Psychological Health in Military Personnel

Study Overview
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Brief Summary
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The study is designed to compare the efficacy of a simple, non-spiritual, self-management strategy that can strengthen personal and occupational resources-resources that can positively impact adverse reactions to military-specific demands and promote personal and work outcomes. Our app-based intervention, designed to strengthen a balanced self-identity through affirmation of growth and balance values, will be adapted to military occupational contexts, utilizing an existing self-management strategy (QE) to a military occupational context to maximize it effectiveness in strengthening participants' balanced sense of self, which we expect to have positive benefit on personal and work outcomes in military service members.

Official Title
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Psychological Health in Military Personnel: Phase III

Conditions
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Well-being

Intervention / Treatment
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* Behavioral: Direction Check App
* Behavioral: Direction Check App (Time Management Version)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All participants in the study will include males and females between the ages of 17-70 years. Participants of all racial and ethnic backgrounds will be eligible to participate. Participants of all religious and spiritual orientations will be eligible to participate. Participants must be active-duty military personnel. Exclusion Criteria: None.

Ages Eligible for Study
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Minimum Age: 17 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

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: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: BRAVE Group<br>The BRAVE program aims to examine the effectiveness of an intervention strategy designed to increase personal and work outcomes through the strengthening of quiet ego characteristics. The BRAVE intervention (delivered over four weeks) will ask study participants to use the app each week, with specific instructions on selecting one section each week and first listening to the longer version and reflect. At least two other times during the week they will be asked to listen to a recording of their choice on the same topic. On the final week (week 5) all participants (experimental and control) will return to the lab to complete post-study assessment tools (SART, post-study on-line questionnaire, provide a urine sample, and weight measurement). | Behavioral: Direction Check App<br>* Direction Check is a simple, inexpensive app that builds resilience through balanced values to target the everyday personal and occupational stressors faced by military populations.<br>|
| Active Comparator: Time Management Group<br>The time management program aims to examine the effectiveness of an intervention strategy designed to increase personal and work outcomes through the strengthening of time management characteristics. The time management intervention (delivered over four weeks) will ask study participants to use the time management version of the app each week, with specific instructions on selecting one section each week and first listening to the longer version and reflect. At least two other times during the week they will be asked to listen to a recording of their choice on the same topic. On the final week (week 5) all participants (experimental and control) will return to the lab to complete post-study assessment tools (SART, post-study on-line questionnaire, provide a urine sample, and weight measurement). | Behavioral: Direction Check App (Time Management Version)<br>* Direction Check (Time Management Version) is a simple, inexpensive app that builds resilience through time management exercises to target the everyday personal and occupational stressors faced by military populations.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quiet Ego | Change between baseline and five weeks, the Quiet Ego Scale (QES; Wayment, Bauer, & Sylaska, 2014) will be used to assess an identity that strikes a balance between a strong sense of agency (but not egoism) and a strong concern for the welfare of others. The QES is comprised of 14 items arranged in a 5-point Likert-type format with responses ranging from 1 (Strongly disagree) to 5 (Strongly agree). Sample items include: I try to look at everybody's side of a disagreement before I make a decision and for me, life has been a continuous process of learning, changing, and growth. Higher scores on the QES indicate a stronger quiet ego. The QES has been found to have adequate internal validity (α = .76 to .78; (Wayment et al., 2014). | Baseline, 5 weeks | 
| Self-Image | The self-image and compassionate goals scale developed by Crocker and Canevello (2008) will be used to assess the change in self-image between baseline and five weeks. The scale is comprised of 13 items total with six items assessing self-image goals. The scale is arranged in a 5-point Likert-type format with responses ranging from 1 (Almost never) to 5 (Always). All items begin with the phrase, In the past week, in the area of friendships, how much did you want to or try to... Six of the items assess self-image goals such as, get others to recognize or acknowledge your positive qualities and avoid taking risks or making mistakes. Higher scores for the self-image subscale represents a higher endorsement of self-image. | Baseline, 5 weeks | 
| Compassioante Goals | The self-image and compassionate goals scale developed by Crocker and Canevello (2008) will be used to assess the change in compassionate goals between baseline and five weeks. The scale is comprised of 13 items total with seven items assessing compassionate goals. The scale is arranged in a 5-point Likert-type format with responses ranging from 1 (Almost never) to 5 (Always). All items begin with the phrase, In the past week, in the area of friendships, how much did you want to or try to... Seven items asses compassionate goals such as, be supportive of others and make a positive difference in someone else's life. Higher scores for the compassionate goals subscale represents a higher endorsement of compassionate goals. | Baseline, 5 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Spiritual Fitness | Change between baseline and five weeks, the Spiritual Fitness Scale (SFS; Hammer, Cragun, & Hwang, 2013) will be used to assess the degree to which an individual has a sense of meaning, purpose, and accomplishment in their life that extends beyond the self (Peterson et al., 2011). The SFS is comprised of five items arranged in a 5-point Likert-type format with responses ranging from 1 (Not like me at all) to 5 (Very much like me). Sample items include: I have a core of beliefs, ethics, and values that give my life a sense of meaning and purpose and The work I am doing in the military is meaningful to me. Higher scores on the SFS indicate a greater capacity to identify one's core self, access resources that facilitate the realizing of the core self and strivings, and experience a sense of connectedness with people and the world (i.e., spiritual fitness). The SFS has been found to have adequate internal consistency (α = .77; Hammer et al., 2013). | Baseline, 5 weeks | 
| Positive and Negative Affect Schedule | Change between baseline and five weeks, the positive and negative affect schedule (I-PANAS-SF; Thompson, 2007) will be used to assess positive and negative affect. The I-PANAS-SF is comprised of 10 items arranged in a 5-point Likert-type format with responses ranging from 1 (Very slightly or not at all) to 5 (Very much). Five items of the scale measure positive affect while the other five items measure negative affect. Respondents are asked to rate these positive and negative adjectives according to the extent to which each describes the way they have felt during the past week. Sample positive affect items include 'attentive', while sample negative affect items include 'upset'. Higher scores on both positive affect or negative affect indicate a tendency to experience a positive and negative mood. Both subscales (positive affect and negative affect) have been found to have adequate internal consistency (positive affect: α = .78; negative affect: α = .76; Thompson, 2007). | Baseline, 5 weeks | 
| High Risk Demands | Change between baseline and five weeks, a scale developed by Castro and Adler (2000) will be used to assess high-risk demands among respondents. The scale is comprised of seven items with short answer responses. Sample items include: In the past week, how many hours of work have you average per day? and How many days have you been on a training exercise in the past 6 months? | Baseline, 5 weeks | 
| Traditional Occupational Demands | Change between baseline and five weeks, the Organizational Constraints Scale (OCS; Spector & Jex, 1998) will be used to assess the ability of individuals to perform their jobs given their occupational demands. The OCS is comprised of 11 items arranged in a 5-point Likert-type format with responses ranging from 1 (Never) to 5 (Several times per day). Respondents are first asked to indicate how often it is difficult or impossible to do his or her job because of the listed items. Sample items include: poor equipment or supplies, inadequate training, and interruptions by other people. Higher scores on the OCS indicate a high level of organizational constraints. The OCS has been found to have adequate internal consistency (α = .85; Spector & Jex, 1998). | Baseline, 5 weeks | 
| Work Overload | Change between baseline and five weeks, a shortened version of the overload subsection of the Michigan Organizational Assessment Questionnaire (MOAQ; Cammann, Fichman, Jenkins, & Klesh, 1983) will be used to assess work overload. The shortened MOAQ being utilized is comprised of three items arranged in a 7-point Likert-type format with responses ranging from 1 (Strongly disagree) to 7 (Strongly agree). Sample items include: I never seem to have enough time to get everything and I have too much work to do to do everything well. One item is reverse-coded. Higher scores on the MOAQ and the overload subsection indicate greater work overload. | Baseline, 5 weeks | 
| Coping | Change between baseline and five weeks, the Emotion Regulation Questionnaire (ERQ; Gross, John, & Diener, 2003) will be used to assess participant's coping methods and ability among two common emotional regulation strategies - cognitive reappraisal and expressive suppression. The ERQ is comprised of 10 items total; six items which asses cognitive reappraisal and four items that assess expressive suppression. Each item is arranged in a 7-point Likert-type format with responses ranging from 1 (Strongly disagree) to 7 (Strongly agree). Sample items include: When I want to feel more positive emotion (such as joy or amusement), I change what I am thinking about and I control my emotions by not expressing them. Higher scores in each subsection (reappraisal and suppression) indicate a higher tendency for respondents to use the related emotional regulation strategies. The ERQ has been found to have adequate internal consistency (α = .68 to .76; Gross et al., 2003). | Baseline, 5 weeks | 
| Self-Compassion | Change between baseline and five weeks, the Self-Compassion Scale (SCS; Raes, Pommier, Neff, & Van Gucht, 2011) will be used to assess the ability to extend compassion to the self. The SCS is comprised of 12 items and six subscales, each measuring a different component of self-compassion. Each item is arranged in a 5-point Likert-type format with responses ranging from 1 (Almost never) to 5 (Almost always). Sample items include: When I fail at something important to me I become consumed by feelings of inadequacy and I try to see my failings as part of the human condition. Higher subscale scores on the SCS indicate greater endorsement of the related component of self-compassion. The SCS has been found to have adequate internal consistency (α = .86; Raes et al., 2011). | Baseline, 5 weeks | 
| Family Functioning | Change between baseline and five weeks, an adapted version of the Self-Report Measures of Family Functioning (SRMFF; Bloom, 1985) will be used to assess family functioning among two dimensions: family cohesion and family conflict. The SRMFF is comprised of 10 items total, five items relating to the dimension of cohesion and the other five items relating to the dimension of conflict. Respondents are asked to think about their family-life over the past week; each item is arranged in a 5-point Likert-type format with responses ranging from 1 (Strongly disagree) to 5 (Strongly agree). Sample items relating to the dimension of cohesion include: Family members really helped and supported one another and We really got along well with each other. Sample items relating to the dimension of conflict include: We fought a lot in our family and Family members sometimes hit each other. Items 3 and 5 in both the dimensions of family cohesion and family conflict are reverse-coded. | Baseline, 5 weeks | 
| Work-Family Conflict | Change between baseline and five weeks, a shortened Work-Family Conflict Scale (WFSC; Carlson, Kacmar, & Williams, 2000) will be used to assess interrole conflict. The shortened WFSC being utilized is comprised of 12 items total; three items which assess time-based work interference with family, three items which assess time-based family interference with work, three items which assess strain-based work interference with family, and three items that assess strain-based family interference with work. Each item is arranged in a 5-point Likert-type format with responses ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Sample items include: My work keeps me from my family activities more than I would like and Due to stress at home, I am often preoccupied with family matters at work. | Baseline, 5 weeks | 
| Personal Resources | Change between baseline and five weeks, an adapted version of a social support and social strain survey developed by Wayment and Brookshire (2017) will be used to assess personal resources. The shortened version of the survey is comprised of six items arranged in a 5-point Likert-type format with responses ranging from 1 (Never) to 5 (All the time). Respondents are first asked to think about the most important person in their social network and are then asked about how often that person engaged in specific types of responses in the previous week. Sample items include: listen to you when you wanted to talk. Higher scores for the social support questions indicate higher levels of social support. Higher scores for the social strain questions indicate higher levels of social strain. The survey has been found to have adequate internal consistency (social support: α = .89; social strain: α = .80; Wayment & Brookshire, 2017). | Baseline, 5 weeks | 
| Military Pride | Change between baseline and five weeks, three items adapted from a soldier will survey created by Marlowe, Furukawa, Griffith, Ingraham, and Kirkland (1985) will be used to assess military pride. The three items are arranged in a 5-point Likert-scale ranging from 1 (Strongly disagree) to 5 (Strongly agree). Sample items include: I am proud to be in the Army and What I do in the Army is worthwhile. Higher scores on the survey indicate greater military pride. | Baseline, 5 weeks | 
| Environment Life | Change between baseline and five weeks, a scale developed by Huffman, Adler, Castro, and Dolan (2000) will be used to assess environmental life among respondents. The scale is comprised of five items arranged in a 5-point Likert-type format with responses ranging from 1 (Never) to 5 (Always). Sample items include: I know what duty I will be doing day to day and I have a predictable mission schedule. | Baseline, 5 weeks |