Ten years of continuous war - characterized by multiple deployments, elusive guerilla adversaries and occupied populations seemingly more tilted toward resentment than gratitude - have taken a significant toll on US troops. In addition to those who have been killed, physically maimed or neurologically impaired by combat, many soldiers have experienced debilitating psychological disorders including post-traumatic stress disorder (PTSD), depression and anxiety. Large numbers are on antidepressants and other psychotropic medications, while the suicide rate among troops has risen to alarming levels.
The sobering realities of the psychological effects of war pose a serious challenge for the US military tasked with simultaneously fighting multiple wars and anticipating years of "persistent conflict" ahead. The good news is that key sectors within the military have now identified the mental health of our troops as a major issue that must be addressed. Indeed, in addition to treatment for those suffering psychological impairment, the military leadership is pursuing intervention efforts aimed at preventing such adverse outcomes by increasing soldiers' psychological resilience to combat exposure. The largest of these new initiatives is the Army's Comprehensive Soldier Fitness (CSF) program, launched in 2009 and based upon the "positive psychology" framework of psychologist Martin Seligman. And that brings us to the bad news: despite the overhyped claims of CSF's leading proponents, at this point, there is little evidence to suggest that CSF works.
Since its inception, CSF has been the target of numerous criticisms from psychologists and others, including an article, "The Dark Side of Comprehensive Soldier Fitness," we co-authored with colleague Marc Pilisuk last year, a series of critical comments published in the October 2011 issue of the American Psychologist and criticism voiced on PBS "NewsHour." Concerns raised by critics span a wide range of significant issues (and led to Congressional inquiries last year): the questionable empirical evidence behind the rapid creation and implementation of CSF; indications that CSF is actually a research study involuntarily imposed upon troops without appropriate protections such as independent ethical review and informed consent; the possibility that CSF may distract attention from addressing the documented adverse effects of multiple and lengthy deployments and high levels of combat exposure; potential negative effects of CSF, common in prevention programs, that have not been carefully considered or monitored; concerns as to whether the "spirituality" component of CSF is inappropriately promoting religion; the insufficient examination of ethical questions posed by efforts to build "indomitable" soldiers; issues concerning the awarding of a $31 million no-bid contract to Seligman's positive psychology center at the University of Pennsylvania for CSF development; and the seemingly uncritical embrace and promotion of CSF by the American Psychological Association (of which Seligman is a past president).
Recently, we identified yet another deeply problematic issue with the CSF program: The research evaluating the program is of questionable quality and it does not support the strong claims being made about CSF's effectiveness. Most notably, last December, CSF researchers released a report, "Report #3: Longitudinal Analysis of the Impact of Master Resilience Training on Self-Reported Resilience and Psychological Health Data," purporting to demonstrate that CSF "works." On the report's first page, the researchers boldly assert: "There is now sound scientific evidence that Comprehensive Soldier Fitness improves the resilience and psychological health of Soldiers." And, in a prefatory statement to the report, Army Vice Chief of Staff Gen. Peter Chiarelli wrote: "I and other Army senior leaders are often asked if it [CSF] really works - if it actually makes Soldiers more resilient and psychologically healthier. I believe the answer is yes."
The Army News Service quickly and broadly disseminated the "news" this way: "The Master Resilience Training aspect of Comprehensive Soldier Fitness is working well. That's the conclusion of an Army report, released last month, covering a 15-month period of statistical evaluation." This summary has appeared on dozens of web sites, including the official web sites of the US Army, the CSF program, the Army National Guard, the US Army magazine Soldiers and the Fort Hood Sentinel.
"Report #3" assesses the Master Resilience Trainer component of CSF. After undergoing an intensive ten-day training course, each newly minted "Master Resilience Trainer" is placed in an Army unit. Trainers are charged with equipping fellow soldiers with thinking skills and strategies intended to help them more effectively handle the physical and psychological challenges of military life, including, most especially, combat operations.
In our report released this week, "Does Comprehensive Soldier Fitness Work? CSF Research Fails the Test," we critique "Report #3" in detail and identify five major areas of weakness: (1) the researchers' failure to measure the important outcomes of PTSD, depression or other psychological disorders despite the availability of validated measures for doing so; (2) a flawed research design that fails to control for important confounding variables; (3) significant problems with the method of data analysis; (4) the researchers' failure to acknowledge plausible risks of harm from the CSF intervention; and (5) a miscellaneous set of related issues of concern. (While much of our report addresses issues of research design and methodology, we have aimed to make it as accessible as possible to the broader public.)
Based upon our careful analysis of "Report #3," we believe that the claims of CSF proponents regarding the program's effectiveness are vastly inflated. We, therefore, call upon the Army to retract this report or, at a minimum, issue an unambiguous and widely disseminated statement acknowledging that the report is seriously flawed and that, as a result, the verdict is still out as to whether CSF actually "works."
In making this recommendation, we fully recognize that large-scale evaluation research is an intrinsically difficult undertaking inevitably imperfect in its execution. However, the public that has paid over $100 million for the CSF program and, even more, the one million soldiers who are involuntarily subjected to CSF's resiliency training deserve much better than the misrepresentations of effectiveness aggressively promoted by "Report #3."
Certainly, the psychological health of our nation's soldiers and of all citizens, should be a top priority. As a country, we must commit ourselves to addressing the alarming rates of PTSD, suicide and other serious behavioral and emotional difficulties among our troops, especially those repeatedly exposed to the horrors of combat and war. But it is simply wrong at this time to present CSF as part of a solution, because to date there is no solid empirical evidence demonstrating that the program accomplishes any of these lofty goals.
Note: This article draws upon material in our report "Does Comprehensive Soldier Fitness Work? CSF Research Fails the Test."