Improving Performance of Combat Soldiers by Utilizing Attentional Training Based on Eye Tracking

Improving Performance of Combat Soldiers by Utilizing Attentional Training Based on Eye Tracking - Improvement of Combat Performance

Military service in combat units entails exposure to traumatic events that require mental adjustment. To develop and efficiently apply attentional interventions aimed at enhancing soldiers' combat performance, it is essential to extensively investigate the efficiency of these training programs, which has yet to been done. The prupose of the current study is to examine the efficiency of the new attention eye-tracking based training, in comparison to RT-based training and to a control group, in improving performance of combat soldiers. In addition, the influence of the attention training on aspects of psychological resilience will also be examined in questionnaires.

Study Overview

• Status: Terminated
• Conditions: Military Combat Performance
• Intervention / Treatment: Behavioral: Gaze-Contingent Feedback Training; Behavioral: Attention Bias Modification; Behavioral: Non-Contingent Feedback Training

Detailed Description

Following the explanation to participants regarding the study process, those who give written consent to participate will be randomly placed into one of three groups: GCFT (N=60), ABMT (N=60), and a neutral control group - task based on eye-tracking (N=60). The study will include 2 measurement points during the military service: before the attention training and after the attention training. In each measurement point, the soldiers will complete computerized tasks to measure threat attention, questionnaires, and performance data from shooting ranges and combat fitness.

• Study Type: Interventional
• Enrollment (Actual): 79
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Israel
  • Tel Aviv, Israel, 6997801
    • Tel Aviv University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Each soldier from the cohort that will give his written consent will be able to participate in the study.

Exclusion Criteria:

• Hebrew proficiency is insufficient to complete the study questionnaires.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Gaze-Contingent Feedback Training (toward threat); In the task, 30 different matrices, each consisting of 16 faces, will be presented. Each matrix includes 8 angry faces and 8 neutral, 8 women and 8 men, and the locations are counterbalanced between matrices. The participants are asked to view the matrices in any way they choose, and the eye-tracking camera records their viewing location relative to the stimuli presented on the screen. At the beginning of each training session, the soldier will choose to which music he would like to listen during the 12-minute session from a diverse list of music. After calibrating the eye-tracker, the participant will be instructed to view matrices of faces as he chooses, as described above in the assessment task. The music chosen by the participant will play only when he is looking at threatening faces and it will stop when he looks at neutral faces. Thus, a change in viewing patterns is expected by implementing operant conditioning principles.	Behavioral: Gaze-Contingent Feedback Training; Feedback according to participants' viewing patterns, in order to modify their attention toward threat stimuli.
Active Comparator: Active Comparator: RT-Based Attention Bias Modification (toward threat); A dot-probe task of 160 trials. Trials begins with a fixation cross (+), on which the participant is asked to focus (500ms). Then two face stimuli (one angry one neutral) are presented above and below the fixation cross (500ms). After the stimuli disappear, a target probe (right- or left-pointing arrowhead) appears in place of one of the face stimuli. The participant is asked to indicate which target probe was presented using a predetermined key. The target probe will remain on the screen until response, after which a new trial will begin. Participants are instructed to identify the probe type as quickly and accurately as possible. In the training task, all of the target probes will appear in the threat location (angry face). Thus, over multiple trials, learning is expected to occurs such that the threatening face predicts the location of the target probe, thereby achieving the desired change in attention pattern.	Behavioral: Attention Bias Modification; Attention training via repeated trials of a dot-probe task intended to direct attention toward threat stimuli using threat and neutral face stimuli.
Placebo Comparator: Non-Contingent Feedback Training; This condition is also based on the eye-tracking task (see Experimental Arm) with a fundamental change - The music chosen by the soldier will play continuously without any reinforcement for looking at threat or neutral faces.	Behavioral: Non-Contingent Feedback Training; Participants listen to a musical track they chose with no operant conditioning.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Combat Performance	Composite scores for Static marksmanship, simulator shooting performance (Bagira), running test grades, and obstacle course grades will be gathered from soldiers' commanders before and after intervention sessions to test for change.	Approximately 3 months after baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-Combat Trauma	Score on on self-report questionnaire Posttraumatic stress disorder checklist for DSM-5 (PCL-5). The total score, ranging from 0 to 80, reflects PTSD symptom severity, with higher scores representing greater severity.	Change from baseline Post-Combat PTSD Symptoms at approximately 3 months
Post-Combat General Anxiety	Score on self-report questionnaire Generalized Anxiety Disorder questionnaire (GAD-7). The total score, ranging from 0 to 21, reflects GAD symptom severity, with higher scores representing greater severity.	Change from baseline Post-Combat General Anxiety Symptoms at approximately 3 months
Post-Combat Depression	Score on self-report Patient Health Questionnaire 9 (PHQ-9). The total score, ranging from 0-27, reflects severity of depressive symptoms, with higher scores representing greater severity.	Change from baseline Post-Combat Depression Symptoms at approximately 3 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-Training RT-based Attention Bias toward threat	Change in Attention Bias will be assessed with a response-time based dot-probe task.	Change from baseline Attention Bias within 3 months of baseline measurement
Post-Training Subjective Attention Bias toward threat	Change in Subjective Attention Bias will be assessed with a self-reported attention bias using the Attention Bias Questionnaire (ABQ). The total score, ranging from 0 to 36, represents threat-related attention bias, with higher scores representing greater bias toward threat.	Change from baseline Attention Bias within 3 months of baseline measurement
Post-Training Eye-tracking Attention Bias toward threat	Change in Attention Bias will also be assessed with an eye-tracking task.	Change from baseline Attention Bias within 3 months of baseline measurement

Collaborators and Investigators

• Sponsor: Tel Aviv University
• Investigators: Principal Investigator: Yair Bar-Haim, PhD, Tel Aviv University

Publications and helpful links

General Publications

• Wald I, Fruchter E, Ginat K, Stolin E, Dagan D, Bliese PD, Quartana PJ, Sipos ML, Pine DS, Bar-Haim Y. Selective prevention of combat-related post-traumatic stress disorder using attention bias modification training: a randomized controlled trial. Psychol Med. 2016 Sep;46(12):2627-36. doi: 10.1017/S0033291716000945. Epub 2016 Jul 5.

Study record dates

Study Major Dates

• Study Start (Actual): March 14, 2022
• Primary Completion (Actual): February 27, 2024
• Study Completion (Actual): June 21, 2024

Study Registration Dates

• First Submitted: March 22, 2022
• First Submitted That Met QC Criteria: March 31, 2022
• First Posted (Actual): April 1, 2022

Study Record Updates

• Last Update Posted (Actual): July 9, 2024
• Last Update Submitted That Met QC Criteria: July 8, 2024
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Keywords: Randomized Control Trial; Attention Bias Modification; Eye-tracking
• Other Study ID Numbers: TAU-GCFTperformance

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No