Page 97 - Journal of Special Operations Medicine - Summer 2014

and “human performance modification.” These first Figure 1 HPO demands/resources model.
terms—“enhancement,” “sustainment,” and “restora-
tion”—can easily be aligned with phases of SOF mis-
sions: predeployment, when every system must be
optimized and enhanced to the fullest degree possible;
during deployment, when the goal is to sustain perfor-
mance to predeployment levels; and postdeployment,
when performance may need to be restored or returned
to predeployment levels. In contrast, “human perfor-
mance modification” (HPM) is a term that was redefined
based on a report from the Committee on Assessing For-
eign Technology Development published in 2012. This
4
report stated the HPM “can encompass actions rang- cognitive to genetic and physiologic, from behavioral
ing from the use of ‘natural’ materials, such as caffeine and individual skills and practices to social and physi-
or khat as a stimulant, to the application of nanotech- cal environmental factors. Some of the contributors are
nology as a drug delivery mechanism or in an invasive inherent, whereas others may be state or “situation”
brain implant. Although the literature on HPM typically dependent. One area with a limited, but growing, sci-
addresses methods that enhance performance, another entific base is the role of “exposures” both in utero and
possible focus is methods that degrade performance or those of everyday life—the importance of epigenetics in
negatively affect a military force’s ability to fight.” We modulating behaviors and metabolic control is becom-
4p1
favor the term “human performance optimization” over ing clear. For example, the role of early-life nutritional
the other ones because it encompasses all other terms— exposures in health and disease is being recognized.
8,9
optimal is the end result— through either enhancement, Similarly, the role of epigenetic regulation of various
modification, sustainment, or restoration. Human per- genes (such as the oxytocin receptor gene in social infor-
formance should be optimal, whenever possible. mation processing) is being explored. 10,11 The proposed
model is intended to be dynamic. As new evidence and
information become available, it can be inserted into the
The Model
model. In addition to the resources indicated in Figure
A variety of models have been offered to depict the con- 2, other social support networks may be available to
cept of HPO. The value of creating a conceptual model the SOF community. The intricacies, interactions, and
is that it helps guide identification of contributing fac- intersections of how and what impacts performance are
tors and the relationship among these factors. Although many, and it is a topic of great importance to SOF.
the exact contribution of any particular factor is often
unclear at first, over time, the amount explained by Figure 3 provides examples of how various resources
each factor and multiple domains might emerge when may affect performance. These examples demonstrate
guided by a conceptual model to gather and evaluate how individual, family, external resources, and compet-
information. The demands/resources model (DRM) has ing family and work demands can affect performance,
been chosen as a framework to develop an HPO model, including work or personal goals. A multitude of other
because the DRM was developed to evaluate work per- examples could be provided, and the overall contribu-
formance and SOM is about peak performance and tion of any one factor is currently not known.
5–7
mission success. The model proposed in Figure 1 has
been modified from the original to suit the SOF per- For example, the effect of excessive caffeine consump-
7
formance metrics in other venues (i.e., family, relation- tion, particularly as an energy drink, on sleep disruption
ships, and work have been included). Another addition is clear. Studies have shown that persons in the deployed
12
to the original model is the inclusion of multiple re- setting who drank three or more drinks a day were “more
sources (individual, family, and external environment) likely to report sleep disruption related to stress and ill-
as well as other well-established demands (e.g., work, ness and fall asleep during briefings or on guard duty.”
12
family, financial, social). Overall, the concept is that It is well accepted that caffeine can restore wakefulness
performance will be optimized when resources (indi- and counteract decrements in cognitive task performance
vidual, family, and external) match or exceed demands. when sleep deprived, but caffeine also can impose sig-
13
nificant impairments in subsequent sleep. Therefore,
Figure 2 presents an overview of the groups of multiple these issues are important with regard to degrading or
and competing individual, family, and other resources moderating all individual resources and how they influ-
that contribute to performance in the diverse venues. Al- ence multiple aspects of performance. Other examples
though not complete, these various factors and environ- could be provided, but the intersection of multiple nega-
mental issues demonstrate the holistic approach—from tive resources with competing demands is key.

An Integrated Approach for Special Operations 87