The problem is that it’s difficult for someone untrained in a given area to evaluate claims within that area, even if they are otherwise quite competent. This idea is sometimes referred to as “unskilled intuition” — I might have a strong
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The problem is that it’s difficult for someone untrained in a given area to evaluate claims within that area, even if they are otherwise quite competent. This idea is sometimes referred to as “unskilled intuition” — I might have a strong feeling that the guy fixing my car is trying to rip me off, but since I can barely understand the terms he is using to describe my steering-wheel issue, I’m really just feeling around in the dark. I’m a professional writer, not a mechanic.
Few areas of behavioral science better exemplify the danger of unskilled intuition than the increasingly popular endeavor of positive psychology, one of the newest established subfields of psychology and one that has successfully sold questionable theories to many institutions, most notably the U.S. Army, for very large sums.
Positive psychology was founded by Martin Seligman, a legendary researcher at the University of Pennsylvania (Mihaly Csikszentmihalyi also played a key role and co-wrote a pathbreaking 2000 article with Seligman). Marty, as he is known to everyone in his orbit, is an iconic, divisive figure in the world of academic psychology. If you looked only at the early part of his career, you’d be surprised that he ended up being one of the godfathers of a field dedicated to positivity. That early work was, well, dark. Through experiments that involved shocking dogs in different ways, Seligman developed the extremely important psychological concept of learned helplessness. It refers to a situation in which an organism’s lack of control over its surroundings prompts it to stop engaging in standard acts of self-preservation.
But later in his career, Seligman shifted focus dramatically. He came to realize, as he would explain in many speeches and interviews, that psychology was too focused on pathology, on fixing broken people, and less on cultivating strengths and helping people who were otherwise basically healthy to maximize their potential. Seligman wanted to transform American psychology, and the best way to do that would be as president of its flagship organization, the American Psychological Association. Seligman was elected in 1996 — “by the largest vote in modern history,” his faculty page notes — and when he took office in 1998, he made positive psychology the theme of his presidency.
This new, highly marketable subfield arrived at an important juncture for the broader discipline of psychology. As Barbara Ehrenreich explained in her 2009 critique of the positive-thinking movement, Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America:
Positive psychology provided a solution to the mundane problems of the psychology profession. Effective antidepressants had become available at the end of the 1980s, and these could be prescribed by a primary care physician after a ten-minute diagnostic interview, so what was left for a psychologist to do? In the 1990s, managed care providers and insurance companies turned against traditional psychotherapy, effectively defunding those practitioners who offered lengthy courses of talk therapy. The Michigan Psychological Association declared psychology “a profession at risk” and a California psychologist told the San Francisco Chronicle that “because of managed care, many clinical psychologists aren’t being allowed to treat clients as they believe they should. They still want to work in the field of helping people, so they’re moving out of therapy into coaching.” If there was no support for treating the sick, there were endless possibilities in coaching ordinary well people in the direction of greater happiness, optimism, and personal success.
In this view, positive psychology enabled professional psychology to greatly expand its market, allowing psychologists to advertise themselves as coaches to companies, schools, and other organizations.
At root, positive psychology claims that there are reliable ways to make people happier and more optimistic and that these changes bring with them benefits like increased mental health and longevity. But the underlying science is controversial. As Daniel Horowitz writes in his excellent 2018 cultural and scientific history of the field, Happier? The History of a Cultural Movement That Aspired to Transform America, “Virtually every finding of positive psychology under consideration remains contested, by both insiders and outsiders ... Major conclusions have been challenged, modified, or even abandoned.”
In a highly cited 2005 article, for example, the positive psychologist Sonja Lyubomirsky and her colleagues argued that 50 percent of the variance in human happiness is accounted for by genetics, 10 percent by circumstance, and 40 percent by factors within individuals’ control, the result of choices they make. This encouraging “happiness pie” concept went viral, leading to book contracts, speaking engagements, and other professional rewards for Lyubomirsky. Seligman transformed it into a “happiness formula” in his own work: H = S + C + V. That is, happiness, H, equals S (genetic set point) plus C (circumstances) plus V (things under the individual’s voluntary control). In part on the basis of Lyubomirsky’s finding, he argued that there was a great deal of potential for the average person to become significantly happier.
Remarkably, it appears to have taken almost a decade and a half for anyone to critically evaluate Lyubomirsky’s sunny claim in a peer-reviewed journal. But when Nicholas J.L. Brown and Julia M. Rohrer did, for an April 2020 article published in the Journal of Happiness Studies, they found many statistical problems. Among others, “there is only very limited evidence to place the figure for the heritability of well-being as low as (precisely) 50%. Consequently, there is little reason to believe that 40% is a reliable estimate of the variance in chronic happiness attributable to intentional activity — for example, if Lyubomirsky et al. had chosen a different (but, in our view, at least equally plausible) set of estimates, they might just as easily have concluded that as little as [5 percent] of variance in chronic happiness can be attributed to volitional activities.” Suffice it to say that there is a massive difference between 5 percent and 40 percent of an individual’s level of happiness being within their control — a difference with obvious ramifications for the usefulness of positive psychology’s books and interventions.
It’s little surprise, in light of all this, that both external and internal critics have argued that positive psychology has made unwarranted claims. “The first data on rigorously tested positive psychology have only recently begun to show up in journals,” wrote the positive psychologists Todd B. Kashdan and Michael F. Steger in 2011, “yet people have been offering to ‘apply’ positive psychology for several years already. What kind of message does this convey about the scientific endeavor of positive psychology? Is it any wonder that positive psychology is often dismissed as ‘happiology’ or the equivalent of accepting a Dixie cup of Kool-Aid from Jim Jones?” As Horowitz writes in Happier?, a primary concern of some positive psychologists “involved the dangers of popularization,” of polishing rough claims to make them look smoother for marketing purposes.
But these serious questions surrounding the field’s rigor haven’t stopped positive psychology from quite successfully selling its wares to the public. One key player in that economy is Seligman’s Positive Psychology Center at the University of Pennsylvania. Founded in 2003, the center has been good, from both a public-relations and a financial standpoint, for the university that hosts it. In his center’s annual reports, Seligman regularly notes that “the PPC is financially self-sustaining and contributes substantial overhead to Penn.”
The PPC’s s most important client is probably the U.S. Army. That’s thanks to the fact that in 2008 the Army turned to Seligman to help it solve a crisis involving PTSD and suicide among soldiers, rewarding him and his academic home base with what would become many millions of dollars’ worth of military contracts. To a keen observer of the Positive Psychology Center’s offerings and promotional style, it might have come across as a questionable bet. On multiple occasions, Seligman and his center have made impressive claims about interventions that outpace the available evidence.
One example is the so-called Strath Haven Positive Psychology Curriculum, which is named for the suburban Philadelphia high school where it was piloted. Its “major goals . . . are 1) to help students identify their signature character strengths and 2) to increase students’ use of these strengths in day-to-day life,” write Seligman and some of his colleagues in an article in the Oxford Review of Education. The researchers explain that 347 ninth graders were assigned to either a class that included the curriculum or a control group in which the school day was business as usual. “Students, their parents and teachers completed standard questionnaires before the programme, after the programme, and through two years of follow-up,” write the authors. “Questionnaires measured students’ strengths (e.g., love of learning, kindness), social skills, behavioural problems and enjoyment of school. In addition, we examined students’ grades.”
Strikingly, even though these researchers were given almost $3 million to run a randomized controlled evaluation of their intervention, they never published one in comprehensive form. The Oxford Review article’s brief discussion of the program provides some provisional results, but few of the statistical details one would expect in a full-blown published evaluation. The authors make a somewhat vague claim about improved grades being seen in one subgroup (and presumably not others), but provide no statistics to back it up. It’s clear, though, that the general results were disappointing: “The positive psychology programme did not improve other outcomes we measured, such as students’ reports of their depression and anxiety symptoms, character strengths, and participation in extracurricular activities.”
And yet if a school administrator curious about Seligman’s track record visited the “Resilience Training for Educators” section of his Penn website, they’d find a rosier assessment: There, Seligman claims that the Strath Haven program “builds character strengths, relationships, and meaning, as well as raises positive emotion and reduces negative emotion.”
Seligman’s tendency to overclaim can also be seen in the case of the Penn Resilience Program, or PRP. PRP is one of the Positive Psychology Center’s biggest “hits”; it has been purchased by schools all over the world and adapted to various noneducational settings as well.
PRP, which was first created by Jane Gillham in the 1990s, is geared to 10- to 14-year-olds, and its goal is to improve these students’ mental-health outcomes, particularly by making them more resistant to depression. The trainings are usually conducted not by licensed mental-health professionals but by others (usually teachers) who can, in theory, be quickly trained up to the task: As Gillham and her colleagues write, the program’s leaders “typically participate in a 4- or 5-day training workshop, where they first apply PRP skills in their own lives and then learn to deliver the curriculum to groups of late-elementary and middle school students.”
The program is delivered to groups of six to 15 students over the course of about 20 hours, total, though the number and length of individual sessions can vary. The primary purpose is to help the children and early adolescents better understand basic cognitive behavioral principles, including the potential harms of negative self-talk (I failed this test; I really am just worthless) and catastrophizing (My mom was supposed to be home by now; she must have gotten into a horrible accident). The goal is to instill, in healthy young people, cognitive habits and skills that will prevent depression and anxiety in the long run (though there are also variants geared at groups of kids already exhibiting mental-health warning signs).
The Positive Psychology Center clearly views the Penn Resilience Program as one of its premier offerings. In a talk he gave at the 2009 annual conference of the American Psychological Association, Seligman presented the results of a review of 19 PRP studies conducted over 20 years. The accompanying APA press release noted that “based on the students’ assessments of their own feelings, the researchers found that PRP increased optimism and reduced depressive symptoms for up to a year. The program also reduced hopelessness and clinical levels of depression and anxiety. Additionally, the PRP worked equally well for children from different racial/ethnic backgrounds.”
Unfortunately, Seligman doesn’t appear to have ever published this review of the literature anywhere (I did ask him about this directly in an email, and in response he pointed me to other research instead), so it’s unclear how impressive the effects he found were, what criteria he used to include or exclude given studies, and so forth. But another, more formally conducted review of the literature — a meta-analysis co-written by Gillham herself — came to a different conclusion.
That meta-analysis, led by Steven Brunwasser and published in 2009, examined 17 controlled evaluations of the PRP — that is, studies that compared the outcomes of a PRP group and a control group. It found that while the PRP did appear to reduce depressive symptoms among students exposed to it, those reductions were small, statistically speaking. “Future PRP research should examine whether PRP’s effects on depressive symptoms lead to clinically meaningful benefits for its participants, whether the program is cost-effective, ... and whether PRP is effective when delivered under real-world conditions,” the authors concluded.
This is not an impressive evaluation, referring as it did to a program already being sold to schools on the basis of its supposedly impressive evidence base. And in 2016, the Journal of Adolescence delivered an even harsher verdict about PRP in another meta-analysis. “No evidence of PRP in reducing depression or anxiety and improving explanatory style was found,” the authors wrote. “The large scale roll-out of PRP cannot be recommended.”
Seligman, for his part, pointed me to a 2015 meta-analysis conducted by researchers in Australia and New Zealand that appears to show that PRP has some effectiveness. But a close look reveals that that meta-analysis doesn’t tell an appreciably different story from the one told by Brunwasser and Gillham’s evaluation, especially when it comes to the specific “flavor” of PRP that makes the program so attractive on the grounds of potential cost-effectiveness — one in which the intervention is delivered to (mostly) healthy students by laypeople who can be quickly trained for that task. In fact, the researchers from Australia and New Zealand themselves write that “Our results are consistent with another review of the PRP” — and cite the underwhelming meta-analysis by Brunwasser and Gillham.
Whatever the reasons for PRP’s shortcomings, as of 2020 many of the Positive Psychology Center’s clients around the world don’t appear to have gotten the message; they keep purchasing it. In fact the program’s purview has expanded beyond schools. The PPC’s 2018 annual report touts the fact that the center received a two-year grant from the Department of Justice to adapt PRP for law-enforcement personnel, as well as contracts to develop similar programs for the medical schools at Yale and Penn, among myriad other clients. Over all, notes Seligman in his report, “Since 2007, we have delivered more than 270 Penn Resilience Programs to more than 50,000 people.” The fact that these are adult contexts adds a whole other layer of uncertainty given that PRP was designed for kids.
The Positive Psychology Center has had a substantial impact on education around the country, but the adoption of its ideas by the U.S. military may be more consequential still. It is here that what Daniel Horowitz calls the “dangers of popularization” come most clearly into focus.
Soldiers in both Iraq and Afghanistan, like their predecessors in Vietnam, became occupiers of lands where they mostly didn’t speak the language, often couldn’t tell friend from foe, and were beset by threats that came seemingly out of nowhere. The results were staggering: about 15.7 percent of deployed veterans and 10.9 percent of non-deployed veterans screened positive for PTSD during this era, according to a major study, compared with a lifetime prevalence of about 6.8 percent in the general population. In 2002, a terrifying uptick in suicides among Army soldiers, who bore the brunt of the conflicts, began, and many of those deaths appeared to be directly connected to PTSD symptoms. There was also a series of horrible killings and other violent crimes committed by soldiers who had been exposed to trauma — these were less common but appeared to get far more media attention.
In October 2007, Col. Jill W. Chambers, an energetic survivor of the 9/11 attack on the Pentagon who had herself been diagnosed with PTSD, was handed the monumental task of figuring out how to solve this problem. Adm. Michael Mullen, who had just arrived at the Pentagon as the new chair of the Joint Chiefs of Staff, named her “Special Assistant to the Chairman for Returning Warrior Issues” and gave her a simple imperative, as she described it to me: “Jill, go forth, get away from the Pentagon — get out there and start talking to people and find out what it is that’s causing our service members so many problems.” Chambers took on her new role with gusto. “For the next eight months, I was out and about all over the world,” she explained. She had contacts throughout the armed forces, so she traveled all over the country to have conversations with those who were shouldering the heaviest load of the ongoing wars. “It got to be, Jill’s coming in, she’s cool, please get your guys to talk with her,” Chambers explained with evident pride. Over and over, soldiers back from Iraq and Afghanistan would tell Chambers stories of trauma tinged with stigma.
One said he had been sleeping in his garage because he kept waking up to find himself choking his terrified wife. He was scared of his own behavior, but also scared of speaking about it aloud. “Look, if you tell anybody about this, I’m going to deny it,” he told Chambers. This was a crisis, and it was clear the military needed to do something. That something arrived via a coincidence. One day, Chambers was on a flight from Washington, D.C., to Boston with her husband, the country musician Michael Peterson, and he nudged her. He was reading a book called Learned Optimism: How to Change Your Mind and Your Life, written by a psychologist named Martin Seligman. It seemed relevant to Chambers’s current work; Peterson’s key takeaway from Learned Optimism, as Chambers explained it, was that “you can really prime your pump before you face adversity to actually get yourself prepared for it.” Could there be a way to instill in soldiers a sense of resilience and optimism that would help them both during combat and after, that would effectively inoculate them against the worst psychological ravages of war? “Why don’t you just call Marty Seligman?” Peterson asked Chambers. So she did.
In August 2008, Chambers and Peterson met with Seligman in the garden of his Philadelphia home and came away very impressed. A few more calls and meetings later — and some pushback from Army higher-ups who wanted to sweep the problem under the rug but whom Chambers could brush off because of her direct mandate from Mullen (“Four stars beat any of those two- and three-star generals,” as she put it) — and Seligman had earned a meeting with Gen. George W. Casey Jr., chief of staff of the Army, to whom Mullen had delegated the task of vetting him.
Casey proved a quick convert. “He put his fist down and he said, By golly, we have a problem, and we are going to start talking about post-traumatic stress,” Chambers recalled. Seligman, armed as he was with what appeared to be reams of research and impressively rigorous books supporting his approach, emerged from the meeting as the Army’s go-to guy for addressing this newly acknowledged crisis. “Who else out there had a resilience-building program, right?” said Carl Castro, a retired colonel who was involved in multiple Army mental-health initiatives and who is currently an associate professor of social work at the University of Southern California. “Who else had a validated program, some data, any data around building resilience? And if you go back and look in the literature, there was only one person.”
Comprehensive Soldier Fitness would become one of the largest mental-health interventions geared at a single population in the history of humanity.
And that’s how the Comprehensive Soldier Fitness program, or CSF, was born. Soon, it was a mandatory part of Army life for every soldier: more than a million in all. It would become one of the largest mental-health interventions geared at a single population in the history of humanity, and possibly the most expensive.
Comprehensive soldier fitness is a hybrid consisting of three different components: One is a set of online-learning modules geared at boosting mental health adapted from Battlemind, an existing military mental-health program. Another is a mandatory annual survey, the Global Assessment Tool, or GAT, which was cobbled together from a number of different instruments. All soldiers are required to take the GAT every year and to complete a set number of hours of the online modules.
But the centerpiece of CSF, at least when it came to how it was advertised to the public, was the Master Resilience Training program. MRT, as it is known, is a train-the-trainer program closely modeled after the PRP. Like the online-learning modules and the GAT, it is mandatory for all soldiers. It was also the main reason Seligman’s Positive Psychology Center won its initial $31 million from the Army, in the form of a 2010 no-bid contract, as well as the funding that would follow. That initial contract contained common Pentagon budgeting language indicating that the recipient is the only provider of a particular service: “There is only one responsible source due to a unique capability provided, and no other supplies or services will satisfy agency requirements.” It’s clear, from Seligman’s account of the early days of CSF in his book Flourish, as well as various statements from others, that the military’s claims about “unique capability” stemmed from the supposedly strong evidence base for PRP.
Seligman’s argument was that Comprehensive Soldier Fitness could help reduce PTSD and suicidality, and it’s worth pausing here to reflect on how many steps removed this claim is from the initial goals and scope of the Penn Resilience Program. When the PRP began, it was novel and untested, given that it was attempting to prevent depression and anxiety with tools that had only been validated for treating those conditions. But still, it was premised on a reasonable theory in light of cognitive behavioral therapy’s solid base of evidence, and all it was claiming was that it could prevent anxiety and depression in some students.
Comprehensive Soldier Fitness was founded on a more radical claim: that an adapted version of the PRP could prevent PTSD and therefore suicide. “That’s why we instituted the Comprehensive Soldier Fitness program,” General Casey told a Senate appropriations subcommittee in 2010, “to give the soldiers and family members and civilians the skills they need on the front end to be more resilient and to stay away from suicide to begin with. It’s a long-term program, but I think that is the only way that we are ultimately going to begin to reduce this.”
PRP itself, though, was never designed for anything remotely like that; no one associated with it, until Seligman linked up with the Army, appears to have ever claimed it could prevent PTSD or suicide, and such an idea wasn’t even on the radar of the program’s designers as they built it. And yet in one paper, Seligman, his Penn Positive Psychology peer Karen Reivich, and Sharon McBride of the Army wrote of the Penn Resilience Program — which by that time had been shown in a meta-analysis not to be particularly effective in reducing depression among 10- to 14-year-olds — that “the preventive effects of the PRP on depression and anxiety are relevant to one of the aims of the MRT course, preventing post-traumatic stress disorder (PTSD), since PTSD is a nasty combination of depressive and anxiety symptoms.”
But just because PTSD can cause depression or anxiety doesn’t mean that treating depression and anxiety cures PTSD, or that preventing depression and anxiety prevents PTSD. Having a cold might make you cough, but simply curing the cough may fail to address the underlying illness.
As the researcher and data sleuth Nick Brown (who helped debunk the happiness pie concept) wrote in a critical review of Comprehensive Soldier Fitness published in the open-access online academic journal The Winnower, “Much of PTSD consists of symptoms whose prevention is not addressed by the PRP, or indeed anything else that comes under the umbrella of positive psychology.” He delivered an unflinchingly harsh verdict about the chain of causal claims Seligman had sold to the Army: “The idea that techniques that have demonstrated, at best, marginal effects in reducing depressive symptoms in school-age children could also prevent the onset of a condition that is associated with some of the most extreme situations with which humans can be confronted is a remarkable one that does not seem to be backed up by empirical evidence.”
Stretching things even further, Seligman and his colleagues didn’t merely adapt PRP to a new and unfamiliar context; they also bolstered the Master Resilience Training program with components taken from other corners of positive psychology, many of them involving attempts to make people a bit more optimistic in general. “Resilient people bounce, not break,” reads one slide from an MRT session. Under that, two images: “You” over a tennis ball, “Not you” over a cracked egg with yolk oozing out. A bit later in that same slide deck, an in-class exercise: “Discuss resilience using the quotes [from earlier slides], your personal experiences, and what we’ve discussed so far in the course. Create a list of the strengths, skills, and abilities that you believe are critical for resilience.” Later still, the module promises that resilience “can be developed: Everyone can enhance his or her resilience by developing the MRT competencies.” Elsewhere, soldiers are instructed to “hunt the good stuff” — that is, to remain optimistic by thinking of the good things in life. (This had become somewhat infamous among some of the critics of Comprehensive Soldier Fitness with whom I spoke: Before sending a 20-year-old into an urban-combat hellhole, you’re reminding him to “hunt the good stuff.”)
Other aspects of positive psychology were shoehorned into the CSF curriculum as well, such as the aforementioned theory about finding and cultivating character strengths, which does not appear to have ever been tested as an anti-PTSD or anti-suicide measure in any context. These materials were not from PRP as it was originally conceived, and they have a far weaker evidence base than interventions premised on cognitive behavioral principles. In an email, Gillham, after cautioning that she was unfamiliar with CSF itself, noted that “the original PRP did not include positive psychology activities. I personally don’t consider the original PRP a positive psychology intervention.”
Over all, there was no evidence PRP itself could prevent PTSD or suicide in its existing form; Seligman and his colleagues then padded it with elements that are, according to the available evidence (or lack thereof), even less suited to that task.
If you send young soldiers into deadly situations and allow terrible things to happen to them, you need to approach the aftermath in a careful, responsible, evidence-based way.
CPT is considered a “gold standard” PTSD treatment by the Pentagon. Another such treatment is prolonged exposure, or PE, therapy. Developed by the Israeli researcher Edna Foa, who is based (as fate would have it) at the University of Pennsylvania’s Perelman School of Medicine, PE therapy entails helping patients to face down and process their trauma and its triggers, rather than fall victim to the avoidance strategies that so often cut them off from other people and stymie their ability to integrate their trauma into a recuperated sense of self. Neither of these treatments is perfect, and both have their critics. But the available research strongly suggests that the average veteran with PTSD would benefit from a course of PE therapy or CPT.
The problem, though, is that the military has long had a serious problem getting veterans to enter and stick with these treatments.
The numbers are stark: A 2017 paper found that only 56 percent of returned veterans from Iraq and Afghanistan who screened positive for PTSD had any subsequent engagement with mental-health services, and over the years the rates at which veterans with PTSD have partaken of therapies like PE or CPT have hovered at just about a third. Research suggests that veterans’ obstacles to treatment range from logistics — some are simply unable to get to a VA center or other treatment facility on a regular basis — to stigma against open discussion of trauma symptoms.
So at the time the U.S. military faced its burgeoning PTSD crisis, there was one rather obvious approach to take: expanding access to scientifically validated treatment for veterans, and seeking to better understand why they often shied from or felt cut off from it. But that wasn’t what happened.
The Army’s leadership appears to have been particularly drawn to PTSD interventions that would piggyback on its institutional fixation with “resilience” and prevention. It’s understandable why: First, the prospect of preventing PTSD rather than having to treat it after the fact was likely irresistible to many who understood how bad the situation had gotten. “Build resilience, prevent PTSD” was too good a promise to refuse, because if kept it would forestall a tremendous amount of human suffering, and to the unskilled layperson there did appear to be evidence supporting this approach, in the form of Seligman’s impressive claims about PRP. But CSF also fit neatly with the Army’s beliefs in self-possession and self-efficacy, meaning that it could be pitched to Army bigwigs in a language they were already fluent in. On top of all that, for the Army to introduce a sweeping new program rather than bolstering or tweaking existing ones would bring with it obvious PR opportunities, such as videos of soldiers participating in an exciting, novel mental-health initiative (which were indeed shot and disseminated to the public).
The adoption of Comprehensive Soldier Fitness was not driven by PTSD experts. Neither the Pentagon staffer initially tasked with narrowing down the Army’s range of potential options for addressing the PTSD crisis (Chambers) nor the general who became CSF’s arguably fiercest advocate (Casey) was an actual expert on PTSD, nor was Seligman himself. “We were never asked to consult on prevention of PTSD, or whether this program would work, or whether it should be funded,” said Resick. Those who did have expertise in the relevant areas did not find the CSF storyline credible. “When I first heard about it I was more or less floored,” George A. Bonanno, a clinical psychologist at Columbia University and leading resilience researcher, told the journalist and American studies scholar Daniel DeFraia for a 2019 article he published in The War Horse, a military-focused journalism outlet. “I’ve been studying resilience for 20 years, and I don’t know of any empirical data that shows how to build resilience in anybody.” But the Army personnel who were convinced “Marty” was their man encountered a reasonable-sounding explanation for how CSF would resolve the issue of Army PTSD and suicidality via resilience boosting. None of this is particularly surprising in light of how human institutions work.
With pilot testing, the idea is to roll out a smaller-scale version of the program in question on a subset of the population for which it’s designed — not only to test for evidence of its efficacy, but also to ensure it has no adverse effects. But General Casey, besotted as he was with Seligman’s ideas, would have none of this pilot-test talk. During a key exchange recounted in Flourish, Seligman described what happened when he and Cornum asked Casey for an initial pilot test to see how their program performed. “Hold on,” the general “thundered,” as Seligman put it. “I don’t want a pilot study. We’ve studied Marty’s work. They’ve published more than a dozen replications. We are satisfied with it, and we are ready to bet it will prevent depression, anxiety, and PTSD. This is not an academic exercise, and I don’t want another study. This is war. General [Cornum], I want you to roll this out to the whole Army.”
This is a veritable carnival of unskilled intuition and exaggerated storytelling, a striking example of how science can be adulterated and misunderstood by an organization seeking to apply it. “They’ve published more than a dozen replications”: Well, but when those and other studies were meta-analyzed, PRP didn’t seem to do much, and those studies were conducted on kids, anyway. “We are satisfied with it, and we are ready to bet it will prevent depression, anxiety, and PTSD”: No published literature on PRP claimed it could prevent PTSD, because that wasn’t what it was designed for.
Unsurprisingly, the Army never produced any real evidence CSF works. While it did publish four “technical papers,” none of them peer-reviewed, that purported to show the effectiveness of CSF (“Study concludes Master Resilience Training effective,” touted the Army’s website), these analyses don’t survive close scrutiny. The psychologists Roy Eidelson and Stephen Soldz, for example, published a working paper showing that the Army’s evaluations were riddled with cherry-picking and basic methodological errors; in one instance, for example, the outcomes for soldiers who hadn’t been deployed were compared with those for soldiers who had, introducing a mega-confound that renders the comparison meaningless, because it would be impossible to know whether any differences between the groups should be attributed to CSF or to deployment itself.
The Institute of Medicine, an august branch of the National Academy of Sciences, came to the same conclusion in a major 2014 report that evaluated the military’s various efforts for improving the psychological well-being of service members and their families: “Although evaluations that were conducted by CSF staff and were not subject to peer review have demonstrated statistically significant improvement in some GAT subscale scores, the effect sizes have been very small, with no clinically meaningful differences in pre- and post-test scores. Accordingly, it is difficult to argue there has been any meaningful change in GAT scores as a result of participation.” In addition, the institute’s report notes, the one attempt the Army made to evaluate CSF on the basis of actual diagnoses among service members found “no difference in diagnosis among those receiving the [CSF] intervention” and those who had not participated in it.
None of this was cheap. There’s some fuzziness to the numbers, but in 2017 the Army told Daniel DeFraia that CSF cost $43.7 million the previous year. This tracks, roughly speaking, with the USA Today journalist Gregg Zoroya’s estimate that as of 2015 the program had been a six-year, $287-million enterprise (like DeFraia, Zoroya is one of the few journalists who has dug deeply into the program). Of course from a military perspective this is peanuts: A single F-35 costs about $100 million. But if, as the numbers suggest, CSF has cost the Army somewhere in the neighborhood of half a billion dollars since it was launched more than a decade ago (and has cost the Pentagon even more if you include the funds spent on the Air Force version, Comprehensive Airman Fitness, which launched in 2011), that’s still a tremendous amount of money, absolutely speaking, when one considers the good it could do in helping get soldiers the mental-health care they need. There may be no other single mental-health intervention in the history of humanity that has cost this much, and the Army has almost nothing to show for it.
The absence of evidence that the Penn Resilience Program and Comprehensive Soldier Fitness actually work as anti-PTSD interventions — as well as evidence that other approaches do, on average, work (at least as far as treating trauma that has already been inflicted) — was right there in the literature all along. The trauma and anxiety researchers Patricia Resick, Richard McNally, and Edna Foa could have told anyone who asked, and in some cases did tell those who asked, that what the Army was rolling out was based on no one’s expert understanding of PTSD. But it didn’t matter: The program slid too effortlessly into military ideals, and was such a big, important-seeming, attention-getting response to the crisis that it attained a formidable internal momentum and quickly snowballed on the basis of its own overheated promises.
Or, phrased differently: Imagine Marty Seligman and Patricia Resick competing for the same giant military contract. During Seligman’s presentation, he explains how his idea, Comprehensive Soldier Fitness, will help reinforce values the Army already holds dear: self-possession, hard work, respect for and trust in authority. The trainings can slot right into soldiers’ other responsibilities. Soldiers can be trained up as Master Resilience Trainers. A relatively simple, universal intervention will make the military stronger in an easy, convenient way that won’t interfere with anything. It will save lives. Best of all, adopting this program will allow the Army to broadcast out to America inspiring scenes of soldiers receiving life-enhancing training, and of Master Resilience Trainers fanning out throughout the Army, imparting these messages at the unit level. And as a result, countless tragedies will be averted; this is a remarkable, revolutionary opportunity to nip Army PTSD and suicidality in the bud, en masse.
Then Resick gets up to make the case that the grant should go to her and to her cognitive-processing therapy approach. This is actually less straightforward than what Marty just posited, she explains. Post-traumatic stress disorder isn’t about a lack of optimism, or about a failure to “hunt the good stuff.” It’s much more complicated than that, and there’s no evidence it can really be prevented, and treating it involves carefully unpacking soldiers’ thought patterns and, in many cases, undoing the military’s very own teachings. At the end of the day, if you send young soldiers into deadly situations and allow terrible things to happen to them, you need to approach the aftermath in a careful, responsible, evidence-based way. There’s no simple solution here, no quick fix. Trauma is trauma, and it’s ugly and takes time to unpack. And, if she’s being honest, she can’t really claim, as Marty did, that beefing up the Army’s investment in cognitive-processing therapy will bring with it PR opportunities. These stories aren’t inspiring; they involve young men sitting with a therapist talking about the worst days of their lives and their lingering feelings of guilt and anger about what happened on those days. Sometimes they’re crying. It’s hardly ever photogenic.
Who do you think gets the contract?