Mechanisms of Risk and Resilience in Military Families: Theoretical and Empirical Basis of a Family-Focused Resilience Enhancement Program

Recent studies have confirmed that repeated wartime deployment of a parent exacts a toll on military children and families and that the quality and functionality of familial relations is linked to force preservation and readiness. As a result, family-centered care has increasingly become a priority across the military health system. FOCUS (Families OverComing Under Stress), a family-centered, resilience-enhancing program developed by a team at UCLA and Harvard Schools of Medicine, is a primary initiative in this movement. In a large-scale implementation project initiated by the Bureau of Navy Medicine, FOCUS has been delivered to thousands of Navy, Marine, Navy Special Warfare, Army, and Air Force families since 2008. This article describes the theoretical and empirical foundation and rationale for FOCUS, which is rooted in a broad conception of family resilience. We review the literature on family resilience, noting that an important next step in building a clinically useful theory of family resilience is to move beyond developing broad “shopping lists” of risk indicators by proposing specific mechanisms of risk and resilience. Based on the literature, we propose five primary risk mechanisms for military families and common negative “chain reaction” pathways through which they undermine the resilience of families contending with wartime deployments and parental injury. In addition, we propose specific mechanisms that mobilize and enhance resilience in military families and that comprise central features of the FOCUS Program. We describe these resilience-enhancing mechanisms in detail, followed by a discussion of the ways in which evaluation data from the program’s first 2 years of operation supports the proposed model and the specified mechanisms of action.     

Threat and defense as goal regulation: from implicit goal conflict to anxious uncertainty, reactive approach motivation, and ideological extremism

Four studies investigated a goal regulation view of anxious uncertainty threat (Gray & McNaughton, 2000) and ideological defense. Participants (N = 444) were randomly assigned to have achievement or relationship goals implicitly primed. The implicit goal primes were followed by randomly assigned achievement or relationship threats that have reliably caused generalized, reactive approach motivation and ideological defense in past research. The threats caused anxious uncertainty (Study 1), reactive approach motivation (Studies 2 and 3), and reactive ideological conviction (Study 4) only when threat-relevant goals had first been primed, but not when threat-irrelevant goals had first been primed. Reactive ideological conviction (Study 4) was eliminated if participants were given an opportunity to attribute their anxiety to a mundane source. Results support a goal regulation view of anxious uncertainty, threat, and defense with potential for integrating theories of defensive compensation.     

Examining the potential impact of a family session in therapeutic assessment: a single-case experiment

Most clinicians concede the benefits of conceptualizing children in systemic terms. Yet, many child assessments involve parents only on a limited basis. The Therapeutic Assessment model for children and families (TA-C) emphasizes parental involvement and family-driven collaboration throughout the intervention. Child TA has shown promise as an effective brief intervention (e.g., Smith, Handler, & Nash, 2010; Tharinger et al., 2009). Family intervention sessions (Finn, 2007; Tharinger, Finn, Austin, et al., 2008) are an integral component of the child TA model in facilitating familial changes. However, TA-C research has yet to empirically examine the potential impact of a family session on treatment trajectory. This case study includes an extended presentation of the development and execution of a family session. The authors use a daily measures time-series experiment to empirically examine the clinical effectiveness of the TA-C and the hypothesis that the family session was a tipping point in the trajectory of improvement.     

Community Readiness for Change and Youth Violence Prevention: a Tale of Two Cities

This case study identifies a situation in which there exists a set of preconditions for the successful application of evidence based practice to bear on the community based problem of youth violence. The concept of readiness to change and its impact on the success or failure of interventions designed to change harmful or dangerous behavior among individuals is well established and understood in intervention research. In recent years this concept has been discussed and developed in the community intervention and harm reduction literatures. The current study is one of a community where an attempt was made to identify community levels of harm, develop a strategic plan to reduce the source of harm, and develop, implement, and evaluate youth violence prevention interventions. Over more than 5 years of involvement by university based researchers and community partners, the effort was largely unsuccessful. The events of this project are discussed within the context of the Community Readiness Model Edwards et al. (J Community Psychol 28(3): 291-307, 2000) and we present a narrative that helps to highlight the reasons for the relative lack of success of the effort. We suggest additional strategies and actions that might have helped to overcome the lack of readiness of this particular community to reduce the harms associated with youth violence. Suggestions that may improve chances for a more successful set of outcomes for other communities in similar states of readiness to change and with similar challenges are given.     

Variation in working memory capacity and temporal-contextual retrieval from episodic memory

Unsworth and Engle (2007) recently proposed a model of working memory capacity characterized by, among other things, the ability to conduct a strategic, cue-dependent search of long-term memory. Although this ability has been found to mediate individual variation in a number of higher order cognitive tasks, the component processes involved remain unclear. The current study was designed to investigate individual variation in successfully retrieving information from episodic memory by examining various aspects of the retrieval process. Both high- and low-working memory capacity participants were found to initiate recall in a similar fashion; however, low-working memory capacity participants did not show the classic asymmetry in their conditional-response probabilities that is typically observed. Overall, the retrieval deficits observed in low-working memory capacity individuals appear to be rooted in their inability to use the products of retrieval to further aid their search.     

Adaptive disclosure: an open trial of a novel exposure-based intervention for service members with combat-related psychological stress injuries

We evaluated the preliminary effectiveness of a novel intervention that was developed to address combat stress injuries in active-duty military personnel. Adaptive disclosure (AD) is relatively brief to accommodate the busy schedules of active-duty service members while training for future deployments. Further, AD takes into account unique aspects of the phenomenology of military service in war in order to address difficulties such as moral injury and traumatic loss that may not receive adequate and explicit attention by conventional treatments that primarily address fear-inducing life-threatening experiences and sequelae. In this program development and evaluation open trial, 44 marines received AD while in garrison. It was well tolerated and, despite the brief treatment duration, promoted significant reductions in PTSD, depression, negative posttraumatic appraisals, and was also associated with increases in posttraumatic growth.     

Inferential Precision in Single-Case Time-Series Data Streams: How Well Does the EM Procedure Perform When Missing Observations Occur in Autocorrelated Data?

The case-based time-series design is a viable methodology for treatment outcome research. However, the literature has not fully addressed the problem of missing observations with such autocorrelated data streams. Mainly, to what extent do missing observations compromise inference when observations are not independent? Do the available missing data replacement procedures preserve inferential integrity? Does the extent of autocorrelation matter? We use Monte Carlo simulation modeling of a single-subject intervention study to address these questions. We find power sensitivity to be within acceptable limits across four proportions of missing observations (10%, 20%, 30%, and 40%) when missing data are replaced using the Expectation-Maximization Algorithm, more commonly known as the EM Procedure (Dempster, Laird, &; Rubin, 1977). This applies to data streams with lag-1 autocorrelation estimates under 0.80. As autocorrelation estimates approach 0.80, the replacement procedure yields an unacceptable power profile. The implications of these findings and directions for future research are discussed.     

The relationship among sex-role stereotyping,sex-role preference,and the sex difference in spatial visualization

At an early age, children attain concepts of sex-appropriate activities, behaviors, attitudes, and goals, i.e., sex-role stereotypes. These conceptual stereotypes seem to assign a less favorable role to females. Thus it seems plausible that their acceptance (by both sexes) might be at least partly responsible for the performance differences that begin to arise in adolescence and adulthood. In view of the importance of early adolescence as a transitional period during which sex-role requirements are augmented and intellectual sex differences emerge, 105 11-year-olds and 102 14-year-olds were selected as subjects. Their spatial abilities, sex-role concepts, and sex-role preferences were assessed. Stereotyping sex roles (in general) was not associated with spatial performance; stereotyping sex roles that included information regarding subjects' views about intellectual competence was related to performance. The sex difference in spatial ability that emerged at age 14 was among subjects with own-sex preferences only; there were no sex differences among subjects who preferred to be boys.This article is based upon a doctoral dissertation presented to the Department of Psychology of Columbia University. The author would like to express her thanks to her advisers, Phillip Shaver and Deanna Kuhn; to her committee members, Robert Krauss, Norma Graham, Patrick Lee, and Wayne Proudfoot; to Carol Jacklin and Ruth Wylie for their advice and support; and to Flora Churnin, Douglas Churnin, and Carl Nash for their invaluable assistance during all phases of this study.