Page 43 - JSOM Winter 2021

FIGURE 2 SIT-NORCAL: hybrid algorithm.

practice these skills between training modules/sessions and Units of Difficulty/Distress Scale [SUDS] and Situational Ad-
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in real-world situations or simulations (in vivo). The associ- aptation to Stress Scales [SASS] ). Trainees are educated in
ated manual outlines processes by which elements can be con- evidence-driven observational techniques to evaluate their own
densed, expanded, and reconstructed/tailored for individual performance and the performance of others objectively, using
needs. Heart Rate Variability Biofeedback is incorporated in qualitative observational measurement systems in the achieve-
all phases (emWave by HeartMath). In Phases I and II, it is ment of Phase III skills and objectives (see Figure 1, Evaluation,
used as a demonstration tool during skills practice to monitor levels 0 through 5).
physiological arousal and response to interventions, and to in-
crease buy-in and self-application inside and outside training. Core Content
In Phase III, it is used to measure efficiency in skills appli-
cation, during labs for rapidly enhancing skills practice, and Incorporation of Learning Science/Neuroscience/Clinical
during simulations (by active observers/trainers) to measure and Sport Psychology/Neuropsychology
physiological management capability and efficiency, as well as A wide evidence base was used in making determinations re-
response to simulation elements. garding the selection, design, and delivery of the core skills.
Learning principles and methodologies were derived from
Practice Assignments Cognitive Load Theory and the Cognitive Theory of Multi-
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PowerPoint presentations incorporate notes sections and prac- modal Learning to speed the efficiency of learning and skill
tice assignments for use between modules/sessions. Trainees acquisition. Material designs and delivery processes (i.e., multi-
are encouraged to review notes and materials for repetition media) were configured according to evidence-based learning
and enhanced learning and may also share them with their science methodologies. 57–62
support network (e.g., spouses, family) to increase communi-
cation and improve support, self-assessment, self- awareness, Designs of materials and the selection of core skills were fur-
and adaptive skills practice. “‘Homework” is kept to a min- ther grounded in neuroscientific evidence and physiological
imum and focuses on approaching actual real-world skills principles, selected based on their ability to confer a rapidly
practice during sessions and in daily life, incorporating the use enhancing skill set in the core cognitive capacities required
of technology (e.g., phone apps) for practicing and advancing in numerous occupational specialties, as per the RAND rec-
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skills and experimentation with core skills. ommendations. Furthermore, the design employs relative
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strengths in PTSD, such as error monitoring and visual mem-
Lab, Simulations, and Exercises ory and learning 64-67 to improve encoding, retention, and skills
Phase III focuses on adapting skills and knowledge learned in adaptation. Importantly, instruction does not rely explicitly on
Phases I and II and building confidence through real-world ap- verbal learning or verbal memory, a known deficit in PTSD. 64–67
plications. Trainees complete labs in which the focus of learning Fusions of the above were used in the creation of the four
is on strategies for identifying training targets and constructing main categories of learning activities used in SIT-NORCAL—
gradual exposure-based practice activities and training plans Education, Catalytics, Adaptives, and Simulation—which will
to meet objectives. A common language and measurement sys- be described further in Part 2, alongside Interventional Imple-
tem is established for tracking goals and objectives (Subjective mentation and Maintenance.

Stress Inoculation Training: A Performance Training Protocol, Part 1 | 41