Author: Hammermeister, Jon
Date published: March 1, 2012
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Psychological resilience refers to an individual's capacity or tendency to thrive in the face of adversity (Connor & Davidson, 2003), or to positively adapt in response to stress or trauma (Luthar, Cicchetti, & Becker, 2000; Campbell-Sills & Stein, 2007) and it's presence may confer protection against the development of a variety of adverse mental health conditions including post traumatic stress disorder (PTSD) (Hoge, Austin, & Pollack, 2007; King, King, Fairbank, Keane, & Adams,1998; Pietrzak, Goldstein, Malley, Johnson, & Southwick, 2009; Waysman, Schwarzwald, & Solomon 2001). With PTSD prevalence rates in excess of 10% among soldiers returning from active duty in Operation's Enduring Freedom and Iraqi Freedom (OEF / OIF), the need for furthering our understanding of the characteristics which promote psychological resilience take on critical importance (Hoge, Auchterlonie, & Milliken, 2006; Martin, 2007, Milliken, Auchterlonie, & Hoge, 2007; Tanielian & Jaycox, 2008). The study of this construct takes on even more meaning given the U. S government's unremitting War on Terror (WOT) and thus, U.S. soldiers continued heightened exposure to terrorism, armed conflict, and increased manifestation of the pathologic effects of exposure to trauma.
While the need for better understanding of psychological resilience is both emergent and apparent, the debate regarding how resilience develops remains unresolved. The purpose of this paper will be to examine the role that a unique constellation of mental skills, referred to as "sport-related psychological skills" plays in enhancing perceived resilience and how, in turn, perceived resilience is associated with PTSD.
A useful conceptual framework for understanding the antecedents of resilience comes from Luthar and Zelazo's (2003) comprehensive review of the resilience literature. Luthar and Zelazo (2003) suggest resilience is a complex transactional process involving the interaction among (a) risk factors, (b) protective factors, (c) vulnerability factors, and (d) positive adaptation. Risk factors generally refer to conditions which may increase an individual's exposure to adversity (Luthar & Cicchetti, 2000; Masten, 200 1 ; Rutter, 2000; 2003). Soldiers participating in OIF / OEF clearly operate in a condition of heightened exposure to a variety of resiliencerelated risk factors, not the least of which being combat experience. Protective factors are those which promote adaptive, or positive, responses to adversity (Rutter, 1987) and may include personality traits, family life and support, external social support, high IQ, and high socioeconomic status (Garmezy, Masten, & Tellegen, 1984; Rutter, 1987; Ryff & Singer, 2003). Vulnerability factors are those that serve to intensify the effects of adversity and are often the flip side of the same coin shared with protective factors (Luthar & Zelazo, 2003 ). External social support, which a Soldier may receive from his/her unit or leadership, is a good example of this notion as positive external social support can be viewed as a protective factor while poor social support can be seen as a vulnerability factor. Finally, positive adaptation refers to outcomes that are much better than would be expected given the presence of any particular risk factor (Luthar & Zelazo, 2003). Positive adaptation can be viewed in different ways. The most common definition of positive adaptation refers to an individuals' adaptive response following a setback; however, positive adaptation can also be considered the absence of a given condition in a situation in which the presence of such a condition is known to occur (Kaplan, 1999; Luthar & Zelazo, 2003). Soldiers exposed to traumatic events in combat, but who do not exhibit PTSD symptoms, would exemplify this form of positive adaptation.
Thus, for positive adaptation to occur, individuals need to possess protective factors that outweigh their vulnerability factors in order to overcome the risk factors they face in their lives (Galli & Vealey, 2008). Figure 1 shows how positive adaptation can be enhanced by either increasing the number of protective factors, or decreasing the number of vulnerability or risk factors an individual possesses. In order to improve resilient responses to adversity in any population, but especially among soldiers, it makes sense for research initiatives to focus on the identification of protective factors which are both personally controllable and trainable.
Sport-Related Psychological Skills
"Upon the fields of friendly strife are sown the seeds that upon other fields on other days will bear the fruits of victory" General Douglas MacArthur
The field of sport psychology has been interested in how psychologically adaptive responses develop and can be trained among athletes for many years (e.g., Greenspan & Feltz, 1989; Mahoney, Gabriel, & Perkins, 1987; Meyers, Whelan, & Murphy, 1996; Ogilvie & Tutko, 1966). These psychologically adaptive responses, often referred to as "mental toughness" (Jones, Hanton, & Connaughton, 2007), may provide a unique and useful framework from which to address some of the current mental health issues confronting the military.
Influence of Sport-Oriented Psychological Skills Outside of Sport
While the positive role that sport-oriented psychological skills plays in enhancing performance is well-supported in the sport literature, it also appears to have some generalizability into realms beyond sport performance (e.g., Smith, 1999; VonGuenthner & Hammermeister, 2007). In Smith's (1999) review of the generalization effects of sport coping skills training, he suggests that the sport-oriented psychological skills should be viewed as "life skills" which have value and utility beyond the playing field. Smith suggests that athletes who display the ability to cope successfully in stressful sport settings should possess the skill set which allows them to cope with more general life Stressors as well. The most reported "athletic" coping skill-set in the sport literature is characterized by high confidence, sport intelligence, the ability to focus, competitiveness, a strong work ethic, goal-setting abilities, coachability, high levels of hope and optimism, and adaptive perfectionism (e.g., Gould, Dieffenbach & Moffet, 2002; Smith, Schutz, Smoll, & Ptacek 1995). Other coping skills often seen in the sport literature include positive thinking and positive imagery to visualize success (Weinberg & Gould, 2007) and well-developed plans for competition (e.g., Orlick & Partington, 1 988; Thomas, Murphy, & Hardy, 1999).
There also appears to be abundant empirical support for Smith's (1999) contention regarding the utility of sport-oriented coping skills in realms beyond sport. Indeed, positive aspects of mental health have been associated with many psychological skills frequently utilized in sport settings including: (a) confidence and self-efficacy (Bandura, 1997; Barlow, Wright, & Cullen, 2002; Caprara, 2002; Creed, Muller, & Patton, 2003 ; Gallagher, Parle, & Cairns, 2002; Kashdan & Roberts, 2004; Kuijer & deRidder, 2003; Lent et al., 2005), (b) self-regulation (Luszczynska, Gutiérrez-Dofia, & Schwarzer, 2005), (c) optimism and positive thinking (Carver et al., 2005; Eid & Diener, 2004; Shnek, Irvine, Stewart, & Abbey, 200 1 ; Vickers & Vogeltanz, 2000), and (d) goal-setting (Kavussanu & Harnisch, 2000; Locke & Latham, 1990; Ntoumanis & Biddle, 1999; Schwarzer, 1992).
Recently, the U.S. Army has formally recognized the potential positive application of a sport-oriented psychological skill set in military settings by its development and promotion of the Army Center for Enhanced Performance (ACEP). Based on two decades of work with the cadet corps at the United States Military Academy's Center for Performance Enhancement (CEP), ACEP's mission is to teach these sport-related skills to soldiers to a large and very diverse cross-section of the U. S Army with the intent of enhancing both soldier performance and resilience. ACEP's influence across the force can best be illustrated by the number of soldiers currently engaging in this type of training, with over 40,000 soldiers participating in FY10 (Harada & Burbelo, 2010; personal communication).
Sport-Related Psychological Skills and Resilience
One area in which the sport oriented psychological skills concept remains relatively unexplored is the role it may play in the development of psychological resilience. Indeed, many of the variables associated with this sport concept could also be classified as resilience protective factors (Luthar & Zelazo, 2003). However, the body of research related to this notion is limited. In one of the few studies examining these constructs, Galli and Vealey (2008) showed that the development of resilience outcomes among athletes is multi-factorial and requires the use of many sport psychology-related processes such as being positive, determined, competitive, mature, and persistent in the face of adversity. In another sport-specific study, Mummery and colleagues (2004) demonstrated that strong self-perceptions of physical endurance, confidence in the ability to perform well under pressure, and a level of independence from social support were deemed important resilience processes among a sample of elite swimmers. While these studies provide some preliminary insight into what resilience processes are and how they develop, the question still remains as to the precise role that sport-oriented psychological skills training plays in both resilience processes and outcomes.
Rationale for Study
While it is intuitive to suggest that soldiers who are mentally skilled (i.e., "mentally tough") are, in turn, more resilient and thus more resistant to adverse emotional outcomes, to date, no studies exist which empirically show the nature of the relationships between sport related psychological skill variables, resilience, and adverse mental health outcomes. An understanding of these associations is important for many reasons, but none more so than as a guide for the development of interventions to enhance Soldier resilience, health, and performance. Furthermore, if the sport related psychological skills are truly related to optimal human functioning, then aspects of this type of training should also be a factor in providing a degree of inoculation against the adverse psychological effects which can result from exposure to combat settings. To date, no studies exist that provide evidence of this effect.
While many may view sport as a trivial endeavor compared to the serious consequences associated with war, a recent call has been made in the military psychology literature for the U.S. military to adopt sport psychology methods and techniques (Fiore & Salas, 2008) in the attempt to promote more resilient responses to combat-related stress.
Thus, the purpose of this paper was to examine the feasibility of a conceptual model implying that perceived resilience holds a mediating role within the relationship between psychological skills and PTSD, by determining if such a model is consistent with self-report data obtained from a sample of Stryker Brigade soldiers who had experienced at least one combat deployment.
A sample of 427 male soldiers from two United States Army Stryker Battalions volunteered to participate in the study. Of these volunteers, 35 1 had been deployed to combat at least once, and will be used in the analyses herein. The majority of those who had been deployed (n = 332) were enlisted soldiers, and 17 were officers (rank was not identified by two participants). The mean age of the deployed soldiers was 26.18 years (SD = 528), and the average time served in the Army was 5.28 years (SD = 4. 1 0). Most of the soldiers who had been deployed, had been so only once (n = 254, 72%).
Ottawa Mental Skills Assessment Tool-3 - Revised for Soldiers (OMSAT-RS)
The OMSAT-3 was originally designed, and has been subsequently used, to assess sport-related psychological skills (Durand-Bush, Salmela, & Green-Demers, 200 1 ). The original version includes 48 items, representing 12 mental skill subscales, grouped into three conceptual components: (a) foundation skills [goal-setting, self-confidence, commitment], (b) psychosomatic skills [stress reactions, fear control, relaxation, activation], and (c), cognitive skills [imagery, mental practice, focusing, refocusing, and competition planning]. The OMSAT-3 uses a 7-point Likert scale, with responses ranging from "strongly disagree" to "strongly agree." In their original scale development study, the authors reported acceptable internal consistency (α= .68 to .88) and temporal stability (r = .78 to .96) for the 12 OMSAT-3 subscales.
In this study, wording of the OMSAT-3 was modified to make items relevant to soldiers and military performance. In an analysis of data from all soldiers completing the survey (not just those who were deployed at least once) an exploratory factor analysis resulted in emergence of a reliable three-factor solution that consisted of 21 of the original 48 items (Hammermeister, Pickering, McGraw, & Ohlson, 2010). The first factor consisted of items that assessed goal-setting, mental practice, commitment, and planning, and was labeled the "P-factor" because it appeared to represent a planning and preparation construct. The second factor included items that assessed fear control, stress reactions, and lack of focus. We labeled it the "F-factor" for fear/failure/focus. Finally, the third factor had relaxation and activation items, which we concluded to be an "?-factor" that represented an energy management construct. This revised 21 -item instrument will be referred to here as the Ottawa Mental Skills Assessment Tool - Revised for Soldiers (OMSAT-RS).
Connor-Davidson Resilience Scale (CD-RISC)
The CD-RISC measures perceived psychological resilience, or the capacity and tendency to respond positively to adversity. In the original instrument development report the CD-RISC authors suggested that resilience consisted of five sub-dimensions: (a) Personal Competence, High Standards, and Tenacity; (b) Trust in One's Instincts, Tolerance of Negative Affect, and Strengthening Effects of Stress; (c) Positive Acceptance of Change, and Secure Relationships; (d) Control, and (e) Spiritual Influences (Connor & Davidson, 2003). However, since its original development, the same authors have used 25-item, 1 1 -item and 2item versions of the CD-RISC (Vaishnavi, Connor, & Davidson, 2007) and have consistently scored the instrument as a uni-dimensional construct. Recently, Campbell-Sills and Stein (2007) have reported a reliable 10-item, version of the CD-RISC that also taps a single resilience dimension. Using the entire sample of soldiers completing our survey, we confirmed the 10-item measurement model reported by Campbell-Sills and Stein (Pickering et al., 20 1 0). Based on the psychometric work reported by Campbell-Stills and Stein and our own confirmatory factor analyses of the 10-item measurement model, perceived resilience scores in this paper were computed based on the refined 1 0-item-CD-RISC instrument. Participant responses were based on a 5-point Likert scale ranging from "not true at all" to "true nearly all of the time."
Post Traumatic Stress Disorder
The Primary Care Post Traumatic Stress Disorder Screen (PC-PTSD) consists of 4 items related to PTSD (Prins et al., 2003). The PC-PTSD is designed to measure the various dimensions of PTSD captured in the post traumatic stress disorder checklist (PCL) including reexperiencing symptoms, avoidance or psychic numbing, and hyperarousal symptoms (Weathers, Litz, Herman, Huska, & Keane, 1 993 ). The PC-PTSD asks participants about recent behavioral responses and reactions to an "experience that was... frightening, horrible, or upsetting". Answers are dichotomized (yes or no). This brief tool has demonstrated reasonable test-retest reliability (r=.83) and criterion validity (r=.83).
Six cases were eliminated from the complete data set based on screening for multivariate outliers. Subsequently, a classic regression approach to mediation was used to explore the plausibility of our data fitting models that suggested that any observed relationship between mental skills (as measured by the OMSAT-RS) and self-reported PTSD symptoms would be mediated by self-reported resilience. The mediation approach used for testing the potential indirect effect involved the following four steps, based on three regression equations (Baron & Kenny, 1986; MacKinnon, Fairchild, & Fritz, 2007):
(1) Path c: The independent variable (each OMSAT-RS variable) is required to be related to the criterion (PTSD).
(2) Path a: The independent variable is required to be related to the potential mediator (resilience).
(3) Path b: The potential mediator is required to be related to the criterion when control ling for the relationship the predictor shares with both.
(4) Path c': Finally, the coefficient relating the predictor alone to the criterion must be substantially larger in magnitude than the coefficient relating the predictor to the criterion when the potential mediator is also included in the regression model.
This fourth step is statistically equivalent to testing the significance of the mediating effect (MacKinnon et al., 2007). The coefficients estimated in the third and fourth steps are computed using a single regression equation where the criterion is regressed upon the predictor and the potential mediator simultaneously.
Evaluating the statistical significance of the fourth step is computed by dividing the total mediating effect by its standard error, using Equation 1 below (Sobel, 1982). The numerator of the equation (the mediating effect) is simply the product of the individual structural path coefficients, a and b. The denominator (the standard error of the mediating effect) is computed using the individual structural path coefficients and their respective standard errors, sa and sb (obtained respectively, from the second and third regression, equations described above).
Equation 1: Sobel test statistic = ...)
This study complied with ethical standards in the recruitment and treatment of participants, and in the management of study data and was approved by the United States Military Academy Institutional Review Board. Participants were recruited from two separate battalions on two different days either immediately prior to, or immediately following their regular training activities. Soldiers were given an informational briefing and informed of their rights as human subjects by an investigator in civilian attire to avoid perception of coercion or reward for participation in the study. Soldiers who agreed to participate in the anonymous survey gave implied consent and completed the survey in the battalion staging areas.
Figures 2-4 show the regression coefficients and associated standard errors for the mediation analyses. Table 2 includes the magnitude of the indirect mediating effect and the associated results of the Sobel test of significance, the overall shared variance between each OMSAT-RS variable and PTSD (i.e., R2 when PTSD is regressed upon each OMSAT-RS variable alone), and the unique shared variance between each OMSAT-RS variable and PTSD in the mediation model (i.e., the change in R2 when resilience is added as a second predictor to a model with PTSD already regressed on the respective OMSAT-RS variables). The following paragraphs summarize the information in Figures 2-4 and Table 1 as it applies to the three-step mediation process.
Step 1. Do OMSAT-RS variables predict PTSD? The effect size (R2) of the relationship between energy management (OMSAT-E) and PTSD was .03 (p <.01), between planning/preparation (OMSAT-P) and PTSD was .0 1 (p =.07), and was .03 (p <.0 1 ) between fear/failure/focus (OMSAT-F). The R2 value for planning/prep fell just short of reaching traditional statistical significance and accounted for approximately one-third as much variance in PTSD as did the other two OMSAT-RS factors, which both met traditional statistical significance guidelines.
Step 2. Do OMSAT-RS variables predict perceived resilience? The effect sizes (R3) of the relationships between energy management, planning/preparation, and fear/failure/focus and resilience were. 14, .16, and .13 respectively (all p<.01), suggesting that, individually, all three OMSAT-RS variables have the ability to predict perceived resilience.
Step 3. Does perceived resilience predict PTSD symptoms when controlled for each mental skill? The regression coefficients for perceived resilience predicting PTSD symptoms, when controlled for energy management, planning/preparation, and fear/failure/focus respectively were -.37 (p < .01), -.43 (p < .01), and -.37 (p < .01), suggesting that perceived resilience predicts a significant amount of unique variance in PTSD symptoms.
Step 4. Does perceived resilience mediate the relationship between OMSAT-RS variables and PTSD? The magnitudes of the indirect effects of the OMSAT-RS variables on PTSD, through the perceived resilience construct were -.08 (p < .01) for energy, -.11 (p < .01) for planning/prep, and . 1 0 (p < .0 1 ) for fear/failure/focus. In all three mediation models the effect size of the direct path between each OMSAT-RS variable and PTSD, after controlling for the relationship between perceived resilience and PTSD, was very small in magnitude and statistically insignificant (Table 2). These results satisfy the necessary conditions for suggesting that the observed relationships between the individual OMSAT-RS variables and PTSD are all mediated by perceived resilience.
This study examined the role of perceived resilience as a mediator between psychological skills and indicators of PTSD. The direct relationship between planning/preparation and PTSD was especially small and exhibited a p-value slightly above .05. Because of the exploratory nature of this investigation we did include mediation analysis for this predictor along with the other two mental skills variables. If considered a small, but real effect, the association between planning and preparation and PTSD symptoms did appear completely mediated by perceived resilience in the same manner as the energy and fear/failure/focus mental skill constructs.
The planning and preparation factor is characterized by a Soldier's ability to set goals, to mentally practice job execution, to sacrifice most other things to excel, and to commit themselves to the service of their country. Thus, planning and preparation may act as a resilience protective factor through its emphasis on a committed and systematic grounding of the individual to their duty. This systematic process, in turn, may result in individuals who are better prepared for the difficulties, both expected and unexpected, of military service. This notion seems congruent with the findings of Kumpfer ( 1 999) who identified five clusters of protective factors, which she termed "internal resilience factors." The five clusters were: (a) spiritual or motivational characteristics, (b) cognitive competencies, (c) behavioral/social competencies, (d) emotional stability and management, and (e) physical well-being competencies. Kumpfer's (1999) cognitive competencies included planning ability, intelligence, and creativity, which are consistent with the composition of our "P" factor. We are not suggesting that soldiers spend the bulk of their time planning for things to go wrong. However, it does appear soldiers who are well prepared for events that may offer psychological challenges are more likely to adapt positively to those circumstances.
Perceived resilience fully mediated the relationship between the OMSAT-RS "E" factor and PTSD suggesting that soldiers who are better able to manage personal energy using both relaxation and activation skills also perceive themselves as more resilient. Again, these soldiers report fewer PTSD symptoms. The ability to control one's emotional energy, especially in stressful situations is well documented as a useful coping mechanism (e.g., Lazarus, 1991; 1999; Lazarus & Folkman, 1984) and this seems a feasible mechanism by which the "E" factor is related to resilience. Individuals who possess these types of energy management skills can regulate their psychological and physiological responses before, during, and after exposure to adversity. This notion is also compatible with Kumpfer's ( 1 999) finding that emotional stability and management is a resilience protective factor.
Finally, perceived resilience appears to completely mediate the relationship between the fear/failure/focus factor and PTSD symptoms. Soldiers who struggle with fear of job-related danger, fear of making mistakes, and subsequently experience concentration problems perceive themselves as less resilient, and may be more susceptible to PTSD. These results suggest that the fear/failure/focus construct is a likely vulnerability factor, whereby these traits serve to intensify the effects of being exposed to adversity and facilitate a higher level of susceptibility to functional deterioration in the face of excessive stress or adversity. Fear of failure also has long been recognized as a powerful antecedent of anxiety as well as being a performance inhibitor (Conroy, 2004; Conroy & Elliot, 2004; Conroy, Coatsworth, & Fifer, 2005). Our findings suggest that soldiers with this type of mindset are less likely to exhibit a resilient response when exposed to adversity. This notion also seems congruent with Luthar and Zelazo's (2003) notion that vulnerability and protective factors are two sides of the same coin as soldiers who scored low on the "F" factor display the inverse relationship with resilience and PTSD.
One way to help conceptualize these findings follows from the ideas of Luthar, Cicchetti, & Becker (2000), who suggested adding suffixes to the term "protective" to provide a more precise definition of protective variables. For example, Luthar and colleagues (2000) state that variables which stabilize, or help individuals maintain their previous level of functioning despite risk, should be termed "protective-stabilizing" factors. Any factor that works to improve an individual's level of functioning despite risk is considered "protective-enhancing" factors. Finally, factors that are generally protective, but less so in the presence of risk are termed "protective but reactive" Although this classification of protective factors may vary by individual and by situation, it provides a useful framework from which to consider our results.
Given this structure, we posit that planning and preparation likely act as protective reactive factors among the soldiers in this sample. Planning and preparation appear to be generally beneficial, however, when adversity is present neither would seem to serve as an immediate and tangible tool for directly mitigating the Soldier's initial responses to stress. Furthermore, the low predictive ability of this factor to predict PTSD suggests that the generally protective, planning and preparation factor is only a small contributor to perceived resilience, at best.
Conversely, we suggest the "E" factor is likely used in different ways by different soldiers. For example, the "E" factor may be used as a protective-stabilizing factor for inexperienced soldiers while also serving as protective-enhancing for experienced ones. This may be because experienced soldiers have had years of exposure to adversity with which to cultivate and develop their resilience response, while less experienced soldiers have not had these opportunities. In both instances, however, the "E" factor could be regarded as "protective" since it influences the effects of stress at both low and high levels.
Finally, the "F" factor, when viewed in its inverse form (i.e., low levels of fear/failure/ focus) could be conceptualized as both protective stabilizing and as enhancing, depending on situation. For example, soldiers who are about to deploy could use the "F" factor as a resilience stabilizer in their attempts to cope with pre-deployment stress. Conversely, those who are currently in combat zones and prone to exposure to trauma, or those who have recently witnessed a traumatic event, may use the "F" factor as a resilience enhancing tool.
Overall, our data suggests that self-reported sport related psychological skills probably do not have a direct influence on PTSD. Instead, it appears more likely that individuals who perceive themselves as possessing strong mental skills also perceive themselves as responding well to adversity, and that such a tendency relates to experiencing fewer PTSD symptoms. These results say nothing with regards to how individuals obtain these desirable mental skills. However, to the extent that these types of mental skills may be trainable, interventions aimed at proactively improving these skills in soldiers, either prior to, during, or after deployment, might help reduce PTSD by enhancing personal resilience.
As with any study, several limitations should be noted herein. First, the cross-sectional nature of this study makes it impossible to make strong cause and effect inferences. Future studies which incorporate experimental designs will help to further clarify the relationships among the sport-related psychological skills, resilience, and PTSD. Secondly, we have presented an incomplete model of the relationship amongst mental skills, resilience and PTSD. For example, this study did not address the role a variety of other factors plays in the relationship between resilience and PTSD including social support, childhood experiences, IQ, and SES (among others). Likewise, there may be additional mental skills not reported in this study. Future researchers wishing to identify complete models of these constructs need to incorporate a broader range of concepts. For these analyses, the revised OMSAT-3 items were factored into a structure (the OMSAT-RS) relevant for this specific sample. This resulted in a reduced set of three psychological skills compared to the 12-subscale sport-related representation. Additional research is needed to identify the most relevant and comprehensive psychological skill instrument to use in military contexts. Next, the version of the CD-RISC utilized in this investigation assesses Soldiers' perceptions about their resilience, not necessarily their true display of resilient behaviors. Finally, our sample of previously deployed Stryker Brigade soldiers represents only a small subset of the Army population, and may not be generalizable to other military subgroups.
Psychological skills such as planning and preparation, appropriate management of energy, and a fear of failure and poor focus appear related to perceived psychological resilience, which in turn appears to provide some degree of protection against some adverse mental health consequences associated with exposure to combat. These results help to confirm Smith's (1999) contention that the sport-related psychological skills should have relevance beyond sport. Our findings support the notion that psychological skills can serve as a resilience protective factor and may help soldiers display more resilient mental health outcomes.
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Eastern Washington Unversity
Michael. A. Pickering
Embry Riddle Aeronautical University
Army Nursing Research Service, Madigan Army Medical Center
Center for Enhanced Performance, United States Military Academy
Address correspondence to: Jon Hammermeister, Ph.D., Eastern Washington University, Cheney, WA 99004. Phone: 509-995-7783. email: email@example.com