Improving Performance of Combat Soldiers by Utilizing Attentional Training Based on Eye Tracking

Study Overview
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Brief Summary
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Military service in combat units entails exposure to traumatic events that require mental adjustment. To develop and efficiently apply attentional interventions aimed at enhancing soldiers' combat performance, it is essential to extensively investigate the efficiency of these training programs, which has yet to been done. The prupose of the current study is to examine the efficiency of the new attention eye-tracking based training, in comparison to RT-based training and to a control group, in improving performance of combat soldiers. In addition, the influence of the attention training on aspects of psychological resilience will also be examined in questionnaires.

Detailed Description
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Following the explanation to participants regarding the study process, those who give written consent to participate will be randomly placed into one of three groups: GCFT (N=60), ABMT (N=60), and a neutral control group - task based on eye-tracking (N=60). The study will include 2 measurement points during the military service: before the attention training and after the attention training. In each measurement point, the soldiers will complete computerized tasks to measure threat attention, questionnaires, and performance data from shooting ranges and combat fitness.

Official Title
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Improving Performance of Combat Soldiers by Utilizing Attentional Training Based on Eye Tracking - Improvement of Combat Performance

Conditions
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Military Combat Performance

Intervention / Treatment
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* Behavioral: Gaze-Contingent Feedback Training
* Behavioral: Attention Bias Modification
* Behavioral: Non-Contingent Feedback Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Each soldier from the cohort that will give his written consent will be able to participate in the study. Exclusion Criteria: Hebrew proficiency is insufficient to complete the study questionnaires.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Gaze-Contingent Feedback Training (toward threat)<br>In the task, 30 different matrices, each consisting of 16 faces, will be presented. Each matrix includes 8 angry faces and 8 neutral, 8 women and 8 men, and the locations are counterbalanced between matrices. The participants are asked to view the matrices in any way they choose, and the eye-tracking camera records their viewing location relative to the stimuli presented on the screen. At the beginning of each training session, the soldier will choose to which music he would like to listen during the 12-minute session from a diverse list of music. After calibrating the eye-tracker, the participant will be instructed to view matrices of faces as he chooses, as described above in the assessment task. The music chosen by the participant will play only when he is looking at threatening faces and it will stop when he looks at neutral faces. Thus, a change in viewing patterns is expected by implementing operant conditioning principles. | Behavioral: Gaze-Contingent Feedback Training<br>* Feedback according to participants' viewing patterns, in order to modify their attention toward threat stimuli.<br>|
| Active Comparator: Active Comparator: RT-Based Attention Bias Modification (toward threat)<br>A dot-probe task of 160 trials. Trials begins with a fixation cross (+), on which the participant is asked to focus (500ms). Then two face stimuli (one angry one neutral) are presented above and below the fixation cross (500ms). After the stimuli disappear, a target probe (right- or left-pointing arrowhead) appears in place of one of the face stimuli. The participant is asked to indicate which target probe was presented using a predetermined key. The target probe will remain on the screen until response, after which a new trial will begin. Participants are instructed to identify the probe type as quickly and accurately as possible. In the training task, all of the target probes will appear in the threat location (angry face). Thus, over multiple trials, learning is expected to occurs such that the threatening face predicts the location of the target probe, thereby achieving the desired change in attention pattern. | Behavioral: Attention Bias Modification<br>* Attention training via repeated trials of a dot-probe task intended to direct attention toward threat stimuli using threat and neutral face stimuli.<br>|
| Placebo Comparator: Non-Contingent Feedback Training<br>This condition is also based on the eye-tracking task (see Experimental Arm) with a fundamental change - The music chosen by the soldier will play continuously without any reinforcement for looking at threat or neutral faces. | Behavioral: Non-Contingent Feedback Training<br>* Participants listen to a musical track they chose with no operant conditioning.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Combat Performance | Composite scores for Static marksmanship, simulator shooting performance (Bagira), running test grades, and obstacle course grades will be gathered from soldiers' commanders before and after intervention sessions to test for change. | Approximately 3 months after baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post-Combat Trauma | Score on on self-report questionnaire Posttraumatic stress disorder checklist for DSM-5 (PCL-5). The total score, ranging from 0 to 80, reflects PTSD symptom severity, with higher scores representing greater severity. | Change from baseline Post-Combat PTSD Symptoms at approximately 3 months | 
| Post-Combat General Anxiety | Score on self-report questionnaire Generalized Anxiety Disorder questionnaire (GAD-7). The total score, ranging from 0 to 21, reflects GAD symptom severity, with higher scores representing greater severity. | Change from baseline Post-Combat General Anxiety Symptoms at approximately 3 months | 
| Post-Combat Depression | Score on self-report Patient Health Questionnaire 9 (PHQ-9). The total score, ranging from 0-27, reflects severity of depressive symptoms, with higher scores representing greater severity. | Change from baseline Post-Combat Depression Symptoms at approximately 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Attention Bias Modification, Randomized Control Trial, Eye-tracking