GREAT LAKES, IL — When Navy recruits have injuries preventing them from participating in intense physical conditioning, they usually are pulled out of boot camp training and receive treatment that includes daily physical therapy, pain medications and psychoeducational groups.

For these recruits, graduation from boot camp requires not only recovery from their injuries but also passing a Physical Fitness Assessment consisting of a timed 1.5-mile run, curl-ups and push-ups. That doesn’t work out, however, for about 50-60% of those recruits, who will eventually be separated out and sent home.

A new study published in Military Medicine examined the effectiveness of an Acceptance and Commitment Therapy (ACT)-based program. Mindfulness for Pain and Performance Enhancement (MPPE) was created to help recruits effectively handle pain, as well as assist them in improving their physical performance so they can recover, complete boot camp and fully enter Navy service.1

With treatment voluntary, 373 recruits enrolled in one of the 32 cycles of MPPE which were administered, with an attrition rate of 35.1%. The MPPE participants were compared to a control group of 310 recruits not in the program.

Recruits continued to receive standard treatment services, including physical therapy, medical interventions and psychoeducational groups while participating in MPPE, which is a six-session, two week Acceptance and Commitment Therapy-based approach to pain and physical performance that was added to existing treatment services.

Results indicated that, while effect size changes were small for anxiety and experiential avoidance, they were moderate for pain acceptance, mindfulness, cognitive inflexibility and depression and large for pain reduction.
Researchers pointed out that MPPE completers graduated at a higher rate (58.3%) than those who backed out of the program (34.4%) or controls (45.5%). Variables predictive of graduation included MPPE completion, age, and reported pain rating, the study noted.

“Results supported the use of this program for helping recruits recover from injuries and successfully pass physical training requirements for graduation,” study authors concluded. “Recruits were not randomly assigned to treatment, thus limiting the interpretation of outcomes. Incorporating this treatment earlier in boot camp training and making it available to more recruits (i.e., not only injured recruits) may further reduce attrition and contribute to greater resiliency of sailors within the U.S. Navy fleet.”

1Udell CJ, Ruddy JL, Procento PM. Effectiveness of Acceptance and Commitment Therapy in Increasing Resilience and Reducing Attrition of Injured US Navy Recruits. Mil Med. 2018 Mar 6. doi: 10.1093/milmed/usx109. [Epub ahead of print] PubMed PMID: 29518230.