Army program works to make soldiers fit in body and mind

The soldiers crowd around a large conference table, their maroon berets scattered on top. A digital clock on the wall shows the time in Afghanistan and Iraq. The unit’s flag, hung with battle streamers, rests at one end of the room.

Outside, not far away, stands the 16-foot bronze statue of World War II paratrooper “Iron Mike,” grim-faced with submachine gun in hand — the epitome of the rugged American soldier.

But the training here this morning has little to do with war.

A young soldier from Rhode Island is telling how his wife walked out on him when she was two months pregnant and he fell into depression and alcoholism.

A burly soldier with red hair admits that he has a bad temper, which leads to disputes with his spouse. There are murmurs of assent around the room, and other problems galore.

It feels like an intense group-therapy session.

In a way, it is.

It’s also a radical shift in the Army’s approach to mental health, a switch from the just-suck-it-up tradition of the past and a change that was expected to get a grumpy reception from rank-and-file “Joes.”

But the new program, designed largely by outside psychologists, appears to have been embraced by soldiers.

The critics, it turns out, are other psychologists.

The Army, burdened by almost a decade of war and beset by increases in suicides, substance abuse and combat stress, embarked on the controversial $125 million project to instill psychological strength in soldiers the same way it teaches physical fitness.

The program, called Comprehensive Soldier Fitness, is designed to make soldiers more psychologically “resilient” amid the pressures of combat, repeated deployments, and family and financial crises.

The effort runs counter to many military traditions.

“It’s a big culture change,” said Col. Jeffery Short, a physician and the program’s medical director.

“For decades,” he said, the Army attitude was “everybody’s just going to be tough. . . . You’re going to sweat this out, and when you come out the other end, you’re going to be better for it.

“Now, to concentrate on how people are thinking, and how they’re feeling . . . that is an Army culture change,” he said.

Brig. Gen. Rhonda Cornum, who oversees the program, said: “The Army recognized that its historical way of dealing with psychological fitness was to wait until somebody showed evidence of not having psychological fitness and then trying to fix it.”

This is an effort to help soldiers before that happens.

The program includes a mandatory confidential online assessment tool so soldiers can gauge their emotional status around issues such as relationships, job satisfaction and life in general. They can take further optional online training to get help in areas where they would like to improve.

The Army also wants resilience to be taught face to face, classroom-style and is in the process of teaching “master resilience trainers,” who go back to their bases and conduct sessions in person.

There, the MRTs use slides, excerpts from TV shows and round-the-table discussions to talk about ways to stay optimistic, avoid prejudging others and forestall “catastrophic thinking,” or dwelling on worst-case scenarios.

During one recent session touching on prejudgment, MRTs here played the now-famous segment of the “Britain’s Got Talent” TV show in which the drab-looking phone salesman Paul Potts turns out to have a world-class opera voice.

So far, according to recent interviews here and at training sessions at the University of Pennsylvania, Comprehensive Soldier Fitness seems to be a hit.

“It’s a revolution for us younger-generation soldiers,” said Spec. Matthew Gregg, 27, a Fort Bragg truck driver from Leesville, La., who has twice been deployed to Iraq.

“It shows that the military does care,” he said during a break in a recent Fort Bragg session. “When you fill out surveys, they’re not just going in the trash. People are actually . . . listening to what soldiers are saying.”

The program’s most vocal critics have been outside the Army — other psychologists who contend that it won’t work and that it is not training at all but rather a vast, quasi-ethical research project.

“There’s little reason to believe that these techniques would have any efficacy at all,” said James C. Coyne, a psychology professor in the psychiatry department at the University of Pennsylvania School of Medicine. “It’s very difficult to do anything preventively before the fact.”

In cases of combat stress, he said, he fears that preventive techniques could disrupt a soldier’s natural coping process.

“Getting upset, saying, ‘I don’t like feeling this way, this is a horrible way to feel,’ can often be the first step in a very healthy, adaptive response,” he said.

“Targeted, secondary prevention is much wiser and has much more of an evidence base than primary prevention,” he said.

Another critic, Roy Eidelson, a board member of the Coalition for an Ethical Psychology, added: “This is the largest experiment ever undertaken — it involves a million soldiers.”

“The stakes are very high,” he said, “because we’re talking about war. We’re talking about life and death. And there’s a lot that wasn’t done to prepare for this experiment.”

Search for a strategy

The program was launched after the Army said it recognized some alarming trends.

Suicides among active-duty soldiers jumped from 138 in 2008 to 162 in 2009, according to the most recently available Army statistics.

Cases of spousal abuse and child abuse or neglect almost doubled between 2004 and 2009, from 913 to 1,625, the Army said. And referrals for alcohol and drug abuse rose from 15,000 in 1999 to 22,500 in 2009.

“It used to be that you just kind of joined the Army and lived your life . . . and there wasn’t anything very dangerous about it,” Cornum said.

“When I came in the Army, which was 1978, nobody was going anywhere and doing anything. Vietnam was over.”

Now, she said, almost everybody who joins is quickly deployed to a hot zone and faces redeployment over and over. “It’s a different Army, and nobody sees peace breaking out.”

The idea for the program was that of Gen. George W. Casey Jr., the recently retired Army chief of staff, who Cornum said was dismayed by the cases of suicide, post-traumatic stress disorder and family violence.

“We’ve got to have something besides the Whac-a-Mole theory,” Cornum quoted Casey as saying. “We need a strategy to teach people to do better and not just wait till they do badly.”

The Army’s vice chief of staff, Gen. Peter W. Chiarelli, said day-to-day pressures on the modern soldier are enormous.

“We are putting as much stress on a soldier in the first six years in the United States Army” as many 80-year-old civilians have experienced in an entire lifetime, he said.

In 2008, Cornum said, the Army asked the University of Pennsylvania to help design something to combat negative behaviors.

The Army had a similar program, called Battlemind, but it was aimed at soldiers being deployed and coming off deployments and had not been implemented effectively, said Lt. Col. Sharon McBride, a senior research psychologist with the soldier fitness program.

Penn’s Positive Psychology Center and its director, Martin E.P. Seligman, are proponents of the idea of positive psychology, where attention is focused on positive aspects of life.

Seligman and his colleagues had already designed resilience programs for middle schools, high schools and college to prevent anxiety and depression, and they found that it was not that hard to adjust the training for soldiers.

“A lot of the material was directly relevant,” Seligman said. “The struggles of a soldier are relational — families, getting along with others. A very small part of life is going into battle.”

“I was worried that people would say [it was] ‘girlie psychobabble,’ ” he said. Instead, about half the soldiers who rated the program “said it was the best course they ever had in the Army.”

In 2009, the university began teaching resilience to the first 150 of the more than 4,500 noncommissioned officers who have thus far become trainers.

“We teach a set of skills around building mental toughness,” said Karen Reivich, co-director of the Penn Resiliency Project, who helps lead training sessions at a hotel near the university’s campus in Philadelphia.

The teaching is “designed to enhance a person’s ability to handle stress, to perform well, to stay optimistic,” she said during a break in a recent session.

“It’s about making sure that the soldiers have the skill sets to be able to do what our army is asking of them,” she said.

Sgt. 1st Class Brian Diggs, 35, a drill sergeant who has twice been deployed to Iraq and took the Penn trainers course in March, said he found it “excellent.”

He said he believed it would be useful in dealing with recruits.

“The younger generation . . . coming in the military, some of them have, already, issues that they bring with them,” he said. “I think this is just a better tool for leaders to help these new recruits get past those individual barriers that they bring with them.”

Psychologists criticize

In January, at the suggestion of Seligman, a special issue of American Psychologist, the flagship journal of the American Psychological Association, devoted 13 articles — by Cornum, Casey and others — to the Comprehensive Soldier Fitness program.

Norman B. Anderson, head of the association and the journal’s editor, said Seligman’s work is a hot topic, and so is the mental health of American military personnel.

But in March, a trio of psychologists — Eidelson, Marc Pilisuk and Stephen Soldz — wrote a blistering online essay accusing the journal of “cheerleading” and attacking the Army program as research, not training.

And as research, the program should involve the consent of its subjects, the soldiers, the authors stated. “Such research violates the Nuremberg Code developed during post-World War II trials of Nazi doctors,” the authors said.

In addition, Seligman’s resilience work in schools has been “only modestly and inconsistently effective,” the authors contended, producing only small reductions in mild depression.

The critics also charged that the resilience work done in schools is probably not applicable to soldiers who face combat.

Finally, the authors worried that the program might actually harm soldiers: “Might soldiers who have been trained to resiliently view combat as a growth opportunity be more likely to ignore or underestimate real dangers, thereby placing themselves, their comrades, or civilians at heightened risk of harm?”

“Given those ethical questions,” Eidelson said, “psychology . . . should be thinking really hard about whether this is a good idea.”

Seligman countered that “it’s not remotely” a research project. “It’s an Army-wide course. . . . It’s no more subject to consent than . . . when you’re told to run in sneakers rather than boots.”

Chiarelli, the vice chief of staff, said: “We do all kinds of mandatory things. . . . We make people pee in a bottle every month, too. We take mandatory physical fitness tests.”

At the same time, “they’re probably right in saying it’s an experiment,” he said. “Take an organization of 1.1 million people and try to institute a program like this, it probably is a little bit of an experiment. But that’s okay.”

Chiarelli said the debate is understandable.

“There are always going to be naysayers out there,” he said. “That doesn’t mean that we should wait until all the publishers publish all the articles.

“I think we have enough evidence on Comprehensive Soldier Fitness,” he said. “We know resiliency is key. And we know we can train people to be more resilient. To me, that’s all I need to know right now.”

Working through crises

At Fort Bragg one recent morning, sun streamed through an open door to a meeting room of the 264th Combat Sustainment Support Battalion.

Inside, the soldiers were among the first “lower enlisted” to be exposed to the notions of resilience by the newly minted teachers.

They had broken into small groups to analyze a personal crisis detailed by one person in each group.

The Rhode Island soldier’s group offered the story of his reaction to his pregnant wife’s departure for general discussion in the room.

“What was the activating event?” asked the moderator, Staff Sgt. Nathan Hayes, 27.

“Uh, finding out your wife was two months pregnant, and she leaves you,” a spokesman for the group replied.

“Sorry to hear that,” Hayes said.

He asked for the soldier’s reaction to his wife’s departure.

“He went into a drunken rage,” the spokesman related, “went into a downward spiral, got put into AA . . . got put on medicine, went through depression, didn’t want to work, didn’t want to do anything.”

Why did he turn to alcohol? Hayes asked.

“Just to forget everything,” the 24-year-old Rhode Island soldier, who had been sitting quietly, replied. “Just block it out.”

“So, ‘I can’t handle this on my own? I need alcohol?’ ” Hayes asked.

“Yeah, basically” the soldier said.

“So what’s the thinking trap there?” Hayes asked.

A “thinking trap,” a decades-old psychological concept, is one of the things the program wants soldiers to identify and avoid.

Reivich, of Penn, identified eight thinking traps in “The Resilience Factor,” a 2002 book she co-authored with Andrew Shatte. They include jumping to conclusions, overgeneralizing and “personalizing,” or always blaming oneself for setbacks.

“ ‘Alcohol’s the solution’ was the conclusion you jumped to,” Hayes told the young specialist.

After the session ended, the Rhode Island soldier, who has since reached an understanding with his wife, said he found the program valuable.

“If I had this kind of training before, I probably would have still been with my wife,” he said. “It definitely does help.”

 
Read what others are saying

    3 men shot in Southeast D.C.