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Mind fitness: improving operational effectiveness and building warrior resilience.

Today's complex, fluid, and unpredictable operational environment both demands more from the military in terms of mission requirements and exposes troops to more stressors and potential trauma than ever before. On the one hand, situational awareness Situation awareness or situational awareness [1] (SA) is the mental representation and understanding of objects, events, people, system states, interactions, environmental conditions, and other situation-specific factors affecting human performance in , mental agility, and adaptability are characteristics that the military wants to cultivate to succeed in such complex environments. In part, this complexity comes from the number and nature of the different missions the military must concurrently fill. The military needs to be able to mix offensive, defensive, and stability operations conducted along multiple lines of operations Lines that define the directional orientation of the force in time and space in relation to the enemy. They connect the force with its base of operations and its objectives. , without the benefit of a clearly demarcated "frontline." Many Soldiers liken lik·en  
tr.v. lik·ened, lik·en·ing, lik·ens
To see, mention, or show as similar; compare.



[Middle English liknen, from like, similar; see like2
 this complexity and unpredictability to "the faucet," that is, needing to adjust to situations that could change from cold to hot instantaneously. Moreover, Servicemembers must navigate morally ambiguous situations with balance and nonreactivity, while drawing on stores of cultural awareness to "win hearts and minds." Finally, these missions require that decisionmaking be pushed down to the most junior levels, as the doctrine of "distributed operations Distributed Operations (DO) is a new warfighting concept being adopted by the United States Marine Corps and is being developed by their Warfighting Laboratory as a response to the changing environment of the Global War on Terror. " makes clear. Such challenges require a tremendous amount of attentional capacity, self-awareness, and situational awareness.

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On the other hand, because of the stressors and challenges of this operating environment In computing, an operating environment is the environment in which users run programs, whether in a command line interface, such as in MS-DOS or the Unix shell, or in a graphical user interface, such as in the Macintosh operating system. , the U.S. military is showing signs of strain. In 2007, the Army experienced its highest desertion rate since 1980, an 80 percent increase since the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area.  invaded Iraq in 2003. The warning signs of future retention problems are increasingly apparent: suicide, post-traumatic stress disorder (PTSD PTSD posttraumatic stress disorder.

PTSD
abbr.
posttraumatic stress disorder


Post-traumatic stress disorder (PTSD) 
), substance abuse, divorce, domestic violence, and murder within the force are on the rise. Recent attention has focused on the growing number of suicides, with the Marine Corps experiencing more suicides in 2008 than since the war began and the Army logging its highest monthly total in January 2009 since it began counting in 1980. Not surprisingly, PTSD rates are highest among Iraq and Afghanistan veterans who saw extensive combat (28 percent). However, military health care officials are seeing a spectrum of psychological issues, even among those without much combat experience. Various surveys provide a range of estimates, with up to half of returning National Guard and Reservists, 38 percent of Soldiers, and 31 percent of Marines reporting mental health problems. (1)

It is no wonder. Troops manning checkpoints or on patrol have to make split-second decisions on when to use lethal force, and veterans say fear often clouded their judgment. As Army Sergeant Dustin Flatt put it, "The second you left the gate of your base, you were always worried. You were constantly watchful for IEDs [improvised explosive devices].... If you've been in firefights earlier that day or week, you're even more stressed and insecure to a point where you are almost trigger-happy." (2) The perpetual uncertainty is mentally exhausting and physically debilitating de·bil·i·tat·ing
adj.
Causing a loss of strength or energy.


Debilitating
Weakening, or reducing the strength of.

Mentioned in: Stress Reduction
, and often its effects linger even after returning home.

What can be done to enhance the military's capacities to operate in such complex environments while simultaneously protecting against the stressors inherent in them? This article proposes a new training program for both improving operational effectiveness and building resilience to the stressors of deployment: Mindfulness-based Mind Fitness Training (MMFT MMFT Monthly Mecha Fighting Tournament
MMFT Method of Moments plus Fourier transform
, pronounced M-Fit). This program includes techniques and exercises that previous research in civilians has demonstrated to be effective at enhancing the capacities central to mind fitness, such as mental agility, emotion regulation, attention, and situational awareness. Importantly, these exercises appear to achieve improvements in mind fitness by changing brain structure and function so that brain processes are more efficient. Our pilot research, conducted in pre-deployment Marine Reservists, suggests that MMFT is similarly successful at bolstering mind fitness and building resilience against stressors in a military cohort. Drawing on the well-documented theory of neuroplasticity, which asserts that experience changes the brain, this article argues that mind fitness training could complement the military's existing stress inoculation inoculation, in medicine, introduction of a preparation into the tissues or fluids of the body for the purpose of preventing or curing certain diseases. The preparation is usually a weakened culture of the agent causing the disease, as in vaccination against  training by developing skills to promote resilience against stress and trauma so that warriors can execute their missions more effectively.

Stress Can Degrade Performance

A variety of research indicates that harmful conditions such as chronic stress, neglect, and abuse can produce harmful changes in the brain. (3) Stress is produced by real or imagined events that are perceived to threaten an individual's physical and mental well-being. Today, stress is commonly understood to mean external events or circumstances, and as a result, we tend to think of stress as something external to us. However, stress is actually a perceived, internal response. The right amount of stress will allow a decisionmaker to function at peak performance. However, excessive stress has biological and psychological consequences that reduce the capacity to process new information and learn. Stress may also bias decisionmaking more toward reactive, unconscious emotional choices.

Recent empirical research about decisionmaking in stressful military environments demonstrates that trauma and stress lead to deficits in cognitive functioning. One large study of Army troops found that Soldiers who served in Iraq were highly likely to show lapses in memory and an ability to focus, a deficit that often persisted more than 2 months after they arrived home. (4) In the study, 654 Soldiers who deployed to Iraq between April 2003 and May 2005 did significantly worse in tasks that measured spatial memory, verbal ability, and the ability to focus than 307 Soldiers who had not deployed. In contrast, the Soldiers who had deployed outperformed those who had not in terms of quick reaction time (for example, how long it takes to spot a computer icon and react). In effect, the deployed Soldiers' brains built the capacity for quick reaction, a function more necessary for survival in Iraq, while experiencing degradation in other mental capacities.

In another study, Soldiers who screened positive for mental health problems after returning home were up to three times more likely to report having engaged in unethical behavior while deployed. (5) Such behavior, including unnecessarily damaging private property or insulting or physically harming noncombatants, is obviously counterproductive to winning the confidence of the local population. This finding suggests a strong link between the negative effects of stress, which degrades Soldiers' capacity to manage their own emotions and thereby control impulsive, reactive behavior, and a decrease in their ability to perform their mission effectively.

Other studies of military environments have found substantial degradation in cognitive performance when subjects experience sleep deprivation sleep deprivation Sleep disorders A prolonged period without the usual amount of sleep. See Driver fatigue, Poor sleeping hygiene, Sleep disorders, Sleep-onset insomnia.  and other environmental stressors. One recent study of sleep deprivation among Navy SEALs and Army Rangers during a field training exercise demonstrated that the lack of sleep affected troops so badly that after a week they performed worse on cognitive tests than if they were sedated or legally drunk. In this study, the SEALs and Rangers showed severe degradation in reaction time, vigilance, visual pattern recognition, short-term memory, learning, and grammatical reasoning skills. (6)

Another group of studies examined more than 530 Soldiers, Sailors, and pilots during military survival training, including time in mock prisoner of war camps, to prepare them to withstand the mental and physical stresses of capture. In these studies, exposure to acute stressors resulted in symptoms of dissociation (alterations of one's perception of body, environment, and the passage of time), problem-solving deficits (as measured by objectively assessed military performance), and significant inaccuracies in working memory and spatial memory (as measured by eyewitness identification tests).7 These findings corroborated with other studies that found multistressor environments lead to substantial degradation of executive control capacity and cognitive skills, and such degradation has been linked to battlefield errors, such as friendly fire incidents and collateral damage collateral damage Surgery A popular term for any undesired but unavoidable co-morbidity associated with a therapy–eg, chemotherapy-induced CD to the BM and GI tract as a side effect of destroying tumor cells . (8)

Mind Fitness Training and Performance

Optimal combat readiness requires three things:

* mission essential knowledge and skills

* physical fitness

* mind fitness.

All three components are crucial for equipping warriors to handle the challenges and stressors of deployment. The military devotes substantial resources to the first two categories, both in terms of funding and time on the training schedule. However, there is virtually no focus on mind fitness training today. The Army's Battlemind program is a first effort to raise Soldiers' awareness of the psychological health issues associated with deployment, but Battlemind mostly occurs after Soldiers return home and provides no skills training. Instead, it introduces them to the cognitive and psychological effects of being deployed, provides psychological debriefing sessions, and helps them identify warning signs for when to seek help. In short, the military generally lacks proactive mind fitness training programs designed to give warriors skills that optimize performance and protect against the stressors of deployment.

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Most military training is "stress inoculation training" because it exposes and habituates warriors to the kinds of stressors they will face while deployed. Paradoxically, however, as the previous section demonstrates, stress inoculation training depletes warriors' executive control capacity--that is, the mental capacity that allows us to focus on demanding cognitive tasks and/or emotionally challenging situations. As we explain below, mind fitness training may counteract this cognitive degradation that results from stress inoculation training. Therefore, it could complement existing military predeployment training, as it helps warriors to perceive and relate to deployment stressors differently. In other words Adv. 1. in other words - otherwise stated; "in other words, we are broke"
put differently
, mind fitness training may provide "mental armor" to protect troops as they prepare for deployment and experience the stressors of deployment itself.

Just as stress and trauma can functionally and structurally change the brain, so too can training, practice, and expertise. The brain of an expert--such as surgeon, taxi driver, or musician--is functionally and structurally different from that of a nonexpert. In one study of London cab drivers, for example, researchers found that cab drivers have larger hippocampi than matched controls and that the longer an individual worked as a cab driver cab·driv·er also cab driver  
n.
One who drives a taxicab for hire.

cab driver ntaxista m/f

cab driver n
, the larger the hippocampus hippocampus

fabulous marine creature; half fish, half horse. [Rom. Myth. and Art: Hall, 154]

See : Monsters
. The hippocampus is the brain region that controls conscious memory, obviously needed to navigate London's circuitous cir·cu·i·tous  
adj.
Being or taking a roundabout, lengthy course: took a circuitous route to avoid the accident site.
 streets. These differences in hippocampus size were the result of experience and training as a cab driver, not of preexisting differences in the hippocampal hip·po·cam·pus  
n. pl. hip·po·cam·pi
A ridge in the floor of each lateral ventricle of the brain that consists mainly of gray matter and has a central role in memory processes.
 structure. (9)

The London cab driver study highlights the well-documented theory of neuroplasticity, which states that experience changes the brain. (10) Areas of the brain may shrink or expand-become more or less functional--based on experience. In other words, the brain, like the rest of the body, builds the "muscles" it uses most, sometimes at the expense of other abilities. This concept is something athletes, musicians, and martial artists have known for a long time: with physical exercise and repetition of certain body movements, the body becomes stronger, more efficient, and better able to perform those movements with ease. A similar process can occur with the brain: with the engagement and repetition of certain mental processes, the brain becomes more efficient at those processes. This improved efficiency arises because any time we perform a physical or mental task, the brain regions that serve task-related functions show increased neuronal activity. Over time, as we choose to build a new mental skill, the repeated engagement of the brain regions supporting that skill creates a more efficient pattern of neural activity, for example, by rearranging structural connections between brain cells involved in that skill. In other words, experience and training can lead to functional and structural reorganization of the brain.

Thus, there is a profound parallel between physical fitness and mind fitness. Athletes know that with repetition, physical fitness exercises can produce training-specific muscular, respiratory, and cardiovascular changes in the body. They know that specific training will correspond to specific benefits and promote better recovery from specific injuries. For example, sprints can build fast-twitch muscles, while longer runs can teach the body to burn fat instead of glucose. Similarly, specific mental exercises may allow the mind to become more "fit" and better protected against certain types of challenges by neuroplastic changes in the brain.

Mind fitness in today's operational environment entails having a mind with highly efficient capacities for mental agility, emotional regulation, attention, and situational awareness (of self, others, and the wider environment). Just as physical fitness corresponds to specific enhancements in the body, mind fitness may correspond to enhancements in specific brain structures and functions that support these capacities. And, like physical fitness, mind fitness may be protective: it may build resiliency and lead to faster recovery from cognitive depletion and psychological stress. We propose that mind fitness can be maintained even in high-demand and high-stress contexts by regularly engaging in certain mental exercises. These exercises engage and improve core mental processes, such as working memory capacity, which lead to a more mentally agile, emotionally regulated, attentive, and situationally aware mode of functioning.

This scientific understanding is starting to be recognized and applied with many recent research studies and popular books describing training programs to bolster mind fitness. (11) These training techniques have existed for thousands of years, originating in Eastern spiritual traditions. In recent decades, they have been adapted for secular use, including in medical and mental health settings, corporations, prisons, and elementary schools. The most common and well-validated training program is mindfulness-based stress reduction mindfulness-based stress reduction (MBSR),
n meditation technique that promotes relaxation through the nonjudgmental awareness of moment-to-moment sensations, experiences, and reactions.
 (MBSR MBSR Mindfulness Based Stress Reduction (Dr. Myra Weiss) ); more than 250 U.S. hospitals offer MBSR programs, and more than 50 research articles document its utility in many domains. (12)

Mind fitness can be enhanced through a variety of training techniques, but the foundational skill cultivated in both MBSR and our MMFT program is called "mindfulness." Mindfulness has been described as a process of "bringing one's attention to the present experience on a moment-by-moment basis" (13) and as "paying attention in a particular way, on purpose, in the present moment and non-judgmentally." (14) Mindfulness differs from a more conceptual mode of processing information, which is often the mind's default way of perceiving and cognizing. In other words, paying attention is not the same thing as thinking, although we often equate the two.

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A growing body of empirical scientific evidence supports the efficacy of mindfulness-based interventions. Clinical studies demonstrate that civilian patients who participated in such programs saw improvement in many physical and psychological conditions and reported a decrease in mood disturbance from, and stress related to, these conditions. Similarly, numerous studies have documented how mindfulness training positively alters emotional experience by reducing negative mood as well as improving positive mood and well-being. (15) Mindfulness training has also been shown to increase tolerance of unpleasant physical states, such as pain, (16) produce brain changes consistent with more effective handling of emotions under stress, and increase immune functioning. (17) Finally, many studies have shown that mindfulness training improves different aspects of attention, which is the ability to remain focused on task-relevant information while filtering out distracting or irrelevant information. (18) While this research draws from civilian populations, its findings clearly have implications in the military context. These techniques have already been extended to war veterans with PTSD, and preliminary results from this work suggest a reduction in symptoms. (19) In addition, mindfulness training could help optimize warrior performance by cultivating competencies critical for the modern battlefield, such as improved self-regulation, better attentional skills, and enhanced situational awareness.

Working Memory Capacity and Mental Armor

Mind fitness, as we have operationalized it here, comprises mental faculties critical for military effectiveness, such as mental agility, emotion regulation, attention, and situational awareness. Interestingly, the cognitive neuroscience construct of "working memory capacity" (WMC WMC Winter Music Conference
WMC Weill Medical College (Cornell University)
WMC Wisconsin Manufacturers and Commerce (Madison, WI)
WMC Westchester Medical Center
WMC Western Mining Corporation
) has also been linked to these faculties. WMC is the ability to maintain relevant information online while resisting interference from irrelevant information. Growing evidence suggests that working memory capacity is tied to the ability to engage in abstract problem-solving and counterfactual thinking. Recently, neuroscientists report that in addition to these "cold" cognitive processes Cognitive processes
Thought processes (i.e., reasoning, perception, judgment, memory).

Mentioned in: Psychosocial Disorders
 requiring a high degree of mental flexibility and agility, "hot" emotional regulation processes also rely on WMC.

While individuals differ in their baseline WMC, everyone's WMC can be fatigued and degraded after engaging in highly demanding cognitive or emotional tasks.20 Conversely, WMC can be improved and strengthened through training. Studies have shown that individuals with higher WMC have better attentional skills, abstract problem-solving skills, and general fluid intelligence (that is, the ability to use rather than simply know facts). They also suffer less from emotionally intrusive thoughts and are more capable of suppressing or reappraising emotions when required. In contrast, individuals with lower WMC have poorer academic achievement, lower standardized test scores, and more episodes of mind-wandering. They are more likely to suffer from PTSD, anxiety disorders, and substance abuse, and are more likely to exhibit prejudicial behavior toward personally disliked groups.21 Thus, WMC corresponds to an individual's success at willfully willfully adv. referring to doing something intentionally, purposefully and stubbornly. Examples: "He drove the car willfully into the crowd on the sidewalk." "She willfully left the dangerous substances on the property." (See: willful)  guiding behavior while overcoming cognitive or emotional distractions or impulsive tendencies.

Warriors with higher WMC are more likely to have better mind fitness and thus be better equipped for responding to the cognitive and emotional challenges that come from preparing for and experiencing deployment. These warriors are also more likely to maintain an effective level of performance when confronted by obstacles, setbacks, and distractions, and return to their baseline functioning after being exposed to stressors or traumatic experiences. Nonetheless, all warriors (even those with higher WMC) are likely to suffer from some degree of WMC degradation through the deployment cycle because the stressors of this time period are so depleting of cognitive and emotional resources. Moreover, an individual's position within the military command structure may exacerbate the problem because recent evidence suggests that being lower in a power hierarchy reduces WMC. (22)

Thus, an important component of optimal combat readiness should be to maintain or increase baseline levels of WMC, despite the increase in stressors over the deployment cycle. Because WMC can be strengthened through training, performance on both cold cognitive processes and hot emotional regulation can be enhanced. Maintaining or enhancing warriors' baseline levels of WMC could have cascading effects for effective decisionmaking, complex problem-solving, and emotional regulation processes, all of which are heavily taxed over the deployment cycle and are crucial for mission effectiveness. In other words, training to improve WMC may provide "mental armor" to protect against impending deployment-related degradation in mind fitness.

MMFT

Mindfulness-based Mind Fitness Training is a 24-hour course that is taught over 8 weeks in groups of 20 to 25 Servicemembers. MMFT is based on the well-established MBSR course known to improve attentional functioning and reduce the negative effects of stress. However, MMFT is tailored for the military predeployment training cycle, with real-world examples from the counterinsurgency coun·ter·in·sur·gen·cy  
n.
Political and military strategy or action intended to oppose and forcefully suppress insurgency.



coun
 environment that show how mind fitness skills can enhance performance and mission accomplishment. During the course, troops learn about the stress reaction cycle and its effects on the mind and body. They also learn how mind fitness training can boost resilience to stress. Most importantly, and unlike the Army's Battlemind training, MMFT provides skills training through mind fitness exercises. These exercises are practiced 30 minutes a day. Some exercises build concentration by focusing on one object of attention, such as a particular body sensation. Others build situational awareness and non-reactivity through wider attention on internal and external stimuli. And some exercises use focused attention to reregulate physiological and psychological symptoms that develop from traumatic or stressful experiences. The exercises are incorporated into physical training and other mission essential tasks and completed during the duty day, in groups and/or individually. Thus, an important component of the course is engaging in MMFT training exercises each day.

We recently conducted a pilot study of MMFT with a detachment of 31 Marine Reservists, who received the training before they deployed to Iraq. (In March 2009, they returned home from this deployment.) While some Marines resisted the effort required by the training, the initial exposure was relatively positive. The entire detachment received training, and MMFT's didactic information and group practices helped to socialize so·cial·ize  
v. so·cial·ized, so·cial·iz·ing, so·cial·iz·es

v.tr.
1. To place under government or group ownership or control.

2. To make fit for companionship with others; make sociable.
 the concept. Once deployed, the Marines personalized their approach to the MMFT exercises, differing in how they incorporated them into their daily routines. From their anecdotal reports during and after the deployment, it appears some Marines continued the exercises during their down time, some incorporated them into their physical fitness regimes, some employed them as part of their premission rehearsals, and some employed them to keep themselves alert and focused while on missions. Many Marines reported using the exercises at bedtime, which they said helped them to quiet their minds, fall asleep faster, and sleep more soundly.

Before and after MMFT training (before they deployed), the Marines participated in a battery of behavioral tasks to measure their cognitive capabilities. We had predicted that the increase in stressors during predeployment training would degrade the Marines' cognitive performance. However, statistical analysis shows that the Marines who spent more time engaging in mind fitness exercises (on average, 10 hours outside of class) saw an improvement in their cognitive performance compared to Marines who spent less time engaging in the exercises (on average, 2 hours outside of class). (23) Specifically, despite the real increase in stressors during the predeployment period, the Marines who engaged in more mind fitness training maintained the same perceived stress level and preserved or even improved their working memory capacity over their initial baseline.

In contrast, the Marines who engaged in less mind fitness training experienced an increase in their perceived stress levels and the predicted decrease in their working memory capacity. This degradation in their WMC produced test scores of working memory capacity on par with populations that have suffered psychological injuries such as PTSD and major depression. (24) It is important to note that this degradation in working memory capacity occurred before deployment, and thus does not reflect the additional stressors of the deployment itself. The apparent costs of the predeployment context are striking, given that the intention of the predeployment training is to prepare Servicemembers physically, emotionally, and cognitively for the stressors of deployment. Our findings highlight the potential importance of providing mind fitness training within the predeployment time period to buffer against WMC depletion.

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While we have not yet fully analyzed the data from their postdeployment cognitive behavioral testing, it is clear from a postdeployment survey that the Marines continued to engage in mind fitness training and/ or use the skills they learned while deployed. Sixteen percent of the Marines said that they "practiced regularly while deployed," while 35 percent gave neutral responses, and 48 percent said they did not practice regularly. In contrast, 26 percent of the Marines said that they practiced mind fitness exercises "after particularly stressful or traumatic experiences," while 35 percent gave neutral responses and 38 percent said they did not. Perhaps more importantly, 54 percent of the Marines said that they "used the skills learned in this course downrange down·range  
adv. & adj.
In a direction away from the launch site and along the flight line of a missile test range: landed a thousand miles downrange; the downrange target area. 
," while 27 percent gave neutral responses, and the rest said they did not use MMFT skills while deployed.

Thus, while only 16 percent practiced mind fitness exercises regularly during the deployment, more than a quarter used the practices to reregulate themselves after stressful experiences and more than half used MMFT skills during the deployment. These findings suggest the need for adding more structured mind fitness exercise sessions into a unit's daily schedule during deployment. They also highlight again the parallel to physical fitness: just as building muscle requires repetitive physical exercise, improving cognitive and emotional performance requires engaging in mind fitness exercises in a sustained, disciplined manner. While mind fitness skills are quickly and easily taught, they require ongoing commitment to develop and strengthen over time.

We acknowledge several limitations to this pilot study. Our cohort was a convenience sample, consisting of a detachment that agreed to receive training. There was no waitlist wait·list  
n.
A waiting list.

tr.v. also wait-list wait·list·ed, wait·list·ing, wait·lists
To put on a waiting list.
 or active control group, although we are currently gathering control group data for further analysis. We think this weakness was partially mitigated by our use of well-validated cognitive behavioral instruments shown to be stable over time. This minimizes the possibility that the observed changes simply reflected measurement artifact.

Nonetheless, the fact that all Marines started with similar WMC scores and that changes in their scores over time correlate, in a statistically significant way, with the amount of time spent engaging in mind fitness exercises highlights the need for further study. To this end, we have recently received funding from the Department of Defense to examine how mind fitness training can build resilience and combat readiness among Army Soldiers. The first study will compare MMFT to the Army's Battlemind program in a predeployment context. The second study will compare different versions of MMFT in a nondeployment context, to see which version is most effective at producing optimal cognitive and psychological performance among warriors.

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As this article has shown, mind fitness training can immunize im·mu·nize
v.
1. To render immune.

2. To produce immunity in, as by inoculation.



im
 against stress by buffering the cognitive degradation of stress inoculation training and by permitting more adaptive responses to and interpretation of stressors. Mind fitness training can also enhance warrior performance by cultivating competencies critical for today's security environment. Finally, beyond its immediate effects for managing stress and enhancing mission performance, mind fitness training is protective: it builds resiliency and leads to faster recovery from cognitive degradation and psychological injury. While warriors may choose to engage in mind fitness exercises to optimize their performance downrange, the protective effects will still be accruing--likely leading to a decrease in psychological injury upon returning home. As a result, mind fitness training could reduce the number of warriors in need of professional help and thereby reduce caregiver burnout Burnout

Depletion of a tax shelter's benefits. In the context of mortgage backed securities it refers to the percentage of the pool that has prepaid their mortgage.
 among Armed Forces' chaplains and medical and mental health professionals. In other words, mind fitness training's beneficial effects could continue long after the deployment is over, increasing the likelihood that warriors will be ready, willing, and able to deploy again when needed.

NOTES

(1) L. Baldor, "Army desertions surge in past year," San Jose Mercury News The San Jose Mercury News is the major daily newspaper in San Jose, California and Silicon Valley. The paper is owned by MediaNews Group. Its headquarters and printing plant are located in North San Jose next to the Nimitz Freeway (Interstate 880). , November 17, 2007, 4A; C.W. Hoge et al., "Mental Health Problems, Use of Mental Health Services health services Managed care The benefits covered under a health contract , and Attrition from Military Service after Returning from Deployment to Iraq or Afghanistan," Journal of the American Medical Association JAMA: The Journal of the American Medical Association is an international peer-reviewed general medical journal, published 48 times per year by the American Medical Association. JAMA is the most widely circulated medical journal in the world.  295, no. 9 (2006), 1023-1032; Charles S. Milliken et al., "Longitudinal Assessment of Mental Health Problems among Active and Reserve Component Soldiers Returning from the Iraq War," Journal of the American Medical Association 298, no. 18 (2007), 2141-2148; "Alcohol Abuse Rises among Combat Veterans: Study," Reuters, August 12, 2008; "Divorce Rate Up in U.S. Army, Marine Corps," Associated Press, December 3, 2008; A. Keteyian, "Suicide Epidemic among Veterans," CBS News, November 13, 2007; Tony Perry, "Marine suicides in 2008 at a yearly high since Iraq invasion," The Los Angeles Times Los Angeles Times

Morning daily newspaper. Established in 1881, it was purchased and incorporated in 1884 by Harrison Gray Otis (1837–1917) under The Times-Mirror Co. (the hyphen was later dropped from the name).
, January 14, 2009; Lizette Alvarez, "Army Data Shows Rise in Number of Suicides," The New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of
 Times, February 5, 2009; D. Sontag and L. Alvarez, "Across America, Deadly Echoes of Foreign Battles," The New York Times, January 13, 2008, A1; Terri Tanielian and Lisa Jaycox, eds., Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery (Santa Monica, CA: RAND, 2008); Office of the Surgeon Multi-National Force-Iraq, Office of the Command Surgeon, and Office of the Surgeon General The U.S. Surgeon General is charged with the protection and advancement of health in the United States. Since the 1960s the surgeon general has become a highly visible federal public health official, speaking out against known health risks such as tobacco use, and promoting disease  United States Army Medical Command The U.S. Army Medical Command, known as MEDCOM, is a major command of the U.S. Army that provides command and control of the Army's fixed-facility medical, dental, and veterinary treatment facilities, providing preventive care, medical research, development and training , Mental Health Advisory Team (MHAT MHAT Mental Health Advisory Team (US Army) ) V Operation Iraqi Freedom 06-08: Iraq Operation Enduring Freedom 8: Afghanistan, February 14, 2008.

(2) C. Hedges and L. Al-Arian, "The Other War," The Nation (July 30-August 6, 2007), 23.

(3) Douglas Bremner, Does Stress Damage the Brain? Understanding Trauma-related Disorders from Mind-Body Perspective (New York: Norton, 2002); Robert Scaer, The Trauma Spectrum: Hidden Wounds and Human Resiliency (New York: Norton, 2005).

(4) Jennifer J. Vasterling et al., "Neuropsychological neu·ro·psy·chol·o·gy  
n.
The branch of psychology that deals with the relationship between the nervous system, especially the brain, and cerebral or mental functions such as language, memory, and perception.
 outcomes of Army personnel following deployment to the Iraq War," Journal of the American Medical Association 296, no. 5 (2006), 519-529.

(5) Office of the Surgeon Multi-National Force-Iraq, Office of the Command Surgeon, and Office of the Surgeon General United States Army Medical Command, 32.

(6) Harris R. Lieberman et al., "Severe decrements in cognition function and mood induced by sleep loss, heat, dehydration and under-nutrition during simulated combat," Biological Psychiatry 57 (2005), 422-429.

(7) Charles A. Morgan III et al., "Accuracy of eyewitness memory for persons encountered during exposure to highly intense stress," International Journal of Law and Psychiatry 27 (2004), 265-279; Charles A. Morgan III et al., "Stress-Induced Deficits in working memory and visuo-constructive abilities in Special Operations Soldiers," Biological Psychiatry 60 (2006), 722-729.

(8) D.R. Haslam, "The military performance of soldiers in sustained operations," Aviation, Space and Environmental Medicine 55 (1984), 216-221; Harris R. Lieberman et al., "Effects of caffeine, sleep loss and stress on cognitive performance and mood during U.S. Navy Seal training," Psychopharmacology psychopharmacology (sī'kōfär'məkŏl`əjē), in its broadest sense, the study of all pharmacological agents that affect mental and emotional functions.  164 (2002), 250-261; K. Opstad, "Circadian rhythm circadian rhythm: see rhythm, biological.
circadian rhythm

Inherent cycle of approximately 24 hours in length that appears to control or initiate various biological processes, including sleep, wakefulness, and digestive and hormonal activity.
 of hormones is extinguished during prolonged physical stress, sleep and energy deficiency in young men," European Journal of Endocrinology Journal of Endocrinology

This is a journal published by the Society for Endocrinology, which publishes original research articles in the field. It is abbreviated "J Endocrinol".

[1]
 131 (1994), 56-66; G. Belenky et al., "Sustaining Performance during Continuous Operations: The U.S. Army's Sleep Management System," in Pennington Center Nutritional Series 10, Countermeasures for Battlefield Stressors, ed. K. Friedl et al. (Baton Rouge: Louisiana State University Press This article needs sources or references that appear in reliable, third-party publications. Alone, primary sources and sources affiliated with the subject of this article are not sufficient for an accurate encyclopedia article. , 2000).

(9) E.A. McGuire et al., "Navigation expertise and the human hippocampus: a structural brain imaging analysis," Hippocampus 13, no. 2 (2003), 250-259.

(10) Jeffrey M. Schwartz Jeffrey M. Schwartz, M.D. is a well known American scientist in the field of Neuroplasticity, and its application to obsessive-compulsive disorder (OCD).

After receiving a bachelors with honors in Philosophy, he changed career directions to the medical sciences.
 and Sharon Begley, The Mind and the Brain: Neuroplasticity and the Power of Mental Force (New York: Harper Perennial, 2003).

(11) Sharon Begley, Train Your Mind, Change Your Brain (New York: Random House, 2007); Ryuta Kawashima, Train Your Brain: 60 Days to a Better Brain (New York: Kumon Publishing, 2005); Joel Levy, Train Your Brain: The Complete Mental Workout for a Fit and Agile Mind (New York: Barnes and Noble Publishing, 2007).

(12) A. Lutz et al., "Attention regulation and monitoring in meditation," Trends in Cognitive Sciences 12, no. 4 (2008), 163-169. See also A.P. Jha et al., "Mindfulness Training Modifies Subsystems of Attention," Cognitive, Affective and Behavioral Neuroscience 7, no. 2 (2007), 109-119.

(13) G.A. Marlatt and J.L. Kristeller, "Mindfulness and Meditation," in Integrating Spirituality into Treatment: Resources for Practitioners, ed. William R. Miller (Washington, DC: American Psychological Association, 1999), 68.

(14) Jon Kabat-Zinn, Wherever You Go, There You Are: Mindfulness Meditation in Daily Life (New York: Hyperion, 1994), 4.

(15) P.C. Broderick, "Mindfulness and Coping with Dysphoric Mood: Contrasts with Rumination rumination /ru·mi·na·tion/ (roo?mi-na´shun)
1. the casting up of the food to be chewed thoroughly a second time, as in cattle.

2.
 and Distraction," Cognitive Therapy cognitive therapy
n.
Any of a variety of techniques in psychotherapy that utilize guided self-discovery, imaging, self-instruction, and related forms of elicited cognitions as the principal mode of treatment.
 and Research 29, no. 5 (2005), 501-510. See also, Ruth A. Baer, "Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review," Clinical Psychology: Science and Practice 10, no. 2 (2003), 125-143.

(16) Joshua Grant, "Pain Perception, Pain Tolerance, Pain Control and Zen Meditation," presentation at the Mind and Life Summer Research Institute, June 5, 2007.

(17) Richard J. Davidson et al., "Alterations in brain and immune function Immune function
The state in which the body recognizes foreign materials and is able to neutralize them before they can do any harm.

Mentioned in: Herbalism, Traditional Chinese, Stress Reduction
 produced by mindfulness meditation," Psychosomatic Medicine psychosomatic medicine (sī'kōsōmăt`ĭk), study and treatment of those emotional disturbances that are manifested as physical disorders.  65, no. 4 (2003), 564-570.

(18) A.P. Jha et al., "Mindfulness Training Modifies Subsystems of Attention"; E.R. Valentine and P.L.G. Sweet, "Meditation and attention: A comparison of the effects of concentrative and mindfulness meditation on sustained attention," Mental Health, Religion and Culture 2 (1999), 59-70; Heleen Slater et al., "Mental Training Affects Distribution of Limited Brain Resources," PLoS Biology 5, no. 6 (2007), 138.

(19) A.P. King et al., "Pilot Study of a Mindfulness-based Group Therapy for Combat Posttraumatic Stress Disorder Posttraumatic stress disorder

An anxiety disorder in some individuals who have experienced an event that poses a direct threat to the individual's or another person's life.
 (PTSD)," poster presented to American Psychosomatic psychosomatic /psy·cho·so·mat·ic/ (-sah-mat´ik) pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin.

psy·cho·so·mat·ic
adj.
1.
 Society, Baltimore, MD, 2008.

(20) B.J. Schmeichel, "Attention control, memory updating, and emotion regulation temporarily reduce the capacity for executive control," Journal of Experimental Psychology: General 136, no. 2 (2007), 241-255.

(21) A.R. Conway et al., "Working memory span tasks: A methodological review and user's guide," Psychonomic Bulletin & Review 12, no. 5 (2005), 769-786.

(22) P.K. Smith et al., "Lacking power impairs executive functions," Psychological Science 19, no. 5 (2008), 441-447.

(23) A.P. Jha et al., "Examining the Protective Effects of Mindfulness Training on Working Memory Capacity and Affective Experience," Emotion (in review).

(24) C.R. Brewin, and L. Smart, "Working memory capacity and suppression of intrusive thoughts," Journal of Behavioral Therapy and Experimental Psychiatry 36, no. 1 (2005), 61-68; T. Dalgleish et al., "Reduced autobiographical memory specificity and posttraumatic posttraumatic /posttrau·mat·ic/ (post?traw-mat´ik) occurring as a result of or after injury.

post·trau·mat·ic
adj.
Following or resulting from injury or trauma.
 stress: Exploring the contributions of impaired executive control and affect regulation," Journal of Abnormal Psychology Journal of Abnormal Psychology is a scientific journal published by the American Psychological Association. It has previously been entitled Journal of Abnormal & Social Psychology

   
 117 (2008), 236-241; T. Dalgleish et al., "Reduced specificity of autobiographical memory and depression: The role of executive processes," Journal of Experimental Psychology: General 136 (2007), 23-42.

Dr. Elizabeth A. Stanley is an Assistant Professor in the Edmund A. Walsh School of Foreign Service This article or section needs sources or references that appear in reliable, third-party publications. Alone, primary sources and sources affiliated with the subject of this article are not sufficient for an accurate encyclopedia article.  and Department of Government at Georgetown University. Dr. Amishi P. Jha is an Assistant Professor in the Department of Psychology at the University of Pennsylvania (body, education) University of Pennsylvania - The home of ENIAC and Machiavelli.

http://upenn.edu/.

Address: Philadelphia, PA, USA.
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