Spiritual and Ethical Fitness Defining Total Fitness for the 21 st Century Conference Uniformed Services University of the Health Sciences December 2009

2 Growing evidence base in spirituality in health Number of MEDLINE-indexed articles by year, with TITLES using the terms Religio* or Spirit*

3 The role of chaplains Spirituality and health research lacks studies of the role of chaplains Spiritual fitness practice MUST work with and through the line and chaplains

4 Definition of spiritual and ethical fitness A state in which one feels connected beyond oneself both horizontally and vertically, and which motivates one in life and enhances strength and resilience in all total fitness domains Individual and unit characteristics include: –Meaning –Purpose –Values –Self-worth –Dignity –Hope Promotes healthy relationships, responsible living and the ability to respond effectively to stress and hardship (AFPD- 52-1, 2006)

5 Theoretical Model Environmen- tal resources Policy Leadership Units Families & Community Education & Training Programs & Services Personal resources Self- awareness and adaptability Beliefs and perceptions about importance of life and experiences Accepting and valuing diversity Practicing virtuous behaviors Key Mediators Spiritually- ethically-driven engagement Self- Transcendence Religious and spiritual practices Targeted Outcomes Individual & Unit Fitness Citizenship behaviors (service, peer- to-peer support) Moral disengagement Resilience Post-traumatic growth Inner conflict and moral injury Operational demands Small force High operational tempo Repeated deployments Harsh conditions High physical and cognitive demands Protracted conflicts Based in part on Conservation of resources theory. Ref: Hobfoll et al. Fact or Artifact: The Relationship of Hope to a Caravan of Resources

6 Execution: Modifying external resources can enhance mission-related outcomes via mediators Environmental resources PolicyUnitsLeadership Families & Community Education & Training Programs & Services Personal resources Self- awareness and adaptability Accepting and valuing diversity Practicing virtuous behaviors Beliefs and perceptions about importance of life and experiences Key Mediators Spiritually- ethically- driven engagement Self- Transcendence Religious and spiritual practices Outcomes Individual & Unit Fitness Citizenship behaviors Moral disengage- ment Resilience Post- traumatic growth Inner conflict and moral injury Beliefs/ perceptions Sense of purpose Sense of belonging Trust within unit Confidence in leaders Faith Leadership Warrior culture and ethos Spirituality and religion Ethics training Leadership behaviors Individual and unit fitness Organizational citizenship behaviors Unit cohesion Self- transcendence Self-transcendence: Ability to move outside oneself and place an allegiance with God or higher calling including to ones Service branch Note: For efficiency, we are highlighting this path of action for just one of several mediators

7 Definitions of other mediators Spiritually and ethically-driven engagement: Positive and fulfilling state of mind that is characterized by vigor, dedication to spiritual or ethical principles, and absorption Definition adapted from Schaufeli et al., 2002 Religious and spiritual practices: Practices, which can be outward or inward, that allow one to connect to something beyond oneself Examples include symbolic and contemplative practices Reference: Bandura, 2009

8 Table of outcomes, variables, and metrics Outcome Variable(s)Possible Metrics Individual and unit fitness- Unit cohesion citizenship behaviors Appreciating diversity/differences Via MHAT or metric TBD (e.g., McClure et al, Military Family Institute) Prevalence of unit disciplinary problems Qualitative methods- e.g., Inspections, focus groups, surveys HEXACO Personality Inventory– agreeableness subscale Interpersonal Support Evaluation List Productivity and performance Health and Work Performance Questionnaire Effective coping Coping Style Questionnaire, General Self-Efficacy (GSE) scale Retention Trends in early separation and re-enlistment rates General Health Status Veterans SF-36, Post-Deployment Readjustment Inventory (PDRI) Perceived Stress Perceived Stress Scale (PSS) Resilience Connor-Davidson Resilience Scale, Deployment Risk and Resilience Inventory Ineffective coping, manifest as Substance abuse anxiety / depression depression PDHA, PDHRA Alcohol Disorders and Use Identification Test Patient Health Questionnaire PHQ-9, Compassion fatigue Professional Quality of Life -- Compassion Satisfaction and Fatigue Subscales Dimensions of Self-Concept Form W (DOSC-W)-- Job Stress sub-scale Post Traumatic Stress PTSD Checklist – Military Version (PCL-M) Burnout Shirom- Melamed Burnout measure Moral Injury and Trauma EEQ subscales of experiences of ego loss, psychopathological experiences Sense of Coherence Questionnaire;

9 Bottom line for the Line Provide ethical understanding and guidance in all levels of operational functioning including training (Spiritually and ethically- driven engagement) Model and encourage citizenship behaviors, volunteerism, and community service (Self-Transcendence) Accommodate individual and unit worship and spiritual opportunities (Religious and spiritual practices)

10 Questions? Note: non-animated version of slide 3 follows

11 Execution: Modifying external resources can enhance mission-related outcomes via mediators Environmental resources PolicyUnitsLeadership Families & Community Education & Training Programs & Services Personal resources Self- awareness and adaptability Accepting and valuing diversity Practicing virtuous behaviors Beliefs and perceptions about importance of life and experiences Key Mediators Spiritually- ethically- driven engagement Self- Transcendence Religious and spiritual practices Outcomes Individual & Unit Fitness Citizenship behaviors Moral disengage- ment Resilience and recovery Inner conflict and moral injury Beliefs/ perceptions Sense of purpose Sense of belonging Trust within unit Confidence in leaders Faith Leadership Warrior culture and ethos Spirituality and religion Ethics training Leadership behaviors Individual and unit fitness Organizational citizenship behaviors Unit cohesion Self- transcendence Note: For efficiency, we are highlighting this path of action for just one of several mediators Self- transcendence: Ability to move outside oneself and place an allegiance with God or higher calling including to ones Service branch