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All content in this area was uploaded by Amy Adler on Jun 26, 2015
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Content uploaded by Amy Adler
Author content
All content in this area was uploaded by Amy Adler on Jun 26, 2015
Content may be subject to copyright.
Building Social Resilience in Soldiers: A Double Dissociative Randomized
Controlled Study
John T. Cacioppo
University of Chicago Amy B. Adler
Walter Reed Army Institute of Research,
Silver Spring, Maryland
Paul B. Lester
Research Facilitation Laboratory–Army Analytics Group,
Monterey, California
Dennis McGurk
U.S. Army Medical Research and Materiel Command,
Frederick, Maryland
Jeffrey L. Thomas
Walter Reed Army Institute of Research,
Silver Spring, Maryland
Hsi-Yuan Chen and Stephanie Cacioppo
University of Chicago
Can social resilience be trained? We report results of a double-dissociative randomized controlled study
in which 48 Army platoons were randomly assigned to social resilience training (intervention condition)
or cultural awareness training (active control group). The same surveys were administered to all platoons
at baseline and after the completion of training to determine the short-term training effects, generalization
effects beyond training, and possible adverse effects. Multilevel modeling analyses indicated that social
resilience, compared with cultural awareness, training produced small but significant improvements in
social cognition (e.g., increased empathy, perspective taking, & military hardiness) and decreased
loneliness, but no evidence was found for social resilience training to generalize beyond these training
foci nor to have adverse effects. Moreover, as predicted, cultural awareness, compared with social
resilience, training produced increases in knowledge about and decreases in prejudice toward Afghans.
Additional research is warranted to determine the long-term durability, safety, and generalizability of
social resilience training.
Keywords: social isolation, military, loneliness, training, group randomized trial
Supplemental materials: http://dx.doi.org/10.1037/pspi0000022.supp
In the past decade, organizations including the U.S. military have
sought to develop resilience-building programs to reduce mental health
and behavioral problems (Cornum, Matthews, & Seligman, 2011). To
date, these resilience programs have been associated with small effects
(Lester, Harms, Herian, Krasikova, & Beal, 2011;Mulligan, Fear, Jones,
Wessely, & Greenberg, 2011;Russell et al., 2014), but even small effects
when applied to large numbers of individuals may result in significant
economic and societal benefits (Fishbein, 1996;Zatzick, Koepsell, &
Rivara, 2009). Whereas the focus in prior research has been on individual
resilience, social resilience training may also be relevant to military
organizations given the potentially isolating nature of and significant
demands associated with combat deployment.
Social resilience refers to the capacity to foster, engage in, and
sustain positive relationships, and to endure, recover from, and
John T. Cacioppo, Department of Psychology, Department of Psychiatry
and Behavioral Neuroscience, and Center for Cognitive and Social Neu-
roscience, University of Chicago; Amy B. Adler, Walter Reed Army
Institute of Research, Silver Spring, Maryland; Paul B. Lester, Research
Facilitation Laboratory–Army Analytics Group, Monterey, California;
Dennis McGurk, U.S. Army Medical Research and Materiel Command,
Frederick, Maryland; Jeffrey L. Thomas, Walter Reed Army Institute of
Research; Hsi-Yuan Chen, Center for Cognitive and Social Neuroscience,
University of Chicago; Stephanie Cacioppo, Department of Psychiatry and
Behavioral Neuroscience, and Center for Cognitive and Social Neurosci-
ence, University of Chicago.
This research was supported by Department of the Army Award
W81XWH-11-2–0114 and was reviewed and approved by the University
of Chicago Institutional Review Board (IRB H11297) and the U.S. Army
Medical Research and Material Command Human Research Protection
Office (HRPO A-16547). We express our gratitude to Rhonda Cornum,
Kenneth Riddle, Louise Hawkley, Maike Luhmann, Jessica Bell, Harry
Reis, Alex Zautra, Katharine Nassauer, Ramon Prieto, D. Alan Nelson,
Mike Fravell, Katie Nasser, Carson Mayo, Josh Mayo, Paul Bliese, and the
Social Awareness and Action Training team for their contributions to
various aspects of this research.
Correspondence concerning this article should be addressed to John T.
Cacioppo, University of Chicago, Department of Psychology, 5848 S.
University Avenue, Chicago, IL 60637. E-mail: Cacioppo@uchicago
.edu
Journal of Personality and Social Psychology In the public domain
2015, Vol. 109, No. 1, 90–105 http://dx.doi.org/10.1037/pspi0000022
90
grow as a result of life stressors and social isolation (Cacioppo,
Reis, & Zautra, 2011). Individual resilience emphasizes an indi-
vidual’s capacity to find opportunities in tragedy and to turn
adversity to advantage; in contrast, social resilience emphasizes an
individual’s capacity to work with others to achieve these end-
points, and consequently the group’s capacity to do so, as well.
Unlike other forms of personal resilience, social resilience is
intrinsically multilevel and includes an individual’s characteristic
ways of relating and interpersonal capacities (e.g., empathy, per-
spective taking, trust, hostility, and loneliness) and collective re-
sources and capacities (e.g., organizational trust, perceived group
efficacy, and group cohesion and conflict; Cacioppo et al., 2011).
Social resilience may be useful in facilitating adaptive response to
a significant life stressor or to the loss of relationships such as
moving to a new location, a new job, or other times when the
individual is at risk for social isolation. Social resilience may also
lead to personal growth through enhancing interpersonal relation-
ships, meaning-making, social engagement, and coordinated social
responses to threatening situations.
Social resilience does not imply monolithic pressures toward
uniformity nor an uncritically rosy view of the joys of relating.
What is unique about social resilience is an appreciation for the
key contributions of coordinated social activity and feelings of
connectedness to human welfare (Cacioppo, Cacioppo, &
Boomsma, 2014;Christakis & Fowler, 2013;Holt-Lunstad, Smith,
& Layton, 2010). In other words, when people work together
toward their common benefit, taking into account their differences
and seeking to profit from them, while recognizing and valuing the
bonds that link them to each other, their collective outcomes can
transcend those that would be obtained from more solitary activ-
ities and promote the development and expression of individual
resilience. Of course, other forms of resilience may also strengthen
and preserve, but social resilience emphasizes the role of connec-
tions with other individuals, groups, and large collectives as a
means of fostering adaptation through new learning (including
social learning) and growth.
Research on social connections, group processes, and interper-
sonal relationships suggest that socially resilient individuals are
engaged in meaningful social encounters and relationships; that is,
feelings of being socially isolated (lonely) are relatively brief or
mild. The amount of time spent alone and introversion are not
particularly good predictors of loneliness; instead, loneliness is
more strongly related to the nature and quality of the interactions
and relationship with others (e.g., Hawkley et al., 2008). For
instance, individuals who are distant from spouse or friends, who
are having marital strain or who experience a loss of a significant
relationship, or who do not identify with their group are at risk for
feeling socially isolated (Hawkley, Browne, & Cacioppo, 2005).
Being ignored or ridiculed also contributes to feelings of isolation
(Williams, 2007), whereas the greater people believe they can trust
others, the less isolated they tend to feel over time (Rotenberg et
al., 2010), and shared social identities and commitments, such as
pride in being a member of and loyalty to a particular group,
contribute to lower feelings of isolation (Hawkley et al., 2005).
Rather than a discrete categorical state, loneliness is best concep-
tualized as part of a continuum ranging from salutary social
relationships to the perceived absence of any such relationships
(for a review, see Cacioppo et al., 2006;Cacioppo & Patrick,
2008).
Numerous studies have documented the serious health conse-
quences of loneliness and social isolation. At one extreme, lone-
liness is a well established risk factor for suicidal ideation (Stra-
vynski & Boyer, 2001). Lonely people tend to have poor coping
mechanisms that, at times, manifest as alcohol abuse (Åkerlind &
Hornquist, 1992). Yet, research suggests that loneliness is also an
insidious problem. For example, it negatively impacts somatic
function while promoting daytime dysfunction (Cacioppo, Hawk-
ley, Berntson et al., 2002) and can increase objective measures of
stress, such as a morning rise in cortisol (Adam, Hawkley, Kud-
ielka, & Cacioppo, 2006). Likewise, loneliness can lead to other
physical ailments, such as elevated blood pressure (Hawkley,
Masi, Berry, & Cacioppo, 2006), increased vascular resistance
(Cacioppo, Hawkley, Crawford et al., 2002) and cardiovascular
disease (Caspi, Harrington, Moffitt, Milne, & Poulton, 2006). Thus
loneliness is an important variable to understand and more impor-
tantly, a potential candidate for intervention (Cacioppo & Patrick,
2008).
Similarly, it is important to note that loneliness and depression
are related but independent constructs. Prior research has shown
that depressive symptomatology, alcohol and substance abuse, and
suicide intentions and behavior have a strong social component,
and each is exacerbated when people are exposed to significant
stress (e.g., Brailey, Vasterling, Proctor, Constans, & Friedman,
2007;Hoge, Auchterlonie, & Milliken, 2006) and when people
feel lonely (Cacioppo, Hawkley, & Thisted, 2010;S. Cacioppo et
al., 2014;Ong, Fuller-Rowell, & Bonanno, 2010;Reich, Zautra, &
Hall, 2010;Stanley, Allen, Markman, Rhoades, & Prentice, 2010).
Research has also shown that loneliness and depressive symptom-
atology are related but separable constructs (e.g., Cacioppo et al.,
2006); experimental manipulation of loneliness in humans in-
creases depressive symptomatology (e.g., Cacioppo et al., 2006);
naturalistic changes in loneliness from normal life events, as
assessed in longitudinal research, influence subsequent levels of
depressive symptomatology (Cacioppo et al., 2010) for as long as
two years (VanderWeele, Hawkley, Thisted, & Cacioppo, 2011);
and experimental manipulation of social loss or separation from a
preferred partner in animal research increases depressive behavior
(cf. Cacioppo, Cacioppo, Cole, Capitano, Goosens, & Boomsma,
2015). Thus loneliness can be identified as a valuable target for
intervention that can reduce depression as well as other negative
health outcomes.
Given the pernicious effects of loneliness, previous studies have
examined various interventions to reduce loneliness. These inter-
ventions have demonstrated that it is possible to reduce loneliness,
and a meta-analysis of these interventions indicated that maladap-
tive social cognition is a key mechanism for reducing loneliness
(Masi, Chen, Hawkley, & Cacioppo et al., 2011). Reducing mal-
adaptive social cognition, such as unrealistic perceptions of others
or a preoccupation with self-preservation, was more effective than
interventions focused on enhancing social support, and resulted in
improved basic social skills and increasing opportunities for social
contact (Masi et al., 2011). At its core, interventions designed to
enhance social resilience appear to be best focused on loneliness
and the concomitant skills of social cognition.
Social resilience may be a particularly good target in an occu-
pational setting in which social cohesion is explicitly valued as
part of the organizational culture and endemic to job performance.
Nowhere is the importance of cohesion more evident than in
91
BUILDING SOCIAL RESILIENCE IN SOLDIERS
high-risk occupations such as police, fire fighters and the military
in which social cohesion and connectedness are a key part of the
occupation’s identity and critical for survival (e.g., Adler & Cas-
tro, 2013). This is the first randomized controlled study assessing
a training program designed to enhance social resilience in a
high-risk occupation context.
Given the putative qualities of social resilience (Cacioppo et al.,
2011), the evidence that training can reduce loneliness (Masi et al.,
2011), and a high-risk occupation that values group cohesion
(Griffith, 1988), the goal of the present study was to assess the
efficacy of social resilience training developed for the U.S. Army.
Consistent with the occupational emphasis of working as a unit,
intact groups were randomly assigned to different study conditions
(social resilience training and an active comparison training con-
dition).
Efficacy was operationalized with a set of proximal outcomes.
First, efficacy was assessed in terms of the extent to which social
resilience training, which was focused on social cognition as
recommended by Masi and colleagues (2011), actually resulted in
improved in social cognition and reduced loneliness. Social cog-
nition included concepts such as increased perspective taking and
empathy. Efficacy was also assessed in terms of the degree to
which the training resulted in reduced feelings of loneliness and
social disconnection, the underlying correlate of many negative
health outcomes, and a principal target. Second, training efficacy
was assessed in terms of the extent to which social resilience
training enhanced positive work group attitudes such as increased
platoon cohesion, collective platoon efficacy, and lower platoon
conflict. The training, provided to existing small groups (platoons),
was designed to increase the platoon’s understanding of the rele-
vance of social connection to their own functioning. These out-
comes were primary objectives of the training; all three outcomes
were expected to improve in the social resilience training condition
relative to the comparison training condition.
The degree to which the active comparison training, which was
focused on cultural awareness, actually resulted in greater cultural
awareness was also assessed. This assessment addressed the de-
gree to which cultural awareness training resulted in proximal
changes in cultural awareness attitudes. While not the focus of
social resilience, it was important to test for the efficacy of cultural
awareness training in order to demonstrate that social resilience
training did not simply result in improvements across the board
due to overarching demand characteristic or the Hawthorne effect.
Furthermore, studies have identified the importance of cultural
competence in the military (Abbe & Gouge, 2012) and the poten-
tial for training to positively affect cross-cultural attitudes (Cali-
giuri, Noe, Nolan, Ryan & Drasgow, 2011;Gabrenya, Griffith,
Moukarzel, Pomerance & Reid, 2012;Rehg, Gundlach, & Grigo-
rian, 2012).
Another objective was to investigate the impact of training on
relatively distal outcomes associated with social connection and
work attitudes beyond the platoon. Thus, training was assessed in
terms of how the intervention generalized to soldier perceptions of
other personal relationships (e.g., satisfaction with relationships
with family and friends) and the Army as a whole (e.g., organi-
zational commitment, perceived organizational support). In addi-
tion, given the link between loneliness and mental health, the distal
outcome of mental health was included in the assessment of
training efficacy. Specifically, the training was assessed in terms
of whether there were immediate improvements in mental health,
operationalized as lower depressive symptomatology. If evidence
is found that training can enhance social resilience, subsequent
research can address the long-term impact of resilience training in
high-risk occupational groups.
Even if an intervention has a positive mean effect, it is possible
that the training is not effective or perhaps is even harmful to
specific subgroups of individuals (Eidelson & Soldz, 2012). There-
fore, we also investigated potential beneficial or adverse effects of
the social resilience training on the health and wellbeing of sol-
diers. For instance, ancillary analyses were performed on data
from soldiers to assess the extent to which the effects of social
resilience training varied as a function of dispositional (e.g., open-
ness, conscientiousness) and situational factors (e.g., combat ex-
perience). Both dispositional and situation factors have been found
to impact resilience outcomes in previous research (e.g., Hoge,
Austin, & Pollack, 2007;Adler et al., 2009).
Method
Design and Participants
The study was a double-dissociative randomized controlled
study design in which platoons were randomly assigned to receive
either Social Resilience Training (SRT) to improve maladaptive
social cognition and loneliness (intervention condition) or Afghan-
istan Cultural Awareness Training (CAT) to improve understand-
ing of and reduce prejudice toward Afghans (active control con-
dition). Both were characterized as “Social Awareness and Action
Training” (SAAT) with the goal of increasing “social fitness.” The
intervention condition was hypothesized to improve maladaptive
social cognition, loneliness, and work group attitudes while having
no effect on knowledge of or outgroup bias toward Afghans; the
active control condition was hypothesized to increase knowledge
of and decrease outgroup bias toward Afghans while having no
effect on maladaptive social cognition, loneliness, or work group
attitudes.
The double-dissociative aspect of the randomized clinical design
comes from neuropsychology where one region of the brain (or a
lesion in one region of the brain) is shown to influence a self-report or
performance on a task that involves behavioral process “A” rather
than “B,” and a different region of the brain (or lesion in this region
of the brain) is shown to influence a self-report or performance on a
task that involves behavioral process “B” rather than “A.” This double
dissociation makes it possible to distinguish general versus specific
effects of an activation (or lesion) of a region of the brain (see Bechara
et al., 1995, for an example in neuroscience and Adler et al., 2015, for
an example in organizational psychology), although there are disad-
vantages in neuroscience associated with modularity or independence
of effect (van Orden, Pennington, & Stone, 2001). In the present
context, however, the expectations were that the trainings would have
different targets: (a) the social resilience training (the intervention
condition) was hypothesized to improve specific aspects of social
resilience such as decreased levels of loneliness and hostility and
increased levels of empathy, perspective taking, military hardiness,
and social skills practice but to have no effect on the rated competence
or warmth of Afghans; and (b) the education and cultural awareness
training (the active control condition) was hypothesized to increase
the rated competence and warmth of Afghans (and, consequently, to
92 CACIOPPO ET AL.
lower outgroup prejudice) but to have no effect on the measures of
social resilience. Thus, the “double dissociative” randomized con-
trolled study means the two types of training are hypothesized to have
unique, specific, and directional consequences, whereas the operation
of any general bias, such as demand characteristics, placebo effects,
expectancy effects, or Hawthorne effects, should have similarly pu-
tatively beneficial effects on the measures of social resilience and the
ratings of the competence and warmth of Afghans. As a result of the
directional nature of these experimental hypotheses one-tailed tests
were specified.
The between-subjects factors were a series of hierarchical or-
ganizational command structures labeled Brigade (very large or-
ganizations, ⬃3000 soldiers), Battalion (⬃700 soldiers), Company
(⬃100 soldiers), Platoon (⬃30 soldiers), and experimental Condi-
tion (SRT or CAT), and the within-subjects factor was Measure
(within Variable Set) and Time (Pretest, Posttest). Platoons were
randomly assigned to receive either an 8-hr SRT program (inter-
vention condition) or an 8-hr CAT program (active control condi-
tion). Participants completed surveys immediately before the first
training session (pretest, Time 1) and immediately after the last
training session (posttest, Time 2).
The sample size was estimated based on an expected effect size
of d⫽.15, and plans were made to recruit soldiers from two
brigades at two large Army posts in the US. Despite the plan to
include a total of 64 platoons from the two brigades, 16 platoons
from one brigade deployed to combat just prior to the start of the
study. To mitigate the effects of the smaller number of platoons
(and soldiers) on statistical power, platoons were randomly as-
signed to the two arms of the training with the constraint that
approximately 60% of the platoons were assigned to the social
resilience arm of the intervention. This oversampling of the inter-
vention arm was done to provide greater statistical power in
ancillary analyses to determine the extent to which the SRT was
differentially helpful for subgroups of soldiers.
Soldiers were from two maneuver brigades located on two
different large Army posts. The brigades were from the full-time
Active Duty component of the Army (rather than part-time Army
units, such as the National Guard and Army Reserves). While there
was no specific expectation regarding an upcoming deployment,
these were operational brigades subject to constant preparation for
deployment to combat zones (rather than training units designed
for individual skill attainment that are not subject to deployment).
On average, the soldiers were 24 years old (ranging from 18 to 42),
and had served in the Army for 4.5 years (ranging from 1 and 24
years, with 90% of the Soldiers having served 10 years or less);
76% had deployed previously to combat. In terms of rank, 78%
were junior enlisted, 19% were noncommissioned officers, and 3%
were officers.
Procedure
The study procedure was reviewed and approved by the Uni-
versity of Chicago Institutional Review Board and by the U.S.
Army Medical Research and Materiel Command Human Research
Protection Office. Both training programs were developed in col-
laboration with research psychologists in the U.S. Army and
through focus groups and pilot studies with soldiers at three U.S.
Army posts over an 18-month period. Soldiers consented as to
whether or not they wanted to be in the study. The rate of consent
was 93.7%, which is comparable to the consent rate reported in
previous research on Army soldiers (e.g., Wilk et al., 2010).
Allocation Strategy
Of the 48 platoons, 29 platoons consisting of 688 soldiers were
randomly assigned to SRT and 19 platoons consisting of 450
soldiers were randomly assigned to CAT. In the SRT condition,
489 soldiers (71.1%) completed a 1-hr pretest, and the data from
10 of these soldiers were not included in the analyses based on
exclusionary criteria (see below). In the CAT condition, 328
soldiers (72.8%) completed the pretest, and the data from 6 of
these soldiers were not included in the analyses based on exclu-
sionary criteria. The number of participants at each measurement
occasion and the reasons for attrition are shown in Figure 1, and
the demographic data on the sample at each measurement occasion
are summarized in Table 1.
Measures
To minimize Type I error rate, outcome measures were identi-
fied and organized within Variable Sets, and the experimental
hypotheses were tested at the level of Variable Set within our
multilevel data analysis. Specifically, for each Variable Set, a fixed
effect of the Measure variable was added to the model to account
for the use of multiple measures within each Variable Set. Uni-
variate tests to examine the specific effects of the training are
interpreted only when the tests of the corresponding aggregate
measure reaches statistical significance, but the results and effect
size for all measures are provided in tables to support future
research endeavors and meta-analyses. Given that the primary goal
of grouping by variable set was to reduce Type I error, the
groupings themselves are constructed relatively broadly.
Measures were identified to assess the effects of social resil-
ience versus cultural awareness training on how soldiers (a) re-
ported greater social cognition and overall sense of social connec-
tion (social cognition; Variable Set 1), (b) perceived their platoon
as a more positive entity (work group attitudes; Variable Set 2), (c)
knew more about Afghans and Afghanistan and felt less outgroup
prejudice toward Afghans (cultural awareness & outgroup preju-
dice; Variable Set 3), (d) perceived people and organizations
beyond the platoon more positively (training generalization; Vari-
able Set 4), and (e) were doing better or worse in terms of
measures of health and wellbeing (health and wellbeing; Variable
Set 5). The measures were clustered within Variable Sets a priori
on theoretical grounds, and two experts reviewed the variable sets.
There was agreement on all but one measure, and the issue was
resolved through discussion. After the Variable Sets were defined,
a confirmatory factor analysis was conducted, and the results
confirmed the grouping of these variable sets was reasonable.
1
Surveys were administered before and after training. The survey
data were de-identified along with the soldiers’ consent informa-
1
Confirmatory factor analysis was conducted using SEM. The results
suggested our five-factor latent structure was reasonable with RMSEA of
0.079 and CFI of 0.784. Analyses also confirmed the five-factor model is
superior to models with fewer factors. For detail correlation tables of
individual items within each variable set and of latent factors, please refer
to online supplementary material.
93
BUILDING SOCIAL RESILIENCE IN SOLDIERS
tion. Some of our outcome measures were adapted when the
original instructions referred to the last two weeks. Since the
pretest (Time 1) and posttest (Time 2) were conducted a work-
week apart (Monday and Friday, respectively), these instructions
were consistently changed to the last week in the posttest. A list of
the outcome measures collected at the pretest and posttest; the
moderator variables collected at pretest, posttest, or through an
Army database; and a detailed description of each measure is
provided in Supplementary Materials_Measures. These measures
are described briefly below. Where appropriate, reverse scoring of
scale items was performed prior to the calculation of the scale
score. Unless specified otherwise, responses were given on a
5-point scale ranging from 1 (strongly disagree)to5(strongly
agree) and averaged to yield a total score (e.g., from 1 [low] to 5
[high]).
Social cognition (Variable Set 1). Outcome measures were
developed to evaluate the effectiveness of SRT and to determine
the unique effects of SRT relative to CAT. The concepts in this
variable set primarily encompassed variables reflecting individuals
rating their attitudes toward social connection with others and their
experience of that social connection (i.e., improved in social cog-
nition and reduced loneliness). This variable set cast a relatively
wide net but is characterized by proximal social resilience out-
comes targeted by the training. The specific measures of how
soldiers thought about others and felt about themselves in relation
to others (i.e., social cognition; in alphabetical order) were as
follows: (A) Beliefs about Social Fitness were assessed with three
items, such as “I believe that social skills can be improved through
Table 1
Sample Characteristics by Social Resilience Training (SRT) and
Cultural Awareness Training (CAT) Condition
SRT (N⫽346) CAT (N⫽235) Statistical test
Age 24.3 (SD ⫽4.3) 24.6 (SD ⫽4.9) t(579) ⫽.69
Female (percent) 3.5% 2.5%
2
(1) ⫽.64
High-school diploma 98.3% 97.9%
2
(1) ⫽.13
Married or living
with partner 48.7% 52.2%
2
(1) ⫽1.14
Jr Enlisted status 77.7% 78.7%
2
(1) ⫽.08
Previous deployment 79.2% 67.5%
2
(1) ⫽10.04
ⴱⴱ
ⴱ
p⬍.05.
ⴱⴱ
p⬍.01.
ⴱⴱⴱ
p⬍.001.
Figure 1. CONSORT flow diagram for Social Awareness and Action Training (SAAT).
94 CACIOPPO ET AL.
practice.” (B) Empathy was assessed using four items from the
Empathic Concern subscale of the Interpersonal Reactivity Index
developed by Davis (1980). (C) Generalized Trust in people was
assessed using the first three items from Rosenberg’s Faith in
People Scale (Rosenberg, 1956) to assess generalized trust. (D)
Hostility was assessed using a 9-item version (Barefoot et al.,
1989) of the Cook–Medley Hostility Scale (CMHo; (Cook &
Medley, 1954). (E) Loneliness was measured using the 9-item short
version (Hawkley et al., 2005) of the Revised UCLA scale (Russell,
1996). (F) Military Hardiness was assessed with items drawn from a
scale developed by Dolan and Adler (2006) to assess a person’s
commitment to and involvement in daily life, feelings of control of the
events of one’s life, and the extent to which change, and the antici-
pation of change, was perceived as an exciting opportunity for per-
sonal growth. (G) Perceived Social Fitness refers to the confidence
people have to be able to perform various social fitness behaviors. The
scale consisted of 15 social fitness skills that were adapted from the
UCLA-R scale, the Social Intelligence Scale (Silvera, Martinussen, &
Dahl, 2001), and the Perceived Social Self-Efficacy Scale (Smith &
Betz, 2000). (H) Perspective Taking was assessed with four items
from the perspective taking subscale of the Interpersonal Reactivity
Index developed by Davis (1980). (I) Practiced Social Skills was
assessed by asking soldiers to indicate how often they had shown 7
different behaviors in the past week by selecting one of the following
response options: 0 (never), 1 (once), 2 (2–3 times), 3 (4 times or
more).
Work group attitudes (Variable Set 2). The measures of how
soldiers perceived their platoon (i.e., work group attitudes; in alpha-
betical order) were as follows: (A) Collective Platoon Efficacy was
assessed by adapting five items from the family efficacy scale (Ban-
dura, 2006). (B) Counterproductive Work Behaviors (CWBs) were
assessed at the platoon-level with a 6-item scale used by Dalal et al.
(2009). (C) Organizational (Platoon) Trust was assessed using 5
items that are military adaptations by Sweeney, Thompson, and
Blanton (2009) of organizational trust scales (Mayer & Davis, 1999).
(D) Organizational (Platoon) Citizenship Behaviors (OCBs) were
assessed by adapting five items from the military version (Deluga,
1995) of the 24-item OCB scale by Podsakoff, MacKenzie, Moor-
man, and Fetter (1990). (E) Platoon Cohesion and Support was
assessed using items from a 3-item cohesion scale adapted from
Podsakoff and MacKenzie (1994) for a military sample and four items
from Griffith (2002) to assess emotional support from leaders and
emotional support from fellow soldiers. (F) Platoon Conflict was
measured with a 4-item scale used in research with military samples
(Spector & Jex, 1998). (G) Satisfaction with Relationships in the
Platoon was assessed with 2 items: “On average, how well do you
know the people in your platoon?” and “On average, how satisfied are
you with your relationships with people in your platoon?” (H) Treat-
ment of Weakest Link was assessed by asking soldiers to rate the
extent to which they agreed with the statements, “It is right for a
platoon to socially isolate its poorly performing members,” and “It is
right for a platoon to commit time to help its poorly performing
members.” Higher score means better treatment of the weakest link.
Afghanistan cultural awareness and outgroup prejudice
(Variable Set 3). Measures were also developed to evaluate the
effectiveness of CAT and to determine the unique effects of CAT
versus SRT. The specific measures of what soldiers knew about
Afghanistan and how they felt and thought about Afghans and
Americans (i.e., outgroup knowledge and prejudice; in alphabeti-
cal order) were as follows: (A) Competence and Warmth of Af-
ghans was measured by asking soldiers to rate the warmth and
competence of the Afghan people (Fiske, Cuddy, & Glick, 2007)
using adapted items from Collange, Fiske, and Sanitioso (2009).
(B) Competence and Warmth of Americans was measured using
the same items as that was used for the Afghan people. (C)
Knowledge about Afghanistan/Cultural Awareness was assessed
using 5 multiple-choice items covering different aspects of Af-
ghans culture, economy, and religion that were taught soldiers in
the CAT Condition. (D) Outgroup Prejudice was defined as the
mean score for perceived warmth of Americans minus the mean
score for perceived warmth of Afghans to yield a score that
reflected prejudice toward the outgroup (Afghans). A comparable
difference score was calculated for perceived competence. Lower
ratings of Afghans relative to American people signifies greater
outgroup prejudice on the dimensions of warmth and/or compe-
tence (Collange et al., 2009).
Potential resilience training generalization (Variable Set 4).
Measures were developed to evaluate the possible effects of SRT
beyond the platoon in terms of perceptions of friends, family, and
the U.S. Army. The measures (i.e., training generalization effects;
in alphabetical order) were as follows: (A) Malingering Beliefs
were assessed by two items, “It is acceptable to seek medical care
in order to avoid duties that are difficult, unpleasant, or danger-
ous,” and “It is acceptable to go on sick call for minor medical
problems that I could handle myself.” (B) Perceived Organiza-
tional Support was measured using 3 items from the Perceived
Organizational Support scale (Eisenberger, Huntington, Hutchi-
son, & Sowa, 1986). (C) Organizational Commitment was defined
as an affective commitment to or identification with the military
service or unit and was assessed with four items from Allen and
Meyer (1990). (D) Satisfaction with Personal Relationships with
children, parents, friends, and relatives were assessed with 1 item
for each relationship domain (i.e., “On average, how satisfied are
you in your relationship with . . .”).
Potential adverse effects of resilience training on health and
well-being (Variable Set 5). The measures of potential adverse
effects on health and wellbeing of soldiers (i.e., health and well-
being; in alphabetical order) were as follows: (A) Alcohol Misuse
was assessed using the Two-Item Conjoint Screen (TICS; Brown
et al., 1997). Response options were yes or no, and the number of
affirmative responses was summed for a scale score ranging from
0 (low) to 2 (high). (B) Anxiety was measured using three items
from the Interaction Anxiousness Scale (Leary, 1983). (C) Cata-
strophizing, the tendency to explain bad events in a pessimistic
way, was assessed with four items drawn from the Attributional
Styles Questionnaire (Peterson & Villanova, 1988). (D) Depres-
sive Symptoms were assessed using the 9-item depression scale of
the Patient Health Questionnaire (PHQ-9; Spitzer, Kroenke, &
Williams, 1999). (E) Life Satisfaction was assessed with an item
used by Lucas and Donnellan (2012). (F) Mood in the past week
of work was assessed with the following item: “On average, how
would you describe your mood in the last work week?” (G)
Perceived Stress was measured using the 4-item Perceived Stress
Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983). (H) Sleep
Quality was assessed by asking a single question taken from the
Pittsburgh Sleep Quality Index (Buysse et al., 1989): “During the
past work week, how would you rate your sleep quality overall?”
95
BUILDING SOCIAL RESILIENCE IN SOLDIERS
(I) Vitality was assessed using four items from the RAND version
of the SF-36 (Hays, Sherbourne, & Mazel, 1993).
Moderator variables. Ancillary analyses were also per-
formed to investigate whether the beneficial or adverse effects of
the training varied based on situational or dispositional factors.
The Army database was used to secure demographic data (age,
gender,
2
education, rank [noncommissioned officer, NCO, or en-
listed soldier]). Additional information regarding social relation-
ships (marital/partner status, number of children, number of
friends, number of close relatives, and whether or not they have a
religious affiliation) was obtained in the pretest survey. The re-
maining moderator variables (in alphabetical order) were as fol-
lows (see Supplementary Materials_Measures for details): (A)
Childhood Trauma was assessed at pretest using an eight item
version of the Childhood Trauma Questionnaire (Bernstein et al.,
2003). (B) Combat Experiences were measured in the posttest
using 29 items from the Combat Experiences Scale (CES) to
obtain a global assessment of combat exposure. For each of the six
categories, soldiers were asked to endorse (Yes/No) all the expe-
riences that applied. “Yes” responses are summed to generate a
scale score that ranged from 0 (low) to 29 (high). (C) Leadership
Quality was assessed using a 10-item version of the Multidimen-
sional Leadership Quality scale (MLQ; Avolio & Bass, 2009).
Items were rated on a 5-point scale from 0 (not at all) to 4 (always)
regarding frequency with which soldiers observed their first line
supervisor display each behavior (D) (Negative). Leadership Be-
havior was measured by having soldiers rate their first line super-
visor on three negative leadership behaviors drawn from McGurk,
Sinclair, Thomas, Merrill, and Bliese (2014) that asks, for exam-
ple, how often “your supervisor embarrasses platoon members in
front of other platoon members.” (E) Big 5 Personality Traits of
extraversion, agreeableness, conscientiousness, openness, and neu-
roticism (Goldberg, 1992) were measured using an abbreviated
10-item scale (Gosling, Rentfrow, & Swann, 2003). (F) Platoon
Type was designated as falling within one of two broad categories
(combat or combat support) based on their main function/specialty.
Combat platoons included Infantry, Artillery, and Cavalry units;
whereas combat support platoons included Headquarters, Medical,
and other support units. (F) Previous Deployment was assessed in
the pretest by asking soldiers how many times they had deployed
to a combat zone. Approximately 75% of the soldiers were previ-
ously deployed, the data were highly skewed, and as such this
measure was treated as a dichotomous variable (N/Y) in the
moderator analyses.
Intervention
Each platoon was assigned for 2-hr training blocks per day for
each of five consecutive days. Each 2-hr block was divided into
two 50-min training sessions separated by a 10 min break, with the
exception that the first 50-min session was spent completing a
pretest survey (T1) and the final 50-min session was spent com-
pleting the posttest survey (T2). Trainers were randomly assigned
and taught the full 8-hr block. The primary mode of delivery for
both the training sessions was verbal instruction delivered by the
trainer and accompanied by a PowerPoint session.
Social resilience training (intervention condition). SRT was
designed to address feelings of isolation and maladaptive social
cognition, with an emphasis on modifying maladaptive social
cognitions and motivating soldiers to practice the new perspectives
and skills that were taught (Cacioppo et al., 2011;Masi et al.,
2011). In addition, Squad leaders assisted trainers in guiding
soldiers through the exercise in small groups and in the platoon as
a whole. The soldiers were encouraged to collaboratively contrib-
ute answers. Written reflection activities included small group
collaborations and were shared with the group. The training man-
ual for the SRT intervention is available from the corresponding
author.
SRT consisted of eight training sessions. Session 1 (Survival
Skills) introduced social fitness, its relevance and benefits to
overall soldier fitness, and its comparability to physical fitness in
terms of its malleability. Session 2 (Mind-Reading) was devoted to
descriptions and demonstrations of the variety of ways people
obtain information about others through nonverbal means (e.g.,
reading facial expressions, tone of voice), and how to avoid falling
into the trap of behavioral confirmation and self-fulfilling proph-
ecy when interpreting nonverbal signals (e.g., verify rather than
assume one knows what the other is thinking or feeling). Session
3 (Learning to Connect at a Distance) sensitized soldiers to “mirror
processes” (automatic processes such as mimicry, reciprocity) and
how they contribute to social contagion, and taught skills and
values required to consider one’s own interests within the context
of concern for others and for the platoon. Session 4 (Expanding
Unit Cohesion) focused on identifying and developing platoon
identity; transmitting the unit’s norms to new soldiers; and bene-
fiting from diversity along multiple dimensions including opin-
ions, beliefs, and capacities to improve unit performance and
decision-making.
Session 5 (Building Social Resilience) taught how to benefit
from and productively share negative and positive experiences
with others in the unit, and the importance of role flexibility in
accommodating changing needs within the unit. Session 6 (Deal-
ing With Your and Others’ Feelings of Isolation) focused on the
importance of recognizing and coping with the pain of social
isolation, and taught specific skills soldiers could use to prevent
social pain from spreading, including good communication skills
(listening and speaking) along with the use of perspective-taking
accompanied by verification of social assumptions and inferences.
Session 7 (Conflict Resolution) defined conflict and its effect on
interpersonal relationships and group performance, taught how to
address conflict constructively, to de-escalate conflict, to avoid
blaming others, and to take advantage of the skills among unit
members to resolve conflicts. The eighth (capstone) session re-
quired the soldiers to apply what they had learned in the training.
The trainer presented socially challenging scenarios that required
soldiers to draw on the skills and principles they had learned to
devise strategies to minimize negative effects and optimize soldier
and unit wellbeing and performance.
Afghanistan cultural awareness training (active control
condition). The CAT was designed to reduce social prejudice
toward Afghans in part by increasing their knowledge about the
population, culture, history, geography, and diversity of Afghani-
2
Given only 6 of the participants in the social resilience condition and
13 of the participants in the cultural awareness condition were female, we
could not investigate the possible moderating effects of gender. However,
the results reported in the text were unchanged when the analyses were
repeated excluding the data from female soldiers.
96 CACIOPPO ET AL.
stan. Unlike SRT, the CAT did not include any group activities but
focused on individual rather than collective learning. The soldiers
were encouraged to individually contribute answers rather than
collaborate. All the written reflection activities were done on an
individual basis and were not shared with the group. CAT also
consisted of eight training session (Cultural Awareness & Geog-
raphy; History; Religion; Ethic Groups & Social Customs; Econ-
omy & Politics; Recreation; Food, Dress, Health, & Education;
and Capstone). The training manual for the CAT intervention is
available from the corresponding author.
Training of Trainers and Treatment Adherence
Trainers were nine former Army noncommissioned officers
with extensive military instruction experience. All trainers had
prior experience with Army training doctrine that requires strict
adherence to a Program of Instruction. The train-the-trainer pro-
gram lasted 3 weeks. During the first week trainers received
training in how to conduct both the SRT and the CAT. Trainers
were (and remained) blind to the experimental hypotheses. During
the second and third week, trainers studied, rehearsed and prac-
ticed both training packages. The trainers presented the training
sessions to their fellow trainers to practice their delivery, be
critiqued and receive feedback from their peers. During the final
week of training, each trainer was evaluated individually and
critiqued by the project leader and research team to ensure adher-
ence to the training material. Based on these evaluations, the eight
best trainers were selected to conduct both the SRT and the CAT
programs.
Training sessions were digitally recorded, and two judges rated
the adherence of each trainer to the training manual for each
session on a 3-point scale (1 ⫽material not covered, 2 ⫽material
covered partly or poorly, 3 ⫽material covered well). The mean of
these scores across topics within a session constituted a measure of
Overall Training Adherence. In addition, judges rated each train-
ing session in terms of “pacing and efficient use of time,” “teach-
ing effectiveness (organized),” and “interpersonal effectiveness
(engaging/motivational),” using a 3-point scale (1 ⫽poor, 2 ⫽
good, 3 ⫽excellent), and the mean of these scores served as the
measure of Overall Session Quality. Analyses of the measures of
treatment adherence confirmed that trainers were uniformly high
in terms of treatment adherence (M
SRT
⫽2.65, SD ⫽0.38;
M
CAT
⫽2.65, SD ⫽0.41, t(200) ⫽0.07, ns) and overall session
quality (M
SRT
⫽2.50, SD ⫽0.45; M
CAT
⫽2.48, SD ⫽0.43,
t(192) ⫽0.41, ns).
Data Preparation
To identify careless responding, three instructed response items
were presented at different places in the survey. The general
format of these items was: “To help us monitor the quality of the
data you’re giving us, please select the option [the “correct” option
is requested]...”Meade and Craig (2012) have shown that
instructed response items are a valid and economic tool to detect
careless responding. To ensure data quality, three exclusionary
criteria were applied to the obtained responses: (a) all three re-
sponses to the Instructed Response Items were answered incor-
rectly, (b) evidence of straight-line responding was observed on
more than 75% of the scales with reverse worded items, or (c) two
of the three responses to the Instructed Response Items were
answered incorrectly and evidence of straight-line responding was
observed on at least 40% of the scales with reverse worded items.
As noted in Figure 1, data from 20 soldiers on the pretest or
posttest (11 from the SRT, 9 from the CAT) were judged to be of
questionable validity based on these criteria and were not included
in analyses. Additionally, outliers were handled in accordance with
Tabachnick and Fidell (2007).
Although platoons were randomly assigned to condition, we per-
formed preliminary analyses to investigate possible differences in the
pretest between participants in the SRT and CAT conditions. We
employed a two-step procedure: In Step 1, we examined the correla-
tions between group membership and all variables examined in this
study. For each association, we selected the correlation coefficient that
is most appropriate for this combination of variables: the point-
biserial correlation for a binary and a continuous variable, and Cra-
mér’s V(Cramér, 1946) for a binary and a categorical variable. In Step
2, we selected those variables that were significantly associated with
group membership and performed a logistic regression analysis with
group membership as the outcome to identify the most relevant
predictors of baseline differences. These variables were then included
as covariates in the central model. Two baseline measures were found
to differ between the two conditions: combat experience and empathy.
Therefore, these measures served as covariates in the multilevel
models. Results were the same when the analyses were performed
without including covariates.
Finally, we examined the number of training sessions attended
and soldier satisfaction ratings. Soldiers in the SRT condition
attended slightly but significantly more sessions (M
SRT
⫽7.41,
SD ⫽1.30) than soldiers in the CAT condition (M
CAT
⫽7.15,
SD ⫽1.60, t(577) ⫽2.16, p⬍.05). Analyses of the percent of
soldiers who attended all of the training sessions indicated an
equally high percentage in both conditions (78.5% in SRT, 71.9%
in CAT, ⌾
2
(1) ⫽3.29, ns). To determine whether differences
between Conditions existed in the soldier’s satisfaction with the
training, we assessed satisfaction with the training in the posttest
using the item “Overall, how satisfied are you with the SAAT
training?” Responses are given on a 5-point scale ranging from 1
(not at all)to5(very much). Analyses confirmed that the soldiers
were generally satisfied with the training and that there were no
differences between Conditions (M
SRT
⫽3.84, SD ⫽1.14;
M
CAT
⫽3.72, SD ⫽1.12, t(570) ⫽1.23, ns).
Data Analytic Plan
To account for the multilevel structure of the data, the data
were analyzed with multilevel models with Time on Level 1,
Individuals on Level 2, Platoons on Level 3, Companies on
Level 4, Battalions on Level 5.
3
R was used for the analyses (R
3
Brigade was the highest level in our data structure. When it was
included as Level 6, the ICC estimates revealed the values for Brigade were
quite low (⬍.005). Although it could have been specified as Level 6, we
decided to include it as a fixed effect variable because with only two
brigades in the dataset, we might not have enough information to make
appropriate distributional assumptions. By including the dummy-coded
brigade predictor in the model, we allowed for conditional mean differ-
ences between the brigades, which essentially took the Brigade level of
dependence into account. Results were not changed meaningfully when
Brigade served on Level 6.
97
BUILDING SOCIAL RESILIENCE IN SOLDIERS
Development Core Team, 2011). The lme4 package (Bates &
Maechler, 2010) was used to estimate the multilevel models, the
lmerTest package (Kuznetsova, 2012) was used to estimate the
corresponding pvalues based on Satterthwaite’s approximation
for the degree of freedom.
For each outcome, the first model we checked was an empty model
without any predictors. This model allowed us to estimate the pro-
portion of variance accounted for by each level using intraclass
correlation coefficients (ICCs) for each dependent variable. The re-
sults are summarized in Supplementary Materials_ICC. The results
across all measures showed ICCs in the double digits for Level 1
(Md ⫽.35) and Level 2 (Md ⫽.61), and much smaller ICCs for
Level 3 (Md ⫽.03), Level 4 (Md ⫽.00), and Level 5 (Md ⫽.00).
The ICCs for Levels 3–5 were in the single digits except for the
measures in Variable Set 3 (i.e., targets of CAT), where the ICCs
ranged from 0 to .20 (Md ⫽.03). The analyses of these measures
were not meaningfully altered by the exclusion of the higher order
levels, but we retained these in the multilevel model in keeping with
the data structure.
The effect size for each Variable Set and for each dependent
variable was determined based on calculations of the standard
deviation from the individual level variance reported in the
multilevel model output (Schagen & Elliot, 2004). The effect
size was calculated by dividing the multilevel model regression
coefficient by the standard deviation at the individual level. To
simplify the presentation of the Time ⫻Condition interaction
results, we coded each effect size so that a positive effect size
reflects a larger improvement in the SRT condition than in the
CAT condition. The directional experimental hypotheses in this
double-dissociative randomized controlled study are that the
effect sizes would be positive for the variable sets for social
cognition (Variable Set #1) and work group attitudes (Variable
Set #2) but negative for the variable set for Afghanistan knowl-
edge and outgroup bias (Variable Set #3). The tests of the
remaining variable sets are two-tailed, as the predictions are not
directional. If there are beneficial effects of SRT, relative to
CAT, on perceptions of family, friends, and the U.S. Army,
then the effect size should be positive for the variable set for
training generalization effects (Variable Set #4), and if there are
adverse effects of SRT, relative to CAT, then the effect size
should be negative for the variable set for health and wellbeing
(Variable Set #5). Finally, we performed ancillary moderator
analyses to explore whether training effectiveness or adverse
effects varied across subgroups that differ by disposition or
circumstance (situation).
Results
Test of Experimental Hypotheses
We first examined the effects of the SRT condition on the
soldiers’ feelings of isolation and social cognition (Variable Set
1). If SRT was effective, the Time ⫻Condition interaction
should show that soldiers in the SRT condition reported greater
(pretest to posttest) improvement on these outcomes than sol-
diers in the CAT condition. Results revealed the predicted
Time ⫻Condition interaction, ⫽0.13, SE ⫽0.07, t(9848) ⫽
1.80, p⫽.04 (one-tailed) with an overall effect size of ⫹0.21
(see Figure 2).
Univariate analyses and effect sizes for measures in the social
cognition variable set are summarized in Table 2. The Time ⫻
Condition interaction reached statistical significance and
showed greater improvements on six of nine measures: belief in
social fitness, ⫽0.12, SE ⫽0.06, t(579) ⫽2.05; empathy,
⫽0.11, SE ⫽0.05, t(1154) ⫽2.08; military hardiness, ⫽
0.12, SE ⫽0.05, t(578) ⫽2.45; perceived social isolation
(loneliness), ⫽⫺0.54, SE ⫽0.31, t(570) ⫽⫺1.74; perspec-
tive taking, ⫽0.10, SE ⫽0.05, t(579) ⫽1.80; and showing
social skills, ⫽0.13, SE ⫽0.05, t(578) ⫽3.05 (see Table 2).
We next analyzed the effects of the SRT condition on work
group attitudes (Variable Set 2). Results revealed the Time ⫻
Condition interaction was not significant, ⫽0.03, SE ⫽0.03,
t(8683) ⫽1.428, with an overall effect size of ⫹0.08 (see
Figure 2). Univariate analyses and effect sizes are summarized
in Table 2.
If the interventions had specific rather than general effects,
the Time ⫻Condition interaction should show that soldiers in
the SRT condition reported less (pretest to posttest) improve-
Figure 2. Mean Summary Pretest and Posttest Scores for Social Resil-
ience and Afghanistan Cultural Awareness Training Conditions on the
Outcome Measures of Social Cognition (Top Panel), Work Group Atti-
tudes (Middle Panel), and Afghanistan Cultural Awareness and Outgroup
Prejudice (Bottom Panel)
98 CACIOPPO ET AL.
ment on the measures of how soldiers felt about Afghans and
knew about Afghanistan (Variable Set 3) than soldiers in the
CAT condition. Results revealed the predicted Time ⫻Condi-
tion interaction, ⫽⫺0.51, SE ⫽0.05, t(5147) ⫽⫺9.93, p⫽
.0001 with an overall effect size of ⫺1.52 (see Figure 2).
Univariate analyses and effect sizes are summarized in Table
2. The Time ⫻Condition interaction reached statistical signif-
icance and, as predicted based on training content, showed
greater improvements in the CAT than SRT conditions on two
of the five measures: knowledge about Afghanistan,
⫽⫺1.63, SE ⫽0.11, t(579) ⫽⫺14.46; and perceived
warmth of Afghans, ⫽⫺0.67, SE ⫽0.08, t(564) ⫽⫺8.43
(see Table 2). Analyses of the derived measures to assess
outgroup prejudice also revealed the predicted improvements in
Table 2
Group ⫻Time Interaction Outcomes
Group ⫻Time coefficient
Outcome variables BSEP
1
ID level SD Adjust
2
Effect size
Social cognition (Variable Set #1)
Overall test: Social cognition 0.13 0.07 0.04 0.61 1 0.21
Beliefs in social fitness 0.12 0.06 0.02 0.52 1 0.22
Empathy 0.11 0.05 0.02 0.37 1 0.29
Generalized trust 0.02 0.02 ns 0.29 1 0.09
Hostility ⫺0.01 0.02 ns 0.15 ⫺1 0.08
Military hardiness 0.12 0.05 0.01 0.70 1 0.16
Perceived isolation ⫺0.54 0.31 0.04 4.66 ⫺1 0.12
Perceived social fitness 0.02 0.05 ns 0.62 1 0.03
Perspective taking 0.10 0.05 0.04 0.45 1 0.21
Practicing social skills 0.13 0.04 0.00 0.42 1 0.31
Work group attitudes (Variable Set 2)
Overall test: Work group attitudes 0.04 0.03 ns 0.50 1 0.08
Collective platoon efficacy 0.06 0.06 ns 0.72 1 0.08
Counterproductive work behavior ⫺0.01 0.06 ns 0.51 ⫺1 0.02
Organizational trust 0.03 0.05 ns 0.72 1 0.04
Organizational citizenship behavior 0.11 0.05 0.02 0.48 1 0.23
Platoon cohesion and support 0.05 0.05 ns 0.68 1 0.07
Platoon conflict 0.06 0.06 ns 0.64 ⫺1⫺0.09
Platoon relationship satisfaction 0.07 0.06 ns 0.77 1 0.10
Treatment of the weakest link 0.04 0.07 ns 0.53 1 0.08
Afghanistan cultural awareness and outgroup prejudice (Variable Set 3)
Overall test: Outgroup knowledge and prejudice ⫺0.51 0.05 ⬍.001 0.33 1 ⫺1.52
Cultural awareness (Afghan knowledge) ⫺1.63 0.11 ⬍.001 0.70 1 ⫺2.33
Outgroup prejudice–warmth 0.61 0.10 ⬍.001 0.95 ⫺1⫺0.64
Outgroup prejudice–competence 0.00 0.10 ns 0.79 ⫺1 0.00
Perceived competence of Afghans ⫺0.09 0.08 ns 0.65 1 ⫺0.13
Perceived warmth of Afghans ⫺0.67 0.08 ⬍.001 0.72 1 ⫺0.92
Perceived competence of Americans ⫺0.08 0.06 ns 0.59 1 ⫺0.14
Perceived warmth of Americans ⫺0.04 0.07 ns 0.60 1 ⫺0.07
Potential training generalization effects (Variable Set 4)
Overall test: Training generalization effects 0.02 0.05 ns 0.51 1 0.04
Malingering beliefs ⫺0.05 0.09 ns 0.72 ⫺1 0.07
Organizational commitment 0.12 0.06 0.05 0.90 1 0.13
Perceived organizational support ⫺0.03 0.08 ns 0.87 1 ⫺0.04
Satisfaction with personal relationship ⫺0.06 0.06 ns 0.64 1 ⫺0.09
Health and well-being (Variable Set 5)
Overall test: Health and well-being 0.05 0.04 ns 0.77 1 0.07
Alcohol misuse ⫺0.05 0.04 ns 0.36 ⫺1 0.14
Anxiety 0.03 0.06 ns 0.60 ⫺1⫺0.05
Catastrophizing 0.01 0.05 ns 0.70 ⫺1⫺0.02
Depressive symptoms ⫺0.01 0.03 ns 0.52 ⫺1 0.01
Life satisfaction 0.20 0.12 ns 1.88 1 0.11
Mood 0.12 0.15 ns 1.80 1 0.07
Perceived stress ⫺0.07 0.06 ns 0.63 ⫺1 0.11
Sleep quality 0.04 0.06 ns 0.71 1 0.05
Vitality 0.05 0.07 ns 0.92 1 0.06
1
One-tailed.
2
Adjusted for direction to simplify the presentation/interpretation of results, refer to Data Analytic Plan section for details.
99
BUILDING SOCIAL RESILIENCE IN SOLDIERS
CAT, relative to SRT, conditions on one of the two measures of
outgroup prejudice: perceived difference in warmth (US-
Afghans), ⫽0.61, SE ⫽0.10, t(563) ⫽5.83 (see Table 2).
Potential Training Generalization Effects
An ancillary aim was to test the notion that building social
resilience would generalize to how soldiers related to their family
and friends as well as the U.S. Army (Variable Set 4). Results
revealed the overall Time ⫻Condition interaction was not signif-
icant, ⫽0.02, SE ⫽0.05, t(4009) ⫽0.39, with an overall effect
size of .02 (see Figure 3). Univariate analyses and effect sizes are
summarized in Table 2.
Potential Adverse Effects
To investigate potential adverse effects of resilience training
programs, we analyzed measures of health and wellbeing (Vari-
able Set 5). Results revealed the Time ⫻Condition interaction
was not significant, ⫽0.05, SE ⫽0.04, t(9720) ⫽1.33, with
an overall effect size of ⫹0.07 (see Figure 3). Univariate
analyses and effect sizes are summarized in Table 2.
Ancillary Moderator Analyses
The full exploratory moderator analyses
4
are reported in Supple-
mentary_Materials_Moderators. The results suggested possible
situational and dispositional factors that are associated with better
outcomes from social resilience training. For instance, significant
Group ⫻Time ⫻Moderator interactions indicated that soldiers
who had not been previously deployed and those high in consci-
entiousness, agreeableness, or openness showed evidence of ben-
efitting more from SRT than their counterparts, whereas these
moderators had no effect on the efficacy of CAT (see online
Supplementary_Materials_Moderator).
In addition, as summarized in the online supplementary mate-
rials on moderator analyses, depressive symptomatology was in-
volved in two significant interactions involving a moderator, both
of which suggested resilience training was beneficial: (1) depres-
sive symptomatology decreased following SRT in soldiers who did
not attend religious services but did not change in in soldiers who
attend religious services; and (2) depressive symptomatology de-
creased more following SRT in soldiers who reported a history of
childhood trauma than in soldiers who did not. For soldiers in the
CAT condition, neither moderator was related to the change in
depressive symptomatology following training.
Moreover, personality moderated the effects of SRT but not
CAT, with soldiers in the SRT condition who were high in: (a)
openness showing greater decreases in loneliness, larger increases
in organizational citizenship behavior, and larger increases in
platoon relationship satisfaction; (b) conscientiousness showing
greater decreases in loneliness, and larger increases in organiza-
tional citizenship behavior; and (c) agreeableness showing larger
increases in perceived social fitness, larger increases in platoon
relationship satisfaction, and, paradoxically, larger increases in
malingering beliefs (see Supplementary_Materials_Moderators).
Given the exploratory nature of these analyses, results should be
interpreted cautiously.
Discussion
Resilience building training programs have been adopted by the
U.S. Army and have been associated with small but measurable
benefits. Among the criticisms raised about these efforts are failing
to control for confounding variables, account for the hierarchical
structure of the data, test the applicability of the resilience training
programs for soldiers prior to widespread implementation, attend
to potential adverse effects of resilience training programs for
soldiers (or subgroups of soldiers), and control for biases in self-
report data such as placebo effects and demand characteristics
(Eidelson & Soldz, 2012). The design of the present study ad-
dresses these criticisms while evaluating an intervention developed
specifically for the U.S. Army to improve social resilience.
Results indicated that the SRT and the CAT each produced
significant improvements, relative to the other, in the specific
domain in which the platoons were trained. Soldiers in the CAT,
compared with SRT, showed significant improvements in their
perceptions of Afghans, and follow-up analyses indicated that the
changes most evident by the end of training were found for the
soldiers’ knowledge of Afghanistan, the perceived warmth of
Afghans and, consequently, reductions in the perceived differences
in warmth between Americans and Afghans (i.e., reduced outgroup
prejudice). On the other hand, soldiers in the SRT, compared with
CAT, showed an overall improvement in social cognition, with
follow-up analyses indicating that the SRT condition increased
empathy, perspective taking, military hardiness, beliefs in social
4
Exploratory moderator analyses were conducted by testing 17 unique
potential moderators against all of the outcome variables. All of the
significant results are reported in the online supplemental materials.
Figure 3. Mean Summary Pretest and Posttest Scores for Social Resil-
ience Training and Afghanistan Cultural Awareness Training Conditions
on the Outcome Measures of Potential Training Generalization Effects
(Top Panel) and Health and Wellbeing (Bottom Panel)
100 CACIOPPO ET AL.
fitness, the use of the social perspectives and skills they were
taught and decreased feelings of loneliness. The overall effect size
for SRT, although small (d⫽⫹.21), is slightly larger than typi-
cally found for community-level interventions (see Fishbein, 1996;
Zatzick et al., 2009) as well as for prior studies of resilience
training in organizational contexts (e.g., Adler et al., 2009;Castro,
Adler, McGurk & Bliese, 2012;Fortney, Luchterhand, Zak-
letskaia, Zgierska, & Rakel, 2013;Hodges, 2010;Lester et al.,
2011;Millear, Liossis, Shochet, Biggs & Donald, 2008;Williams
et al., 2007). These results demonstrated that training intact work
groups in social resilience can improve self-reported use of these
skills and that these skills can have an immediate impact on
perceptions of loneliness. Perhaps just being armed with these
alternative behaviors and aware of the value of social connection
is enough to facilitate the sense of connection with one’s imme-
diate work group in a high-risk occupation. This impact, however,
was limited in its impact and is not a simple panacea.
Soldiers in the SRT condition did not show overall improve-
ments in how they felt about their platoon or the Army (i.e., work
group attitudes), or how they felt about and interacted with family
and friends (i.e., training generalization effects). On the positive
side, these findings suggest that the survey responses showing
improvements in social cognition were not an artifact of demand
characteristics, expectancy effects, or placebo effects, but these
findings also question whether any improvements in soldier resil-
ience were achieved beyond specific targets of training. A second
possibility is that, as in the case of physical fitness, it may not be
sufficient to know or to begin to practice social fitness behaviors,
it may also take time for these social behaviors to reshape the
soldiers’ interpersonal relationships and collective identities and
then only if the soldiers continue to exercise what they learned
during training under the auspices of a supportive platoon leader-
ship. If this is the case, then work group attitudes and training
generalization effects may take time and practice to manifest.
Similarly, it may be that perception of one’s internal state (e.g.,
loneliness) may be easier to identify whereas it may be more
difficult to perceive changes in the group and may require more
direct experience (e.g., cohesion). Regardless of the reason, if it
takes longer to identify changes in the group, it may also be that
these changes will not occur because of the short-term nature of
psycho-educational gains. Nevertheless, given short-term effects
of social resilience training have now been identified, longer-term
investigations are warranted. Consideration should also be given in
future research to incorporating SRT into ongoing platoon training
rather than limiting the training to a single point in time.
We also investigated possible short-term adverse effects of the
SRT on health and wellbeing. No evidence for an overall adverse
effect was detected, and moderator analyses provided little evi-
dence that the training had harmful effects on any subgroup.
Moderator analyses pointed to possible personality characteristics
and situations that may promote SRT efficacy. For instance, sol-
diers who had not been previously deployed also appeared to
benefit more from SRT condition than soldiers who had been
deployed previously, a finding that raises the possibility that pro-
viding SRT earlier rather than later in a soldier’s career may
produce larger training effects. The fact that the moderating effects
were specific to the SRT suggests that these dispositions did not
simply increase attention to Army training. Although additional
research is needed, it may be that SRT builds on the strengths these
soldiers bring, by disposition, to social resilience training.
Among the limitations of the present study are the modest
statistical power and the emphasis on short-term outcomes. The
former limitation was due in part to the unexpected deployment of
16 platoons that were scheduled to be involved in the study. We
nevertheless detected training effects on topics that were the direct
focus of training, and the effect sizes from this study should
contribute to a growing body of work on resilience training. The
focus on short term outcomes is an important initial step to
determine the extent to which the training is effective and safe.
Questions about the persistence and generalization of training are
now important to address. The use of one-tailed statistical tests to
evaluate the statistical reliability of the effects of training on the
target outcomes might also be questioned, but directional predic-
tions regarding the targets of training were made a priori (as
required by the double-dissociative randomized experimental de-
sign) based on a sizable literature on social cognition, human
relationships, and interventions for treating perceived isolation
(e.g., Bolier et al., 2013;Cacioppo et al., 2011;Gable & Reis,
2010;Masi et al., 2011). Another limitation is the potential confound
of social resilience training delivering information through collective
learning activities whereas the cultural awareness activities relied on
individual learning tasks. The degree to which these differences in
training activities resulted in differential outcomes between the two
conditions, rather than the content of training itself, is uncertain.
Finally, some of the measures used short-term time referents whereas
other outcomes measures used longer-term time referents. This dif-
ference in time course may have inadvertently biased what variables
were found to be changed by the training given the short-term nature
of the present study.
Among the strengths of the study are the double-dissociative
randomized controlled study design (where platoons were ran-
domly assigned to training conditions), the multilevel modeling to
capture the hierarchical structure of the data, and testing the direct
and indirect (potential training generalization and adverse) effects
of the training. The double-dissociative randomized controlled
study design offers important advantages. First, the experimental
design was developed to provide a better control for potential
confounding factors (e.g., awareness of being in a placebo or
wait-list control group), general experimental artifacts especially
when relying on self-reported outcome measures (e.g., demand
characteristics, expectancy effects, Hawthorne effects), experi-
mental attrition due to the failure to see any treatment benefits, and
treatment-contamination from cross-training. Second, the use of an
active control group (as opposed to a wait-list control group or a
group that never receives the training) minimizes the risk of biased
data due to demand characteristics, placebo effects, Hawthorne
effects, or poor compliance and careless responding that is more
prevalent in nonactive control groups. Moreover, with an active
control group, all soldiers receive a training that is in fact infor-
mative and useful, decreasing the risk of cross-contamination.
Finally, the “double dissociative” randomized controlled study
permits an evaluation of the specific, directionally predicted ef-
fects of each experimental condition as well as a determination of
any general effects of the training (e.g., expectancy effects; exper-
imental mortality). This experimental design may prove useful in
a wide range of intervention studies.
101
BUILDING SOCIAL RESILIENCE IN SOLDIERS
There was little evidence of domain general effects of the
training, with the exception of the measure perceived social fit-
ness, which showed significant and equivalent posttest improve-
ments in both conditions. The improvement in both conditions may
reflect the fact that soldiers in both conditions received training to
improve their social awareness and behavior, and soldiers in both
conditions showed improvements in domain specific areas of
social behavior (improved social cognition in the social resilience
condition, reduced outgroup prejudice in the cultural awareness
condition).
The finding that both training programs proved somewhat ef-
fective, at least for the targeted domains of social behavior, illus-
trates an ancillary benefit of the double-dissociative randomized
controlled study design, which is that one can evaluate the efficacy
of two distinct interventions (e.g., training programs) in the same
study while controlling for any general effects of the training,
including but not limited to experimental artifacts such as demand
characteristics, while also minimizing problems of treatment con-
tamination from subjects in control conditions who receive treat-
ment outside the confines of the experimental design. While not
the focus of the present study, the cultural awareness training was
effective in improving cultural knowledge and increasing positive
attitudes toward Afghans. Given the call for more studies demon-
strating the efficacy of cross-cultural training with military per-
sonnel (Caligiuri et al., 2011), the present study provides evidence
that such training can be effective in changing attitudes measured
by self-report.
In terms of theoretical contribution, the study moves the field
forward by suggesting that social connection needs to be more
explicitly studied in terms of context. Typically, loneliness re-
search addresses social connection irrespective of the social con-
text (work, friends and family). Yet the skills associated with
building social connection in a work setting in which individuals
are dependent on one another for survival (and not simply financial
well-being) may not be the same skills as those associated with a
circle of personal friends and family. Given that the effects of
social resilience training were limited to relationships within the
unit, the present study suggests that it is important to untangle
these different venues for social connection and to determine not
only how to boost social connection in each setting but also to
identify if one setting is a more relevant target for relieving
feelings of loneliness than another. The intense relationships in-
herent in military units, where terms like “band of brothers” and
“battle buddy” are routinely used to characterize the strong con-
nections, may be optimal for training in social resilience. Social
resilience training may be less effective in other work settings such
as factories or office work, where connections play less of a role
in survival.
Alternatively, it may be that the impact of social resilience
training was limited to work group factors (and did not expand to
distal outcomes) because the training occurred in the context of
these work groups. It may not be that the skills failed to transfer to
other contexts so much as the training itself was a joint experience
and provided a kind of language for the unit to understand the
importance of their social bonds. Perhaps the development of a
specific set of skills is less important than a more global attitude of
appreciating what the group’s bonds have to offer, consistent with
what Walton (2014) terms “wise interventions.” Walton describes
how specific psychological processes can be harnessed in simple
ways to effect significant change in important social problems.
Future research should examine the degree to which highlighting
the bonds across the group serve to enhance that sense of connec-
tion, and the role that specific social skills play in enhancing those
bonds.
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Received November 2, 2014
Revision received March 17, 2015
Accepted April 12, 2015 䡲
New Policy for the Journal of Personality and Social Psychology
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105
BUILDING SOCIAL RESILIENCE IN SOLDIERS
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