MARCH 19, 2024 – Researchers from the U.S. Army Medical Research and Development Command’s Walter Reed Army Institute of Research and Institute of Environmental Medicine recently traveled to Austin, Texas, to showcase the Army’s commitment to innovation, technology and transformation at the 2024 South by Southwest Conference & Festival, the annual music, film and interactive extravaganza that ran from March 8-16.
Three WRAIR researchers participated in a panel session titled “Resilience Remix: Innovations in High Stakes Performance.” The panel showcased WRAIR’s extensive research into the beneficial effects of mindfulness, techniques for dealing with acute stress and methods for helping people improve the amount and quality of sleep they get.
“The Army is always trying to innovate in this area because we really are a people-first organization,” says Dr. Tina Burke, associate director of WRAIR’s Behavioral Biology Branch. “The Army believes it’s very important to take care of its people, especially when their jobs are very demanding. We see sleep as being a foundational building block of overall health because it helps ensure people are able to perform at their best.”
Burke, whose research focuses on developing novel solutions for improving sleep, alertness and performance, says better sleep can lead to a wide range of health benefits.
“If you help someone improve their sleep, you can actually improve how they’re eating, how well they recover after working out and how well they perform both in their mission and in their day-to-day lives,” says Burke. “We think of sleep as a force multiplier in terms of helping ensure resiliency.”
A lack of sleep can negatively affect the body’s production of hormones that a body needs to maintain a healthy metabolism. For example, it is well known that testosterone plays a key role in muscle and bone strength; a recent WRAIR study found that just one night without sleep can lower testosterone secretion levels in men by as much as 90% compared to historical levels.
“When we talk with Warfighters about the importance of sleep, a lot of times they’ll say, ‘Oh, I’ll sleep when I die,’” says Burke. “My response to that is, ‘Well, if you don’t take care of that aspect of your health, you might actually die sooner!’”
One method that WRAIR is exploring to help Service Members improve their sleep is by using tiny electrical pulses that mimic the restorative brainwaves that occur during restful sleep.
“The theory is that we can introduce the pulses at certain parts during either a sleep cycle or during wakefulness to get essentially the same recovery that you would get during a good eight-hour sleep,” says Maj. David Manley, a physician assistant and medical investigator in WRAIR’s Sleep Research Center. “This can be critical for Warfighters operating in austere environments who are not able to get the rest and recuperation they need.”
Manley, an investigator on the studies into this approach being conducted at WRAIR, said that the potential applications extend beyond the military; on-call doctors and nurses, law enforcement and other first responders and even sleep-deprived parents of newborns could all benefit from getting more restorative sleep every day. As an Army Master Parachutist and Jumpmaster, Manley understands from first-hand experience the importance of being rested for managing stress.
“When a Warfighter is staring out the door of an aircraft going 130 knots a thousand feet above the ground, you don’t want them to shut down,” says Manley. “One poor decision or one moment of inattention could present a danger to the rest of the team as well as to themselves. Having an adjunct to improve natural sleep could potentially help people be more focused, pay more attention to what’s going on around them and perform successfully in high-stress situations.”
Mitigating the effects of extreme stress is the objective of a methodology being developed by a team led by Dr. Amy Adler, a clinical research psychologist at WRAIR called iCOVER. When a person becomes overwhelmed by stress, they may experience what medical professionals call an acute stress reaction – they “freeze” or become detached from what’s happening around them, experience extreme emotions or behave erratically. iCOVER is an easy to learn protocol in which each letter in the name reflects one of the protocol’s six steps:
- i = Identify the team member who is having an acute stress reaction
- C = Connect through eye contact, touch or hearing to bring them to the present moment
- O = Offer commitment to reduce sense of isolation
- V = Verify facts with simple questions to get the thinking brain back in gear
- E = Establish order of events to reorient the individual
- R = Request action to re-engage in purposeful action
“When people have really extreme responses to stress, it’s because a part of their brain called the amygdala, which is responsible for the fear response, goes into overdrive and overpowers everything,” explains Dr. Emily Lowery-Gionta, section chief of WRAIR’s Performance Assessment and Chemical Evaluation Laboratory. “The idea behind iCOVER is to take simple steps to help someone experiencing an extreme acute stress reaction reduce their amygdala activation and bring the prefrontal cortex, which is the part of the brain that’s responsible for decision-making and planning, back online so they can calm down and go about their job in the face of the stressful event.”
The WRAIR team will be exploring civilian applications of iCOVER in a DOD-funded collaborative study with researchers at the University of North Carolina at Chapel Hill and Cooper Medical School of Rowan University in Camden, New Jersey. The study will test iCOVER’s effectiveness at relieving the distress of people in hospital emergency departments who are experiencing acute stress reactions and improving the cognitive performance. Lowery-Gionta says that because iCOVER is designed to be easily taught and rapidly used, it is an ideal intervention for use in military and civilian settings.
Dr. Jess Gwin, a research physiologist with USARIEM’s Military Nutrition Division, participated in a panel session titled “Optimizing Human Performance Through Nutrition,” which focused on the critical role of nutrition in maintaining health and wellness and improving human performance. She says that while Service Members share many of the same day-to-day experiences as the general population – busy work schedules, immersive family and social lives, hobbies and pastimes – they are also called upon to operate in austere environments and unpredictable, high-stress conditions. These conditions may affect their nutritional requirements in ways that even those who engage in strenuous activities, like endurance athletes or construction workers, are unlikely to experience.
“Service Members often carry equipment and supplies across long distances through challenging terrain and in extreme environments, which is a lot of physical activity that results in extreme energy expenditures,” explains Gwin. “It’s very difficult for them to consume enough food in order to match the energy or that they’re burning. Much of our work is dedicated to understanding the best formulations, such as protein and carbohydrate enhanced foods or beverages, to fuel Soldiers before, during and after their missions. On top of that, these high-stress, high-stakes activities place additional psychological and cognitive demands on the Warfighter, so we also consider how nutrient intake supports cognitive function. Finally, these unique stressors may also challenge a Soldier’s immune and microbiome systems, which creates a need for Soldier specific fueling that best promotes health through these intricate systems.”
Gwin says that one example of the translatable nutrition research conducted at USARIEM that establishes the unique nutrition requirements of Service Members during initial military training has led to the development of what her team calls the Performance Readiness Bar. This nutrition bar is fortified with calcium and vitamin D to optimize bone health. The bars are now being provided to new Army recruits throughout their basic combat training phase upon joining the service.
“Nutrition research is a priority within USARIEM, and we have a very specialized group of scientists who are dedicated to understanding and solving unique problems through biomedical research,” says Gwin. “It’s also important for people to understand that our research is focused on helping improve the health, well-being and performance of Warfighters, and that these efforts are also translated to the general public when possible.”
WRAIR’s Burke echoes the sentiments of her colleagues participating in SXSW when she says that one thing she would like people to take away from the two sessions is how committed MRDC’s scientists, engineers, program managers, acquisition experts and support personnel are to solving the most challenging health-related problems facing society.
“I am surrounded by so many people as part of MRDC who are so hardworking and who care so much about the Warfighter,” says Burke. “It is my privilege to work with them every day and to share the podium with them in Austin.”
To hear an audio recording of the “Resilience Remix: Innovations in High Stakes Performance” panel session, visit https://schedule.sxsw.com/2024/events/PP146041. To hear an audio recording of the “Optimizing Human Performance Through Nutrition” panel session, visit https://schedule.sxsw.com/2024/events/PP146040.
Story by Paul Lagasse
Medical Research and Development Command