Enhancing Mental Health and Resilience Across the U.S. Armed Forces with Chimney Trail Health

November 8, 2024

Introduction

The U.S. Department of Defense (DoD) has made considerable strides in addressing mental health challenges among service members, but the complex issues they face—such as stress, burnout, and suicide risk—require ongoing, evidence-based solutions. Chimney Trail Health, a leader in preventive behavioral health training, offers a highly customizable program that directly addresses these challenges. Drawing on decades of empirical research in Prospect Theory, Cognitive Behavioral Theory (CBT), adult learning, and design thinking, our serialized Waypoint Kit training program has been meticulously crafted to deliver solutions that promote resilience, foster behavioral change, and enhance mission readiness across all branches of the armed forces—all in engaging and accessible formats.

The Challenge

Mental health challenges in the military are persistent and multifaceted. According to the 2023 Suicide Prevention and Response Independent Review Committee (SPRIRC) Final Report, rates of suicide remain stubbornly high and elevated relative to civilians, with approximately 519 service members dying by suicide in 2021.1 In addition to increased suicide risk, U.S. military service members are at increased risk for a range of behavioral health concerns, including depression (23%),2 anxiety (15.4%),3 and substance use (11%),4 all of which also increase suicide risk. This ongoing crisis reflects a need for more effective mental health support and prevention strategies, customized to the military experience and varied to promote engagement.

In the midst of this crisis, access to effective treatment and preventive tools is paramount, but as the SPRIRC report highlights, access is severely impeded across the military: 38% of military personnel do not seek care due to stigma and fear of career impact, critical provider shortages and long waits for those who do seek care, and a lack of access to evidence-based treatments that are proven to address their concerns.1

Given these risks, service member suicide prevention competency is a critical priority. Yet the SPRIRC report notes that “At all installations, service members from every Service and at all ranks agreed that the content, frequency/dosage, and means of delivering suicide prevention training are ineffective and serve only to ‘check the block’” (p. 43).1 And the report strongly recommends that suicide prevention training be modernized and varied across military career cycles, drawing upon a variety of topics and teaching modalities to boost engagement.

Taken together, this evidence highlights an urgent need for accessible, diverse, evidence-based solutions that support suicide prevention training and bolster resilience across the armed forces.

Chimney Trail Health’s Solution

Chimney Trail Health provides a serialized training program designed to address suicide prevention training and resilience-focused skill development challenges through a tailored approach. Chimney Trail Health’s fun, engaging, and evidence-based Waypoint Kit program employs preventive Cognitive Behavioral training (CBt) to equip service members with skills to identify and challenge the maladaptive thought patterns that lead to isolation, destructive levels of anxiety and depression, and suicide—in themselves and others.

The Waypoint Kit training program includes:

A kickoff seminar, which sets the foundation for the training. Followed by
Three bimonthly Waypoint Kits, delivered directly to the participant, which each contain:

A magazine-style Waypoint Book, which guides participants through progressive skill development,
Instructions for hands-on activities designed to solidify their learning, and
High-quality gear to complete the activity and keep as a reminder of their learning.

Critically, the Waypoint Kit training program targets a key risk factor that drives suicidal ideation and behavior: destructive cognitive distortions.5 But this training goes beyond just helping service members prevent the worst outcomes. The Waypoint Kit Curriculum helps service members enhance their overall wellness and performance–serving as an evidence-based wellness tool that bolsters resilience, a nonclinical skills-based training that can help address a range of stressors when clinical care is not needed or not feasible, and a primer to fast-track progress in clinical care, if needed.

Key Features of the Waypoint Kit Solution

Evidence-Based at Every Level: The Waypoint Kit program integrates proven tools within a rigorously designed, multifaceted learning approach to make the tools that work accessible, increase engagement, and facilitate retention of skills.
Serialized Curriculum: Delivered quarterly over the training year, Waypoint Kits provide ongoing learning opportunities designed to allow service members to build CBt skills progressively and integrate them generally by practicing them in their daily lives.6
Focus on Prevention: Aligning with the suicide prevention findings from the SPRIRC report that emphasize the need for continuous proactive support,1 proactive intervention is central to the Chimney Trail Health approach.
Generalizable: CBt skills are generalizable and can help individuals overcome multisystemic stressors, bolstering suicide prevention and increasing wellness in one fun training program.
Something Real: Studies routinely show that mental health apps, though cheap and abundant, do not promote engagement–with some studies noting 96–97% churn rates within the first month.7 However, hands-on experiences and learning in novel environments both promote memory retention.8

Training for What?

People often don’t realize that there is a problem until they are in crisis. Yet, due to a confluence of processing biases, including stigma, psychological dissonance, and confirmation biases, people also often struggle to see how they would benefit from preventive behavioral health training. Thus, the critical first steps in suicide prevention and resilience training are building awareness of—and motivating to address—the problem.

Fortunately, Prospect Theory offers an evidence-based, relatable, and engaging avenue to build insight and motivation. Prospect Theory highlights that the human brain has two processing speeds: fast (or automatic) for rapid processing of everyday inputs, and slower (or intentional) for more complex and demanding tasks.9 While this two-channel system is helpful in allowing us to react quickly in high pressure and life threatening situations, it also leaves us vulnerable to developing patterns of processing errors outside of our intentional awareness.

Decades of study of Prospect Theory, across dozens of fields and applications, have illuminated these patterns and yielded fun and relatable activities and examples that spotlight the cognitive biases to which we are all prone. Drawing upon these tools and lessons learned, the Chimney Trail Health training program uses Prospect Theory as a foundation to introduce and normalize why our brains are likely to make the kinds of errors that lead to destructive levels of anxiety and depression, as well as suicidal ideation—and how to tackle them.

Why Cognitive Behavioral training (CBt)?

Cognitive Behavioral Theory (CBT) offers an extensive and well researched framework and toolkit to address the potentially destructive, automatic processing errors highlighted by Prospect Theory. CBT has been tested and used extensively in the field of psychotherapy (also known as Cognitive Behavioral Therapy) and found to be effective in virtually every population and for every problem yet tested. A recent meta-analysis concluded that “CBT will remain effective in conditions for which we do not currently have available evidence… We need to recognize the consistent evidence for the general benefit which CBT offers” (p. 1).10

Broadly speaking, CBT theorizes that our thoughts drive our emotions and resulting urges and behavior.11 Thus, our thoughts play a large role in shaping our reactions to situations. However, given that the majority of processing in the human brain happens automatically, we are often unaware of the thoughts that shape our emotions and behavioral responses to daily situations. CBT-based tools teach learners how to identify, challenge, and revise their potentially harmful automatic thoughts to address—or prevent—negative outcomes, such as anxiety, depression, and suicidal ideation and behavior.

CBT-based interventions have been found to be particularly effective in addressing suicide risk among individuals at a range of risk levels.12 Moreover, CBT tools are highly effective in addressing the most common mental health concerns facing service members, including anxiety, depression, and others.10 Thus, CBT tools are not only helpful during a crisis (i.e., once suicidality emerges), but also successfully address many of the root causes of suicide before a crisis emerges.

But can CBT be helpful before a problem even emerges? Fortunately, recent study has focused on preventative applications of the same CBT-based tools. These nonclinical, Cognitive Behavioral trainings (CBt) draw upon the same robust Cognitive Behavioral Theory that has been tested for decades, using the same well-validated tools honed across the psychotherapy literature, and have now been shown to be effective in preventing the development of behavioral health concerns in numerous studies.13

The Role of Experiential Learning in Behavioral Change

In the rush to address the emerging mental health crisis, an overwhelming number of solutions have been advanced. For example, as of May 2023, there were more than 10,000 mental health apps available on the market.¹⁴ Studies routinely show that mental health apps, though cheap and abundant, do not promote engagement or change, with studies noting 96–97% churn rates within the first month.⁷

Similarly, traditional “train and hope” methods of training without ongoing practice or follow-up have been demonstrated to yield poor results over time, with an average finding that 75–80% of training information is lost following a single-event training.⁸ Conversely, hands-on experiences and learning in novel environments both promote memory retention.⁸

Ongoing, experiential learning—or learning through hands-on activities—is a critical component of the Chimney Trail Health approach. Four decades of research have demonstrated strong effects of experiential learning in enhancing retention and engagement, especially when combined with cognitive exercises.^15,16 The tactile and interactive elements of the Waypoint training kits allow service members to apply CBT techniques in real-world scenarios, increasing the likelihood of long-term behavioral change.⁶

Something Real: Adaptation of CBT for Military Environments

As noted above, CBT tools are highly adaptable and have been demonstrated to be effective across cultures, languages, problems, and contexts, including with military populations.10 CBT is particularly effective in high-stress populations like military personnel and has been shown to improve problem-solving skills17 and cognitive flexibility,18 which are essential for maintaining focus during challenging missions.

The SPRIRC report emphasizes the importance of cultural adaptation in mental health interventions.1 By incorporating military-specific scenarios and language into the CBT training, we increase the relevance and impact of the training. This adaptation ensures that the skills taught in each kit are directly applicable to the stressors faced by service members, making them more likely to engage with, and benefit from, the program.

Finally, as noted above, service members demonstrate a reluctance to seek care, and the military behavioral health system continues to face staffing challenges. Thus, a nonclinical, yet highly evidence-based training, focused on adaptable cognitive tools that can be used to address a range of stressors, is uniquely suited to the current reality of the complex and demanding military environment.

Alignment with DoD Initiatives

Chimney Trail Health’s program directly aligns with DoD’s key mental health and resilience initiatives as outlined in Secretary of Defense Austin’s 2023 memo, New DoD Actions to Prevent Suicide in the Military,19 and as supported by the 2023 SPRIRC report.1 Our focus on early, sustained intervention matches the DoD’s goals of reducing suicide rates and fostering a culture of resilience:

Foster a Supportive Environment: Each Waypoint Kit is designed to increase connectedness, with a hands-on activity designed to include others, be it family or fellow service members, according to the participant’s preference.
Improve the Delivery of Mental Health Care: Waypoint CBt toolkits offer preventive engagement in generalizable tools to prevent mental health concerns from emerging and can serve as a primer before behavioral health care, if needed.
Address Stigma and Other Barriers to Care: The Waypoint Curriculum normalizes the fact that everyone deals with cognitive distortions, and offers practical tools to identify and address these patterns before problems emerge. The tools also offer hope that change is possible and highlight that individuals can address the root causes of anxiety, depression, and self-harm.
Revise Suicide Prevention Training: The SPRIRC Final Report notes that tailored, serialized training can help address underreporting of mental health issues by creating a safe, consistent touchpoint for service members. Waypoint Kits provide this consistent support, helping to bridge gaps in access.
Promote a Culture of Lethal Means Safety: Chimney Trail Health has developed an additional offering, the Complete Marksman Kit, that supplements the standard Waypoint Kit program, helping service members to identify and target cognitive distortions as they relate to elite firearms operation and a culture of safety.

Initial Program Outcomes

To date, Chimney Trail Health has engaged with units from every branch of the military, with numerous ongoing pilots across the globe. We focused on a tiered evaluation strategy as we partnered with units and commands to refine our training program, focusing on: 1) satisfaction with our curriculum, 2) engagement with the training program, and 3) sustained behavior change.

Initial Engagement and Satisfaction

As we know from the SPRIRC report (2023),1 service members from all branches routinely report that standard suicide prevention training is not helpful and does not respect their time.1 Thus, our first aim was to ensure that service members felt respected by our training program and that it was a good use of their time. Results from hundreds of military participants have overwhelmingly confirmed that the Chimney Trail Health program meets this mark.

Ongoing Engagement

As an ongoing training program, sustained engagement is at the heart of our model. Our second critical target was sustained engagement to facilitate behavior change. To date, 100% of surveyed participants have reported positive engagement with the ongoing curriculum.

Behavior Change Data Collection and Outcomes Assessment Strategy

As our in run programs reach completion, we will expand our analyses to include behavior change and wellness outcomes. Preliminary outcomes indicate high levels of sustained satisfaction, ability to use cognitive tools, and positive emotional and behavior change outcomes resulting from sustained kit engagement. This will be a critical area of continued evaluation as our yearlong evaluation programs come to fruition, and results of these analyses will be included in future editions of this white paper.

Conclusion

Chimney Trail Health offers an evidence-based, scalable solution that supports the Department of Defense’s commitment to preventing suicide and improving mental health and resilience among service members. Kits are customizable and allow service members to engage at their own pace, in a private and comfortable setting, anywhere in the world. By implementing the Waypoint Kit program, the DoD can provide service members with the proactive, continuous support they need to thrive, ensuring both their well-being and mission readiness.

We invite the DoD to collaborate with Chimney Trail Health to implement the scalable, individually-focused Waypoint Kit solution across all branches, addressing the urgent need for suicide prevention training, mental health support, and building resilience for the future.

Works Cited

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