Page 143 - JSOM Summer 2022

An Ongoing Series

Physiological and Psychological Stressors Affecting
Performance, Health, and Recovery in Special Forces Operators:
Challenges and Solutions
A Scoping Review

Reginald B. O’Hara, PhD *; Lewis Sussman, PsyD ;
2
1
3
4
Jeffrey Tiede, MD, MSS, D.ABA-PM ; Riley Sheehan, PhD ; Benjamin Keizer, PhD 5

ABSTRACT
Introduction: Special Operations Forces (SOF) Operators (SOs) and OTS, resulting in harmful psychological and hormonal
are exposed to high levels of physiological and cognitive stress- disruptions. The recurring demands placed on SOs may re-
ors early in their career, starting with the rigors of training, sult in a chronically high burden of physical and mental stress
combined with years of recurring deployments. Over time, known as allostatic overload. Future investigation, especially
these stressors may degrade SOs’ performance, health, and in the purview of longitudinal implementation, health, and re-
recovery. Objectives: (1) To evaluate sources identifying and covery monitoring, is necessary for the health and readiness of
describing physiological and psychological stressors affecting the SOF population.
performance, health, and recovery in SOs, and (2) to explore
interventions and phenomena of interest, such as the biolog- Keywords: humans; cognition; overtraining syndrome; allo static
ical mechanisms of overtraining syndrome (OTS). Methods: load; military personnel; sports
This review followed the recommendations and methodology
of the Joanna Briggs Institute and the Preferred Reporting
Items for Systematic reviews and Meta-Analyses extension for
Scoping Reviews (PRISMA-ScR) guidelines. A database search Introduction
from December 1993 to December 2021 was performed in Special Operations Forces Operators (SOs) experience fre-
PubMed, the Cochrane Library, and the Defense Technical quent combat deployments and missions that expose them
Information Center (DTIC). Potential articles were identified to a plethora of physiological and psychological stressors.
1-3
using search terms from their titles, abstracts, and full texts. To meet the mission’s unique physical, emotional, and envi-
Articles effectively addressing the review questions and objec- ronmental demands, SOs train rigorously and continuously.
tives were eligible. Results: After 19 articles were excluded for Ideally, this training process is allostasis, the body’s optimal
not meeting established inclusion criteria, a total of 92 full-text adaptive behavioral and physiological state of readiness to an
articles were assessed for eligibility. After the final analysis, environmental stressor.
72 articles were included. Conclusions: Allostatic imbalance
may occur when supra-maximal demands are prolonged and SOs routinely operate in austere environments ranging from
repeated. Without adequate recovery, health and performance dry/arid deserts to subarctic/arctic regions, traverse through
may decline, leading to nonfunctional overreaching (NFO) varying terrain, and sometimes operate at extreme altitudes. It
*Correspondence to reginald.b.ohara.civ@mail.mil
1 Reginald B. O’Hara currently serves as director of the Military Performance Laboratory at the Center for the Intrepid, Department of Rehabil-
itation Medicine, Brooke Army Medical Center, Joint Base San Antonio–Fort Sam Houston, TX. Dr. O’Hara formerly served as the laboratory
director and lead scientific investigator at the United States Air Force School of Aerospace Medicine’s Satellite Human Performance Laboratory,
housed within the United States Air Force Research Laboratory, Wright-Patterson AFB, OH. Lewis Sussman is a clinical psychologist at the
2
Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, Joint Base San Antonio–Fort Sam Houston.
3 COL Jeffrey Tiede is a pain management physician who serves as Director of the Center for the Intrepid, Department of Rehabilitation Medi-
cine, Brooke Army Medical Center, Joint Base San Antonio–Fort Sam Houston. He also commands the 5th Brigade (HS), 94th Training Division,
United States Army Reserves. Riley Sheehan is a contract research scientist at the Center for the Intrepid, Department of Rehabilitation Medicine,
4
Brooke Army Medical Center, Joint Base San Antonio–Fort Sam Houston; the Henry M. Jackson Foundation for the Advancement of Military
Medicine, Bethesda, MD; and the Uniformed Services University of the Health Sciences, Bethesda. Benjamin Keizer is a board-certified clinical
5
health psychologist at the Center for the Intrepid and serves as the director of the Functional Restoration Program, Department of Rehabilitation
Medicine, Brooke Army Medical Center, Joint Base San Antonio–Fort Sam Houston.
139