Page 39 - JSOM Winter 2021

Stress Inoculation Training (SIT-NORCAL), Part 1

The Development and Preliminary Evaluation
of a Psychological Performance Training Protocol

3
Sarah Jackson, MFT, PhD *; Matthew R. Baity ; Patrick R. Thomas ;
1
2
5
Douglas Barba ; Daniel Jacobson ; Madeleine Goodkind ; Diane Swick ; A. Sarah Ivey 8
4
7
6

ABSTRACT
Background: Stress inoculation training (SIT) interventions treatment initiation rates have been observed in evidence-based
have demonstrated promise within military contexts for human protocols for the “signature injuries” of the Iraq/Afghanistan
performance enhancement and psychological health applica- conflicts, posttraumatic stress disorder (PTSD) and traumatic
tions. However, lack of manualized guidance on core content brain injury (TBI) (<6% to 13%). 9,11–14 Furthermore, studies
selection, delivery, and measurement processes has limited their report high dropout rates in evidence-based protocols for
use. Purpose: The purpose of this study was to develop and PTSD in military and veteran populations (20% to ≥50%), 15–19
evaluate a comprehensive SIT intervention protocol to enhance and lower success rates than in civilian populations. 20,21
the performance and health of military personnel engaged in
special warfare and first-response activities. Methods: Multi- These critical barriers continue to represent the greatest and
disciplinary teams of subject matter experts (n = 19) were most imminent threat to the warfighting community along the
consulted in protocol generation. The performance improve- full spectrum of experience, from battlefield to home front,
ment/human performance technology (HPT) model was used the cost of which is evident in accelerating psychological mor-
in the selection, refinement, and measurement of core skills. bidity and mortality trajectories, both during and following
The protocol was trialed and refined (44 cohorts, n ≥300; military service. 22–25 Health and human performance profes-
2013–2020) to generate the results. Results: Four primary aims sionals aligned with the warfighter community are facing an
were achieved: (1) The generation of a flexible, evidence-based/ inevitable truth: there is not one battle, but two. The first is
evidence-driven psychological performance and health sus- defined by the ability to fight, survive, and accomplish the mis-
tainment hybrid, SIT-NORCAL. (2) Manualized content and sion within the crucible of warfare; the second, to survive the
process guidance. (3) The creation of multimedia materials long-term physical and psychological injuries characteristic
using evidence-based methodologies. (4) The design of initial of their sacrifices and to thrive against the odds. The current
measurement systems. Preliminary quality improvement anal- studies propose a strategy for warfighter alignment on both
ysis demonstrated positive results using standard-of-care and battlefields.
performance enhancement assessments. Conclusion: Hybrid-
ized human performance and psychological health sustainment This report (Part 1) outlines the use of the performance im-
protocols represent a paradigm shift in the delivery of psycho- provement/HPT model in the design and refinement of an
26
logical performance training with the potential to overcome algorithm employing the SIT paradigm and the resultant
barriers to success in traditional care. Further study is needed protocol, SIT-NORCAL, a psychological performance and
to determine the effectiveness and reach of SIT-NORCAL. health-sustainment (i.e., treatment) hybrid. The second report
(Part 2) of this series provides a demonstration of the content
Keywords: stress inoculation; training; performance training and process elements of SIT-NORCAL and its application in
the human performance context.

Introduction Stress Inoculation Training
There is a compelling need for culturally congruent, evidence- Background
based/evidence-driven interventions in psychological health SIT is a flexible, cognitive-behaviorally based training inter-
and human performance programming within the US mili- vention originally developed by Meichenbaum. 27–29 The key
tary. Rates of psychological health problems among US Ser- tenets of SIT align with the medical concept of inoculation in
1,2
vicemembers and veterans are high and continue to increase that structured, graduated exposure to a stressor (e.g., tasks
(19% to 57%), yet care seeking remains low, particularly involving excess noise, time pressure, distracting sensory stim-
3–6
among those most in need (13% to 50%). 6–10 Even lower ulus, thermal stress, fatigue, task novelty or complexity, or
*Correspondence to sarah.jackson@natuniv.edu
8
1 Dr Sarah Jackson and A. Sarah Ivey are part of the PTSD Clinical Team, Veterans Affairs Northern California Healthcare System, Mather, CA.
2 Matthew Baity is affiliated with Clinical Psychology, California School of Professional Psychology at Alliant International University, Alhambra,
CA. Patrick R. Thomas is affiliated with Psychology, Griffith University, Queensland, Australia. Douglas Barba is affiliated with The Center for
4
3
Performance Psychology, at National University, San Diego, CA. Daniel Jacobson is affiliated with Clinical Psychology, US Air Force. Madeleine
5
6
7
Goodkind is affiliated with the PTSD Clinical Team, New Mexico VA Healthcare System, Albuquerque, NM. Diane Swick is affiliated with the
Research Service, VA Northern California Healthcare System, Mather, CA.
37
37