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Kluge MG, Maltby S, Kuhne C, Walker N, Bennett N, Aidman E, Nalivaiko E, Walker FR. Evaluation of a Virtual Reality Platform to Train Stress Management Skills for a Defense Workforce: Multisite, Mixed Methods Feasibility Study. J Med Internet Res 2023; 25:e46368. [PMID: 37930751 PMCID: PMC10659241 DOI: 10.2196/46368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Psychological stress-related injuries within first-responder organizations have created a need for the implementation of effective stress management training. Most stress management training solutions have limitations associated with scaled adoption within the workforce. For instance, those that are effective in civilian populations often do not align with the human performance culture embedded within first-responder organizations. Programs involving expert-led instructions that are high in quality are often expensive. OBJECTIVE This study sought to evaluate a tailored stress management training platform within the existing training schedule of the Australian Defense Force (ADF). The platform, known as Performance Edge (PE), is a novel virtual reality (VR) and biofeedback-enabled stress management skills training platform. Focusing on practical training of well-established skills and strategies, the platform was designed to take advantage of VR technology to generate an immersive and private training environment. This study aimed to assess the feasibility of delivering the VR platform within the existing group-based training context and intended training population. In this setting, the study further aimed to collect data on critical predictors of user acceptance and technology adoption in education, including perceived usability, usefulness, and engagement, while also assessing training impacts. METHODS This study used a mixed methods, multisite approach to collect observational, self-reported, and biometric data from both training staff and trainers within a real-world "on-base" training context in the ADF. Validated scales include the Presence Questionnaire and User Engagement Scale for perceived usefulness, usability, and engagement, as well as the State Mindfulness Scale and Relaxation Inventory, to gain insights into immediate training impacts for specific training modules. Additional surveys were specifically developed to assess implementation feedback, intention to use skills, and perceived training impact and value. RESULTS PE training was delivered to 189 ADF trainees over 372 training sessions. The platform was easy to use at an individual level and was feasible to deliver in a classroom setting. Trainee feedback consistently showed high levels of engagement and a sense of presence with the training content and environment. PE is overall perceived as an effective and useful training tool. Self-report and objective indices confirmed knowledge improvement, increased skill confidence, and increased competency after training. Specific training elements resulted in increased state mindfulness, increased physical relaxation, and reduced breathing rate. The ability to practice cognitive strategies in a diverse, private, and immersive training environment while in a group setting was highlighted as particularly valuable. CONCLUSIONS This study found the VR-based platform (PE) to be a feasible stress management training solution for group-based training delivery in a defense population. Furthermore, the intended end users, both trainers and trainees, perceive the platform to be usable, useful, engaging, and effective for training, suggesting end-user acceptance and potential for technology adoption.
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Affiliation(s)
- Murielle G Kluge
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Steven Maltby
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Caroline Kuhne
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, Australia
| | - Nicole Walker
- Army School of Health, Australian Defence Force, Canberra, Australia
| | - Neanne Bennett
- Joint Health Command, Department of Defence, Canberra, Australia
| | - Eugene Aidman
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- Human and Decision Sciences Division, Defence Science & Technology Group, Edinburgh, Australia
| | - Eugene Nalivaiko
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Frederick Rohan Walker
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
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Molendijk T, Kramer EH, Verweij D. Moral Aspects of “Moral Injury”: Analyzing Conceptualizations on the Role of Morality in Military Trauma. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/15027570.2018.1483173] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Tine Molendijk
- Centre for International Conflict Analysis and Management, Nijmegen School of Management, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Eric-Hans Kramer
- Section of Military Management Studies, Faculty of Military Sciences, Netherlands Defence Academy, Breda, The Netherlands
| | - Désirée Verweij
- Section of Military Management Studies, Faculty of Military Sciences, Netherlands Defence Academy, Breda, The Netherlands
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Moyle W, Jones C, Dwan T, Petrovich T. Effectiveness of a Virtual Reality Forest on People With Dementia: A Mixed Methods Pilot Study. THE GERONTOLOGIST 2017; 58:478-487. [DOI: 10.1093/geront/gnw270] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/01/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wendy Moyle
- Optimising Health Outcomes, Menzies Health Institute Queensland, Griffith University, Nathan Campus, Brisbane, Australia
- School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Australia
| | - Cindy Jones
- Optimising Health Outcomes, Menzies Health Institute Queensland, Griffith University, Nathan Campus, Brisbane, Australia
- School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Australia
| | - Toni Dwan
- Optimising Health Outcomes, Menzies Health Institute Queensland, Griffith University, Nathan Campus, Brisbane, Australia
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Winslow BD, Carroll MB, Martin JW, Surpris G, Chadderdon GL. Identification of resilient individuals and those at risk for performance deficits under stress. Front Neurosci 2015; 9:328. [PMID: 26441503 PMCID: PMC4584989 DOI: 10.3389/fnins.2015.00328] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/31/2015] [Indexed: 01/01/2023] Open
Abstract
Human task performance is affected by exposure to physiological and psychological stress. The ability to measure the physiological response to stressors and correlate that to task performance could be used to identify resilient individuals or those at risk for stress-related performance decrements. Accomplishing this prior to performance under severe stress or the development of clinical stress disorders could facilitate focused preparation such as tailoring training to individual needs. Here we measure the effects of stress on physiological response and performance through behavior, physiological sensors, and subjective ratings, and identify which individuals are at risk for stress-related performance decrements. Participants performed military-relevant training tasks under stress in a virtual environment, with autonomic and hypothalamic-pituitary-adrenal axis (HPA) reactivity analyzed. Self-reported stress, as well as physiological indices of stress, increased in the group pre-exposed to socioevaluative stress. Stress response was effectively captured via electrodermal and cardiovascular measures of heart rate and skin conductance level. A resilience classification algorithm was developed based upon physiological reactivity, which correlated with baseline unstressed physiological and self-reported stress values. Outliers were identified in the experimental group that had a significant mismatch between self-reported stress and salivary cortisol. Baseline stress measurements were predictive of individual resilience to stress, including the impact stress had on physiological reactivity and performance. Such an approach may have utility in identifying individuals at risk for problems performing under severe stress. Continuing work has focused on adapting this method for military personnel, and assessing the utility of various coping and decision-making strategies on performance and physiological stress.
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Jensen PR, Simpson D. A qualitative analysis of the experience and impact of killing in hand-to-hand combat. J Trauma Stress 2014; 27:468-73. [PMID: 25158640 DOI: 10.1002/jts.21938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A growing body of research suggests that killing during military combat is closely associated with posttraumatic stress disorder (PTSD), as well as a number of other adverse mental health related conditions (e.g., dissociative experiences, violent behavior, functional impairment). This article provides first-person perspectives on the experiences and impact of killing by service members with the goal of expanding our understanding of the impact of taking a life during war. In audio-recorded phenomenological interviews, 9 service members described their experiences and the subsequent impact of killing during hand-to-hand combat. A description, supported by participant quotations, was constructed to represent the participants' experiences. Results suggest the experience and aftermath of taking a life in hand-to-hand combat was disturbing, psychologically stressful, and necessitated some form of coping after the event. Service members who killed in hand-to-hand combat viewed their actions as necessary to preserve their life and that killing in hand-to-hand combat was more emotionally taxing than killing by shooting. Our findings may help to improve providers' understanding of service members' first-person experiences of killing in hand-to-hand combat and thus provide the basis for the development of a connected and genuine relationship with such military clients.
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Affiliation(s)
- Peter R Jensen
- Department of Kinesiology, Recreation and Sport Studies, University of Tennessee, Knoxville, Tennessee, USA
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Characteristics of successful technological interventions in mental resilience training. J Med Syst 2014; 38:113. [PMID: 25062750 DOI: 10.1007/s10916-014-0113-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
Abstract
In the last two decades, several effective virtual reality-based interventions for anxiety disorders have been developed. Virtual reality interventions can also be used to build resilience to psychopathology for populations at risk of exposure to traumatic experiences and developing mental disorders as a result, such as for people working in vulnerable professions. Despite the interest among mental health professionals and researchers in applying new technology-supported interventions for pre-trauma mental resilience training, there is a lack of recommendations about what constitutes potentially effective technology-supported resilience training. This article analyses the role of technology in the field of stress-resilience training. It presents lessons learned from technology developers currently working in the area, and it identifies some key clinical requirements for the supported resilience interventions. Two processes made up this research: 1) developers of technology-assisted resilience programs were interviewed regarding human-computer interaction and system development; 2) discussions with clinicians were prompted using technology-centered concept storyboards to elicit feedback, and to refine, validate and extend the initial concepts. A qualitative analysis of the interviews produced a set of development guidelines that engineers should follow and a list of intervention requirements that the technology should fulfill. These recommendations can help bridge the gap between engineers and clinicians when generating novel resilience interventions for people in vulnerable professions.
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Bouchard S, Bernier F, Boivin E, Morin B, Robillard G. Using biofeedback while immersed in a stressful videogame increases the effectiveness of stress management skills in soldiers. PLoS One 2012; 7:e36169. [PMID: 22558370 PMCID: PMC3338628 DOI: 10.1371/journal.pone.0036169] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 04/02/2012] [Indexed: 11/18/2022] Open
Abstract
This study assessed the efficacy of using visual and auditory biofeedback while immersed in a tridimensional videogame to practice a stress management skill (tactical breathing). All 41 participants were soldiers who had previously received basic stress management training and first aid training in combat. On the first day, they received a 15-minute refresher briefing and were randomly assigned to either: (a) no additional stress management training (SMT) for three days, or (b) 30-minute sessions (one per day for three days) of biofeedback-assisted SMT while immersed in a horror/first-person shooter game. The training was performed in a dark and enclosed environment using a 50-inch television with active stereoscopic display and loudspeakers. On the last day, all participants underwent a live simulated ambush with an improvised explosive device, where they had to provide first aid to a wounded soldier. Stress levels were measured with salivary cortisol collected when waking-up, before and after the live simulation. Stress was also measured with heart rate at baseline, during an apprehension phase, and during the live simulation. Repeated-measure ANOVAs and ANCOVAs confirmed that practicing SMT was effective in reducing stress. Results are discussed in terms of the advantages of the proposed program for military personnel and the need to practice SMT.
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McCuaig Edge HJ, Ivey GW. Mediation of Cognitive Appraisal on Combat Exposure and Psychological Distress. MILITARY PSYCHOLOGY 2012. [DOI: 10.1080/08995605.2012.642292] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Heather J. McCuaig Edge
- a Director General Military Personnel Research and Analysis, Department of National Defence , Ottawa , Ontario , Canada
| | - Gary W. Ivey
- b Director General Military Personnel Research and Analysis, Canadian Forces , Ottawa , Ontario , Canada
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