Teaching mental skills for self-esteem enhancement in a military healthcare setting

Journal of Instructional Psychology, Sept, 2009 by Jon Hammermeister, Michael A. Pickering, Carl J. Ohlson

The need exists for educational methods which can positively influence self-esteem, especially in demanding military healthcare settings. Warrior Transition Units (WTU's) are tasked with the challenging mission of caring for seriously injured or ill U.S. Army Soldiers. This paper explored the hypothesis that an educationally-based Mental Skills Training (MST) intervention can enhance self-esteem in members of a Warrior Transition Unit in the U.S. Army. The sample was comprised of 27 WTU cadre members who participated in an Army Center for Enhanced Performance (ACEP) MST educational workshop at a large Army installation on the West Coast. Instruments included the Ottawa Mental Skills Inventory (OMSAT-3; Durand-Bush & Salmela, 2001) and the Self-Esteem Rating Scale (SERS; Wagnild, 1993). Results showed that SERS scores were significantly higher following the intervention. Furthermore, the ACEP instructional components of self-confidence, imagery, and mental practice were significant predictors of self-esteem. Results suggest that MST might be a viable educational approach for enhancing self-esteem in the WTU cadre.

Introduction

Although the U.S. military is responsible for fighting and winning the nations' wars, caring for and rehabilitating Soldiers who become seriously injured or ill while serving their country is also of prime importance. To address this concern the Army has developed "Warrior Transition Units" (WTU's) to aid wounded warriors through their recovery process and their transition either back to Army units or to civilian life. Not surprisingly, as engagement in the War on Terror continues, the number of injuries to Soldiers, and therefore the number of Soldiers being assigned to WTU's, is increasing. For example, approximately 6000 Soldiers were assigned to WTU's in 2007, but this number is projected to grow to over 20,000 in 2008 (Kennedy, 2008). This greater than three-fold rise in Soldiers assigned to WTU's substantially increases the workload and the associated amount of job-related adversity experienced by the WTU cadre members (Kennedy, 2008).

Positive self-esteem is an important attribute for workers wishing to cope effectively with worksite adversity in any demanding situation (Folkman, 1998). This is especially true in healthcare settings as workers with high self-esteem are likely to affect patient care in positive directions (Abraham, 1999; Browning, et al., 2006; Chen, Thomas and Casper 2004). Having high self-esteem means healthcare providers feel good about themselves. As individuals become more positive about themselves, they generally become more positive about others, resulting in a more positive "bedside manner" which is essential for caregiver success (Andersson 1993).

While it is difficult to argue the need for good self-esteem among healthcare workers, little is known about how to enhance this attribute within the military healthcare community, and more specifically, with members of Warrior Transition Units.

Mental Skills Training (MST), developed primarily for enhancing mental fitness and performance in sport settings, represents a potentially innovative educational approach for enhancing attitude-related cognitions such as self-esteem. However, to date, no studies have investigated its potential for impacting cognitions within military healthcare environments. Therefore, the focus of this study was to explore the possible utility of using this type of instructional approach to enhance self-esteem among the WTU cadre.

Warrior Transition Units

In October of 2007 the Army established 35 WTU's at major installations across the force to streamline care for wounded, injured, and seriously ill Soldiers. The WTU mission is to facilitate the healing and rehabilitation of Soldiers, return them to duty when possible, or to prepare them for a successful life as a veteran in their community. A typical WTU company will have a Commander, Executive Officer, First Sergeant, six Platoon Sergeants and 18 Squad Leaders. A key element of the WTU framework is the "Triad of Support" which consists of a Primary Care Manager, who is a physician; a Nurse Case Manager, who is a registered nurse; and a Squad Leader, usually at the rank of Staff Sergeant, who will oversee 12 patients.

The Army Medical Command currently staffs WTU's with a cadre of approximately 2500 personnel. This includes approximately 750 active-component Soldiers, 380 National Guard Soldiers, 380 Army Reserve Soldiers, and 915 Army Civilians (Sheftick & Holzer, 2007).

Self-Esteem

Rosenberg (1965) provided a broad and frequently cited description of self-esteem as a favorable or unfavorable attitude toward the self(p. 15). The mechanisms which facilitate the development of self-esteem are complex, however, Petlichkoff (2004) identified the importance o fan individuals' mental "skill-set" (e.g., self-confidence, ability to concentrate, goal-setting skill, ability to control emotions, etc.) as being an important contributor to psychosocial health, and self-esteem in particular. Similarly, Bandura (1997) and Flammer (1990) found that individuals with high self-efficacy beliefs, a construct strongly related to self-confidence (Feltz, 1988), also report strong feelings of well-being and high self-esteem in general.