OBJECTIVES:
There are many potential challenges and dangers in carrying out human space flight. From a behavioral health standpoint, stress and anxiety-related problems, fatigue/sleep disturbance, and interpersonal conflict, are common problems that can arise for those working in operational environments. These problems, if not addressed in advance via training, can potentially escalate into significant problems such as anxiety disorder, depressive episode, severe sleep disturbance or conflict that can seriously impact performance, safety, and well-being. Exploration missions present unique challenges to addressing behavioral health issues due to communication delays where real-time communication limitations could hamper the delivery of behavioral health support. This study addressed these potential problems by examining and evaluating existing behavioral health techniques and determining the best practices for addressing behavioral health concerns that could arise on exploration missions.
The final research product comprised several components. The main deliverable was data from a randomized controlled trial (RCT) examining the efficacy, feasibility, and acceptability of asynchronous behavioral techniques in comparison to traditionally delivered psychotherapy (i.e., in-person) focusing on a behavioral health condition of relevance to space flight such as stress, sleep/fatigue, and conflict. The behavioral health techniques examined were evidence-based (e.g., cognitive-behavioral therapy--CBT) and did not consist of new or unvalidated treatments. The RCT was conducted at the UCLA Psychology Clinic with high functioning and healthy participants who report current symptomatology such as stress, low-level anxiety, or depressive symptoms.
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APPROACH:
The techniques examined in the RCT were selected, in part, by conducting a comprehensive review of current standards of behavioral health practice for space flight, including consultation with behavioral health clinicians at NASA Johnson Space Center (JSC) and subject matter experts (SMEs). Investigators also conducted a systematic review of the literature of behavioral health approaches, (e.g. computer-guided, bibliotherapy, smart phone apps) suitable for use in an asynchronous communication environment, in comparison to traditional psychotherapy. Based on information from the reviews and data from the RCT, a “best practice guidelines” was formulated for addressing behavioral health issues of relevance to exploration missions where communication delays are a concern. The best practice guidelines comprised of behavioral health training and treatment that address pre-mission, mission, and post-mission phases of exploration class missions.
RESULTS:
This proposal examined and evaluated existing behavioral health techniques and determined the best practices for addressing behavioral health concerns that could arise on exploration missions where asynchronous communication can be a barrier to delivering real-time behavioral healthcare.
The main deliverable was data from a randomized controlled trial (RCT) examining the efficacy, feasibility, and acceptability of asynchronous behavioral techniques which was a self-guided internet-based cognitive behavioral therapy program (iCBT) in comparison to videoconference-delivered psychotherapy focusing on a behavioral health condition of relevance to spaceflight (i.e., stress, depression, and/or anxiety).
The results from the RCT (N=108) comparing iCBT(N=55) to videoconference delivered CBT was that both conditions improved on all major outcome measures of anxiety, depression and stress symptomatology as well functioning, with no significant differences between conditions. This suggests that both self-guided iCBT and video-conference delivered CBT are equally effective for addressing anxiety, depression and stress.
Video conferencing is the current standard of behavioral health delivery on International Space Station (ISS) so this RCT demonstrated that self-guided or asynchronous behavioral health care works as well as the current NASA standard for addressing the most common behavioral health conditions. Additional qualitative analyses showed that both conditions were viewed as very useful and acceptable and had very good treatment completion rates. The user experience can also impact other barriers to care among the broader population such as stigma, not having access to evidence- based care, or not having time or knowing where to receive such care. Self- guided approaches have unlimited scalability.
Crew health and performance is critical to successful human exploration beyond low Earth orbit.
The Human Research Program (HRP) investigates and mitigates the highest risks to human health
and performance, providing essential countermeasures and technologies for human space exploration.
Risks include physiological and performance effects from hazards such as radiation, altered gravity,
and hostile environments, as well as unique challenges in medical support, human factors,
and behavioral health support. The HRP utilizes an Integrated Research Plan (IRP) to identify
the approach and research activities planned to address these risks, which are assigned to specific
Elements within the program. The Human Research Roadmap is the web-based tool for communicating the IRP content.
The Human Research Roadmap is located at:
https://humanresearchroadmap.nasa.gov/
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