Self-Guided Multimedia Stress Management and Resilience Training

In the present study, we evaluated the effectiveness, usefulness, and usability of SMART-OP with a sample of flight controllers, trainees, and directors at Johnson Space Center (JSC) in a randomized controlled trial (RCT) by comparing SMART-OP to a wait-list condition (WLC). Evaluating SMART-OP with this population at JSC provided us the opportunity to assess the program’s use with an operationally focused analogous sample to astronauts.

We hypothesized that participants in the SMART-OP group would show significantly lower perceived stress, higher perceived control of stress, and increased resilience based on measures of self-report than the WLC from pre- to post-assessment. We also hypothesized that participants would rate the program as very useful and easy to use.

Our second aim was to provide feedback to SFRM and FOD (Flight Operations Directorate) based on data from the RCT and suggest modifications and implementation strategies of SMART-OP for use with astronauts.

The main deliverable of our task was to provide data on the effectiveness, usefulness, and usability of a self-guided, multimedia, stress management and resilience training program as tested in an RCT with flight controllers. The outcome data on perceived stress and perceived control over stress provides information on the efficacy of such training in helping to alleviate stress, a problem identified by SFRM working group in the training flow of flight controllers. Data on the usefulness and usability of SMART-OP will provide important information on the acceptability of self-guided multimedia behavioral health training with individuals who work in operational settings. For additional sources of data, we collected stress biomarker and heart rate data and had participants perform an acute stressor/frustrating task and measure neurocognitive performance. This data will inform future potential applications of such training with other individuals at JSC working in stressful environments including astronauts.

Since this is the last task report for this study, we are presenting task progress since the last report period from the end of 2017 as well as a summary of task progress over the course of the 4 years. Since the last report, recruitment was completed at the end of December 2017 and we wrapped up running the remaining subjects (approximately N=10) through the study protocol, which concluded in March 2018. The remainder of this last task period was spend organizing and cleaning data. The JSC Nutritional Biochemistry Lab conducted biomarker assays on saliva samples conducted over the course of the project and send those results to us. We closed out the assessments and organized a return of the equipment from JSC as well as all data retrieval via encrypted methods. Lastly, we spent this task period conducting analyses as well as writing up the final task report with study results and conclusions and began preparation for submitting a peer-reviewed manuscript.

Over the course of the 4-year study 189 individuals expressed interest in participating. This was typically done by signing an interest sheet after presentation pitches about the study to different groups of flight controllers. Eighty-eight or 46% of those interested were screened for eligibility which means that over half of those interested in the study were never screened for study eligibility. The team at UCLA worked with NASA BHP (Behavioral Health & Performance) personnel over the course of the study to try to address the issues in recruitment and screening and while strides were made; unfortunately most of the people who expressed interest in participating were never screened.

Of the 88 who were screened, 61 were eligible with the remaining 27 not eligible primarily due to having too low stress scores. Of the eligible 61, 45 individuals completed pre-assessment and were randomized to one of our two conditions. Twenty-four participants were randomized to the SMART-OP condition, and 21 participants were randomized to the wait-list condition (WLC). Forty-one participants completed the first post-assessment, 20 from SMART-OP and 21 from WLC which constituted the main outcome comparison groups. Sixteen participants from the WLC completed a second post-assessment after they completed SMART-OP sessions, for a total of 37 final post-assessments.

It should be noted that this was the first study to utilize the BHP Lab facilities and organizational structure; thus, there was steep learning curve to implementing this project. Many valuable lessons were learned over the course of this study in terms of subject recruitment that will ideally help future similarly conducted research.