1. THE PRIMARY DELIVERABLE IS A COUNTERMEASURE TO HELP CREWS MANAGE INTERPERSONAL CONFLICT. We have produced an interactive media intervention program to assist persons to manage real, ongoing conflicts on LD missions. This intervention is based on cognitive-behavioral therapy and is designed to help individuals to: A) work out strategies to manage the conflict, and B) maintain good psychosocial/mental wellbeing and good work productivity despite the conflict, via the assistance of a coach, on computer.

2. A SECOND DELIVERABLE IS PRELIMINARY DATA ON THE USABILITY, ACCEPTABILITY, AND EFFECTIVENESS OF THE COUNTERMEASURE IN FIREFIGHTERS. We conducted an open trial to obtain these data using firefighters (a population analogous to astronauts) who are in ongoing conflicts. This open trial also enabled us to develop and assess our procedures and instruments for data collection, and estimate effect size, in preparation for a future randomized controlled trial. THIS APPEARS TO BE THE FIRST STANDARDIZED INTERVENTION (SELF-GUIDED OR OTHERWISE) TO BE EVALUATED FOR THE MANAGEMENT OF WORKPLACE CONFLICTS BETWEEN PEERS IN ANY INDUSTRY. This interactive media program rounds out a suite of assessment, intervention, and training tools for long-duration flyers, all accessible via a single portal: the Virtual Space Station (see Carter et al., 2005). Other major resources in the Virtual Space Station developed through NSBRI (National Space Biomedical Research Institute) support include an intervention for depression, an intervention for chronic stress, and self-assessment of depression and conflict with tailored feedback.

Year 4 involved the design of a methodology to collect data from firefighters who would use the program across the United States. The process involved the executable program bundling and sending data to a HIPAA-compliant cloud server and the subsequent transfer of that data to a local server behind the firewall at Partners Healthcare. This year also involved the programming of a web-based assessment for completion of pre- and post-intervention. Finally, the conflict management program was evaluated with a sample of firefighters. Throughout, we have worked closely with NASA flight surgeons, plus the Houston Fire Department, the Phoenix Fire Department, and the San Diego Fire Department.

UNIQUE ASPECTS OF THIS STUDY:

1. This software appears to be the FIRST COMPUTER-AUTOMATED BEHAVIORAL INTERVENTION THAT TAILORS THE INTERVENTION COMPONENTS TO THE USER'S NEEDS. Prior computer-automated treatments have provided the same clinical components to all users, without regard to whether the user needed them or not. This makes our intervention highly tailored to the unique status of the individual and also highly efficient, since users are only presented with content that is applicable to them.

2. TAILORING THE PROGRAM TO USERS FOLLOWS A UNIQUE PROCESS. We have developed a set of algorithms that approximates an item-response procedure to decide whether users should receive domains of interventional content or not. Computer-adaptive testing is performed in the first intervention setting to create a treatment plan to help him or her manage the interpersonal conflict. Users answer questions from validated measures to determine whether or not a given content area will be presented to them. The assessments are only used to make a binary decision of whether a user should receive that interventional content. Once the user's responses reach a numerical threshold (or cannot reach it), the program ceases asking questions in that domain and moves to the next. This application of computer-adaptive testing technology reduces the amount of questions needed to be answered by users to tailor their treatment, making the intervention more time-efficient.

3. This appears to be the FIRST INTERACTIVE MEDIA PROGRAM EVER DEVELOPED TO ASSIST PERSONS TO FORMULATE AN ACTION PLAN TO MANAGE A SPECIFIC WORKPLACE CONFLICT.

4. The planned evaluation of the program will be THE FIRST TO EVALUATE ANY INTERVENTION FOR CONFLICT BETWEEN CO-WORKERS ACROSS MULTIPLE SETTINGS IN ANY INDUSTRY. Current computer-delivered behavioral interventions have generally guided users through a pre-determined set of activities designed to address a presenting problem. This study advances the field of automated, computer-based interventions by tailoring the contents of the intervention—and even the clinical topics presented—to the user's needs. The conflict intervention program delivers a core set of interventions to assist users with their interpersonal conflict: problem solving, cognitive restructuring, and negotiation skills training. In addition, a series of empirically supported self-assessments also evaluate whether a user should receive content to improve his or her assertiveness, ability to manage anger, or empathy (the ability to understand the other party's point of view and emotional state). With this approach, the users receive content tailored to their particular needs, and they don't waste time on unnecessary content. Persons involved in intense workplace conflicts may also experience problems with sleep, anxiety, depression, alcohol abuse, stress, rumination, and others. This program incorporates empirically supported measures of these problems to determine whether users would benefit from content on any or all of these seven topics. If so, the program provides optional content on the topic area.

Finally, to date, research on workgroup conflict has generally been phenomenological and descriptive. Despite the ubiquity of conflict between co-workers across all industries, and the potentially large costs of conflict in productivity, NO PRIOR STUDIES HAVE EMPIRICALLY EVALUATED A STANDARDIZED INTERVENTION FOR WORKPLACE CONFLICTS.

1. THE PRIMARY DELIVERABLE IS A COUNTERMEASURE TO HELP CREWS MANAGE INTERPERSONAL CONFLICT. We have produced an interactive media intervention program to assist persons to manage real, ongoing conflicts on LD missions. This intervention is based on cognitive-behavioral therapy and is designed to help individuals to work out strategies to manage the conflict via the assistance of a coach, on computer.

2. A SECOND DELIVERABLE IS PRELIMINARY DATA ON THE USABILITY, ACCEPTABILITY, AND EFFECTIVENESS OF THE COUNTERMEASURE IN FIREFIGHTERS. We will conduct an open trial to obtain these data using fire fighters (a population analogous to astronauts) who are in an ongoing conflict. This open trial will also enable us to develop and assess our procedures and instruments for data collection, and estimate effect size, in preparation for a future randomized controlled trial. THIS APPEARS TO BE THE FIRST STANDARDIZED INTERVENTION (SELF-GUIDED OR OTHERWISE) TO BE EVALUATED FOR THE MANAGEMENT OF WORKPLACE CONFLICTS BETWEEN PEERS IN ANY INDUSTRY. This interactive media program rounds out a suite of assessment, intervention, and training tools for long-duration flyers, all accessible via a single portal: the Virtual Space Station (see Carter et al., 2005). Other major resources in the Virtual Space Station developed through NSBRI support include an intervention for depression, an intervention for chronic stress, and self-assessment of depression and conflict with tailored feedback.

Year 3 has involved the production and completion of the interactive media program for conflict intervention, which included these major activities: 1. Scriptwriting, 2. Storyboard Development, 3. Media production, 4. Programming, 5. Debugging. The year has been tremendously busy and productive on all of the above fronts; each of which have posed their unique academic, intellectual, organizational, and administrative challenges. Additionally, we have continued to maintain contact with the Houston Fire Department, the Phoenix Fire Department, and the San Diego Fire Department. The program will be evaluated at these sites during Year 4.

UNIQUE ASPECTS OF THIS STUDY:

1. This software appears to be the FIRST COMPUTER-AUTOMATED BEHAVIORAL INTERVENTION THAT TAILORS THE INTERVENTION COMPONENTS TO THE USER'S NEEDS. Prior computer-automated treatments have provided the same clinical components to all users, without regard to whether the user needed them or not. This makes our intervention highly tailored to the unique status of the individual and also highly efficient, since users are only presented with content that is applicable to them.

2. TAILORING THE PROGRAM TO USERS FOLLOWS A UNIQUE PROCESS. We have developed a set of algorithms that approximates an item-response procedure to decide whether users should receive domains of interventional content or not. Computer-adaptive testing is performed in the first intervention setting to create a treatment plan to help him or her manage the interpersonal conflict. Users answer questions from validated measures to determine whether or not a given content area will be presented to them. The assessments are only used to make a binary decision of whether a user should receive that interventional content. Once the user's responses reach a numerical threshold (or cannot reach it), the program ceases asking questions in that domain and moves to the next. This application of computer-adaptive testing technology reduces the amount of questions needed to be answered by users to tailor their treatment, making the intervention more time-efficient.

3. This appears to be the FIRST INTERACTIVE MEDIA PROGRAM EVER DEVELOPED TO ASSIST PERSONS TO FORMULATE AN ACTION PLAN TO MANAGE A SPECIFIC WORKPLACE CONFLICT.

4. The planned evaluation of the program will be THE FIRST TO EVALUATE ANY INTERVENTION FOR CONFLICT BETWEEN CO-WORKERS ACROSS MULTIPLE SETTINGS IN ANY INDUSTRY. Current computer-delivered behavioral interventions have generally guided users through a pre-determined set of activities designed to address a presenting problem. This study advances the field of automated, computer-based interventions by tailoring the contents of the intervention—and even the clinical topics presented—to the user's needs. The conflict intervention program delivers a core set of interventions to assist users with their interpersonal conflict: problem solving, cognitive restructuring, and negotiation skills training.

In addition, a series of empirically-supported self-assessments also evaluate whether a user should receive content to improve his or her assertiveness, ability to manage anger, or empathy (the ability to understand the other party's point of view and emotional state). With this approach, the users receive content tailored to their particular needs, and they don't waste time on unnecessary content. Persons involved in intense workplace conflicts may also experience problems with sleep, anxiety, depression, alcohol abuse, stress, rumination, and others. These subsidiary problems can make managing interpersonal conflict challenging. This program incorporates empirically-supported measures of these problems to determine whether users would benefit from content on any or all of these seven topics. If so, the program provides optional content on the topic area.

Finally, to date, research on workgroup conflict has generally been phenomenological and descriptive. Despite the ubiquity of conflict between co-workers across all industries, and the potentially large costs of conflict in productivity, NO PRIOR STUDIES HAVE EMPIRICALLY EVALUATED A STANDARDIZED INTERVENTION FOR WORKPLACE CONFLICTS. We will do this in Year 4.

ORIGINAL AIMS: 1. The primary deliverable will be a countermeasure to help crews manage interpersonal conflict. We will produce an interactive media intervention program to assist persons manage real, ongoing conflicts on LD missions. This intervention will be based on cognitive-behavioral therapy and will help individuals to work out strategies with the assistance of a coach, on computer. 2. A second deliverable will be preliminary data about the countermeasure. We will conduct an open trial to obtain data about the intervention's potential effectiveness in settings that share some characteristics of the space setting (group living, small work groups). The open trial will also enable us to develop and assess our procedures and instruments for data collection, and estimate effect size, in preparation for a future randomized controlled trial.

KEY FINDINGS: Year 2 has involved 5 major activities: 1. Writing the Design Document for the intervention program, 2. Engineering the process of data collection and transfer for the program trial, 3. Securing IRB approval, 4. Writing the storyboard and shooting script for the first 2 (of 4) sessions, 5. Programming the first session.

Additionally, we have continued to build trust and rapport, and do evaluation planning with the Houston Fire Department, the Phoenix Fire Department, and the San Diego Fire Department. The program will be evaluated at these sites. The year has been tremendously busy and productive on all of the above fronts; each of which have posed their unique academic, intellectual, organizational and administrative challenges.

PROPOSED RESEARCH PLAN: In Year 3 we will complete the production of the conflict intervention program, conduct alpha testing (debugging and in-house usability testing) and begin the evaluation of the program in the analog settings of real fire departments with fire fighters who are involved in real, ongoing interpersonal conflicts. Test sites will be the Houston Fire Department, the Phoenix Fire Department and the San Diego Fire Department. In Year 4, we will complete the evaluation study in those departments, making any necessary revisions to the software as we go. Also in Year 4 we will prepare a paper for publication about the program and its use in fire departments.

Additionally, we have continued to build trust and rapport, and do evaluation planning with the Houston Fire Department, the Phoenix Fire Department, and the San Diego Fire Department. The program will be evaluated at these sites.

Through this year we have learned that:

1. It is possible to implement the conceived research plan, from a technical perspective: the intervention is delivered via USB flashdrive, data is uploaded at the end of each session to a cloud computer that is controlled by Partners Healthcare (which owns Brigham and Women's Hospital). All data will be protected to HIPAA-level standards, although no protected health information (PHI) will actually be transmitted.

2. It is possible to design the program in such a way that it tailors the intervention to the user's unique situation; providing guidance and training they need based on an extensive algorithm. Users will answer questions derived from standardized measures and this data will be fed to the algorithm to determine the user's intervention plan. It should be noted that no previous intervention for workplace conflict has ever been empirically evaluated in any workplace. Therefore, no evidence-based intervention was available for "off the shelf" adaptation. The investigators created an intervention plan that is based on the literature from couples therapy, mediation, workplace conflict epidemiology (i.e., studies of what typically happens in workplace conflict, versus interventions to manage it), and school-based conflict interventions. Our program appears to be the first intervention for workplace conflict that will be evaluated in a scientific manner.

Some amount of interpersonal conflict is expected on long-duration (LD) missions, whether between crewmembers or between the crew and the ground; however, severe conflicts can interfere with mission success and even safety. Severe, ongoing conflicts have been reported on LD space missions, Antarctic expeditions, and a recent LD space mission simulation. Nonetheless, empirically-supported tools to help crews prevent, assess, and manage interpersonal conflicts have not been developed.

This study will design and produce an interactive media intervention program to assist persons manage real, ongoing conflicts on long-duration missions. A preliminary evaluation of the conflict intervention will be conducted in a variety of settings where individuals live, train, and work together: fire departments and university residence halls. It will also be evaluated in two NSBRI-supported mission simulations, when conflicts arise. The goal of this preliminary evaluation is to gather data on response rate, sample characteristics, and effect size, in preparation for a randomized controlled trial.

1. The primary deliverable will be a countermeasure to help crews manage interpersonal conflict. We will produce an interactive media intervention program to assist persons manage real, ongoing conflicts on LD missions. This intervention will be based on cognitive-behavioral therapy and will help individuals to work out strategies with the assistance of a coach, on computer.

2. A second deliverable will be preliminary data about the countermeasure. We will conduct an open trial to obtain data about the intervention's potential effectiveness in settings that share some characteristics of the space setting (group living, small work groups). The open trial will also enable us to develop and assess our procedures and instruments for data collection, and estimate effect size, in preparation for a future randomized controlled trial.

Key findings:

The principal activity of the first year of this study was to solidify the content of the intervention program, develop its design, and begin interactive media production (with the major production years being grant years 2 and 3).

Grant administration problems beyond the Principal Investigator's control required significant attention during this first year. Currently, these problems have still not been solved, and efforts are underway to find a suitable institutional home for the grant work. The project has been on hold since July 1, 2010, after completing 10 months of Year 1.

Despite these problems, good progress was made in defining the clinical content of the intervention and the general design of the program.

In an earlier study, we had interviewed long duration flyers about interpersonal conflicts in space. Since this countermeasure will be evaluated with firefighters, it was also necessary to interview representatives from fire departments. Interviews were conducted with the San Diego, Houston, and Phoenix fire departments. A structured questionnaire was presented to our contacts at the Fire Departments to assess our approach to conflict and to help us to determine the kinds of conflicts and scenarios that would be most likely to occur in these settings. The content is soundly based in cognitive-behavioral therapy; however, no empirically supported intervention for workplace conflict exists. Therefore, the clinical specifics of the intervention needed to be specified.

The research team established agreements with major fire departments: the San Diego Fire Department, the Phoenix Fire Department, and the Houston Fire Department. The intervention is planned to be evaluated in the operational analog of the fire department. These fire departments have agreed to be test sites, review content, and provide consultation as needed. They are a critical component to the research plan, and excellent to bring on board at this early stage.

Proposed Research Plan:

The first critical step is to identify a suitable organization to accept this grant. Then, to complete the remaining 2 months of work in Year 1, initiate interactive media production, and continue to build out the countermeasure in Year 2.

Grant administration problems beyond the Principal Investigator's control required significant attention during this first year. Currently, these problems have still not been solved, and efforts are underway to find a new institutional home for the grant work. The project has been on hold since July 1, 2010, after completing 10 months of Year 1.

Despite these problems, good progress was made in defining the clinical content of the intervention and the general design of the program. Interviews were conducted with the San Diego, Houston and Phoenix fire departments about interpersonal conflicts. A structured questionnaire was presented to our contacts at the Fire Departments to assess our approach to conflict and to help us to determine the kinds of conflicts and scenarios that would be most likely to occur in these settings. The content is soundly based in cognitive-behavioral therapy; however, no empirically supported intervention for workplace conflict exists. Therefore, the clinical specifics of the intervention needed to be specified.

Additionally, the research team established agreements with major fire departments: The San Diego Fire Department, the Phoenix Fire Department, and the Houston Fire Department. The intervention is planned to be evaluated in the operational analog of the fire department. These fire departments have agreed to be test sites, review content, and provide consultation as needed. They are a critical component to the research plan, and excellent to bring on board at this early stage.

The investigators have begun development of an interactive multimedia portal to help long-duration flyers prevent, detect, assess and manage their own psychosocial problems. This work has been supported by two NSBRI grants. In the first grant, program architecture was developed to organize the types of content and experiences users can find in the portal. Sample content about depression and interpersonal conflict was also developed as a prototype to demonstrate how training could be delivered through the system. The second NSBRI grant was to complete and evaluate the depression content, including self-treatment of depression.

The present project will design and produce an interactive media intervention program to assist persons manage real, ongoing conflicts on long-duration missions. A preliminary evaluation of the conflict intervention will be conducted in a variety of settings where individuals live, train and work together: fire departments and university residence halls. It will also be evaluated in two NSBRI-supported mission simulations when conflicts arise. The goal of this preliminary evaluation is to gather data on response rate, sample characteristics and effect size, in preparation for a randomized, controlled trial.