab Commander in Thailand, Colonels Krueger and 

Penetar were the second and third MSC psychologists to command a 

USAMRMC lab.

Additional MSC psychologists who worked at USARIEM over 

the decades include R. Curtis Graeber, Donald R. Sweeney, Dennis M. 
22 THE 71F ADVANTAGE

Kowal, Jared B. Jobe, Terry M. Rauch, Harold E. Modrow, Kathryn Popp, 

Sharon A. McBride, Gina E. Adam, Lolita Burrell, and Lynee D. Murray.

Liaison at Canadian Defence and Civil Institute of Environmental 

Medicine

In 1980–1981, the MRMC established a medical research liaison 

and exchange scientist position with the armed forces of Canada. This 

amounted to stationing a uniformed MSC research scientist (initially 

Captain David O. Cote, a human factors specialist) at the Defence and 

Civil Institute of Environmental Medicine (DCIEM) at Downsview, Toronto. The purpose was to facilitate exchange of scientific information 

between the USAMRMC laboratories and DCIEM, whose research missions most closely resemble those of USARIEM and HEL. From 1986 to 

1991, the second person to fill the position at DCIEM was Robert H. 

Stretch, a research psychologist who served as an investigator on studies 

of combat stress, readjustment of Canadian Vietnam veterans, and small 

group interactions of command post personnel during sleep deprivation and sustained performance studies.

U.S. Army Aeromedical Research Laboratory

The U.S. Army Aeromedical Research Laboratory was established 

as a research unit at Fort Rucker, Alabama, in October 1962. It was redesignated as a laboratory in 1969. Collocated with the Army Aviation 

Center and School, USAARL’s predominant mission was initially to accomplish aviation medicine research for the growing Army air force, 

which during and after the Vietnam conflict included thousands of helicopter aviators and crews. USAARL is also positioned across the street 

from the Army Aeromedical Center, where aviation medicine is key, 

Army flight surgeons are trained, and guidelines for crewmember flight 

physicals are determined, prompting much cross-fertilization among 

the respective organizational missions. In 1974, the research staffs of the 

vision and auditory sciences sections of the Army Medical Research Lab 

at Fort Knox, Kentucky, relocated to Fort Rucker and were incorporated 

into the USAARL aviation medicine mission base. Several uniformed 

psychologists from that lab were among the newcomers.

In 1970–1971, USAARL established an Aviation Psychology Division to examine helicopter pilot workload and flight performance issues. Research projects included extensive use of instrumented 

helicopters and simulators for in-flight and lab assessments of Army 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 23

helicopter pilot performance under various stressful flight conditions. 

Some of those studies included sustained flight operations involving 

aviator fatigue; extended flight periods while using night vision goggles; 

flight while wearing chemical protective clothing; flight performance of 

aviators taking drugs such as chemical warfare agent prophylaxis compounds, antihistamines, and even stimulants; copilot navigation workload during nap-of-the-Earth flight; assessments of pilot workload during helicopter transatlantic self-deployment flights; workload during 

helicopter air-to-air combat scenarios; verification of developmental 

aeromedical evacuation equipments; and so on.

The first uniformed MSC psychologist to establish and direct 

USAARL’s Aviation Psychology Division was Mark A. Hofmann (1971–

1972). Mark left Active duty soon thereafter to become a DAC and 

went on to represent human factors in Army aviation development programs in St. Louis, Missouri; from there he moved on to become Deputy 

Director of the Human Engineering Lab at Aberdeen, where he continued to employ MSC research psychologists. Kent A. Kimball

succeeded Mark as Aviation Psychology Chief at USAARL. Kent 

devoted considerable effort to completing the design and construction 

of the Laboratory’s Helicopter In-flight Monitoring System (HIMS), 

an airborne data capturing system capable of simultaneously measuring pilot and helicopter performance aboard a JUH–1H Iroquois 

research helicopter. The HIMS provided Army aviation psychologists 

with a unique tool that was used for several decades to examine pilot 

performance in actual flight, simulating military air operations. After 

completing his initial obligated Active-duty tour in 1975, Dr. Kimball 

took on the role of Aviation Psychology Division Chief as a DAC. In 

keeping with a broadened mission including performing human factors 

evaluations of developmental aviation systems, he changed the name of 

the division to the Biomedical Applications Research Division (BARD), 

which he directed for over a decade. Gerald P. Krueger, who initially 

served as Chief of the Manned Systems Branch (1976–1980), returned 

to USAARL to serve as the BARD Division Director from 1988–1990.

MSC psychologists who worked in either the Aviation Psychology 

or the BARD Division at USAARL included Andrew Martin, James Bynum, Michael G. Sanders, Michael A. Lees, Aaron W. Schopper, Bruce 

Hamilton, George Mastrianni, and Charles A. Salter.

MSC psychologists also worked in other divisions of the USAARL, typically doing vision or auditory science work. These included 
24 THE 71F ADVANTAGE

Franklin F. Holly, Richard R. Levine, and Bruce C. Leibrecht. James H. 

Patterson, Jr., who served in the Fort Knox lab, was among those in 1974 

who relocated to USAARL, where Jim worked in auditory research before he too converted to a DAC position to direct the blast overpressure research program for another two decades. Along the way, Aaron 

W. Schopper served as the Biodynamics Research Division Chief; and 

Robert M. Wildzunas served as Chief of the Visual Sciences Branch 

(1996–1997) and later as Research Director of the Aviation Human Performance Division (2005–2008).

As part of the Army’s Manpower-Personnel Integration (MANPRINT) Program, USAARL gradually broadened its behavioral science 

studies to involve assessments of health hazards associated with operation of large developmental Army weapons and materiel systems in 

accordance with Army Regulation 40–10 (see Krueger, 1983; Ranadive 

et al., 1983). Assessments included multidisciplinary studies of the mechanical threats to the body by impact, shock, acceleration, vibration, 

acoustical noise, and visual enhancement via night vision systems. MSC 

psychologists involved in some of the most prominent of these studies 

at USAARL included Bruce C. Leibrecht, Gerald P. Krueger, Aaron W. 

Schopper, Franklin F. Holly, and Jim Patterson while he was a DAC.

More recent assignments of MSC military psychologists who 

worked at USAARL include James M. King (1991–1993), Robert M. 

Wildzunas, (1993–2000 and 2005–2008), Lawrence C. Katz (1997–

2000), Gina E. Adam (2000–2004), Michael W. Boye (2003–2005), Melba C. Stetz (2005–2008), and Michael N. Dretsch (2007–present).

Research psychologists who regularly performed U.S. Army Reserve Individual Mobilization Augmentee duty with USAARL include 

James H. Patterson, Michael A. Lees, Elmar T. Schmeisser, William D. 

Springer, and Christopher P. Long.

U.S. Army Medical Research Institute of Chemical Defense

The U.S. Army Medical Research Institute of Chemical Defense 

traces its origins to 1915 when the War Department gave the Army 

Medical Department responsibility for designing protective equipment 

against chemical agents. The Medical Department was tasked to provide the first gas masks to the Army in 1917. In 1922, the Medical Research Division was organized at Edgewood Arsenal, Maryland, and 

charged to study the pharmacological action of chemical warfare agents. 

In 1940, increased emphasis was placed on development of methods for 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 25

prophylaxis and treatment of chemical warfare casualties. At the end of 

World War II, the United States learned that Germany had stockpiled 

organic phosphate compounds far more deadly than those in the Allied 

arsenal. Russia had seized German stocks of some chemical agents (for 

example, tabun) and reassembled a chemical warfare agent factory in 

Russia. Basic and applied medical research continued on these colorless, 

odorless threat compounds, among others, in the search for medical 

defense against chemical agents.

On Thanksgiving Day 1969, President Richard Nixon declared 

that the United States would unilaterally withdraw from researching 

and producing chemical and biological weapons (which the United 

States had begun in earnest in 1941). It took almost a decade to disengage some Army labs from that sort of work. Washington ratified the 

Biological Weapons Convention in 1975 but stubbornly declined to do 

the same with the Chemical Weapons Convention through the 1990s. 

One prominent laboratory affiliated with chemical weapons research 

(both offensive and defensive work) was the Army Biomedical Research 

Lab at Edgewood Arsenal. Others in biological and infectious diseases 

were at Fort Detrick.

During the 1970s, the following MSC research psychologists 

worked at the Army Biomedical Research Lab: George Crampton, Stanley H. Holgate (1970–1977), Ronald Peterson (1972–1976), Thomas 

Bennett (1973–1977), Agu Pert (1973–1976), Thomas Bevin (1974–

1977), James M. King (1977–1981), John H. McDonough (1975–1985), 

Daniel L. Rickett (1976–1982), David M. Penetar (1977–1981), Donald B. Headley (1978–1983), and James A. Romano (1978–1982). These 

officers worked on animal and human experiments studying various 

chemical threats, key pharmacological countermeasures, and behavioral research issues. This was prior to the Biomedical Research Lab being 

taken over by the Army Medical Department, circa 1979, with some assignment overlap extending into the time when the Medical Research 

Institute of Chemical Defense came into being.

In a major shift of emphasis (July 1979 through the early 1980s), 

DOD reestablished the Biomedical Research Lab as a part of the Office of the Army Surgeon General. It became a subcommand of USAMRMC, with a directive to serve as the lead laboratory for research 

in medical chemical defense for DOD. This initiative was part of the 

Army’s transition from development of offensive chemical weapons, 

mostly under the auspices of the Army Materiel Command’s Chemical 
26 THE 71F ADVANTAGE

Systems Laboratory, also located at Edgewood, to significant research 

into medical defense against chemical battlefield threat agents. Thus, the 

mission and tenor were altered in favor of medical research to protect 

our forces against enemy use of chemical threat agents. In May 1981, 

the lab was redesignated the U.S. Army Medical Research Institute of 

Chemical Defense. 

The main thrust at the institute is first to develop antidotes and 

medical countermeasures to chemical warfare agents, but also to inform 

military medical policymaking regarding the preparation of combatants 

for a fight in a chemically contaminated battlefield. Additionally, the lab 

is tasked to train medical personnel in the management of chemical casualties. Whereas most of the research findings immediately go into 

DOD medical decisionmaking, some published references documenting work done at USAMRICD labs are scattered through the biochemical literature, but they are not commonly found in the psychological research literature per se.

As a key part of multifaceted medical research programs at 

USAMRICD, MSC research psychologists join other colleagues in both 

government and nongovernment agencies to conduct numerous programs and experiments using either animal or human models to develop or evaluate pretreatment prophylaxis, treatment drugs, and medical antidotes for administration to Soldiers who might be exposed to 

battlefield chemical threats. The uniformed research psychologists who 

worked at USAMRICD tend to be experimental physiological or pharmacological psychologists, or neuroscientists, with backgrounds in 

comparative behavioral biology and biological toxicology.

Memorable MSC psychologists who worked at the institute after it was formed in 1979–1980 include these officers, some of whom 

served a second or third tour at this laboratory: John Frazier Glenn 

(1981–1985), Charles Burdick (1982–1985), Mary Z. Mays (1984–

1987), Carl A. Castro (1988–1992), Daniel L. Rickett, Harold E. Modrow (1983–1986), James A. Romano, James M. King (1995–1998), and 

Maurice Sipos (1997–present). James A. Romano was Commander of 

USAMRICD from 1995 to 2000, making him the fourth MSC research 

psychologist to serve as an MRMC laboratory Commander.

Letterman Army Institute of Research

At the Presidio of San Francisco, the Army Surgeon General 

formed the Western Medical Research Laboratory in 1966 to carry out 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 27

research in tropical medicine, nutrition, surgery, blood replacement, pathology, and psychiatry. From 1971 to 1974, the Army opened four new 

laboratory buildings at the Presidio. The facility was renamed the Letterman Army Institute of Research, as it adjoined the Letterman Army 

Medical Center. LAIR was primarily a medical research center doing 

specialized experimentation on artificial blood, laser physics, and treatment of trauma.

A few MSC research psychologists worked at LAIR with Colonel 

Edwin S. Beatrice, MC, who headed up a vision research program doing studies involving ocular hazards. In particular, Dr. Beatrice’s studies examined electromagnetic threats (that is, lasers) risking damage 

to the eyesight of Soldiers or to visual performance. In 1974, when the 

Army Medical Research Lab at Fort Knox closed, at least three of its uniformed MSC psychologists, Andre J. Lloyd, Peter A. O’Mara, and Bruce 

C. Leibrecht, relocated to LAIR to continue doing visual research in 

Beatrice’s division. Other MSC research psychologists who worked on 

assignment at LAIR included George Luz, James H. Patterson, Samuel 

Shiflett, Eugene Grossman, and Gregory Lewis.

Both the Letterman hospital center and the research institute 

were deactivated in 1995 as part of the Base Realignment and Closure. 

Portions of LAIR’s visual science program were moved to the Brooks 

City Base, Texas, where they were made part of a tri-Service research 

program on ocular hazards. More recently, Michael W. Boye, assigned 

to the detachment there, has been developing and validating new ocular 

diagnostic tools for field use to permit rapid battlefield triage of eye injuries, including those from lasers.

U.S. Army Human Engineering Laboratory 

The HEL was founded at Aberdeen Proving Ground in 1951 as a 

part of the Army’s extensive materiel development community, known 

most recently as the Army Materiel Command. For the past decade, 

HEL, now known as the Human Research Engineering Directorate, has 

been a subcommand of the Army’s corporate lab, the Army Research 

Laboratory headquartered at Adelphi, Maryland. From the beginning, 

under the directorship of Dr. John D. Weisz, a DAC research psychologist, HEL devoted one-third of its efforts to field experiments measuring the performance of Soldiers operating new developmental hardware 

systems. Another third was devoted to ensuring appropriate application 

of human engineering design guidance for development and testing of 
28 THE 71F ADVANTAGE

hundreds of Army materiel systems over the decades. Importantly for 

this treatise, one-third of HEL programs consisted of basic psychological research (program 6.1 funding) on human sensory input and handling of information. It is in this later section of work at HEL where two 

and sometimes three MSC uniformed research psychologists were assigned to work.

After their initial 4-year tours at the lab, George R. Price and Lynn 

C. Oatman stayed on at HEL as DACs, where they continued to manage and conduct highly productive basic science programs in auditory 

and vision research. A third officer, Murray Levine, did stress research 

with monkeys in the mid to late 1960s, leaving after one tour. Other uniformed psychologists fulfilled a single 4-year assignment at HEL before 

leaving Government service, and still others went on to military assignments where they established their own programs. Such was the case 

with Lawrence E. Symington, a specialist in psychological reaction time 

studies, who worked as an MSC research psychologist at HEL (1969–

1972), doing work on computer display symbology for application in 

Army missile command and control centers. After his tour, Dr. Symington moved to the Natick RDEC, where after a 4-year tour, he stayed on 

as a DAC and became a prominent human factors researcher and member of the Natick Army Labs management staff.

James M. King was assigned at HEL from 1986 to 1991 and 

worked in applied research, focusing on military performance in simulated operational conditions. For a time King served as Director of 

HEL’s basic research program, and for almost 2 years he was Deputy 

Director of HEL.

Gradually, during the 1980s and early 1990s, the Army Medical Department assigned fewer MSC research psychologists directly to 

HEL. However, the lab continued an active collaborative relationship 

with uniformed psychologists in the USAMRMC labs largely because of 

the Army’s need for health hazard assessment data inputs on major developmental systems (tanks, helicopters, anti-aircraft gun systems, missiles, and so forth) as part of the MANPRINT program and for providing medical inputs into the system acquisition decisionmaking forums at the Department of the Army staff level. This medical research 

relationship with HEL was solidified by Headquarters, USAMRMC, 

when, circa 1979, MRMC began assigning a medical liaison staff officer to work part-time at HEL to ensure input of medical research findings into the Army Medical Department’s portion of the health hazard 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 29

assessments of developing the Army’s major weapons systems. John D. 

LaMothe, MSC, a pharmacist, was the first such MRMC medical liaison to HEL.

The second and third MRMC medical liaison officers to the Army’s human engineering programs, and therefore to HEL, were MSC 

research psychologists Bruce C. Leibrecht and Gerald P. Krueger. They 

teamed with occupational and preventive medicine specialists in the 

Army Surgeon General’s office and at the Army Environmental Hygiene 

Agency (now the Center for Health Promotion and Preventive Medicine) to shape the health hazard assessment program, formalize it, and 

institutionalize it by crafting and writing Army Regulation 40–10 for 

the Army’s Health Hazard Assessment Program for Developmental Materiel Systems. That formal program and the regulation, published first 

in 1983 (Ranadive et al., 1983), remain largely unchanged and stand as a 

key and effective domain within the Army MANPRINT program.

Natick Army Labs–Soldier Systems Center

The Army Materiel Command’s Natick Research, Development, 

and Engineering Center (NRDEC) at Natick, Massachusetts, is a center for materiel development of Soldier clothing, individual protective 

equipment, parachutes, tentage, and field kitchen equipment. It is also 

home to DOD’s entire food and nutrition research and development 

program. This NRDEC is called the Soldier Systems Center, but due to 

numerous name changes since the 1950s, this lab, the host organization at the Natick Army facility, is often simply referred to as the Natick 

Army Labs. Since USARIEM always has been collocated on the Natick 

facility, it too is often identified as one of the Natick Army labs.

Over the early decades of the MSC research psychology program, 

two uniformed MSC psychologists were usually assigned to the Natick 

RDEC. They worked as applied researchers, conducting what would 

be labeled as human factors testing, or in some cases they spearheaded experimental designs for field tests of Natick developmental items 

such as clothing, individual equipment, chemical protective gear, and 

other equipment items as well as participating in food preference tests 

for newly developed field food rations (for example, Meals Ready to 

Eat) and evaluations of field kitchen kits. Sometimes these officers acted as military coordinators for contractor work. Such was the case for 

Stanley H. Holgate, who in the late 1980s coordinated most of the work 

done on the extensive, well-known anthropometry survey of several 
30 THE 71F ADVANTAGE

thousand men and women to establish the Army’s anthropometry database used to set the tariffs for most of the military clothing in DOD. 

This anthropometry database is also used in countless commercial applications both in the United States and abroad.

MSC psychologists who worked at NRDEC include Richard 

F. Johnson (1970–1972), Lawrence E. Symington (1972–1975), Earl 

S. Stein (1975–1977), Robert H. Stretch (1985–1986), and Stanley H. 

Holgate (1986–1992). Among uniformed psychologists at the Natick 

Army labs in the 1960s were Frederick Isgrig, Philip Friedman, Douglas Bloomquist, and Harold O. Kiess, with J. Bradley Swanson, Laurence 

G. Branch, Thomas L. Nichols, and F. Thomas Eggemeir in the 1970s.

Headquarters, USAMRMC Research and Development Staff 

Officer Positions 

At least 30 uniformed MSC psychologists served as Research and 

Development (R&D) staff officers at Headquarters (HQ), USAMRMC 

(Fort Detrick). Some served two or more such tours as R&D staff officers. Most of these assignments were to act as R&D programs officers 

in one of the five to six Research Area Director (RAD) staffs. These personnel staffs supplied the Commanding General of USAMRMC with 

effective span of control over Army medical research lab programs, and 

over extensive intramural and extramural contract research programs 

in such diverse topical areas as infectious disease research and defense 

against biological agents, whether from naturally occurring environmental exposures or from weaponized threats; research in combat casualty care; military operational medicine research and applications; field 

and combat dentistry and maximal facial injury research; and medical 

research to protect against chemical agents. There were occasionally 

other select areas that warranted a singular identifiable title by virtue of 

either the substantial funding being invested or a high medical research 

priority in Pentagon circles. Additional staff positions filled by research 

psychologists were in the USAMRMC Research Plans and Programs office and elsewhere. Some of these MSC R&D staff officers worked in 

various capacities for the Headquarters, with duty in the USAMRMC’s 

Pentagon or Surgeon General offices in the Washington, DC, area.

In these multifaceted roles, psychology officers assisted the command in the programmatic oversight of millions of dollars in research 

in the nine USAMRMC laboratories. The important work carried out 

in all of these staff officer positions involved almost daily coordination 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 31

with senior Army staffers in the Pentagon, the Army Surgeon General’s office, senior medical research staffers in the sister Services, and the 

USAMRMC subordinate laboratories’ commanders, directors, and 

management staffs. Work included preparation of the command’s 

short-, mid-, and long-range research plans in programmatic areas, 

preparation of budget estimates, formulation of requests for research 

funding, justification of resource requests, preparation of descriptive 

explanations of ongoing research programs, and preliminary results and 

progress reports.

As indicated earlier, many uniformed psychologists excelled at 

fulfilling headquarters staff officer roles. The command, the nine research laboratories, and the officers themselves all benefited greatly 

from their work. A chart listing many psychologists who served in R&D 

staff officer positions appears as an appendix to this chapter. Following 

are a few who left significant memories if only because they reached the 

pinnacle of staff officer roles within the command.

James A. Romano not only rose to the executive managerial level 

as Commander of USAMRICD at Edgewood (1995–2000) but subsequently served as Deputy Commander at HQ, USAMRMC at Fort Detrick, and for 6 months in 2006 as the Commander of all of USAMRMC.

John Frazier Glenn, who served a tour at USAMRICD at Edgewood and for several years as Deputy Commander of USARIEM at 

Natick, took on an assortment of senior staff officer positions at HQ, 

USAMRMC, where he spent the last dozen years of his Active-duty career. Ultimately, in his last assignment before retiring, Frazier acted as 

Deputy Assistant Commander for Research and Technology Programs, 

a position he assumed after retirement and now holds as a DAC.

Robert K. Gifford served as Research Area III Director for the 

Systems Hazards Research Program (1993–1995) at HQ, USAMRMC, 

renaming it the Military Operational Medicine Program. More recently, Carl A. Castro took on the RAD III leadership role in September 

2007. As senior R&D staff officers, the position of RAD entails carrying out programmatic and budgeting oversight for many of the research 

efforts conducted in three to four of the labs in which MSC research 

psychologists work.

After one assignment to the Academy of Health Sciences, Terry 

M. Rauch worked as a staff officer in RAD III in the 1980s, followed 

by an eventful research assignment to USARIEM. For me, Terry receives the award for perfecting the role of consummate staff officer, for 
32 THE 71F ADVANTAGE

subsequent to his USARIEM stint, he spent his entire career in the 

Washington, DC, area working as a medical research staff officer in various positions at HQ, USAMRDC, and lastly in the office of the Under Secretary of Defense for Health Affairs–Force Health Protection. In 

these capacities, Terry served as a Pentagon front-runner for many of 

the research programs in which our psychologists were involved. At one 

point, he was Commander, U.S. Army Science and Technology Center, 

Europe. For years, he coached the Army marathon team and personally 

ran numerous marathons.

Other Lab Assignments

The mainstay common career path of alternating assignments 

through the USAMRMC labs or working at the two materiel development labs (HEL and Natick RDEC) was flexible enough to permit occasional assignments to other exciting organizations and locations. There 

have always been several other Army postings where one or two MSC 

research psychologists (rarely more than three at a time) were assigned.

Among the numerous opportunities for assignments during my 

Active-duty days were chances for uniformed MSC research psychologists to work at the Army’s Combat Development Experimentation 

Center (CDEC) at Hunter-Liggett, Fort Ord, California, or at the Armed 

Forces Radiobiological Research Institute (AFRRI) at Bethesda, Maryland, and even a pair of assignments at the National Aeronautics and 

Space Administration (NASA) Ames Research Center in California. 

On occasion, one could be assigned as an exchange scientist in the sister Service labs—for example, the Navy’s Aerospace Medical Research 

Lab at Pensacola, Florida, or the Armstrong lab collocated with the 

U.S. Air Force School of Aerospace Medicine at Brooks Air Force Base, 

San Antonio, Texas.

Research Psychology Assignments to Academia

Academic research and teaching assignments were also possible for uniformed psychologists at places like the Army’s Academy of 

Health Sciences at Fort Sam Houston, Texas; the U.S. Army School of 

Aviation Medicine at Fort Rucker, Alabama; the U.S. Military Academy at West Point, New York; the U.S. Army War College at Carlisle, 

Pennsylvania; the Air Force Academy at Colorado Springs, Colorado; 

the Uniformed Services University for the Health Sciences (USUHS) 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 33

at Bethesda, Maryland; and the National Defense University and the 

Industrial College of the Armed Forces, both at Fort Lesley McNair, 

Washington, DC.

Some of these special assignments involved placing an officer in 

an organization without an existing personnel authorization (a slot or 

billet) for a research psychologist. In many cases, such nontraditional 

assignments resulted in creation of permanent MSC research psychologist billets where none existed before. For example, due to their proven 

value as researchers, teachers, and leaders, new MOS 71F permanent 

billets were created at the U.S. Military Academy at West Point, the National Defense University, and the Army Physical Fitness Research Center at the U.S. Army War College.

Several MSC uniformed research psychologists held prominent 

teaching, research, and staff management positions at military academic institutions where they mentored and taught students and accomplished superb research or program management as well.

Paul T. Bartone and Mark A. Vaitkus both served in the Department of Behavioral Sciences and Leadership at the U.S. Military Academy. They not only worked with countless cadets but also found time to 

do research and publish their works on such topics as “Combat Exposure and Post Traumatic Stress Disorder” (Adler, Vaitkus, and Martin, 

1996), “Cognitive and Personality Predictors of Leader Performance” 

(Bartone, Snook, and Tremble, 2002), and “Factors Influencing Smallunit Cohesion in Cadets” (Bartone, Johnsen, Eid, Brun, and Laberg, 

2002). More recently, Lolita Burrell and Paul Lester have carried on the 

tradition at the academy, where current studies center on developing 

more effective mentors and leaders.

Colonel Paul T. Bartone continued this upper level academic 

research tradition by carrying out a Fulbright Fellowship, working 

predominantly with Norwegian forces in Europe while a staffer at the 

Industrial College of the Armed Forces. Bartone is now assigned at 

the National Defense University’s Center for Technology and National 

Security Policy. For some of his works there, see his timely treatise on 

“Positive Meaning in Military Operations: Reflections on Abu Ghraib” 

(Bartone, 2005, 2008); and his thorough outline of factors involved 

with leaders influencing stress hardiness and resilience in small units 

(Bartone, 2006).

Mark A. Vaitkus served as acting Director of Research at the Army 

Physical Fitness Research Institute at the U.S. Army War College, where 
34 THE 71F ADVANTAGE

he conducted studies with leading researchers in the fields of heart 

disease, stress management, physiology, prostate cancer, and nutritional health as they applied to senior military leaders over 40. After graduating with honors from the Industrial College of the Armed Forces 

in 2007, Mark became an Associate Professor of Behavioral Science on 

its faculty, where he teaches the Strategic Leadership course and conducts research to improve the college’s strategic leadership and executive 

development assessments.

A number of MSC psychologists, particularly while they were assigned at WRAIR, served in an adjunct psychology professorship role 

at USUHS, usually in the Department of Medical Clinical Psychology. 

Ross H. Pastel garnered the first full-time assignment (2008–present) 

for a MSC research psychologist to do research and teaching there.

After postdoctoral cross-training in clinical psychology, Robert 

H. Stretch served as a liaison scientist and professor from WRAIR’s Department of Military Psychiatry to the USUHS Department of Psychiatry (1995). More recently, Charles A. Salter was Director of the Congressional Programs Office and then the Scientific Director of the Office of 

Grants and Contracts Management at USUHS; and Robert K. Gifford 

acted as Director of Admissions for the USUHS School of Medicine.

Mary Z. Mays was named the Air Force Academy’s professor 

of the year (circa 1998) while she was assigned as a professor of military psychology in the Department of Behavioral Sciences and Leadership at the Academy in Colorado Springs, Colorado. G. Rufus Sessions and George Mastroianni also served several years as psychology 

professors on staff there.

James M. King served in the Health Care Studies and Clinical Investigations Activity at the Army’s Academy of Health Sciences 

(1982–1986). The focus was on evaluation studies addressing stress, 

chemical-biological defense, patient data capture, physical fitness, and 

so on. At one point, Robert K. Gifford served as Chief of the Staff and 

Faculty Development Division at the academy. More recently, Sandie 

Escolas was assigned to the Office of the Dean at the academy, where she 

addressed institutional challenges from evaluating effectiveness of various curriculum approaches to identifying causes of early attrition from 

AMEDD training programs at the academy.

Sandie has also deployed to Iraq as part of an AMEDD research 

and field assessment team.
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 35

Anticipating the Future

The introduction to this chapter suggested that projections would 

be made concerning the role of uniformed research psychologists in 

the “war of the social scientists and beyond.” While this treatise could 

proceed in many directions, this chapter limits discussion to just two 

thrusts: a simple listing of some areas where more military psychology 

research is needed, and some changes that might be predicted.

Areas for Subsequent Research 

Traumatic brain injury. In 2007, at a Human Sciences Research Conference I coordinated for the Assistant Secretary of the Navy, then Navy 

Surgeon General, Vice Admiral Donald C. Arthur, described suffering 

his own brain injury in a motorcycle crash. In assessing his recovery, 

Admiral Arthur indicated he could “pass any neuropsychological test” 

administered to him, but he also knew somehow that his cognitive functioning had still not returned to normal. He challenged psychologists 

and other behavioral scientists to explain that. Secondly, he pointed out 

that TBIs suffered through exposure to explosive blasts of the type our 

forces encounter in Iraq and Afghanistan are not quite like those resulting from motorcycle crashes or football. Admiral Arthur’s experience 

and his quest for answers to understanding TBIs provide challenges for 

neuropsychological research. We must determine how to assess the extent of cognitive impairment resulting from the kind of TBIs Soldiers 

and Marines experience from exposure to single or repeated blasts from 

explosions brought about by improvised explosive devices. Suitable diagnosis and recovery treatment regimens, as well as functional tests for 

recertification of cognitive wellness, are needed.

Augmented cognition. For 5 years, the Defense Advanced Research 

Projects Agency devoted significant funding to push the state of the art 

of research on augmented cognition (Aug Cog). Aug Cog work to date 

directly touches many facets of military psychology, invoking the possibility of impacting Soldier performance in a select number of operational scenarios, especially those of equipment operators faced with 

cognitive overload in stressful operating conditions (Schmorrow and 

Stanney, 2008). The Aug Cog concept is to configure an array of psychophysiological sensors to monitor the cognitive state of an operator, 

and then, based on those monitored signals, the machinery will make 

decisions to automatically provide augmentation to that operator (that 
36 THE 71F ADVANTAGE

is, to unburden the operator from excessive workload). While that may 

sound attractive, more psychological research is needed to ensure that 

such machine augmentation is better than human decisionmaking, including whether Aug Cog mechanisms should supersede the operator’s 

choice to be augmented or not by automated machinery. As technological advances are made, the military applications must be validated and 

confirmed as providing “value added assistance” to human operators of 

systems in military settings.

PTSD and prevention of military suicides. These two topics are the hot 

issues of the day and no doubt are covered adequately elsewhere. Predictably, much more psychological research should be done on these 

two military stress-related maladies, which in some cases might even 

be linked.

Psychological aspects of combat. Robert K. Gifford (2006) reported that 

although we have learned much about the positive and negative psychological consequences of serving in war, there is even more we do not 

understand. He suggests three critical areas for future research: longterm (longitudinal) consequences for those who have been in combat, 

positive and growth-enhancing reactions to having been in combat, and 

psychological reactions to having killed other people. All three charges 

are right on target and need to be researched.

Preparing Soldiers for combat stress. In the “Military Life” book series, 

the volume on Operational Stress (Adler, Castro, and Britt, 2006) identifies psychological research needs that still confront us. One is identifying the best methods for preparing military personnel psychologically 

for operational stress. As Adler, Castro, and Britt point out, there is little 

empirical evidence regarding the best method for providing that support. Should training be geared toward the individual or the unit? Can 

military personnel benefit from better preparation for the psychological 

stressors encountered in combat?

Human dimensions as promulgated by U.S. Army Training and Doctrine Command. The Army’s future direction takes its cue primarily 

from the development of doctrine at the U.S. Army Training and Doctrine Command (TRADOC)—essentially the staff cells at the Army’s 

schools charged with predicting where, what, and how the Army will 

fight and envisioning what weapons and personnel will be needed. Recent developments at Headquarters, TRADOC, have witnessed a rekindling of the notion of Human Dimensions being a critical aspect of 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 37

all Army doctrinal planning (see TRADOC Pamphlet 525–3–7, June 

2008). TRADOC’s “doctrine” defines human dimension as the:

moral, physical, and cognitive components of Soldier, 

leader, and organizational development and performance 

essential to raise, prepare, and employ the Army in full 

spectrum operations. Army concepts acknowledge the 

Soldier as the centerpiece of the Army, but none, individually or collectively, adequately addresses the human 

dimension of future operations. This concept provides an 

integrating and forcing function that draws on other joint 

and Army concepts to describe those aspects of a highly 

nuanced human dimension interacting at all levels. 

It is important for uniformed research psychologists and their 

Army civilian counterparts in the laboratories to engage and participate 

with Army doctrinaires at TRADOC as they flesh out those concepts 

and plans for the future Army. 

Human diversity research for the military. Three areas of human diversity in the force call for more behavioral science research. Due to current total force strength limitations, and in part due to the fast tempo of 

recent military encounters overseas, all three Services have seemingly 

curtailed their plans of significantly increasing the number of women in 

the force. Nevertheless, those plans will likely come to fruition eventually. In addition to the other variables behavioral scientists study about 

all Soldiers, women undergo additional gender-related stressors, raising psychological and physiological issues that call for additional biobehavioral research.

Secondly, increasing numbers of Soldiers for whom English is a 

second language are joining the ranks. They join the Army not only for 

patriotic and economic reasons, but also to speed up the immigration 

and naturalization process as a reward for their Active-duty service. Additional psychological research needs to be done concerning integration 

of minority Soldiers into the Army. 

Integration of Soldiers with alternative sexual preferences (gays 

and lesbians) into the total force has been inadequately addressed since 

the Revolutionary War (Shilts, 1993; Herek, Jobe, and Carney, 1996). 

While this is not a new concern, suggestions of impending change to the 

current military policy regarding Soldiers’ individual sexual preferences 
38 THE 71F ADVANTAGE

(“don’t ask, don’t tell”) also foretell that more psychological research is 

called for in topical areas pertaining to integration of Soldiers with alternative sexual orientation.

Military family stresses during deployment. Research is needed on 

ways to enhance the resilience of military families (see Military Families, 

Volume 3, in “Military Life” series, edited by Castro, Adler, and Britt, 

2002). Such research should provide better understanding of how military spouses and children cope throughout the deployment cycle, particularly when the Servicemember is deployed to a combat zone.

Psychology of serving in the military Reserves. Volume 4 of the “Military Life” Series (Britt, Adler, and Castro, 2006) echoes Wisher and 

Freeman’s (2006) call for a thorough understanding of the impact of 

increased activation on the psychology of serving in the Reserves. This 

includes the stresses civilian communities encounter when Reservists 

deploy on Active duty and when they return. Better methods are needed to 

facilitate reintegration of Reservists into their home and civilian work lives.

Adopting an overall health and wellness philosophy. While much psychological research has focused on military operational fitness (both 

physical and mental), a glaring need for new research ideas concerns 

the overall health and wellness of the troops and their families. The 

medical treatment communities of the three Services are spending 

countless dollars on medical diagnosis and treatment issues to work 

with not only Servicemembers, but also their dependent families, on 

such issues as smoking, obesity, hypertension, diabetes, and stress. If 

surveys of the poor health of new recruits and many military members’ 

dependent teenagers are any indication, there are opportunities for big 

gains in the overall fitness of the force and additional gains through 

applying preventive medicine to save huge sums in military medical 

funding. More behavioral research is needed on health and wellness 

topics to prompt program Health and Wellness program actions in our 

total force.

General Scales’s 9-point challenge. In his article, “Clausewitz and 

World War IV” (2006, 2009), General Scales states that we are already in 

World War IV, the war of the social scientist, and he addresses nine elements for victory. Each element contains specific challenges for military 

psychologists. Primarily, they involve a need for more psychological 

research. Briefly, they are:
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 39

■ cultural awareness: Soldiers need empathy for foreign cultures

■ building alien armies and alliances: Soldiers need to build foreign armies

■ perception changing as art, not science: shaping opinions of 

foreign peoples

■ inculcate knowledge and teach wisdom: take time to immerse 

in alien cultures

■ tactical intelligence: leverage human sciences to determine 

whom to kill or not

■ psychological and physiological tuning: provide psychological conditioning for close combat

■ develop high-performing Soldiers and small units: selection 

for bonding and psychological preparation of small tactical 

units

■ leadership and decisionmaking: develop intuitive decisionmaking in young, ambidextrous leaders

■ intuitive battle command: teach commanders how to think 

and intuit rather than what to think; anticipate how the enemy 

will act. 

71F study is needed. This chapter depicts a variety of assignments, 

mentions myriad research careers, and lists opportunities for uniformed research psychologists to contribute in meaningful ways. 

However, memories are still fresh of the early 1990s personnel downsizing threats to our Medical Service Corps and specifically to our 

MOS as research psychology officers. See, for example, the article by 

Ruck and Mitchell (1993) as they grappled with post–Desert Storm era 

questions about the need for, and the role of, uniformed behavioral 

scientists in the Air Force. Recall that Army personnel downsizing anticipated a so-called peace dividend after the fall of the Berlin wall in 

1989, and that the dividend (cuts in troop strength) was postponed until after Desert Storm (early 1991). Subsequent personnel cutbacks and 

laboratory consolidations under Base Realignment and Closure Commission recommendations have put additional stresses on research 

psychology billets.

Thus, if we scan General Scales’s list of challenges for World War 

IV, it suggests that it may be time for another analytical review of what 
40 THE 71F ADVANTAGE

the Army should have in the way of uniformed research psychologists 

going forward. As we approach what may be another downsizing of U.S. 

forces in both Iraq and Afghanistan, it might behoove us to reexamine 

which are our strongest skill sets, and we should look toward the midto long-range future to envision where our group’s members can best 

meet the needs of the Army and the overall military. In a strategic planning exercise, we might want to predict where and how many of our 

uniformed research psychologists ought to be assigned, and what kind 

of work they should be prepared to conduct.

Changes for Military Research Psychologists

Jointly sponsored and conducted research projects. In the future, we 

will likely witness more joint laboratory cooperation in research programs and projects. There will be more cross-Service collaborative studies among the Air Force, Army, Navy, and Marines. Tri-Service–sponsored and –funded research programs will become more common. The 

Army’s movement of armor forces from Fort Knox, Kentucky, to join the 

infantry at Fort Benning, Georgia, provides synergistic opportunities to 

conduct forward-looking performance studies combining several major 

combat arms communities of how the Army should prepare to fight in 

subsequent wars (note the merging of tank and infantry forms of warfare 

in counterinsurgency battles in Iraq). Our psychologists are encouraged 

to participate in such tri-Service and combined arms field test endeavors.

International networking and multinational studies. There will be an 

enhanced international network of military psychologists involved in 

research. More military psychologists will collaborate on multinational 

experiments, joint projects, and international research programs. There 

will be more sharing of resources, instrumentation, and data. Joint multinational studies are more difficult to coordinate and carry out, but the 

rewards of getting to know one’s allies help to maintain working relationships that often pay off when joint military maneuvers are called for 

to meet operational commitments. Use of the Internet helps to facilitate 

some of this activity. Military psychologists will continue to be in the 

forefront of joint military service and multinational research programs.

Sharing results internationally. Countries with formal alliances agreeing to cooperate will sponsor more professional military psychology 

meetings at which researchers will present technical papers on their 

work and intermingle with foreign counterparts. Whereas the North 
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 41

Atlantic Treaty Organization (NATO) used to be a major sponsor of cooperative research panels, boards, international meetings, and exchange 

forums, the prediction is that there will be more such activity from 

countries outside NATO that are also friendly with the United States.

Electronic communication and publications media. Omniaccess to the 

Internet and other forms of electronic telecommunications will make 

international and even cross-country collaborations more likely. More 

publishing of experimental and research test results will be done on the 

Internet. Everyone seems to want things in an easily stored digital format these days. Consequently, print media publications will likely become more scarce.

Conclusion

This chapter only scratches the surface of what could be written 

about our coterie of Army MSC uniformed research psychologists. Since 

I write with a memory bank that reflects on my departure from Active 

duty as far back as 1994, no doubt I have short-changed many of the 

more contemporary MSC psychologists in MOS 71F. Would space permit, many other vignettes concerning our psychologists could be mentioned or elaborated. There are indeed many more accomplishments 

of uniformed research psychologists that have received scant attention 

in this chapter. Nevertheless, I hope the reader now has a sense of the 

remarkable history and contributions of this specialty. The remaining 

chapters in this volume will serve as further contemporary examples of 

how Army research psychologists are working to protect and enhance 

the health and performance of our military personnel and their families. 
42 THE 71F ADVANTAGE

References 

Adler, A.B., Castro, C.A., and Britt, T.W. (eds.) (2006). Military life: The psychology of serving in 

peace and combat. Vol. 2. Operational stress. Westport, CT: Praeger Security International.

Adler, A.B., Vaitkus, M.A., and Martin, J.A. (1996). Combat exposure and posttraumatic stress 

symptomatology among U.S. soldiers deployed to the Gulf War. Military Psychology 8 (1), 

1–14. 

Banderet, L.E., and Burse, R.L. (1991). Effects of high terrestrial altitude on military performance. 

In Gal, R. and Mangelsdorff, A.D. (eds.). Handbook of Military Psychology, 233–254. New 

York: John Wiley and Sons. 

Bartone, P.T. (2005). The need for positive meaning in military operations: Reflections on Abu 

Ghraib. Military Psychology 17 (4), 315–324.

———. (2006). Resilience under military operational stress: Can leaders influence hardiness? Military Psychology 18 (Supplement), 131–148.

———. (2008, April). Army uniformed research psychologists: Making a difference. The Military 

Psychologist 24, 17–22.

———. (2008). Lessons of Abu Ghraib: Understanding and preventing prisoner abuse in military operations. Defense Horizons 64. Washington, DC: National Defense University Press.

Bartone, P.T., Adler, A.B., and Vaitkus, M. (1998). Dimensions of psychological stress in peacekeeping operations. Military Medicine 163, 587–593.

Bartone, P.T., Johnsen, B.H., Eid, J., Brun W., and Labert, J.C. (2002). Factors influencing small-unit 

cohesion in Norwegian navy officer candidates. Military Psychology 14 (1), 1–22.

Bartone, P.T., Snook, S.A., and Tremble, T.R. (2002). Cognitive and personality predictors of leader 

performance in West Point cadets. Military Psychology 14 (4), 321–338.

Bartone, P.T., Ursano, R.J., Wright, K.M., and Ingraham, L.H. (1989). The impact of a military air 

disaster on the health of assistance workers. Journal of Nervous and Mental Disease 177, 

317–318.

Brady, J.V. (1956). Assessment of drug effects on emotional behavior. Science 8, 123 (3206), 1033–

1034.

———. (1958). Ulcers in executive monkeys. Scientific American 199 (4), 95.

Britt, T.W., Castro, C.A., and Adler, A.B. (eds.) (2006a). Military life: The psychology of serving in 

peace and combat. Vol. 1, Military performance. Westport, CT: Praeger Security International.

Britt, T.W., Adler, A.B., and Castro, C.A. (eds.) (2006b). Military life: The psychology of serving in 

peace and combat. Vol. 4, Military culture. Westport, CT: Praeger Security International.

Castro, C.A., and Adler, A.B. (2005). Operations Tempo (OPTEMPO). Military Psychology, Special 

Issue 17 (3), 131–246.

Castro, C.A., Adler, A.B., and Britt, T.W. (eds.) (2006). Military life: The psychology of serving in 

peace and combat. Vol. 3, The military family. Westport, CT: Praeger Security International.

Castro, C.A., Hoge, C.W., and Cox, A.L. (2006). Battlemind training: Building soldier resiliency. In 

Human Dimensions in Military Operations—Military leaders’ strategies for addressing stress 

and psychological support, 42-1–42-6. Meeting proceedings RTO–MP–HFM–134, Paper 

42. Neuilly-sur-Seine, France, NATO Research and Technology Organization. 

Committee on Military Nutrition Research, Food and Nutrition Board, Institute of Medicine 

(1999). Committee on military nutrition research: Activity report 1994–1999. Washington, 

DC: The National Academies Press.

Cronin, C. (ed.) (1998). Military psychology: An introduction. Needham Heights, MA: Simon and 

Schuster Custom Publishing.

Department of the Army (2007). Army Medical Department Officer Development and Career 

Management. (Pamphlet 600–4). Washington, DC: Headquarters Department of the 

Army. Available at <www.army.mil/usapa/epubs/pdf/p600_4.pdf>.

Gal, R., and Mangelsdorff, A.D. (eds.) (1991). Handbook of Military Psychology. New York: John 

Wiley and Sons.
RESEARCH PSYCHOLOGISTS: MAKING A DIFFERENCE 43

Gifford, R.K. (1995). Military field research in Somalia: Findings and implications for military psychology. The Military Psychologist (Summer 1995).

———. (2006). Psychological aspects of combat. In Britt, T.W., Castro, C.A., and Adler, A.B. (eds.). 

Military life: The psychology of serving in peace and combat. Vol. 1, Military performance, 

15–30. Westport, CT: Praeger Security International.

Gifford, R.K., Marlowe, D.H., Wright, K.M., Bartone, P.T., and Martin, J.A. (November/December 

1992). Unit cohesion in Operations Desert Shield/Desert Storm. Journal of the U.S. Army 

Medical Department, PB 8–92–11/12, 11–13.

Glenn, J.F., Burr, R.E., Hubbard, R.W., Mays, M.Z., Moore, R.J., Jones, B.H., and Krueger, G.P. (eds.). 

(1990). Sustaining health and performance in the desert: Environmental medicine guidance 

for operations in southwest Asia (USARIEM Technical Notes No. 91–1 and 91–2, pocket 

version). Natick, MA: U.S. Army Research Institute of Environmental Medicine. 

Grimmett, R.F. (2009). Instances of use of United States armed forces abroad, 1798–2008 (Congressional Research Service Report for Congress, No. 7–5700). Washington, DC: Congressional Research Service.

Headley, D.B. (1982). Effects of atropine sulfate and pralidoxime chloride on visual, physiological, 

performance, subjective and cognitive variables in man: A review. Military Medicine 147, 

122–132.

Herek, G.M., Jobe, J.B., and Carney, R.M. (eds.) (1996). Out in force: Sexual orientation and the 

military. Chicago: The University of Chicago Press.

Horvath, S.M., and Horvath, E.C. (1973). The Harvard Fatigue Laboratory: Its history and contributions. Englewood Cliffs, NJ: Prentice-Hall, Inc.

Hursh, S.R., and Silberberg, A. (2008). Economic demand and essential value. Psychological Review

115 (1), 186–198.

Ingraham, L.H., and Manning, F J. (1981). Cohesion: Who needs it, what is it, and how do we get it 

to them? Military Review LXI (6), 2–12.

———. (1984). Boys in the barracks: Observations on American military life. Philadelphia, PA: Institute for the Study of Human Issues.

Kennedy, C.H., and Zillmer, E.A. (eds.) (2006). Military psychology: Clinical and operational applications. New York: The Guilford Press.

Kobrick, J.L., and Johnson, R.F. (1991). Effects of hot and cold environments on military performance. In Gal, R., and Mangelsdorff, D. (eds.). Handbook of Military Psychology, 215–232. 

New York: John Wiley and Sons. 

Krueger, G.P. (1983). The role of the behavioral scientist in assessing the health hazards of developmental weapon systems. In Schopper, A.W., and Nowak, U.V. (eds.). Proceedings of the 

Army Medical Department Behavioral Sciences R&D Conference. Fort Rucker, AL: U.S. 

Army Aeromedical Research Laboratory.

———. (1986). Publications of the Department of Behavioral Biology: 1958–1986, Walter Reed Army 

Institute of Research (WRAIR–BB–Technical Report No. 86–1). Washington, DC: Walter 

Reed Army Institute of Research.

———. (1989). Sustained work, fatigue, sleep loss and performance: A review of the issues. Work 

and Stress 3 (2), 129–141.

———. (1991). Sustained military performance in continuous operations: Combatant fatigue, rest 

and sleep needs. In Gal, R., and Mangelsdorff, D. (eds.). Handbook of Military Psychology, 

255–277. New York: John Wiley and Sons.

———. (1998). Psychological research in the military setting. In Cronin, C. (ed.). Military psychology: An introduction, 15–30. Needham Heights, MA: Simon and Schuster Custom Publishing.

———. (2006). U.S. Army research in human performance. In Mangelsdorff, A.D. (ed.). Psychology in the service of national security, 71–81. Washington, DC: American Psychological 

Association.

———. (2008). Contemporary and future battlefields: Soldier stresses and performance. In Hancock, P.A., and Szalma, J.L. (eds.). Performance under Stress, 19–44. Aldershot, UK: Ashgate 

Publishing Co.
44 THE 71F ADVANTAGE

Krueger, G.P., and Babkoff, H. (1992). Stimulants to ameliorate sleep loss during sustained operations. Military Psychology, Special Issue 4 (4), 189–287.

Krueger, G.P., and Banderet, L.E. (1997). Effects of chemical protective clothing on military performance. Military Psychology, Special Issue 9 (4), 251–415.

Krueger, G.P., Cardinal, D.T., and Stephens, M.E. (1992). Publications and technical reports of the 

United States Army Research Institute of Environmental Medicine (1961–1991). Natick, MA: 

U.S. Army Research Institute of Environmental Medicine.

Mangelsdorff, A.D. (ed.) (1999). Military Cohesion: Special Issue. Military Psychology 11 (1), 1–128.

———. (ed.) (2006). Psychology in the service of national security. Washington, DC: American Psychological Association.

McDonough, J.H. (2002). Performance impacts of nerve agents and their pharmacological countermeasures. Military Psychology 14 (2), 83–177.

Parsons, H.M. (1972). Man-machine system experiments. Baltimore, MD: The Johns Hopkins University Press.

Pastel, R.H. (2001). Proceedings of the international conference on the operational impact of psychological casualties from weapons of mass destruction. July 25–27, 2000. Supplement to 

Military Medicine 166 (12), 1–91.

Penetar, D.M., and Beatrice, E.S. (1986). Effects of atropine sulfate on human pursuit tracking performances. Aviation, Space, and Environmental Medicine 57, 654–658.

Ranadive, M.W., Fitz, R.J., Krueger, G.P., Wolfe, H., and Jones, L. (1983). U.S. Army Regulation 

40–10: Health hazard assessment program in support of the Army materiel acquisition decision process. Washington, DC: Headquarters Department of the Army.

Romano, J.A., and King, J.M. (2002). Chemical warfare and chemical terrorism: Psychological and 

performance outcomes. Military Psychology, Special Issue 14 (2), 83–177.

Ruck, H.W., and Mitchell, J.L. (1993). Perceived need for and roles of uniformed behavioral scientists in the United States Air Force. Military Psychology 5 (4), 219–233.

Scales, R.H. (2009). Clausewitz and World War IV. Armed Forces Journal, July 2006, 15–24. 

Schmorrow, D.D., and Stanney, K.M. (2008). Augmented cognition: A practitioner’s guide. Santa 

Monica, CA: Human Factors and Ergonomics Society.

Shilts, R. (1993). Conduct unbecoming: Lesbians and gays in the U.S. military, Vietnam to the Persian 

Gulf. New York: St. Martin’s Press.

U.S. Army Combined Arms Center and the U.S. Marine Corps Combat Development Command 

(2006). Counterinsurgency (U.S. Army Field Manual 3–24). Fort Leavenworth, KS: U.S. 

Army Combined Arms Center. Available at <http://usacac.army.mil/CAC/Repository/Materials/COIN-FM3-24.pdf>. 

U.S. Army Training and Doctrine Command (2008). The U.S. Army concept for the human dimension in full spectrum operations: 2015–2024 (TRADOC Pamphlet 525–3–7, June 11, 

2008). Fort Monroe, VA: U.S. Army Headquarters, Training and Doctrine Command. 

Vaitkus, M., and Griffith, J. (1990). An evaluation of unit replacement on unit cohesion and individual morale on the U.S. Army all-volunteer force. Military Psychology 2 (4), 221–239.

Vogel, J.A., and Gauger, A.K. (1993). An annotated bibliography of research involving women: Conducted at the U.S. Army Research Institute of Environmental Medicine (USARIEM Technical 

Note No. 93–5). Natick, MA: U.S. Army Research Institute of Environmental Medicine.

Williams, H.L., Lubin, A., and Goodnow, J.J. (1959). Impaired performance with acute sleep loss. 

Psychological Monographs 484, 73 (14), 1–26.

Wisher, R.A., and Freeman, M.W. (2006). The U.S. Reserve component: Training strategies for 

adapting to deployment. In Britt, T.W., Adler, A.B., and Castro, C.A. (eds.), Military life: 

The psychology of serving in peace and combat. Vol. 4, Military culture (81–96). Westport, 

CT: Praeger Security International.

Wiskoff, M.F. (1997). Defense of the nation: Military psychologists. In Sternberg, R.J. (ed.), Career 

paths in psychology: Where your degree can take you (245–268). Washington, DC: American Psychological Association.

Wiskoff, M.G. (1998). Careers in military psychology. In Cronin, C. (ed.), Military psychology: An 

introduction (257–267). Needham Heights, MA: Simon and Schuster Custom Publishing.
Part II

Protecting and Enhancing 

Cognitive Performance

Chapter 2

Army Research Psychology: Moving from 

Science to Solutions

Steven R. Hursh

This is a story about one person’s career as an Army research psychologist. The theme of this story is not the person but the opportunity 

—how an opportunity at the right time with the right team can turn 

possibility into probability, and probability into product.

Upon graduation from Wake Forest University, I was commissioned as a product of the Army Reserve Officers’ Training Corps. I was 

an Armor Corps lieutenant at the height of the Vietnam War in 1968. 

However, I wanted to go to graduate school in psychology and applied 

for a delay of Active duty to pursue further study. Perhaps because I 

was less dangerous in the laboratory than on the battlefield, my request 

was granted. I attended the University of California, San Diego, and 

specialized in animal learning and conditioning under Edmund Fantino. After finishing 4 years later, I was granted a transfer to the Medical 

Service Corps. 

Fantino knew Fred Hegge of the Division of Neuropsychiatry at 

the Walter Reed Army Institute of Research (WRAIR), and with the 

help of Captain Frank Sodetz, I found a congenial assignment to the 

Division of Neuropsychiatry, Department of Experimental Psychology, 

where I joined the animal research laboratory looking at problems of 

drug abuse and treatment. The Department of Experimental Psychology was founded by Joseph V. Brady around 1950, probably making him 

the first person to be designated as an Army research psychologist, a 

separate pursuit from clinical psychology. His organization at WRAIR 

has the distinction of having been home to many noted research psychologists, including Murray Sidman, Richard Herrnstein, Philip 

Hineline, John Boren, Larry Stein, Elliot Hearst, Hal Williams, Elliot 

Valenstein, William Hodos, Norman Krasnegor, Dennis Kelly, Joe 

Sharp, Sol Steiner, Ed Schein, Bill Stebbens, Bernie Beer, and George 

Koob, to name a few. For me, it was an opportunity to use the tenets of 

basic conditioning and choice to address a problem of pressing concern 

47
48 THE 71F ADVANTAGE

to the military—namely, the many Vietnam veterans returning home 

with an addiction to heroin. 

My next 18 years were dedicated to related research with primates 

and the development of what has become known as behavioral economics, a framework for understanding the strength of reinforcement and 

the conditions that lead to behaviors of excess. But this essay will focus 

on the last 5 years of my Army career and the development of a product 

that has become the basis of a solution to cognitive fatigue, a common 

problem facing millions of civilians around the world. For me, there is 

nothing better than being part of an organization that is driven not simply by a thirst for knowledge but also by a thirst for solutions.

The Medical Research and Development Command Modeling 

Initiative

During the latter stages of my Army career, I was asked to represent the Army Medical Research and Development Command—now 

the Medical Research and Materiel Command (MRMC)—not as a research psychologist, but as a career scientist with a general interest in 

promoting the products and achievements of the command. I was not 

alone in this type of assignment, and several other research psychologists had paved the way, notably Fraser Glenn and Dan Rickett. During 

one of three tours in those hectic halls, I was tapped to lead a project 

seeking to model the effects of medical products as force multipliers—

aids to Soldier health and performance that have a material effect to improve the performance capabilities of military units. The rationale for 

this initiative was to put medical products on a similar footing with other materiel, which nearly always enjoys the benefits of battlefield modeling to illustrate its impact on lethality, sustainability, or force protection. 

In May 1989, a generous budget was provided to develop these various 

models in conjunction with a Science Applications International Corporation (SAIC) team led by Rich McNally and supported by statistician Joe Fanzone. 

Perhaps the largest share of our budget was dedicated to modeling the improvements in unit effectiveness afforded by the use of chemical and biological medical defense products. We modeled protection offered by nerve agent pretreatments and therapies and biological threat 

agent vaccines (Hursh and McNally, 1993). However, of greater interest to me as a psychologist were products coming from the Military 
MOVING FROM SCIENCE TO SOLUTIONS 49

Operational Medicine program. Specifically, heat stress prediction and 

management products from the Army Institute for Environmental 

Medicine and sleep and fatigue prediction and management products 

from WRAIR caught my attention (Hursh and McNally, 1993). Both 

programs were seeded with many influential research psychologists, including Jerry Krueger, Curt Graeber, Dave Penetar, and later Ross Pastel, Paul Bliese, and William Killgore. 

The initial modeling platform for all these studies was the Army 

Unit Resilience Analysis (AURA) program developed by the Ballistics 

Research Laboratory at Aberdeen Proving Grounds. The code was massive and could only be executed on a supercomputer. My role was therefore supervisory, with all the coding done by SAIC. The very first model 

of the effects of sleep deprivation on Army unit effectiveness came into 

being under that contract, building on some initial fatigue code developed by Terry Klopcic in 1989 that was subsequently translated by Rich 

McNally into a FORTRAN computer program in 1993 for ease of experimentation. This code allowed us to demonstrate that the productivity of artillery units was maximized when they had 8 hours of sleep a 

day—enough to be fully rested. These gains in productivity outweighed 

the losses caused by devoting extra time to sleep. This model was later 

abandoned based on certain fundamental contradictions with laboratory research results from WRAIR on chronic sleep restriction (Belenky, 

Wesensten, Thorne, Thomas, Sing, Redmond et al., 2003). However, the 

success of that initial model as a tool to translate basic fatigue research 

results into operational productivity metrics laid the foundation for additional research and modeling that continues today.

The WRAIR Sleep Research Program and Modeling of Sleep and 

Performance 

I retired from Active duty 2 years after the AURA fatigue modeling work was completed and in 1995 joined SAIC to lead their biomedical modeling and analysis program. We continued to conduct modeling 

in support of many of the MRMC research areas, but my technical involvement focused on fatigue modeling. Of particular importance to this 

story was the long tradition of sleep research at WRAIR going back to the 

early 1950s, with studies stimulated by reports of sleep deprivation torture during the Korean War. Williams, Lubin, and Goodnow (1959) reported on studies of sleep deprivation at WRAIR and the resulting acute 
50 THE 71F ADVANTAGE

impairment of performance, which they characterized as due to lapses or 

“brief periods of no response accompanied by extreme drowsiness and 

a decline in EEG alpha amplitude.” This portrayal of the physiological 

impact of sleep loss remains current in textbooks for sleep medicine.

In keeping with the tradition of sleep research for the Soldier, 

WRAIR focused on developing products to counter the effects of acute 

sleep loss during continuous or sustained operations. For instance, 

WRAIR contracted with SAIC to develop a sleep and performance 

model that could be built into a wrist-worn activity monitor to provide 

the Soldier and unit leaders immediate real-time feedback on Soldier 

capability. I met with the scientists at WRAIR, including Lieutenant 

Colonel Greg Belenky (Medical Corps) and Tom Balkin. We discussed 

the various lines of research and the limitations of prior modeling. It was 

noted that one of the implications of the AURA model was that anyone 

lacking the required 8 hours of sleep per day would eventually exhaust 

their performance resources and degrade to zero effectiveness. While 

no direct laboratory research was available to test that implication, it 

was the opinion of the sleep experts that while restricted sleep degraded 

performance, equilibrium was eventually reached and performance did 

not degrade to zero. It was known that Army units getting 4 or 5 hours 

of sleep were degraded but not totally incapacitated. This set of observations and deductions has turned out to be pivotal for both the eventual 

research agenda and the shape of fatigue modeling.

First, we realized that fatigue modeling was limited by the lack 

of necessary data. We had ample information on baseline performance 

when individuals were fully rested and extensive data on performance 

when individuals were totally deprived of sleep for as long as 84 hours. 

What we lacked were data on “sleep doses” between 8 and 0 hours per 

day. All modeling had to interpolate between those extremes with no 

guidance on the effects of partial sleep deprivation or sleep restriction. 

This crucial knowledge gap led to a line of research that continues today to document the effects of various patterns of sleep restriction on 

cognitive performance. Several crucial experiments at WRAIR and the 

University of Pennsylvania ultimately changed the basic mechanics of 

fatigue modeling (Belenky et al., 2003; Van Dongen, Maislin, Mullington, and Dinges, 2003).

Second, we realized that similar to many other physiological 

processes, fatigue models needed to be homeostatic. During the winter of 1996, I began to sketch out the basic mathematical structure of a 
MOVING FROM SCIENCE TO SOLUTIONS 51

homeostatic fatigue model in a simple spreadsheet calculator. That 

spreadsheet model evolved many times but ultimately became the basis of the WRAIR Sleep and Performance Model (SPM). It was delivered 

to the Army the following spring and implemented in a wrist activity 

monitor that could detect and score sleep, calculate performance effectiveness, and report to the Soldier on an embedded display. The concept 

was later the subject of several Army patents.

From Vision to Application

The initial model was then validated against data from various 

studies conducted by WRAIR and other labs and was found to have surprising generality and utility. At that point, we did not have the results 

of studies using chronic sleep restriction, but hypothetical experiments 

with the model suggested reasonable predictions that would be tested in 

planned experiments.

Due to the Army’s continued interest in SPM, the Natick Research and Development Center sponsored a follow-on contract to have 

the SPM further extended to be included in the Integrated Unit Simulation System (IUSS). Over the next several years, SPM evolved further 

and became the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTE) 

model—a three-process biomathematical simulation of the combined 

effects of sleep pattern, time of day, and sleep inertia. As the name implies, available estimates from wrist activity monitors continued to be a 

prime source of sleep information to drive the model. This work culminated in a Natick technical report that documented the equations and 

parameters of the model in early 1998 (Hursh, 1998). That report subsequently became the basis for a patent now held by the Army.

The initial military application of a sleep and performance model rapidly expanded into a broader vision of a model that could be used 

in the civilian environment for fatigue estimation associated with work 

schedules. In the spring of 1996, I proposed to the Department of Transportation that fatigue modeling could revolutionize the management of 

fatigue in all modes of transport. While the vision had merit, it was premature. What was first needed was a clear validation that such a model would be useful and predictive when applied to performance in the 

workplace. It would be 10 years before that vision was fulfilled, but the 

roadmap was clear. We needed user-friendly software to implement 

the model, a method to estimate sleep associated with civilian work 

schedules, and a large epidemiological study to verify that fatigue 
52 THE 71F ADVANTAGE

predictions from such a model could accurately predict changes in accident risk associated with work schedules.

The Evolution of a Product

The next step was to develop software that would take the crude 

developmental platform for SAFTE using a spreadsheet and transform 

it into a user-friendly, standalone computer program. In 1999, I visited 

the Air Force sleep and fatigue research program at Brooks Air Force 

Research Laboratory. The key leaders were research psychologists Jon 

French and Bill Storm. I presented a series of graphics illustrating the 

application of the SAFTE model to a range of typical military scenarios. 

By coincidence, they had been experimenting with their own form of 

fatigue model but quickly realized that a physiological simulation like 

SAFTE was a superior approach. Their support contractor, NTI (under the direction of Doug Eddy), coordinated with SAIC to develop a 

convenient software interface and display shell for the SAFTE model 

(Hursh, 2001; Hursh, Balkin, Miller, and Eddy, 2004). 

Soon thereafter, the impact of Army research psychology again 

emerged. An old colleague at WRAIR and a former uniformed research 

psychologist, Tim Elsmore, had been doing programming software to 

read, score, and display wrist activity data (actigraphs) for Ambulatory 

Monitoring, Inc. Elsmore was retained by NTI to develop the software 

implementation of the SAFTE model, a program subsequently named 

the Fatigue Avoidance Scheduling Tool (FAST). That program became 

the first Air Force implementation of the SAFTE model in 2000 and later was further advanced by investment from the Department of Transportation to allow for modeling of fatigue in civilians. 

The Military Product 

The Air Force version of FAST was primarily a platform for entry of 

duty periods and sleep episodes along a convenient timeline. The tool took 

that simple timeline of events and processed them through the SAFTE 

model to graph predicted performance, in this case, percent change in 

cognitive performance in a battery of tests similar to the Automated Neuropsychological Assessment Metrics (ANAM) performance battery. The 

user could position the cursor at any point in the schedule and get a prediction of performance that was a percent of the best performance of a 

fully rested person. The model provided a useful tool for flight surgeons 

to estimate how a projected mission would alter the capability of pilots. It 
MOVING FROM SCIENCE TO SOLUTIONS 53

became a standard tool for advising squadron commanders and to this 

day is taught to all flight surgeons at the School of Aerospace Medicine. 

Meanwhile, the Army continued to evolve the SPM and later adopted the SAFTE model as well. In 2002, Department of Defense scientists from the Army, Navy, and Air Force agreed on the SAFTE model 

as the foundation for all future fatigue modeling in DOD (Hursh, Redmond, Johnson, Thorne, Belenky, Balkin et al., 2003). True to its roots in 

Army sleep research, FAST can draw a graph of performance lapses like 

those reported in the early studies of sleep deprivation in 1959. Currently in development are enhancements to overlay pharmacological countermeasures, a Web-based fatigue assessment tool for flight operations, 

and a Web-based tool for aviation accident investigations.

As if to punctuate continuing Army support for SAFTE, the Army 

Research Laboratory has sponsored work to have the model incorporated into IMPRINT Pro, its human factors model for evaluating materiel. 

As of 2009, the SAFTE model was an optional plug-in to that software 

so Army units and materiel can be evaluated under the effects of sleep 

deprivation or chronic sleep restriction prior to a mission.

The Spinoff to Civilian Science and Application

With the DOD product well developed, I then responded to a request for proposals to develop fatigue management tools for the Department of Transportation. The promise of SAFTE and FAST for predicting and managing fatigue in civilian transportation applications was 

immediately recognized by Thomas Raslear, the head of human factors 

research for the Federal Railroad Administration (FRA) and a former 

WRAIR Army research psychologist. The FRA invested in significant 

additions to FAST that allowed it to be used for fatigue estimation associated with work schedules.

The leap from a military tool to a civilian product required an important additional step; it was not likely that the civilian employer would 

have access to either wrist activity data or records of employee sleep patterns, so we had to develop a way to estimate sleep directly from the 

work record. Fortunately, John Pollard had done a study of railroad engineers who maintained logs of their sleep and work. From that naturalistic data, I was able to develop a computer simulation of the decision processes that were the foundation of the sleep habits of railroad engineers. 

The algorithm (AutoSleep) proved surprisingly accurate in predicting the average pattern of sleep and was sufficient to provide an 
54 THE 71F ADVANTAGE

aggregate assessment of fatigue associated with any work schedule 

(Hursh and Eddy, 2005). In recent validation experiments against wrist 

activity records and sleep logs, AutoSleep has proven to be about 88–92 

percent accurate in predicting the timing of sleep under most shift work 

and on-call schedules. For greatest accuracy, especially for certain challenging schedules like night duty and split shifts, the algorithm should 

be trained with sleep estimates from wrist activity data and then used 

for prospective modeling of proposed new schedules.

The FAST was subsequently enhanced with AutoSleep and became a useful tool for assessment of fatigue associated with civilian 

work schedules. However, the promise of this tool for broad application 

in the workplace was limited by the absence of operational validation. 

The tool could accurately predict changes in cognitive performance using laboratory cognitive tests but it had yet to be shown that it could 

predict performance in the workplace. More importantly, as a tool for 

improved safety, could it predict an elevation of accident risk when provided with only work schedule data?

The FRA noted this limitation and sponsored an aggressive study 

to evaluate work schedules preceding 1,400 freight railroad accidents 

over 21⁄2 years. Each accident was associated with two employees in the 

locomotive. We processed 30-day work histories of these 2,800 employees through a special batch processor version of FAST developed by Tim 

Elsmore. It implemented SAFTE and AutoSleep and could read schedule data directly from an Access database. The program could process 

an entire 30-day history in several seconds, recording estimates from 

the model for every 30-minute interval of work. I was aided by Joe Fanzone, the statistician I first encountered as an Army research psychologist and who was later an SAIC colleague. When the study was complete, 

we had processed over 57,000 work starts and over a million 30-minute 

work periods. 

Of the 1,400 accidents, 400 were attributed to an error by the 

crew. For those accidents, the SAFTE model was able to predict a highly significant relationship between decreased performance and elevated accident risk. At the most extreme levels of predicted performance 

degradation (fatigue), the model accurately predicted a 65 percent elevation in risk. As expected, no such relationship existed for the 1,000 

accidents attributed to nonhuman causes (Hursh, Raslear, Kaye, and 

Fanzone, 2006). Subsequent work has shown that the model accurately predicts an 86 percent elevation in damage risk when fatigued, and 
MOVING FROM SCIENCE TO SOLUTIONS 55

a 250 percent increase in average accident cost, relative to well-rested 

workers. Furthermore, the model also showed that being rested was 

protective, reducing damage risk 57 percent and average accident damage cost 50 percent relative to the average accident.

On a parallel track, the Army was continuing its evaluation of the 

effects of sleep restriction. Results of that work were published (Balkin, 

Thorne, Sing, Thomas, Redmond, Wesensten et al., 2000), and the 

SAFTE model was updated with an expression that adapts the model 

to the prolonged effects of sleep restriction and optimized it for prediction of the most sensitive performance test, the Psychomotor Vigilance 

Task (Balkin, Bliese, Belenky, Sing, Thorne, Thomas et al., 2004). This 

feature of the SAFTE model is key to accurate applications in the civilian 

world, where chronic sleep restriction, not total sleep deprivation, is the 

dominant sleep pattern that threatens performance in the workplace. 

It is currently the only fatigue model with that capability, which may 

account for the findings of a 2004 independent peer review published 

by the University of Pennsylvania that judged SAFTE to have the lowest estimation error of any fatigue model (Van Dongen, 2004; see also 

Hursh et al., 2004). 

The Future of the Product

The SAFTE model has now been implemented in a range of software tools that can apply it to mass evaluation of work schedules. For 

example, it was used to evaluate fatigue under civilian flight schedules 

of over 2,000 pilots and was found to have an accuracy of 79 percent in 

predicting when a pilot would call in too fatigued to carry out an assigned trip. Another tool has been developed that makes it easy for an 

accident investigator to enter work and sleep data into a laptop program 

while in the field and get a comprehensive report of potential fatigue 

factors associated with the accident. The tool combines the predictions 

of the SAFTE model with a set of standard fatigue factors used by the 

National Transportation Safety Board. The FAST software is used by the 

Federal Aviation Administration, the Canadian Defence Forces, the Canadian workmen’s compensation board, and a wide range of civilian industries in the United States and abroad.

The predictions of the model and the validation work with the 

model were important inputs to recent legislation mandating more 

stringent hours of service rules for the rail industry and recommending the use of scientific fatigue risk management tools like SAFTE for 
56 THE 71F ADVANTAGE

limiting fatigue in railroad workers. The trend in transportation and 

other industries is away from further prescriptive rules for limiting fatigue and toward the use of fatigue models like SAFTE to target the specific causes of fatigue and design mitigations that are more effective, 

economical, and practical. Fatigue models like SAFTE are a key component of fatigue risk management systems that provide objective metrics 

for fatigue, specific mitigations to reduce fatigue, and tools for auditing 

the results for continuous performance improvement. 

In the last year, we have seen a radical reduction in the cost of measuring sleep with wrist activity monitors utilizing off-the-shelf accelerometers. With such devices now costing less than a tenth of what they cost 

just 3 years ago, it is possible to equip employees in safety-sensitive positions with a noninvasive monitor to track actual sleep patterns and drive 

the fatigue model with near laboratory precision. This improves the accuracy of real-time performance prediction and provides high-quality data 

to train AutoSleep for prospective schedule evaluation and design.

A Glance Backward and a Lesson for the Future

Looking back on this progression, we can now see that a parochial project aimed at modeling the military impact of Army research on 

sleep and performance has evolved into a useful product. This history 

illustrates how basic laboratory research can be translated into a tool for 

improving the safety and well-being of thousands of workers in a wide 

range of military and civilian environments as well as the millions of 

people these industries serve. Military psychologists led the way. They 

shared a common vision, a systematic and empirical approach to problemsolving, and a willingness to tackle difficult issues confronting human performance. 

However, this is not a story about talented people. Rather, as Joe 

Brady often observed, this is a record of the “gifts of a fortuitous environment.” Consistent with our appreciation for the control of behavior 

by its environment, Army research psychologists understand that we 

ourselves have been and will be shaped by the research environments 

created for us by the Army medical research establishment and, beyond our military careers, by the many civilian research opportunities 

that can aptly leverage our Army experiences. One need only have a vision, a tenacious adherence to that vision, and a willingness to exploit 

opportunities offered up by a “fortuitous environment” to take discoveries from science to solutions.
MOVING FROM SCIENCE TO SOLUTIONS 57

References

Balkin, T.J., Bliese, P.D., Belenky, G., Sing, H., Thorne, D.R., Thomas, M., Redmond, D.P., Russo, M., and Wesensten, N.J. (2004). Comparative utility of instruments for monitoring 

sleepiness-related performance decrements in the operational environment. Journal of 

Sleep Research 13, 219–227.

Balkin, T.J., Thorne, D., Sing, H., Thomas, M., Redmond, D., Wesensten, N.J., Williams, J., Hall, 

S., and Belenky, G. (2000). Effects of sleep schedules on commercial driver performance

(Report No. DOT–MC–00–133). Washington, DC: U.S. Department of Transportation, 

Federal Motor Carrier Safety Administration.

Belenky, G., Wesensten, N.J., Thorne, D.R., Thomas, M.L., Sing, H.C., Redmond, D.P., Russo, 

M.B., and Balkin, T.J. (2003). “Patterns of performance degradation and restoration during sleep restriction and subsequent recovery: a sleep dose-response study.” Journal of 

Sleep Research 12, 1–12.

Hursh, S.R. (2001). Fatigue and alertness management using FAST. Presentation at the 2001 Human Performance, Root Cause, and Trending Conference, Baltimore, MD.

Hursh, S.R., Balkin, T.J., Miller, J.C., and Eddy, D.R. (2004). The fatigue avoidance scheduling 

tool: Modeling to minimize the effects of fatigue on cognitive performance. SAE Transactions 113 (1), 111–119. 

Hursh, S.R., and Eddy, D.R. (2005). Fatigue modeling as a tool for managing fatigue in transportation operations. Proceedings of the 2005 International Conference on Fatigue Management in Transportation Operations, September 2005 (TP 14620E). Seattle, WA.

Hursh, S.R., and McNally, R. (1993). Modeling human performance to predict unit effectiveness. 

In Kamely, D., Bannister, K., and Sasmor, R. (eds.). Army science: The new frontiers, military and civilian applications (309–328). Saratoga, WY: Borg Biomedical Books.

Hursh, S.R., Raslear, T.G., Kaye, A.S., and Fanzone, J.F. (2006). Validation and calibration of a 

fatigue assessment tool for railroad work schedules, summary report. (Report No. DOT/

FRA/ORD–06/21). Washington, DC: Federal Railroad Administration.

Hursh, S.R., Redmond, D.P., Johnson, M.L., Thorne, D.R., Belenky, G., Balkin, T.J., Miller, J.C., 

Eddy, D.R., and Storm, W.F. (2003). The DOD sleep, activity, fatigue, and task effectiveness model. In Proceedings of the 12th Conference on Behavior Representation in Modeling 

and Simulation. Scottsdale, AZ.

Hursh, S.R., Redmond, D.P., Johnson, M.L., Thorne, D.R., Belenky, G., Balkin, T.J., Storm, W.F., 

Miller, J.C., and Eddy, D.R. (2004). Fatigue models for applied research in warfighting. 

Aviation, Space, and Environmental Medicine 75 (3), 44–53.

Van Dongen, H.P.A. (2004). Comparison of mathematical model predictions to experimental 

data of fatigue and performance. Aviation, Space, and Environmental Medicine 75, A15–

A36. 

Van Dongen, H.P.A., Maislin, G., Mullington, J.M., and Dinges, D.F. (2003). The cumulative cost 

of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep 

physiology from chronic sleep restriction and total sleep deprivation. Sleep 26, 117–126.

Williams, H.L., Lubin, A., and Goodnow, J.J. (1959). Impaired performance with acute sleep loss. 

Psychological Monographs: General and Applied 73, 1–26.

59

Chapter 3

Asleep at the Trigger: Warfighter 

Judgment and Decisionmaking during 

Prolonged Wakefulness

William D.S. Killgore

Clear judgment and effective decisionmaking are critical tools in 

the arsenal of the modern Soldier and leader, but these capacities are 

susceptible to many of the stresses inherent to combat operations. As 

the strategies and tactics employed by our enemies are changing rapidly, American Soldiers must acquire greater cognitive agility to adapt 

to these new environments. Urban combat requires that Soldiers make 

sound decisions in the face of pervasive uncertainty and fluctuating 

rules of engagement. These cognitive demands are compounded by the 

rapid implementation of new technologies that present the individual Soldier with an unprecedented stream of information that he or she 

must evaluate and attend to. Operational success under these conditions 

requires sound judgment, clear reasoning, and highly effective decisionmaking skills. Unfortunately, many of these critical decisionmaking capacities can be significantly degraded by the emotional, cognitive, and 

physical stresses associated with combat operations. 

Perhaps one of the most cognitively degrading yet potentially 

modifiable stresses Soldiers face is lack of sleep. While it may not be 

possible to eliminate sleep loss during military operations, it is important for Soldiers, and particularly for their leaders, to understand the 

profoundly adverse effects that sleep loss can have on cognitive functioning—effects that can have life and death consequences. While the 

effects of sleep loss on simple alertness and vigilance are well documented and broadly understood, the more subtle and insidious impact on 

complex mental functions such as judgment and decisionmaking has 

only recently been explored. The present chapter introduces the problems associated with poor judgment and decisionmaking in combat, 

outlines two major theories of decisionmaking, provides a neurobiological model that describes the major brain regions involved in judgment 
60 THE 71F ADVANTAGE

and the more intuitive aspects of the decisionmaking processes, and describes how these brain systems may be disrupted by inadequate sleep.

Errors in Judgment and Decisionmaking during Combat 

While errors in judgment and decisionmaking have always been 

a by-product of the murky confusion and emotionally charged context of war (Lieberman, Bathalon, Falco, Morgan, Niro, and Tharion, 

2005), technological advances in modern weapons systems have greatly amplified the lethality as well as the financial and social cost of even 

minor mistakes (Wilson, Salas, Priest, and Andrews, 2007). A brief 

lapse in judgment or a poorly considered decision on the battlefield 

that might have easily gone unnoticed or had only minor consequence 

in previous conflicts is now likely to receive instantaneous worldwide 

dissemination and scrutiny due to modern media, satellite communication, and the World Wide Web. This became particularly apparent 

on April 17, 2002, when two U.S. Air Force pilots on a 20-hour patrol 

near Kandahar, Afghanistan, mistook a nighttime training exercise by 

the Canadian Light Infantry for threatening enemy fire. The U.S. F–16 

fighter pilots, thinking they were under attack by enemy forces, requested permission to fire on the location of the ground activity. Despite being directed to “hold fire” by the airborne warning and control 

system aircraft overseeing the mission, one of the pilots decided to release a 500-pound laser-guided bomb on what was later discovered to 

be friendly forces, killing four Canadians and wounding eight. This 

grave error in judgment quickly received global attention and impacted U.S. international relations. As the conflicts in Iraq and Afghanistan continue, additional examples of lapses in judgment or failed 

decisionmaking are likely to emerge. While it is easy in hindsight to see 

critical errors in judgment and the pathways leading to poor decisionmaking, mental clarity is often difficult to sustain during intense conflict, when time is of the essence and a high-stakes decision must be 

made (Lieberman, Bathalon, Falco, Kramer, Morgan, and Niro, 2005; 

Lieberman et al., 2005). 

Classical Approaches to Judgment and Decisionmaking 

Early in their military education, junior Army officers are indoctrinated with classical theories of decisionmaking and problemsolving. These theories outline rational approaches to decisionmaking 
WARFIGHTER JUDGMENT DURING PROLONGED WAKEFULNESS 61

that follow a logical sequence: defining the problem, gathering relevant information, establishing goals, identifying potential solutions, 

systematically evaluating all possible solutions, selecting and executing a solution, and assessing the outcome. According to rational 

decisionmaking models, logical decisions can be arrived at by 

systematically developing multiple courses of action, objectively specifying evaluation criteria that bear on the problem, and then rating each 

potential course of action on each criterion. These ratings can then 

be multiplied by a rationally derived numerical weight that represents 

the importance of each criterion. This approach permits the decisionmaker to sum the weighted outcome values and determine the highest 

scoring and presumably the best course of action. Some of the advantages of the rational decisionmaking model include its thoroughness, 

reliability, and objectivity, which are particularly useful for novice or 

inexperienced decisionmakers or when there is ample time for such a 

meticulous, cover-all-the-bases approach (Klein, 1998). The objectivity of the approach makes it ideal for presentation in doctrinal publications and for didactic exposition in the classroom. Many critical 

combat and urban peacekeeping missions, however, do not lend themselves to methodical decisionmaking. A fascinating line of research 

has focused on the types of split-second judgments and decisions that 

are made by trained and experienced professionals when confronted 

with serious, often life threatening situations under conditions of severe time pressure (Klein, 1998). This line of research has led to the 

development of specialized models of how people make decisions in 

time-constrained crisis situations.

Naturalistic Decisionmaking

In contrast to the systematic comparative approach of the rational decisionmaking model, it appears that decisionmaking in naturalistic time-constrained situations involves the use of cognitive heuristics 

or timesaving strategies that quickly focus the decisionmaker toward a 

satisfactory (as opposed to ideal) solution (Orasanu, 2005). The recognition primed decisionmaking model attempts to account for the types of 

decisions that experienced professionals such as fire commanders, military leaders, and intensive care nurses make when faced with confusing and ambiguous situations, rapidly changing goals, and severe time 

pressures (Klein, 1998). Under these conditions, experts are able to rely 

on their vast experience to recognize patterns within each new situation 
62 THE 71F ADVANTAGE

as either consistent with a prototype, thus suggesting a typical course 

of action, or as a deviation from expectation and therefore necessitating additional diagnosis and clarification. Thus, rather than comparing 

multiple courses of action as in the rational decisionmaking model, an 

expert is led by experience to pigeonhole the current situation based 

on its similarity to many others encountered previously, thereby drastically reducing the relevant courses of action to be considered. Drawing 

from experience, the expert decisionmaker quickly identifies the typical 

course of action for that prototype and then rapidly conducts a mental 

simulation to determine whether it will succeed or fail. The course of action does not necessarily have to be the “best” possible solution; it just 

has to be sufficient to accomplish the task or solve the problem at hand. 

If the first course of action works, that solution is executed. If the mental 

simulation or actual implementation reveals that the first course of action is flawed, then the decisionmaker modifies the approach or switches to the next workable course of action.

Intuition is a term often used to describe the gut-level response 

that guides a person to make a decision or solve a problem despite 

the inability to verbally articulate the reasoning that led to the decision (Hayashi, 2001). The intuitive decisionmaker “just knows” when 

a course of action “feels right” or “feels wrong.” Many cognitive psychologists now believe that intuition is not a random or supernatural process but may actually be based on well-developed cognitive 

heuristics refined through experience and years of repetitive exposure to similar circumstances so a sense of familiarity and typicality 

are formed (Slovic, Finucane, Peters, and MacGregor, 2004). Intuition 

has been described as a kind of well-developed pattern-matching ability that allows an expert to see when things fit a typical pattern, when 

typical patterns have been violated, or if a key element is absent altogether (Klein, 1998). Intuitive decisions based on pattern matching 

are reached more efficiently because the decisionmaker does not even 

need to consider most of the nonpertinent information. Like a folder with a brightly marked tab in an overstuffed file cabinet, the relevant course of action is highlighted and obvious to the expert, despite 

an overwhelming number of alternatives. Much of this pattern matching appears to occur automatically and outside of conscious awareness, 

which makes the concept of intuition seem mysterious and nonrational. Recent advances in neuroscience, however, have shown that the 

intuitive responses that affect our decisionmaking appear to have a 
WARFIGHTER JUDGMENT DURING PROLONGED WAKEFULNESS 63

neurobiological basis and are not as mysterious as once believed (Bierman, Destrebecqz, and Cleeremans, 2005).

Somatic Marker Hypothesis 

One influential theory, known as the somatic marker hypothesis, explains how these intuitive decisionmaking processes are formed 

within the brain. This hypothesis posits that the gut-level reactions are 

essentially learned associations between environmental stimuli or life 

experiences and visceral somatic states that coincide with those experiences. A person, place, object, or other experience that is associated with 

a positive somatic emotional feeling will tend to reactivate a similar somatic state in the individual when similar stimuli or experiences are encountered again. This causes some stimuli and experiences to produce 

pleasant visceral sensations or somatic markers of “goodness” and others to produce unpleasant somatic markers indicating “badness.” Consequently, in subsequent encounters these somatic markers can serve 

to bias an individual toward or away from specific stimuli or behaviors when they emerge. Evidence suggests that the associative process 

that forms somatic markers relies heavily on a brain region known as 

the ventromedial prefrontal cortex (Damasio, 1994), a sector of cerebral 

tissue located along the inferior and medial aspects of the brain a few 

millimeters behind the eyes. This brain region appears to form associational links between classes of situations (for example, public speaking 

or walking alone at night) and emotionally relevant somatic states encountered during such experiences (such as heart pounding, sweating, 

and muscle tension). Through these ventromedial prefrontal linkages, 

activation of components of specific classes of situations within other 

regions of the prefrontal cortex (perhaps the thought of walking to one’s 

car late at night in an empty lot) will evoke a somatosensory emotional 

response via emotional centers such as the amygdala and insular cortex, 

which quickly indicate whether an object or situation is judged as good 

or bad (that is, a gut reaction; Damasio, 1994). When the associated somatic marker is strong, it provides the decisionmaker with a clear gutlevel response as to whether an anticipated course of action is positive or 

negative. Somatic markers can also operate outside of conscious awareness, serving to bias a decisionmaker toward or away from a particular course of action without overt awareness of the process (Damasio, 

1994). Intuitive decisionmaking is believed to rely heavily on the use of 

somatic markers to bias an individual away from courses of action that 
64 THE 71F ADVANTAGE

have previously led to negative outcomes and toward courses of action 

that have a higher probability of success (Bierman et al., 2005). This 

appears to be one basis of the intuitive reactions that streamline the 

decisionmaking process for expert decisionmakers.

Effects of Sleep Loss on Decisionmaking 

Lack of sleep is a problematic but frequently unavoidable aspect 

of modern military operations. It is well known that insufficient sleep 

has a direct and profoundly negative impact on the ability to perform 

simple tasks involving alertness and vigilance (Dinges, Williams, Gillen, Powell, Ott, Aptowicz, and Pack, 1997; Glenville, Broughton, Wing, 

and Wilkinson, 1978; Horne, Anderson, and Wilkinson, 1983; Wesensten, Belenky, Thorne, Kautz, and Balkin, 2004), a fact that can be attested to by nearly any Soldier who has performed all-night sentry duty 

or been involved in continuous operations. A normal waking period 

for most humans is 16 to 18 hours. When waking is extended beyond 

this duration, the drive to sleep begins to overpower the will to remain 

awake, and decrements in alertness and vigilance become noticeable 

and progressively more severe (Wesensten, Killgore, and Balkin, 2005). 

Without adequate sleep, Soldiers are likely to have difficulty sustaining 

their attention on task, become more inconsistent in their responses, 

and take longer than usual to respond to stimulation or changing demands. Eventually, the pressure for sleep can become so strong that even 

the most motivated Soldiers will show significant lapses in attention and 

eventually fall asleep.

While the adverse impact that reduced alertness and attention 

may have on military operations cannot be overemphasized, the effects of sleep loss appear to have even more insidious and potentially 

far-reaching effects beyond simple decrements in alertness. Recent evidence suggests that even one night of sleep loss can impair certain types 

of higher level executive functions such as supervisory control (Nilsson, Soderstrom, Karlsson, Lekander, Akerstedt, Lindroth, and Axelsson, 2005); problemsolving, divergent thinking capacity (Horne, 1988; 

Linde and Bergstrom, 1992); verbal creativity, flexibility, inhibitory control (Harrison and Horne, 1998); and cognitive set shifting (Wimmer, 

Hoffmann, Bonato, and Moffitt, 1992). Results from a brain imaging 

technique known as positron emission tomography (PET) suggest that 

as little as 24 hours of sleep deprivation (one night of sleep loss) significantly reduces the metabolic activity within the prefrontal cortex 
WARFIGHTER JUDGMENT DURING PROLONGED WAKEFULNESS 65

(Thomas, Sing, Belenky, Holcomb, Mayberg, Dannals et al., 2000). 

Moreover, sleep deprivation reduces the normal modulatory control 

exerted by the medial prefrontal cortex over the more primitive limbic 

regions of the brain, resulting in elevated amygdala responses to negative emotional stimuli during periods of inadequate sleep (Yoo, Gujar, Hu, Jolesz, and Walker, 2007). Indeed, some of the most prominent 

findings during sleep deprivation include altered mood (Scott, McNaughton, and Polman, 2006), emotional processing (Killgore, KahnGreene, Lipizzi, Newman, Kamimori, and Balkin, 2008), dysphoria 

(Kahn-Greene, Killgore, Kamimori, Balkin, and Killgore, 2007), and 

poor responses to frustrating situations (Kahn-Greene, Lipizzi, Conrad, 

Kamimori, and Killgore, 2006), possibly as a consequence of prefrontal 

limbic dysregulation. Thus, sleep deprivation not only reduces the ability to remain vigilant and stay on task, but it also directly impairs the prefrontal and associated limbic regions of the brain that are most critical to 

intuitive judgment and decisionmaking. Because of the ubiquitous nature of sleep loss in the military, it is imperative that the leadership fully 

understand the potential consequences on their own decisionmaking 

and judgment capacities and that of their Soldiers.

Insensitivity to Future Consequences

A recent study by Killgore, Balkin, and Wesensten (2006) examined the effect of sleep deprivation on the Iowa Gambling Task (IGT) 

by means of an experimental paradigm designed specifically to examine emotionally based decisionmaking (Bechara, Damasio, Tranel, and 

Damasio, 1997). During the IGT, subjects were presented with 4 decks 

of cards on a computer screen and were told to select cards, one at a 

time, from any of the decks; every card would win them some amount 

of money and some cards would also include a penalty that would lose 

some amount. The subjects were also told that some were “good decks” 

and that playing them would ultimately lead them to win money while 

others were “bad decks” that should be avoided or else they would ultimately lose money. The specific payout schedules of the decks were 

not made known to the subjects, although the program was written so 

that two of the decks yielded high immediate payoffs but were accompanied by relatively larger long-term penalties. Selecting predominantly 

from those decks would ultimately lead to a net loss over time. The other two decks yielded low immediate payoffs, but the occasional losses 

were very small. Selecting consistently from those two decks would lead 
66 THE 71F ADVANTAGE

to an overall net gain by the end of the game (Bechara, Damasio, Damasio, and Lee, 1999). Perhaps the most intriguing aspect of the IGT is 

the finding from early studies showing that when healthy subjects were 

queried about their choices midway through the game, most consciously reported that they were uncertain about their choices and had no explicit knowledge of the reinforcement conditions, despite obvious improvement in performance as the game progressed. Moreover, analyses 

of skin conductance responses showed that subjects were “unconsciously” learning the task and showed increased autonomic activity when deciding to select from riskier options. Together, those findings suggest 

that successful performance of the IGT involves nonconscious emotional learning, akin to a gut-level feeling or hunch (Turnbull, Evans, Bunce, 

Carzolio, and O’Connor, 2005). The IGT has been shown to discriminate patients with damage to the ventromedial prefrontal cortex from 

healthy controls and other groups of brain injured patients (Bechara, 

Damasio, Damasio, and Anderson, 1994; Bechara et al., 1997; Bechara, 

Tranel, and Damasio, 2000). Brain imaging studies also suggest that this 

task specifically activates the ventromedial prefrontal regions of the cerebral cortex (London, Ernst, Grant, Bonson, and Weinstein, 2000). 

Because sleep deprivation significantly reduces glucose metabolism within the same ventromedial prefrontal regions as those required for successful completion of the IGT, we hypothesized that sleepdeprived volunteers would show a deficit in decisionmaking that would 

mimic the performance of patients with damage to these same brain 

regions (Killgore, Balkin et al., 2006). Thirty-four healthy adults were 

recruited to undergo several nights of sleep deprivation and to complete 

the IGT when fully rested at baseline and again following 49.5 hours 

without sleep. When tested on the IGT while fully rested, our volunteers 

performed in a manner similar to that seen in most samples of healthy 

normal individuals, learning easily to avoid the high-risk “bad” decks 

and shift their strategy toward selecting predominantly from advantageous, low-risk “good” decks as the game progressed. In other words, 

rested subjects were adept at using their intuitive emotional reactions to 

guide their decisionmaking. After two nights of sleep loss, however, volunteers showed a dramatic impairment of performance. Sleep-deprived 

individuals tended to select more frequently from risky “bad” decks as 

the game progressed, preferring short-term gains and ignoring the high 

probably of long-term losses. In other words, sleep deprivation led to impairment in the ability to use emotional experiences (somatic markers) 
WARFIGHTER JUDGMENT DURING PROLONGED WAKEFULNESS 67

to guide ongoing decisionmaking, leading to an increase in risky choices. This phenomenon has been described as “myopia for the future” 

(Bechara et al., 2000) and is a hallmark of patients with ventromedial 

prefrontal lobe damage. These data raise the possibility that sleep deprivation may produce a “functional” (and presumably reversible) brain lesion within the ventromedial prefrontal cortex. 

A second important finding also emerged: the tendency to make 

risky decisions following sleep loss was significantly positively correlated with age (Killgore, Balkin et al., 2006). Participants in their late teens 

and twenties were less likely to make risky choices following sleep loss 

than those in their thirties. This latter finding may be particularly relevant to military decisionmaking, as most unit leaders and decisionmakers are likely to be older than those they command, with field grade 

officers typically being in their thirties or above and strategic leaders 

frequently being in their forties or fifties. The finding of greater sleepdeprived decisionmaking impairment with age contrasts with recent 

data regarding vigilance performance and subjective ratings of sleepiness. For tasks involving simple alertness, vigilance, and sleepiness, older individuals appear to be less affected by sleep loss than their younger 

counterparts (Adam, Retey, Khatami, and Landolt, 2006). The implications of these findings for the military are considerable. Older military 

leaders may “feel” less affected by sleep loss and may show objectively 

better vigilance in performance than their younger Soldiers. However, 

this may provide a false sense of security, as they may in fact be more 

susceptible to making critical errors in judgment when sleep deprived, 

a dangerous effect that might be masked by their objectively sustained 

vigilance and subjective sense of alertness. It is particularly important, 

therefore, for leaders to obtain adequate sleep in order to maximize 

their ability to make sound decisions regardless of their general sense of 

sleepiness or objective level of vigilance.

Effect of Duration of Sleep Deprivation

Some evidence utilizing PET imaging techniques suggests that 

glucose metabolism within the prefrontal cortex continues to decline up 

to at least 72 hours of sleep deprivation. Because it was unclear whether the previously described deficits in decisionmaking observed on the 

IGT would continue to decline with periods of sleep loss beyond 49 

hours, Killgore, Lipizzi, Kamimori, and Balkin (2007) conducted a subsequent study that examined IGT performance at 51 and 75 hours of 
68 THE 71F ADVANTAGE

continuous wakefulness. Twenty-six healthy Soldiers were administered 

the IGT at baseline and completed alternate versions of the task after 2 

and 3 nights of sleep deprivation. As in the previous study, well-rested Soldiers showed no difficulty learning to avoid the disadvantageous 

decks and progressively increasing their monetary winnings by selecting from the “good” decks. By 51 hours of sleep deprivation, however, 

the findings were strikingly similar to those reported in the previous 

study (Killgore, Balkin et al., 2006)—sleep-deprived Soldiers showed 

deficits in decisionmaking and tended to select more frequently from 

the “bad” decks by the end of the game relative to their performance at 

rested baseline. However, contrary to our expectations, we did not find 

any further decline in risky decisionmaking between 51 and 75 hours 

awake, with similar levels of impairment evident at both sessions. These 

findings suggest that sleep deprivation for 2 nights produces significant 

decrements in decisionmaking, but that these decrements are not significantly worsened with additional sleep loss.

Effects of Sleep Loss on Moral Judgment

When operating in hostile environments, Soldiers are likely to be 

confronted with difficult moral dilemmas. There may be times when 

a Soldier must make a split-second decision that may ultimately cost 

some lives in order to achieve an objective, accomplish the larger mission, or to save the lives of others. While realistic training can improve 

Soldiers’ ability to make sound judgments under stressful situations, 

many other factors can influence the quality of such judgments. As noted, the ability to use emotions and somatic markers to guide intuitive 

decisionmaking appears to rely heavily on the functioning of the ventromedial prefrontal cortex (Damasio, 1994). This seems to be true of 

some types of moral judgments as well. In a particularly compelling 

study, Greene, Sommerville, Nystrom, Darley, and Cohen (2001) used 

functional neuroimaging to study neural activity in the brain as participants considered a series of narratives describing dilemmas of three 

different types: mundane nonmoral (NM) dilemmas, moral impersonal (MI) dilemmas that were low in emotional arousal and immediacy, and moral personal (MP) dilemmas that were high in emotional 

arousal and personal immediacy. In that neuroimaging study, MP dilemmas produced significantly greater activity in the ventromedial prefrontal cortex relative to either the MI or NM dilemmas, and participants were significantly slower to respond when deciding to approve of 
WARFIGHTER JUDGMENT DURING PROLONGED WAKEFULNESS 69

solutions requiring MP violations than when disapproving of them, a difference that was not observed for MI violations. Recent evidence further 

suggests that this medial prefrontal region of the brain is critical to a 

variety of social and emotional reasoning processes, many of which 

have recently been classified under the term “emotional intelligence” 

(Bar-On, Tranel, Denburg, and Bechara, 2003). Emotionally intelligent individuals are effective at monitoring their own emotions and the 

emotions of others, able to discriminate among subtle aspects of those 

emotions, and skilled at applying emotional information effectively to 

make decisions and guide behavior (Salovey and Mayer, 1990). 

As described above, the ventromedial prefrontal cortex, which 

is so critical to emotionally intelligent behavior and the ability to form 

moral judgments, appears to be particularly vulnerable to prolonged 

sleep deprivation, which produces significant reductions of the metabolic activity within this region (Thomas et al., 2000). Unfortunately, 

sleep loss is common in many military operations, and Soldiers must 

frequently make morally relevant decisions with less than adequate 

sleep. Therefore, in a recent study (Killgore, 2007; Killgore et al., 2007), 

we examined the effects of sustained wakefulness on emotional intelligence, the types of moral judgments reached, and the speed with which 

such judgments were made. At rested baseline and again following 53.5 

hours of continuous wakefulness, 26 healthy Soldiers were given an 

emotional intelligence test and then presented with a series of scenarios 

that included NM, MI, and MP dilemmas. For each moral scenario, a 

solution was proposed and the Soldier made a judgment as to whether 

that solution was “appropriate” or “inappropriate” within the context of 

the various contingencies present in the situation. 

We found that measured emotional intelligence scores significantly declined after 2 nights of sleep deprivation. This change was most 

apparent in intrapersonal and interpersonal skills and functioning, as 

well as stress management abilities. This suggests that sleep-deprived 

Soldiers are likely to have difficulty understanding their own emotions 

as well as the emotions of their unit members and may be more prone 

to making errors in judgments that rely heavily on emotional processes. Moreover, there were significant changes in the moral judgments of 

Soldiers following sleep deprivation, but these changes were restricted exclusively to the highly emotionally charged dilemmas that have 

been shown in previous research to recruit the medial prefrontal cortex (Greene et al., 2001). In other words, sleep deprivation selectively 
70 THE 71F ADVANTAGE

slowed the ability of Soldiers to make judgments about highly emotionally charged moral dilemmas but did not affect judgments about 

similar dilemmas with low or no emotional involvement (Killgore, 

2007; Killgore et al., 2007). Finally, sleep loss led to a greater propensity 

to judge controversial solutions to moral dilemmas as “appropriate,” but 

this effect appeared to be mitigated by premorbid levels of emotional 

intelligence. Specifically, Soldiers with normal levels of emotional intelligence were susceptible to an alteration in moral reasoning due to 

sleep loss, whereas highly emotionally intelligent Soldiers remained stable even when sleep deprived. 

The present findings have implications for Soldiers who are required to function under conditions of highly restricted sleep in order to 

achieve operational objectives. During continuous operations or during 

periods when sleep is fragmented or restricted, military personnel may 

experience increased difficulty in reaching morally based decisions, 

particularly when the judgments evoke strong emotions or feelings of 

personal responsibility. Under such circumstances, Soldiers are likely 

to experience significant slowing of the thought processes required to 

reach a judgment or decision about the best course of action. Moreover, the evidence suggests that the likely course of action chosen during sleep deprivation appears to differ significantly from the choice that 

would have been made by the same Soldier in a fully rested state, with a 

tendency toward reduced empathy and degraded interpersonal awareness. Military leaders and decisionmakers need to consider the effects of 

sleep loss on the judgment and decisionmaking capacities in themselves 

and in their Soldiers.

Effects of Sleep Loss on the Willingness to Take Risks

Another aspect of warfighter judgment involves the willingness 

or propensity of Soldiers and leaders to take risks when faced with uncertainty. One of the major stresses of combat is the uncertainty that is 

present when facing a mortal enemy. Soldiers then must make judgments regarding the risks involved in each course of action or inaction. 

Some evidence suggests that sleep deprivation affects the way risk is perceived as well as the willingness to take risks. As described earlier, it has 

been demonstrated that when presented with a forced choice among 

several alternatives, subjects became more willing after sleep deprivation to select from tantalizing high-risk card decks that were likely to 
WARFIGHTER JUDGMENT DURING PROLONGED WAKEFULNESS 71

lead to long-term losses rather than from less exciting, low-risk decks 

that promised consistent long-term gains (Killgore, Balkin et al., 2006). 

A recent study by McKenna, Dicjinson, Orff, and Drummond (2007) 

showed that sleep deprivation alters the willingness to take risks but 

that this effect depends on whether the risk was perceived in terms of 

gains or losses. Specifically, they found that sleep-deprived subjects were 

more likely than usual to take a risk if they considered the outcome in 

terms of potential gains, but less likely to if the outcome was framed in 

terms of potential losses (McKenna et al., 2007). Further research using 

functional neuroimaging has shown that sleep deprivation enhances activation within some reward regions of the brain following risky decisions, suggesting that sleep loss may lead to an increased expectation 

of gains (Venkatraman, Chuah, Huettel, and Chee, 2007). Interestingly, 

when sleep-deprived subjects experienced losses, they showed reduced 

activity in brain regions associated with aversion and punishment (Venkatraman et al., 2007). Together, these findings suggest that sleep deprivation may alter the risk-related judgments of individuals by modifying 

the normal functional activity within brain networks involved in the 

evaluation of rewards and punishments.

To evaluate risk-taking propensity following sleep deprivation, 

Killgore (2007) administered a battery of risk-taking questionnaires and 

a behavioral test of risk-taking when subjects were well rested, then following 1 night of sleep deprivation, and finally after a 12-hour night of 

recovery sleep. The study found that relative to well-rested and postrecovery sleep periods, subjects who were awake for 1 night expressed 

a reduced willingness to engage in high-risk, sensation-seeking activities. Similarly, when the sleep-deprived subjects had to repeatedly press 

a response key to engage in a risky task to earn money, they tended 

to behave relatively conservatively, cashing in their winnings well before the task became risky. The common element among the tasks and 

questionnaires in that battery was the requirement for expending energy and putting forth effort to engage in the risky behavior. These findings, together with the preceding work described earlier, suggest that 

the judgment and decisionmaking processes involved in assessing risk 

appear to be impaired by sleep deprivation, along with the energy and 

motivation to act on those judgments. While speculative, it seems likely 

that the fatigue that normally accompanies sleep loss may actually provide a modest level of protection against the tendency to act on the poor 
72 THE 71F ADVANTAGE

judgment that occurs with inadequate sleep. This may have implications for the use of stimulants such as caffeine to reduce fatigue in sleepdeprived Soldiers. Specifically, if stimulants increase the propensity to 

take risks but do not equally restore the capacity to judge their appropriateness, poor decisions with grave consequences could result.

Effects of Caffeine

Caffeine is the most frequently used stimulant in the world and 

is routinely taken by individuals to sustain alertness and concentration during prolonged wakefulness (Fredholm, Battig, Holmen, Nehlig, 

and Zvartau, 1999). The alerting effects of caffeine are well documented, and its performance-enhancing effects include temporary improvements in alertness, psychomotor vigilance, subjective sleepiness, and 

mood (Childs and de Wit, 2008; Penetar, McCann, Thorne, Kamimori, 

Galinski, Sing et al., 1993; Wesensten et al., 2005). The alerting properties of caffeine have proven value under conditions of sustained military 

operations by enhancing Soldier marksmanship, alertness, and physical fitness performance (McLellan, Kamimori, Bell, Smith, Johnson, 

and Belenky, 2005; McLellan, Kamimori, Voss, Bell, Cole, and Johnson, 2005). Some research shows, however, that caffeine can enhance 

the speed at which a Soldier can engage a target but may not improve 

shooting accuracy (Gillingham, Keefe, and Tikuisis, 2004; Tikuisis, 

Keefe, McLellan, and Kamimori, 2004). The ability to respond quickly and to decisively engage a target with lethal firepower is important 

to military success. It is of even greater importance, however, to ensure 

that the decision to engage lethal force is the most appropriate option 

for the situation and that the correct target has been selected. These are 

matters of judgment and decisionmaking. While the ability of a sleepdeprived Soldier to remain alert and rapidly engage a target appears to 

be enhanced by caffeine, it remains uncertain whether caffeine also facilitates the judgment and decisionmaking processes of sleep-deprived 

Soldiers to a commensurate level.

Presently, there are very few available studies addressing whether caffeine affects judgment and decisionmaking capabilities in sleepdeprived individuals. One study recently evaluated the effectiveness of 

repeated doses of caffeine on the emotional decisionmaking of Soldiers 

on the IGT after 51 and 75 hours of sleep deprivation (Killgore, Lipizzi 

et al., 2007). In that study, Soldiers were administered the IGT at rested 

baseline and again after 2 and 3 nights without sleep. Half of the Soldiers 
WARFIGHTER JUDGMENT DURING PROLONGED WAKEFULNESS 73

were given four doses of caffeinated gum (200 milligrams [mg] every 2 

hours for a total of 800 mg) between 1:00 a.m. and 7:00 a.m., while the 

other half received an identical placebo gum over the same schedule. 

The IGT was administered at 10:00 a.m. each session (3 hours after the 

last dose). The results of that study clearly showed that caffeine did not 

provide any significant advantage over placebo after 51 and 75 hours of 

sleep deprivation. Specifically, both groups showed similar patterns of 

degraded ability to make advantageous decisions. Instead, both groups 

tended to make riskier choices than they had when rested, similar to the 

findings of our previous study and suggesting that caffeine, in the dosing schedule used, was essentially ineffective at restoring emotion-based 

decisionmaking during sleep deprivation. 

The effects of sleep deprivation have been examined on other aspects of judgment as well. In another study, we evaluated whether sleepdeprived subjects were able to accurately judge the humorous content 

of verbal statements and visual images (Killgore, McBride, Killgore, and 

Balkin, 2006). Humor appreciation, a highly developed cognitive-affective ability, was found to be significantly impaired following 2 nights 

without sleep and was not significantly altered by the administration of 

600 mg of caffeine 5.5 hours earlier. Because psychomotor vigilance was 

sustained relative to placebo at this same time period, it was concluded 

that although caffeine sustained alertness and vigilance, it had no significant effect on the judgment of humor. Similarly, in another report, we 

found that 600 mg of caffeine had no effect beyond placebo on the ability to estimate unknown quantities, distances, weights, and durations 

following 2 nights of sleep loss (Killgore, Muckle, Grugle, Killgore, and 

Balkin, forthcoming). Interestingly, one aspect of judgment during sleep 

deprivation that does appear to be improved by stimulant medications 

such as caffeine is the ability to make subtle discriminations regarding 

complex emotional blends in facial expressions (Huck, McBride, Kendall, Grugle, and Killgore, 2008). In that study, subjects viewed series 

of photographs of facial expressions, some of which were clear exemplars of specific emotions and others that were complex blends of two 

emotions created using computerized image morphing software. Sleep 

deprivation had no effect on the ability to identify the emotions in the 

simple expressions, but produced a dramatic impairment in the ability 

to accurately judge the dominant emotion in the blended expressions. 

This impairment was reversed by a 600 mg dose of caffeine given 2.3 

hours before the test. The effect was not specific to caffeine however, as 
74 THE 71F ADVANTAGE

other stimulants including dextroamphetamine (20 mg) and modafinil 

(400 mg) were equally effective at restoring that capacity.

Given the paucity of studies examining the effects of caffeine on 

judgment and decisionmaking during sleep deprivation, it is premature to draw firm conclusions. At present, however, the available evidence tentatively suggests that while caffeine is highly effective at restoring simple alertness and vigilance during prolonged wakefulness, it 

does not appear to provide commensurate restoration of a broad range 

of complex judgment and decisionmaking capabilities. Some aspects of 

judgment, such as complex discrimination of facial expressions of emotion, may be selectively enhanced, although it is not clear whether these 

effects might be due simply to the enhanced alertness provided by caffeine, which improved the ability of subjects to remain focused on a monotonous task, or to the neural enhancement of specific complex emotional judgment capacities. Clearly, further research is necessary to determine whether stimulants such as caffeine can be used to restore effective judgment and intuitive decisionmaking abilities in Soldiers during 

periods of prolonged wakefulness.

Conclusion

The social, emotional, and mental requirements of warfare are 

constantly changing. To optimize performance under these stresses, 

Soldiers must possess sound judgment and the ability to utilize intuitive decisionmaking skills under fire, capacities that often involve the 

integration of emotion and cognition and are mediated, to a large extent, by specific regions of the prefrontal cortex. The quality of judgments and decisions that emerge at a critical moment will depend on 

the neural integrity of these brain structures and the types of emotionally relevant training and experiences that have repeatedly molded their 

interconnections. A growing body of research suggests, however, that 

these critical capacities and the brain regions that mediate them are significantly degraded during periods of prolonged wakefulness. Without 

adequate sleep, Soldiers are prone to lose sight of long-term goals in favor of short-term benefits, are more likely to waver in their moral judgments and show indecisiveness during emotionally charged situations, 

and may demonstrate changes in their normal level of empathy, social 

awareness, and tolerance for risk and ambiguity. These decrements impair warfighter decisionmaking capabilities. Moreover, limited evidence 

to date suggests that these decrements in judgment and decisionmaking 
WARFIGHTER JUDGMENT DURING PROLONGED WAKEFULNESS 75

capacities may not be fully restored by commonly used stimulants such 

as caffeine. Thus, it is important for military leaders to understand the 

profoundly degrading effects that sleep loss can have on Soldier readiness and performance and make every effort to provide their Soldiers 

with adequate opportunities for sleep.

References

Adam, M., Retey, J.V., Khatami, R., and Landolt, H.P. (2006). Age-related changes in the time 

course of vigilant attention during 40 hours without sleep in men. Sleep 29 (1), 55–57.

Bar-On, R., Tranel, D., Denburg, N.L., and Bechara, A. (2003). Exploring the neurological substrate of emotional and social intelligence. Brain 126 (Pt. 8), 1790–1800.

Bechara, A., Damasio, A.R., Damasio, H., and Anderson, S.W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 50 (1–3), 7–15.

Bechara, A., Damasio, H., Damasio, A.R., and Lee, G.P. (1999). Different contributions of the 

human amygdala and ventromedial prefrontal cortex to decisionmaking. Journal of Neuroscience 19 (13), 5473–5481.

Bechara, A., Damasio, H., Tranel, D., and Damasio, A.R. (1997). Deciding advantageously before 

knowing the advantageous strategy. Science 275 (5304), 1293–1295.

Bechara, A., Tranel, D., and Damasio, H. (2000). Characterization of the decisionmaking deficit 

of patients with ventromedial prefrontal cortex lesions. Brain 123 (pt. 11), 2189–2202.

Bierman, D.J., Destrebecqz, A., and Cleeremans, A. (2005). Intuitive decisionmaking in complex 

situations: Somatic markers in an artificial grammar learning task. Cognitive Affective 

and Behavioral Neuroscience 5 (3), 297–305.

Childs, E., and de Wit, H. (2008). Enhanced mood and psychomotor performance by a caffeinecontaining energy capsule in fatigued individuals. Experimental and Clinical Psychopharmacology 16 (1), 13–21.

Damasio, A.R. (1994). Descartes’ error: Emotion, reason and the human brain. New York: Grosset/

Putnam.

Dinges, D.F., Pack, F., Williams, K., Gillen, K.A., Powell, J.W., Ott, G.E., Aptowicz, C., and Pack, A.I. 

(1997). Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance 

decrements during a week of sleep restricted to 4–5 hours per night. Sleep 20 (4), 267–277.

Fredholm, B.B., Battig, K., Holmen, J., Nehlig, A., and Zvartau, E.E. (1999). Actions of caffeine in 

the brain with special reference to factors that contribute to its widespread use. Pharmacological Reviews 51 (1), 83–133.

Gillingham, R.L., Keefe, A.A., and Tikuisis, P. (2004). Acute caffeine intake before and after fatiguing exercise improves target shooting engagement time. Aviation, Space, and Environmental Medicine 75 (10), 865–871.

Glenville, M., Broughton, R., Wing, A.M., and Wilkinson, R.T. (1978). Effects of sleep deprivation on short duration performance measures compared to the Wilkinson auditory 

vigilance task. Sleep 1 (2), 169–176.

Greene, J.D., Sommerville, R.B., Nystrom, L.E., Darley, J.M., and Cohen, J.D. (2001). An FMRI investigation of emotional engagement in moral judgment. Science 293 (5537), 2105–2108.

Harrison, Y., and Horne, J.A. (1998). Sleep loss impairs short and novel language tasks having a 

prefrontal focus. Journal of Sleep Research 7 (2), 95–100.

Hayashi, A.M. (2001). When to trust your gut. Harvard Business Review 79 (2), 58–65, 155.

Horne, J.A. (1988). Sleep loss and “divergent” thinking ability. Sleep 11 (6), 528–536.

Horne, J.A., Anderson, N.R., and Wilkinson, R.T. (1983). Effects of sleep deprivation on signal 

detection measures of vigilance: Implications for sleep function. Sleep 6 (4), 347–358.
76 THE 71F ADVANTAGE

Huck, N.O., McBride, S.A., Kendall, A.P., Grugle, N.L., and Killgore, W.D. (2008). The effects of 

modafinil, caffeine, and dextroamphetamine on judgments of simple versus complex 

emotional expressions following sleep deprivation. International Journal of Neuroscience

118 (4), 487–502.

Kahn-Greene, E.T., Killgore, D.B., Kamimori, G.H., Balkin, T.J., and Killgore, W.D.S. (2007). The 

effects of sleep deprivation on symptoms of psychopathology in healthy adults. Sleep 

Medicine 8 (3), 215–221.

Kahn-Greene, E.T., Lipizzi, E.L., Conrad, A.K., Kamimori, G.H., and Killgore, W.D.S. (2006). 

Sleep deprivation adversely affects interpersonal responses to frustration. Personality 

and Individual Differences 41, 1433–1443.

Killgore, W.D.S. (2007). Effects of sleep deprivation and morningness-eveningness traits on risktaking. Psychological Reports 100 (2), 613–626.

Killgore, W.D.S., Balkin, T.J., and Wesensten, N.J. (2006). Impaired decisionmaking following 49 

hours of sleep deprivation. Journal of Sleep Research 15, 7–13.

Killgore, W.D.S., Kahn-Greene, E.T., Lipizzi, E.L., Newman, R.A., Kamimori, G.H., and Balkin, 

T.J. (2008). Sleep deprivation reduces perceived emotional intelligence and constructive 

thinking skills. Sleep Medicine 9 (5), 517–526.

Killgore, W.D.S., Killgore, D.B., Day, L.M., Li, C., Kamimori, G.H., and Balkin, T.J. (2007). The 

effects of 53 hours of sleep deprivation on moral judgment. Sleep 30 (3), 345–352.

Killgore, W.D.S., Lipizzi, E.L., Kamimori, G.H., and Balkin, T.J. (2007). Caffeine effects on risky 

decisionmaking after 75 hours of sleep deprivation. Aviation, Space, and Environmental 

Medicine 78 (10), 957–962.

Killgore, W.D.S., McBride, S.A., Killgore, D.B., and Balkin, T.J. (2006). The effects of caffeine, 

dextroamphetamine, and modafinil on humor appreciation during sleep deprivation. 

Sleep 29 (6), 841–847.

Killgore, W.D.S., Muckle, A.E., Grugle, N.L., Killgore, D.B., and Balkin, T.J. (forthcoming). Sex 

differences in cognitive estimation during sleep deprivation: Effects of stimulant countermeasures. International Journal of Neuroscience.

Klein, G. (1998). Sources of power. Cambridge, MA: MIT Press.

Lieberman, H.R., Bathalon, G.P., Falco, C.M., Kramer, F.M., Morgan, C.A., and Niro, P. (2005). 

Severe decrements in cognition function and mood induced by sleep loss, heat, dehydration, and undernutrition during simulated combat. Biological Psychiatry 57 (4), 422–429.

Lieberman, H.R., Bathalon, G.P., Falco, C.M., Morgan, C.A., Niro, P.J., and Tharion, W.J. (2005). 

The fog of war: Decrements in cognitive performance and mood associated with combat-like stress. Aviation, Space, and Environmental Medicine, 76 (7 Suppl), C7–14.

Linde, L., and Bergstrom, M. (1992). The effect of one night without sleep on problem-solving 

and immediate recall. Psychological Research 54 (2), 127–136.

London, E.D., Ernst, M., Grant, S., Bonson, K., and Weinstein, A. (2000). Orbitofrontal cortex 

and human drug abuse: Functional imaging. Cerebral Cortex 10 (3), 334–342.

McKenna, B.S., Dickinson, D.L., Orff, H.J., and Drummond, S.P. (2007). The effects of one night 

of sleep deprivation on known-risk and ambiguous-risk decisions. Journal of Sleep Research 16 (3), 245–252.

McLellan, T.M., Kamimori, G.H., Bell, D.G., Smith, I.F., Johnson, D., and Belenky, G. (2005). Caffeine maintains vigilance and marksmanship in simulated urban operations with sleep 

deprivation. Aviation, Space, and Environmental Medicine 76 (1), 39–45.

McLellan, T.M., Kamimori, G.H., Voss, D.M., Bell, D.G., Cole, K.G., and Johnson, D. (2005). 

Caffeine maintains vigilance and improves run times during night operations for Special 

Forces. Aviation, Space, and Environmental Medicine 76 (7), 647–654.

Nilsson, J.P., Soderstrom, M., Karlsson, A.U., Lekander, M., Akerstedt, T., Lindroth, N.E., and 

Axelsson, J. (2005). Less effective executive functioning after one night’s sleep deprivation. Journal of Sleep Research 14 (1), 1–6.
WARFIGHTER JUDGMENT DURING PROLONGED WAKEFULNESS 77

Orasanu, J. (2005). Crew collaboration in space: A naturalistic decisionmaking perspective. Aviation, Space, and Environmental Medicine 76 (6 Suppl), B154–163.

Penetar, D., McCann, U., Thorne, D., Kamimori, G., Galinski, C., Sing, H., Thomas, M., and 

Belenky, G. (1993). Caffeine reversal of sleep deprivation effects on alertness and mood. 

Psychopharmacology Series-Berlin 112 (2–3), 359–365.

Salovey, P., and Mayer, J.D. (1990). Emotional intelligence. Imagination, Cognition, and Personality 9, 185–211.

Scott, J.P., McNaughton, L.R., and Polman, R.C. (2006). Effects of sleep deprivation and exercise 

on cognitive, motor performance and mood. Physiology and Behavior 87 (2), 396–408.

Slovic, P., Finucane, M.L., Peters, E., and MacGregor, D.G. (2004). Risk as analysis and risk as 

feelings: Some thoughts about affect, reason, risk, and rationality. Risk Analysis 24 (2), 

311–322.

Thomas, M., Sing, H., Belenky, G., Holcomb, H., Mayberg, H., Dannals, R. et al. (2000). Neural 

basis of alertness and cognitive performance impairments during sleepiness. I. Effects 

of 24 h of sleep deprivation on waking human regional brain activity. Journal of Sleep 

Research 9 (4), 335–352.

Tikuisis, P., Keefe, A.A., McLellan, T.M., and Kamimori, G. (2004). Caffeine restores engagement 

speed but not shooting precision following 22 h of active wakefulness. Aviation, Space, 

and Environmental Medicine 75 (9), 771–776.

Turnbull, O.H., Evans, C.E., Bunce, A., Carzolio, B., and O’Connor, J. (2005). Emotion-based 

learning and central executive resources: An investigation of intuition and the Iowa 

Gambling Task. Brain and Cognition 57 (3), 244–247.

Venkatraman, V., Chuah, Y.M., Huettel, S.A., and Chee, M.W. (2007). Sleep deprivation elevates 

expectation of gains and attenuates response to losses following risky decisions. Sleep 30 

(5), 603–609.

Wesensten, N.J., Belenky, G., Thorne, D.R., Kautz, M.A., and Balkin, T.J. (2004). Modafinil vs. 

caffeine: Effects on fatigue during sleep deprivation. Aviation, Space, and Environmental 

Medicine 75 (6), 520–525.

Wesensten, N.J., Killgore, W.D.S., and Balkin, T.J. (2005). Performance and alertness effects of 

caffeine, dextroamphetamine, and modafinil during sleep deprivation. Journal of Sleep 

Research 14, 255–266.

Wilson, K.A., Salas, E., Priest, H.A., and Andrews, D. (2007). Errors in the heat of battle: Taking 

a closer look at shared cognition breakdowns through teamwork. Human Factors 49 (2), 

243–256.

Wimmer, F., Hoffmann, R.F., Bonato, R.A., and Moffitt, A.R. (1992). The effects of sleep deprivation on divergent thinking and attention processes. Journal of Sleep Research 1 (4), 

223–230.

Yoo, S.S., Gujar, N., Hu, P., Jolesz, F.A., and Walker, M.P. (2007). The human emotional brain 

without sleep: A prefrontal amygdala disconnect. Current Biology 17 (20), R877–878.

Chapter 4

Advances in Measuring Higher Order 

Cognitive Performance in Warfighters 

under Environmental Stress

Gina E. Adam

Maintaining a high level of both physical and cognitive performance in the face of environmental and operational stressors has long 

been a challenge for military forces. These stressors include exposure to 

heat, cold, and high altitude as well as sleep deprivation and the potential for inadequate hydration and nutrition. In addition to these physical stressors, military operations impose increasing cognitive demands 

on warfighters. These stressors and challenges are neither new nor unknown. In fact, researchers have been studying the performance of 

Servicemembers for years and have often looked to the operational environment to provide a framework for research questions. This chapter provides an overview of the assessment of cognitive performance of 

military personnel, chronicling both the changes in the cognitive abilities required for successful operations and the research adaptations that 

have been made to assess the relevant cognitive concepts. While this 

topic is quite broad, the scope of this chapter is focused on work that 

has been conducted within the Army Medical Research and Materiel 

Command laboratories. Furthermore, the review provided here covers 

recent investigations that utilize computerized tests and performance 

metrics designed to assess the effects of environmental and operational stressors such as altitude, high workload, and caloric deprivation on 

multiple aspects of cognitive performance. 

The cognitive performance of warfighters has been extensively studied over the years, often prompted by the observation of performance declines in conjunction with the cognitive demands of warfare. One early instance of anecdotal reports leading to scientific study 

was the observation of vigilance decrements in radar observers during 

World War II that led to Mackworth’s (1948) investigation of this performance decline. By presenting brief and barely detectable signals, Mackworth demonstrated that sustained attention deteriorates over time. 

79
80 THE 71F ADVANTAGE

Additional research has confirmed these early findings and shown that 

performance on vigilance tasks can be influenced by many factors, such 

as the modality of sensory input, signal salience, predictability or pace 

of the signal, the context or background within which critical cues are 

embedded, and the complexity of the vigilance task itself (Warm and 

Berch, 1985; Warm, Dember, and Hancock, 1996).

Scientists at the Army Medical Research and Materiel Command 

(MRMC) laboratories have continued this tradition of observing cognitive patterns of military personnel and studying cognitive performance 

under controlled conditions. Vigilance performance has frequently been 

studied with the use of a sentry duty paradigm showing that target detection times deteriorate over a 3-hour sentry duty vigil, with impairments 

clearly evident after 60 minutes (Johnson and Merullo, 1996; McBride, 

Johnson, Merullo, and Bartow, 2001). Decrements in sustained attention 

performance have also been studied through the use of a computerized 

vigilance task that requires participants to scan a computer screen for 

brief, intermittent stimuli (Scanning visual vigilance; Lieberman, Coffey, 

and Kobrick, 1998). Both methods of studying sustained attention have 

also demonstrated the efficacy of caffeine administration for sustaining vigilance performance as well as the exacerbation of vigilance decrements after the consumption of drugs with hypnotic properties, such 

as antihistamines (Johnson and McMenemy, 1989; Johnson and Merullo, 1996; Fine, Kobrick, Lieberman, Riley, Marlowe, and Tharion, 1994).

Yet warfighters are often beset by harsh environmental conditions 

and hydration and nutritional challenges. Recent work has examined 

sustained attention in conditions simulating operational stressors such 

as a double-blind study conducted with a Ranger battalion in garrison 

(Lieberman, Falco, and Slade, 2002a). In this study, Lieberman et al. observed significant impairments in vigilance performance during a brief 

(10-hour) simulated combat operation. Furthermore, cognitive performance in studies of operational stressors can be improved with carbohydrate supplementation (Lieberman et al., 2002a) and the administration of caffeine (Lieberman, Tharion, Shukitt-Hale, Speckman, and 

Tulley, 2002). Additionally, a laboratory study of the effects of cold and 

dehydration (Adam et al., 2008) found that performance on a sentry 

duty task deteriorated in the cold, but performance on a visual vigilance 

task was not impaired. These studies have shown that environmentally 

stressful conditions can have deleterious effects on the performance of 

tasks requiring vigilance.
ADVANCES IN MEASURING HIGHER ORDER COGNITIVE PERFORMANCE 81

Changing Cognitive Demands

While vigilance performance continues to be important to successful completion of operational duties by military personnel, the requirement to divide attention between two tasks has become increasingly prevalent. The observation of dual-task demands in military jobs 

led to new research questions, such as how well individuals could sustain attention to one task when an additional task was imposed. Using the sentry duty paradigm, McBride, Merullo, Johnson, Banderet, 

and Robinson (2007) manipulated both the rate of targets requiring a 

friend-foe decision and the need for participants to respond to a secondary auditory detection task. Results showed that the addition of a 

very simple auditory task to the primary task did not affect performance 

on any of the sentry duty measures. However, by moderately increasing 

the required work rate on the sentry duty task, performance improved 

as compared to when a low number of friend-foe judgments were required. Building on these results, Adam and Merullo (2006) increased 

the cognitive demands of this dual-task paradigm by increasing both 

the work rate of the sentry duty task and the cognitive demand of the 

auditory task. They again found that sentry duty performance declined 

when demands on this task were lower, especially when auditory task 

demands were high; but they also showed that performance on the auditory task declined when that task’s cognitive demands were highest.

However, the cognitive demands of the battlefield are ever-changing, and while sentry duty experiments can assess sustained attention 

and dual-task demands, many aspects of cognitive performance relevant 

to warfighters are not well represented in this paradigm. In fact, it can 

be argued that military operations impose increasingly complex cognitive demands and that personnel must perform their tasks while using 

equipment that is often capable of providing a vast amount of information. Furthermore, the current battlefield environment may include such 

challenges as small unit patrols, exposure to asymmetric warfare, and 

changing mission priorities. This transforming environment requires individual warfighters to monitor multiple sources of information, develop and maintain battlefield situation awareness, quickly make judgments 

and decisions to take appropriate action, and manage simultaneous tasks. 

In addition to these cognitive demands, the operational and environmental demands still impose stress on military personnel.

As the cognitive demands of the battlefield and its tools have increased, so has our ability to study performance in laboratory simulations 
82 THE 71F ADVANTAGE

of operational and environmental stress. In one of the earliest acknowledgments of the shift in cognitive demands affecting military personnel, 

Killgore introduced executive function tests to sleep deprivation studies, 

enabling the assessment of higher order cognitive functions such as risktaking, judgment, and decisionmaking (Killgore, Balkin, and Wesensten, 

2006; Killgore, Lipizzi, Kamimori, and Balkin, 2007). These studies showed 

that decisionmaking as measured by a computerized gambling task was 

impaired after 50 and 75 hours of sleep deprivation and not improved 

by the administration of caffeine. By utilizing these tasks in studies at 

the Walter Reed Army Institute of Research, Killgore et al. encouraged the 

use of these kinds of metrics in other studies conducted by MRMC laboratories, such as the Army Research Institute of Environmental Medicine. 

Assessing Executive Functions 

Although there are many ways to categorize higher order cognitive performance, sometimes called executive function, the types of 

cognitive functions considered here are the ability to consider alternatives, 

evaluate risk, make decisions, and plan tasks. Many computerized tests 

of these cognitive functions exist, but the ones discussed here are limited 

to tests recently used in MRMC laboratories to assess cognitive performance in various environmental and operational stress conditions. Each 

test is briefly introduced before current studies and results are discussed.

The Iowa Gambling Task (IGT) (Bechara, Damasio, Tranel, and 

Damasio, 1997; Bechara, Damasio, Damasio, and Lee, 1999) has been 

used extensively to study various samples of neurologic patients (for example, those with prefrontal cortex damage, Bechara et al., 1997; ventromedial prefrontal cortex and/or amygdala damage, Bechara et al., 

1999) and to examine brain region activation in normal volunteers 

(Bolla, Eldreth, Matochik, and Cadet, 2004; Ernst et al., 2002). The ability to adjust behavior to changing reward/punishment contingencies and 

to learn to identify risky choices is an important aspect of sound judgment and has been shown to be impaired in patients with lesions to the 

ventromedial prefrontal cortex (Bechara, Tranel, and Damasio, 2000). 

The IGT measures risk-taking and decisionmaking by having participants select from decks of cards that provide monetary rewards and 

punishments. Some decks are generally good (lower reward and lower punishment) and others are generally bad (higher reward but higher punishment). Evaluation of the participants’ deck choices provides a 

measure of decisionmaking patterns. 
ADVANCES IN MEASURING HIGHER ORDER COGNITIVE PERFORMANCE 83

Another measure of risk-taking and decisionmaking is the Balloon Analogue Risk Task (BART) (Lejuez et al., 2002), which asks individuals to fill a simulated balloon with air without letting it pop, thereby 

testing the individual’s willingness to take risks versus “playing it safe.” 

Points are given for maintaining the flow of air and keeping the volume of the balloon as full as possible: the more the balloon expands, the 

more points are earned. However, all points are lost if the balloon pops. 

Decisionmaking is often conducted within a social context. The 

ability to detect and understand others’ emotions is an important aspect 

in judgments and decisionmaking when interacting with others. Often, 

these judgments regarding others’ emotions are made by determining 

emotion by facial expressions. By utilizing pictures of faces with different emotions displayed, the Ekman 60 and Emotion Hexagon Tests provide computerized tests of emotion detection (Young, Perrett, Calder, 

Sprengelmeyer, and Ekman, 2002) that allow researchers to assess simple and complex emotion judgment. Both include a series of faces (pictures of people) to which the participant must respond with a judgment 

regarding the emotion displayed (happiness, surprise, fear, sadness, disgust, or anger). The Ekman 60, the simpler of the two tasks, includes 

pictures showing the prototypical expression of the emotion (for example, the face displaying happiness is shown smiling). The Emotion 

Hexagon contains stimuli created by combining the facial expressions of 

two emotions (such as happiness and disgust), which results in a more 

complex emotion judgment (Young et al., 2002). 

Finally, the ability to attend to multiple tasks and/or multiple 

sources of information is essential to the completion of many military jobs. The Synthetic Work Test (SynWin) (Elsmore, 1994) is a multitask performance assessment program that displays four simultaneous subtasks on one computer screen. This multitasking test provides 

a measure of participants’ ability to divide attention while maintaining 

performance across multiple tasks. The four screen quadrants constitute a memory task, an arithmetic task, and continuous visual monitoring and auditory detection tasks. In the memory task, the volunteer 

memorizes a set of six letters, which soon disappear. Then, single letters 

intermittently appear in that same quadrant and the volunteer must indicate whether or not that particular letter was in the original set. The 

arithmetic task consists of the addition of two 3- or 4-digit numbers and 

is self-paced. In the visual monitoring quadrant, participants prevent a 

moving pointer (in the form of a fuel gauge) from reaching “empty” by 
84 THE 71F ADVANTAGE

clicking in the gauge and returning the pointer to the “full” position. 

The auditory detection task requires the participant to correctly recognize a particular sound (high tone), and then respond with a mouse 

click on a button on the screen. Low tones do not require a response. 

Multitask performance ability is reflected in the overall score, but individual subtasks can be independently scored.

Recent Experiments and Results 

In addition to work by Killgore et al. (2006, 2007) with regard to 

decisionmaking and sleep deprivation, the tests outlined above have been 

included in several recent studies of environmental or operational stressors. One recent study was designed to evaluate the impact of caloric deprivation on cognitive performance. Military personnel engaged in field 

operations are often at risk of being unable to consume sufficient calories to offset their energy expenditure needs. While this study used a 

laboratory-based, low energy expenditure scenario, it also allowed for a 

double-blind, placebo-controlled energy intake paradigm whereby volunteers consumed hydrocolloid gel meals calibrated to provide either energy-balanced caloric needs or caloric deprivation. This study assessed a 

mixture of cognitive abilities over the 2-day period and showed that caloric deprivation did not negatively impact vigilance, four-choice reaction time, memory, or grammatical reasoning (Lieberman et al., 2008). 

Caloric Deprivation and Executive Functions

However, the effects of caloric deprivation on tests of risk-taking 

and decisionmaking showed a different pattern of results. Caloric deprivation did not affect decisionmaking and risk-taking performance as 

measured by the BART. Over time, participants made more responses, 

ultimately popping more balloons and also increasing the average number of pumps on redeemed balloons; but there were no changes in performance related to the diets consumed (Adam, Szelenyi, Killgore, and 

Lieberman, 2007). Conversely, results from performance on the IGT 

showed that decisionmaking changes were related to the diets consumed. 

When looking at the rate of good deck choices (net score, number of 

good deck choices minus bad deck choices), results showed that participants made significantly more good choices when in the caloric deprivation diet condition than in the two full-calorie diet conditions. Figure 

4–1 displays these results and shows that in the latter half of the task (approximately choices 50–100), responses made in the caloric deprivation 
ADVANCES IN MEASURING HIGHER ORDER COGNITIVE PERFORMANCE 85

condition are significantly different than those in the other meal conditions, reflecting a better risk-taking strategy (Adam et al., 2007).

Figure 4–1. Comparison of Iowa Gambling Task Performance when 

under Caloric Deprivation Diet versus Two Full-calorie 

Diets

Full Calorie Diet 1 Full Calorie Diet 2 Caloric Deprivation Diet

* = Significant differences between diets, p <.05

Net Scores for Each Block of 20 Trials

0 1 2 3 4 5 6

10

5

0

-5

-10

Net Score: Good Choices-Bad

-15

Net Scores for Each Block of 20 Trials

* *

This study is one of the first to demonstrate changes in higher order cognitive performance related to a military stressor other than sleep 

deprivation. It is important to note that at no time did the volunteers 

know which diet they were consuming, so there is no possibility that behavior changed as a result of participant knowledge about their nutritional status. Furthermore, in the caloric deprivation conditions, interstitial glucose levels remained stable across the entire test period, never 

falling below clinically acceptable levels (Lieberman et al., 2008). Thus, 

we examined nutritional changes and observed a different card-choice 

strategy within the calorie-deficient diet such that it appeared that 

volunteers consuming a very low calorie diet adopted a more conservative strategy than those consuming full-calorie diets without knowing 

their diet status. From these results, it is clear that real-world decisionmaking, judgments, and other higher order cognitive functions may be 

impacted by the nutritional stress of caloric deprivation.
86 THE 71F ADVANTAGE

Executive Functions at High Altitude

Another operational stressor that is common to deployed military 

personnel is the need to ascend rapidly to high altitudes, which generally results in reduced oxygenation of the blood (hypoxemia) and neurological changes such as increased cerebral blood flow and hypoxia in 

the hippocampal and limbic systems (Virués-Ortega, Buela-Casal, Garrido, and Alcázar, 2004; Finnoff, 2008). Additionally, performance is 

thought to decline in complex cognitive tasks more often than simple 

tasks (Banderet and Shukitt-Hale, 2002). Due to the operational importance of high altitude environments, two recent projects have included 

assessments of higher order cognitive functions. One study evaluated 

multitask performance using the SynWin at sea level, moderate altitude 

(2,200 meters [m]), and high altitude (4,300 m, both simulated and actual). This multitask performance assessment was part of a larger study 

investigating the effects of staging at a moderate altitude as an intervention for the deleterious effects of high altitude, and allowed for the first 

known evaluation of multitask ability at high altitude. After a training 

period, participants engaged in a full day of tests at sea level, a day of 

testing at simulated high altitude (preacclimatization), a 6-day stay at 

moderate altitude with retraining (acclimatization period), and a final 

assessment period at high altitude (postacclimatization).

While this study produced a wealth of data regarding the multitask 

assessment and performance on the individual subtasks, initial analyses concentrated on evaluating multitask performance at sea level and 

high altitude, both pre- and postacclimatization. Adam, Fulco, and 

Muza (2008) recently presented results showing that multitask performance declined at high altitude as compared to sea level (a 7 percent 

decrease in performance) but that this decrement in performance was 

absent at high altitude after an intermediate staging period at moderate altitude (see figure 4–2). Individual task results showed that auditory score performance was higher at sea level than high altitude at 

preacclimatization (18 percent decline in performance), but there were 

no differences in the other subtasks of the SynWin at either of the high 

altitude time points relative to sea level performance. Additionally, 

multitask performance during the moderate altitude staging period was 

not different from either sea level or high altitude performance, indicating a stable level of performance that reflects a positive effect of acclimatization due to staging. In fact, other measures from this study provided 
ADVANCES IN MEASURING HIGHER ORDER COGNITIVE PERFORMANCE 87

evidence of acclimatization, such as the decreased incidence of acute 

mountain sickness and increased oxygenation of the blood at high altitude after acclimatization as compared to the preacclimatization high 

altitude assessment period.

Figure 4–2. Overall Task Performance on SynWin

Sea Level Preacclimatization Postacclimatization

* = Significant difference between sea level and preacclimatization performance, p <.05

SynWin at Sea Level and High Altitude Pre- and Postacclimatization

2400

2200

2000

1800

1600

1400

Overall Score

Condition

*

The results of this study are the first indication that multitask performance is negatively impacted by exposure to high altitude while unacclimatized. Moreover, the study was the first to demonstrate the importance of a moderate altitude staging intervention. A second study 

has recently furthered these results. It expanded the breadth of executive functions studied, again utilizing sea level and high altitude (4,300 

m, simulated) and incorporating not only the SynWin, but also the IGT, 

Ekman 60, and Emotion Hexagon tests. Data from the study will provide a thorough overview of the impact of high altitude exposure on 

multitasking, judgments, risk-taking, and decisionmaking. The pattern 

of results obtained will greatly advance our understanding of complex 

cognitive performance in conditions of environmental stress.

Conclusion

As we have seen from recent combat operations, exposure of 

warfighters to environments with extremes of temperature and altitude 
88 THE 71F ADVANTAGE

is not only likely but commonplace. Likewise, high operational tempos, 

the need for sustained and continuous operations, and the challenge of 

providing sufficient food and water will continue to plague any fighting 

force. Recent research has shown that decisionmaking, risk-taking, and 

multitask ability are affected by sleep deprivation, caloric deprivation, 

and exposure to high altitude. Thus, the operational and environmental 

stressors on today’s battlefield are important to understanding cognitive 

performance by military personnel.

MRMC laboratories have a strong history in the assessment of 

the cognitive demands of warfighters and the translation of that understanding to laboratory studies of these cognitive functions. The recent 

adoption of various computer-based tests of risk-taking, judgment, and 

decisionmaking will help these laboratories keep pace with the everincreasing cognitive demands on today’s military personnel in environmentally and operationally stressful conditions.

Future studies designed to evaluate the performance effects of operational or environmental stressors should incorporate as many tests 

of cognitive function as possible. From the results presented above, it 

is clear that more cognitively complex tasks may be more susceptible to 

the negative effects of stressors than simpler tasks. It is understood that 

cognitive demands on warriors may be multiple, complex, and dynamic, and future studies should attempt to capture this dynamism. What 

has not been explicitly studied is how some of these higher order cognitive functions affect each other. For example, one open question is: 

What happens to decisionmaking ability when an individual is already 

cognitively loaded by handling multiple other tasks or sources of information? It may be that an individual reduces the number of tasks attended while making the decision or that the quality of decisionmaking 

suffers due to attention paid to the other simultaneous tasks. Answering 

such questions is of paramount importance, and future work should account for these dynamic cognitive demands and assess the effects of environmental stressors on performance accordingly.

Psychologists should continue to study the cognitive performance of military members in all conditions, including environmental or operational stress. These researchers should keep an eye on the 

military operational environment to fully understand the ways that 

cognitive demands will change for military personnel. Finally, creative 

studies of higher order cognitive function should be designed to better understand how performance in different cognitive domains may 
ADVANCES IN MEASURING HIGHER ORDER COGNITIVE PERFORMANCE 89

change in the face of multiple stressors, as well as how individuals develop increased abilities in these domains with time and experience. 

Acknowledgments

The research presented here is the result of several collaborative 

efforts between the author and other investigators at the Army Research 

Institute of Environmental Medicine. For these collaborations, the author is thankful to Harris N. Lieberman, Ph.D., Steve R. Muza, Ph.D., 

Juli Jones, Ph.D., and Chuck S. Fulco, Ph.D.

The investigators have adhered to the policies for protection of 

human subjects as prescribed in Army Regulation 70–25 and USAMRMC Regulation 70–25, and the research was conducted in adherence 

with the provisions of 32 CFR Part 219.

References

Adam, G.E., Carter, R., Cheuvront, S., Merullo, D.J., Castellani, J.W., Lieberman, H.R., and Sawka, M.N. (2008). Hydration effects on cognitive performance during military tasks in 

temperate and cold environments. Physiology and Behavior 93, 748–756.

Adam, G.E., Fulco, C.S., and Muza, S.R. (2008). Multitask performance at sea level and high 

altitude. Proceedings of the 25th Army Science Conference.

Adam, G.E., and Merullo, D. (2006). Sentry duty performance is robust under high cognitive 

load. Proceedings of the 50th Annual Meeting of the Human Factors and Ergonomics Society.

Adam, G.E., Szelenyi, E., Killgore, W.D.S., and Lieberman, H.R. (2007). A double-blind study of 

two days of caloric deprivation: Effects on judgment and decisionmaking. Aerospace

Medical Association 78 th Annual Scientific Meeting, New Orleans, LA.

Banderet, L.E., and Shukitt-Hale, B. (2002). Cognitive performance, mood, and neurological 

status at high terrestrial elevation. In Lounsbury, D.E., Bellamy, R.F., and Zajtchuk, R. 

(eds.). Medical aspects of harsh environments. Washington, DC: Office of the Surgeon 

General, Borden Institute, 729–763. 

Bechara, A., Damasio, H., Tranel, D., and Damasio, A.R. (1997). Deciding advantageously before 

knowing the advantageous strategy. Science 275, 1293–1295.

Bechara, A., Damasio, H., Damasio, A.R., and Lee, G.P. (1999). Different contributions of the 

human amygdala and ventromedial prefrontal cortex to decisionmaking. The Journal of 

Neuroscience 19 (13), 5473–5481. 

Bechara, A., Tranel, D., and Damasio, H. (2000). Characterization of the decisionmaking deficit 

of patients with ventromedial prefrontal cortex lesions. Brain 123, 2189–2202.

Bolla, K.I., Eldreth, D.A., Matochik, J.A., and Cadet, J.L. (2004). Sex-related differences in a gambling task and its neurological correlates. Cerebral Cortex 14, 1226–1232.

Elsmore, T.F. (1994). SYNWORK1: A PC-based tool for assessment of performance in a simulated work environment. Behavior Research Methods, Instruments, and Computers 26, 

421–426.
90 THE 71F ADVANTAGE

Ernst, M., Bolla, K., Mouratidis, M., Contoreggi, C., Matochik, J.A., Kurian, V., Cadet, J.L., Kimes, 

A.S., and London, E.D. (2002). Decisionmaking in a risk-taking task: A PET study. Neuropsychopharmacology 26 (5), 682–691.

Fine, B.J., Kobrick, J.L., Lieberman, H.R., Riley, R.H., Marlowe, B., and Tharion, W.J. (1994). Effects of caffeine or diphenhydramine on visual vigilance. Psychopharmacology (Berlin) 

114, 233–238.

Finnoff, J.T. (2008). Environmental effects on brain function. Current Sports Medicine Reports 

7, 28–32.

Johnson, R.F., and McMenemy, D.J. (1989). Antihistamines and sentry duty: Effects of terfenadine and diphenhydramine on target detection and rifle marksmanship. Proceedings of 

the 1989 Medical Defense Bioscience Review, 823–826. Aberdeen Proving Ground, MD: 

U.S. Army Medical Research Institute of Chemical Defense.

Johnson, R.F., and Merullo, D.J. (1996). Effects of caffeine and gender on vigilance and marksmanship. Proceedings of the Human Factors Society 40 th Annual Meeting 40, 1217–1221.

Killgore, W.D.S., Balkin, T.J., and Wesensten, N.J. (2006). Impaired decisionmaking following 49 h 

of sleep deprivation. Journal of Sleep Research 15, 7–13.

Killgore, W.D.S., Lipizzi, E.L., Kamimori, G.H., and Balkin, T.J. (2007). Caffeine effects on risky 

decisionmaking after 75 hours of sleep deprivation. Aviation, Space, and Environmental 

Medicine 78 (10), 957–962.

Lejuez, C.W., Read, J.P., Kahler, C.W., Richards, J.B., Ramsey, S.E., Stuart, G.L. et al. (2002). Evaluation of a behavioral measure of risk taking: The balloon analogue risk task (BART). 

Journal of Experimental Psychology: Applied 8, 75–84.

Lieberman, H.R., Caruso, C.M., Niro, P.J., Adam, G.E., Kellogg, M.D., Nindl, B. et al. (2008). A 

double-blind, placebo-controlled test of 2 d of calorie deprivation: Effects on cognition, 

activity, sleep, and interstitial glucose concentrations. American Journal of Clinical Nutrition 88, 667–76.

Lieberman, H.R., Coffey, B., and Kobrick, J. (1998). A vigilance task sensitive to the effects of 

stimulants, hypnotics, and environmental stress: The scanning visual vigilance test. Behavior Research Methods, Instruments and Computers 30 (3), 416–422.

Lieberman, H.R., Falco, C.M., and Slade, S.S. (2002a). Carbohydrate administration during a day 

of sustained aerobic activity improves vigilance, as assessed by a novel ambulatory monitoring device, and mood. American Journal of Clinical Nutrition 76, 120–127.

Lieberman, H.R., Tharion, W.J., Shukitt-Hale, B., Speckman, K., and Tulley, R. (2002). Effects 

of caffeine, sleep loss, and stress on cognitive performance and mood during U.S. Navy 

SEAL training. Psychopharmacology 164, 250–261.

Mackworth, N.H. (1948). The breakdown of vigilance during prolonged visual search. Quarterly 

Journal of Experimental Psychology 1, 6–21.

McBride, S.A., Johnson, R.F., Merullo, D.J., and Bartow, R.E. (2001). Effects of intermittent stimuli 

on marksmanship and vigilance during simulated sentry duty. Technical Report T01–7, 

AD No. A390246. Natick, MA: U.S. Army Research Institute of Environmental Medicine.

McBride, S.A., Merullo, D.J., Johnson, R.F., Banderet, L.E., and Robinson, R.T. (2007). Performance during a 3-hour simulated sentry duty task under varied work rates and secondary task demands. Military Psychology 19 (2), 103–117.

Virués-Ortega, J., Buela-Casal, G., Garrido, E., and Alcázar, B. (2004). Neuropsychological functioning associated with high-altitude exposure. Neuropsychology Review 14, 197–224.

Warm, J.S., and Berch, D.B. (1985). Sustained attention in the mentally retarded: The vigilance 

paradigm. In Ellis, N.R., and Bray, N.W. (eds.). International review of research in mental 

retardation, Volume 13, 1–41. Orlando, FL: Academic Press.

Warm, J.S., Dember, W.N., and Hancock, P.A. (1996). Vigilance and workload in automated systems. In Parasuraman, R., and Mouloua, M. (eds.). Automation and human performance: 

Theory and applications (183–200). Hillsdale, NJ: Erlbaum.

Young, A.W., Perrett, D., Calder, A., Sprengelmeyer, R., and Ekman, P. (2002). Facial expressions 

of emotion: Stimuli and test. Bury St. Edmunds, England: Thames Valley Test Co.
91

Chapter 5

Rapid Assessment of Eye Injuries on the 

Battlefield

Michael W. Boye

Soldiers’ eyes are their most important sensors on the modern battlefield. The risk of eye injuries from laser radiation and other causes has 

risen substantially with the increased use of several types of laser-based 

weapons systems. The absence of expertise and the unavailability of 

ophthalmic instruments in the field have rendered tools to screen or assess visual function deficits an essential and growing requirement. However, nearly all of the visual assessment methodologies currently available have been designed for use exclusively in the eye care clinic. The 

need for tools that provide much-needed visual information in the field 

of battle and other settings outside of the clinic was the impetus for developing the Aidman Vision Screener (AVS) (NSN 6549 NCM040061). 

The AVS is a black-and-white vision screening measure designed 

specifically to assist in triaging retinal abnormalities in settings lacking advanced vision assessment equipment. It has several advantages, 

including portability, ease of use, and nearly immediate assessment results. However, color vision and visual function under low contrast conditions are not currently assessed by the AVS. An effort is under way to 

develop an upgraded version that can assess these visual abilities, thus 

increasing sensitivity and accuracy. This chapter discusses the impetus 

for this developmental effort, the methods used to create the specialized 

eye charts for this tool, and the initial validation research for this new 

metric. This tool will enhance the capabilities of medical personnel to 

quickly triage and treat eye injuries occurring in battlefield settings, thus 

increasing the operational effectiveness of the U.S. military.

Introduction 

The use of directed energy systems (for example, lasers) on the 

modern battlefield has become prevalent. Lasers are widely used by 

armed forces for purposes such as range finding, target designation, 

weapon guidance, detection and safe detonation of landmines and 
92 THE 71F ADVANTAGE

bombs, detection of battlefield contaminants, slowdown of approaching vehicles, and as training devices. This has led to significant numbers 

of laser eye injuries (Harris, Lincoln, Amoroso, Stuck, and Sliney, 2003). 

Further, a new class of weapons recently has emerged in which one or 

more laser beams is used to damage electro-optical sensors. 

Most of these sensors operate within the visible and near-infrared 

(IR) spectrum and are vulnerable within the same region of the electromagnetic spectrum. The retina is the most susceptible organ of the 

eye to this class of weapons because the cornea and lens focus light on 

it, thus greatly magnifying the effect of a laser on this very small area. 

The deployment of lasers during combat that are designed to cause permanent blindness of unenhanced vision has been prohibited by international laws (Anderberg, Bring, and Wolbarsht, 1992; Doswald-Beck, 

1996). Nonetheless, it is probable that enemy forces will use these types 

of weapons in the future. This raises a new threat to the visual ability of 

military personnel and may potentially increase the number of casualties substantially. In light of the increased use of lasers on the battlefield 

and the heightened probability of their use by enemy forces, tools that 

can diagnose visual function have become an urgent need. The plethora of lasers on the modern battlefield, along with the documentation of 

several incidents and injuries involving lasers as tools of battle, provide 

the impetus for the development of an upgraded tool for assessing and 

triaging retinal injuries and abnormalities in field settings where no advanced ophthalmological equipment is available.

Lasers on the Modern Battlefield

The application of lasers in combat situations and settings has 

broadened considerably the last several years. Laser range finders and 

designators have been a part of military inventories for decades. More 

recently, laser illuminators, detection systems, and training devices have 

been added and are frequently used among military forces, thus increasing risks to the eyes. Many of these laser applications have been classified 

at dangerous levels, according to the Army Radiation Safety Program 

(Department of the Army, 1999), which utilizes the ANSI–Z136.1–2007 

laser standard (Laser Institute of America, 2007) to measure the safety 

of laser equipment. This standard is also well accepted among leaders in 

the field of laser bioeffects. 

The following is an overview of several types of laser systems being 

used on the modern battlefield. This review is far from exhaustive; many 
RAPID ASSESSMENT OF EYE INJURIES ON THE BATTLEFIELD 93

other laser systems are currently being used in battlefield settings. The 

purpose here is to provide a rudimentary understanding of the diversity 

of lasers and laser systems that may pose a threat to the modern Soldier 

and to demonstrate the need for a visual function screening tool that can 

be used in the absence of advanced ophthalmological equipment.

Range Finders

Laser range finders were the first military application of the laser as a tool of war (Neuenswander, 2001). A laser range finder is a laser 

light source that uses a laser beam to determine the distance to a reflective object. It has two basic parts, the laser and a laser receiver. After the 

laser is fired, the object it hits reflects the laser energy. Some of this dispersed energy is reflected back toward the laser and is detected by the 

receiver, which processes the speed that the laser energy took to travel 

to the target and return. Distance to the target is then computed based 

on the speed of the laser light and the duration of time it traveled. This 

process is completed quickly and accurately, and it substantially increases the probability that first shots will be hits for many military weapons. 

However, unintentional blindness can result from accidents involving 

laser range finders, and several retinal injuries have occurred because 

of these tools. Injuries involving these range finders can take place in 

a number of ways, including unintended use of the tools (for example, 

looking into the aperture where the beams exit), careless adjustment, 

and viewing an active range finder from a downrange position.

An example of an accident involving a laser range finder is provided by Manster, Stuck, and Brown (2004). A Soldier viewing the exit 

aperture of a laser range finder he was holding exposed his right eye 

to several powerful laser pulses in the near infrared range (that is, a 

1,064-nanometer [nm] wavelength). He reported no pain but noticed 

an immediate decrease in vision in that eye. A professional examination showed that blood that had leaked into the vitreous humor of his 

eye covered two retinal holes in the right fovea. Five days after the laser 

exposure, the eye contained three prominent lesions. Central scarring 

progressed, and visual acuity 18 months after the incident was 20/400 

(with his right eye, the Soldier could see at 20 feet what other people 

could see at 400).

Target Acquisition Designation Sight. The Target Acquisition Designation Sight (TADS) laser range finder was built specifically for the 

Apache AH–64A Longbow Attack Helicopter (Northrop Grumman, 
94 THE 71F ADVANTAGE

2008). It enables the Longbow Hellfire missile system and other laserguided munitions to precisely locate and lock onto targets. The TADS 

contains stabilized electro-optical sensors and a laser target designator 

(discussed below), along with the laser range finder. 

AH–1S laser range finder. The AH–1S laser range finder is a laser system mounted on the nose of the AH–1 Cobra helicopter. It can cause 

eye damage at distances of 6.3 kilometers (km) when viewed with no 

optical equipment and 40 km when viewed through magnifying optical instruments. 

The AH–1S laser system utilizes a neodymium-doped yttrium 

aluminum garnet laser, which operates at a wavelength of 1,064 nm. 

This wavelength is invisible to the human eye under most conditions, 

but is still within the range of wavelengths that can damage a human 

retina (approximately 400 to 1,400 nm). The AH–1S is a high-powered 

laser that can cause considerable damage, including permanent blindness, to the eyes of Soldiers.

Designators 

A laser designator is a laser range finder with enhanced targeting 

capabilities. In addition to the normal functions of a laser range finder, laser designators can be used to guide weapons to a target (Neuenswander, 2001). Laser designators provide targeting for laser-guided 

bombs, missiles, and other weaponry. To use a designator, the operator 

shines the laser on a target during the last seconds of the laser-guided 

weapon’s flight. The weapon is then guided by the laser energy reflected 

from the target.

Because laser designators are laser range finders, they pose all 

the same risks to personnel as laser range finders (laser exposure due 

to unintended use, careless adjustment, or viewing a projected laser 

beam from a downrange position). They also present further dangers 

to the eyes of Soldiers and others due to possible inaccurate illumination of the target area. When this happens, civilians and other nonparticipants in the battle may be unintentionally exposed to the laser beam 

of the designator. 

The AN/AAS–38A laser designator system is designed to be 

mounted to the F/A–18 Hornet fighter jet (Federation of American Scientists Military Analysis Network, 1998). It allows U.S. Navy and Marine Corps pilots to attack ground targets day or night with a precision 

strike capability, and enhances the Hornet’s night attack capability by 
RAPID ASSESSMENT OF EYE INJURIES ON THE BATTLEFIELD 95

providing real-time TV-like forward looking infrared (FLIR) thermal 

imagery on a cockpit display. The AN/AAS–38A FLIR can be fully integrated with other Hornet avionics, and data from the unit are used for 

the calculation of weapons release solutions. The system assists in the 

delivery of both laser-guided and conventional weapons.

Illuminators

Visible and infrared laser illuminators are used routinely in Operations Iraqi Freedom and Enduring Freedom to illuminate or point out 

targets (in much the same way a laser pointer is used in a lecture hall) or 

areas of interest in the area of operations. Visible illuminators have also 

been used effectively in an optical warning or deterrence mode to warn 

or discourage potential combatants from approaching fixed military assets such as the ends of convoys. Laser illuminators are mounted on vehicles and selected weapons systems, and thousands of handheld laser 

illuminators have been issued to Soldiers. 

Both visible light laser illuminators and infrared laser illuminators are present on the battlefield. Visible light laser illuminators generally operate at either red wavelengths (632 to 670 nm) or a green wavelength (532 nm). They are typically used to temporarily blind parties 

who are approaching a fixed point, such as an entry control point to 

a restricted area. These illuminators are generally used to send a visual warning and make it difficult for the parties to move closer. Infrared laser illuminators operate in the near infrared range (wavelengths 

of approximately 700 to 1,400 nm), which is invisible to the human eye 

except at the very short wavelength end of the range. Lasers operating 

within this wavelength, however, can be harmful to the human retina, 

depending on factors such as power and pulse length. Infrared laser illuminators are designed to be detected by weapons systems and by parties 

wearing night vision goggles. They are usually used for precise weapon 

aiming and target acquisition at long ranges. 

Green handheld optical surveillance and targeting system (GHOST).

The GHOST laser system is a day/night green laser system with a variety of applications. It combines four green lasers in a small package that 

can be rail mounted. When fitted with a scope, it adds an optical augmentation capability that can detect optical systems. The laser source 

for the GHOST is currently doubled neodymium: yttrium aluminum 

garnet lasing at 532 nm. The system also has multiple modes of operation. Models vary slightly, but generally speaking the GHOST includes 
96 THE 71F ADVANTAGE

a day, a night, and one or more strobe or pulse modes. In the day mode, 

all four of the lasers fire continually. In an earlier model of GHOST, the 

night mode was pulsed; in later models, two of the four lasers fire continually. Various combinations of strobe modes, varying by model, are 

generated with varied numbers of the lasers firing in pulses. 

Helios. The Helios laser system is also a day/night green laser system 

designed as a warning system for approaching parties. The Helios contains seven individual 532 nm lasers; each has a specified output of 70 

milliwatts. The lasers are diode pumped (with 808 nm) neodymium: 

yttrium vanadate crystal with a potassium titanium oxide phosphate 

crystal, which doubles the frequency resulting in a 532 nm wavelength. 

The seven lasers are configured in a circle with six lasers surrounding 

the seventh in the center. In the day mode, all seven lasers of the Helios 

are on, whereas only two of the lasers are on in the night mode.

Green laser-baton illuminator. The green laser-baton illuminator is a 

low powered diode pumped, solid-state green light (532 nm) handheld 

laser illuminator designed to induce glare and possibly flashblindedness, both of which are temporary effects. The eye hazard zone of this 

laser tool is only 1.4 meters. It is very safe outside of this zone because of 

a large beam divergence and long pulse duration. However, it can cause 

permanent eye damage if the laser beam is stared into at close range. 

Many of these illuminators have been issued to Soldiers.

Effects of Laser Exposure 

Exposure or even suspected exposure to a laser may have several adverse effects, including severe vision problems, skin burns, and 

psychological reactions. While skin is susceptible to laser damage, the 

greatest risk of damage is to the eye, because the human eye increases 

the irradiance or radiant exposure of laser light with parallel waves (that 

is, collimated laser light) at the retina. For visible and near-infrared laser exposure of the human eye, the radiant exposure at the retina can be 

100,000 times greater than that at the cornea or the skin surrounding 

the eye due to focusing or imaging by the eye. Laser emission is generally well collimated; that is, the diameter of the beam increases very little 

with distance (low divergence). Thus, the energy contained in the beam 

diminishes only slightly over great distances. When taken in combination, low divergence of a laser emission and the increased radiant exposure due to ocular focusing means that low-powered lasers, such as range 
RAPID ASSESSMENT OF EYE INJURIES ON THE BATTLEFIELD 97

finders, pose little hazard to the skin at short ranges, but pose significant eye hazards at tactical ranges. Optical instruments such as binoculars or day sights increase light-collecting capabilities, thereby increasing 

the radiant exposure. This increases the range at which eye injuries can 

occur. For visible lasers, this focusing results in seeing extremely bright 

light at distances that exceed anticipated eye injury ranges.

Injuries result when the energy from the laser is absorbed by various anatomical structures. The most vulnerable structure is the eye, but 

other structures such as the skin can also be affected. The wavelength of 

the laser radiation determines which structure absorbs the energy, and 

the power density of the laser determines the damage level.

The biological effects of laser radiation on the eyes vary with the 

laser’s wavelength, pulse duration, and intensity. The cornea and lens 

focus visible and near-infrared laser radiation onto the retina where the 

concentrated energy directly impacts the photoreceptor cell and supporting tissue. The cornea and lens absorb ultraviolet and mid- to farinfrared laser radiation. Alteration can occur in these tissues, but the 

retina will be spared.

The retina is the back inside of the eye where images are formed. 

During laser exposure of the retina, no image is formed and all energy 

is simply focused to a pinpoint less than 50 micrometers in diameter. A 

laser exposure occurring in the retinal periphery will have a minimal 

effect on normal vision functions, unless large portions of the retina 

are involved. A laser exposure in the central retina (called the macula, which includes the fovea) can cause serious visual impairment since 

that is the only part of the eye where high acuity and color vision occur.

Lower Level Effects 

At the lowest levels of laser energy, temporary changes in the ability to see can be produced without permanent damage to the retina. 

Continuous wave or repetitively pulsed visible wavelength lasers can 

produce veiling glare while the laser is on but disappear when the laser 

is off. The laser simply appears so bright that it is difficult to see anything else around it. At slightly higher energy, these same lasers can saturate the photoreceptor cells in the retina. This saturation results in afterimaging that fades after the laser is turned off. Only visible lasers will 

produce veiling glare and afterimages; near-infrared lasers will not produce these effects even though the laser energy reaches the photoreceptor cells. Note that these effects can also be caused by other bright light 
98 THE 71F ADVANTAGE

sources, such as searchlights, flares, and strobes. Further increases in 

laser energy levels result in irreversible retinal damage.

Longer term exposure to lower level laser radiation may cause 

small to significant deficits in color vision. A small amount of research 

evidence (Robbins and Zwick, 1980; Zwick, Bedell, and Bloom, 1974) 

shows that repeated exposure to lower level laser radiation (for example, 

a one millijoule Q-switched Ruby laser pulse) brought about fairly substantial color vision deficits that did not heal quickly with time. Color 

vision discrepancies induced by lower level laser exposure in this research were shown to exist 30 days and 6 months after exposure.

Ultraviolet and far-infrared radiation can injure the cornea, a 

condition that is painful and visually handicapping. At lower powers, 

this injury is primarily due to a photochemical reaction. A latency period of hours may exist between the time of exposure and the development of the corneal pathology. Minimal corneal lesions, which usually 

produce a decrement in visual performance, heal within a few days and 

generally result in a full recovery. More severe corneal lesions may scar.

Higher Level Effects

When the retina is exposed to a high-energy laser, the tissue is 

superheated and undergoes an explosive change of state, creating shock 

waves that mechanically disrupt the tissue and spread the area of damage. If more energy is introduced, the injured area will become larger. 

The mechanical force produced can puncture a hole through the retina 

and choroid, resulting in hemorrhaging and possibly leading to severe 

visual loss. The blood can collect beneath the photoreceptor cell layer 

of the retina, disturbing its contact with the retinal pigment epithelium 

and resulting in retinal detachment. A subretinal hemorrhage can result 

in the death of the photoreceptor cells, and a “spot” may form in the vision that is much larger and more disruptive to the person than the thermal burn or mechanical disruption. The blood may also move into the 

vitreous humor through the disrupted retina, where it may obstruct the 

passage of light through the eye. An extensive or centrally located hemorrhage can produce a significant loss of vision. Blood in the vitreous 

is absorbed very slowly, but in most cases it is absorbed. The visual impairment remains as long as the blood persists, but vision may improve 

to normal with absorption of the blood. Persistent vitreous hemorrhages may be removed by a complicated surgical technique called vitrectomy. This procedure may also return vision to “near normal” level if the 

underlying damage does not involve the central portion of the retina.
RAPID ASSESSMENT OF EYE INJURIES ON THE BATTLEFIELD 99

Laser injury to the retina may damage the conducting fibers (axons) of the retina, producing a visual field defect peripheral to the site of 

injury. Laser damage to the retinal/choroidal areas may produce brief, 

severe pain. A major long-term effect of laser retinal injury is a scarring 

process that may degrade vision for weeks or even months.

High-energy, far-infrared laser radiation is absorbed mainly by 

the cornea, producing immediate burns at all corneal layers. An infrared laser can produce a burn that results in immediate visual incapacitation and that may lead to corneal scarring. Very high energy can perforate the cornea; this perforation may lead to loss of the eye.

Psychological Effects

Psychological reactions to lasers and their effects can also be severe (DeVour, 1993; Fitzgerald, 1993; Nahin, 1977; Warren, 1993). The 

hazards of current laser range finders, target designators, and laser illuminators (from flash effects to blindness) risk substantial psychological effects. It is inevitable that some Soldiers will suffer laser injuries to 

their eyes. The reactions of the injured Soldiers and their comrades will 

depend on:

■ their response to the stress of a new, silent, futuristic weapon 

■ their training in and knowledge about laser weapons

■ the treatment they receive.

Laser injuries may be an especially stressful type of wound. Vision is one of our primary means of relating to the world around us, and 

the fact or prospect of being deprived of vision will be a source of strong 

fear. In the imagination of some Soldiers whose careers, activities, and 

self-image depend heavily on vision, blindness may rank high as a crippling wound that makes a person helpless and an object of pity. Yet bystanders accustomed to seeing external wounds of combat may be reluctant to accept a disabling injury that produces no outward evidence. 

Several aspects of the laser threat increase mental stress relative to 

that produced by other weapons. The fact that laser radiation travels at 

the speed of light along line-of-sight gives a new urgency to the saying, 

“If you can be seen, you can be hit.” This may produce the types of psychological stress reactions and inhibitions of combat initiative that have 

been described in response to sniper fire. However, unlike the sniper’s 

bullet, most lasers produce serious injury only to the extent that the 

target is looking at the laser source and/or through optical equipment. 
100 THE 71F ADVANTAGE

Because the danger is so specific, Soldiers may be especially inhibited 

from performing critical surveillance, target acquisition, and aiming 

tasks. This is especially likely if they have just seen their fellow Soldiers 

suffer the effects of lasers while performing their tasks. 

Laser training must provide the Soldier with the knowledge to 

protect himself (Department of the Army, 1990; Department of the 

Army, 1999; Laser Institute of America, 2007). He must be aware that 

protective equipment for certain laser frequencies is available and that 

additional protection is anticipated from ongoing research. Understanding lasers requires a certain amount of technical information. 

Now that lasers are widespread on the battlefield, many Soldiers are 

undoubtedly accustomed to their use. However, the Soldiers’ fear of 

laser injury may increase as the instance of such injuries increases. 

Flashes of blinking lights are now fairly common on the battlefield and 

often must be looked at carefully to determine if they should be engaged as targets. 

Calm, professional treatment at each echelon of medical care is 

mandatory following a laser injury, including reassurance that the injury is not life-threatening and that chances for some, if not total, recovery 

are good. The psychological effects of lasers could be enormous. It is imperative that secondary gain be minimized by prompt return to duty of 

those individuals with temporary flashblindness or noncritical (nonfoveal) burns of the retina without hemorrhage. If an error is to be made, 

it should be on the side of return to duty of Soldiers with questionable 

injuries. Medical management of stress reactions for patients suffering 

from real or imagined laser injuries is like stress management of other 

injuries. Care providers should repeat the reassurance that symptoms 

will improve with rest, nutrition, hygiene, and the expectancy of an early return to the Soldier’s unit. Army Field Manual 8–51 outlines specific 

combat stress control procedures.

Strategies need to be developed to reduce the psychological impact on Soldiers by the increase in lasers on the modern battlefield. As 

with individual or collective chemical protective equipment, the use 

of protective eyewear is not a simple solution that guarantees 100 percent safety. The leader and the individual Soldier must be trained to 

accept necessary risk to accomplish the mission in accordance with 

mission, enemy, terrain, troops available, time, and civilian considerations, taking into account the risk of laser injury from both enemy and 

friendly lasers.
RAPID ASSESSMENT OF EYE INJURIES ON THE BATTLEFIELD 101

Current Assessment Approaches

Effects of exposure to laser energy range from concern and anxiety about possible exposure to hemorrhaging and loss of vision or severe 

skin burns. All of these effects are detrimental to some degree. Once a 

Soldier’s eye has been exposed to directed energy, it is important to determine the extent to which tissue and visual function have been affected. The following section addresses many of the tools available to assess 

the physiology and functioning of the eyes. 

Ocular Observation and Imaging

Ophthalmoscopy. Ophthalmoscopy is a method of examining the vitreous and fundus in great detail through an ophthalmoscope (Stamper, 

1991). It is performed exclusively by the ophthalmologist and usually 

requires the pupils to be dilated with eyedrops to permit the viewing of 

a greater area of the retina and vitreous. Because pupillary dilation can 

alter the results of certain visual acuity and papillary tests, ophthalmoscopy is usually performed after these procedures. 

Although the ophthalmoscope is a simple tool, the conditions 

that it can uncover are diverse. Ophthalmoscopy is often used with patients complaining of headaches to identify problems such as swollen 

discs. Raised intracranial pressure and arterial hypertension, which can 

be symptoms of serious conditions in the body, can be detected using the 

ophthalmoscopic technique. Further, ophthalmologists and other ophthalmic professionals can regularly assess the ocular conditions of diabetics to prevent diabetic retinopathy or diabetes-related vision loss. They 

can also see “cupped” optic discs, which are often seen in glaucoma cases. 

The two main types of instruments used to perform ophthalmoscopic procedures are the direct and indirect ophthalmoscopes (Stamper, 1991). The direct ophthalmoscope is a hand-held tool with a handle, 

a concave mirror, a light source, and an eyepiece for the ophthalmic 

professional conducting the examination. The light-and-mirror system 

provides a narrow 15-times-magnified view of the fundus, and the light 

source is powered by rechargeable batteries located in the handle. The 

indirect ophthalmoscope is worn on the head of the ophthalmologist. 

The headset consists of a binocular viewing device and an adjustable 

lighting system wired to a transformer power source. The ophthalmologist holds one of a variety of magnifying lenses a few inches from the patient’s eye, and the ophthalmoscope headset provides both the lighting 
102 THE 71F ADVANTAGE

and the stereoscopic vision for the examination. Unlike the upright (direct) view provided by the direct ophthalmoscope, the view of the fundus as seen by the physician is inverted but provides a wider, two to four 

times magnified, field of view.

Fundus camera. The fundus camera is, in effect, a large ophthalmoscope 

that can produce color photographs of the retina (Stamper, 1991). It consists of an optical system to view the retina, a light/flash system for illumination, and a camera in back. To allow the vision professional to obtain the best pictures of the retina, eyes are usually dilated with eyedrops.

Optometrists, ophthalmologists, and trained medical professionals often use the fundus camera to diagnose a disease and monitor its 

progress, or for screening programs where the pictures can be analyzed 

later. A high level of skill is needed to properly operate the camera and 

interpret and use the information.

Fluorescein and indocyanine green angiography. Angiography is a diagnostic test used by ophthalmologists to photograph structures in the 

back of the eye and is especially useful in finding damage to the blood 

vessels that nourish the retina (VisionRX, 2005). The two types of angiography are fluorescein and indocyanine green (ICG). Both techniques 

use the fundus camera. Fluorescein angiography is used primarily to 

study blood circulation in and just beneath the surface of the retina, 

while ICG angiography is better for photographing the deeper choroidal vessels. 

The purpose of either type of angiography is to determine whether there are irregularities in the circulatory system of the retina. Several serious eye disorders, such as diabetic retinopathy, affect retinal circulation and are usually studied with the fluorescein procedure. Other 

problems, such as age-related macular degeneration, are caused by leakage from the deeper choroidal blood vessels. In these cases, the ICG 

procedure can provide additional information that may not be available 

through a fluorescein angiography. 

In both angiography procedures, a small amount of colored dye 

is injected into a vein in the arm where it travels through the circulatory 

system and into the vessels in the eye. The dye makes these vessels visible to a special camera that is used to take photographs used by the doctor to diagnose various eye disorders. 

Side effects from either procedure are minimal. The dye used 

in fluorescein angiography sometimes causes temporary, harmless 
RAPID ASSESSMENT OF EYE INJURIES ON THE BATTLEFIELD 103

discoloration of the skin and urine, and a few patients may feel slightly nauseated for a short time during the initial phase of the procedure. 

Allergic reactions to the ICG dye are rare. However, patients allergic to 

iodine or shellfish, or those with a history of liver disease, should advise 

their physician.

Optical coherence tomography. Optical coherence tomography (OCT) 

is a noninvasive, noncontact imaging technology that uses optical signal acquisition and processing to clearly image the structures of the retina. Using OCT, the anatomic layers within the retina can be differentiated and retinal thickness can be measured. OCT has been shown to be 

clinically useful for imaging selected macular diseases including macular holes, macular edema, age-related macular degeneration, central serous chorioretinopathy, epiretinal membranes, schisis cavities associated with optic disc pits, and retinal inflammatory diseases (New England 

Eye Center, 2008).

Scanning laser ophthalmoscopy. Scanning laser ophthalmoscopy (SLO) 

is a diagnostic imaging technique in which the fundus is illuminated by 

a narrow laser beam scanned horizontally and vertically over the surface 

of the retina (Nagpal and Banait, 2002). The timing of this procedure 

is designated to synchronize with a wide range of computer and video 

equipment. A detector captures the reflected light from the laser and the 

image of the fundus is viewed in real time on a monitor.

SLO has several major advantages over more traditional camera and imaging systems. First, pupillary dilatation is not mandatory 

because the technique can collect images even from a small aperture. 

There is less iridescence from the retinal surface, and the patient can 

tolerate the procedure better because it does not involve bright flashes. 

Further, the resolution provided by SLO is better as compared to conventional camera systems. Finally, the infrared wavelengths of the SLO 

can penetrate media opacities such as cataracts, corneal opacities, and 

hemorrhages and can thus provide useful information that some imaging systems, such as the fundus camera, cannot.

Measures of Vision Acuity 

Eye charts are a typical part of routine eye examinations. Several 

types of charts are available but almost all of them assess one and only 

one capability of the eye—visual acuity under high contrast conditions. 

For each of the charts, the general procedure is for patients to be placed 
104 THE 71F ADVANTAGE

at a specified distance from the chart and asked to read aloud the line 

of smallest letters they can distinguish.

Snellen chart. Most people have seen the traditional Snellen eye chart 

in school or community vision screening programs. It is printed with 11 

lines of block letters. The first line consists of one very large letter, which 

may be one of several letters (for example, E, A, or N). Rows below the 

first have increasing numbers of letters in decreasing size. The sizes of 

the letters are standardized so the letters in each row should be clearly 

legible at a designated distance to a person with normal vision. 

Despite its widespread use, several criticisms of the Snellen chart 

have been made. For example, subjects can memorize the chart either 

before or between tests. Also, there are fairly large and uneven jumps 

in acuity between the rows, and some of the letters are harder to distinguish than others (for example, C versus G, Q versus O). 

Landolt C chart. The characters on a Landolt C (or Landolt ring) eye 

chart are rings that have gaps, thus resembling the letter C. The gap can 

be at various positions—usually left, right, bottom, top, and the 45o

 positions in between. These rings are arranged on the chart in a manner similar to the letters of a Snellen chart, with large rings in the top row and 

rows below containing increasing numbers of rings that decrease in size. 

A primary advantage of the Landolt C chart, as compared to the 

Snellen chart, is that the rings are merely the same targets with the gap 

in different positions. Thus, none of the characters are harder to distinguish than others. Further, the Landolt C chart may be more difficult to 

memorize than the Snellen chart.

Measures of Contrast Sensitivity

Even if a Soldier’s visual acuity is sharp or considered normal for 

high contrast under high luminance conditions, his contrast sensitivity 

may be poor or compromised. Contrast sensitivity is the ability to visually perceive differences between an object and its background, to detect 

boundaries and slight changes in luminance at regions without distinct 

contours. If a Soldier has poor contrast sensitivity, his vision may be 

similar to viewing objects under twilight or foggy conditions. 

A number of measures have been developed to assess contrast sensitivity. Several of them, such as the Mars Letter Contrast Sensitivity Test 

and the Pelli-Robson Test, present the patient with a printed chart showing 

letters or symbols in a faint gray print rather than the usual sharp, 

black-on-white characters of standard charts. Other more technical 
RAPID ASSESSMENT OF EYE INJURIES ON THE BATTLEFIELD 105

assessments involve the presentation of graded patterns or letters on an 

oscilloscope screen, such as the VectorVision CSV–1000E.

Measures of Glare Sensitivity 

Glare occurs when light from a single bright source, such as the 

sun, an automobile headlight, or a light emitting diode, scatters across 

the entire visual field (Stamper, 1991). Such scattering often dazzles the 

sight and substantially reduces the quality of the image received by the 

retina. Laser dazzlers used on the battlefield are designed to produce this 

effect in greater or lesser degrees. Glare can also be quite painful. Glare 

sensitivity testing measures the extent to which a patient’s vision is degraded in the presence of a bright light. This allows a vision professional 

to determine whether glare sensitivity is contributing to a patient’s visual symptoms. Examples of glare sensitivity measures are the VectorVision CSV–1000HGT Halogen Glare Test and the Berkeley Glare Test.

Chromatic Assessment Tools 

Discrepancies in color vision are not usually disabling. However, 

they can hinder individuals from pursuing or excelling in certain specialized careers. Further, in some situations, such as when driving or attempting to identify dangerous stimuli, the loss of color vision can be 

life-threatening. Several assessment tools have been developed to evaluate color vision in clinical settings.

Ishihara Color Test. The Ishihara Color Test is especially designed to 

detect red-green color deficiencies. Each eye is tested separately. The 

test consists of a number of colored plates containing a circle of dots that 

have been randomized in size and color. Patients with normal color vision can easily detect numbers and figures made up of, and embedded 

in, the multicolored dots. Patients with color vision deficits cannot see, 

or have great difficulty seeing, them. Combinations of colors are used to 

identify the nature of the color vision deficit (Stamper, 1991).

Farnsworth-Munsell 100 Hue Test. The Farnsworth-Munsell 100 Hue 

Test assesses hue discrimination ability often used in vocational and 

diagnostic applications. This test consists of 4 trays of 85 total colored 

removable color reference caps (incremental hue variation) spanning 

the visible spectrum. Color vision abnormalities and aptitude are detected by the ability of the test subject to place the color caps in order of 

hue. The four sequences of hues are difficult to discern for those with 

color deficits.
106 THE 71F ADVANTAGE

Visual Field Tests 

A visual field examination tests the expanse and sensitivity of a 

patient’s noncentral (peripheral) vision, that is, the perception of light 

and objects surrounding the direct line of sight (Stamper, 1991). Defects 

in peripheral vision are often not as apparent to the patient as are central vision deficiencies and may go unnoticed. However, peripheral vision problems are often caused by diseases to the retina, optic nerve, or 

structures to the visual pathway in the brain. Some of these diseases can 

be life-threatening as well as vision-threatening. Early detection by a visual field examination allows treatment initiation that may stop further 

disease progression and prevent irreversible vision loss.

Two visual field screening measures, the confrontational field test 

and the Amsler Grid, are addressed here first and can be used to obtain 

a rapid nontechnical evaluation of the patient’s peripheral vision. The 

results of these tests may indicate the need for more advanced testing.

Confrontational field test. This test compares the boundaries of the 

patient’s visual field to those of the examiner, who is assumed to have 

normal vision. The patient, seated two to three feet away facing the examiner, closes one eye while the examiner closes the opposite eye (for 

example, the patient’s left eye and examiner’s right eye are closed). The 

examiner then moves his fingers in from the far visual periphery to the 

near periphery in four separate quadrants. If the patient does not see one 

or more of the examiner’s fingers at the same time as the examiner, the 

patient is assumed to have a reduced field of vision in the corresponding 

quadrant or quadrants and may be scheduled for further testing.

Amsler grid. The Amsler Grid assists the patient in reporting deficits in 

the central portion of his visual field. This measure contains a handheld 

card with a set of vertical and horizontal lines arranged in a grid pattern 

on either a black or white background with a dot in the center. Distortions in the patient’s visual field are generally seen as distortions in specific areas of the grid.

Static and kinetic perimetry. Both of these tests sample the field of vision in a clinical setting, and accomplish this by increasing the intensity of a stimulus to a known area of the retina until the stimulus is seen. 

Static perimetry uses a stationary target that can be changed in size, 

brightness, and position, whereas kinetic perimetry utilizes a moving test 

object of a predetermined size and brightness. Types of static perimetry 

include suprathreshold and threshold, and the Humphreys Field Analyzer 
RAPID ASSESSMENT OF EYE INJURIES ON THE BATTLEFIELD 107

II is a visual field assessment tool that uses static perimetry. There 

are many assessment tools that use kinetic perimetry, including the 

Tangent Screen Test, Goldmann Perimeter, Arc Perimeter, and Autoplot.

Other tools can evaluate most of the visual capabilities addressed 

in this chapter. However, those discussed here highlight an important 

truth concerning visual assessment. Except for a very few visual assessment procedures (such as the Confrontational Field Test and the Amsler 

Grid), these methods have been designed exclusively for clinical settings. The vast majority of visual measurement devices require special 

circumstances that can be provided and controlled in the clinic or laboratory. For example, the eye charts discussed above require standardized 

conditions of lighting and distance. The color vision assessment techniques addressed also require standardized lighting and would be difficult to complete outside of a quiet environment with few distractions. 

The fundus camera and varied types of equipment used for perimetry 

assessment are specifically designed for use in an optical clinic. Almost 

none of these procedures or tools can provide vital assessment information in battlefield or other settings outside of the eye clinic.

Aidman Vision Screener. Tools for providing vision information in the 

field of battle, particularly after a vision-related injury takes place, have 

been sorely lacking. This need provided the impetus for the development of the first Aidman Vision Screener (AVS) (Gunzerhauser, 1990), 

a portable vision assessment tool that can easily be used by an Aidman 

or medic supporting far-forward military operations. One of the mission 

goals of the U.S. Army Medical Research Detachment (USAMRD) is to 

improve medical triage for laser-induced ocular trauma. The development of an advanced AVS supports the mission of developing a quick 

and effective triage tool for making informed decisions concerning the 

use and evacuation of personnel who were dazzled or possibly injured 

by a laser or some other type of directed energy system. Effectively used, 

this tool will facilitate the medical evacuation of Soldiers with actual eye 

injuries to a higher level of care. Conversely, Soldiers who experience a 

bright light exposure but have no resultant eye injury can be rapidly assessed and sent back to continue their mission. Hence, the range of psychological effects resulting from the exposure can be rapidly mitigated 

and the Soldiers’ duty effectively resumed. Clearly, the advanced AVS will 

also have value for assessing battlefield eye injuries from other etiologies.

The original AVS is a portable black-and-white card (approximately 5 by 8 inches) designed to triage retinal disturbances and assist in 
108 THE 71F ADVANTAGE

determining whether more advanced examination is needed. The AVS 

was developed by vision experts at USAMRD in San Antonio, Texas, 

and includes two near visual acuity tests, one composed of English letters and the other made up of 12 rows of Landolt rings. In both of these 

measures, the rows of characters are in order of descending size, and a 

metric is included that enables the user to make the conversion from the 

number and size of characters correctly identified to the typically used 

Snellen visual acuity measurement (for example, 20/20). In the chart 

made up of Landolt rings, the magnitude of the size decrease from each 

row to the row beneath is 0.2 log units. The AVS also includes the near 

visual field test discussed above, the Amsler Grid. The Amsler Grid of 

the AVS contains a set of white vertical and horizontal lines arranged in 

a grid pattern on a black background, with two diagonal white lines superimposed on the grid in an “X” pattern. Each of these diagonal lines 

extends from one of the corners of the grid to the opposite corner. This 

grid provides a measure of the extent to which any retinal injury or abnormality distorts the subject’s vision. Finally, the AVS includes a table 

that contains criteria for triage. Based on results from the provided metric, the table will recommend that the respondent be evacuated for further evaluation, returned to duty, or reevaluated in 15 minutes.

The AVS has several features that have made it a valuable tool in 

the supply pack of those who would provide help for eye injuries on the 

battlefield. It is fairly small and exceedingly lightweight, which is important considering that the deployed Soldier often carries over 100 pounds 

of equipment on his person. Second, it is easy to use. Results can be obtained by following a simple set of instructions that include holding the 

AVS approximately two lengths of the tool in front of the Soldier and 

following a simple scoring scheme. Third, results can be obtained almost immediately, thus minimizing the time between the occurrence 

and the treatment.

The original AVS has been found by many to be helpful in the assessment of retinal disturbances. However, it was developed using the 

highest level of contrast possible (100 percent contrast using black characters on a white background). Thus, it is unable to detect vision deficits at low levels of contrast, a type of contrast sensitivity. This visual 

attribute is extremely important for Soldier tasks such as driving, enemy detection, and target discrimination. Lives often depend on these 

capabilities. Further, because the AVS is achromatic (black and white), 

it is unable to detect abnormalities in color vision. Color vision is also 
RAPID ASSESSMENT OF EYE INJURIES ON THE BATTLEFIELD 109

important to the aforementioned tasks and thus to the well being of Soldiers. A fairly large and diverse body of research (Jackson, Ong, and Ripley, 2004; King-Smith, Lubow, and Benes, 1984; Krill, 1972; Page and 

Crognale, 2005; Williams and Leaver, 1980; Zwick, Bedell, and Bloom, 

1974) indicates that chromatic measures (measures with color) can obtain information that is helpful in detecting retinal abnormalities and 

injuries that achromatic measures cannot provide. These studies, considered together, point toward the need to add chromatic assessment 

tools to those that are achromatic (black-on-white measures of visual 

acuity) when attempting to determine the presence of decrements to 

visual function.

A research program has been launched to add lower contrast and 

chromatic measures into the Aidman Vision Screener, which is currently achromatic. This screener is being developed to assist medical providers in making informed decisions concerning the use and evacuation of 

military personnel who were dazzled or possibly injured by a laser or 

some other type of directed energy system. As part of the larger project of fielding an advanced AVS, validation research will be conducted 

to explore the functionality of the experimental eye charts under various conditions of exposure to bright light. Subjects will read the charts 

in three experimental conditions, which will be created by the presentation of three separate light emitting devices. The eye-chart development 

work described below is presented as a critical first stage of this work.

Development of the Advanced AVS

To provide more sensitive measures of visual function than are 

currently available in settings without advanced ophthalmological 

equipment, an effort is being made to upgrade the AVS. High contrast, 

lower contrast, and chromatic metrics are included in the advanced 

AVS. Gunzenhauser (1990) describes the work that was done to develop the original version of this tool. Because of the similarities between 

the first AVS and the advanced version, this work is also important to 

the advanced AVS. Two of the visual function tests contained in the 

original AVS, the Amsler Grid and the 100 percent contrast near visual 

acuity test made up of Landolt rings, are also included in the experimental version of the advanced AVS. 

Because detecting objects under low luminance and contrast conditions is so important to many tasks conducted on the battlefield (such as 
110 THE 71F ADVANTAGE

tracking, driving, and enemy detection), a set of eye charts was developed 

to assess near visual acuity under lower levels of contrast. These charts, 

taken together, provide information on both how large an object must 

be and how much contrast it must have in comparison to its background 

to be seen by the subject. These charts each consist of 12 rows of Landolt rings, arranged in the same pattern of decreasing size (that is, a size 

decrease of 0.2 log units from each row to the next beneath) as they are 

arranged on the 100 percent contrast eye chart contained in the original 

AVS. These eye charts were developed using contrast levels that have been 

shown to differentiate foveal from parafoveal functioning and adequately represent the range of contrast sensitivity in previous research (Ness, 

Zwick, and Molchany, J., 1996; Zwick, Ness, Molchany, Stuck, and Loveday, 1998). These levels of contrast are 70, 50, 30, 10, and 2 percent. This 

set of charts is designed to assess contrast sensitivity for the smallest gap 

in the Landolt rings. Only the 100, 30, 10, and 2 percent charts are being 

used for the initial research, to simplify the design and shorten the time 

needed to complete it. To assess the functioning of the individual long, 

medium, and short wavelength cone systems of the retina, three charts 

consisting of colored Landolt rings on a white background were also developed. The theory providing the foundation for this development effort 

is relatively straightforward. When individual cone systems are presented with a very bright stimulus at the approximate wavelength for which 

they are the most sensitive, their functionality will temporarily decrease 

and they should perform more poorly in identifying targets of approximately the same wavelength. This developmental work parallels in some 

respects the work of Rabin (2004), who was the first to develop a chromatic eye chart that assesses the functionality of the individual cone systems 

for clinical use, thus applying a growing body of research highlighting the 

importance of assessing color vision in addition to achromatic visual acuity. This work also parallels the work of Rabin in that it employs logarithmic decreases in the size of the targets on the charts from each row to 

the next beneath. As with the black-and-white charts described above, the 

colored charts to be used in this research each consist of 12 rows of rings 

decreasing 0.2 log units in size from each row to the next beneath. The test 

targets are yellow in one chart, green in another, and blue in a third, corresponding to the peak sensitivities of the long, medium, and short wavelength cone systems, respectively. The targets of these charts are placed on 

a white background. To minimize radiance as a factor in their evaluation, 
RAPID ASSESSMENT OF EYE INJURIES ON THE BATTLEFIELD 111

the eye charts were designed to be as close to equal in radiances as possible. Table 5–1 displays the radiance measures of the final pigments used, 

as measured with an incandescent 2,803 Kelvin light source mounted at a 

45-degree angle in relation to the charts. As shown in table 5–1, all radiance measurements are within one order of magnitude.

Table 5–1. Radiance of Pigments in Colored Target on White 

Background Near Visual Acuity Charts

Color Radiance 

(Watts/m2

sr)*

Yellow .1081

Green .0354

Blue .0275

White .1197

* = Watts per steradian per square meter

A third set of eye charts was developed to assess the neural processing of the retina that is used to create color opponency (Hurvich and 

Jameson, 1957). The identical 12-row Landolt ring pattern was used in 

the construction of this third set of charts. The chromaticities of pairs of 

pigments (for example, pairs of blue and yellow in various shades, pairs 

of magenta and green in various shades)were assessed in CIE x-y space 

(Wyszecki and Stiles, 2000). Color pairs were chosen for the charts 

largely by whether the color plots indicated that they were complementary. In a color pair, color A is complementary to color B if it produces 

white when mixed in an appropriate portion with color B. In x-y color 

space, colors are shown to be complementary if two points representing 

the plotted colors A and B are on opposite sides of the achromatic center point (representing “white”) in a linear configuration of “color point, 

center point, color point” order. X-y space was used for this color plotting due to the ease with which complementary colors can be evaluated 

in this type of color space. Figures 5–3 through 5–5 provide examples 

illustrating how these color plots were evaluated. Figure 5–1 displays a 

shade of blue and a shade of green that are not complementary, plotted 

in x-y color space. As can be seen in the figure, their color coordinates 

place them at nearly right angles to each other in the color space. These 

two color shades would be evaluated as noncomplementary due to the 

extent of their deviation from a linear pattern. 
112 THE 71F ADVANTAGE

Figure 5–1. Blue and Green Plotted in x-y Color Space

0.9

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0

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0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8

Blue White Green

Figure 5–2 displays the blue-yellow pairs used in three of the 

charts in this set, and figure 5–3 displays the magenta-green pairs used 

in the other four charts. Examining figures 5–2 and 5–3, it can be seen 

for each pair that the blues are directly across from the yellows in x-y 

space, and that the magentas are almost directly across from the greens. 

This indicates that these pairs are complementary (or very nearly so, in 

the case of the pairs of magenta and green). 

Figure 5–2. Yellows and Blues in Advanced Aidman Vision Screener 

Plotted in x-y Color Space

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Blue White Green

 Yellow #1 Yellow #2
RAPID ASSESSMENT OF EYE INJURIES ON THE BATTLEFIELD 113

Figure 5–3. Magentas and Greens in Advanced Aidman Vision 

Screener Plotted in x-y Color Space

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White

Magenta #1

Magenta #2

Magenta #3

Green #1

Green #2

Green #3

Green #4

Reflected energy was also used as a criterion for color pair selection, to control its potential confounding effect on the experimental results. A color pair was not selected unless the level of energy reflected from one pigment in the dyad was on the same order of magnitude 

as the energy level reflected by the other. These charts each consist of 

Landolt rings of one color against a background of a complementary 

(opponent) color of similar radiance, using the same layout of decreasing row sizes as the charts described above. Table 5–2 displays the radiance measurements of the color pairs in each of the seven opponentcolored experimental eye charts. As can be seen in table 5–2, no one chart 

has differentials in radiance that exceed an 11:5 ratio. Further, all the differentials are small, with none exceeding a difference of .0384 watts per 

steradian per square meter. Thus, seven experimental charts were created to assess neural processing in the inner retina. Three are composed of 

shades of blue and yellow; the other four are made up of shades of magenta and green. To simplify the initial research and shorten the time 

needed to complete it, only two blue and yellow charts and two magenta 

and green charts are being used. The research program launched to explore the effectiveness of these eye charts is being conducted both to ascertain that they work and to guide any modification needed to improve the effectiveness of the advanced AVS. Subjects in this research will 

be asked to respond to the eye charts under varied lighting conditions. In
114 THE 71F ADVANTAGE

Table 5–2. Radiance of Pigments in Each Opponent-colored Near 

Visual Acuity Chart

Chart Color Radiance 

(Watts/m2

sr)*

1 Light blue .0623

1 Yellow .0778

2 Light blue .0744

2 Yellow .0657

3 Light blue .0614

3 Yellow .0645

4 Green .0337

4 Magenta .0394

5 Green .0349

5 Magenta .0643

6 Green .0368

6 Magenta .0720

7 Green .0349

7 Magenta .0733

* = Watts per steradian per square meter

the experimental conditions of this research, subjects will look into light 

emitting devices and then respond to the charts while experiencing a 

large temporary afterimage in their visual field.

Directions for Future Research 

The primary purpose for developing an advanced Aidman Vision 

Screener is to provide a more sensitive and accurate tool for visual function assessment in battlefield settings than the original AVS. An assumption driving the development of the advanced AVS is that accuracy will be increased by adding capabilities for the assessment of color vision and lower contrast visual acuity. This increase in accuracy is 

probable due to the increased ability to detect visual function deficits 

among those not previously identified as experiencing vision problems. 

However, the accuracy of this tool in identifying retinal abnormalities 

has yet to be determined. It is possible that the advanced AVS may also 

make more “false positives” than the original version, unnecessarily 
RAPID ASSESSMENT OF EYE INJURIES ON THE BATTLEFIELD 115

classifying more Soldiers as needing to be evacuated due to vision deficits. Because of difficulties in recruiting sufficient subjects with possible retinal abnormalities for a laboratory study, such a study may not be 

completed for some time. However, careful gathering of data from military operations may allow the accuracy of the advanced AVS to be estimated. Additionally, further research using methodologies similar to 

that briefly mentioned above (inducing temporary visual deficits) may 

assist in the further validation of this upgraded metric.

An issue often discussed among military vision scientists concerns the extent to which visual physiology and/or functioning must be 

compromised before evacuation from a military operation is deemed 

appropriate. A Soldier may be experiencing significant visual deficits 

and have one or more physical alterations of the retina (for example, 

retinal lesions), yet be deemed capable of performing his duties because 

the injuries cannot be seen without advanced ophthalmological equipment and are not substantially altering his behavior or job performance. 

Many retinal injuries rapidly become worse if they are not detected and 

treated. It would be of interest to determine the extent to which the advanced AVS can detect problems of intermediate severity, and whether 

it can detect most retinal alterations quickly after onset.

Given the extent of laser use on the modern battlefield, it is probable that some Soldiers have acquired or are currently developing subtle 

pathologies of vision due to lower level laser effects that have not yet had 

significant effects on the performance of their military duties. It may 

be that the physiology of these Soldiers’ eyes has been slightly degraded and is growing steadily worse, and/or that visual function has been 

compromised to a slight to moderate extent but has yet to be detected 

due to its gradual onset. It would be important for the military to be able 

to detect these types of pathologies in battlefield settings. Early intervention in such cases could very possibly change the course of many of 

these types of retinal disorders. It would be of interest to know the extent to which the advanced AVS is able to detect subtle changes in visual 

pathology or functioning, and how severe a vision pathology has to be 

before is it detectable by this new vision assessment metric.

Conclusion 

The proliferation of lasers on the modern battlefield has substantially increased the level of risk to Soldiers. Laser exposure can bring 
116 THE 71F ADVANTAGE

about severe injuries to the eyes and skin. Soldiers’ exposure to lasers in 

combat settings may also result in fear and anxiety relating to performing many warrior tasks due to fear of incurring laser-related injuries.

While the skin is susceptible to laser damage, the risk of damage 

is much higher for the eye because the eye increases the irradiance or 

radiant exposure of collimated laser light at the retina. A variety of tools 

and measures have been developed to assess the many aspects of vision, 

including measures of eye physiology, visual acuity, contrast sensitivity, 

glare sensitivity, color vision, and the visual field. A major drawback of 

the vast majority of vision screening tools, however, is that they are designed exclusively for use in clinical settings. They require special conditions for their use that need to be provided and controlled in the clinic 

or laboratory. Because of this drawback, tools for providing vision information in the field of battle have been sorely needed.

The need for vision screening tools that can be used in combat settings provided the impetus for the development of the Aidman Vision 

Screener, an achromatic visual function assessment device that can be 

used to evaluate both high-contrast visual acuity and the visual field of 

the Soldier. The AVS has several features that make it a valuable tool in 

the supply pack of military medical personnel and others who would 

provide help for eye injuries on the battlefield. These features include 

portability, ease of use, and nearly immediate assessment results. However, several aspects of vision are not currently assessed by the AVS. 

These include color vision and visual function under low levels of contrast. An effort is under way to develop an upgraded version of the AVS 

that will have the means to assess these visual abilities. This chapter presented the methodology used to develop the eye charts being used for 

the advanced AVS, along with a brief description of research being conducted to collect validation evidence supporting this new metric.

References

Anderberg, B., Bring, O.E., and Wolbersht, M.L. (1992). Blinding laser weapons and international 

humanitarian law. Journal of Peace Research 29 (3), 287–297.

Department of the Army (1990). Prevention and medical management of laser injuries. (Field 

Manual 8–50). Washington, DC: Headquarters Department of the Army.

———. (1999). The Army radiation safety program (Army Regulation 11–9). Washington, DC: 

Headquarters Department of the Army.

DeVour, R. (1993). Possible psychological and societal effects of sudden permanent blindness 

of military personnel caused by battlefield use of laser weapons. In L. Doswald-Beck 
RAPID ASSESSMENT OF EYE INJURIES ON THE BATTLEFIELD 117

(ed.). Blinding weapons: Reports of the meetings of experts convened by the International 

Committee of the Red Cross on battlefield laser weapons, 1989–1991 (46–51). Geneva: 

International Committee of the Red Cross.

Doswald-Beck, L. (1996). New protocol on blinding laser weapons. International Review of the 

Red Cross 312, 272–299.

Federation of American Scientists Military Analysis Network (1998). AAS–38A/B Nite Hawk. 

Retrieved July 20, 2009, from <www.fas.org/man/dod-101/sys/smart/aas-38.htm>.

Fitzgerald, R. (1993). Psychiatric, psychosomatic and socio-economic status reactions to blindness. In L. Doswald-Beck (ed.). Blinding weapons: Reports of the meetings of experts 

convened by the International Committee of the Red Cross on battlefield laser weapons, 

1989–1991 (258–268). Geneva: International Committee of the Red Cross.

Gunzenhauser, J.D. (1990). Issues in the development of the Aidman vision screener (Laboratory 

Note No. 90–81). San Antonio, TX: United States Army Medical Research Detachment.

Harris, M.D., Lincoln, A.E., Amoroso, P.J., Stuck, B., and Sliney, D. (2003). Laser eye injuries in 

military occupations. Aviation, Space, and Environmental Medicine 74, 947–952.

Hurvich, L.M., and Jameson, D. (1957). An opponent-process theory of color vision. Psychological Review 64, 384–404.

Jackson, T.L., Ong, G.L., and Ripley, L.G. (2004). Orientational contrast sensitivity and chromatic 

contrast thresholds in multiple sclerosis. American Journal of Ophthalmology 137 (2), 

283–286.

King-Smith, P.E., Lubow, M., and Benes, S.C. (1984). Selective damage to chromatic mechanisms 

in neuro-ophthalmic diseases I. Review of published evidence. Documenta Ophthalmologica 58 (3), 241–250.

Krill, A.E. (1972). Hereditary retinal and choroidal diseases (vol. 1, 337). Hagerstown, MD: Harper 

and Row.

Laser Institute of America. (2007). American national standard for the safe use of lasers. Orlando, 

FL: Laser Institute of America.

Mainster, M.A., Stuck, B.E., and Brown, J. (2004). Assessment of alleged retinal laser injuries. 

Archives of Ophthalmology 122, 1210–1217.

Nagpal, M., and Banait, M. (2002). Scanning laser ophthalmoscopy in macular degeneration. 

Bombay Hospital Journal 44 (3), 333–339.

Nahin, P.J. (1977). The laser BMD and other radiant energy weapons: Some thoughts. IEEE 

Transactions on Aerospace and Electronic Systems 13 (2), 96–107.

Ness, J., Zwick, H., and Molchany, J. (1996). Laser-inflicted eye injuries: Epidemiology, prevention, and treatment. Proceedings of the International Society for Optical Engineering 

(SPIE) 2674, 131–135.

Neuenswander, D. (2001). Joint laser interoperability, tomorrow’s answer to precision engagement. Air and Space Power Journal—Chronicles Online Journal, 15(2).

New England Eye Center (2008). Optical coherence tomography (OCT). Retrieved July 20, 2009, 

from <www.neec.com/ Pages/Services/Glaucoma/OCT.php>.

Northrop Grumman (2008). Target acquisition designation sight (TADS) laser rangefinder/

designator (LRF/D). Retrieved July 20, 2009, from <www.es.northropgrumman.com/

solutions/tads/>.

Page, J.W., and Crognale, M.A. (2005). Differential aging of chromatic and achromatic visual 

pathways: Behavior and electrophysiology. Vision research 45 (11), 1481–1489.

Rabin, J. (2004). Quantification of color vision with cone contrast sensitivity. Visual Neuroscience 

21, 483–485.

Robbins, D.O., and Zwick, H. (1980). Changes in spectral acuity following brief laser (647 nm) 

exposure. In Verriest, G. (ed.). Colour vision deficiencies (106–110). London: Adam Hilger Ltd.
118 THE 71F ADVANTAGE

Stamper, R.L. (1991). Ophthalmic medical assisting: An independent study course. San Francisco, 

CA: American Academy of Ophthalmology.

VisionRX (2005). Angiography. In Eye care library encyclopedia. Retrieved July 20, 2009, from 

<www.visionrx.com/library/enc/enc_angiography.asp>.

Warren, D. (1993). Psychological effects of total permanent blindness occurring in early adulthood. In Doswald-Beck, L. (ed.). Blinding weapons: Reports of the meetings of experts 

convened by the International Committee of the Red Cross on battlefield laser weapons, 

1989–1991 (52–68). Geneva: International Committee of the Red Cross.

Williams, C.M., and Leaver, P.K. (1980). Visual acuity and colour vision in central serous retinopathy. In G. Verriest (ed.). Colour vision deficiencies (306–309). London: Adam Hilger Ltd.

Wyszecki, G., and Stiles, W.S. (2000). Color science: Concepts and methods, quantitative data and 

formulae (2d

 ed.). New York: John Wiley and Sons.

Zwick, H., Bedell, R.B., and Bloom, K. (1974). Spectral and visual deficits associated with laser 

irradiation. In G. Verriest (ed.). Modern Problems in Ophthalmology (299–306). Basel, 

Switzerland: S. Karger, AG.

Zwick, H., Ness, J.W., Molchany, J.M., Stuck, B.E., and Loveday, D. (1998). Neural motor ocular strategies associated with the development of a pseudofovea following laser induced 

macular damage and artificial macular occlusion: Is the fovea replaceable? Journal of 

Laser Applications 10 (3), 144–147.
Part III

Psychology of Leadership

Chapter 6

New Wine in Old Bottles: Leadership and 

Personality in the Military Organization

Paul T. Bartone

Leadership is a topic of abiding interest to the military, as well 

as to social scientists who study military organizations and people. In 

seeking to understand the personal qualities associated with effective 

leadership, psychologists have largely focused on intelligence and other 

mental abilities, to the neglect of factors such as personality traits. This 

chapter summarizes the major theoretical perspectives on leadership 

that have dominated the field for the last 50 years, and shows how normal personality has reemerged as a legitimate topic in the study of leadership. Examples are provided of recent studies that document the influence of five main personality factors on leadership, and also the influence of personality “hardiness.” In addition to empirical studies showing that hardiness is associated with healthy response to stress and effective leader performance, the hardiness construct provides a theoretical 

framework for understanding the leader influence process under highstress conditions. Especially as regards stressful and ambiguous events, 

military leaders can apply hardiness qualities to facilitate generalized 

positive interpretations or “sense-making” among unit members. Leaders do this through actions, policies, and personal example, and in this 

way they increase stress resilience throughout the organization.

Introduction

Military organizations have long emphasized the importance of 

leadership and sought to train or develop highly effective leaders in a 

multitude of ways. For example, in the epic classical stories of The Iliad

and The Odyssey, Homer portrays a number of personal leader qualities 

including courage, strength in adversity, loyalty, persistence, and mental agility (Homer, 1975). More recently, Jonathan Shay has provided an 

interesting analysis of Homer’s Odysseus, drawing lessons for the impact of leadership and policy on the mental health of American troops 

today (Shay, 2002). Leadership was also an important topic for the 

Greek philosophers; for example, in Plato’s Republic, the ideal leader is 

121
122 THE 71F ADVANTAGE

described as a “philosopher-king,” one who is intelligent, highly moral, 

and selfless (Plato, 1991).

As roles and missions have expanded in the postmodern military, demands on military personnel have increased substantially 

(Moskos, Williams, and Segal, 2000; Nagl, 2005). Our forces today are 

called upon to serve in a broader range of missions that are complex 

and changeable. The challenges for leaders are especially severe in this 

new environment (Shamir and Ben-Ari, 2000).

In this context, understanding the range of factors that contribute to effective leadership is more important than ever. What are the 

personal qualities that contribute to effective leadership? There is considerable speculation on this question, and answers too often rely on 

anecdotes and hearsay. Historically, social scientists who have tried to 

address the question empirically have tended to focus on intelligence 

and various mental abilities, while personality factors have drawn considerably less attention. In recent years, however, more studies have 

examined personality variables as predictors of leader performance. 

This trend toward increased scientific study of the role of personality promises to bring new understanding for enhancing the quality of 

leadership in military organizations. 

The chapter begins with a summary of the more important theoretical perspectives on leadership from recent decades. Next, it shows 

how these theoretical ideas, together with a growing number of empirical studies, converge on an understanding of leadership as primarily a “sense-making” activity in which both personal and contextual factors have important influence. Especially in organizations like 

the military, a key aspect of leadership concerns the ways in which 

events get interpreted by members of the unit. Empirical studies provide some evidence that highly effective military leaders possess certain 

personality attributes that allow them to adapt quickly and make constructive sense of rapidly changing and ambiguous situations. Perhaps 

more importantly, these qualities are also used to inspire subordinates 

and peers to construct similar positive interpretations of experience. 

The influence of leaders on subordinates in this regard may be even 

greater under highly stressful external conditions. 

What Is Military Leadership?

Before going further, it is useful to define military leadership. One 

option is simply that it is leadership within the military organization 
LEADERSHIP AND PERSONALITY IN THE MILITARY ORGANIZATION 123

or context, across the range of missions and activities in which military 

organizations are engaged. But this definition is unsatisfying, mainly 

because it leaves the key term unspecified. The real problem in defining military leadership lies in specifying what is meant by leadership, 

and then applying it to the military case. 

In a detailed review of the leadership literature, Stogdill (1974) 

observed, “There are almost as many definitions of leadership as there 

are persons who have attempted to define the concept.” The confusion 

goes beyond definitions. The literature is vast, extending from rigorous scientific studies including experiments and correlational and case 

studies, all the way to folk wisdom, popular how-to guides, metaphors 

of every kind, magic formulas, and rules for success. While some of the 

confusion can be overcome by focusing only on careful theoretical formulations, case studies, and empirical investigations, it is not always 

easy to separate science from superstition when it comes to leadership. 

It is also fair to say there is little agreement even among the more scientific approaches as to just what leadership is. According to a recent special report of the National Research Council (Druckman, Singer, and 

Van Cott, 1997), “the leadership literature is full of ambiguous theory 

and contradictory research findings.” 

How, then, should leadership be defined? This brief report will 

not attempt to cover all the definitions. For this, the interested reader 

is referred to comprehensive summaries by Stogdill (1974) and Bass 

(1990). Yukl (1998) also provides an excellent overview of leadership 

definitions, theories, and research. Similar to Yukl, I will here define 

leadership in broad terms as both a social influence process as well as 

a particular, specialized role of “the leader.” Leaders provide leadership 

by influencing the choice of objectives and strategies, organizing tasks 

and activities, developing skills, committing and motivating people in 

an organization or group, and, most importantly, by influencing how 

events get interpreted. 

Leadership Models and Theories

As with definitions of leadership, there is likewise a multiplicity of models, frameworks, and metaphors for understanding the leadership process. As an example, the U.S. Army’s doctrinal manual on 

leadership, Field Manual 22–100, Army Leadership, puts it in terms of 

the “Be–Know–Do” framework of leadership, which is said to include 

character, values, and other personal attributes (the “Be” dimension), 
124 THE 71F ADVANTAGE

knowledge and skills (the “Know” dimension), and behaviors or actions (the “Do” dimension). Similar to many other models of leadership, the “Be–Know–Do” model is both descriptive and prescriptive, 

defining both what leaders are and what they should be, all in somewhat global terms. Military organizations like the U.S. Army also favor 

geometric and spatial metaphors (including pyramids, pillars, and building blocks) to describe how leadership is composed, and to suggest how 

leader development might occur. As another example, Hughes, Ginnett, 

and Curphy (1996) rely on Venn diagrams to indicate overlapping influences between leaders, followers, and situations. While such models and metaphors can stimulate thinking and communication about 

leadership, they generally do not tell us anything about the nature of 

leadership or its underlying processes. For example, to assert that “leadership” occurs at the overlap between followers, leaders, and situations sounds sensible, but actually explains little. A danger with such 

leadership models is that they can create the illusion of understanding, 

leading to complacency and failure to seek more substantial explanations of the complex phenomenon of leadership. 

Another common model or framework for understanding leadership attempts to partition it into component pieces, or levels-of-analysis. This is the approach in the required course on military leadership at 

the U.S. Military Academy, West Point (United States Military Academy, 

2000). The syllabus divides the course into four main content areas: Individual System, Group System, Leadership System (focusing on leaderfollower interactions as well as situational factors), and Organizational 

System (macro-level factors including culture). This approach has the 

virtue of being comprehensive, and it exposes students to multiple theoretical perspectives but does not attempt to compare these perspectives 

critically or determine their relative importance to effective leader performance. Many other models have been proposed as aids or heuristics 

for understanding leadership. 

One of the most important and influential theories of leadership 

is known as the contingency model of leader effectiveness, developed 

by Fiedler (1964, 1967). Prior to Fiedler, most research focused on two 

styles of leader, authoritarian versus nonauthoritarian, also known as 

directive versus nondirective, or task-oriented versus human relations–

oriented (Katz and Kahn, 1952; Shaw, 1955; Shaw and Blum, 1966). The 

Ohio State University leadership studies conducted in the 1950s and 

1960s established a strong research tradition of evaluating performance 
LEADERSHIP AND PERSONALITY IN THE MILITARY ORGANIZATION 125

correlates of rated leader behaviors. These studies led to the identification of two leadership styles, “consideration” (of subordinates) and “initiating structure,” or defining structures and tasks aimed at achieving 

the goals of the organization (Fleishman and Harris, 1962). About the 

same time, researchers at the University of Michigan described three 

distinctive types of leader behavior: task-oriented, relations-oriented, 

and participative (Likert, 1967). 

Fiedler in 1964 developed a specialized instrument, the least preferred coworker (LPC), to assess the extent to which a leader was more 

task-oriented (low LPC scores) or relations-oriented (high LPC scores) 

(Fiedler, 1964). In this framework, high scores reflect more forgiving 

or lenient ratings of one’s “least preferred” coworker, while low scores 

show more harsh and unfavorable ratings. Those who are more accepting toward their least preferred coworker are presumed to be more relations-oriented and supportive of coworkers in general. Over hundreds 

of studies, Fiedler and colleagues found essentially that leader effectiveness is a function of the interaction between leader style (task- or relations-oriented) and the favorable or unfavorable nature of the situation. 

The model basically indicates that low LPC leaders (task-oriented) are 

more effective in extremely unfavorable or favorable situations, whereas 

high LPC leaders (relationship-oriented) are more effective in intermediate situations. The performance effects of leadership style are thus 

contingent on aspects of the situation or work context, so this is known 

as a “contingency theory” of leadership. 

A special value of Fiedler’s contingency model (and others like 

it) is that it directs attention to the importance of contextual factors in 

understanding the effects of various leader styles and approaches. Research findings are generally supportive of the model, but among other 

criticisms, it has been faulted for not paying enough attention to medium LPC leaders (more balanced in task and relational tendencies), 

who likely outnumber the extreme types (Yukl, 1998). Nevertheless, until fairly recently Fiedler’s contingency model was viewed by many as 

“probably the best theory of leadership proposed to date” (Shaw and 

Costanzo, 1982). 

Another influential contingency theory is known as the “pathgoal theory” of leadership (House, 1971, 1996). This approach emphasizes the influence leaders can have on the motivation of subordinates 

by identifying goals, establishing environments in which people are rewarded for attaining them, and clearly communicating the pathways for 
126 THE 71F ADVANTAGE

achieving them (thus the term path-goal theory). Early versions of the 

path-goal theory identified two main approaches, supportive leadership and directive leadership (similar to the relations-oriented and taskoriented styles discussed earlier). Interestingly, a later and less familiar 

version of path-goal theory included two additional behavior orientations: participative leadership and achievement leadership (House and 

Mitchell, 1974; House, 1988). As with Fiedler’s model, the contingency 

aspect of path-goal theory has to do with which type of leader approach is 

considered most effective under various external conditions. When situations are tedious, dangerous, or stressful, supportive leadership is posited 

to be more effective. When situations are ambiguous and complex and 

subordinates are inexperienced, directive leadership is presumed to be 

preferable. Similar to other contingency theories, research on path-goal 

theory has yielded mixed results regarding these hypothesized interaction effects. However, it is clear that various situational as well as leader 

characteristics have measurable direct effects on performance, and that 

at least in some cases situation and leader variables interact (Wofford and 

Liska, 1993; Podsakoff, MacKenzie, Ahearne, and Bommer, 1995).

A later modification of Fiedler’s contingency theory emphasizes the importance of the leader’s “cognitive resources” (Fiedler, 1986). 

According to this model, intelligence and experience are two different 

types of cognitive resources that have more or less relative value depending on the nature of the situation and whether the leader tends to 

be directive or not. Leader intelligence presumably leads to better performance across a broad range of circumstances, especially when the 

leader is also directive and the task is complex. However, under highly 

stressful conditions, intelligence fades in importance (and may even be 

a detractor), and performance is more a function of the leader’s practical 

experience. Interestingly then, this later version of Fiedler’s contingency 

theory of leadership incorporates person-variables that go beyond intelligence or traditional cognitive abilities. Research has provided some 

support for this model (Blythe, 1987; Potter and Fiedler, 1981). 

Robert Sternberg presented a somewhat related theory focusing 

directly on “practical intelligence” or experience-based knowledge—

“tacit knowledge”—as important for leader success, and applied this 

model specifically to the military (Sternberg, Forsythe, Hedlund, Horvath, Wagner, Williams, Snook, and Grigorenko, 2000; Hedlund, Forsythe, Horvath, Williams, Snook, and Sternberg, 2003). Previously, 

Stephen Zaccaro and colleagues presented a similar model that 
LEADERSHIP AND PERSONALITY IN THE MILITARY ORGANIZATION 127

emphasized the importance of experience-based knowledge for leader 

flexibility and effectiveness across a range of situations (Zaccaro, Gilbert, Thor, and Mumford, 1991). In general, this tacit knowledge perspective on leadership is universalistic, not contingency-oriented. That 

is, according to this approach, increased levels of practical intelligence 

and tacit knowledge will be of value to leaders across the entire spectrum 

of situations they may encounter (although it may be of even greater value in novel and ambiguous circumstances). Thus far, not much research 

has been done on this new concept in military leadership, but early 

results are promising (Hedlund et al., 2003).

Other significant leadership research in recent years has emphasized cognitive abilities and problem-solving skills that may distinguish 

effective from ineffective leaders (Jacobs and Jaques, 1986; Mumford, Zaccaro, Harding, Fleishman, and Reiter-Palmon, 1993; Phillips and Hunt, 

1992; Mumford, Zaccaro, Harding, Jacobs, and Fleishman, 2000). In part 

this emphasis on cognitive variables comes as a result of claims that personality traits do not appear to predict leadership very well, at least independently of other variables (Hollander and Julian, 1969; Stodgill, 1948; 

House, 1988). But interest has persisted in personal traits other than cognitive abilities that might distinguish good from bad leaders (Bass, 1998; 

Burns, 1978; House and Howell, 1992). This may be in part because cognitive abilities, while important, leave much unexplained about variance in effective leadership. In a review of research and theory on military leadership, Alan Lau (1998) suggests that some of the early lack of 

support for a trait or personality approach is due to measurement limitations. When better measures are utilized, results generally support the 

importance of trait variables (Lau, 1998; Bass, 1990). Robert Lord and 

colleagues (Lord, DeVader, and Alliger, 1986), in a meta-analysis of 19 

samples first presented by R.D. Mann in 1959, also observed that methodological factors influenced early results and conclusions. Lord points out 

that Mann and Stogdill in their reviews did not examine personality traits 

in relation to actual leader performance, but rather in relation to leader emergence or “attained leadership status.” This leads Lord to the conclusion that the early work on leadership and personality traits has been 

misinterpreted, and that personality variables merit renewed attention. 

Probably the most influential theoretical perspective on leadership 

in recent years is referred to as transformational leadership, developed 

first by Burns and elaborated by Bass and Avolio (1989). Judge and Bono 

(2000) found that of all articles dealing with leadership published since 
128 THE 71F ADVANTAGE

1990, over half dealt with transformational leadership in some significant 

way. Transformational leadership is closely related to the earlier concept 

of charismatic leadership. One of the first scholars to discuss charismatic 

leadership was Max Weber (1947), who described it as a form of social authority based on perceived exceptional and inspirational qualities of the 

leader, as opposed to rational-legal authority or authority based on tradition. Several leadership theories emphasize the charismatic influence of 

leaders: House (1977) focuses on the traits and behaviors of charismatic 

leaders; Conger (1989) puts additional emphasis on the attributions made 

by followers about their charismatic and visionary leaders; and Shamir, 

House, and Arthur (1993) argue that charismatic leaders are influential 

mainly through the need followers have to build up their self-concepts 

through social identification with powerful leaders. Several authors have 

also discussed the “dark side” of charisma, or ways in which charismatic leaders can have destructive effects on organizations and people (Yukl, 

1989; Conger, 1989; Hogan, Raskin, and Fazzini, 1990).

Bernard Bass developed his model of transformational leadership following on Burns’s (1978) ideas about transforming leadership 

as something that inspires followers to higher levels of motivation and 

moral behavior (Bass, 1985). The Bass model posits basically two kinds 

of leadership styles: transformational and transactional. The transactional leader operates mainly on the basis of exchange, or transactions, 

rewarding subordinates for desired behaviors and sometimes punishing them for undesired ones. In contrast, the transformational leader 

seeks to empower and inspire subordinates, providing an exciting vision of the future while also communicating personal concern and support. Bass and colleagues developed a simple instrument, the Multifactor Leadership Questionnaire, for assessing transformational and transactional behaviors (Bass and Avolio, 1989; Avolio, 1999). Despite some 

limitations, this instrument has been widely used in studies showing 

significant associations between transformational leadership style and 

performance. But even Bass admits that little is known about how leaders develop to be transformational versus transactional (Bass, 1998).

Personality and Leadership

The reemergence of personality variables is apparent in several domains related to leadership (Sashkin, 1992). For example, stratified systems theory, which puts heavy emphasis on cognitive abilities 

that are important for leaders at the senior executive organizational 
LEADERSHIP AND PERSONALITY IN THE MILITARY ORGANIZATION 129

levels, has recently incorporated variables that go beyond cognitive 

abilities. Self-esteem and “social perspective-taking” are now included in a broadened concept of “cognitive complexity,” something Lewis and Jacobs (1992) consider essential for effective strategic leadership. Growing interest in the concept of “emotional intelligence” in 

both popular and professional literature also suggests a tendency to 

incorporate personality and other noncognitive ability variables into 

an expanded definition of intelligence or mental capacities (Salovey 

and Mayer, 1990; Goleman, 1995). David Ryback (1998) is one of several authors who have discussed potential applications of emotional 

intelligence to the leadership domain.

One of the major developments in personality psychology in recent years is a growing consensus on the so-called five-factor model 

(FFM), or “Big Five,” of normal personality. These factors are neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness (Digman, 1990; McCrae, 1992). Progress in conceptualizing 

and measuring normal personality has also contributed to the renewed 

interest in applying personality to leadership research and theorizing 

(Barrick and Mount, 1999; Judge and Bono, 2000; Rubenzer, Faschingbauer, and Ones, 2000). Conceptually, personality traits are generalized 

consistencies in styles of thinking, feeling, and acting, and thus can be 

expected to affect many aspects of behavior, including leadership. While 

the content of a leader’s goals, concerns, and plans is influenced by organizational factors and situational contexts, basic personality traits of 

the individual may influence how goals and plans are pursued, how efficiently they are formulated, and how conscientiously they are followed. 

In a recent study examining cognitive and personality factors in West 

Point cadets, the FFM personality dimensions of conscientiousness and 

agreeableness emerged as significant predictors of cadet leader performance over a 3- to 4-year time span (Bartone, Snook, and Tremble, 

2002). In a similar study with Australian Army officers, leader achievement was predicted by high conscientiousness and high openness, and 

low extraversion (introversion) (McCormack and Mellor, 2002). 

Recent studies have also begun to investigate the influence of 

personality factors on transformational leadership style. For example, 

Timothy Judge and Joyce Bono conducted a meta-analysis of 14 samples, 

exploring the relations of the five-factor model to transformational leadership (Judge and Bono, 2000). They found that agreeableness and extraversion predicted transformational leadership, as rated by subordinates. 
130 THE 71F ADVANTAGE

Their findings, while provocative, left much of the variance in transformational leadership unexplained. In a followup to this work, Bono 

and Judge (2004) again used meta-analysis to look at the five-factor 

model personality dimensions as predictors of both transformational 

and transactional leadership. They found the strongest effects for extraversion and (-)neuroticism, but concluded that other personality 

dimensions besides the Big Five should be explored in future research.

While the five-factor model certainly represents an important scientific advance in the field of personality, it need not be viewed as describing the sum total of normal personality. As argued by Jack Block 

(1995) and others, there may be traits not fully represented in the Big 

Five paradigm that have considerable influence on behavior in various 

domains including leadership (Widiger and Trull, 1997; Dawda, 1997; 

Hough, 1992). Transformational leadership style and its component elements, as described by Bass and Avolio, may thus incorporate or be influenced by personality traits or tendencies not completely covered by 

the Big Five model and that are more theoretically relevant to leadership 

styles (Bono and Judge, 2004). 

An especially promising personality dimension for predicting 

military leader performance and also transformational leadership is described as psychological hardiness. Conceptually rooted in existential 

psychology, hardiness involves a high sense of commitment to life and 

work, a strong belief in one’s ability to control events and influence outcomes, and greater openness to changes and challenges in life (Kobasa, 

1979; Maddi and Kobasa, 1984; Maddi, 1999). Persons high in hardiness are more resilient when exposed to a range of environmental stressors and tend to remain healthy and perform well despite high stress levels (Bartone, 1989; 1998a; 1999a). The underlying mechanisms whereby 

hardiness confers resiliency, though still poorly understood, most likely involve the interpretation or meaning individuals impute to events 

around them, and how they see themselves in regard to the world of experiences (Maddi, 1967). Highly hardy people typically interpret experience as interesting and worthwhile overall, something they can exert control over, and challenging, presenting opportunities to learn and grow. 

Many studies have now documented positive health and performance effects for hardiness in a variety of groups, including the military (Bartone, 

Ursano, Wright, and Ingraham, 1989; Bartone, 2000; Westman, 1990). 

In military units, this “meaning-making” process is likely something leaders can influence. The units are highly interdependent, 
LEADERSHIP AND PERSONALITY IN THE MILITARY ORGANIZATION 131

group-oriented structures. Most tasks require the coordinated actions 

of individuals. Also, units are organized hierarchically, with those at 

the top having the greatest influence over policies, procedures, and 

goals. Through their policies, advice, and examples, leaders may help 

shape the way their subordinates make sense of events and experiences (Weick, 1995). Many sociologists and social psychologists have advanced the idea that how meaning gets constructed at the individual 

level is to some degree a reflection of social processes (Berger and Luckmann, 1966; Janis, 1972; Allport, 1985). It thus seems likely that leaders, as well as peers and the entire organizational culture, can have an 

impact on how individuals interpret their experiences. 

Several recent research studies support the idea of the influence 

of personality hardiness on leadership style and performance. For example, a longitudinal study of West Point cadets identified both hardiness 

and transformational leadership style as significant independent predictors of leader performance, as measured by military development grades 

(Bartone, 1999b). Examined alongside several other personality and 

cognitive abilities measures, personality hardiness was found to be the 

strongest predictor of leader performance. These results show that people who are high in hardiness—a characteristic sense of commitment, 

control, and challenge—are more effective in positions of leadership in a 

military organization. Additional analyses found that the hardiness facet 

of commitment was moderately correlated with transformational leadership style, although total hardiness scores were not. This suggests that 

those high in psychological hardiness are more apt to develop a transformational leadership style, but only under certain external conditions. 

In another study of West Point cadets, hardiness was a stronger predictor of leader performance for female cadets (Bartone and Snook, 2000). 

A similar study of Norwegian Navy officer cadets found that in 

the context of a highly stressful training exercise, hardiness and leadership interacted to increase small unit cohesion levels (Bartone, Johnsen, 

Eid, Brun, and Laberg, 2002). This provides further evidence that psychological hardiness can affect leadership, and that there are important 

consequences for relevant outcomes such as unit cohesion. An important question for future research thus concerns to what degree hardiness 

can be trained or developed in military leaders. There is preliminary 

evidence that hardiness levels can be increased through specialized 

training (Judkins, Reid, and Furlow, 2006; Maddi, 1987; Maddi, Khoshaba, Jensen, Carter, Lu, and Harvey, 2002), but more work is needed. 
132 THE 71F ADVANTAGE

Also arguing for the importance of noncognitive variables that 

can influence leader effectiveness, Gal (1987) suggests that more demanding military operations call for leaders who can increase the commitment of subordinates. Gal posits that this is the critical contribution of transformational leaders. The research summarized above on 

hardiness and leader performance lends credence to this view. A critical aspect of this commitment-building process likely concerns how 

experiences get interpreted individually and as groups. 

A number of other personality dimensions relevant to military 

leadership are also being actively investigated. For example, a series of 

studies with cadets and Army officers indicate that a person’s stage of psychosocial development, as articulated by Harvard University psychologist Robert Kegan, can have broad influence on leader style and performance (Kegan, 1982; Forsythe, Snook, Lewis, and Bartone, 2002; Bartone, Snook, Forsythe, Lewis, and Bullis, 2007). Additional research has 

identified possible links between Kegan’s constructive-developmental 

framework and transformational leadership style in Army officers, and 

also found significant correlations between constructive-developmental 

stage level and “conceptual work capacity,” a measure of strategic leader 

conceptual ability (Kuhnert and Lewis, 1987; Lewis and Jacobs, 1992). 

Significant associations have also been found between military leadership (variously assessed) and personality measures that do not seem fully encompassed by the five-factor model, including the Hogan Personality Inventory, the California Personality Inventory, and the Myers-Briggs 

Type Indicator (Lall, Holmes, Brinkmyer, Johnson, and Yatko, 1999; 

Thomas, Dickson, and Bliese, 2001; Gough, 1990; McCaulley, 1990). At 

this point, then, studies of personality and leader performance should 

probably not be unduly restricted to the Big Five model, but should 

consider other dimensions as well, such as hardiness and Kegan’s constructive-developmental level. The same point is made by Bono and 

Judge in their report on a comprehensive meta-analytic study, in which 

they examine the effects of the Big Five personality dimensions on transformational and transactional leadership styles (Bono and Judge, 2004). 

Gender Differences in Personality and Leadership

As the proportion of women military leaders continues to rise in 

the U.S. all-volunteer force (Segal, 1995), it is important to understand 

gender differences in factors influencing leader styles and performance. 
LEADERSHIP AND PERSONALITY IN THE MILITARY ORGANIZATION 133

Bass summarizes evidence showing that women tend to be higher in 

transformational leadership style than men; studies also suggest that 

more “feminine” (concerned leadership, individualized attention) approaches may lead to better performance in modern organizational 

cultures that tend to emphasize cooperation and collaboration within relatively flat and flexible structures, as compared to “male” taskoriented approaches which are characterized by instrumental strategies 

in more hierarchical and rigid structures (Bass, 1998; Eagley, Karau, and 

Makhijani, 1995). 

In their meta-analytic study, Judge and Bono (2000) identified 

agreeableness and extraversion as significant predictors of transformational leadership style. While these authors do not address gender differences directly, it happens that women made up 57 percent of their 

sample, a factor that might have influenced their results. Costa and McCrae likewise report a general finding across many samples that women 

tend to score higher in agreeableness (Costa and McCrae, 1992). Female 

cadets at West Point also fit this pattern, scoring higher in agreeableness 

than their male counterparts (Bartone, Snook, and Tremble, 2002). This 

higher agreeableness may incline female cadets toward a more transformational style, which in turn is more effective and valued in modern 

organizations. Interestingly, it has also been reported that female cadets 

are higher in hardiness than male cadets at West Point, and that hardiness appears to be a stronger moderator of psychosocial stress for female cadets (Bartone and Priest, 2001). This suggests that under stressful conditions, hardiness may be a more important influence on leader 

performance for women than for men. Future research is needed to explore this intriguing possibility. 

The U.S. Army is currently placing greater emphasis on efforts to 

increase self-awareness, adaptability, flexibility, and mentoring of subordinates, as evidenced, for example, in the formation in 2001 of a special panel to examine leader development programs and future needs 

for Army officers (Army Training and Leader Development Panel Officer Study: Report to the Army, 2001). This shift is also apparent at the 

Army’s primary leader development institution, the U.S. Military Academy (United States Military Academy, 2002). But these programmatic 

efforts need to be guided by sound research into the underlying processes involved, and clarifying what works and what does not. Important areas for future research include examining the possible direct and 
134 THE 71F ADVANTAGE

interacting effects of gender, personality, transformational leadership 

style, job, life experiences, and organizational factors on leader adjustment and performance. 

Leader Development

 If certain individual characteristics, attributes, or skills are associated with effective leader performance under various conditions, a 

vital practical question for organizations such as the military concerns 

how to develop or cultivate these characteristics. While a detailed review 

of the leader development literature is beyond the scope of this chapter 

(see Day, 2001, for a comprehensive treatment), some trends of special 

relevance to the military can be identified. One is a growing recognition that effective development of leaders must involve not only skills 

acquisition, but also personal growth and increasing individual maturity. Simple training, no matter how elaborate or intensive, is not likely to 

produce the kind of sophistication and breadth of perspective that the 

military needs in its leaders (Forsythe et al., 2002; Bartone et al., 2007). 

Reflecting this trend, West Point has recently incorporated an explicitly 

developmental philosophy into its overall leader development program 

(United States Military Academy, 2002; Bartone, 2001). Another trend 

is the increased attention to personality and cognitive factors that may 

be related to effective leader performance (Bartone, Snook, and Tremble, 2002; McCormack and Mellor, 2002; Hedlund et al., 2003). Both of 

these developments reflect a recognition of and appreciation for abiding individual differences and at the same time an understanding that 

growth and change can occur across the lifespan. Military academies 

are paying more attention to the assessment of personality factors in cadets, while also providing personalized feedback in a manner designed 

to facilitate improved self-understanding and growth in those characteristics associated with positive leader performance (Costa, Bartone, 

Herbst, Brazil, Kelly, Friedman, and McCrae, 2002). 

Various personality measures are also being used increasingly in 

the developmental programs for leaders at U.S. military senior Service 

colleges. For example, both the U.S. Army War College and the Industrial College of the Armed Forces at National Defense University have 

implemented comprehensive leader development assessment programs 

that include measures of the Big Five personality factors and involve 

detailed feedback sessions for students. Another development worth 
LEADERSHIP AND PERSONALITY IN THE MILITARY ORGANIZATION 135

noting is increased cross-national comparative research into factors that 

may influence military leader development. For example, a five-nation 

cross-national study applied a “grounded theory” approach to identify 

common career and job experiences that appear to spur leader development, possibly in interaction with personality variables (Larsson et al., 

2006). The South African military is also using more personality measures in selection and developmental applications (van Dyke, 2008; van 

Wijk and Waters, 2000).

Conclusion

This chapter has summarized several major theoretical perspectives on leadership and reviewed recent conceptual and empirical work 

in personality, leadership, and performance in the military. While a profusion of models and approaches continues to mark the leadership field, 

advances in personality theory and assessment have led to a growing 

consensus on the importance of individual or personality variables as 

well as situational ones. It is now clear that personality variables merit 

serious consideration in high-risk occupations like the military. With 

a better understanding of how personality factors can influence leader 

and Soldier performance under rapidly shifting, high-stress conditions, 

military organizations will be better able to select and develop the best 

leaders and troops for the future. 
136 THE 71F ADVANTAGE

References

Allport, G.W. (1985). The historical background of social psychology. In G. Lindzey and E. Aronson (eds.). Handbook of social psychology (3d

 ed., vol. 1) (1–46). New York: Random 

House.

Army training and leader development panel officer study: Report to the Army (May 2001). Retrieved January 15, 2009, from <www.army.mil/features/ATLD/report.pdf>. 

Avolio, B.J. (1999). Full leadership development. Thousand Oaks, CA: Sage.

Barrick, M.R., and Mount, M.K. (1999). The big five personality dimensions and job performance: a meta-analysis. Personnel Psychology 44, 1–26.

Bartone, P.T. (August 1988). Stress, hardiness and symptoms in Bosnia deployed soldiers. Paper 

presented at the American Psychological Association Convention, San Francisco, CA.

———. (1989). Predictors of stress-related illness in city bus drivers. Journal of Occupational 

Medicine 31, 657–663.

———. (1999a). Hardiness protects against war-related stress in Army Reserve forces. Consulting 

Psychology Journal 51, 72–82.

———. (1999b). Personality hardiness as a predictor of officer cadet leadership performance. Paper 

presented at the International Military Testing Association Meeting, Monterey, CA.

———. (2000). Hardiness as a resiliency factor for United States forces in the Gulf War. In J.M. 

Violanti, D. Paton, and C. Dunning (eds.). Posttraumatic stress intervention: Challenges, 

issues, and perspectives (115–133). Springfield, IL: Charles Thomas. 

———. (2001). Leader development programs and research at the U.S. Military Academy, West 

Point. Paper presented at the American Psychological Association annual convention, 

Symposium on Leader Development at the Service Academies: Current and Future Directions, San Francisco, CA.

Bartone, P.T., Johnsen, B.H., Eid, J., Brun, W., and Laberg, J.C. (2002). Factors influencing smallunit cohesion in Norwegian Navy officer cadets. Military Psychology 14, 1–22.

Bartone, P.T., and Priest, R.F. (2001). Sex differences in hardiness and health among West Point cadets. Paper presented at the American Psychological Society Meeting, Toronto, Canada. 

Bartone, P.T., and Snook, S.A. (2000). Gender differences in predictors of leader performance over 

time. Paper presented at the American Psychological Society 12th Annual Convention, 

Miami Beach, FL.

Bartone, P.T., Snook, S.A., Forsythe, G.B., Lewis, P., and Bullis, R.C. (2007). Psychosocial development and leader performance of military officer cadets. Leadership Quarterly 18, 

490–504.

Bartone, P.T., Snook, S.A., and Tremble, T. (2002). Cognitive and personality predictors of leader 

performance in West Point cadets. Military Psychology 14, 321–328.

Bartone, P.T., Ursano, R.J., Wright, K.W., and Ingraham, L.H. (1989). The impact of a military air 

disaster on the health of assistance workers: A prospective study. Journal of Nervous and 

Mental Disease 177, 317–328.

Bass, B.M. (1985). Leadership and performance beyond expectations. New York: Free Press.

———. (1990). Bass and Stogdill’s handbook of leadership. New York: Free Press.

———. (1998). Transformational leadership. Mahweh, NJ: Lawrence Erlbaum.

Bass, B.M., and Avolio, B.J. (1989). Manual: Multifactor leadership questionnaire. Palo Alto, CA: 

Consulting Psychologists Press.

Berger, P.L., and Luckmann, T. (1966). The social construction of reality. Garden City, NJ: Doubleday.

Block, J. (1995). A contrarian view of the five-factor approach to personality description. Psychological Bulletin 117, 187–215.

Blyth, D.E. (1987). Leader and subordinate expertise as moderators of the relationship between 

directive leader behavior and performance. Doctoral dissertation, University of Washington, Seattle, WA.
LEADERSHIP AND PERSONALITY IN THE MILITARY ORGANIZATION 137

Bono, J.E., and Judge, T.A. (2004). Personality and transformational and transactional leadership: 

A meta-analysis. Journal of Applied Psychology 89, 901–910.

Burns, J.M. (1978). Leadership. New York: Harper and Row.

Conger, J.A. (1989). The charismatic leader: Behind the mystique of exceptional leadership. San 

Francisco, CA: Jossey-Bass.

Costa, P.T., Bartone, P.T., Herbst, J.H., Brazil, D., Kelly, D., Friedman, S.B., and McCrae, R.R. 

Five-factor model of personality and leader performance among United States Army cadets: 

Prediction equations and feedback strategies. Unpublished manuscript.

Costa, P.T., and McCrae, R.R. (1992). The NEO PI–R professional manual. Odessa, FL: Psychological Assessment Resources.

Dawda, D. (Summer 1997). Personality or factor-analytically developed, lay person, self-reported, single-word, adjectival descriptors of global characteristics of personality structure: 

The NEO five-factor model and skimming the surface of the wetlands of personality. 

Psybernetika. Retrieved January 15, 2009, from <http://psybernetika.ca/issues/1997/

summer/dawda.htm>.

Day, D. (2001). Leadership development: A review in context. Leadership Quarterly 11, 581–613.

Department of the Army (1990). Field Manual 22–100, Army Leadership. Washington, DC: U.S. 

Government Printing Office.

Digman, J.M. (1990). Personality structure: Emergence of the five-factor model. Annual Review 

of Psychology 41, 417–440.

Druckman, D., Singer, J.E., and Van Cott, H. (eds.). (1997). Enhancing organizational performance. Washington, DC: National Academy Press, 98.

Druskat, V.U. (1994). Gender and leadership style: Transformational and transactional leadership 

in the Roman Catholic Church. Leadership Quarterly 5, 99–119.

Eagley, A.H., Karau, S.J., and Makhijani, M.G. (1995). Gender and the effectiveness of leaders: A 

meta-analysis. Psychological Bulletin 117, 125–145.

Fiedler, F.E. (1964). A contingency model of leader effectiveness. In Leonard Berkowitz (ed.). 

Advances in experimental social psychology, vol. I (149–190). New York: Academic Press.

———. (1967). A theory of leadership effectiveness. New York: McGraw-Hill.

———. (1986). The contribution of cognitive resources to leadership performance. Journal of Applied Social Psychology 16, 532–548.

Fleishman, E.A., and Harris, E.F. (1962). Patterns of leadership behavior related to employee 

grievances and turnover. Personnel Psychology 15, 43–56.

Forsythe, G.B., Snook, S.A., Lewis, P., and Bartone, P.T. (2002). Making sense of officership: Developing a professional identity for 21st century Army officers. In D.M. Snider, G.L. Watkins, and L.J. Matthews (eds.). The future of the Army profession (357–378). New York: 

McGraw Hill. 

Gal, R. (1987). Military leadership for the 1990s: Commitment-derived leadership. In L. Atwater 

and R. Penn (eds.). Military leadership: Traditions and future trends. Annapolis, MD: U.S. 

Naval Academy. 

Goleman, D. (1995). Emotional Intelligence. New York: Bantam Books.

Gough, H. (1990). Testing for leadership with the California psychological inventory. In K.E. 

Clark and M.B. Clark (eds.). Measures of leadership (355–379). West Orange, NJ: Leadership Library of America, Inc.

Hedlund, J., Forsythe, G.B., Horvath, J.A., Williams, W.M., Snook, S.A., and Sternberg, R.J. 

(2003). Identifying and assessing tacit knowledge: Understanding the practical intelligence of military leaders. Leadership Quarterly 14, 117–140.

Hogan, R., Raskin, R., and Fazzini, D. (1990). The dark side of charisma. In K.E. Clark and M.B. 

Clark (eds.). Measures of leadership (343–354). West Orange, NJ: Leadership Library of 

America, Inc.

Hollander, E.P., and Julian, J.W. (1969). Contemporary trends in the analysis of leadership processes. Psychological Bulletin 71, 387–397.
138 THE 71F ADVANTAGE

Homer (1975). The odyssey of Homer (R. Lattimore, trans.). New York: Harper and Row.

Hough, L. (1992). The “big five” personality variables—construct confusion: Description versus 

prediction. Human Performance 5, 139–155.

House, R.J. (1971). A path-goal theory of leader effectiveness. Administrative Science Quarterly

16, 321–339. 

———. (1977). A 1976 theory of charismatic leadership. In J.G. Hunt and L.L. Larson (eds.). Leadership: The cutting edge. Carbondale, IL: Southern Illinois University Press.

———. (1988). Leadership research: Some forgotten, ignored, or overlooked findings. In J.G. 

Hunt, B.R. Baliga, H.P. Dachler, and C.A. Schriesheim (eds.). Emerging leadership vistas. 

Lexington, MA: Lexington Books.

———. (1988). Power and personality in complex organizations. In L.L. Cummings and B.M. 

Straw (eds.). Research in Organizational Behavior. Greenwich, CT: JAI Press.

———. (1996). Path-goal theory of leadership: Lessons, legacy, and a reformulated theory. Leadership Quarterly 7, 323–352.

House, R.J., and Howell, J.M. (1992). Personality and charismatic leadership. Leadership Quarterly 3, 81–108.

House, R.J., and Mitchell, T.R. (Fall 1974). Path-goal theory of leadership. Contemporary Business

3, 81–98. 

Hughes, R.L., Ginnett, R.C., and Curphy, G.K. (1996). Leadership: Enhancing the lessons of experience. Chicago: Irwin.

Jacobs, T.O., and Jaques, E. (1986). Leadership in complex systems. In J. Zeidner (ed.). Human 

productivity enhancement: Volume 2, Organizations, personnel and decision-making (7–

65). New York: Praeger.

Janis, I. (1972). Victims of groupthink. Boston, MA: Houghton-Mifflin.

Judge, T.A., and Bono, J.E. (2000). Five-factor model of personality and transformational leadership. Journal of Applied Psychology 85, 751–765.

Katz, D., and Kahn, R.L. (1952). Some recent findings in human relations research in industry. 

In G.E. Swanson, T.M. Newcomb, and E.L. Hartley (eds.). Readings in social psychology. 

New York: Holt Rinehart and Winston.

Kegan, R. (1982). The evolving self: Problem and process in human development. Cambridge, MA: 

Harvard University Press.

Kobasa, S.C. (1979). Stressful life events, personality, and health: An inquiry into hardiness. Journal of Personality and Social Psychology 37, 1–11.

Kuhnert, K.W., and Lewis, P. (1987). Transactional and transformational leadership: A constructive/developmental analysis. Academy of Management Review 12, 648–657.

Lall, R., Holmes, E.K., Brinkmyer, K.R., Johnson, W.B., and Yatko, B.R. (1999). Personality characteristics of future military leaders. Military Medicine 164, 906–910.

Larsson, G., Bartone, P.T., Bos-Bakx, M., Danielsson, E., Eid, J., Jelusie, L., Johansson, E., Moelker, 

R., Sjöberg, M., Vrbanjac, A., Bartone, J., Forsythe, G.B., Pruefert, A., and Wachowicz, M. 

(2006). Leader development in natural context: A grounded theory approach to discovering how military leaders grow. Military Psychology 18S, 69–81.

Lau, A. (1990). Military leadership. In C. Cronin (ed.). Military psychology: An introduction (49–

69). Needham, MA: Simon and Schuster.

Lewis, P. and Jacobs, T.O. (1992). Individual differences in strategic leadership capacity: A constructive/developmental view. In R.L. Phillips and J.G. Hunt (eds.), Strategic leadership: 

A multiorganizational-level perspective (121–137). Westport, CT: Quorum Books.

Likert, R. (1967). The human organization: Its management and value. New York: McGraw-Hill.

Lord, R.G., DeVader, C.L., and Alliger, G.M. (1986). A meta-analysis of the relation between 

personality traits and leadership perceptions: An application of validity generalization 

procedures. Journal of Applied Psychology 71, 402–410.
LEADERSHIP AND PERSONALITY IN THE MILITARY ORGANIZATION 139

Maddi, S.R. (1967). The existential neurosis. Journal of Abnormal Psychology 72, 311–325. 

———. (1987). Hardiness training at Illinois Bell Telephone. In J.P. Opatz (ed.). Health promotion 

evaluation. Stevens Point, WI: National Wellness Institute.

———. (1999). Comments on trends in hardiness research and theorizing. Consulting Psychology 

Journal 51, 67–71. 

Maddi, S.R., Khoshaba, D.M., Jensen, K., Carter, E., Lu, J.L., and Harvey, R.H. (2002). Hardiness 

training for high risk undergraduates. NACADA Journal 22, 45–55.

Maddi, S.R., and Kobasa, S.C. (1984). The hardy executive: Health under stress. Homewood, IL: 

Dow Jones-Irwin.

Mann, R.D. (1959). A review of the relationship between personality and performance in small 

groups. Psychological Bulletin 56, 241–270.

McCaulley, M.H. (1990). The Myers-Briggs type indicator and leadership. In K.E. Clark and M.B. 

Clark (eds.). Measures of leadership (381–418). West Orange, NJ: Leadership Library of 

America, Inc.

McCormack, L. and Mellor, D. (2002). The role of personality in leadership: An application of the 

five-factor model in the Australian military. Military Psychology 14, 179–197. 

McCrae, R.R. (ed.). (1992). The five-factor model: Issues and applications. [Special Issue]. Journal of Personality 60 (2).

Moskos, C.C., Williams, J.A., and Segal, D.R. (2000). The postmodern military: Armed forces after 

the Cold War. New York: Oxford University Press.

Mumford, M.D., Zaccaro, S.J., Harding, F.D., Fleishman, E.A., and Reiter-Palmon, R. (1993). 

Cognitive and temperament predictors of executive ability: Principles for developing leadership capacity (ARI Technical Report 977, AD A267 589). Alexandria, VA: U.S. Army 

Research Institute for the Behavioral and Social Sciences. 

Mumford, M.D., Zaccaro, S.J., Harding, F.D., Jacobs, T.O., and Fleishman, E.A. (2000). Leadership skills for a changing world. Leadership Quarterly 11, 11–35.

Nagl, J.A. (2005). Learning to eat soup with a knife: Counterinsurgency lessons from Malaya and 

Vietnam (2d

 ed.). Chicago, IL: University of Chicago Press. 

Phillips R.L., and Hunt, J.G. (eds.). (1992). Strategic leadership: A multiorganizational level perspective. Westport, CT: Quorum Books. 

Plato (1991). The republic (Allan Bloom, trans.). New York: Basic Books.

Podsakoff, P.M., MacKenzie, S.B., Ahearne, M., and Bommer, W.H. (1995). Searching for a needle 

in a haystack: Trying to identify the illusive moderators of leadership behaviors. Journal 

of Management 21, 423–470. 

Potter, E.H., and Fiedler, F.E. (1981). The utilization of staff member intelligence and feedback 

under high and low stress. Academy of Management Journal 24, 361–376.

Rubenzer, S.J., Faschingbauer, T.R., and Ones, D.S. (2000). Assessing the U.S. Presidents using the 

Revised NEO Personality Inventory. Assessment 7, 403–420.

Ryback, D. (1998). Putting emotional intelligence to work: Successful leadership is more than IQ. 

Boston, MA: Butterworth-Heinemann.

Salovey, P. and Mayer, J.D. (1990). Emotional intelligence. Imagination, Cognition and Personality

9, 185–211.

Sashkin, M. (1992). Strategic leadership competencies. In R.L. Phillips and J.G. Hunt (eds.). Strategic leadership: A multiorganizational-level perspective (139–160). Westport, CT: Quorum Books.

Segal, M.S. (1995). Women’s military roles cross-nationally: Past, present and future. Gender and 

Society 9, 757–775. 

Shamir, B., and Ben-Ari, E. (2000). Challenges of military leadership in changing armies. Journal 

of Political and Military Sociology 28, 43–59.

Shamir, B., House, R.J., and Arthur, M.B. (1993). The motivational effects of charismatic leadership: A self-concept based theory. Organizational Science 4, 1–17. 
140 THE 71F ADVANTAGE

Shaw, M.E. (1955). A comparison of two types of leadership in various communication nets. 

Journal of Abnormal and Social Psychology 50, 127–134. 

Shaw, M.E., and Blum, J.M. (1966). Effects of leadership style upon group performance as a function of task structure. Journal of Personality and Social Psychology, 238–242.

Shaw, M.E., and Costanzo, P.R. (1982). Theories of social psychology. New York: McGraw-Hill, 

388. 

Shay, J. (2002). Odysseus in America: Combat trauma and the trials of homecoming. New York: 

Scribner. 

Sternberg, R.J., Forsythe, G.B., Hedlund, J., Horvath, J.A., Wagner, R.K., Williams, W.M. et al. 

(2000). Practical intelligence in everyday life. New York: Cambridge University Press.

Stodgill, R.M. (1948). Personal factors associated with leadership: A survey of the literature. Journal of Psychology 25, 35–71.

———. (1974). Handbook of leadership. New York: Free Press, 259.

Thomas, J.L., Dickson, M.W., and Bliese, P.D. (2001). Values predicting leader performance in the 

U.S. Army Reserve Officer Training Corps Assessment Center: Evidence for a personality-mediated model. Leadership Quarterly 12, 181–196.

United States Military Academy (2000). PL300 military leadership course guide. West Point, NY: 

Department of Behavioral Sciences and Leadership, U.S. Military Academy.

United States Military Academy (June 2002). Cadet leader development system (USMA Circular 

1–101). West Point, NY: U.S. Military Academy, Office of the Superintendent. 

van Dyk, G. (September 2008). A profile analysis of students at the South Africa Military Academy. 

Paper presented at First International Conference on Strategic Challenges for African 

Armed Forces for the Next Decade, Saldanha, South Africa.

van Wijk, C., and Waters, A.H. (2000). Personality characteristics of South African Navy submarine personnel. Military Medicine 165, 656–658. 

Weber, M. (1947). The theory of social and economic organizations (T. Parsons, trans.). New York: 

Free Press.

Weik, K.E. (1995). Sensemaking in organizations. Thousand Oaks, CA: Sage.

Westman, M. (1990). The relationship between stress and performance: The moderating effect of 

hardiness. Human Performance 3, 141–155.

Widiger, T.A., and Trull, T.J. (1997). Assessment of the five-factor model of personality. Journal of 

Personality Assessment 68, 228–250.

Wofford, J.C., and Liska, L.Z. (1993). Path-goal theories of leadership: A meta-analysis. Journal 

of Management 19, 858–876.

Yukl, G. (1998). Leadership in organizations. Upper Saddle River, NJ: Prentice Hall.

Zaccaro, S.J., Gilbert, J., Thor, K.K., and Mumford, M.D. (1991). Leadership and social intelligence: Linking social perceptiveness and behavioral flexibility to leader effectiveness. 

Leadership Quarterly 2, 317–331.
Chapter 7

Development and Fielding of the U.S. 

Army Leader Self-development Portfolio

James Ness, Thomas A. Kolditz, Philip Lewis, and David M. Lam

Leader Self-development in the U.S. Army

In a 2002 review of Army leader training and development, the 

Army Training and Leader Development Panel (2003) determined that 

leader adaptability and self-awareness are critical for the leadership 

of our future force. The panel was chartered by then–Chief of Staff of 

the Army (CSA), General Peter Schoomaker, to examine the state of 

training, education, and leader development programs and the extent 

to which these programs meet the Army’s transformation objectives. 

In October 2003, as a result of the panel’s recommendations, General 

Schoomaker announced “The Bench” as one of the Army’s 15 focus areas to address the leader self-development needs identified by the panel 

(Institute of Land Warfare, 2004).

The broad purpose of The Bench initiative was to develop leader adaptability and self-awareness within the Army. The Army War 

College (AWC), under the leadership of Major General David Huntoon, accepted strategic oversight of this initiative, which included policy change initiatives and the implementation of an Army-wide virtual leader self-development program.  On July 2, 2004, the AWC received authorization from the office of the CSA to execute a strategy 

to accomplish Bench initiatives.  This authorization included guidance 

that the Department of Behavioral Sciences and Leadership (BS&L) at 

the U.S. Military Academy design and implement a virtual leader selfdevelopment program that included an online portfolio providing leaders a view over time of the development of their leadership perspective 

and decisionmaking processes.  

In this chapter, we will describe the development and implementation of the online Leader Development Portfolio (LDP) and its transition to the U.S. Army Training and Doctrine Command (TRADOC) in 

October 2007. We will begin with a discussion of the process of turning 

the CSA’s intent into reality and of how constraints were identified and 

141
142 THE 71F ADVANTAGE

managed through leveraging resources extant on Army Knowledge Online/Defense Knowledge Online (AKO/DKO).1

 We will then describe 

how “self-awareness” was defined. This was critical in developing methods to generate information to provide feedback to the leader. We will 

then turn to the structure of the LDP and discuss the goal of developing a software system that was scalable, adaptable, and usable, and the 

means by which the goal was accomplished. Finally, we will provide data 

showing the effectiveness of the system and how the metadata were used 

to modify the structure of the system to better diffuse leadership lessons 

and best practices throughout the force. 

Building the Leader Development Portfolio

Constraints and Their Resolution

The U.S. Military Academy (USMA) received $500,000 from the 

Army War College shortly after being tasked to build the LDP. These 

resources were gladly accepted, but the challenge was how to build the 

system specified by the CSA for $500,000. Further, the money had to be 

obligated by the end of the fiscal year. That is, a contract had to be initiated before the end of October 2004, about 2 months from the time we 

received the funding.2

 The constraints of limited dollars and time to obligate the dollars were significant in our planning process. 

Some initial decisions about what was and was not possible had 

to be made.3

 First, it was recognized that necessary information assurances required for the system could not be instituted in a timely manner (HQDA, 2007). Second, there was not enough lead time for Defense 

Contracting to establish a new contract. Third, there was not enough 

money to build a unique standalone system, purchase the necessary 

hardware, and hire personnel to program and maintain the system. 

Asking for more funding and time was considered, but it was felt that 

with some creative thinking, a functional system could be built with the 

available resources. One idea was to house the system on USMA servers, 

but information assurance was still an issue and there were no programmers organic to USMA available to work on the system. The other idea 

was to work with AKO and leverage its resources.

After a few cold calls, we found our way to the AKO program 

manager, Lieutenant Colonel Kenneth Blakely. He agreed in principle to 

assist, and we arranged a meeting at USMA to work out an agreement. 

The result was that AKO would accept our $500,000 and amend its contract to support our effort. AKO was interested in both bolstering the 
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 143

functionality of its portal and hearing our ideas, especially since it had 

ambitions to explore similar LDP functionality, such as private blogs. 

With AKO came a solution to our information assurance, contracting, 

storage, programming, and access issues. Our next step was to specifically define the requirements for an operational prototype. 

LDP Concept of Leader Self-development

Before constructing an online leader self-development system, 

we had to resolve what leader self-development meant in the context of 

CSA intent. In defining the issues, we consulted our colleagues within BS&L, the AWC, the U.S. Army Research Institute, the Center for 

Army Leadership, and the Army’s clinical mental health fields.4

 Without a well-defined conceptual framework, the specific functional requirements for the software engineers to build an online system could 

not be written. The conceptual framework required a theoretical underpinning supported in the professional scientific literature. It needed 

to be congruent with doctrinal concepts of U.S. Army leader development, to meet the CSA’s leader development intent and specified 

functionality, and have broad acceptance from the community of 

intended users. 

Doctrinal and CSA Guidance

In the year leading up to the announcement of The Bench initiative 

at the October 2003 Association of the U.S. Army (AUSA) meeting, the 

Army Training and Leader Development Panel (ATLDP) released its findings in a report to the Army (ATLDP, 2003). The overall study included 

Officer, Noncommissioned Officer (NCO), Warrant Officer, and Civilian panels (Army Leader Development Panel Study Reports [n.d.]; AUSA, 

2008). The major finding was that to meet transformation objectives, 

training and leader development programs should produce self-aware and 

adaptive leaders. The panels found that formal educational and operational experiences cannot provide all the knowledge needed to be self-aware 

and adaptive leaders. Further, the panels commented that self-development is essential to lifelong learning and provides the training and education that formal educational and operational experiences cannot supply.

From this recommendation, we chose as our goal for the LDP to 

improve self-awareness for the purpose of improving leader adaptability. To begin the requirements process for the LDP, we adopted from the 

report those leader development and training principles related to selfdevelopment and self-awareness:
144 THE 71F ADVANTAGE

■ Know Yourself. Self-aware and adaptive leaders are the basis for 

success in full-spectrum operations. The relationship between 

self-awareness and adaptability is symbiotic. The greater the 

self-awareness gained by assessment against measurable standards, the more adaptive the leader. Through a commitment 

to lifelong learning enabled by self-development, leaders can 

narrow the knowledge gaps not filled or addressed through 

educational and operational experiences. 

■ Lifelong Learning. Part of the Army’s culture should be the 

commitment to lifelong learning by its leaders. Learning organizations support self-awareness and adaptability. Lifelong 

learning requires standards, with related tools for assessment, 

feedback, and self-development. 

■ Mentorship. Mentoring is not a formal program, but part of 

the stock and trade of the profession. It focuses on the art of 

leadership. 

The “Know Yourself” aphorism is at the core of the LDP’s leader 

developmental goal. The LDP must help leaders know how they tend to 

think, feel, and react, and who they tend to surround themselves with 

in the various contexts of decisionmaking to be able to lead with full 

awareness of the nature and effects of their decisions. The “Lifelong 

Learning” principle addresses the need for the LDP to be accepted and 

compelling as part of the culture of the Army. Further, the principle specifically states that the LDP requires standards, tools, and feedback. The 

“Mentorship” principle was adopted because it is part of the profession 

and fundamental to accelerating life experience through the experiences and wisdom of others. Working through mentors adds perspective to 

issues confronting a leader, puts feedback in context, guides resolution, 

and mitigates repeating one’s own and others’ past errors.

Drawing from the ATLDP study and the CSA’s tasks, we began 

to sketch out the requirements for the LDP. We knew from the CSA 

specified task that we needed a leader self-development system that was 

online and on-demand, maintained user anonymity, and had a twostore security system. From the ATLDP, we knew that the system needed a toolbox of standardized methods for promoting self-development 

relevant to current and future leader positions, a mechanism for feedback, and a means for mentoring. Further, this system had to be accepted by the force. 
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 145

Although the Army wanted self-aware and adaptive leaders, there 

was no developmental pedagogy offered to achieve this endstate. Identifying the leader development need was the charge of the panel. Development of mechanisms to achieve the endstate was the panel’s tasking 

to the leader development community. Thus, we had to develop a working definition of self-awareness within a self-development context so we 

could measure it and provide structured developmental feedback that 

would improve leader adaptability. 

Self-awareness Defined

Engaging the USMA library staff, we performed an exhaustive 

review of the literature to find a theory of self and self-awareness that 

was parsimonious, easily applied, and effective within the context of U.S. 

Army leader self-development. Duval and Wicklund’s (1972) concept 

of self-awareness was decided on. Most appealing was the fact that this 

theory only had two states, the subjective and the objective. All other 

theories had many more divisions of the self and simply lacked the parsimony to be practically applied. Second, there were specific findings that 

showed that indeed becoming more self-aware, under their rubric, had 

positive effects to include those that could be categorized as adaptable.

However, self-awareness was also shown to have significant negative effects, illustrating that one must be careful with how one facilitates 

self-awareness and provides feedback in a self-development context. As 

an analogy, a system that facilitates self-awareness is like a mirror that 

directs attention to reflections from that mirror. A mirror that provides 

enough resolution to comb one’s hair helps improve one’s appearance. 

However, a mirror that provides too much detail about one’s “flaws” can 

bring about unhealthy obsessive or compulsive body-focused behaviors. 

For Duval and Wicklund, the self is indivisible; however, consciousness can act in two ways in relation to the self. It can be focused on 

the task in which the self is engaged, a state referred to as the “Subjective 

Self.” Consciousness can also be focused on the self, a state referred to 

as the “Objective Self.” While in the Subjective Self state, one is focused 

on external events, where one is typically absorbed in the task, with 

the purpose of achieving goals or otherwise influencing task-related 

outcomes. While in the Objective Self state, one is focused on the self as 

the object of study. In this state, attention is on, for example, a state of 

arousal, likes and dislikes, and personal history. It is in this state that the 

individual self-monitors and self-reflects. Both objective and subjective 
146 THE 71F ADVANTAGE

states are susceptible to conscious activity with attention as the limiting 

resource. Under this rubric, our goal was to promote a healthy amount 

of self-monitoring in situations demanding a focus on external events to 

check stereotypic or ritualized behavior often employed to solve problems. In this way, the evaluation of such behaviors could promote more 

creative and critical thinking about a problem, and potentially improve 

perspective-taking when engaging others.

A number of studies showed that self-awareness promotes constructive outcomes in the areas of perspective-taking, self-control, creative achievement, and self-esteem (Silvia and Duval, 2001; Wicklund 

and Gollwitzer, 1987). However, a unique set of feedback structures and 

tools is required. In addition, a context of privacy, anonymity, and security are needed to promote self-reflection in order to engender selfawareness and diminish the threat of self-consciousness. If the system 

used to promote self-reflection did not take care to incorporate psychological safeguards, then instead of healthy outcomes, the system could 

yield self-consciousness, an exacerbation of the negative, a limited focus, and a decrease in intrinsic motivation (Fenigstein, Scheier, and 

Buss, 1975). Thus, when building the LDP, care was taken in structuring the tools, context, and feedback to promote self-awareness without 

inducing self-consciousness or control by a “generalized other” (Mead, 

1934). In other words, we did not want people to strive toward a mean 

or to view a norm as a “minimum standard,” but to come to know their 

strengths and weaknesses within the context of self (versus in comparison to the generalized other). Further, the goal was that the knowledge 

gained would be useful to better perform duties and achieve personal goals. For this reason, the tools employed did not make comparisons to populations or norms. Comparisons were made across natural 

groupings within the Army’s organizational and social structure (for example, peers, subordinates, seniors, NCOs, officers, acquaintances, and 

friends). Developmentally, we followed the Army’s doctrinal progression from junior to senior leader for both uniformed and civilian leaders, and focused on aspects particular to each period of progression. 

LDP Functional Components

The LDP system was programmed such that it was scalable, 

adaptable, and usable.5

 By scalable, we mean the ability of the system to 

adapt to increased demand. By adaptable, we mean the ability to easily 

incorporate functionality written for the AKO portal and the capacity of 
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 147

the system to meet the self-development needs of the individual leader 

and leader development community. By usable, we refer to a system that 

is easy to learn and use, efficient, well laid out, effective, and compelling. To ensure adaptability, the LDP was written as an integrated system 

of major functional components on which other components can call 

when that particular functionality is needed. The major functional components of the LDP are the User Interface, the Management Console, 

the Developmental Box, and the Administrator Console. Subcomponents of each of these major components were phased in to meet timelines and budget constraints. Each major component is discussed in detail in the subsequent sections.

User Interface

Figure 7–1 shows the major components of the User Interface: 

the leader development portfolio, the database, the results engine, and 

the two-store security system where the LDP context and database are 

linked by way of the Web services bridge. Major components of the 

portfolio include the leader development toolbox, where one can initiate a self-assessment instrument, engage a mentor, solicit feedback 

through the respondent chooser, view assessment feedback, reach the 

Help Desk, and access the Benchworks supplemental leader development Web site. 

Figure 7–1. Leader Development Portfolio Major Components

Army Knowledge Online (AKO)/ Defense Knowledge Online (DKO) Store

Leader Development Portfolio (LDP) User Context

Leader Development Portfolio Major Components

U.S. Military Academy (USMA) Store

LDP Omnibus Database

Leader’s self-development portfolio

■ Initiate assessments

■ View portfolio

■ Engage mentor

■ Leader self-development,

 knowledge management site

 https://www.benchworks.army.mil

AKO/DKO user

AKO/DKO

authentication and

authorization

AKO Web 

service

USMA Web 

service

Load

balancer

LDP database

LDP database

Results engine

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
148 THE 71F ADVANTAGE

Two-store security system. The two-store security system posed a bit 

of a problem. The original concept as presented to us was to physically 

remove the data from the network, load it onto a “standalone” storage 

device that was not connected to the net, and, when requested, physically move the data back to the server from the storage device. This was 

deemed impractical, as it would significantly hinder the ability to have 

an online on-demand system if we were continually taking individual 

leader development portfolios off- and online. However, the CSA’s specified tasks remained: no one was to be able to access this information 

except the user, and the security system would be a two-tiered system. 

Our solution was to separate the data from the context and to only allow access to the data through the AKO portal authentication process. 

The data reside on servers outside of AKO’s physical plant, and the data 

backups are separated from the active data servers. The program itself, 

or context, resides on the AKO portal. The only way to access the data 

is through the portal, which activates a Web services encryption bridge 

that allows access only to that user’s information. We took great pains to 

set up this procedure for two reasons: the CSA directed such a system; 

and pedagogically, in order to promote self-reflection, the user has to 

feel a sense of privacy and security. Thus, there is no way to access another’s data, even at the administrative level. The program is designed 

to be anonymous and used exclusively for individual leader self-developmental purposes. We specifically put in safeguards so LDP data could 

not be incorporated into the formal evaluation system or used to assess 

command climate. 

Leader Development Toolbox. The Leader Development Toolbox consists of tools designed to solicit others’ feedback on those competencies identified by the Army for leaders to perform well. The toolbox 

tailors available content based on the user’s position within the Army. 

The individual leader’s developmental needs within the Army are defined in the LDP by the individual’s rank and position. The principal 

tool is the 360 (Toegel and Conger, 2003). This tool consists of 12 to 

15 questions about doctrinally identified competencies required to perform well in one’s rank and position. The 360 programs were developed 

separately for different groups of Army leaders: NCOs, company grade 

officers, field grade officers, civilian personnel, and some specialty-specific groups, such as chaplains. 

To execute a 360, the leader first answers the questions for himself and then solicits peers, subordinates, and seniors to anonymously 
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 149

respond to the same questions. The responses are not presented to the 

initiator until a minimum number within a category have responded. 

The feedback is presented as a box plot of the pooled data within a category. Minimum numbers of respondents in each category (6 subordinates, 6 peers, 3 seniors) were an optimization of respondent anonymity, 

timeliness of feedback, and available pool of individuals within each respondent category. Usability tests showed that on average, a leader could 

expect a completed 360 assessment within 30 days. There were provisions within the system to remind respondents of outstanding feedback, 

to add respondents to an ongoing assessment, or to close out an assessment and only be allowed to view feedback from those respondent categories that met the minimums. 

The 360 was designed to provide insights to prepare the leader for 

the next level of leadership. Thus, the 360 assessments were constructed 

from research identifying leader core competencies from doctrine and 

from interviews and focus-group testing. The Company Grade 360 was 

developed by members of the USMA BS&L through work with company 

grade officers returning from Iraq and Afghanistan. The Field Grade 

360 was derived from the Leadership Lessons at Division Command 

Level study with permission of the lead author (Ulmer et al., 2004). The 

Civilian Leadership 360 was developed by BS&L through work with 

Department of Defense Senior Executive Service personnel. The NCO 

360 was developed in collaboration with the U.S. Army Sergeants Major 

Academy. Other 360s such as that for the Chaplain Corps were provided 

directly by the leader developers within the respective corps. 

Also within the toolbox is a coach’s journal where leaders can privately share results of their portfolio with a mentor and create private 

blogs to discuss leadership issues within their selected groups. The purpose of this system is to support the stock and trade of the profession, 

facilitating contact between leaders and their mentors, and to provide 

leader forums regardless of distance. Finally, prior to transition to TRADOC, BS&L developed and added a personality tool to the toolbox, 

which will be discussed later. 

Respondent Chooser. The program itself is adaptable in that it calls a 

number of AKO functions, such as the White Pages function. The White 

Pages call within the Respondent Chooser allows the initiator of an assessment to quickly and efficiently choose colleagues from whom input is desired. Within the Respondent Chooser, the initiator can search 

for respondents by all or part of a respondent’s first name, last name, 
150 THE 71F ADVANTAGE

service, rank, and branch. With this functionality, the initiator can find 

individuals with a registered AKO/DKO account and choose them to 

respond to an assessment. The system automatically emails the potential respondents with a link to respond or decline. The initiator is provided feedback on how many individuals within each category have responded, have responses pending, or have declined, but the system does 

not track which individuals choose or decline to participate. The initiator can choose to send out reminder emails or add new respondents if 

the trends indicate that a particular category may not reach the minimum number of respondents. The initiator can also choose to close out 

an assessment at any time after 30 days in process. However, only the 

feedback from those respondent categories that reach the required minimum number of responses will be displayed. 

The dynamic that we had to optimize in defining an assessment 

time window so feedback would keep up with developmental events 

(promotion, position change, critical incidents, and so forth) was the 

balance between the initiator’s need for timely feedback and the respondent’s need for anonymity and a reasonable interval to respond. We began with a system that reminded respondents weekly of their requirement to respond or decline. That strategy produced many angry emails 

and telephone calls to the Help Desk. We needed a different tactic. 

For those who may foray into a software development project, a 

rule of thumb is that for usability issues, the best solution is typically to 

give users sufficient information that they can take control. In this case, 

we provided a table that was updated in real time as to the number of 

respondents registered by category, as well as the number who had responded, declined, or were pending. Then we gave users the ability to 

send out email reminders as well as information about the last time they 

sent out reminders and the ability to add more respondents.

Further, after 30 days, we gave users three options. Option 1 provided the ability to leave an assessment open, which meant they could 

continually add new respondents and send out reminders, but would 

have to wait to view their results until all category minimums were met 

and they could not initiate a new assessment of that current type. Option 2 provided the ability to close an assessment, which meant users 

could view the results from the categories of respondents in which the 

minimums were reached and that the results would continue to update as respondents provided feedback. Under this option, reminder 

emails could be sent, but no further respondents could be added and 
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 151

they could not initiate a new assessment of that current type. Option 3 

provided the ability to complete an assessment, which meant the results 

would be posted for the respondent categories that met the minimums. 

No further reminders could be sent, no additional respondents could be 

added, and no further updates to the results were made. Under this condition, the initiator could begin a new assessment. 

We chose this course of action because in our tests of the system, 

the majority of assessments were completed within 30 days. Therefore, 

we wanted to give the respondents that period to answer and to prevent 

the initiator from prematurely closing an assessment. However, the initiator had the power to send reminders, monitor the numbers of individuals responding, declining, or pending, and add more respondents 

to more quickly meet minimums for timely feedback. After 30 days, we 

turned control over to the initiator to continue with an open assessment 

or to close or complete an assessment. We maintained a distinction between close and complete so the portfolio would maintain a continuous 

timeline of assessments. Thus, when leaders looked back over their assessment portfolio, clear chronological demarcations and naming conventions (rank, position, and unit are suggested in the program) would 

be evident. This structure was put in place to facilitate recall when reflecting on leader developmental issues over the course of a career. 

Help Desk. Over the first year of the program, the Help Desk was the 

first author’s AKO email address. This involved good news and bad 

news. We went with the first author’s address because we did not have 

the resources to institute a Help Desk, and at the time AKO was a bit 

stingy with corporate accounts. The bad news about the Help Desk was 

that whatever can go wrong with new software does go wrong, and it 

was always the first author’s fault. In terms of responding to Help Desk 

issues, we discovered that people react with different levels of intensity despite the similarity of the problem. Notwithstanding that, all are 

grateful that there is a real person at the other end of the line. However, 

this is not enough. For a system to remain usable, the Help Desk must 

respond to queries as soon as possible, provide updates on progress, and 

deliver resolution that restores user satisfaction with and confidence in 

the system and gives users a sense that they constructively contribute to 

system improvement. 

Even though we ran usability tests that revealed gross human 

factor failures with the user interface and brainstormed new functionality in our weekly meetings, the Help Desk was our best source of 
152 THE 71F ADVANTAGE

information to refine system usability. Although time-consuming, it 

was a means for the first author to understand user concerns and habits to ensure that programming requirements were refined in a manner 

that produced a more usable system. Knowing the system from the user’s perspective also improved our brainstorming process through shaping our big ideas into good ideas that rendered a more scalable, adaptable, and usable system. 

AKO eventually granted us a corporate account, and we were also 

able to hire a professional staff person who managed the Help Desk and 

tabulated issues for consideration at our weekly meetings to determine 

how to approach our fixes. The approaches included instructional fixes 

such as pop-up boxes, additional to-the-point instructions, improved 

buffering to prevent aberrant mouse clicks, redesigns of user interfaces, 

and the addition of user functionality. From the logging of Help Desk issues, we were able to improve the LDP. One such improvement was the 

design of our Management Console, which will be discussed below. Its 

design included the ability to change and publish instructions without 

having to wait for the AKO build cycle.6

BenchWorks Web site. A Benchworks Web site was developed and deployed as a response to many Help Desk calls as to what leaders could do 

next to support their own leader development.7

 The Web site contained 

resources to further research those issues that emerged in the self-reflection process.8

 It also offered other leader developmental tools, which 

were tested for incorporation into the LDP toolbox. The approach was 

twofold: there was plenty of leader development information in the literature and simply synthesizing that information could provide useful 

applications that could be tested on the Web site; and with a nominal investment we could buy a limited number of site licenses of leader selfdevelopment “serious games” and offer them as resources to the Army 

through the Web site. 

From the first approach, we developed a critical thinking tool. 

The tool was based on the research of the U.S. Army Research Institute 

on the Army Green Program (Hinkle, Karrasch, and Burke, 2006). The 

Army Green Program recognized that “platoon leaders (PL) are often 

required to resolve non-tactical problems on which they have received 

little to no formal training. Many of these problems are atypical, undocumented, and require judgmental resolution by PLs with limited experience as they take command of their first platoon.” The Army Green Program researched common issues on which junior leaders often make 
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 153

errors in judgment and compiled reflections from senior leaders as to 

what newer leaders should do. However, these scenarios were didactic 

and did not provide a means for junior leaders to explore the extent of 

the implications of decisions. For this purpose, Vroom’s theory of leadership style (Vroom, 2000) was overlaid on the scenarios to generate a 

series of plausible decisions from which the junior leader could select 

and then explore the consequences. The scenarios were introduced to 

remind leaders that decisions are made to optimize a future outcome. 

The outcome itself cannot be known until the decision is made and its 

consequences are manifest. In this sense, a decision uses what is known 

in the present to affect the future. Although outcomes of decisions are 

not perfectly predictable, they are far from random. From Vroom’s theory, critical to an optimal outcome are: 

■ an understanding of one’s habits in assessing the quality of 

present information 

■ the leader’s and the team’s expertise to make the decision 

■ the competence and motivation of the team to execute the decision.

Appendix A presents the Army Physical Fitness Test (APFT)9

 scenario, one of 10 scenarios available on the Benchworks Web site. The senior leader commentary is based on actual reported mentorship from 

battalion and brigade commanders.

Concerning the second approach, and working with the Army 

Green findings, the question arose as to how to accelerate the development of military leadership skills outside the context of one’s own 

real-world decisions. Knowledge gained from real-world experience 

can take years. Moreover, stakes are high and the breadth of possible 

decisionmaking practices cannot be systematically explored. Within a 

simulation, the leader can gain insight into strengths and weaknesses of 

courses of action and explore the breadth of possible decisions to gain 

the full awareness of their nature and effects. 

Our view of leader development and the tools needed to facilitate the skills and habits of good leaders was that if a tool or program 

was successful in venues outside the military, it was highly likely it 

could be scaled and made relevant to the particulars of leader development within the military. We reviewed a number of serious games and 

practicewares that we could deploy on our Benchworks Web site. We decided on and negotiated a limited site license with Simulearn for Army 
154 THE 71F ADVANTAGE

leaders to access the VLeader program (Simulearn, 2007). The VLeader program has as its theoretical underpinning that leaders must balance tension, ideas, and power to accomplish work (Aldrich, 2004). The 

VLeader program met with success within the LDP and was transitioned 

as a commercial-off-the-shelf (COTS) program with the transition of 

the Leader Development Portfolio to TRADOC. The VLeader program 

has since been scaled to meet additional Army Leadership requirements 

and developed into the Army Influence Trainer (PRWeb, 2008). 

Management and Administrator Consoles 

and the Developmental Box

The Management Console has multiple functionalities. The console’s primary function is to allow designated administrators to add 

tools to the LDP toolbox and thus build an instrument with the ability to 

apply a variety of scales (for example, Likert, Semantic Differential, Bogardus-like distance scales [Parrillo and Donoghue, 2005], and others), 

write customized instructions, target content to specific AKO/DKO users and groups, apply a variety of feedback displays via an integrated display generator, and designate respondent groups (such as seniors, peers, 

subordinates, friends, acquaintances). The ability to create new content 

allowed us to be immediately responsive to leader developer communities within the Army (like the Chaplain Center and School) through tailoring tools to subject matter experts’ specifications and posting content 

to their communities of interest. 

Besides instrument development functionality, the Management 

Console also has a user log to monitor usage and support Help Desk 

functions. It provides information on the state of individual assessments 

to support “bug tracking,” a functionality allowing administrators to 

be immediately responsive to Help Desk calls and to triage problems 

that need to be forwarded to the software developers. This functionality greatly enhanced user satisfaction through expedient resolution 

of issues. 

The function of the Administrator Console is to change the state 

of LDP functionality from read/write, to read only, to offline. This console is used for system maintenance. The administrator can post a warning of temporary outage and status of the LDP to users, and also perform local builds to apply security patches, upgrade hardware, and apply software upgrades of applications independent of the AKO portal. 

Upgrades that involve the AKO portal are performed by AKO and have 
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 155

to meet build-cycle timelines and software quality control. These upgrades cannot be fixed, undone, or otherwise modified until the next 

scheduled monthly build. For this reason, we built a Developmental 

Box, which is separate from and mirrors the functionality and systems 

of the “live” system. The Developmental Box was used to test new code 

and functionality using test accounts outside of the live system. The testing ensured the code would behave as expected when released on the 

live system. (As an aside, AKO personnel liked the Developmental Box 

idea so much that they implemented their own.) 

Two further Management Console developments that were 

planned but not instituted were passed on to TRADOC as recommendations: the ability of an initiator to voluntarily send his or her anonymized data to a Test Psychometrics Repository, and creation of levels 

of administrator control within the Management Console. The repository would entail the development of a database to store anonymized 

data and would include procedures for obtaining informed consent to 

use the data for research purposes to improve current tools and develop 

new ones. 

The creation of levels of administrator control was to give leader 

development principals the ability to control leader self-development 

content for their communities of practice. The idea was to stratify control based on the existing organizational structure of the U.S. Army 

Combined Arms Center subordinate schools, with the Center for Army 

Leadership and USMA as omnibus administrators. 

The Army Personality Tool

One of the charges to the leader development team from the Army 

War College was that the LDP should not be just a 360 tool. At the time 

of its development, the U.S. Military Academy was using the Revised 

NEO Personality Inventory (NEO–PI–R) (Costa and McCrae, 2003) instrument as a developmental feedback tool with cadets taking the test in 

their freshman and again in their junior year. Informed consent was also 

collected so longitudinal data existed. However, what was lacking was a 

focus for applying the data and a theoretical framework for interpreting 

the practical significance of personality on military performance. 

Personality is a construct long debated in the field of psychology and a construct that the authors struggled with in terms of the “so 

what” of knowing that you are an introvert or extrovert. Our vexation 

centered on the question of stability of the personality phenotype. We 
156 THE 71F ADVANTAGE

readdressed this debate because it was critical to determining how the 

individual leader could use the information developmentally and to advantage. 

There is little doubt that any given individual tends to behave in 

a relatively stable manner (Siegel and Bergman, 2002). However, there 

is considerable debate as to the source of the stability (Mischel, 1977). 

Arguments generally emphasize either personal or situational variables, 

or some combination of them. Although analogous to nature/nurture 

dichotomies, the debate over the stability of personality has its roots 

in a learning theory debate over the specificity versus the generality of 

learning experience. The catalyst for the debate was a series of transfer 

of training studies led by Hartshorne (1928, 1929, 1930). The studies 

showed significant inconsistencies across situations in children’s moral behavior. Notwithstanding that, consistent but low intercorrelations 

across situations in behavior were also revealed. Herein lies the crux of 

the debate: how to explain the source of low but consistent intercorrelations. Hartshorne attributed the consistencies to identical elements in 

the stimulus conditions across the test situations. In other words, Hartshorne argued that the stability for the psychological construct of personality exists in the situational variables. 

The notion that situational variables afford consistent behavior originated with connectionist-oriented learning theories. In 1903, 

Thorndike articulated the specialist viewpoint, arguing the theory of 

common elements. The theory states that a change in one function alters any other only insofar as the two functions have common elements. 

Thus, to the extent stimulus characteristics spur equivalent responses, 

habits will form and behavior will generalize across these situations. 

This consistency is only understood in relation to the experiences of the 

individual and not as a result of any dispositional characteristics. This 

suggests that ontologically, what develops in terms of the personality is 

an ability to see consistencies in the stimulative environment and behave in a like manner in response to perceptions of consistent stimulus 

events. 

Despite the appeal of causal stimulus-response connections to 

explain learning, connectionist theorists were unable to uniquely define the stimulus-response connections across contexts. The inability to 

define “identical elements” a priori across conditions rendered the notion of “identical elements” arbitrary to the post hoc justifications of 

the researcher. This weakness led those who maintained the potency of 
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 157

situational variables to shift their focus from respondent behavior, a 

class of responses defined in terms of stimuli that reliably produce them, 

to operant behavior, a class of behavior modifiable by the consequences 

of the behavior. Skinner (1977) makes the case for operant behavior, 

suggesting that what guides behavior is an ability to respond to contingencies in the environment. What develops is the ability to perceive relevant contingencies in the environment acquired through a reinforcement history. Thus, situational variables account for the stability in behavior, but the relevant stimulus conditions are made salient through 

a reinforcement history initiated by the organism emitting a behavior. 

The set of relevant stimulus conditions is thus constructed by the organism. This, of course, spurred a further debate as to whether there are 

mediating cognitions, which Skinner (1977) argued against. 

Even though the environment is predictable and reliable, it is at 

the same time a source of instability. The problem in determining what 

matters behaviorally for environmental consistency and inconsistency 

is that an environment cannot be defined devoid of an organism (Lickliter and Ness, 1990). Organisms certainly have biological structures 

that render certain stimuli relevant or salient and other stimuli irrelevant. Further, the extent of behavior an organism can emit, or the conditions an organism finds reinforcing, is certainly shaped by biology. The 

human visual system, for example, renders perception of certain spatial and temporal characteristics of stimuli more easily than others under specific lighting conditions. Certainly, experience is essential (Held 

and Hein, 1963), but the underlying sensitivities for which perceptions 

are built begin with the limits of the resolving power of the eye. In this 

sense, there are dispositional characteristics that impose organization 

on the stimulus environment and thus impose stability on behavior. Examples of such perceptual tendencies are well articulated by gestalt psychologists (Ellis, 1997). 

On the generalist side of the generalist/specialist learning theory debate are arguments for such dispositional characteristics. In 1937, 

Gordon Allport hypothesized the existence of personal dispositions, 

which are more or less stable determinants of behavior. These dispositions were hypothesized to have the capacity to render many stimuli functionally equivalent, and to initiate and guide consistent or equivalent forms of behavior. Allport’s discussion of dispositional variables is careful not to posit a reduction to ever finer fundamental elements. The suggestion was that the organism itself is a source of stability, 
158 THE 71F ADVANTAGE

given its structural characteristics. However, for personality, these dispositional characteristics or traits are only knowable through inference. Statistically, they are constructs defined using correlations and co-variation 

(Eysenck, 1970; McPhee, 1983; Winkelspecht, Lewis, and Thomas, 2006).

Given reasonable evidence supporting dispositional and situational variables, a natural compromise to the stability question was to 

suggest that some portion of the stability of personality exists in the situation and some in the person. However, since situations are never devoid of a person, and personality is always measured in a context or 

through questions of preference for a context, person and context are 

inextricably confounded and possibly indivisible for constructs such as 

personality. Thus, we propose that the observed stability is constructed 

and develops over one’s lifespan. 

Although not espousing a theory of mind here, we do believe that 

situational and dispositional variables meet and are integrated to construct personality in the brain. In this perspective, personality is viewed 

as something one produces, rather than as something one has. Antecedents are an active personal construction and the resulting personality is 

not uniquely understandable by the structural preconditions of person 

or environment, or both. Rather, personality is understood through the 

functions or goals of the individual or group. In this way, it is induced 

through the social group and ongoing activity, and is not predictable by 

material entity, whether stimuli, trait, or a combination thereof. 

A means to test whether personality is predictable in terms of 

material entity or function is to longitudinally evaluate personality under supernormal stimulus conditions (Hinde, 1970; Tinbergen, 1951). 

Some environments, such as the academic and social environment at 

West Point, are “strong” and are designed to instill a set of organizational 

values and beliefs. West Point appears to be an environment that pervasively and repeatedly prompts and reinforces particular personality attributes, and discourages others with their associated behaviors. 

If personality is predictable in terms of material entity, then either 

situational variables or dispositional variables should dominate in the 

strong environment. If dispositional variables are at play, then the presence of a strong environment should result in a greater than expected attrition of those cadets not possessing ideal characteristics. Moreover, for 

those who remain, the further cadets are from an ideal, the poorer their 

overall performance will be by standard Academy metrics. If situational 

variables are at play, then attrition and overall performance should not 
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 159

be predicted by distance from ideal personality characteristics. Cadets 

who remain at the Academy should show strong uniform changes in 

their personality profiles toward the ideal that are not attributable to 

maturation. Academic performance should not correlate with personality measures given a regression of personality characteristics to an 

Academy ideal. If personality is a result of an interaction between dispositional and situational variables, then personality facets should show 

some uniform intermediary movement to the ideal with entry personality measures moderately predictive of attrition and Academy performance metrics. 

If personality is not predictable in terms of material entity, then 

neither situational variables nor dispositional variables should dominate. Personality facets should adapt to the pressures of the organization; however, the organizational ideal should also show shifts toward 

the reality of the cadets. Further, only those facets relevant to the organization should show this compromise. Personality facets should not 

correlate with attrition. However, since entering students come with a 

developmental history, they should self-select into the environment and 

show differences from the population on ideal characteristics. Personality facets also should not be predictive of academic performance, but 

should be predictive of more subjective, socially based Academy metrics. That is, evaluators will grade like individuals on qualitative measures (for example, leader potential) more favorably than those who deviate from the ideal.

Much contemporary research on personality traits has been conducted using the “five-factor model” of personality (Goldberg, 1981). 

A central feature of the model is the proposition that personality dispositions can be subsumed under five broad traits. The most popular 

measure of these five broad traits (extraversion, agreeableness, conscientiousness, emotional stability [neuroticism], and openness to experience) is the NEO–PI–R (Costa and McCrae, 1992). Longitudinal administration of the inventory at West Point permitted an exploration of 

some assumptions about the nature and malleability of personality traits.

Members of USMA Class of 2006 (N = 945; 142 females, 803 

males) were given the NEO–PI–R during their freshman year. The remaining members of that class (N = 766; 113 females, 653 males) were 

again given the NEO–PI–R their junior year. Randomly selected faculty 

(N = 18), staff (N = 14), and seniors (N = 25) responded to the inventory 

with the “ideal cadet” in mind. 
160 THE 71F ADVANTAGE

The results showed that freshmen scores did not differ reliably 

between those who remained at the Academy and those who resigned, 

nor did they predict academic performance (Bartone, Snook, and Tremble, 2002). NEO–PI–R scores for the total cohort differed from population norms on Neuroticism and Conscientiousness for males and on 

Neuroticism for females. Cadets tended to be higher on Conscientiousness and lower on Neuroticism. Scores on the NEO–PI–R did not predict attrition. For those who remained at the Academy, Neuroticism and 

Conscientiousness scores migrated reliably from freshman to junior 

year toward the “ideal”—that is, lower and higher, respectively. These 

factor scores were strongly agreed upon by the faculty and staff, and differed greatly from actual cadet scores, constituting a “strong environment” (Ness et al., 2008). Figure 7–2 shows a slight but statistically significant uniform movement in the Neuroticism scores from freshman 

to junior year toward the ideal. There was no difference between the 

scores of those freshmen who remained at and those who resigned from 

the Academy. As with Neuroticism, there was strong consistent agreement as to the ideal for Conscientiousness. The Conscientiousness factor showed a similarly small but consistent uniform migration of scores 

from freshman to junior year toward the ideal. 

The data support a developmental influence on the personality 

phenotype and the idea that personality is understandable in terms of the

Figure 7–2. Change in Distribution of Neuroticism Scores by Class 

Year and Compared to “Ideal”

50 100 150 200

0.35

0.3

0.25

0.2

0.15

0.1

0.05

Relative Frequency

Neuroticism Score

..........................................................................

Freshman

Junior

Ideal .........
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 161

functions or goals of the individual or group. In this framework, personality is induced by the present organization and the ongoing activity, and is 

not predictable in terms of material entity, whether stimuli, trait, or combination thereof. Here we emphasize the epigenetic nature of personality and the nature of its stability. Stability of the personality is as much 

a function of individuals seeking certain niches as of adapting to those 

niches. Evidence for self-selection is demonstrated in the fact that those 

students entering the U.S. Military Academy were only different from 

their peers on Conscientiousness and Neuroticism. However, there was 

no evidence of an effect of lack of fitness for the environment since no 

personality factor or facet predicted attrition, whether transformed to reflect distance from the ideal or as the untransformed raw score. Further, 

this lack of predictability was not due to a lack of variability, as shown in 

the distribution. There was evidence of adaptation to the influences of the 

strong environment. Evident from the graph is the reliable shift toward 

the ideal from freshman to junior year. Experience served to shape and 

channel the expression of the personality phenotype. Thus, experiences 

become foundational but not determinant of individual expression. 

The responses on the NEO–PI–R do not appear to be biased. All 

cadets reported that the test was completed honestly and assumed adherence to the cadet honor code, anonymity of the feedback for personal development, and course preparation,10 supporting self-development 

arguments against the likelihood of response bias. Developmentally, 

these shifts in behavior become foundational for more permanent shifts 

maintained through habit strength, social conformity, engendered values, and reinforcing instruction and evaluations. The hope of the Academy is that these foundational shifts in desired behavior will lead to a 

relatively permanent change in behavior given the cadet’s future responsibility with lethal force. 

In the field of Army psychology, it is not enough to know; one 

must also apply. The purpose of the research was to develop a self-development tool specific to developing one’s positive personal presence and 

bearing on the job. From the study above, we abstracted four qualities 

that present an archetypical Soldier based on those facets that showed 

reliable concordance among the staff and faculty, and that showed 

a reliable change from freshman to junior year: Gets the Job Done, 

Trusts Others, Friendly, and Resilient. These four qualities were then 

measured by 36 questions selected from the International Personality 

Item Pool11 based on psychometric correspondence with the like items 
162 THE 71F ADVANTAGE

on the NEO–PI–R identified in the study. The resulting instrument was 

the Army Personality Inventory. 

The Army Personality Inventory was deployed to the Army in a 

manner similar to that described by Bem and Allen (1974). The instructions introduced the concept of the Army as a “strong” environment, 

which places heavy demands on the leader. Adapting to these demands 

can be exhilarating and rewarding, as well as exhausting. Presenting oneself consistently and well in these varied situations is important to getting 

one’s message out. The Army Personality Inventory was designed to provide some insights into how leaders present themselves to others by gauging those qualities important to their message being heard. In executing 

the tool, the leader was asked to choose a group of individuals (friends) 

who have observed him in various contexts and know him relatively well. 

This group should have insights into the leader’s character and should be 

best able to reflect his consistent qualities. The leader was also asked to 

choose a group of individuals with whom he has had occasion to work 

in a particular context (acquaintances). This group should have opinions 

of what others perceive the leader to be like within a particular context 

while not being influenced by prior and varied experiences with him. 

The leader could also choose a group of acquaintances of homogeneous 

character, such as foreign officers or ones of a particular ethnic/gender 

background, and thereby use the inventory as a cultural awareness tool. 

Upon receipt of feedback, the leader was encouraged to engage 

in a thoughtful and personal reflective process. All the tools of the LDP 

were designed to foster healthy self-awareness through honestly evaluating the degree of concordance between how leaders believe they are 

presenting themselves and how they are perceived. The leaders were advised to use the coach’s journal to compile thoughts and positions resulting from the reflection process. They were also encouraged to sort 

through scenarios considering alternate courses of action they might 

have to take and work through them with a mentor. 

The Army Personality Inventory was designed to provide the leader 

with feedback on the subjective, socially based metrics of the Army. It 

was also developed to broaden leadership feedback by soliciting it from 

colleagues beyond the 360 structure and thus further diffusing leadership lessons and best practices throughout the force. The tool was well 

received, and over the 3-month period from deploying the tool to the 

Army until transition of the LDP to TRADOC, 260 assessments were 

initiated with a total of 4,469 respondents providing leader feedback. 
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 163

Use of Metadata to Structure Diffusion of Knowledge

Help Desk calls and usability studies are great sources of information to improve systems, as are big ideas, provided there is honest deliberation to evaluate them. However, these were not the only sources for 

improving the system. Another source was the information within the 

metadata. Metadata are an often forgotten source that gives information 

about communication within the system and between its users. The data 

depicted in figure 7–3 show one of our last investigative efforts prior to 

transitioning the LDP to TRADOC.12 The purpose of this effort was to 

build and maintain a distributive knowledge management system for 

leader self-development and self-study. The figure shows the networks 

among users in the soliciting and distribution of leader-related information. This map was rendered after the personality tool was released 

to the Army. The Coach’s Journal was still under development, and the 

few nodes seen are from the software developer’s test of the module. The 

other represented instruments are the various 360s, with which feedback from peers, subordinates, and seniors is solicited. 

With the 360 tools, the figure shows that warrant officers only 

seek information from within their ranks and appear relatively isolated 

from the other ranks. Future steps were planned to restructure tools to 

better integrate warrant officers into the process but were never executed

Figure 7–3. Leadership Development Profile Network Clouds 

Showing Connections among User Types and Functions

Senior Warrant Officer

Senior NCO

Civilian GS>11

Field Grade

Army Personality Inventory

Chaplain

Coach’s Journal

Warrant Officer Company Grade
164 THE 71F ADVANTAGE

due to the transition to TRADOC. The Chaplain’s tool was developed 

by the Chaplain Center and School to solicit feedback from members of 

a chaplain’s religious community for feedback on his ministry. It was expected that a broad representation of rank would be a result of the open 

structure. However, the metadata indicate that the chaplains nearly 

exclusively solicited feedback from NCOs. It is quite possible that they 

only solicited feedback from their assistants and not from those who 

participated in their religious community. The information was passed 

to the Chaplain Center and School, and an instructional fix was planned. 

Senior civilians appeared to solicit information from themselves and 

field grade officers. This outcome was not expected and indicates an 

isolation of civilians from other ranks, which was most likely a result of 

the forcing function of the structure of the 360 to their seniors, peers, 

and subordinates. NCOs and company and field grade officers reliably 

solicited feedback from each other. NCOs and company grade officers 

rarely solicited feedback from civilians, again possibly because of the nature of the structure of the 360. 

The data concerning the networks rendered by the various leader 

self-development tools were known prior to the development and implementation of the Army Personality Inventory. This latter tool was designed to solicit a broader range of respondents for feedback to the leader. 

Our hypothesis was that the isolation, particularly for civilians with 

NCOs and company grade officers, was due to the structure imposed 

by the 360. To yield feedback from across the spectrum of leaders, the 

Army Personality Inventory was structured in a manner that would allow for feedback from across organizations and ranks. The cluster labeled Army Personality Inventory in figure 7–3 shows direct connections between company grade officers, field grade officers, and senior 

NCOs with civilians. The links from the Civilians to the Army Personality Inventory run under the Field Grade cloud and are not visible in 

this rotation. This distributional change in the flow of information supports the hypothesis that the structure of the tool constrains feedback. 

The authors highly encourage the use of this analysis to gain an understanding about the likelihood that the leadership message is being 

distributed to ensure the breadth and scope of the diffusion of lessons 

and best practices. The pedagogical motivation here was to provide a 

rich base of content knowledge to the leader (Chi, 1981). In theory, the 

richer the content knowledge, the greater the formation of networks of 
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 165

associations that link different entities to each other and thus improve 

discernment of features that indicate novel aspects and distinctive approaches to leadership challenges. This remains an empirical question 

and was presented to the Center for Army Leadership to explore with 

the transition of the LDP to TRADOC. 

Conclusion

The Leader Development Portfolio tools were designed to provide 

feedback showing the differences and similarities between how leaders 

believe they are presenting themselves to organizationally (peers, subordinates, seniors) or socially (friends, acquaintances, males, females) defined subgroups. The feedback indicates to leaders how they are viewed 

along organizationally critical aspects of their personality and leader 

competencies. This self-knowledge is meant to motivate them to act on 

the information through discerned self-awareness. This feedback, along 

with the coach’s input and self-reflection journal, provides the structure 

of a powerful online, on-demand, secure, and anonymous leader selfdevelopment system. 

The system itself is flexible and seamlessly integrated into AKO/

DKO such that without any additional programming, one can add new 

tools to the assessment toolbox, tailor the portfolio to target audiences, 

tailor feedback results, and establish online mentorship of leaders. In 

addition, the system has a support Web site for additional information 

and support tools that can be used individually or as part of unit officer and NCO professional development programs. The integrated Help 

Desk tracks user logs allowing administrators to resolve most support 

issues within 24 hours. 

In October 2007, the concepts, processes, and content of the LDP 

were successfully transitioned to TRADOC under their Multi-Source 

Assessment and Feedback program.13 In the year between the launch of 

the LDP to the Army and its transition to TRADOC, the system boasted 

over 10,000 assessments. During this time, the Company Grade and Field 

Grade 360s were deployed for 1 year, the NCO 360 for 9 months, the Civilian and Warrant Officer 360s for 6 months, and the Army Personality 

Inventory for 3 months. At the transition, there were over 230,000 respondents and 50 to 100 new assessments initiated weekly. For an unpublicized, 

voluntary, self-development tool, that is arguably a high volume of usage. 
166 THE 71F ADVANTAGE

The question remains whether the LDP is effective in promoting self-awareness and motivating positive leadership behaviors. We will 

close with an anecdote from the many comments posted to the Help 

Desk. A female company commander from 1st Cavalry Division initiated a 360. She had the personal opinion that she was fair, open, and honest. When the results of her 360 feedback came back, her subordinates 

gave her particularly low ratings on fairness, and in the free text comments 

they accused her of favoritism toward the females in the unit. The captain was devastated. After a period of rumination about what she thought 

of herself and what was reflected back to her, she was prepared to reengage the system (self-control). The instructions for feedback reminded 

her to work through these dissimilarities and to put them in context.

The first thing the captain noticed was that her peers and seniors 

saw her as she saw herself. She then reflected on the discrepancy between subordinates and self, as well as peers and seniors. It was then 

she realized that members of her company might have felt as they did 

because she was granting special privileges to a female in her company 

(perspective-taking). This particular female specialist was early in what 

her physicians deemed a high-risk pregnancy. The specialist could work, 

but only on desk duty for limited hours. The specialist asked the captain 

to keep the pregnancy a secret in the event things did not go well, so she 

would not have to relive an experience of a lost child through answering 

the questions of acquaintances. The request was granted. With this selfawareness, the captain rearranged work schedules (creative achievement) to give less of an appearance of favoritism, but was comfortable 

in the decision she made given her full awareness of the nature and effects of her decision (self-esteem).
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 167

Appendix 

Vignette: Failing the Army Physical Fitness Test

Lieutenant (LT) Davis had just taken over as platoon leader when 

orders were received for deployment to a combat theater of operations 

in 2 months. A review of physical training (PT) records for the platoon 

revealed that Private First Class (PFC) Freeman failed the last two Army 

Physical Fitness Tests (APFTs). However, there is no record that the private was flagged, counseled, or given any special PT program. PFC Freeman is given the test and once again fails due to an inability to run without periodically stopping to walk. The private is an otherwise good Soldier with a strong desire to serve. 

Courses of Action 

1. Protect unit deployment readiness by giving a passing APFT 

with the understanding that PFC Freeman will not be promoted until he passes.

2. This is an indiscipline problem; put PFC Freeman on a remedial PT program.

3. Work with platoon sergeant (PSG), squad leader, and PFC 

Freeman to remediate him.

4. Too busy with deployment issues; delegate the issue to the PSG 

and focus on preparing for the deployment. 

Outcome Assessment 1

This is a directive approach to the decision that takes into account 

mission, a belief in the Soldier, and confidence in one’s own ability to 

motivate. The directive approach is most appropriate in instances when 

the quality of the information relevant to the decision is high, the decisionmaker has the expertise to make the decision, subordinates can and 

will comply, and time is of the essence. 

Quality of information. There is a lack of historical data as to why PFC 

Freeman does not have a profile or a flag. The leader assumed that Freeman’s chronic problem was motivation. 

Expertise. The platoon leader is new to the unit and failed to consult the 

PSG concerning the private. He also shows lack of expertise in the belief 
168 THE 71F ADVANTAGE

that a platoon leader can stop the promotion of a subordinate after promotion requirements are documented. 

Compliance. There is no evidence that PFC Freeman is physically capable of passing the APFT. He may have a medical condition that impacts 

running performance and may or may not be aware of it. The private 

was not asked, and this was not ruled out. Further, the NCO chain was 

not brought in on the decision or to monitor compliance.

Time. Two months presents a time constraint, given a significant increase in unit tempo in preparing for deployment. 

Outcome Assessment 2

This is a directive approach to the decision that takes into account 

PFC Freeman’s shortfall and seeks to direct the Soldier to pass the APFT. 

Quality of information. There was a lack of historical data as to why 

PFC Freeman did not have a profile or a flag. The platoon leader assumed that PFC Freeman’s chronic problem was a result of indiscipline. 

The lack of a profile, flag, or other documentation could be a result of 

poor recordkeeping or a misplaced file.

Expertise. The platoon leader is new to the unit and failed to consult the 

PSG concerning PFC Freeman or the personnel administration center 

(PAC) NCO about the records. 

Compliance. There is no evidence that PFC Friedman is physically capable of passing the APFT. PFC Freeman may have a medical condition that impacts running performance and may or may not be aware 

of it. PFC Freeman was not asked, and this was not ruled out. The NCO 

chain was not brought in on the decision or to monitor compliance.

Time. Two months presents a time constraint, given a significant increase 

in unit tempo in preparing for deployment. 

Outcome Assessment 3

This is a participative approach to the decision that takes into 

account the ambiguity of the information concerning why the Soldier 

was not flagged or put on profile. The participative approach is most 

appropriate when the quality of the information relevant to the decision is poor, the decisionmaker has limited expertise to make the decision, subordinates may be unwilling to comply, and time is moderately critical. 
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 169

Quality of information. There was a lack of historical data as to why 

PFC Freeman did not have a profile or a flag. Improving the quality of 

the information is critical to an optimal outcome.

Expertise. The platoon leader is new to the unit. Consulting the NCO 

chain and those in recordkeeping will leverage unit expertise to augment leader expertise. 

Compliance. There is no evidence that PFC Freeman is physically capable of passing the APFT. There is a reason why he periodically has to 

stop running (for example, smoker, asthma, allergy, fitness). Informally 

counseling Freeman may bring out the underlying cause and invest him 

in the solution. Consulting the NCO chain invests them in the course of 

action to ensure followthrough. 

Time. Two months presents a time constraint, given a significant increase 

in unit tempo in preparing for deployment. 

Outcome Assessment 4

This is a delegate approach to the decision that takes into account 

the Soldier’s shortfall and seeks to establish a trusting relationship with 

the PSG. The delegate approach is most appropriate in those instances 

when you wish to develop subordinate leaders, their commitment is 

high, and the subordinates are competent to make the decision. This 

approach can be used purely as developmental in those cases where the 

significance of the decision is low.

Developing. Developing Soldiers is something every leader must do. 

However, developing an NCO requires some history or knowledge of 

the NCO. The platoon leader was new to the unit and has limited or no 

such knowledge. 

Importance of decision. This decision will present a first impression to 

the platoon leader’s rater and senior rater. This makes the outcome critical to setting expectations and a power base. 

Competence. The platoon leader has reason to suspect some hindrance 

to competence given that there is no profile or flag in PFC Freeman’s file. 

Given the ambiguity of the information on this point, it is hard to judge 

competence. The platoon leader should discuss this issue with the PSG. 

Commitment. There is evidence of some barrier to PFC Freeman passing the APFT. PFC Freeman may have a medical issue or be an indiscipline problem. The NCO chain of responsibility may have some 
170 THE 71F ADVANTAGE

hindrance keeping them from managing the issue, or there may be a 

problem with filing or recordkeeping in the PAC. 

Time. Implicit to a delegate approach is the time and space to develop. 

Two months to deployment presents a time constraint, given a significant increase in unit tempo in preparing for deployment. 

Senior Leader Coaching

Themes

■ Be a role model

■ Be a good communicator

■ Be consistent

■ Be a learner

■ When in charge, take charge

■ Know your Soldiers.

In the real situations on which this vignette is based, the lieutenant believed the private could be motivated to pass the APFT. The unit 

deployed with PFC Freeman. LT Davis put the Soldier on a remedial 

PT program for running and went to great lengths to motivate him to 

run. Six months later, Freeman failed again. Everyone in the platoon was 

aware of the situation. PFC Freeman appeared on the promotion list, 

along with those who actually passed the APFT. LT Davis was powerless 

to stop the private from being promoted.

The Soldier had a physical ailment preventing completion of the 

2-mile run. Had this been simply a motivational or indiscipline issue, 

the decisions based on these assumptions would have produced a good 

outcome. Since the quality of the data in this case could not disambiguate these assumptions, the leader in this case should seek more information as to the cause of the chronic PT failure and the lack of a record of 

unit remediation. 

In general, a leader needs to balance Army standards with relationship development and safety. In the reference for this case, there was 

a clinical reason the Soldier could not run. The private’s safety and those 

of the unit can be at risk if this is not addressed before deployment. A 

full medical checkup was warranted. Moreover, the leader should understand that once the Soldier passed the APFT, “forged” or legitimate, 

this promotion requirement is considered fulfilled. 
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 171

In terms of developing/motivating the PFC, barring a medical 

condition causing the poor performance, the lieutenant did not know 

the Soldier well enough to be able to motivate him. Especially being 

new to the unit, the lieutenant should at least consult the NCOs individually. The lieutenant must provide fair and consistent treatment for 

each Soldier or risk negatively affecting unit morale. Falsifying a report 

will damage credibility with the unit and up the chain of command (if 

someone will falsify a report, what else will that person do?). 

To recover, the lieutenant must see that PFC Freeman gets medically evaluated, counsel the Soldier that future APFTs will not be falsified, and work with the PSG on a program that will enhance the private’s 

chances of passing. He should admit the mistake to the PSG and ask for 

help with damage control. The lieutenant must admit the mistake to the 

company commander. The lesson learned is to never compromise standards and commit to upholding standards in the future.

References

Aldrich, C. (2004). Simulations and the Future of Learning: An innovative (and perhaps revolutionary) approach to e-Learning. San Francisco, CA: John Wiley and Sons, Inc.

Allport, G. (1937). The functional autonomy of motives. American Journal of Psychology 50, 

141–156.

Army Training and Leader Development Panel (2003). The Army Training and Leader Development Panel Officer Study Report to the Army. Washington, DC: Defense Technical Information Center, Accession No. AD415810. Retrieved from <http://handle.dtic.mil/100.2/

ADA415810>. 

Army Leader Development Panel Study: Officer, NCO, and Warrant Officer Reports. Retrieved 

from <www.army.mil/features/ATLD/ATLD.htm>.

Association of the United States Army (October 1, 2008). Army to enhance civilian career programs. Retrieved from <www.ausa.org/publications/ausanews/specialreports/09_08/

Pages/Armytoenhanceciviliancareerprograms.aspx>. 

Bartone, P., Snook, S., and Tremble, T. (2002). Cognitive and personality predictors of leader 

performance in West Point cadets. Military Psychology 14 (4), 321–338.

Bem, D., and Allen, A. (1974). On predicting some of the people some of the time: The search for 

cross-situational consistencies in behavior. Psychological Review 81 (6), 506–520.

Chi, M. (1981). Knowledge development and memory performance. In J.P. Pas and N. O’Conner 

(eds.). Intelligence and learning. New York: Plenum Press.

Costa, P.T., and McCrae, R.R. (1992). Professional manual for the NEO Personality Inventory. 

Odessa, FL: Psychological Assessment Resources. 

———. (2003). Revised NEO Personality Inventory (NEO–PI–R). Lutz, FL: Psychological Assessment Resources, Inc. 

Duval, T.S. and Wicklund, R.A. (1972). A theory of objective self-awareness. New York: Academic.

Ellis, W. (1997). A source book of Gestalt psychology. Berlin, Germany: Gestalt Journal Press.

Eysenck, H. (1970). The structure of human personality (3d

 ed.). London: Methuen.
172 THE 71F ADVANTAGE

Fenigstein, A., Scheier, M., and Buss, A. (1975). Public and private self-consciousness: Assessment and theory. Journal of Consulting and Clinical Psychology 43 (4), 522–527.

Goldberg, L. (1981). Language and individual differences: The search for universals in personality lexicons. In L. Wheeler (ed.), Review of personality and social psychology, vol. 2 

(141–165). Beverly Hills, CA: Sage.

Hartshorne, H., and May, M. (1928). Studies in the nature of character: Volume 1, Studies in deceit. 

New York: McMillan.

———. (1929). Studies in the nature of character: Volume 2, Studies in service and self control. New 

York: McMillan.

Hartshorne, H., May, M., and Shuttleworth, F. (1930). Studies in the nature of character: Volume 

3, Studies in the organization of character. New York: McMillan.

Headquarters Department of the Army (October 24, 2007). Army Regulation 25–5: Information 

Assurance. Retrieved from <www.fas.org/irp/doddir/army/ar25-2.pdf>.

Held, R., and Hein, A. (1963). Movement-produced stimulation in the development of visually 

guided behavior. Journal of Comparative and Physiological Psychology 56, 872–876.

Hinde, R.A. (1970). Animal behaviour (2d

 ed.). Tokyo: McGraw-Hill Kogakusha, Ltd.

Hinkle, R., Karrasch, A., and Burke, T. (July 1, 2006). Army Green: Training non-tactical problem 

solving by platoon leaders. U.S. Army Research Institute for the Behavioral and Social 

Sciences, Research Report 1855. Accession No. ADA454772. Retrieved from <http://

handle.dtic.mil/100.2/ADA454772>.

Institute of Land Warfare (February 2004). The U.S. Army and beyond: Strategically agile and adaptive. Association of the United States Army, Torchbearer. Retrieved from <www.ausa.org/

programs/torchbearer/nsr/National%20Security%20Reports/TB_StratBook.pdf>.

Lickliter, B., and Ness, J. (1990). Domestication and comparative psychology: Status and strategy. 

Journal of Comparative Psychology 104, 211–218.

MacPhee, D. (April 1983). What do ratings of infant temperament really measure? Poster presented 

at the Biennial Meeting of the Society for Research in Child Development, Detroit, MI. 

(ERIC Document Reproduction Service No. ED233817). Retrieved from <http://eric.

ed.gov/ERICDocs/data/ericdocs2sql/content_storage_01/0000019b/80/30/1a/61.pdf>.

Mead, G.H. (1934). Mind, self, and society. Chicago: University of Chicago Press.

Mischel, W. (1977). On the future of personality measurement. American Psychologist 32, 246–254.

Ness, J., Dieper, V., Lewis, P., and Brazil, D. (August 2008). Personality development in strong 

environments. Proceedings XXIX International Congress of Psychology. Berlin, Germany.

Parrillo, V., and Donoghue, C. (2005). Updating the Bogardus social distance studies: A new 

national survey. The Social Sciences Journal 42, 257–271.

PRWeb (May 28, 2008). U.S. Army partners with Simulearn to train soldiers in the art of influence. 

Retrieved from <www.prweb.com/releases/leadership_development/simulation_training/prweb976254.htm>.

Siegal, M., and Bergman, A. (2002). Waddington’s canalization revisited: Developmental stability 

and evolution. Proceedings of the National Academy of Sciences 99, 10528–10532. Retrieved from <www.pnas.org/cgi/content/full/99/16/10528>.

Silvia, P., and Duval, T. (2001). Objective self-awareness theory: Recent progress and enduring 

problems. Personality and Social Psychology Review 5 (3), 230–241.

Simulearn (2007). VLeader. Simulearn Inc. Norwalk, CT. Retrieved from <www.simulearn.net/

leadership_training/leadership_training.html>.

Skinner, B.F. (1977). Why I am not a cognitive psychologist. Behaviorism 5, 1–11.

Thorndike, E. (1903). Educational psychology. New York: Lemcke and Buechner.

Tinbergen, N. (1951). The study of instinct. New York and London: Oxford University Press. 

Toegel, G. and Conger, J. (2003). 360-degree assessment: Time for reinvention. Academy of Management Learning and Education 2, 297–311.
U.S. ARMY LEADER SELF - DEVELOPMENT PORTFOLIO 173

Ulmer, W., Shaler, M., Bullis, R., DiClemente, D., Jacobs, T., and Shambach, S. (November 5, 

2004). Leadership Lessons at Division Command Level. Army War College, Carlisle Barracks, PA. Accession No. ADA435928. Retrieved from <http://handle.dtic.mil/100.2/

ASA435928>.

Vroom, V. (2000). Leadership and the decision making process. Organizational Dynamics 28, 

82–94.

Wicklund, R., and Gollwitzer, P. (1987). The fallacy of the private-public self-focus distinction. 

Journal of Personality 55 (3), 491–523. 

Winkelspecht, C., Lewis, P., and Thomas, A. (2006). Potential effects of faking on the NEO–PI–R: 

Willingness and ability to fake changes who gets hired in simulated selection decisions. 

Journal of Business and Psychology 21, 243–259.

Notes

1

 Army Knowledge Online (AKO) is the U.S. Army’s corporate intranet, which was expanded to include the entire Department of Defense in 2007. AKO/DKO is accessed through 

<http://www.us.army.mil>.

2

 Even though fiscal years run from October to October, the closeout of the Leadership 

Development Portfolio account was extended to November 1 to give us time to transfer funds to 

AKO and for AKO to accept and obligate the funds.

3

 We began our planning process using a Strengths, Weaknesses, Opportunities, and 

Threats Analysis. The results of this analysis were used to evaluate and direct our initial courses 

of action.

4

 Of special acknowledgment in helping to formulate the concept of self-awareness and 

how to reflect information back to the leader are Dr. Don Campbell, MAJ Silas Martinez, and 

COL Donna Brazil from BS&L, Dr. Lenny Wong and Dr. Craig Bullis from the Army War College, Dr. Angela Karrasch from the Center for Army Leadership, and COL Sally Harvey from 

Clinical Mental Health, Fort Bragg, NC, not to mention the occasional “skull sessions” with LTC 

Todd Henshaw of BS&L.

5

 Michael Stewart and Adrian Hartline from Appian Corporation, who held the contract 

for AKO/DKO software development, were the lead software engineers on the LDP project (see 

<www.appian.com>).

6

 AKO updates all portal code on a regular basis. At these times, typically once a month, 

updates are published to the portal to fix bugs or to add new functionality. There is an involved 

process for getting code into the build cycle and minimizing dependency on the build cycle greatly improves agility to meet user needs. 

7

 The Benchworks site was designed and maintained by Marianne Carlson, MAJ Dennis 

O’Neil, and John VanVynck.

8

 With the transition to TRADOC, the benchworks.army.mil site was shut down and the 

information reconstructed at <https://msaf.army.mil/ResourcesAndTraining.aspx>. 

9

 The Army Physical Fitness Test is a test of minimum fitness to perform operational 

duties. The test consists of 3 timed events, tested every 6 months, with different standards of 

performance by age grouping for men and women. For a summary of purpose, events, standards, 

and relevant links, see <http://en.wikipedia.org/wiki/Army_Physical_Fitness_Test_(APFT)>.

10 The NEO–PI–R was used as a self-development tool in the required freshman and 

junior level leader development courses. The administration of the NEO–PI–R followed a block 

of instruction on self-development and self-awareness. 

11 See <http://ipip.ori.org>.

12 The graph was rendered based on discussions with LTC John Graham of BS&L, whose 

area of research is in social networks. 

13 See <https://msaf.army.mil/Default.aspx>.

Chapter 8

Understanding and Measuring Creative 

Thinking in Leaders

Mark A. Vaitkus

To address complex problems related to changing global markets 

and security concerns, corporations and government agencies are increasingly interested in diagnosing and enhancing the potential of their 

leaders to generate flexible, multifaceted, and innovative solutions. In 

the research reported here, government, military, and industry leaders 

attending a senior Service college were studied to discover the extent 

and degree to which leaders could be classified as having a propensity 

toward creativity, originality, and innovation based on the so-called 

five-factor model of personality. Two measures of “openness” were included. While both measures performed well on standard tests of internal reliability and construct validity, they yielded significantly different 

estimates of high openness in the study sample (30 percent high versus 

4 percent high). This chapter considers possible reasons for these disparate results, including variable question wording, scale metrics, and subfactor conceptualization. The conclusions offer some important guidelines and caveats regarding possible approaches for identifying and developing creative thinking potential in senior leaders. 

Introduction

In an era of global markets and rapid technological change, few 

question the value of creativity and the innovations it generates within 

organizations that wish to remain viable and competitive. To the extent that leaders are viewed as critical agents of organizational change 

(Kotter, 1990), it would seem imperative that they at least be open to 

the products of creativity and imagination, if not key to their genesis. 

Indeed, Puccio, Murdock, and Mance (2007) view creativity as a “core 

leadership competence” that can facilitate effective change through 

questioning the status quo, considering new ideas, experimenting and 

risk-taking, and developing novel approaches for meeting challenges.

175
176 THE 71F ADVANTAGE

This chapter examines and compares two conventional psychological measures of creative disposition within a senior leader population. Both measures view such a disposition under the rubric of “openness” within the so-called big five or five-factor model of personality. 

The analysis will attempt to answer the following questions:

■ Is each measure of openness reliable and valid in its ability to 

differentiate this factor from other personality factors?

■ How different are the measures in terms of describing this 

population with respect to creative proclivities, and what accounts for these differences?

■ What are the caveats that leader developers should keep in 

mind when using these and other “standard” measures of personality to screen for creative qualities, and how should such 

caveats inform feedback and training programs? 

Personality Conceptualization and the Five-factor Model

Since the early 1990s, there has been considerable convergence 

in the field of personality assessment toward a five-factor or “Big Five” 

measurement model (John and Srivastava, 1999). Movement toward a 

five-factor taxonomic model of personality can be traced back to Fiske 

(1949), Tupes and Christal (1961/1992), and Norman (1963), who built 

on, and partially replicated, Cattell’s (1945) factor analytic work, concluding that five factors adequately described the analytical space of extant personality trait measures (John and Srivastava, 1999). In their review of published studies to that time, Digman and Takemoto-Chock 

(1981) and Goldberg (1981, 1993) reaffirmed that the Big Five did indeed capture the most generalizable categorization of personality characteristics. Following Digman (1990), we may describe these as follows:

■ Surgency or extraversion. Those who score higher on this factor tend to enjoy the stimulation that comes from interacting 

with large numbers of people in whose company they are generally talkative and assertive. They are not shy and have a high 

degree of positive energy that leads them to actively engage in 

a wide variety of activities.

■ Agreeableness. Individuals who display higher agreeableness 

tend to be kind and value cooperation and getting along with 
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 177

others. They are more sensitive to, and concerned about, the 

feelings of others, more likely to give people the benefit of the 

doubt, and will often compromise to avoid conflict and the 

prospect that others will not like them.

■ Conscientiousness. People reporting higher levels of conscientiousness desire orderliness, organization, and efficiency in their 

lives. They take their perceived responsibilities and duties very 

seriously, and have considerable investment in viewing themselves as dependable, thorough, and achievement-oriented. 

■ Emotional stability. Those exhibiting greater emotional stability report relative freedom from experiencing “negative feelings” such as anger, anxiety, and depression. They are also less 

likely to be moody, mercurial, and temperamental. In general, 

they will display calmness and less nervousness than those who 

score low on this factor. Some researchers have preferred to 

concentrate on its opposite pole instead (that is, the negative 

feelings themselves), and thus label it “neuroticism.”

■ Openness. Variably called culture, intellect, and openness to 

experience, this factor attempts to measure dispositions that 

skew toward higher curiosity, imagination, and creativity. 

Those on the higher end may think of themselves as being 

more open-minded and appreciative of the arts, while also 

valuing originality, new experiences, and deep or intellectual 

reflection.

The dimension labeled openness clearly comes closest to describing the personality factor linked to a creative disposition and its contingent leanings or preferences, and therefore the one on which I will focus 

in this chapter.

Openness and Organizational Leader Effectiveness

Openness is probably the least understood of the five personality factors. Part of the problem lies squarely with poor conceptualization and attempts to variably describe the factor as a disposition toward 

critical thinking and inquisitiveness (intellect), a need for variety and 

new experiences, a tendency to be creative and imaginative, an interest in aesthetic pursuits and the arts, an antiauthoritarian orientation, 

and an empathy with or understanding of diverse others (McCrae and 

Costa, 1997). Such subdimensions do not always correlate well with one 
178 THE 71F ADVANTAGE

another in analyses, certainly when compared to the other four factors. 

Yet such effects of openness on the endorsement of liberal political and 

social values (McCrae, 1996; Van Hiel and Mervielde, 2004), as well as 

liberal candidates for political office (Caprara and Zimbardo, 2004), are 

fairly well documented. Of the Big Five, openness also comes closest to 

predicting personal exploration of spiritual phenomena (versus holding conventional beliefs) and the profession of virtues such as forgiveness (MacDonald, 2000). To the extent that we are talking about an active curiosity about the unknown, a desire to experience the unfamiliar, 

taking an original and innovative approach to problems, and not shying 

away from the complex or abstract, such qualities of the “open” personality may indeed be functional for the executive leader operating in an 

ambiguous and culturally diverse strategic environment. 

Psychometric measures of basic intelligence are correlated with 

openness (DeYoung, Peterson, and Higgins, 2005; McCrae and Costa, 

1997). There is also little doubt that openness is an important ingredient in what Thomas (2006; cf. Earley, 2002) calls “cultural intelligence” 

(or “cultural quotient” [CQ]) (Thomas, 2007, and Earley, 2002) or “the 

ability to interact effectively with people who are culturally different.” 

Coupled with a desire for new cultural experiences, another aspect of 

openness, CQ is further enhanced. However, while personality factors 

such as openness are related to the raw capacity for CQ development, 

the latter remains distinct from its actual development or exhibition in a 

particular circumstance, which depends on interactional experiences as 

much as the individual’s motivation (Thomas).

In terms of studies that have looked at Big Five models of personality with respect to leadership criteria variables, Judge, Ilies, Bono, 

and Gerhardt (2002) find the following correlational averages with effective leadership outcomes across 73 samples: extraversion (.31), conscientiousness (.28), openness to experience (.24), neuroticism (-.24), 

and agreeableness (.08). While just 23 percent of the variance in positive 

leadership outcomes across samples was explained by personality differences, this is a significant number and demonstrates that personality, including openness, should indeed be considered part of the variable solution set for modeling leadership.

In his most comprehensive attempt to lay out an integrated theory of executive leadership based on a meta-analysis of dozens of Army 

Research Institute and other studies, Zaccaro (2001) identifies such 
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 179

personality characteristics as openness, curiosity, flexibility, adaptability, 

and risk propensity as all being requisite for executive effectiveness beyond expertise, intelligence, and other cognitive capacities. Streufert and 

Swezey (1986) also provide evidence in the civilian sector that executives 

who possess greater “multidimensional thinking” make better decisions 

and, therefore, more valuable contributions to their organizations.

When it comes to the special case of transformational leadership, 

the results for Big Five linkages are somewhat different than for leadership generally. In their review of study results from 14 samples of leaders representing over 200 organizations, Judge and Bono (2000) report 

that transformational leader behaviors had moderate zero-order associations with higher extraversion, agreeableness, and openness. Surprisingly, there were no significant effects for neuroticism and conscientiousness. In a more sophisticated analysis incorporating a military 

sample, Ployhart, Lim, and Chan (2001) employed structural equation 

modeling that differentiated “typical” versus “maximum” performance 

criteria related to transformational leadership to show that extraversion 

was strongly predictive of both types of criteria, but openness had predictive power only for the maximum criteria, and low neuroticism was 

exclusively related to the typical performance criteria.

Along with a highly developed conceptual capacity, deeply held 

ethical values, and a mature and flexible perspective, Jacobs (2006) believes that openness is a critical attribute of transformational leaders because it enables them to consider new ideas and solutions without dismissing them based on preconceived notions. Indeed, Jacobs states flatly 

that openness, in terms of a disposition toward intellectual curiosity, 

imagination, and creative problem-solving, may well be the most important Big Five dimension for strategic leadership. This is partially because strategic leaders must not only be able to apply a systems perspective to gauging their organization’s environment in time and space, but 

they also must take that necessarily complex understanding, fashion a 

vision for an organizational path forward consistent with that understanding, and communicate that vision in an effectively parsimonious, 

meaningful, clever, and ideally original and inspiring manner. 

It should be noted that openness is not a panacea, especially when 

taken to an extreme. Jacobs (2006) makes it clear that “[t]op-level executives must understand the necessity to fix it even ‘when it ain’t broke’” 

and that openness helps a strategic leader be functionally proactive in 
180 THE 71F ADVANTAGE

this regard. At the same time, an executive with an extremely high drive 

for openness may initiate change for its own sake to fulfill a thirst for 

stimulation and excitement, thus squandering resources and putting 

the organization at unnecessary risk (Jacobs). Openness is ultimately no 

different, therefore, than the other dimensions of personality in terms of 

the need to achieve a reasonable balance. However, there is little doubt 

that its elements are closely tied to an affinity for the kind of creative 

problem-solving and complex thinking skills associated with effective 

leadership in volatile and changing environments (Puccio, Murdock, 

and Mance, 2007; Yukl, 2002), and therefore with the leader behaviors 

associated with transformational, charismatic, and visionary leadership 

(House and Shamir, 1993).

Method

Participants

The subjects in this study were students attending a U.S. Government senior Service college during the 2006–2007 academic year. The 

present study was reviewed and approved by the Institutional Review 

Board at the National Defense University, and completion of any one or 

more of the instruments was voluntary with the guarantee that all individual results would remain confidential.

All 292 U.S. students in the class completed either or both of the 

two instruments under examination here. Four international fellows 

also did so, but these subjects were removed from the analysis. Demographic data were available for 266 of the U.S. students. Of these, 75.6 

percent (201) were male, and 24.4 percent (65) female. The youngest 

participant was 32, and the oldest 59, with a mean age of 44.2 (standard deviation = 4.5) and both a median and modal age of 43. A majority of the participants were in the military (70.1 percent) with 29.9 

percent holding civilian positions. Of the 261 who reported their Service or component, 53 (20.3 percent) said Army, 64 (24.5 percent) Air 

Force, 43 (16.5 percent) Navy, 19 (7.3 percent) Marine Corps, 4 (1.5 percent) Coast Guard, 53 (20.3 percent) Department of Defense civilian, 

19 (7.3 percent) other Government agency civilian, and 6 (2.3 percent) 

reported that they were civilian industry fellows. Finally, regarding ethnicity, of the 250 responding to this question, 187 (74.8 percent) stated they were non-Hispanic white, 31 (12.4 percent) African-American, 
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 181

9 (3.6 percent) Hispanic, 7 (2.8 percent) Asian and Pacific Islander, and 

16 (6.4 percent) chose “other.” 

Measures

Mini-markers. Gerard Saucier (1994) developed the mini-markers 

(MM) instrument as a shortened version of Lewis Goldberg’s (1992) 

100-item set of single adjective, unipolar markers for measuring the 

Big Five personality dimensions. It is representative of the lexical approach. While the 100-item set had respectable loadings on five factors as predicted in factor analyses (Goldberg, 1992), they produced 

scales that were intercorrelated at moderately high levels (over .40) 

and included some “user-unfriendly” terms such as “imperturbable” 

and “uncharitable” (Saucier). By choosing “homogeneous” items that 

loaded highest on their respective predicted factors and less than half 

as highly on any other factor across a dozen samples, Saucier successfully whittled down the adjective list to 40, with 8 items representing 

each of the Big Five dimensions. Following Goldberg’s (1992) original designations, he labeled these extraversion or surgency, agreeableness, conscientiousness, emotional stability, and intellect or openness. 

The resulting scales had better interitem correlations and orthogonal 

properties than those reported by Goldberg, although reliability scores 

(coefficient alphas) were predictably, but marginally, sacrificed and remained above .73 (Saucier). Dwight, Cummings, and Glenar (1998) 

reported that the validity of the mini-markers compared favorably 

with that of Goldberg’s full set of markers.

The 40 items of the original mini-markers used in this study are 

found in table 8–1. Eight single adjective items are included to measure each of the Big Five factors. Participants were asked to rate how 

accurately each trait presented describes them. Responses are then 

scored on a 9-point scale, from 1 being extremely inaccurate to 9 being extremely accurate. MM scale scores were constructed using Saucier’s (1994) original method. The appropriate 20 adjective responses 

addressing the negative pole of the relevant factor were reverse-coded (from 9 to 1) before being added together with the response scores 

of their positive-pole counterparts to produce the respective Big Five 

scale score. Each of the five scale scores was then divided by 8 to rescale the sum to the original metric. There were no missing data by 

individual item response, which rendered a total of 289 cases with 

complete MM data for analysis.
182 THE 71F ADVANTAGE

Table 8–1. Mini-markers Factor Analysis: 40 Item Factor Loadings for 

Five-factor Solution (N = 289)

Component*

1 2 3 4 5

Talkative .747 .208 .176 .024 .131

Extroverted .841 .138 .074 -.067 .077

Bold .540 -.167 -.018 -.006 .275

Energetic .452 .172 -.128 -.197 .243

Shy -.797 -.059 .131 .059 -.047

Quiet -.838 .015 -.003 -.042 .016

Bashful -.766 -.010 .101 .135 -.062

Withdrawn -.676 -.295 .178 .146 .063

Sympathetic .019 .761 .055 -.072 .133

Warm .272 .684 -.078 -.116 .055

Kind .117 .735 -.044 -.139 .118

Cooperative .030 .579 -.005 -.139 .038

Cold -.185 -.691 .069 .097 .017

Unsympathetic -.018 -.727 .073 .093 -.154

Rude .039 -.564 .448 .140 .119

Harsh .144 -.482 .470 -.021 .008

Organized .108 .084 .012 -.789 -.095

Efficient .126 .060 -.026 -.645 .158

Systematic .051 .028 .027 -.602 .131

Practical -.010 .152 -.063 -.454 .075

Disorganized -.011 -.052 .021 .751 .084

Sloppy -.064 -.099 .094 .656 .082

Inefficient -.110 -.089 .119 .746 -.065

Careless .092 -.183 .215 .502 -.127

Unenvious .094 -.102 -.531 -.041 .122

Relaxed .011 .200 -.441 .244 .008

Moody -.138 -.144 .657 .098 .126

Jealous -.094 -.096 .728 .103 -.071

Temperamental .093 -.130 .713 .099 .117

Envious .020 -.044 .714 .065 -.189

Touchy .097 .018 .592 .134 .095
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 183

Fretful -.198 .051 .621 .037 -.068

Creative .248 .208 -.093 .096 .731

Imaginative .228 .235 -.075 .074 .724

Philosophical -.075 .073 .046 .042 .646

Intellectual .099 -.080 -.041 -.300 .589

Complex -.029 -.147 .138 -.025 .615

Deep -.042 .065 .082 -.065 .686

Uncreative -.256 -.193 .172 .002 -.679

Unintellectual -.133 -.035 .129 .273 -.550

*Rotated Component Matrix (Varimax Rotation with Kaiser Normalization)

International Personality Item Pool. The second instrument examined 

in this study is based on items drawn from the International Personality Item Pool (IPIP). Goldberg and colleagues (1999; Goldberg, Johnson, Eber, Hogan, Ashton, Cloninger, and Gough, 2006) constructed 

the IPIP in 1996 as a free and open source, online repository of personality measurement items collected from multiple public-domain 

sources. Their goal was to accelerate advancement in the field of personality research by alleviating copyright and other restrictions related 

to commercial test publishing and, thereby, increasing the prospect for 

collaborative research networks, data-sharing, and study replication. 

They have since referred to their project as a “collaboratory,” defined as 

“a computer-supported system that allows scientists to work with each 

other, facilities, and data bases without regard to geographical location” 

(Finholt and Olson, 1997). The IPIP currently has over 2,000 items on 

its Web site, which is maintained by the Oregon Research Institute.

Johnson’s short form IPIP-based representation of the NEO–PI–R. The 

NEO–PI–R (Neuroticism, Extraversion, Openness Personality Inventory–Revised; Costa and McCrae, 1992), a licensed commercial product, is perhaps the most widely recognized and accepted standardized 

tool for measuring the five-factor domains and the facets that are hypothesized to underlie them (see Johnson, 2000a). The NEO–PI–R itself contains 240 items representing 30 facets, or 6 facets for each of 

the overarching 5 factor domains: neuroticism, extraversion, openness, agreeableness, and conscientiousness (sometimes rearranged to 

form the acronym OCEAN). The “middle-level” personality categories reflected by the 30 facets of the NEO–PI–R are perhaps the most 
184 THE 71F ADVANTAGE

frequently measured in empirical studies (John and Srivastava, 1999). 

In short, the comprehensiveness of the NEO–PI–R and its high concurrent validity with a host of other personality instruments have often rendered it the preferred instrument of choice for many researchers 

and clinicians.

Johnson (2001) took Goldberg’s 300-item proxy for the NEO–

PI–R found in the IPIP and uploaded it to his own Web site on September 1, 1998. In 2000, using standard correlational, factor, reliability, and 

content analytic techniques, Johnson produced a new, abbreviated instrument with somewhat lower scale and facet alpha reliability scores. 

This short form, which he added to his Web site as an alternative to the 

300-item inventory, consists of 120 items with 30 four-item sets intended to measure the NEO–PI–R facets, for a total of 24 items (6 facets with 

4 items per facet) representing each of the Big Five factor domains. It is 

a collection of brief, descriptive phrases and represents the more deductive, theoretical approach in contemporary personality psychology as 

opposed to the lexical approach. Following Johnson (2001), this NEO–

PI–R proxy instrument is labeled the IPIP–NEO. Johnson labels his five 

factors in the same manner as Costa and McCrae for the NEO–PI–R, 

although he has somewhat varying names for the 30 facets. Johnson’s 

facet labels for the openness factor, with Costa and McCrae’s (1992) labels given in parentheses, are: O1–Imagination (Fantasy), O2–Artistic 

Interests (Aesthetics), O3–Emotionality (Feelings), O4–Adventurousness (Actions), O5–Intellect (Ideas), and O6–Liberalism (Values). The 

24 items comprising the openness factor can be found in appendix A.

Participants were asked to rate how accurately each of the 120 

phrases presented describes them on a 5-point scale, with 1 being very 

inaccurate to 5 being very accurate. The IPIP–NEO Big Five domain 

scales and the 30 facet scales were constructed using Johnson’s (2001) 

methodology. The appropriate 55 short-phrase responses addressing the 

negative pole of the relevant factor or facet were reverse-coded (from 5 

to 1) before being added together with the response scores of their positive-pole counterparts to produce their respective Big Five domain scale 

or facet score. Each of the 5 domain scale scores was then divided by 24, 

and each of the 30 facet scores by 4, to rescale the sums to the original 

metric. There were 156 instances of missing item data across the 120 

item variables, leaving 174 cases with complete IPIP–NEO data. A missing data analysis showed that items with missing data were apparently 

randomly distributed across facets and scales.
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 185

Results

Factor Analyses

The issue of construct validity for the included items on the two 

different openness scales is examined through the use of factor analysis. 

For the mini-markers, the initial principal components analysis of the 

40 items comprising the instrument revealed a 10-factor solution with 

the minimum eigenvalue = 1.0 criterion. However, an examination of 

the associated scree plot for the analysis showed a decided drop in initial 

eigenvalues from 2.74 to 1.50 between the fifth and sixth factors, giving 

some support for a five-factor solution.

Saucier’s (1994) published factor analysis of the mini-markers (N 

= 636) was replicated by forcing a five-factor solution using varimax 

rotation with Kaiser normalization. This rotation converged in six iterations and the five factors accounted for a total of 51 percent of sums 

of squared loadings (variance). The results are shown in table 8–1 and 

closely match those of Saucier. Although the factor judged to be emotional stability comes up third instead of fourth in the rotated component order, and conscientiousness fourth rather than third, the factor 

loadings of the individual items are very clear in their relatively high 

loadings (over .40 absolute value) on the factors predicted, and simultaneously low loadings (.30 or less) on the other four factors. For the items 

purporting to measure openness in particular (see the eight highlighted factor loadings under the fifth component), there are no cases where 

predicted items fail to load highly on the presumed factor.

Factor analyses conducted with the IPIP–NEO proved to be 

more difficult to interpret. In terms of the initial principal components solution with all 120 items and the minimum eigenvalue = 1.0 

criterion, 32 factors were extracted. The scree plot was of little help in 

determining a “natural break” in the number of factors based on initial eigenvalues, which do not drop below 2.0 until after the 13th factor. If we take an IPIP–NEO facet point of view, there is also no such 

break between the 30th and subsequent factors. Forcing a 30-factor solution does not produce the expected loading patterns for the 30-facet item groupings. Forcing the five-factor solution using the varimax 

rotation method with all 120 items accounts for just 35 percent of the 

sums of squared loadings or variance. Although there are clear clusterings of items on expected factors, there are dozens of exceptions 

to our standard of having items with (absolute value) loadings over 
186 THE 71F ADVANTAGE

.40 on the apparent predicted factor and .30 or less on any of the other 

four factors.

As a method for coping with this complexity, Johnson (2000b; 

2001; cf. Buchanan, Johnson, and Goldberg, 2005) suggests using the 

30 facet scores instead of the 120 individual items for conducting factor analysis. In his findings based on a forced five-factor solution using 

varimax rotation and a sample of 20,993 cases gathered from the Internet, Johnson found that the solution converged in 11 iterations. Results based on an attempt to replicate Johnson’s Internet findings are 

found in table 8–2. The factor solution converged in 13 iterations and 

the five-factor components produced accounted for 54 percent of the 

variance (sums of squared loadings). However, while the factor loadings 

led in the right direction, they were not as tightly arrayed as those for the 

mini-markers and fell somewhat short of those reported by Johnson as 

well. For the openness factor in particular (see the six highlighted factor 

loadings under the fifth component), the following facets did not load 

highly (over .40) on the predicted factor: emotionality (.34) and liberalism (.398). Furthermore, there were three instances where openness facets loaded above .30 (absolute value) on one or more of the other four 

factors, with a high loading (.47) for O3–Emotionality on the presumed 

neuroticism factor (component 3).

Table 8–2. IPIP–NEO Factor Analysis: 30 Facet Factor Loadings for 

Five-factor Solution (N = 174)

Component*

1 2 3 4 5

A1 Trust .381 -.014 -.099 .519 -.036

A2 Morality .023 .514 -.158 .444 -.017

A3 Altruism .452 .239 .111 .618 .295

A4 Cooperative -.172 .299 -.312 .592 .125

A5 Modesty -.129 -.023 .031 .661 -.076

A6 Sympathy .110 .147 .062 .576 .426

C1 Self-efficacy .226 .619 -.122 -.292 .272

C2 Orderliness .081 .489 -.015 .079 -.292

C3 Dutiful .031 .635 .054 .177 -.120
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 187

C4 Achievement .238 .557 .038 .062 .320

C5 Self-discipline .239 .589 -.332 -.129 .074

C6 Cautious -.324 .592 -.228 .129 .025

E1 Friendliness .849 .117 -.100 .182 .053

E2 Gregariousness .825 -.039 -.021 -.067 .095

E3 Assertiveness .494 .422 .063 -.474 .058

E4 Activity .352 .159 -.114 -.053 .077

E5 Excitement .569 -.426 .087 -.158 .309

E6 Cheerful .650 -.028 -.464 .193 .125

N1 Anxiety -.262 -.107 .782 .008 -.094

N2 Anger .028 -.029 .679 -.405 .001

N3 Depression -.413 -.187 .664 -.001 .034

N4 Self-conscious -.780 -.090 .148 .022 -.078

N5 Immoderation .064 -.421 .374 -.040 .223

N6 Vulnerability -.195 -.419 .611 .044 -.270

O1 Imagination .151 -.307 .165 -.079 .554

O2 Artistic .160 .087 -.083 .230 .619

O3 Emotionality .372 .135 .466 .266 .341

O4 Adventurous .253 -.027 -.256 .005 .646

O5 Intellect .030 .096 .090 -.105 .685

O6 Liberalism -.107 -.116 -.139 .242 .398

*Rotated Component Matrix (Varimax Rotation with Kaiser Normalization)

These factor analyses lead to the conclusion that the mini-markers items show better construct validity than either the IPIP–NEO individual items or facet scores as far as the presumed Big Five factor domains, and openness specifically, are concerned. However, both measures are certainly reasonable in their ability to differentiate openness 

items from those hypothesized to be related to other personality dimensions.

Correlational Analyses

Concurrent validity. The question of concurrent validity across the two 

instruments on their respective Big Five scales is addressed by examining 
188 THE 71F ADVANTAGE

the correlation matrix relating each instrument’s scales with those of the 

other (see table 8–3). These results generally support the assertion that 

each instrument’s scales are roughly measuring the same Big Five dimension. The critical correlations in terms of concurrent validity are 

found along the diagonal, where they range from an absolute value of 

.57 to .77, with that between the two openness measures being .60. At 

the same time, one can be encouraged that in terms of the off-diagonal 

correlations, there are none for openness that are above .25. While even 

lower off-diagonal correlations would be desirable, the mutually discriminating power of the scales across instruments is fairly good.

Table 8–3. Mini-markers and IPIP–NEO Big Five Scale Intercorrelation 

Matrix

IPIP–NEO Mini-markers

Surgency Agreeableness

ConscientiousnessEmotional 

Stability

Openness

Extraversion .77* .21* .08 .17* .18*

Agreeableness -.06 .57* .19* .30* .01

Conscientiousness .11 .31* .64* .17* .17*

Neuroticism -.32* -.29* -.22* -.65* -.10

Openness .25* .19* -.12 -.04 .60*

Note: N = 235–242; all (*) correlations are significant at p < .05.

Within-instrument scale orthogonality. Within each instrument, one 

should see interscale correlations as low as possible to justify assertions 

that each is measuring an orthogonal or conceptually distinct Big Five 

personality dimension. This assumption, of course, also underlies the 

varimax rotation method in the factor extraction analyses. Table 8–4 

presents the scale intercorrelations for both the MM and IPIP–NEO instruments on the openness measures. While openness has statistically 

significant correlations with extraversion/surgency and agreeableness 

for both instruments, these are moderate to low, which renders some 

confidence these respective instrument scales are at least partially orthogonal to one other.
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 189

Table 8–4. Big Five Openness Scale Intercorrelations by Instrument

Mini-markers Openness IPIP–NEO Openness

Surgency .26* Extraversion .36*

Agreeableness .18* Agreeableness .21*

Conscientiousness .13* Conscientiousness .02

Emotional Stability .07 Neuroticism -.11

N = 289 N = 241–223

Note: All (*) correlations are significant at p < .05.

Reliability analyses. A comparison of instrument openness scales was 

also conducted to assess scale utility in terms of relative reliability and 

internal consistency. The internal consistency (coefficient alpha) results 

were based on 8 items for the MM openness scale and 24 items for the 

IPIP–NEO openness scale. As a result of the higher number of included 

items, the IPIP–NEO scale was expected to show a higher coefficient alpha (Schultz and Whitney, 2005; cf. Saucier, 1994). Results are presented 

in table 8–5.

Table 8–5. Comparative Reliability Analyses of Mini-markers and 

IPIP–NEO (Item Level) for Openness

Range Alpha Inter-item r Range Item-total r

MM 

Openness

Items = 8, 

N = 289 .83 .18 to .81 (Mean = .38) .44 to .67

IPIP–NEO 

Openness

Items = 24, 

N = 234 .81 -.12 to .85 (Mean = .15) .11 to .51

There is little difference in analysis results regarding the two openness scales. The MM openness scale actually has a slightly higher coefficient alpha (.83) than the IPIP–NEO one (.81), despite having fewer 

scale items, though both alphas are still quite strong. Saucier (1994) reports an alpha of .78 for his openness scale, and Johnson (2006) reports 

an alpha of .82 for his. The average inter-item correlation for the IPIP–

NEO scale (.15), however, is less than half that for the MM scale (.38), 
190 THE 71F ADVANTAGE

with correspondingly lower item-total correlations as well. The lowest 

interitem correlation on the MM scale is .18, but there are 21 such correlations that are negative for the IPIP–NEO openness scale and another 85 positive ones that are less than .10. There were no weak items (net 

negative contribution to coefficient alpha) on the MM scale, but four on 

the IPIP–NEO: “experience my emotions,” “believe that there is no absolute right or wrong,” “rarely notice my emotional reactions” (inverted), and “believe that we should be tough on crime” (inverted).

It must be kept in mind here that the IPIP–NEO openness scale 

purports to be measuring six distinct facets within the factor, which 

would conceptually tend to weaken a certain number of interitem correlations across included facets. To address the issue of “noise” introduced 

by individual items tied to IPIP–NEO facets, a reliability analysis for the 

openness scale was repeated using just the six facet scales instead of the 

individual items. The results of the reanalysis are shown in table 8–6. Coefficient alpha drops from .81 to .63, but this was not surprising given 

the fact that the factor is now being analyzed in terms of 6 rather than 

24 component variables. Importantly, the mean interfacet correlation 

(.22) is markedly better than the mean interitem correlation found in the 

previous analysis (.15), and item-total correlations were also improved, 

although O3–Emotionality and O6–Liberalism remain under .30.

Cross-facet weaknesses for the IPIP–NEO openness scale may be 

seen clearly in table 8–7 and summarized as follows: O3–Emotionality

Table 8–6. IPIP–NEO Facet Level Reliability Analysis for Openness 

(N = 234)

IPIP–NEO Openness Zero-Order r Item-Total r (Corrected)

Facet

O1 Imagination .57 .34

O2 Artistic Interests .69 .46

O3 Emotionality .50 .28

O4 Adventurousness .67 .46

O5 Intellect .64 .42

O6 Liberalism .47 .20

Cronbach’s coefficient alpha = .63

Interfacet correlations range from .04 to .39 (Mean = .22)

Note: All zero-order and item-total correlations are significant at p < .05.
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 191

is correlated at less than .20 with both O4–Adventurousness and O5–

Intellect; O6–Liberalism is correlated at less than .20 (and as low as 

.04) with O1–Imagination, O2–Artistic Interests, O3–Emotionality, 

and O5–Intellect, and its deletion from the openness scale would raise 

coefficient alpha. While the six facets are meant to be distinct, these 

correlations are lower than one would expect within a common factor 

domain. Few to no such problems exist for the individual items comprising the MM openness scale, whose intercorrelations are shown in 

table 8–8. There is certainly correlational variability here, with the likelihood of facet patterns especially along “creative-imaginative” and “complex-deep” axes, but nothing of great concern. 

Table 8–7. IPIP–NEO Openness Facet Intercorrelations

Facet Artistic 

Interests

EmotionalityAdventurousness Intellect Liberalism

Imagination .23 .23 .24 .25 .09 (n.s.)

Artistic Interests .22 .33 .39 .19

Emotionality .17 .17 .09 (n.s.)

Adventurousness .39 .23

Intellect .04 (n.s.)

Note: N = 234; all correlations are significant at p < .05 except (n.s.).

Table 8–8. Mini-markers Openness Item Intercorrelations

Item 2 3 4 5 6 7 8

1. Complex .30 .54 .27 .30 .36 -.18 -.20

2. Creative .36 .81 .30 .35 -.78 -.27

3. Deep .32 .37 .50 -.30 -.33

4. Imaginative .29 .38 -.75 -.28

5. Intellectual .27 -.31 -.61

6. Philosophical -.33 -.23

7. Uncreative -.39

8. Unintellectual

Note: N = 289; all correlations are significant at p < .05.
192 THE 71F ADVANTAGE

Descriptive Measures and Norms

Descriptive statistics for the openness scales as measured separately by the mini-markers and IPIP–NEO are presented in table 8–9, 

with histograms for the two scales shown respectively in figures 8–1 and 

8–2. Recall that for both the MM and the IPIP–NEO, the raw additive 

scores were rescaled to the original item metric (that is, divided by the 

number of included items) for ease of interpretation. It is also useful to 

keep in mind that the midpoint of the MM scales is 5.0 on a 1.0 to 9.0 

scale, with scores less than 5.0 indicating relatively increasing degrees of 

reported inaccuracy (that is, slightly, moderately, very, and extremely), 

and those above 5.0 indicating the same degrees of relative accuracy for 

the openness adjective set. Regarding the IPIP–NEO scales, the midpoint 

is 3.0 on a 1.0 to 5.0 scale, with scores below the midpoint representing 

relative inaccuracy (moderately and very), and those above 3.0 the same 

degrees of relative accuracy with respect to the openness set of phrases.

Table 8–9. Descriptive Statistics for Openness Measures

Mini-markers IPIP–NEO

Openness Openness

Valid N 289 Valid N 234

Missing 3 Missing 58

Mean 6.37976 Mean 3.1051

Median 6.50000 Median 3.0833

Standard Deviation 1.120520 Standard Deviation .44287

Skewness -.409 Skewness .106

Kurtosis -.152 Kurtosis .422

The two openness scales give us very disparate pictures of the population distributions across instruments. While both mean scores are 

above their scale midpoints, for the IPIP–NEO scale this is just barely 

the case (mean = 3.11), while for the mini-marker, this is significantly 

so (mean = 6.38). The MM scale yields 85.8 percent above the midpoint, compared to just 56.8 percent on the IPIP–NEO. On the high end 

of these scales (above 7.0 and 4.0), the percentages are 29.8 percent and

3.8 percent, respectively. The MM openness scale is far more negatively
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 193

Figure 8–1. Histogram for Mini-markers: Openness

50

40

30

20

10

0

Frequency

Openness

3.000 4.000 5.000 6.000 7.000 8.000 9.000

Midpoint

Mean=6.37976

Standard Deviation=1.12052

N=289

Figure 8–2. Histogram for IPIP–NEO: Openness

40

30

20

10

0

Frequency

Openness

1.50 2.00 2.50 3.00 3.50 4.00 4.50

Midpoint

Mean=3.1051

Standard Deviation=0.44287

N=234
194 THE 71F ADVANTAGE

skewed (-.41 versus .11), but also considerably less leptokurtic (-.15 

versus .42), meaning that the preponderance of MM openness scores 

are far more positively leaning than those for the IPIP–NEO, as well as 

having a flatter or wider distribution. These results raise the question 

whether the two scales are measuring the same phenomena with respect 

to our population, at least in terms of how they differentially distribute 

our subjects.

It is instructive to compare our sample’s openness means on the 

two instruments to those from Sauciers’s (1994) MM sample of 1,125 

community residents of Eugene-Springfield, Oregon, and Johnson’s 

(2006) IPIP–NEO sample of 20,993 Web users. For the mini-markers, 

Saucier reports an openness scale mean of 6.6, or nearly the same as 

ours (6.4). Johnson, however, finds an openness mean that is decidedly 

higher than ours (3.6 versus 3.1). This comparison alone, however, does 

not make clear whether the differences are due to the instruments themselves, or rather the variable nature of the sample populations.

The descriptive statistics for the individual openness MM items 

and IPIP–NEO facets are shown in table 8–10. These statistics help clarify the sources of variability on the respective measures. While there 

are statistically significant mean differences among the MM items—for 

example, between “intellectual” and “philosophical” (t = 7.8, p < .05)—

differences are more pronounced on the IPIP–NEO. To cite two examples, means on both O1–Imagination and especially O6–Liberalism are 

below the scale midpoint (neutral) and are significantly lower than the 

O5–Intellect mean (t = 11.1, p < .05 and t = 21.0, p < .05, respectively). 

(Statistics for the individual IPIP–NEO items are found in appendix B.)

Multivariate Analysis

A multivariate regression analysis was conducted to help answer 

the critical question of how well the MM openness scale represents the 

relevant facets on the IPIP–NEO openness scale. Standardized betas are 

presented to show the relative predictive power of each IPIP–NEO facet 

vis-à-vis MM scale scores. The results are presented in table 8–11.

The conclusion from the descriptive analyses that the IPIP–NEO 

openness scale might well be measuring at least somewhat different 

phenomena than the MM openness scale is considerably reinforced 

by these results. The MM openness scale scores are most clearly predicted by O5–Intellect with an extremely strong standardized beta or 

beta weight of .62. There is only one other definitely significant effect for 

an associated IPIP–NEO facet, O4–Adventurousness, though its relative 
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 195

Table 8–10. Descriptive Statistics for Openness Items

Raw Descriptive Statistics for Mini-markers Openness Items

Item N Minimum Maximum Mean Standard 

Deviation

5 Complex 289 1.00 9.00 5.8270 1.91970

7 Creative 289 2.00 9.00 6.5121 1.65434

8 Deep 289 1.00 9.00 5.9827 1.84364

16 Imaginative 289 2.00 9.00 6.4810 1.52996

18 Intellectual 289 1.00 9.00 6.6886 1.41908

23 Philosophical 289 1.00 9.00 5.8166 1.71723

35 Uncreative 289 1.00 8.00 3.3010 1.70050

37 Unintellectual 289 1.00 8.00 2.9689 1.47045

Descriptive Statistics for IPIP–NEO Openness Facets

N Mean Standard 

Deviation Skewness Kurtosis

O1 Imagination 259 2.9035 .74276 .322 .053

O2 Artistic Interests 260 3.3923 .83014 -.264 -.568

O3 Emotionality 262 3.4218 .62788 -.105 -.019

O4 Adventurousness 259 3.2191 .73004 .066 -.812

O5 Intellect 263 3.5618 .76806 -.489 .247

O6 Liberalism 259 2.1844 .74776 .222 -.649

effect (.23) is only about one-third the size as that for Intellect. O1–

Imagination and O3–Emotionality display very weak to insignificant 

effects, and O2–Artistic Interests and O6–Liberalism do not independently predict MM openness scores, net of (or controlling for) the other facets. The zero-order correlation between O6–Liberalism and MM 

openness (.12) is the lowest of any of the six facets. The squared multiple 

correlation or model r2of .49 means that only about half of the variance 

in MM openness scores is explained by the IPIP–NEO facets.

Discussion

This analysis raises several issues for practical consideration when 

it comes to the goal of enhancing creative thinking among senior leaders
196 THE 71F ADVANTAGE

Table 8–11. Multivariate Regression Analysis of Mini-markers Openness 

on Related IPIP–NEO Domain Facets (N = 172; d.f. = [6, 165])

MM Openness Zero-Order r Partial r Standardized Beta

IPI–NEO Facet

O1 Imagination .34* .15 .12 (p<.06)

O2 Artistic Interests .30* -.07 -.06 (n.s.)

O3 Emotionality .27* .15 .12 (p<.06)

O4 Adventurousness .46* .27* .23*

O5 Intellect .64* .52* .62*

O6 Liberalism .12 (n.s.) .03 .02 (n.s.)

Model R2 = .49

Note: All (*) correlations and betas are significant at p < .05 except (n.s.).

and the likelihood they will produce innovative solutions within their 

organizations. The first involves the value of psychological testing as a 

method for screening personnel for either creative predilections or abilities. If it is agreed that such screening has merit, then we must ask what 

instruments and feedback reporting systems are most useful for this 

purpose. Second, with or without such screening data in hand, the question arises of what training techniques and developmental programs are 

most valuable for fostering growth in this area. Finally, the roles of organizational climate and the wider culture for facilitating or dampening 

creative effort should be addressed.

The openness scales examined herein are just two of the over 200 

instruments available for measuring creative tendencies or potential (Puccio and Murdock, 1999). Some instruments, like the popular Torrance 

Tests of Creative Thinking, attempt to measure global creative abilities 

across a number of subdimensions (Torrance, 1998). Others focus more 

clearly on domain-specific measures of creativity (Baer, 1998; Kaufman 

and Baer, 2004; cf. Chen, Himsel, Kasof, Greenberger, and Dmitrieva, 

2006). Still others, such as the Creative Personality Scale, involve checklists of demonstrated creative behavior (Plucker, 1999). The examples of 

the five-factor personality measures used in this paper or other psychological tests that include creativity factors, such as “Innovative” (Gordon, 

1993) or “New Ideas Generator” (Belbin, 2003) in their pool of traits, are 

often attractive because they include creativity as part of a comprehensive 

personality assessment, feedback, and development program.
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 197

Whatever method one uses to tap creative potential or openness 

to innovation, the current analysis makes it abundantly evident that different measures, though designed to tap the same underlying phenomena, may produce very different results for characterizing individuals 

and populations. In the case of the MM and the IPIP–NEO, while different measurement methods (single adjectives versus phrases) and metrics (five versus nine response choices) may account for some variation 

in the data, outcome disparities are most likely due to operationalization and content issues. It appears that a high tendency toward “openness” is much more likely to be found in our population by using the 

MM, because the IPIP–NEO includes Liberalism as one of its facets and 

its Imagination facet includes such items as “enjoy[s] wild flights of fantasy,” which are underrepresented by the mini-marker that emphasizes 

Intellect and simply stated creative and imaginative thought. It is indeed possible on a facet such as Liberalism, which includes such items 

as “Tend to vote for liberal political candidates,” where a total of just 11.4 

percent of students found it at all accurate for themselves, and “Being 

tough on crime” (classified as “anti-liberal”), where less than 1 percent 

said it was not an accurate statement for them, that these items and their 

associated facet response variability are not generalizable from the larger 

civilian population to our government-military one.

One may argue that Liberalism, while important conceptually as 

an indicator of tendencies away from authoritarianism and dogmatism 

(McCrae and Costa, 1997) is not well constructed in the IPIP–NEO, 

with three of its four items referencing voting behavior (“liberal” versus “conservative” candidates) and being “tough on crime.” It may also 

be unclear, for example, just how critical the IPIP–NEO Artistic Interests facet truly is from a strategic leader development perspective. In 

any event, the takeaway lesson is that it is incumbent upon the leader 

development and screening team to be as concrete and detailed as possible about the creative or innovative qualities desired and proceed on 

that basis to choose the appropriate instrument or instruments to measure these, rather than adopt some standard screening tool in wholesale 

fashion based on global descriptors alone. All included individual items 

should also be carefully evaluated for relevance, appropriateness, and 

bias within one’s organizational context.

Assuming the leader developer has the right instrument for capturing creative abilities or attitudes deemed positive for the organization, 

it is then critical to know to what degree the measured characteristics 
198 THE 71F ADVANTAGE

are desirable and how to deliver the proper feedback and, if applicable and possible, the recommended training program for creativity enhancement. Although the goal may be to raise scores that are “too low” 

on creativity to foster innovative potential, scores that are “too high” (either globally or on some particular facet such as in the IPIP–NEO) may 

also be problematic or dysfunctional for the organization’s needs. In addition, feedback and training should be tailored to the particular leader 

based on role. For example, it may not be necessary for certain administrators to be especially creative themselves as long as they can facilitate innovation and are open to new ideas from peers and subordinates. 

A counseling tool like the prescriptive Career Architect/Leadership Architect (Lombardo and Eichinger, 2004) is useful in this regard since it 

has separate sets of recommendations for developing creativity, managing innovation, broadening perspective, dealing with ambiguity, and becoming strategically agile.

In sum, tailored developmental programs that include feedback, 

coaching, role-playing, and the like can make most people better leaders, regardless of any natural advantage they may or may not have due to 

personality or prior experiences (Zenger and Folkman, 2002). Because 

there are as many kinds of creativity training as there are screening instruments, leader developers must be very careful in selecting or designing the best courses for their participants if they are to add value to their 

organizations given resource and time expenditure (see Birdi, 2007). For 

leaders, one fruitful form of training certainly involves learning how to 

successfully identify and evaluate useful original ideas (Blair and Mumford, 2007; Licuanan, Dailey, and Mumford, 2007). Increasing awareness of the variables, processes, and conditions leading to positive consideration of original ideas can provide the foundation for skill development under both simulated and real conditions. Specifically, the effects 

of such factors as job challenge and autonomy, social norms, group or 

team cohesion and diversity, and organizational identity must be understood if leaders are to effectively respond to and manipulate them to 

foster innovative growth (Adarves-Yorno, Postmes, and Haslam, 2007; 

Carmeli, Cohen-Meitar, and Elizur, 2007; Mirowsky and Ross, 2007; 

Nemeth and Ormiston, 2007). The best facilitators of creative thinking 

thoroughly understand both their own and others’ thinking processes 

(Catling, 2007).

Ferris, Perrewe, Anthony, and Gilmore (2000), believe that personality assessment and the self-awareness and understanding that 
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 199

follow are critical first steps to developing the political and social skills 

that do lead to organizational innovation and success. This stance has 

clearly been taken to heart at such corporations as Intel, which in 1998 

launched its Leadership Development Forum as an effort to develop the 

leadership necessary to meet the challenges of technological change and 

burgeoning demand (Carter, Ulrich, and Goldsmith, 2005). Its premise 

is that “leadership is just as much about who we are as it is about what 

we do” (Carter, Ulrich, and Goldsmith). Thus, a key part of the program 

involves a “self-discovery process” through which participants come to 

understand how they think and make decisions, and are encouraged 

to step out of their “comfort zones” and question their assumptions and 

paradigms. They learn that leadership necessitates continuous learning 

and moving beyond “known” management skills and techniques to incorporating their personal values into an innovative, passionate, even 

“audacious” vision or specific project for the organization that will help 

set corporate direction, align constituents, and inspire others for the future (Carter, Ulrich, and Goldsmith). Participants practice what they 

have learned through production of a leadership autobiography that 

embodies their self-reflection, a leader action plan, and special project. 

The program to date continues to enjoy concrete results in the form 

of organizationally beneficial project outcomes, as well as the enthusiastic support of senior and junior executives alike (Carter, Ulrich, 

and Goldsmith).

Ultimately, of course, leader developers can do all the personality screening and training it is possible to do and still have little impact 

on organizational change and implementation of innovation if managerial support and organizational climate and culture are inconsistent 

with creative work, and thus diminish motivation to perform the latter 

(Birdi, 2007; McLean, 2007; Senge, 1990). In fact, Ekvall (1999) specifically links a transformational leadership style to fostering a creative climate. The broader society must also be taken into account for possible 

cultural hindrances to creative expression, especially when working in 

international settings (Averill, Chon, and Hahn, 2001; Kim, 2007). Finally, it must be kept in mind that some but certainly not all psychological instruments are “culturally transferable” in terms of the meaningfulness of their referents. 

This study has a number of limitations that affect drawing generalizations and conclusions. First, it must be remembered that the 

IPIP–NEO instrument used was only a proxy representation of the 
200 THE 71F ADVANTAGE

NEO–PI–R itself and although that proxy may have acceptable correlations with the original (Goldberg, 1999), ultimately it is not the same 

and may be criticized on that basis. In addition, the particular IPIP–

NEO proxy that was used was the short form of the full 300-item proxy, 

which further limits confidence in the instrument’s power in this regard. 

Although there appeared to be no noteworthy patterns of response bias, 

the fair number of cases missing complete data on the IPIP–NEO detracts somewhat from a strong faith in comparisons to the mini-markers. The most important limitation of the current study is that it falls 

short of comparing the two instruments head-to-head with respect to 

some external criterion, and thus we can make no claims regarding the 

relative external or predictive validity of the instruments with respect 

to outcomes of interest. Such a head-to-head comparison would indeed 

have provided recommendations with far heavier weight regarding further utilization of either or both of these instruments (cf. Saucier and 

Goldberg, 2003).

Conclusion

Openness, as the “Big Five” dimension of personality most closely tied to a proclivity for creative thinking and intellectual or innovative 

pursuits, has importance for successful executive leadership at the strategic level. To enhance this disposition, leader developers have many 

options for what screening tools to use for personnel assessment, as well 

as the appropriate program to execute for feedback and development. 

Though each had some problems, the two personality instruments examined here to measure openness had reasonable correlational properties, to include both validity and internal consistency. Despite these psychometric properties, each produced a fairly different distribution and 

thus description of the subject population due to the nature of included 

subfacets and question wording. “Overlap” or shared variance between 

the instruments was only about 50 percent.

The content of this chapter serves as a caveat for those who would 

consider using standard psychological instruments for measuring creative proclivities without carefully scrutinizing such instruments in 

terms of precisely what creative qualities or tendencies are the desired 

targets of testing. Relevant external criteria of importance to one’s organization must be identified for definitive decisions regarding the value 

of specific instruments versus others. A discerning evaluation must then 
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 201

be made to determine how the results of feedback and follow-on development programs will be structured to render the best or most balanced 

creative force for producing the level of workplace innovation desired. 

Efforts that focus solely on individual development in this area, however, without addressing a conducive organizational climate and culture 

for innovative behavior stand little chance of making a positive difference to the bottom line.

References

Adarves-Yorno, I., Postmes, T., and Haslam, S.A. (2007). Creative innovation or crazy irrelevance? The contribution of group norms and social identity to creative behavior. Journal 

of Experimental Social Psychology 43 (3), 410–416.

Averill, J.R., Chon, K.K., and Hahn, D.W. (2001). Emotions and creativity, East and West. Asian 

Journal of Social Psychology 4 (3), 165–183.

Baer, J. (1998). The case for domain specificity of creativity. Creativity Research Journal 11, 173–

177.

Belbin, M.R. (2003). Management teams: Why they succeed or fail (2d ed.). Oxford, United Kingdom: Butterworth-Heinemann.

Birdi, K. (2007). A lighthouse in the desert? Evaluating the effects of creativity training on employee innovation. Journal of Creative Behavior 41 (4), 249–270.

Blair, C.S., and Mumford, M.D. (2007). Errors in idea evaluation: Preference for the unoriginal? 

Journal of Creative Behavior 41 (3), 197–222.

Buchanan, T., Johnson, J.A., and Goldberg, L.R. (2005). Implementing a five-factor personality 

inventory for use on the Internet. European Journal of Psychological Assessment 21 (2), 

116–128.

Caprara, G.V., and Zimbardo, P.G. (2004). Personalizing politics: A congruency model of political preference. American Psychologist 59, 581–594.

Carmeli, A., Cohen-Meitar, R., and Elizur, D. (2007). The role of job challenge and organizational 

identification in enhancing creative behavior among employees in the workplace. Journal of Creative Behavior 41 (2), 75–90.

Carter, L., Ulrich, D., and Goldsmith, M. (eds.) (2005). Best practices in leadership development 

and organization change: How the best companies ensure meaningful change and sustainable leadership (213–231). San Francisco: Pfeiffer.

Catling, T. (2007). Creative thinking: A truly renewable energy source. The British Journal of 

Administrative Management, October/November, 22–23.

Cattell, R.B. (1945). The description of personality: Principles and findings in a factor analysis. 

American Journal of Psychology 58, 69–90.

Chen, C., Himsel, A., Kasof, J., Greenberger, E., and Dmitrieva, J. (2006). Boundless creativity: 

Evidence for the domain generality of individual differences in creativity. Journal of Creative Behavior 40 (3), 179–199.

Costa, P.T., and McCrae, R.R. (1992). Revised NEO Personality Inventory (NEO PI–R) and NEO 

Five-Factor Inventory (NEO–FFI). Professional manual. Odessa, FL: Psychological Assessment Resources.

DeYoung, C.G., Peterson, J.B., and Higgins, D.M. (2005). Sources of openness/intellect: cognitive 

and neuropsychological correlates of the fifth factor of personality. Journal of Personality

73, 825–858.

Digman, J.M. (1990). Personality structure: Emergence of the five-factor model. Annual Review 

of Psychology 41, 417–440.
202 THE 71F ADVANTAGE

Digman, J.M., and Takemoto-Chock, N.K. (1981). Factors in the natural language of personality: 

Reanalysis, comparison, and interpretation of six major studies. Multivariate Behavioral 

Research 16, 149–170.

Dwight, S.A., Cummings, K.M., and Glenar, J.L. (1998). Comparison of criterion-related validity 

coefficients for the Mini-Markers and for Goldberg’s markers of the Big Five personality 

factors. Journal of Personality Assessment 70, 541–550.

Earley, P.C. (2002). Redefining interactions across cultures and organizations: Moving forward 

with cultural intelligence. Research in Organizational Behavior 24, 271–299.

Ekvall, G. (1999). Creative climate. In M.A. Runco and S.R. Pritzker (eds.). Encyclopedia of creativity (vol. I, 403–412). San Diego: Academic Press.

Ferris, G.R., Perrewe, P.L., Anthony, W.P., and Gilmore, D.C. (2000). Political skill at work. Organizational Dynamics 28 (4), 25–37. 

Finholt, T.A., and Olson, G.M. (1997). From laboratories to collaboratories: A new organizational 

form for scientific collaboration. Psychological Science 8 (1), 28–36.

Fiske, D.W. (1949). Consistency of the factorial structures of personality ratings from different 

sources. Journal of Abnormal and Social Psychology 44, 329–344.

Goldberg, L.R. (1981). Language and individual differences: The search for universals in personality lexicons. Review of Personality and Social Psychology 2, 141–166.

———. (1992). The development of markers for the Big-Five factor structure. Psychological Assessment 4, 26–42.

———. (1993). The structure of phenotypic personality traits. American Psychologist 48, 26–34.

———. (1999). A broad-bandwidth, public domain, personality inventory measuring the lowerlevel facets of several five-factor models. In I. Mervielde, I. Deary, F. De Fruyt, and F. Ostendorf (eds.). Personality psychology in Europe (vol. 7, 7–28). Tilburg, The Netherlands: 

Tilburg University Press.

Goldberg, L.R., Johnson, J.A., Eber, H.W., Hogan, R., Ashton, M.C., Cloninger, C.R., and Gough, 

H.G. (2006). The international personality item pool and the future of public-domain 

personality measures. Journal of Research in Personality 40, 84–96.

Gordon, L.V. (1993). Gordon Personal Profile-Inventory: Manual. San Antonio, TX: Harcourt Assessment, Inc.

House, R.J., and Shamir, B. (1993). Toward the integration of transformational, charismatic, and 

visionary theories. In M.M. Chemers and R. Ayman (eds.). Leadership theory and research: Perspectives and directions (81–108). San Diego, CA: Academic Press.

Jacobs, T.O. (2006). Strategic leadership: The competitive edge (Revised ed.). Washington, DC: 

National Defense University.

John, O.P., and Srivastava, S. (1999). The Big-Five trait taxonomy: History, measurement, and 

theoretical perspectives. In L.A. Pervin and O.P. John (eds.). Handbook of personality 

theory and research (2d

 ed., 102–138). New York: Guilford Press.

Johnson, J.A. (2000a). Predicting observers’ ratings of the Big Five from the CPI, HPI, and NEOPI-R: A comparative validity study. European Journal of Personality 14, 1–19.

———. (2000b, March). Web-based personality assessment. Paper presented at the 71st Annual 

Meeting of the Eastern Psychological Association, Baltimore, MD. 

———. (2001, May 9). Screening massively large data sets for non-responsiveness in web-based personality inventories. Invited talk to the joint Bielefeld-Groningen Personality Research 

Group, University of Groningen, The Netherlands. Retrieved November 12, 2006, from 

<www.personal.psu.edu/~j5j/papers/screening.html>.

———. (2006). IPIP20993iteminfo.xls. Unpublished analysis available from Dr. Johnson at j5j@

psu.edu.

Judge, T.A., and Bono, J.E. (2000). Five factor model of personality and transformational leadership. Journal of Applied Psychology 85, 751–765.
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 203

Judge, T.A., Ilies, R., Bono, J.E., and Gerhardt, M.W. (2002). Personality and leadership: A qualitative and quantitative review. Journal of Applied Psychology 87 (4), 765–780.

Kaufman, J.C., and Baer, J. (2004). Sure I’m creative—but not in mathematics! Self-reported creativity in diverse domains. Empirical Studies of the Arts 22, 143–155.

Kim, K.H. (2007). Exploring the interactions between Asian culture (Confucianism) and creativity. Journal of Creative Behavior 41 (1), 28–53.

Kotter, J.P. (1990). A force for change: How leadership differs from management. Boston: Harvard 

Business School Press.

Langer, E.J, and Moldoveanu, M. (2000). The construct of mindfulness. Journal of Social Issues 

56, 1–9.

Licuanan, B.F., Dailey, L.R., and Mumford, M.D. (2007). Idea evaluation: Error in evaluating 

highly original ideas. Journal of Creative Behavior 41 (1), 1–27.

Lombardo, M.M., and Eichinger, R.W. (2004). FYI For Your Improvement: A guide for development and coaching (4th ed.). Minneapolis, MN: Lominger International.

MacDonald, D.A. (2000). Spirituality: Description, measurement, and relation to the Five Factor 

model of personality. Journal of Personality 68, 153–197.

McCrae, R.R. (1996). Social consequences of experiential openness. Psychological Bulletin 120, 

323–337.

McCrae, R.R., and Costa, P.T. (1997). Conceptions and correlates of openness to Experience. In 

R. Hogan, J. Johnson, and S. Briggs (eds.). Handbook of personality psychology (825–847). 

San Diego: Academic Press.

McLean, J. (2007). The art of thinking outside the box. The British Journal of Administrative Management, October/November, 16.

Mirowsky, J., and Ross, C.E. (2007). Creative work and health. Journal of Health and Social Behavior 48 (4), 385–403.

Nemeth, C.J., and Ormiston, M. (2007). Creative idea generation: Harmony versus stimulation. 

European Journal of Social Psychology 37 (3), 524. 

Norman, W.T. (1963). Toward an adequate taxonomy of personality attributes: Replicated factor structure in peer nomination personality ratings. Journal of Abnormal and Social 

Psychology 66, 574–583.

Ployhart, R.E., Lim, B.-C., and Chan, K.-Y. (2001). Exploring relations between typical and maximum performance ratings and the Five Factor Model of personality. Personnel Psychology 54 (4), 809–843.

Plucker, J.A. (1999). Reanalyses of student responses to creativity checklists: Evidence of content 

generality. Journal of Creative Behavior 33 (2), 126–137. 

Puccio, G.J., and Murdock, M.C. (eds.) (1999). Creativity assessment: Readings and resources. Buffalo, NY: Creative Education Foundation Press.

Puccio, G.J., Murdock, M.C., and Mance, M. (2007). Creative leadership: Skills that drive change.

Thousand Oaks, CA: Sage Publications.

Saucier, G. (1994). Mini-Markers: A brief version of Goldberg’s unipolar Big-Five Markers. Journal of Personality Assessment 63 (3), 506–516.

Saucier, G., and Goldberg, L.R. (2003). The structure of personality attributes. In M.R. Barrick 

and A.M. Ryan (eds.). Personality and work: Reconsidering the role of personality in organizations. San Francisco: Jossey-Bass.

Schultz, K.S., and Whitney, D.J. (2005). Measurement theory in action: Case studies and exercises.

Thousand Oaks, CA: Sage Publications. 

Senge, P.M. (1990). The fifth discipline: The art and practice of the learning organization. New 

York: Doubleday.

Streufert, S., and Swezey, R.W. (1986). Complexity, managers, and organizations. Orlando, FL: 

Academic Press.
204 THE 71F ADVANTAGE

Thomas, D.C. (2006). Domain and development of cultural intelligence: The importance of 

mindfulness. Group and Organization Management 31 (1), 78–99.

Torrance, E.P. (1998). Norms-technical manual: Torrance Tests of Creative Thinking. Bensenville, 

IL: Scholastic Testing Service.

Tupes, E.C., and Christal, R.C. (1992). Recurrent personality factors based on trait ratings (1961). 

Journal of Personality 60, 225–251.

Van Hiel, A., and Mervielde, I. (2004). Openness to experience and boundaries in the mind: 

Relationships with cultural and economic conservative beliefs. Journal of Personality 72, 

659–686.

Yukl, G. (2002). Leadership in organizations (5th ed.). Upper Saddle River, NJ: Prentice-Hall.

Zaccaro, S.J. (2001). The nature of executive leadership: A conceptual and empirical analysis of success. Washington, DC: American Psychological Association.

Zenger, J.H., and Folkman, J. (2002). The extraordinary leader: Turning good managers into great 

leaders. New York: McGraw-Hill.
UNDERSTANDING AND MEASURING CREATIVE THINKING IN LEADERS 205

Appendix A

Items Comprising the IPIP–NEO Openness Facets

Facet: Imagination

Q3. Have a vivid imagination

Q33. Enjoy wild flights of fantasy

Q63. Love to daydream

Q93. Like to get lost in thought

Facet: Artistic Interests

Q8. Believe in the importance of art

Q38. See beauty in things that others might not notice

Q68. Do not like poetry

Q98. Do not enjoy going to art museums

Facet: Emotionality

Q13. Experience my emotions intensely

Q43. Feel others’ emotions

Q73. Rarely notice my emotional reactions

Q103. Don’t understand people who get emotional

Facet: Adventurousness

Q18. Prefer variety to routine

Q48. Prefer to stick with things that I know

Q78. Dislike changes

Q108. Am attached to conventional ways

Facet: Intellect

Q23. Love to read challenging material

Q53. Avoid philosophical discussions

Q83. Have difficulty understanding abstract ideas

Q113. Am not interested in theoretical discussions

Facet: Liberalism

Q28. Tend to vote for liberal political candidates

Q58. Believe that there is no absolute right or wrong

Q88. Tend to vote for conservative political candidates

Q118. Believe that we should be tough on crime
206 THE 71F ADVANTAGE

Appendix B

Raw Descriptive Statistics for IPIP–NEO Openness Items

Item N Minimum Maximum Mean Standard 

Deviation

Q301 265 1.00 5.00 3.5358 0.94530

Q802 263 1.00 5.00 3.5513 0.95920

Q1303 266 1.00 5.00 2.9887 1.04785

Q1804 265 1.00 5.00 3.5434 0.98040

Q2305 265 1.00 5.00 3.3623 1.02474

Q2806 265 1.00 5.00 2.1019 1.12857

Q3301 265 1.00 5.00 2.3849 1.03854

Q3802 266 1.00 5.00 3.4511 0.88566

Q4303 262 1.00 5.00 3.5840 0.85243

Q4804 265 1.00 5.00 3.1396 0.97669

Q5305 265 1.00 5.00 2.4340 1.00960

Q5806 263 1.00 5.00 2.8327 1.23040

Q6301 263 1.00 5.00 2.8365 1.04839

Q6802 264 1.00 5.00 3.0076 1.21459

Q7303 266 1.00 4.00 2.3083 0.93309

Q7804 264 1.00 5.00 2.5038 0.95128

Q8305 265 1.00 5.00 2.3132 1.00943

Q8806 265 1.00 5.00 3.7170 1.10057

Q9301 264 1.00 5.00 2.8258 1.04278

Q9802 265 1.00 5.00 2.4302 1.21381

Q10303 266 1.00 5.00 2.5865 0.98001

Q10804 263 1.00 5.00 3.0228 0.94881

Q11305 266 1.00 5.00 2.3872 1.10080

Q11806 264 2.00 5.00 4.4432 0.66740
Part IV

Soldier Psychological 

Health

Chapter 9

U.S. Army Mental Health 

Advisory Teams

Sharon A. McBride, Jeffrey L. Thomas, Dennis McGurk, Michael D. Wood, 

and Paul D. Bliese

Combat and operational stress has repeatedly been documented 

as a factor affecting the overall effectiveness and readiness of military 

units (see Department of the Army Field Manual 4–02.51, Combat and 

Operational Stress Control). Soldier mental health and well-being are 

important facets of such overall effectiveness and readiness. As such, 

military leaders and policymakers have emphasized the importance of 

understanding the causes and prevalence of mental health problems, 

ensuring access to mental health care, and determining potential interventions that can mitigate the effects of mental health problems for deployed Soldiers and veterans. 

A key cornerstone of the Army’s strategy to understand combat 

and operational stress effects among Soldiers deployed to Iraq and Afghanistan is the Mental Health Advisory Team (MHAT) theater evaluation and report. The MHAT was established in July 2003 through a 

charter from the U.S. Army Surgeon General in order to provide recommendations to commanders and medical personnel deployed to Iraq. 

Since 2003, an MHAT has been deployed each year to Iraq (2003–2007) 

and twice to Afghanistan (2005 and 2007). In total, nearly 8,500 Soldiers 

have been surveyed across MHATs. The focus of this chapter will be on 

the specific findings from MHAT V (2007). Each of the MHATs has 

sought to determine the following:

■ Behavioral health of Soldiers. What is the behavioral health status of Soldiers? How does it compare to Soldiers who deployed 

previously to Operation Iraqi Freedom (OIF) or Operation 

Enduring Freedom (OEF)? Are there other at-risk groups (for 

example, junior enlisted, married, or deployment-extended 

personnel)?

■ Behavioral health care system effectiveness. What is the status 

of the behavioral health care system in Iraq and Afghanistan? 

209
210 THE 71F ADVANTAGE

What are the systemic factors that need to be addressed to 

ensure that Soldiers are receiving the best care? 

■ Future needs. What are the planning and resource factors that 

must be considered to care for Soldiers engaged in future deployments to Iraq and Afghanistan? As both wars evolve, what 

can the Army do to prepare to meet behavioral health needs?

MHAT V (2007): Assessment of U.S. Soldiers in Iraq and Afghanistan

An in-theater assessment of Soldier mental health was conducted 

from September to November 2007. This was the fifth iteration of an 

MHAT deployment to Iraq and the second to Afghanistan. The team 

produced two separate reports—one for OIF, which includes a section 

on Soldiers in Kuwait, and one for OEF. The OIF and OEF reports were 

independent and designed to be standalone documents. At the same 

time, there was close coordination between the two teams. 

MHAT V was staffed primarily by U.S. Army research psychologists from the Walter Reed Army Institute of Research and its subordinate unit, the U.S. Army Medical Research Unit–Europe. Both the OIF 

and OEF research teams used nearly identical assessment tools as well as 

similar analytic strategies and collaborated in writing the reports. Both 

research teams collected Soldier well-being data using anonymous, voluntary paper and pencil surveys. While in theater, the research teams 

processed and analyzed survey data, examined secondary data sources, 

and conducted focus group interviews with Soldiers. The MHAT V 

team report and recommendations were based on these data sources. 

Behavioral health, unit ministry team, and medical personnel were also 

surveyed and interviewed by the MHAT V researchers; however, this 

chapter focuses primarily on the Soldier survey. Detailed information 

about support unit findings can be found in the complete MHAT V report (see below). 

The MHAT V survey instrument contains the same core measures that were used in all previous MHAT assessments. The survey 

focuses on four main areas that target Soldier mental health and wellbeing illustrated in the conceptual model below. These are risk factors, 

such as combat and deployment experiences; protective factors, such as 

training and willingness to seek care; behavioral health status and performance indices, such as individual and unit morale, depression, anxiety, and acute stress symptoms; and unethical behaviors. 
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 211

Figure 9–1. Soldier Combat and Well-being Model

Protective Factors

Leadership, cohesion, readiness

Willingness to seek care

Barriers to care

R&R

Family and marital support

Reporting ethical violations

Training (stress, ethics)

Source: Bliese & Castro, 2003

Behavioral Health Status

Morale (personal and unit)

Depression, anxiety, acute stress

Work performance

Suicide

Concussion (TBI)

Sleep restriction

Risk Factors Use of inhalants

Combat exposure

Deployment concerns

Deployment length

Multiple deployments Unethical Behaviors

The findings that follow are presented by theater and represent 

a summary of the two independent MHAT V reports. The complete 

OIF and OEF MHAT report is available on the Army Medical Department Web site at <www.armymedicine.army.mil/reports/mhat/mhat_v/

mhat-v.cfm>. The OIF section mainly presents Soldier responses to the 

2007 survey in comparison to responses from the 2006 OIF survey. 

However, in some cases, MHAT V indices are interpreted within the 

context of data from all previous MHAT missions. The OEF section 

presents data from the 2007 survey in comparison to the 2005 OEF 

survey, as well as the 2007 OIF survey. These latter comparisons with 

OIF data were made because the previous OEF data collection was conducted almost 3 years earlier, and many of the responses on the surveys 

needed to be interpreted in a broader, more recent context. 

Readers may occasionally note small discrepancies in the OIF 

2007 values reported in the sections below. These differences reflect the 

fact that it was often necessary to adjust values for demographic and 

other sample differences to clearly delineate findings. For each section 

below, data are presented in the broad categories of Soldier Behavioral 

Health and Performance, Soldier Risk Factors, and Soldier Protective 

Factors. This is followed by key recommendations that were made to 

commands following examination of all collected data.
212 THE 71F ADVANTAGE

MHAT V Operation Iraqi Freedom Findings

Data Collection Procedures and Demographics

Anonymous surveys were completed primarily by Brigade Combat Team Soldiers in OIF. All regions within the Iraqi theater of operations with significant numbers of U.S. Army Soldiers were surveyed. 

Data from 2,195 surveys were compared to findings from the MHAT IV 

(2006) data collection, which had a sample size of 1,368. Demographic 

variables of gender, rank, and months in theater are statistically controlled to ensure that observed differences between both samples were 

not an artifact of demographic differences. For instance, when comparing combat experiences across samples, it is important to normalize the 

length of time Soldiers have been deployed in order to determine whether 

there has been either a decline or an escalation in combat intensity. Also, 

adjusted values are typically provided based on the relative numbers of 

junior enlisted male Soldiers in theater for 9 months due to this being 

the most prevalent group. A comparison of selected demographic variables for both samples can be found in the full online report cited above. 

Soldier Behavioral Health and Performance

Soldier behavioral health and performance are viewed as outcomes that are determined by risk factors and protective factors. This 

section examines behavioral health and performance outcomes, and 

uses subsequent sections on risk factors and protective factors to interpret the behavioral health and performance results. Specific measures of 

behavioral health and performance that will be presented here include 

individual and unit morale, acute stress, depression, anxiety, stress and 

work performance, suicidal ideation, alcohol and substance abuse, and 

unethical behaviors.

Morale: individual and unit. The percentage of Soldiers who rated 

their individual morale as high or very high did not change significantly 

between 2006 and 2007 (15.3 percent and 19.1 percent, respectively). 

However, ratings of unit morale increased significantly over the same 

time period (6.4 percent and 12.7 percent).

Acute stress, depression, and anxiety. Included in the MHAT V survey 

was a standardized, validated scale for assessing acute stress symptoms, 

the Post-Traumatic Stress Disorder Checklist (Weathers, Litz, Herman, 

Huska, and Keane, 1993), and validated scales for assessing depression 
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 213

and generalized anxiety from the Patient Health Questionnaire (Spitzer, 

Kroenke, and Williams, 1999). These scales have been used in previous 

MHAT surveys and have formed the basis of several peer-reviewed publications from the Walter Reed Army Institute of Research (for example, 

Bliese et al., 2007; Hoge et al., 2004; Hoge et al., 2007). 

The OIF rates for acute stress, depression, anxiety, or any of these 

mental health problems tended to be lower in 2007 than in 2006; however, using a conventional criterion of p < .05, none of the differences 

were statistically significant (see figure 9–2). 

Figure 9–2. Operation Iraqi Freedom Brigade Combat Team Soldiers 

Reporting Mental Health Problems (adjusted percent)

35

30

25

20

15

10

5

0

Depression Anxiety Acute Stress Any Problem

 2006 MHAT IV

■ 2007 MHAT V

Percent Scoring Positive

10.0

7.6 7.8 9.6

16.1

19.0 18.9

22.2

Figure 9–3 presents the 5-year trend for Soldiers scoring positive 

for any mental health problem. The 5-year trend for these rates has remained relatively steady, with the exception of 2004. The 2007 rate differs significantly only from that reported in 2004. These rates remain 

consistently higher than those reported in the general population. 

Stress and work performance. In the Soldier Well-being Survey, work 

performance is assessed with three items. Soldiers are asked to indicate 

whether stress or emotional problems in the last 4 weeks have “limited 

your ability to do your job”; “caused you to do work less carefully than 

usual”; or “caused your supervisor to be concerned about your performance.” After adjusting for sample differences, Soldiers in 2007 were 

significantly less likely than Soldiers in 2006 to report that stress or emotional problems had limited their ability to do their job (15.1 versus 18.8
214 THE 71F ADVANTAGE

Figure 9–3. Operation Iraqi Freedom Soldiers Reporting Any Mental 

Health Problem (adjusted percent)

35

30

25

20

15

10

5

0

2003 2004 2005 2006 2007

Percent Scoring Positive

Any Problem

21.3

14.8

18.4

20.7

20.6

percent) and caused them to do their work less carefully than usual 

(23.8 versus 27.7 percent). The difference for the item about supervisor 

concern was not significant (15.0 versus 15.7 percent). 

Suicidal ideation. The MHAT survey includes one question that is used 

as an indicator of suicidal ideation. This item asks Soldiers if, over the 

last 4 weeks, they have been bothered by “thoughts that you would be 

better off dead or of hurting yourself in some way.” Any response other 

than “Not at all” was considered a positive response. In 2006, the adjusted positive response rate was 17.7 percent. In contrast, in 2007, the 

adjusted rate was 15.2 percent. Raw rates were 14.5 percent and 13.1 

percent for 2006 and 2007, respectively. These rates did not change significantly between 2006 and 2007 and did not mirror the significant increase in rates for completed suicides found between 2006 and 2007.

Divorce intent. Another possible indication of behavioral health problems is the percentage of Soldiers who report they are considering divorce. In 2007, the in-theater adjusted percent for junior enlisted was 

17.0 percent; for noncommissioned officers (NCOs), 12.3 percent; and 

for officers, 3.5 percent. Raw rates were 20.8 percent, 15.1 percent, and 

4.3 percent for E1–E4, NCOs, and officers, respectively. Values significantly differed across ranks but did not differ from 2006 to 2007. 

Alcohol and substance abuse. Although alcohol use is not permitted 

while deployed, 8 percent of Soldiers surveyed in 2007 reported using 
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 215

alcohol in Iraq. Although slightly higher, this rate was not significantly 

different than the reported rate of 6.8 percent in 2006. The reported rate 

for illegal drug use in 2007 was 1.4 percent and also did not differ significantly from the 2006 rate of 1.6 percent. 

Inhalants. Inhalants have been described as a frequently overlooked 

substance that are readily available, low cost, and undetectable by randomized drug screens (Lacy and Ditzler, 2007). A recent U.S. Department of Health and Human Services study found that a little less than 

1 percent of the population reported using inhalants in the past year 

(HHS SAMHSA National Survey on Drug Use and Health 2007 Report). The 2007 MHAT survey included an item about inhalant use, the 

first year these items were included. Overall, 3.8 percent of Soldiers in 

OIF reported that they “huffed” a substance. The most frequently inhaled substance was compressed air (3.1 percent), followed by paint (1.1 

percent), fuels (.10 percent), aerosols (.07 percent), and nitrous oxide 

(.04 percent). It appears that the overall rate for Soldiers in theater is elevated when compared to rates reported for the overall U.S. population.

Unethical behavior. The 2006 and 2007 MHAT survey included ethical issues. The questions specifically addressed battlefield ethics and the 

adequacy of ethics training. When responses were compared, there was 

only one significant difference between 2006 and 2007. Percentages for 

2006 and 2007, respectively, follow the items in parentheses: 

■ Insulted and/or cursed noncombatants in their presence (34.6 

percent versus 33.0 percent)

■ Damaged and/or destroyed private property when it was not 

necessary (10.9 percent versus 13.6 percent)

■ Hit/kicked a noncombatant when it was not necessary (5.3 percent versus 6.1 percent)

■ Modified the rules of engagement in order to accomplish the 

mission (10.0 percent versus 7.4 percent)

■ Ignored the rules of engagement in order to accomplish the 

mission (5.7 percent versus 4.3 percent).

Unethical behavior and behavioral health status. One of the central 

findings from MHAT IV (2006) was that Soldiers were more likely to 

report they had engaged in unethical behavior if they had also screened 

positive for behavioral health problems. The relationship between unethical behaviors and behavioral health status was reevaluated in 2007 
216 THE 71F ADVANTAGE

and the findings were replicated. Specifically, Soldiers who screened 

positive for mental health problems of depression, anxiety, or acute 

stress were significantly more likely to report engaging in unethical behaviors than those who did not. These behaviors included insulting or 

cursing at noncombatants (48.4 percent versus 26.5 percent), unnecessarily damaging or destroying private property (19.1 percent versus 9.9 

percent), and hitting or kicking a noncombatant (10.2 percent versus 

3.8 percent).

Summary of behavioral health and performance indices in OIF. The 

examination of OIF Soldiers’ behavioral health in 2007 compared to 

other MHAT data indicates positive trends on several measures. Soldiers’ ratings of unit morale, although still low, showed a large increase 

relative to 2006, and their reports of stress-related performance problems significantly declined relative to 2006. In terms of unethical behaviors, Soldiers reported a significant decline in the degree to which their 

units modify the rules of engagement. Other indices remained stable 

from 2006 to 2007. These included reported rates for individual morale, 

suicidal ideation, in-theater alcohol usage, and four of the five unethical 

behavior measures. Additionally, the positive relationship between unethical behaviors and mental health problems was consistent with findings from the 2006 MHAT.

Soldier Risk Factors

The examination of risk factors provides a theoretical basis from 

which to explain changes in Soldier behavioral health and reported performance indices. Two risk factors potentially unique to the 2007 deployment cycle are the length of the deployment and the potential cumulative impact of deploying multiple times. These factors and their 

correlates are examined in detail below. Evaluating the effect of deployment length and multiple deployments is unique to MHAT V because 

Soldiers deploying in 2007 were among the first to go for 15-month 

tours, and a fairly large number had deployed three or four times. An 

additional reason to examine risk factors is to specifically focus on those 

known factors that can be directly influenced by command and/or mental health providers. To this end, this section also focuses on the relationship between sleep deprivation and behavioral and performancerelated problems. 

Combat experiences. Exposure to potentially traumatic experiences is 

one of the principal risk factors for behavioral health problems in combat 
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 217

settings (Fontana and Rosenheck, 1998). In the Soldier Well-being Survey, combat experiences are measured with 33 items assessing experiences such as “Knowing someone seriously injured or killed” and “Being wounded/injured.” A combat experience score (ranging from 0 to 

33) was created by summing the number of reported experiences.

MHAT V OIF data reflect a decline in combat intensity from 2006 

to 2007. Scores for 11 of the 33 items on the combat experience scale 

declined significantly and none increased substantially relative to 2006. 

This decline is also evident by examining results based on the number 

of months deployed and the data collection year. For example, at month 

2, only 21.5 percent of Soldiers reported being attacked or ambushed 

in 2007, whereas the value had more than doubled by month 2 in 2006 

(50.8 percent).

Deployment concerns. Combat experiences are intense events that 

put Soldiers at risk for mental health problems. From a behavioral 

health perspective, however, less dramatic chronic concerns have also 

been shown to negatively relate to health (Gilbert, Lieberman, Morewedge, and Wilson, 2004). In the MHAT surveys, less dramatic chronic 

events are captured with a series of 11 questions addressing deployment concerns rated on a scale from 1 (very low trouble or concern) 

to 5 (very high trouble or concern). Long deployment length, separation from family, boring and repetitive work, and lack of privacy or personal space are consistently rated as the top deployment concerns in 

MHAT surveys.

■ Deployment length. The MHAT V OIF sample was well suited 

for examining the effects of deployment length on outcomes 

such as mental health because the sampling distribution and 

the large sample size of 2,195 provided a wide range of data 

across months deployed. This wide range provided the opportunity to model months deployed as a continuous variable.

■ Deployment length and morale. The number of months deployed was related to both individual and unit morale. Ratings 

of morale were initially high and fell to their lowest levels at 

months 8, 9, and 10 before gradually increasing (see figure 9–4). 

Subsequent analyses were conducted to determine whether the 

changes in morale were related to cumulative combat experiences. These analyses indicated that combat experiences were 

unrelated to ratings of either individual or unit morale. 
218 THE 71F ADVANTAGE

Figure 9–4. Predicted Levels of Individual and Unit Morale by 

Months in Operation Iraqi Freedom Theater

35

30

25

20

15

10

5

0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Percent Reporting High or Very High

Individual Morale

Unit Morale

Months in Theater

■ Deployment length and behavioral health. Figure 9–5 illustrates 

the relationship between months deployed and screening positive for depression, anxiety, or acute stress (that is, having any 

mental health problem). The figure shows a linear increase, with 

some degree of leveling off or decrease for the latter months. It 

is unclear why this decrease occurs. It could be due to the optimism of being able to return home, or by theater psychiatric 

evacuations in the earlier months of the deployment. As with 

morale, the highest risk times are at 8, 9, and 10 months. In 

figure 9–5, it is important to point out that the model predicts 

a threefold increase in the number of junior enlisted male 

Soldiers that will test positive for mental health problems by 

the end of a 15-month deployment. It is also important to consider that with shorter deployments, the shape of the curve 

might be the same as that shown in figure 9–5; however, with 

shorter deployments the apex of the curve might not reach the 

same high point as it does in the figure.

These results suggest that the post–6-month deployment period 

is an especially heightened risk time for mental health problems (a finding also noted in MHAT IV), and that reports of mental health problems 

level off in the months immediately before redeployment. As figures 

9–4 and 9–5 demonstrate, the last months of deployment show increases in morale and decreases in mental health problems, which could
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 219

Figure 9–5. Predicted Levels of Mental Health Problems by Months 

in Operation Iraqi Freedom Theater

35

30

25

20

15

10

5

0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Percent Scoring Positive

Any Mental Health Problem

Months in Theater

be labeled as redeployment optimism. However, even with redeployment optimism, by the end of a 15-month deployment, levels did not return to those seen at 1 month. Further redeployment research strongly 

suggests that rates for Soldiers reporting mental health problems will 

rise when Soldiers return home (Bliese et al., 2007).

■ Deployment length and suicidal ideation. The MHAT V survey 

asked Soldiers, “Over the last four weeks, how often have you 

been bothered by thoughts that you would be better off dead 

or hurting yourself in some way?” Junior enlisted Soldiers 

were twice as likely to endorse this question during the middeployment window. As seen with the relationship between 

deployment length and behavioral health status, this mid-deployment peak decreases as redeployment nears. 

■ Deployment length, stress, and work performance. Rates for 

Soldiers reporting that stress or emotional problems had limited their ability to do their jobs, caused them to work less 

carefully than usual, and caused their supervisors to be concerned about their performance generally showed a linear increase as deployment time lengthened. The only variable to 

show a quadratic trend was working “less carefully,” which 

leveled off and slightly declined after month 12. As with mental health problems, the cumulative effect of months deployed 
220 THE 71F ADVANTAGE

has a pronounced impact on reports of work performance by 

month 15.

■ Deployment length and divorce intent. Rates for Soldiers reporting that they plan on getting a divorce or separation increased significantly as a function of deployment length (see 

figure 9–6). Note that there are substantial rank differences for 

this measure. Although junior enlisted Soldiers are the most 

likely to endorse this question at all time points, the slopes 

for junior enlisted Soldiers and NCOs are significantly steeper 

than for officers. 

Figure 9–6. Predicted Divorce Intent for Officers, Noncommissioned Officers, and Junior Enlisted by Months in 

Operation Iraqi Freedom Theater

35

30

25

20

15

10

5

0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Percent Planning Divorce or Separation

E1–E4 NCO Officer 

Months of Deployment

■ Deployment length and substance abuse. Deployment length 

was a significant predictor of Soldiers’ reports of inhalant 

and alcohol use. Reported use of both alcohol and inhalants 

showed significant quadratic effects: reported alcohol abuse 

tapered off after month 11, and reported use of inhalants 

peaked between 8 and 9 months. 

■ Deployment length and unethical behaviors. Deployment length 

was also significantly related to the probability that a Soldier would report having engaged in the unethical behaviors 
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 221

of insulting/cursing at noncombatants, damaging property 

unnecessarily, or hitting or kicking a noncombatant. The form 

of the relationship for all three of these variables was a rise 

in the first 10 months of a deployment, followed by a decline 

after month 9.

Multiple deployments. Both the MHAT III report in 2005 and the 

MHAT IV report in 2006 identified multiple deployments as a risk factor for mental health problems. In previous years, analyses have examined the effects of multiple deployments by comparing first-time deployers with those who had deployed at least once before. In both 2005 

and 2006, however, the multiple deployment group was almost entirely 

comprised of Soldiers on their second deployment. By contrast, the 

2007 sample contains a sufficiently large number of individuals on their 

third or fourth deployment, making it possible to create three deployment groups: first-time deployers (n = 1,496), second-time deployers 

(n = 538), and third-/fourth-time deployers (n = 129), with 32 Soldiers 

not reporting number of deployments. 

In presenting the findings related to multiple deployments, results are provided for NCOs rather than for junior enlisted because Soldiers in the multiple deployer group are predominantly NCOs. Specifically, in the first-time deployer group, NCOs constitute 19 percent of the 

sample, whereas they constitute 60.8 percent of the second-time deployer sample and 74.4 percent of the third-/fourth-time deployer sample. 

■ Multiple deployments and morale. Figure 9–7 shows adjusted 

rates of morale for male NCOs deployed for 9 months. NCOs 

on their second or third/fourth deployments have significantly lower morale than NCOs on their first deployment (for 

third-/fourth-time deployers compared to first-time deployers 

for unit morale, p < .10). In the figure, the difference between 

those on a second deployment and those on their third/fourth 

for individual and unit morale is not statistically significant.

■ Multiple deployments and behavioral health status. Both the 

MHAT III and MHAT IV reports found that the behavioral 

health status of Soldiers on their second deployment was significantly lower than on their first. This finding was replicated 

in the 2007 sample and was able to be extended to Soldiers on
222 THE 71F ADVANTAGE

Figure 9–7. Operation Iraqi Freedom Noncommissioned Officer 

Brigade Combat Team Soldiers Reporting High Morale 

(adjusted percent)

35

30

25

20

15

10

5

0

Percent Reporting High or Very High Morale

■ First Deployment ■ Second Deployment ■ Third/Fourth Deployment

Individual Morale Unit Morale

26.7

20.2

14.7

11.0

6.4 5.9

their third or fourth deployment. The form of the relationship 

is illustrated in figure 9–8 for the combined behavioral health 

measure of being positive for depression, anxiety, and/or acute 

stress. An NCO on his second or third/fourth deployment reported significantly more mental health problems than did an 

NCO on his first deployment. Furthermore, the value for NCOs 

on their third/fourth deployment (unadjusted percent of 29.2 

percent) was significantly different from NCOs on their second 

deployment (unadjusted percent of 19.0 percent).

■ Multiple deployments, stress, and work performance. Three 

different statistical models were run to examine whether 

there was a multiple deployment effect if NCOs reported 

stress or emotional problems while deployed. Results indicated that Soldiers in their third/fourth deployment were 

significantly more likely than first-time deployers to report 

that stress or emotional problems in the last 4 weeks limited 

their ability to do their job (16.6 percent versus 9.7 percent) 

and caused their supervisor to be concerned (14.1 percent 

versus 7.9 percent). Soldiers on their second deployment did 

not differ from either first-time deployers or third-/fourthtime deployers. 
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 223

Figure 9–8. Operation Iraqi Freedom Noncommissioned Officer 

Brigade Combat Team Soldiers with Mental Health 

Problem (unadjusted percent)

35

30

25

20

15

10

5

0

Percent Scoring Positive

■ First Deployment ■ Second Deployment ■ Third/Fourth Deployment

Any Mental Health Problem

12.7

19.0

29.2

Several measures were not found to be associated with multiple 

deployments. NCOs’ reports of suicidal ideation, divorce or separation

intent, unethical behaviors, or use of inhalants or illegal drugs/substances 

were not found to be related to the number of deployments.

Sleep deprivation. Sleep deprivation is a risk factor for behavioral health 

and performance problems. Importantly from a prevention perspective, 

sleep problems and sleep deprivation represent risk factors that may be 

manageable with good leadership. In 2007, the MHAT V survey included 

a number of questions about Soldiers’ sleep patterns while deployed. 

Soldiers in OIF reported needing 6.4 hours of sleep per day to feel 

well rested, while they reported receiving 5.6 hours. Both of these values 

are less than the 8 hours a night shown to be necessary to maintain optimal cognitive functioning (Belenky et al., 2003). The difference between 

what Soldiers report needing and what they report receiving represents 

a sleep deprivation value of 0.8 hours per day. There was, however, considerable variability across individuals. In all, 44.6 percent of the Soldiers reported no sleep deprivation, 52.1 percent reported some degree 

of sleep deprivation, and 3.2 percent had missing data. 

■ Sleep and behavioral health. Soldiers who reported that they 

were sleep deprived screened positive for a mental health 

problem significantly more often than those who did not 
224 THE 71F ADVANTAGE

report being sleep deprived. Only 11.7 percent of junior enlisted male Soldiers in theater 9 months who reported no sleep 

deprivation were positive for depression, anxiety, or acute 

stress. In contrast, 23.1 percent of the Soldiers who reported 

2 hours of sleep deprivation screened positive for any mental 

health problem. 

■ Sleep and work performance. Sleep deprivation has a known negative link to performance. Even relatively small amounts of sleep 

deprivation can result in a cumulative performance decline over 

time (Belenky et al., 2003; Bliese et al., 2006; Van Dongen et al., 

2003). In MHAT V, the relationship between sleep loss and work 

performance was examined. Analyses revealed that even 1 hour 

of reported sleep deprivation was significantly associated with 

increased work-related problems and accidents.

Summary of risk factors. Compared to 2006, the intensity of combat in 

OIF appears to have declined significantly, with the drop particularly 

evident among those who have been in theater for only a few months. 

As a whole, however, the Soldiers deployed to OIF in 2006 through 2008 

have clearly witnessed a high degree of intense combat events while deployed. In particular, a high percent of the sample reported knowing 

someone seriously injured or killed. As with combat experiences, on a 

normalized basis, many deployment concerns are lower than in 2006. 

On an unadjusted basis, concerns about deployment length and being 

separated from family are high among the 2007 OIF sample.

The MHAT V OIF sample allowed for a detailed analysis of the 

relationship between deployment length and a variety of mental health 

outcomes. In some cases, such as with reports of getting a divorce or 

separation or of stress and emotional problems impacting work, the relationship was linear. In these cases, as deployment months increased 

so did the probability that a Soldier would screen positive on the outcome measure. In a number of other cases, such as with morale and reports of any mental health problems, the relationship was curvilinear 

so that toward the end of the deployment, the probability of problems 

decreased. Even with the curvilinear patterns, however, a much higher 

percent of Soldiers reported problems at the end of the deployment than 

at the beginning.

One of the most dramatic findings centered on the effects of multiple deployments. As a group, those Soldiers who were on their second 
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 225

or third/fourth deployment were at increased risk for low morale, 

mental health problems, and degraded performance due to stress or 

emotional problems.

Soldier Protective Factors

In the conceptual model used to guide the MHAT reports, protective factors represent the area most amenable to intervention. This 

section examines unit social climate (leadership, readiness, and cohesion), willingness to seek behavioral health care, reducing barriers to 

care, family and marital support, willingness to report ethical violations, 

and training as protective factors.

Leadership, readiness, and cohesion. Social factors within platoons 

and companies play a critical role in how well unit members respond 

to combat experiences. In the current report, we examine the combined 

variables of cohesion, readiness, and perceptions of NCO and officer 

leadership. These variables were measured on five-point scales, with 3 

being a generally neutral response. To facilitate the presentation of results in the tables, the combined climate measure was considered positive if the mean score was above 3. There was a significant increase of 

5.6 percentage points between 2006 (54.5 percent) and 2007 (60.1 percent) in ratings of positive climate for junior enlisted male Soldiers in 

theater for 9 months. 

Figure 9–9 illustrates the importance of social climate as a protective factor in terms of Soldiers’ responses to the risk factor of combat exposure. Soldiers who rate social climate positively have lower levels of acute 

stress than those who rate the social climate negatively across all levels of 

combat exposure. Just as importantly, however, figure 9–9 also shows that 

there is less of an increase (flatter slope) for combat exposure on acute 

stress for those who rate the social climate positively. This is a typical 

buffering effect in the social science literature (Cohen and Wills, 1985).

Behavioral health care seeking. A Soldier’s willingness to seek behavioral health care may also serve as a protective factor. A key impediment to seeking care involves overcoming the associated stigma. A major challenge to providing mental health care is the fact that sensitivity 

to stigma appears strongest among individuals who screen positive for 

mental health problems (Hoge et al., 2004). Therefore, when looking at 

stigma rates across years, it is informative to examine those individuals. 

Table 9–1 provides the adjusted percents for Soldiers who 

also screen positive for depression, anxiety, or acute stress. As the table
226 THE 71F ADVANTAGE

Figure 9–9. Predicted Acute Stress Scores for Operation Iraqi 

Freedom Soldiers

57

52

47

42

37

32

27

22

17

Acute Stress Score

Low Combat Exposure High Combat Exposure

Negative Social Climate Positive Social Climate 

Table 9–1. Reported Stigma-related Rates for Operation Iraqi Freedom

Soldiers Who Screen Positive for Mental Health Problem 

(adjusted percent)

Factors that Affect Your 

Decision to Receive 

Mental Health Services

Agree or Strongly Agree

MHAT IV 2006 MHAT V 2007

p-value

It would be too 

embarrassing 36.6 32.0 0.04

It would harm my career 33.9 29.1 0.02

Members of my unit might 

have less confidence in me 51.1 44.8 0.00

My unit membership might 

treat me differently 57.8 52.1 0.00

My leaders would blame me 

for the problem 43.0 38.5 NS

I would be seen as weak 53.2 49.8 NS
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 227

Table 9–2. Reported Barriers to Care for Operation Iraqi Freedom

Soldiers who Screen Positive for Mental Health Problem 

(adjusted percent)

Factors that Affect Your 

Decision to Receive 

Mental Health Services

 Agree or Strongly Agree

MHAT IV 2006 MHAT V 2007 p-value

Mental health services 

aren’t available 6.8 9.6 0.053

I don’t know where to 

get help 13.3 13.4 0.920

It is difficult to get an 

appointment 13.6 20.3 0.002

There would be difficulty 

getting time off work for 

treatment

41.0 40.6 0.845

It’s too difficult to get to the 

location where the mental 

health specialist is

8.7 17.9 0.000

My leaders discourage the 

use of mental health services 14.6 21.2 0.006

indicates, rates of stigma for four of the six items were significantly lower 

in 2007 than in 2006. This is a positive finding and may reflect an increased emphasis by leadership to destigmatize seeking treatment.

Reducing barriers to care. Perceived barriers to care also vary depending on whether a Soldier screens positive. As with stigma issues, Soldiers 

who screen positive for a mental health problem typically report higher 

barriers to care. Table 9–2 presents perceived barriers to care and indicates that a number of them increased from 2006 to 2007. 

The increases in perceived barriers to care almost certainly reflect 

changes in the distribution of Soldiers on the battlefield in Iraq. As a result of surge operations, more Soldiers were located on outposts in 2007 

than in 2006. Survey findings indicated that those on outposts reported 

higher barriers to care. For instance, while 17.9 percent of all Soldiers in 

table 9–2 reported difficulty getting to mental health specialists, the value 

increased to 29.3 percent for those who reported being on outposts versus 12.9 percent for those who were not.

Marital functioning and rear detachment support. The Well-being 

Survey assessed Soldiers’ perceptions of the quality of their marital 
228 THE 71F ADVANTAGE

relationships and their satisfaction with family support. Analyses revealed that there were no significant changes from 2006 to 2007. In general, a majority of respondents indicated that they have a good marriage 

and a positive relationship with their spouse. However, an even larger 

majority indicated that they were not satisfied with the rear detachment 

support for their family. 

Reporting ethical violations. Soldiers’ willingness to report unit members for unethical behaviors almost certainly runs counter to the strong 

sense of bonding that occurs among unit members during deployment. 

However, the degree to which Soldiers believe their unethical behaviors 

will be reported by other unit members may serve as a powerful deterrent. Therefore, given that unit morale is significantly higher in 2007, it 

is not surprising that Soldiers continue to be reluctant to report ethical 

violations by other unit members. Table 9–3 provides adjusted responses

Table 9–3. Reported Rates of Ethical Violations for Operation Iraqi 

Freedom Soldiers (adjusted percent)

Reporting Ethical 

Violations

Agree or Strongly Agree

MHAT IV 2006 MHAT V 2007 p-value

I would report a unit member for the mistreatment 

of a noncombatant

37.1 34.3 0.11

I would report a unit member for injuring or killing an 

innocent noncombatant

45.5 41.2 0.02

I would report a unit member for unnecessarily 

destroying private property

32.8 30.7 0.22

I would report a unit 

member for stealing from 

a noncombatant

38.9 34.8 0.02

I would report a unit 

member for violating the 

Rules of Engagement

37.1 35.9 0.52

I would report a unit 

member for not following 

General Orders

36.9 35.5 0.43
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 229

from both 2006 and 2007. Response rates to four of the six items remained statistically unchanged from 2006 to 2007. However, in 2007 

Soldiers indicated less willingness to report a unit member for injuring 

or killing an innocent noncombatant and stealing from a noncombatant.

Training adequacy for deployment stress and suicide. Soldiers were asked 

whether the training they received for deployment stressors and suicide 

was adequate. From 2006 to 2007, there were significant increases in perceptions of training adequacy for three of the four items (see table 9–4). 

The only item that did not change significantly addressed Soldiers’ confidence about helping fellow Servicemembers get mental health assistance. 

Battlemind training and training adequacy. One of the initiatives recommended in MHAT IV was to implement Battlemind training (Castro, 

2004, 2005; Castro, Hoge, and Cox, 2006). Battlemind is a mental health 

resiliency–building training system with different modules for pre- and 

post-deployment. Several modules have been shown to reduce deployment-related behavioral health problems in large-scale group randomized 

trials (for example, Adler, Bliese, Hoge, McGurk, and Castro, in press). 

In the 2007 OIF sample, a number of deploying units reported 

that they received predeployment Battlemind training. Those Soldiers

Table 9–4. Adequacy of Suicide and Stress Training for Operation Iraqi 

Freedom Soldiers (adjusted percent)

Adequacy of Suicide 

and Stress Training

Agree or Strongly Agree

MHAT IV 2006 MHAT V 2007 p-value

I am confident in my ability 

to help Servicemembers get 

mental health assistance

54.6 56.5 0.34

The training in managing 

the stress of deployment 

and/or combat was 

adequate

40.0 45.4 0.00

I am confident in my ability 

to identify Servicemembers 

at risk for suicide

50.9 54.8 0.04

The training for identifying 

Servicemembers at risk for 

suicide was sufficient

47.6 55.3 0.00
230 THE 71F ADVANTAGE

who reported that they had received the training were significantly 

more likely to agree that the training in managing the stress of deployment was adequate (p < .01), and the training to identify Servicemembers at risk for suicide was sufficient (p < .01).

Predeployment Battlemind training efficacy. Soldiers who reported 

that they had attended predeployment Battlemind training were significantly less likely to screen positive for a mental health problem (12 percent adjusted) than those who did not attend (20.5 percent adjusted). 

While these results are impressive, it should be noted that certain units 

implemented predeployment Battlemind training in conjunction with 

a number of other best practice behavioral health interventions. Therefore, the differences cannot be attributed solely to predeployment Battlemind training and may represent an increased emphasis on overall 

behavioral health training in certain units.

Ethics training. Soldiers were asked whether they recalled having ethics 

training and whether the training was adequate. In MHAT IV (2006), 80 

percent of Soldiers reported that they had received ethics training; this 

was similar to the percent reported in the 2007 MHAT V (81 percent). 

Adequacy was evaluated both by directly asking if it was adequate, and 

also by asking if the Soldier had encountered situations that were ethically difficult despite the training, such as following the rules of engagement. In 2007, there was a significant increase (p < .05) in the percent of 

Soldiers who reported that “the training they had received in the proper 

(ethical) treatment of noncombatants was adequate.” In 2006, 77 percent of respondents reported the training was adequate, whereas in 2007 

the figure was 80 percent.

Summary of protective factors. Relative to the 2006 MHAT, the 2007 

sample as a whole had significantly better perceptions of leadership, cohesion, and readiness as indexed by a unit climate variable. Second, although the sample from 2007 had significantly lower worries about stigma 

in seeking care, Soldiers who were symptomatic for mental health problems were somewhat less able to perceive being able to obtain care in 

2007 than in 2006. Finally, Soldiers reported being better trained for 

the stresses of combat and part of their preparation may be attributed 

to receiving Battlemind training. Other factors, such as marital support, remained unchanged from 2006. Finally, in terms of ethical training, more Soldiers reported that ethical training was adequate, yet fewer 

Soldiers reported that they would report their unit member for the 
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 231

unethical behavior of stealing from a noncombatant or injuring or killing an innocent noncombatant.

MHAT V Operation Enduring Freedom Findings

Data Collection Procedures and Demographics

The OEF 2007 MHAT assessment of Soldiers focused on companies from brigade combat teams (BCTs) and supporting task forces located primarily in the Regional Command East section of Afghanistan, 

the zone that is under U.S. command and has the highest density of 

American ground forces. In this section of the chapter, Soldier responses 

to the OEF 2007 survey (n = 699) are compared to responses to the OEF 

2005 survey (n = 610) and the OIF 2007 survey (n = 2,195). Comparisons 

across the sampled populations were evaluated using both adjusted and 

unadjusted percents. Adjusted values are typically provided for junior enlisted males in theater for 9 months. Key demographic variables across 

the three sample populations can be found in the full report, available 

at <www.armymedicine.army.mil/reports/mhat/mhat_v/mhat-v.cfm>. 

Soldier Behavioral Health and Performance

In general, health and performance indices for OEF 2007 are examined relative to data from OEF 2005 as well as OIF 2007. However, 

in OEF 2007, surveys were completed by BCT and supporting task 

force Soldiers, whereas in OIF 2007 only BCT Soldiers completed surveys. There are differences between BCT Soldiers and supporting task 

force Soldiers, both demographically and in the missions they complete. Therefore, additional analyses were conducted in some cases 

comparing data from BCT Soldiers in OEF 2007 with BCT Soldiers in 

OIF 2007.

Morale: individual and unit. Soldiers’ ratings of individual morale were 

significantly lower in OEF 2007 than OEF 2005 but similar to ratings in 

OIF 2007. However, ratings of unit morale did not differ significantly 

for the three samples. The percentages of Soldiers reporting high or very 

high individual and unit morale are presented in figure 9–10. When 

these percentages are adjusted to control for gender, rank, and months 

in theater, unit morale in OEF 2007 (9 percent) was significantly lower 

(p < .05) than unit morale in OIF 2007 (11.9 percent).

Acute stress, depression, and anxiety. Rates for depression, anxiety, and 

acute stress either singly or in combination were significantly higher in
232 THE 71F ADVANTAGE

Figure 9–10. Individual and Unit Morale Rates for Operations 

Enduring Freedom and Iraqi Freedom Soldiers

35

30

25

20

15

10

5

0

Percent Reporting High or Very High Morale

■ OEF 2005

■ OIF 2007

■ OEF 2007

Individual Morale Unit Morale

27.8

20.6 21.7

10.8 11.2 10.0

OEF 2007 (p < .001) than those reported in OEF 2005. There was a tendency for Soldiers in OEF 2007 to report higher depression and anxiety 

values than Soldiers in OIF 2007; however, using a conventional criterion 

of p < .05, these differences were not statistically significant. If these percentages are adjusted to control for gender, rank, and months in theater, 

then rates on all scales for OEF 2007 remain significantly greater than 

OEF 2005, and additionally the rate of depression in OEF 2007 was significantly higher than OIF 2007 (11.4 percent versus 7.6 percent; p < .01). 

As previously stated, in OEF 2007, surveys were completed by 

Soldiers supporting task forces as well as BCTs. However, in OIF 2007, 

surveys were completed by Soldiers in BCTs only. Therefore, additional 

analyses were run to compare OEF 2007 BCT Soldiers with OIF 2007 

BCT Soldiers. The unadjusted analyses are presented in figure 9–11. 

A significantly higher percentage of OEF 2007 BCT Soldiers screened 

positive for depression compared to OIF 2007 Soldiers using both unadjusted (p < .01) and adjusted (p < .001) rates. Although unadjusted rates 

for anxiety and any mental health problem in OEF 2007 BCT Soldiers 

tended to be higher than OIF 2007 BCT Soldiers, these differences were 

not statistically significant. However, when adjusted, the OEF 2007 BCT 

Soldiers were more likely to screen positive for depression (p < .001), 

anxiety (p < .01), and any mental health problem (p < .05). 

Stress and work performance. Just over 14 percent of OEF 2007 Soldiers 

reported that stress or an emotional problem limited their ability to do
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 233

Figure 9–11. Mental Health Rates for Operations Enduring Freedom 

and Iraqi Freedom Brigade Combat Team Soldiers 

(unadjusted percent)

35

30

25

20

15

10

5

0

Percent Scoring Positive

■ OIF 2007 ■ OEF 2007

Depression Anxiety Acute Stress Any Problem

6.9

11.0

7.3

9.6

15.2 15.3

17.9

20.2

their job; 21.0 percent of OEF Soldiers reported that stress or an 

emotional problem had caused them to work less carefully; and 10.3 

percent reported their supervisor was concerned. No significant 

differences were found among the three samples on these measures of 

stress and work performance. 

Suicidal ideation. A significantly higher percentage of OEF 2007 Soldiers (p < .001) indicated suicidal ideation compared to OEF 2005 (15 

percent versus 8 percent), whereas suicidal ideation was similar for both 

OEF 2007 and OIF 2007 (15 percent versus 13 percent, respectively). 

When comparing these populations using adjusted values, the same 

pattern of significance was found. Furthermore, while 87 percent of 

OEF 2007 Soldiers reported receiving suicide prevention training, only 

51 percent reported the training to be sufficient, indicating the need to 

ensure that Soldiers receive suicide prevention training that is applicable 

to a combat environment.

Divorce intent. Significantly more Soldiers were planning to get divorced (p < .01) in OEF 2007 (19 percent) compared with OEF 2005 (13 

percent). Soldiers’ reports of their intent to divorce did not differ significantly when comparing OEF 2007 and OIF 2007 (19 percent). This pattern was the same using adjusted values. 

Alcohol and substance abuse. The reported use of alcohol in OEF 2007 

was significantly lower compared to OEF 2005 (7 percent versus 12 
234 THE 71F ADVANTAGE

percent; p < .01). However, significant differences were not found when 

the values were adjusted for gender, rank, and time in theater. Reported alcohol usage in OIF 2007 (8 percent) was the same as in OEF 2007. 

Reported use of illegal drugs or substances was significantly 

higher (p < .05) in OEF 2007 (2.6 percent) than OIF 2007 (1.4 percent). 

These statistical differences were also found when adjusting for gender, 

rank, and time in theater. Rates of illegal drug use were similar in OEF 

2007 (2.6 percent) and OEF 2005 (2.3 percent) using both adjusted and 

unadjusted values.

Unethical behaviors. As outlined in the OIF section of this chapter, the 

2007 MHAT survey included questions pertaining to ethical behaviors. 

These items were not included in the OEF 2005 survey; therefore, comparisons for OEF 2007 are only presented relative to OIF 2007. Approximately 10 percent of OEF 2007 Soldiers reported unnecessarily damaging or destroying property, while almost 4 percent reported that they 

hit or kicked noncombatants when it was not necessary. Using the conventional p-value of p < .05, the analyses reveal that for most questions, 

responses did not differ between the two theaters. The only significant 

difference (p < .001) was found for the item, “Insulted and/or cursed 

noncombatants in their presence,” in which 36.6 percent of OEF 2007 

Soldiers reported compared to 29.6 percent in OIF 2007. This relationship was also significant for adjusted values (p < .001).

As previously reported (MHAT IV and MHAT V OIF), Soldiers 

who screened positive for mental health problems of depression, anxiety, or acute stress were significantly more likely to report engaging in 

unethical behaviors. This relationship was also found in OEF 2007. Specifically, Soldiers who screened positive for any mental health problem 

were more than twice as likely to report engaging in unethical behaviors 

as those who did not. This included insulting or cursing at noncombatants (60.7 percent versus 31.7 percent), unnecessarily damaging or destroying private property (22.2 percent versus 7.2 percent), and hitting 

or kicking noncombatants (11.1 percent versus 2.5 percent).

This pattern was also found when evaluating reports of unethical 

behavior as a function of high anger levels. Reports of unethical behavior 

were significantly higher for Soldiers who had high rather than low levels of anger. This included insulting or cursing at noncombatants (53.4 

percent versus 21.5 percent), unnecessarily damaging or destroying 

private property (15.1 percent versus 5.0 percent), and hitting or kicking 

a noncombatant (7.1 percent versus 1.1 percent). Anger therefore may 
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 235

serve as an additional key factor for an increased propensity to engage 

in unethical or inappropriate behaviors.

Summary of behavioral health and performance indices in OEF. Overall, Soldiers’ behavioral health status in OEF 2007 was significantly lower 

than in OEF 2005. Ratings of individual morale in OEF 2007 were substantially lower than in OEF 2005. Considerably more OEF 2007 Soldiers reported planning to get a divorce compared to OEF 2005 Soldiers. 

Further, ratings of depression, generalized anxiety, and acute stress were 

significantly higher in OEF 2007 than OEF 2005. 

Ratings of individual and unit morale and behavioral health were 

similar for OEF 2007 and OIF 2007. Other comparisons revealed that 

Soldiers in OEF 2007 BCTs reported significantly more overall mental 

health problems than OIF 2007 Soldiers in BCTs when using adjusted 

values. Self-reports of drug use were also higher in OEF 2007 than in OIF 

2007, and more OEF Soldiers reported insulting or cursing at noncombatants. As with OIF 2007, there was also a significant relationship between 

reported unethical treatment of noncombatants and screening positive 

for a mental health problem, as well as high levels of anger in OEF 2007.

Soldier Risk Factors

This section examines behavioral health indices in relation to risk 

factors while deployed to OEF.

Combat experiences. Given the importance of combat experiences in 

terms of behavioral health, a detailed examination of differences between OEF 2007 compared to OEF 2005 and OIF 2007 follows.

■ Combat experiences for OEF 2007 compared to OEF 2005. The 

average months in theater for OEF 2007 were 7.66 compared 

to 9.56 in OEF 2005 and 9.40 for OIF 2007. Comparisons using adjusted values based on a junior enlisted Soldier deployed 

for 9 months are presented here. 

Comparison across years (see table 9–5) indicates significantly 

higher combat intensity in OEF 2007 compared to OEF 2005. 

However, some combat experiences have declined. The pattern of combat experiences reported by Soldiers reflects the 

changing nature of the war from operations in 2005 to counterinsurgency in 2007. Overall, there is evidence that Soldiers 

exposure to potentially traumatic combat experiences has 

increased in OEF.
236 THE 71F ADVANTAGE

Table 9–5. Combat Experiences in Operation Enduring Freedom 2005 and 

2007

Combat Experiences Percent (adjusted)

OEF 2005 OEF 2007 p-value

Significantly Higher

Being attacked or ambushed 49.6 61.6 0.00

Seeing dead bodies or human remains 50.7 59.2 0.01

Seeing dead or seriously injured 

Americans 44.7 55.2 0.00

Knowing someone who was seriously 

injured or killed 65.9 73.7 0.01

Being in a threatening situation where 

you were unable to respond because of 

the rules of engagement

34.6 44.2 0.00

Being wounded/injured 5.5 13.7 0.00

Receiving incoming artillery, rocket, or 

mortar fire 71.3 81.5 0.00

Being directly responsible for the death 

of an enemy combatant 13.3 21.0 0.01

Had a close call: was shot or hit but 

protective gear saved you 3.0 8.0 0.01

Significantly Lower

Seeing destroyed homes and villages 63.3 50.1 0.00

Working in areas that were mined or 

had improvised explosive devices 72.6 64.3 0.00

Disarming civilians 42.7 28.7 0.00

Clearing/searching homes or buildings 53.1 32.3 0.00

Clearing/searching caves or bunkers 45.3 31.2 0.00

Seeing ill/wounded women and children 

whom you were unable to help 46.9 33.3 0.00
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 237

■ Combat experiences for OEF 2007 BCT Soldiers compared to OIF 

2007. Although both samples reported high combat exposure, OEF 2007 BCT Soldiers reported more combat exposure 

than OIF 2007 Soldiers across many of the combat experience 

items (see table 9–6). These findings are quite striking, showing that the 2007 reported levels of combat exposure in OEF 

BCTs (the units most involved in direct combat) were significantly higher on 24 indicators than in OIF BCTs.

■ Combat experiences and acute stress. The relationship between 

combat experiences and acute stress in OEF 2007 was examined. Soldiers were divided into low, medium, and high combat 

experience groups based on the number of combat events they 

reported experiencing during the deployment. Soldiers with 

high levels of combat exposure were significantly more likely 

to screen positive for acute stress or any mental health problem.

Deployment concerns. OEF 2007 Soldiers indicated a higher level of 

concern with the chronic, less traumatic aspects of being on a combat 

deployment compared to OEF 2005 Soldiers. When compared to OIF

2007 Soldiers, OEF 2007 Soldiers reported similar levels of chronic deployment concerns. 

Effect of multiple deployments. As discussed in the OIF section, multiple deployments are a risk factor for behavioral health problems. Also, 

results are presented for NCOs rather than for junior enlisted because 

Soldiers in the multiple deployer group are predominantly NCOs. For 

NCOs in OEF 2007, 9.8 percent of first-time deployers screened positive for any mental health problem, whereas 14.2 percent of NCOs who 

had previously deployed screened positive. This difference was significant (one tailed, p < .05). This is consistent with the findings from 

other MHATs. 

Sleep deprivation. Overall, 31 percent of OEF 2007 Soldiers reported 

high or very high concern that they were not getting enough sleep. 

Nearly one-quarter of OEF 2007 Soldiers reported falling asleep during 

convoys. Additionally, 16 percent of OEF 2007 Soldiers reported taking mental health medications, approximately half of which were sleep 

medications. The relationship between sleep and performance was assessed by examining Soldiers’ responses to the item, “During this deployment, have you had an accident or made a mistake that affected the
238 THE 71F ADVANTAGE

Table 9–6. Combat Experiences for Brigade Combat Team Soldiers in 

Operations Enduring Freedom and Iraqi Freedom

Combat Experience Percent (adjusted)

OIF 2007 OEF 2007 BCTs p-value

Being attacked or ambushed 52.5 75.1 0.00

Receiving small arms fire 59.7 70.3 0.00

Seeing dead bodies or human 

remains 60.8 74.4 0.00

Handling or uncovering human 

remains 29.7 44.8 0.00

Witnessing an accident that 

results in serious injury or death 37.0 47.7 0.00

Witnessing violence within the 

local population or between 

ethnic groups

37.8 46.2 0.01

Seeing dead or seriously injured 

Americans 46.3 63.7 0.00

Knowing someone who was 

seriously injured or killed 72.3 87.4 0.00

Participating in demining 

operations 22.2 37.8 0.00

Having hostile reactions from 

civilians 45.6 58.8 0.00

Being in a threatening situation 

where you were unable to 

respond because of the rules of 

engagement

41.8 54.3 0.00

Shooting or directing fire at the 

enemy

38.5 62.7 0.00

Calling in fire on the enemy 11.9 31.0 0.00

Clearing/searching caves or 

bunkers 16.4 51.2 0.00

Being wounded/injured 11.9 24.4 0.00

Receiving incoming artillery, 

rocket, or mortar fire 80.7 91.6 0.00
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 239

Being directly responsible for the 

death of an enemy combatant 13.7 32.8 0.00

Observing abuse of the Law of 

War/Geneva Convention 6.2 11.2 0.01

Having a member of your unit 

become a casualty 54.5 76.5 0.00

Had a close call: dud landed 

near you

25.0 38.0 0.00

Had a close call: equipment shot 

off your body 4.6 15.2 0.00

Had a close call: was shot or hit 

but protective gear saved you 6.4 12.9 0.00

Had a buddy shot or hit who was 

near you

16.6 24.6 0.01

Informed unit members/friends 

of a Servicemember’s death 10.5 22.2 0.00

mission because of sleepiness?” with 6 percent of OEF 2007 Soldiers reporting in the affirmative. 

Summary of risk factors. The intensity of combat in OEF 2007 was significantly higher than in OEF 2005. As a whole, Soldiers deployed to 

OEF in 2007 witnessed a higher degree of intense combat and experienced more significant levels of combat activity. Additionally, the rates 

for OEF 2007 BCT Soldiers are significantly higher than those of OIF 

2007 BCT Soldiers on 24 of the 33 combat experience scale items.

There was also a significantly higher rate of noncombat, deployment-related concerns raised by Soldiers in OEF 2007 compared 

to OEF 2005. Interestingly, comparisons between OIF 2007 and OEF 

2007 indicate a high degree of similarity between the two theaters on 

noncombat deployment concerns. Finally, there was a significant relationship between mental health problems and multiple deployments in 

the current OEF sample. Consistent with other MHAT findings, NCOs 

who had deployed more than once were at increased risk for a mental 

health problem compared to those on their first deployment.

Soldier Protective Factors 

Leadership, readiness, and cohesion. As discussed in the OIF section, we 

examined social climate as the combined variables of cohesion, readiness, 
240 THE 71F ADVANTAGE

and perceptions of NCO and officer leadership. There was a decrease 

of 6 percentage points between OEF 2005 (64 percent) and OEF 2007 

(58 percent) in adjusted percentage reporting a positive social climate. 

While small in absolute terms, this value is statistically significant (p < 

.05). No significant differences were found between OEF 2007 (58 percent) and OIF 2007 (61 percent). As mentioned in the combat experiences section of this report, exposure to high levels of combat significantly increases the risk of reporting a mental health problem. Previous MHATs have found that good NCO leadership can, to some extent, 

limit the degree to which Soldiers screen positive for any mental health 

problem (see MHAT IV report at <www.armymedicine.army.mil/ 

reports/mhat/mhat_iv/mhat-iv.cfm>).

Behavioral health care seeking. Soldier ratings of stigma related to 

seeking mental health care were not statistically different from ratings 

of OEF 2005 or OIF 2007. The fact that perceptions have not changed 

significantly from 2005 suggests that more attention should be given 

to outreach and education programs that emphasize reducing stigma. 

Some 35 percent of OEF 2007 Soldiers reported that seeking mental 

health care would be too embarrassing, 31 percent believe it would harm 

their career, 45 percent felt that members of their unit might have less 

confidence in them, 56 percent reported that unit members might treat 

them differently, 44 percent worried that leaders might blame them for 

the problem, and 57 percent worried about being seen as weak.

Reducing barriers to behavioral health care. When comparing barriers 

across years and theaters, a number of perceived barriers are higher in 

the OEF 2007 sample compared to both OEF 2005 and OIF 2007.Table 

9–7 provides the results using adjusted values. As the table indicates, perceived barriers to care have mostly increased since 2005 and, in general, 

are higher in the present OEF theater than in OIF. The OEF theater has 

considerable transportation challenges that may contribute significantly 

to some of these findings. This limits the ability of behavioral health personnel to get to outlying posts as well as the ability of Soldiers to get back 

to behavioral health personnel at the larger forward operating bases.

Marital satisfaction. Overall reports of marital satisfaction were significantly lower in OEF 2007 than they were in OEF 2005 (see table 9–8). 

Significantly fewer OEF 2007 Soldiers reported that they have “a good marriage,” that “my relationship with my spouse makes me happy,” and that 

“I really feel like a part of a team with my spouse” compared to Soldiers
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 241

Table 9–7. Reported Barriers to Behavioral Health Care for Operations 

Enduring Freedom and Iraqi Freedom Soldiers who Screen 

Positive for Mental Health Problem (adjusted percent)

Factors that Affect Your 

Decision to Receive Mental 

Health Services

Agree or Strongly Agree

OEF 2005 OIF 2007 OEF 2007

Mental health services aren’t 

available 21.4 11* 19.9

I don’t know where to get 

help 17.2 14.3 15.1

It is difficult to get an 

appointment 17.4* 21.3 26.8

There would be difficulty getting time off for treatment 43* 43.4* 56.3

It’s too difficult to get to 

the location where the 

mental health specialist is

24.2* 17.7* 32.7

My leaders discourage the 

use of mental health services 19.5* 21.8* 33.0

*Indicates statistically significant difference from OEF 2007 (p < .05).

in OEF 2005. On these same questions, rates for OEF 2007 Soldiers were 

similar to OIF 2007 Soldiers. 

Reporting ethical violations. In terms or reporting ethical violations, 

OEF 2007 Soldiers were not significantly different than OIF 2007 Soldiers. Not surprisingly, Soldiers are reluctant to report the ethical violations of unit members, and this reluctance is consistent across theaters. 

Unadjusted rates were consistent with adjusted values. These questions 

were not included in the OEF 2005 survey.

Training. Slightly fewer OEF 2007 Soldiers (87.5 percent) and OEF 2005 

(87.5 percent) Soldiers reported receiving suicide prevention training 

compared to OIF 2007 (93.3 percent). Similarly, fewer OEF 2007 Soldiers (80.7 percent) reported receiving training in managing the stress 

of deployment and/or combat prior to deployment compared to OIF 2007 

(86.8 percent). Slightly fewer OEF 2007 Soldiers (63.9 percent) reported receiving predeployment Battlemind training compared to OIF 2007
242 THE 71F ADVANTAGE

Table 9–8. Marital Satisfaction Ratings for Operations Enduring 

Freedom and Iraqi Freedom Soldiers (adjusted percent)

Marital and Family 

Support

Agree or Strongly Agree

OEF 2005 OIF 2007 OEF 2007

I have a good marriage 73.5 66.8 65.6

My relationship with my 

spouse is very stable 70.4 63.5 62.7

My relationship with my 

spouse makes me happy 75.8 69.2 67.7

I really feel like a part of 

a team with my spouse 73.3 63.9 63.6

(67.6 percent). These last two questions were not included in the OEF 

2005 survey. 

With respect to ethics training, significantly fewer Soldiers in 

OEF 2007 reported having received such training or that the training 

was adequate. Additionally, fewer Soldiers reported that the training 

made it clear how they should behave toward noncombatants.

Summary of protective factors. On most measures, reports of barriers 

to behavioral health care were higher in OEF 2007 compared to OEF 

2005 and OIF 2007. This may largely be due to transportation difficulties in Afghanistan. Additionally, fewer OEF 2007 Soldiers reported that 

the training preparing them for the stress of deployment, identifying 

Soldiers at risk for suicide, and ethically treating noncombatants was 

adequate compared to OIF 2007 Soldiers. 

Recommendations

Recommendations based on the findings from the OIF and OEF 

MHAT V data were included in the full report and also presented at 

senior leadership briefings. Some applied to both theaters, and others were theater specific. A complete list of recommendations appears 

in the full MHAT V report. The key recommendations pertaining to 

both theaters are summarized below: 

■ Increase in-theater behavioral health assets.

■ Develop a mechanism to allow Government or contracted 

psychiatrists, psychologists, and social workers to fill selected 
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 243

behavioral health positions in theater to augment military 

personnel.

■ Create and fill Behavioral Health Officer and NCO positions 

in aviation brigades.

■ Mandate that all combat medics receive Battlemind Warrior Resiliency (formerly Battlemind First Aid) Training before deploying to OEF or OIF to augment behavioral health personnel.

■ Change the Modified Table of Organization and Equipment 

to maximize the impact of organic behavioral health assets:

■ Move Division Psychiatrist position from Sustainment 

Brigade to Division Surgeon Cell

■ Move Brigade Behavioral Health Officer and NCO 

positions from Brigade Support Battalions to Brigade 

Surgeon cell.

■ Mitigate the effects of multiple deployment:

■ Provide Soldiers who have deployed multiple times priority for temporary duty assignments

■ Ensure adequate dwell time between deployments.

■ Adopt strategies to reduce suicide risk:

■ Amend TRICARE rules to cover marital and family 

counseling as a medical benefit

■ Tailor suicide prevention training packages to focus on 

phase of deployment and aim at building psychological 

resiliency.

■ Continue and enhance training:

■ Continue emphasis on Battlemind training for Soldiers 

and families

■ Enhance training for NCOs at the Warrior Leader 

Course, Basic Noncommissioned Officer Course, and 

Advanced Noncommissioned Officer Course on their 

role in maintaining Soldier resiliency through counseling and mentorship

■ Develop and implement senior leader Battlemind 

training 

■ Continue emphasis on ethics training.
244 THE 71F ADVANTAGE

Conclusion

This chapter has outlined the findings from the fifth Mental 

Health Advisory Team Report. The MHAT V report continued the 

practice of surveying the behavioral health and well-being of a deployed 

force. This report identified deployment length, combat exposure, and 

multiple deployments as major risk factors for mental health problems 

and found that reports of barriers to behavioral health care in theater 

had increased from previous years. This was the first MHAT to collectively evaluate and present findings from both the OEF and OIF theaters 

of operation. These findings indicated that combat experiences and 

mental health problem rates were higher in Afghanistan than in Iraq in 

2007. Finally, the findings from OIF, taken with findings from previous 

MHAT reports, embody a collection of 5 consecutive years of in-theater 

mental health data. This ongoing effort represents the first cumulative 

record of Soldier mental health over the course of a prolonged conflict. 

A sixth MHAT was to be conducted in both theaters in 2009, thus continuing to build on this invaluable repository of mental health data. 

References

Adler, A.B., Bliese, P.D., Hoge, C.W., McGurk, D., and Castro, C.A. (in press). Early interventions 

during reintegration with soldiers returning from Iraq: Randomization by platoon. Journal of Consulting and Clinical Psychology.

Belenky, G., Wesensten, N.J., Thorne, D.R., Thomas, M.L., Sing, H.C., Redmond, D.P., Russo, 

M.B., and Balkin, T.J. (2003). Patterns of performance degradation and restoration during sleep restriction and subsequent recovery: a sleep dose-response study. Journal of 

Sleep Research 12, 1–12.

Bliese, P.D. (2006).  Social climates: Drivers of soldier well-being and resilience.  In A.B. Adler, 

C.A. Castro, and T.W. Britt (eds.). Military life: The psychology of serving in peace and 

combat: Vol. 2.  Operational Stress (213–234).  Westport, CT:  Praeger Security International.

Bliese, P.D., and Castro, C.A. (2003). The soldier adaptation model (SAM): Applications to peacekeeping research. In T.W. Britt and A.B. Adler (eds.). The psychology of the peacekeeper. 

Westport, CT: Praeger Security International.

Bliese, P.D., Wesensten, N., and Balkin, T.J. (2006). Age and individual variability in performance 

during sleep restriction. Journal of Sleep Research 15, 376–385.

Bliese, P.D., Wright, K.M., Adler, A.B., Thomas, J.L., and Hoge, C.W. (2007). Timing of postcombat mental health assessments. Psychological Services 4, 141–148.

Castro, C.A. (2004). How to build Battlemind. NCO Journal, April, 23–24.

———. (2005). Building Battlemind. Countermeasures 26, 6–8.

Castro, C.A., Hoge, C.W., and Cox, A.L. (2006). Battlemind training: Building soldier resiliency. In 

Human Dimensions in Military Operations: Military Leaders’ Strategies for Addressing Stress 

and Psychological Support, 42–1 to 42–6. Proceedings of RTO-MP-HFM-134, Paper 42. 

Neuilly-sur-Seine, France: RTO. Retrieved from <www.rto.nato.int/abstracts.asp>.
U.S. ARMY MENTAL HEALTH ADVISORY TEAMS 245

Cohen, S., and Wills, T.A. (1985). Stress, social support, and the buffering effect. Psychological 

Bulletin 98, 310–357. 

Fontana, A., and Rosenheck, R. (1998). Psychological benefits and liabilities of traumatic exposure in the war zone. Journal of Traumatic Stress 3, 485–503.

Gilbert, D.T., Lieberman, M.D., Morewedge, C.K., and Wilson, T.D. (2004). The peculiar longevity of things not so bad. Psychological Science 15, 14–19.

Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D., and Koffman, R.L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New 

England Journal of Medicine 351, 13–22.

Hoge, C.W., Terhakopian A., Castro, C.A., Messer, S.C., and Engel, C.C. (2007). Association of 

posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq War veterans. American Journal of Psychiatry 164, 150–153.

Lacy, B.W., and Ditzler, T.F. (2007). Inhalant abuse in the military: An unrecognized threat. Military Medicine 172, 388–392.

Spitzer, R.I., Kroenke, K., and Williams, J.B. (1999). Validation and utility of a self-report version of PRIME–MD: The PHQ primary care study. Primary Care Evaluation of Mental 

Disorders. Patient Health Questionnaire. Journal of the American Medical Association

282, 1737–1744.

Van Dongen, H.P.A., Maislin, G., Mullington, J.M., and Dinges, D.F. (2003). The cumulative cost 

of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep 

physiology from chronic sleep restriction and total sleep deprivation. Sleep 26, 117–126.

Weathers, F.W., Litz, B., Herman, D., Juska, J., and Keane, T. (1993). The PTSD Checklist (PCL): 

Reliability, validity, and diagnostic utility. Poster session presented at the annual meeting 

of the International Society of Traumatic Stress Studies, October 1993, San Antonio, TX.

247

Chapter 10

Military Benefit Finding: Turning 

Adversity to Advantage

Michael D. Wood and Thomas W. Britt

The war environment is treacherous and burdens Soldiers with 

many unique stressors, including combat exposure, separation from 

friends and family, barriers in communicating with home, harsh living 

conditions, lack of privacy, environmental stressors, and an unpredictable combination of boredom, uncertainty, and threat (Bartone, Adler, 

and Vaitkus, 1998; Ritzer, Campbell, and Valentine, 1999). Despite 

these challenges, many Soldiers emerge from war reporting that they 

benefited from their experiences (Schok, Kleber, Elands, and Weerts, 

2007). This tendency to report benefits from traumatic or highly stressful events—including rape, car accidents, and life-threatening diseases 

—has also been reported in the civilian literature (Helgeson, Reynolds, 

and Tomich, 2006). By researching the benefits individuals derive from 

trauma, scientists have been able to take a salutogenic perspective in 

expanding treatment concepts to support human health and wellbeing, while addressing causative disease factors (Helgeson, Reynolds, 

and Tomich, 2006). 

In this chapter, we describe the concept of benefit finding (BF) or 

“post-traumatic growth” (PTG) (Tedeschi and Calhoun, 1996) and discuss how the concept has been applied to members of the military. Most 

of the current body of work on the antecedents and consequences of BF 

has been conducted using civilian samples; the little research that has 

been carried out in military settings is often based on the recollections 

of veterans who served in combat over 20 years ago. In this respect, the 

work conducted by psychologists at the Walter Reed Army Institute of 

Research (WRAIR) is unique; the research is based on BF that occurs 

during and closely following military operations. 

This chapter will review theoretical approaches to benefit finding, 

then address research on the benefits of trauma among military personnel. Finally, areas needing future research in order to better understand 

how the concept of benefit-finding can be used to enhance the health 

and well-being of military personnel are highlighted.
248 THE 71F ADVANTAGE

Theory and Research on Benefit Finding

The concepts of benefit finding, post-traumatic growth, and 

stress-related growth (SRG) have been considered by prior researchers 

for some time (see Taylor, 1983). However, Tedeschi and Calhoun (1996) 

and Park, Cohen, and Murch (1996) were some of the first researchers 

to systematically categorize and measure benefits resulting from exposure to stressful or traumatic events. These authors synthesized the concepts and developed subscales assessing New Possibilities, Relating to 

Others, Personal Strength, Spiritual Change, and Appreciation of Life. 

They found that individuals who rated their traumatic events as more 

stressful were more likely to report PTG than those who rated the events 

as less stressful. The study also showed that the results of PTG were related to the personality traits of optimism and extraversion. 

Park et al. (1996) developed their SRG scale based on qualitative analyses of participants’ descriptions of how stressful events had affected them. The authors ultimately decided on a 50-item scale that assessed a single general factor of growth. They also found that SRG was 

related to the stressfulness of the events as well as the amount of social 

support they reported. 

Since the publication of these seminal articles, researchers have 

elaborated on the concept of benefit finding following stressful events 

and devoted more attention to the theoretical mechanisms by which exposure to stressful events results in BF or growth (Helgeson, Reynolds, 

and Tomich, 1996; Affleck and Tennen, 1996). Furthermore, Affleck 

and Tennen (1996) provided evidence for the important distinction between BF and benefit reminding. The latter term reflects the intentional 

use of benefits as a coping mechanism to help the individual deal with 

the demands imposed by stressful events. In this way, benefit reminding becomes a problem-focused coping strategy (see Lazarus and Folkman, 1984) so that individuals can “nourish the conviction that we are 

in some way better off than we were before” (Affleck and Tennen, 1996). 

The authors emphasized that it was important to identify differences 

between beliefs about benefits from adversity (BF) and the use of that 

knowledge as a strategy for managing problems (benefit reminding). 

In their review, Tedeschi and Calhoun (2004) summarized the 

work that had been conducted on benefit finding or PTG and emphasized that positive transformative changes can result from traumatic events. For true growth to occur, the authors claim that events 

need to be traumatic enough to engender positive changes. The authors 
MILITARY BENEFIT FINDING: TURNING ADVERSITY TO ADVANTAGE 249

emphasized that they were not denying the negative consequences of 

stressors, but rather arguing that researchers should also study the positive changes resulting from transformative events. In fact, the authors 

indicated that psychological distress and the perception of benefits can 

occur simultaneously as the individual processes the full impact of the 

traumatic event. This latter point will become particularly important in 

the review of research on BF among military personnel.

In an important meta-analytic review, Helgeson et al. (2006) examined the cross-sectional relationship between BF and measures of 

health and well-being across 77 studies. The authors found that perceived benefits were related to lower depression, lower anxiety, higher 

positive effect, and higher levels of intrusive thoughts. The results of the 

meta-analysis also highlighted the relative independence of perceived 

benefits or growth and distress following highly stressful events.

The few longitudinal studies conducted on benefit finding in civilian literature suggest that finding benefits is prospectively related to 

higher levels of well-being and reduced illness symptoms (Bower, Kemeny, Taylor, and Fahey, 1998; Carver and Antoni, 2004; McMillen, 

Smith, and Fisher, 1997; but see Tomich and Helgeson, 2004). However, 

Park and Helgeson (2006) noted that more longitudinal research was 

needed to clarify the effects of such variables as the length of time between the traumatic event and the assessment of benefits. 

Benefit Finding Among Military Personnel: World War II, Korea, 

and Vietnam

A significant percentage of veterans perceive positive changes 

in personal growth and report benefits following their war experience (Lewis, 2006; Schok, Kleber, Elands, and Weerts, 2007). Stouffer, 

Suchman, Devinney, Star, and Williams (1949) examined post–World 

War II Soldiers’ adjustment following Army institutional life and war. 

The veterans were honorably discharged, with approximately 50 percent reporting combat experience. Soldiers were asked, “Do you feel 

that Army life changed you?” to which 22 percent reported desirable 

changes only, 20 percent reported desirable and undesirable changes, 

and 37 percent reported undesirable changes only. The remaining 21 

percent reported no change. 

Examining the positive or negative long-term consequences of 

wartime imprisonment, Sledge, Boydstun, and Rabe (1980) found that 

221 Vietnam War prisoners of war (POWs) suffered higher levels of 
250 THE 71F ADVANTAGE

physical and psychological problems when compared to 415 non-POW 

controls. However, the study revealed higher levels of favorable change 

among POWs in their “mental character” than unfavorable change. 

POWs who reported favorable benefits also identified a greater number 

of injuries during war and captivity and more extreme levels of physical 

and psychological suffering during captivity than other POWs. The Soldiers’ sense of having benefited from war imprisonment was positively 

correlated with the harshness of their experience. 

To understand the means by which one may perceive benefits following combat, Elder and Clipp (1989) examined a longitudinal sample of 149 World War II and Korean War veterans at three points in 

time, including pre- and postwar, for emotional or psychological impairment and resilience. Subjects were categorized by level of combat 

experience: noncombatants (40 percent), light combatants (30 percent), 

and heavy combatants (30 percent), based on an itemized combat scale. 

The scale featured a selection of combat-related experiences, the frequency of which identified the combat level of intensity. All Soldiers reported both positive and negative outcomes. Sixty to 70 percent of the 

men selected “learned to cope with adversity” and “exercised self-discipline” and “greater independence,” while 40 to 50 percent reported undesirable outcomes such as a “disrupted life” and “separation from loved 

ones.” Less than 20 percent cited “combat anxieties.” Soldiers with heavy 

combat experience were more likely to report both benefits and stressful symptoms later in life than noncombat veterans. The study emphasized that both benefits and detriments can occur in the same postwar 

individual. 

The authors explained that higher levels of combat experience 

created valuable coping skills such as self-discipline and an increased 

appreciation for life, while it simultaneously led to experiencing traumatic memories, personal loss, anxiety, and nightmares. Additionally, 

the authors identified a potential vulnerability marker by comparing 

pre- and postwar psychological functioning on ego resilience and helplessness. They found that low levels of prewar ego resilience were also 

associated with higher levels of post-traumatic stress. 

Perceptions of desirable and undesirable outcomes of combat 

were further investigated by Aldwin, Levenson, and Spiro (1994), who 

examined positive and negative military experiences as a mediator and 

moderator of the relationship between combat stress and post-traumatic stress disorder (PTSD). Subjects included 1,287 male veterans 
MILITARY BENEFIT FINDING: TURNING ADVERSITY TO ADVANTAGE 251

selected from a database that tracked Servicemembers from World 

Wars I and II, Korea, and Vietnam, with the majority of the sample having served in World War II and Korea. Similar to the findings of Sledge, 

Boydstun, and Rabe (1980), more men reported desirable than undesirable effects of military service and were generally perceived to have 

had “maturational and positive effects.” Results showed that combat exposure significantly predicted PTSD symptoms, and that this relationship was partially mediated in the expected directions by both the desirable and undesirable effects of military service. Additionally, a linear 

relationship was found between benefits and combat exposure, but the 

authors failed to find the expected quadratic relationship (with benefits 

decreasing again at high levels of combat exposure). The authors explained that positive effects of combat, such as developing coping resources, were negatively related to PTSD. Thus, the lack of BF may enhance war stress, and subsequently the intensity of PTSD. 

Fontana and Rosenheck (1998) similarly viewed BF as a means of 

coping with or managing the aftermath of war (cf. Aldwin et al., 1994). 

Nonetheless, the seminal contribution of their study was to identify the 

type of perceived benefits (self-improvement, solidarity, affirmation of 

patriotic beliefs) and liabilities (disillusionment of patriotic beliefs, selfimpoverishment, alienation from others) as a function of the amount 

and type of combat exposure (fighting, killing, threat, death, atrocities). 

The authors used 1,198 subjects from the National Vietnam Veterans 

Readjustment Study (NVVRS), and measured BF, liabilities, and combat 

exposure using a method similar to that of Aldwin et al. (1994). Bivariate relationships revealed that the benefit category “self-improvement” 

and the overall benefit score were related to the following types of combat exposure: fighting, killing, perceived threat, and death of others, but 

not to atrocities. Liabilities appreciably correlated with fight disillusionment, fighting, perceived threat, and atrocities. Linear relationships between the type of benefit and liability and the type and level of combat 

exposure revealed significant quadratic relationships in the form of an 

inverted U. More specifically, solidarity was closely associated with perceived threat, indicating that the highest level of solidarity emerges from 

moderate levels of perceived threat. Additionally, self-improvement and 

the overall measure of BF were significantly associated with death of others, but not with a true quadratic relationship. Rather, moderately high 

combat exposure revealed the highest feelings of self-improvement and 

overall BF score. The authors described this effect as a leveling process as 
252 THE 71F ADVANTAGE

opposed to a true quadratic function. Conclusions yielded that some level of suffering or stress (combat exposure) may encourage coping in the 

form of benefits perceived (for example, solidarity or self-improvement). 

Additional reports have focused on how BF following combat is related to such factors as wisdom and alienation later in life. Jennings, Aldwin, Levenson, Spiro, and Mroczek (2006) surveyed 1,990 World War II 

and Korean War veterans nested in the Normative Aging Study (cf. Aldwin et al., 1994) to assess prior military service, degree of combat exposure, and positive and negative aspects of military service. Subjects were 

resurveyed 10 years later to complete measures of coping (taking positive 

or negative action to solve problems), wisdom (less dependent on extrinsic sources for self-fulfillment), and alienation (the absence of meaning 

in life and feeling isolated). The authors found that combat exposure was 

related to both positive and negative outcomes associated with military 

service, but the relationship was much stronger for negative outcomes. 

Positive outcomes of military service were positively related to wisdom 

later in life, while negative outcomes were related to alienation later in 

life. Additional investigation revealed that low combat exposure was related with the later development of wisdom, while high combat exposure was associated with lower levels of wisdom. The authors concluded 

that how one appraised and coped with problems was more important 

in the prediction of positive adaptation than simply experiencing stress.

The influences of BF later in life were also investigated by Dohrenwend et al. (2004), who sought to establish if perceived benefits (appraisals) represent a positive adaptation to war experience, defensive denial, or maladaptive outcomes. The authors used 1,183 subjects from 

the NVVRS (cf. Fontana and Rosenheck, 1998) and clustered them according to how important their war experience was (salient) and if the 

experience was positive or negative (valence). The findings revealed 

that 71 percent of male U.S. veterans appraised the effect of their war 

experience on their present lives as positive, and 42 percent indicated 

that these experiences were highly salient. Results revealed that those 

reporting positive salience were less likely to have PTSD, had higher 

rates of occupational attainment, reflected higher levels of education, 

and were more likely to maintain marital relationships than those reporting negative salience. The authors concluded that the perceived 

benefits (appraisals) of war experience are affirmations of successful 

wartime and postwar adaptation as opposed to defensive denials and 

maladaptive outcomes.
MILITARY BENEFIT FINDING: TURNING ADVERSITY TO ADVANTAGE 253

Benefit Finding Among Military Personnel: Bosnia, Kosovo, and 

the Iraq War

Although prior research on BF following military operations and 

service is informative, it is important to note that these studies involved 

a time lag as long as 20 to 40 years between the combat experience and 

the report of benefits (Aldwin, Levenson, and Spiro, 1994; Elder and 

Clipp, 1989; Fontana and Rozenheck, 1998; Jennings, Aldwin, Levenson, Spiro, and Mroczek, 2006). Therefore, the benefit reports likely 

reflected a great deal of postcombat accommodation, rationalization, 

and bias. A full understanding of the issue requires the examination of 

benefits closer to real-time military operations. Research psychologists 

working for WRAIR have been involved in this, and the remainder of 

the chapter highlights the findings and advantages of this work. 

In order to better examine the multiple ways peacekeeping operations might impact Servicemembers, Britt (1998) administered a questionnaire to 800 military personnel who had just participated in Operation Joint Endeavor in Bosnia and were in a staging area awaiting return 

to their home stations. Participation was voluntary. One of the openended questions was, “How has this deployment impacted you?” Although a number of individuals indicated negative effects of the deployment, 33 percent of the Servicemembers indicated some personal benefit as a result of the operation (“I am a stronger person,” “I can deal with 

stress better now”), 8 percent indicated a positive effect on work (“I got 

a chance to do my MOS [military occupational specialty]”), and 5 percent even indicated a positive effect of the deployment on their family 

(“I realized the importance of family”). 

Little research has examined the predictors of deriving benefits 

from combat or peacekeeping operations. Britt, Adler, and Bartone 

(2001) conducted a longitudinal study examining engagement in meaningful work (assessed as a latent variable through self-report measures 

of possessing a peacekeeper identity, doing important work, and being 

personally engaged in work) during the Bosnia operation as a possible predictor of derived benefits from the deployments 3 months after 

it was over. Soldiers who reported higher engagement in meaningful 

work during the deployment also reported benefits (“I deal with stress 

better because of this deployment,” “This deployment made me more 

aware of problems in this world”) from the deployment 3 months after 

it was over, even after controlling for the personality variable of hardiness. In addition, Britt et al. (2001) found that deployed Soldiers who 
254 THE 71F ADVANTAGE

reported seeing the destruction caused by the war and who interacted 

with the local civilians were more likely to report benefits than Soldiers 

who lacked this exposure. 

Britt, Dickinson, Moore, Castro, and Adler (2007) replicated key 

aspects of these results in another longitudinal study of U.S. Soldiers 

on a peacekeeping mission to Kosovo. Engagement in meaningful work 

during the Kosovo peacekeeping deployment was a strong predictor of 

derived benefits from the operation 6 months after it was over. Furthermore, engagement in meaningful work was a stronger predictor of benefits than the negative experiences encountered during the deployment. 

Therefore, researchers working at WRAIR have identified meaningful 

aspects (morale, engagement in meaningful work, confidence in the 

unit functioning, perceptions of leadership) of deployment that predict 

the likelihood of finding benefits after the deployment is over.

In addition to examining benefit finding following peacekeeping 

operations, WRAIR researchers have investigated it following combat 

deployments to Iraq. One important factor that has received little attention with respect to military benefit finding is the influence of stressor 

duration or deployment length on BF perception. Wood, Thomas, 

Klocko, Bliese, and Hoge (2008) surveyed Soldiers at various times during a 15-month deployment and found that the number of months of 

deployment was negatively related to BF. However, this effect was qualified by a significant quadratic function in the shape of a U, indicating a 

mid-deployment slump in reported benefit finding. Thus, BF appeared 

to undergo a transition by phase throughout the 15-month deployment. 

The early deployment phase (approximately 0–6 months) showed a decline and may reflect a diminishing hope or mood brought about by reflecting on the remaining months of deployment. Mid-deployment (approximately 6–10 months) revealed the lowest levels of BF. 

Anecdotal reports collected from focus groups indicated a middeployment foreboding influenced by the long separation from home 

(U.S. Army Surgeon General, 2008, February 14) which may have 

caused the slump in mid-deployment BF. In late deployment (approximately 10–15 months), researchers again found the positive relationship between combat and BF (Aldwin et al., 1994), perhaps mimicking 

a runner’s high based on “redeployment optimism” (U.S. Army Surgeon 

General, 2008, February 14). 

Wood, Britt, Thomas, Klocko, Bliese, and Hoge (unpublished) 

tested the effects of two moderators, deployment length and BF, on the 
MILITARY BENEFIT FINDING: TURNING ADVERSITY TO ADVANTAGE 255

relationship between combat exposure and PTSD. Findings revealed a 

significant three-way interaction between the predictor (combat) and 

two moderating variables (deployment length and BF). Figure 10–1 illustrates that high BF buffers Soldiers from the negative effects of combat exposure on PTSD regardless of deployment length. Nonetheless, 

subjects who report low benefits appear more vulnerable to high combat-derived PTSD symptoms early in deployment (approximately 0–7 

months) than those late in deployment (approximately 8–15 months). 

These data indicate that high BF shows a protective influence on mental health, as in previous research (Aldwin, Levenson, and Spiro, 1994; 

Fontana and Rosenheck, 1998), but also clarifies that low benefit finders 

do develop ways of coping with PTSD symptoms relative to the increase 

in combat exposure and time in the war environment.

Social variables such as leadership climate and unit cohesion are 

also related to the perception of benefits. Wood, Kim, Bliese, Castro, and

Figure 10–1. Interaction of Benefit Finding (± 1 SD) and Deployment 

Length by Combat Level on Post-traumatic Stress Disorder 

Symptoms (± 1 SD)

50

45

40

35

30

25

20

15

10

5

0

PTSD Symptoms

Low Combat High Combat

*= controlling for rank, gender, and marital status in a hierarchical regression model (N=1925)

(1) High Deployment Length,

 High Benefit Finding

(2) High Deployment Length,

 Low Benefit Finding

(3) Low Deployment Length,

 High Benefit Finding

(4) Low Deployment Length,

 Low Benefit Finding
256 THE 71F ADVANTAGE

Hoge (2008) sought to identify the buffering capability of social variables (unit cohesion and noncommissioned officer [NCO]/officer leadership) on the combat exposure–benefit finding relationship in Operation Iraqi Freedom veterans. However, in contrast to previous designs, 

the researchers introduced a two-points-in-time measure in which social variables and combat at Time 1 (3 months after redeployment) predicted BF at Time 2 (6 months after redeployment). Both positive NCO 

leadership and unit cohesion predicted BF. However, only the cohesion 

by combat interaction emerged as significant. These data revealed that 

Soldiers who reported higher unit cohesion showed a steeper rate of increase in reported BF. Thus, unit cohesion among Soldiers and NCOs 

significantly enhanced combat-derived BF. 

Britt, Castro, Hoge, McGurk, Herleman, and Odle-Dusseau 

(2008) examined the consequences of benefit finding for PTSD, morale, combat readiness, and overall health using a longitudinal sample of 

Iraq War veterans. The veterans completed measures of all constructs 3 

months after their redeployment from Iraqi Freedom and then 3 months 

later (6 months after redeployment). Using structural equation modeling, Britt et al. found that benefit finding at Time 1 predicted reduced 

levels of PTSD at Time 2, and higher levels of morale, combat readiness, 

and overall health at Time 2. The study found more statistical support 

for benefit finding as a predictor of these outcomes than for outcomes 

as predictors of benefit finding (see Zapf, Dormann, and Frese, 1996). 

These results suggest that BF following combat may be related 

to psychological problems resulting from combat, but also to positive 

psychological states that contribute to personal thriving and resiliency. 

The findings echo recent calls from researchers to study not only what 

leads to dysfunction and psychological symptoms, but also what leads to 

thriving under stress and achieving a meaningful purpose in life (Britt 

et al., 2008; Helgeson et al., 2006; Southwick, Vythilingam, and Charney, 2005; Tugade, Fredrickson, and Barret, 2004). We do not mean to 

suggest that combat is desirable because it leads to particular types of 

benefits for Servicemembers. Nonetheless, it is worth the investment to 

design programs and interventions to maximize the benefits found and 

their concomitant positive consequences.

Future Directions and Conclusion

BF research within military populations has a long history, and 

psychologists’ research for the Army has contributed to this literature. 
MILITARY BENEFIT FINDING: TURNING ADVERSITY TO ADVANTAGE 257

However, much of the research on military benefit finding has been 

plagued by long time lags between the experience of stressors during 

deployment and the assessment of the benefits following operations. 

Additionally, recent research conducted by uniformed research psychologists has not used standardized measures of benefit finding that 

are available in the literature (see Tedeschi and Calhoun, 1996). In their 

meta-analytic review, Helgeson et al. (2006) noted that research on BF 

often includes a variety of scales that may not relate to each other. Current measures used by WRAIR were originally constructed from Soldiers’ feedback on open-ended questions concerning how deployment 

to a peacekeeping environment had affected them (Britt et al., 2001). Although these measures show similar relationships to positive outcomes, 

as well as interactions with the level of exposure to stress and trauma 

on mental health outcomes, as those in other reports (Aldwin, Levenson, and Spiro, 1994; Elder and Clipp, 1989; Helgeson, Reynolds, and 

Tomich, 2006; Schok et al., 2007), future research ought to focus on restructuring the current scale and pattern questions after those found in 

validated measures of BF. 

Helgeson et al. (2006) noted a low representation of studies 

measuring BF over time and emphasized the need for longitudinal research. The recent research conducted by uniformed 71Fs has used 

longitudinal designs that have been recommended by civilian psychologists. However, additional research is needed using multiple time 

lags to distinguish between benefits that reflect true personal growth 

following exposure to trauma versus rationalized benefits from Servicemembers who want to find something positive from horrors they have 

witnessed. To improve the understanding of benefit finding, WRAIR is 

currently involved in longitudinal research to follow veterans over multiple time points during the postdeployment period and to track the development of conscious benefits and their consequences. This represents an important area for continued and future research.

Along with additional research on the predictors and consequences of BF in combat, there is a need to begin exploring interventions that increase the likelihood of Servicemembers accruing benefits from participation in military operations. We know from longitudinal research conducted during and following peacekeeping operations that engagement in meaningful work during a deployment 

is related to derived benefits from the deployment months after it is 

over (Britt et al., 2001; Britt et al., 2007). Therefore, interventions that 
258 THE 71F ADVANTAGE

enhance the personal relevance and meaning associated with Servicemembers’ work during a military operation may increase the benefits 

Soldiers derive from their participation in deployments. For example, 

Britt (2003) discussed aspects of predeployment training for Operation 

Joint Endeavor to Bosnia that highlighted the purpose of the mission and 

how Servicemembers were contributing to a lasting peace in the region. 

Thus, military planners and leaders should be vigilant in finding opportunities to communicate the meaning of a given military operation 

to Servicemembers.

In addition to understanding the importance and relevance of 

the mission itself, Servicemembers can be encouraged to realize the 

positive consequences of their mission experience as training and for 

stress resiliency. Many Servicemembers come through a difficult mission recognizing a strength and resiliency they were not previously aware that they possessed. As discussed above, the finding of benefits can occur simultaneously with symptoms related to stressors encountered during military operations. In light of this fact, the approach 

of focusing on strengths learned during deployment is actively used 

in the form of Battlemind training to help Soldiers cope with combat 

and its aftermath (Thomas et al., 2007). Adler et al. (2006) found that 

Battlemind training given soon after Soldiers’ return from deployment 

significantly reduced mental health symptoms 4 months postdeployment. Thus, highlighting the strengths Servicemembers demonstrated 

during combat might capitalize on the salutary effects of benefits that 

occurred in the face of high levels of adversity. 

Although BF is not the cure-all for military trauma and stress, the 

current literature identifies it as a valuable cognitive resource with a potential to reduce the impact of war trauma on mental health both during and after military deployment. Additionally, BF has been shown to 

be an adaptive or learned process, which may be enhanced by personality factors such as ego resilience, social factors such as unit cohesion and 

leadership, and other factors such as meaningfulness of work. BF may 

also be useful for the identification of individuals who are vulnerable to 

mental health problems. In conclusion, benefit finding is a valuable coping mechanism that can augment a Soldier’s psychological toolbox to 

better manage personal mental health. 
MILITARY BENEFIT FINDING: TURNING ADVERSITY TO ADVANTAGE 259

References

Adler, A.B., Castro, C.A., McGurk, D., Bliese, P.D., Wright, K.M., and Hoge, C.W. (2006, November). Post-deployment interventions to reduce the mental health impact of combat deployment to Iraq: Public health policies, psychological debriefing and battlemind training. Paper presented at the International Society for Traumatic Stress Studies, Hollywood, CA.

Affleck, G., and Tennen, H. (1996). Construing benefits from adversity: Adaptational significance and dispositional underpinnings. Journal of Personality 64, 899–922. 

Aldwin, C.M., Levenson, M.R., and Spiro III, A. (1994). Vulnerability and resilience to combat 

exposure: Can stress have lifelong effects? Psychology and Aging 9, 34–44. 

Bartone, P.T., Adler, A.B., and Vaitkus, M.A. (1998). Dimensions of psychological stress in peacekeeping operations. Military Medicine 163, 587–593. 

Bower, J.E., Kemeny, M.E., Taylor, S.E., and Fahey, J.L. (1998). Cognitive processing, discovery of 

meaning, CD4 decline, and AIDS-related mortality among bereaved HIV-seropositive 

men. Journal of Consulting and Clinical Psychology 66, 979–986.

Britt, T.W. (1998). Psychological ambiguities in peacekeeping. In H.J. Langholtz (ed.), The psychology of peacekeeping (111–128). Westport, CT: Praeger Publishers.

———. (2003). Can participation in peacekeeping operations be beneficial? The importance of 

meaning as a function of attitudes and identity. In T.W. Britt and A.B. Adler (eds.). The 

psychology of the peacekeeper: Lessons from the field (71–88). Westport, CT: Praeger Publishers.

Britt, T.W., Adler, A.B., and Bartone, P.T. (2001). Deriving benefits from stressful events: The 

role of engagement in meaningful work and hardiness. Journal of Occupational Health 

Psychology 6, 53–63.

Britt, T.W., Castro, C.A., McGurk, D., Herleman, H.A., and Odle-Dusseau, H.N. (2008, March 

7). Benefit finding predicts dysfunctional and functional deployment outcomes. In T.W. 

Britt and J. Thomas (co-chairs), Deriving benefits from stressful work: The case of combat 

veterans. Paper presented at the American Psychological Association/U.S. National Institute for Occupational Safety and Health Work, Stress, and Health Conference, Washington, DC.

Britt, T.W., Dickinson, J.M., Moore, D.M., Castro, C.A., and Adler, A.B. (2007). Correlates and 

consequences of morale versus depression under stressful conditions. Journal of Occupational Health Psychology 12, 34–47.

Carver, C.S., and Antoni, M.H. (2004). Finding benefit in breast cancer during the year after 

diagnosis predicts better adjustment 5 to 8 years after diagnosis. Health Psychology 23,

595–598.

Dohrenwend, B.P., Neria, Y., Turner, J.B., Turse, N., Marshall, R., Lewis-Fernandez, R. et al. 

(2004). Positive tertiary appraisals and posttraumatic stress disorder in U.S. male veterans of the war in Vietnam: The roles of positive affirmation, positive reformulation, and 

defensive denial. Journal of Consulting and Clinical Psychology 72, 417–433.

Elder, G.H., and Clipp, E.C. (1989). Combat experience and emotional health: Impairment and 

resilience in later life. Journal of Personality 57, 311–341.

Fontana, A., and Rosenheck, R. (1998). Psychological benefits and liabilities of traumatic exposure in the war zone. Journal of Traumatic Stress 11, 485–503.

Helgeson, V.S., Reynolds, K.A., and Timich, P.L. (2006). A meta-analytic review of benefit finding 

and growth. Journal of Consulting and Clinical Psychology 74, 797–816. 

Jennings, P.A., Aldwin, C.M., Levenson, M.R., Spiro III, A., and Mroczek, D.K. (2006). Combat 

exposure, perceived benefits of military service, and wisdom in later life: Findings from 

the normative aging study. Research on Aging 28, 115–134.

Lazarus, R.S., and Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer. 
260 THE 71F ADVANTAGE

Lewis, S.J. (2006). Combat stress control: Putting principle into practice. In Britt, T.W., Castro, 

C.A., and Adler, A.B. (eds.). Military life: The psychology of serving in peace and combat

(121–140). Westport, CT: Praeger Security International. 

McMillen, J.C., Smith, E.M., and Fisher, R.H. (1997). Perceived benefit and mental health after 

three types of disaster. Journal of Consulting and Clinical Psychology 65, 733–739.

Park, C.L., Cohen, L.H., and Murich, R.L. (1996). Assessment and prediction of stress-related 

growth. Journal of Personality 64, 71–105.

Park, C.L., and Helgeson, V.S. (2006). Introduction to the special section: Growth following highly stressful life events—current status and future directions. Journal of Consulting and 

Clinical Psychology 74, 791–796.

Ritzer, D.R., Campbell, S.J., and Valentine, J.N. (1999). Human dimensions research during operation “Joint Guard,” Bosnia. Army Medical Department Journal 8, 5–16.

Schok, M.L., Kleber, R.J., Elands, M., and Weerts, Jos M.P. (2007). Meaning as a mission: A review 

of empirical studies on appraisals of war and peace keeping experiences. Clinical Psychology Review 28, 357–365.

Sledge, W.H., Boydstun, J.A., and Rabe, A.J. (1980). Self-concept changes related to war captivity. 

Archives of General Psychiatry 37, 430–443.

Southwick, S.M., Vythilingam, M., and Charney, D.S. (2004). The psychobiology of depression 

and resilience to stress: Implications for prevention and treatment. Annual Review of 

Clinical Psychology 1, 255–291.

Stouffer, S.A., Suchman, E.A., DeVinney, L.C., Star, S.A., and Williams, R.A. (1949). The American soldier adjustment during army life (vols. 1 and 2). Princeton: Princeton University 

Press. 

Taylor, S.E. (1983). Adjustment to threatening events: A theory of cognitive adaptation. American 

Psychologist 38, 1161–1173.

Tedeschi, R.G., and Calhoun, L.G. (1996). The posttraumatic growth inventory: Measuring the 

positive legacy of trauma. Journal of Traumatic Stress 9, 455–471. 

Thomas, J.L., Castro, C.A., McGurk, D.M., Cox, A., and Hoge, C.W. (2007, August). The efficacy 

of Battlemind training at immediate post-deployment reintegration. Paper presented at 

the American Psychological Association Conference, San Francisco, CA. 

Tomich, P.L., and Helgeson, V.S. (2004). Is finding something good in the bad always good? Benefit finding among women with breast cancer. Health Psychology 23, 16–23.

Tugade, M.M., Fredrickson, B.L., and Barrett, L.F. (2004). Psychological resilience positive emotional granularity: Examining the benefits of positive emotions on coping and health. 

Journal of Personality 72, 1161–1190.

U.S. Army Surgeon General. (2008, February 14). Mental Health Advisory Team IV. Operation 

Iraqi Freedom 05–07. Retrieved June 26, 2008, from the U.S. Army Medical Command 

Web site, <www.armymedicine.army.mil/news/U.S. Army Surgeon General>. 

Wood, M.D., Britt, T.W., Thomas, J.T., Klocko, R., Bliese, P.D., and Hoge, C.W. Benefit finding in 

the war environment: A matter of time. Unpublished manuscript.

Wood, M.D., Kim, P., Thomas, J.L., Bliese, P.D., and Hoge, C.W. (2008, March). Active Duty Soldier’s Postdeployment Benefit-Finding. Paper presented at the Occupational Stress and 

Health Conference, Washington, DC.

Wood, M.D., Thomas, J.T., Klocko, R., Bliese, P.D., and Hoge, C.W. (2008, August). Benefit finding 

in the war environment: A matter of time. Poster presented at the Force Health Protection 

Conference, Albuquerque, NM.

Zapf, D., Dormann, C., and Frese, M. (1996). Longitudinal studies in organizational stress research: A review of the literature with reference to methodological issues. Journal of Occupational Health Psychology 2, 145–169.
261

Chapter 11

Enhancing Operational Readiness 

through Neuroimaging: Mapping 

the Pathophysiology of Mild 

Traumatic Brain Injury in Warfighters

Michael N. Dretsch

Estimates of mild traumatic brain injury (mTBI) in U.S. Soldiers 

as a result of blast injury during Operations Iraqi Freedom (OIF) and 

Enduring Freedom (OEF) are as high as 50 percent. Accordingly, there 

has been a surge of research to understand the pathophysiologic changes 

associated with mTBI, from inception to persistent and long-term sequelae. Technological advancement and innovative research in brain 

imaging techniques over the last two decades have greatly contributed to 

our current understanding of the pathophysiology of brain injury. Improved imaging techniques and sequences result in enhanced temporal 

and spatial resolution, validation, improved sensitivity and specificity, 

and utility of neuroimaging for assessing the degree of physical damage 

as well as predicting outcomes. Multimodal neuroscience approaches 

to neuroimaging will be the key to successful intervention of mTBI. 

Background

Every Soldier understands the importance of placing the mission first. Yet when there is a rise in the number of Soldiers with impaired cognitive functioning and psychological well-being, whether 

transient or permanent and regardless of origin (for example, sleep deprivation, intoxication, combat stress conditions, or mTBI), then the 

risk of the mission failing greatly increases. In order to maintain operational readiness of our troops, leaders must establish guidelines and 

protocols to protect warfighters from exacerbation of their condition, 

while simultaneously achieving the mission objectives. Mild TBI cases 

present many difficulties for commanders because the injuries are predominantly “closed” head wounds, and diagnostic symptoms can overlap with psychological syndromes and malingering. Through advances 
262 THE 71F ADVANTAGE

in experimental design and integration of sophisticated techniques and 

disciplines, neuroscience research has been a pioneer in mapping the 

pathophysiology of mTBI. However, the application of neuroscience 

techniques for diagnoses and assessment of functioning has not yet 

been standardized. This chapter provides a general introduction to recent advances in neuroimaging techniques that have contributed to our 

knowledge of the pathophysiology of mTBI and explores the current 

and future trends in detection, diagnosis, and assessment of the injury 

fostered by the U.S. Army. 

The brain, although remarkably resilient, is susceptible to transient and permanent dysfunction following an array of physical events. 

The activities in OIF and OEF have unfolded novel forms of physical 

insult to the central nervous system. Compared to previous wars, the 

current operations in southwest Asia have produced a greater number of brain-injured Soldiers, although this is accompanied by a greater 

survivability rate (Gawande, 2004; Ruff, 2005; Holcomb, Stansbury, 

Champion, Wade, and Bellamy, 2006). Trauma from the blast of improvised explosive devices is increasingly survivable due to improvements 

in armored vehicles, body armor, and medical care. However, medical 

providers are reporting staggering incidences of traumatic brain injury 

(TBI) among survivors. Reports from the Centers for Disease Control 

and Prevention (CDC, 2003) indicate that mTBI makes up 80 percent 

of all traumatic brain injuries in both military and civilian populations. 

Furthermore, some estimates indicate that 50 percent of Soldiers returning from OIF and OEF have sustained some level of mTBI (Jackson, 

Hamilton, and Tupler, 2008), with as many as 20 to 40 percent being 

redeployed with residual symptoms.

Similar to athletes who compete at a high level of intensity, Soldiers often have an ideology of warrior attributes such as resilience, invincibility, and risk-taking. What accompanies this ideology is an attitude to push through the pain of an injury and continue contributing 

to the team’s goals. Such a virtue is laudable, especially when the injury 

is visible (for example, a wound to an extremity). However, mTBI is often invisible and consists of symptoms such as difficulty concentrating, 

headache, fatigue, irritability, sleep disturbances, and poor decisionmaking. Symptoms may persist or develop latently into transient, longterm, or permanent physical, psychological/behavioral, and cognitive 

symptoms. While headache is the most common physical symptom, 

a significant percentage of warriors develop sensory sensitivities and 
ENHANCING OPERATIONAL READINESS THROUGH NEUROIMAGING 263

insomnia. Psychological/behavioral symptoms include depression, 

anxiety, fatigue, aggression, personality changes, emotional volatility, 

and reduced motivation (apathy). Cognitive changes include deficits 

in memory, attention, concentration, and judgment and decisionmaking (Ryan and Warden, 2003). The variation in symptom manifestation 

complicates diagnosis and leads to the need for advances in early detection and accurate diagnosis (for example, TBI versus acute stress disorder) and assessment of etiology (for example, asphyxia, focal lesions, 

contusion, intracranial hematoma/hemorrhage) and severity (mild, 

moderate, severe) of brain injury. 

Classification

The terms concussion and mTBI are abundant within the literature and can be used interchangeably. Post-concussion syndrome (PCS) 

refers to the symptoms associated with the injury that persist for more 

than 3 months (Bigler, 2008). When residual symptoms are present past 

6 months, the condition is referred to as persistent post-concussion syndrome. Currently, PCS is a proposed psychiatric disorder that is undergoing research for possible inclusion in future editions of the Diagnostic 

and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000, Fourth Edition Text Revision). In an attempt to minimize 

confusion, the term mTBI is used throughout this chapter and refers to 

the injury and associated symptoms across time. 

Currently, there is no solid evidence-based definition of mTBI. 

Criteria for the diagnosis vary by classification scheme. One of the most 

common screening tools for TBI is the Glasgow Coma Scale (GCS). It 

includes questions on motor responses (6 grades), verbal responses (5 

grades), and eye-opening responses (4 grades). Lower scale scores indicate greater likelihood of more severe TBI (Teasdale and Jennett, 1974). 

Typically, a score of 13 to 15 suggests mild brain injury; 9 to 12 suggests moderate injury; and lower than 9, severe injury. There are various severity grading scales developed by different organizations. While 

each of these scales has shown a degree of success, experts have failed 

to reach a consensus. The Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine has 

developed its own definition of mTBI (Esselman and Uomoto, 1995). 

For example, grade 1 is any alteration in mental state at the time of injury (such as feeling dazed, disoriented, or confused). Grade 2 is any 

loss of memory of the event immediately before or after the injury, with 
264 THE 71F ADVANTAGE

post-traumatic amnesia less than 24 hours. Finally, grade 3 is defined as 

any period of loss of consciousness (LOC) of less than 30 minutes followed by a GCS score of 13 to 15.7. The American Academy of Neurology guidelines (Kelly, 1999) require for a grade 1 that there be confusion, 

symptoms that last less than 15 minutes, and no loss of consciousness; 

grade 2, symptoms that last longer than 15 minutes and no loss of consciousness; and grade 3, loss of consciousness including coma, lasting 

either seconds (3a) or minutes (3b).

MTBI in military operational settings is defined by the Defense 

and Veterans Brain Injury Center’s (DVBIC’s) Clinical Practice Guideline and Recommendations (2006; http://dvbic.org/public_html/pdfs/

clinical_practice_guideline_recommendations.pdf) as “an injury to the 

brain resulting from an external force and/or acceleration/deceleration 

mechanism from an event such as a blast, fall, direct impact, or motor 

vehicle accident which causes an alteration in mental status typically 

resulting in the temporally related onset of symptoms.” DVBIC determines severity of TBI by set criteria based on duration of loss of consciousness, alternations of consciousness, and post-traumatic amnesia 

(see table 11–1).

Table 11–1. Classification of Traumatic Brain Injury Severity

Criteria Mild Moderate Severe

Structural imaging Normal Normal or 

abnormal

Normal or 

abnormal

Loss of consciousness 0–30 

minutes

> 30 minutes 

and < 24 hours > 24 hours

Alteration of consciousness/

mental state*

A moment 

up to 

24 hours

> 24 hours; 

severity based 

on other criteria

Post-traumatic amnesia 0–1 day > 1 and 

< 7 days > 7 days

Glasgow Coma Scale (best 

available score in first 24 hours) 13–15 9–12 < 9

*Alteration of mental status must be immediately related to the trauma to the head. Typical symptoms 

would be looking and feeling dazed and uncertain of what is happening, confusion, difficulty thinking 

clearly or responding appropriately to mental status questions, and being unable to describe events 

immediately before or after the trauma event. 

Source: VA/DOD Clinical Practice Guideline for Management of Concussion/Mild Traumatic Brain Injury, 

Version 1.0, March 2009, Table A–1, 8. Available at <www.dvbic.org/Providers/TBI-Screening.aspx>. 
ENHANCING OPERATIONAL READINESS THROUGH NEUROIMAGING 265

Experts have varying opinions of how accurate each TBI classification scheme is. However, all agree that clinical judgment is crucial 

in the majority of cases. This includes consideration of factors that frequently confound patient evaluation: preexisting conditions, intoxication, polypharmacy, and baseline functioning. 

Impact on Physical, Metabolic, Vascular, and Endocrine Processes

Most cases of mTBI are acquired through mechanistic insult from 

explosion/blast, motor vehicle crash, blunt object, fragments, and gunshot wound. Brain injury may be from primary (exposure to overpressurization wave from blast), secondary (impact from blast, debris), tertiary (impact after displacement), quaternary (inhalation of toxins, hypoxia), or a combination of affects that results in stretching, lacerations, 

and contusions to grey and white matter, both directly (bony structures, 

foramen magnum, anterior and posterior fossa) and indirectly (intracranial hemorrhage or hematoma) and dysregulation of vascular, endocrine, and metabolic processes (Giza and Hovda, 2001; Bay and McLean, 

2007; Korn, Golan, Melamed, Pascual-Marqui, and Friedman, 2005). To 

further complicate the process, the type of personal protective equipment a Soldier uses may accentuate the severity of the injury (Moore, 

Radovizky, Shupenko, Klinoff, Jaffee, and Rosen, 2008; Bhattacharjee, 

2008). Although mild TBI can manifest as an open head wound, it more 

often is a closed wound, which has made this war injury easily misunderstood and often overlooked. 

The brain’s vulnerability to injury is a result of a number of structural and constitutional issues such as the surface location of arterial 

branches that nourish it and the soft arachnoid sinuses that filter cerebral 

sinus fluid and waste. These vessels can be impacted by coup-contracoup impact with the skull (that is, the brain hitting the skull, then 

bouncing back and hitting the other side of the skull), resulting in degrees of contusion, intracranial hemorrhaging, and/or hematomas that 

can lead to increased intracranial pressure, and ultimately herniation of 

cortical mass. Herniation can stretch, tear, and compress cortical and 

subcortical nuclei, arteries, cranial nerves, and the brain stem, as well as 

produce secondary and tertiary hemorrhaging and swelling. Such structural alterations often result in an abnormal volume of cerebral spinal 

fluid and reduced circulation (Bay et al., 2007). 
266 THE 71F ADVANTAGE

Individuals who experience repetitive concussions are at increased risk for developing long-term symptoms and even permanent 

brain damage (Mori, Katayama, and Kawamata, 2006). At a micro level, 

diffuse axonal injury and focal lesions impact biomechanical, hemodynamic, neurobiologic, and metabolic mechanisms leading to reduced 

or compromised axonal function, vascular blood flow, neurotransmitter and neuropeptide regulation, intra-axonal ion-gating, cerebral glucose metabolism, and cerebral immune response expression (Giza et al., 

2001). Behan and colleagues (2008) identified pituitary hormone deficiencies in patients with previous brain injury in a study examining 

prevalence of neuroendocrine dysfunction in patients recovering from 

traumatic brain injury. 

One of the medical community’s biggest concerns is Soldiers prematurely returning to full duty following mTBI. Evidence suggests that 

premature return is associated with an increased susceptibility to a subsequent head injury with a prolonged neurological recovery and possible permanent neurobiologic and metabolic changes (Guskiewicz, 

McCrea, Marshall, Cantu, Randolph, Barr, Onate, and Kelly, 2003). Repetitive mTBI can produce increased vascular congestion and cerebral 

swelling, resulting in transtentorial herniation and subsequent death 

(Mendez, Hurley, Lassonde, Zhang, and Taber, 2005; Bailes and Hudson, 2001). It is of paramount importance to note that this vulnerability may exist even if the individual initially appears to be asymptomatic 

(CDC, 2002). Furthermore, regardless of severity, a repeat brain injury 

can be life threatening if experienced within hours or days of the first 

(Mori, Katayama, and Kawamata, 2006). The collateral loss from compromised cognitive functioning and the resulting human error includes 

decreased battlefield efficiency and increased risk of both fratricide and 

equipment loss.

Neuropsychological Functioning

The initial symptoms and persistent sequelae associated with 

mTBI can have deleterious effects on work performance. Individuals 

who report being asymptomatic after hours to days may still suffer from 

undiagnosed neurocognitive impairments, which can result in suboptimal long-term physical, mental, social, and occupational functioning 

(Kraus, Schaffer, Ayers, Stenehjem, Shen, and Afifi, 2005). In the context 

of operational combat settings, compromised functioning of the brain 

is particularly important when considering the job description. Initial 
ENHANCING OPERATIONAL READINESS THROUGH NEUROIMAGING 267

mTBI-related symptoms reported often include fatigue, headache, nausea, amnesia, irritability, difficulties with memory and concentration, 

and affect/mood dysregulation (Creamer, O’Donnell, and Pattison, 

2005; Stulemeijer, van der Werf, Bleijenberg, Biert, Brauer, and Vos, 

2006; Bay et al., 2007). Furthermore, approximately 10 to 20 percent of 

individuals with mTBI suffer from long-term (greater than 6 months) 

neuropsychological sequelae that are often disabling (Nolin and Heroux, 

2006; Kashluba, Paniak, Blake, Reynolds, Toller-Lobe, and Nagy, 2004). 

The current literature provides good overviews of the various 

cognitive processes typically impacted by mTBI (Malojcic, Mubrin, Coric, Susnic, and Spilich, 2008; Kurca, Sivak, and Kucera, 2006; McAllistar, Sparling, Flashman, Guerin, Mamourain, and Saykin, 2001; McIntire, Langan, Halterman, Drew, Osternig, Chou, and van Donkelaar, 

2006). Overall, the cognitive processes most often implicated include attention, memory, and speed of information processing. 

Impairment in neuropsychological tasks has been observed in 

individuals with mTBI. For example, Nolin (2006) reported that patients with mTBI have executive dysfunction when engaged in memory 

tasks as assessed via the California Learning Test. The results revealed 

a specific deficit of impaired retrieval processes, but not of encoding or 

storage of information. Other studies concur with the notion that mTBI 

cognitive symptoms can be a result of a specific impairment such as 

inattention. However, disentangling the precise deficits associated with 

mTBI can sometimes be difficult. 

Multiple studies have revealed attentional deficits in individuals with mTBI. Using single- and dual-task conditions, Azouvi and colleagues (2004) provided evidence that individuals with mTBI performed 

similar to controls, but reported significantly higher levels of effort. The 

results suggest that divided-attention deficits in individuals with mTBI 

are related to a reduction in available processing resources. 

The concept that individuals with mTBI have reduced resources 

to apply to various tasks is supported by other studies. Tombaugh and 

colleagues (2007) reported a positive linear relationship between reaction time and complexity on computerized tests of information processing. A similar relationship between severity of injury and reaction time 

was also reported. 

McIntire and colleagues (2006) provided evidence in accord with 

Azouvi et al. by using the rapid serial visual presentation task, which 

requires the participant to respond to a target letter and determine 
268 THE 71F ADVANTAGE

whether a probe letter was present or not in a stream of rapidly presented letters. Individuals with mTBI showed normal attentional blink 

as compared to matched controls. However, unlike health controls, the 

mTBI group showed impaired selective attention with significantly 

more omission errors. Based off results from a Gap Saccade task, Drew 

and colleagues (2007) reported that deficits in visuospatial attention associated with mTBI might be attributed to difficulties with the initial 

disengagement process. This was only present when the temporal gap 

was short, not when long. However, this deficit was resolved within 1 

week. Other evidence suggests that mTBI results in deficits in cognitivemotor association (Sosnoff, Broglio, and Ferrara, 2008), which may be 

attributed to impairments in visuospatial attention. 

Top-down processes often moderate general functions that we 

may take for granted. For example, reduced processing speed, attention, 

memory, and overall efficacy of cerebral functioning can dampen language ability. Aphasia batteries have been criticized for lack of sensitivity 

and specificity when used for assessment of subtle impairments associated with mTBI (Duff, Proctor, and Haley, 2002). In contrast, recent reports indicate that returning Soldiers being treated for mTBI show significant communication deficits that are not attributed to changes in 

hearing (personal communication, Dr. Anthony Salvatore, University of 

Texas–El Paso, and LTC Kathy Prue-Owens, USA, William Beaumont 

Army Medical Center, Fort Bliss, TX). 

Most of the neuropsychology research has focused on “coolheaded” cognitive processes. Hence, there is a paucity of information 

concerning how mTBI impacts affective processes. This may be partially 

due to the complex affect-by-cognitive interplay that has been under 

investigation by psychological scientists from many fields of research 

(Dretsch and Tipples, 2008; Pecchinenda, Dretsch, and Chapman, 2006; 

Gray, Braver, and Raichle, 2002). Affective-based decisionmaking impairments have been associated with mTBI (Levine, Black, Cheung, 

Campbell, O’Toole, and Schwartz, 2005). Some evidence suggests reduced sensitivity of judgments and responding to stimulus-reinforcement contingencies following mTBI (Schlund and Pace, 2000). 

An understanding of mTBI-related cognitive impairments, both 

transient and permanent, is necessary for determining treatment courses 

of action. Over the course of OIF and OEF, command leadership expressed a desire to know the cognitive status of the troops. However, 

understanding the impact of mTBI on neuropsychological functioning 
ENHANCING OPERATIONAL READINESS THROUGH NEUROIMAGING 269

will require a multimodal research approach to account for limitations 

of behavioral measures.

Advances in Brain Imaging for Assessment of 

Neuropsychological Functioning 

One of the greatest obstacles with mTBI is finding a nonintrusive way to see what is going on inside of the brain in order to evaluate 

the extent of damage and to provide appropriate treatment and rehabilitation interventions. While clinical neuropsychological assessment 

has been a chief contributor to capturing cerebral dysfunction following 

possible brain injury, the profession has acknowledged limitations. This 

being said, structural and functional brain biomarkers have advanced 

our understanding of the brain-mind interplay, which is one of the truly 

paramount enigmas of the 21st century. 

Within the last decade, there has been a surge in the development 

of advanced neuroscience techniques for the assessment of mTBI. This 

is largely attributed to funding opportunities presented by the Department of Defense (DOD) for both independent and collaborative studies. Progressive advances in magnetic resonance (MR) techniques are 

currently being developed and applied, which has greatly improved our 

understanding of the impact of mTBI on multiple processes associated 

with physical, behavioral, psychological, and cognitive symptoms. The 

most common imaging findings include contusions, axonal shearing, 

hemorrhages, and herniations (Lizerbram and Moffit, 2001). The following sections will briefly outline some of the most recent advances in 

mTBI neuroimaging research. Emphasis will be on more recent imaging 

techniques that have only been available since the early 1990s (Belliveau, 

Kennedy, McKinstry, Buchbinder, Weisskoff, Cohen, Vevea, Brady, and 

Rosen, 1991; Basser and LeBihan, 1992).The reasons for primarily focusing on these more recent techniques are their noninvasive nature 

and potential for assessing mTBI symptoms.

Computed Tomography

Computed tomography (CT) is considered the gold standard for 

imaging in the acute management of TBI. However, less than 10 percent of patients with mTBI have positive CT findings (Saboori, Ahmadi, 

and Farajzadegan, 2007). Until recent advances, even the most sophisticated structural imaging analysis techniques lacked information about 

the functioning of the intact brain matter. This highlights the less than 
270 THE 71F ADVANTAGE

optimal predictive sensitivity and specificity of CT in comparison to 

other more advanced techniques (Lewine, Davis, Bigler, Thoma, Hill, 

Funke, Sloan, Hall, and Orrison, 2007; Niogi, Mukherjee, Ghajar, Johnson, Kolster, Sarkar, Lee, Meeker, Zimmerman, Manley, and McCandliss, 2008). This also emphasizes the importance of integrating functional imaging techniques, which may be more informative than structural imaging for milder cases of mTBI.

Magnetic Resonance Imaging

Unlike CT, magnetic resonance imaging (MRI) does not use ionizing radiation, but instead relies on a powerful magnetic field to align 

the nuclear magnetization of atoms in the water of the brain (Levine, 

Fujiwara, O’Connor, Richard, Kovacevic, Mandic, Restagno, Easdon, 

Robertson, Graham, Cheung, Gao, Schwartz, and Black, 2006). Although MRI has superior resolution to CT, small lesions associated with 

mTBI are often not visible to the naked eye and can result in underestimates of neuropathology. Approaches have been developed with combined field gradients and radiofrequency excitation to create higher resolution images. Structural imaging techniques such as diffusion tensor 

imaging (DTI), and functional techniques such as functional magnetic 

resonance imaging (fMRI), magnetic resonance spectroscopy (MRS), 

and positron emission tomography (PET), have contributed to the understanding of the impact of mTBI and show promise for diagnostic application to mTBI. Other imaging techniques such as fluid attenuated 

inversion recovery, arterial spin labeling, and magnetic resonance angiography have been shown to be superior to the conventional spin-echo 

images in detecting mTBI-related abnormalities. Yet studies have only 

shown weak correlations between abnormal findings on MRI and residual symptoms (Topal, Hakyemez, Erdogan, Bulut, Koksal, Akkose, 

Dogan, Parlak, Ozguc, and Korfali, 2008; Mendez et al., 2005). For this 

reason, we will focus on a few select MR techniques that appear to have 

the most potential at this time for use of diagnosis and clinical assessment of mTBI.

Diffusion tensor imaging. DTI is acquired with a standard MRI scanner, 

and has been shown to be much more sensitive to white matter injury 

than conventional T1- and T2-weighted anatomic MRI. DTI noninvasively represents myelin structural integrity and cellular membranes 

of white matter tracts. The technique is based on movement of water 

molecules or anisotropic diffusion (indexed as fractional anisotropy), 
ENHANCING OPERATIONAL READINESS THROUGH NEUROIMAGING 271

which tend to move faster along, rather than perpendicular to, nerve 

fibers. Tractography is an advanced DTI application that has shown itself to be sensitive to detection of mTBI, especially in measuring the 

thickness of myelin sheaths and axons, distribution of directions, and 

density of white matter tracts (Kraus, Susmaras, Caughlin, Walker, 

Sweeney, and Little, 2007; Niogi, Mukherjee, Ghajar, Johnson, Kolster, 

Sarkar, Lee, Meeker, Zimmerman, Manley, and McCandliss, 2008). 

DTI has shown promising results in its ability to detect subtle 

structural abnormalities associated with mTBI (Wilde, McCauley, Hunter, Bigler, Chu, Wang, Hanten, Troyanskaya, Yallamalli, Li, Chia, and 

Levin, 2008). Recently, Niogi and colleagues (2008) found that the number of damaged white matter structures, but not the number of traumatic microhemorrhages, was significantly correlated with mean reaction time on a simple cognitive task (Attention Network Task). These 

results are in accord with behavioral findings from other studies of deficits in speed of processing and attention following mTBI (Tombaugh et 

al., 2007; Drew et al., 2007). 

The development of DTI is in the early stage, and therefore needs 

more validating. New methodological developments may lead to improved quantitative assessment of white-matter integrity and volume. 

This will greatly enhance clinicians’ and researchers’ ability to apply DTI 

to the diagnosis and assessment of mTBI. 

Functional MRI. Functional MRI (fMRI) is a specialized form of MRI 

scan that measures the hemodynamic response related to neural activity in the brain or spinal cord. With fMRI, neuroimagers can map 

various types of physiological information, including baseline cerebral 

blood volume and changes in cerebral blood volume, baseline and cerebral perfusion, cerebral blood oxygenation, resting state cerebral oxygen 

extraction fraction, and cerebral metabolic rate for oxygen (Bandettini, 

2006). Functional MRI studies typically incorporate blood oxygen level 

dependent (BOLD) changes that measure the hemodynamic response 

to neuronal activity. This response is a process in which blood releases 

oxygen to active neurons at a greater rate than to inactive neurons. The 

BOLD method measures the difference in magnetic susceptibility between oxyhemoglobin and deoxyhemoglobin. 

Assessment of overall brain function and region(s) of interest using fMRI requires the use of experimental paradigms. For mTBI, fMRI 

imaging typically occurs during the performance of tasks that load 

frontal lobe functioning (for example, attention and working memory). 
272 THE 71F ADVANTAGE

Tasks that rely on working memory neural circuitry have been helpful 

in many neuroimaging studies of mTBI. The impetus is that the psychological domains linked with frontal lobe functioning are inherently involved in many functional aspects of interest to humans, and they are 

the most anatomically vulnerable to cerebral insult as a result of coupcontra-coup contusions to the frontal and posterior (also temporal-temporal, which may include damage to lateral prefrontal cortex, somatosensory, insular cortices, and so forth) grey matter resulting from acceleration/deceleration impact against the skull. 

Behavioral and imaging studies provide support for the use of 

working memory tasks as valid measures of frontal lobe functioning in 

mTBI patients (Lovell, Collins, Iverson, Field, Maroon, Cantu, Podell, 

Belza, and Fu, 2003; Chen, Johnston, Collie, McCrory, and Ptito, 2008; 

Tucker, 1999; Chen, Johnston, Petrides, and Ptito, 2008). Using various 

n-back conditions, McAllister and colleagues (2001) provided evidence 

that fMRI is sensitive to differential effects of memory load in individuals with mTBI. Using fMRI and a working memory task, Chen and colleagues (2008) replicated these findings and demonstrated atypical brain 

activation patterns in the dorsolateral prefrontal cortex (DLPFC) in all 

symptomatic concussed athletes compared to nonconcussed athletes. At 

a follow-up session, individuals that remained symptomatic continued 

to show atypical DLPFC activation. Jantzen, Anderson, Steinberg, and 

Kelso (2004) used a test battery that included mathematical, memory, 

and sensorimotor coordination tasks for comparing preseason baselines 

with postconcussion measures in athletes. Their results indicated that 

concussed players had marked within-subject increases in BOLD activation of parietal and lateral frontal and cerebellar regions during fingersequencing. These studies plus findings from other studies (Laatsch, Thulborn, Krisky, Shobat, and Sweeney, 2004) reveal the potential value for 

the use of fMRI in developing return-to-duty standards for the military. 

There is also evidence that fMRI may have predictive value for 

determining successful recovery from mTBI. Using athletes, Lovell and 

colleagues (2007) found that abnormal fMRI results during the first 

week of recovery predicted clinical recovery. The study suggested that 

some individuals with greater cerebral hyperactivation may recover 

more slowly than athletes with less hyperactivation. 

Overall, compared to other functional imaging techniques such 

as PET and single photon emission computed tomography (SPECT), 

fMRI is preferred due to higher temporal resolution, better availability, 
ENHANCING OPERATIONAL READINESS THROUGH NEUROIMAGING 273

lower costs, and the absence of ionizing radiation exposure. However, 

there are specific limitations of fMRI for assessing brain activation that 

can be attributed to the methods used to collect data and the relationship between neuronal activity and hemodynamic change. For example, 

compared to other underlying processes such as action potentials, the 

hemodynamic response is relatively slow with a latency range of 4 seconds, due to variation in the neuronal activity and oxygen and cerebral 

blood flow that accompanies brain activation.

Methodological considerations are also important for improving the diagnostic value of fMRI. Spatial resolution with BOLD fMRI is 

determined by spatial spread of hemodynamic and neurovascular coupling. Techniques allow for good resolution in the range of 1 to 3 cubic 

millimeters. In addition, BOLD can have a low signal sensitivity and a 

wide range of possible artifacts (for example, susceptibility artifact between air and tissue in ventral-frontal and temporal regions) that can 

pose difficulties. However, this issue has also been addressed by methodological strategies such as emphasizing task modulation to assess 

changes in latency and width of region activation (Bellgowan, Saad, and 

Bandettini, 2003). In addition, neurochemical and metabolic changes 

occur immediately following mTBI. These changes often disrupt various neuropsychological processes, but are typically ephemeral in that 

they resolve within days or weeks. For this reason, repetition of fMRI 

may be useful for patients who manifest symptoms of cognitive dysfunction after the acute phase has passed in order to tease apart transient physiological changes from residual cognitive deficits. 

Brain Receptor Imaging

One aspect of cerebral trauma is an increased postinjury need 

for glucose (the brain’s primary metabolic fuel), but due to the injury, there is hypoperfusion (Bonne, Gilboa, Louzon, Sherf, Katz, Fishman, Nahum et al., 2003). Thus, there is an imbalance between the 

brain’s need for energy and the body’s ability to meet that need on a 

metabolic basis. PET scans produce a 3–D image of functional processes in the brain by detecting pairs of gamma rays emitted indirectly 

by a radionuclide that is introduced into the body attached to an active biological molecule. Similarly, SPECT uses the detection of gamma rays to produce a valid 3–D image. However, the difference is that 

while the PET tracer emits positrons that collide with electrons, causing 

gamma photons to be emitted, the SPECT tracer (a radioactive tracer; 
274 THE 71F ADVANTAGE

isotope) emits gamma radiation. Findings from PET and SPECT studies have shown frontal and temporal hypometabolism following mTBI 

at rest and during working memory tasks (Chen, Kareken, Fastenau, 

Trexler, and Hutchins, 2003; Umile, Sandel, Alavi, Terry, and Plotkin, 

2002). PET scans can demonstrate precise regions of increased glucose 

needs, whereas SPECT can detect cerebral perfusion (Frankle, Slifstein, 

Talbot, and Laruelle, 2005). 

Although SPECT scans are much less expensive than PET scans, 

both are considered to be invasive and risky because the procedures involve an intravenous injection of a radioactive tracer. Furthermore, due 

to the radioactive substance, imagers must limit the number of sessions/

studies, therefore limiting serial testing, which has important clinical 

implications. Currently, there are an insufficient number of radiotracers 

available, making PET and SPECT less than optimal and not the most 

practical for serial assessment of mTBI. Overall, PET has better temporal resolution than SPECT (Frankle et al., 2005), which explains why it 

is often the preferred method.

Magnetic Resonance Spectroscopy

MRS is an advanced quantitative technique based on signals generated from the net spin of atomic nuclei from various molecules when 

disrupted by a radio frequency. Molecules utilized for MRS include hydrogen, phosphorus, lithium, fluorine, and sodium. These signals can 

be converted to a form of spectra to provide meaningful data on the 

chemical composition at the region of interest (Keshavan, Kapur, and 

Pettegrew, 1991). 

This approach has shown promise for assessing brain metabolic 

abnormalities following cerebral insult. Using MRI with a group of 

mTBI patients, Cohen and colleagues (2007) were able to detect neuronal injury beyond the minimal focal lesions observed with MR using 

a whole-brain N-acetylaspartate analysis (NAA). Using proton magnetic 

resonance spectroscopy, Yeo and colleagues (2006) provided some evidence that neurometabolic ratios of NAA/creatine and choline/creatine 

predict neuropsychological performance in TBI patients. Changes in 

these ratios from 3 to 21 weeks post-injury were suggestive of neurometabolic recovery. In addition to Yeo et al., other studies have provided 

evidence, using athletes who experienced LOC, that brain metabolite 

ratios may be useful to support return-to-duty decisions (Vagnozzi, 
ENHANCING OPERATIONAL READINESS THROUGH NEUROIMAGING 275

Signoretti, Tavazzi, Floris, Ludovici, Marziali, Tarascio, Amorini, Di Pietro, Delfini, and Lazzarino, 2008). 

MRS is limited by varying ranges of detectable chemicals, neurochemical noise, and varying metabolite to parenchyma (that is, brain 

matter) ratios for each receiver coil (Danielsen and Ross, 1999). Also, 

increased leakiness following cell membrane damage can result in a 

washout of metabolites, therefore making it more difficult to differentiate smaller areas that have been damaged from widespread cellular 

apoptosis and necrosis. Overall, MRS has good spatial resolution, but 

low sensitivity and specificity for optimal use in assessment of mTBI. 

MRS is best used in post-acute stages because cellular energy status is 

maintained until relatively late in the process.

Discussion

Roadblocks

With the exception of visible damage to brain matter, there is not 

one simple symptom or marker that can be reliably used to make a diagnosis of brain injury. Unless the TBI-related event is witnessed by an 

objective observer, or there is external damage to the head providing 

conclusive information detailing the mechanism of injury, orientation, 

and other relevant characteristics of the accident, health care providers 

must apply clinical judgment to bridge information gaps that diagnostic 

tools do not currently fill. 

Neuroimaging techniques have greatly contributed to our understanding of the impact of mTBI. However, there are some pragmatic 

limitations of MR technology. With the use of ultra-high magnetic 

fields, there is better signal-to-noise ratio and improved temporal and 

spatial resolution. For example, scientists can map submillimeter columnar and laminar functional structures and detect neural activity in 

certain tasks to tens of milliseconds (Kim and Ogowa, 2002). However, 

strong magnetic fields such as those greater than 3 Tesla (3T) have 

greater technical demands, are more expensive, and have trade-off limitations such as increased noise within the scanner (Kim and Ogawa, 

2002). The current standard is the use of the 3T in human research and 

clinical settings. Use of MRI is inadvisable for patients with shrapnel due 

to the inherent risks presented by the powerful magnet, which can be an 

obstacle when working with Soldiers.
276 THE 71F ADVANTAGE

Integration

Limitations in the spatial and temporal resolution of imaging techniques highlight the need to integrate neuroscience approaches (Lewine, Davis, Bigler, Thoma, Hill, Funke, Sloan, Hall, and Orrison, 2007; 

Niogi et al., 2008). There has been some work that combines structural 

and functional imaging to provide a more detailed analysis. For example, DTI and fMRI are complementary for use for assessing neuropsychological functioning. Nagy, Westerberg, and Klingerg (2004) provided 

evidence that DTI fractional anisotropy values in fronto-parietal white 

matter correlated with BOLD response in areas that could form a functional network underlying working memory function. Other evidence 

suggests that combined use of DTI and susceptibility weighted imaging (SWI) improve detection of mTBI (Kou, Benson, Gattu, and Haacke, 

2008). These studies reported that SWI detected more hemorrhages than 

conventional MRI, and DTI detected more nonhemorrhagic lesions than 

observed with SWI. Concomitant use of various imaging approaches 

in assessment of cerebral functioning improves clinical utility for assessing mTBI (Schlosser, Nenadic, Wagner, Gullmar, Von Consbruch, 

Kohler, Schultz, Koch, Fitzek, Matthews, Reichenach, and Sauer, 2007).

Other physiological modalities have been simultaneously carried 

out during collection of fMRI data. Electroencephalography, eye tracking, 

optical imaging, skin conductance responses, magnetoencephalography, 

respiration, and heart rate have all been used concomitantly to enhance 

precision and alleviate uncertainty of imagers (Gosseries, Demertzi, 

Noirhomme, Tshibanda, Boly, de Beek, Hustinx et al., 2008). Improved 

methodological strategies, such as pre- and/or post-fMRI, have also minimized some uncertainty. Additionally, accurately reflecting physiological activity linked with mTBI requires continued sophistication of statistical analysis of single and combined techniques. Importantly, statistical models need to be developed to incorporate and integrate results 

from different laboratories across all the methods. Methodological and 

statistical analysis standardization would help homogenize efforts across 

the myriad of organizations and facilities involved with TBI research. 

Imaging Biomarkers and Clinical Application

To date, CT and MRI are the only imaging techniques used for 

clinical diagnosis. As research progresses, there are prospects of the 

clinical application of functional imaging (fMRI, PET, and DTI) for 
ENHANCING OPERATIONAL READINESS THROUGH NEUROIMAGING 277

mTBI diagnosis and evaluation. For the U.S. Armed Forces, this has 

beneficial implications when considering the need for return-to-duty 

guidelines. However, there is a need for validation of images to ensure 

face validity; standardization of imaging protocols, including upgraded 

scanners; development of sophisticated informatics to integrate with 

information collected from different imaging modalities, genetics, and 

protein expression; and the identification and development of new radiotracers and drugs capable of penetrating the blood-brain barrier. 

In-theater Multimodal Technologic Approach

Improvements in helmet sensors for quantifying blast exposure 

and the addition of video instrumentation may provide better injuryevent information for improving clinical diagnosis and assessment. In 

the future, if mTBI is suspected, new technologies will be used for multimodal testing, including neuropsychological testing (against pre-established baseline), structural and functional imaging, biomarker assaying, 

and advanced telemedicine capabilities, to get clinical interpretation of 

the results from experts. In addition, there is a need to develop algorithms based on models from neurocognitive, eye pupilometry, imaging, electrophysiology, genetic, and serum biomarkers measures for assessing the degree of neural damage sustained. 

Conclusion

Recent brain imaging approaches and technologies have contributed to the medical and research communities’ understanding of mTBI 

pathophysiological outcomes. Although there have been tremendous 

gains, limitations remain—produced not only by uncertainties that resulted in the injury, but also by the interplay between neurophysiology 

and imaging technology. To address the various gaps, enhance diagnostic accuracy, and improve imaging utility, DOD should emphasize basic 

projects that calibrate and validate the correlation of different imaging 

methods and physiological brain events. 
278 THE 71F ADVANTAGE

References

Azouvi, P., Couillet, J., Leclercq, M., Martin, Y., Asloun, S., and Rousseaux, M. (2004). Divided 

attention and mental effort after severe traumatic brain injury. Neuropsychologia 42, 

1260–1208.

Bailes, J.E., and Hudson, V. (2001). Classification of sport-related head trauma: a spectrum of 

mild to severe injury. Journal of Athletic Training, 36, 236–243.

Bandettini, P.A. (2006). Functional magnetic resonance imaging. In C. Senior, T. Russell, and 

M.S. Gazzaniga (eds.). Methods in Mind (193–235). Cambridge, MA: MIT Press.

Basser, P.J., and LeBihan, D. (1992). Fiber orientation mapping in an anisotropic medium with 

NMR diffusion spectroscopy [Abstract]. SMRM Proceedings 11:1221. Presented at Society for Magnetic Resonance in Medicine 11th Annual Meeting, Berlin, Germany.

Basser, P.J., Mattielo, J., and LeBihan, D. (1992) Diagonal and off-diagonal components of the 

self-diffusion tensor: Their relation to and estimation from the NMR spin-echo signal 

[Abstract]. SMRM Proceedings 11:1222. Presented at Society for Magnetic Resonance in 

Medicine 11th Annual Meeting, Berlin, Germany.

Bay, E., Hagerty, B.H., and Williams, R.A. (2007). Depressive symptomotology after mild-tomoderate traumatic brain injury: A comparison of three measures. Archives of Psychiatric Nursing 21, 2–11. 

Bay, E., and McLean, S.A. (2007). Mild traumatic brain injury: An update for advanced practice 

nurses. Journal of Neuroscience Nursing 39, 43–51.

Behan, L.A., Phillips, J., Thompson, C.J., and Agha, A. (2008). Neuroendocrine disorders after 

traumatic brain injury. Journal of Neurology, Neurosurgery, and Psychiatry 79, 757.

Bellgowan, P.S.F., Saad, Z.S., and Bandettini, P.A. (2003). Understanding neural system dynamics through task modulation and management. Proceedings of the National Academy of 

Sciences 100, 1415–1419.

Belliveau, J.W., Kennedy, D.N., McKinstry, R.C., Buchbinder, B.R., Weisskoff, R.M., Cohen, M.S., 

Verea, J.M., Brady, T.J., and Rosen, B.R. (1991). Functional mapping of the human visual 

cortex by magnetic resonance imaging. Science 254, 716–719.

Bhattacharjee, Y. (2008). Shell shock revisited: Solving the puzzle of blast trauma. Science 319, 

406–408.

Bigler, E.D. (2008). Neuropsychology and clinical neuroscience of persistent post-concussive 

syndrome. Journal of the International Neuropsychological Society 14, 1–22. 

Bonne, O., Gilboa, A., Louzon, Y., Sherf, O.K., Katz, M., Fishman, Y., Nahum, Z.B., Krausz, Y., Bocher, M., Lester, H., Chisin, R., and Lerer, B. (2003). Cerebral blood flow in chronic symptomatic mild traumatic brain injury. Psychiatry Research: Neuroimaging 124, 141–152.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. 

(2003). Report to Congress on mild traumatic brain injury in the United States: Steps to 

prevent a serious public health problem. Atlanta, GA: Centers for Disease Control and 

Prevention.

Centers for Disease Control and Prevention. (2002). Heads up: Facts for physicians about mild 

traumatic brain injury (MTBI). Retrieved March 28, 2008, from <www.cdc.gov/Migrated_Content/Brochures_and_Catalogs/tbi_mtbi_facts_for_physicians.pdf>. 

Chen, J., Johnston, K.M., Petrides, M., and Ptito, A. (2008). Recovery from mild head injury 

in sports: Evidence from serial functional magnetic resonance imaging studies in male 

athletes. Clinical Journal of Sports Medicine 18, 241–175.

Chen, S.H.A., Kareken, D.A., Fastenau, P.S., Trexler, L.E., and Hutchins, G.D. (2003). A study 

of persistent post-concussion symptoms in mild head trauma using positron emission 

tomography. Journal of Neurology, Neurosurgery, and Psychiatry 74, 326–332.

Cohen, B.A., Inglese, M., Rusinek, H., Babb, J.S., Grossman, R.I., and Gonen, O. (2007). Proton 

MR spectroscopy and MRI-volumetry in mild traumatic brain injury. American Journal 

of Neuroradiology 28, 907–913. 
ENHANCING OPERATIONAL READINESS THROUGH NEUROIMAGING 279

Creamer, M., O’Donnell, M.L., and Pattison, P. (2005). Amnesia, traumatic brain injury, and 

posttraumatic stress disorder: A methodological inquiry. Behaviour Research and Therapy 43, 1383–1389.

Danielsen, E.R., and Ross, B. (1999). Magnetic resonance spectroscopy diagnosis of neurological 

diseases. New York: Marcel Dekker. 

Dretsch, M., and Tipples, J. (2008). Working memory involved in predicting future outcomes 

based on past experiences. Brain and Cognition 66, 83–90.

Drew, A.S., Langan, J., Halterman, C., Osternig, L.R., Chou, L., and van Donkelaar, P. (2007). Attentional disengagement dysfunction following mTBI assessed with the gap saccade task. 

Neuroscience Letters 417, 61–65.

Duff, M.C., Proctor, A., and Haley, K. (2002). Mild traumatic brain injury (mTBI): Assessment 

and treatment procedures used by speech-language pathologists (SLPs). Brain Injury 16, 

773–787.

Esselman, P.C., and Uomoto, J.M. (1995). Classification of the spectrum of mild traumatic head 

injury. Brain Injury 9, 417–424.

Frankle, W.G., Slifstein, M., Talbot, P.S., and Laruelle, M. (2005). Neuroreceptor imaging in psychiatry: Theory and applications. International Review of Neurobiology 67, 385–440. 

Giza, C.C., and Hovda, D.A. (2001). The neurometabolic cascade of concussion: Sport-related 

concussion. Journal of Athletic Training 36, 228–235. 

Gosseries, O., Demertzi, A., Noirhomme, O., Tshibanda, J., Boly, M., de Beeck, M.O., Hustinx, 

R., Maquet, P., Salmon, E., Moonen, G., Luxen, A., Laureys, S., and De Tiège, X. (2008). 

Functional neuroimaging (fMRI, PET and MEG): What do we measure. Revue Medicale 

de Liege 63, 231–237.

Gray, J.R., Braver, T.S., and Raichle, M.E. (2002). Integration of emotion and cognition in the 

lateral prefrontal cortex. Proceedings of the National Academy of Sciences 99, 4115–4120.

Guskiewicz, K.M., McCrea, M., Marshall, S.W., Cantu, R.C., Randolph, C., Barr, W., Onate, J.A., 

and Kelly, J.P. (2003). Cumulative effects associated with recurrent concussion in collegiate football players: The NCAA Concussion Study. Journal of the American Medical 

Association 19, 2549–2555. 

Holcomb, J.B., Stansbury, L.G., Champion, H.R., Wade, C., and Bellamy, R.F. (2006). Understanding combat casualty care statistics. Journal of Trauma 60, 397–401. 

Jackson, G.L., Hamilton, N.S., and Tupler, L.A. (2008). Detecting traumatic brain injury among 

veterans of Operations Enduring and Iraqi Freedom. North Carolina Medical Journal 69, 

43–47. 

Jantzen, K.J., Anderson, B., Steinberg, F.L., and Kelso, S. (2004). A prospective functional MR imaging study of mild traumatic brain injury in college football players. American Society 

of Neuroradiology 25, 738–745. 

Johnston, K.M., Ptito, A., Chankowsky, J., and Chen, K. (2001). New frontiers in diagnostic imaging in concussive head injury. Clinical Journal of Sport Medicine 11, 166–175.

Kashluba, S. Paniak, C., Blake, T., Reynolds, S., Toller-Lobe, G., and Nagy, J. (2004). A longitudinal, controlled study of patient complaints following treated mild traumatic brain injury. 

Archives of Clinical Neuropsychology 19, 805–816.

Kelly, J.P. (1999). Traumatic brain injury and concussion in sports. Journal of the American Medical Association 282, 989–991.

Keshavan, M.S., Kapur, S., and Pettegrew, J.W. (1991). Magnetic resonance spectroscopy in psychiatry: Potential, pitfalls, and promise. American Journal of Psychiatry 148, 976–985.

Kim, S., and Ogawa, S. (2002). Insights into new techniques for high resolution functional MRI. 

Current Opinion in Neurobiology 12, 607–615.

Korn, A., Golan, H., Melamed, I., Pascual-Marqui, R., and Friedman, A. (2005). Focal cortical 

dysfunction and blood-brain barrier disruption in patients with postconcussion syndrome. Journal of Clinical Neurophysiology 22, 1–9.
280 THE 71F ADVANTAGE

Kou, Z., Benson, R., Gattu, R., and Haacke, M. (2008). Improving the detection of diffuse axonal 

injury by complementary use of advanced MRI: 0037. Journal of Head Trauma Rehabilitation 23, 351–352.

Kraus, J., Schaffer, K., Ayers, K., Stenehjem, J., Shen, H., and Afifi, A.A. (2005). Physical complaints, 

medical service use, and social and employment changes following mild traumatic brain 

injury: A 6-month longitudinal study. Journal of Head Trauma Rehabilitation 20, 239–256. 

Kraus, M.F., Susmaras, T., Caughlin, B.P., Walker, C.J., Sweeney, J.A., and Little, D.M. (2007). 

White matter integrity and cognition in chronic traumatic brain injury: A diffusion tensor imaging study. Brain 130, 2508–2519.

Kurca, E., Sivak, S., and Kucera, P. (2006). Impaired cognitive functions in mild traumatic brain 

injury patients with normal and pathological magnetic resonance imaging. Neuroradiology 48, 661–669. 

Laatsch, L.K., Thulborn, K.R., Krisky, C.M., Shobat, D.M., and Sweeney, J.A. (2004). Investigating the neurobiological basis of cognitive rehabilitation therapy with fMRI. Brain Injury

18, 957–974. 

Levine, B., Black, S.E., Cheung, G., Campbell, A., O’Toole, C., and Schwartz, M.L. (2005). Cognitive and Behavioral Neurology 18, 45–54.

Levine, B., Fujiwara, E., O’Connor, C., Richard, N., Kovacevic, N., Mandic, M., Restagno, A., 

Easdon, R., Robertson, I.H., Graham, S.J., Cheung, G., Gao, F., Schwartz, M.L., and 

Black, S.E. (2006). In vivo characterization of traumatic brain injury neuropathology 

with structural and functional neuroimaging. Journal of Neurotrauma 23, 1396–1411. 

Lewine, J.D., Davis, J.T., Bigler, E.D., Thoma, R., Hill, D., Funke, M., Sloan, J.H., Hall, S., and Orrison, W.W. (2007). Objective documentation of traumatic brain injury subsequent to 

mild head trauma: multimodal brain imaging with MEG, SPECT, and MRI. Journal of 

Head Trauma Rehabilitation 22, 141–155. 

Lizerbram, E., and Moffit, B. (2001). Neuroimaging in acute brain injury. Topics in Emergency 

Medicine 23, 47–59.

Lovell, M.R., Collins, M.W., Iverson, G.L., Field, M., Maroon, J.C., Cantu, R., Podell, K., Powell, 

J.W., Belza, M., and Fu, F.H. (2003). Recovery from mild concussion in high school athletes. Journal of Neurosurgery 98, 295–301.

Lovell, M.R., Pardini, J.E., Welling, J., Collings, M.W., Bakal, J., Lazar, N., Roush, R., Eddy, W.F., 

and Becker, J.T. (2007). Functional brain abnormalities are related to clinical recovery 

and time to return-to-play in athletes. Neurosurgery 61, 352–360.

Macciocchi, S.N., Barth, J.T., Alves, W., Rimel, R.W., and Jane, J.A. (1996). Neuropsychological 

functioning and recovery after mild head injury in collegiate athletes. Neuroscience Online 39, 510–514. Retrieved from <http://ovidsp.tx.ovid.com/spb/ovidweb.cgi>.

Malojcic, B., Mubrin, Z., Coric, B., Susnic, M., and Spilich, G.J. (2008). Consequences of mild 

traumatic brain injury on information processing assessed with attention and shortterm memory tasks. Journal of Neurotrauma 25, 30–37.

McAllistar, T.W., Sparling, M.B., Flashman, L.A., Guerin, S.J., Mamourain, A.C., and Saykin, A.J. 

(2001). Differential working memory load effects after mild traumatic brain injury. Neuroimage 14, 1004–1012. 

McIntire, A., Langan, J., Halterman, C., Drew, A., Osternig, L., Chou, L., and van Donkelaar, P. 

(2006). The influence of mild traumatic brain injury on the temporal distribution of attention. Experimental Brain Research 174, 361–366.

Mendez, C.V., Hurley, R.A., Lassonde, M., and Taber, K.H. (2005). Mild traumatic brain injury: 

Neuroimaging of sports-related concussion. Journal of Neuropsychiatry Clinical Neuroscience 17, 297–303.

Moore, D.F., Radovizky, R.A., Shupenko, L., Klinoff, A., Jaffee, M.S., and Rosen, J.M. (2008). Blast 

physics and central nervous system injury. Future Neurology 3, 243–250.

Mori, T., Katayama, Y., and Kawamata, T. (2006). Acute hemispheric swelling associated with 

thin subdural hematomas: pathophysiology of repetitive head injury in sports. Acta Neurochirurgica Supplement 96, 40–43. 
ENHANCING OPERATIONAL READINESS THROUGH NEUROIMAGING 281

Nagy, Z., Westerberg, H., and Klingberg, T. (2004). Maturation of white matter is associated with 

the development of cognitive functions during childhood. Journal of Cognitive Neuroscience 16, 1227–1233.

Niogi, S.N., Mukherjee, P., Ghajar, J., Johnson, C., Kolster, R.A., Sarkar, R., Lee, H., Meeker, M., 

Zimmerman, R.D., Manley, G.T., and McCandliss, B.D. (2008). Extent of microstructural white matter injury in postconcussive syndrome correlates with impaired cognitive reaction time: A 3T diffusion tensor imaging study of mild traumatic brain injury. 

American Journal of Neuroradiology 29, 967–973.

Nolin, P. (2006). Executive memory dysfunctions following mild traumatic brain injury. Journal 

of Head Trauma Rehabilitation 21, 68–75. 

Nolin, P., and Heroux, L. (2006). Relations among sociodemographic, neurologic, clinical, and 

neuropsychiatric variables, and vocational status following mild traumatic brain injury. 

Journal of Head Trauma Rehabilitation 21, 514–526. 

Office of the Surgeon General and Office of Surgeon, Multi-National Force–Iraq. (2006). Mental 

health advisory team (MHAT) IV report, Operation Iraqi Freedom 05–07.

Ombaugh, T.N., Rees, L., Stormer, P., Harrison, A.G., and Smith, A. (2007). The effect of mild 

and severe traumatic brain injury on speed of information processing as measured by the 

computerized tests of information processing (CTIP). Archives of Clinical Neuropsychology 22, 24–36.

Pecchinenda, A., Dretsch, M., and Chapman, P. (2006). The effect of working memory load on 

emotion-based processes involved in choosing advantageously. Experimental Psychology

53, 191–197.

Ruff, R. (2005). Two decades of advances in understanding of mild traumatic brain injury. Journal of Head Trauma Rehabilitation 20, 5–18.

Ryan, L.M., and Warden, D.L. (2003). Post concussion syndrome. International Review of Psychiatry 15, 310–316.

Saboori, M., Ahmadi, J., and Farajzadegan, Z. (2007). Indication for brain CT scan in patients 

with minor head injury. Clinical Neurology and Neurosurgery 109, 399–405.

Schlosser, R.G.M., Nenadic, I., Wagner, G., Gullmar, D., Von Consbruch, K., Kohler, S., Christoph, S.C., Koch, K., Fitzek, C., Matthews, P.M., Reichenbach, J.R., and Sauer, H. (2007). 

White matter abnormalities and brain activation in schizophrenia: A combined DTI and 

fMRI study. Schizophrenia Research 89, 1–11.

Schlund, M.W., and Pace, G. (2000). The effects of traumatic brain injury on reporting and responding to causal relations: an investigation of sensitivity to reinforcement contingencies. Brain Injury 14, 573–583. 

Schneiderman, A.I., Braver, E.R., and Kang, H.K. (2008). Understanding sequelae of injury 

mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and 

Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder. 

American Journal of Epidemiology 15, 1446–1452.

Sivák, S., Kurca, E., Hladká, M., Zelenák, K., Turcanová-Koprusáková, K., and Michalik, J. (2008). 

Early and delayed auditory oddball ERPs and brain MRI in patients with mTBI. Brain 

Injury 22, 193–197.

Sosnoff, J.J., Broglio, S.P., and Ferrara, M.S. (2008). Cognitive and motor functions are associated 

following mild traumatic brain injury. Experimental Brain Research 187, 563–571.

Stulemeijer, M., van der Werf, S, Bleijenberg, G., Biert, J., Brauer, J., and Vos, P.E. (2006). Recovery 

from mild traumatic brain injury: A focus on fatigue. Journal of Neurology 253, 1041–1047. 

Taber, K.H., Warden, D.L., and Hurley, R.A. (2006). Blast-related traumatic brain injury: What is 

known? Journal of Neuropsychiatry and Clinical Neuroscience 18, 141–145.

Teasdale, G. and Jennett, B. (1974). Assessment of coma and impaired consciousness: A practical 

scale. Lancet 2, 81–84.

Tombaugh, T.N., Rees, L., Stormer, P., Harrison, A.G., and Smith, A. (2007). The effects of mild 

and severe traumatic brain injury on speed of information processes as measured by the 
282 THE 71F ADVANTAGE

computerized tests of information processing (CTIP). Archives of Clinical Neuropsychology

22, 25–36.

Topal, N., Hakyemez, B., Erdogan, C., Bulut, M., Koksal, O., Akkose, S., Dogan, S., Parlak, M., 

Ozguc, H., and Korfali, E. (2008). MR imaging in the detection of diffuse axonal injury 

with mild traumatic brain injury. Neurological Research 30, 274–278.

Tucker, G. (1999). Functional MRI reveals dysfunction in the working brain. Journal Watch Psychiatry, 1201. 

Umile, E., Sandel, E., Alavi, A., Terry, C., and Plotkin, R. (2002). Dynamic imaging in mild traumatic brain injury: Support for the theory of medial temporal vulnerabilities. Archives of 

Physical Medicine and Rehabilitation 83, 1506–1513.

Vagnozzi, R., Signoretti, S., Tavazzi, B., Floris, R., Ludovici, A., Marziali, S., Tarascio, G., Amorini, 

A.M., Di Pietro, V., Delfini, R., and Lazzarino, G. (2008). Temporal window of metabolic 

brain vulnerability to concussion: A pilot 1H-magnetic resonance spectroscopic study in 

concussed athletes—part III. Neurosurgery 62, 1286–1295.

Vanderploeg, R.D., Curtiss, G., and Belanger, H.G. (2005). Long-term neuropsychological outcomes following mild traumatic brain injury. Journal of International Neuropsychological 

Society 11, 228–236.

Warden, D. (2006). Military TBI during the Iraq and Afghanistan wars. Journal of Head Trauma 

Rehabilitation 21, 398–402. 

Wilde, E.A., McCauley, S.R., Hunter, J.V., Bigler, E.D., Chu, Z., Wang, Z.J., Hanten, G.R., Troyanskaya, M., Yallampalli, R., Li, X., Chia, J., and Levin, H.S. (2008). Diffusion tensor imaging 

of acute mild traumatic brain injury in adolescents. Neurology 70, 948–955.

Yeo, R.A., Phillips, J.P., Jung, R.E., Brown, A.J., Campbell, R.C., and Brooks, W.M. (2006). Magnetic resonance spectroscopy detects brain injury and predicts cognitive functioning in 

children with brain injuries. Journal of Neurotrauma 23, 1427–1435.
283

Chapter 12

Why Do Soldiers Kill Themselves? 

Understanding Suicide in the Military

Sandra M. Escolas, Paul T. Bartone, Marek Rewers, Joseph M. Rothberg, 

and Joel Carter 

Despite much research on suicide, we still do not have a clear understanding of what causes people to kill themselves. Recent upward 

trends in suicide in the U.S. military have raised concern among senior 

leaders and led to additional education and prevention efforts. Unfortunately, these programs to date have shown scant evidence of success 

(Kuehn, 2009). A better understanding of the causes of suicide is needed 

in order to take more effective preventive steps.

At least as far back as World War II, suicide rates have been lower 

in the U.S. military than in age-matched civilian groups (Cassimatis 

and Rothberg, 1997; Rothberg, Bartone, Holloway, and Marlowe, 1990). 

Historical trends also show that in general, suicide rates in the military 

tend to decline during wartime (for example, Oesterlen, 1865; Rothberg, 

Holloway, and Ursano, 1987). One possible reason is that wartime may 

impart a greater sense of meaning in soldiers’ lives, thereby reducing 

any suicidal tendencies. Somewhat surprisingly, then, military suicide 

rates have increased in the years since 2003 when the United States began operations in Iraq. For example, in 2008, the U.S. Army suicide rate 

climbed to 20.2 (per 100,000), up from 12.7 in 2005 (see figure 12–1). 

For the first time, the Army suicide rate is higher than the comparable 

civilian rate, which was 19.5 for 2005 (most recent civilian data available; Centers for Disease Control [CDC], 2009). This alarming increase 

has led to redoubled efforts by the U.S. military to reduce or prevent suicides. Unfortunately, they continue to rise, as evidenced by continuing 

high figures for January and February of 2009 (Sheftick, 2009). Clearly, 

a better understanding of suicide in the military is needed in order to 

address it effectively.

This chapter will give a somewhat selective review of available 

studies and reports on suicide in the military, with the aim of clarifying 

the range of factors that can influence suicide in the military context. 

The research findings are diverse and at times inconsistent, but taken 
284 THE 71F ADVANTAGE

Figure 12–1. Suicide Rate among Active-duty U.S. Army

*Includes Reserve Component on Active duty

Source: Army Suicide Prevention Program Fact Sheet, January 26, 2009 available at <www.blackfive.net/SuicidePressKit.pdf>

2005 2006 2007 2008

25

20

15

10

5

0

Confirmed Suicides (per 100,000)*

Year

12.7

15.3

16.8

20.2

together, they can offer a better understanding of the factors that may 

lead to suicide. This understanding is a prerequisite to developing any 

truly effective prevention programs. The final section of this chapter 

will review some of the prevention programs that have been enacted by 

the military to date.

Definition of Suicide

Suicide is generally defined as the act of intentional, self-inflicted 

death. While this definition seems straightforward, in practice suicides 

are often difficult to determine with certainty. If the victim leaves no 

note or other clear evidence of intent, a suicidal death can easily be classified as an accident. For example, death by drug overdose, poisoning, 

motor vehicle accident, falling from a high place, or gunshot can be truly 

accidental or else suicide. In the U.S. military, all questionable deaths 

are carefully investigated to determine the cause. However, since many 

cases are ambiguous, investigations can last a year or more and do not 

always result in a clear determination. Most suicide rates are calculated 

using only clearly determined suicide cases, discarding ambiguous ones. 

Thus, the true prevalence of suicide in any group (including the military) is most likely underestimated. 

This problem is underscored by a study of U.S. military casualties 

across all Services (Carr, Hoge, Gardner, and Potter, 2004). The authors 

examined deaths of Active-duty (including very recent retirees) Servicemembers in the Army, Navy, Marine Corps, and Air Force for 1998–
UNDERSTANDING SUICIDE IN THE MILITARY 285

1999. All deaths (N = 124) that were classified in the Department of 

Defense Medical Mortality Registry as accidents (excluding motor vehicle 

deaths) or of undetermined cause were further examined as possible suicides. Suspicion of suicide was judged using Brent, Perper, and Allman’s 

(1987) criteria, which include psychiatric history and evidence of intent 

to commit suicide communicated verbally or in writing. Based on these 

criteria, the authors found six “accidental” deaths that were likely suicides 

within their sample. The authors also identified four suspicious gunshot-related deaths that were classified as accidents. Extrapolating from 

these numbers, correcting such misclassifications would increase the U.S. 

military suicide rate in 1998–1999 from 10.4 to 12.4 per 100,000. This 

means that suicides in the military could have been underreported by as 

much as 21 percent in that year. Similar studies in the civilian population 

have identified comparable rates of underreporting (Carr et al., 2004).

The problem of misclassification is compounded by the difficulties of calculating valid population-based suicide rates. Since suicide is 

a relatively low frequency event, even in large populations a small increase or decrease in incidence can have a dramatic effect on rates. 

To investigate this problem further, Eaton, Messer, Wilson, and Hoge 

(2006) reviewed suicides from 1990 to 2000 among all Active-duty Servicemembers aged 17 to 64 as compared to appropriate civilian population groups. Data were obtained from the Defense Medical Surveillance System, Centers for Disease Control (CDC), National Center for 

Health Statistics, and Vital Health Statistics System. After adjusting for 

demographic differences, the authors found that rates of suicide among 

the military were 25 to 33 percent lower than in the civilian population. 

However, with unaccounted variables and suicide rate fluctuations of 20 

to 40 percent per year, it is extremely difficult to link suicide rate differences to membership in the military, or for that matter to any particular prevention program. One weakness of the study is that while it recognizes the problems inherent in comparing demographically disparate 

populations, the age range among the civilian population also includes 

15- and 16-year-olds due to the Census Bureau’s method of age stratification. Similar demographic challenges arise when adjusting for race 

and gender. 

Theories of Suicide

Perhaps a less confounding introduction to the topic is a theoretical perspective on suicide. Durkheim (1951; originally published 1897) 
286 THE 71F ADVANTAGE

was one of the first to examine suicide from a population standpoint, 

noting a number of interesting trends and differences in suicide rates 

across various national and religious groups, as well as across seasons. 

In fact, Durkheim is credited with providing the first figures on suicide in the U.S. military (68 per 100,000 in the U.S. Army after the Civil War, from 1870 to 1884; Durkheim, 1951, as cited by Cassimatis and 

Rothberg, 1997). Durkheim describes four types of suicide: egotistical, 

altruistic, anomic, and fatalistic. Perhaps the most common is egotistical suicide, which occurs when people feel disconnected or separated 

from relevant social groups. This leads to a feeling of lonely desperation. 

Durkheim’s conception of altruistic suicide is in some ways opposite to 

egotistical suicide. It is the result of overly deep integration of the individual with the group, to the point that the individual loses a sense of 

separate individuality and is willing to “die for the cause” of the group. 

Most suicide bombers would fall into this category. Anomic suicide occurs when the normal regulatory functions of society are loosened or 

absent, as, for example, in times of economic turbulence or any dramatic 

change. In theory, people feel lost or without guideposts under such conditions, leading to anomie and increased suicide. Fatalistic suicide, on 

the other hand, increases when individuals feel overregulated or controlled by society (for example, slaves or serfs). In this case, suicide may 

appear as a reasonable escape route. 

Early studies by Menninger (1938) applied a Freudian psychoanalytic perspective, seeing suicide as the expression of basic self-destructive 

tendencies, or aggression turned inward. Another important theoretical 

perspective is that of Aaron Beck, for whom hopelessness is the common 

denominator for understanding suicide (Beck, Kovacs, and Weissman, 

1979). In several studies, Beck and colleagues have shown that hopelessness is highly predictive of suicidal behavior (Beck, Brown, Berchick, 

Stewart, and Steer, 1990). Schneidman (1996) described suicide as mainly 

the result of frustrated or thwarted needs that result in intense psychic 

pain, or “psychache.” This perspective is based largely on the personality theory of Henry Murray (1938), who emphasized the importance 

of satisfying a range of human needs, from primary biological ones to 

secondary psychological ones, including the need for affiliation, need 

for achievement and sense of competence, and the need for autonomy.

More recently, Joiner (2005) draws on Schneidman and Murray to provide his own theoretical explanation for suicide. Joiner posits three factors that must be present for suicide (or a serious attempt 
UNDERSTANDING SUICIDE IN THE MILITARY 287

at suicide) to occur: the acquired capacity for lethal self-injury, which 

comes with practice and involves desensitization to pain and fear of 

death; thwarted effectiveness, which also increases the sense of being a 

burden on others; and thwarted belongingness (disconnection from social groups). Thwarted effectiveness refers to the growing sense that one 

is lacking competence, is ineffective at getting things done, and is a failure. Thwarted belongingness involves the perception of being isolated, 

not a part of the social world. Perhaps significantly for understanding 

military suicide, Joiner also suggests that the acquired capacity for lethal 

self-injury can come about indirectly, through repeated exposure to violence and death in the surrounding environment (Joiner, 2005). Joiner 

argues that these three factors align to form a “dangerous convergence 

zone,” contributing to a greater risk for serious suicide behavior.

International Studies on Suicide

In this section, we review relevant studies on military suicide outside the United States. While not directly related to the topic of U.S. military suicide, these studies do examine the relationship between suicide 

and the trauma experienced by military populations exposed to wartime stressors. This relationship is clearly present among U.S. personnel 

deployed in Iraq and Afghanistan, and more broadly among all military 

personnel. After all, war and conflict represent the primary conditions 

for which soldiers continually train. Considered together, the works 

enumerated below may yield some insights into how people in general, 

and soldiers specifically, may slip into stress-related suicidal behaviors. 

The available research has yielded inconsistent findings as to how 

suicide rates are affected by war. A study in Croatia before, during, and 

after the Croatian War of Independence found that the rate rose 20.9 

percent during the wartime period itself over the prewar period (Bosnar, Stemberga, Coklo, Koncar, Definis-Gojanovic, Sendula-Jengic, and 

Katic, 2005). Conversely, the end of the war saw a drop of 26.2 percent. 

These findings found elevated wartime suicide rates as compared to 

peacetime rates. This trend was even more pronounced among the population under the age of 40, which saw a 45.3 percent rise in suicide rates 

from prewar to war, followed by a 56.6 percent drop in the 5 years after 

the war. However, because this study did not distinguish between military and civilian populations, the results are not readily generalizable 

to military forces. Also, the study does not explicitly use the standard 

method of reporting suicide rates as expressed per 100,000, making it 

difficult to interpret the results.
288 THE 71F ADVANTAGE

Despite these limitations, some valuable information can be taken from the study by Bosnar and colleagues (2005). They suggest that 

the availability of alcohol and firearms increases the risk of suicide during wartime, and that males are at greater risk than females. Results 

showed increases in completed suicides using firearms, and in the prevalence of intoxication among those committing suicide. Analysis also 

showed that the proportion of male to female suicides was significantly 

higher throughout all three time periods, which is consistent with 

other studies. 

In a similar study of a wartime population, Henderson, Stark, 

Humphry, and Selvaraj (2006) reviewed suicide rates in Scotland before, during, and after World War II. Contrary to the Bosnar et al. (2005) 

study, these authors found that suicide rates for both females and males 

decreased during World War II. However, they observe that this overall 

trend conceals a sizable increase in suicides among certain subgroups. 

For example, the rate among young men (15–24 years old) rose to a 

peak of 14.8 per 100,000 during 1942, and declined to 3.9 by 1945 as 

the war wound down. Similarly, the rate among men 25–34 years old 

reached 19.9 per 100,000 in 1943 before falling to 6.6 by 1946. Throughout the same period there was little change in the age-specific suicide 

rates among females. This suggests that young men suffer an increased 

risk of suicide relative to women during times of war. 

Henderson et al. (2006) also found an increase in the use of selfinflicted gunshot wounds. The authors attribute this in part to the increased availability of firearms, and the potential of becoming a combatant likely contributed to this rise. As in the Croatian study, occupation 

was not specifically considered, although the authors note that some of 

the observed suicides were likely members of the armed forces. Their 

conclusions are consistent with findings from the Bosnar et al. (2005) 

study in that males are more likely to commit suicide, and the ready 

availability of firearms is an added risk factor. This study also refines the 

understanding of changes in suicide rates during wartime by examining 

the rates among young males separately from the general population 

rates. This demographic group (which is roughly analogous to the population of the U.S. military) saw significant increases in suicide during 

wartime (World War II). While these studies of population suicide rates 

in Croatia and Scotland do not look specifically at military groups, they 

do suggest that the stress of war is associated with a rise in suicide rates 

generally, and especially among young males. 
UNDERSTANDING SUICIDE IN THE MILITARY 289

Perhaps a more relevant study from a military perspective is that 

of Mahon, Tobin, Cusack, Kelleher, and Malone (2005, 1688), who conducted a retrospective review of all deaths (N = 732) among regularduty Irish Defence Forces between 1970 and 2002. The authors found 

an average suicide rate of 15.3 per 100,000, with most suicides carried 

out while soldiers were alone shortly after starting morning duty. Additionally, 53 percent were committed using a firearm. The authors 

conclude that the military occupation has an influence on incidence and 

manner of suicide, and that easy access to lethal weapons in the workplace is an inherent risk factor. In order to prevent suicides, the authors 

suggest that “moderating the opportunity for suicide is critically important,” and that occupations that entail high exposure to lethal weapons 

should take greater measures for harm reduction centered on reducing 

the opportunity for self-injury (Mahon et al., 2005). This study once 

again confirms the risk associated with ready access to weapons. Recommendations for prevention are consonant with the “battle buddy” 

approach to suicide prevention that the U.S. military has recommended 

—that is, that small unit leaders and soldiers within the unit should be 

alert for any signs of suicide in their comrades, and move quickly to refer 

them for medical/professional support. While such steps are important 

and may indeed prevent some suicides, it must be recognized that they 

are in no way addressing the root causes of suicide in the military.

One study that sought to investigate the effectiveness of such preventive measures as well as determine the underlying causes of military suicide was conducted by the Russian Board of the Chief Military 

Prosecutor’s Office. As reported by Ryvkin (2000), this study examined 

causes of death among Russian servicemen during peacetime and found 

that suicide rates had not diminished despite preventive measures. The 

authors reported that almost 75 percent of suicides were committed by 

enlisted soldiers or sergeants, 10 percent by warrant officers, and the 

remaining 15 percent by officers. While this suggests that enlisted soldiers are at greater risk, these figures may be skewed by the disproportionate distribution of various ranks—a fact that is not addressed in 

the study. Young males (age 20–24) made up the largest demographic 

group among those committing suicide, with 98.3 percent of suicides 

within this age group being enlisted men in the first year of service—

although, again, proportionally adjusted rates were not provided. Similar to the studies already discussed, Ryvkin notes that enlisted servicemen generally commit suicide with firearms or by hanging, presumably 
290 THE 71F ADVANTAGE

because these are the most readily available methods. However, the authors also express concern about the growing use of explosives, which 

can have dangerous consequences for other military personnel or civilian bystanders. Like firearms, explosives (such as hand grenades) 

are readily available to military personnel and are highly lethal, which 

could make them an appealing means of suicide. High incidence of alcohol and narcotics use was also noted as contributing to suicide among 

Russian servicemen. 

Ryvkin claims that conditions of Russian military life by themselves may increase the risk for suicide, citing “difficulties in adapting to 

army conditions, bullying and harassment, an unhealthy moral climate 

in military collectives, excessive workloads connected with under manning of military units and detachments, and failure to meet prescribed 

food-ration standards” (Ryvkin, 2000, 43). This conclusion differs from 

many other studies, which tend to focus on external factors such as relationship troubles or financial problems as primary causes of suicide in 

the military. Ryvkin also notes the important role played by psychological disorders that go undetected during the recruit screening process or 

that develop during military service. He states that the lack of a sense of 

meaning and the absence of effective coping mechanisms significantly 

increase a soldier’s likelihood of committing suicide.

Bodner, Ben-Artzi, and Kaplan (2006) investigated suicide among 

18- to 21-year-old Israeli soldiers in combat arms units, as compared to 

support units. The study examined 429 soldier suicides (388 males, 41 

females) from 1979 to 1999, comparing them to a control group of 499 

soldiers (450 males, 49 females) who did not commit suicide. Military 

service in the Israel Defense Force (IDF) is mandatory for all healthy 

men and women, and a large portion of the force is assigned to support 

units (noncombatants). Bodner et al. (2006) compared combat arms 

and noncombat arms units, using a distinction established in a previous 

study by Fishman, Morris-Dycian, and Kotler (1990), who said conditions in combat arms units are “physically tough and very demanding; 

their overall service conditions are harder and more often involve lifethreatening situations than those of noncombatants” (226). 

During the entry phase for Israeli military service, all recruits 

thought to have psychological or behavioral problems are referred for 

a mental health assessment interview (MHAI). In the nonsuicide control group, there were no significant differences between combat arms 

unit and noncombat arms unit soldiers sent for MHAIs. In contrast, 
UNDERSTANDING SUICIDE IN THE MILITARY 291

among the suicide group, noncombat unit soldiers had been sent for 

mental health assessments significantly more often than combatant suicides. The authors suggest that noncombatant suicide may be related to 

preexisting dispositional factors. However, scores on the MHAI did not 

differentiate between soldiers who committed suicide and those who 

did not. Bodner and colleagues (2006) also found that combat unit soldiers who committed suicide showed a better behavioral adjustment to 

military service and expressed more motivation to serve than did noncombat unit soldiers committing suicide. High motivation, autonomy, 

and independence were seen as potential risk factors for combat unit 

member suicides because they may reflect perfectionist tendencies. The 

study also found that combat unit soldiers who committed suicide were 

referred for mental health services less frequently than noncombat unit 

soldier suicides. The combat unit suicides also had a stronger sense of 

duty, higher autonomy scores, and fewer unit changes. This suggests 

that combat unit suicides may be related to situational factors and firearms availability. The authors recommend further research into the personality and situational influences on soldier suicide, and more attention to identifying preexisting vulnerability characteristics in order to 

enable more effective prevention strategies.

Bodner et al. (2006) use combat-related service as a proxy for 

increased operational stress; however, they do not examine separately 

those troops who actually spent time in a war zone. Other studies have 

used peacekeeping operations as a proxy for increased operational 

stress, presumably because peacekeeping troops face many of the same 

difficult conditions and challenges as combat-deployed troops. A study 

conducted by Hansen-Schwartz, Jessen, Andersen, and Jørgensen 

(2002) looked at the frequency of suicide among Danish soldiers who 

participated in United Nations–mandated forces throughout the 1990s. 

Out of 3,859 soldiers deployed between 1995 and 1997, 4 male soldiers 

between the ages of 21 and 24 committed suicide. Of these four suicides, 

two were committed less than 1 month before deployment, and the other 

two soldiers committed suicide within 6 to 9 months of being repatriated. The study concluded that while suicide is not an overwhelming 

problem quantitatively, there are certain experiences “during a mission 

that may contribute to destabilizing the individual soldier psychologically 

and lead to suicidal ideation or even suicide” (Hansen-Schwartz et al., 

2002, 57). The authors note that the soldiers studied had suffered severe 

artillery bombardment, and the resultant stress may have contributed 
292 THE 71F ADVANTAGE

to the suicides. The relative infrequency of suicide, however, calls into 

question whether deployment-related stress truly brings about higher 

incidence of suicide among soldiers than the general population.

This question is explored further in a study by Michel, Lundin, 

and Larsson (2007), which compared suicide rates among 39,768 former 

Swedish peacekeeping personnel with the general population in Sweden between 1960 and 1999. Data gathered from the Swedish National 

General Population Registry and the Cause-of-Death Registry demonstrated that rates were lower in peacekeeping personnel than among the 

general population. This is consistent with studies of U.S. military personnel, which (until very recently) exhibited lower rates of suicide than 

the general population. The authors suggest that the rigorous selection 

and screening process for peacekeepers may account for the lower suicide rate among former peacekeeping personnel. They also recommend 

that further studies be conducted to investigate the differences in suicide rates and selection criteria between countries.

Similar conclusions were reached in a Canadian study comparing 66 military suicides during the period 1990 to 1995 to 2,601 randomly selected military controls, and also to 66 matched controls containing complete personnel and medical data (Wong, Escobar, Lesage, 

Loyer, Vanier, and Sakinofsky, 2001). The study assessed whether military personnel who had served as peacekeepers demonstrated elevated 

rates of suicide. Of the 66 suicides examined, 95 percent were male, 91 

percent were enlisted, and 46 percent were single persons. The mean 

age for those committing suicide was 30.4 years. While the authors did 

not find that peacekeeping increased overall suicide risk, they did conclude that “military lifestyles may strain interpersonal relationships, encourage alcohol abuse, and contribute to psychiatric illness and suicide 

in a minority of vulnerable individuals irrespective of peacekeeping assignment” (Wong et al., 2001, 103). They suggest that suicide risk may 

be reduced through a careful selection process and preparatory military 

training that encourages intra-group bonding and mutual support. In 

dealing with suicide prevention, the authors suggest there is an overarching problem of a “macho” soldier culture, which creates an environment that discourages soldiers from admitting to any emotional issues 

(Wong et al., 2001, 111).

In a large cohort study of suicide among 22,275 Norwegian former peacekeepers, Thoresen, Mehlum, and Moller (2003) found a moderate but statistically significant elevation in the standardized mortality 
UNDERSTANDING SUICIDE IN THE MILITARY 293

ratio (SMR) for suicide among peacekeepers compared to the general 

population. However, when the figures were adjusted for marital status, the SMR became statistically nonsignificant. For this reason, the authors believed that lower rates of marriage among military peacekeepers 

may be an indication “that the personnel were characterized by certain 

vulnerability factors before entering peacekeeping service, resulting in 

a reduced ability to enter into and remain in stable love relations” and 

a greater susceptibility to suicide (Thoresen et al., 2003, 605). The authors also noted a significant increase in suicide by firearms and carbon monoxide poisoning among military peacekeepers, presumably because these means are readily available. 

Thoresen conducted several other studies investigating suicide 

among military peacekeepers. Thoresen and Mehlum (2006) compared 

43 suicide cases with a control group of 41 fatal accident cases among 

Norwegian peacekeepers from 1978 to 1995. This “psychological autopsy” study sought to discover risk factors for suicide among veterans of 

peacekeeping operations. Findings showed that some preexisting mental health problem was the major risk factor for suicide. Additionally, 

both living alone and the break-up of a love relationship contributed 

to suicide risk, even when controlling for known mental health problems. No specific peacekeeping-related factor was significantly correlated with suicide. A later study, also examining psychological autopsy 

results, demonstrated that involuntary repatriation (early return to 

home country) from peacekeeping service, negative life events prior to 

the mission, and marital status were all factors with unique impact on 

suicide risk for peacekeepers. Consistent with other studies, single soldiers were at greater risk (Thoresen, Mehlum, Røysamb, and Tønnessen, 2006). 

Another study by Thoresen and Mehlum (2008) investigated the 

connection between war zone stress exposure and suicidal ideation in 

a 7-year followup of 1,172 Norwegian peacekeepers. The link between 

military stress exposure and suicidal ideation was stronger for those soldiers who also reported post-traumatic stress symptoms and general 

mental health problems. This suggests that post-traumatic stress disorder (PTSD) and other mental health problems may indicate greater risk 

for stress-related suicide. Thoresen and Mehlum (2004) also compared 

suicides with other types of death among peacekeepers. The authors observed that “alcohol-related fatal accidents were found to share many 

common features with the suicide group, such as depression, alcohol and 
294 THE 71F ADVANTAGE

substance abuse, and various social problems, and were also found to differ significantly from the other fatal accidents” (Thoresen and Mehlum, 

2004, 988). These findings may indicate the misclassification of suicides as alcohol-related accidents, or at the least, a common disposition 

toward self-destruction between alcohol-related fatal accidents and 

suicides (Thoresen and Mehlum, 2004, 991). 

The usefulness of these studies for understanding the impact of 

wartime stress exposure on outcomes such as suicide may be limited, 

however, because troops in peacekeeping operations are not generally 

exposed to the same acute stressors of combat. Several studies, such as 

Sareen, Cox, Afifi, Stein, Belik, Meadows, and Asumundson (2007), 

have attempted to understand the distinction between the two types of 

deployment as it pertains to troop mental health. Sareen et al. (2007) 

examined the perceived need for mental health care, usage of mental 

health services, and prevalence of suicidality among 8,441 active-duty 

Canadian military forces, comparing those deployed to combat zones 

with those on peacekeeping missions. They found that experiencing 

traumatic events (such as witnessing atrocities) during deployments on 

either combat or peacekeeping missions was related to increased mental health problems. However, in the absence of exposure to traumatic 

events, peacekeeping operations could be protective (related to decreased mental health problems). The study also demonstrated that 

perceived need for and use of mental health services and presence of 

common mental health diagnoses were not related to increased mental health problems. Few soldiers with a mental health diagnosis were 

receiving services even if they perceived a need for it. This could be a 

function of lack of confidence in the available services and the generalized stigma associated with admitting to any mental health problem. 

A somewhat contradictory study by Belik, Stein, Gordon, and Sareen (2009) reported that “deployment-related traumatic experiences 

do not appear to confer additional likelihood of lifetime suicide attempt 

above and beyond the presence of development of a psychiatric disorder” (Belik et al., 2009, 93). Using data from the Canadian Community 

Health Survey, the authors derived a cross-sectional survey (N = 8,441) 

and concluded that “sexual and other interpersonal traumatic events are 

associated with suicide attempts in a representative sample of Canadian 

military men and women” (Belik et al., 2009, 93). This study thus points 

to the potential importance of previous history of exposure to traumatic 

events as a risk factor. 
UNDERSTANDING SUICIDE IN THE MILITARY 295

In 2004, the Centre for Military and Veterans’ Health in Australia reviewed postdeployment health consequences, combining perspectives from American, British, Canadian, and Australian sources (Kitchener, 2005). The panel discussed the issues of poor understanding of 

health and well-being consequences, the positive and negative outcomes arising from deployment, and definitional distinctions between 

the many types of deployments associated with the topic of health and 

military deployments research. Their primary recommendation was to 

establish systems to better monitor Australian Defence Force personnel, 

starting with recruitment and continuing through service and following discharge. The panel also recommended that the health of servicemembers be closely monitored for each operational deployment, with 

systematic reviews of all personnel involved, and that systematic “hazard profiles” be created for each operational deployment to identify the 

primary occupational, environmental, operational, and psycho-social 

threats. While suicide is not addressed directly by this group, their recommendations for better surveillance would in principle lead to better 

documentation of factors associated with military suicide. 

Specifically comparing mortality rates of military veterans to civilians, Crane, Barnard, Horsley, and Adena (1997) analyzed data from 

the Australian Department of Defence, Department of Veterans’ Affairs, 

National Death Index, and Electoral Commission rolls. The authors 

compared Vietnam male veterans in Australia with the general male 

population. Even though the overall veteran death rate for all causes relative to the general population was lower (0.68), some specific categories of death were higher for veterans, including suicide (1.21). However, the authors indicate that this elevated risk for suicide in veterans was 

not statistically significant.

While the methods and findings of these international studies are 

quite diverse, they nevertheless provide useful insights. For example, a 

consistent finding across most studies is that young males make up the 

highest risk group for suicide during wartime. This parallels peacetime 

trends and is all the more relevant for the military since young males 

comprise its largest demographic group. However, the data are unclear 

as to whether this increased relative risk for young males in the military 

is a function of differential exposure to war-induced stress or to other 

factors. There is general consensus that increased availability of firearms 

and alcohol in the military environment elevates suicide risk. Thus, the 

inherent nature of serving in the armed forces, which usually demands 
296 THE 71F ADVANTAGE

ready access to weapons, can increase the risk. On the other hand, military selection standards may exclude those applicants from the general 

population most likely to commit suicide. Also, the stricter limitations 

on conduct imposed on soldiers in relation to their civilian counterparts 

may reduce the likelihood of alcohol or drug abuse, thereby protecting 

them from suicide. Successful interpersonal and intimate relationships 

also seem to play a role in mitigating risk. Some of the international 

studies reviewed here also indicate that increased operational and warrelated stressors do have adverse effects on the mental health of soldiers, 

most notably with regard to the development of PTSD. However, the 

relationship between these mental health factors and suicide remains 

unclear. A number of studies recommend preventive measures such as 

more stringent selection criteria, greater supervision of at-risk soldiers, 

and limited access to weapons. 

Suicide among Vietnam War Troops and Veterans

More systematic studies of suicide in the U.S. military appeared 

after the Vietnam War. The apparently high incidence of mental illness 

among those who served in Vietnam led to more in-depth studies, and 

subsequently to greater attention to suicide as a cause of death. For example, using data from the Southeast Asia Combat Area Casualties Database, Adams, Barton, Mitchell, Moore, and Einagel (1998) examined 

mortality in male U.S. ground troops in Vietnam from 1957 to 1973. 

Suicide deaths were compared to all other deaths in regard to military 

branch, age, race, marital status, religious preference, Service component, and year of death (Adams et al., 1998). No suicides were reported 

in the Navy, Coast Guard, or National Guard, so these branches were excluded. In contrast to other studies showing that young men were at the 

greatest risk, this study found that individuals who committed suicide 

in Vietnam were significantly older than those dying of other causes. 

According to Adams and colleagues (1998), those who committed 

suicide had been in Vietnam approximately 2 months longer than those 

who died from other causes, suggesting a relationship between length 

of deployment and incidence of suicide. They also found that suicides 

peaked in early 1968 (coinciding with the Tet Offensive), while deaths 

from all other causes peaked in late 1967. The authors suggest that these 

two observations may indicate that combat-induced stress and depression were contributing factors to increased risk. Single men died more 

often from all causes than married men, which supports the conclusion 
UNDERSTANDING SUICIDE IN THE MILITARY 297

of other studies that marriage may be a protective factor. Adams and 

colleagues (1998) discussed the difficulties of working with inconsistent mortality data and recommended further research to clarify risk 

factors such as history of suicidal behavior or depression and genetic 

factors. Interviews with surviving comrades, former girlfriends, and 

family members, and examination of documentary materials (letters, 

diaries, etc.) were also recommended.

As indicated previously, war-related mental health issues are a serious problem not only for Active-duty troops, but also among veterans. In 1987, the CDC published a study examining mortality figures 

for Vietnam veterans after their discharge from service (Boyle, Decoufle, Delaney, DeStefano, Flock, Hunter, Joesoef et al., 1987). Findings 

showed a 17 percent higher mortality rate for Vietnam veterans (N = 

9,324) compared to veterans who served in Korea, Germany, or the 

United States (N = 8,989). The most dramatic difference between the 

two groups was during the first 5 years after discharge, when the mortality rate among Vietnam veterans was 1.45 times that of the non-Vietnam veterans. Death by motor vehicle accidents was a primary factor in 

the increased death rates. The study notes a 72 percent rise in the suicide rate over the first 5 years after deployment, followed by a drop in 

the rate. After the first 5 years, suicide rate ratios were not significantly 

different from 1.0, indicating that Vietnam veterans were no more likely 

than nonveterans to commit suicide. 

Suicide in Soldiers Deployed during Operation 

Desert Shield / Desert Storm

A number of studies examined soldier mental health and mortality during and after the first Gulf War. Writer, DeFraites, and Brundage 

(1996) sought to determine cause-specific mortality rates among U.S. 

troops stationed in the Persian Gulf during Operations Desert Shield

and Desert Storm compared with those of U.S. troops serving elsewhere. 

The study looked at all Active-duty deaths between August 1990 and 

July 1991. Age-adjusted mortality rates among deployed soldiers were 

compared with rates projected from mortality rates among troops on 

Active duty elsewhere. Of the 1,769 Active-duty deaths, 372 occurred 

in the Persian Gulf region, while 1,397 happened elsewhere. Of the 372 

deaths in the Persian Gulf region, 147 (39.5 percent) occurred as a direct 

result of combat during the war, 194 (52.2 percent) resulted from injuries not incurred in battle, and 30 (8 percent) resulted from illness. The 
298 THE 71F ADVANTAGE

Table 12–1. Comparison of Self-inflicted Deaths among Deployed and 

Nondeployed Soldiers

Cause of 

Death

Deployed

Number

Deployed 

Rate

Nondeployed 

Number

Nondeployed 

Rate

Total

Number

Total

Rate

Self-inflicted 10 3.78 206 10.82 216 9.96

Gunshot 10 3.78 120 6.30 130 5.99

Hanging/

asphyxiation0 0.00 54 2.84 54 2.49

Other 0 0.00 32 1.68 32 1.48

Number and rate (expressed as per 100,000 person-years) of self-inflicted deaths among U.S. military personnel deployed to the Persian Gulf region and nondeployed forces, August 1, 1990, through July 31, 1991. 

Source: Writer et al. (1996). Comparative Mortality among U.S. Military Personnel in the Persian Gulf 

Region and Worldwide during Operations Desert Shield and Desert Storm. Journal of the American Medical Association 275 (2), 118–121. 

study found that there were 10 suicides among personnel stationed in 

the Persian Gulf region and 206 suicides outside of theater during this 

same 1-year period (see table 12–1). 

Of the 10 suicides among those deployed in the Gulf region, all 

were by self-inflicted gunshot wounds. Meanwhile, of the 206 nondeployed suicide deaths, 120 were caused by gunshot, 54 by hanging or 

asphyxiation, and 32 by other means. The study found that deployed 

soldier suicide was lower than expected based on suicides elsewhere. 

Except for deaths from unintentional injury, deployed soldiers did not 

experience significantly higher mortality rates than soldiers serving 

elsewhere, nor were there any clusters of unexplained deaths (see table 

12–2). The number and circumstances of nonbattle deaths among deployed soldiers were typical for the U.S. military population. This seems 

to indicate that deployment to a war zone does not necessarily increase 

the risk for suicide, although there may have been factors unique to the 

first Gulf War—including, for example, that casualties were relatively 

low, and the war was over in a matter of weeks. 

A retrospective study by Macfarlane, Thomas, and Cherry (2000) 

compared all United Kingdom personnel who served in the Gulf at 

some time between September 1990 and June 1991 (N = 53, 416) to 

those serving elsewhere during the same period (N = 53, 450). They 

found that “the higher mortality rate from ‘external’ causes in the 

Gulf cohort was principally due to higher mortality rates from accidents”
UNDERSTANDING SUICIDE IN THE MILITARY 299

Table 12–2. Observed and Expected Non-battle Deaths among Soldiers 

Deployed to Persian Gulf

Cause of Death Observed 

Deaths

Expected 

Deaths Difference

Standardized 

Mortality Ratio 

(95 percent confidence interval)

All non–battlerelated deaths 225 202.7 22.3 111.5 (96.5–125.5)

All injury 

deaths 194 164.7 29.3 117.8 (101.2–134.3)

Unintentional 

Injury 183 118.6 64.4 154.3 (132.0–176.7)

Homicide 1 16.7 -15.7 6.0 (0.0–33.5)

Self-inflicted 10 29.4 -19.4 34.0 (16.3–62.6)

Deaths due to 

illness 30 31.9 -1.9 93.9 (63.3–134.2)

Cardiovascular, 

unexpected, or 

undefined 23 20.0 3.0 115.0 (72.9–172.6)

Number of observed and expected non-battle deaths (adjusted for age) in U.S. military personnel deployed to the Persian Gulf region, August 1, 1990, through July 31, 1991.

Source: Writer et al. (1996). Comparative Mortality among U.S. Military Personnel in the Persian Gulf Region 

and Worldwide during Operations Desert Shield and Desert Storm. Journal of the American Medical Association 275 (2), 118–121.

(MacFarlane et al., 2000, 17). Also, there were not more suicides in the 

Gulf cohort compared to the non-Gulf cohort. The authors concluded 

that Gulf War veterans had only a small increase in mortality compared 

to the non–Gulf War veterans. The groups differed somewhat in the 

causes of death, as Gulf War veterans had a slightly lower mortality from 

disease-related causes but higher mortality from external causes (due to 

an increased rate of accidental deaths). Suicide deaths in both groups 

were approximately equal. However, the study did note that suicide rates 

may have been higher than reported, since it is often difficult to differentiate between accidental deaths and suicides.

Bell, Amoroso, Wegman, and Senier (2001) reviewed elevated 

rates of injury among Persian Gulf War veterans in order to highlight 

the need for better data on suicide. They compared death rates of U.S. 

veterans of the Persian Gulf War with nondeployed veterans and the 

U.S. population at large. Findings showed that while death rates among 

veterans of the Gulf War were lower than for their counterparts, Gulf 
300 THE 71F ADVANTAGE

War veterans were at significantly greater risk of mortality from injuries. The authors proposed five hypotheses as to why injury mortality 

was higher among the Gulf War veterans. First, the increased risk might 

be a consequence of depression, post-traumatic stress disorder, and 

symptoms of other psychiatric conditions developed after the war. Second, the development of unhealthy coping behaviors incident to physical and psychological trauma experienced during the war (for example, drinking) may be a risk factor. Third, increased risk may be an indirect consequence of the increased experience of ill-defined diseases 

and symptoms. Fourth, veterans may experience poorer survivability 

for a certain injury, resulting in a greater mortality but not morbidity. Finally, there may be a bias for selecting individuals for deployment 

who are inherently at greater injury risk. Bell et al. (2001) suggest that 

more research is needed so policymakers can better understand the link 

between deployment and increased risk of postwar injury.

Kang and Bullman (1996) concluded there was only a small increase in deaths from accidents among Gulf War veterans compared to 

non–Gulf War veterans, and no apparent increase in suicide. Their study 

examined mortality among 695,516 Gulf War veterans compared to 

746,291 non–Gulf War veterans. Records indicated that out of 1,765 Gulf 

War veteran deaths, 261 were suicides, as compared to 277 suicides among 

1,729 deaths of other veterans. This represents an almost identical rate of 

15.3 per 100,000 for Gulf War veterans, and 15.4 per 100,000 for other 

veterans. A later report by Haley (1998) challenged these results, claiming the Kang and Bullman study was biased due to “errors in the calculation of confidence intervals for tests of statistical significance, a failure to 

appreciate a more pertinent application of the ‘healthy-soldier effect,’ and 

the unequal effects of excluding hospitalizations in nonmilitary hospitals” 

(Haley, 1998, 316). Kang and Bullman (2001) published a subsequent report that, though not a direct response to Haley, concluded that on further investigation there was still no significant difference between suicide 

rates of Persian Gulf deployed veterans and non–Persian Gulf veterans. 

Overall, then, most studies examining suicide among soldiers deployed 

in the first Gulf War have found no significant increase in risk for suicide. 

More Recent U.S. Experience

In recent years, further studies have sought to identify factors that 

are inherent to military life and may therefore be helpful in explaining why suicide is on the rise. One of the foundations for this line of 
UNDERSTANDING SUICIDE IN THE MILITARY 301

research, a study by Rothberg (1991), investigated the relationship of 

U.S. Army suicides and relocation from 1979 to 1983. Findings showed 

no correlation between suicide and geographic moves among total Active-duty Army personnel. However, in the 17 to 21 age group specifically, relocation was positively correlated with suicide (accounting for 

10 percent of variance) from 1980 to 1983 (Rothberg, 1991). This implies that younger men may be more affected by relocation and thereby 

be more vulnerable to suicide. 

In a more recent literature review by Allen, Cross, and Swanner (2005), the authors analyzed distal and proximal risk factors and 

problems with research, and provided some recommendations for preventing suicide in the military. Distal risk factors were found to include 

previous attempts (30 to 40 percent of suicides have made previous attempts), alcoholism, social isolation, and concurrent depression or other 

psychiatric condition (approximately 90 percent of suicides have had at 

least one diagnosable psychiatric condition). Proximal risk factors include having a specific plan to commit suicide, openly talking about suicide, and giving away one’s possessions. Other events that seem to exacerbate risk include relationship problems, job loss, legal problems (including incarceration), and economic problems. 

The authors provide several recommendations for preventing 

suicide in the military. These include educating medical and behavioral 

health specialists as to the distal, proximal, and exacerbating risk factors for suicide, improving coordination between the health care provider and the individuals’ command structure, and establishing an environment in which individuals believe they are able to seek help without 

damaging their careers. 

Regan, Outlaw, Hamer, and Wright (2005) examined trends 

among several different U.S. military groups. For example, they report 

that the suicide rate of Soldiers deployed to Kuwait and Iraq in 2003 

was 17.3 per 100,000, while the overall rate in the Army was just 12.8 

per 100,000. The Army suicide rate for the entire year of 2003 was even 

lower at 12.2 per 100,000. This suggests that deployment itself is a risk 

factor for suicide. The authors contend that suicide prevention is particularly important for U.S. forces in Iraq, since these forces have a higher 

percentage of males than the rest of the Army, and males historically exhibit higher rates of suicide. 

 The 2008 Mental Health Advisory Team V (MHAT–V), commissioned by the Office of the U.S. Army Surgeon General, reviewed 
302 THE 71F ADVANTAGE

Table 12–3. Demographics for Confirmed U.S. Army Suicides during 

Operation Iraqi Freedom 

2003 

Iraq 

Suicides

2004 

Iraq 

Suicides

2005 

Iraq 

Suicides

2006 

Iraq 

Suicides

2007 

Iraq 

Suicides*

2007 

Army 

Suicides

Suicide Rate 18.8 10.5 19.9 19.4 24.0 24.0**

Suicide by 

firearm/gunshot (percent)95 100 95 100 91 65

Male (percent) 91 100 95 82 100 94

Age 30 or 

younger 

(percent)

82 91 80 86 83 69

E–4 or below 

(percent) 68 82 65 77 61 46

Married 

(percent) 41 0 35 18 32 49

Minority/nonwhite (percent) 43 20 10 14 18 20

*Through October 15, 2007

** Estimated November 14, 2007

Source: Mental Health Advisory Team V (2008).

mental health effects associated with participation in Operation Iraqi 

Freedom (OIF) and Operation Enduring Freedom (OEF). While not primarily concerned with suicide, the issue was nevertheless included as 

one of a range of mental health problems meriting attention. The study 

found 113 confirmed U.S. Army suicides in Iraq since OIF began in 

2003. The annual rates per 100,000 were 18.8 in 2003, 10.5 in 2004, 19.9 

in 2005, and 19.4 in 2006 (MHAT–V, 2008). The estimated rate for 2007 

was 24.0 per 100,000. The incidence of reported suicidal ideation was 

also elevated among troops deployed to Iraq. Soldiers committing suicide while deployed in OIF were mostly young, white, lower enlisted, 

single males who used a firearm. These demographic factors are summarized in table 12–3. 

The MHAT–V team reported a curvilinear relationship between months deployed and suicide for the 2007 year. In the analysis, 

15-month tours were divided into three 5-month deployment phases. 
UNDERSTANDING SUICIDE IN THE MILITARY 303

Findings showed significantly more suicides during the middle third of 

the deployment than in either the early or late phases. It is possible that 

once the Soldiers make it past the tenth month, they may see the end of 

their deployment is near and thus can deal with stresses that previously 

seemed overwhelming or that the Soldiers at risk had been identified 

and had received treatment that prevented a suicide. A similar curvilinear relationship was also noted for emergency psychiatric referrals. 

Based on forensic investigations conducted by the Army’s Criminal Investigation Division (CID), the MHAT–V identified failed intimate relationships as the single greatest precipitating factor (present in 

68 percent of cases) for suicide while deployed in OIF. Other factors included pending Uniform Code of Military Justice (legal) actions (35 percent), other failed relationships (21 percent), job problems (17 percent), 

and financial debt (10 percent). The CID investigation also found that 

60 percent of the cases demonstrated signs of depression or behavioral 

changes prior to suicide. In addition, a sizable percentage of victims had 

sought assistance for mental health problems within the 30 days prior to 

committing suicide. Of the soldier suicides in Iraq, 27 percent were seen 

at a medical treatment facility, 36 percent by a chaplain, 26 percent by 

mental health personnel, and 21 percent by both a chaplain and mental 

health personnel; and 13 percent were taking psychotropic medications. 

This finding suggests that the problem of stigma associated with seeking 

mental health care in the military may not be a major obstacle at least as 

regards suicidal persons. The reported data show that for U.S. soldiers 

who committed suicide in Iraq, up to one-third sought medical or mental health support immediately preceding the suicide. But the fact that so 

many soldiers committed suicide even though they were known to the 

military medical care system raises the disturbing possibility that current care and treatment approaches are ineffective. At any rate, these data 

suggest that simply making sure that suicidal soldiers are brought to the 

attention of the medical/mental health care system will not be sufficient 

to prevent a large proportion of military suicides. The rate of patients 

who sought assistance and did not later commit suicide was not reported. 

The MHAT–V authors reported the most relevant risk factors to 

be a sense of loss (whether relational, social, work, or financial), isolation (defined as a feeling of being cut off from other people), barriers to accessing mental health treatment, and an unwillingness to seek 

help because of the stigma attached to mental health. Easy access to lethal weapons is also a risk factor. None of these factors, however, can 
304 THE 71F ADVANTAGE

account for the upward trends in suicide since they have all been present 

throughout the period of study, from 2003 through 2007.

The MHAT–V study group did suggest some possible protective 

factors for soldiers operating in the Iraqi theater. Although not yet studied in depth, these factors include the lack of intoxicants available in the 

theater; effective clinical care for mental, physical, and substance abuse 

disorders; easy access to a variety of clinical interventions and support 

for help seeking; family and community support; and teaching skills in 

problem solving and conflict resolution. 

In another relevant study, Hoge, Auchterlonie, and Milliken (2006) 

investigated the mental health status of U.S. troops returning from combat deployments in Iraq and Afghanistan. Between May 2003 and April 

2004, the authors conducted a population-based descriptive study of all 

U.S. Army Soldiers and Marines participating in routine mental health 

examinations as they came back from Iraq (N = 222,620), Afghanistan 

(N = 16,318), and other overseas deployments (N = 64,967). Findings 

showed that 19.1 percent of Servicemen returning from Iraq reported 

mental health problems—a higher proportion than those serving in Afghanistan (11.3 percent) or other locations (8.5 percent). The study also 

investigated the correlation between the postdeployment mental health 

screening results, the use of mental health services, and the rates of attrition from military service. The authors conclude that compared to deployments elsewhere, combat duty in Iraq was associated with higher utilization of mental health services (35 percent) and higher attrition from 

the military (17.3 percent) in the year following the deployment. Also, the 

high rate of utilization of mental health services after return from deployments (especially to Iraq) underscores the need to have adequate resources 

for returning veterans. While not specific to the problem of suicide, this 

study indicated that U.S. Service personnel seem to suffer disproportionate mental health problems as a result of deployment to a war zone.

Other studies have addressed the problem of suicide among 

veterans. Using data from the National Health Interview survey and 

the National Death Index, Kaplan, Huguet, McFarland, and Newsom 

(2007) compared veteran and nonveteran suicide rates between 1986 

and 1994. The sample included 320,890 males, 104,026 of whom were 

veterans. Findings revealed that while causes of natural death were similar between both veterans and nonveterans, veterans were twice as likely 

to commit suicide. Veterans were also 58 percent more likely to use a 

firearm. This study was particularly interesting because it also included 
UNDERSTANDING SUICIDE IN THE MILITARY 305

veterans who were not enrolled with the Department of Veterans Affairs 

(VA), who are often neglected when data are collected. As highlighted 

by the authors, relying only on data from veterans currently enrolled in 

the VA system is a critical research limitation, as this group comprises 

only about 25 percent of the total veteran population. 

The Congressional Research Service also conducted a valuable 

study of suicide among veterans (Sundararaman, Panangala, and Lister, 2008). Their report states that “veterans have a number of risk factors that increase their chance of attempting suicide. These risk factors 

include combat exposure, PTSD and other mental health problems, 

traumatic brain injury (TBI), poor social support structures, and access 

to lethal means” (Sundararaman et al., 2008, 2). The authors stress the 

need to develop a more robust and reliable data system to track suicide 

issues among veterans. An improved data system would produce more 

accurate numbers for veteran suicides and also provide a means to analyze risk and protective factors. The system would also be useful in evaluating the effects of suicide intervention programs and to specifically 

identify which programs work and which ones do not.

These studies have pointed to a variety of risk factors for suicide, 

such as marital strife or general instability in a soldier’s life. A few demonstrated some correlation between war deployment and increased likelihood of suicide. This does not necessarily mean that the current wars 

in Iraq and Afghanistan are to blame for rising suicide rates. There are 

many factors involved in suicide, and wartime deployment may have no 

real effect, or could be an aggravating factor, or even a protective factor 

as some older studies suggest (Oesterlen, 1865; Rothberg et al., 1987). 

Nevertheless, wartime deployment cannot be discounted as a potential 

cause of suicide. Many of the military’s fledgling efforts to reduce suicide rates lay aside these questions and focus instead on more traditional explanations. For this reason, the resulting preventive approaches 

have tended to fall into a single mold: boosting suicide education. 

Recent Prevention Efforts and Programs

The U.S. military is well aware of the increasing rates of suicide 

among its members and has initiated several measures aimed at curbing the rise. These efforts have focused on two aspects of the problem: 

gathering accurate data, and increasing awareness and education. By 

gathering more complete data on the suicides that occur, the military 

hopes to discover the root causes behind the rising rates. Meanwhile, 
306 THE 71F ADVANTAGE

increased awareness and education are intended to reduce the stigma 

associated with suicide and encourage preventive treatment of at-risk 

soldiers. While all branches have enacted similar measures, the Army 

has suffered the highest rates of suicide and been the most active in 

combating them. As such, this analysis will focus primarily on prevention programs enacted by the U.S. Army.

The Army’s primary means of improving suicide data collection 

is the mandated use of the Army Suicide Event Report (ASER). These 

reports, which gather additional information regarding demographics, medical and psychological history, and event-specific information, 

are now required for all suicide-related behaviors that result in death, 

hospitalization, or evacuation. Such reporting should give researchers 

a better understanding of the factors involved in military suicide and 

help to reduce underreporting. In 2006, the Suicide Risk Management 

and Surveillance Office (SRMSO) received a total of 1,032 ASERs. Of 

these cases, 948 did not result in death, and 84 resulted in death (Active 

force only, excluding National Guard and Reserves; the total number 

of confirmed suicides in 2006 is 97, based on Armed Forces Medical 

Examiner’s reports; SRMSO, 2007). The SRMSO found that suicide was 

more common among males (88 percent of suicides), Caucasians (64 

percent), junior enlisted (63 percent), those under the age of 25 (49 percent), and unmarried (49 percent) (SRMSO, 2007). Other factors were 

failed marital relationships (present among 55 percent of completed 

suicides) and a history of at least one OIF/OEF deployment (62 percent) 

(SRMSO, 2007). The SRMSO report also concluded that within the U.S. 

Army population, marriage may be a factor related to prevention of 

suicide completion but unrelated to attempts.

The SRMSO released another ASER for 2007 with results quite 

similar to those of 2006. Of 108 confirmed suicides, the most common categories were again males (95 percent), Caucasians (67 percent), junior enlisted (55 percent), and Soldiers under the age of 25 

years (45 percent) (SRMSO, 2008). Unlike the 2006 report, however, 

the 2007 statistics indicated that married Soldiers were disproportionately more likely to commit suicide (49 percent), raising some question 

as to the previous year’s assessment of marriage as a preventive factor. 

Other factors that may have contributed were failed marital relationships (50 percent), a history of at least one mental disorder (44 percent), and a history of at least one OIF/OEF deployment (61 percent) 

(SRMSO, 2008). 
UNDERSTANDING SUICIDE IN THE MILITARY 307

While this demographic information is useful, it does little more 

than confirm the elevated risk for suicide among known at-risk groups. 

More relevant are the efforts to identify the causes of suicidal events. 

While in nearly half of committed suicides the primary motivation 

could not be identified, among those that could, emotion relief (stop 

bad feelings, self-hatred, or anxiety) made up the highest proportion (14 

percent) (SRMSO, 2008). This was also reflected among attempted suicides, where 35 percent of cases were motivated primarily by emotion 

relief. Among unsuccessful suicide attempts, hopelessness, depression, 

and avoidance/escape also featured heavily (11 percent, 11 percent, and 

10 percent respectively) (SRMSO, 2008). This trend shows that Soldiers 

attempting and committing suicide often sought to “stop bad feelings” 

or suffered from self-hatred and anxiety (SRMSO, 2008, 13). It is also interesting to note that suicidal activity was often not premeditated, and in 

most cases intent to commit suicide was not communicated to anyone.

The Army has also taken a broader look into fluctuations in the 

overall suicide rate. In January 2009, the Department of the Army released the “Army Suicide Prevention Program Fact Sheet.” This report demonstrated the rising rates of suicide within the Army population. During the calendar year 2005, the Army suicide rate was 12.7 per 

100,000; this rose to 15.3 in 2006, 16.8 in 2007, and 20.2 (estimated) in 

2008 (Army Suicide Prevention Program, 2009). Interestingly, the study 

also listed the deployment status of those who committed suicide. The 

study found that 29 percent of suicides were committed while deployed, 

39 percent were committed after deployment, and 30 percent had no deployment history.

The Army’s suicide awareness and prevention efforts predated 

the recent uptick in military suicides. In 1997, the Army introduced the 

“Building Strong and Ready Families” program that encouraged relationship-building by Soldiers. The program held that strong intimate relationships were a key part of a Soldier’s mental well-being and thereby 

a protective factor against suicide. In 2005, the program was renamed 

“Strong Bonds” and was expanded to address the full spectrum of those 

affected by military life, including single Soldiers, couples, and families 

with children. “Strong Bonds” seeks to establish common bonds and 

nurture friendships among Soldiers and their families. A particular effort has been made to connect those who are on the same deployment 

cycles. The program is led by chaplains who receive support from commanding officers and is fully funded through a grant managed by the 
308 THE 71F ADVANTAGE

Army Chief of Chaplains (Strong Bonds, 2009). The American Forces 

Press Service reported on March 24, 2009, that more than 60,000 

Soldiers from the Active and Reserve Components have gone through 

the “Strong Bonds” program (Quigley, 2009). While Soldiers and their 

leaders generally speak highly of such programs, it is unclear whether 

they are having any impact on the military’s suicide rate.

There have also been several efforts aimed at preventing suicide 

among veterans. The Department of Veterans Affairs has recognized the 

risks for veterans and has responded with numerous initiatives including 

the establishment of a suicide prevention coordinator for each VA Medical Center to ensure veterans receive needed counseling and services; 

increases in the total number of VA mental health employees to 17,000 

(400 of whom are specifically devoted to preventing suicide among veterans); the addition of 61 new veterans’ centers (bringing the total to 

268); continued education of veterans and family members on suicide 

risk factors and warning signs; screening of all new veterans from OEF/

OIF to determine suicide risk; the development and testing of clinical 

and public health intervention standards for suicide prevention; and increased research into the clinical and neurobiological conditions that 

contribute to increased risk (U.S. Department of Veterans Affairs, 2009).

Congress has also taken note of the suicide risk faced by veterans. 

As a result, the 1st session of the 110th Congress passed H.R. 327—commonly referred to as the Joshua Omvig Veterans Suicide Prevention Act. 

This bill states that “suicide among veterans suffering from posttraumatic 

stress disorder is a serious problem” that must be rectified (U.S. Congress, 2007, 2). This comprehensive program mandates staff education, 

health assessments of veterans, designation of suicide prevention counselors, best practices research, sexual trauma research, 24-hour mental 

health care, a suicide hotline, outreach and education for veterans and 

families, a peer support counseling program, and “other components” that 

the Secretary of Veterans Affairs considers appropriate to reduce suicide 

among veterans. The act also required the Secretary of Veterans Affairs 

to submit a report to Congress addressing the status of program implementation, the time line and costs for complete implementation within 

2 years, a plan for additional programs to reduce suicide among veterans, and recommendations for further legislation or administrative action 

deemed appropriate to improve suicide prevention (U.S. Congress, 2007). 

All of these preventive efforts have helped to raise awareness regarding military suicide, and there is a growing body of literature on 
UNDERSTANDING SUICIDE IN THE MILITARY 309

the subject. Unfortunately, there has not yet been a concerted effort to 

analyze the effectiveness of the programs described above and it is 

unclear whether they are having a positive effect. It is likely that a real 

reduction in the military suicide rate will require policy changes beyond 

the sphere of educational programs, and much more concerted study 

must be devoted to developing effective prevention measures.

Conclusion

The various studies reviewed in this chapter suggest that a variety 

of factors contribute to suicide among soldiers and recently discharged 

veterans. It is clear from the studies that certain demographic groups are 

in greater danger. Young males are clearly at the greatest risk. Caucasian 

ethnicity and lower enlisted ranks are also associated with higher suicide 

risk. There is near universal agreement that access to firearms and alcohol 

can be a lethal combination precipitating the danger. However, according to several studies, access to weapons alone does not seem to significantly raise the risk of suicide. Several studies suggest that recent exposure to war or deployment to conflict zones has an escalating effect on the 

rate of suicide among both civilian and military populations, most notably for young men. However, these conclusions are countered somewhat 

by studies showing lower than expected rates for soldiers in the first Gulf 

War. A better understanding of suicide during and following deployments 

is necessary in order to successfully address this pressing problem. 

Notably, risk for suicide seems to be especially elevated after discharge from the military, rather than during service. However, difficulties in tracking and reporting suicide in the military thus far have greatly 

complicated efforts to identify the underlying causes. A history of mental illness as well as major life stressors (such as marital strife) increase 

the risk of suicide, but to what extent they are causal versus correlated 

but noncausal is unclear. Further research is needed to clarify risk factors such as history of suicidal behavior, depression, and genetic factors 

(Adams et al., 1998). Additional steps such as postmortem interviews 

with comrades, friends, and family members as well as examination of 

documentary materials (letters, diaries, etc.) can also help in identifying 

the causes of suicide, thus providing the knowledge to develop more effective prevention techniques. 

A potentially important consideration for understanding suicide 

relates to soldier perceptions of how society regards their activities. If 

an already stressed deployed soldier also feels a lack of societal support 
310 THE 71F ADVANTAGE

for the war or mission, this could increase the sense of alienation and 

meaninglessness. Also, the usual beneficial effects of cohesion within 

the military (which may contribute to the lower peacetime military/civilian suicide ratio) could be diminished in that the soldier may feel he 

is part of a socially undesirable group. The potential impact of societal 

attitudes toward the military and toward particular operations merits 

further attention.

Under the current investigation and assessment system, it is still 

unclear who has real responsibility for determining if a death is a suicide. Investigations can take up to 2 or 3 years, and in some cases may 

never occur. This further complicates efforts to understand the causes 

and cures. Educational programs aimed at preventing suicide are being 

expanded, but this is being done without a real understanding of the 

factors at work. Not surprisingly, then, these prevention efforts have not 

worked. Despite a variety of awareness enhancement, stigma reduction, 

and relationship-building programs, the Army’s suicide rate continues 

to rise. Suicide in the military can be prevented, or at least greatly reduced. But this will require selection, training, and treatment programs 

that are built upon a solid understanding of the range of factors, at multiple levels, that raise or lower the risk for such unfortunate outcomes. 

References

Adams, D.P., Barton, C., Mitchell, G. L., Moore, A.L., and Einagel, V. (1998). Hearts and minds: 

Suicide among United States combat troops in Vietnam, 1957–1973. Social Science and 

Medicine 47 (11), 1687–1694.

Allen, J., Cross, G., and Swanner J. (2005). Suicide in the Army: A review of current information. 

Military Medicine 170 (7), 580–584.

Army Suicide Prevention Program. (2009). Fact sheet. Washington, DC: Army Public Affairs.

Beck, A., Brown, G., Berchick, R., Stewart, B., and Steer, R. (1990). Relationship between hopelessness and ultimate suicide: A replication with psychiatric outpatients. American Journal of Psychiatry 147 (2), 190–195.

Beck, A.T., Kovacs, M., and Weissman, A. (1979). Assessment of suicidal intention: The scale for 

suicide ideation. Journal of Consulting and Clinical Psychology 47, 343–352.

Belik, S., Stein, M., Gordon, J.G.A., and Sareen, J. (2009). Relation between traumatic events and suicide attempts in Canadian military personnel. Canadian Journal of Psychiatry 54 (2), 93–103.

Bell, N., Amoroso, P., Wegman, D., and Senier, L. (2001). Proposed explanations for excess injury 

among veterans of the Persian Gulf War and a call for greater attention from policymakers and researchers. Injury Prevention 7, 4–9.

Bodner, E., Ben-Artzi, E., and Kaplan, Z. (2006). Soldiers who kill themselves: The contribution 

of dispositional and situational factors. Archives of Suicide Research 10 (1), 29–43.

Bosnar, A., Stemberga, V., Coklo, M., Koncar, G., Definis-Gojanovic, M., Sendula-Jengic, V. and 

Katic, P. (2005). Suicide and the war in Croatia. Forensic Science International 147, S13–S16.

Boyle, C., Decoufle, P., Delaney, R., DeStefano, F., Flock, M., Hunter, M., Joesoef, M., Karon, J., 

Kirk, M., Layde, P., McGee, D., Moyer, L., Pollock, D., Rhodes, P., Scally, M., and Worth, 

R. (1987). Postservice mortality among Vietnam veterans. U.S. Department of Health and 

Human Services. Public Health Service Centers for Disease Control. 
UNDERSTANDING SUICIDE IN THE MILITARY 311

Brent, D.A., Perper, J.A., and Allman, C.J. (1987). Alcohol, firearms, and suicide among youth. 

Journal of the American Medical Association 257, 3369–3372.

Carr, J., Hoge, C., Gardner, J., and Potter, R. (2004). Suicide surveillance in the U.S. military: 

reporting and classification biases in rate calculations. Suicide and Life-Threatening Behavior 34, 233–242.

Cassimatis, E.G., and Rothberg, J.M. (1997) Suicide in the United States military. In A.J. Botsis, 

C.R. Soldatos, and C.N. Stefanis (eds.). Suicide: Biopsychosocial approaches. Amsterdam: 

Elsevier Science B.V. 23–32.

Centers for Disease Control. (2009). Web-based Injury Statistics Query and Reporting System: 

Fatal Injury Reports. Retrieved from <www.cdc.gov/injury/wisqars/index.html>.

Crane, P.J., Barnard, D.L., Horsley, K.D., and Adena, M.A. (1997) Mortality of Vietnam veterans: 

The veteran cohort study. A report of the 1996 retrospective cohort study of Australian 

Vietnam veterans. Canberra: Department of Veterans’ Affairs.

Durkheim, E. (1951, originally published 1897). Suicide: A Study in Sociology. Trans. J.A. Spaulding and G. Simpson. New York: The Free Press.

Eaton, K., Messer, S., Wilson, A., and Hoge, C. (2006). Strengthening the validity of populationbased suicide rate comparisons: An illustration using U.S. military and civilian data. Suicide and Life-Threatening Behavior 36 (2), 182–191.

Fishman, G., Morris-Dycian, A., and Kotler, M. (1990). Suicide in the Israeli army. Suicide and 

Life-Threatening Behavior 20 (3), 225–239.

Haley, R. (1998). Point: Bias from the “healthy-warrior effect” and unequal follow-up in three 

government studies of health effects of the Gulf War. American Journal of Epidemiology

148 (4), 315–323.

Hansen-Schwartz, J., Jessen, G., Andersen, K., and Jørgensen, H.O. (2002). Suicide after deployment in UN peacekeeping missions—A Danish pilot study. Crisis 23 (2), 55–58.

Henderson, R., Stark, C., Humphry, R.W., and Selvaraj, S. (2006). Changes in Scottish suicide 

rates during the Second World War. BMC Public Health 6, 167. 

Hoge, C., Auchterlonie, J., and Milliken, C. (2006). Mental health problems, use of mental health 

services, and attrition from military service after returning from deployment to Iraq or 

Afghanistan. The Journal of the American Medical Association 295 (9), 1023–1032.

Joiner, T. (2005). Why People Die by Suicide. Cambridge: Harvard University Press.

Kang, H., and Bullman, T. (1996). Mortality among U.S. veterans of the Persian Gulf War. The 

New England Journal of Medicine 335 (20), 1498–1504.

———. (2001). Mortality among U.S. veterans of the Persian Gulf War: 7-year follow-up. American Journal of Epidemiology 154 (5), 399–405.

Kaplan, M., Huguet, N., McFarland, B., and Newsom, J. (2007). Suicide among male veterans: A 

prospective population-based study. The Journal of Epidemiology and Community Health

61, 619–624.

Kitchener, S. (2005). The health and wellbeing consequences of military deployment. The Australian Defence Force Journal 168, 45–53.

Kuehn, B.M. (2009). Soldier suicide rates continue to rise. The Journal of the American Medical 

Association 11, 1111–1113.

Macfarlane, G., Thomas, E., and Cherry, N. (2000). Mortality among UK Gulf War veterans. The 

Lancet 356, 17–21.

Mahon, M.J., Tobin, J.P., Cusack, D.A., Kelleher, C., and Malone, K.M. (2005). Suicide among regular-duty military personnel: A retrospective case-control study of occupation-specific 

risk factors for workplace suicide. American Journal of Psychiatry 162 (9), 1688–1696.

Menninger, K. (1938). Man against himself. New York: Harcourt, Brace and World.

Mental Health Advisory Team V. (2008). Operation Iraqi Freedom 06-08: Iraq and Operation Enduring Freedom 08: Afghanistan. Washington, DC: U.S. Army Medical Command, Office 

of the Surgeon General.

Michel, P.O., Lunden, T., and Larsson, G. (2007). Suicide rate among former Swedish peacekeeping personnel. Military Medicine 172 (3), 278–282. 
312 THE 71F ADVANTAGE

Murray, H.A. (1938). Explorations in personality. New York: Oxford University Press.

Oesterlen, F. (1865). Handbuch der medicinischen Statistik. Tübingen.

Quigley, S. (2009). Army program builds ‘strong bonds’ among couples, families. Retrieved July 

23, 2009, from American Forces Press Service Web site: <www.defenselink.mil/news/

newsarticle.aspx?id=53621>.

Regan, J., Outlaw, F., Hamer, G., and Wright, A. (2005). Mental health series: Suicide in the military. Tennessee Medicine (July 2005), 400–401.

Rothberg, J., Bartone, P., Holloway, H., and Marlowe, D. (1990). Life and death in the U.S. Army: 

In corpore sano. The Journal of the American Medical Association 264 (17), 2241–2244.

Rothberg, J., Holloway, H., and Ursano, R. (1987). Suicide in the United States military. Psychiatric Annals 17, 545–548. 

Rothberg, J. (1991). Stress and suicide in the U.S. Army: Effects of relocation on service members’ 

mental health. Armed Forces and Society 3, 449–458.

Ryvkin, S. (2000). Suicidal phenomena among servicemen: Problem and ways of solution. Military Thought 6, 43–48. 

Sareen, J., Cox, B.J., Afifi, T.O., Stein, M.B., Belik, S., Meadows, G., and Asumundson, G.J. (2007). 

Combat and peacekeeping operations in relation to prevalence of mental disorders and 

perceived need for mental health care. Archive of General Psychiatry 64 (7), 843–852. 

Schneidman, E. (1996). The suicidal mind. New York: Oxford University Press.

Sheftick, G. (2009) Army creates suicide prevention task force during ‘stand down.’ American Forces 

Press Service. Retrieved from <www.defenselink.mil/News/newsarticle.aspx?id=53378>.

Strong Bonds. (2009). The history of strong bonds. Retrieved May 19, 2009, from <www.strongbonds.org/skins/strongbonds/display.aspx>.

Suicide Risk Management and Surveillance Office. (2007). Army suicide event report (ASER) calendar year 2006. Tacoma, WA: Suicide Risk Management and Surveillance Office.

———. (2008). Army suicide event report (ASER) calendar year 2007. Tacoma, WA: Suicide Risk 

Management and Surveillance Office.

Sundararaman, R., Panangala, S.V., and Lister, S.A. (2008). Suicide prevention among veterans. 

Washington, DC: Congressional Research Service.

Thoresen, S., and Mehlum, L. (2004). Risk factors for fatal accidents and suicides in peacekeepers: 

Is there an overlap? Military Medicine 169 (12), 988–993.

———. (2006). Suicide in peacekeepers: Risk factors for suicide versus accidental death. Suicide 

and Life-Threatening Behavior 36 (4), 432–442.

———. (2008). Traumatic stress and suicidal ideation in Norwegian male peacekeepers. The Journal of Nervous and Mental Disease 196 (11), 814–821.

Thoresen, S., Mehlum, L., and Moller, B. (2003). Suicide in peacekeepers: A cohort study of mortality from suicide in 22,275 Norwegian veterans from international peacekeeping operations. Social Psychiatry and Psychiatric Epidemiology 38 (11), 605–610.

Thoresen, S., Mehlum, L., Røysamb, E., and Tønnessen, A. (2006). Risk factors for completed 

suicide in veterans of peacekeeping: Repatriation, negative life events, and marital status. 

Archives of Suicide Research 10 (4), 353–363.

U.S. Congress. (2007). Joshua Omvig veterans suicide prevention act. (H.R. 327—1st Session, 110th

Congress). Washington, DC: U.S. Government Printing Office. Retrieved May 20, 2009, 

from <http://thomas.loc.gov/cgi-in/query/D?c110:6:./temp/~c110hpFVh8:>.

U.S. Department of Veterans Affairs. (2009) Suicide prevention. Retrieved July 23, 2009, from 

<www.mentalhealth.va.gov/suicide_prevention/index.asp>.

Wong, A., Escobar, M., Lesage, A., Loyer, M., Vanier, C., and Sakinofsky, I. (2001). Are UN peacekeepers at risk for suicide? Suicide and Life-Threatening Behavior 31 (1), 103–112.

Writer, J.V., DeFraites, R.F., and Brundage, J.F. (1996). Comparative mortality among U.S. military 

personnel in the Persian Gulf region and worldwide during Operations Desert Shield 

and Desert Storm. The Journal of the American Medical Association 275 (2), 118–121. 
Part V

Applying Psychology to 

Chemical and Biological 

Defense

Chapter 13

Psychological Effects of Chemical, Biological, Radiological, and Nuclear Weapons

Ross H. Pastel

Chemical, biological, radiological, and nuclear (CBRN) weapons have gained increased international attention in the last 20 years. 

Although the Soviet Union had long been suspected of developing biological warfare (BW) agents, it was not until 1992 that Russian 

President Boris Yeltsin admitted that the Soviet Union continued its 

offensive BW development program following its ratification of the 

Biological and Toxin Weapons Convention in 1972 (General Accounting Office, 2000). In 1994 and again in 1995, Japan suffered sarin attacks. 

It was not until after the second attack that the sarin was traced to the 

Aum Shinrikyo cult. Further investigation revealed that the cult had also 

attempted several attacks with BW agents—botulism and anthrax. The 

United States was rocked by the bombing of the Murrah Federal Building 

in Oklahoma City in April 1995. The new millennium was greeted with 

the September 11, 2001, al Qaeda attacks on the Pentagon and the twin 

towers of the World Trade Center in New York City. Although anthrax 

attacks in the mail followed within the week, the first realization of them 

was not until October when the first victim fell ill. In 2002–2003, Mother 

Nature released a new contagious disease: severe acute respiratory 

syndrome, better known as SARS. Although not spread by terrorists, the 

disease caused widespread death and illness in multiple countries including China, Taiwan, Hong Kong, Singapore, Vietnam, and Canada. 

CBRN weapons, which have been a high priority for al Qaeda, are 

no longer weapons possessed only by states; they have become available 

to terrorists as well. Many experts believe that a large-scale terrorist attack with CBRN weapons is not a matter of if, but of when. Therefore, it 

is critical that mental health practitioners become aware of the possible 

psychological consequences following a CBRN attack. 

The psychological effects of a CBRN attack differ from other 

medical effects in that personnel do not need to be physically exposed 

to these agents in order to exhibit symptoms. Psychological effects can 

315
316 THE 71F ADVANTAGE

cause symptoms that may mimic the prodromal or early symptoms 

of CBRN weapons. Either psychological stress or CBRN weapons can 

cause such ubiquitous symptoms as fatigue, headache, nausea, joint and 

muscle ache, dizziness, and shortness of breath. Many of these symptoms can also be induced by respiratory alkalosis caused by hyperventilation. Fortunately, the acute and long-term psychological effects 

after CBRN attacks demonstrate no apparent unique psychological disorders, but rather seem to exist on a continuum with effects seen after 

exposure to natural disasters or high explosives (Scharf, Vaught, Kidd, 

Steiner, Kowalski, Wiehagen et al., 2001). Therefore, currently available treatments for mental disorders will help victims of CBRN attacks 

(Ritchie, Watson, and Friedman, 2006). Psychophysiologic effects, typically syndromes of medically unexplained physical symptoms (MUPS), 

will likely dominate the long-term picture (Hyams, Murphy, and Wessely, 2002). Historically, this has been seen in war syndromes as well as 

civilian disasters (Hyams et al., 2002; Vasterman, Yzermans, and Dirkzwager, 2005). However, treatment of MUPS may be difficult, due to patient resistance and difficulties with doctor-patient relationships (Engel, 

Adkins, and Cowan, 2002). 

This review will begin with a discussion of risk and risk perception, which have important impacts on the psychological effects of 

CBRN. Both risk communication and the mass media influence risk 

perception. Potential acute and long-term effects of CBRN agents will 

be discussed briefly, followed by a study of historical examples of the 

psychological effects of chemical, biological, radiological, and nuclear 

weapons. In addition to discussion of the anthrax attacks in the United States, this study will also discuss the pneumonic plague outbreak in 

India in 1994 and SARS in 2003, because the psychological effects 

accompanying these two natural outbreaks of contagious disease will 

likely resemble the psychological effects seen following a biological 

weapons attack with a contagious agent such as smallpox or plague.

Risk, Risk Communication, Risk Perception, and the Mass Media 

In a CBRN event, it is likely that the extent of the danger will not 

be known immediately. Public health authorities and public officials will 

need time to survey the damage and determine the location of the victims before they can calculate the extent of the threat and inform the 

media and the public. 
PSYCHOLOGICAL EFFECTS OF CBRN WEAPONS 317

Risk Communication

Risk communication has been defined as the “interactive process 

of exchange of information and opinions among individuals, groups, 

and institutions concerning a risk or potential risk to human health or 

the environment” (National Research Council, 1989). Although risk 

communication can be used in a variety of contexts, this review is most 

concerned with crisis communication in response to situations of extreme, sudden danger as seen in a CBRN incident. Risk communication plays an important role in how people react to the threat. New York 

Mayor Rudolph Giuliani was extremely effective following the events of 

September 11. He demonstrated the value of daily or twice-daily scheduled information briefings with the media and the public. In times of 

crisis, people have an overwhelming need to hear what is happening 

from a credible, trustworthy person, well placed in the administration, 

who can give up-to-date information. Risk communication following a 

CBRN attack should be based on existing principles of health communication. Some of the more important principles include having a consistent message delivered by a knowledgeable and credible official, listening and responding to the concerns of the public, and avoiding the 

appearance of defensiveness or concealment. 

After any toxic industrial accident or terrorist CBRN attack, many 

people will feel anxious about the health effects of any release. Such anxieties may be multiplied by the news media, which will be full of devastating descriptions of the event and the potential consequences. Public 

officials will need to provide accurate hazard communication and information on workable measures that individuals can take to protect themselves and their families.

According to one risk communication approach, risk equals hazard plus outrage (Sandman, 2003). Hazard is the scientifically based risk 

assessment, but outrage is made up of nonquantifiable factors related 

to the public’s concern about and perception of the event. Outrage following a CBRN attack may significantly influence both acute and longterm psychological effects. If people focus on the idea that the event 

should not have happened, they are more likely to respond with feelings 

of hopelessness and helplessness. On the other hand, effective leaders 

may be able to use risk communication to promote a more helpful resilience in the community. For example, research on hardiness has suggested that hardy individuals face crises as challenges to overcome, feel 
318 THE 71F ADVANTAGE

a greater sense of control, and respond with high commitment (Bartone, 

2006). Studies in the military have demonstrated that leaders can influence hardiness in their personnel (Bartone, 2006). 

Risk Perception 

Risk perception is an important driver of the outrage component in risk communication. There are a number of factors involving 

CBRN weapons that increase the perception of risk. Many of them are 

invisible and odorless (radiation, biological agents, and some chemical 

agents), which leads to uncertainty about whether exposure occurred 

and if so, the amount. In many cases, exposure is not known until the 

patients become symptomatic. However, these agents may initially induce nonspecific symptoms—for example, fatigue, headache, nausea, 

difficulty breathing, dizziness, and muscle/joint ache. Regardless of illness induced, chemical agent and radiation exposures will also increase 

the fear of long-term effects of the exposure.

In the risk literature, a number of factors have been shown to increase the perception of risk, including potentially fatal illness, involuntary exposure (lack of control), catastrophic event, presence of an unknown perpetrator, delayed detection and reaction by authorities, and 

potential effect on future generations (Brecher and Flynn, 2002; Covello, Peters, Wojtecki, and Hyde, 2001). Fear of radiation in particular is 

prevalent, largely due to ignorance and misinformation. The thoughts 

and images typically associated with radiation are death, cancer, sterility, and fear for future generations. A number of factors—scapegoating, 

distrust of governmental and industrial experts, and news media hype 

and misinformation—may further amplify risk perception.

Mass Media

The acute and long-term consequences of terrorism and CBRN are 

shaped by risk perception, which itself is shaped, at least in part, by the mass 

media. The media have played an important role in various outbreaks of 

multiple unexplained symptoms (Vasterman, Yzermans, and Dirkzwager, 

2005). The media are an important risk perception amplifier because they 

select and frame risk messages to inform the public, and ensuing media hype 

can create waves of news due to intensive reporting (Covello et al., 2001). 

The power of the media can be seen in studies that followed both 

the Oklahoma City bombing and the events of September 11, 2001. In a 
PSYCHOLOGICAL EFFECTS OF CBRN WEAPONS 319

study done 7 weeks after the Oklahoma City bombing, post-traumatic 

stress symptomatology was higher in nonexposed children (those with 

no direct or emotional exposure to the bombing) who had high television exposure than in those who did not (Pfefferbaum, Nixon, Tivis, 

Doughty, Pynoos, Gurwitch et al., 2001). A telephone survey study done 

3 to 5 days following September 11 found that 44 percent of the people surveyed had one or more substantial stress symptoms, including 

sleep difficulties, irritability and anger, difficulty concentrating, and disturbing thoughts, memories, and dreams (Schuster, Stein, Jaycox, Collins, Marshall, Elliott et al., 2001). It is important to note that people responding to the survey were not present at the event. Therefore, much 

of what they knew was presumably based on media reporting. 

Similarly, in a contagious disease outbreak, information becomes 

extremely important. The public is eager for information and needs to 

know what precautionary measures should be taken. In Hong Kong, 90 

percent of respondents to a telephone survey reported actively seeking 

SARS information on a daily basis, and relied more on mass media (television, newspapers, and radio), than on medical professionals, friends, 

or the Internet (Lau, Yang, Tsui, and Kim, 2003). Substantial misinformation and false beliefs persisted even at an advanced stage of the SARS 

epidemic, despite constant media and public service announcements 

(Leung, Lam, Ho, Ho, Chan, Wong et al., 2003). For example, recommended measures were not practiced uniformly. Many people did not 

understand transmission routes—only one-third of respondents avoided 

direct contact by touch with contaminated objects (fomites), and less 

than half practiced at least five of the seven recommended precautions. 

Acute and Long-term Psychological Effects

Many symptoms commonly seen following a CBRN incident (fatigue, nausea, vomiting, headaches, and anorexia) are common in combat (Stouffer, Lumsdaine, Lumsdaine, Williams, Smith, Janis et al., 1949) 

and can be induced by acute radiation sickness (ARS), chemical agent 

exposure, and during the prodromal syndrome of various biological 

agents and toxins (Anno, Baum, Withers, and Young, 1989; U.S. Army 

Medical Research Institute of Chemical Defense [USAMRICD], 2000; 

U.S. Army Medical Research Institute of Infectious Diseases [USAMRIID], 2005). Because many CBRN agents are invisible, Soldiers may experience symptoms that they may blame on CBRN exposure, regardless 
320 THE 71F ADVANTAGE

of actual exposure or dose of exposure. These patients are not “worried 

well.” They are worried—possibly with good reason—but they are not 

well if they are in distress and pain. The term worried well has a pejorative connotation. The doctor-patient relationship may become strained 

if patients feel that their symptoms are being dismissed by health care 

providers. Thus, the term should be avoided. 

Some CBRN agents may directly induce psychological effects, in 

addition to medical effects—for example, nerve agents can induce anxiety (DiGiovanni, 1999). In other cases, symptoms may precede signs—

pulmonary agents may initially be present with respiratory distress 

without measurable physical signs (USAMRICD, 2000). Symptomatic 

ambulatory cases with mild or perceived exposures will present difficulties for CBRN event triage.

Based on historic experience in World War II, military medical 

planners can get a rough estimate of battle fatigue or combat stress casualties (CSC), based on the number of the wounded in action (WIA) 

expected from different types of battles (Levin, 1991; Vineberg, 1965). 

In World War II, the ratio of CSC to WIA was in the range of 1:10 to 

1:2 (Levin, 1991; Vineberg, 1965). An analogous measure among a civilian population would be the ratio of psychological casualties (PC) to 

wounded. During the first Israeli Scud missile attack, this ratio was 16:1 

(172 PC plus 171 unjustified atropine injections to 22 wounded) or 8:1 

(if atropine injections are excluded). In the 1985 radiological contamination accident in Goiania, Brazil, where no explosion occurred, the ratio of PC to wounded was 500:1 (if wounded is defined as the 249 people 

contaminated either externally or internally) or 2,500:1 (if wounded is 

defined as the 50 people requiring close medical surveillance). This implies that CBRN events are significantly more psychologically traumatic 

than normal combat, especially on civilian populations.

While neither of these cases occurred with American military 

populations, the available data do suggest that it is unlikely that the PC 

to wounded ratio following a CBRN attack or incident will resemble the 

1:10 to 1:2 range seen in World War II battles. The low end of the range 

may resemble World War II statistics, but the high end could go much 

higher, depending on the characteristics of the CBRN attack. Unfortunately, most CBRN exercises account for relatively few psychological casualties. These exercises should include a minimum of 25 percent psychological casualties and would be more realistic with ratios of 3:1 or 

greater PC to wounded ratios.
PSYCHOLOGICAL EFFECTS OF CBRN WEAPONS 321

Mass Panic 

The popular expectation for behavior during or after a disaster is mass panic, described as “highly disorganized flight by hysterical individuals who have stampeded at the sight of actual or potential danger” (Janis, 1951). During the Cold War, many civil defense planners feared that a mass panic would follow a nuclear attack. 

However, studies of disasters and wars over the last 50 years show 

that disorganized flight (mass panic) is, in fact, very rare (Caldwell, 

Ranson, and Sacks, 1951; Glass and Schoch-Spana, 2002; Quarantelli, 1960; Smelser, 1962). The few occasions when it did occur were 

very circumscribed and were characterized by limited escape routes 

with the possibility of entrapment, a perception of collective powerlessness, and a feeling of individual isolation (Caldwell et al., 1951; 

Quarantelli, 1960; Smelser, 1962). The most frequent historical examples of mass panic are in cases of fires, mine collapses, and sinking ships. Mass anxiety is not mass panic. Mass anxiety is an expression of fear. If public officials use effective risk communication, they 

can help people deal with their fears and guide them to more helpful 

responses.

Distress and Outbreaks of Multiple Unexplained Symptoms (OMUS)

Based on published literature concerning effects of terrorist 

bombing attacks, psychological distress should be common following 

a CBRN attack. Acute psychological effects were reported in 50 percent 

of bomb-injured patients in one study (Hadden, Rutherford, and Merrett, 1978). Another study reported that 12 percent of the casualties presented with emotional distress, with another 6 percent presenting with 

medical problems (such as angina, diabetes, headache, or asthma) (Carley and Mackway-Jones, 1997). Thus, it seems likely that acute psychological effects will also be seen with CBRN attacks, although the scale of 

response probably would be greater due to fear and the uncertainty of 

both exposure and its effects.

Perceived exposure to a CBRN agent can also result in the appearance of symptoms that may be hard to differentiate from mild symptoms expected from actual exposure to a CBRN agent. Thus, OMUS 

can occur independently or concurrently with a CBRN event. Consequently, in a CBRN event, not all symptomatic casualties have been exposed to a toxic agent (Singer, 1982). Symptoms of psychological origin 

can also occur in casualties actually exposed to a CBRN agent and may 
322 THE 71F ADVANTAGE

make treatment more difficult. Regardless of the degree of exposure, it 

is important to address the patient’s symptoms of pain and distress while 

attempting to discern actual exposure.

An example of perceived exposure leading to OMUS was seen in 

1988, when 1,800 male military recruits were evacuated from military barracks when an epidemic of coughing, difficulties with breathing, and chest 

pain broke out at a training center (Struewing and Gray, 1990). These 

symptoms were consistent with exposure to a pulmonary chemical agent. 

Although recruits and medical personnel suspected an airborne toxin, 

none was detected. Various OMUS have demonstrated that perceived 

exposure can induce symptoms resembling an actual toxic exposure.

Although acute OMUS has been widely studied, the possibility 

of long-duration and large-scale OMUS syndromes has only recently 

been suggested (Showalter, 1997). In recent years, a number of different chronic syndromes (chronic fatigue syndrome, environmental somatization syndrome, multiple chemical sensitivity syndrome, and 

sick building syndrome) have appeared, all characterized by multiple 

nonspecific symptoms (fatigue, headaches, sleep disturbances, nausea, 

dizziness, muscle and joint pains, and difficulties with memory and 

concentration) that are not connected with specific infectious or toxic agents (Gothe, Molin, and Nilsson, 1995; Rothman and Weintraub, 

1995; Weiss, 1998). Each of these syndromes is characterized by an invisible contaminant or infectious agent that is blamed for the symptoms.

The military has seen several chronic OMUS syndromes, including Atomic Veterans Syndrome, Agent Orange Syndrome, and Gulf War 

Illness (Hyams, Wignall, and Roswell, 1996). Agent Orange Syndrome 

began when the media publicized an association between exposure of 

Vietnam veterans to Agent Orange and a reported epidemic of cancer 

and children born with birth defects. Epidemiological studies done by 

the Centers for Disease Control (CDC) found no evidence for an increased incidence of cancer or birth defects in this population (CDC, 

1998b; CDC, 1998c). However, an increased prevalence of depression, 

anxiety, alcohol abuse or dependence, and post-traumatic stress disorder (PTSD) was demonstrated in Vietnam veterans compared with 

subjects who had not fought in Vietnam (CDC, 1998a). Another study 

found that symptoms of psychological distress were strongly associated with self-reported herbicide exposure (Decoufle, Holmgreen, Boyle, 

and Stroup, 1992). This group presented with more symptoms than 

were found in Air Force personnel actively involved in aerial spraying of 
PSYCHOLOGICAL EFFECTS OF CBRN WEAPONS 323

herbicides. This suggests that Agent Orange Syndrome might be more 

related to a perception of exposure than to actual exposure.

Mental Disorders

Long-term psychological consequences after terrorist bomb attacks have also been reported. After the Oklahoma City bombing, 45 

percent of the survivors suffered a post-disaster psychiatric disorder, including 34 percent with PTSD (North, Nixon, Shariat, Mallonee, McMillen, Spitznagel et al., 1999). Another study reported PTSD in 50 percent of the patients 6 months after a bombing (Curran, Bell, Murray, 

Loughrey, Roddy, and Rocke, 1990). Nearly one in five (18 percent) civilian survivors of terrorist attacks in another study suffered from PTSD, 

while another 13 percent suffered from major depression (Abenhaim, 

Dab, and Salmi, 1992). When broken down by severity of injury, PTSD 

was present in 31 percent of the severely injured, but in only 11 percent 

of the uninjured and 8 percent of the moderately injured. The adjusted 

prevalence ratio for PTSD (severely injured/others) was 4.2. Similarly, 

major depression occurred in 22 percent of the severely injured but in 

only 9 percent of the moderately injured or uninjured. 

Chemical Warfare Agents

World War I Chemical Warfare

Although World War I chemical warfare agents (CWAs) (predominantly chlorine, phosgene, and mustard) caused 31 percent of battle injuries, they were responsible for only 2 percent of deaths in U.S. 

forces (Gilchrist, 1928). Nevertheless, CWAs had an enormous psychological effect. One contemporary report described “the most horrible 

and ghastly sight of the war. . . to see a hundred or more men, hale and 

hearty a few hours before, slowly strangling to death from pulmonary 

edema, with gradually increasing dyspnea, cyanosis and pallor, making 

futile efforts to expectorate” (Norris, 1919). 

In the initial use of chlorine gas on the Western Front by the Germans in 1915, “a full-blown, blind, contagious panic swept portions of 

the line” (Hammerman, 1987). However, there was no panic farther out 

on the line where there was little or no gas. In the next six gas attacks 

over the next 2 months, there were no mass panics, although protective 

equipment was rudimentary and not widely available. In total, only four 

other gas panics were documented during World War I. 
324 THE 71F ADVANTAGE

The American military experienced several OMUS with relation 

to chemical weapons. In World War I, outbreaks of gas neurosis (gas 

hysteria) occurred, in which some soldiers experienced symptoms of 

gas poisoning (dyspnea, coughing, and burning of skin) without clinical exposure to gas (Hulbert, 1920). In one incident, 500 battle-tested 

troops drifted into medical aid stations over a 1-week period following desultory gas shelling. They suffered from chest pain, fatigue, dyspnea, coughing, husky voice, and indefinite eye symptoms—all consistent with chemical exposure (Salmon and Fenton, 1929). However, the 

divisional gas officer found no evidence of gas inhalation or burning. 

Three years after World War I, approximately one-half of gassed 

veterans claimed subjective complaints in medical examinations (Wachtel, 1941). When there were no objective findings, no compensation 

or pensions were paid, nor were these included in statistics of permanent disabilities. There were reports of large numbers of men who had 

recovered from acute gas poisoning and had good physical examinations, but suffered from serious sequelae, most particularly of easy fatigability and difficulty breathing on exertion (Haldane, 1919). This condition was variously known as effort syndrome, disordered action of the 

heart, and neurocirculatory asthenia. In chronic gas cases, there were 

often acute attacks of breathlessness at night accompanied by nightmares, and patients usually reported insomnia and unrefreshing sleep 

(Haldane, 1919). 

Chemical Warfare Attacks on Sardasht, Iran

During the 1980–1988 Iran-Iraq War, Iraq attacked both military 

and civilian targets with a variety of chemical warfare agents. In June 

1987, Iraq attacked Sardasht, Iran, with four 250-kilogram warheads 

filled with sulfur mustard (SM), a vesicant chemical warfare agent first 

used in World War I (Hashemian, Khoshnood, Desai, Falahati, Kasl, 

and Southwick, 2006). Vesicants produce delayed effects—blisters (vesicles)—with a latent period of hours following exposure. Depending on 

exposed areas, the most common effects are on the skin, eyes, and upper 

respiratory system (Chemical Casualty Care Division, 2000). 

Approximately 4,500 civilians, over one-third of the Sardasht 

population of 12,000 residents, were exposed to SM (Ghanei, Aslani, 

Khateri, and Hamadanizadeh, 2003). Most sustained mild exposure and 

were treated on an outpatient basis, but 1,500 developed moderate to 

severe medical complications that required hospitalization (Khateri, 
PSYCHOLOGICAL EFFECTS OF CBRN WEAPONS 325

Ghanei, Keshavarz, Soroush, and Haines, 2003). Many suffered injuries 

from the explosions in addition to their exposure to SM.

One brief report looked at the long-term psychosocial impact on 

Sardasht civilians 16 years after the attack (Khateri, Ghanei, and Palmer, 

2004). They administered a questionnaire to 400 individuals (69 percent 

male, 31 percent female) with confirmed exposure to SM in the June 

1987 attack. Nearly all (94 percent) remembered the deaths from the attack as more horrifying than death by conventional weapons. Many (54 

percent) reported long-term feelings of depression. Although 76 percent reported improved family cohesion and stronger friendships, 83 

percent reported that relationships with some family and friends deteriorated significantly. Women were reported as being more vulnerable, 

and those who were younger than 19 years old at the time of the attack 

suffered more severe psychological effects. The authors also reported 

that 69 percent of males and 89 percent of females suffered from PTSD, 

based on response to a standard PTSD assessment instrument. The results are interesting, but it is hard to evaluate them due to the brevity of 

the report and the lack of detail on the methodology. Although all subjects had confirmed SM exposure, no mention is made of any long-term 

health effects. In a review article, mention is made of a neuropsychiatric 

evaluation of 1,428 Iranian veterans 3 to 9 years following SM exposure 

(Balali-Mood and Hefazi, 2005). The study found high rates of depression (46 percent), personality disorders (31 percent), and anxiety (15 

percent). Unfortunately, no diagnostic detail is given in the review.

Recently, a cross-sectional randomized survey study was published that looked at anxiety, depression, and PTSD in three towns exposed to warfare in northwestern Iran (Hashemian et al., 2006). One 

town was exposed to low-intensity conventional warfare (LIW), one 

to high-intensity warfare (HIW), and one (Sardasht) to high-intensity warfare in addition to exposure to SM (HIW/SM). Those from Sardasht had a verified SM exposure–related disability, with a median disability score of 30 (range 5–70). Seventeen years after exposure, 56 percent of the Sardasht sample experienced mild respiratory, ocular, and 

cutaneous symptoms, 22 percent had at least 1 moderate symptom, and 

11 percent had at least 1 severe symptom. The combination of HIW/

SM was associated with higher rates of Clinician-Administered PTSD 

Scale–diagnosed PTSD (lifetime and current; partial and full) as well as 

anxiety and depressive symptoms. There was no current full PTSD for 

those exposed to LIW or HIW compared to 12 percent for HIW/SM. 
326 THE 71F ADVANTAGE

For lifetime full PTSD, the corresponding rates were 0 percent (LIW), 

6 percent (HIW), and 24 percent (HIW/SM). With regard to anxiety 

symptoms, 47 percent of the LIW group reported none compared to 

29 percent (HIW) and 6 percent (HIW/SM). Reporting of no depressive symptoms showed a similar progression: LIW, 41 percent; HIW, 31 

percent; and HIW/SM, 14 percent. Multivariate analysis showed that 

compared to the HIW group, the HIW/SM group were at elevated risk 

for lifetime PTSD (OR, 3.4; 95 percent CI, 1.5–7.4), current PTSD (OR, 

6.2; 95 percent CI, 2.0–20.1), increased anxiety symptoms (OR, 5.6; 95 

percent CI, 2.5–12.6), and increased depressive symptoms (OR, 3.7; 95 

percent CI, 1.8–7.2).

Scud Missile Attacks on Israel, 1991

The Israeli experience of suffering 18 Scud missile attacks during 

the 1991 Gulf War involved both the effects of missile explosions and, at 

least initially, the perception of a possible nerve agent attack. One study 

of patients arriving in the emergency departments of 11 local hospitals 

in Israel (Bleich, Dycian, Koslowsky, Solomon, and Wiener, 1992) found 

that 332 (43 percent) of the 773 casualties were psychological casualties 

and an additional 209 (27 percent) had injected themselves with atropine because they thought the missiles contained nerve agent. After the 

first Scud attack, there were 365 casualties: 172 (47 percent) psychological casualties, 171 (47 percent) unjustified atropine injections, and 

only 22 (6 percent) physical injuries. Another study looked at patients 

reporting to the emergency department of a Tel Aviv hospital within 8 

hours of a Scud attack (Rotenberg, Noy, and Gabbay, 1994). Of the 103 

patients admitted, 70 (68 percent) were for psychological distress and 19 

(18 percent) were for unjustified atropine injections; only 9 (9 percent) 

had direct injuries. The reported findings for the Israeli Scud missile experience are for civilians, not for soldiers. Both of these studies clearly 

demonstrate that psychological casualties should be expected to be at 

least as frequent as physical injuries, if not more frequent.

Tokyo Sarin Attack, 1995

In March 1995, terrorists released sarin, a nerve agent, in the Tokyo subway system during the morning rush hour (Asukai and Maekawa, 2002; Ohbu, Yamashina, Takasu, Yamaguchi, Murai, Nakano et al., 

1997). Most of the victims were office workers commuting to central 

Tokyo. Despite the crowded conditions of the morning rush hour and 
PSYCHOLOGICAL EFFECTS OF CBRN WEAPONS 327

the limited escape routes, there were no reports of mass panic. One fireman reported a “perplexing silence” at the accident scene—no talking, 

just the coughing of the victims as they awaited medical assistance (Asukai and Maekawa, 2002). 

Over 5,500 people visited 280 medical facilities the following 

week and 1,046 were admitted as patients. St. Luke’s International Hospital saw the most patients: 641 on the first day and 349 in the following 

week (Ohbu et al., 1997). Of the 641 patients admitted to the emergency 

department on the first day, 111 were admitted to the hospital for further treatment (4 severe cases, 107 moderate cases), and 530 mild cases 

were observed for 6 hours and then released from the emergency department. The mild cases suffered mainly from eye problems. It is difficult to determine from the literature how many of the mild cases may 

have actually been psychological casualties.

Most admitted patients from the Tokyo sarin attack were hospitalized for a few days. Some reported sleep disturbances, nightmares, 

and anxiety. Whether these were due to acute stress disorder or to exposure to nerve agent is not known. In studies conducted 1 month after the 

event, nearly 60 percent of casualties reported suffering from post-incident symptoms including fear of using the subway, sleep disturbances, 

flashbacks, depression, nightmares, irritability, headaches, malaise, 

physical tension, and emotional lability (Asukai and Maekawa, 2002; 

Ohbu et al., 1997). Follow-up questionnaires at 3- and 6-month intervals showed little decrease in the percentage reporting symptoms. Unfortunately, it is difficult to determine the extent to which these symptoms were either psychological effects or sequelae to the cholinergic effects of sarin exposure. Given that most of the casualties from St. Luke’s 

were mild cases (suffered mainly eye symptoms), it is possible that many 

of the post-incident symptoms were psychological effects.

A long-term study of sarin patients who had been hospitalized at 

St. Luke’s found that somatic and psychological symptoms continued for 

5 years after the incident (Kawana, Ishimatsu and Kanda, 2001). There 

was a high rate of reporting of medically unexplained physical symptoms. Eye symptoms, fatigue, muscle stiffness, and headache were all reported by more than 10 percent of the study population.

According to follow-up studies done 3 and 5 years after the incident by the National Police Agency and the National Research Institute 

for Police Science, reporting of somatic complaints—eye strain, weakened eyesight, and easy fatigability—remained relatively stable from 
328 THE 71F ADVANTAGE

the acute stage through both follow-up periods (Asukai and Maekawa, 

2002). Post-traumatic stress symptoms still reported by 14 to 18 percent 

of studied survivors included flashbacks, fear of the subway, intense distress at exposure to reminders of the attack, and avoidance of thinking 

about the attack (Asukai and Maekawa, 2002).

The casualties seen at St. Luke’s Hospital were surveyed at 2, 3, and 

5 years, using a questionnaire asking about 14 physical symptoms, 8 eye 

symptoms, and 11 psychological symptoms (avoidance, hyperarousal, 

and re-experiencing) (Kawana et al., 2001). The most common symptoms across all time periods were eye symptoms, broken down into eye 

strain (33–39 percent), dim vision (23–26 percent), and difficulty focusing (17–21 percent). Physical symptoms (tiredness, fatigue, muscle 

ache, headache) were also common. Most of the psychological symptoms remained stable over the three time periods, with rates of 10 to 

16 percent still being reported at the 5-year point for memory difficulties, depressed mood, avoidance of accident reminders, flashbacks, and 

fear in the subway or at the attack site. PTSD by DSM–IV criterion remained stable with 2 to 3 percent meeting criteria during the three time 

points. The incidence of partial PTSD (one symptom from each category) ranged from 7 to 9 percent. Due to the persistence of physical symptoms, a modified set of PTSD criteria (adding at least one medically 

unexplained physical symptom to the diagnosis) were developed. Using these criteria, 10 to 14 percent met criteria for modified PTSD. The 

physical symptoms were reported to deteriorate following flashbacks 

and to improve during psychiatric therapy. The victims continued to be 

stressed by the lack of support from government systems, limits on resources available for medical follow-ups, and a feeling of stigmatization.

Radiological Agents

Three Mile Island

The Three Mile Island (TMI) nuclear power plant accident in 

1979 demonstrated the importance of psychological effects in a CBRNtype event. According to the President’s Commission that studied the 

accident, the only medical effect documented was mental distress (Kemeny, Babbitt, Haggerty, Lewis, Marks, Marrett et al., 1979). There 

were no cases of acute radiation sickness (ARS), and the estimated 

dose for people living within 10 miles of TMI was approximately that 

of an average chest x-ray and much lower than the annual background 
PSYCHOLOGICAL EFFECTS OF CBRN WEAPONS 329

radiation dose. Populations exhibiting the most distress were TMI workers, families with preschool-age children, and those living within 5 miles 

of TMI (Fabrikant, 1983). Studies of TMI workers reported no longterm effects, only short-term acute effects. TMI personnel reported 

nausea, stomach troubles, headaches, diarrhea, sleep disturbances, and 

loss of appetite in greater frequency than did control group personnel. 

These symptoms are also common to the acute radiation sickness prodrome, but TMI personnel were not exposed to such doses. 

No long-term psychological stress in TMI workers has been reported (Parkinson and Bromet, 1983). However, TMI residents, compared to controls, displayed a significant amount of stress on several 

measures (performance, self-report measures of anxiety, depression and 

somatic complaints, physiological measures of urinary norepinephrine, 

epinephrine, and cortisol, disturbed sleep, and changes in immune system parameters) for up to 6 years after the accident (Baum, Gatchel, 

and Schaeffer, 1983; Davidson, Fleming, and Baum, 1987; McKinnon, 

Weisse, Reynolds, Bowles, and Baum, 1989). It would appear that the 

TMI symptoms were not the result of exposure to radiation but to perceived radiation threat. Therefore, TMI demonstrates that fear of exposure to radiation can cause significant distress and stress symptoms that 

can mimic some of the symptoms of actual radiation exposure. 

Chernobyl 

Unlike the TMI accident, the Chernobyl accident in 1986 did release significant amounts of radiation. Approximately 135,000 people 

were evacuated from a 30-kilometer zone in the first 2 weeks after the 

accident. Most of these people had to be permanently relocated. In addition, an estimated 600,000 to 800,000 liquidators (workers who were 

brought in to handle the emergency situation and for the subsequent 

cleanup operations) were also exposed to significant levels of radiation 

(Nuclear Energy Agency [NEA], 2002). Although there were over 200 

cases of ARS, the primary health effect was widespread psychological 

distress (NEA, 2002). 

A variety of psychoneurological syndromes have been reported 

as sequelae of Chernobyl in the Russian literature (Novikov, Tsygan, 

Borisova, and Rybina, 1997; Pastel, 2002; Torubarov, 1991). These syndromes are characterized by medically unexplained physical symptoms 

(MUPS) including fatigue, sleep and mood disturbances, headaches, 

impaired memory and concentration, and muscle and/or joint pain. 
330 THE 71F ADVANTAGE

These syndromes were reported in both liquidators who had suffered 

ARS and those who had not (Novikov et al., 1997; Torubarov, 1991). No 

significant correlations were found among physical symptoms, radiation dose, and physical examination data (Torubarov, 1991). 

A study of over 1,400 Latvian liquidators found that 44 percent had 

an International Classification of Disease, 9th edition (ICD–9)–coded 

mental-psychosomatic disorder (depression, physiologic malfunction 

arising from mental factors, or unspecified disorders of the autonomic nervous system) (Viel, Curbakova, Dzerve, Eglite, Zvagule, and Vincent, 1997). Due to lack of ICD–9 codes, anxiety, PTSD, and sleep disturbances were not diagnosed. PTSD and PTSD symptoms have been 

found in two studies of people exposed to Chernobyl (Cwikel, Abdelgani, Goldsmith, Quastel, and Yevelson, 1997; Tarabrina, Lazebnaya, 

Zelenova, and Lasko, 1996).

An epidemiologic study of over 4,700 Estonian liquidators found 

an increase in suicide, but no increases in cancer, leukemia, or overall 

mortality (Rahu, Tekkel, Veidebaum, Pukkala, Hakulinen, Auvinen et 

al., 1997). Suicide accounted for almost 20 percent of mortality in the liquidator cohort. Reasons for the increased suicide rate are not currently 

known. However, data from Vietnam veterans with PTSD have demonstrated an increased risk for traumatic deaths, including suicide (Bullman and Kang, 1997). Given other studies demonstrating a variety of 

mental health disorders in Chernobyl liquidators, one could speculate 

that fear of radiation in these liquidators might cause depression, PTSD, 

and other disorders that are associated with increased rates of suicide. As 

such, the primary toxic agent appears to be fear, not radiation.

Goiania

In September 1987, two scavengers removed a cesium-137 (Cs137) teletherapy unit from an abandoned radiotherapy institute in 

Goiania, the capital of Goias State in Brazil (International Atomic Energy Agency [IAEA], 1988). While dismantling the unit, they accidentally 

ruptured the source capsule, which contained radioactive Cs-137 powder. When the radiation accident became public, the perceived threat of 

radiation exposure caused over 120,000 people (approximately 10 percent of the city of 1.2 million people) to be screened over a 6-month span 

for possible contamination (Lipsztein, Cunha, and Oliveira, 1991). Residents and others who happened to be in the city at that time felt sufficiently at risk that they took time off from work or came on weekends to 
PSYCHOLOGICAL EFFECTS OF CBRN WEAPONS 331

wait in line to be scanned (Petterson, 1988; Rosenthal, de Almeida, and 

Mendonca, 1991). Approximately 5,000 (8 percent) of the first 60,000 

people screened presented with symptoms that mimicked acute radiation sickness (for example, rash around neck and upper body, vomiting, 

diarrhea), but none of these individuals were contaminated (Petterson, 

1988). Only 249 people had measurable radiological contamination.

The 11 most seriously affected victims at Goiania had previously 

been hospitalized, but were all moved to one hospital. Due to immunosuppression, patients were kept confined and isolated and medical personnel wore protective masks. Both measures increased stress 

in patients. Most of the 20 hospitalized patients suffered from depression and anxiety (Brandao-Mello, Oliveira, and de Carvalho, 1991). 

Uncertainty about future health effects also increased stress, as did the 

lack of information concerning the duration of their treatment and the 

long-term prognosis.

The large number of people (approximately 10,000) who lived or 

worked within 300 meters of the contaminated area in Goiania exhibited fear, psychosomatic reactions, apprehension about the future, insecurity, and disbelief regarding the effectiveness of remedial measures 

the government took (Curado, Costa Neto, and Helou, 1991). A public opinion poll found that two-thirds of both affected Goiania residents and a control group living away from the contamination believed 

that Goiania was still contaminated. Research conducted 3 years later 

showed that stress parameters were still increased and performance was 

decreased both in nonirradiated individuals with perceived exposure 

(those living within 1 kilometer of Abadia, the area where contaminated 

waste from the incident had been stored) and in irradiated individuals 

from Goiania (Collins and de Carvalho, 1993). 

Nuclear Weapons

Of all the CBRN agents, nuclear weapons have the greatest destructive impact; they are the quintessential weapons of mass destruction. The atomic weapons dropped on Hiroshima and Nagasaki caused 

incredible devastation, outbreaks of fires, and large numbers of dead, 

dying, and injured people (Janis, 1951). In interviews done after the 

war, approximately two-thirds described psychological disturbances of 

intense fear, emotional upset, or depression. Nevertheless, there was 

only a single incident of an apparent mass panic reported at Hiroshima: 
332 THE 71F ADVANTAGE

a large group of frightened people in a park pressed some victims into a 

river, resulting in several deaths (Hersey, 1946). 

During the following weeks, survivors continued to witness severely injured people suffering from burns and blast injuries. In addition, there were outbreaks of acute radiation sickness. The continued 

exposure to the devastation and human suffering served as a constant 

reminder to survivors and reinforced the psychological impact of the 

original event (Janis, 1951). 

An estimated 200,000 Department of Defense personnel, both 

military and civilian, observed the early U.S. above-ground nuclear tests 

(Johnson, Goetz, and McRaney, 1986). The external doses received by 

these “atomic veterans” averaged about 0.5 rem, with many receiving 

no dose and only 1 percent receiving a dose greater than 5 rem (5 rem 

= maximum annual occupational dose). Several case studies of atomic 

veterans reported long-term psychological distress (Garcia, 1994; Vyner, 

1983). Initially, troops at Desert Rock V seemed to go through the testshot experience with equanimity (White, 1953), but many years later, 

an anecdotal study found that veterans reported vivid recollections of 

an atmosphere of tension and fear at the test sites and thought they had 

been ill prepared (Garcia, 1994).

Survivors of Hiroshima and Nagasaki were stigmatized, especially 

those with severe burns that resulted in scarring and keloids. Lifton 

(1967) described a “Neurasthenic Survivor Syndrome” characterized 

by “persistence of symptoms of withdrawal from social life, insomnia, 

nightmares, chronic depressive and anxiety reactions and far-reaching 

somatization. . . . in addition, fatigue, emotional lability, loss of initiative, 

and generalized personal, sexual and social maladaptation.” A study of 

over 7,000 Nagasaki atomic bomb patients conducted 15 years later 

showed long-term psychological effects in approximately 7 percent, 

with the majority complaining of fatigue, lack of spirit, poor memory, 

and introversion (Nishikawa and Tsuiki, 1961). These symptoms were 

twice as common in survivors who had shown ARS symptoms and were 

related to severity of ARS symptoms.

A cluster of functional somatic symptoms reported in atomic veterans was dubbed the Radiation Response Syndrome (RRS) (Vyner, 

1983). RRS has two components: a core belief that radiation had caused 

physical harm, and functional somatic symptoms that appeared to be 

an expression of this belief. The RRS belief system included the views 

“that men were dying, that doctors are of little help, that one doctor 
PSYCHOLOGICAL EFFECTS OF CBRN WEAPONS 333

may exist who could help, that the government is to blame for their illness, and that people think they are crazy for blaming exposure to ionizing radiation for their illnesses” (Vyner, 1983). RRS resembles a delayedonset PTSD, but rather than a re-experiencing of the trauma, the veteran 

is preoccupied with radiation and its impact on his life. 

Biological Agents

U.S. Anthrax Attacks

In the fall of 2001, the United States was shocked by the mailing 

of anthrax-laced letters leading to 23 cases of anthrax (CDC, 2001). Following September 11, 2001, and prior to the first case of anthrax, there 

had already been media reports of increased purchases of gas masks and 

ciprofloxacin (commonly called cipro), which is an antibiotic used to 

treat anthrax. After the anthrax mail attack was discovered, there were 

increased patient requests for cipro as well as anecdotal reports of increased prescriptions for cipro (Steinhauer, 2001). Hospitals reported 

their already busy emergency rooms were filled with people anxious 

about anthrax, many demanding treatment.

Puzzling long-term effects were seen in the survivors of anthrax. 

Newspapers reported that survivors suffered symptoms of fatigue, 

shortness of breath, chest pains, memory problems, nightmares, and 

rage 6 to 12 months after their illnesses (Stolberg, 2002). Only one of 

the inhalational anthrax survivors was well enough to return to work. 

In the one published study of anthrax survivors one year after the attack, many reported reduced health-related quality of life (HR QOL) 

and psychological distress (Reissman, Whitney, Taylor, Hayslett, Dull, 

Arias et al., 2004).

1994 Plague Outbreak in India

In 1994, there were two outbreaks of plague in India: a bubonic 

plague outbreak in Maharashtra State followed a month later by a pneumonic plague outbreak 500 kilometers away in Surat (John, 1994). Of the 

5,000 suspected cases of plague, there were 167 confirmed cases and 55 

deaths (Mavalankar, 1994). Unfortunately, no data is readily available on 

psychological reactions or rates of such reactions. However, there were 

observable effects on behavior. The local media helped fuel the anxiety 

with exaggerated reports (Mavalankar, 1994; Madan, 1995). An estimated 

400,000 to 600,000 people fled Surat, including hospital staff, private 
334 THE 71F ADVANTAGE

medical practitioners, and municipal workers (Kumar, 1994; Ramalingaswami, 1995). In Delhi, 1,200 kilometers from Surat, people fashioned 

masks from available materials and many bought and hoarded tetracycline, an antibiotic used to treat plague (Ramalingaswami, 2001). 

Severe Acute Respiratory Syndrome

The outbreak of SARS, a new and emerging infection, likewise 

created much fear and anxiety. In Beijing, schools and universities were 

shuttered, hundreds of companies closed their doors, and some surrounding villages shut themselves off (Pomfret, 2003). Rumors of neighborhoods being quarantined led to people stockpiling food (Eckholm, 

2003). Although officials asked people to avoid travel, thousands of 

businessmen, migrant workers, and college students left Beijing. In Taiwan, 160 doctors and nurses quit work at various hospitals out of fear 

that infection control measures were inadequate (McNeil, 2003). 

SARS patients often spent hours in isolation between contacts 

with staff and were deprived of family visits, leading to complaints of 

sadness, anxiety, boredom, loneliness, and nonspecific anger and frustration (Avendano, Derkach, Swan, 2003; Maunder, Hunter, Vincent, 

Bennett, Peladeau, Leszcz et al., 2003). Fear and anxiety often waxed 

and waned with fever (Maunder et al., 2003).

One study used questionnaires to measure the psychosocial effects of SARS on staff in a Toronto hospital (Nickell, Crighton, Tracy, 

Al Enazy, Bolaji, Hanjrah et al., 2004). Almost two-thirds of the respondents reported concerns for their own or their family’s health. Factors 

associated with increased concerns were perception of a greater risk of 

death from SARS, living with children, personal or family lifestyle affected by SARS outbreak, and being treated differently because of employment in a hospital. Emotional distress was found in almost 30 percent of all responders but was present among 45 percent of nurses, who 

were most at risk for infection. Factors identified for significant association with emotional distress were being a nurse, part-time employment 

status, lifestyle affected by SARS outbreak, and the ability to do one’s job 

affected by precautionary measures.

Several infectious disease outbreaks have been reported to cause 

both PTSD and a decreased HR QOL. For example, the majority of survivors of an outbreak of Legionnaire’s disease reported fatigue, neurologic symptoms, and neuromuscular symptoms 17 months after diagnosis (Lettinga, Verbon, Nieuwkerk, Jonkers, Gersons, Prins et al., 2002). 
PSYCHOLOGICAL EFFECTS OF CBRN WEAPONS 335

HR QOL was impaired in seven out of eight dimensions, and 15 percent of patients experienced PTSD. Similarly, survivors of acute respiratory distress syndrome have also reported PTSD and decreased HR QOL 

(Schelling, Stoll, Haller, Briegel, Manert, Hummel et al., 1998; Weinert, 

Gross, Kangas, Bury, and Marinelli, 1997). Because most of the most severe (Centers for Disease Control Category A) BW agents cause acute respiratory distress syndrome, similar long-term effects should be expected.

Summary

Risk perception will be a critical variable that mediates the psychological effects following a CBRN attack. Effective risk communication by authorities may decrease psychological effects while the mass 

media is likely to increase risk perception and possible psychological 

effects. Although mass panic can occur in situations involving limited 

escape routes, it will still likely be a rare event. Psychological effects are 

likely to cause large numbers of casualties following attacks using CBRN 

weapons. Initial presentation may resemble combat stress casualties or 

may present with a variety of nonspecific symptoms including difficulty 

breathing, dizziness, fatigue, headache, and sleep disturbances. Triage 

and differential diagnosis may present problems in the initial stages. 

The number of psychological casualties could increase based on possible amplification of risk perception by mass media reporting. Unlike 

most physical injuries or illnesses caused by CBRN agents, psychological effects can be contagious. People anxious about a CBRN attack may 

suffer from psychologically induced nonspecific symptoms such as fatigue, headache, muscle ache, and dizziness. 

Given the history of postcombat war syndromes (Hyams et al., 

1996), long-term effects are also very likely and will be difficult to diagnose and treat. These chronic OMUS syndromes will be greatly influenced by risk perception and mass media reporting. 

References

Abenhaim, L., Dab, W., and Salmi, L.R. (1992). Study of civilian victims of terrorist attacks 

(France 1982–1987). Journal of Clinical Epidemiology 45, 103–109.

Anno, G.H., Baum, S.J., Withers, H.R., and Young, R.W. (1989). Symptomatology of acute radiation effects in humans after exposure to doses of 0.5–30 Gy. Health Physics 56, 821–838.

Asukai, N. and Maekawa, K. (2002). Psychological and physical health effects of the 1995 sarin 

attack in the Tokyo subway system. In J.M. Havenaar, J.G. Cwikel, and E.J. Bromet (eds.). 

Toxic turmoil: Psychological and societal consequences of ecological disasters (149–162). 

New York: Kluwer Academic/Plenum Publishers.
336 THE 71F ADVANTAGE

Avendano, M., Derkach, P., and Swan, S. (2003). Clinical course and management of SARS in 

health care workers in Toronto: A case series. Canadian Medical Association Journal 168, 

1649–1660.

Balali-Mood, M. and Hefazi, M. (2005). The pharmacology, toxicology, and medical treatment of 

sulphur mustard poisoning. Fundamental and Clinical Pharmacology 19, 297–315.

Bartone, P. (2006). Resilience under military operational stress: Can leaders influence hardiness? 

Military Psychology 18 (Suppl.), S131–S148.

Baum, A., Gatchel, R.J., and Schaeffer, M.A. (1983). Emotional, behavioral, and physiological 

effects of chronic stress at Three Mile Island. Journal Consulting and Clinical Psychology

51, 565–572.

Bleich, A., Dycian, A., Koslowsky, M., Solomon, Z., and Wiener, M. (1992). Psychiatric implications of missile attacks on a civilian population: Israeli lessons from the Persian Gulf 

War. Journal of the American Medical Association 268, 613–615.

Brandao-Mello, C.E., Oliveira, A.R., and de Carvalho, A.B. (1991). Psychological effects of the 

Goiania radiation accident on the hospitalized victims. In R.C. Ricks, M.E. Berger, and 

F.M. O’Hara (eds.). Medical basis for radiation-accident preparedness III: The psychological perspective (121–129). New York: Elsevier.

Brecher, R.W., and Flynn, T. (2002). Principles of risk communication: building trust and credibility with the public. In W.M. Haschek, C.G. Rousseaux, and M.A. Wallig (eds.), Handbook of toxicologic pathology. New York: Academic Press.

Bullman, T.A., and Kang, H.K. (1997). Posttraumatic stress disorder and the risk of traumatic 

deaths among Vietnam veterans. In C.S.Fullerton and R.J. Ursano (eds.), Posttraumatic 

stress disorder. Acute and long-term responses to trauma and disaster (175–189). Washington, DC: American Psychiatric Press, Inc.

Caldwell, J.M., Ranson, S.W., and Sacks, J.G. (1951). Group panic and other mass disruptive reactions. United States Armed Forces Medical Journal 2, 541–567.

Carley, S.D., and Mackway-Jones, K. (1997). The casualty profile from the Manchester bombing 

1996: A proposal for the construction and dissemination of casualty profiles from major 

incidents. Journal of Accident and Emergency Medicine 14, 76–80.

Centers for Disease Control (1988a). Health status of Vietnam veterans I. Psychosocial characteristics. The Centers for Disease Control Vietnam experience study. Journal of the 

American Medical Association 259, 2701–2707.

———. (1988b). Health status of Vietnam veterans II. Physical health. The Centers for Disease 

Control Vietnam experience study. Journal of the American Medical Association 259, 

2708–2714.

———. (1988c). Health status of Vietnam veterans III. Reproductive outcomes and child health. 

The Centers for Disease Control Vietnam experience study. Journal of the American 

Medical Association 259, 2715–2719.

———. (2001). Update: Investigation of bioterrorism-related inhalational anthrax—Connecticut, 

2001. Morbidity and Mortality Weekly Report 50, 1049–1051.

Collins, D.L., and de Carvalho, A.B. (1993). Chronic stress from the Goiania 137Cs radiation 

accident. Behavioral Medicine 18, 149–157.

Covello, V.T., Peters, R.G., Wojtecki, J.G., and Hyde, R.C. (2001). Risk communication, the West 

Nile virus epidemic, and bioterrorism: Responding to the communication challenges 

posed by the intentional or unintentional release of a pathogen in an urban setting. Journal of Urban Health 78, 382–391.

Curado, M.P., Costa Neto, S.B., and Helou, S. (1991). Psychological aspects of the radiation accident in Goiania: a general overview on victims and population. In R.C. Ricks, M.E. 

Berger, and F.M. O’Hara (eds.), Medical basis for radiation-accident preparedness III. The 

psychological perspective (143–154). New York: Elsevier.

Curran, P.S., Bell, P., Murray, A., Loughrey, G., Roddy, R., and Rocke, L.G. (1990). Psychological 

consequences of the Enniskillen bombing. British Journal of Psychiatry 156, 479–482.
PSYCHOLOGICAL EFFECTS OF CBRN WEAPONS 337

Cwikel, J., Abdelgani, A., Goldsmith, J.R., Quastel, M., and Yevelson, I.I. (1997). Two-year follow up study of stress-related disorders among immigrants to Israel from the Chernobyl 

area. Environmental Health Perspectives 105, 1545–1550.

Davidson, L.M., Fleming, R., and Baum, A. (1987). Chronic stress, catecholamines, and sleep 

disturbance at Three Mile Island. Journal of Human Stress 13, 75–83.

Decoufle, P., Holmgreen, P., Boyle, C.A., and Stroup, N.E. (1992). Self-reported health status of 

Vietnam veterans in relation to perceived exposure to herbicides and combat. American 

Journal of Epidemiology 135, 312–323.

DiGiovanni, C. (1999). Domestic terrorism with chemical or biological agents: Psychiatric aspects. American Journal of Psychiatry 156, 1500–1505.

Eckholm, E. (2003, April 24). Illness psychological impact in China exceeds its actual numbers. 

The New York Times, A13.

Engel, C.C., Jr., Adkins, J.A., and Cowan, D.N. (2002). Caring for medically unexplained physical 

symptoms after toxic environmental exposures: Effects of contested causation. Environmental Health Perspectives 110, 641–647.

Fabrikant, J.I. (1983). The effects of the accident at Three Mile Island on the mental health and 

behavioral responses of the general population and nuclear workers. Health Physics 45, 

579–586.

Garcia, B. (1994). Social-psychological dilemmas and coping of atomic veterans. American Journal of Orthopsychiatry 64, 651–655.

Ghanei, M., Aslani, J., Khateri, S., and Hamadanizadeh, K. (2003). Public health status of the 

civil population of Sardasht 15 years following large-scale wartime exposure to sulfur 

mustard. Journal of Burns and Surgical Wound Care 2, 7–18.

Gilchrist, H.L. (1928). Comparative study of world war casualties from gas and other weapons. 

Washington, DC: U.S. Government Printing Office.

Glass, T.A., and Schoch-Spana, M. (2002). Bioterrorism and the people: How to vaccinate a city 

against panic. Clinical Infectious Disease 34, 217–223.

Gothe, C.J., Molin, C., and Nilsson, C.G. (1995). The environmental somatization syndrome. 

Psychosomatics 36, 1–11.

Hadden, W.A., Rutherford, W.H., and Merrett, J.D. (1978). The injuries of terrorist bombing: A 

study of 1532 consecutive patients. British Journal of Surgery 65, 525–531.

Haldane, J.S. (1919). Lung-irritant gas poisoning and its sequelae. Journal of the Royal Army 

Medical Corps 33, 494–507.

Hammerman, G. (1987). The psychological impact of chemical weapons on combat troops in 

World War I. In R.W. Young and B.H. Drum (eds.), Proceedings of the defense nuclear 

agency symposium/workshop on the psychological effects of tactical nuclear warfare (87–

209). Washington, DC: Defense Nuclear Agency.

Hashemian, F., Khoshnood, K., Desai, M.M., Falahati, F., Kasl, S., and Southwick, S. (2006). Anxiety, depression, and posttraumatic stress in Iranian survivors of chemical warfare. Journal of the American Medical Association 296, 560–566.

Hersey, J. (1946). Hiroshima. New York: Knopf.

Hulbert, H.S. (1920). Gas neurosis syndrome. American Journal of Insanity 77, 213–216.

Hyams, K.C., Murphy, F.M., and Wessely, S. (2002). Responding to chemical, biological, or nuclear terrorism: The indirect and long-term health effects may present the greatest challenge. Journal of Health Politics, Policy and Law 27, 273–291.

Hyams, K.C., Wignall, F.S., and Roswell, R. (1996). War syndromes and their evaluation: From 

the U.S. Civil War to the Persian Gulf War. Annals of Internal Medicine 125, 398–405.

International Atomic Energy Agency (1988). The radiological accident in Goiania. Vienna: International Atomic Energy Agency.

Janis, I.L. (1951). Air war and emotional stress. Psychological studies of bombing and civilian defense. New York: RAND Corporation.
338 THE 71F ADVANTAGE

John, T.J. (1994). Learning from plague in India. Lancet 344, 972.

Johnson, A.A., Goetz, J.L., and McRaney, W.K. (1986). For the record—A history of the nuclear test 

personnel review program, 1978–1986 (Rep. No. DTIC AD No. ADA190410). Washington, DC: U.S. Government Printing Office.

Kawana, N., Ishimatsu, S., and Kanda, K. (2001). Psycho-physiological effects of the terrorist 

sarin attack on the Tokyo subway system. Military Medicine 166, 23–26.

Kemeny, J.G., Babbitt, B., Haggerty, P.E., Lewis, C., Marks, P., Marrett, C.B. et al. (1979). Report of 

the president’s commission on the accident at Three Mile Island. New York: Pergamon Press.

Khateri, S., Ghanei, M., Keshavarz, S., Soroush, M., and Haines, D. (2003). Incidence of lung, 

eye, and skin lesions as late complications in 34,000 Iranians with wartime exposure 

to mustard agent. Journal of Occupational and Environmental Medicine 45, 1136–1143.

Khateri, S., Ghanei, M., and Palmer, C. (2004). Long-term psycho-social impact of a chemical weapons attack on the population of Sardasht, Iran. Applied Science and Analysis Newsletter.

Kumar, S. (1994). Plague in India. Lancet 344, 941–942.

Lau, J.T., Yang, X., Tsui, H., and Kim, J.H. (2003). Monitoring community responses to the SARS 

epidemic in Hong Kong: From day 10 to day 62. Journal of Epidemiology and Community 

Health 57, 864–870.

Lettinga, K.D., Verbon, A., Nieuwkerk, P.T., Jonkers, R.E., Gersons, B.P., Prins, J.M. et al. (2002). 

Health-related quality of life and posttraumatic stress disorder among survivors of an 

outbreak of legionnaires disease. Clinical Infectious Disease 35, 11–17.

Leung, G.M., Lam, T.H., Ho, L.M., Ho, S.Y., Chan, B.H., Wong, I.O. et al. (2003). The impact 

of community psychological responses on outbreak control for severe acute respiratory 

syndrome in Hong Kong. Journal of Epidemiology and Community Health 57, 857–863.

Levin, S.G. (1991). Estimating battle fatigue casualties in tactical nuclear combat (Rep. No. DNA–

TR–90–114). Washington, DC: Defense Nuclear Agency.

Lifton, R. (1967). Death in life: Survivors of Hiroshima. New York: Random House.

Lipsztein, J.L., Cunha, P.G., and Oliveira, C.A. (1991). The Goiania accident: Behind the scenes. 

Health Physics 60, 5–6.

Madan, T.N. (1995). The plague in India, 1994. Social Science and Medicine 40, 1167–1168.

Maunder, R., Hunter, J., Vincent, L., Bennett, J., Peladeau, N., Leszcz, M. et al. (2003). The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching 

hospital. Canadian Medical Association Journal 168, 1245–1251.

Mavalankar, D.V. (1994). Plague in India. Lancet 344, 1298.

McKinnon, W., Weisse, C.S., Reynolds, C.P., Bowles, C.A., and Baum, A. (1989). Chronic stress, leukocyte subpopulations, and humoral response to latent viruses. Health Psychology 8, 389–402.

McNeil, D.G. (2003, May 21). SARS fears shake Taiwan medical staffs. The New York Times, A14.

Nickell, L.A., Crighton, E.J., Tracy, C.S., Al Enazy, H., Bolaji, Y., Hanjrah, S. et al. (2004). Psychosocial effects of SARS on hospital staff: Survey of a large tertiary care institution. 

Canadian Medical Association Journal 170, 793–798.

Nishikawa, T., and Tsuiki, S. (1961). Psychiatric investigations of atomic bomb survivors. Nagasaki Medical Journal 36, 717–722.

Norris, G.W. (1919). Some medical impressions of the war. American Journal of the Medical Sciences 157, 628–634.

North, C.S., Nixon, S.J., Shariat, S., Mallonee, S., McMillen, J.C., Spitznagel, E.L. et al. (1999). 

Psychiatric disorders among survivors of the Oklahoma City bombing. Journal of the 

American Medical Association 282, 755–762.

Novikov, V.S., Tsygan, V.N., Borisova, E.D., and Rybina, L.A. (1997). Changes in cerebral bioelectric activity in the Chernobyl NPP accident liquidators. Human Physiology 23, 542–546.

Nuclear Energy Agency (2002). Chernobyl. Assessment of radiological and health impacts. 2002 

update of Chernobyl: Ten years on. Paris: Organization for Economic Co-operation and 

Development.
PSYCHOLOGICAL EFFECTS OF CBRN WEAPONS 339

Ohbu, S., Yamashina, A., Takasu, N., Yamaguchi, T., Murai, T., Nakano, K. et al. (1997). Sarin 

poisoning on Tokyo subway. Southern Medical Journal 90, 587–593.

Parkinson, D.K., and Bromet, E.J. (1983). Correlates of mental health in nuclear and coal-fired 

power plant workers. Scandinavian Journal of Work, Environment and Health 9, 341–345.

Pastel, R.H. (2002). Radiophobia: Long-term psychological consequences of Chernobyl. Military 

Medicine 166, 134–136.

Petterson, J.S. (1988). Perception vs. reality of radiological impact: The Goiania model. Nuclear 

News 31, 84–90.

Pfefferbaum, B., Nixon, S.J., Tivis, R.D., Doughty, D.E., Pynoos, R.S., Gurwitch, R.H. et al. (2001). 

Television exposure in children after a terrorist incident. Psychiatry 64, 202–211.

Pomfret, J. (2003, May 1). SARS inciting “mass panic” in Beijing. The Washington Post.

Quarantelli, E.L. (1960). Images of withdrawal behavior in disasters: Some basic misconceptions. 

Social Problems 8, 68–79.

Rahu, M., Tekkel, M., Veidebaum, T., Pukkala, E., Hakulinen, T., Auvinen, A. et al. (1997). The 

Estonian study of Chernobyl cleanup workers: II. Incidence of cancer and mortality. Radiation Research 147, 653–657.

Ramalingaswami, V. (1995). Plague in India. Nature Medicine 1, 1237–1239.

———. (2001). Psychosocial effects of the 1994 plague outbreak in Surat, India. Military Medicine

166, 29–30.

Reissman, D.B., Whitney, E.A., Taylor, T.H., Hayslett, J.A., Dull, P.M., Arias, I. et al. (2004). Oneyear health assessment of adult survivors of bacillus anthracis infection. Journal of the 

American Medical Association 291, 1994–1998.

Ritchie, E.C., Watson, P.J., and Friedman, M.J. (2006). Interventions following mass violence and 

disasters. New York: Guilford Press.

Rosenthal, J.J., de Almeida, C.E., and Mendonca, A.H. (1991). The radiological accident in 

Goiania: The initial remedial actions. Health Physics 60, 7–15.

Rotenberg, Z., Noy, S., and Gabbay, U. (1994). Israeli ED experience during the Gulf War. American Journal of Emergency Medicine 12, 118–119.

Rothman, A.L., and Weintraub, M.I. (1995). The sick building syndrome and mass hysteria. Neurology Clinics 13, 405–412.

Salmon, T.W., and Fenton, N. (1929). Neuropsychiatry in the American expeditionary force. In 

T.W. Salmon and N. Fenton (eds.), Volume 10. Neuropsychiatry (217–474). Washington, 

DC: U.S. Government Printing Office.

Sandman, P.M. (2003). Bioterrorism risk communication policy. Journal of Health Communication 8 (Suppl. 1), 146–147.

Scharf, T., Vaught, C., Kidd, P., Steiner, L., Kowalski, K., Wiehagen, B. et al. (2001). Toward a 

typology of dynamic and hazardous work environments. Human Ecology and Risk Assessment 7, 1827–1841.

Schelling, G., Stoll, C., Haller, M., Briegel, J., Manert, W., Hummel, T. et al. (1998). Health-related 

quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Critical Care Medicine 26, 651–659.

Schuster, M.A., Stein, B.D., Jaycox, L., Collins, R.L., Marshall, G.N., Elliott, M.N. et al. (2001). A 

national survey of stress reactions after the September 11, 2001, terrorist attacks. New 

England Journal of Medicine 345, 1507–1512.

Showalter, E. (1997). Hystories: Hysterical epidemics and modern culture. New York: Columbia 

University Press.

Singer, J.E. (1982). Yes Virginia, there really is a mass psychogenic illness. In M.J. Colligan, J.W. 

Pennebaker, and L.R. Murphy (eds.), Mass psychogenic illness (127–135). Hillsdale, NJ: 

Lawrence Erlbaum Associates, Inc.

Smelser, N.J. (1962). Theory of collective behavior. New York: The Free Press.

Steinhauer, J. (2001, October 21). Hysteria can be hazardous. The New York Times, C9.
340 THE 71F ADVANTAGE

Stolberg, S.G. (2002, May 7). For anthrax survivors, a halting, painful recovery. The New York 

Times, F1.

Stouffer, S.A., Lumsdaine, A.A., Lumsdaine, M.H., Williams, R.M., Jr., Smith, M.B., Janis, I.L. et 

al. (1949). The American soldier: combat and its aftermath. Princeton: Princeton University Press.

Struewing, J.P., and Gray, G.C. (1990). An epidemic of respiratory complaints exacerbated by 

mass psychogenic illness in a military recruit population. American Journal of Epidemiology 132, 1120–1129.

Tarabrina, N., Lazebnaya, E., Zelenova, M., and Lasko, N. (1996). Chernobyl clean-up workers’ 

perception of radiation threat. Radiation Protection and Dosimetry 68, 251–255.

Torubarov, F.S. (1991). Psychological consequences of the Chernobyl accident from the radiation 

neurology point of view. In R.C. Ricks, M.E. Berger, and F.M. O’Hara (eds.), The medical 

basis for radiation-accident preparedness III: The psychological perspective (81–91). New 

York: Elsevier Science Publishing.

U.S. Army Medical Research Institute of Chemical Defense (2000). Medical Management of 

Chemical Casualties Handbook (3d

 ed.). Aberdeen Proving Grounds, MD: USAMRICD.

Vasterman, P., Yzermans, C.J., and Dirkzwager, A.J. (2005). The role of the media and media 

hypes in the aftermath of disasters. Epidemiolic Reviews 27, 107–114.

Viel, J.F., Curbakova, E., Dzerve, B., Eglite, M., Zvagule, T., and Vincent, C. (1997). Risk factors 

for long-term mental and psychosomatic distress in Latvian Chernobyl liquidators. Environmental Health Perspectives 105, 1539–1544.

Vineberg, R. (1965). Human factors in tactical nuclear combat (Rep. No. HumRRO TR 65-2). 

Alexandria, VA: George Washington University, Human Resources Research Office.

Vyner, H.M. (1983). The psychological effects of ionizing radiation. Culture, Medicine and Psychiatry 7, 241–261.

Wachtel, C. (1941). Chemical warfare. Brooklyn, NY: Chemical Publishing Co., Inc.

Weinert, C.R., Gross, C.R., Kangas, J.R., Bury, C.L., and Marinelli, W.A. (1997). Health-related 

quality of life after acute lung injury. American Journal of Respiratory and Critical Care 

Medicine 156, 1120–1128.

Weiss, B. (1998). Neurobehavioral properties of chemical sensitivity syndromes. Neurotoxicology

19, 259–268.
Chapter 14

Mitigating the Medical Consequences 

of Exposure to Chemical Weapons: 

Contributions of U.S. Army Research 

Psychologists to Chemical Defense

Maurice L. Sipos and Matthew G. Clark

U.S. Army research psychologists play a key role in evaluating the 

behavioral and functional impact of all sorts of chemical and pharmaceutical toxicants, including chemical warfare agents and potential therapeutics. Additionally, they are essential to the mission of developing 

safe and effective therapies for warfighters, particularly medical countermeasures against chemical warfare agents. This chapter provides a 

brief survey of the contributions of research psychologists in support of 

the Medical Chemical Defense Program with emphasis on the effects of 

chemical warfare nerve agents (CWNAs) like sarin, soman, tabun, and 

VX and the development of medical countermeasures.

Introduction

Chemical warfare agents (CWAs) are extremely toxic chemicals 

that are intended to kill, seriously injure, or incapacitate military and civilian personnel. The threat of CWAs on the battlefield dates back to ancient times. The American perspective on the history of chemical warfare is summarized in the Textbook of Military Medicine (Part 1): Medical Aspects of Chemical and Biological Warfare (Smart, 1997).

In brief, World War I marked the beginning of the modern era of 

chemical warfare. Its horror was captured by Lieutenant Wilfred Owen 

of the Royal Army in the poem entitled “Dulce et Decorum Est” (Owen, 

1963). The image of a soldier “guttering, choking, drowning” permeated 

the narrator’s dreams, forcing him to relive the horror of hearing “the 

blood come gargling from the froth-corrupted lungs.” Chlorine, phosgene, and sulfur mustard were common CWAs during World War I, and 

they had a devastating psychological impact on Allied forces that the 

Germans were not prepared to exploit. 

341
342 THE 71F ADVANTAGE

Following World War I, there was a rapid escalation in the science surrounding all aspects of chemical warfare, to include research 

and development of decontamination methods, chemical detection and 

alarms, treatment strategies, protective devices, and mechanisms to deliver CWAs to the enemy. The discovery by German chemist Dr. Gerhard Schrader in the 1930s of tabun, an extremely toxic organophosphorus insecticide that affected the nervous system, led to the development of a new class of CWA—nerve agents including sarin, soman, and 

VX (Smart, 1997).

Although CWAs have not been used extensively since World War 

I, several incidents involving them in the last half-century underscored 

the need to continue toxicological research on the threats and develop 

countermeasures for defending military and civilian populations from 

their indiscriminate effects (Salem, Ternay, and Smart, 2008). For example, Iraq used sulfur mustard and nerve agents against Iran during the 

Iran-Iraq War in the 1980s. In the mid-1990s, Aum Shinrikyo, a Japanese religious sect, used the nerve agents sarin and VX in a series of terrorist incidents that specifically targeted civilians.

The fact that CWAs are relatively easy and inexpensive to synthesize on a large scale, coupled with the fact that rogue nations and militant 

groups rely on asymmetric warfare, has led pundits to state that it is not a 

matter of if, but when, CWAs will be used on American soil or against U.S. 

military and civilians. The Defense Threat Reduction Agency and the National Institutes of Health continue to invest in research directed toward 

mitigating and eliminating the medical consequences of exposure to CWAs. 

Outside of counterterrorist activities, the U.S. Army is aggressively 

expanding preparations to conduct full-spectrum operations worldwide 

as evidenced by new doctrine on counterinsurgency and stability operations (U.S. Army Field Manual [FM] 3–07, Stability Operations [Army, 

2008b]; FM 3–24, Counterinsurgency [Army, 2006]; FM 7–0, Training for Full Spectrum Operations [Army, 2008c]; FM 3–0, Operations

[Army, 2008a]). These military operations emphasize the increased potential for unconventional attacks on conventional U.S. forces involving 

asymmetric threats. In addition to the use of improvised explosive devices, these asymmetric threats will likely include CWAs ranging from 

toxic industrial compounds (such as chlorine and bromine) to deadly 

nerve agents (for example, sarin and soman), as has been exhibited to 

some degree in current operations. Thus, understanding the functional 
MITIGATING THE MEDICAL CONSEQUENCES OF EXPOSURE TO CHEMICAL WEAPONS 343

psychological and toxicological impact of CWAs and potential therapies 

is critical for both U.S. citizens and military personnel. 

U.S. Army research psychologists are essential for supporting the 

mission of evaluating the behavioral and functional impact of CWAs 

and potential therapeutics. More specifically, as uniformed military scientists, they are trained to employ and understand holistic functional 

assessments in the areas of psychobiology, toxicology, and neuroscience, 

while also receiving extensive training and field experience in military 

operational medicine. As presented in this chapter, Army research psychologists conducted much of the early research on the performance 

impacts of nerve agents and their pharmacological countermeasures, 

and are ideally suited to investigate nerve agent–induced seizure activity and the resulting brain injury. 

While this chapter has a limited focus, it must be noted that the 

breadth and volume of work done by Army neuroscientists, psychobiologists, and neurotoxicologists could fill a separate volume. This chapter will survey the contributions of U.S. Army research psychologists in 

support of the Medical Chemical Defense Program, with emphasis on 

the effects of CWNAs such as sarin, soman, tabun, and VX.

Defining the Physiological Toxicity of Chemical Warfare Nerve 

Agents

Research on the neurobehavioral and physiological impact of 

CWNAs has been limited due to the highly toxic nature of these compounds. U.S. Army and allied research psychologists provided much 

of the seminal data on these threats. They conducted research on the 

physiological and behavioral toxicity of cholinesterase-inhibiting 

nerve agents. 

Classical CWNAs are extremely toxic organophosphorus cholinesterase inhibitors that cause a rapid progression of clinical signs that 

include hypersecretions, fasciculations, generalized convulsions, coma, 

and eventually death due primarily to respiratory failure (Taylor, 1990). 

The physiological consequences of exposure to CWNAs have been defined in part by research psychologists over the past three decades. 

In the 1980s, research psychologists helped characterize the effects of CWNAs on general health, lethality, and brain function (McDonough, Hackley, Cross, Samson, and Nelson, 1983; Churchill et 
344 THE 71F ADVANTAGE

al., 1984; Rickett, Glenn, and Beers, 1986; McDonough, McLeod, and 

Nipwoda, 1987). For example, McDonough et al. (1983) suggested 

that the brain damage seen in rats following soman exposure was 

likely due to the excessive neuronal stimulation that occurs during 

prolonged soman-induced seizures. Other research psychologists 

determined that the predominant cause of CWNA-induced respiratory failure was related to the effects of CWNAs on the central respiratory drive rather than to their peripheral effects in the diaphragm 

(Rickett et al., 1986). 

To further elucidate the central effects of CWNAs, McDonough 

et al. (1987) directly infused soman or VX into discrete brain regions 

and found that neuropathology was only observed in animals that 

developed repetitive convulsions. Their results indicated that 

CWNAs were not directly neurotoxic, that peripherally induced 

hypoxia or anoxia was unlikely to be the mechanism of the neuropathology, and that the brain damage produced by these compounds 

was primarily seizure-mediated (McDonough et al., 1987). These 

studies identified the need to include an anticonvulsant in the 

standard treatment regimen, as described below.

Age-related differences in soman toxicity, in signs of soman intoxication, and in blood and brain regional cholinesterase activity have 

also been examined by military research psychologists and their civilian 

colleagues (Shih, Penetar, McDonough, Romano, and King, 1990). Shih 

et al. (1990) found that older rats were more susceptible than younger 

rats to the lethal and nonlethal effects of soman. These findings had 

important implications for subsequent neurobehavioral, toxicological, 

and pharmacological studies of CWNAs across the lifespan. 

More recently, U.S. Army research psychologists and their colleagues have assessed the consequences of repeated sublethal exposure 

to CWNAs (Moffett, Price, Anderson, Sipos, Moran, Tortella, and Dave, 

2003; Dave, Connors, Genovese, Whipple, Chen, DeFord, Moran, and 

Tortella, 2007; Johnson, Daugherty, Gallagher, Moran, and DeFord, 

2008). Repeated exposures to sublethal doses of soman (Moffett et al., 

2003) and sarin (Dave et al., 2007) significantly increased DNA fragmentation in blood leukocytes, suggesting that assays measuring leukocyte DNA fragmentation may provide a sensitive biomarker for lowdose CWNA exposure. Repeated sublethal exposure to soman has also 

been found to affect glutamate receptor subunit expression (Johnson et 
MITIGATING THE MEDICAL CONSEQUENCES OF EXPOSURE TO CHEMICAL WEAPONS 345

al., 2008) that may contribute to other cognitive deficits observed following sublethal nerve agent exposure.

Defining the Behavioral Toxicity of Chemical Warfare 

Nerve Agents

Military research psychologists have conducted a significant 

number of studies to understand the functional manifestations of neurotoxicants including CWNAs. By understanding the functional impact 

of exposure to CWNAs, research psychologists gained insight into their 

mechanism of action and were thus able to evaluate whether therapeutic strategies were effective countermeasures devoid of untoward behavioral side effects if administered in the absence of exposure. 

Functional assessments of toxicity in rodents have involved a variety of techniques ranging from very simple to complicated measures 

of behavior. For example, Romano and Landauer (1986) studied the effects of tabun on motor performance and balance using a rotarod and 

were able to determine the dose range that disrupted performance on 

this task. Similarly, Koplovitz, Romano, and Stewart (1989) used a very 

simple inverted screen test to assess motor function in mice following 

soman poisoning to rapidly screen the effectiveness of pretreatment and 

treatment compounds against CWNA toxicity. In their study, Koplovitz and colleagues (1989) found that pretreatment with pyridostigmine 

bromide combined with therapy of atropine and pralidoxime chloride 

(2-PAM) after soman exposure significantly improved performance 

on the inverted screen test. All three of these compounds are currently 

fielded as components of the nerve agent antidote kit and are discussed 

more below. 

A variety of other assessment techniques have also been used to 

define the functional impact of CWNAs, including measuring acute 

signs of toxicity and weight loss (Shih et al., 1990), conditioned taste 

aversions (Romano and Landauer, 1986), nociception using tail flick 

and hot plate tests (Romano, King, and Penetar, 1985), conditioned 

avoidance (Romano, Terry, Murrow, and Mays, 1991), fixed ratio operant responding and extinction (Harris, McDonough, Stitcher, and Lennox, 1984; Modrow and Jaax, 1989), acoustic startle response (Sipos, 

Moran, Kahler, Lukefahr, and DeFord, 2005), active avoidance learning (Sipos et al., 2005), and spatial memory via the Morris water maze 

(Johnson et al., 2008). 
346 THE 71F ADVANTAGE

Research psychologists have used more complex behavioral assessments to determine the correlation between brain damage and performance in some of these tasks. For example, McDonough, Smith, and 

Smith (1986) demonstrated that exposure to high doses of soman can 

lead to neural damage as well as significant, long-term decrements in 

certain learned behaviors. Raffaele, Hughey, Wenk, Olton, Modrow, 

and McDonough (1987) demonstrated that rats that performed abnormally in behavioral tests following soman exposure were more likely to 

have abnormal brain pathology than rats that performed normally in 

the same behavioral tests. 

Behavioral assessments of toxicity in nonhuman primates have 

included assessments of cognition and short-term memory using serial 

probe recognition (Castro, Gresham, Finger, Maxwell, Solana, Lenz, 

and Broomfield, 1994), balance and equilibrium (Doctor, Blick, Caranto, Castro, Gentry, Larrison et al., 1993), and the rate and incidence of 

convulsions (Castro, Larsen, Finger, Solana, and McMaster, 1992), to 

name only a few. All of these studies were useful in establishing the neurotoxic effects of CWNAs, and they served as a battery of tests that were 

used subsequently to evaluate the effectiveness of therapeutics in preventing or ameliorating the consequences of exposure.

Therapeutic Development

In general, research on therapeutics against CWNAs has focused 

on four types of compounds: anticholinergics (for example, atropine) 

that reduce the impact of cholinergic hyperactivity; cholinesterase reactivators (such as 2-PAM); short-acting cholinesterase inhibitors (for 

example, pyridostigmine bromide) that serve as a prophylactic to physically block CWNAs; and anticonvulsants (such as diazepam and its 

likely replacement midazolam). The current standard therapy for nerve 

agent exposure in the military now includes one of each type of these 

compounds. Research psychologists helped characterize the impact of 

these compounds and contributed to the development of the new and 

novel therapeutics detailed below.

Regarding assessments of general health and toxicity, research 

psychologists demonstrated that the therapeutic regimen of atropine 

and 2-PAM provides protection against soman-induced lethality and 

behavioral incapacitation of a conditioned avoidance response in guinea 

pigs (Romano et al., 1991). More specifically, McDonough, Jaax, 
MITIGATING THE MEDICAL CONSEQUENCES OF EXPOSURE TO CHEMICAL WEAPONS 347

Crowley, Mays, and Modrow (1989) demonstrated that atropine and diazepam provide dose-dependent protection against soman-induced epileptiform seizure activity and cardiac and neural pathology. However, 

while this regimen reduced mortality, it did not eliminate most of the 

acute signs of CWNA toxicity. 

In pharmaceutical development, scientists must understand the 

mechanism of action, the functional behavioral impact, and the potential side effects of a given compound. Research psychologists helped 

demonstrate that while atropine increases the core body temperature, 

repeated exposure to the prophylactic pyridostigmine offsets this increase and improves heat tolerance and thermoregulation (Matthew, 

Glenn, Bowers, and Navara, 1994). Given the environmental range 

within which warfighters operate (from sweltering deserts to frigid tundra), any effect on thermoregulation must be understood for the effective planning of military operations.

Romano and Shih (1983, 1984) examined anticholinesterase 

physostigmine as a potential therapeutic and demonstrated that the 

cholinergic system is likely involved in centrally mediated analgesia. 

They also identified key targets in the brain for the analgesic/antinociceptive effects of physostigmine (Romano and Shih, 1984). Similarly, Romano et al. (1985) identified the limits of nociception and conditioned taste aversion produced by physostigmine. This mechanistic 

understanding provided important information about potential effects 

and unintended side effects of CWNAs and therapeutics. Furthermore, 

this understanding helps military scientists identify targets for future 

drug development.

In addition to more basic biological assessments, research psychologists bring a specific expertise in toxicological assessments of 

whole animals (including humans), particularly in the area of behavior 

and performance. Research psychologists used behavioral screening of 

large numbers of therapeutic compounds including various anticholinergics in search of a potential replacement for atropine. Sipos, Burchnell, and Galbicka (1999, 2001) screened eight different anticholinergic 

compounds using an assessment of locomotor activity and the acoustic 

startle reflex. These behavioral assessments provided an excellent way 

to quickly evaluate overt peripheral and central nervous system function. While still in development, this research provided data that proved 

useful in down-selecting potential drugs before testing with more 
348 THE 71F ADVANTAGE

complex behavioral assessments. For example, these data collectively 

demonstrated that biperiden, benactyzine, and procyclidine might serve 

as candidate drugs for further development.

Beyond basic physiological and simple behavioral assessments, 

research psychologists also employ and evaluate higher order cognitive 

assessments including coordinated fine motor performance, memory, 

cognition, and neurobehavioral performance. These assessments serve as 

very sensitive neurobehavioral and psychological measures that can detect changes in the central and peripheral nervous systems. In addition to 

enhanced sensitivity, results from these assessments correlate well across 

species, thus allowing screening of candidate drugs using less expensive 

species. Lastly, these assessments examine the impact of CWNAs on the 

entire organism and go well beyond more common biological assessments 

that tend to focus on specific systems or portions of biological systems.

Various anticholinergics including atropine, benactyzine, scopolamine, and biperiden and the anticholinesterase physostigmine have 

been evaluated using complex behavioral assessments that included 

evaluations of delayed reinforcement of low rate schedules, repeated acquisition, delayed match to sample, and serial probe recognition. These 

sensitive assessments have examined fine and gross motor learning and 

performance, and memory tasks including short-term memory, primacy and recency, and serial list recall (Castro, 1997; McDonough, 1982; 

Myers, Galbicka, Sipos, Varadi, Oubre, and Clark, 2002; Penetar, 1985; 

Penetar and McDonough, 1983). 

Research on anticholinergics using complex behavioral assessments has characterized the dose-dependent impact of these drugs on 

sensitive and highly militarily relevant behaviors and cognition. This 

characterization helps combat and medical leadership and advisors understand the relative benefit and potential risks of current and future 

therapeutics. Clearly, the standard therapy against CWNAs significantly 

reduces mortality. However, the research indicates that when therapeutic anticholinergics are given alone, they too may have a deleterious effect on motor performance, cognition, and short-term memory. The research also indicates that the cholinergically mediated impact on memory and centrally mediated performance deficits might be moderated 

by the development and use of a centrally active anticholinesterase prophylactic as a possible future replacement for pyridostigmine bromide.

As previously mentioned, the standard therapy against CWNAs 

now includes the anticonvulsant diazepam (brand name Valium). 
MITIGATING THE MEDICAL CONSEQUENCES OF EXPOSURE TO CHEMICAL WEAPONS 349

Research psychologists helped determine that the cessation of convulsions and epileptiform seizure activity is critical for enhanced survivability, reduced cardiac and brain pathology, and long-term outcome 

(McDonough et al., 1989). 

Behaviorally, it was also demonstrated that when given alone, 

diazepam impacts primacy and recency as measured in a serial probe 

recognition assessment (Castro et al., 1992). Moreover, Castro and 

colleagues (1992) demonstrated that when combined with the standard therapy, diazepam improved the outcome following exposure to 

CWNAs. The addition of diazepam reduced the incidence of convulsions and attenuated CWNA-induced behavioral impairments in a serial 

probe recognition task. Functionally, diazepam-treated nonhuman 

primates exposed to soman recovered in only 6 days compared to nondiazepam-treated control subjects that required 15 days for recovery. 

Additionally, only one of five diazepam-treated subjects exhibited the 

excitotoxic epileptiform convulsions whereas all five control subjects 

that received only the standard therapy demonstrated this deleterious 

activity. Thus, research psychologists played a key role in demonstrating 

that diazepam is a valuable addition to the standard therapy against 

CWNA exposure.

Beyond the standard therapy of pyridostigmine, atropine, 2-PAM, 

and diazepam, research psychologists contributed to the development of 

novel bioscavengers of CWNAs (Broomfield, Maxwell, Solana, Castro, 

Finger, and Lenz, 1991; Castro et al., 1994; Clark, Sun, Myers, Bansal, 

Doctor, and Saxena, 2005; Doctor et al., 1993; Saxena, Luo, Bansal, Sun, 

Clark, Ashani, and Doctor, 2004). CWNA bioscavengers are primarily 

enzymes (for example, acetylcholinesterase or butyrylcholinesterase) 

that permanently bind CWNAs before they can cause physiological or 

behavioral damage.

Broomfield and colleagues (1991) demonstrated that nonhuman primates pretreated with butyrylcholinesterase showed no signs of 

CWNA poisoning after exposure to 2 LD50 of soman, a dose that is typically fatal to those exposed without prophylaxis or postexposure therapy. 

Serial probe recognition, a complex assessment of memory and motor 

behavior, was briefly depressed following CWNA exposure but returned 

to its baseline within only 8 hours. Similar results were obtained with 

even larger doses of CWNA.

Doctor and colleagues (1993) demonstrated similar results with 

the bioscavenger acetylcholinesterase by showing protection against 
350 THE 71F ADVANTAGE

lethality of up to 5 LD50 of soman. As before, complex motor and shortterm memory performance, as measured by serial probe recognition, were preserved in nonhuman primates treated with bioscavenger 

and then exposed to soman. Complex motor, vestibular equilibrium, 

and balance performance were preserved as assessed using a primate 

equilibrium platform, a highly challenging neurobehavioral assessment. 

The Broomfield and colleagues (1991) and Doctor and colleagues (1993) 

studies demonstrated protection against significant levels of CWNAs. 

The protection against the highly toxic CWNA soman by these novel 

bioscavengers is notable because it preserved both life and militarily relevant neurobehavioral performance with limited side effects.

Collectively, the research by uniformed and civilian psychologists 

on therapeutics against CWNAs demonstrated that novel therapies and 

prophylactics can be developed against the most toxic CWNAs known 

to man. It also demonstrated the importance of understanding and protecting immediate and long-term behavior and cognition as medical 

science develops to the point where protection against lethality is surpassed as the main objective. Uniformed research psychologists provide 

the capability to examine not only the threat, but also the neurobehavioral response of organisms, and potential therapies as a whole.

Safety Assessments

After animal testing has identified candidate drugs, two questions 

must be answered before the Food and Drug Administration (FDA) approves a drug for use in humans. First, is the drug safe (are there any 

secondary or tertiary effects and what is the margin of safety)? Second, 

is the drug effective at treating the identified disease, symptom, or condition? Research psychologists helped characterize the safety of both 

the standard and developing therapies against CWNAs (see reviews by 

Headley, 1982, and Penetar, 1990). 

Penetar and Beatrice (1986) and Penetar, Haegerstrom-Portnoy, 

and Jones (1988) evaluated the effects and duration of atropine and 

2-PAM on pursuit tracking, visual function, general health measures 

(such as heart rate and blood pressure), and cognitive function in humans. In brief, they found that the standard therapy had the greatest impact on the visual system, while psychological and cognitive functions 

were relatively unaltered over time. Thus, this research suggested that 

the standard therapy is relatively innocuous when given in the absence 

of CWNAs.
MITIGATING THE MEDICAL CONSEQUENCES OF EXPOSURE TO CHEMICAL WEAPONS 351

Research psychologists further examined the psychoactivity 

and abuse potential of atropine in humans (Penetar and Henningfield, 

1986). Atropine was administered intramuscularly to normal volunteers 

using the same route of administration Soldiers would use in the field. 

This research established that while atropine alone had a noticeable 

effect immediately following administration in humans, the drug was 

not likely to be abused as indicated by a drug addiction assessment. This 

determination is important because it indicates that Soldiers in the field 

can safely carry several autoinjectors of this compound so it is available 

for immediate use and maximal effectiveness. Understanding the potential risks of a given capability helps military leaders develop a strategy to mitigate potential operational risks during combat. 

The research with atropine represents a type of “postmarketing” 

safety assessment (that is, after the FDA has approved a therapy for use). 

However, safety assessments are also important as a pharmaceutical 

is under development or being considered for an alternate indication 

than originally approved because they help to identify potential risks 

and possible mitigation strategies early. For example, Myers and Clark 

(2006) recently examined the functional impact of the next generation 

anticonvulsant midazolam, which will likely replace diazepam. They examined memory and fine motor performance in a serial probe recognition task following administration of the likely dose of midazolam that 

will be included in future autoinjectors. The data indicated that at that 

dose, midazolam has minimal impact on memory and fine motor performance. This is notable, because a common surgical practice involves 

the use of a much larger dose of midazolam to reduce the likelihood of 

surgery-related memories.

Similar research with potential bioscavengers has also demonstrated limited adverse impact. Saxena and colleagues (2004) and Clark 

and colleagues (2005) demonstrated that a dose 30 times greater than 

that required for protection against 2 LD50 of soman had no negative 

physiological impact and minimal to no alteration in avoidance behavior in rodents. Together with other bioscavenger data involving nonhuman primates (Broomfield et al., 1991; Doctor et al., 1993), the data suggest that cholinesterase bioscavengers will be safe for both prophylactic 

and therapeutic use and have limited physiological and neurobehavioral 

side effects. The work also demonstrates research psychologists’ efforts 

to characterize the safety of both the standard and developmental therapies against CWNAs.
352 THE 71F ADVANTAGE

Administrative and Operational Support

Beyond the laboratory, uniformed research psychologists provide 

essential information on the functional employment of therapies and their 

potential impact on operational military units in the field. They have also 

managed large-scale chemical defense research and acquisition programs, 

commanded military medical research units focused on chemical defense, 

supported military leadership in chemical defense and pharmaceutical development, and even supported recent combat operations in the area of 

chemical defense. More specifically, in addition to commanding the primary Army medical chemical defense research laboratory, research psychologists have commanded around the Army in deployed field medical 

units; helped to develop employment doctrine for chemical and biological 

protective shelters in Korea; served in a valuable advisory role to combatant commanders and key medical and chemical officer staffs in the MultiNational Corps and Multi-National Force–Iraq during recent combat operations; and served as Army Headquarters Staff in support of strategic 

level initiatives involving chemical and various asymmetric warfare threats.

Discussion

Research psychologists have played a key role in measuring the 

short- and long-term impact of toxicants and demonstrating the efficacy and safety of therapies against CWNAs. More specifically, because 

they employ behavioral and holistic assessments at the systems and organism levels, they provide a valuable evaluation and screening of candidate therapeutics. Research psychologists have provided data essential 

for pharmaceutical development and approval by the FDA. However, 

valuable research on nerve agent toxicity and the development of medical chemical defense countermeasures are not the only contributions of 

uniformed research psychologists in the Army.

Through their contributions both in the laboratory and in the 

field, uniformed research psychologists help to mitigate the horrific image so graphically illustrated in Lieutenant Wilfred Owen’s poem. We 

must continue to recruit and retain the expertise of neuroscientists, psychobiologists, and neurotoxicologists in uniform as we face the challenges of unconventional warfare in the future.
MITIGATING THE MEDICAL CONSEQUENCES OF EXPOSURE TO CHEMICAL WEAPONS 353

References

Broomfield, C., Maxwell, D., Solana, R., Castro, C., Finger, A., and Lenz, D. (1991). Protection 

by butyrylcholinesterase against organophosphorus poisoning in nonhuman primates. 

Journal of Pharmacology and Experimental Therapeutics 259 (2), 633–638.

Castro, C. (1997). Primacy and recency effects in rhesus monkeys (Macaca mulatta) using a serial probe recognition task: II. Effects of atropine sulfate. Behavioral Neuroscience 111 

(4), 676–682.

Castro, C., Gresham, V., Finger, A., Maxwell, D., Solana, R., Lenz, D., et al. (1994). Behavioral 

decrements persist in rhesus monkeys trained on a serial probe recognition task despite 

protection against soman lethality by butyrylcholinesterase. Neurotoxicology and Teratology 16 (2), 145–148.

Castro, C., Larsen, T., Finger, A., Solana, R., and McMaster, S. (1992). Behavioral efficacy of diazepam against nerve agent exposure in rhesus monkeys. Pharmacology Biochemistry and 

Behavior 41 (1), 159–164.

Churchill, L., Pazdernik, T., Jackson, J., Nelson, S., Samson, F., and McDonough, J.H. (1984). 

Topographical distribution of decrements and recovery in muscarinic receptors from 

rat brains repeatedly exposed to sublethal doses of soman. Journal of Neuroscience 4 (8), 

2069–2079.

Clark, M., Sun, W., Myers, T., Bansal, R., Doctor, B., and Saxena, A. (2005). Effects of physostigmine and human butyrylcholinesterase on acoustic startle reflex and prepulse inhibition 

in C57BL/6J mice. Pharmacology Biochemistry and Behavior 81 (3), 497–505.

Dave, J., Connors, R., Genovese, R., Whipple, R., Chen, R., DeFord, S., et al. (2007). DNA fragmentation in leukocytes following repeated low dose sarin exposure in guinea pigs. Cellular and Molecular Life Sciences 64 (21), 2823–2828.

Doctor, B., Blick, D., Caranto, G., Castro, C., Gentry, M., Larrison, R., et al. (1993). Cholinesterases as scavengers for organophosphorus compounds: protection of primate performance against soman toxicity. Chemico-Biological Interactions 87 (1–3), 285–293.

Harris, L., McDonough, J.H., Stitcher, D., and Lennox, W. (1984). Protection against both lethal 

and behavioral effects of soman. Drug and Chemical Toxicology 7 (6), 605–624.

Headley, D. (1982). Effects of atropine sulfate and pralidoxime chloride on visual, physiological, 

performance, subjective, and cognitive variables in man: a review. Military Medicine 147 

(2), 122–132.

Johnson, E., Daugherty, K., Gallagher, S., Moran, A., and DeFord, S. (2008). Glutamate receptor 

pathology is present in the hippocampus following repeated sub-lethal soman exposure 

in the absence of spatial memory deficits. Neurotoxicology 29 (1), 73–80.

Koplovitz, I., Romano, J., and Stewart, J. (1989). Assessment of motor performance decrement 

following soman poisoning in mice. Drug Chemical Toxicology 12 (3–4), 221–235.

Matthew, C., Glenn, J., Bowers, W.J., and Navara, D. (1994). Cholinergic drug interactions and 

heat tolerance. Life Sciences 54 (17), 1237–1245.

McDonough, J.H. (1982). Effects of anticholinergic drugs on DRL performance of rhesus monkeys. Pharmacology Biochemistry and Behavior 17 (1), 85–90.

McDonough, J.H., Hackley, B.J., Cross, R., Samson, F., and Nelson, S. (1983). Brain regional glucose use during soman-induced seizures. Neurotoxicology 4 (2), 203–210.

McDonough, J.H., Jaax, N., Crowley, R., Mays, M., and Modrow, H. (1989). Atropine and/or 

diazepam therapy protects against soman-induced neural and cardiac pathology. Fundamentals of Applied Toxicology 13 (2), 256–276.

McDonough, J.H., McLeod, C.J., and Nipwoda, M. (1987). Direct microinjection of soman or 

VX into the amygdala produces repetitive limbic convulsions and neuropathology. Brain 

Research 435 (1–2), 123–137.
354 THE 71F ADVANTAGE

McDonough, J.H., Smith, R., and Smith, C. (1986). Behavioral correlates of soman-induced neuropathology: deficits in DRL acquisition. Neurobehavioral Toxicology and Teratology 8 

(2), 179–187.

Modrow, H., and Jaax, N. (1989). Effect of soman exposure on the acquisition of an operant alternation task. Pharmacology Biochemistry and Behavior 32 (1), 49–53.

Moffett, J., Price, R., Anderson, S., Sipos, M., Moran, A., Tortella, F., and Dave, J.R. (2003). DNA 

fragmentation in leukocytes following subacute low-dose nerve agent exposure. Cellular 

and Molecular Life Sciences 60 (10), 2266–2271.

Myers, T., and Clark, M. (2006). Serial-probe recognition in rhesus macaques: effects of midazolam. Pharmacology Biochemistry and Behavior 85 (3), 555–561.

Myers, T., Galbicka, G., Sipos, M., Varadi, S., Oubre, J., and Clark, M. (2002). Effects of anticholinergics on serial-probe recognition accuracy of rhesus macaques (Macaca mulatta). 

Pharmacology Biochemistry and Behavior 73 (4), 829–834.

Owen, W. (1963). “Dulce et Decorum Est.” In C.D. Lewis (ed.), The Collected Poems of Wilfred 

Owen. New York, NY: New Directions Publishing.

Penetar, D. (1985). The effects of atropine, benactyzine, and physostigmine on a repeated acquisition baseline in monkeys. Psychopharmacology (Berl) 87 (1), 69–76.

———. (1990). Brief review of atropine effects on physiology and performance. Drug Development Research 20, 117–121.

Penetar, D., and Beatrice, E. (1986). Effects of atropine on human pursuit tracking performance. 

Aviation, Space, and Environmental Medicine 57 (7), 654–658.

Penetar, D., Haegerstrom-Portnoy, G., and Jones, R. (1988). Combined atropine and 2-PAM Cl 

effects on tracking performance and visual, physiological, and psychological functions. 

Aviation, Space, and Environmental Medicine 59 (12), 1125–1132.

Penetar, D., and Henningfield, J. (1986). Psychoactivity of atropine in normal volunteers. Pharmacology Biochemistry and Behavior 24 (4), 1111–1113.

Penetar, D., and McDonough, J.H. (1983). Effects of cholinergic drugs on delayed match-tosample performance of rhesus monkeys. Pharmacology Biochemistry and Behavior 19 

(6), 963–967.

Raffaele, K., Hughey, D., Wenk, G., Olton, D., Modrow, H., and McDonough, J.H. (1987). Longterm behavioral changes in rats following organophosphonate exposure. Pharmacology 

Biochemistry and Behavior 27 (3), 407–412.

Rickett, D., Glenn, J., and Beers, E. (1986). Central respiratory effects versus neuromuscular actions of nerve agents. Neurotoxicology 7 (1), 225–236.

Romano, J., King, J., and Penetar, D. (1985). A comparison of physostigmine and soman using taste aversion and nociception. Neurobehavioral Toxicology and Teratology 7 (3), 

243–249.

Romano, J., and Shih, T.M. (1983). Cholinergic mechanisms of analgesia produced by physostigmine, morphine and cold water swimming. Neuropharmacology 22 (7), 827–833.

———. (1984). The effect of adrenalectomy and dexamethasone on the antinociceptive effects of 

physostigmine. Psychopharmacology (Berlin) 84 (3), 426–430.

Romano, J. and Landauer, M. (1986). Effects of the organophosphorus compound, O-ethyl-Ndimethyl-phosphoramidocyanidate (tabun), on flavor aversions, locomotor activity, and 

rotarod performance in rats. Fundamentals of Applied Toxicology 6 (1), 62–68.

Romano, J., Terry, M., Murrow, M., and Mays, M. (1991). Protection from lethality and behavioral incapacitation resulting from intoxication by soman (pinacolyl methylphosphonofluoridate) and treatment with atropine sulfate and 2-PAM chloride in the guinea pig, 

cavia porcellus. Drug and Chemical Toxicology 14 (1–2), 21–44.

Salem, H., Ternay, A.L.J., and Smart, J.K. (2008). Brief history and use of chemical warfare agents 

in warfare and terrorism. In J.A. Romano, Jr., B.J. Lukey, and H. Salem (eds.), Chemical 
MITIGATING THE MEDICAL CONSEQUENCES OF EXPOSURE TO CHEMICAL WEAPONS 355

Warfare Agents: Chemistry, Pharmacology, Toxicology, and Therapeutics (2d ed.), 1–20. 

Boca Raton: CRC Press.

Saxena, A., Luo, C., Bansal, R., Sun, W., Clark, M.G., Ashani, Y., et al. (2004). Human butyrylcholinesterase: A future generation antidote for protection against organophosphate agents. 

In S.J.S. Flora, J.A. Romano, S.I. Baskin, and K. Sekhar (eds.), Pharmacological Perspectives of Toxic Chemicals and Their Antidotes. New York: Springer.

Shih, T.M., Penetar, D., McDonough, J.H., Romano, J., and King, J. (1990). Age-related differences in soman toxicity and in blood and brain regional cholinesterase activity. Brain 

Research Bulletin 24 (3), 429–436.

Sipos, M., Burchnell, V., and Galbicka, G. (1999). Dose-response curves and time-course effects 

of selected anticholinergics on locomotor activity in rats. Psychopharmacology (Berlin)

147 (3), 250–256.

Sipos, M., Burchnell, V., and Galbicka, G. (2001). Effects of selected anticholinergics on acoustic 

startle response in rats. Journal of Applied Toxicology 21 (Suppl. 1), S95–101.

Sipos, M., Moran, A., Kahler, D., Lukefahr, H., and DeFord, S. (2005). Development of a behavioral assessment model in guinea pigs to study the effects of low dose chronic exposure to chemical warfare nerve agents. In Low Level Chemical Warfare Agent Toxicology 

Research Program FY04 Report and Analysis. AFRL-HE-WP-TR-2005-0054. Air Force 

Research Laboratory, Aberdeen Proving Ground, MD.

Smart, J.K. (1997). History of chemical and biological warfare: An American perspective. In F.R. 

Sidell, E.T. Takafuji, and D.R. Franz (eds.), Medical Aspects of Chemical and Biological 

Warfare, vol. 1, 9–86. Washington, DC: Department of the Army, Office of the Surgeon 

General.

Taylor, P. (1990). Anticholinesterase agents. In A. Gilman, T. Rall, A. Nies, and P. Taylor (eds.), 

The Pharmacological Basis of Therapeutics, 131–149. New York: Pergamon Press.

U.S. Army (2006). Field Manual 3–24, Counterinsurgency. Washington, DC: Headquarters Department of the Army.

———. (2008a). Field Manual 3–0, Operations. Washington, DC: Headquarters Department of 

the Army.

———. (2008b). Field Manual 3–07, Stability Operations. Washington, DC: Headquarters Department of the Army.

———. (2008c). Field Manual 7–0, Training for Full Spectrum Operations. Washington, DC: 

Headquarters Department of the Army.

357

Chapter 15

New Biodosimetry Tools for Mental 

Health Support in Nuclear/Radiological 

Accidents or Terrorism

Charles A. Salter, David J. Sandgren, Ira H. Levine, and William F. Blakely

Terrorist attacks or disasters involving radiological materials can 

cause severe stress. After an accidental release of radioactive material in 

Goiania, Brazil, the ratio of noncontaminated people to those actually 

contaminated reporting for voluntary radiological screening was about 

500 to 1. This ratio was derived from a total of approximately 125,000 

people seeking screening. The public health community would be overwhelmed in such incidents. Rapid biodosimetry tools may help distinguish those needing medical treatment for radiation injuries from those 

needing psychological support alone. The Armed Forces Radiobiology 

Research Institute (AFRRI) has prepared a rapid biodosimetry tool in a 

CD-ROM package entitled “Radiation Training and Assessment Tools” 

(4th edition, December 2007) that includes:

■ Casualty Management Guidance, including the Terrorism with 

Ionizing Radiation Guidance Pocket Guide and Medical Management of Radiological Casualties Handbook 

■ Medical Data Forms, including the AFRRI Adult/Pediatric 

Medical Field Record and the AFRRI Biodosimetry Worksheet

■ Exposure Assessment Software, including the Biodosimetry 

Assessment Tool (BAT), which was developed to record diagnostic information and estimated dose in suspected radiological exposures based on symptoms reported. 

The First-responders Radiological Assessment Triage (FRAT), 

which will be available for a future edition of the AFRRI CD-ROM, is 

similar to the BAT but is intended for use on hand-held personal digital 

assistant (PDA) devices. With the beta version released August 2008, it 

will provide “triage” dose assessments and estimates of hospitalization 
358 THE 71F ADVANTAGE

and mortality outcomes. The contents of the AFRRI CD-ROM are also 

available to download from AFRRI’s Web site (www.afrri.usuhs.mil).

Introduction

Although the world has not experienced nuclear warfare since 

1945, there have been a large number of nuclear/radiological accidents 

over the years and a recent increase in the perceived threat of nuclear 

terrorism. Most people fear a nuclear/radiological threat even more 

than a conventional explosion due to their inability to perceive the presence of radiation with the ordinary human senses and their concerns 

about long-lasting radiation effects.

Public fears about radiation are often excessive, unrealistic, and 

persistent. Attitudes have been shaped over time by viewpoints expressed in the media and in the culture at large. While there was considerable American pride in nuclear weaponry after World War II, decades 

of exaggeration and misconceptions in books, movies, television, and 

other media led primarily to fear regarding anything related to radiation. Following Chernobyl, for instance, some people who actually had 

little exposure risk became obsessed with avoiding contamination. Some 

became so depressed due to their fears that they gave up hope entirely 

and committed suicide (Drottz-Sjoberg and Persson, 1993). Similarly, 

the 1979 Three Mile Island nuclear power plant accident in Pennsylvania—generally considered America’s worst nuclear disaster to date—

caused no actual radiation injuries or deaths and only a minor release 

of radioactive gas into the environment (Collins, 1991). Few people received a detectable dose of radiation above the general background level, and even of those, the largest possible exposures were roughly equivalent to the dose of an ordinary chest X-ray. Yet the concern and anxiety 

were very real. Psychophysiologic reactions were common among the 

citizens of the area, and many fled the region in the mistaken belief that 

a major nuclear detonation might occur at any moment.

More typical stress reactions may take many forms, including 

psychophysiologic reactions, adjustment disorders, acute stress disorder, and post-traumatic stress disorder. For example, data from the Hiroshima and Nagasaki attacks revealed widespread acute reactions such 

as psychic numbing, severe anxiety, and disorganized behavior, and 

there were later chronic effects including survivor guilt and psychosomatic reactions (Mickley, 1989).
BIODOSIMETRY TOOLS FOR MENTAL HEALTH SUPPORT 359

Studies of severe radiological accidents have revealed that the 

number of people frightened and/or demonstrating psychophysiologic symptoms may far outweigh the number of victims actually 

contaminated. The ratio of people with medically unexplained physical 

symptoms to radiation injured may be as high as 500 to 1, as occurred 

in the radiation accident in Goiania, Brazil, the worst radiological incident in the Western Hemisphere to date (Petterson, 1988). A deliberate terrorist attack with a radiological dispersal device, such as a socalled dirty bomb, would use conventional explosives to spread radiological material. In such an event, the psychological impact may prove 

far worse than the medical effects. The potential for additional attacks 

might also contribute to the fear.

Providing early response diagnostic assessment information about 

radiation dose and injury received by each victim may help prevent or 

reduce anxiety and other adverse psychological reactions following a radiological incident. In addition, facilitating accurate exposure assessment 

would support medical triage and treatment of those actually exposed to 

significant levels of radiation and reassure minimally and non-exposed 

persons that they have not received medically significant doses.

The Concept of Biodosimetry

Workers at nuclear facilities who may be exposed to radiological materials must wear physical dosimetry devices by regulation. These 

devices directly measure radiation received in the event of an accident. 

The public at large, however, does not typically have access to such devices. Thus, in the event of a surprise attack or accident, the vast majority of those affected will have no idea about their potential radiation exposure—whether it was minimal, enough to sicken but not kill them, or 

lethal. This uncertainty regarding exposure and its consequences adds 

to the victim’s psychological distress.

Biodosimetry can provide a quantitative assessment of potential exposure. Years of research on the victims of past exposures have 

revealed a number of biological indicators of the dose received. Simply 

put, the greater the radiation dose, the greater the biomedical effect on 

the body. Therefore, the assessment of physiological effects in those present at an incident can be compared to historic data and the approximate 

radiation dose estimated. These biological indicators include a decline in 

lymphocytes with increasing dose, an increase in dicentric chromosomes, 
360 THE 71F ADVANTAGE

and an increasing severity of various prodromal signs and symptoms 

such as nausea, vomiting, and erythema (Blakely, Brooks, Lofts, van der 

Schans, and Voisin, 2002; Waselenko, MacVittie, Blakely, Pesik, Wiley, 

Dickerson et al., 2004; Blakely, Salter, and Prasanna, 2005). Some of these 

dose indicators, such as the dicentric assay, require sophisticated equipment and too much time to be practical in a mass casualty situation where 

immediate triage is necessary. We have developed tools that can provide 

a reasonably accurate estimation of dose within a few minutes per victim, 

using only laptop computers or even hand-held computer devices.

A Dynamic Package of Biodosimetry Tools for First Responders

The fourth edition of the Radiation Training and Assessment 

Tools includes guidance for managing casualties, forms for recording 

medical information, and software tools for assessing exposure doses. 

This CD can be obtained by taking the Medical Effects of Ionizing Radiation course held routinely by the AFRRI’s Military Medical Operations department. More information is available at the AFRRI Web site.

Casualty Management Guidance 

The CD-ROM emphasizes what treatment providers should administer in the medical management of casualties, providing a complete 

handbook, an abbreviated summary for quick reference, and a brief 

overview. The Medical Management of Radiological Casualties Handbook (2d

 edition, 2003) helps prepare medical care providers to treat injuries complicated by ionizing radiation exposure and radioactive contamination. The handbook provides concise reading material for health 

care professionals in the management of uncontrolled ionizing radiation 

exposure. The AFRRI Emergency Radiation Medicine Response Pocket 

Guide can be quickly consulted in a radiation emergency for assistance 

in assessing and controlling the situation. It includes such topics as diagnosis, treatment considerations, decontamination procedures, and 

public health reporting procedures. This document was originally developed by the U.S. Department of Veterans Affairs as a two-page pocket guide. Both the handbook and the pocket guide are available in print 

form or downloadable at the AFRRI Web site.

Medical Data Forms

The second subset of biodosimetry tools on the CD-ROM 

deals with the actual recording of medical data relevant to radioactive 
BIODOSIMETRY TOOLS FOR MENTAL HEALTH SUPPORT 361

contamination, exposure, and the resulting patient symptoms. Included 

are tools such as a brief field record and a more comprehensive biodosimetry worksheet. The AFRRI Adult/Pediatric Field Medical Record 

is a convenient one-page form for recording emergency medical information in the field. It was adapted from the U.S. Army’s Field Medical 

Card into an electronic form applicable to both military personnel and 

civilians, for adult and pediatric cases alike. For instance, it has both an 

adult and a pediatric body map for labeling areas of contamination or 

injury. It also includes sections on personal data, types of injury, other 

symptoms, treatments administered, and disposition of the case. The 

AFRRI Biodosimetry Worksheet provides a six-page data entry worksheet for gathering facts about a case of radiation exposure, including 

the source and type of radiation, the extent of exposure, and the nature 

of the resulting injuries. It also is applicable to both adult and pediatric 

cases. This worksheet was adapted by AFRRI from the North Atlantic Treaty Organization Standardization Agreement 2474 Appendix 1, 

“Medical Record of Ionising Radiation Dose and Contamination,” and 

incorporates a version of the Medical Treatment Protocols for Radiation Accident (METREPOL) grading scale (Fliedner, Friesecke, and 

Beyrer, 2001). It includes the basic items from the one-page Field Medical Record, and quite a bit more as well. Additional features include a 

detailed section on types of radiation sources present, radioactive exposure, external and internal contamination, and consequent symptoms. There are two sets of adult and pediatric body maps, one for contamination distribution and the other for estimated dose distribution. 

There is also a section for tracking changes in counts of various blood 

cell lines over time. Using a modified METREPOL grading system, the 

Acute Radiation Syndrome Responses Assessment based on the neurovascular, cutaneous, gastrointestinal, and hematopoietic systems can 

be determined. Finally, there is an entire page for additional notes and 

comments. The Biodosimetry Worksheet is in PDF format and can be 

filled out on the computer, or printed to be filled out by hand. Information on this Biodosimetry Worksheet can be used to complete many 

sections of the BAT software program.

Exposure Assessment Software

The current edition of the CD-ROM includes one complete software program and will soon include a hand-held application that is 

currently in beta testing phase.
362 THE 71F ADVANTAGE

Biodosimetry assessment tool. The BAT software program was developed by AFRRI in collaboration with the Radiation Emergency 

Assistance Center/Training Site for recording diagnostic information in 

suspected radiological exposures. Version 1.03 is included on the CDROM and information on downloading BAT is also available on the 

AFRRI Web site. The minimum system requirements for BAT are Microsoft Windows XP SP2 operating system and a Pentium 200 with 256 

MB of RAM and 10 MB of free disk space. A typical patient’s complete 

record will require about 1 MB of disk space.

The BAT software equips health care providers with diagnostic 

information (for example, physical dosimetry and clinical signs and 

symptoms) germane to the management of human radiation casualties. 

Designed primarily for prompt use after a radiation incident, the userfriendly program facilitates collection, integration, and archiving of data 

obtained from exposed persons. Data collected in templates are compared with established radiation dose responses obtained from the literature to provide multiparameter dose assessments. The program archives 

clinical information (such as the extent of contamination, wounds, and 

infection) that is useful for casualty management, displays relevant diagnostic information in a concise format, and can be used to manage 

both military and civilian radiation accidents (see figure 15–1). In addition, the use of this program to monitor individual patient diagnostic 

information could minimize the severity of psychological casualties to

Figure 15–1. Biodosimetry Assessment Tool Flowchart

Erythema Infection

Hematology Physical

Dosimetry

Lymphocyte

Cytogenetics

Prodromal

Symptoms

Overview

Information

Patient

Report

Exposure

Information

Radioisotope

Information

Physician’s

Notes

Summary

Contamination/

Wound
BIODOSIMETRY TOOLS FOR MENTAL HEALTH SUPPORT 363

radiation victims and the concerned public by influencing how they view 

their exposure, dose, and potential risk for the development of disease.

Background information about the patient and the circumstances 

of the suspected radiological incident (date of exposure, time of exposure, location) are entered first. Next, medical data on various symptom 

categories are entered under the appropriate tabs (physical dosimetry, 

contamination/wound, prodromal symptoms, hematology, lymphocyte 

cytogenetics, erythema, infection) on the master screen. Only the categories for which data are available would be used for a given patient. 

In some cases, that may mean only two or three sections would be used, 

and the other tabs could be ignored.

Clinical signs and symptoms associated with radiation exposure 

are varied and numerous (see table 15–1) (Anno et al., 1989). The BAT’s 

prodromal symptom screen allows data entry of this diagnostic information. While all the symptom categories for which data are available 

would be useful in treating a patient, three are especially relevant to estimating dose received. These are latency to vomiting in the prodromal symptoms category and the absolute number of lymphocytes and 

rate of lymphocyte depletion in the hematology category. These data are 

used by the BAT program to estimate exposure dose based on human 

accident databases and algorithms (see table 15–2). In the BAT prodromal symptom screen there are cells for entry of vomiting data, including 

time of onset and duration, while an “Obtain Dose Assessment” button 

can then be clicked to display an estimated dose from onset of emesis. 

The hematology data entry screen has room for up to 13 serial 

measures of lymphocytes over time (see figure 15–2). Note that in this 

screen, dose can be estimated from a single lymphocyte count simply by 

clicking on the “SHOW DOSE” button after entering the number. A better estimate, however, can be derived from lymphocyte kinetics showing changes over time as revealed by multiple measurements. A click 

on “Get Multi-Sample Dose Estimate” will reveal a feedback screen estimating dose and 95 percent confidence level. The dose estimate based 

on lymphocyte kinetics is determined by one of two methods based primarily on data from Goans, Holloway, Berger, and Ricks (1997, 2001) 

and Goans (2001) or Guskova, Barabanova, Baranov, Gruszdev, Pyatkin, Nadezhina et al. (1988) (see table 15–2). While other patient data 

like cytogenetics can be used to calculate dose later, the advantage of 

the onset of vomiting and lymphocyte counts or depletion kinetics is 

that the physician or other user of the BAT program can get immediate 
364 THE 71F ADVANTAGE

Table 15–1. Early Clinical Responses Following Radiation Exposure

Nausea Fatigue

Vomiting Weakness

Headache Abdominal pain

Fever Parotid pain

Tachycardia Erythema

Table 15–2. Human Databases Used in BAT Dose Assessment Algorithms

Onset of 

Vomiting Hematology Radiation Quality References

X X Photon

Anno et al., 1989

Dr. George Anno 

(personal communication)

X X

Photon, Mixed 

Photon, and 

Neutron

Goans et al., 1997; 2001; 

Goans, 2001

Dr. R.E. Goans 

(personal communication)

X X

Photon, Mixed 

Photon, and 

Neutron

REAC/TS Registry

X

Photon, Mixed 

Photon, and 

Neutron

Guskova et al., 1988

Dr. A.K. Guskova 

(personal communication)

X N/A (control) AFRRI studies (BD–02)

feedback on estimated dose, bound by error bars or upper and lower 

confidence limits.

The BAT summary screen captures all the most relevant information entered or computed earlier for the given patient (see figure 

15–3). In this screen the various symptom categories present are displayed, along with information on dose estimates. Note in this example 
BIODOSIMETRY TOOLS FOR MENTAL HEALTH SUPPORT 365

Figure 15–2. Hematology Data Entry Screen

that the dose estimated by onset of vomiting is slightly different from 

that estimated using hematology. An expert can view the information 

and assign a dose in the specified box. If more information or additional 

diagnostic indices became available later, of course, the operator could 

add that at any time.

First-responders radiological assessment triage. A beta version FRAT 

was released in August 2008, and the final version will be available in a 

later edition of the CD-ROM. While the two programs are somewhat 

related, BAT requires a desktop or laptop computer, while FRAT works 

on a hand-held PDA device using the Palm operating system. BAT computers could be used in a far-forward command post, but the size and 

portability of FRAT make it ideal for first responders or others who will 

enter a radiological incident zone and need to make patient data entry 

or dose estimates while operations are under way.

The FRAT was developed by surveying experts in radiobiology 

and medical effects of ionizing radiation. A group of experts responded 

to a questionnaire asking them to provide their judgments about the 

possible contributions of several diagnostic factors to predict radiation 

dose received. First, they were asked to estimate how useful each factor
366 THE 71F ADVANTAGE

Figure 15–3. Summary Screen

would be in predicting whether radiation exposure had occurred. Then 

they were asked to rate how reliable that factor might be in estimating 

the dose if exposure had indeed occurred. Answers were to be provided on a 100-point scale with 0 indicating that the item had no value in 

such judgments. Ratings on each item were ranked and then the median 

score was used to weigh each sign and symptom factor in the multiparameter-based determination of a triage dose.

The FRAT software allows first responders to triage suspected radiation casualties based on the initial or prodromal features as listed in 

the AFRRI Emergency Radiation Medicine Response Pocket Guide. An 

additional feature of FRAT is the inclusion of a digital version of the 

AFRRI Pocket Guide that can be accessed quickly from the help menu. 

FRAT was developed initially to use the Palm operating system due to 

the portability of PDA devices. The program was written using NS Basic 

Palm and is compatible with Palm OS3 or higher.

The FRAT program permits convenient entry of signs and symptoms, blood lymphocyte counts, and dosimetry data, all with minimum 

text entry requirements (see figure 15–4 for a schematic of possible 
BIODOSIMETRY TOOLS FOR MENTAL HEALTH SUPPORT 367

inputs to FRAT). As with BAT, only the program components for 

which data are available are used. Otherwise, they can be ignored until 

such time as pertinent data are gathered.

Figure 15–4. Schematic Outline for First-responder Radiological 

Assessment Triage

Dosimetry and

radioactivity

contamination

Blood lymphocyte

counts

Diagnostic,

hospitalization,

and mortality messages

Dose assessment

Signs, symptoms and

erythema

Locationbased dose

estimate

Dosimeter

readings

Internal

contamination

Vomiting

Diarrhea Headache Tachycardia Consciousness Body

temperature Weakness Fatigue

Erythema

Figure 15–5. Sample First-responder Radiological Assessment 

Triage Entry Screens
368 THE 71F ADVANTAGE

The program comes equipped with a variety of input screens (see 

figure 15–5). The main input screen allows the user to link to the three 

subsections mentioned above. The “Signs Symptoms and Erythma” 

screen allows the responder to select from the nine symptomatic conditions indicated in the input schematic. The symptoms highlighted in 

bold, such as vomiting, have a sub-screen where additional information 

on time of onset and duration can be logged. The “Blood” screen is capable of saving up to 10 lymphocyte counts. The “Dosimetry/Contamination” screen allows the responder to store exposure information. Note 

that no writing is required for most data entry since in most cases the options are built in and one must simply touch the on-screen menus with a 

stylus to proceed. Once familiarity with the program has been achieved, 

it is possible to enter all the known facts about a given case quite rapidly. 

At the conclusion of data entry, the user taps the “Dose Assessment” button on the main screen to get immediate feedback in the form 

of five triage dose assessment screens to advise the first responder about 

triage and prognosis on the case (see figure 15–6). “Triage Dose Assessment 1” indicates whether the patient has received no dose, a dose of inestimable magnitude, or a measurable degree of overexposure. The second dose assessment screen supplies messages related to hematology, 

such as warnings related to dose estimate or to draw serial blood samples.

Figure 15–6. First-responder Radiological Assessment Triage Dose 

Assessment Screens
BIODOSIMETRY TOOLS FOR MENTAL HEALTH SUPPORT 369

The third assessment screen provides a dose estimate for each of the 

three categories (if available) as well as a weighted multiparameter triage dose in centi-Gray (cGy), along with confidence limits. The fourth 

assessment screen provides reliability and diagnostic information. Finally, the fifth screen reports hospitalization estimations and mortality 

projections. All this information has great utility for triage in a mass casualty situation as well as for treatment.

Conclusion

The tools included on AFRRI’s CD-ROM can greatly assist first 

responders at the scene of a nuclear/radiological mass casualty accident 

or attack and medical treatment providers at all subsequent echelons 

back to tertiary care. The doctrinal guidelines and articles provided offer an enormous amount of useful information pertaining to both radiation and casualty care management. The medical data forms offer 

a means to collect the necessary information that physicians can use 

to help triage a patient and decide on the best course of treatment. The 

BAT and FRAT software can provide almost immediate radiation received dose estimates for each individual with a tremendous potential 

to triage large groups of victims rapidly. Such expedited triage can differentiate patients who actually have been exposed from those showing 

psychosomatic symptoms, thereby allowing medical treatments to be 

rapidly focused where they are needed most. With the truly exposed being taken care of, the likely hundreds of non-seriously exposed persons 

can be reassured that they are in no medical danger from radiation. The 

psychodynamics causing persons to be less likely to trust such “government/official pronouncements” are beyond the scope of this chapter, as 

is the interaction between such distrust and continuing psychological 

distress. Not everyone will be reassured, but many might experience a 

significant relief of stress and impetus toward sustained mental health 

through the use of biodosimetry tools to assess radiation exposure.

References

Anno, G.H., Baum, S.J., Withers, H.R., and Young, R.W. (1989). Symptomatology of acute radiation effects in humans after exposure to doses of 0.5–30 Gy. Health Physics 56 (6), 

821–838.

Blakely, W.F., Brooks, A.L., Lofts, R.S., van der Schans, G.P., and Voisin, P. (2002). Overview of 

low-level radiation exposure assessment-biodosimetry. Military Medicine 167 (2), 20–24.

Blakely, W.F., Salter, C.A., and Prasanna, P.G. (2005). Early-response biological dosimetry: Recommended countermeasure enhancements for mass-casualty radiological incidents and 

terrorism. Health Physics 89 (5), 494–504.
370 THE 71F ADVANTAGE

Collins, D.L. (1991). Stress at Three Mile Island: Altered perceptions, behaviors, and neuroendocrine measures. In R. Ricks, M. Berger, and F. O’Hara (eds.). The medical basis for radiation-accident preparedness III: The psychological perspective (71–79). New York: Elsevier.

Drottz-Sjoberg, B.M., and Persson, L. (1993). Public reaction to radiation: Fear, anxiety, or phobia? Health Physics 64, 223–231.

Fliedner, T.M., Friesecke, I., and Beyrer, K., eds. (2001). Medical management of radiation accidents—manual on the acute radiation syndrome. London: The British Institute of Radiology.

Goans, R.E., Holloway, E.C., Berger, M.E., and Ricks, R.C. (1997). Early dose assessment following severe radiation accidents. Health Physics 72 (4), 513–518.

———. (2001). Early dose assessment in criticality accidents. Health Physics 81 (4), 446–449.

Goans, R.E. (2001). Clinical care of the radiation-accident patient: patient presentation, assessment, and initial diagnosis. In R. Ricks, M. Berger, and F. O’Hara (eds.). The medical 

basis for radiation-accident preparedness: The clinical care of victims, proceedings from 

the fourth international conference REAC/TS conference on the medical basis of radiationaccident preparedness, March 2001, Orlando, Florida (11–22). Boca Raton, FL: The Parthenon Publishing.

Guskova, A.K., Barabanova, A.V., Baranov, A.Y., Gruszdev, G.P., Pyatkin, Y.K., Nadezhina, N.M. 

et al. (1988). Acute radiation effects in victims of the Chernobyl nuclear power plant 

accident. In United Nations Scientific Committee on the Effects of Atomic Radiation 

(UNSCEAR). Sources, effects and risks of ionizing radiation (613–647). New York: United 

Nations.

Mickley, G.A. (1989). Psychological factors in nuclear warfare. In R. Zajtchuk (ed.). Medical 

consequences of nuclear warfare (153–169). Falls Church, VA: U.S. Army Office of the 

Surgeon General.

Petterson, J.S. (1988). Perception vs. reality of radiological impact: The Goiania model. Nuclear 

News 31, 84–90.

Waselenko, J.K., MacVittie, T.J., Blakely, W.F., Pesik, N., Wiley, A.L., Dickerson, W.E. et al. (2004). 

Strategic national stockpile radiation working group medical management of the acute 

radiation syndrome: Recommendations of the strategic national stockpile radiation 

working group. Annual of Internal Medicine 140 (12), 1037–1051.
Part VI

Psychology and 

Military Families

Chapter 16

Families Facing the Demands of Military 

Life: New Research Directions

Lolita Burrell, Gary A. Adams, Doris Durand, and Carl Andrew Castro 

Military families, whether Active-duty, Reserve, or National 

Guard, face a multitude of demands in times of both peace and war, and 

these demands will shift throughout a Servicemember’s career. Our research at the Walter Reed Army Institute of Research (WRAIR), as well 

as research done at other institutions, has shown that the demands experienced by military families have both negative and positive effects in 

terms of health, marital satisfaction, and satisfaction with the Army. Appraisal of these demands and the ability to obtain the necessary resources 

to deal with them are important determinants of a variety of well-being–, family-, and Army-related outcomes. This chapter will focus on 

the findings of family studies conducted by researchers at WRAIR and 

examine the road ahead with studying military families based on the 

outcomes discussed.

Introduction

As of September 2006, a total of 275,016 Active-duty (54 percent 

of the Active force), 189,975 Army Reserve (47 percent of the Reserve 

force), and 160,921 Army National Guard (46 percent of the National Guard force) Servicemembers were married (Maxfield, 2006). As we 

can see from the demographics, many in the Army have families that 

will experience a multitude of demands while part of the military, some 

of which have always existed. However, the war on terror has brought 

unexpected additional challenges. The long-term impact of these recurring demands within a military and society that continue to grow and 

change remains to be seen. Segal discusses a number of military lifestyle demands that may negatively impact family members. These include geographic mobility, residence in foreign countries, periodic separations from family, and risk of Servicemember injury/death. These 

demands may be experienced individually or collectively. They are also 

connected to another demand, which is the ability to integrate with the 

373
374 THE 71F ADVANTAGE

military community. Of course, these demands are not all-inclusive, but 

they may often be closely tied to one another whether through creating 

conditions that lead to other demands and/or through their effects on 

various health-, family-, and Army-related outcomes.

Geographic Mobility and Residence in Foreign Countries

The relocations that are part of military life can disrupt family life 

and existing supportive relationships. Although moving can be a positive experience for some spouses (Warner, 1983), many report experiencing difficulty adjusting to their most recent move (Croan, Levine, 

and Blankinship, 1992; Orthner, 2002). In the Survey of Army Families 

IV, recently moved spouses reported less positive adjustments on 13 out 

of 18 family, personal, and Army adjustment indicators (Orthner, 2002). 

Research in this area suggests that geographic mobility is related to lower 

psychological well-being (Croan et al., 1992; Gaylord and Symons, 1986; 

Norell and Copeland, 2002) and physical health (Jensen, Lewis, and Xenakis, 1986; Andersen and Arnetz, 1999), as well as with lower marital 

happiness (Schneider and Gilley, 1984; Ozkaptan, Sanders, and Holz, 

1986; Makowsky, Cook, Berger, and Powell, 1988) and lower retention 

(Lewis, 1985; Mohr, Holzbach, and Morrison, 1981). 

Moving across town may be difficult enough for some, so moving to an entirely different country, complete with its own customs and 

language, is likely to place a strain on even those families looking forward to the new assignment. As of 2006, approximately 186,393 of the 

1,381,401 Active-duty Servicemembers were stationed overseas (Bruner, 2007), not including those who were deployed. Like geographic mobility, residence in a foreign country can be a positive experience (Ozkaptan, Sanders, and Holz, 1983);however, research also suggests that it 

can lead to lower well-being (Burnam, Meredith, Sherbourne, Valdez, 

and Vernez, 1992; Puskar, 1990).

Separation from Family

Moving and living overseas may be tied to separation from family 

when the Soldier is assigned to a unit that is likely to deploy and/or frequently travel for field training exercises, school, peacekeeping, or combat missions. These separations can place additional demands on family 

members in terms of managing the household and taking on the role of 

single parent. They can also lead to feelings of isolation and loneliness. 
FAMILIES FACING THE DEMANDS OF MILITARY LIFE 375

Some of the research on periodic separations has examined its impact by 

focusing on the frequency of separations (Rohall, Segal, and Segal, 1999), 

while other research has focused on the hardships imposed on the family 

by separations (Rosen, Teitelbaum, and Westhius, 1993; Marshall-Mies, 

2001). Generally, the research has shown a negative relationship between 

separations and well-being (Adler, Bartone, and Vaitkus, 1995; Bell and 

Schumm, 1999, Frankel, Snowden, and Nelson, 1992) and separations 

and marital satisfaction (Schumm, Bell, and Gade, 2000; Roschman, Patterson, and Schofield, 1989). While the effects of deployment on marital and familial relationships reported are generally negative, positive effects may also occur. Positive outcomes may include the opportunity for 

the spouse to develop independence and self-sufficiency (Coolbaugh and 

Rosenthal, 1992; Hunter and Hickman, 1981; Schwartz, Braddy, Griffith, 

and Wood, 1988). Generally speaking, research has indicated that there 

are spillover effects between job and family that can affect marital 

quality and job satisfaction (Gal and Syna, 1998; Rogers and May, 2003). 

Risk of Soldier Injury or Death

While the risk of Servicemember injury or death is most obvious during wartime, it is also present during humanitarian and peacekeeping missions, as well as during field training exercises. Approximately 500 civilian wives of enlisted Soldiers were surveyed regarding 

their spouses’ deployment to Somalia in 1993. Fears regarding Soldier 

safety were some of the most cited problems regarding the deployment 

along with loneliness and lack of knowledge of the Somalia situation 

(Schumm, Bell, and Knott, 2001).Research conducted during the Gulf 

War (Operation Desert Storm) also indicated that spouses feared for the 

safety and welfare of their Soldiers (Rosen and Durand, 1995). This and 

other studies of wartime fears have shown that spouse reports of such 

fears were related to their reports of health symptoms (Scurfield and 

Tice, 1992; Cohen and Dotan, 1976). Other studies have found that negative health symptoms such as anxiety and depression can also occur 

during peacekeeping missions (Adler, Bartone, and Vaitkus, 1995; Van 

der Kloet and Moelker, 2002).

Integration with the Military Community

Such fears may be exacerbated if spouses feel isolated from the 

military community. Reserve and National Guard Soldiers have taken 
376 THE 71F ADVANTAGE

on duties and responsibilities closely reflecting those of the Active Component, to include deployments. Yet it is unclear how well the spouses of 

these Soldiers have become integrated into the military way of life and 

how that may compare to the integration of Active-duty spouses, especially considering that they are more likely to be geographically isolated 

from military communities. In McClure and Broughton’s (1988) study 

of military communities, they note that the term community refers to 

constructs, such as satisfaction with and attachment to the community, social networks, and a psychological sense of community, which tap 

into the construct cohesion. Regardless of component, if spouses feel 

they are not integrated into the military community, findings indicate 

that they may experience less marital satisfaction and have a negative 

attitude toward their Soldier continuing in the organization (Bourg and 

Segal, 1998; McClure and Broughton, 1988).

The focus of this chapter will be on health-, family-, and Army-related findings, and those demands spouses experienced that either positively or negatively contributed to those outcomes. The findings presented below reflect earlier studies conducted by researchers at 

Walter Reed that examine the impact of both deployed (peacekeeping) 

and nondeployed environments on Active-duty, Reserve, and National 

Guard spouses who were primarily civilian. 

Research Hypotheses

The findings presented are from two survey studies we conducted 

in the late 1990s to early 2000s timeframe. Each spouse study was based 

on a study that was conducted separately with their Soldiers. Before discussing the findings, a brief overview of the study questions and methodology will be presented.

Study 1

1. Active-duty spouses will report greater levels of integration 

within the military community than will Reserve or National 

Guard spouses.

2. Spouses who are less integrated into the military way of life 

will a) report poorer physical health; b) report higher depression levels; c) report increased drinking and smoking; and d) 

want their Soldier to leave the military.
FAMILIES FACING THE DEMANDS OF MILITARY LIFE 377

Study 2

1. Hypothesis 1a-d: Fear for the Soldier’s safety will be negatively 

related to (a) psychological well-being, (b) physical well-being, (c) Army life satisfaction, and (d) marital satisfaction. 

2. Hypothesis 2a-d: Impact of moving will be negatively related 

to a-d above. 

3. Hypothesis 3a-d: Impact of separations will be negatively 

related to a-d above. 

4. Hypothesis 4a-d: Impact of foreign residence will be negatively related to a-d above. 

Study 1 Methods

Participants and Procedures

During 2000, a convenience sample of Soldiers within the III 

Corps area completed a questionnaire that was given in person. A subsample of all participants who indicated they were married was identified (N = 1,384). This subsample included 444 Active-duty, 417 Guard, 

and 523 Reserve Soldiers ranging in age from 18 to 63 years (M = 33.44, 

SD = 9.97). Of these, 92 percent were men, 74 percent had children living in the home, and 70 percent had working spouses.

Questionnaires were then mailed or delivered, via the units, to the 

spouses of the Soldiers who previously participated. Of the 709 spouses 

who participated, 90 percent were female and 8 percent were male. The response rate for Active-duty spouses was 31 percent, while the rates for National Guard and Reserve spouses were 76 percent and 42 percent, respectively. The mean age of the participants was 35. With regard to education, 

only 1 percent had less than a high school education. Twenty-two percent 

had a high school diploma or its equivalent; 66 percent had some college 

or a college degree; and 10 percent had some graduate training or a graduate degree. The majority of participants (89 percent) were Caucasian; 4 

percent were Hispanic, 2 percent were African-American, 2 percent were 

either Asian, Native American, or other, and 2 percent were multiracial. 

Measures

Integration. Two programs that the Army offers to assist spouses in 

adjusting to the military way of life include Family Support Groups 

(FSGs), which are now known as Family Readiness Groups (FRGs), and 
378 THE 71F ADVANTAGE

Army Family Team Building (AFTB). These programs provide assistance regardless of deployment status. Spouses were asked if their units 

had FSGs, if they attended meetings, and if they had received AFTB 

training. Spouses also answered a two-part question regarding where 

they would go if they needed support: “Many spouses need support at 

some time—whether it is someone to talk to or someone to help with a 

specific problem. Below are listed persons or agencies where one might 

go for support.” The first part of the question was: “Please indicate how 

likely you are to seek support from each.” The resource choices were: 

1) Your spouse, 2) Your children, 3) Your extended family (parents, 

siblings, etc.), 4) A clergyman from the civilian community, 5) Members of your church/mosque, synagogue, 6) Your boss, 7) Co-workers, 

8) Friends/neighbors not associated with your Soldier’s unit, 9) A Soldier from your Soldier’s unit, 10) A spouse from your Soldier’s unit, 11) 

Army Community Service (ACS), 12) Army Emergency Relief (AER), 

13) An Army Chaplain, and 14) Your Family Support Group. The 

second part of the question was: “Please indicate how often you have 

gone to that person or agency for support during the past year.” The four 

response categories were: 1) not at all, 2) a few times, 3) moderately, and 

4) very often.We had two other questions that looked at military associations: “Are you friends with the members of your Soldier’s unit?” and 

“Are you friends with the spouses of unit members?” 

An “integration score” was developed based upon spouses answering “yes” to attending FSG meetings, taking AFTB training, having friends in the unit, or being friends with spouses of unit members. 

Additionally, spouses who answered that they “moderately/very often” 

sought support from Army resources (AER, ACS, Chaplain) were included in the score. A score of 1 was given for each “yes” or “moderately/

very” answer. Therefore, scores could range from 0 to 7, with 7 showing 

the highest degree of integration with the military.

Physical and psychological health. Physical health was measured through 

a self-assessment of one question: “How would you rate your current state 

of physical health?” Responses ranged from “excellent” to “very poor.” 

Questions also addressed the individual’s smoking and drinking habits. 

We used the four-item CAGE scale (Mayfield, McLeod, and Hall 1974) 

to determine if there was an alcohol abuse problem (key words, as italicized below, form the acronym CAGE). 1) Have you ever felt you should 

cut down on your drinking? 2) Have people annoyed you by criticizing 

your drinking? 3) Have you ever felt guilty about your drinking? 4) Have 
FAMILIES FACING THE DEMANDS OF MILITARY LIFE 379

you ever had a drink first thing in the morning (an eye-opener) to steady 

your nerves or get rid of a hangover? A score of > 2 on the CAGE indicates a problem with alcohol. Participants were also asked how much 

alcohol they consumed in a typical week and scores were categorized 

from 1 (none) to 5 (10 or more). Smoking behavior was determined by 

the question: “Which statement best describes your smoking habits in 

the last year?” The statements were: 1) I have never been a smoker, 2) 

I smoked but quit, 3) I smoke 10 or fewer cigarettes a day, 4) I smoke 

11–19 cigarettes a day, and 5) I smoke more than 20 cigarettes a day.

The individual’s psychological health was evaluated by the Center for Epidemiological Studies for Depression Scale, which consists of 

20 questions chosen to reflect various aspects of depression including 

depressed mood; feelings of guilt and worthlessness, helplessness, and 

hopelessness; psychomotor retardation; loss of appetite; and sleep disturbance (Radloff, 1977). Respondents reported the frequency of occurrence for each item during the previous week on the following 4-point 

scale: 0 (rarely, less than 1 day), 1 (some of the time, 1 to 2 days), 2 (a 

moderate amount of the time, 3 to 4 days), or 3 (most or all of the time, 

5 to 7 days). Summary scores can range from 0 to 60 with a score of 16 

or above indicating depression.

Retention intentions. We asked the spouses what their Soldiers’ retention intentions were. Options included: 1) My Soldier wants to make 

the Army a career, 2) My Soldier wants to stay in the Army after his/her 

current enlistment/tour, 3) My Soldier wants to get out at the end of his/

her current enlistment/tour, 4) My Soldier wants to get out of the Army 

before the end of his/her current enlistment/tour. Spouses were asked 

if they agreed with their Soldiers’ retention intentions and, if not, what 

they would prefer their Soldiers to do.

Study 2 Methods

Participants and Procedures

During 2002, approximately 3,900 questionnaires were either 

mailed directly to spouses or delivered via units that were located within 

Germany and Italy. A total of 506 questionnaires were returned for a 

response rate of 13 percent. From this sample, a subsample of spouses 

who reported at least one deployment was drawn. Deployment was 

defined as the spouse being away from home for 30 days or more on 

a combat, peacekeeping, or humanitarian mission. This subsample 
380 THE 71F ADVANTAGE

consisted of 346 (7 men and 339 women) persons ranging in age from 

18 to 51 years (M = 30.41, SD = 6.36), the majority of whom were Caucasian (77 percent). African-Americans accounted for 9 percent of the 

sample, Hispanics 6 percent, Asians 3 percent, and others 5 percent. 

Most were well educated, with 25 percent indicating that they graduated 

from college and another 15 percent reporting either some graduate 

training or a graduate degree. 

Measures

Military lifestyle demands. Fear for Soldiers’ safety was measured with 

four items: “I worry about my spouse being injured while on deployment,” “I worry about my spouse being killed on deployment,” “There 

is a strong possibility that my spouse will be involved in combat during deployment,” and “Given my spouse’s job in the military, there is a 

higher risk for injury or death during deployment.” Impact of moving 

was measured with seven items: “Moving has had a positive impact on 

my family,” “We move more frequently than I would like,” “Moving has 

provided me with many positive opportunities,” “Moving has allowed 

me to make new friends,” “We have moved to exciting places,” “Moving 

is difficult on our children,” and “One of the benefits of being a military 

spouse is getting to move.” Impact of separations was measured with 

four items: “The separations from my spouse are stressful,” “The number of deployments has put a strain on our family,” “The number of deployments has hurt the stability of our marriage,” and “I worry about 

the effects of my spouse’s deploying on our children.” Impact of foreign 

residence was measured by 11 items: “I like living in Europe,” “I find the 

people in this country are very friendly to our Soldiers and families,” 

“Since I have been living here, I feel isolated,” “I am comfortable using 

the local language,” “It has been difficult for me to make friends with 

others in the military community,” “I like learning about this country,” 

“I like to shop on the economy,” “It has been difficult to make friends 

with the Germans/Italians,” “I try to participate in this country’s activities,” “I can hardly wait to get back to the States,” and “Being away from 

friends and relatives back home is very hard for me.” All items for these 

measures were rated on a five-point, Likert-type scale ranging from 1 

(strongly agree) to 5 (strongly disagree), and then scored/reverse-scored 

such that a higher score indicates a higher/more negative standing on 

the variable of interest. That is, higher scores indicated greater fear and 

a greater negative impact of moving, separations, and foreign residence.
FAMILIES FACING THE DEMANDS OF MILITARY LIFE 381

Physical and psychological health. Well-being was measured in two 

ways. The Brief Symptom Inventory was used to assess psychological 

well-being. Participants were asked to indicate how much they had been 

bothered or distressed by each of 18 items over the past 7 days (Derogatis, 2000). Sample items included, “Feeling no interest in things” and 

“Nervousness or shakiness inside.” The response scale ranged from 1 

(none) to 5 (extreme). Walter Reed Army Institute of Research’s physical 

health symptom checklist was used to assess physical well-being. Participants were asked to indicate how often they experienced each of 22 

health symptoms during the past month. Sample items included “headaches,” “eye/ear/nose problems,” “stomach/intestinal problems,” and 

“shortness of breath.” The response scale ranged from 1 (not at all) to 5 

(very often). For both measures, items were scored/reverse-scored such 

that a higher value represented higher levels of well-being (fewer symptoms). These scores were then averaged to create a composite score. 

Army-related attitudes. Participants were asked to indicate how satisfied they were with each of five items related to Army life attitudes. 

Items included, “The Army as a way of life,” “The concern your spouse’s 

unit has for families,” “The respect the Army shows spouses,” “How 

you would feel if your spouse were to make the Army a career,” and 

“The kind of family life you can have in the Army.” The response scale 

ranged from 1 (very satisfied) to 5 (very dissatisfied). Items were scored/ 

reverse-scored such that a higher value represented a more favorable 

value on the variable and then averaged to create a composite score. 

Marital satisfaction. Participants were asked to indicate how much 

they agreed with each of six items from Norton’s Quality of Marriage 

Index (Norton, 1983). Sample items included, “I have a good marriage,” 

“I am happy in my marriage,” and “I feel like I am part of a team with 

my partner.” 

Results of Studies 1 and 2

Various analyses, including correlations, analyses of variance, chisquares, and regressions, were conducted to assess the impact of separations, moving, residence in a foreign country, fear for a Soldier’s safety, and 

community integration on health, Army, and family-related outcomes.

Predictors

Using our indicators of integration in study 1, the data suggested 

that the United States Army Reserve (USAR) and Army National Guard 
382 THE 71F ADVANTAGE

(ARNG) spouses are not integrated into the military way of life to any 

great degree. Table 16–1 shows that only about half of the Reserve Components had FSGs and, where they were available, only about one-fifth 

of spouses attended meetings. Similarly, only about 20 percent of them 

had taken AFTB training. Approximately half of ARNG spouses claimed 

no friends in the unit, as did 70 percent of USAR spouses.

There were significant differences between the Reserve and Active 

Component spouses on all these measures. Significant results emerged 

on whether or not they attended FSG meetings (X2 = (2, N = 494) = 

67.62, p = .000) and if they attended AFTB training (X2 = (2, N = 663) 

= 77.87, p = .000). Likewise, there were significant differences on where 

they had friends in the unit: with regard to having Soldiers as friends (X2 

= (2, N = 697) = 34.70, p = .000) and with regard to having unit spouses 

as friends (X2 = (2, N = 693) = 34.95, p = .000). Thus, hypothesis 1 was 

supported. However, while there were significant differences between 

Active-duty spouses and the Reserve Component spouses, even Activeduty spouses were not strongly integrated into the military way of life;

Table 16–1. Indicators of Army Spouse Integration into Military Way 

of Life (in percent)

Integration Indicator Active-duty 

spouses 

Reserve 

spouses 

National 

Guard spouses 

Does your Soldier’s unit have 

a Family Support Group (FSG)? 

“Yes” (N = 691) 88 52 54

If yes, do you attend FSG meetings?

“I do not attend” (N = 494) 43 86 79

Have you taken Army Family Team 

Building (AFTB) training?

57 77 83

“I have not taken AFTB training” 

(N = 663)

Are you friends with members 

of your Soldier’s unit?

34 68 49 “No, I have no friends in the 

unit” (N = 697)

Are you friends with the 

spouses of unit members?

44 76 53

“No, I have no friends who are 

unit spouses” (N = 693)
FAMILIES FACING THE DEMANDS OF MILITARY LIFE 383

a large percentage of them did not attend FSGs, take AFTB training, or 

have friends in the unit, as indicated in table 16–1. 

Another indicator of integration was the use of unit or formal 

Army support programs for problems. We asked spouses how often they 

have sought support from the unit, Army formal support programs, or 

others for their problems. As can be seen in table 16–2, these resources 

were used by very few of the spouses. Integration scores ranged from 0 

to 6, with 74 percent of responses in the 0 to 2 range, suggesting little 

overall integration into the military. A score of 3 was indicated by 16 

percent, approximately 9 percent scored 4, and only 1 percent scored in 

the 5–6 range. Active-duty spouses were significantly more integrated 

than either Reserve or National Guard spouses (p < .05). The mean 

score for Reserve spouses was .84, while for National Guard spouses 

the mean was 1.42; for Active-duty spouses, the mean integration 

score was 2.38.

Military Lifestyle Demands 

In the second study, different factors were assessed with regard 

to the outcomes described above. The impact of four different demands 

was analyzed, and descriptive findings are presented in table 16–3. Mean

Table 16–2. Moderate or Frequent Army Spouse Use of Military 

Resources for Support (in percent)

Resource Active-duty Reserve National Guard 

Unit Resources:

A Soldier from your 

Soldier’s unit (N = 663) 2 1 1

Another spouse from your 

Soldier’s unit (N = 663) 11 2 2

Family Support Group 

(N = 667) 4 1 < 1

Army Resources:

Army Community Service 

(N = 666) < 1 2 1

Army Emergency Relief 

(N = 665) < 1 2 1

Army Chaplain 

(N = 667) 3 2 1
384 THE 71F ADVANTAGE

scores show that fear for Soldier safety was the greatest concern, followed by the impact of separations, of moving, and of foreign residence.

Outcomes

Physical and Psychological Health

Although the first study indicated significant differences in terms 

of integration across the three components, level of integration within 

the military community was not significantly correlated with, or predictive of, any of the physical or psychological health measures studied; this 

Table 16–3. Descriptive Statistics (N = 346)

Variable Mean Standard 

Deviation

Possible 

Range

Observed 

Range

Cronbach’s 

Coefficient Alpha

Age 30.41 6.36 18- 18–51 N/A

Soldier rank 8.91 6.78 (2–29)

E1–O10

(2–28)

E2–O8 N/A

Number of 

moves 3.43 3.10 0- 0–33 N/A

Number of 

separations 3.53 5.10 1- 1–40 N/A

Fear for 

Soldier safety 3.76 .81 1–5 1.25–5 .81

Impact of 

moving 2.89 .69 1–5 1.38–5 .82

Impact of 

separations 3.28 .75 1–5 1–5 .70

Impact 

of foreign 

residence

2.63 .68 1–5 1–5 .84

Psychological 

well-being 4.59 .44 1–5 2–5 .88

Physical wellbeing 4.25 .52 1–5 1.5–5 .86

Army life 

satisfaction 3.01 .81 1–5 1–5 .82

Marital 

satisfaction 4.49 .83 1–5 1–5 .97
FAMILIES FACING THE DEMANDS OF MILITARY LIFE 385

indicates a lack of support for hypotheses 2a–c in study 1. However, some 

of the demands in the second study did yield significant results. After 

controlling for age, rank, number of moves, and number of separations 

the family had experienced, a series of two-step hierarchical regressions 

were calculated. Control variables were entered on the first step and the 

four lifestyle demand variables were entered on the second step. 

As can be seen in table 16–4, on the first step, the control variables accounted for 7 percent of the variance in psychological health 

(R2 = .07, F [4, 341] = 6.04, p <. 01). The addition, the lifestyle demand 

variables accounted for an additional 12 percent of the variance (ΔR2 = 

.12, F [4, 337] = 11.79, p < .01). An examination of the betas for the individual variables at this second step indicated that impact of separation 

and impact of foreign residence each had significant negative relationships with psychological health. In terms of physical health (see table 

16–5), the control variables accounted for 1 percent of the variance in 

physical well-being (R2 = .01, F [4, 341] = .37, ns), while the addition of 

the lifestyle demand variables accounted for an additional 6 percent 

of the variance (ΔR2 = .06, F [4, 337] = 5.23, p <. 01). An examination 

Table 16–4. Regression of Psychological Health on Control and 

Lifestyle Demand Variables (N = 346)

Step 1 

(R2

 = .07*)

Beta

Step 2 

(R2 = .18*, ∆ R2 = .11*)

Beta

Control Variables

Age .19* .11

Rank .11 .05

Number of moves .03 .05

Number of separations .01 .04

Lifestyle Demand Variables

Fear for Soldier safety – -.07

Impact of moving – .09

Impact of separations – -.22*

Impact of foreign residence – -.24*

*p < .01
386 THE 71F ADVANTAGE

Table 16–5. Regression of Physical Health on Control and Lifestyle 

Demand Variables (N = 346)

Step 1

(R2

 = .01)

Beta

Step 2 

(R2 = .06**, ∆ R2 = .05**)

Beta

Control Variables

Age -.02 -.06

Rank .04 .04

Number of moves -.04 -.02

Number of separations .03 .00

Lifestyle Demand Variables

Fear for Soldier safety – -.12*

Impact of moving – .14*

Impact of separations – -.12*

Impact of foreign residence – -.16**

*p < .05; **p < .01

that fear for Soldiers’ safety, impact of moving, impact of separation, 

and impact of foreign residence each had significant relationships with 

physical well-being. Contrary to expectations, the relationship between 

impact of moving and physical well-being was actually positive in sign 

and significant (p < .05).

Army-related Outcomes

Although integration into the military community was not correlated with health, it was significantly correlated with the spouse’s desire 

for their Soldier to remain in the military (r = .12, p < .05). Spouses who 

felt more integrated indicated a desire for their Soldiers to remain in 

the military even when Soldier age and component were partialed from 

integration scores (see table 16–6). When assessing satisfaction with 

Army life, mixed results occurred in the second study (see table 16–7). 

The control variables in the regression analysis accounted for 13 percent 

of the variance in Army life satisfaction (R2 = .13, F [4, 341] = 12.87, p < 

.01). The addition of the four lifestyle demand variables accounted for 

an additional 14 percent of the variance (ΔR2 = .14, F [4, 337] = 16.47, 
FAMILIES FACING THE DEMANDS OF MILITARY LIFE 387

Table 16–6. Logistic Regression of Integration into the Military 

Community and Retention Preference

Variable b SE Wald p Estimated 

Odds Ratio

Confidence 

Interval (Odds)

Age .105 .018 33.889 .000 1.111 1.072–1.151

Active-duty 

spouse -.058 .419 .019 .891 .944 .415–2.146

National 

Guard spouse .411 .344 1.426 .232 1.508 .768–2.962

Integration 

into military .302 .116 6.748 .009 1.353 1.077–1.699

Constant -2.691

Table 16–7. Regression of Army Life Satisfaction on Control and 

Lifestyle Demand Variables (N = 346)

Step 1 

(R2

 = .13*)

Beta

Step 2 

(R2 = .27*, ∆ R2 = .14*)

Beta

Control Variables

Age .26* .18*

Rank -.02 .02

Number of moves .01 .04

Number of separations .20* .13*

Lifestyle Demand Variables

Fear for Soldier safety – .02

Impact of moving – -.20*

Impact of separations – -.25*

Impact of foreign residence – -.10

*p < .01

p < .01). An examination of the betas for the individual variables at this 

second step indicated that the impact of moving and impact of separation had significant negative relationships with Army life satisfaction. 
388 THE 71F ADVANTAGE

Residence in a foreign country and fear for their Soldiers’ safety were 

not significantly related to satisfaction with the Army. 

Family-related Outcomes

Again, mixed findings occurred for the second study (see table 

16–8). On the first step, the control variables accounted for 3 percent of 

the variance in marital satisfaction (R2 = .03, F [4, 341] = 2.37, ns). The 

addition of the lifestyle demand variables accounted for an additional 3 

percent of the variance (ΔR2 = .03, F [4, 337] = 3.04, p < .05). An examination of the betas for the individual variables at this second step indicated that only one of the four lifestyle demands, impact of separation 

(beta = -.17), had a significant relationship with marital satisfaction. 

Conclusion

The results of the analyses from the two studies yielded mixed 

support for the hypotheses. While we did find that Active-duty spouses 

indicated a greater degree of integration into the military community 

than did Reserve or National Guard spouses, a high degree of integration was not experienced by any of the three components. Additionally,

Table 16–8. Regression of Marital Satisfaction on Control and Lifestyle 

Demand Variables (N = 346)

Step 1 

(R2

 = .03)

Beta

Step 2 

(R2 = .06**, ∆ R2 = .03*)

Beta

Control Variables

Age -.14* -.19**

Rank -.01 .02

Number of moves .03 .04

Number of separations .13* .12*

Lifestyle Demand Variables

Fear for Soldier safety – .04

Impact of moving – .02

Impact of separations – -.17**

Impact of foreign residence – -.07

*p < .05; **p < .01
FAMILIES FACING THE DEMANDS OF MILITARY LIFE 389

integration was not significantly related to any of the health measures; 

however, a greater degree of integration was associated with wanting the 

Soldier to remain in the Army. One possible explanation for the low levels of integration is that the Soldiers of the spouses surveyed were not 

deployed and deployment would likely result in a greater need to use 

such resources to obtain information about their Soldiers and their safety. A second possible explanation may be due to children and employment, which may not leave time for friends or involvement within the 

military community. In our study, 65 percent of the spouses were working either part- or full-time and 80 percent had at least 1 child living at 

home. A third possibility is that the spouses may indeed feel integrated 

but their behavior suggests otherwise. 

The impact of separations was the one demand variable that was 

predictive of all of the outcomes reported in study 2, which suggests that 

it may play a more critical role in determining how spouses are affected. Moving was associated with physical health and Army life satisfaction. Living in a foreign residence was associated with both physical and 

psychological health, and fear concerning Soldier safety was associated 

with physical health. Based on these findings, physical health was the 

outcome most susceptible to the influence of the military life demands 

as it was the only variable predicted by all four demands. However, in 

study 1, integration was not predictive of physical health outcomes. 

One possible explanation for the difference in findings between 

study 1 and study 2, beside the different predictors measured, is that 

study 1 included nondeployed Soldiers while study 2 included deployed 

Soldiers. Deployment status has been linked to health. Adler, Bartone, 

and Vaitkus (1995) assessed the effects of deployment on spouses whose 

Soldiers were on a peacekeeping mission in Croatia and found that over 

half of the spouses reported sleep problems and more than a third reported a loss of appetite. In another study of health outcomes that included Navy wives, spouses whose husbands were deployed were not 

significantly different in terms of physical or psychological symptoms 

when compared to wives whose husbands were not deployed; the only 

exception was depression (Nice and Beck, 1980). Those wives whose 

husbands were deployed had significantly higher depression scores during the pre- and mid-deployment phases than did the nonseparated 

wives. During the deployment, separated wives also went to the doctor 

significantly more than the nonseparated wives. As mentioned previously, integration was not predictive of psychological health. However, 
390 THE 71F ADVANTAGE

in study 2, impact of separations, which is consistent with deployment, 

was predictive of psychological health. 

Based on the findings from the two studies we can see that, regardless of deployment status, Army-related outcomes such as retention 

preferences and Army life satisfaction may be impacted by integration 

and a variety of demands. However, deployment status may play a role 

in health outcomes. In the first study, level of integration in a nondeployed environment was not related to health outcomes; however, this 

might have been different if studied in a deployed situation. It is possible 

that integration may serve as a buffering source of social support rather 

than a main source. The buffering effect suggests that support is beneficial under stressful conditions such as deployment, but is neither helpful 

nor harmful in the absence of stress (Griffith, 1985).

Several topics within military family research deserve further 

study. While the effects of deployment on families is certainly at the forefront of our minds and is another demand that extends beyond its ties to 

separation and integration, it is also important to continue to study the 

effects on those families whose spouses have not deployed. It should be 

noted if there are differences in health-, family-, and Army-related outcomes between the two groups as well as the potential unique challenges 

these families may face. For example, Soldiers who do not deploy may 

not have enough manpower back in garrison to efficiently accomplish 

the mission, or perhaps these families feel somewhat ostracized/isolated 

and find it difficult to relate to other military families who have been 

through a deployment experience. Although we do not know just how 

different or similar the experiences of deployed and nondeployed spouses 

are, the findings presented hopefully shed some light on that issue.

Additionally, understanding the ties that spouses in the various 

components have to the military community, and the impact these ties 

have on a broad range of outcomes, should continue to be investigated. 

This is especially important as spouses are an integral part of the Army 

as an organization. Typically, it is the spouse that is called upon to hold 

fundraisers or participate in community service programs that are used 

to ensure a better quality of life for the military family. In many cases, it 

is the spouse who notifies other spouses about what is happening with 

a Soldier’s unit through means such as FRGs and, if this support system 

is not in place, this may place an even greater burden on the organization to inform spouses of what the units are currently doing. Even if the 

spouse does not like the deployments, feeling supported may at least 

buffer the stressful effects of the separation; this would give them a more 
FAMILIES FACING THE DEMANDS OF MILITARY LIFE 391

positive view of the organization for its sense of community and, perhaps, a subsequent desire for the Soldier to stay in the Service. 

Along those same lines, a better understanding of coping strategies families use, and the appraisal of the demands the military places on 

its families, is critical to reducing the negative effects that may occur in 

response to these demands. Fortunately, programs such as FRGs, AFTB, 

Morale Welfare and Recreation, and others exist within the Army to 

help families have a better quality of life. However, not everyone knows, 

uses, or has easy access to these programs. This suggests a need to explore other coping strategies as well.

The variables described above, which include deployment status, 

military community integration, and coping, are just a few that will provide better insight into how families are affected by a wide range of demands. Thus, new opportunities for resolving the stress associated with 

these demands may be discovered in the process. Opportunities may be 

reflected in programs and/or policies, and may exist within the individual, the unit, and the Army as an organization where, ideally, all three 

will collaborate to develop family resilience. 

Portions of this chapter were previously published in Burrell, L., 

Durand, D.B., and Fortado, J. (2003). Military community integration 

and its effect on well-being and retention. Armed Forces and Society, 

30, 7–24; and Burrell, L., Adams, G.A., Durand, D.B., and Castro, C.A. 

(2006). The impact of military lifestyle demands on well-being, Army, 

and family outcomes. Armed Forces and Society, 33, 43–58.

References

Adler, A.B., Bartone, P.T., and Vaitkus, M.A. (1995). Family stress and adaptation during a U.S. 

Army Europe peacekeeping deployment (USAMRU–E Technical Report 95–1). Fort Detrick, MD: U.S. Army Medical Research Unit–Europe.

Allen, T.D., Herst, D.E., Bruck, C.S., and Sutton, M. (2000). Consequences associated with work 

to family conflict: A review and agenda for future research. Journal of Organizational 

Health Psychology 5, 278–308.

Anderzen, I., and Arnetz, B.B. (1999) Psychophysiological reactions to international adjustment: 

Results from a controlled longitudinal study. Psychotherapy and Psychosomatics 68, 67–75.

Bedeian, A.G., Burke, B.G., and Moffett, R.G. (1988). Outcomes of work-family conflict among 

married male and female professionals. Journal of Management 14, 475–491.

Bell, D.B., and Schumm, W.R. (1999). Family adaptation to deployments. In Peggy McClure (ed.), 

Pathways to the future: A review of military family research. Scranton, PA: Military Family 

Institute, Marywood University. 

Bourg, C., and Wechsler Segal, M. (1999). The impact of family supportive policies and practices 

on organizational commitment to the Army. Armed Forces and Society 25 (4), 633–652.

Bruner, E.F. (2007). U.S. military dispositions: Fact sheet. Retrieved July 27, 2008, from <http://

digital.library.unt.edu/govdocs/crs/permalink/meta-crs-10172:1>.
392 THE 71F ADVANTAGE

Burnam, M.A., Meredith, L.S., Sherbourne, C.D., Valdez, R.B., and Vernez, G. (1992). Army families and soldier readiness (R–3384–A). Santa Monica, CA: RAND.

Cohen, A.A., and Dotan, J. (1976). Communication in the Family as a Function of Stress during 

War and Peace. Journal of Marriage and the Family 38, 141–148.

Coolbaugh, K.W., and Rosenthal, A. (1992). Family separations in the Army (ARI Technical Report 964). Alexandria, VA: U.S. Army Research Institute for the Behavioral and Social 

Sciences.

Copeland, A.P., and Norell, S.K. (2002). Spousal adjustment on international assignments: The 

role of social support. International Journal of Intercultural Relations 26 (3), 255–272.

Croan, G.M., Levine, C.T., and Blankinship, D.A. (1992). Family adjustment to relocation (ARI 

Report 968). Alexandria, VA: U.S. Army Research Institute for the Behavioral and Social 

Sciences. 

Derogatis, L.R. (2000). The brief symptom inventory 18 (BSI 18): Administration, scoring and procedures manual. Minneapolis, MN: National Computer Systems. 

Finkel, L.B., Kelley, M.L., and Ashby, J. (2003). Geographic mobility, family, and maternal variables as related to the psychosocial adjustment of military children. Military Medicine

168 (12), 1019–1024.

Frankel, H., Snowden, L.R., and Nelson, L.S. (1992). Wives’ adjustment to military deployment: 

An empirical evaluation of a family stress model. International Journal of Sociology of the 

Family 22, 93–117.

Frone, M.R., Yardley, J., and Markel, K.S. (1997). Developing and testing an integrative model of 

the work-family interface. Journal of Vocational Behavior 50, 145–167.

Gal, R., and Syna, H. (1988). Relationship between the soldier in the military unit and family (No. 

ADA 198585). Israeli Institute for Military Studies Zikhron Ya’akov.

Gaylord, M., and Symons, E. (1986). Relocation stress: A definition and a need for services. Employee Assistance Quarterly 2 (1), 31–36.

Griffith, J. (1985). Social support providers: Who are they? Where are they met? And the relationship of network characteristics to psychological distress. Basic and Applied Social 

Psychology 6 (1), 41–60.

Hunter, E.J., and Hickman, R.A. (1981). Family separation and reunion: A style of life in the military. San Diego, CA: United States International University.

Jensen, P.S., Lewis, R.L., and Xenakis, S.N. (1986). The military family in review: Context, risk, 

and prevention. Journal of the American Academy of Child Psychiatry 25, 225–234. 

Kopelman, R.E., Greenhaus, J.H., and Connolly, T.F. (1983). A model of work, family, and interrole conflict: A construct validation study. Organizational Behavior and Human Performance 32, 198–215.

Lewis, P.M. (1985). Family factors and the career intent of Air Force enlisted personnel (LMDC 

Technical Report 85–9). Washington, DC: USAF Office of Scientific Research.

Makowsky, P.P., Cook, A.S., Berger, P.S., and Powell, J. (1988). Womens’ perceived stress and wellbeing following voluntary and involuntary relocation. Lifestyles: Family and Economic 

Issues 9 (2), 111–122.

Marshall-Mies, J.C. (2001). Civilian spouses of soldiers: Comparison of the results for male and 

female spouses (ARI Technical Report 2001–04). Alexandria, VA: U.S. Army Research 

Institute for the Behavioral and Social Sciences.

Maxfield, B.D. (2006). Army Demographics: FY06 Army Profile. Retrieved July 26, 2008, from 

<www.2k.army.mil/downloads/FY06Tri-Fold.pdf>.

Mayfield, D., McLeod, G., and Hall, P. (1974). The CAGE questionnaire: Validation of a new 

alcoholism instrument. American Journal of Psychiatry 131, 1121–1123.

McClure, P., and Broughton, W. (1988). Military community cohesion (MFI Technical Report 

98–4). Scranton, PA: Marywood University.
FAMILIES FACING THE DEMANDS OF MILITARY LIFE 393

Mohr, D.A., Holzbach, R.L., and Morrison, R.F. (1981). Surface warfare junior officer retention: 

Spouses’ influence on career decisions (NPRDC Technical Report 81–17). San Diego, CA: 

Navy Personnel Research and Development Center.

Netermeyer, R.G., Boles, J.S., and McMurrian, R. (1996). Development and validation of workfamily conflict and family-work conflict scales. Journal of Applied Psychology 81, 400–

410.

Nice, D.S., and Beck, A. (1980) Feelings of depression in Navy wives prior to family separation. San 

Diego, CA: Navy Personnel Research and Development Center.

Norell, S., and Copeland, A.P. (2002).US–UK moves: Cross cultural adjustment in American and 

British expatriate accompanying spouses. Retrieved November 16, 2003, from <www.interchangeinstitute.org/html/ research.htm>.

Norton, R. (1983). Measuring marital quality: A critical look at the dependent variable. Journal of 

Marriage and the Family 45 (1), 141–151.

Orthner, D.K. (2002). Deployment and separation adjustment among Army civilian spouses. SAF 

IV Survey Report retrieved September 13, 2005, from <www.armymwr.com/corporate/

operations/planning/surveys.asp>.

Ozkaptan, H., Sanders, W., and Holz, R. (1986). A profile of Army families in USAREUR: Results 

of the 1983 families in Europe survey (ARI Technical Report 925). Alexandria, VA: U.S. 

Army Research Institute for the Behavioral and Social Sciences.

Puskar, K.R. (1990). International relocation: Womens’ coping methods. Health Care for Women 

International 11, 263–276.

Radloff, L.S. (1977). The CES-D Scale: a self-report depression scale for research in the general 

population. Applied Psychological Measurement 1, 385–400.

Raschman, J.K., Patterson, J.C., and Schofield, G.L. (1989). A retrospective study of marital discord 

in pilots (Technical Report USAFSAM–JA–90–5). Brooks AFB, TX: The USAF School 

of Aerospace Medicine.

Rogers, S.J., and May, D.C. (2003). Spillover between marital quality and job satisfaction: Long 

term patterns and gender differences. Journal of Marriage and Family 65 (2), 482–495.

Rohall, D.E., Segal, M.W., and Segal, D.R. (1999). Examining the importance of organizational 

supports on family adjustment to Army life in a period of increasing separation. Journal 

of Political and Military Sociology 27, 49–65.

Rosen, L.N., and Durand, D.B. (1995). The family factor and retention among married soldiers 

deployed in Operation Desert Storm. Military Psychology, 7 (4), 221–234.

Rosen, L.M., Teitelbaum, J.M., and Westhuis, D. (1993). Stressors, stress mediators, and emotional well-being among spouses of soldiers deployed to the Persian Gulf during Operation 

Desert Shield/Storm. Journal of Applied Social Psychology 23, 1587–1593.

Schneider, R., and Gilley, M. (1984). Family adjustment in USAREUR. U.S. Army Medical Research Unit–Europe Final Report. Heidelberg, Germany. 

Schumm, W.R., Bell, D.B., and Gade, P. (2000). Effects of a military overseas peacekeeping deployment on marital quality, satisfaction, and stability. Psychological Reports 87 (3), 815–821.

Schumm, W.R., Bell, D.B., and Knott, B. (2001). Predicting the extent and stressfulness of problem rumors at home among Army wives of soldiers deployed overseas on a humanitarian 

mission. Psychological Reports 89 (1), 123–134.

Schwartz, J.B., Braddy, B.A., Griffith, J.D., and Wood, L. (1988). The employment status of Army 

spouses (ARI Technical Report 14). Alexandria, VA: U.S. Army Research Institute for the 

Behavioral and Social Sciences.

Scurfield, R.M., and Tice, S.N. (1992). Interventions with medical and psychiatric evacuees and 

their families: From Vietnam through the Gulf War. Military Medicine 15 (2), 88–97.

Van der Kloet, I., and Moelker, R. (2002). Overcoming stressful experiences: Military families in the 

frontline. Paper presented at the 38th IAMPS. Amsterdam, Netherlands.

Warner, W.M. (1983). The Air Force wife: Her perspective. Unpublished manuscript, Maxwell Air 

Force Base, AL: Air Command and Staff College. 

395

Chapter 17

To Stay or Not to Stay? Family-friendly 

Unit Climate and Career Intentions

Edward N. Edens, Lyndon A. Riviere, Charles W. Hoge, and Paul D. Bliese

For decades, the Army has invested substantial amounts of money 

into training Soldiers. Therefore, it is in our best interest to retain as 

many of them as possible. However, many Soldiers voluntarily separate 

from the Army before retirement. According to a Congressional Budget 

Office report, since 2000, over 15 percent of Active-duty Soldiers have 

left the Army annually.

In this study, the outcome of interest is career or turnover intentions. The relationship between turnover intentions and behavior 

has been established (Huffman, Adler, Dolan, and Castro, 2005). They 

found that among Soldiers who were undecided as to whether they 

planned to stay in the Army or separate early, more than 75 percent actually remained in the Army. Approximately 96 percent of those who indicated that they would stay actually did, while a plurality (59 percent) 

of those who planned to leave actually left. 

When analyzing why Soldiers decide to leave the Army or remain 

in until retirement, many possible reasons emerge. These vary on an individual basis, but one theme that often appears is family ties. With family ties come family demands, which have been associated with Soldier 

attrition, particularly among those who are married with children (Bedeian, Burke, and Moffett, 1988; Carlson and Perrewe, 1999; Duxbury 

and Higgins, 1991; Frone, Yardley, and Markel, 1997; Major, Klein, and 

Ehrhart, 2002). As of 2004, over half of all Active-duty Soldiers were 

married; 58 percent of those had an average of two children, which 

adds up to roughly 1.17 million children belonging to Active-duty 

military families (Ender, 2006; National Council on Family Relations, 

2004). At the same time, the military is seeing an increase in dual-career 

couples, many of whom have dependents (Griffith, Rakoff, and Helms, 

1992; Huffman and Payne, 2006; Martin and McClure, 2000; Schumm, 

Bell, Rice, and Sanders, 1996). In 2004, there were over 47,000 dual-Service couples with children in the military (National Council on Family 

Relations, 2004).
396 THE 71F ADVANTAGE

The purpose of this study is to examine the relationship between 

a family-friendly unit climate and the decision of married Soldiers with 

children to remain or leave the Army beyond their present commitment. Examining the relationship between a family-friendly unit climate and married Soldiers’ decisions to remain in the Army or leave 

early can ultimately benefit the military as a whole and help the Army 

extend Soldiers’ enlistment beyond their present time commitment.

Work-Family Conflict

Like people employed in other careers, Soldiers sometimes experience the conflicting demands of work and family (Kopelman, Greenhaus, and Connolly, 1983). Work-family conflict (WFC) is likely experienced most acutely by those Soldiers who have dependent children 

(Bedeian et al., 1988; Bruck and Allen, 2003; Eagle, Icenogle, Maes, and 

Miles, 1998; Frone, 2003; Grywacz and Marks, 2000; Kinnunen and 

Mauno, 1998; Major et al., 2002). Further, military personnel have obstacles that are not common to their civilian counterparts, such as multiple deployments into life-threatening situations for long periods and 

increasing demands to begin training for the next deployment as soon 

as they complete their current deployment. 

In recent years, there has been an increase in the number of deployments as the United States continues to send military personnel to 

Afghanistan as well as Iraq. During these deployments and the concomitant training for them, Soldiers are separated from their families. Several studies have been conducted on how separation between military 

personnel and their families increases the likelihood that they will not 

remain in the military beyond their current obligation (Schumm, Jurich, Stever, Sanders, Castelo, and Bollman, 1998; Smith, 1988).

Other demands more common to military personnel than the 

typical civilian workforce include residence in foreign countries, frequent moves, physical separation, long working hours, and demanding 

shift work. These demands increase WFC for all Soldiers, but especially 

for those with children at home. Implementing a family-friendly working environment may help alleviate the intensity of WFC (Weiss, 2003). 

In the past, the military has been in the forefront of providing 

medical care for dependents. In recent years, the military has also followed the lead of many civilian organizations by incorporating familyfriendly working environments. One example is instituting flexible 
UNIT CLIMATE AND CAREER INTENTIONS 397

work hours so Soldiers can be available to take care of their families in 

emergencies. Again like many civilian companies, the military has also 

embraced on-site Childhood Development Centers where parents can 

leave their children, with one or more located on many posts and bases 

throughout the United States and around the world. The Department of 

Defense also provides youth services to Soldiers’ school-age children in 

order to focus on their particular needs (Office of Family Policy, 1999). 

Recently, the Department of Defense has begun to use the Internet as a medium to help military family members cope with unique situations. A particular example is the creation of the “Military Teens on 

the Move” Web site (<www.defenselink.mil/mtom>), which has coined 

the catch phrase, “Moving can be cool . . . and sometimes challenging.” 

It provides information to children of military personnel about posts 

they are moving to, as well as other tips on how to handle the move 

(Ender, 2006). 

Other family-friendly policies and programs implemented in recent years include the “family/Soldier time” policy where Soldiers are 

allowed to leave work early to tend to personal business or spend time 

with family. On-site military family service centers have been built to 

offer support groups for family members and host Army Family Team 

Building, which trains family members on such topics as “family and 

military expectations.” In addition, mentoring programs have been advanced where a married Soldier is teamed up with another married Soldier, or a married Soldier with children is teamed up with another Soldier who is married with children, to offer each other comfort, support, 

and insight into programs and policies they can use to assist themselves 

and their dependents (Huffman and Payne, 2006). 

The significant increase in dual-military career couples over the 

past decade introduces a unique set of issues that the Army must work 

on to prevent losing qualified personnel. In this case, it can mean the 

loss of not just one but two Soldiers if both spouses leave the Army as 

soon as their enlistments are concluded. 

One of the biggest issues the Army faces with this group of Soldiers is what will happen if two married Soldiers cannot be reassigned 

to the same new location due to their career fields or branch of service (Huffman and Payne, 2006). The Married Army Couples Program 

was created to assist dual-career Army couples in being relocated to the 

same place (U.S. Army Human Resource Command, 2008). Yet it is 
398 THE 71F ADVANTAGE

sometimes necessary that dual-career couples accept less than desired 

locations in order to be stationed together (Williams, 1978). 

The old adage “A happy family makes for a happy soldier” appears 

to be true. It has been shown that military spouses have a significant 

impact on the career intentions of Soldiers (Rosen and Durand, 2000). 

One of the major causes for spouses giving their active support is that 

the military environment is considered conducive for raising a family 

(Ender, 2006). 

While there has been a substantial amount of research focusing 

on family-friendly working environments and their impact on WFC, 

very little has been done examining the relationship between a familyfriendly unit climate and the decision of married Soldiers with children 

to remain or leave the Army beyond their present commitment (Bourg 

and Segal, 1999; Huffman, Culbertson, and Castro, 2008).

Method

Sample

The sample for this study is comprised of 492 Active-duty Soldiers 

from three brigades, who were surveyed 3 months after returning from 

a year-long deployment to Iraq between May and June of 2004. The response rate was 66 percent. The sample only included junior enlisted or 

noncommissioned officer (NCO) married male Soldiers with children. 

Thirty-eight percent of the respondents were between 30 and 39 

years of age, 30 percent between 25 and 29 years of age, 26 percent between 20 and 24, 1 percent under 20, and 5 percent over 39. The average 

time of military service was more than 10 years. Almost two-thirds of 

the respondents were NCOs and, of those, 16 percent were senior NCOs 

(E8–E9). More than half of the respondents had some college education, 

while almost 40 percent had a high school diploma or less. Ethnically, 

the sample was segregated into two groups: 67 percent were Caucasian, 

and 33 percent were minorities. 

Females were removed from this study because they represented 

a very small sample of the total population (<1 percent). Officers and 

warrant officers were also excluded because their perception of what 

constitutes a family-friendly unit climate is different enough from 

those of junior enlisted soldiers and NCOs to warrant a separate study 

in the future.
UNIT CLIMATE AND CAREER INTENTIONS 399

Measures

Career intentions of Soldiers. This was a single-item, six-point Likert 

scale: “Which best describes your current Active-duty Army career intentions?” The response options were (1) definitely stay in until retirement; (2) probably stay in until retirement; (3) definitely stay in beyond 

my present obligation but not until retirement; (4) undecided about 

whether to stay after completion of my current obligation; (5) probably 

leave upon completion of my current obligation; or (6) definitely leave 

upon completion of my current obligation. If participants answered (4), 

undecided, they were removed from the sample. The distribution of the 

sample is displayed in figure 17–1. This item has been used previously 

in military research to measure career intent (Tremble et al., 2003). The 

mean for this variable was 3.17. This result is displayed in table 17–1.

Demographic variables. These include age, education, race/ethnicity, 

rank/grade, and years in the military. The distributions of the demographic variables are displayed in table 17–2. 

Family-friendly unit climate. This measure includes six items, each with 

a five-point Likert scale ranging from strongly disagree (1) to strongly 

agree (5). An example of an item for this measure is, “My unit makes allowances for Soldiers to drop off and pick up children.” Two of the items

Figure 17–1. Career Intentions of Soldiers (N = 492)

40

35

30

25

20

15

10

5

0

Percent

Definitely stay in until 

retirement

Probably stay in until

retirement

Definitely stay in 

beyond present obligation 

but not until retirement

Probably leave upon

completion of current

obligation

Definitely leave upon

completion of current 

obligation

18.5

9.3 9.3

27.5

35.3
400 THE 71F ADVANTAGE

Table 17–1. Measures Affecting Soldiers’ Decision to Remain in Army 

Scales 

(possible range of 

response in brackets) Mean SD α n

Career intentions 

(1 item [1–6]) 3.17 2.09 492

Family-friendly unit 

climate (6 items [6–30]) 15.69 4.70 .80 492

Individual morale 

(1 item [1–5]) 2.97 1.15 487

Unit morale 

(1 item [1–5]) 2.63 0.93 485

Unit cohesion 

(3 items [3–15]) 9.97 2.75 .88 492

Combat experiences 

(29 items [29–145]) 67.15 18.89 .89 492

were negative (“Attending to family needs such as taking time off for 

sick children is frowned upon”) and were recoded so all questions would 

have a positive scale. Scores were calculated by summing up the items 

with the higher numbers representing a greater belief in a positive family-friendly unit climate. The mean for this scale was 15.69, and the 

Cronbach’s alpha coefficient was .80 (see table 17–1). 

Individual morale. This was a single-item, five-point Likert scale that 

asked the respondent to rate his personal morale. Response choices 

ranged from very low (1) to very high (5). The mean for this variable 

was 2.97 (see table 17–1).

Unit morale. This was a single-item, five-point Likert scale that asked 

the respondent to rate the morale of his unit. Response choices ranged 

from very low (1) to very high (5). The mean for this variable was 2.63 

(see table 17–1).

Unit cohesion. This contains three different items, each with a fivepoint Likert scale ranging from strongly disagree (1) to strongly agree 

(5). One example of an item for this measure is, “The members of my 

unit know that they can depend on each other.” Scores were calculated 

by summing the results from each of the three items. All items with a 

higher number represent a greater belief in positive unit cohesion. The
UNIT CLIMATE AND CAREER INTENTIONS 401

Table 17–2. Sample Demographic Variables

Variable Sample (N = 492) (in percent)

Age

18–19 1

20–24 26

25–29 30

30–39 38

40 and over 5

Education

GED 8

High school diploma 31

Some college 58

Bachelor’s degree 2

Advanced 1

Race/Ethnicity

Caucasian 67

Minority 33

Rank/Grade

E1–E4 39

E5–E6 45

E7–E9 16

Years in Military

1 or less 5

2 12

3–4 19

5–9 28

10+ 36

mean for this scale was 9.97, and the Cronbach’s alpha coefficient was 

.88 (see table 17–1). 

Mental health status (screened positive for depression, anxiety, or posttraumatic stress disorder [PTSD]). This was measured using the Posttraumatic Stress Disorder Checklist, an extremely useful assessment 

tool for conducting mental health screenings on a large population 

where a structured interview is not feasible due to time and manpower 

constraints (Blanchard, Jones-Alexander, Buckley, and Forneris, 1996). 
402 THE 71F ADVANTAGE

It was therefore well suited for the current sample of a large group of 

Soldiers returning from a military theater at the same time. The 17-item 

checklist yielded a total of 96 Soldiers (19.5 percent of the sample) who 

screened positive for a mental health problem. 

Combat experience/exposure. This measure includes 29 items, each with 

a five-point Likert scale ranging from never (1) to 10 or more times (5). 

An example of an item for this measure is, “Being attacked or ambushed.” 

Scores were calculated by adding together all of the items. Results with 

a higher number represented a higher exposure to combat. The mean 

for this scale was documented as 67.15, and the Cronbach’s alpha coefficient was .89. This particular index has been used in previous military 

research, and its results can be seen in table 17–1 (Hoge et al., 2004). 

Analysis 

Logistic regression was used to determine the relationship between career intention (outcome) and family-friendly unit climate, individual and unit morale, unit cohesion, mental health status, combat 

exposure, age, rank, education, race, and years in service (predictors).

Results

Demographics. A cross-tabulation was conducted for age and career intentions for this group of Soldiers. As the age of the Soldier increased, 

he was more inclined to remain in the Army beyond his current enlistment. Only 49 percent of Soldiers under 30 years of age intended to remain in the Army, while almost 80 percent over 30 years of age reported 

that they were going to continue beyond their current enlistment time. 

Similarly, when number of years in service was compared to career intention in a cross-tabulation, an increase in likelihood to remain 

in the Army can be seen as the number of years in the Army increases. 

While 51 percent of the Soldiers with less than 10 years of service intended to stay in the Army, 83 percent with 10 or more years of service 

planned to remain. 

When cross-tabulation between race and career intentions is 

conducted based on ethnic differences with regard to intended career 

choice, there was only a slight difference, with 64 percent of Caucasians 

and 62 percent of minorities intending to remain in the Army. 

Additionally, there was only a small increase in intention to make 

the Army a career when education was examined in a cross-tabulation with the career variable. Whether the Soldier had only obtained a 
UNIT CLIMATE AND CAREER INTENTIONS 403

general equivalency diploma (GED) or an advanced degree, the likelihood that he would make the Army a career was only minimally different (GED, 56 percent; high school diploma, 57 percent; some college, 

68 percent; college graduate, 69 percent). 

The results of the logistic regression analysis in table 17–3 revealed that, among the demographics, the variables of age (β = .458, 

p < .05) and rank (β = .806, p < .05) significantly predicted the career 

intentions for this group (0 = probably or definitely leave the Service after current obligation, 1 = definitely stay in the Service at least beyond 

current obligation). However, ethnicity, education, and years in service 

were not significant predictors of whether these Soldiers would remain 

or leave after their current commitment. 

It is not surprising that rank was the strongest significant predictor of career intentions in this study. Sixty-one percent of the 

respondents were NCOs and, of those, 16 percent were senior NCOs. 

Table 17–3. Logistic Regression Analysis on Career Intention to Stay in 

Service (N = 485)

Predictors B Odds-Ratio CI

Family-friendly unit climate 

(low = 0, high = 1) .085* 1.09 (1.03–1.15)

Unit cohesion 

(low = 0, high = 1) .157 1.17 (.97–1.42)

Unit morale 

(low = 0, high = 1) .219 0.80 (.36–1.79)

Individual morale 

(low = 0, high = 1) .687* 1.99 (1.10–3.60)

Combat exposure .035 1.04 (.99–1.08)

Mental health status 

(no problem = 0, problem = 1) -.027* 0.97 (.96–.99)

Race/ethnicity 

(Caucasian = 0, minority = 1) .115 1.12 (.69–1.83)

Age .458* 1.58 (1.10–2.28)

Education -.238 0.79 (.59–1.05)

Rank .806* 2.24 (1.34–3.74)

Years in service .005 1.01 (.94–1.07)

Constant 3.706*

*p < .05
404 THE 71F ADVANTAGE

As Soldiers rose in rank, especially to the senior levels, their motivation 

to stay in the Army shifted strongly; more than likely, they would make 

a career out of serving.

Only 38 percent of junior enlisted Soldiers reported that they 

wanted to remain in the Army beyond their current enlistment. On the 

other hand, almost three-quarters of the lower level NCOs (E5–E6) stated that they wish to it make a career. This number increased to 88 percent for senior NCOs (E7–E9). 

Mental health status and combat exposure. There was a significant 

relationship between career intentions and mental health status (β = 

-.027, p < .05). This indicated that married soldiers with children who 

screened positive for depression, anxiety, or PTSD were more likely to 

intend to leave the Army. This argument was strengthened by running a 

cross-tabulation on career intentions and mental health issues. Soldiers 

who screened positive for mental health issues were much more likely 

to get out of the Army when their enlistment was completed than those 

who had not screened positive. In fact, 58 percent of Soldiers with mental health issues intended to leave, as opposed to the 33 percent without 

the issues. 

While mental health status was a significant predictor of the career intentions for this group of Soldiers, combat exposure was not. In 

an attempt to examine this further, combat exposure was divided into 

three categories: low, moderate, and high. These categories were determined by breaking the overall combat exposure index into quartiles, 

with the lowest quartile representing low combat exposure, the middle two representing moderate combat exposure, and the highest representing high combat exposure. When career intention was examined 

with these three combat exposure categories by way of cross-tabulation, 

the level of combat exposure did not appear to be a driver of career intention. Soldiers in this study with low combat exposure were just as 

likely to leave the Army upon completion of their contract as Soldiers 

who had experienced moderate or even high levels of combat exposure 

(low, 37 percent; moderate, 35 percent; high, 42 percent). While there 

was a distinct relationship between the amount of combat exposure a 

Soldier experienced and mental health problems, combat exposure was 

not a significant predictor of career intentions within this study group, 

whereas mental health was. This suggested that Soldiers with high levels 

of combat exposure were no more likely to plan to leave or stay in the 

Army than those with low levels.
UNIT CLIMATE AND CAREER INTENTIONS 405

Family-friendly unit climate. When cross-tabulation was conducted on 

career intention and family-friendly unit climate, it became clear that 

family-friendly unit climate was a strong driver of the career intentions 

of those in this study. Soldiers who believed that their unit climate was 

family-friendly were much more likely to be interested in making a career out of the Army. Eighty-five percent of them chose to remain, compared to the 54 percent who chose to leave because they did not find 

their unit to be family-friendly. To conduct the cross-tabulation, the 

family-friendly unit index was divided at the median into two categories: low and high. 

The logistic regression analysis displayed in table 17–3 revealed 

that family-friendly unit climate was found to be a significant predictor of a Soldier’s career intention (β = .085, p < .05). Thus, we can argue 

that married Soldiers with children who perceived their unit climate to 

be family-friendly were more likely to stay in the Army than those who 

believed their unit was not family-friendly. This suggests that unit leadership should provide a family-friendly unit climate for the Soldiers directly under them. This may be accomplished through giving appropriate amounts of time off to take care of dependents when needed, or a 

flexible work schedule for Soldiers who have children in daycare. Failure to address these needs may result in greater turnover of qualified 

Soldiers.

Morale and cohesion. In 1999, morale was identified by the Department 

of the Army as “the state of the spirits of an individual or group as shown 

by confidence, cheerfulness, discipline, and willingness to perform tasks” 

(Department of the Army, 1999). When a dichotomous cross-tabulation 

was conducted on these variables and career intention, the findings indicated that those with high individual morale were more likely to report 

they would remain in the Army (83 percent) than those reporting high 

unit morale (79 percent) or high unit cohesion (71 percent). To examine 

unit cohesion in the cross-tabulation, this index was divided at the median into two categories: low and high. Unit level morale and individual 

morale were dichotomized based on their own lower (“very low,” “low,” 

and “medium”) and higher (“high” and “very high”) categories.

The logistic regression analysis displayed in table 17–3 shows that 

at the unit level, both morale and cohesion were found to be nonsignificant predictors of career intentions; however, high individual morale was found to significantly predict the career intentions among these 

Soldiers (β = .687, p < .05). 
406 THE 71F ADVANTAGE

While unit morale and unit cohesion were not significant indicators of career intention for this group, married Soldiers with children 

that have high individual morale were significantly more likely to remain in the Army. After studying these results, the question becomes 

why unit cohesion and unit morale were not significant predictors in the 

model, while individual morale was a significant indicator of career intentions. Our research suggests that, while individual morale has a more 

direct influence on the personal lives of Soldiers, unit cohesion and unit 

morale does not have the same direct influence. While a family-friendly 

unit climate is not directed at Soldiers on an individual level per se, its 

influences are very personal in the lives of Soldiers and their families; 

therefore, it is clear that the dynamics measured by unit cohesion and 

morale differ from those of family-friendly unit climate. 

Discussion

Given the relationship between turnover intent and behavior, and 

despite the fact that the study used a peacekeeping sample, the percentages give us reason to expect that a large proportion of Soldiers who indicate that they will leave the Army actually will. 

From this study, we know that career intentions of married Soldiers with children are influenced by factors including family-friendly 

unit climate, individual morale, mental health issues, age, and rank. 

While the effect is modest, Soldiers who see their units as family-friendly 

are more likely to remain in the Army. 

Kelley, Hock, Bonney, Smith, Jarvis, and Gaffney (2001) found 

support among Navy personnel with dependents that their commitment 

to the military was the main reason they were making a career out of the 

Navy. Additionally, many respondents reported that military benefits 

were a huge incentive in continuing their careers. Among dual-member Army families, items that contributed to Soldiers wanting to remain 

involved their spouse’s military career intention, family income, family 

size, and job satisfaction (Lakhani and Gade, 1992). In 1998, however, 

Pierce conducted a study on Active-duty Air Force women with young 

children. These women believed that civilian work conditions were better than those in the military, and they were much more likely to leave. 

Furthermore, it was found that women who left the military after giving birth perceived their role as mothers to be conflicting with their job 

behavior. Kelley and colleagues (2001) also reported that a significant 
UNIT CLIMATE AND CAREER INTENTIONS 407

percentage of Navy mothers identified the conflict of balancing their 

naval career and family responsibilities as the reason for planning on 

not renewing their contract after their current obligation. 

In this study, it is not being suggested that Soldiers with dependents be given preferential treatment or a reduction in their workload to 

accommodate their family needs; however, given the amount spent on 

Soldiers’ training, the Army has a vested interest in ensuring that attrition is minimized. This study points to the importance of unit leadership, both at the command level, as well as the immediate supervisor, to 

ensure that their Soldiers are given at least some flexibility to take care 

of emergency family needs. Additionally, work predictability is important to Soldiers, especially those with dependents. It is in the unit leadership’s best interest to work with their Soldiers who have preschool-age 

children in childcare facilities to try to match the daycare schedule. 

Available programs and policies should also be a reflection of the 

population of the Army; therefore, as the number of single parents increases, so should the development of leadership programs focusing on 

that population’s specific needs. Currently, many Army programs are 

geared toward the traditional family (Kelley, 2006). Failure to adapt to 

the changing needs of Army members will result in reduced productivity and the possible loss of excellent workers who are successfully contributing to the mission. Neither the Army nor unit leadership can be 

expected to not deploy Soldiers with dependents; however, they can put 

supportive practices and policies in place that assist these Soldiers at all 

times, whether prior to deployment or during it. Failure may result in a 

continued loss of qualified Soldiers who would otherwise remain till retirement (Bourg and Segal, 1999). 

Leaders should strive to create a culture and climate that are conducive to the needs of Soldiers who have outside commitments due to 

their dependents, instead of one where these individuals are viewed as 

less effective in the workplace. As the Army population has changed, 

many family-friendly programs and policies have been implemented 

within the Service to adapt. However, not all of these policies and programs have been embraced by military leaders or those that they were 

created to assist (Huffman and Payne, 2006). 

Our findings show that, while there is a dose-response relationship between combat exposure and mental health problems, mental 

health status is a significant direct predictor of career intentions among 
408 THE 71F ADVANTAGE

Soldiers who are married and are parents, and combat exposure is not. 

This indicates that Soldiers with high levels of combat exposure are no 

more likely to plan to leave or stay in the Army than those with low levels, unless mental health problems have developed as a result. 

Interestingly enough, while unit cohesion and unit morale are not 

significant predictors in the model, individual morale is. This indicates 

that even though unit cohesion and morale are often reflective of indicators of unit dynamics like the family-friendly unit climate measure, they 

measure distinct aspects of those dynamics that are not additive when it 

comes to individual career intentions. 

Overall, it appears as though certain factors, like unit familyfriendliness and individual morale, may have a more direct influence on 

the personal lives of Soldiers and their career intentions, while factors 

that operate at a more distal level do not. 

References

Bedeian, A.G., Burke, B.G., and Moffett, R.G. (1988). Outcomes of work-family conflict among 

married male and female professionals. Journal of Management 14, 475–491.

Blanchard, E.B., Jones-Alexander, J., Buckley, T.C., and Forneris, C.A. (1996). Psychometric 

properties of the PTSD checklist (PCL). Behaviour Research and Therapy 34, 669–673.

Bourg, C., and Segal, M.W. (1999). The impact of family supportive policies and practices on 

organizational commitment to the Army. Armed Forces and Society 25, 633–652. 

Bruck, C.S., and Allen, T.D. (2003). The relationship between big five personality traits, negative affectivity, type A behavior, and work-family conflict. Journal of Vocational Behavior 63, 457–472.

Carlson, D.S., and Perrewe, P.L. (1999). The role of social support in the stressor-strain relationship: An examination of work-family conflict. Journal of Management 25, 513–540.

Congressional Budget Office (2006). Recruiting, retention, and future levels of military personnel

(Publication No. 2777). Washington, DC: Government Printing Office.

Department of the Army (1999). Army leadership: Be, know, do (Field Manual 22–100). Washington, DC: Headquarters Department of the Army.

Duxbury, L.E., and Higgins, C.A. (1991). Gender differences in work-family conflict. Journal of 

Applied Psychology 76, 60–73.

Eagle, B.W., Icenogle, M.L., Maes, J.D., and Miles, E.W. (1998). The importance of employee 

demographic profiles for understanding experiences of work-family inter-role conflict. 

The Journal of Social Psychology 138, 690–709.

Ender, M.G. (2006). Voices from the backseat: Demands of growing up in military families. In 

T.W. Britt, A.B. Adler, and C.A. Castro (eds.). Military life: The psychology of serving in 

peace and combat. Vol. 3: The military family (138–166). Westport, CT: Praeger Security 

International. 

Frone, M.R. (2003). Work family balance. In J.C. Quick and L.E. Tetrick, Handbook of occupational health psychology (143–162). Washington, DC: American Psychological Association. 

Frone, M.R., Yardley, J., and Markel, K.S. (1997). Developing and testing an integrative model of 

the work-family interface. Journal of Vocational Behavior 50, 145–167.

Grzywacz, J.G., and Marks, N.F. (2000). Reconceptualizing the work-family interface: An ecological perspective on the correlates of positive and negative spillover between work and 

family. Journal of Occupational Health Psychology 5, 111–126.
UNIT CLIMATE AND CAREER INTENTIONS 409

Griffith, J., Rakoff, S.H., and Helms, R.F. (1992). Family and other impacts of retention (Technical 

Report 951). Alexandria, VA: U.S. Army Research Institute for the Behavioral and Social 

Sciences.

Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D.I., and Koffman, R.L. (2004). 

Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. The 

New England Journal of Medicine 351, 13–22.

Huffman, A.H., Adler, A.B., Dolan, C.A., and Castro, C.A. (2005). The impact of operations 

tempo on turnover intentions of Army personnel. Military Psychology 17 (3), 175–202.

Huffman, A.H., and Payne, S.C. (2006). The challenges and benefits of dual-military marriages. 

In T.W. Britt, A.B. Adler, and C.A. Castro (eds.). Military life: The psychology of serving in 

peace and combat. Vol. 3: The military family (115–137). Westport, CT: Praeger Security 

International.

Huffman, A.H., Culbertson, S.S., and Castro, C.A. (2008). Family-friendly environments and 

U.S. Army soldier performance and work outcomes. Military Psychology 20 (4), 251–270.

Kelley, M.L. (2006). Single military parents in the new millennium. In T.W. Britt, A.B. Adler, and 

C.A. Castro (eds.). Military life: The psychology of serving in peace and combat. Vol. 3: The 

military family (93–114). Westport, CT: Praeger Security International.

Kelley, M.L., Hock, E., Bonney, J.F., Smith, K.M., Jarvis, M.S., and Gaffney, M.A. (2001). Enlisted 

Navy mothers experiencing and not experiencing deployment: reasons for staying or 

leaving the military. Military Psychology 13, 17–20.

Kopelman, R.E., Greenhaus, J.H., and Connolly, T.F. (1983). A model of work, family, and interrole conflict: A construct validation study. Organizational Behavior and Human Performance 32, 198–215.

Kinnunen, U., and Mauno, S. (1998). Antecedents and outcomes of work-family conflict among 

employed women and men in Finland. Human Relations 51, 157–177.

Lakhani, H., and Gade, P.A. (1992). Career decisions of dual military career couples: A multidisciplinary analysis of the U.S. Army. Journal of Economic Psychology 13, 153–166.

Major, V.S., Klein, K.J., and Ehrhart, M.G. (2002). Work time, work interface with family, and 

psychological distress. Journal of Applied Psychology 87, 427–436.

Marshall-Mies, J.C., Seligson, T.B., and Martin, J.A. (2000). Differences in Job Satisfaction of Soldiers in Dual Military and Traditional Marriages (Technical Report 2000–04). Alexandria, VA: United States Army Research Institute for the Behavioral and Social Sciences.

Martin, J.A., and McClure, P. (2000). Today’s active-duty military family: The evolving challenges 

of military family life. The military family. A practice guide for human service providers, 

3–24. 

National Council on Family Relations (2004). Building strong communities for military families.

Minneapolis, MN. Retrieved from <www.parenting.umn.edu/militaryKids/buildingStrongCommunities.pdf>.

Office of Family Policy (1999). Strategic youth action plan. Arlington, VA: Office of Family Policy, 

Department of Defense Office of Personnel Support, Families and Education.

Pierce, P.F. (1998). Retention of Air Force women serving during Desert Shield and Desert Storm. 

Military Medicine 10, 195–213.

Rosen, L.N., and Durand, D.B. (2000). Coping with the unique demands of military family life. 

The military family: A practice guide for human service providers, 55–72. 

Schumm, W.R., Bell, D.B., Rice, R.E., and Sanders, D. (1996). Trends in dual military couples in 

the U.S. Army. Psychological Reports 78, 1287–1298.

Schumm, W.R., Jurich, A.P., Stever, J.A., Sanders, D., Castelo, C., and Bollman, S.R. (1998). Attitudes of Reserve component service members regarding the consequences of frequent 

overseas deployments. Psychological Reports 83, 983–989.

Smith, A.L. (1988). A multivariate analysis of determinants of re-enlistment: A decision-making 

model for enlisted personnel (ARI Technical Report No. 797). Alexandria, VA: U.S. Army 

Research Institute.
410 THE 71F ADVANTAGE

Tremble, T.R., Jr., Payne, S.C., Finch, J.F., and Bullis, R.C. (2003). Opening organizational archives to research: Analog measures of organizational commitment. Military Psychology

15, 167–190.

U.S. Army Human Resource Command. (2008). U.S. Army Human Resource Command. Fort 

Hood, TX. Retrieved from <https://www.hrc.army.mil/site/index-flash.aspx>.

U.S. General Accounting Office. (1982). Army needs better data to develop policies for sole and 

in-service parents (GAO/FPCK–92–50). Washington, DC: Government Printing Office.

Weiss, H., MacDermid, S., Strauss, R., Kurek, K., Le, B., and Robbins, D. (2003). Retention in the 

Armed Forces: Past approaches and new research directions. Purdue University, Military 

Family Research Institute.

Williams, J.W., Jr. (1978). Dual-career military families. In E.J. Hunter and D.S. Nice, Military 

families: Adaptation to change (103–110). New York: Praeger Publishers.
Part VII

Perspectives on Army 

Research Psychology

Chapter 18

Science in Action: Meeting Urgent 

Field Requirements through Science and 

Technology on the Ground in Iraq

Matthew G. Clark

The uniformed Services currently identify capability requirements using a deliberate process that is ineffective in emergency situations. Similarly, operational needs statements take time to validate and 

even more time to fund and address. The Army Materiel Command/

Research Development and Engineering Command Field Assistance in 

Science in Technology (AMC/RDECOM FAST) Team and the Rapid 

Equipping Force lead efforts that capture and address current and urgent requirements on the fluid battlefield. Since early 2005, these programs have been augmented by personnel from the U.S. Army Medical 

Command (USAMEDCOM), who work with operational units to identify capability gaps for both current and future operations and provide 

commanders with immediate access to the development centers within the RDECOM and USAMEDCOM. As a result, potential technology solutions can be tested by the warfighter, and performance in the 

field can be evaluated for immediate and long-term effectiveness. Uniformed Army research psychologists have served on these AMC/RDECOM FAST teams and have enabled significant equipment programs 

such as the armored ambulance initiative.

Uniformed Army research psychologists serve in roles that span 

the spectrum of military operations, from the more traditional fields of 

psychological and biological laboratory and field research, to operational assessments and systems acquisition. In addition to their field of expertise, many Army medical and scientific research officers can also be 

acquisition professionals. One nonstandard acquisition assignment opportunity for research psychologists and other Army Medical Department (AMEDD) officers involves identifying urgent warfighter requirements for full-spectrum operations as part of the four-man AMC/RDECOM FAST team in Iraq.

413
414 THE 71F ADVANTAGE

Background: Requirements Process Limitations during War

Generally, addressing warfighter capability requirements in the 

Department of Defense (DOD) involves three key components: the 

requirements process, the acquisition process, and the budgeting and 

funding process. Previously referred to as “the requirements generation 

and identification process,” the requirements process now focuses on 

the broader capability needs of all Services and is called the Joint Capabilities Integration and Development System (JCIDS). Per the Chairman of the Joint Chiefs of Staff Instruction 3170.01F (2007): “The JCIDS 

process was created to support the statutory requirements of the JROC 

[Joint Requirements Oversight Council] to validate and prioritize joint 

warfighting requirements. JCIDS is also a key supporting process for 

DOD acquisition and PPBE [Planning, Programming, Budgeting, and 

Execution] processes. The primary objective of the JCIDS process is to 

ensure that the joint warfighter receives the capabilities required to successfully execute the missions assigned to them.” 

The current JCIDS process was initiated in 2003 and updated in 

December 2008 to overcome shortfalls in joint Service capability integration, as required by the JROC. An outgrowth of the Goldwater-Nichols Department of Defense Reorganization Act of 1986, the JCIDS is a 

top-down process in which joint capability requirements (that is, military needs) evolve through a lengthy and deliberate developmental process. Through JCIDS, equipment and capability requirements are validated. With a validated capability requirement, Services can acquire 

systems to address the specific need. Accordingly, the chosen system is 

funded and budgeted until the item is removed from the military inventory. The JCIDS is contrasted against the previous requirements generation system, in which Service-unique requirements were captured and 

developed in Service-specific “silos.” In the old system, joint interoperability and shared utility were an afterthought at best. In total, JCIDS, the 

acquisition system, and the PPBE processes are intended to effectively 

control resources to maximize capability development across and between the Services in DOD.

However, as highlighted in a December 2006 article in Defense 

AT&L, “Recent reporting has also brought to light the United States’ 

deficiencies in getting innovative solutions to our warfighters rapidly 

enough to adjust to the changing tactics and techniques of our enemies” 

(Buhrkuhl, 2006). Simply put, the DOD acquisition and budget systems 
MEETING URGENT FIELD REQUIREMENTS THROUGH SCIENCE AND TECHNOLOGY 415

and JCIDS are not agile enough to respond to the demands of war when 

rapid adaptation is required on the battlefield. A change in emphasis from maneuver warfare to full-spectrum operations (as defined by 

Army Field Manual 3–0, Operations), and specifically the security, stability, transition, and reconstruction missions in Iraq and Afghanistan, revealed significant shortfalls in doctrine, training, and equipment across 

the Army. Therefore, the Army needed a means to identify and address 

current shortfalls and unforeseen capability gaps on a fluid battlefield 

because the capabilities identification and acquisition systems were 

incapable of meeting the need.

Out of necessity, the U.S. Army and DOD developed and continue to employ various approaches to identify and address critical 

shortfalls for current military operations. Some of these approaches included the Rapid Equipping Force, the Joint Improvised Explosive Device Defeat Organization, the Asymmetric Warfare Group, the Army 

Asymmetric Warfare Office, and the AMC/RDECOM FAST team, to 

name just a few. 

FAST Teams in the Iraqi Theater and Need for AMEDD Input

The broader FAST Activity started in 1985 to “bring Army Materiel Command Laboratories and Research, Development and Engineering Centers into closer contact with their ‘customers’—the major 

Army commands throughout the world” (<www.rdecom-fast.army.mil/

about_fast.htm>). Regarding Operation Iraqi Freedom wartime efforts, 

the first three-member AMC/RDECOM FAST teams, also called Science and Technology Assistance Teams, deployed in 2003. These teams 

comprised an acquisition corps major or lieutenant colonel (officer in 

charge), a government civilian scientist or engineer, and a senior noncommissioned officer (staff sergeant to sergeant major). The team was 

an extension of the RDECOM in AMC. Initially, during the 4-month rotations (extended to 6 months in 2007) they focused largely on issues related to weapons, vehicles, and various other unit, individual, and force 

protection systems. 

In 2005, the AMC FAST Headquarters recognized their inability to address requests for new medical capabilities related to the reality 

on the ground. To meet the growing need, they invited the USAMEDCOM and the U.S. Army Medical Research and Materiel Development 

Command (USAMRMC) to participate in their battlefield rotations. 
416 THE 71F ADVANTAGE

Accordingly, the science and technology assistance teams were expanded to include an AMEDD officer (captain, major, or lieutenant colonel). 

As is often the case with new initiatives, the initial rotations that 

included a medical professional produced mixed results. Sometimes 

they were well received as a value-added additional staff member across 

various levels of command, from combat battalions through the MultiNational Corps–Iraq (MNCI) and Multi-National Force–Iraq (MNFI). 

Occasionally, however, the officer was viewed with skepticism or resistance in the theater as medical and nonmedical leaders learned and 

tested the capabilities and limitations of the program. 

Early FAST successes involving the AMEDD were primarily 

medical-specific shortfalls such as the need for hypothermia management in combat casualties. This was addressed particularly for those 

evacuated with truncal or abdominal insult or recently controlled hemorrhage via air medical evacuation (MEDEVAC). This large-scale effort 

led to broad employment of the hypothermia management kit (North 

American Rescue Products, Inc., Greenville, SC) in both medical and 

nonmedical vehicles and settings. These are now used in Humvees, 

Mine Resistant Ambush Protected (MRAP) vehicles, and with combat, 

engineer, and explosive ordnance disposal teams. 

The early FAST teams also assisted by addressing numerous requests for information and leading fielding and feedback efforts on the 

Improved First Aid Kit. Notably, these teams assisted with initial efforts in the evaluation, deployment, and even developmental feedback 

of body cooling and ventilation systems, “golden hour” blood shipment 

containers, and even new and novel tactical communication headsets 

with active noise reduction for hearing protection. These efforts were 

urgently required because of the unique nature of irregular combat, 

and the need for improved Soldier effectiveness and health in desert 

and urban environments. More relevant to the traditional role of medical researchers, these efforts also contributed to the long-term health 

and immediate safety of American Soldiers fighting in an extreme and 

atypical environment.

In early 2006, the medical FAST effort started to build momentum by tackling military medical and materiel issues that required a 

coordinated AMEDD and AMC effort. One of the major efforts was 

the analysis of personal protective equipment (PPE). This effort required the shared resources and skills of operationally minded medical, research, acquisition, and materiel development professionals. 
MEETING URGENT FIELD REQUIREMENTS THROUGH SCIENCE AND TECHNOLOGY 417

These professionals included the AMEDD and AMC FAST team on 

the ground in Iraq and various individuals from the USAMRMC, RDECOM, and Program Executive Offices (for example, PEO Soldier) under the Assistant Secretary of the Army for Acquisition, Logistics, and 

Technology (ASA[ALT]). 

The PPE project began as a proof of concept conducted by the 

AMC/RDECOM FAST team where PPE was collected from Soldiers 

who were wounded or killed in action. Following a combat incident, the 

FAST team collected Interceptor Body Armor and Advanced Combat 

Helmets. The equipment was then shipped to PEO Soldier in the United States for analysis. The PPE study included an analysis of operational 

data from each combat incident co-analyzed with casualty medical data. 

Effectively, this was the first effort to combine operational information 

with medical and materiel analyses to help develop the next generation 

of protective equipment and improve tactics, techniques, and procedures 

(TTPs) as quickly as possible. This “fusion analysis” approach, which included the examination of operational, intelligence, medical, and materiel data, eventually developed into the Joint Trauma Analysis for the Prevention of Injury in Combat program. This program is now progressing 

toward becoming an enduring capability for support to combat operations, materiel developers, and the military intelligence community.

After the first three rotations, the USAMRMC prepared a selection process to ensure that the AMEDD provided the most qualified 

officers for the team. Besides the appropriate rank, command support, 

and letters of recommendation, the team’s only eligibility requirement 

was completion of the Captain’s Career Course. Other career experiences that improved selection for this opportunity included field or deployment experience, certification as a Defense Acquisition Workforce 

Professional, completion of the Combat Casualty Care Course, and 

possession of the Expert Field Medical Badge. 

My FAST Team Experience and the Armored MEDEVAC 

Challenge

In 2006, the first officer selected and deployed through the 

USAMRMC process was a research psychologist. The FAST mission in 

Iraq at that time was four-fold:

■ to provide expert technical advice and support to commanders and staff in the theater of combat operations
418 THE 71F ADVANTAGE

■ to query Operation Iraqi Freedom units on science and technology gaps at the user level for both combat and stability 

and support operations

■ to provide operational commanders immediate access to the 

development centers within the RDECOM and USAMEDCOM

■ to expedite technology solutions to the warfighter and act as 

an RDECOM/AMEDD forward element to evaluate and integrate solutions.

As the research psychologist who was selected for this team, I used a 

fusion analysis approach similar to that used in the PPE analysis to address various issues including a countersniper effort, burn mitigation, 

and the need for armored ground MEDEVAC on the rapidly adaptive 

battlefield. While changes in materiel systems did not occur immediately, TTPs were altered and rapid battlefield feedback and education to 

warfighters were completed without delay. 

During this rotation, the FAST team tackled the need for improved ground medical evacuation, arguably the most challenging issue to date because it spanned various sectors of the Army and had to 

counter widely held and incorrect beliefs and assumptions. Like the 

PPE analysis, the issues required the shared resources of the AMEDD 

and AMC FAST team on the ground in Iraq, with the support of stateside activities. Various individuals from the USAMRMC, the U.S. Army 

Medical Materiel Development Activity (USAMMDA), the AMEDD 

Center and Schools Directorate of Combat and Doctrine Development 

(DCDD), and Program Management shops (for example, PM–Light 

Tactical Vehicle) under ASA(ALT) were involved in providing this immediate warfighter need. 

In the summer of 2006, the heightened threat and record use of 

improvised explosive devices (IEDs) created several significant challenges for medical care in the austere environment of urban Iraq and 

Afghanistan. Most notably, the prevalence of IEDs, rocket-propelled 

grenades, and certain small arms resulted in restrictions that kept all 

unarmored vehicles to forward operating bases, particularly in Iraq. 

As reported in January 2007, this restriction applied to all unarmored 

Humvees, including M996 and M997 ambulances (McDonnell, 2008). 

Medical support units were severely impacted by the restriction because 

a comprehensive patient evacuation and medical treatment plan must 
MEETING URGENT FIELD REQUIREMENTS THROUGH SCIENCE AND TECHNOLOGY 419

include effective ground and air MEDEVAC (FM 8–10–6, Medical Evacuation in a Theater of Operations, 2000). 

Addressing this particular issue required the presence of the 

FAST team, which could evaluate and address shortfalls across all levels of command, from the company through MNCI and MNFI levels. 

This issue also required rapid collection, organization, and analysis of 

data from a highly adaptive and seemingly disjointed battlefield. The 

data included information about combat incidents, the type, number, 

and method of threats, the TTPs and equipment used, the method and 

time of evacuation needed, and the outcomes for Soldiers involved. In 

total, the data set that had to be synthesized was not simply maintained 

in one location in a usable or readily accessible fashion. Instead, the data 

was diffuse and variously collected across several levels of command 

and staff. One of the key contributions of having a research psychologist on the team was the capability to address the lack of a defined 

data source. With my research background, I brought methodological integrity, knowledge, and a broader understanding of the analysis 

of a poorly defined but clearly evident problem. Additionally, the collective efforts of the FAST team identified related needs and provided 

potential solutions.

Addressing the ground MEDEVAC issue required clear and open 

communication with development centers in the United States. Data 

was collected from various command, control, communications, computers, intelligence, surveillance, and reconnaissance systems. It was 

also drawn from Soldiers and Marines on the ground and from generic patient information collected by various staff surgeons for units including MNCI and the Joint Theater Trauma Registry. The analysis required a clear understanding of doctrinal and current medical and combat operations and required support from new, nondoctrinal units like 

the Combined Joint Task Force, which addressed asymmetric threat 

and IED defeat issues.

The first challenge was that no data had been collected, collated, 

or analyzed regarding the requirement and magnitude of the ground 

MEDEVAC problem. Once collected, an initial assessment and discussions with the commander of the 30th Medical Brigade revealed 

that the first approach had to be the development of nonstandard vehicles for casualty evacuation (CASEVAC) use. Usually conducted by 

nonmedical personnel, CASEVAC is the movement of casualties in 

a combat zone without en route medical care to an initial treatment 
420 THE 71F ADVANTAGE

location or facility (FM 8–10–6, Medical Evacuation in a Theater of 

Operations, 2000). This was the most expeditious way to start to address the problem because CASEVAC provided at least some form 

of armored ground evacuation in an environment with zero ground 

MEDEVAC capacity due to the threat and a potentially limited air 

MEDEVAC capability. 

Stateside, the USAMMDA and DCDD began working on CASEVAC conversion kits for all up-armored Humvees, an issue that eventually became a reality in late 2007 to early 2008. In theater, we designed 

two CASEVAC configurations for the Rhino Runner armored buses 

and prepared rapid conversion kits with the 134th Medical Company 

(Ground Ambulance) that could be used in a mass casualty situation. 

This CASEVAC alternative allowed these buses to be used to evacuate 

from 5 to 12 litter patients or from 1 to 23 ambulatory patients. However, there were a very limited number of these vehicles, they did not 

travel on combat missions, and they could only be used in a catastrophic mass casualty situation. These vehicles were designed and employed 

to keep Servicemembers, government workers, and contractors somewhat safe as they traversed the battlefield between bases much like a 

very small public transit system. Due to the availability, developing 

a CASEVAC configuration for the Rhino Runner would only serve as 

a potential Band-Aid for the greater need that might only be available 

for the worst cases.

As the use and effectiveness of IEDs expanded to record levels, 

combatant commanders and staff throughout the Iraqi theater of operations began to acknowledge the magnitude of the ground MEDEVAC 

shortfall. After initially working with a brigade combat team and brigade support battalion commander from the 10th Mountain Division in 

the Baghdad area, various division and corps leaders and medical advisors started to realize and accept that air MEDEVAC could not address 

all urgent evacuation situations. This was particularly true for some urban areas. The need was clearly evident and growing when a resourceful 

combat medic cut a hole in the back blast wall of his up-armored Humvee to accommodate a casualty as a CASEVAC vehicle (Powell, 2006). 

In support of the definition of MEDEVAC from Medical Evacuation in 

a Theater of Operations (FM 8–10–6, 2000), the simple reality was that a 

timely means of moving patients with en route care by medics on medically equipped vehicles was needed both to enhance casualties’ potential for recovery and to reduce the potential for long-term disability. 
MEETING URGENT FIELD REQUIREMENTS THROUGH SCIENCE AND TECHNOLOGY 421

An armored wheeled ground MEDEVAC vehicle (that is, an armored 

ambulance) was badly needed.

Unfortunately, the misunderstanding of the MEDEVAC problem 

was perpetuated by poor communication across the combat theater. Incorrect information existed at all levels of command and even within 

the stateside military medical community. They believed that the problem was already being addressed and that a solution was on its way. To 

gather the facts on the issue, the FAST team constantly communicated 

with PEO and PM shops in the United States. The team learned that the 

reason that M996 and M997 Humvee ambulances were not available 

was because it was not technologically possible to up-armor these specific vehicles. That is, the solution many believed was already in production could not be implemented because these vehicles could not support the weight of armor in an ambulance configuration along with the 

weight of all personnel and related equipment. Despite repeated efforts 

to communicate this reality, a widespread misunderstanding of the situation made it very difficult to address the issue within the Army. 

Adding to the state of affairs, the MEDEVAC problem was viewed 

as unique to Army units. This incorrect and widely held belief limited 

the possibility of any joint Service request because all joint requests had 

to address an “inherently joint” problem that involved other Services 

(for example, the Marines). Despite the FAST team’s work with Soldiers 

and Marines at the MNCI and MNFI levels, U.S. Central Command 

(USCENTCOM) did not understand the situation until the end of 2006. 

Eventually, with the support of the MNFI Surgeon, the late Colonel Brian Allgood, I presented the issue at the USCENTCOM Surgeon’s conference in November 2006, which educated and energized the appropriate levels of leadership across the military Services. The result was that 

the Navy surgeon representing the Marine Corps Central Command 

and surgeons and staff covering the USCENTCOM area of responsibility finally understood the full nature of the situation. This realization, 

along with the help of Frank Van Syckle, a key science and technology 

advisor in USCENTCOM headquarters, led to the identification of 

and required support for a joint immediate warfighter need request for 

armored ambulances. 

As the AMEDD FAST representative on the ground, I collected the data, analyzed the issue, and then wrote the urgent requirement request that was initiated with an MNCI endorsement and forwarded to the Joint Staff through USCENTCOM. When we returned 
422 THE 71F ADVANTAGE

stateside at the end of 2006, I worked through USCENTCOM, the 

Joint Staff, and up to the Joint Rapid Acquisition Cell and Office of the 

Deputy Secretary of Defense to procure funding approval for the first 

16 heavy armored ground ambulances (HAGA) for Soldiers and Marines in Iraq and Afghanistan. This modest request was approved by 

the Deputy Secretary of Defense in May 2007. However, delivery of 

the urgent request for 16 vehicles was only the beginning of addressing a much larger requirement. Accordingly, in a follow-on appointment I served as one of the primary subject matter experts in the design of the HAGA and MRAP ambulance along with representatives 

from the AMEDD DCDD and USAMMDA. The development and 

production of the vehicles was achieved through work with the Marine 

Corps Systems Command and the MRAP Joint Program Office. The 

vehicle that met the identified need was produced by BAE Systems. By 

the end of 2008, nearly 700 armored ambulances were fielded for use 

in current operations. 

Progress on a materiel solution to the armored ambulance requirement had been stalled prior to fall 2006. Therefore, the recognition and fielding of this urgent warfighter requirement was a major success for the AMEDD. Even with increased interest in armored 

vehicles and the larger MRAP effort that developed at the beginning 

of 2007, an armored ambulance was not included as one of the first 

vehicles until the FAST team entered the process. This success required the skills of personnel who could rapidly collect, analyze, and 

merge data from diverse levels of command, locations, and sources. It 

required personnel who could think strategically, yet understand the 

people and processes so that they could coordinate action and move 

between tactical and operational levels through a highly convoluted, 

constantly changing bureaucratic process. Lastly, the number of ambulances and the seemingly low density of the requirement meant that 

its success was dependent on personnel who could speak across levels 

of combat leadership, champion the effort through to the highest levels of the Department of Defense, conduct and translate the analysis of 

data employed, and communicate the strategic and psychological impact of medical support to American forces. Collectively, these qualities were key in accelerating the timeline to make armored ambulances a reality. These are also qualities required for success as an Army 

research psychologist.
MEETING URGENT FIELD REQUIREMENTS THROUGH SCIENCE AND TECHNOLOGY 423

Summary: Uniformed Army Research Psychologists in Combat 

Operations

It is important to understand the value that this assignment provided to both research psychologists and the Army. First, the FAST position provided scientific and acquisition officers the opportunity to work 

in an area that is immediately relevant to current operations, instead of 

the more traditional roles of researching post-traumatic stress disorder, 

battle stress, and mild traumatic brain injury. It also allowed research 

psychologists to work on medical integration across functional areas, 

branches, and Services, thereby expanding medical lessons learned and 

improving the understanding of medical research shortfalls. This understanding will enhance future medical research and development.

Similarly, several research psychologists have completed research 

on medical, chemical, and biological defense issues as is presented in 

other chapters in this publication. They have knowledge and expertise 

that can serve as a force multiplier on the current battlefield for current 

operations. While serving on the FAST team, I served on the MNCI 

Corps Chemical Officer’s chemical, biological, radiological, nuclear, and 

explosive working group. Thus, a medical chemical defense researcher 

was able to impact and assist current chemical defense issues in real 

time. The combatant command benefited from relevant and timely research expertise on urgent and unexpected events. In short, research 

psychologists were immediately relevant to the current fight rather than 

just future or investment operations through research and development.

Additionally, the Army and the research psychology specialty shared the advantage of applying the core acquisition abilities of a 

highly skilled and motivated workforce to some of the more challenging 

analytical and operational challenges facing combat and military medical operations. This is particularly apparent because the FAST assignment was accomplished one-on-one with Soldiers and Marines from 

the level of combat and the battalion aid station, through combat support hospitals, or even through the combatant command, Department 

of the Army, and joint levels of command. Thus, the core research and 

acquisition capabilities were applied and extended to the benefit of both 

the Army and the individual. 

Groups like the FAST team provide the Army immediate relevance and utilization of research and analytical subject matter experts 

for current operations. This flexibility of assignments raises questions 

about the future role and placement of research psychologists across the 
424 THE 71F ADVANTAGE

Army. A full mission analysis of the requirements for this specialty in 

full-spectrum operations will likely lead to the conclusion that research 

psychologists can and should play a greater role in defense acquisition, 

both medical and nonmedical research and development, and military 

intelligence analysis and fusion. This conclusion may be particularly 

compelling when considering irregular and asymmetric warfare, and it 

is amplified by the recent placement of a research psychologist in the 

Army Asymmetric Warfare Office of the Army Operations Center (under the Deputy Chief of Staff for Operations, Headquarters Department 

of the Army G-3/5/7). While a full consideration of the future assignments for this specialty is beyond the scope of this article, the success 

of research psychologists in the field illustrates the need for a comprehensive evaluation of their role, particularly for positions outside of the 

USAMEDCOM.

In conclusion, research psychologists serve in various assignments that include roles as acquisition and analytical professionals. 

They must continue to be prepared to meet general medical, Army, 

or even joint requirements as a commissioned officer of the United States. Uniformed research psychologists of all backgrounds must 

be prepared to modify, develop, create, and execute efforts outside 

more traditional assignments in laboratories. The success of research 

psychologists in various relevant, nontraditional assignments like the 

AMC/RDECOM FAST team in Iraq underscores the potential future 

role this specialty can play across the U.S. Army. These accomplishments clearly show that the analytical and leadership skills of research 

psychologists are useful well beyond the medical research realm.

References

Buhrkuhl, R.L. (2006, November/December). When the warfighter needs it now. Defense AT&L, 

28–31.

Joint Chiefs of Staff. (2007). Chairman of the Joint Chiefs of Staff instruction 3170.01F. Washington, DC: U.S. Government Printing Office. 

McDonnell, J.J. (2007). Instilling innovation in Iraq. Army Logistician, 39. 

Powell, A. (2006, July 27). Medics humvee design not much of a stretch. Stars and Stripes, Mideast 

Edition. 

RDECOM–FAST. (n.d.) About FAST. Retrieved December 8, 2008, from <www.rdecom-fast.

army.mil/about_fast.htm>. 

U.S. Army. (2008). Field Manual 3–0, Operations. Washington, DC: Headquarters Department 

of the Army.

U.S. Army. (2000). Field Manual 8–10–6, Medical operations in a theater of operations. Washington, DC: Headquarters Department of the Army.
Chapter 19

Looking Back: From the Lab to Iraq. . . 

and to the Clinic

Melba C. Stetz

In this chapter, I share some of my experiences as a uniformed 

Army research psychologist (71F). My primary goal is to interest and 

invite more researchers to join our group. I was raised in a bicultural 

and medical household (with psychiatrist and dietitian parents), which 

probably helped prepare me for the eclectic Army Medical Department 

(AMEDD) life. 

In 1986, I became the first military Servicemember in my family. Because I already had completed 2 years toward a Bachelor’s degree, 

I was able to start in the Army as a private first class. After training at 

Fort Sam Houston, in San Antonio, Texas, and at the Walter Reed Army 

Medical Center, in Washington, DC, I served as an orthopedic specialist in the 8th Evacuation Hospital at Fort Ord, California. After this tour, 

I went back to Puerto Rico to finish college. While working full-time in 

my parents’ medical center and part-time in the Puerto Rico Army National Guard, I finished a bachelor’s degree with a double minor in Clinical Psychology and Industrial/Organizational (I/O) Psychology. 

Once promoted to a second lieutenant in the National Guard, I 

went back to Fort Sam Houston to the Officer Basic Course (OBC). In 

the Guard I had held jobs ranging from an ambulance platoon leader 

in the medical company to a Total Quality Management (TQM) Advisor for the 92d

 Infantry Brigade (Separate). After finishing a Masters of Science degree in I/O Psychology, I received the TQM assignment, following a meeting with my Brigade General, Felix Ocasio, to 

whom I offered a few win-win solutions based on insights from my I/O 

Psychology background. At the time, I worked as a research assistant 

during the day at Carlos Albizu University in San Juan, Puerto Rico, 

and studied for my master’s and doctorate degrees at night and during 

the weekends. After a decade in “the National Guard system” (Reserve 

promotions are slow!), I became a first lieutenant and was sent back to 

Fort Sam Houston to attend the Officer Advanced Course (OAC). A 

425
426 THE 71F ADVANTAGE

few months after graduation, I volunteered for a short tour in Panama 

as a medical plans officer (70H). I spent 9 months in the Civil Military 

Operations section of Fort Clayton, where I coordinated medical readiness training exercises (MEDRETEs) for the U.S. Army South General Office. Specifically, my mission was to bring Reserve Component 

(Guard or Reserve) medical units to remote areas in the U.S. Southern Command (USSOUTHCOM) to provide free medical services to 

the local populace. Units would typically participate during their annual 2-week training. It was a tough environment for a junior female 

officer in a male-dominated environment. One highlight for me was 

meeting the president of Panama, Ernesto Pérez Balladares, who invited me to one of his special inaugurations after being impressed by 

our MEDRETEs.

After Panama and a logistics course at Fort Sam Houston, I transferred to the Active Guard Reserve as a Medical Logistician (70K). In 

my new role, I led the 424th Medical Logistics Battalion (Rear), a Reserve 

unit in Pedricktown, New Jersey. We supported five states during their 

continental U.S. (CONUS) and deployment (that is, Bosnia) missions. 

While on that job, I finished my dissertation. At that time, sexual harassment was becoming a more commonly recognized social problem, 

with cases against VIPs such as President Bill Clinton and Sergeant Major Gene McKinney, USA. Therefore, I decided to study sexual harassment, and administered the validated and standardized “Military Equal 

Opportunity Climate Survey” to Army, Marine, and Navy Reserve units 

in the area. I presented my findings during the Defense Equal Opportunity Management Institute conference at Patrick Air Force Base in Florida and published part of the data. Validation analysis suggested that 

a shorter, 17-item version of the original 50-item scale could be used 

when studying military equal opportunity climate (Estrada, Stetz, and 

Harbke, 2007). While defending my study in Puerto Rico, I also passed 

the general psychology licensing board exams. 

In 1999, I transferred to the Individual Ready Reserve (IRR) to be 

part of an Army group that made it easier to accept a 71F slot when one 

became available. For a year, I worked as a Government civilian in the 

Office of Personnel Management in Washington, DC. As a personnel 

research psychologist, I worked on I/O-related issues (such as organizational diagnoses and training). I met my husband, a fellow I/O psychologist and researcher in the local area, while working there.
LOOKING BACK: FROM THE LAB TO IRAQ . . . AND TO THE CLINIC 427

Walter Reed Army Institute of Research

Once commissioned as a 71F captain, I attended the longer active versions of both the OBC and the OAC, and reported to the Walter Reed Army Institute of Research (WRAIR) on graduation. At that 

lab, I helped with survey design and administration, unit coordination, participant recruitment, and data analysis, and gave presentations 

to commanders and at professional conferences. One of my first military research opportunities was analyzing data recently acquired by the 

WRAIR on Army Rangers. Our main results suggested that Rangers with 

work-relevant values may experience a stronger relationship between 

work stressors and outcomes such as job satisfaction and distress than 

Rangers with stronger affiliation values (Britt, Stetz, and Bliese, 2004). 

While at WRAIR, we also studied Reservists activated after the 

terrorist attacks on September 11, 2001 (Stetz, Castro, and Bliese, 2007). 

The data suggested that with high deactivation uncertainty, workload, 

and organizational constraints, Reservists reported low psychological 

well-being and high turnover intentions. Some of these activated Reservists also shared their concern about the security of the jobs they 

were leaving behind. We also interviewed civilian supervisors and, interestingly, found that supervisors generally supported their employees’ 

military activation (Allison-Aipa, De la Rosa, Stetz, and Castro, 2005). 

In other research, we found moderating effects of social support 

on a few stressor-strain relationships (Stetz, Stetz, and Bliese, 2006). Specifically, we found that this moderating effect depended on one’s selfefficacy or sense of preparedness. Following the importance of self-efficacy, we developed a theoretical model of Reservists activated after 9/11 

on the impact of their perceptions of procedural justice during the early months of their mobilization on their job satisfaction and well-being 

(Bliese and Stetz, 2007). Procedural justice, self-efficacy, and intragroup 

conflict showed a 3-way interaction where self-efficacy served only as a 

buffer when accompanied by procedural justice. 

A few of us (Killgore, Stetz, Castro, and Hoge, 2006) also analyzed 

the relationship between deployment experience and somatic symptoms in Soldiers. Consistent with the literature, previously deployed Soldiers reported less affective, but more somatic complaints than those 

without any deployment experience. Following these research efforts at 

WRAIR, I attended the Combined Arms and Services Staff School at 

Fort Leavenworth, Kansas, where I learned more about military history, 
428 THE 71F ADVANTAGE

cohesion, and leadership. More importantly, I was able to interact with 

non-AMEDD military officers. 

U.S. Army Medical Research and Materiel Command

My next assignment was with the U.S. Army Medical Research 

and Materiel Command (USAMRMC) Headquarters (HQ) at Fort 

Detrick, Maryland. I worked as the Deputy Director for the Research 

Area Directorate 3—Medical Operational Medicine. I screened and 

supported research from throughout the USAMRMC laboratories 

and collaborating parties. I was able to help others while still continuing to analyze and publish my own data. For example, we analyzed 

5,671 records of Servicemembers who had been medically evacuated 

(MedEvac) out of theater during 2003 (Stetz, McDonald, Lukey, and 

Gifford, 2005). Following the International Statistical Classification 

of Diseases and Related Health Problems, it seemed that 13 percent 

of this sample was classified as either under “top level mental disorders” or “persons without reported diagnosis encountered during examination and investigation of individuals and populations.” Sadly, 

further analysis of that data (Stetz, Thomas, Russo, Stetz, Wildzunas, 

McDonald et al., 2007) suggested that most of these MedEvac cases 

had psychiatric problems prior to deploying to the battlefield (Operations Iraqi Freedom and Enduring Freedom). 

An advantage of not being in a specific research laboratory was 

being able to work different facets of research psychology. Thus, I was 

also able to contribute to an article about the relationship between cognitive fitness and decisionmaking in the increasingly complex networkcentric military world (Russo, Stetz, and Thomas, 2005). I believe all of 

my opportunities and early career achievements were validated when in 

2004 I received the Arthur W. Melton Award, which the American Psychological Association, Division 19, gives in recognition of early career 

achievement in military psychology. 

I also developed as an officer by working with Brigadier General 

Lester Martínez-López, whom I coincidentally had escorted during a 

ceremony at WRAIR. While at HQ, I coordinated the 2004 71F meeting. 

I also took courses at the Defense Acquisition University and became 

Level III–certified in Science and Technology Management and Level 

II–certified in Program Management.

During this tour, I attended the Aeromedical Psychology Course 

at Fort Rucker, Alabama (2004), where I learned about the cognitive 
LOOKING BACK: FROM THE LAB TO IRAQ . . . AND TO THE CLINIC 429

demands that pilots and their crews face while flying (for example, eyehand coordination demands while fatigued and under foggy vision). We 

had to take a battery of tests inside a hyperbaric chamber, swim with flying gear, tread water for an extended period, and get spun around in a 

simulated helicopter cabin under water while finding “the nearest exit.” 

Another important experience was being able to work with clinical psychologists. 

Colonel James McGhee, the commander of the U.S. Army Aeromedical Research Laboratory (USAARL), also at Fort Rucker, asked me 

to come to the laboratory to do research. When he discovered that I had 

always wanted to be a company commander, however, he offered me a 

detachment commander position to be followed by a research psychology slot. 

Upon getting my orders to Fort Rucker, I decided to apply to the 

Airborne School. I thought I should earn another pair of wings (in addition to the flight psychology ones) before reporting to Fort Rucker, 

the well-known “U.S. Army Aviation Center of Excellence.” Jump school 

was physically demanding. However, I enjoyed jumping out of “perfectly functioning” airplanes (such as C–130s and C–17s) with Soldiers who 

were almost young enough to be my own kids.

U.S. Army Aeromedical Research Laboratory

I was, and still am, proud to be the first laboratory officer, the first 

71F, and the first woman ever to serve as the Detachment Commander and Adjutant of USAARL. I helped open a door for other scientists 

to follow in my footsteps, adding diversity to the typical group of very 

smart but not research-minded pilots. Keeping the holistic approach to 

health, I was able to maintain my physical training badge while training 

with my Soldiers. In fact, one of my contributions to the lab was bringing the German Armed Forces Proficiency Badge certification training 

there. Considering my new role in life as a commander, an adjutant, and 

a mom, earning the gold was probably as challenging as my first day 

learning SPSS syntax. I also took the opportunity to organize the 2006 

biannual 71F meeting.

After my year in command, I reported to Fort Belvoir, Virginia, to attend the 4-month Command and General Staff College, 

Intermediate-level Education. Upon graduation, I returned to USAARL and became the Chief of Combat Stress Research. I ran several 

studies that were funded by USAMRMC’s Telemedicine and Advanced 
430 THE 71F ADVANTAGE

Technologies Research Center (TATRC). While working in that lab, I 

had access to other types of scientists (such as physiologists and engineers) and was able to discuss additional ways to measure stress that 

were not limited to the typical paper-and-pencil surveys.

In my first research project at USAARL, I brought in a 71F Individual Mobilization Augmentee, Lieutenant Christopher Long, who 

helped me with virtual reality (VR) technology during his 2-week annual training. Our research team ran a few pilot studies testing this 

technology (Stetz, Long, Schober, Cardillo, and Wildzunas, 2007; Stetz, 

Wildzunas, Wiederhold, and Hunt, 2006), including a study in which 

participants played a game where they had 3 minutes to save, triage/ 

assess, and treat a casualty.

We used monitors and biofeedback equipment to measure participants’ reactions while they played a triage and treat casualties video game. Our three main experimental groups comprised: one that did 

only VR (play a game), one that did VR and relaxation techniques, and 

one that did only relaxation techniques. Our main findings suggested 

that the group only exposed to VR showed higher levels of hostility than 

the other groups. The participants in the VR group that practiced relaxation techniques showed higher levels of sensation-seeking. Interestingly, further analyses showed higher levels of both anxiety and dysphoria in previously deployed participants in the VR and relaxation groups 

(Stetz, Long, Wiederhold, and Turner, 2008). 

For the second TATRC-funded study, my team examined relaxation techniques using VR. Our participants were Forward Surgical 

Teams training at the Ryder Trauma Center in Miami. In this study, 

we tested the usefulness of VR for relaxation by translating an existing 

relaxation environment being used in a laboratory in Milan, Italy, and 

adding simultaneous progressive muscular relaxation and controlled 

breathing techniques. Participants took the Combat Stress Assessment 

test (a Stroop test adapted for military populations) after practicing 

relaxation techniques on a laptop. They practiced the relaxation techniques again at night via portable play stations and wore an actigraph 

(a wristwatch-sized instrument to measure movement and activity) 

to measure sleep (related to relaxation). Early results suggest that VR 

may be a promising deployable technology for relaxation, and not just 

for entertainment.
LOOKING BACK: FROM THE LAB TO IRAQ . . . AND TO THE CLINIC 431

Field Assistance in Science and Technology Team

In 2008, I volunteered to serve in Operation Iraqi Freedom for 

6 months as part of the Field Assistance in Science and Technology 

(FAST) Team, where I followed in the footsteps of Major Matt Clark, another 71F who was the first to serve on a FAST Team. The other members of our four-person team worked for the Army Materiel Command 

(AMC)/Research and Development Command (RDECOM), while I 

represented the U.S. Army Medical Command and the USAMRMC. It 

was difficult being away from my family, but we did have access to a 

phone, as well as a web camera to help us maintain communication. 

My mission was to identify the needs of the various medical 

levels of care in the whole theater of operations. I quickly recognized 

some gaps and worked with CONUS USAMRMC personnel to identify what could be accomplished at the Medical Research and Materiel 

Command level versus what should be done at the unit level (that is, 

logistical or command issues). In one project, we provided the veterinary community with intravenous (IV) fluid warmers that were needed to prevent dogs from experiencing hypothermia during surgery. 

Another project developed a smaller safety harness to be used as a restraint system for injured children and smaller adults who would otherwise slide off the chopper seats when traveling to the nearest medical care facility. The U.S. Army’s Rapid Equipping Force helped fund 

20 civilian air-worthy seats to test in both Operation Iraqi Freedom

and Operation Enduring Freedom. During my trips, we also provided 

feedback to developers about already-in-use items, such as the combat 

tourniquet and the Talon litters.

I also visited a few combat stress control clinics. Since the FAST 

team supporting Operation Enduring Freedom in Afghanistan had no 

medical representative, I also flew there to meet the corps surgeon. We 

discussed many of the ongoing projects in Operation Iraqi Freedom 

(such as up-armored ambulances), and I sent them a few of the IVs we 

had given to the veterinarians in Iraq. 

As I was still on “flight status” at USAARL, I was able to engage 

with pilots and crewmembers—and collected more data as part of a 

study to identify the main stressors and coping methods used by aviators. Preliminary results found that 59 out of 283 deployed aviators were 

having problems sleeping. A further analysis of 22 (8 percent) of those 
432 THE 71F ADVANTAGE

with a self-reported head injury suggested that the group scored higher than eight points on the Epworth Sleepiness Scale (the threshold for 

excessive daytime sleepiness and referral to a sleep specialist (Stetz, Russo, and Stetz, forthcoming).

Tripler Army Medical Center

I am currently Director of Research for the Psychology Department at Tripler Army Medical Center (TAMC) in Hawaii. I recently finished collecting data for an anger study in which we compared technologies (VR head-mounted display [HMD] versus flat-screen computer monitors) and their effectiveness in prompt behavioral reactions 

(that is, anger) to video vignettes in participants. In the study, 30 participants viewed video anger vignettes through a VR HMD and 30 on a 

flat-screen computer monitor. Preliminary results (Folen, Miyahira, and 

Stetz, 2009) suggest that the VR HMD technology might positively affect presence and reactivity to anger stimuli (psychological, emotional, 

and physiological). 

Presently, we are continuing to investigate VR applications to important warfighter and family matters including Post-traumatic Stress 

Disorder, pain tolerance (for example, during cystoscopy), biofeedback, 

and nicotine cravings. Furthermore, we are engaging in collaborative 

efforts with USAMRMC as the TATRC’s Pacific Telehealth and 

Technology Hui and fellows in TAMC’s departments of Neurosurgery 

and Urology.

In summary, the field of research psychology has been a very exciting military career path. In this profession, individuals can contribute to the fighting force by generating scientific findings in a laboratory, 

by commanding research units, and even by branching out and carving 

new paths for others to follow at home or abroad. 

References

Allison-Aipa, T.S., De la Rosa, G.M., Stetz, M.C., and Castro, C.A. (2005). The impact of National 

Guard activation for homeland defense: Employer’s perspective. Military Medicine 170 

(10), 846–850. 

Bliese, P.D., and Stetz, M.C. (2007). Modeling the effects of efficacy, justice, and conflict among 

reservists activated for homeland defense. Military Psychology 19 (1), 27–43.

Britt, T.A., Stetz, M.C., and Bliese, P. (2004). Work-relevant values strengthen the stressor–strain 

relation in elite army units. Military Psychology 16 (1), 1–17.

Estrada, A.X., Stetz, M.C., and Harbke, C.R. (2007). Further examination of the psychometric 

properties of the military equal opportunity climate survey in a sample of reserve component personnel. International Journal of Intercultural Relations 31, 137–161.
LOOKING BACK: FROM THE LAB TO IRAQ . . . AND TO THE CLINIC 433

Folen, R.A., Miyahira, S.D., and Stetz, M.C. (2009, June). Immersive panoramic video display 

compared to flat screen display: Psychological and physiological reactions to anger stimuli. 

Presentation at the 14th Annual International CyberTherapy and CyberPsychology Conference, Verbania-Intra, Italy.

Killgore, W., Stetz, M.C., Castro, C.A., and Hoge, C.W. (2006). Somatic and emotional stress 

symptom expression prior to deployment by soldiers with and without combat experience. Journal of Psychosomatic Research 60, 379–385.

Russo, M.B., Stetz, M.C., and Thomas, M.L. (2005). Monitoring and predicting cognitive state 

and performance via physiological correlates of neuronal signals. Aviation, Space, and 

Environmental Medicine, C59–63.

Stetz, M.C., Castro, C.A., and Bliese, P. (2007). The impact of deactivation uncertainty, workload, 

and organizational constraints on reservists’ psychological well-being and turnover intentions. Military Medicine 172 (6), 576–580.

Stetz, M.C., Long, C.P., Schober, W.V., Cardillo, C.G., and Wildzunas, R.M. (2007). Stress assessment and management while medics take care of the VR wounded. Annual Review of 

Cybertherapy and Medicine, 191–204.

Stetz, M.C., Long, C.P., Wiederhold, B.K., and Turner, D.D. (2008). Combat scenarios and relaxation training to harden medics against stress. Journal of CyberTherapy & Rehabilitation, 

239–246.

Stetz, M.C., McDonald, J.J., Lukey, B.J., and Gifford, R.K. (2005). Psychiatric diagnoses as a cause 

of medical evacuation. Aviation, Space, and Environmental Medicine 76 (7), C15–20.

Stetz, M.C., Russo, M.B., and Stetz, T.A. (2009, June). An accessible sleep tool for military personnel: The post traumatic stress disorder checklist. Presentation at the 23d SLEEP annual 

meeting, Seattle, WA.

Stetz, M.C., Thomas, M.L., Russo, M.B., Stetz, T.A., Wildzunas, R.M., McDonald, J.J., Wiederhold, B.K., and Romano, J.A. (2007). Stress, mental health, and cognition: A brief review 

of relationships and countermeasures. Aviation, Space, and Environmental Medicine 78 

(5), B252–260.

Stetz, M.C., Wildzunas, R.M., Wiederhold, B.K, and Hunt, M.P. (2006). The usefulness of virtual 

reality stress inoculation training for military medical females: A pilot study. Annual 

Review of Cybertherapy and Medicine, 51–58.

Stetz, T.A., Stetz, M.C., and Bliese, P.D. (2006). The importance of self-efficacy in the moderating 

effects of social support on stressor-strain relationships. Work & Stress 20 (1), 49–59.

435

Chapter 20

Notes from a Research Psychologist at 

U.S. Special Operations Command

Craig A. Myatt

This chapter describes my role as the first military research psychologist assigned to the headquarters of U.S. Special Operations Command (USSOCOM). This descriptive account of the research psychologist duties in USSOCOM headquarters provides new perspectives on 

the application of military psychology. The research psychology position at USSOCOM is new and was created to meet command leadership concerns articulated by the commander. As the first incumbent in 

this position, my contributions rely on research skills and expertise in 

biopsychosocial (BPS) applications, as well as leadership perspectives 

gained from previous assignments as a platoon leader, company 

commander, and battalion commander. 

The Special Operations Forces (SOF) environment, further 

described below, is a somewhat unique one for the command research 

psychologist to work within. He or she can play a critical role in SOF 

command consultation by bringing specialized knowledge on the 

psychology of leadership and on enhancing program development. A 

good understanding of the principles of operational psychology is also 

important for effective consultation and program development in this 

environment (Staal and Stephenson, 2006; Williams, Picano, Roland, 

and Banks, 2006). 

The U.S. military Services as a whole currently number approximately 1.8 million military and civilian personnel (U.S. Department of 

Defense, 2009); USSOCOM has only 56,000. As a relatively small and 

specialized force, USSOCOM aims to develop a well-structured, properly resourced, culturally attuned, and adaptive SOF. The assignment of 

a research psychologist to the command is a seminal step toward reaching this goal. This chapter will also highlight the SOF leadership perspectives that a research psychologist must appreciate in order to support his work at the headquarters of USSOCOM.
436 THE 71F ADVANTAGE

USSOCOM and Research Psychology

SOF Characteristics 

The USSOCOM is a unified combatant command that maintains 

authorized oversight for special operations of the U.S. Armed Forces. 

There are two parts to its mission. First, the mission established by U.S. 

Code, Title 10 (Section 167), is to organize, train, and equip SOF and 

to command and control continental United States (CONUS)-based 

SOF. The second part of the mission, directed by the Unified Command 

Plan, is to synchronize planning of global operations against terrorist 

networks. 

USSOCOM is unique in that it functions as a combatant command with Service-like functions and distinct acquisition authorities. 

The commander’s funding, however, differs from that for the other 

combatant commanders because Congress granted USSOCOM its own 

budget authorities. The Major Force Program 11 (MFP–11) budgetary 

control established for USSOCOM enables it to modernize SOF and 

provide SOF-peculiar program support to maintain SOF characteristics 

(see table 20–1). 

Table 20–1. Special Operations Forces Characteristics

Leadership Culture and language familiarity

Warrior ethos Innovation and creativity

Integrity Intellect and problemsolving skills

Teamwork Adaptability to changing environments

Physical and moral courage Savvy and diplomatic awareness

Maturity and reliability Physical readiness

Consultation and Program Development

The duties of a research psychologist assigned to USSOCOM involve consultation and program development tailored to the unique 

characteristics of SOF. For example, if a military Servicemember at USSOCOM exhibits disruptive behavior in the workplace that leads to behavioral interventions, the research psychologist is available to consult 

supervisors on the use of counseling, social work services, and other 

available programs. In such instances, the military psychologist serves 
A RESEARCH PSYCHOLOGIST AT U.S. SPECIAL OPERATIONS COMMAND 437

as an additional source of research-based information. For example, the 

research psychologist assigned to USSOCOM helps to formulate metrics that reveal shortfalls in program support for both military and civilian personnel to complete the assessment and analysis required for 

the Planning, Programming, and Budgeting System (PPBS) process. 

The relevance of outlining leadership perspectives in SOF psychology at 

USSOCOM arises from the commander’s unique institutional authority under Title 10, the budget process with MFP–11, and a commandfocused interest in developing programs that effectively mitigate potentially adverse behavioral effects stemming from an increased operations 

tempo (OPTEMPO). 

My own perspectives on leadership were developed through previous training and experiences as a platoon leader, as well as a commander at the company and battalion levels (Department of the Army, 

2003). These experiences have proven highly relevant to the decisionmaking processes exercised by the leadership at USSOCOM, in part because they enhance multidisciplinary approaches in supporting SOF 

and their families. Though SOF is a relatively small force, it is faced with 

many of the same OPTEMPO challenges encountered by conventional forces due to accelerated rotational deployment cycles and training 

exercises in support of overseas contingency operations. SOF’s smaller 

force structure may, however, enhance its ability to mitigate potentially 

adverse behavioral effects resulting from a high OPTEMPO. 

As USSOCOM’s current research psychologist, I place leadership 

at the forefront of my approach to SOF psychology. While I also focus 

on developing programs that support the well-being of Servicemembers and their families, from a leadership standpoint it is also important 

to recognize how MFP–11 funding leverages opportunities to develop 

SOF-specific programs. 

Strategic Perspective

The strategic perspective of a research psychologist in a combatant command with MFP–11 funding is different from that of the operational psychologist functioning at the component or unit level. In 

the USSOCOM setting, the research psychologist must pay attention to 

the strategic dynamics of leadership and the delivery of leadership perspectives unique to SOF (see table 20–1). Program development, even 

if streamlined by supplemental funding for rapid execution, is strategic in nature. Therefore, as the research psychologist attends to strategic 
438 THE 71F ADVANTAGE

approaches for program planning, his support for rapid implementation 

of USSOCOM command-direct initiatives reinforces the unique leadership ethos for warriors trained in the application of irregular warfare 

(U.S. Department of Defense, 2008). 

Stress on the Forces

Concern about stress on the forces is due, in part, to the contemporary global operating environment. As a result, an increasing number 

of units now have stronger institutional support to address combat and 

operational stress (Mangelsdorff, 2006). While not used by SOF, Combat Stress Control teams are an example of this type of support. Operational psychologists supporting SOF in the Army, Air Force, and Navy 

are typically assigned at the SOF group level and provide direct support 

to subordinate units based on mission requirements. 

OPTEMPO Behavioral Effects

The research psychologist assigned to USSOCOM receives direct guidance from the USSOCOM commander on the development 

of a centralized SOF-peculiar program with decentralized execution. A 

research psychologist was chosen to develop the program in order to 

allow component level operational psychologists to mitigate the potential adverse effects stemming from the operational demands on Servicemembers and their families generated by a high OPTEMPO. This is feasible since potential strain in SOF and family member resilience, based 

on operations tempo behavioral effects (OTBE), can be assessed at 

every level throughout an organization. Thus, the USSOCOM research 

psychologist functions in a consultative capacity at the headquarters 

level, providing leaders at every level with additional tools to manage 

these demands.

Multidisciplinary Approach

The USSOCOM research psychologist offers a central role in addressing OTBE and works closely with clinical psychologists throughout the component commands. The use of formal working groups supports this collaboration. Although the research psychologist is not an 

operational psychologist, both research and clinical psychologists counsel unit commanders on issues related to combat and operational stress 

control (COSC). As consulting psychologists, they offer commanders an additional mechanism to reinforce the favorable interpersonal 
A RESEARCH PSYCHOLOGIST AT U.S. SPECIAL OPERATIONS COMMAND 439

aspects of leadership, such as sustaining the dynamics of caring, support, and growth. 

Consulting psychologists function as staff officers trained to provide a multidisciplinary approach to COSC (Kennedy and Zillmer, 

2006). The USSOCOM research psychologist offers organizational consultation and supports a multidisciplinary approach to COSC that involves other USSOCOM personnel—teams of psychologists, mental 

health specialists, psychiatrists, psychiatric nurses, chaplains, and social workers—also serving the needs of SOF warriors and their families. From a consultation standpoint, the teams work outside of a clinic 

setting to support command programs. The USSOCOM research psychologist works with the multidisciplinary teams to address what the 

U.S. Army Training and Doctrine Command (2008) describes as combat and operational stress responses (COSR) and combat and operational stress injury (COSI). 

Leadership Focus

Previous command experience helps the research psychologist 

maintain timely awareness of command-focused issues for program 

development that is responsive to the USSOCOM commander’s focus. 

Mission-directed leadership focuses on achieving the mission’s objective. Concerns for personnel exist, but not at the cost of the mission. 

Interpersonal leadership also places a high value on the mission’s objective, but often prioritizes issues of personnel. The balance between 

mission-directed and interpersonal leadership may vary, depending on 

national strategic, operational, and tactical goals and the effects of the 

different types of goals on warriors, their friends, and families. Ensuring 

clarity across the entire spectrum from strategic to tactical is a challenge 

for effective leaders at all levels (Wass de Czege, 2009). 

With experience in the applied knowledge of the BPS perspective (Engel, 1980), the research psychologist at USSOCOM is familiar with research perspectives that assess behavior using a systems approach, along a continuum from individual physiologic subsystems 

to social macrosystems. Previous command experience in deployable 

units and a working knowledge of the BPS perspective provide the USSOCOM research psychologist with innovative insights on how to integrate a BPS systems approach into program development. That insight is tailored to maximize what effective leaders do to improve their 

organizations across all applicable systems, both individual and social. 
440 THE 71F ADVANTAGE

Effective leaders use their staff and subordinate leaders to establish balance throughout the spectrum of strategic, operational, and tactical interests. In elite and high-OPTEMPO organizations and units, the use of 

multidisciplinary staff components (such as consulting psychologists) 

aids in leadership focus. 

When leadership is focused, organizations, units, and teams perform to standard or better, regardless of the complexity or ambiguity of a 

given situation. Central to that focus is an element of caring that defines 

a leader not only as a person in a position of authority and power, but 

also as one who, through experience and support, channels all required 

energies and resources toward the achievement of specified goals. Caring is an aspect of leadership focus that is observed not only in the outcomes of mission-directed effort and leader interpersonal skills, but also 

in the types of programs supported and endorsed by the leadership.

Screening and Selection

The availability of military psychology consultants allows command leaders to obtain practical and expert input on the potential 

fragility of forces based on assessments of OTBE, COSR, COSI, and 

decisionmaking. While the military utilizes extensive screening and 

selection criteria for personnel decisions, personality factors in potential 

selectees are only one of several psychological assessments that consulting psychologists can provide to institutional leaders and subordinate 

commanders. Although personality affects leadership focus, dynamics, 

and perspectives, the degree to which personality influences each is variable and insufficient to transcend the overall dynamics of leadership. 

Historically, personality factors are measured along several domains. 

The Domains of Personality

Personality taxonomy contains three to five well-defined domains. The three basic domains, as defined by Eysenck and Eysenck 

(1985), are neuroticism, extraversion, and psychoticism. Neuroticism 

expresses negative affect, sadness, anger, guilt, and shame. Extraversion 

is characterized by sociability, ambition, dominance, positive emotionality, and excitement-seeking. Psychoticism involves aggressive, impersonal, and impulsive behavior with underlying thought patterns that can 

be antisocial, unempathetic, creative, and tough-minded (Hall, Lindsey, 

and Campbell, 1997). 

Derivations of those three basic domains offer a different 

taxonomy with five domains: neuroticism, extraversion, openness, 
A RESEARCH PSYCHOLOGIST AT U.S. SPECIAL OPERATIONS COMMAND 441

agreeableness, and conscientiousness (McCrae and Costa, 1996). 

Costa and McCrae (1997) correlate openness (to experience) with 

creativity, unconventionality, and broad-mindedness. Agreeableness 

reflects an interpersonal stance of cooperation, trustfulness, and 

compliance. The five-factor model removes psychoticism from the 

taxonomy, assigning many of its factors to one of three different 

domains: openness, agreeableness, and conscientiousness. 

When one analyzes each of these domains as multiple or single 

factors for measure, analyses can support choices about which factors 

are inherently relevant to leadership and unit performance. Personality patterns in distinct performing groups, such as elite warriors, deviate 

from the general population. For example, in military pilots who completed the five-factor Neuroticism Extroversion Openness Personality 

Inventory–Revised (Bernard and Walsh, 2004), those in initial military 

flight training showed higher levels of extraversion and openness with 

lower levels of agreeableness compared to the normal population (Callister, King, Retzlaff, and Marsh, 1999). Those with substantial military 

flight experience showed lower levels of neuroticism and some extraversion—but not significantly high compared to the normal population—

and lower levels of openness (Grice and Katz, 2006). 

Hardiness and Resilience 

Like the more mature and experienced pilot, the SOF warrior displays the hardiness and mental toughness common among groups that 

undergo rigorous physical and cognitive screening. Hardiness as a personality construct provides the SOF warrior with initial advantages that 

promote selection, but leadership focus helps to direct performance enhancement observed through the biobehavioral construct resilience. 

The focus of leadership applied through its dynamics is what governs 

the delivery of leadership perspectives in elite warrior units. Understanding the role that personality plays in the SOF screening and selection process and how hardiness as a personality construct is a trait characteristic (Bartone, 1999; Maddi, 2002) helps the USSOCOM research 

psychologist appreciate how important leadership focus is in the development of SOF resilience (Lukey and Tepe, 2008). 

Dynamics of Leadership

If one accepts that a leadership focus is important in the development of SOF resilience, he may then acknowledge that the dynamics of 
442 THE 71F ADVANTAGE

leadership also develop resilience. The research psychologist offers an 

essential role at USSOCOM; this is seen in his interactions with leadership in the capacity of a consultant and program manager to reinforce 

mastery over the dynamics of leadership for stronger resilience development in SOF and their families. 

No leader is ever fully isolated from OTBE, though the inherent 

demands of leadership can at times remove a leader from direct involvement with execution. Awareness of OTBE through a reporting process 

may be less than ideal, but an effective leader will employ mechanisms 

within an organization to strengthen awareness and mitigate the adverse effects of OTBE. 

The role of leadership can also separate a key decisionmaker from 

full participation in COSC, but well-developed multidisciplinary teams 

can circumvent that alienation. Leaders of elite warriors, regardless of 

how much they become isolated from OTBE, can effectively participate 

in COSC with the aid of well-trained consulting psychologists who can 

assist leadership in making appropriate strategic, operational, or tactical mission-directed decisions to reinforce mastery over the dynamics 

of leadership. Regardless of the leadership traits and characteristics that 

one exhibits as a leader, three dynamics are universal: caring, support, 

and growth.

Caring

There must be an observable methodology for acknowledging 

care to Servicemembers, including well-defined programs and clearly 

understood leadership behaviors. For example, when there are mishaps 

such as loss of life during training exercises, effective leaders should 

demonstrate care for their personnel by adhering to the basic aspects 

of grieving, such as maintaining a continued presence among Servicemembers, attending to the immediate concerns of family members, and 

showing active participation at memorial and funeral services.

In the small USSOCOM community, failure to show presence 

and care in the midst of often hectic and time-consuming incident investigations would qualify as a failure of leadership contrary to the SOF 

culture. The USSOCOM research psychologist must appreciate longstanding military traditions that reinforce the dynamic of caring and 

the value added in providing ancillary participation as a staff consultant. 

Leaders who have access to consultative services build an atmosphere 

of caring that strengthens command effectiveness. Multidisciplinary 
A RESEARCH PSYCHOLOGIST AT U.S. SPECIAL OPERATIONS COMMAND 443

consultative services offer responsive delivery for both leadership and 

other Servicemembers.

Although uncommon, consultative mental health services, such 

as those provided by a clinical psychologist or psychiatrist working in 

a medical treatment facility, can be therapeutic in nature. More commonly, nontherapeutic consultative mental health services for the leadership are available within the chain of command and can be offered by 

psychologists, mental health specialists, psychiatrists, psychiatric nurses, chaplains, social workers, and authorized support elements outside 

of the chain of command. Used effectively, each addresses the dynamic 

of caring. A command-directed program with a formal working group 

authorized to review best business practices within each discipline can 

address the dynamic of caring on behalf of a commander and then make 

recommendations for improvement. 

Nontherapeutic consultative mental health services provided to 

the leadership can occur in the scope of operational psychology (Williams, Picano, Roland, and Banks, 2006). In the USSOCOM setting, the 

research psychologist may provide nontherapeutic consultative mental health services depending on the situation and preliminary assessments. For example, the research psychologist may be summoned to the 

command suite to provide insight to senior leaders who are attempting 

to address a civilian employee’s family-related problem.

Called into a meeting to review the situation on behalf of the 

commander and to provide appropriately constructive input, the research psychologist might ask if the employee had been referred to the 

Employee Assistance Program (EAP) on the supporting installation. If 

the military psychologist discovered that there was no EAP at the supporting installation, he or she would provide short-term recommendations to address the immediate family-related problem. In a consultative role, the research psychologist could also provide long-term recommendations to assess the overall feasibility of developing an EAP to offer 

counselors to civilian employees and their family members

Support 

The dynamic of support, like caring, requires mechanisms of human intervention. Unlike caring, support as a mechanism of human 

intervention can be augmented by technological systems, such as online access to information and referral services. The application of adequate telecommunications techniques, graphic user interfacing, and 
workstation ergonomics cannot be ignored in the process of reaching 

out to prospective warriors and families in need of command-sponsored support. Technology-based programs are better received if the 

applications meet identified end-user technology requirements. Familiarity with acquisitions assists the research psychologist involved in the 

planning and programming phases of the PPBS.

Growth 

The third dynamic, growth, is typically transactional and transformational, and it can occur at various levels within any institution, 

organization, or unit. Transactional leadership is highly task-oriented, while transformational leadership is highly person-oriented (Bass, 

1990). The combination of transactional and transformational leadership can establish meaningful trust, which in turn promotes synergy. 

Regardless of the personality factors infused in leadership style (McCormack and Mellor, 2002), elite warriors are highly responsive to growth 

in an organization that builds trust and promotes synergy (Westphal, 

Bonanno, and Bartone, 2008). 

The research psychologist at USSOCOM facilitates the leadership’s role in establishing the dynamic of growth, building trust, and 

promoting synergy. Assessments made by the research psychologist facilitate training and psychoeducation (Dixon et al., 2001) to enhance 

resilience throughout the headquarters and component levels, which 

establishes the groundwork for sharing individual and unit level reactions to operational demands. Resilience developed through training, 

psychoeducation, and operational demands fosters growth in Servicemembers and their families, instilling stronger purpose and adherence 

to SOF characteristics. 

Leadership Perspectives

As leadership perspectives help the research psychologist apply 

SOF characteristics in program development, he or she should possess 

innovative leadership skills based on previous experience in deployable 

units. Though the command psychologist functions as a staff officer, the 

position requires strong familiarity with command-focused decisionmaking, field operations, and training. 

Staff officers in the command are routinely engaged in airborne operations, other types of flight operations, and rotations into 

theater. Perspectives developed in the high-OPTEMPO USSOCOM 

444 THE 71F ADVANTAGE
A RESEARCH PSYCHOLOGIST AT U.S. SPECIAL OPERATIONS COMMAND 445

environment reflect the capacity of the research psychologist to register the impact of OTBE from the bottom up and to responsively develop a command-directed program to mitigate that impact 

from the top down. 

Social Learning

The delivery of leadership perspectives unique to SOF reinforces 

the unique ethos of warriors trained in the application of irregular warfare. Simple deliveries of leadership perspectives that keep organizations 

and individuals on target with purpose can be more meaningful than 

complex applications that diffuse efforts and distract from purpose. 

Social learning principles demonstrate the value of validation among 

warriors and further suggest that validation contributes to resilience 

(Campbell, Campbell, and Ness, 2008; Grossman, 1995). The intensity 

of the SOF selection and screening process provides a unique validation 

or sense of purpose to those accepted into the community. That sense of 

purpose contributes to a greater sense of coherence, or resilience, in adversity (Van Breda, 2001). 

Grossman offers examples of how the trauma of warfare can be 

viewed in a social context that helps validate the aggressions and natural 

reactions involved. SOF warriors and families who thrive on a socially 

acknowledged sense of purpose train themselves to face adversity and 

overcome it. Grossman demonstrates, for example, how families that 

provide support to each other in ordinary crises tend to provide better 

support for returning warriors. The SOF family prepares, or trains, itself 

for adversity by adhering to its social commitment to purpose. The research psychologist assigned to USSOCOM should understand the importance of social validation for warriors and incorporate those principles into programs that provide command-directed support to SOF 

warriors and their families. 

The Biopsychosocial Systems Approach

The research psychologist assigned to USSOCOM benefits from 

possessing a strong background in the biological sciences so that he 

or she can support the use of physiologic and genomic studies to augment psychological applications. Psychological and biological applications address potentially adverse OTBE in SOF and their families. Analysis of physiologic markers (such as neuropeptides and proteins) can be 

incorporated into studies that support programs designed to enhance 
446 THE 71F ADVANTAGE

resilience. From a BPS perspective (Engel, 1980), program development 

will benefit from a systems approach that spans from physiologic subsystems within the individual to macrosystems within society that influence health and behavior. 

From a BPS perspective, the research psychologists at USSOCOM can track meaningful trends by gathering data from a continuum 

of factors, ranging from individual to social. Trained to recognize fragility in the force and formulate appropriate metrics, the research psychologist at USSOCOM offers a multidisciplinary approach to COSC that 

can increase the efficiency and productivity of SOF personnel and their 

families. The systems review methodologically supports confidential 

analyses of data (U.S. Department of Health and Human Services, 2003 

and 2004). Conceptually, the systems review also supports an analysis 

of intrasystem changes associated with one’s existence that influence the 

functional cognitive behavioral framework of what Antonovsky (1993) 

refers to as sense of coherence. 

Biobehavioral Resilience

Leadership perspectives exercised at USSOCOM warrant the use 

of a research psychologist who can quantitatively assess OTBE and recommend training, protocols, and actions for preventing, interdicting, 

and mitigating COSI. The research psychologist’s goal is to instill a sense 

of coherence and overall performance in individual SOF warriors and 

their family members through a program that supports resilience. Applications in COSC require clear distinctions between resilience and 

hardiness: resilience is a biobehavioral construct, while hardiness is a 

personality construct (Westphal, Bonanno, and Bartone, 2008). Hardiness is a component of resilience and is psychological in nature (Maddi, 

2004). Resilience is both biological and psychological in nature (Lukey 

and Tepe, 2008). 

Understanding the distinctions between biobehavioral resilience 

and hardiness can assist the USSOCOM research psychologist in tracking behavioral trends and potential causative or associative factors. 

When exploring the factors associated with PTSD or other behaviors, 

it is useful to know the measures of resilience and hardiness in SOF 

warriors. The biobehavioral construct, resilience, can be reinforced and 

strengthened to contribute to post-traumatic growth (Tedeschi and Calhoun, 2004). In contrast, one would not expect hardiness as a personality construct to be reinforced and strengthened based on the principles 

of trait-based personality theory (McCrae and Costa, 1997). Instead, it 
A RESEARCH PSYCHOLOGIST AT U.S. SPECIAL OPERATIONS COMMAND 447

is a useful construct for operational psychologists engaged in selection 

and screening (Stephenson and Staal, 2007). 

Consulting psychologists play a proactive role in preventing and 

managing COSR and COSI so as to ensure that SOF personnel are 

healthy and medically ready to deploy. This role is critical given the 

high OPTEMPO of SOF personnel and the contemporary operating environment. Research psychologists in USSOCOM also strengthen the 

commitment of SOF leadership to developing and supporting their elite 

personnel and families as they sustain and modernize the force. 

Conclusion

In describing the observations of USSOCOM’s first research psychologist as he employed new strategic and leadership perspectives in 

the application of military psychology, this treatise has emphasized several important lessons. First, the professional background of the research psychologist at USSOCOM affects his or her ability to carry out 

mission-essential duties, including psychology consultation and program development in accordance with the PPBS. Second, a successful 

USSOCOM research psychologist must possess a thorough appreciation of SOF’s unique characteristics and, third, employ a distinct, leadership-focused strategic perspective.

The research psychologist assigned to USSOCOM receives direct 

guidance from the commander and command surgeon on the development of a centralized SOF-peculiar program with decentralized execution. Each shares a common breadth of command experience in highly 

deployable units, which helps to galvanize collective leadership focus 

and perspectives. The intent of the command-directed program development is to mitigate potential adverse effects stemming from OTBE 

in Servicemembers and their families. Furthermore, an understanding 

of the role of personality in the SOF screening/selection process and of 

how hardiness as a personality construct is a trait characteristic helps 

the USSOCOM research psychologist appreciate how important leadership focus is in the development of SOF resilience. Another important 

lesson is that in order to promote resilience, the USSOCOM research 

psychologist must employ a multidisciplinary approach while maintaining a mission-directed and interpersonal leadership focus. Finally, 

the research psychologist at USSOCOM must reinforce and strengthen 

biobehavioral resilience through the use of a BPS systems approach that 

supports social learning theory and the application of psychoeducation.
448 THE 71F ADVANTAGE

References

Antonovsky, A. (1993). The structure and properties of the sense of coherence scale. Social Science Medicine 36 (6), 725–733.

Bartone, P. (1999). Hardiness protects against war-related stress in Army reserve forces. Consulting Psychology Journal 51, 72–82.

Bass, B. (1990). Bass and Stogdill’s handbook of leadership (3d ed.). New York: The Free Press.

Bernard, L., and Walsh, P. (2004). Socially desirable and non-purposeful responding on the neuroticism extraversion openness personality inventory-revised. Counseling and Clinical 

Psychology Journal 1 (1), 4–16.

Callister, J., King, R., Retzlaff, P., and Marsh, R. (1999). Revised NEO personality inventory profiles of male and female U.S. Air Force pilots. Military Medicine 164, 885–890.

Campbell, D., Campbell, K., and Ness, J. (2008). Resilience through leadership. In B. Lukey and V. 

Tepe (eds.), Biobehavioral resilience to stress (57–88). Boca Raton, FL: CRC Press.

Costa, P., and McCrae, R. (1997). Stability and change in personality assessment: The revised NEO

personality inventory in the year 2000. Journal of Personality Assessment 68 (1), 86–94.

Dixon, L., McFarlane, W., Lefley, H., Lucksted, A., Cohen, M., Falloon, I., Mueser, K., Miklowitz, 

D., Solomon, P., and Sondheimer, D. (2001). Evidence-based practices for services to 

families of people with psychiatric disabilities. Psychiatric Services 52, 903–910.

Department of the Army. (2003). Field Manual 6–0. Mission command: Command and control of 

Army forces. Washington, DC: Headquarters Department of the Army.

Engel, G. (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry 137 (5), 535–544.

Eysenck, H., and Eysenck, M. (1985). Personality and individual differences: A natural science approach. New York: Plenum Publishers.

Grice, R., and Katz, L. (2006). Personality profiles of experienced U.S. Army aviators across mission 

platforms (Technical Report 1185). Arlington, VA: U.S. Army Research Institute for the 

Behavioral and Social Sciences. 

Grossman, D. (1995). On killing: The psychological cost of learning to kill in war and society. Boston: Little, Brown and Company.

Hall, C., Lindzey, G., and Campbell, J. (1997). Theories of personality (4th ed.). New York: John 

Wiley and Sons, Inc. 

Kennedy, C., and Zillmer, E. (eds.). (2006). Military psychology: Clinical and operational applications. New York: Guilford Press. 

Lukey, B., and Tepe, V. (eds.). (2008). Biobehavioral resilience to stress. Boca Raton, FL: CRC Press.

Maddi, S. (2002). The story of hardiness: Twenty years of theorizing, research and practice. Consulting Psychology Journal 54, 173–185.

———. (2004). Hardiness: An operationalization of existential courage. Journal of Humanistic 

Psychology 44 (3), 279–298.

Mangelsdorff, A. (ed.). (2006). Psychology in the service of national security. Washington, DC: 

American Psychological Association.

McCormack, L., and Mellor, D. (2002). The role of personality in leadership: An application of 

the five-factor model in the Australian military. Military Psychology 14 (3), 179–197.

McCrae, R., and Costa, P. (1996). Toward a new generation of personality theories: Theoretical 

contexts for the five-factor model. In J.S. Wiggins (ed.), The five-factor model of personality: Theoretical perspectives (51–87). New York: Guilford Press.

———. (1997). Personality trait structure as a human universal. American Psychologist 52, 509–516.

Staal, M., and Stephenson, J. (2006). Operational psychology: An emerging subdiscipline. Military Psychology 18 (4), 269–282.

Stephenson, J., and Staal, M. (2007). An ethical decision-making model for operational psychology. Ethics and Behavior 17 (1), 61–82.
A RESEARCH PSYCHOLOGIST AT U.S. SPECIAL OPERATIONS COMMAND 449

Tedeschi, R., and Calhoun, L. (2004). Posttraumatic growth: A new perspective on psychotraumatology. Psychiatric Times 21 (4).

U.S. Army Training and Doctrine Command. (2008). The U.S. Army study of the human dimension in the future 2015–2024 (TRADOC Pamphlet 525–3–7–01). Fort Monroe, VA: 

TRADOC.

U.S. Department of Defense. (2008). Irregular warfare. (Department of Defense Directive 

3000.07). Washington, DC: Office of the Under Secretary of Defense for Policy.

———. (2009). DOD personnel and procurement statistics: Personnel and procurement reports and 

data files. Statistical Information Analysis Division. Retrieved February 5, 2009, from 

<http://siadapp.dmdc.osd.mil/index.html>.

U.S. Department of Health and Human Services. (2003). The health and insurance portability and 

accountability act (HIPAA) privacy rule (overview). Bethesda, MD: National Institutes of 

Health. Retrieved December 12, 2008, from <http://privacyruleandresearch.nih.gov/>.

———. (2004). Protecting personal health information in research: Understanding HIPAA Privacy 

Rule. Bethesda, MD: National Institutes of Health. Retrieved December 12, 2008, from 

<http://privacyruleandresearch.nih.gov/pr 02.asp>.

Van Breda, A.D. (2001). Resilience theory: A literature review. Pretoria, South Africa: South African Military Health Service. Retrieved from <www.vanbreda.org/adrian/resilience.

htm>. 

Wass de Czege, H. (2009). Systemic operational design: learning and adapting in complex missions. Military Review, January–February 2009, 2–12.

Westphal, M., Bonanno, G., and Bartone, P. (2008). Resilience and personality. In B. Lukey and 

V. Tepe (eds.), Biobehavioral resilience to stress (219–257). Boca Raton, FL: CRC Press.

Wiggins, J. (ed.). (1996). The five-factor model of personality: Theoretical perspectives. New York: 

Guilford Press.

Williams, T., Picano, J., Roland, R., and Banks, L. (2006). Introduction to operational psychology. In C. Kennedy and E. Zillmer (eds.), Military psychology: Clinical and operational 

applications (193–214). New York: Guilford Press. 

Chapter 21

The Total Force and the Army Reserve 

Component: Contributions of Research 

Psychology

James E. Griffith

This chapter provides a brief history of the Army Reserve force 

and the changed nature of Reserve military service, particularly since 

the 1980s, and how such changes have introduced several issues relevant 

to research psychology. It briefly summarizes these issues and provides 

sources to obtain additional information. The chapter concludes by describing current and likely future concerns related to Reserve military 

service, in addition to opportunities for research psychologists in the 

Army Reserve. 

What Is the Army Reserve?

At present, the U.S. Army is organized into two entities: the Active force, which consists of full-time Soldiers; and the Reserve force, 

which consists of part-time Soldiers. The Reserve force is a complex organization of several subentities representing different levels of Reservists’ involvement in the military. Figure 21–1 depicts the organization of 

the U.S. Army Reserve Component.

The focus of this article is on the “Ready Reserve,” the subentity 

that currently represents the most combat-ready Reservists (the dotted 

ellipse in figure 21–1). The Ready Reserve consists of three memberships: the Selected Reserve, the Individual Ready Reserve (IRR), and 

the Inactive National Guard. About three-quarters of the Ready Reserve 

force falls in the Selected Reserve, one-quarter in the IRR, and a small 

proportion in the Inactive National Guard. The former two represent 

Reservists most likely to be called on to support major military operations. The Selected Reserve consists of the Army Reserve and Army National Guard. Army Reservists make up the IRR, and Army National 

Guard members make up the Inactive National Guard. The Army Reserve represents about a third of the support organization of the entire

451
452 THE 71F ADVANTAGE

Figure 21–1. Organization of Army Reserves

Total Reserve Manpower

3,560,000

Retired Reserve

630,000

Standby Reserve

230,000

Retired Regular

1,500,000

Ready Reserve

1,100,000

Army Reserve

Army National Guard

Focus Population

Inactive Status

21,000

Active Status

209,000

Inactive National Guard

1,500

Selected Reserve

840,000

Indvidual Ready Reserve

250,000

Active Guard/Reserve

Individual Mobilization

Augmentees

Units

USAR 200,000

ANG 350,000

Source: Commission on the National Guard and Reserves: Transforming the National Guard and Reserves into a 21st Century Operational Force, Final report. January 31, 2008, 334. All numbers are approximate.

Army, and the Army National Guard represents about half of the Army’s available combat force (Commission on the National Guard and Reserves, 2008). The Army Reserve now numbers about 200,000 drilling 

Soldiers, and its units primarily perform support functions to combat 

units. Reserve units mainly perform combat service support functions 

(for example, logistics, maintenance, transportation, and health services) 

and combat support functions (such as chemical warfare, intelligence, security, and communications). The Army National Guard now numbers 

about 350,000 drilling Soldiers and consists mainly of combat (infantry, 

armor, artillery, cavalry, air defense artillery) and combat support units. 

Generally, Army Reserve Soldiers work part time, compared to 

Active-duty Soldiers who work full time. Army Reserve Soldiers usually 

perform training or duty one weekend a month and over two consecutive weeks (called annual training). These Reservists are often referred 

to as drilling Reservists, since they attend unit assemblies one weekend 

a month. Reservists generally serve in units that are within driving distance (50 to 100 miles), but some serve individually to augment either 

Reserve or Active Army units. Below is a description of the types of 

Reservists (for a more detailed discussion, see Commission on the National Guard and Reserves, 2008). 
THE TOTAL FORCE AND THE ARMY RESERVE COMPONENT 453

There are several general categories of part-time Reserve Soldiers representing progressively less involvement or participation in 

the Army (see table 21–1). The majority of members of most Reserve 

units serve one weekend a month plus 15 days annual training. These 

Soldiers are called traditional, drilling, M-day (mobilization asset), or 

Troop Program Unit (TPU) members. To manage administrative matters, many units are assigned a few full-time Reservists, called Active 

Guard/Reserve (AGR) and full-time, dual-status (M-day and Mondaythrough-Friday state or Federal employee) technicians. Some Reservists serve much like TPU members but with less fixed dates and times 

of monthly drills, and they usually support something other than a 

combat or combat support unit, such as a medical facility. They are 

called Drilling Individual Mobilization Augmentees. Reserve Soldiers 

who have an established relationship with or position in a unit but 

are not in a drilling status (one weekend a month) are called Individual Mobilization Augmentees (IMAs). These Soldiers are attached to 

specific units but usually drill for pay only during the 15-day annual 

training period. IRR Soldiers are not associated with any unit and do 

not perform monthly drills. These Soldiers can apply for annual training days to complete training required for their military occupational 

specialties. 

There are three types of full-time Reserve Soldiers. First, the Active Guard/Reserve Soldier serves full time on Active-duty status in the 

Reserve Component in support of a Reserve unit. For example, a unit 

personnel specialist often serves full time to manage administrative affairs of the unit. Second, civilian positions are authorized in Reserve 

units that require the employee to be a member of the Army Reserve 

Component. These positions are called technicians and can be funded 

by Federal or state funds (in the case of the Guard). During the week, 

the employee serves as a civilian but usually wears the uniform, and 

during the drill weekend, the employee has similar status to the M-day 

Soldier. Third, some Reserve Soldiers are brought on Active duty for a 

short time (for example, 6 months) to perform a specific mission. These 

Soldiers are called Active Duty for Special Work.

All Soldiers in the U.S. Army incur an 8-year obligation that can 

be served in the capacities previously described. When joining, the 

initial contract specifies the amount of time to be served on Active duty 

(2, 3, or 4 years) and the remaining years are spent in Reserve military 

service. Soldiers who join only the Reserve force and enter the Army
454 THE 71F ADVANTAGE

Table 21–1. Types of Reserve Military Service

Type

Frequency in 

the Military 

Environment

Description

Location 

of Military 

Service

Part-time

Troop 

Program 

Unit (TPU)

One weekend 

per month, 

15 days 

annual 

training

Serves monthly in the Reserve military 

(one weekend a month and 15 days 

annual training). Also called traditional Reservist or M-day (mobilization 

asset). Comprises the greater part of 

members in Reserve units.

Unit

Drilling 

Individual 

Mobilization 

Augmentee 

(DIMA)

Certain 

number of 

drill days, 

15 days 

annual 

training

Serves periodically, much like the TPU 

member, but with fewer fixed dates 

and times of monthly drills and 

usually in support of something other 

than a combat or combat support unit 

(for example, a medical facility).

Usually 

installation

Individual 

Mobilization 

Augmentee

15 days 

annual 

training

Serves periodically, much like a DIMA 

but less monthly frequency, usually 

having no or few drill days but having 

the 15-day annual training period. 

Often attached to specific units.

Usually 

installation

Individual 

Ready 

Reserve

15 days 

annual 

training

Serves infrequently, not associated 

with any unit, and does not perform 

monthly drills. Can apply for annual 

training days to complete training 

required for military occupational 

specialty.

No unit

Full-time

Active 

Guard/ 

Reserve

Every 

workday

Serves full time on Active-duty status 

in the Reserve component in support 

of a Reserve unit (for example, unit 

personnel specialist often serves full 

time to manage administrative affairs 

of the unit).

Unit

Technician Every 

workday

Serves full time as civilian “technician” 

in authorized positions in Reserve 

units, funded by Federal or state funds. 

Requires employee to be a member of 

the Army Reserve component. Usually 

wears uniform during the workweek, 

and during the drill weekend has similar status as the M-day soldier.

Unit

Active Duty 

for Special 

Work

Every workday 

for specified 

time period

Serves full time for short duration. 

Brought on Active duty to perform 

a specific mission

Unit
THE TOTAL FORCE AND THE ARMY RESERVE COMPONENT 455

Reserve Component directly are called non–prior service Reservists.

They are required to serve on Active or full-time military duty only 

during their introductory training (that is, basic training and advanced military occupational specialty training). Other Reservists 

serve an Active-duty term of 3 or 4 years and then enter Reserve 

military service, at which point they are considered prior service 

Reservists. 

Historical Role of the Army Reserve

Both policy decisions and geopolitical events have determined 

what role the Reserve force has served. What follows is a cursory history 

of the Army Reserve and Army National Guard (taken from the Commission on the National Guard and Reserve, 2008), including what I see 

as their functional roles (see table 21–2). These roles are associated with 

different demands on individual Reservists, often giving rise to issues 

pertinent to research psychology. 

Community Protection 

The Army National Guard is the oldest military organization in 

the United States, dating back to the colonial militias. In 1636, militia 

companies were formally organized to protect the Jamestown colonists from the growing threat of the Pequot Indians. Lacking a formal military cadre, the colonies adopted the English militia system, 

which obligated all males between the ages of 16 and 60 to possess 

arms and participate in the defense of the community. These militias formed the basis for the modern-day Army National Guard, formally established by the Militia or Dick Act of 1903. This law aligned 

the militias with the Army Reserve and made the organization, pay, 

regulations, and equipment similar to those of the Active Army. The 

number of training days increased, and training was performed with 

the Active Army. The National Defense Act of 1933 made the National Guard part of the U.S. Army at all times. Prior to this time, the 

National Guard was a state’s militia (Doubler, 2003). The act also established two Army Reserve entities: the Army National Guard and 

the U.S. Army Reserve. 

Medical Support

The beginning of the Army Reserve can be traced to the need for 

medical care of Soldiers. In 1908, Congress passed a law authorizing 

a cadre of medical officers who would provide medical care to Soldiers
456 THE 71F ADVANTAGE

Table 21–2. Army Reserve Component throughout History

Time Period Role Precipitating Event

Early colonial 

times 

Community 

protection

Need to protect colonists from growing 

threat of Pequot Indians

Civil War through 

start of 20th century

Medical 

support

Need for more formal medical care and 

support during early American wars

War of 1812 through 

Civil War, SpanishAmerican War, World 

Wars, Korean War 

into the Cold War

Strategic 

reserve 

of citizensoldiers

Need to complement small Active-duty 

Army with great numbers of Soldiers to 

conduct major war effort to protect U.S. 

interests

1970 to 1990

Interdependency of 

Active and 

Reserve 

forces

—Need to reduce active military force 

and expense by optimizing Active-Reserve 

cooperation

—Need to adopt policy that would 

integrate the Active and Reserve military 

organizations into a single force

1990s Search for 

relevance

Need for new role in national security 

following the collapse of Soviet Union, 

strategic reserve questioned

2000 to present

Shift from 

strategic to 

operational 

force

Need to rethink use of Reserve force in 

the wake of required mobilizations and 

deployments of Army Reserve units for 

major wartime operations

and who could be ordered to Active Duty by the Secretary of War during emergencies (Currie and Crossland, 1977). Later, the National Defense Act of 1916 established the Officers Reserve Corps, the Enlisted 

Reserve Corps, and the Reserve Officers Training Corps.

Strategic Reserve of Citizen-Soldiers

Throughout U.S. history, meeting national security threats necessitated major military operations, including the War of 1812, the Civil 

War, the Spanish-American War, World Wars I and II, and the Korean 

War. Because of a lack of sufficient Active-duty personnel, Reservists 

were called up and youths were drafted to support these large-scale military operations. When operations ended, Reservists and draftees more 

often than not returned to society as civilians. This pattern changed 

after World War II. The United States had gained hegemony in world 
THE TOTAL FORCE AND THE ARMY RESERVE COMPONENT 457

politics but faced perceived and real national security threats from both 

the Soviet Union and the People’s Republic of China, thus requiring a 

large force to protect its interests (Knutsen, 1999). However, maintaining a large army was expensive. A small standing army, which would be 

complemented by Reservists and could serve as a Reserve force when 

threats escalated, was seen as less costly (Drew, 1994). Thus, the Reserve force became largely a strategic force, to be used for extraordinary 

circumstances. 

Interdependency of Active and Reserve Forces

In 1970, Secretary of Defense Melvin Laird announced a new 

policy for the U.S. Armed Forces, called the Total Force concept (also 

known as the Abrams Doctrine). What prompted the policy change 

were the rising costs of maintaining a large military and growing discontent with the draft. Integrating the Active and Reserve force reduced the size of the U.S. military, especially the Active force. Efficiencies gained in the integration would mean fewer Soldiers, likely no draft, 

and preliminary steps toward the all-volunteer force. The policy called 

on the Army Reserve to assume many of the combat support and combat service support roles of Active force units and for the Army National Guard to augment several combat divisions. For any large-scale 

military operation, both the Army Reserve and Army National Guard 

would now have to be activated. As observed by Segal and Tiggle (1997), 

the Total Force “made the reserve components full partners with active forces in a structure that guaranteed that the active forces would 

not deploy without reserves.” With the threat of thermonuclear warfare, the Reserve force continued to serve as a strategic deterrent from 

about 1970 through 1980 (Janowitz and Moskos, 1979). Thus, the Total 

Force would not be tested unless a major military operation was initiated, which was unlikely given that it might provoke a nuclear exchange. 

Search for Relevance

The Soviet Union and many communist satellite nations collapsed 

in the 1990s. U.S. policymakers and the public were looking for peace 

dividends, which could easily be found in a large Reserve force no longer having to deter Soviet threats. During this time, the Army Reserve 

and Army National Guard leadership sought mission relevance, including becoming more like Active light infantry Soldiers (Osterberg, 1990); 

assuming new missions, such as overseas peacekeeping (Segal and 
458 THE 71F ADVANTAGE

Tiggle, 1997; Segal, Reed, and Rohall, 1998); providing domestic support, such as medical assistance to the underprivileged; and conducting 

nationbuilding missions, such as several state National Guards developing relationships with former Soviet bloc countries. This search for relevance ended with the first Gulf War, during which the Total Force concept necessitated calling on Reserve forces. 

Shift from Strategic to Operational Force

The reconfigured Total Force required the mobilization and deployment of Army Reserve units for major military operations. During 

Operation Desert Storm (ODS), more than 84,000 Army Reserve and 

60,000 Army National Guard Soldiers were called to Active duty (Nelson et al., 2001). Later, operations in Iraq and Afghanistan would require that even more Reserve forces be called up and deployed overseas 

for periods of 1 to 11⁄2 years. This marked the beginning of the shift from 

a strategic Reserve to an operational Reserve (Commission on the National Guard and Reserves, 2008; Wormuth, 2006), which introduced a 

new set of policy issues appropriate for research psychology study and 

evaluation. 

Admittedly, this description of the changed roles of the Army Reserve Component is brief and simple. Even so, connections among the 

varied nature of threats to U.S. national security, changes in the Army 

Reserve Component, and its overall role in national defense policy 

are evident. 

Reserve Policy Issues Pertinent to Research Psychology

Army Reserve issues having relevance to research psychology can 

be described in terms of three “Rs”: retention, recruitment, and readiness. Each is described below.

Unscheduled Losses and Retention

An issue of historic interest (since the Vietnam War and during 

the all-volunteer Army in the early 1980s) has been retention, in particular, retaining non–prior service, first-term, junior-ranking enlistees 

(Perry, Griffith, and White, 1995). Typically, about one-third of these 

Soldiers leave either before the end of their current obligation or at the 

end of their 6-year obligation (White and Simpson, 1990). Soldiers who 

leave before the end of their obligation usually just stop attending drills. 

These losses are of great concern. The military invests about $80,000 in 
THE TOTAL FORCE AND THE ARMY RESERVE COMPONENT 459

the recruitment and training of each new Soldier, so these unanticipated losses represent a significant fiscal drain in addition to manpower 

losses. This situation made retention a key research topic for the 1980s 

into the 1990s. 

Historically, Reservists have reported leaving Reserve service due 

to poor training and leadership and the lack of engaging and meaningful work activities. This was especially evident among junior enlisted Soldiers. Troops often complained of doing little or nothing during 

weekend drills, though they desired to do something both meaningful 

and consistent with their military occupational specialty. Family affairs 

and civilian job conflicts have been of less importance to leaving Reserve service. However, with more frequent and prolonged deployments 

since 2005, Reservists have expressed less willingness to remain in Reserve service due to frequent and lengthy separations from families. For 

a recent summary of findings relating to retention and associated factors, see Griffith (2005). Losses before or at the end of Soldiers’ obligations were, however, typically balanced by recruitment of more Soldiers. 

It seemed that units and commanders preferred to get new Soldiers 

than motivate those who had already joined but became disenchanted and stopped attending drills. Thus, a second research interest has 

been recruitment. 

Recruitment to Replace Losses

Recruitment research has attempted to identify subpopulations 

having the greatest propensity to join the Army Reserve Component 

along with the incentives that would interest members of such subpopulations to join. As a result, many of the recruiting efforts in the 1980s 

and 1990s were directed at developing incentives for particular youth 

markets (Shavelson, Haggstrom, and Winkler, 1983). While other Services defined markets and developed successful recruitment methods 

and advertising (Barnes, Dempsey, Knapp, Lerro, and Schroyer, 1991; 

U.S. Army Research Institute, 1976), the Army, and in particular the 

Army Reserve, struggled.

Incentives to join the military, such as enlistment bonuses and 

educational scholarships, were offered. In particular, the rising cost 

of tuition and increased emphasis on college attendance in the 1970s 

and 1980s led the Army to offer young adults financial assistance for 

education. After some initial recruiting success, college-bound youth 

became the primary market for the Army Reserve Component (Hintze 
and Lehnus, 1996). The Army broadened efforts to develop educational and other monetary benefits as incentives to attract and recruit 

college-bound youth (Schmitz, 1990; Verdugo and Berliant, 1989). This 

market had the added advantage of providing higher aptitude Soldiers 

who represented the broad spectrum of the general population. 

Offering material incentives, such as educational benefits, bonuses, and increased pay, has worked well for Reservists serving part-time 

(attending monthly weekend drill training and 2-week annual training). 

However, since dramatic changes in force organization, structure, and 

missions occurred under the Total Army concept in 2004, fewer college-bound high school students have joined the military. Nevertheless, 

offering bonuses in general and targeting certain military occupational 

specialties in particular continues to be an effective recruitment strategy, especially when bonus amounts are increased substantially. A sense 

of patriotism and the urge to serve the country have also been typical 

reasons Soldiers give for joining, although the Army’s emphasis on such 

incentives has been less evident than the development of educational 

benefits and bonus money. For a report on the effects of ODS on enlistment motivations of Reservists, see Griffith and Perry (1993); and for a 

more recent analysis of motives, see Griffith (2008a).

Present, but Not Ready

ODS introduced an entirely new research issue: readiness. During ODS, more than 84,000 Army Reserve and 60,000 Army National 

Guard Soldiers were called to Active duty (Nelson et al., 2001). By some 

accounts (Kirby and Buddin, 1996; Orvis et al., 1996), many Army Reserve units during ODS could not be mobilized in a timely manner, due 

largely to insufficient skill-qualified Soldiers and training on missionrequired equipment. These and other shortcomings—including insufficient individual job skills and combat preparation, utilization during 

weekend drills, noncommissioned officer and officer leadership, and 

collective training—were subsequently documented (General Accounting Office, 1992; Griffith, 1995). What ensued was a series of studies to 

examine the extent to which Reserve Soldiers were ready individually 

(medically, trained in a military occupational specialty, and so forth) 

and as units (based on ratings from Unit Status Reports). Findings 

from these studies spurred several initiatives to improve the readiness 

of Army Reserve Soldiers, including the Reserve Component Training 

Development Action Plan, aimed at improving individual Soldier skills 

460 THE 71F ADVANTAGE
THE TOTAL FORCE AND THE ARMY RESERVE COMPONENT 461

and leader effectiveness, and the Leader Development Action Plan (U.S. 

Department of the Army, 1997), to better select, educate, and assess 

leaders. Other programs include the “Bold Shift” initiative (Sortor, Lippiatt, Polich, and Crowley, 1994), prescribing policies and procedures 

for combat maneuvers during peacetime, and Title XI (U.S. House of 

Representatives, 1993), to improve individual and unit readiness for 

mobilization and deployment. These initiatives, while better preparing 

Soldiers for future mobilizations and deployments, may well have had 

unintended negative effects on reenlistments by requiring Reservists 

to spend more time intermittently in their units, thus competing with 

civilian employment and family obligations (Sortor et al., 1994). Earlier 

studies showed the detrimental effects of extended training on retention rates (Kirby and Buddin, 1996). Detrimental effects of extended 

training and related negative attitudes of families and employers have 

been documented in analyses of the 1986 and 1990 Reserve Components Surveys (Grissmer, Buddin, and Kirby, 1989; Grissmer, Kirby, and 

Sze, 1992). Indeed, after ODS, proportionately fewer Soldiers remained 

in the Reserves (Griffith, 1995; Kirby, 1997). 

Following September 11, 2001, about 300,000 of the 1.2 million 

National Guard and Reserve personnel were called to Active duty (General Accounting Office, 2003). Reservists combined with Active-duty 

members supported worldwide military operations, specifically in Afghanistan and Iraq. With the passing of several years since the last major 

callups, the Reserve Component was expected to have remedied many 

of the problems observed in ODS. Some studies showed improvements 

in mobilization of Reservists, whereas others pointed to persistent problems in Soldiers being trained and available for mobilizations (General 

Accounting Office, 2003; St. Laurent, 2004). Survey findings indicated 

that Soldiers’ perceptions of individual and unit readiness were more 

positive and that Soldiers joined and stayed in Reserve service if properly trained and equipped, especially for their wartime deployments. 

Thus, readiness was tied to reasons for joining and reasons to stay. For a 

recent summary of Soldier reports of individual and unit readiness, see 

Griffith (2005).

The Three “Rs” Intertwined 

Increasingly, recruitment, retention, and readiness have been recognized as being intertwined. Enough quality Soldiers had to be recruited to fill current positions and subsequently retained. If the Reserve 
Component did not fill its strength allocations each year, Congress reexamined and often cut strength levels and units. To meet manpower requirements, those Soldiers who joined had to be retained, both during 

their obligations and after completing their obligations, through reenlistments. Research findings indicated that retained Soldiers have positive unit experiences, especially those indicating greater individual and 

unit readiness. Specifically, Soldiers who were more likely to remain in 

Reserve service were satisfied with their military duties, trained in a 

military occupational specialty, had challenging training, and had leaders who knew their jobs and showed interest in their Soldiers (Griffith, 

2005; Perry, Griffith, and White, 1991). In other words, Soldiers who 

were “more ready” were more likely to want to stay in Reserve military 

service. For a recent summary of Reserve Soldiers’ perceptions about 

readiness, see Griffith (2006). The focus of my own work has evolved 

from the issues of retention to recruitment, and finally to readiness. 

My recent work examines Reserve Soldier commitment in relation to 

both recruitment and reenlistment incentives (for example, monetary 

reward, meaningful training and work, positive unit relationships, and 

sense of obligation to others and the country), as well as perceptions 

about being combat-ready individually and as a unit (Griffith, 2009). 

Current and Future Policy Issues and the Research Psychologist 

What are the current and future issues concerning the Reserve 

force, and how might the research psychologist contribute? Below, I 

have identified some of these issues. 

Recruiting and Retaining through Intangibles

The changed and uncertain nature of Reserve military service has had a negative effect on recruitment. The Army’s response 

has been largely to increase the amount of monetary bonuses. Since 

2000, the Army has more than tripled spending on enlistment bonuses, from $202 million to $639 million. The average bonus jumped 

from $7,900 to $16,500 (Associated Press, 2008). Such monetary bonuses are often double-edged. My recent work suggests this strategy 

has implications for retention and readiness. Soldiers who joined for 

material gain (educational benefits or money) are less likely to intend 

to remain in Reserve military service, perceive themselves as combatready, and report for duty out of a sense of obligation to others, belief in 

mission, and service to country (Griffith, 2008a). Less attention has been 

462 THE 71F ADVANTAGE
THE TOTAL FORCE AND THE ARMY RESERVE COMPONENT 463

paid to what Eighmey (2006) has called “intangibles.” These include 

faithfulness to goals and to the people who share them, willingness to 

make sacrifices, and desire to be near the family and have their approval. Such intangibles and their role in recruitment, retention, and especially readiness deserve more attention. Bondy (2004) has most recently 

called for a shift in strategy, advocating that Western militaries return to 

their past strengths and emphasize re-adoption of social forces associated with military effectiveness. He proposed that military ceremonies, 

symbols, explicit values, and institutional narratives be resurrected as 

part of unit experiences to reestablish Soldiers’ trust of and commitment 

to fellow Soldiers, leaders, the unit, and the military organization. The 

extensive literature on social identity and groups (Ashforth and Mael, 

1989) suggests several directions. Team experiences might be marketed as benefits of military service. Media messages might depict new recruits who gain positive self-identity through team experiences, such 

as cooperation and teamwork in accomplishing tasks and committed 

friendships with fellow Soldiers in their units. Through these and other 

group experiences, Soldiers may develop loyalty and a sense of obligation to others, mutual trust, and self-sacrifice. In other words, Soldiers 

experience a sense of “one for all” and “all for one.” 

Increasing Readiness through Soldier Identification

The changed nature of Reserve military service poses challenges 

that have not been fully addressed (Wallace, 1992). Because of the initial difficulties in deployment of Reserve forces, some have called for a 

reexamination of the viability of Reservists in a national security framework (Wormuth, 2006). Still others have argued for the importance of 

having citizens serving as Soldiers for positive civilian-military relationships (Cohen, 2001; Janowitz, 1975, 1979). The essential issue is whether citizen-Soldiers who participate intermittently in the military can be 

effective modern-day Soldiers. What can be done to better integrate Reservists as they move from being “partially included” to “fully included” 

without the benefit of increased time in the unit? From a research psychology perspective, it seems connections to Reserve military service 

will have to rely on social-psychological mechanisms. A promising area 

of research here includes social identity theory and perceptions of being 

a Soldier, the role of ideology in identifying with military service, and 

the relationship of recruitment and retention incentives and unit experiences to the Reservist’s organizational commitment. Recent studies 
of ideologies in the military have related such attitudes to important 

military outcomes, such as morale (Goldberg and Kasirer, 1985), perceived legitimacy of assigned missions (Wyatt and Gal, 1990), unwillingness to serve as conscientious objectors (Linn, 1995), decisions to report for duty when called (Linn, 1995), and stress-buffering in combat 

(Shechner, Slone, and Bialik, 2007). 

Commitment to Mission

In 1990 (less than a year before ODS), 80 percent of Army Reserve privates through corporals said it was “unlikely” or “uncertain” 

that they would be mobilized during their current obligations, normally 6 to 8 years in length. After ODS (a year later), the percentage 

decreased to 72 percent (Westat, Inc., 1990). After experiences in Iraq 

and Afghanistan, it might be expected that more Soldiers would predict being mobilized and deployed in the future. Such expectations 

would also likely bear on Reservists’ commitment, especially to new, 

emerging, and often demanding missions. Part of the answer to bolstering commitment is perception of the importance and legitimacy of 

missions. However, complicating this process is that Reservists spend 

most of their time in nonmilitary or civilian contexts. For Reservists, 

the dominant context is the civilian environment, unlike the full-time 

Active-duty Soldiers whose dominant context is the military environment. Reserve Soldiers may broadly see themselves as Soldiers, but 

when not drilling one weekend a month or on annual training, they 

likely view themselves according to their civilian roles, such as students, workers, husbands or wives, or fathers or mothers. When the 

saliency of military service is low in everyday life, the identity as a 

Soldier is low. That is, Soldiers may not think about their unit and its 

mission, and focus instead on some enduring personal attributes associated with the military, such as helping others and national pride. 

Immersed in a civilian environment as opposed to a military environment makes Reservists more attuned to and influenced by public opinion (Goldberg and Cassirer, 1985). Studies of Reservists in the Israel Defense Forces have shown the dynamic interplay among reserve 

soldiers’ political orientation, perceived legitimacy of assigned mission, and the degree of distress in its execution (Shechner et al., 2007).

Commitment to missions relates to perceived legitimacy and ability to 

carry out missions (Linn, 1995a; Linn, 1995b; Wyatt and Gal, 1990), 

and as such, this issue deserves attention in future research, especially 

464 THE 71F ADVANTAGE
THE TOTAL FORCE AND THE ARMY RESERVE COMPONENT 465

considering that Reservists are deployed to missions that may be 

controversial.

Post-traumatic Stress

An issue of growing concern for deployed Soldiers is the negative effects of war trauma on psychological well-being. The few studies including Reservists have shown them to have consistently higher 

rates of post-traumatic stress disorder (PTSD) and related symptoms 

than Active-duty members. These studies include Hourani et al. (2007), 

Martin (2007), Milliken et al. (2007), Jacobson et al. (2008), Smith et al. 

(2008), and Schell and Marshall (2008). There are various explanations 

for these findings (Griffith, 2008b). Few at-risk factors or background 

characteristics specific to Reservists have been associated with the occurrence of PTSD, such as marital status or age. However, the change 

from being part-time to full-time Soldiers likely introduces several 

stressors. Not expecting to be deployed (Griffith and Perry, 1993), not 

feeling adequately prepared and equipped (Erbes et al., 2008; Griffith, 

1995), and being unaccustomed to prolonged family separations (Erbes et al., 2008) likely make deployments more difficult for Reservists 

than for Active-duty members. Additionally, Reservists have to negotiate their absences with civilian employers.

Evidence is mixed whether Reservists have more combat exposure than Active-duty Soldiers (Vogt et al., 2008; cf. Milliken et al., 

2007). However, some studies suggest Reserve members are more adversely affected by it (Hourani et al., 2008; Jacobson et al., 2008; Vogt 

et al., 2007). Due to the intermittent nature of Reserve military service, 

Reservists may lack natural supports, such as the material and emotional support provided by unit cohesion that often mitigates the negative 

effects of stress on well-being (Brailey et al., 2007). Few studies have 

examined the stress-buffering effects of cohesion on PTSD symptoms 

among deployed and nondeployed samples of Reservists and Activeduty members. Finally, current demobilization practices may contribute 

to Reservists’ overuse of mental health care, and accordingly, overidentification of PTSD symptoms. 

Future studies must be conducted to determine which explanations have the most merit and to provide data to respond to important 

questions: What are the adverse psychological consequences of deployments on Reservists and their families? What are the common stressors throughout the deployment cycle? Given these stressors, what can 
be done to help Reservists and family members to recognize issues and 

develop initial coping strategies? Are there characteristics of individual 

Reservists and their families that increase the risk of traumatic stress after deployment? What are precipitating and/or contributing factors to 

post-deployment adaptation and post-traumatic stress in families of Reservists? What factors inhibit Reservists and their families in seeking 

mental health care, and how might they be reduced? 

Opportunities in the Army Reserve as a Research Psychologist 

Research psychologists in the Reserve component need not necessarily perform research relating to Reserve issues. However, as elaborated above, the marked changes in the organization, mission, and uses 

of Reserve forces have made several issues prominent and suitable for 

research. Indeed, before ODS, much of the research done by Reserve research psychologists related to issues of Active-duty Soldiers (Griffith, 

1997, 2002; Griffith and Vaitkus, 1997). But as the nature of Reserve military service has changed, the Reserve research psychologist has become 

uniquely positioned to study emerging Reserve force questions of national security importance. For example, the research psychologist understands the distinctions and subtle differences among the various Reserve 

statuses. He also understands the competing demands of a civilian job 

and family. The research psychologist can draw on theories and concepts 

particularly appropriate for analyzing Reserve issues and recommending 

new strategies for improving recruitment, retention, and readiness. 

Unfortunately, there are few opportunities to serve as a Reserve 

component research psychologist. As of this writing, there are no TPU 

positions for research psychologists in which the Reservist attends a 

weekend drill once a month with 15 days of annual training. Although 

not directly related to the specialty, research psychologists are qualified 

for TPU positions in Public Affairs and Psychological Operations units. 

While the primary mission of these units is to implement media campaigns, they often lack the methodological skills to evaluate campaign 

effectiveness, and thus research psychologists can assist them. 

Alternatively, other opportunities do arise, as was the case for me. 

I have been a uniformed Army research psychologist since 1984, and after having served on Active duty for 3 years, I took a civilian research 

consulting position but continued my Army service in the Army Reserve. Because my interest was serving in an active Reserve status or as 

466 THE 71F ADVANTAGE
THE TOTAL FORCE AND THE ARMY RESERVE COMPONENT 467

a TPU member, I explored alternatives. I was able to acquire a drilling 

or TPU position in the Maryland Army National Guard, slotted against 

a “branch immaterial” position. I was initially assigned to the Recruitment and Retention Branch to assist in efforts to retain Soldiers. I have 

served in the Maryland National Guard for 22 years and held such positions as the State Headquarters Detachment Executive Officer and 

subsequently the Commander. At present, most of my duties pertain to 

consulting on the design and data collection of evolving Reserve issues 

relating to psychology. 

Other forms of Reserve service are somewhat limited. Several 

years ago, there were a few Individual Mobilization Augmentee positions supporting the Walter Reed Army Institute of Research and the 

Army Research Institute. Such positions entail serving a 2-week period 

at the unit or at the facility the Reservist is supporting. As of this writing, there is only one IMA position in the Army Reserve, at Fort Rucker, 

Alabama, and two psychologists are slotted against this position. Another possibility for the Reserve research psychologist is to be a member of 

the IRR. In that capacity, the research psychologist can enroll and complete Army correspondence courses to obtain retirement points and is 

also eligible to attend a 2-week training period at an Army school or to 

support a unit. The latter requires funding, if available, and coordination with the receiving unit. 

Conclusion

This chapter provided a broad overview of the history and use of 

the Army Reserve Component. Changes in the structure and organization of the Reserve force in combination with geopolitical events have 

altered the role of the Reserve component, and in turn affected the nature 

of Reserve military service. Many changes have increased the demands 

on Reservists, in particular having to be deployed 1 to 11⁄2 years every 

couple of years. These demands have adversely affected recruitment 

and retention. However, persistent problems in readiness have notably 

improved, and it seems that remedying problems in readiness (such as 

having better training and providing more meaningful duties) improves 

retention since Soldiers looked for such experiences when enlisting 

and see these experiences as better preparing them for deployment. 

They also likely relate to Reservists’ ability to cope with deployment and 

combat stressors, and therefore the probability and severity of PTSD 
468 THE 71F ADVANTAGE

and related symptoms. It is important to assess the three “Rs”—recruitment, retention, and readiness—as the role of the Army Reserve Component evolves. In many ways, the research psychologist is well suited to 

assist in these assessments.

References

Ashforth, B.E., and Mael, F. (1989). Social identity and the organization. Academy of Management 

Review 14 (1), 20–39. 

Associated Press (2008). Military recruiting bonuses grow by 25 percent. International Herald 

Tribune, October 2, 2008.

Barnes, J., Dempsey, J., Knapp, D., Lerro, P., and Schroyer, C. (1991). Summary of military manpower market research studies: A technical report (Report no. FR–PRD–91–08). Alexandria, VA: Human Resources Research Organization. 

Bondy, H. (2004). Postmodernism and the source of military strength in the Anglo West. Armed 

Forces and Society 31 (1), 31–61.

Brailey, K., Vasterling, J.J., Proctor, S.P., Constans, J.I., and Friedman, M.J. (2007). PTSD symptoms, life events, and unit cohesion in U.S. soldiers: baseline findings from the neurocognition deployment health study. Journal of Traumatic Stress 20 (4), 495–503.

Cohen, E.A. (2001). Twilight of the citizen-soldier. Parameters 31 (2), 23–29. 

Commission on the National Guard and Reserves (January 2008). Transforming the National 

Guard and Reserves into a 21st century operational force. Final report. Washington, DC: 

U.S. Congress. 

Currie, J.T., and Crossland, R.B. (1997). Twice the citizen: A history of the United States Army 

Reserve, 1908–1995 (2d ed.). Washington, DC: Office of the Chief, Army Reserve. See 

<www.militaryheritage.org/NationalGuardHistory.html>.

Doubler, M.D. (2003). Civilian in peace, soldier in war, I am the Guard: A history of the Army 

National Guard, 1636–2000. Lawrence, KS: University of Kansas Press. 

Drew, N.S. (1994). NSC–68: Forging the strategy of containment (NSC–20/4, Sec. 21 (a), 31). 

Washington, DC: National Defense University Press. 

Eighmey, J. (2006). Why do youth enlist? Armed Forces and Society 32 (2), 307–328. 

Erbes, C.R., Arbisi, P.A., Courage, C., Polusny, M.A., Thuras, P., and Rath, M. (2008). Contextual predictors of post-deployment symptoms in the RINGS study. Presented at the annual 

American Psychological Association meeting, August 14, 2008. 

General Accounting Office (1992). Operation Desert Storm: Army Guard combat brigade war lessons reflect longstanding problems. Testimony, GAO/T–NSIAD–92–36. Washington, DC: 

General Accounting Office.

Goldberg, G., and Kasirer, M. (1985). Voting patterns among Israel Defence Force soldiers who 

alternate between citizens and reserve soldiers called up for extended military duty. Jewish Social Studies 47 (1), 77–88. 

Griffith, J. (2009). After 9/11, What kind of reserve soldier? Considerations given to emerging 

demands, organizational orientation, and individual commitment. Armed Forces and 

Society 35, 214–240. 

———. (2008a). Institutional motives for serving in the U.S. Army National Guard: Implications 

for recruitment, retention, and readiness. Armed Forces and Society 34 (2), 230–258. 

———. (2008b). Citizens coping as soldiers: Prevalence of post-traumatic stress disorder symptoms 

among deployed reservists. Paper prepared for publication, available from author. 

———. (2006). What do the soldiers say? Needed ingredients for determining unit readiness. 

Armed Forces and Society 32 (3), 367–388. 
THE TOTAL FORCE AND THE ARMY RESERVE COMPONENT 469

———. (2005). Will citizens be soldiers? Examining retention of reserve component soldiers. 

Armed Forces and Society 31 (3), 353–383. 

———. (2002). Multi-level effects of military cohesion on soldier well-being, army identification, 

group disintegration, and combat readiness. Military Psychology 14 (3), 217–240. 

———. (1997). A test of a model incorporating stress, strain, and disintegration in the cohesion 

performance relation. Journal of Applied Social Psychology 27 (17), 1489–1526. 

———. (1995). The Army Reserve soldier in Operation Desert Storm: Perceptions of being prepared for mobilization, deployment and combat readiness. Armed Forces and Society 21 

(2), 195–215.

Griffith, J., and Perry, S. (1993). Wanting to soldier: Enlistment motivations of Army Reserve 

recruits before and after Operation Desert Storm. Military Psychology 5 (2), 127–139. 

Griffith, J., and Vaitkus, M. (1999). Relating cohesion to stress, strain, disintegration, and performance: An organizing framework. Military Psychology 11 (1), 27–55. 

Hintze, W., and Lehnus, J. (November 1996). Recognition of military advertising slogans among 

American youth. Paper presented at the 38th Annual Conference of the International 

Testing Association, San Antonio, TX. 

Hourani, L.L. et al. (2007). 2006 Department of Defense survey of health related behaviors among 

Guard and Reserve force: A component of the Defense Lifestyle Assessment Program 

(DLAP). Research Triangle Park, NC: RTI International.

Kirby, S.N., and Buddin, R. (1996). Enlisted personnel trends in the selected reserve, 1986–1994

(Report No. MR–681/1). Santa Monica, CA: RAND Corporation. 

Jacobson, I.G., Ryan, M.A., Hooper, T.I., Smith, T.C., Amoroso, P.J., Boyko, E.J., Gackstetter, G.D., 

Wells, T.S., and Bell, N.S. (2008). Alcohol use and alcohol-related problems before and 

after military combat exposure. Journal of the American Medical Association 300 (6), 

663–675.

Janowitz, M. (1975). The all-volunteer military as a “sociopolitical” problem. Social Problems 22, 

432–449.

———. (1979). The citizen soldier and national service. Air University Review 30 (1), November–

December. 

Janowitz, M., and Moskos, C.C. (1979). Five years of the all-volunteer force: 1973–1978. Armed 

Forces and Society 5 (2), 171–218.

Knutsen, T.L. (1999). The rise and fall of world orders: The rise and demise of hegemonic powers in 

international politics. Manchester, UK: Manchester University Press. 

Linn, R.R. (1995a). The claim for moral maturity, consistency, and integrity among objecting 

Israeli Soldiers. Journal of Applied Social Psychology 25 (5), 399–417.

———. (1995b). Resistance and motivation—Moral, political, or personal? Israeli soldiers as selective conscientious objectors during the intifada. Social Behavior and Personality 23 

(1), 35–44.

Martin, C.B. (2007). Routine screening and referrals for PTSD after returning from Operation 

Iraqi Freedom in 2005, U.S. Armed Forces. MSMR: Medical Surveillance Monthly Report

14 (6), 2–7. 

Milliken, C.S., Auchterlonie, J.L., and Hoge, C.W. (2007). Longitudinal assessment of mental 

heath problems among active and reserve component soldiers returning from the Iraq 

War. Journal of the American Medical Association 298 (18), 2141–2148. 

Nelson, H.W., Army, H., Jacobs, B., and Bluhm, R.K. (eds.). (2001). The Army. Westport, CT: 

Levin, Hugh, and Lauter Associates. 

Osterberg, D.A. (1990). Reserve component round out of light infantry divisions (Report 

ADA226010). Fort Leavenworth, KS: Army Command and General Staff College, 

School of Advanced Military Studies. 

Orvis, B.R., Shukiar, H.J., McDonald, L.L., Mattock, M.G., Kilburn, M.R., and Shanley, M.G. 

(1996). Ensuring personnel readiness in the Army Reserve Components (Report No. MR–

659–A). Santa Monica, CA: RAND Corporation. 
470 THE 71F ADVANTAGE

Perry, S., Griffith, J., and White, T. (1991). Retention of junior-ranking enlisted in the all-volunteer U.S. Army Reserve. Armed Forces and Society 18 (1), 111–133. 

Schell, T.L., and Marshall, G.N. (2008). Survey of individuals previously deployed to OEF/OIF. In 

T. Tanielian and L.H. Jaycox (eds.). (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery (87–161). Santa Monica, 

CA: RAND Corporation.

Schmitz, E.J. (1990). The Army College Fund and military manpower: A review of existing research

(Technical Report 1572). Alexandria, VA: U.S. Army Research Institute for the Behavioral and Social Sciences. 

Segal, D.R., and Tiggle, R.B. (1997). Attitudes of citizen-soldiers toward military missions in the 

post–Cold War. Armed Forces and Society 23 (3), 373–390.

Segal, D.R., Reed, B.J., and Rohall, D.E. (1998). Constabulary attitudes of National Guard and 

regular soldiers in the U.S. Army. Armed Forces and Society 24 (4), 535–548.

Shavelson, R.J., Haggstrom, G.W., and Winkler, J.D. (1983). Potential for military recruiting from 

two-year colleges and postsecondary vocational schools (Report no. N–1946–MRAL). 

Santa Monica, CA: RAND Corporation.

Shechner, T., Slone, M., and Bialik, G. (2007). Does political ideology moderate stress? The special case of soldiers conducting forced evacuation. American Journal of Orthopsychiatry

77 (2), 189–198.

Smith, T.C., Ryan, M.A.K., Wingard, D.L., Sallis, J.F., and Kritz-Silverstein, D. (2008). New onset 

and persistent symptoms of posttraumatic stress disorder self-reported after deployment 

and combat exposure: Prospective population-based U.S. military cohort study. British 

Medical Journal 336 (7640), 366–371.

Sortor, R.E., Lippiatt, T.F., Polich, J.M., and Crowley, J.C. (1994). Training readiness in the Army 

Reserve components (Report no. MR–474–A). Santa Monica, CA: RAND Corporation. 

U.S. Army Research Institute for the Behavioral and Social Sciences (1976). Research themes and 

technological base program in behavioral and social sciences for the U.S. Army (Technical 

report ADA100830). Alexandria, VA: U.S. Army Research Institute for the Behavioral 

and Social Sciences. 

U.S. Department of the Army (1997). Institutional leader training and education (TRADOC 

Regulation 351–10). Fort Monroe, VA: Headquarters, United States Army Training and 

Doctrine Command.

U.S. House of Representatives (1993). Title XI: The Army National Guard combat readiness reform 

act in the national defense authorization act of fiscal year 1993 (House Report 102–966). 

Washington, DC: Government Printing Office. 

Verdugo, N., and Berliant, K.R. (1989). Estimating the Army’s prime recruiting market (Technical 

Report ARI TR 832). Alexandria, VA: U.S. Army Research Institute for the Behavioral 

and Social Sciences.

Walker, W.E. (1992). Comparing Army Reserve forces: A tale of multiple ironies, conflicting realities, and more certain prospects. Armed Forces and Society 18 (3), 303–323. 

Westat, Inc. (1990). 1990 survey of United States Army Reserve (USAR) troop program unit (TPU) 

soldiers: Final report. Washington, DC: Office of the Chief, Army Reserve.

White, T., and Simpson, J. (February, 1990). Why soldiers really leave the Army Reserve. Military 

Review, 76–77. 

Wormuth, C.E. (2006). The future of the National Guard and Reserves, testimony before the 

Commission on the National Guard and Reserves, June 12, 2006. 

Wyatt, T.C., and Gal, R. (1990). Legitimacy and commitment in the military. Westport, CT: Greenwood Press.
Epilogue

Research for the Soldier: The Story of an 

Army Research Psychologist

James A. Romano, Jr., as told to Richard V.N. Ginn

James A. (Jim) Romano entered the Army in 1978 and served with distinction for 28 years before retiring in 2006. His is a remarkable story, as told 

here to COL Richard Ginn, USA (Ret.). They talked on May 5, 2009, in 

Frederick, Maryland, at Dr. Romano’s office with the Science Applications 

International Corporation.

A Jersey Boy

I grew up in Jersey City, New Jersey. I went to a Jesuit prep school 

there, then to a Jesuit College in Massachusetts, Holy Cross, followed by 

Fordham University in New York. At Holy Cross I majored in psychology, and at Fordham I did a Ph.D. in experimental psychology. I am married to Candy Grimes Romano—the best decision I ever made! To keep 

that in perspective, of all the many good decisions I made, that was the 

best one. We have three children: Candace, our oldest daughter, who’s 

married and has two sons; Alicia, my middle daughter, who is married 

and has one son (and another on the way); and my son Jamie, who’s in 

graduate school now.

My interest in psychology started when I was very young, and it 

is indirectly related to basketball. Some Medical Service Corps [MSC] 

officers and others who served with me know I was a basketball fanatic, 

even in my Active-duty days. As a high school player I would go to New 

York City to Greenwich Village to play. I played some games and then, of 

course, I’d get tired or I would lose, but more likely I would lose! I’d have 

time on my hands, so I would go to the bookstore in Greenwich Village, the 9th Street Bookstore. They had an enormous collection of psychology books and I would go there every week and start reading them. 

The bookstore owner took a shine to me and gave me a chair in the 

corner where I could read. By the time I finished high school and had 

gone on to college, I had read a considerable amount in psychology. To 

get accepted into the Psychology Department at Holy Cross, you had to 

471
interview and have a three-part oral exam. When I interviewed and they 

asked me questions, I was looking at the instructor’s bookcase, and said, 

“Hey, I read that book!” He was astounded by the amount I had read as 

a youngster. I was accepted as a psychology major as a result of that, and 

that was a very good choice. 

Discovering Army Research Psychology

I was at Fordham for a number of years before I finished my 

Ph.D., and while there I was hired into a permanent teaching position at 

Manhattan College. This couldn’t happen today, to be hired into a permanent faculty position before finishing the Ph.D. But in the 1960s and 

’70s, this could happen! I finished my Ph.D. and then was promoted and 

awarded tenure in ’76, but with tenure came a lot of administrative assignments at the university, committees and otherwise. So I reached out 

to a former colleague from college, Rick Manning, who at that time was 

Major Rick [Frederick J.] Manning at the Walter Reed Army Institute 

of Research. Rick put me in touch with some folks who would first of 

all see if I was suitable, and then would process me into the Army, and I 

was accessed as a direct commission into the Army after 10 years of 

university teaching.

In psychology you can go in a number of directions. I went in the 

direction of the scientific side of psychology, experimentation, rather 

than the more applied and clinical sides of psychology. I had an interest in the brain, its development, the development of the receiving characteristics of brain perception, and factors that influenced the development of the brain and its perceptual properties. I had a long-time interest in that and I exploited that in my first assignment in the Army, which 

was at Edgewood Arsenal, Maryland, where they were studying the impact of chemical warfare agents. My mission was to study the impact of 

the antidotes, the countermeasures to those agents, on human perception and performance. 

The Early Years

So I entered the Army in 1978, completed the Officer Basic 

Course at Fort Sam Houston, Texas, and then went to Edgewood Arsenal as a research psychologist. I’m not one to ask for much. I’m very 

willing to accept the assignments given to me by any organization, so I 

didn’t ask for anything other than Edgewood. I assumed, based on what 

472 THE 71F ADVANTAGE
Rick Manning told me, the Army was a great place to work wherever 

you went, and now, after 30 years, I agree with that very much. Wherever you go, you can find the opportunity for great work; I firmly believe 

this. Now sometimes it’s a little harder than others, but there are people, 

normally, at any assignment who will nurture you and help you to succeed and do good work in their organization if they believe that you’re 

interested in doing that.

 I was assigned to the Bio-Medical Research Lab, which later became the Institute of Chemical Defense [U.S. Army Medical Research 

Institute of Chemical Defense, or ICD]. Its name changed several times 

to keep people off the trail! But as with everything, it did actually change 

periodically. We were not in the Medical Department when I first reported there. One year later we were shifted by virtue of an Army staff 

study from something called DARCOM, or Department of the Army 

Materiel Command, into the Medical Department and the USAMRDC 

[U.S. Army Medical Research and Development Command] in, I believe, July of 1979. That was a major sea change for the laboratory. I 

don’t want to denigrate any organization, but it did result in an improvement in the scientific capabilities of the lab. Perhaps, because we were 

in the Medical Department and not in the weapons development arm 

of the Army, so to speak, we were able to get good collaborations going with universities that would be responsive to the Surgeon General’s defensive mission. This was very important, and I think that was a 

major factor in the improvement in the caliber of scientists both in the 

laboratory and those who were willing to collaborate with the scientists 

in the laboratories.

I was at Edgewood Arsenal for 5 years, and I got some additional 

duties that were very instrumental in my subsequent development. The 

Army has a way of giving you work to do that shapes the future work 

that you will do for them, and I was given the job as a custodian of surety 

materials. That sounds like you just owned the vault, but it meant that I 

had to learn all the rules governing surety materials and how to protect 

them, and how to pass the site assistance visits or inspections that accrue to surety materials. I learned a whole armful of Army regulations. It 

was something unique at the time, but the question of surety now is very 

much a significant issue in the Army Medical Department [AMEDD], 

since about 2001. So early on I was given that as an additional duty, and 

it was a good thing for me, because I carried that with me to a couple 

of future assignments where I was able to contribute that experience 

THE STORY OF AN ARMY RESEARCH PSYCHOLOGIST 473
474 THE 71F ADVANTAGE

to policies and procedures, and to the writing of contract clauses that 

MRMC [USAMRDC was reorganized as the U.S. Army Medical Research and Materiel Command in 1994] put in place in the mid-1980s 

to enable universities to work with small amounts of agent, yet adhere 

to the broader principles of Army surety programs. That was sort of a 

compromise policy, but you could only do that if you understood the 

full policy. So that was a good additional duty that I got at the time.

In terms of research projects, we were very interested in the interaction of chemical warfare agents and the endogenous opiate system 

in the body. Some questions that come from that terminology might be 

the stress-enhanced toxicity of chemical warfare agents. Do the things 

that counteract stress perhaps have some impact in counteracting the 

chemical warfare agents and vice versa? I did a lot of that work and 

found some very interesting results, all publishable. I was fortunate to 

have worked with, at that time at ICD, Captain John McDonough [Major John H. McDonough, Jr., MSC, Ret.] and a civilian, Dr. Tony Shih. I 

published in some very reputable journals, which I also believe was an 

important factor in my subsequent vision of uniformed scientists, how 

they should be nurtured and developed at work. 

While I certainly believe that it’s important to publish early in 

your career, later in your career you take on the responsibilities of ensuring that 30 or 40 or 50 or 100 other people can publish effectively. If 

you’re going to do that in the normal progression of leadership in the 

Army, you might need to know what it is to publish, how hard it is, what 

things obstruct it, and what things facilitate it, so you can better manage 

the process for other people.

An officer’s job is to make 30 or 40 or 100 or 1,000 other people 

effective, and in research it’s the same. You could be a great researcher 

and have a certain footprint that you make in your discipline, but you’ll 

make a much more significant footprint if you can make 40 or 50 investigators more effective than they might have been otherwise, and to me 

that’s the goal of the uniformed research scientist. This is not a totally 

accepted view, but my viewpoint is that you must lead. It’s the analogy 

of, I’m 19 years old and if I’m in a squad, my defining goal is to become 

the squad leader, and when I make it there, my next goal is platoon sergeant. To me, that analogy holds true in research. If I’m an investigator, 

my next level is to become a branch chief (if that’s the organizational 

makeup) for seven or eight investigators and make them more productive. Then the step beyond that is to make 30 or 40 investigators more 
productive for the benefit of Army missions. The Army works the same 

all the way across the spectrum.

So at Edgewood, I was just an investigator. My second assignment, after the AMEDD Officer Advanced Course, was to go to Brooks 

Air Force Base, where I was a liaison officer. We finished the Advanced 

Course in Christmas of ’83. I went by way of the CAS3 [Combined Arms 

and Services Staff School] Course to Brooks Air Force Base in April, and 

there I had two assignments in one. That was a wonderful assignment. 

I was an investigator in a lab, and part of that job was to introduce the 

Air Force to what we called the Exempt Surety Program, as the Air Force 

wanted to build a chemical program at the School of Aerospace Medicine. Exempt surety basically means a compromise from the rules that 

might govern the stockpiling of 55-gallon drums of munitions chemical 

agents, to rules for using small amounts in a laboratory. It’s a compromise program that allows you to work in the laboratory. For example, 

if you have chemical munitions and an alarm goes off, the regulation 

called for more than one respondent and they had to have crew-served 

weapons capability for further response. 

Universities do not work like that, but universities might be required to if they had even a small vial of chemical agent. So I was asked 

to contribute to the development of that program there at Brooks as well 

as to conduct my own scientific work. Before 1982 or 1983, there was no 

middle program. The Medical Department was trying to recruit universities as collaborators to strengthen the Army program, but universities 

were not going to adhere to the requirements that governed chemical 

agents at the time. The Army had to adopt what I called a compromise 

program where the security requirement was commensurate with the 

risk. You had to do this without sacrificing the reputation of the Army 

and the safety and the security of the materials. The Army and the Medical Department had to do this, and a number of folks, myself being one 

of the main ones at the time, were asked to write a regulation that universities could live with and therefore work with the Army. This was 

very important to the Army Medical Department, and it was successful.

So I was working on that at Brooks as well as my own scientific investigations. Plus, I was also asked—and this was the odd thing—

to spend half my time as the staff officer in the program manager’s office for Air Force Medical Chemical Defense at the School of Aerospace 

Medicine. That was my first time dealing with staff work. I worked for 

a fellow who spent 7 years in North Vietnam in a prison camp and that 

THE STORY OF AN ARMY RESEARCH PSYCHOLOGIST 475
476 THE 71F ADVANTAGE

[work] was another great experience. Joe Milligan [Colonel Joseph E. 

Milligan, USAF] was released in the prisoner exchange of February 

1973, and he threw out the first ball for the Mets in April 1983. He was a 

tremendous guy, as you might expect, and I learned a lot working with 

him. Of course, he was a true American hero. He was a graduate of the 

“Hanoi Hilton,” and it was amazing to work with him. To say he was unflappable was putting it mildly. Joe shared a couple of anecdotes with 

me. He had a cockroach that was his pet for a while. He would give it 

bread crumbs in the afternoon, and it would climb up to the end of his 

bed. This showed the learned behavior of the cockroach. It’s very interesting—a psychologist puts that twist on it. But yes, it was quite an experience to work with him. He still lives in San Antonio, and he’s retired, 

of course, many years ago.

So I learned a lot from him. People joke, as I often do, about my 

approach to staff work. I have a rule that comes from working with Colonel Milligan. The first rule in staff work is: call the originating officer 

and ask for an extension. And you learn a lot by making that call; that 

was something that you just did. You learn how important it is. 

My second rule was to have a cup of coffee or a Coke, take a pause, 

and think things over. And the third rule was to call the person who is 

the action officer listed at the bottom and talk with them. “What do you 

really want?” So sometimes I would appear to be too casual about approaches to suspense, but that was a learned behavior.

Moving Up the Ranks

The commander of the Institute of Chemical Defense came to 

Texas in the summer of ’84, and he asked me how I liked my assignment. I learned something from him, too. I told him I loved it and it 

was the greatest assignment in the world: “Thanks so much for giving 

me this assignment.” And he said, “Well, Jim, I’m bringing you back to 

the lab next April.” So I learned, don’t crow about your assignment, how 

great it is! I got a year and a half at Brooks. That’s what happens when 

you have such a good assignment and you brag about it. So I came back 

to a branch chief’s role at the Institute. The commander then undertook 

a number of reorganizations, and he created a branch called Plans, Operations, and Training [PO&T]. Now, a lot of people have trouble with 

this. What does that mean in a lab—plans, operations, and training? 

There was training that went on there. We had a course, “Medical Management of Chemical Casualties,” which at that time was more 
THE STORY OF AN ARMY RESEARCH PSYCHOLOGIST 477

of a home-spun small course, one of the AMEDD-sponsored courses. 

It was one of four, I think, that were put in the MRMC as opposed to 

the AMEDD Center and School, because of the unique characteristics 

of the offering. So that would be included as well as the military training, but when the commander asked me to take that position I said, “No, 

I don’t think so.” And he said, “Well, I’ll come back tomorrow and tell 

me what you think.”

I went home and talked to my wife and she said, “Well, he’s asked 

you to come back again, right? I think yes is the answer that you have to 

give, in my mind.” My wife had, by this time, learned what’s best for me. 

So I went back and said, “Yes, sir, I really meant to say yes.” But that was 

an assignment that I dreaded. At the time when I took it I thought it was 

the furthest thing from scientific work. Well, it turned out to be one of 

the most valuable assignments in my career, and the reason for that was 

it was an integrator. It was a PO&T; we had everything but the kitchen 

sink in this branch. We were responsible for the “Medical Management 

of Chemical Casualties” course and the whole reporting requirement 

through the R&D [research and development] system, making sure our 

Institute’s reports were correct. I learned about DTIC, the Defense Technical Information Center, and all the things that go along with that. 

One of the “front burner” issues while I was in that job was a 

tasker we got from OTSG [Office of the Surgeon General] concerning 

a couple of Army IG [Inspector General] reports. One was on medical readiness for deployment, and one was about support of the demilitarization operations in the United States for reducing the stockpile of 

nuclear weapons. They both dinged the Army pretty seriously for not 

having good training programs for the medical support of either combat operations or demilitarization operations. But both of those reports contained almost the same sentence that said the one thing that 

seemed to be different was this course at Edgewood, and if it was made 

more available, then the Army might be able to address this deficiency. 

And here I am at Ground Zero. 

The new commander, Colonel [Michael A.] Dunn, later General 

Dunn, comes in and says, “We’re going to push hard to make this course 

be the go-to requirement for medical training to address this Army deficiency.” I had a couple of jobs to do with respect to that. The first was to 

get the course elevated, and, as an incentive, to get it recognized to go on 

the ORB [Officer Record Brief] of the attending students. That was one 

of my tasks that I worked on with OTSG. General Dunn and I traveled 
to OTSG and we met Colonel [William T.] Tom Gray, who at that time 

was the Comptroller. We briefed Colonel Gray on what financial implications there would be to do this, and he took action. It wasn’t a windfall but we got enough support to bring people TDY [temporary duty] 

in larger numbers. We were also successful in getting it labeled on the 

student’s ORB, which, of course, is a pretty big incentive for someone. If 

they’re going to take time away from a clinic, they’ve got to get some return for it that’s tangible to them, so that was important. 

We made a couple of other adjustments, too. I think the curriculum became more formalized and I believe we extended the training at the time. As to some of the other details, it’s a pretty long time 

ago, but the point was we “plussed up” this course and made it responsive to those IG reports. That was probably one of my major contributions to ICD up to that point. However indirect it was from research, 

it was, nonetheless, a contribution, and General Dunn was supportive 

of me, very much, for that. Then I went up to Fort Detrick, in Frederick, Maryland, to be on the MRMC staff. This was around January 

1988. I was a staff officer in one of the RADs [research area directors], 

the CHEM [chemical] RAD. I was there from ’88 through ’91, during 

the first Gulf War.

 The RAD programs research efforts; it’s like a controller in business. The RAD plans programs out for a few years, and it allocates money to various activities. It also monitors execution and assists the labs 

in reporting. The CHEM program had many labs that were playing in 

this area. As a result, I was able to learn a lot about the various other 

MRMC labs and even visit many of them.

The Gulf War Years

I was there in August of 1990, which you might remember was 

when Iraq invaded Kuwait. That was August 2, I believe, and on August 

6, if I’m not mistaken, I was selected to go with General Russell [Major 

General Phillip H. Russell], the Commanding General of MRMC, to the 

CENTCOM [U.S. Central Command] command element to meet with 

the staff who were planning the response to possible chemical attacks by 

Saddam Hussein. The Army was, I think, accurately concerned about 

the potential use of chemical weapons. In the first week or so of August 

1990 there was only a thin line of U.S. troops to prevent further invasion of the Iraqis should they have chosen to move in. There were real 

concerns about preparatory chemical fire being launched on our troops. 

478 THE 71F ADVANTAGE
THE STORY OF AN ARMY RESEARCH PSYCHOLOGIST 479

I was asked to discuss medical countermeasures to chemical 

weapons, and whether we would be able to fast-track them to get into 

the theater right away. I was asked to talk about three things, beginning 

with a skin decontamination kit. It was interesting because the NBC 

[nuclear, biological, and chemical] cell in their operations section was 

heavily Reservist. I remember talking to two fellows who worked for 

CVS and Rite-Aid and were activated really fast. I had brought a couple 

samples of the skin decontamination kit and a couple of the other countermeasures with me, and they were really appreciative of this information. The MRMC, to its credit, had just taken delivery of a large shipment of skin DECON kits not long before. They were in Pennsylvania, 

with just-in-time delivery. But this kit was so new that it wasn’t in the 

training materials that a Reservist would have. This kit, the M291, had 

a number of significant benefits over the previous kit, the M258 Skin 

DECON Kit, which was not as effective. The new kit was a little better. 

Because we seemed to be providing just-in-time delivery for 

a couple of things, there was also the CANA [Convulsant Antidote, 

Nerve Agent], the nerve agent antidote, which is Diazepam, 10 milligrams, IM with an auto-injector. The Army’s Diazepam, of course, is a 

known anticonvulsant, but not very many of the routinely used anticonvulsants work against nerve agent seizures. Diazepam did, and the Army’s contribution here was to show that in the auto-injector configuration, they can get good distribution of Diazepam throughout the body 

rapidly to counteract the nerve agent. We got that license approved by 

the FDA [Food and Drug Administration] between January and August of 1990 for this protection from a nerve agent—a poison—which 

is important. Fortunately, we did not have to use these countermeasures 

during the war.

There was some concern about putting Diazepam in the hands 

of Soldiers at the time, and the CENTCOM staff had to work through 

and deliberate this issue. My impression was that a really key person in 

the decision process was the CENTCOM surgeon in terms of policy for 

CENTCOM. I seem to remember it was a Colonel Belahar from the Air 

Force, to whom we had to present materials to a couple of times. He was 

open-minded, to his credit.

We were, in a sense, over-prepared in 1991, because chemical 

agents were not used against our troops. But it was good to be prepared, 

and it was based on a real concern about the chemical threat at the time. 

Because of that effort, General Russell took a positive view of me. I was 
a major at the time, and I wanted to go to the Walter Reed Army Institute of Research. But the general and a couple of other fellows would 

not go along with that plan, and I was really discouraged when they sent 

me back to the Institute of Chemical Defense. This was sort of like the 

Plans, Operations, and Training assignment, because I only recognized 

what the right answer was after a couple of attempts. I reported back 

there, and I was put in charge of the Drug Assessment Division. I remember General [Colonel at the time] Dunn when I came in. He said, 

“You’re taking over a failing operation that may not last your time here.” 

Soon thereafter, he changed out and Colonel [Ernest J.] Takafuji came 

in as the commander. However, when I left ICD at the completion of 

my tour, I remember that the incoming deputy commander said, “We 

need to do something to redress the imbalance that is now in favor of 

the drug assessment branch.” That was because we were successful between 1991 and 1995 in terms of moving a couple of products through 

the acquisition channels to advanced development, which is what we 

were supposed to do. So along with that came resources.

In this job, I learned a lot. That was, again, another fabulous assignment, because I learned so much about medical product development and the importance of toxicology and pharmacology research in 

the drug development process. I sat for the American Board of Toxicology exam and became a board-certified toxicologist in 1994, because I really wanted to be able to talk with some credibility in terms 

of drug development to people I was working with who were toxicologists and pharmacologists. Ironically, that’s my key credential for 

my day job today. So that was a good fortune that came along with 

that assignment. 

Finding Fort Detrick

You don’t always know what the reason is at the time, but there’s 

a bigger plan. You can’t anticipate this, and for me it was almost a personal thing. I remember one of my motivations occurred when I was 

speculating about doing the toxicology board, when the Institute’s deputy commander said, “You shouldn’t waste your time studying for that. 

You’re a psychologist, you can’t pass that exam.” That was a red flag. I 

passed it eventually, although it is hard for a psychologist to pass that 

exam, I must say. But I now feel like I can go toe-to-toe with many toxicologists because of my experience and the crossroad that I took to do 

the self-study. So that was a great experience, too.

480 THE 71F ADVANTAGE
THE STORY OF AN ARMY RESEARCH PSYCHOLOGIST 481

After that I was moved back to the headquarters at MRMC to be 

on the staff of Dr. Ana Johnson-Winegar in a combined CHEM/BIO 

[biological] RAD. She told me, “You can’t just stay in your comfort zone 

of CHEM. You have to learn all about the BIO programs in the Army 

and what the big issues are.” That was also another good development 

for me. She later became, at the Department of Defense [DOD] level, a 

very high level person in charge of the program for CHEM/BIO [Deputy Assistant Secretary of Defense for Chemical and Biological Defense 

Programs]. The CG [commanding general] then was [Brigadier] General [Russ] Zajtchuk. Now, as a lieutenant colonel in the Headquarters, 

you get bigger fish to fry, and for him I set up a number of international 

meetings and ran a number of trap lines—major programs where I had 

to brief him—and I guess I did okay. 

For one of the international meetings, I selected the Xerox Center (as it was called at the time) in Leesburg, Virginia. General Zajtchuk 

couldn’t find his way, and his aide let me down. His aide didn’t show 

up; he needed to have that morning off. General Zajtchuk couldn’t find 

his way, so that evening he had an after-action and he said—and this 

is so funny—“I couldn’t find my way. Who picked this place?” Nobody’s hand went up. I raised my hand and I said, “Sir, I picked this 

place.” He looked at me for a moment and said, “Oh, Romano. I’m sorry.” It was so funny. I was upset about his aide who was supposed to 

get him there, but in fact the CG had given him the morning off. So 

it was funny when he said, “I’m sorry.” General Zajtchuk was a very 

nice fellow, and the meeting in the end was really successful. We in the 

CHEM/BIO program reassured the commanding general that we had 

our finger on everything—that one area of his domain was well covered, certainly by Dr. Johnson-Winegar, of course, but then she had 

a staff that seemed to be able to know what was going on and handle 

actions. He selected me to be the Deputy Commander at ICD. I don’t 

know how they feel about me there. They feel a certain way about you 

when you’re in the trenches, but when you get to be deputy and later, commander, they might feel differently because you’re “management.” Yes, you’ve crossed over the divide. But I still have friendships, 

of course, and fond memories of all the assignments. For me, every assignment was better than the previous one. I never expected that. Certainly, I never expected to have a better assignment after 1995 when I 

left the Drug Assessment Division, but every assignment kept getting 

better and better.
482 THE 71F ADVANTAGE

The Mantle of Command

So it was January 1, 1998, when I went back to ICD, and I worked 

under a great commander, Colonel Jim [James S.] Little. Oh, he’s one of 

my heroes. He’s a solid, all-around military officer in every domain in 

which you ask about an officer. I was deputy under him for 2 years. He 

was commander a long time, but then he transferred to CHPPM [U.S. 

Army Center for Health Promotion and Preventive Medicine], and I 

was selected by [Major] General [John S.] Parker to be the commander 

of ICD.

I was the commander for 3 years and that was also a wonderful 

assignment. It’s hard to explain that experience to someone who hasn’t 

been a commander. You have things that happen, parents of employees 

who pass away, or tragic incidents, and you as a commander have to represent the Institute to those people. There was one case where it was just 

a tragic family act of violence and I had to break the information to one 

of my Soldiers. For a few moments, I was representing the U.S. Army to 

that Soldier and I had to get it right. I got immediate assistance from the 

Chaplain and the travel office to help me assist that Soldier. You learn 

other things than just R&D and program management in command, 

and you’d never trade that experience for anything. 

You said I might have had an ICD tattoo! By then, I was of course 

extraordinarily loyal to ICD, but as the commander, you could run the 

risk of thinking that everybody there works for you. I don’t think that 

ever hit me once in my time there. Whenever I met anyone, I felt that I 

worked for them as the commander. I represented them. I was the proponent of that laboratory for its importance in the Army, importance to 

DOD, and importance to the Nation. For commanders, it’s a very paternal or maternal feeling that you have toward your organization; you’d 

do anything for it. “Don’t anyone come here and mess with my organization.” You can tell me what you think is wrong with it and I’ll take 

care of it, but don’t mess with my organization and don’t directly talk 

to my people and tell them things, because you might get them upset. I 

want my people working productively and fruitfully, and from my perspective they all do that. They would all do that whether or not anyone 

bugged them to do it. I mean, you could never lose the loyalty that you 

have to that organization no matter what happens afterward. If I’m still 

alive in 20 years, I will still be passionately loyal to that organization. I 

think that I’m beating a dead horse, but it’s just unbelievable.
THE STORY OF AN ARMY RESEARCH PSYCHOLOGIST 483

Looking Back

You know, I had a very, very fortunate career, almost as if I had 

been groomed from my first assignment for that job somehow, and 

many, many different players were along the way. There wasn’t a plan for 

this, but I went from investigator to staff officer to sort of an inter-service assignment to branch chief to staff in the Army Medical Research 

and Materiel Command, to division chief and then staff and then Army 

lab command in a DOD program, and then MRMC Deputy Commander. It’s almost as if I was being developed all along the way to take command of that organization. 

Within the MRMC, there was sort of an active program of officer development management that may not have been codified in DA 

PAM [Department of the Army Pamphlet] 600–4 [AMEDD Officer Development and Career Management], although we tried to include it later, when I was the Consultant and an Assistant Corps Chief. My whole 

life experience was very much in my mind when we were relooking at 

600–4 in terms of a scientific series officer, as to what that officer’s career should be. You know, 600–4 is just a template, it’s just a normative 

thing that says at this level you take this kind of assignment and you take 

this level of military training, and then at this level you take this kind of 

assignment and these are the corresponding courses that you should be 

looking at along the way. Many of those experiences helped me.

Q: So you’re a part of a larger phenomenon that’s starting to take hold—

Army Medical Department branch-immaterial command. MRMC 

was really ahead of the curve.

A: Yes, MRMC was ahead of the Medical Department in that Colonel 

Little, I think, was such a strong and successful commander that it 

wasn’t going to be hard for a qualified Medical Service Corps officer 

to come along after him to be nominated. I was followed by Colonel 

[Gennady E.] Platoff, who was a Medical Service Corps officer, and 

then Colonel [Brian J.] Lukey, who was also a Medical Service Corps 

officer. And then the string was broken when we had Colonel Tim 

[Timothy K.] Adams as commander, who is a Veterinary Corps officer, but who had similar experiences in terms of development. And 

now, of course, he’s Brigadier General Adams.

Jim Little was an investigator, branch chief, and division chief. He 

went to command in Europe and then came back and commanded ICD. I think he might have been the ICD deputy briefly, under 
Colonel Gary Hurst, but that pattern of progressive assignments in 

lab research leadership has been kind of holding true for a long time. 

I think the current commander, Harry Slife [Colonel Harry F. Slife, 

Jr.], also worked for me. He was an investigator, a branch chief, a division chief, the lab deputy, and now he’s the commander; and he 

worked at the MRMC headquarters in the RAD shop. 

One of the lessons I learned, by the way, in all of this, was that when 

I was asked by General Martinez [Major General Lester Martinez 

Lopez] to be the MRMC deputy commander, I felt that I couldn’t do 

the job to replace Jeff Davies [COL Jeffrey W. Davies] as the deputy 

commander. So I said, “Okay, this seems to be way over my head, 

this job.” And it was, but I said to myself, “If I’m going to go up there, 

I’m not going to fail with other people’s personnel. I’m going to see if 

I have enough influence in the Medical Department to bring a team 

with me.” And somehow I pulled it off. Now, I don’t know if it was 

influence or pure good luck, but I brought five people with me who 

I had watched—two from my role as the 71F [Research Psychology] 

consultant: Mark Vaitkus [Lieutenant Colonel Mark A. Vaitkus] being one of them, and Melba Stetz, then a young captain, a very animated person, very energetic. I thought she’d be the perfect fit for 

the job in the RAD3, the soldier performance RAD. I brought Colonel Lukey [in] as the RAD3. Colonel Slife ultimately became the 

RAD4, which was the CHEM/BIO RAD, and Major Atchison [now 

Lieutenant Colonel Chessley Atchison, VC] worked in the Program 

Office. I brought those five people with me to Frederick. I did everything I could to make sure they were assigned where I was working, and if I was going to go down in flames, I’d go down with people I trust. They, of course, were wonderful people, and successful in 

those operations. Mark Vaitkus is now on the staff at NDU [National 

Defense University]. Interestingly, many 71Fs are very humble too, 

and may say “I can’t do that job.” I remembered telling General Martinez, “I don’t think I can do this job.” Yet at the same time I was reassuring other 71Fs that they can do the job, that I have all the confidence in the world in them, which is true, so there’s an irony there. 

From ICD, I went to MRMC headquarters along with the five people 

mentioned above.

So in 2003, I was Deputy for General Martinez, and Colonel [Mary 

Regina] Gina Deutsch was Chief of Staff. The Deputy and the Chief 

484 THE 71F ADVANTAGE
THE STORY OF AN ARMY RESEARCH PSYCHOLOGIST 485

at MRMC are joined at the hip in terms of supporting the CG, and 

he was a great boss. General Martinez trusted both Gina and me to 

keep his operation going on a daily basis. That, to me, was the biggest fulfillment of the managerial side of my career, that a CG would 

trust me to run his global operation day to day. Well, he trusted us, 

both Gina and me. She’s an extraordinarily competent officer. She’s a 

Kilo [70K, Health Services Materiel]. There’s an MOS [military occupational specialty] or an AOC [area of concentration], and then 

there’s the person. Sometimes the Army raises you above your AOC, 

and that’s why branch-immaterial command, I think, is recognized, 

because through the assignment and education process it raises you 

above an AOC. I don’t mean in the sense that you look down at the 

AOC; that’s not it at all. In fact, it’s quite the opposite. You have a 

great regard for all the AOCs and how they fit in the bigger picture 

of the Medical Service Corps.

Q: Going back to when you entered Active duty, did your expectations 

at that time as to what you would do as a research psychologist in the 

Army live up to what really happened? 

A: You know, when I came in I had hoped that I would be a bench-level 

researcher for most of my career. Many of us come in with this idea. 

I thought I would work on great projects, that I would publish a lot 

and establish a reputation, and if I was lucky I would make lieutenant colonel in 20 years, and then I’d try to get a university position. If 

everything broke right, that would be my dream. 

Well, much of it broke right in the beginning. The Army allows you 

to work hard in the lab and publish and develop yourself. But it puts 

other demands on you too, which have to do with the fact that you’re 

not one individual, you are part of a team, and as a commissioned 

officer the Army expects you to lead. NCOs expect their Soldiers to 

want to lead, I mean, that’s the Army. How can you join the Army 

and say, “I’m going to spend 20 years in the Army and never lead 

anybody?” You don’t know that, though, when you go in. You don’t 

realize that, “Oh, yes, I’m going to cultivate my expertise, but the Army’s going to ask me to use it in ways that I never figured from my 

limited point of view as a university guy.” Even if you’re an ROTC 

graduate, you come in with a limited view of what you can do in the 

Army, and the Army keeps pushing that envelope and telling you 

that you can do more and more and more. 
One of the things I always said was, what’s the highest rank in the 

Army? It’s general. They don’t call them specifics, they call them generals, because they can address a wide range of functions. All of the 

generals that I ever served under or watched were unbelievably astute individuals. I could not believe the human intellect could morph 

that fast, or burrow that deeply into issues. 

[Lieutenant] General [Eric B.] Schoomaker, oh my goodness, 

now there’s a quick study. General Martinez, there’s another quick 

study. These general officers are remarkable. General Zajtchuk, I 

thought, was brilliant. And General Parker, he’s a little bit more 

deliberate than the others. Each was also an individual, but their 

analytic powers are amazing and quick. They are, by their assignment, asked to cover the waterfront, so to speak. Obviously, only 

a very small percentage of people are going be able to do this, but 

the Army tries to make everyone as broad and capable of being a 

general as they can through the assignment and education process. So I wound up sitting as deputy, and even briefly commanding. Between General Martinez and General Schoomaker, I commanded at MRMC. [Lieutenant] General [Kevin C.] Kiley turned 

to me and said, “You’re not just an acting commander. I made you 

the commander.” It was for about 10 or 12 weeks, but that was also 

a remarkable experience. Of course, many things were deferred 

until General Schoomaker came on board, but I had 1 or 2 days 

where I saw what it was like to be the CG. I don’t know how they 

do it. 

I remember one day when I got up at 4:00 in the morning and came 

to Fort Detrick. At about 4:45 we left (I had a driver—that was 

my big perk then). We drove down to a series of meetings in the 

Washington area, two meetings in the morning and an afternoon 

stop at Aberdeen. Then we hit the breast cancer meeting in Philadelphia at night, and I got home at 2:00 the next morning. Now, I 

only had to do that for one day. But General Martinez and General Schoomaker, I watched them doing it day after day after day, 

and being on their toes at every assemblage that they were at. I just 

don’t know how they could do it. They were remarkable, but part 

of what their staff was supposed to do was to get them ready for 

those events. Oh my God, I can’t believe that they could do that! I 

have so much respect for them, it’s amazing. I mean, General Martinez and General Schoomaker, I worked closely with them, and their 

486 THE 71F ADVANTAGE
THE STORY OF AN ARMY RESEARCH PSYCHOLOGIST 487

intellect is way out here. It’s not in that ballpark, it’s way out. I mean, 

they are remarkable.

I don’t think the general public could possibly appreciate the scope of 

what they’re asked to do because it’s outside their range of experience. 

I mean, I couldn’t appreciate it when I was a major. It’s only when you 

stick close to them, and prep them and work with them on things that 

you see the level of energy that they have to bring to the table day after day after day. The Army gets it right, though, when they pick them.

I retired officially on 30 November 2006. Looking back over my career, what was my greatest personal satisfaction? Command, certainly, but there were many things, and they all seemed important 

at the time and then they seemed to pale as you got to bigger challenges. As Deputy Commander of MRMC, one of the things that 

I was working with under General Martinez, and a little bit under 

General Schoomaker, was the campus, the confederation at Fort Detrick [National Interagency Confederation for Biological Research 

and National Interagency Biodefense Campus]. To me, the fact that 

we got that off the ground was very, very significant. It remains to be 

seen, but it could be very, very significant on a national level. 

At Fort Detrick (and this, of course, all spins off of 2001 and the 

national response to the 9/11 attack), since 2003 they have built a 

laboratory for the NIAID [National Institute of Allergy and Infectious Disease], which is another arm of the NIH [National Institutes 

of Health] separate from NCI [National Cancer Institute], but NCI, 

of course, is there as a large presence. There’s also a lab built for the 

DHS [Department of Homeland Security], as well as plans for the 

construction of a new USAMRIID [U.S. Army Medical Research Institute of Infectious Diseases]. There’s a medical logistics joint facility and then a few other lesser construction projects. What you have 

there, then, is not only joint, but enormous interagency pressures on 

a small Army installation. Then you have challenges of integration 

of the different agencies’ business practices, so it remains to be seen 

if they’ll be successful. That’s not a 2- or 3-year process. The garrison 

at Fort Detrick takes the lead in this, and the CG of course. Congress 

has made it so, and put the money there to make it happen.

There is no Army installation that I know of quite like Fort Detrick. 

There is a campus with two Federal agencies, EPA [Environmental Protection Agency] and one of the arms of NIH, at the Research 

Triangle Park in North Carolina, and we looked to them for some 
lessons learned, but they were very different than the challenges here 

at Fort Detrick where the Army supplies the water and the utilities. 

Should the Army do that free for the DHS and for the NIH? Or 

should it ask for fair reimbursement? And you know, those agencies all appropriate their money very differently. It’s remarkable to 

see that it’s still afloat, that this is still working, this confederation 

at Fort Detrick.

Q: So it calls for a spirit of accommodation?

A: Yes, and some agencies are more accommodating than others, I can 

assure you. The Army has been very accommodating. The Army selected Colonel Deutsch after Colonel [John E.] Ball to be the garrison commander, another good call for having the right personality 

type to bring people to the table to talk. I mean, you can’t be rigidly 

uncompromising in that situation or the whole initiative will fail. 

Again, I can assure you there are wide ranges in tolerance and flexibility between the agencies, as well as business practices, but so far 

it’s working. Since I was in on the ground floor, that’s probably one 

of my greatest feelings of accomplishment.

And command, of course, was very satisfying. Bringing the “Chemical Casualty Care” course to a broader customer base far exceeded 

anything I ever thought would happen after 2001, and to make it a 

course that trained Army physicians on a regular basis for their assignments, I think was important. I did that as a major. So at each point I 

had something that stood out to me as a significant accomplishment. 

Now What?

After retiring in 2006, I came to work for SAIC. We have a contract with the NINDS [National Institute of Neurological Disorders and 

Stroke]. We are a prime systems contractor and we integrate the work 

conducted by a dozen or more subcontractors. Our purpose is to find a 

drug to treat spinal muscular atrophy, which is a disease of the newborn. 

There are various tiers of the disease, but Level 1, Type 1 is fatal usually 

in the first year or two, and then Type 2 is a little bit less severe, but usually fatal before age ten. Type 3 is a normal lifecycle, but it’s accompanied by muscular weakness. It’s a small population, so any drug that you 

might get or treatment for this disease would be called an orphan drug.

When I came into the project, for my government points of contact it was, “He’s an Army guy.” And that wasn’t necessarily complimentary. Well, I might not be the most qualified guy, but everything that we 

488 THE 71F ADVANTAGE
THE STORY OF AN ARMY RESEARCH PSYCHOLOGIST 489

developed in the Army for CHEM/BIO is an orphan drug by definition. 

There are no animal models that are really high fidelity, and you’ve got 

to do animal testing to get them approved. So you’ve got a lot of technical work that goes into supporting something that you can’t test in a big 

population, which is the same thing as this disease.

So it turned out that my Army experience was, in fact, quite relevant to this project. I have a view of all of the possible pitfalls and pathways that you can encounter in development, so it was a pretty good 

match for me. Apparently I’m doing okay in the project for the government, but it’s a good application of a subset of skills that I learned in the 

Army. It’s a step backward in terms of program management size, and so 

on, but this disease is cruel to its victims, and I’d really like to be part of 

the group that solves it. I don’t need to be in charge or in command anymore. I have a team of eight and that’s hard enough for me; we’re focused 

on this project and we want to make it work. The great thing is that everything I learned in the Army helps me on this job. 

Do We Need Research Psychologists in Uniform?

Q: If we discuss the 71F research psychology field, I guess the first question could be, why have 71Fs in the Army? Why should research 

psychology be part of the Army’s array of specialties?

A: That’s a big question, actually, and it’s a big question for me because I 

think the answer is easy. It’s easy because there are so many reasons. 

So I’ll try to just kind of take a couple of cracks at it. These are some 

things that I collected while I was consultant for the 71Fs. These are 

papers written by 71Fs; one of the papers is entitled, “The Psychological Resilience of Soldiers.” 

Q: This binder looks like it’s at least 500 pages.

A: Oh, yes. These officers are very productive, but that isn’t the rationale for retaining the AOC, because productivity is assumed. The 

title of this is revealing: “The Psychological Resilience of Soldiers.” It 

doesn’t say “Psychological Problems in Soldiers,” and it doesn’t say, 

“Post-traumatic Stress Disorder in Soldiers.” It doesn’t say, “Occupational Health and Related Problems in Soldiers.” It says, “Psychological Resilience of Soldiers,” and this is the important piece of it. 71Fs 

recognize, of course, all of these other issues and explore them, but 

in the end, uniformed psychologists have, perhaps, a very different 

view of the American Soldier than the media might portray, and that 
490 THE 71F ADVANTAGE

is that these are really awfully strong and psychologically healthy 

people that we have in the military. They look at those things that 

make them like that; they explore those things. Of course, they look 

at the things that might chip away at that: deployments, stressful experiences such as the Gander, Newfoundland, crash [July 20, 1989] 

and recovery of remains, and so on. They’ve explored all of the various domains of the things that nibble away at the psychological 

health of Soldiers, but always with this focus in mind, that the basic starting point is psychological health. These are aberrations, and 

how do we deal with that? How do we deal with these things in such 

a way as to mitigate their effect on the Soldier’s behavioral health? 

The other piece as to why we need them in uniform is that 71Fs 

recognize that the mitigating steps that one would take to, say, reduce deployment stress or impact PTSD [post-traumatic stress 

disorder] and so on, are really not medical steps. They’re unitbased steps; that is, the training and events that go on in the unit 

actually are the most significant things. It’s not really the work of 

the behavioral health system in the clinic; that’s when things have 

gone too far. The basic process of keeping the integrity of the unit’s 

mental health resides in the unit, and you can only understand 

that if you understand the relationship of the Soldier to the unit, 

the unit to the Soldier and his family, the commander to the unit, 

and the impact of a commander on the health of a unit. You need 

to understand that culture, and take the right frame of mind in approaching these problems. Otherwise you fall into the characterization of Soldiers that you’ve seen on TV—burned-out Vietnam 

War vets or Soldiers coming home from Iraq and then shooting up 

somebody. That’s a disservice to our veterans, a big-time disservice. I think to keep the picture straight, you need psychologists, 

who understand the inner workings of the Army, to study the 

problems and then make recommendations about potential solutions. That’s my primary reason for saying that you need them in 

uniform. In uniform they deploy with the units, or they go stateside to various places and stay with the units. They wear a uniform 

that doesn’t differentiate them as Dr. So-and-So, but rather just as 

a fellow Soldier.

Q: The fall of the Soviet Unit coincided with various reductions of 

the Army, such as the series of SERBs [Selective Early Retirement 
THE STORY OF AN ARMY RESEARCH PSYCHOLOGIST 491

Boards]. As I recall, research psychology was being offered up for reductions pretty freely. Was that your impression at the time?

A: Well, I don’t know how freely, but it was offered up, yes. But let me 

ask you, what year are you talking about?

Q: In the late 1980s, early 90s, a whole series of reductions were being 

pushed following the fall of the Soviet Union. They really were looking for cuts in the Army. Remember the “peace dividend”? It just 

struck me that there were sharp knives out for some of the scientific 

specialties of the MSC, and I wasn’t hearing the kind of resistance 

that you would expect that would defend against those cuts.

A: Those are the same sharp knives that came out my last year on Active duty. They have a name for each of these rounds of cuts.

Q: Recently there was the MIL to CIV thing [Army program to convert military positions to civilian slots], which is actually part of the 

same process.

A: Yes, I had to trundle off in my last year to the Pentagon to talk about 

why you need uniformed scientists. How did it go? I was going to say 

it didn’t go well, because the guy who asked for it didn’t really want 

to hear it so he didn’t show up, which I was told was going to happen. I took an NCO with me, and I had him talk about what he did 

while he was in his lab at USAMRIID in the period of 2001 to 2003, 

what he did when he was sent to Iraq, and what he did when he came 

back. What you saw in this very sharp NCO was his learning experience as he was actually leading a Navy unit in the very far north of 

Iraq doing environmental sampling and monitoring. He had a certain focus area in his training before he went to Iraq, and when he 

came back he knew that we needed to look for a lot more things than 

what were studied before. He knew what we needed to do with respect to another biological warfare threat, and he reported this back 

into the program. He modified the direction of the program based 

on his wartime experience. 

I brought the NCO because NCOs are very credible to Pentagon 

executives and senior officers. NCOs are, in fact, where the rubber 

meets the road. I didn’t speak to the fact that he had an officer who 

mentored him before he went, and that the officer who was with 

him in Iraq was the officer that he worked for at USAMRIID. In Iraq 

they were very thin, so he went this way and his officer went that 

way, and then he went back to Fort Detrick after the deployment.
492 THE 71F ADVANTAGE

So, rather than bringing in a Ph.D. officer who would talk in technical terms, I brought in his NCO. We were talking to bureaucrats. 

I didn’t need to talk about the genome for this BW threat versus the 

genome for that threat, or the PCR [polymerase chain reaction] assay and how you need to make modifications. But I did stress that an 

officer learns things in a laboratory, then goes to a theater and comes 

back to apply what he learned in modifying the research that goes on 

in the laboratory, and that uniformed Soldiers have been doing this 

routinely in this war. It’s more the case in this war than it has been 

in the past, at least since Vietnam, actually. My general theme was 

that because they can be deployed into theater, they can apply their 

expertise, which is not unidirectional, but bidirectional. When they 

come back, their experience shapes their research.

Of course, the challenge to that is, “Well, you can put a civilian or a contractor in there.” Of course you could, but I just don’t think you would 

have the flexibility or the appreciation for a unit organization as a uniformed scientist. I don’t know how a civilian would fit into those very 

small, tight-knit deploying units, but I guess they do. The boundaries 

between contractors in theater and civilians in theater are really blurred. 

But the boundaries between the stages of warfare have blurred pretty 

much too, haven’t they? So I could be a company commander in a 

unit that could engage in humanitarian assistance operations in the 

morning, significant combat operations in the afternoon, and nationbuilding the rest of the day, and I would have to adjust my unit’s 

protocols to all of them, which is an enormous challenge. This goes 

way beyond identifying friend or foe, it’s just rapidly tuning up and 

down the military unit on a switch.

Just as the types of warfare have blurred, so have the demands on the 

individuals. Let me give you another example, and this goes along 

with what I was just saying. When I was Deputy Commander we 

had two guys awarded the Purple Heart from MRMC. Two guys 

awarded the Purple Heart from MRMC? What did they do? Well, 

one was a comptroller, [Colonel] Elias Nimmer. He was in a hotel 

that was bombed by a rocket attack and was seriously hurt. He was 

there to help the medical infrastructure in Iraq, to rebuild how they 

do appointment scheduling and ordering, billing, and collecting. He 

was a comptroller, but he was helping to rebuild and strengthen the 

Iraqi medical infrastructure.
THE STORY OF AN ARMY RESEARCH PSYCHOLOGIST 493

And then we had another young fellow [Captain Brian J. Walrath] 

who was near Abu Ghraib and got the Purple Heart. He was a health 

facilities planner, which is a 70K 9I. What was he doing? Well, he 

was over there to design the conversion of a facility into a medical 

clinic to serve the Iraqi population, and he got a Purple Heart. 

So you had these fellows in a clearly nationbuilding role, yet they’re 

building nations in the midst of combat. Just as the phases of warfare have blended, so have the required military unit structures. I 

think one thing that you have to worry about is, are the organizations still accurate? This is just my view. The TO&E [Table of Organization and Equipment] doesn’t have a comptroller or a health facilities planner in any of the units that these guys were assigned to, 

but the Army adapts and brings in the people that it needs to provide that expertise.

So I wouldn’t ask the question anymore, “Why do we need them 

in uniform?” I would say this: We’re way past that, and the question now in Iraq and Afghanistan is, “Where do we need them in 

uniform?” That’s my view. Where could we best put these technical, administrative, and scientific experts? Research psychologists? 

I would have a research psychologist paired with the division psychologist. He’s a healthcare provider, and a research psychologist is 

a data gatherer. They’re very different roles, but they intersect at that 

point, and they would work, then, for the division surgeon. That’s 

where I would put them. Now, I know that structure is changing too, 

if they still even have division surgeons—I presume they do. And 

what is in a BCT [Brigade Combat Team]? I think there is still a Division Surgeon.

Looking Ahead

Not long ago, I told a couple of young 71Fs that I wish I was starting over again as a research psychologist today. They have so many opportunities. For me, there was a certain frustration—not a great deal of 

frustration because my career was wonderful, it was the greatest—but I 

beat the drum for 30 years on PTSD and traumatic brain injury as under-recognized wounds. So I retire and, boom! Now those are probably 

the signature injuries of this current conflict. The recognition of the importance of these injuries signals another major change in military medicine over the last 30 years. It had already taken place probably 10 years 
494 THE 71F ADVANTAGE

ago, but now it’s really on the front burner, and DOD can’t get away with 

saying, “That’s a VA [Veterans Administration] problem. That injury is 

a VA problem.” That thinking is out of place today. The Army and the 

DOD are expected to apply the treatment that restores the person to full 

health even if they can’t keep them in the Army. They’re expected to ensure a continuity of care for the Servicemember as he or she transitions 

from Active duty to retirement. Furthermore, they’re expected to provide the treatment that restores the person to full functioning, so that 

when they leave they are as close as they can be to when they came in. 

So the boundary (just like all other boundaries, I’ve learned) between 

where the Army lets go and the VA picks up is very much blurred. The 

general public doesn’t care, and now that I’m a veteran I don’t care anymore either. I cared when I was in the Army, but I don’t care now, because caring about that boundary is fruitless.

The coming together is going to happen, and one of the things 

that might drive it is the unifying of the medical record. The Army 

has of course been using AHLTA [Armed Forces Health Longitudinal 

Technology Application—the DOD electronic health record] for some 

time. We wish we could find something better. But this problem is being worked on with vigor. The Veterans Administration of course has its 

own system. One of the things for the VA and the DOD is one of them 

has to give. Either the VA gives up its current system, which is built on 

an older platform, and rebuilds it from scratch so that it can marry up to 

the DOD system, or the DOD has to give. Psychologists are right in the 

middle of that. The injuries they study (for example, PTSD, TBI [traumatic brain injury]) are, in fact, right at the blurring boundary between 

the active force, DOD, and the VA. 

One of the things that I have to qualify this with is that the 71Fs, 

as a group, are pretty good at studying the Active force, but they don’t 

have accessibility to the Reserve force, and this is another thing that the 

DOD and VA have to resolve. The Reserve force is very distributed and 

it’s hard for the 71Fs to capture that population and to do followup studies for redeploying Reservists. That’s a challenge for all of DOD medicine. But the 71Fs do have pretty good ability now, more than ever, really, to look at the unfolding of problems in the Active force.

Q: Are the clinical psychologists and the research psychologists working as a combined arms team?
THE STORY OF AN ARMY RESEARCH PSYCHOLOGIST 495

A: I don’t believe so. If they are, that’s news to me. That would have only 

happened in the last year or so. They’re pretty much independent. 

As just one example, in the Medical Service Corps the research 

psychologists are grouped with the applied scientists, MFA [Medical Functional Area] 71, and the clinical psychologists are in MFA 

73, the behavioral sciences, with social workers—they’re healthcare 

providers. 

Their assignment patterns are very different, and I don’t believe 

there are any task forces that have necessarily united them. They 

have an occasional Medical Special Augmentation Team or the like 

that has joint membership, but there’s no formal integrating mechanism in the Army for that. That may not be such a problem now that 

these problems are highly visible. In the past these behavioral health 

problems were not so visible, thus it was more difficult for the things 

that were written about by 71Fs to reach decisionmakers, especially since these decisionmakers always have other burning issues on 

their plate.

Let me give you a good example of a 71F statement that never really got traction. I asked you what year you were talking about with 

the fall of the Soviet Union. I think in the mid-1980s, Rick Manning wrote that the Cold War was ending and another hot war was 

just beginning and had already begun, and by that I mean the 1983 

bombing of the Marine barracks in Lebanon, the attack on the USS 

Cole [October 12, 2000], and before that the Khobar Towers in 1996. 

He argued that it was going to be a lot harder on Soldiers when the 

Cold War ended, because we were no longer stationed and poised 

against another force as in Korea or Germany. We were going to be 

deploying all over the world, and that will turn out to be harder on 

the Soldiers. That was written I think, in ’82 or ’83 by Rick Manning. 

How right was that? How anticipatory was that?

The other thing is, you of course remember all of the hubbub, 

and rightly so, about Abu Ghraib? About 5 to 10 years before Abu 

Ghraib, research psychologists wrote that any deploying force that 

goes into an area and does any kind of peacekeeping mission will 

witness an Abu Ghraib–type phenomenon at a certain percentage 

rate. Two to six percent of any deploying group of soldiers from 

Denmark or the U.S. or Great Britain or Canada or Nigeria or 
496 THE 71F ADVANTAGE

elsewhere reported observing an Abu Ghraib phenomenon while 

they were deployed by the United Nations or NATO [North Atlantic Treaty Organization]. So 71Fs recognized the prevalence 

at a low level, but a persistent low level around the world of Abu 

Ghraib–type atrocities. Maybe if that had gotten more traction, 

more visibility, and more assessment, then possibly Abu Ghraib 

might have been anticipated and deflected.

So they touch on problems that are real, and sometimes when a 

problem goes awry, it’s an embarrassment to the whole country. I 

think in the case of the 71Fs, it’s not a question of should they be 

in uniform, but where should they be, and where are they best deployed? From my perspective as a 71F, you have to take that with a 

grain of salt, but I have watched what these people have been doing 

for 30 years, and as you see from this compilation of papers, they 

generally point out things that need to be addressed. That’s what scientists are supposed to do, point out things, and verify that they are 

real in the sense that the science says this is a phenomenon that is 

actually validated. These are more descriptive models than predictive. Yet they are predictive when they try to recommend mitigation 

approaches. But those mitigation approaches are harder to validate. 

In my last 5 years of Active duty, I was appointed by [Brigadier] 

General [Richard L.] Ursone to his senior leader team. Remember 

his deputies Jim Solomon and Dave Burns [Colonel James G. Solomon and Colonel David C. Burns]? General Ursone is tremendous, 

and together they were mentoring and developing a senior leader 

team. In Las Vegas, in November 2000, we set a target of what would 

be the primary purposes of the senior leader team, something that 

we would tackle over the next couple of years. Communication was 

number one, then competence; you probably have touched on this 

when looking at the Medical Service Corps. So we set forth a plan 

of what kind of activities would help to advance the Medical Service 

Corps in each of these areas. 

I’ll just kind of talk about the area of communication. We did a lot 

of study on that. We plussed up the material in the Corps Chief’s 

letter, and tried to push hard to make it hit every Medical Service 

Corps officer. We then expanded the senior leader team to include 

all of the consultants. We tried to make sure that the consultants, 

as well as the senior leader team, would push out the news through 
THE STORY OF AN ARMY RESEARCH PSYCHOLOGIST 497

their channels. Many of the consultants, me included, didn’t have a 

newsletter before that. I got two young officers to do the newsletter 

for me to just say, more or less, where the Corps is going, what General Ursone is doing with the senior leader team, and so on. We also 

exploited use of Web pages more than in the past, keeping up with 

AKO [Army Knowledge Online].

Much of that was public service announcements, just keeping people 

informed of the activities of the Corps, such as a birthday ball and 

the various Silver Caduceus Societies. Later, we pushed through the 

annual report as a much more collective development that focused 

on young officers and their contributions. If you read some of that 

stuff, it was great. They did reach the young officers and trumpet 

them, not the colonels. I think there are many many officers whose 

careers were influenced by those communications in their view of 

the Medical Service Corps and the assignment process, and their experience was positively influenced by the annual report.

Another area where we tried to work, and this was a little bit harder, 

was what I think you can call relevance. This included the assignments process, making sure that the education that an officer completed, in particular their graduate training, when they came out 

of that educational experience, their skills were used in their next 

assignment. This required getting good linkage between the HRC 

[U.S. Army Human Resources Command] and the consultants in 

terms of the assignments process, a linkage that maybe wasn’t as 

strong as it could have been before. 

We even tried to influence the education experience by having a 

uniformed officer make contact with the officer in graduate school 

(I think we were trying to do this) to shape whatever their papers 

were that they had to do to accomplish their requirements so that 

they might pick a topic that was relevant to their next assignment. 

We worked on trying to shape that, and that’s very hard to do. We 

tried to get more money for more opportunities for education, and 

I think some money came out. We tried to also push what they call 

continuing education, where you have an annual or biannual meeting of an AOC. It’s called PPSC [postgraduate professional short 

course]. We’d try to get more money for that, and General Ursone 

was pretty successful. His successor, [Brigadier] General [Sheila R.] 

Baxter, adopted and expanded that with her deputy, Colonel Lisa 
498 THE 71F ADVANTAGE

Weatherington, from my perspective. They talked about education 

and its value, and the instructions to promotion boards were influenced by the whole series of meetings of the senior leader team and 

the consultants.

The Corps chiefs were, in fact, very responsive to input from the 

Corps. It was remarkable how responsive they were despite enormous constraints within the Army system. I can’t remember if it was 

General Ursone or General Baxter, but they then established a field 

leader team of majors who went to these meetings and then they 

were expected to go out and promulgate the news, “the Gospel.” I 

think that was a good development when they brought them in. 

They have a very different viewpoint than colonels.

But that was good. It was good for the colonels to hear what they had 

to say. But communication to me was the major problem. It still is, 

but there were improvements, and I would suspect that over my last 

5 years in the Medical Service Corps they made enormous improvements in the communication to the field. To me that was extremely 

important, because in my first few years I didn’t hear much from the 

Corps. As a young officer, you hardly even knew it existed, and if it 

did exist you thought it was in San Antonio. So it was very different 

later and that’s good, that’s very good.

The Road to Success

Looking ahead to the future of 71Fs and the MSC, I would take 

a cue from General Martinez. He came and spoke to us at a Silver Caduceus meeting at Fort Detrick, and later, General Schoomaker said 

pretty much the same thing during another meeting at the Community Center. I want to repeat what they said because I respect them 

so much. They’re not Medical Service Corps officers. They’re physicians in the Medical Corps, but they certainly recognized the value 

and contributions of Medical Service Corps officers, no doubt in my 

mind about that.

 I remember General Martinez talking about officers asking for an 

award and saying, “I did something, can I have an Army Achievement 

Medal or an ARCOM [Army Commendation Medal] for it?” I think 

that’s not what an officer does, but officers have asked me for awards 

when I was more senior, and when they did that I think they lost something, in my view, I really do. So my answer is related to the flip side 
THE STORY OF AN ARMY RESEARCH PSYCHOLOGIST 499

of that. It’s all about service. Serve well. Serve the Army well; serve the 

country well. Serve with a passion, serve as if somebody is watching 

and thinks what you’re doing is extremely important, because it’s true. 

Somebody is watching you as an officer, and thinks that what you’re doing is important. If you slip up or do something unethical or behave 

improperly, that sure as shooting will be noticed. But if you quietly serve 

with a passion and with devotion to the mission, that is also noticed and 

the rewards come on their own without asking. Rewards will come, and 

they may not be in the form of an ARCOM or an Army Achievement 

Medal. It may be your name that comes to mind when a challenging assignment is open, and a leader is asked if they have anyone who can step 

in and help us with some particularly important thing. Leaders tend to 

look to those who serve quietly with strength to fill those positions, and 

that’s the reward for this service. At the end you could retire from the 

Army with just an MSM [Meritorious Service Medal] and an ARCOM, 

yet you have served the country tremendously. You could have served 

the country brilliantly and gotten nothing more than those awards.

But it’s not about that. It’s about service, and service brings recognition, not only to you but to your unit and to your AOC. If you’re a 71F 

and you do a good job in a 71F position, and you point out things that 

go all the way up to the Surgeon General (“I have identified a problem 

here and I need to work on it”) he or she may not remember the name of 

the officer who made the discovery, but will probably remember it was a 

psychologist who pointed this out. Then on the way back down, it’s incumbent on those leaders to determine if there was any recognition and 

then give it as appropriate. General Schoomaker and General Martinez 

both said the same thing at these Silver Caduceus Society meetings, and 

I really believe that.

I was fortunate. People looked out for me all along the way. I think 

they looked out for me because I was trying. I certainly never got it all 

right in my assignments; I always made mistakes. Colonel Little once 

told me, “You made a mistake, but a sure-fire strategy to avoid a mistake 

was to not do anything.” That was one of his mottos, that you try and 

you work, you explain what you’re doing and it will come to you—good 

assignments, recognition if warranted, and rewards on a personal level 

that are really much more important than medals. I actually don’t know 

where my awards are, but I’m very proud of my career and it was rewarding to me. I don’t know where my medals are. They’re somewhere 

in my basement. If I find them I would be very proud of them, but I 
500 THE 71F ADVANTAGE

don’t need them to remind me that I had a wonderful career and had 

great blessings. They’re just part of the periphery. If I got an award at a 

ceremony, to me the message was more to the people junior to me—that 

the organization will reward you for effort.

But that to me addresses, at the Corps level and the AOC level, the 

best strategy for making yourself relevant, which is to do the best darn 

job you can at the mission the Army gave you, and it will somehow get 

noticed and factored into the equation. You should be proud of everything that you do for the Army because the Army wouldn’t have a 71F or 

a Medical Service Corps if somewhere along the way at the highest levels in the country someone didn’t determine that they were needed. Why 

would an Army now currently fighting wars on two fronts have excess 

AOCs? Why would it have an excess Corps? They’re there because along 

the way they’ve been revalidated time and time again. So if the question 

comes up in 2011, “What about 71F?” (and it probably will come up in 

2011; there’s no TO&E for those officers), if they say “Keep them,” that’s 

a national decision that says we still need them, and that’s pretty significant and rewarding in and of itself. That an Army compelled to be lean 

and mean still recognizes the need for a 71F speaks volumes. And it also 

speaks volumes that an Army that is now providing healthcare in very 

demanding conditions recognizes that there’s a Corps that is currently 

providing the best possible administrative, transportation, and logistical 

support to that healthcare system. 

So, if the question comes up, “Should we combine the logisticians 

with the Army logisticians?” or “Should we combine the aviators with 

Army aviation?” or “Should we combine the administrative officers 

with Army administrative officers?”—yes, that’s going to come up, just 

like the research people. It’s not offensive. It’s an Army trying to make 

sure that it’s prepared to fight a war on multiple fronts with very limited 

resources. And every time they come down in your favor, that’s a revalidation of your career and your mission.

It’s a wonderful thing. I would have never expected this. Thirty 

years ago when I came into the Army, I was very selfish. I wanted to 

do research and publish papers. That was my goal. Now I look back on 

it and I say, “Gee, I did stuff that was important for the United States 

of America. Holy cow.” I mean, that’s wonderful. It’s so wonderful. You 

don’t want to wind me up and send me into a university because I’d be 

pitching it to the graduate students and the medical students as one of 

the greatest things that they can do in their life!
About the Contributors

Editors

Paul T. Bartone, COL (Ret.), USA, Ph.D., is a Senior Research Fellow 

in the Center for Technology and National Security Policy at the National Defense University (NDU). A Fulbright Scholar, Bartone has 

taught leadership at the Industrial College of the Armed Forces (ICAF) 

at NDU and at the U.S. Military Academy, West Point, where he also 

served as Director of the Leader Development Research Center. Bartone 

was the senior Research Psychologist in the U.S. Army and has served as 

Consultant to the Surgeon General for Research Psychology and as the 

Assistant Corps Chief for Medical Allied Sciences. He is also past President of the American Psychological Association’s Division 19, Society 

for Military Psychology. He earned his Ph.D. in Psychology and Human 

Development from the University of Chicago.

Ross H. Pastel, LTC, USA, Ph.D., serves as an Assistant Professor in 

Medical and Clinical Psychology at the Uniformed Services University of the Health Sciences (USUHS). His previous assignments have included the Walter Reed Army Institute of Research (WRAIR), the U.S. 

Army Science and Technology Center, Far East (Japan), Armed Forces 

Radiobiology Research Institute (AFRRI), U.S. Army Medical Research 

Institute for Infectious Diseases, and U.S. Army Medical Research and 

Materiel Command (USAMRMC). He earned his Ph.D. in Neural and 

Endocrine Regulation at the Massachusetts Institute of Technology and 

did postdoctoral research at the Western Psychiatric Institute and Clinic 

in Pittsburgh, Pennsylvania. 

Mark A. Vaitkus, COL, USA, Ph.D., is Associate Professor of Behavioral Science in the Strategic Leadership Department at ICAF. His prior assignments have included Deputy Technology Program Manager for the 

Future Force Warrior Soldier system, Deputy Director and Chief of Research at the Army Physical Fitness Research Institute at the U.S. Army 

War College, Sociology Program Director in the Department of Behavioral Sciences and Leadership at the United States Military Academy, 

Deputy Director at the U.S. Army Medical Research Unit in Heidelberg, 

Germany, and Research Psychologist at WRAIR. He holds a Ph.D. in sociology from the University of Michigan and an M.S. in National Resource 

501
Strategy from ICAF. He is an author and co-editor of The U.S. Army Guide 

to Executive Health and Fitness and The Total Trainer CD-ROM.

Contributing Authors

Gina E. Adam, MAJ, USA, Ph.D., is assigned to the U.S. Army Research 

Institute of Environmental Medicine, where she investigates cognitive 

performance of the warfighter. Her research interests include the study 

of performance under dual- or multiple-task situations, the use of physiological measurements such as heart rate and eye tracking to understand 

the relationship of task performance to the stress of cognitive overload, 

and the impact of environmental stressors on higher order cognitive 

performance. Her recent work has involved analyzing marksmanship 

performance in cold and dehydration conditions, assessing judgment 

and decisionmaking in calorically deprived Soldier volunteers, measuring multiple task performance at sea level and at moderate and high altitudes, and assessing several domains of judgment and decisionmaking 

at sea level and high altitude. 

Gary A. Adams, Ph.D., is a Professor at the University of Wisconsin–

Oshkosh. His research interests include older workers and occupational stress and health. He has made over 50 professional presentations at 

national conferences such as those sponsored by the American Psychological Association, the Society for Industrial and Organizational Psychology, and the American Psychological Society. He has published two 

books, several book chapters, and over 25 articles in journals such as 

Personnel Psychology, Journal of Applied Psychology, Journal of Occupational Health Psychology, Journal of Organizational Behavior, and Educational and Psychological Measurement.

William F. Blakely has been a Staff Scientist with AFRRI for over 25 

years. He is the Biodosimetry Research Group Advisor for the institute and the course director for USUHS’s Radiation Biology graduate 

course. He also serves as a U.S. representative on the ISO TC85/SC2 

(Radiation Protection) Working Group 18 (Performance Criteria for 

Service Laboratories Performing Biological Dosimetry by Cytogenetics), Chair of a NATO Research Study Group–Radiation Bioeffects and 

Countermeasures, was a founding member of AFRRI’s Medical Radiobiology Advisory Team, and is on the National Council on Radiation 

Protection and Measurements.

502 THE 71F ADVANTAGE
Paul D. Bliese, LTC, USA, Ph.D., joined the WRAIR as a member of an interdisciplinary team studying stress and adaptation 

among Army Soldiers. While at WRAIR, he has studied Gulf War 

syndrome, the adaptation of Soldiers deployed on peacekeeping operations, the impact of new technology implementation, the effects of 

long-term activation on National Guard and Reserve units following 

September 11, and the health of Soldiers returning from Iraq. LTC 

Bliese’s research interests include occupational stress, leadership, and 

multilevel methodology. As an outcome of these interests, he has 

published a number of theoretical papers examining the value of 

multilevel analyses in leadership and occupational stress research. 

He has written and maintains the multilevel package for the open 

source statistical language R. 

Michael W. Boye, MAJ, USA, Ph.D., has been with the U.S. Army Medical Research Detachment since 2005, where he has been conducting research in the area of color vision and serving as the statistical consultant 

and reviewer for several research protocols. Previously, he was assigned 

to the U.S. Army Aeromedical Research Laboratory at Fort Rucker, Alabama, where he examined the relationships of job and life stress to the 

job performance of Army helicopter pilots. He received his Ph.D. from 

DePaul University with an emphasis in research and organizational psychology and has over 20 years of experience as a research psychologist 

and organizational consultant. MAJ Boye is a member of the American 

Psychological Association.

Thomas W. Britt, Ph.D., is a professor in the Department of Psychology at Clemson University. From 1994 to 1999, he was an Active-duty 

Research Psychologist for the U.S. Army and deployed in support of 

multiple military operations. Dr. Britt continues to do research on the 

determinants of resiliency among military personnel and the stigma of 

seeking treatment for psychological problems in the military.

Lolita Burrell, MAJ, USA, Ph.D., began her military career in March 

1999 and is currently an assistant professor at the United States Military Academy. Prior to entering Active duty, MAJ Burrell earned her 

Ph.D. in Medical Psychology at the Uniformed Services University of 

the Health Sciences. MAJ Burrell’s research experience includes conducting studies in the areas of stress, post-traumatic stress disorder, biofeedback, upper extremity disorders, Soldier performance and injuries, 

nutrition, and military family health. 

ABOUT THE CONTRIBUTORS 503
Joel Carter is an Intelligence Analyst for the Department of Defense 

and is a graduate student in the Security Policy Studies Program at The 

George Washington University Elliott School. Mr. Carter served in the 

82d

 Airborne Division from 2000 to 2003, during which time he deployed to Afghanistan. 

Carl Andrew Castro, COL, USA, Ph.D., is the Director of the Military 

Operational Medicine Research Program, Headquarters, USAMRMC. He 

began his military career as an infantryman in 1981 and joined the Medical Service Corps after obtaining his Ph.D. from the University of Colorado. Over the past 18 years, he has served in a variety of research positions, 

including as Chief of the Applied Pharmacology Branch at the U.S. Army 

Medical Research Institute of Chemical Defense (USAMRICD), Assistant Program Manager at AFRII, Director of the Primate Research Facility at WRAIR, and Commander of the U.S. Army Medical Research Unit– 

Europe, in Heidelberg, Germany. COL Castro’s operational experience includes tours of duty in Iraq, Bosnia, and Kosovo. He has authored over 60 

scientific articles and reports in numerous research areas. 

Matthew G. Clark, MAJ, USA, Ph.D., obtained his Ph.D. in Behavioral and Neural Sciences at Rutgers University and is a certified defense acquisition professional. He has served in research and leadership 

positions at two Army medical research laboratories and commanded a medical company in Korea. Prior to his current position managing capability integration at the Army Asymmetric Warfare Office on 

the Army Staff, he served as the Deputy Commander of the U.S. Army 

Medical Materiel Development Activity. He also serves as a consultant 

on various deployment-related military medical issues and research.

Michael N. Dretsch, CPT, USA, Ph.D., is Chief of the Cognitive Assessment and Diagnostics Branch at the U.S. Army Aeromedical Research 

Laboratory. He is an experimental psychologist with a background in 

Cognitive Neuroscience techniques, and is currently involved in validating automated neurocognitive test batteries for the assessment of 

mild traumatic brain injury (mTBI) and identification and validation 

of behavioral, imaging, and serum biomarkers for both mTBI and posttraumatic stress disorder to improve diagnostic accuracy and develop 

return-to-duty guidelines. 

Doris Durand, Ph.D., is retired from the Department of Military 

Psychiatry at WRAIR. Her specialty was Army families. Prior to her 

retirement, her major projects involved the study of deployment on Active duty, Reserve, and National Guard Soldiers and their families.

504 THE 71F ADVANTAGE
Edward N. Edens, CPT, USA, Ph.D., is a Research Psychologist in the 

Department of Military Psychiatry at WRAIR. Prior to joining the 

Army in 2007, CPT Edens spent over 10 years in corporate America as 

a senior research analyst for The Gallup Organization. Since joining the 

Army, CPT Edens has taken the lead with the WRAIR Land Combat 

Study in analyzing data and putting together briefs for the 160th and 5th

Special Forces Group at Fort Bragg. 

Sandra M. Escolas, LTC, USA, Ph.D., is the Assistant Dean for Research 

and Academic Affairs at the Academy for Health Sciences, Army Medical Department Center and School at Fort Sam Houston, Texas. LTC Escolas also serves as the Human Protections Administrator for the Army 

Medical Department Center and School and as a member of the Brooke 

Army Medical Center Institutional Review Board. She recently was on 

deployment orders for Iraq with a follow-on deployment to Afghanistan 

with the Institute of Surgical Research’s Deployed Combat Casualty Research Team.

Richard V.N. Ginn is an Historian with the Army’s Office of Medical History. He is a retired Army Medical Service Corps officer, health 

care company chief executive officer, and veteran of Vietnam, where he 

served with the 173d

 Airborne Brigade. Ginn is the author of The History of the U.S. Army Medical Service Corps (U.S. Army Center of Military History, 1997) and In Their Own Words: The 498th Medical Company (Air Ambulance) in Iraq (U.S. Army Office of Medical History, 2009). 

James E. Griffith, COL, USA, Ph.D., serves as the Research Psychology 

Consultant (Reserve Component) to the Chief, Medical Service Corps, 

and provides research consultation to the Recruitment and Retention 

Branch, National Guard Bureau. His primary Army Reservist role is 

on the staff of the Joint Forces Headquarters, Maryland Army National 

Guard. While on Active duty, COL Griffith conducted research on military personnel manning systems and human dimensions issues at the 

Department of Military Psychiatry at WRAIR. He left Active duty in 

1986 and entered the Maryland Army National Guard where he continues part-time military service. He received the “A” proficiency designator in research psychology from the U.S. Army and was given Fellow 

status by the American Psychological Association and American Education Research Association.

Charles W. Hoge, COL, USA, M.D., leads a psychiatric research program at WRAIR focused on mitigating the mental health impact of 

the current wars in Iraq and Afghanistan. He served in the U.S. Public 

ABOUT THE CONTRIBUTORS 505
Health Service as an Epidemiology Intelligence Service officer at the 

Centers for Disease Control and Prevention before transferring to the 

Army in 1991, where he spent 6 years conducting field studies related 

to the treatment and prevention of tropical infections. He completed his 

residency in psychiatry at Walter Reed Army Medical Center in 2000. 

He has over 70 peer-reviewed publications, including a landmark article 

in the New England Journal of Medicine (January 2008) on mild traumatic brain injury among U.S. troops returning from Iraq. 

Steven R. Hursh is the President of the Institutes for Behavior Resources 

and Professor of Behavioral Biology, Johns Hopkins University School 

of Medicine. Dr. Hursh is a retired Army research psychologist and 

served as Director of the Neuropsychiatry Division, Walter Reed Army 

Institute of Research, and as the 71F Consultant to the Surgeon General 

of the Army. Hursh is the author of over 65 articles, book chapters, and 

books. He holds the patent for the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTE) Model used by the Federal Railroad Administration, the Federal Aviation Administration, and the Federal Motor Carrier Safety Administration to assess fatigue in transportation workers. He 

received his Ph.D. from the University of California.

William D.S. Killgore, MAJ, USA, Ph.D., is a Research Psychologist 

at McLean Hospital and Harvard Medical School, where he has been 

on the faculty for the past 10 years.   Following the 9/11 attacks, Dr. 

Killgore transferred to Active duty status in the U.S. Army as a Research 

Psychologist and served as Chief of the Neurocognitive Performance 

Branch in the Department of Behavioral Biology at WRAIR.  Most of 

his research has focused on the effects of sleep deprivation and combat 

stress on high-level cognitive capacities, including judgment, decisionmaking, and risk-taking propensity, as well as functional neuroimaging studies of affective disorders, anxiety, post-traumatic stress disorder, and brain development.  He has published over 75 peer-reviewed 

manuscripts, 140 conference abstracts and presentations, and numerous 

book chapters. 

Thomas A. Kolditz, COL, USA, Ph.D., is Professor and Head of the 

Department of Behavioral Sciences and Leadership at the United 

States Military Academy. He has served in an array of military tactical 

command and technical staff assignments worldwide, commanding 

troops through battalion level and acting as a leadership and human resources policy analyst in the Pentagon. COL Kolditz has published more 

506 THE 71F ADVANTAGE
ABOUT THE CONTRIBUTORS 507

than 40 articles in academic, military, and leadership trade journals and 

serves on the editorial and advisory boards of several academic journals. His most recent book, In Extremis Leadership (Jossey-Bass, 2007) 

focuses on leadership in dangerous contexts. He holds Master’s and 

Doctoral degrees in Social Psychology from the University of Missouri. 

Gerald P. Krueger, COL, USA (Ret.), Ph.D., spent 25 years in the Army, 

serving as a Human Factors Scientist at the Army Human Engineering 

Lab, Military Advisor for the Defense Advanced Research Projects 

Agency in Vietnam, Deputy Chief of Behavioral Biology at WRAIR, 

Staff Officer at the Army Medical Research and Development 

Command, and Division Director at the Army Aeromedical Research 

Laboratory. He culminated his career as Commander of the U.S. Army 

Research Institute of Environmental Medicine. Krueger is a recognized 

authority on sustained human performance, especially of equipment 

operators experiencing sleep deprivation and fatigue during sustained 

operations. Among his continuing activities, he is an adjunct associate 

professor of military psychology at the Uniformed Services University 

of the Health Sciences.

David M. Lam, M.D., retired from the Army in 2001 after 30 years of Active military service and now serves as Adjunct Associate Professor at the 

University of Maryland School of Medicine, from which position he has 

been seconded to the U.S. Army’s Telemedicine and Advanced Technology Research Center (TATRC) in Fort Detrick, Maryland. He works primarily in the areas of telemedicine standardization, project development, 

and deployment of systems, mostly in the North Atlantic Treaty Organization (NATO) and Partnership for Peace nations. Currently, he serves as 

the TATRC European Liaison Officer, responsible for maintaining links 

to researchers in Europe, including with the NATO Medical Community, 

the European Space Agency, and the European Commission. 

Ira H. Levine is a Senior Computer Scientist with AFRII and has served 

as head of the Information Technology Department for 20 years. He designed and programmed both the Biodosimetry Assessment Tool and 

First-responder Radiological Assessment Triage. Mr. Levine holds an 

M.S. in computer science from Johns Hopkins University and a B.S. in 

physics from the State University of New York–Stony Brook.

Philip Lewis, Ph.D., is a Professor Emeritus of Psychology at Auburn 

University, where he recently served as Acting Head of the Department 

of Music. He received his Ph.D. in Clinical Psychology from Syracuse 
University and completed an internship in clinical psychology at Duke 

University Medical Center. His interests encompass adolescent and 

adult personality development, the assessment and development of 

managerial conceptual capability, and the role of individual differences 

in the workplace. Dr. Lewis was a co-investigator in a longitudinal study 

of West Point cadets and is currently involved in a longitudinal study of 

transformational change in Harvard M.B.A. students.

Sharon A. McBride, LTC, USA, Ph.D., is Chief of the Battlemind Transition Office at WRAIR. She received her Ph.D. in Experimental Psychology from American University, after which she was commissioned 

as a captain in the U.S. Army. She has had assignments at AFRII, the U.S. 

Army Research Institute of Environmental Medicine, and USAMRMC 

Congressionally Directed Medical Research Programs. She deployed to 

Afghanistan in 2007 as a member of the Mental Health Advisory Team 

to evaluate the mental health of deployed Soldiers. 

Dennis McGurk, MAJ, USA, Ph.D., has been commander of the U.S. 

Army Medical Research Unit–Europe since 2007. In previous assignments, he was a Research Psychologist at WRAIR, the Senior Science 

Officer on the U.S. Army Surgeon General’s Mental Health Advisory 

Team (MHAT) IIb in Afghanistan and MHAT IV in Iraq, and Assistant 

Department Chief in the Department of Military Psychiatry at WRAIR. 

He has published in peer-reviewed journals, authored book chapters, 

and presented at numerous scientific and military conferences around 

the world. He is a member of NATO Technical Team HFM 179 Moral 

Dilemmas and Mental Health Problems and NATO Exploratory Team 

104 Mental Health Training. 

Craig A. Myatt, LTC, USA, Ph.D., is the Command Psychologist assigned 

to the Command Surgeon’s Office at the U.S. Special Operations Command, MacDill Air Force Base. Previous assignments include as Chief of 

the Information Management Division, Weed Army Community Hospital, Fort Irwin, California, and as Commander of the 145th Medical Battalion. He also was a Fellow at the University of Texas M.D. Anderson Cancer 

Center. In 2006, he obtained an individual tasking for deployment to Iraq 

as the Deputy G4, Task Force 3 Medical Command (Operation Iraqi Freedom 06–08) and resumed battalion command in September 2007 upon 

redeployment. He is the co-author of several neuroscience publications.

James Ness, LTC, USA, Ph.D., is currently assigned as an Engineer Scientist Exchange Program Officer to the Streitkräfteamt, Bonn, Germany. 

508 THE 71F ADVANTAGE
ABOUT THE CONTRIBUTORS 509

Previously, he was an Associate Professor at the U.S. Military Academy, 

West Point. Throughout his career, LTC Ness has performed work ranging from researching the effects of directed energy on vision and visual 

performance to researching the social networks of terrorist groups. In 

recognition of his accomplishments across the breadth of the field of 

research psychology, the Army awarded LTC Ness the “A” proficiency 

designator.

Marek Rewers was a Research Assistant at the Center for Technology 

and National Security Policy. He is completing his M.A. in Security 

Policy Studies at The George Washington University, where he focuses 

on Political Psychology and Transnational Security.

Lyndon A. Riviere, Ph.D., has been a Soldier and Family Mental Health 

Research Scientist in the Department of Military Psychiatry at WRAIR 

since September 2005. He is the principal investigator of the Land Combat Study II protocol, “Impact of deployment and combat experiences 

on the mental health and well-being of military service members and 

their families.” Dr. Riviere has presented his research findings and departmental training products at military and professional meetings and 

is currently working on book chapters on Army families. His research 

interests include National Guard Soldiers, military families, and mental health. 

James A. Romano, Jr., COL, USA (Ret.), pursued a Ph.D. in Experimental 

Psychology from Fordham University and was in academia at Manhattan 

College before entering the U.S. Army in 1978. He attained the status of 

Diplomate in General Toxicology. He had several commands and served 

as the Surgeon General’s Consultant in Research Psychology, where he 

worked as a recruiter, assigner, advisor, and proponent of 71F officers. 

Joseph M. Rothberg, Ph.D., is an Adjunct Associate Professor of Psychiatry at USUHS. After serving as a draftee in the Army, he completed his undergraduate education at the Illinois Institute of Technology and his M.S. and Ph.D. at the University of Chicago. He retired 

as a Senior Scientist from WRAIR after 26 years with the Division of 

Neuropsychiatry.

Charles A. Salter, LTC, USA (Ret.), Ph.D., S.D., is Director of the Office of Scientific Management at USUHS. He served 9 years at AFRRI 

as Director of the Medical Effects of Ionizing Radiation course and also 

as senior military scientist on the biological dosimetry team. He holds a 
Ph.D. in psychology from the University of Pennsylvania and a Doctor 

of Science in public health from Harvard University. 

David J. Sandgren is a Research Biochemist in the Biodosimetry Research group at AFRRI and serves as the senior laboratory manager on three intramural protocols addressing basic science and applied 

biodosimetry applications. He obtained his B.S. and M.S. in Genetics 

from Iowa State University and previously worked at the U.S. Department of Agriculture in Ames, Iowa. 

Maurice L. Sipos, LTC, USA, Ph.D., is Chief of the Research Division at 

USAMRICD, where he previously served as Director of the Behavioral 

Assessment Laboratory, Chief of the Advanced Assessment Branch, and 

Director of the Collaborative Research Program. Past assignments have 

included serving as a research psychologist at WRAIR and as the Deputy Director for Research at the Army Physical Fitness Research Institute 

at the U.S. Army War College. He obtained his Ph.D. from the Department of Psychology at Lehigh University.

Melba C. Stetz, MAJ, USA, Ph.D., is the Director of Research in the 

Department of Psychology, Tripler Army Medical Center, Hawaii. Her 

research area is combat stress. She has worked in both laboratory and 

managerial positions in places such as the WRAIR, USAMRMC Headquarters, and the U.S. Army Aeromedical Research Laboratory. 

Jeffrey L. Thomas, MAJ, USA, Ph.D., is the Deputy Department Chief 

of Military Psychiatry at WRAIR and the Assistant Team Chief for the 

6th Mental Health Advisory Team for Operation Enduring Freedom. 

His previous assignments include Executive Officer for the 5th Mental 

Health Advisory Team and Chief of Soldier Deployment Mental Health 

at WRAIR. His involvement in deployment mental health research includes work with U.S. Army Europe operations tempo studies, Army 

Suicide Evaluation Report, Psychological Screening Validation Studies, 

Psychological Debriefing Efficacy Studies, WRAIR Land Combat Studies, and the Battlemind Training Studies. 

Michael D. Wood, CPT, USA, Ph.D., is assigned to the U.S. Army Medical Research Unit–Europe, in Heidelberg, Germany. Previous to that 

he was at the Walter Reed Army Institute of Research. He has been deployed to Iraq to support the Mental Health Advisory Team V. His research interests include how agents such as benefit finding and morale 

may buffer the stress of deployment and stigma to mental health care 

and lead to resilience. 

510 THE 71F ADVANTAGE
Index 

Abrams Doctrine, 457

Abu Ghraib, 484–496

academic psychology: versus Army research 

psychology, 4; assignments in, 32–34

accidental deaths: alcohol-related, 293–294; 

Gulf War and, 299–300; Vietnam War 

and, 297

acetylcholinesterase, 349–350

acquisition, FAST teams and, 413–424

Active Duty for Special Work, 453, 454t

Active Guard/Reserve Soldiers, 453, 454t

acute radiation sickness (ARS), 319, 329–330

Acute Radiation Syndrome Responses Assessment, 361

acute respiratory distress syndrome, 335

Adam, Gina E., 22, 24, 79–90

Adams, Gary A., 373–393

Adams, Timothy K., 483

Administrator Console, in LDP, 154–155

Afghanistan: mental health advisory teams in, 

210–211, 231–242; Reserves and, 458

AFRRI. See Armed Forces Radiobiology Research Institute

AFTB. See Army Family Team Building

age: and benefit finding, 252; and career intentions, 402; and effects of sleep loss, 67; and 

suicide, 296

Agent Orange Syndrome, 322–323

agreeableness, 129, 176–177, 441; gender and, 

133

AHLTA. See Armed Forces Health Longitudinal Technology Application

AH–1S laser range finder, 94

Aidman Vision Screener (AVS), 91, 107–109; 

advanced, development of, 109–115, 

111t, 112f–113f, 114t; research directions 

for, 114–115

AKO/DKO. See Army Knowledge Online/Defense Knowledge Online

alcohol abuse: in Afghanistan, 233–234; families and, 378–379; and fatal accidents, 

293–294; in Iraq, 214–215; and suicide, 

288, 290

alienation, 252

Allgood, Brian, 421

altitude, and executive functions, 86–87, 87t

altruistic suicide, 286

AMC. See Army Materiel Command

AMEDD. See Army Medical Department

Amsler grid, 106, 108

AN/AAS-38A laser designator system, 94–95

angiography, 102–103

anomic suicide, 286

anthrax, 315, 333

anticholinergics, 346, 348

anticonvulsants, 346

anxiety: in Afghanistan, 231–232, 233f; and 

families, 401–402; in Iraq, 212–213, 213f

APFT. See Army Physical Fitness Test

Armed Forces Health Longitudinal Technology Application (AHLTA), 494

Armed Forces Radiobiology Research Institute (AFRRI), 357, 360; Adult/Pediatric 

Field Medical Record, 361; Biodosimetry 

Worksheet, 361; Emergency Radiation 

Medicine Response Pocket Guide, 360

armored MEDEVAC vehicles, 417–422

Army: attitudes toward, families and, 381; demands of, and families, 373, 380, 383–384, 

384t. See also under United States Army

Army Family Team Building (AFTB), 378

Army Knowledge Online/Defense Knowledge 

Online (AKO/DKO), 142, 173n1, 497

Army Materiel Command (AMC), 413

Army Medical Department (AMEDD): experiences in, 425–433, 473; FAST teams, 

in Iraq, 413–424; input from, need for, 

415–417

Army National Guard, 452; and families, 381–

382, 382t, 388–389

Army Personality Tool, 155–162

Army Physical Fitness Test (APFT), 173n9; 

training scenario on, 153, 167–170

Army Rangers, research on, 427

Army research psychology (71F), xxii, 1–44; 

career paths in, 7–11, 47–57, 425, 483–

488; and clinical psychologists, 494–495; 

in combat operations, 423–424, 492–493; 

definition of, 4–6; experiences in, 3–4, 

47–57, 425–433, 435–449, 471–500; future of, 35–41, 493–500; importance of, 

489–493, 496; and Reserves, 466–467

Army Suicide Event Report (ASER), 306

Army Training and Leader Development Panel (ATLDP), 143

Army Unit Resilience Analysis (AURA), 49

Army War College (AWC), 141

511
512 THE 71F ADVANTAGE

ARS. See acute radiation sickness

Arthur, Donald C., 35

ASER. See Army Suicide Event Report

Association of the U.S. Army (AUSA), 143

Atchison, Chessley, 484

ATLDP. See Army Training and Leader Development Panel

Atomic Veterans Syndrome, 322, 332–333

atropine, 345–348; safety assessment of, 350–351

attention deficits, mTBI and, 267–268

augmented cognition, need for research on, 

35–36

AURA. See Army Unit Resilience Analysis

AUSA. See Association of the U.S. Army

AutoSleep algorithm, 53–54

AVS. See Aidman Vision Screener

AWC. See Army War College

Balkin, Tom, 50

Ball, John E., 488

Balloon Analogue Risk Task (BART), 83

Bartone, Paul T., xxi–xxiii, 17, 19, 33, 121–140, 

283–312

Bass model, 128

BAT. See Biodosimetry Assessment Tool

Battlemind training, 18; adequacy of, 229–

230, 241–242; recommendations for, 243

Baxter, Sheila R., 497

Beatrice, Edwin S., 27

behavioral health: in Afghanistan, 231–235; 

chemical warfare agents and, 345–346; 

and families, 378–379, 381, 384–386, 

385t–386t, 401–402; investigation of, 209; 

in Iraq, 212–216; multiple deployments 

and, 221–222, 222f; operations tempo 

and, 438; sleep loss and, 223–224; and 

well-being, 211f

behavioral health care: barriers to, 227, 227t, 240, 

240t; seeking, effects of, 225–227, 226t, 240; 

system, investigation of, 209–210

Be-Know-Do model of leadership, 123–124

Belenky, Gregory, 16, 50

belongingness, and suicide, 287

benactyzine, 348

Bench initiative, 141

Benchworks Web site, in LDP, 152–154, 173n7

benefit finding (BF), 247–260; history of, 249–

252; research directions on, 256–258; 

theory on, 248–249

benefit reminding, 248

Bennett, Thomas, 25

Bevin, Thomas, 25

Binnendijk, Hans, xix–xx

biodosimetry, 357–370; concept of, 359–360

Biodosimetry Assessment Tool (BAT), 357, 

362–365; dose assessment algorithms, 

human databases used in, 364t; flowchart, 362, 362f; hematology data entry 

screen, 363–364, 365f; summary screen, 

364–365, 366f

biological agents, 333–335

biopsychosocial (BPS) applications, 435, 439, 

445–446

bioscavengers, of nerve agents, 349–350; safety assessment of, 351

biperiden, 348

Blakely, Kenneth, 142

Blakely, William F., 357–370

blast injury, and mTBI, 261

Bliese, Paul D., 17–19, 209–245, 395–410

Bloomquist, Douglas, 30

Bold Shift initiative, 461

bonuses, versus intangibles, 462–463

Bosnia, benefit finding in, 253–256

botulism, 315

Boye, Michael W., 24, 27, 91–118

BPS. See biopsychosocial applications

Brady, Joseph V., 12, 47, 56

brain. See traumatic brain injury

brain imaging, 269–275; biomarkers for, 

276–277

brain receptor imaging, 273–274

Branch, Laurence G., 30

branch-immaterial command, 467, 483, 485

Britt, Thomas W., 247–260

Burdick, Charles, 26

Burns, David C., 496

Burrell, Lolita, 19, 22, 373–393

butyrylcholinesterase, 349

Bynum, James, 23

Cabrera, Oscar, 19

caffeine: effects of, 72–74; and vigilance, 80

CAGE scale, 378–379

California Personality Inventory, 132

caloric deprivation, and executive functions, 

84–85, 85t

Canadian Defence and Civil Institute of Environmental Medicine, 22
INDEX 513

carbohydrates, and vigilance, 80

carbon monoxide poisoning, and suicide, 293

career intentions: evaluation of, 399, 399f; factors affecting, 400t; regression analysis on, 

403, 403t; unit climate and, 395–410. See 

also retention intentions

caring, and leadership, 442–443

Carter, Joel, 283–312

Castro, Carl Andrew, 17–19, 26, 30, 373–393

casualty evacuation (CASEVAC), 419–420

CBRN. See chemical, biological, radiological, 

and nuclear weapons

Center for Epidemiological Studies for Depression Scale, 379

charismatic leadership, 128

chemical, biological, radiological, and nuclear 

(CBRN) weapons, 315–340; psychological effects of, 315–316, 319–323

chemical warfare agents (CWAs), 323–328; 

behavioral toxicity of, 345–346; bioscavengers of, 349–351; in Gulf War, 478–479; 

history of, 341–343; mitigating effects of, 

341–355; physiological toxicity of, 343–

345; research on, 474–475; safety with 

therapeutics against, 350–351

Chernobyl accident, 329–330, 358

child care, 397

chlorine gas, 323, 341

cholinesterase inhibitors, short-acting, 346

ciprofloxacin, 333

Clark, Matthew G., 341–355, 413–424, 431

coach’s journal, in LDP, 149

cognitive changes, mTBI and, 263, 268–269

cognitive research: on augmented cognition, 

35–36; on environmental stress effects, 

79–90; sleep loss research, 47–57, 59–77

cognitive resources model, of leadership, 126

color vision: advanced Aidman Vision Screener and, 111–113, 112f–113f; assessment 

of, 105; laser exposure and, 98

combat: Army research psychologists in, 

423–424, 492–493; eye injury assessment 

in, 91–118; and judgment errors, 60; psychological aspects of, need for research 

on, 36; and suicide, 291–292

combat and operational stress control 

(COSC), 438

combat and operational stress injury (COSI), 439

combat and operational stress responses 

(COSR), 439

combat exposure: in Afghanistan, 235–237, 

236t–239t; and career intentions, 402, 

404, 407–408; in Iraq, 216–217, 238t–

239t; and PTSD, 250–251; Reserves and, 

465

combat stress casualties (CSC), 320

commitment to mission: leadership and, 131–

132; Reserves and, 464–465

communication: FAST teams and, 421; mTBI 

and, 268 

community integration: and families, 375–

376, 381–382, 382t; need for research 

on, 390–391; and retention intentions, 

386–390, 387t; study of, 377–378

computed tomography (CT), 269–270

conceptual work capacity, 132

concussion: term, 263. See also mild traumatic 

brain injury

confrontational field test, 106

conscientiousness, 129, 177, 441; in cadets, 

160

consciousness, theories of, 145–156

contingency model, of leader effectiveness, 

124–125

contrast sensitivity, measures of, 104–105

coping, 252; families and, need for research 

on, 391

cornea, laser exposure and, 98–99

COSC. See combat and operational stress control

COSI. See combat and operational stress injury

COSR. See combat and operational stress responses

Cote, David O., 22

Cotting, Dave, 17–18

Crampton, George, 25

creativity: in leaders, 175–206; measurement 

of, 196. See also openness

creativity study: concurrent validity in, 

187–188, 188t; correlational analyses in, 

187–191; factor analyses in, 185–187, 

186t–187t; histograms in, 192, 193f; limitations of, 199–200; measures in, 181–

184, 182t–183t; methods in, 180–184; 

multivariate analysis in, 194–195, 196t; 

reliability analyses in, 189–191, 189t; 

results in, 185–195; within-instrument 

scale orthogonality in, 188, 189t

CSC. See combat stress casualties

CT. See computed tomography
514 THE 71F ADVANTAGE

cultural intelligence, and openness, 178

CWAs. See chemical warfare agents

Davies, Jeffrey W., 484

DCDD. See Directorate of Combat and Doctrine Development

decisionmaking: assessment of, 82–84; classical approaches to, 60–64; errors in, 60; 

mTBI and, 268; sleep loss and, 59–77

Defence and Civil Institute of Environmental 

Medicine, Canada, 22

Defense and Veterans Brain Injury Center 

(DVBIC), Clinical Practice Guideline and 

Recommendations, 264

demilitarization operations, 477–478

Department of Homeland Security (DHS), 487

deployment(s): in Afghanistan, 237; Army research psychologists and, 6; and families, 

389, 396; in Iraq, 217–221; medical readiness for, course on, 477–478; recommendations for, 243; research on, 427; and 

suicide, 291–292, 301. See also multiple 

deployments

deployment length: and benefit finding, 254, 

255f; effects of, 217–218, 219f; and suicide, 296, 302–303

depression: in Afghanistan, 231–232, 233f; 

and families, 379, 389, 401–402; in Iraq, 

212–213, 213f

Desert Shield/Storm, Operations. See Gulf War

designators, 94–95

Deutsch, Mary Regina “Gina,” 484–485, 488

Developmental Box, in LDP, 154–155

dextroamphetamine, 74

DHS. See Department of Homeland Security

diazepam, 346–349, 479

diffusion tensor imaging (DTI), 270–271; with 

fMRI, 276

Directorate of Combat and Doctrine Development (DCDD), 418

distress, and CBRN event, 321–323

diversity, need for research on, 37–38

divorce intent: in Afghanistan, 233; deployment length and, 220, 220f; in Iraq, 214. 

See also marital functioning

dosimetry. See biodosimetry

Dretsch, Michael N., 24, 261–282

Drilling Individual Mobilization Augmentees, 

453, 454t

drilling Reservists, 452–453

drug abuse. See substance abuse

DTI. See diffusion tensor imaging

dual-career couples, 395, 397–398

dual-task demands, 81–82

Dunn, Michael A., 477–478, 480

Durand, Doris, 373–393

DVBIC. See Defense and Veterans Brain Injury Center

Eddy, Doug, 52

Edens, Edward N., 18, 395–410

education, and career intentions, 402–403, 

486, 497–498

effectiveness, thwarted, and suicide, 287

Eggemeir, F. Thomas, 30

egotistical suicide, 286

Ekman 60 Test, 83

electronic communications, 41

electronic health records, 494

Elsmore, Timothy, 14, 52, 54

emotional intelligence, 69; sleep loss and, 

73–74

emotional stability. See neuroticism

Emotion Hexagon Test, 83

emotion relief, and suicide, 307

English-language learners, need for research 

on, 37

Environmental Protection Agency (EPA), 487

Epworth Sleepiness Scale, 432

Escolas, Sandra M., 34, 283–312

ethical violations: in Afghanistan, 234–235; 

deployment length and, 220–221; in Iraq, 

215–216; reporting, effects of, 228–229, 

228t, 241; and well-being, 211f

ethics training, adequacy of, 230

executive functions: altitude and, 86–87, 87t; 

assessment of, 82–84; caloric deprivation 

and, 84–85, 85t

Exempt Surety Program, 475

Expert Field Medical Badge, 6

explosives: improvised explosive devices, 418–

419; and suicide, 290

extraversion, 129, 176, 440–441; gender and, 133

eye charts, 103–104; in advanced Aidman Vision Screener, 110, 111t, 114t

eye injuries: assessment of, 91–118; current assessment approaches, 101–109

family issues: coping strategies, need for research 

on, 391; demographics and, 373, 395, 398, 

401t, 402–404; need for research on, 38; re-
INDEX 515

search directions for, 373–393; unit climate 

and career intentions, 395–410

Family Readiness Groups (FRGs), 377–378

Family Support Groups (FSGs), 377–378

Fantino, Edmund, 47

Fanzone, Joe, 48, 54

Farnsworth-Munsell 100 Hue Test, 105

FAST. See Fatigue Avoidance Scheduling Tool; 

Field Assistance in Science and Technology Teams

fatalistic suicide, 286

fatigue. See sleep loss

Fatigue Avoidance Scheduling Tool (FAST), 

52–55

fears: peripheral to terrorist event, 319–320, 

329–331, 358–359; for Soldier safety, by 

families, 375, 380. See also mass panic

Federal Railroad Administration (FRA), 

53–54

female Soldiers: experiences of, 425–433; hardiness in, 131, 133; LDP and, 166; need 

for research on, 37; personality traits and 

leadership in, 132–134; research on, 21

FFM. See five-factor model

Field Assistance in Science and Technology 

(FAST) Teams, 413–424, 431–432

firearms, and suicide, 288, 293, 295–296, 298

First-Responders Radiological Assessment 

Triage (FRAT), 357–358, 365–369; input 

screens, 367f, 368; schematic, 366–367, 

367f; triage dose assessment screens, 

368–369, 368f

five-factor model (FFM), 129–130, 159, 176–177

fluorescein angiography, 102–103

fMRI. See functional magnetic resonance imaging

Fort Detrick, 30–32, 487–488

FRA. See Federal Railroad Administration

FRAT. See First-Responders Radiological Assessment Triage

FRGs. See Family Readiness Groups

Friedman, Philip, 30

FSGs. See Family Support Groups

functional magnetic resonance imaging 

(fMRI), 270–273; with DTI, 276

fundus camera, 102

fusion analysis approach, FAST teams and, 

417–418

gas weapons, 323–324, 341

GCS. See Glasgow Coma Scale

gender differences: in personality traits and 

leadership, 132–134; and suicide, 288, 

295. See also female Soldiers

GHOST. See green handheld optical surveillance and targeting system

Gifford, Robert K., 13, 17–19, 30, 34, 36

Ginn, Richard, xxiii, 471–500

Giuliani, Rudolph, 317

glare sensitivity, measures of, 105

Glasgow Coma Scale (GCS), 263

Glenn, John Frazier, 21, 26, 30, 48

Goiania accident, 330–331, 357

Goldwater-Nichols Department of Defense 

Reorganization Act, 414

Graeber, R. Curtis, 21

Gray, William T., 478

green handheld optical surveillance and targeting system (GHOST), 95–96

green laser-baton illuminator, 96

Griffith, James E., 17, 451–470

Grossman, Eugene, 27

grounded theory approach, 135

growth: and leadership, 444; post-traumatic, 

247–260

Gulf War: experiences in, 478–480; non-battle 

deaths in, 298–299, 299t; Reserves and, 

458; and suicide, 297–300, 298t

Gulf War Illness, 322

HAGA. See heavy armored ground ambulances

Hamilton, Bruce, 23

hardiness, 121, 130, 441, 446–447; gender and, 

131, 133; and leadership, 131–132

Headley, Donald B., 25

heavy armored ground ambulances (HAGA), 

422

Hegge, Frederick W., 15–16, 47

HEL. See Human Engineering Lab

Helios laser system, 96

Help Desk, in LDP, 151–152

high altitude, and executive functions, 86–87, 

87t

Hiroshima, 331–322, 358

Hofmann, Mark A., 23

Hogan Personality Inventory, 132

Hoge, Charles W., 395–410

Holgate, Stanley H., 19, 25, 29–30

Holly, Franklin F., 24

hopelessness, and suicide, 286
516 THE 71F ADVANTAGE

human dimensions: definition of, 37; need for 

research on, 36–37

Human Engineering Lab (HEL), 8, 27–29

humor appreciation, sleep loss and, 73

Humphreys Field Analyzer II, 106–107

Huntoon, David, 141

Hursh, Steven R., 14, 16, 47–57

Hurst, Gary, 484

hydration, and vigilance, 80

hypothermia management kits, 416

identification, as Soldier, and readiness, 463–464

IGT. See Iowa Gambling Task

illuminators, 95–96

improvised explosive devices (IEDs), 418–419

Inactive National Guard, 451

India, plague in, 333–334

Individual Mobilization Augmentees, 453, 454t

individual morale: in Afghanistan, 231, 232f; 

and career intentions, 405–406; evaluation of, 400; in Iraq, 212

Individual Ready Reserve, 451, 454t

indocyanine green angiography, 102–103

Ingraham, Lawrence H., 17, 19

inhalant abuse, in Iraq, 215

intangibles, and recruitment/retention, 462–463

Integrated Unit Simulation System (IUSS), 51

intelligence, and openness, 178

international networking, 40

International Personality Item Pool (IPIP), 

161, 183

Internet, and family support, 397

intuition, 62–63

Iowa Gambling Task (IGT), 65–67, 82; caloric 

deprivation and, 84–85, 85t

IPIP. See International Personality Item Pool

Iranian chemical attacks, 324–326, 342

Iraq: benefit finding in, 253–256; FAST teams 

in, 413–424, 431–432; mental health advisory teams in, 210–231; Reserves and, 

458; suicide in, 301–304, 302t

Isgrig, Frederick, 30

Ishihara Color Test, 105

Israel, Scud missile attacks on, 326

IUSS. See Integrated Unit Simulation System

Jobe, Jared B., 22

Johnson, Richard F., 30

Johnson-Winegar, Ana, 481

Joint Capabilities Integration and Development System (JCIDS), 414–415

joint research projects, 40

Joshua Omvig Veterans Suicide Prevention 

Act, 308

journal, coach’s, in LDP, 149

judgment: classical approaches to, 60–64; errors in, 60; sleep loss and, 59–77. See also

decisionmaking

Katz, Lawrence C., 24

Kegan, Robert, 132

Kiess, Harold O., 30

Kiley, Kevin C., 486

Killgore, William D.S. “Scott,” 18, 59–77

Kimball, Kent A., 23

kinetic perimetry, 106–107

King, James M., 24–26, 28, 34

Klopcic, Terry, 49

Knudson, Kathryn, 17

Kolditz, Thomas A., 141–173

Koob, George, 14

Korean War, benefit finding in, 249–252

Kosovo, benefit finding in, 253–256

Kowal, Dennis M., 21–22

Krueger, Gerald P., 1–44

LAIR. See Letterman Army Institute of Research

Laird, Melvin, 457

Lam, David M., 141–173

LaMothe, John D., 29

Landolt C chart, 104

lasers: in battle, 92–96; effects of, 96–100; and 

eye injuries, 91; psychological effects of, 

99–100; uses of, 91–29

Leader Development Portfolio (LDP), 141–

173; building, 142–146; components of, 

146–155; management/administration 

consoles in, 154–155; metadata uses in, 

163–165, 163f; scenarios in, 153, 167–

171; Toolbox, 148–149; user interface, 

147–154, 147f

leadership: and behavioral health, 225, 239–

240; creative thinking and, 175–206; 

development of, 134–135, 444–447; dynamics of, 441–444; models of, 123–128; 

personality traits and, 121–140; Romano 

on, 474, 486–487; self-development portfolio for, 141–173; in Special Operations 

Forces, 439–441. See also military leadership
INDEX 517

learning, lifelong, in Leader Development 

Portfolio, 144

least preferred coworker (LPC) instrument, 

125

Lees, Michael A., 23–24

Legionnaire’s disease, 334–335

Leibrecht, Bruce C., 24, 27, 29

Letterman Army Institute of Research (LAIR), 

7, 26–27

Leu, John R., 16, 19

Levine, Ira H., 357–370

Levine, Murray, 28

Levine, Richard R., 24

Lewis, Gregory, 27

Lewis, Phillip, 141–173

liberalism, concept of, 197

lifelong learning, in Leader Development 

Portfolio, 144

Little, James S., 482–484, 499

Lloyd, Andre J., 27

Long, Christopher P., 24, 430

LPC. See least preferred coworker instrument

Lukey, Brian J., 483–484

Luz, George, 27

magnetic resonance imaging (MRI), 270–273; 

contraindications to, 275

magnetic resonance spectroscopy (MRS), 270, 

274–275

Management Console, in LDP, 154

Manning, Frederick J. “Rick,” 13, 17, 19, 472, 

495

marital functioning: and behavioral health, 

227–228, 240–241, 242t; families and, 

381, 388, 388t; and suicide, 293, 296–297, 

303, 306. See also divorce intent

marital status, of Soldiers, demographics of, 

373

Marlowe, David H., 17

Married Army Couples Program, 397–398

Mars Letter Contrast Sensitivity Test, 104

Martin, Andrew, 23

Martin, James A., 17

Martínez-López, Lester, 428, 484–486, 498

Mason, J.W., 12

mass media: and biological agents, 333; in 

CBRN event, 318–319

mass panic, 331–332; avoidance of, 327; and 

CBRN event, 321

Mastroianni, George, 23, 34

Mays, Mary Z., 21, 26, 34

McBride, Sharon A., 17–18, 22, 209–245

McCarroll, J. Edward, 17

McDonough, John H., 13, 25, 474

McGhee, James, 429

McGurk, Dennis, 17, 19, 209–245

McNally, Rich, 48–49

M-day Reservists, 453

meaning-making process, in military units, 

130–131

MEDEVAC: armored vehicles for, 417–422; 

research on, 428

media. See mass media

medical data forms, for radiation response, 

360–361

medically unexplained physical symptoms 

(MUPS), 329–330

Medical Management of Radiological Casualties Handbook, 360

medical readiness training exercises (MEDRETEs), 426

medical records, unifying, 494

Medical Research and Materiel Command 

(MRMC), 48, 492–493; experiences in, 

474, 483, 485; and stress research, 79–80

Medical Service Corps (MSC), 2

memory, mTBI and, 272

Mental Health Advisory Teams (MHATs), 6, 

209–245; recommendations from, 242–

243; on suicide trends, 301–304

mental health problems: in Afghanistan, 

231–232, 233f; and career intentions, 404; 

and families, 401–402; in Iraq, 212–213, 

213f–214f

mentorship: and family support, 397; in Leader Development Portfolio, 144

MHATs. See Mental Health Advisory Teams

microsleeps, 15, 50

midazolam, 346, 351

mild traumatic brain injury (mTBI), 261–263; 

assessment of, 269–275; classification of, 

263–265, 264t; effects of, 265–266; issues 

in assessment of, 275; neuroimaging and, 

261–282; symptoms of, 262–263, 267. See 

also traumatic brain injury

military leadership: definition of, 122–123. See 

also leadership

military lifestyle demands, and families, 373, 

380, 383–384, 384t

military milieu: meaning-making process in, 

130–131; and mTBI, 262; nature of, 2, 5
518 THE 71F ADVANTAGE

military psychology, nature of, 5

military suicide. See suicide

Militia (Dick) Act, 455

Milligan, Joseph E., 476

Mine Resistant Ambush Protected (MRAP) 

vehicle, 416

mini-markers (MM) instrument, 181, 182t–

183t

modafinil, 74

Modrow, Harold E., 22, 26

morale: in Afghanistan, 231, 232f; and career 

intentions, 405–406; deployment length 

and, 217, 218f; evaluation of, 400; in Iraq, 

212; multiple deployments and, 221, 221f

moral judgment, sleep loss and, 68–70

motor vehicle accidents, 297

MRAP. See Mine Resistant Ambush Protected 

vehicle

MRI. See magnetic resonance imaging

MRMC. See Medical Research and Materiel 

Command

MRS. See magnetic resonance spectroscopy

MSC. See Medical Service Corps

mTBI. See mild traumatic brain injury

multidisciplinary work: research psychologists and, 10–11; in Special Operations 

Forces, 438–439

Multifactor Leadership Questionnaire, 128

multiple deployments: effects of, 221–223, 

237; recommendations for, 243

multitasking: assessment of, 83–84; and vigilance, 81–82

MUPS. See medically unexplained physical 

symptoms

Murray, Lynee D., 22

Myatt, Craig A., 435–449

Myers-Briggs Type Indicator, 132

N-acetylaspartate analysis (NAA), 274

Nagasaki, 331–332, 358

Natick Research, Development, and Engineering Center, 8, 29–30, 51

National Cancer Institute (NCI), 487

National Defense Act, 455–456

National Institute of Allergy and Infectious 

Disease (NIAID), 487

National Institute of Neurological Disorders 

and Stroke (NINDS), 488

National Institutes of Health (NIH), 487

National Interagency Biodefense Campus, 487

National Interagency Confederation for Biological Research, 487

naturalistic decisionmaking model, 61–63

Nauta, W.J., 12

NCI. See National Cancer Institute

NEO Personality Inventory, Revised, 155, 

159–161, 173n10; IPIP, short form of, 

183–184, 205

nerve agents, 342–343; behavioral toxicity 

of, 345–346; bioscavengers of, 349–351; 

physiological toxicity of, 343–345; safety 

with therapeutics against, 350–351; therapeutics against, 346–350

Ness, James, 19, 141–173

networking, international, 40

neuropsychological functioning: assessment 

of, 269–275; mTBI and, 266–269

neuroticism, 129, 177, 440–441; in cadets, 160, 

160f

Newhouse, Paul, 16

NIAID. See National Institute of Allergy and 

Infectious Disease

Nicholas, Thomas L., 30

NIH. See National Institutes of Health

Nimmer, Elias, 492

NINDS. See National Institute of Neurological 

Disorders and Stroke

9-point challenge, need for research on, 38–39

non–prior service Reservists, 455

nuclear weapons, 331–333; biodosimetry 

tools for, 357–370; demilitarization and, 

course on, 477–478

nutrition: and executive functions, 84–85, 85t; 

and vigilance, 80

Oatman, Lynn C., 28

Ocasio, Felix, 425

OCT. See optical coherence tomography

O’Donnell, Vincent M., 16

Odysseus, 121

Oklahoma City bombing, 315, 318–319, 323

O’Mara, Peter A., 27

OMUS. See outbreaks of multiple unexplained 

symptoms

openness, 129, 177, 440–441; descriptive statistics for, 192–194, 192t, 195t, 206; histograms on, 192, 193f; and leadership, 

177–180; multivariate regression analysis 

of, 194, 196t; reliability analyses for, 190–

191, 190t–191t. See also creativity

operant behavior, 157
INDEX 519

operations tempo, 437; behavioral effects of, 438

ophthalmoscopy, 101–102

optical coherence tomography (OCT), 103

outbreaks of multiple unexplained symptoms 

(OMUS), 321–324

Owen, Wilfred, 341

2-PAM. See pralidoxime chloride

panic, mass, 321, 327, 331–332

Parker, John S., 482, 486

Pastel, Ross H., 34, 315–340

path-goal theory of leadership, 125–126

Patterson, James H., Jr., 24, 27

PC. See psychological casualties

PCS. See post-concussion syndrome

peacekeeping operations, 484–496; benefit 

finding in, 254; and suicide, 292–294

Pelli-Robson Test, 104

Penetar, David M., 14–16, 21

Pérez Balladares, Ernesto, 426

perimetry, 106–107

persistent post-concussion syndrome, 263

personality traits: conceptualization of, 176–

177; domains of, 440–441; LDP on, 155–

162; and leadership, 121–140; stability of, 

156–158; and suicide, 291

personal protective equipment (PPE), 416–417

Pert, Agu, 25

PET. See positron emission tomography

Peterson, Ronald, 25

phosgene, 341

physical health: and families, 381, 384–386, 

385t–386t; families and, 378–379

physostigmine, 347–348

plague, in India, 333–334

Planning, Programming, and Budgeting System (PPBS) process, 437

Planning, Programming, Budgeting, and Execution (PPBE) process, 414

Platoff, Gennady E., 483

Pollard, John, 53

Popp, Kathryn, 22

positron emission tomography (PET), 270, 273

post-concussion syndrome (PCS), 263

postgraduate professional short course 

(PPSC), 497

post-traumatic growth (PTG), 247–260

post-traumatic stress disorder (PTSD), 2; 

benefit finding and, 255, 255f; combat 

and, 250–251; and families, 401–402; in 

Iran, 325; need for research on, 36, 493; 

Reserves and, 465–466; and suicide, 293–

294; in Tokyo, 328

PPBE. See Planning, Programming, Budgeting, and Execution process

PPBS. See Planning, Programming, and Budgeting System process

PPE. See personal protective equipment

PPSC. See postgraduate professional short 

course

pralidoxime chloride (2-PAM), 345–346; safety assessment of, 350

Price, George R., 28

procyclidine, 348

protective factors: in Afghanistan, 239–242; in 

Iraq, 225–231; and suicide, 304; and wellbeing, 211f

psychological casualties (PC), 320

Psychomotor Vigilance Task, 55

psychoticism, 440–441

PTG. See post-traumatic growth

PTSD. See post-traumatic stress disorder

pyridostigmine bromide, 345–347

race, and career intentions, 402

Radiation Response Syndrome (RRS), 332–333

Radiation Training and Assessment Tools CD, 

360–369

radiological agents, 328–331; biodosimetry 

tools for, 357–370; early clinical response 

following exposure to, 363, 364t

range finders, 93–94

Rapid Equipping Force, 413

Raslear, Thomas G., 13–15, 53

rational decisionmaking model, 60–61

Rauch, Terry M., 22, 30–31

RDECOM. See Research Development and 

Engineering Command

readiness: Army research psychologists and, 

6; and behavioral health, 225, 239–240; 

Reserves and, 460–462; Soldier identification and, 463–464

Ready Reserve, 451

rear detachment support, and behavioral 

health, 227–228

recognition primed decisionmaking model, 

61–63

recruitment: intangibles and, 462–463; Reserves and, 459–462

Redmond, Daniel, 16

relaxation techniques, 430
520 THE 71F ADVANTAGE

relocation: and families, 374, 380; and suicide, 

301

requirements process, limitations during war, 

414–415

research, in military laboratories, 11–22, 

474–475

Research Development and Engineering 

Command (RDECOM), 413

research directions, 35–40; on Aidman Vision 

Screener, 114–115; on benefit finding, 

256–258; on family issues, 373–393; on 

personality traits and leadership, 133–

134; on PTSD, 36, 493; on Reserves, 38, 

494; on TBI, 35, 493

Reserves: experiences in, 426; and families, 

381–382, 382t, 388–389; history of, 455–

458, 456t; losses from, 458–459; need 

for research on, 38, 494; organization of, 

451–452, 452f; relation to active forces, 

457; research on, 427, 451–470; types of 

service in, 453, 454t

resilience, 441, 446–447; research on, 489

Respondent Chooser, in LDP, 149–151

retention: intangibles and, 462–463; Reserves 

and, 458–459, 461–462

retention intentions: factors affecting, 400t; families and, 379, 386–389, 387t; unit climate 

and, 395–410. See also career intentions

retina, 92; laser exposure and, 96, 98–99

return to duty, following mTBI, 266

Rewers, Marek, 283–312

Rickett, Daniel L., 25–26, 48

risk communication, in CBRN event, 317–318

risk factors: in Afghanistan, 235–239; in Iraq, 

216–225; and suicide, 303; and well-being, 211f

risk perception, in CBRN event, 318

risk taking: assessment of, 82–84; sleep loss 

and, 65–67, 70–72

Riviere, Lyndon A., 395–410

Romano, James A., Jr., 25–26, 30, 471–500

Rothberg, Joseph M., 283–312

RRS. See Radiation Response Syndrome

Rubenstein, David A., xvii

Russell, Phillip H., 478–479

SAFTE. See Sleep, Activity, Fatigue, and Task 

Effectiveness model

SAIC. See Science Applications International 

Corporation

Salter, Charles A., 23, 34, 357–370

Sanders, Michael G., 23

Sandgren, David J., 357–370

Sardasht, Iran, chemical attacks on, 324–326, 

342

sarin, 315, 326–328, 342

SARS. See severe acute respiratory syndrome

Scales, Robert, 2–3, 38–39

scanning laser ophthalmoscopy (SLO), 103

Schmeisser, Elmar T., 24

Schoomaker, Eric B., 486, 498

Schoomaker, Peter, 141

Schopper, Aaron W., 23–24

Schrader, Gerhard, 342

Science and Technology Assistance Teams. See

Field Assistance in Science and Technology Teams

Science Applications International Corporation (SAIC), 48–49, 52, 488

scopolamine, 348

screening, military psychology consultants 

and, 440

Scud missile attacks, on Israel, 326

selection, military psychology consultants 

and, 440

Selective Reserve, 451

self-awareness: definition of, 145–146; in 

Leader Development Portfolio, 144

separations, and families, 374–375, 389, 396

September 11, 315, 318–319, 461, 487

Sessions, G. Rufus, 13–15, 34

71F, 2; definition of, xxi. See also army research 

psychology

severe acute respiratory syndrome (SARS), 

315, 319, 334

sexual harassment, research on, 426

sexual orientation, need for research on, 37–38

Shiflett, Samuel, 27

Shih, Tony, 474

Sidman, M., 12

Simulearn, 153–154

Sipos, Maurice L., 26, 341–355

Sleep, Activity, Fatigue, and Task Effectiveness 

(SAFTE) model, 51–53, 55–56

sleep loss: in Afghanistan, 237–239; and decisionmaking, 64–68; duration of, effects of, 

67–68; and insensitivity to consequences, 

65–67; in Iraq, 223–224; and moral judgment, 68–70; research on, 15–16, 49–56, 

59–77, 431–432; and risk taking, 65–67, 

70–72; short-term, effects of, 64–65
INDEX 521

Slife, Harry F., Jr., 484

SLO. See scanning laser ophthalmoscopy

SM. See sulfur mustard

Smith, Harold R., 16

smoking, 378–379

Snellen chart, 104

social climate: and behavioral health, 225, 226f,

239–240; and benefit finding, 255–256

social learning, and leadership, 445

Sodetz, Frank J., 13, 21, 47

SOF. See Special Operations Forces

Soldier Systems Center, Natick, 29–30

solidarity, 251

Solomon, James G., 496

soman, 342, 344; effects of, 345–346

somatic marker hypothesis, 63–64

Special Operations Forces (SOF): characteristics of, 436, 436t; experiences in, 435–449

SPECT tracer, 273–274

Springer, William D., 24

SRG. See stress-related growth

staff officers, research psychologists as, 9–10, 

30–31

static perimetry, 106–107

Stein, Earl S., 30

Stetz, Melba C., 18, 24, 425–433, 484

stratified systems theory, 128–129

stress: and cognitive performance, 79–90; 

research on, 18, 438–439; and suicide, 

291–294

stress-related growth (SRG), 247–260

stress symptoms: in Afghanistan, 231–232, 

233f; combat and, 237; deployment length 

and, 219–220; in Iraq, 212–214, 213f; 

multiple deployments and, 111; peripheral to terrorist attacks, 319–320, 329–331, 

358–359

stress training: adequacy of, 229, 229t, 241–

242; need for research on, 36

Stretch, Robert H., 13, 17, 22, 30, 34

Strong Bonds program, 307–308

subjective self, 145

substance abuse: in Afghanistan, 233–234; 

deployment length and, 220; in Iraq, 214–

215; research on, 14, 48; and suicide, 290

suicidal ideation: in Afghanistan, 233; deployment length and, 219; in Iraq, 214

suicide: Chernobyl accident and, 330; definition of, 284–285; military, 283–312; 

international studies on, 287–296; need 

for research on, 36; protective factors for, 

304; risk factors for, 303; trends in, 283, 

284f, 307; Vietnam War and, 296–297; in 

wartime, 283, 287–288; theories of, 285–

287; types of, 286

suicide prevention, 305–309; battle buddy approach, 289; recommendations for, 243; 

training, adequacy of, 229, 229t, 241–242

Suicide Risk Management and Surveillance 

Office (SRMSO), 306

sulfur mustard (SM), 324–326, 341–342

support: and behavioral health, 227–228; for 

families, 375–378, 383, 383t; Internet and, 

397; and leadership, 443–444; research 

on, 427

susceptibility weighted imaging (SWI), 276

Swanson, J. Bradley, 30

Sweeney, Donald R., 21

Symington, Lawrence E., 28, 30

symptoms: medically unexplained, 329–330; 

multiple unexplained, outbreaks of, 

321–324; peripheral to terrorist attacks, 

319–320, 329–331, 358–359. See also

stress symptoms

Synthetic Work Task (SynWin), 83–84; altitude and, 86–87, 87t

tabun, 342

tacit knowledge model, of leadership, 126–127

Takafuji, Ernest J., 480

TAMC. See Tripler Army Medical Center

Target Acquisition Designation Sight (TADS), 

93–94

TBI. See traumatic brain injury

technicians, 453, 454t

terrorist attacks, 315; long-term psychological effects of, 323, 327–328; symptoms 

with peripheral involvement, 319–320, 

329–331, 358–359. See also chemical, biological, radiological, and nuclear weapons

tetracycline, 334

Thomas, Jeffrey L., 17–19, 209–245

360 Tool, 148–149

Three Mile Island accident, 328–329, 358

Title XI, 461

Tokyo subway attacks, 315, 324–328, 342

Total Force concept, 457

TPU. See Troop Program Unit

traditional Reservists, 453

training: Battlemind, 18, 229–230, 241–243; 

ethics, 230; recommendations for, 243; 
522 THE 71F ADVANTAGE

stress, 36, 229, 229t, 241–242; suicide prevention, 229, 229t, 241–242

Training and Doctrine Command (TRADOC), 36–37, 141

transactional leadership, 128

transformational leadership, 127–128; openness and, 179; personality factors and, 

129–132

traumatic brain injury (TBI), 2; classification 

of, 264t; need for research on, 35, 493. See 

also mild traumatic brain injury

Tripler Army Medical Center (TAMC), 432

Troop Program Unit (TPU), 453, 454t

unit climate: and career intentions, 395–410; 

evaluation of, 399–400, 400t, 405

unit cohesion: and behavioral health, 225, 

239–240; and career intentions, 405–406; 

evaluation of, 400–401; hardiness and, 131

United States Army: See also under Army

United States Army Aeromedical Research 

Laboratory (USAARL), 7, 22–24; experiences in, 429–430

United States Army Medical Command 

(USAMEDCOM), 413, 415

United States Army Medical Materiel Development Activity (USAMMDA), 418

United States Army Medical Research and 

Materiel Development Command 

(USAMRMC), 415; experiences in, 473; 

Telemedicine and Advanced Technologies Research Center, 429–430

United States Army Medical Research Institute 

of Chemical Defense (USAMRICD), 7, 24–

26; experiences in, 473, 476–477, 480, 482

United States Army Medical Research Institute 

of Infectious Diseases (USAMRIID), 487

United States Army Medical Research Unit—

Europe at Heidelberg (USAMRU–E), 

18–19

United States Army Research and Materiel 

Command (USAMRMC), 7–8; experiences in, 428–429; Headquarters, Fort 

Detrick, 30–32. See also Medical Research 

and Materiel Command

United States Army Research Institute of Environmental Medicine (USARIEM), 7, 19–22

United States Military Academy (USMA): 

Department of Behavioral Sciences and 

Leadership, 141; and Leader Development Portfolio, 141–173; and leadership 

development, 135; and personality traits, 

131–133, 159–161, 160f

United States Special Operations Command 

(USSOCOM), experiences in, 435–449

unit morale: in Afghanistan, 231, 232f; and 

career intentions, 405–406; evaluation of, 

400; in Iraq, 212

Ursone, Richard L., 496

USAARL. See United States Army Aeromedical Research Laboratory

USAMEDCOM. See United States Army 

Medical Command

USAMMDA. See United States Army Medical 

Materiel Development Activity

USAMRICD. See United States Army Medical 

Research Institute of Chemical Defense

USAMRIID. See United States Army Medical 

Research Institute of Infectious Diseases

USAMRMC. See United States Army Medical Research and Materiel Development 

Command; United States Army Research 

and Materiel Command

USAMRU–E. See United States Army Medical 

Research Unit—Europe at Heidelberg

USARIEM. See United States Army Research 

Institute of Environmental Medicine

USMA. See United States Military Academy

USSOCOM. See United States Special Operations Command

Vaitkus, Mark A., 17, 19, 33–34, 175–206, 484

Valium. See diazepam

Van Syckle, Frank, 421

vesicants, 324

veterans: and suicide, 297, 299–300, 304–305; 

suicide prevention for, 308

Vietnam War: and Agent Orange Syndrome, 

322; benefit finding in, 249–252; and substance abuse, 14; and suicide, 296–297

vigilance performance: dual-task demands 

and, 81–82; mTBI and, 267–268; research 

on, 79–80

virtual reality (VR) technology, 430, 432

vision acuity, measures of, 103–104

visual field tests, 106–109

VLeader program, 154

VX, 342, 344

Walrath, Brian J., 493

Walter Reed Army Institute of Research 

(WRAIR), 7; Department of Medical 

Neuroscience, 13–15; Department of 

Military Psychiatry, 17–18; Department 

of Psychophysiology, 15–17; Division of 
INDEX 523

Neuropsychiatry, 11–18, 47; experiences 

in, 427–428; Fort Bragg field office, 19; 

Headquarters Office, 13; physical health 

symptom checklist, 381; sleep loss research, 15, 49–56

wartime suicide rates, 283, 287–288

Weatherington, Lisa, 497–498

Weber, Max, 128

Weisz, John D., 27

WFC. See work-family conflict

Wildzunas, Robert M., 24

Williams, Harold L., 15

wisdom, 252

Witkin, Jeffery, 14

women. See female Soldiers

Wood, Michael D., 17–18, 209–245, 247–260

work-family conflict (WFC), 396–398

work performance: in Afghanistan, 232–233; 

deployment length and, 219–220; in Iraq, 

213–214; multiple deployments and, 111; 

sleep loss and, 224

World War I, chemical warfare in, 323–324, 341

World War II, benefit finding in, 249–252

worried well, term, 320

WRAIR. See Walter Reed Army Institute of 

Research

Wright, Paul, 18

Yeltsin, Boris, 315

Zajtchuk, Russ, 481, 486

Zych, Kenneth, 13
��F is the area of concentration (AOC) code assigned by the U.S. Army to the 

specialty of Research Psychology. In terms of numbers, the AOC is a small one, 

with only �� to �� officers serving at any given time. However, the ��F impact 

is far greater than this small cadre suggests. Army research psychologists 

apply their extensive scientific expertise and training toward understanding, 

preserving, and enhancing the health, morale, and performance of Soldiers and 

their families. They do this in many ways and in many areas, but always with an 

empirical, evidence-based approach, and always with an applied focus. 

This book, which grew out of an Army research psychology conference, is the 

first of its kind, intended to provide a comprehensive overview of what Army 

research psychologists do. Chapters cover the diverse activity areas of ��Fs, 

from the neurophysiology of sleep, to traumatic brain injury, to leadership and 

organizational process, as well as several personal and historical accounts. 

Army research psychologists are making a difference. Through their research, 

��Fs provide leaders with new insights and tools for increasing the health and 

performance of military personnel. This is the “��F Advantage.”

Edited by Paul T. Bartone, Ross H. Pastel, and Mark A. Vaitkus, with contributions from:

Gina E. Adam

Gary A. Adams

William F. Blakely

Paul D. Bliese 

Michael W. Boye

Thomas W. Britt

Lolita Burrell 

Joel Carter 

Carl Andrew Castro 

Matthew G. Clark

Michael N. Dretsch 

Doris Durand

Edward N. Edens 

Sandra M. Escolas

Richard V.N. Ginn 

James E. Griffith

Charles W. Hoge 

Steven R. Hursh 

William D.S. Killgore

Thomas A. Kolditz

Gerald P. Krueger

David M. Lam 

Ira H. Levine 

Philip Lewis

Sharon A. McBride 

Dennis McGurk 

Craig A. Myatt

James Ness 

Marek Rewers 

Lyndon A. Riviere 

James A. Romano, Jr. 

Joseph M. Rothberg

Charles A. Salter 

David J. Sandgren 

Maurice L. Sipos

Melba C. Stetz 

Jeffrey L. Thomas 

Michael D. Wood