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      Revisión de programas de resiliencia basados en la evidencia en los ejércitos Translated title: A review of evidence-based resilience programs in the Army

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          Abstract

          Introducción: Los riesgos físicos y psicológicos asociados a las operaciones, el desarrollo del modelo positivo de salud mental y el avance en las prácticas basadas en la evidencia en psicología, han determinado que las estrategias de Defensa en determinados países incorporen programas de entrenamiento de la resiliencia para los militares y sus familias. Objetivos: Identificar tendencias en el estudio de la resiliencia en contextos militares; analizar el contenido de los programas de resiliencia en población militar; valorar las evidencias de dichos programas, entre ellos el Comprehensive Soldier and Family Fitness y el Battlemind Trainig; y examinar qué barreras dificultan la implementación de dichos programas en contextos militares. Método: Se emplearon bases de datos civiles y militares para realizar la revisión de publicaciones sobre resiliencia en personal militar. Se seleccionaron aquellas revisiones sistemáticas, metanálisis e investigaciones que hubieran demostrado un grado de evidencia fuerte o moderado. Resultados: Se observa una tendencia creciente a abordar la resiliencia en contextos militares desde las prácticas basadas en la evidencia; se demuestra que los contenidos de los programas militares de resiliencia se basan en evidencias fuertes o moderadas; se expone un resumen de programas militares de resiliencia; se detallan las fuertes evidencias en las que se basan el Battlemind Training y el Comprehensive Soldier and Family Fitness. y se relatan algunas de las barreras que obstaculizan la implementación de dichos programas en los ejércitos. Discusión: El avance de la psicología basada en la evidencia ha sido significativo en los ejércitos, redundando en resultados positivos en el personal militar. Sin embargo, existen todavía algunas barreras que dificultan realizar estos programas en contextos militares.

          Translated abstract

          Background: Since the end of the Cold War and the beginning of the asymmetric warfare, some countries are implementing resilience programs for the mental health´s and well being of their military and families, shaped as Defense strategies. This has been possible because of the development of the positive mental health model and the evidence-based practice in psychology. Objectives: To summarize the information about resilience in the military; to review outstanding factors in resilience military programs; to show how resilience programs are already implemented; to analyze resilience evidenced-based main topics in the Comprehensive Soldier and Family Fitness and in the Battlemind Trainig; to help overcome the idiomatic hurdle; to analyze the barriers of resilience programs; and to suggest research topics. Methods: The publications about resilience and military were review in PsycINFO and DTIC. Meta-analysis, systematic reviews and randomized controlled trial with strong or moderate evidence were selected. Results: There is a growing trend in the use of evidence-based practices in military resilience programs. The content of the resilience programs is usually evidence-based. However, some of these programs haven´t been validated yet. Comprehensive Soldier and Family Fitness and the Battlemind Training are described because of their good validation; finally, the barriers in the implementation of the programs are discussed. Discussion: The growing evidence-based psychology has been significant in military contexts, throwing positive results in the personnel. However, there are still some barriers to develop these programs in the Army.

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          Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.

          The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. Copyright 2004 Massachusetts Medical Society
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            Examining the protective effects of mindfulness training on working memory capacity and affective experience.

            We investigated the impact of mindfulness training (MT) on working memory capacity (WMC) and affective experience. WMC is used in managing cognitive demands and regulating emotions. Yet, persistent and intensive demands, such as those experienced during high-stress intervals, may deplete WMC and lead to cognitive failures and emotional disturbances. We hypothesized that MT may mitigate these deleterious effects by bolstering WMC. We recruited 2 military cohorts during the high-stress predeployment interval and provided MT to 1 (MT, n = 31) but not the other group (military control group, MC, n = 17). The MT group attended an 8-week MT course and logged the amount of out-of-class time spent practicing formal MT exercises. The operation span task was used to index WMC at 2 testing sessions before and after the MT course. Although WMC remained stable over time in civilians (n = 12), it degraded in the MC group. In the MT group, WMC decreased over time in those with low MT practice time, but increased in those with high practice time. Higher MT practice time also corresponded to lower levels of negative affect and higher levels of positive affect (indexed by the Positive and Negative Affect Schedule). The relationship between practice time and negative, but not positive, affect was mediated by WMC, indicating that MT-related improvements in WMC may support some but not all of MT's salutary effects. Nonetheless, these findings suggest that sufficient MT practice may protect against functional impairments associated with high-stress contexts.
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              A validity and reliability study of the coping self-efficacy scale.

              Investigate the psychometric characteristics of the coping self-efficacy (CSE) scale, a 26-item measure of one's confidence in performing coping behaviors when faced with life challenges. Data came from two randomized clinical trials (N1=149, N2=199) evaluating a theory-based Coping Effectiveness Training (CET) intervention in reducing psychological distress and increasing positive mood in persons coping with chronic illness. The 348 participants were HIV-seropositive men with depressed mood who have sex with men. Participants were randomly assigned to intervention and comparison conditions and assessed pre- and post-intervention. Outcome variables included the CSE scale, ways of coping, and measures of social support and psychological distress and well-being. Exploratory (EFA) and confirmatory factor analyses (CFA) revealed a 13-item reduced form of the CSE scale with three factors: Use problem-focused coping (6 items, alpha=.91), stop unpleasant emotions and thoughts (4 items, alpha=.91), and get support from friends and family (3 items, alpha=.80). Internal consistency and test-retest reliability are strong for all three factors. Concurrent validity analyses showed these factors assess self-efficacy for different types of coping. Predictive validity analyses showed that residualized change scores in using problem- and emotion-focused coping skills were predictive of reduced psychological distress and increased psychological well-being over time. The CSE scale provides a measure of a person's perceived ability to cope effectively with life challenges, as well as a way to assess changes in CSE over time in intervention research.
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                Author and article information

                Contributors
                Role: ND
                Journal
                sm
                Sanidad Militar
                Sanid. Mil.
                Ministerio de Defensa (Madrid, Madrid, Spain )
                1887-8571
                September 2013
                : 69
                : 3
                : 182-194
                Affiliations
                [01] Madrid orgnameInspección General de Sanidad de la Defensa orgdiv1Unidad de Apoyo Psicológico España
                Article
                S1887-85712013000300005
                10.4321/S1887-85712013000300005
                4648c0cb-50da-48ce-af5c-e49d0191f541

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 31 January 2013
                : 23 May 2013
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 139, Pages: 13
                Product

                SciELO Spain


                Resiliencia,estrés,salud ocupacional,preparación psicológica,Comprehensive Soldier and Family Fitness,Battlemind Training,Resilience,Stress,Occupational health,Mental health training

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