Psychiatry - July 2008 - (Page 53)

lead to improved primary intervention strategies, better job placement, and lowered risk of PTSD. INTRODUCTION In a recent investigation, we prospectively assessed the degree to which healthy, active duty soldiers would experience symptoms of dissociation before and in response to acute, uncontrollable stress.1 The results of the study provided robust evidence that 1) stress-induced symptoms of dissociation are extremely common in healthy humans; 2) individuals who endorsed greater symptoms of dissociation at baseline exhibited greater symptoms of dissociation under stress; and 3) members of Special Forces troops exhibited fewer stress-induced symptoms of dissociation than general troops. Multiple risk factors for the development of trauma-related psychopathology have been identified in the scientific literature. One of the most replicated risk factors for the development of trauma-related psychopathology is peritraumatic dissociation (i.e., dissociation at the time of exposure to a traumatic event).2–11 Although peritraumatic dissociation may be useful in predicting PTSD in individuals who have already been traumatized, it is not yet known whether the tendency to dissociate under nonstressful circumstances (at baseline) can also serve as a predictor of vulnerability to stress in healthy individuals. In our previous studies of military personnel, individuals endorsing baseline symptoms of dissociation were at greatest risk for stress-induced symptoms of dissociation and stress-induced cognitive deficits, which in turn were associated with poor military performance.1,12,13 However, we are aware of no studies that have measured the relationship between baseline (nonstress) dissociation and overall performance under conditions of high stress such as SFAS training. In this study, we hypothesized that individuals who endorsed baseline symptoms of dissociation would be less likely to tolerate the stress of Special Forces Assessment and Selection (SFAS) and would be more likely to fail. Predicting stress vulnerability would be of great relevance to job selection for high stress professions and may be useful in the development of primary prevention strategies targeting trauma-related psychopathology. METHOD Prior to beginning the course, SFAS candidates provided written informed consent to participate in this study. Due to fact that the military personnel were active duty and being recruited to participate in a research study while enrolled in an official Selection and Assessment program, our research team took a number of precautions in order to ensure that subjects would not experience undue pressure to participate in the research study. First, and in keeping with the guidelines and recommendations of the Human Studies Committee (VA Connecticut), the research team took pains to ensure that soldiers would be able to make free and informed decisions about participation in the study. In order to reduce any element of coercion, all subjects were recruited by a member of the research team who was explicit in the following information: 1) the recruiter/researcher was a civilian and not in the service of the US Army. In addition, the researcher indicated that he was not receiving any money from the SFAS program; 2) participation in the research would in no way affect a candidate’s status (positively or negatively) in SFAS. The researcher further explained that information about enrollment and information provided by enrollees on the questionnaire would be kept confidential and not shared with anyone apart from the research team. Potential participants were also explicitly told that no information would be given to the SFAS personnel; 3) the research project was designed to help scientists evaluate and understand psychological, biological, and physiological aspects of why individuals differ in their performance under stress. The principal investigator (CAM) then gave an oral description of the study (i.e., described what would be required of them if they agreed to participate) after which consent forms were passed out to all potential participants. The principal investigator read through each section of the consent form aloud to the potential participants. After this was completed, all were given time to review the consent forms if they chose to do so. The consent forms provided a description of the study and explicitly indicated that the purpose of the National Center for PTSD study was to evaluate psychological, biological, and physiological aspects of military training stress in an effort to better understand how and why individuals differ in stress tolerance. This information was included in the consent form. Soldiers were not told that we were trying to predict who would fail in SFAS. Finally, all the candidates recruited for this study were on active duty status and therefore were not allowed by the command to accept payment for their participation in the study. All were informed of this fact and told that the only benefit they would receive for participating in the study was the knowledge that their participation in the research may help advance medical science about stress hardiness and stress vulnerability. All were told once more that they were free to refuse participation and that the refusal to participate would not affect their [JULY] Psychiatry 2008 53

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Psychiatry - July 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Reliability of Diagnoses: Do Psychiatrists Use Structured Interviews In Real Clinical Settings? Trend Watch: Use of Atypical Antipsychotics in the Elderly Review: The Struggle for Mental Healthcare in New Orleans-One Case at a Time Psychotherapy Rounds: Psychotherapeutic and Adjuntive Pharmacologic Approaches to Treating Posttraumatic Stress Disorder Original Research: Baseline Dissociation and Prospective Success in Special Forces Assessment and Selection Commentary: Performance-Enhancing Drugs: Where Should the Line Be Drawn and By Whom? Commentary: Psychiatric Diagnosis and the Pathlogist's View of Schizophrenia Journal Watch Classified Advertising Information for Authors

Psychiatry - July 2008

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