Psychological flexibility training to enhance resilience in military personnel
Abstract: The U.S. Department of Defense continues to have a significant interest in the development and evaluation of evidence-based programs for enhancing resilience in military personnel. However, few studies have documented evidence-based interventions to maintain or boost performance and enhance resilience among service members. A robust body of literature describes the positive association between psychological flexibility and resilience as well as outcomes including performance, mental health, and social functioning in both healthy and clinical populations. Acceptance and Commitment Therapy (ACT) is an evidence-based intervention that directly targets the enhancement of psychological flexibility. In the current paper, we first describe the association between psychological flexibility and resilience. Then we briefly note the limitations of existing military resilience training programs and outline the relevant evidence in support of an ACT-based resilience training program. Finally, we describe the six psychological flexibility processes that comprise ACT interventions along with the relevance of each process for resilience enhancement in military personnel. We conclude with information about an in-progress study of a novel ACT-based training program targeting resilience enhancement and readiness optimization in active duty service members.
Abstract: Background: Exposure to potentially morally injurious events (PMIEs) during military service can lead to moral injury (MI) outcomes and posttraumatic stress symptoms (PTSS). This longitudinal study examined the relationships between PMIE exposure, MI outcomes, and PTSS among Israeli combat veterans, and the potential protective role of dispositional forgiveness in these associations. Method: Participants were 169 Israeli combat veterans who participated in a six-year longitudinal study with four measurement points (T1: 12 months before enlistment, T2: Six months following enlistment- pre-deployment, T3: 18 months following enlistment- post-deployment, and T4: 28 months following discharge). Participants’ characteristics were assessed via semi-structured interviews (T1) and validated self-report measures (T2-T4) between 2019-2024. Results: Approximately 36% of participants reported exposure to PMIEs during service, with 13% exceeding the clinical threshold for probable PTSD at T4. PMIE-Betrayal at T3 was positively associated with MI outcomes of shame and trust violation at T4. The indirect effect of PMIEs on PTSS through MI outcome-Shame depended on forgiveness levels. Among veterans with low forgiveness, higher exposure to PMIE-Betrayal was associated with increased MI shame, which was linked to more severe PTSS. Conversely, for those with high forgiveness, exposure to PMIE-Self and Other was associated with decreased MI shame and subsequently reduced PTSS. Conclusion: Dispositional forgiveness moderates the relationship between PMIE exposure and MI outcomes, particularly shame, which mediates the development of PTSS. These findings highlight forgiveness as a potential target for intervention in treating moral injury and preventing PTSS among combat veterans.