Page 46 - JSOM Winter 2021

SUPPLEMENTARY MATERIALS
Phase I (Biomechanical Control) Session 1: Introduction to Stress Inoculation
Education / Conceptualization Training / Biomechanical Awareness
Initial training focuses on establishing a base of knowledge for perfor- Education: Translational redefining of stress and performance. Neu-
mance enhancement training in the context of recovery from PTSD and ral mechanisms underlying degradations in performance caused by
TBI. Education in human physiology and the impact of stress (physical, stress, PTSD, and TBI; demonstration of multidimensional impact.
cognitive, emotional, and behavioral) is approached from a transla- Introduce SIT as a tool to improve performance.
tional neuroscience perspective.
Trainees gain an enhanced awareness of the biomechanical aspects of Session 2: Self-Awareness + Diaphragmatic Breathing
Retraining (DBR)
the stress and relaxation responses and their impact on performance
in terms of four factors: Accuracy, Reliability, Efficiency, and overall Education: PTSD and TBI symptom awareness (Physical, Cognitive,
Effectiveness. Emotional, Behavioral). Introduction to the stress cycle. Upregula-
tion / downregulation processes.
Education in Adaptive Countermeasures. Skills training in-session in- Adaptive: Diaphragmatic Breathing Retraining with HRV biofeed-
corporates opportunities for practice using emWave Heart Rate Vari- back application. (Apps: Breathe2Relax, Tactical Breather, Inner
ability (HRV) biofeedback in conjunction with learning Diaphragmatic Balance)
Breathing Retraining and Progressive Muscle Relaxation. Real-time
monitoring of autonomic arousal in response to interventions allows Session 3: Self-Awareness + Progressive Muscle Relaxation (PMR)
for immediate evaluation of skill impact, increases buy-in, and increases Education: Elements of the stress cycle, applied techniques for en-
adherence to self-guided practice outside of training. hancing physiological self-awareness and improving control over the
Cognitive Self-Monitoring. Techniques are introduced in conjunction stress response. Impact of upregulation/downregulation processes;
with educational Catalytics (detailed narrative story lines of an indi- ”over-recovery” is reinforced as an investment in higher perfor-
vidual encountering the stress response) to enhance the trainee’s under- mance states.
standing of the impact of thoughts on emotions, physiology, cognition, Adaptive: Progressive Muscle Relaxation with HRV biofeedback
and overall performance in various contexts. Adaptive skills practice is application.
introduced using the A-B-C method (A–Activity/Activation, B–Belief/
Thought, and C–Consequence) to prime integration of cognitive aware- Session 4: Situational Awareness + Performance:
ness and identification of performance degrading thought patterns in Introduction to Cognitive Self-Monitoring
preparation for Phase II. Education: Cognitive functioning and the neurobiology of PTSD/
TBI (via functional imaging studies) and translational impact on
Overarching Goals: Create a platform for performance enhancement performance, focusing on enhancing psychological health literacy.
training in the context of recovery from PTSD and TBI. Begin to see the Introduction to automatic thoughts and behaviors, and the impact
stress response as moldable with training, rather than overwhelming of PTSD and TBI on accuracy and reliability of appraisal/reappraisal
and uncontrollable. processes.
Objectives: Education and Skills Training Adaptive: A-B-C method is applied in conjunction with Catalytics;
• Physiologic management and cue building trainees work together to apply Phase I training elements in complet-
• Enhanced self- and situational awareness ing partially worked-out examples while trialing cognitive skills with
• Introduce cognitive awareness training in preparation for Phase II real-time feedback from the training cohort and trainer.
integration. • DBR+PMR combined with HRV biofeedback application.

44 | JSOM Volume 21, Edition 4 / Winter 2021