Date Presented 03/26/20
The study’s aim was to investigate the feasibility and effectiveness of cognitive-control training using mobile phones to improve resilience and QOL among soldiers in the Israeli Defense Forces. A group of 154 combat-unit soldiers were recruited and randomized to a controlled clinical trial group and an active control group. No significant effects of training on QOL, resilience, or mental health were found. The study’s results encourage OTs to develop accessible, occupation-based interventions for enhancing resilience.
Primary Author and Speaker: Yafit Gilboa
Contributing Authors: Mor Nahum, Rina Ben Avraham, Anat Afek
PURPOSE: Resilience is defined as the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress. Soldiers in combat units are exposed to stressful events that may lead to psychological distress and even mental disorders that may impair their functioning and quality of life (Milliken, Auchterlonie, & Hoge, 2007). Cognitive control mechanisms have been shown to underlie mental resilience and well-being (Ochsner & Gross, 2005). In line with this, computerized cognitive control training (CCT) was found effective in improving resilience and mental health in clinical populations (Calkins, McMorran, Siegle, & Otto, 2015; Schweizer, Hampshire, & Dalgleish, 2011). However, the effect of such training among healthy populations was not always significant. The current study examined the feasibility and initial efficacy of mobile delivery of CCT in improving resilience and quality of life among male and female IDF combatants during their army training.
DESIGN: A single-blind randomized controlled trial (RCT).
METHOD: Participants were recruited during their training period at their army base. Following baseline assessments, participants were requested to complete daily 20-min training sessions for two weeks using a mobile app installed on their phones (Moodify). The group that received CCT completed tasks targeting inhibitory control and working memory, while the control group received casual mobile games. At baseline and after 2 weeks of training, participants completed a battery of outcome measures, which collectively measured quality of life (the World Health Organization Quality-of-Life Scale, WHOQOL-BREF), resilience (the Connor-Davidson Resilience Scale, CD-RISK 10), mental health (Kessler Psychological Distress Scale, K6), anxiety (Generalized Anxiety Disorder, GAD-7), rumination (Rumination Response Scale, RRS) and Self-Efficacy (the New General Self-Efficacy Scale, NGSE). Data for a 4-months follow-up to assess the long term effects of training is currently being collected. Repeated measures analysis of variance (ANOVA) was conducted to look for time X group interactions.
RESULTS: We recruited 154 soldiers serving in the IDF’s gender-mixed combat units that were randomly assigned into one of two groups: a cognitive control training (CCT, n=75) group and an active control computer game (Control, n=79) group. No significant differences were found between the groups at baseline. Out of 14 training sessions, participants completed 1-14 sessions in both groups (7.28 ± 3.03). No significant effects of training on cognitive assessments, QOL, resilience, mental health or self-efficacy were found.
CONCLUSION: Partial feasibility was found based on the number of sessions completed. In addition, our results did not show any significant effect of a remote delivered CCT to improve resilience and QOL among Israeli soldiers. Possible reasons for this might include the insufficient training time (the accumulated hours of training), training that was conducted without researchers’ supervision, and the study population which includes non-pathological young adults.
IMPACT STATEMENT: The impact of cognitive training on participation and QOL is the subject of a recently discussed controversy and these results contribute to the skeptical view which queries the ecological validity of these intervention methods. Moreover, these results encourage occupational therapists to develop and validate accessible occupation-based interventions to enhance mental resilience.
References
Milliken C. S., Auchterlonie J. L., & Hoge C. W. (2007). Longitudinal assessment of mental health problems among active and reserve component Soldiers returning from the Iraq war. Journal of American Medical Association;298:2141–2148.
Ochsner, K. N., & Gross, J. J. (2005). The cognitive control of emotion. Trends in cognitive sciences, 9(5), 242-249.
Calkins A.W., McMorran K. E., Siegle G. J., & Otto M. W. (2015). The Effects of Computerized Cognitive Control Training on Community Adults with Depressed Mood. Behavioural and Cognitive Psychotherapy, 43(5):578-89.
Schweizer, S., Hampshire, A., & Dalgleish, T. (2011). Extending brain-training to the affective domain: increasing cognitive and affective executive control through emotional working memory training. PloS one, 6(9), e24372.
