Behavioral Fitness and Resilience

Building on previous work in behavioral health, we define behavioral fitness as conduct, routines, and habits that promote health and the ability to withstand, recover from, or grow in the face of stressors. We identified several areas to include in our review to be consistent with research on important health practices: sleep behaviors, alcohol and drug abuse, and tobacco use. These key behavioral fitness factors, or constructs, are associated with successfully dealing with stress and strain. We address other relevant behavioral health topics in companion reports in this series.

Sleep is critical to physical and psychological functioning, and excessive sleep loss can contribute to chronic health conditions, poor mental health, and reduced adaptability to stress. Moderate sleep loss can significantly impair performance, particularly on cognitive tasks. Interventions for sleep can be broadly differentiated by the severity of the problem. Serious sleep disturbances have been treated using pharmacotherapy and behavior therapy. Minor sleep disturbances can often be addressed by following good sleep hygiene practices, which are also recommended to prevent sleep problems from developing. Examples of these good sleep hygiene practices include going to bed at the same time each night and removing all TVs, computers, tablets, etc., from the bedroom.

Alcohol and drug use disorder can also negatively affect behavioral fitness. In particular, heavy drinking has been strongly linked to many adverse health outcomes. Alcohol use can have stress-buffering effect; however, regular intoxication may present other complications and can lead to addiction. Interventions for drug and alcohol use disorders have focused on both prevention and treatment. In general, research has found that behavioral therapies, which are sometimes combined with medications to treat alcohol and drug addiction, can be effective in treatment. One of the most effective strategies for the prevention of alcohol consumption as well as smoking is to raise prices. Although there may be challenges to implementation, research has shown that the effects of controlling prices are comparatively larger than other prevention policies.

Smoking is associated with the onset of a number of chronic health conditions and can also increase stress and the risk of mood and panic disorders. Smoking cessation is associated with decreased stress and reduced risk of these disorders; however, stress itself may contribute to the maintenance of and relapse into smoking behavior. Interventions for the treatment of tobacco dependence can be classified broadly into counseling and psychosocial interventions, medications, and systems changes (that is, changes in policy, practices, and/or regulations). For psychosocial interventions, general recommendations indicate support for several clinician-directed interventions including screening for tobacco use, encouraging smokers to quit, meeting four or more times with individuals who are in the process of quitting, and providing interventions through different types of clinicians (e.g., nurse, physician, health educator). Although research has shown that medications can also be effective, combining counseling interventions with medication has shown to be even more effective in helping individuals to quit smoking.

A large literature examines health behavior change with respect to sleep, and drug and alcohol use. This literature finds that many factors are associated with health behavior change, including motivation, attitudes, family background, knowledge, health insurance, and social networks. Current thinking suggests that interventions to promote health behavior should target high-risk individuals, and messages should be individually tailored and also use multimodal means of delivery (e.g., in-person, text messages, emails). Ultimately, any attempt to change health-related behavior should be partnered with a realistic expectation about the extent to which the targeted behavior can be changed.

The research described in this article was conducted within the Manpower, Personnel, and Training Program of RAND Project AIR FORCE.