Improving Air Force Resilience
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ClinicalTrials.gov Identifier: NCT05460663 |
Recruitment Status :
Completed
First Posted : July 15, 2022
Last Update Posted : July 21, 2022
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The purpose of this study is to examine the effectiveness of the Stress Management and Resilience Training (SMART) in increasing resilience in Air Force (AF) healthcare personnel. SMART includes practices that focus on six factors that promote individual-level resilience. A pretest-posttest, randomized control trial will be used to examine the effectiveness of SMART and is guided by the Defense Centers of Excellence Resilience Continuum. After institutional review board approval, the principal investigator (PI) will recruit a sample of AF healthcare personnel assigned to the 88th Medical Group or USAF School of Aerospace Medicine at Wright Patterson AF Base.
SMART will be provided via either a two-hour, video teleconference (VTC) or in-person training or a self-paced, on-line version completed over four to eight weeks. VTC or on-line versions will be utilized to prevent transmission of severe acute respiratory syndrome coronavirus-2. If in-person training is feasible and safe at a future point in time, in-person training will replace VTC training.
A baseline survey will include questions regarding age, gender, marital status, race, ethnicity, previous deployment, military rank, and military job duty. The Connor Davidson 10-Item Resilience Scale has demonstrated reliability and validity, and has been used in studies to measure service member resilience. Additional measures include the Perceived Stress Scale, Generalized Anxiety Disorder Scale, and a Quality of Life measure. The CD-10, PSS, GAD-7, and QoL measure will be readministered 12, 18, and 24-weeks after SMART completion.
Initial analysis will include descriptive statistics to characterize demographics, military grade, duty location, and previous deployment status. Cronbach's α will be calculated for each scale. Analyses will be reported as point estimates with 95% confidence intervals and estimates of effect size. Both VTC and on-line groups will be analyzed separately and scores will be pooled to test for overall intervention effects.
The investigators will conduct regression models on the pre-post intervention difference while controlling for demographic characteristics and previous deployment. The investigators will consider clustering effects among participants from the same organizational unit using random effects. Changes in resilience, stress, anxiety, and QoL over time will be assessed by analyzing changes from baseline to weeks 12, 18, and 24. The investigators will consider a joint analysis of resilience, stress, anxiety, or QOL.
Condition or disease | Intervention/treatment | Phase |
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Military Personnel Health Promotion | Behavioral: Stress Management and Resilience Training (SMART) | Not Applicable |

Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 56 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Intervention Model Description: | Randomized Control Trial |
Masking: | None (Open Label) |
Primary Purpose: | Supportive Care |
Official Title: | Improving Resiliency in U.S. Air Force Healthcare Personnel |
Actual Study Start Date : | December 4, 2020 |
Actual Primary Completion Date : | February 1, 2022 |
Actual Study Completion Date : | May 31, 2022 |

Arm | Intervention/treatment |
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Experimental: VTC/In-person SMART training
The two-hour VTC or in-person will be provided SMART synchronously to a maximum of 10 individuals. A study team member will contact participants in the VTC group to provide available dates and times of scheduled classes, and these participants will be scheduled for a class they would like to attend. Participants in the VTC group will be provided a web-link prior to the session, and each session will have a unique password to access the training. Participants in the on-line training group will be provided a code to access the training website. If local conditions permit in-person group meetings (i.e. Health Protection Condition [HPCON] Alpha or Bravo), in-person group SMART training in a classroom will be offered as an alternative to VTC sessions.
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Behavioral: Stress Management and Resilience Training (SMART)
The Stress Management and Resilience Training (SMART) program was developed by Dr. Amit Sood. SMART focuses on improving the practices of gratitude, mindful presence, kindness, and developing a resilient mindset. The SMART program incorporates practices that focus on six individual factors that have been found to promote individual-level resilience: positive coping, positive affect, positive thinking, realism, behavioral control, and altruism. In this proposed study, SMART will be provided via either a two-hour, video teleconference (VTC) or in-person training or by completion of a self-paced, on-line version completed over a period of four to eight weeks. |
Experimental: CBT SMART training
SMART will be provided via completion of a self-paced, on-line version completed over a period of four to eight weeks.
|
Behavioral: Stress Management and Resilience Training (SMART)
The Stress Management and Resilience Training (SMART) program was developed by Dr. Amit Sood. SMART focuses on improving the practices of gratitude, mindful presence, kindness, and developing a resilient mindset. The SMART program incorporates practices that focus on six individual factors that have been found to promote individual-level resilience: positive coping, positive affect, positive thinking, realism, behavioral control, and altruism. In this proposed study, SMART will be provided via either a two-hour, video teleconference (VTC) or in-person training or by completion of a self-paced, on-line version completed over a period of four to eight weeks. |
- Changes in Connor-Davidson 10-Item Scale (CD-10) [ Time Frame: Changes in self-reported CD-10 from Baseline at 12, 18, and 24 weeks post-SMART completion ]Resilience was measured using the CD-10, a 10-item scale derived from the original, 25-item Connor Davidson Resilience Scale. Respondents can answer each item using a five-point rating ranging from not true at all (0) to true nearly all the time (4). A total CD-RISC score is calculated by summing the score of all 10 items for a total possible score of 40, with a higher score reflecting a greater level of resilience. The CD-10 has a reported Cronbach's alpha of .85 and has demonstrated construct validity.
- Changes in Perceived Stress Scale (PSS) [ Time Frame: Changes in self-reported PSS from Baseline at 12, 18, and 24 weeks post-SMART completion ]The PSS was developed to provide both a global measure and a measure for current levels of perceived stress. The PSS is a 14-item instrument, and respondents answer each item on a four-point scale ranging from never (0) to very often (4). An individual's score is calculated by reverse scoring seven items and then summing all item scores, resulting in a score range of 0-56.
- Changes in Generalized Anxiety Disorder Scale (GAD-7) [ Time Frame: Changes in self-reported GAD-7 scores from Baseline at 12, 18, and 24 weeks post-SMART completion ]Anxiety was measured with the GAD-7. Respondents can answer each item using a four-point scale ranging from not at all (0) nearly every day (3). A total score is calculated by summing the scores of the seven items with possible scores ranging from 0-21. Scores between 5-9 are indicative of mild anxiety, and score between 15-21 are indicative of severe anxiety.
- Changes in Quality of Life (QOL) [ Time Frame: Changes in self-reported QOL scores from Baseline at 12, 18, and 24 weeks post-SMART completion ]A Linear Analogue Self-Assessment (LASA) QoL measure was used to measure overall quality of life for this study. Participants responded to each item using an 11-pointLikert scale ranging from as bad as it can be (0) to as good as it can be (10).

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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
- Participants must be active component healthcare personnel (any 4XXX Officer or Enlisted AFSC) serving in the U.S. Air Force, assigned to 88th MDG and USAFA at WPAFB, OH.
- Participants must be ≥ 18 years of age to participate.
Exclusion Criteria:
- Adults unable or unwilling to provide consent and individuals who are not yet adults will be excluded from this study.
- Active component Air Force service members without a healthcare AFSC will be excluded from the study.

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05460663
United States, Ohio | |
Wright-Patterson Air Force Base | |
Dayton, Ohio, United States, 45433 |
Responsible Party: | Stephen H. Hernandez, Associate Professor, University of New Mexico |
ClinicalTrials.gov Identifier: | NCT05460663 |
Other Study ID Numbers: |
FWR20200166E N20A19IR ( Other Grant/Funding Number: TriService Nursing Research Program ) HRRC 20-522 ( Other Identifier: University of New Mexico Health Science Center HRRC ) |
First Posted: | July 15, 2022 Key Record Dates |
Last Update Posted: | July 21, 2022 |
Last Verified: | July 2022 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Plan Description: | There is not a plan to make IPD available. |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Air Force Military Stress Resilience |