Teaching mental skills for self-esteem enhancement in a military healthcare setting.

Teaching mental skills for self-esteem enhancement in a military healthcare setting. The need exists for educational methods which can positivelyinfluence self-esteem, especially in demanding military healthcaresettings. Warrior Transition Units (WTU's) are tasked with thechallenging mission of caring for seriously injured in��jure?tr.v. in��jured, in��jur��ing, in��jures1. To cause physical harm to; hurt.2. To cause damage to; impair.3. or ill U.S. ArmySoldiers. This paper explored the hypothesis that an educationally-basedMental Skills Training (MST See micro systems technology. ) intervention can enhance self-esteem inmembers of a Warrior Transition Unit in the U.S. Army. The sample wascomprised of 27 WTU WTU Washington Teachers UnionWTU Washington Theological UnionWTU Warrior Transition Unit (Army)WTU Whitetails UnlimitedWTU Weapons and Tactics UnitWTU Ward Test Urine cadre (company) CADRE - The US software engineering vendor which merged with Bachman Information Systems to form Cayenne Software in July 1996. members who participated in an Army Center forEnhanced Performance (ACEP ACEPAmerican College of Emergency Physicians. ) MST educational workshop at a large Armyinstallation on the West Coast. Instruments included the Ottawa MentalSkills Inventory (OMSAT-3; Durand-Bush & Salmela, 2001) and theSelf-Esteem Rating Scale (SERS SERS State Employees�� Retirement System (Commonwealth of Pennsylvania)SERS Surface-Enhanced Raman SpectroscopySERS School Employees Retirement SystemSERS Science and Engineering Research Semester ; Wagnild, 1993). Results showed that SERSscores were significantly higher following the intervention.Furthermore, the ACEP instructional components of self-confidence,imagery, and mental practice were significant predictors of self-esteem.Results suggest that MST might be a viable educational approach forenhancing self-esteem in the WTU cadre. Introduction Although the U.S. military is responsible for fighting and winningthe nations' wars, caring for and rehabilitating Soldiers whobecome seriously injured or ill while serving their country is also ofprime importance. To address this concern the Army has developed"Warrior Transition Units" (WTU's) to aid woundedwarriors through their recovery process and their transition either backto Army units or to civilian life. Not surprisingly, as engagement inthe War on Terror This article is about U.S. actions, and those of other states, after September 11, 2001. For other conflicts, see Terrorism. The War on Terror (also known as the War on Terrorism continues, the number of injuries to Soldiers, andtherefore the number of Soldiers being assigned to WTU's, isincreasing. For example, approximately 6000 Soldiers were assigned toWTU's in 2007, but this number is projected to grow to over 20,000in 2008 (Kennedy, 2008). This greater than three-fold rise in Soldiersassigned to WTU's substantially increases the workload and theassociated amount of job-related adversity ad��ver��si��ty?n. pl. ad��ver��si��ties1. A state of hardship or affliction; misfortune.2. A calamitous event. experienced by the WTU cadremembers (Kennedy, 2008). Positive self-esteem is an important attribute for workers wishingto cope effectively with worksite adversity in any demanding situation(Folkman, 1998). This is especially true in healthcare settings asworkers with high self-esteem are likely to affect patient care inpositive directions (Abraham, 1999; Browning, et al., 2006; Chen, Thomasand Casper 2004). Having high self-esteem means healthcare providersfeel good about themselves. As individuals become more positive aboutthemselves, they generally become more positive about others, resultingin a more positive "bedside manner bed��side mannern.The attitude and conduct of a physician in the presence of a patient.bedside mannerMedtalk A popular term for the degree of compassion, courtesy, and sympathy displayed by a physician towards Pts " which is essential forcaregiver care��giv��ern.1. An individual, such as a physician, nurse, or social worker, who assists in the identification, prevention, or treatment of an illness or disability.2. success (Andersson 1993). While it is difficult to argue the need for good self-esteem amonghealthcare workers, little is known about how to enhance this attributewithin the military healthcare community, and more specifically, withmembers of Warrior Transition Units. Mental Skills Training (MST), developed primarily for enhancingmental fitness and performance in sport settings, represents apotentially innovative educational approach for enhancingattitude-related cognitions such as self-esteem. However, to date, nostudies have investigated its potential for impacting cognitions withinmilitary healthcare environments. Therefore, the focus of this study wasto explore the possible utility of using this type of instructionalapproach to enhance self-esteem among the WTU cadre. Warrior Transition Units In October of 2007 the Army established 35 WTU's at majorinstallations across the force to streamline care for wounded, injured,and seriously ill A patient is seriously ill when his or her illness is of such severity that there is cause for immediate concern but there is no imminent danger to life. See also very seriously ill. Soldiers. The WTU mission is to facilitate the healingand rehabilitation rehabilitation:see physical therapy. of Soldiers, return them to duty when possible, or toprepare them for a successful life as a veteran in their community. Atypical WTU company will have a Commander, Executive Officer, FirstSergeant, six Platoon Sergeants platoon sergeantn.The senior noncommissioned officer in an army platoon or comparable unit. and 18 Squad Leaders Squad leader may mean Squad Leader (the Avalon Hill game; note the capitalized "L") Squadron Leader (the Royal Air Force title) Squad Leader is a tactical level board wargame originally published by Avalon Hill in 1977. . A key element ofthe WTU framework is the "Triad of Support" which consists ofa Primary Care Manager, who is a physician; a Nurse Case Manager, who isa registered nurse; and a Squad Leader, usually at the rank of StaffSergeant staff sergeantn.1. a. Abbr. SSG A noncommissioned rank in the U.S. Army that is above sergeant and below sergeant first class.b. Abbr. SSgt A noncommissioned rank in the U.S. , who will oversee 12 patients. The Army Medical Command currently staffs WTU's with a cadreof approximately 2500 personnel. This includes approximately 750active-component Soldiers, 380 National Guard Soldiers, 380 Army ReserveSoldiers, and 915 Army Civilians (Sheftick & Holzer, 2007). Self-Esteem Rosenberg (1965) provided a broad and frequently cited descriptionof self-esteem as a favorable fa��vor��a��ble?adj.1. Advantageous; helpful: favorable winds.2. Encouraging; propitious: a favorable diagnosis.3. or unfavorable attitude toward the self(p.15). The mechanisms which facilitate the development of self-esteem arecomplex, however, Petlichkoff (2004) identified the importance o fanindividuals' mental "skill-set" (e.g., self-confidence,ability to concentrate, goal-setting skill, ability to control emotions,etc.) as being an important contributor to psychosocial psychosocial/psy��cho��so��cial/ (si?ko-so��shul) pertaining to or involving both psychic and social aspects. psy��cho��so��cialadj.Involving aspects of both social and psychological behavior. health, andself-esteem in particular. Similarly, Bandura ban`dur´an. 1. A traditional Ukrainian stringed musical instrument shaped like a lute, having many strings. (1997) and Flammer (1990)found that individuals with high self-efficacy beliefs, a constructstrongly related to self-confidence (Feltz, 1988), also report strongfeelings of well-being and high self-esteem in general. Self-esteem and healthcare worksite outcomes. Self-esteem ispositively associated with work-related outcomes in healthcare settings.Chen, Thomas and Casper (2004) identified self-esteem as an attributethat predicted increased job satisfaction, organizational commitment In the study of organizational behavior and Industrial/Organizational Psychology, organizational commitment is, in a general sense, the employee's psychological attachment to the organization. ,and job involvement in a sample of 159 healthcare employees. Improvementin self-esteem has also differentiated employees who exhibit long-termjob burnout job burnoutOccupational medicine End-stage work-related stress, in which an employee functions at a 'ground state'; at greatest risk for JB are those with low incomes, no college education, and single mothers. See Burn-out. Cf Compassion fatigue. from those who do not (Browning, et al., 2006). Evidencealso suggests that self-esteem may mediate MEDIATE, POWERS. Those incident to primary powers, given by a principal to his agent. For example, the general authority given to collect, receive and pay debts due by or to the principal is a primary power. the antecedents of jobcomplaining behavior (Heck heck?interj.Used as a mild oath.n. SlangUsed as an intensive: had a heck of a lot of money; was crowded as heck.[Alteration of hell. , Bedeian & Day, 2005) as well as therelationship between actual job inequity, job satisfaction and intendedjob turnover (Abraham, 1999). Finally, in a qualitative study of nursehospice workers, Olthuis and colleagues (2007) identified self-esteem asan important contributor to a nurses ability to positively viewthemselves and their world. Olthuis argues that a nurses' view ofthemselves is intertwined with how they view and interact with theirpatients and will ultimately influence the quality of their jobperformance. Mental Skills Training Although the notion that self-esteem can positively influencehealthcare worksite performance seems apparent, little inquiry hasexamined the most effective methods of enhancing this attribute inmilitary settings. One possible approach may lie in the application ofMental Skills Training (MST). MST refers to the systematic andconsistent practice of techniques and strategies designed to enhancemental skills that facilitate optimum performance (Vealy veal��y?adj. veal��i��er, veal��i��est1. Of or like veal.2. Not fully developed; immature. & Campbell,1988). MST is typically taught in an education context, as opposed to aclinical one. MST programs have been used extensively in sport settingsto develop psychological dexterity (e.g., self-confidence, attentioncontrol, appropriate management of energy) that enhanceindividuals' ability to use his or her mind effectively in avariety of performance situations (Gould & Damarjian, 1998). The Army Center for Enhanced Performance (ACEP) is a new Armyprogram tasked with improving Soldier functioning through the deliveryof MST-based educational curricula. ACEP provides instruction toSoldiers in six primary areas related to performance enhancement: 1)mental skills foundations, 2) self-confidence, 3) goal-setting, 4)energy/emotion control, 5) attention control, and 6) imagery. Petlichkoff (2004) has suggested that mental skills training caninfluence components of psychological well-being psychological well-beingResearch A nebulous legislative term intended to ensure that certain categories of lab animals, especially primates, don't 'go nuts' as a result of experimental design or conditions , including self-esteem.However, no studies have appeared that suggest how MST might enhancewell-being of individuals working in military healthcare settings, nordoes any data exist showing which MST skills may be the most appropriateto target. Thus, the purposes of this study were (1) to describe changesin self-esteem scores reported by WTU cadre members before and after anACEP MST educational intervention, and (2) to identify mental skillsthat most effectively predict self-esteem. Method Participants Participants in this study were 27 individuals from WarriorTransition Units (WTU's) located at a large military base on thewest coast. The sample was comprised of 14 males, 12 females, and oneindividual who did not identify his or her gender. There were 16military enlisted personnel ranging in grade from E-5 to E-7, 5 civiliannurses, 4 civilian social workers, and 2 civilian occupationaltherapists occupational therapistA person trained to help people manage daily activities of living–dressing, cooking, etc, and other activities that promote recovery and regaining vocational skills Salary $51K + 4% bonus. See ADL. . Ages ranged from 24 -57 with a mean of 38.3 years. Instruments Demographic and Physical Health Questionnaire. The demographicquestionnaire was designed specifically for this study and assessedbasic demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data. such as age, rank, gender, and occupation. Ottawa Mental Skills Assessment Tool-3. Durand-Bush and Salmela(2001) developed The Ottawa Mental Skills Assessment Tool-3 (OMSAT-3) tomeasure a broad range of mental skills thought to be relevant for sportperformance. It includes 48 items, and assesses 12 mental skill scalesthat are grouped under three broader conceptual components: (a)foundation skills (goal-setting, self-confidence, commitment), (b)psychosomatic psychosomatic/psy��cho��so��mat��ic/ (-sah-mat��ik) pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin. psy��cho��so��mat��icadj.1. skills (stress reactions, fear control, relaxation,activation), and (c) cognitive skills cognitive skillPsychology Any of a number of acquired skills that reflect an individual's ability to think; CSs include verbal and spatial abilities, and have a significant hereditary component (imagery, mental practice,focusing, refocusing Noun 1. refocusing - focusing againfocalisation, focalization, focusing - the act of bringing into focus , and competition planning). The OMSAT-3 wasselected for use in this study because it assesses a set of mentalskills that are similar to those targeted by the ACEP educationalprogram. Each item on the OMSAT-3 is answered on a "stronglydisagree" to "strongly agree" 7-point Likert scale Likert scaleA subjective scoring system that allows a person being surveyed to quantify likes and preferences on a 5-point scale, with 1 being the least important, relevant, interesting, most ho-hum, or other, and 5 being most excellent, yeehah important, etc (e.g.,"I am determined to never give up"). Durand-Bush & Salmela(2001) have reported acceptable internal consistency In statistics and research, internal consistency is a measure based on the correlations between different items on the same test (or the same subscale on a larger test). It measures whether several items that propose to measure the same general construct produce similar scores. and temporalstability of the OMSAT-3. In our study, internal consistency estimates of the OMSAT-3subscales varied from .66 to .92, with a mean value of .80. Self-Esteem Rating Scale. The Self Esteem Rating Scale (SERS;Nugent & Thomas, 1993) is a 40-item instrument designed to provide aclinical measure of self-esteem. Factor analysis of the SERS (Nugent& Thomas, 1993) has confirmed the uni-dimensional nature of theSERS, with all 40-items loading positively on a single factor. SERSitems are answered on a "never" to "always" 7-pointLikert format (e.g., "I feel that I am an attractive person").Twenty of the items are scored positively and twenty are scorednegatively yielding a possible range of scores from -120 to 120. TheSERS has demonstrated strong internal consistency as well as evidence ofcontent and factorial factorialFor any whole number, the product of all the counting numbers up to and including itself. It is indicated with an exclamation point: 4! (read “four factorial”) is 1 × 2 × 3 × 4 = 24. validity, and construct validity construct validity,n the degree to which an experimentally-determined definition matches the theoretical definition. (Nugent &Thomas, 1993). In our study, the SERS demonstrated strong internal consistencydisplaying an alpha coefficient of .97. Procedure Following United States Military Academy United States Military Academy,at West Point, N.Y.; for training young men and women to be officers in the U.S. army; founded and opened in 1802. The original act provided that the Corps of Engineers stationed at West Point should constitute a military academy, but (USMA USMA United States Military AcademyUSMA United States Martial Arts AssociationUSMA U.S. Metric Association, Inc.USMA United States Maritime Administration ) InstitutionalReview Board approval, WTU cadre members were asked to participate inthe study prior to their engagement in a regularly scheduled Army Centerfor Enhanced Performance (ACEP) educational workshop. Participation inthe study involved completion of the survey instruments described aboveprior to and following the delivery of the 12-hour ACEP curriculum. The ACEP educational intervention for the WTU consisted of eight1.5 hour educational modules designed to enhance the cadre's skillsand use of performance psychology principles. The eight modulesincluded: 1) mental skills foundations, 2) self-confidence, 3)goal-setting, 4) attention control, 5) energy management, 6) imagery forhealing, 7) life-coaching theory, and 8) team building. Results Pre-Post Differences in Self-Esteem Results revealed a significant effect from pre- (M = 78.85, SD =31.74) to post-test (M = 89.82, SD = 26.73) scores on the SERS (t (23) =-3.26, p = .003). Predicting Self-Esteem Stepwise stepwiseincremental; additional information is added at each step.stepwise multiple regressionused when a large number of possible explanatory variables are available and there is difficulty interpreting the partial regression multiple regression Multiple regressionThe estimated relationship between a dependent variable and more than one explanatory variable. was used to identify which subscalesof the OMSAT-3 made significant contributions to the prediction of selfesteem scores. A three variable solution was found, accounting for 55%of the variance in self-esteem scores, and included self-confidence,imagery, and mental practice as predictor variables Noun 1. predictor variable - a variable that can be used to predict the value of another variable (as in statistical regression)variable quantity, variable - a quantity that can assume any of a set of values (see Table 1.Because of the exploratory nature of this study, alpha levels were setat. 15 for inclusion in the model. Discussion MST Training and Self-Esteem Mean SERS scores were significantly higher following completion ofthe 12-hour ACEP intervention. Further, multiple regression resultsrevealed that self-confidence, imagery, and mental practice uniquelypredicted cadre members' self-esteem scores. Self-confidence. Self-confidence training was a major part of theACEP educational intervention and focused on teaching cadre members howto a) exercise selective perception (Gauron, 1984), b) control theirself-talk (Zinsser et al., 2001), c) employ meaningful affirmations(Rushall, 1979; Syer & Connolly, 1984), and d) to effectivelyinterpret and attribute successes and failures (Seligman, 1991; Weiner,1985). Of the potential OMSAT-3 predictors, self-confidence accountedfor the most variation in SERS scores. This finding clearly suggeststhat educationally-based self-confidence curriculums may also be aviable technique for enhancing self-esteem. As this study was correlational in nature, the mechanisms drivingthis finding still remain unknown. However, the well-known link betweenself-confidence and self-efficacy may provide some clues. Self-efficacy(Bandura, 1977) is a specific self-perception, and has been referred toas a situational specific form of self-confidence (Feltz, 1988).Confidence (defined as the firmness or strength of one's belief;Bandura, 1997) has been used as an overarching o��ver��arch��ing?adj.1. Forming an arch overhead or above: overarching branches.2. Extending over or throughout: "I am not sure whether the missing ingredient . . . concept that encompassesself-efficacy as well as the notion of competence. Given thatrelationship, our finding seems consistent with Bandura'scontention (1997) that self-efficacy is strongly related to self-esteem.Bandura (1997) argued that efficacy expectations to perform a given taskcould influence perceptions of self-esteem when the success/failure isheavily tied in with self-worth. In our study, it is possible that WTUcadre members placed a high degree of importance to their job-relatedactivities, thus, self-esteem is likely to be derived from thecadre's efficacy expectations about their job rather than thereverse. The MST intervention, we believe, provided educational materialwhich enhanced the WTU cadres' efficacy expectations about theirability to perform their job, thus influencing their self-esteem.Unfortunately, the cross-sectional design of this study does not allowfor confirmation of the directionality of these relationships. Imagery. Imagery's role as a significant predictor ofself-esteem is also noteworthy. Numerous studies have revealed thatimagery has been used effectively by outstanding performers in varioussettings (see Martin, Moritz, & Hall, 1999 for a review) and in avariety of ways (Rushall, 1988). One commonly used function ofsystematic imagery for improving performance and well-being includesmotivational components for enhancing self-confidence (Callow, Hardy,& Hall, 1998). WTU cadre members in this study were instructed to image successfulexecution of their jobs. They were also instructed to develop imageryscripts and were guided through the process of implementing thesescripts as a tool for more systematic imagery practice. Thus, cadremembers were able to refine their imagery use during the intervention bymore consistently creating images that were positive, self-reinforcing,and well controlled. In turn, these types of positive images may havecontributed to how the cadre members' "viewed"themselves, and thus providing a potential the link to improvedself-esteem. Mental practice. Finally, the regression results highlight theimportance of mental practice (e.g., the frequency with which systematicmental training occurs) as an additional behavior that might furtherenhance self-esteem. Since the results of this study suggest thatself-confidence and quality imagery ability appear to be related toself-esteem, it's important to note that the presence of theseskills may not be enough. As self-confidence and imagery need consistentreinforcement to be optimally integrated into one's mentalskill-set (Vealey & Campbell, 1988; Callow, Hardy, & Hall,1998), the systematic and consistent practice of these skills may be anintegral part of the process of maintaining self-esteem. Limitations The findings of this exploratory investigation were based on asmall (n = 27) sample of the WTU cadre, and without a comparison group,we cannot rule out alternative explanations for the improvementsreported in self esteem. Likewise, the cross-sectional nature of thedesign does not facilitate causal conclusions regarding the relationshipbetween mental skills and self esteem, nor did this study addresspotential moderators of the relationship between mental skills andself-esteem. The need clearly exists for more comprehensiveinvestigations with larger samples. Summary This study was one of the first to suggest that Warrior TransitionUnit cadre members' self-esteem can be positively influenced by aMental Skills Training intervention. Participants in the MSTintervention reported improvements in self-esteem. The MST approach,with specific emphasis on self-confidence building, imagery use, andsystematic mental practice, may be an effective tool for helping thisgroup deal with the adversity they face in the worksite. References Anderson, E. P. (1993). The perceptions of student nurses and theirperceptions of professional nursing during their nurse training program.Journal of Advanced Nursing, 18(5), 808-815. Abraham, R. (1999). Emotional intelligence in organizations: Aconceptualization con��cep��tu��al��ize?v. con��cep��tu��al��ized, con��cep��tu��al��iz��ing, con��cep��tu��al��iz��esv.tr.To form a concept or concepts of, and especially to interpret in a conceptual way: . Genetic, Social, and General Psychology Monographs,125,209-224. American Psychological Association The American Psychological Association (APA) is a professional organization representing psychology in the US. Description and historyThe association has around 150,000 members and an annual budget of around $70m. Help Center (2006). Road toresilience. Retrieved from:http://apahelpcenter.org/featuredtopics/feature.php?id=6 Bandura, A. (1977). Social learning theory. New York New York, state, United StatesNew York,Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : GeneralLearning Press. Bandura A. (1977). Self-efficacy: The exercise of control. NewYork: Freeman Browning, L., Ryan, C.S., Greenberg, M., & Rolniak (2006).Effects of cognitive adaptation on the expectation-burnout relationshipamong nurses. Journal of Behavioral Medicine behavioral medicinen.The application of behavior therapy techniques, such as biofeedback and relaxation training, to the prevention and treatment of medical and psychosomatic disorders and to the treatment of undesirable behaviors, such as overeating. , 29(2), 139-150. Callow, N., Hardy, L., & Hall, C. (1998). The effects of amotivational-mastery imagery intervention on the sport confidence ofthree elite badminton badminton(băd`mĭntən), game played by volleying a shuttlecock (called a "bird")—a small, cork hemisphere to which feathers are attached—over a net. Light, gut-strung rackets are used. players. Journal of Applied Sport Psychology, 10,S135. Durand-Bush, N., & Salmela, J.H. (2001). The Ottawa MentalSkills Assessment Tool (OMSAT-3). The Sport Psychologist, 15, 1-19. Feltz, D. L. (1988). Self-confidence and sports performance.Exercise and Sport Sciences Reviews, 16,151-166 Flammer A. (1990). Experiencing self efficacy. Introduction to thepsychology of control beliefs. Berlin: Huber. Folkman, S. (1998). Positive psychological states and coping withsevere stress. Social Science & Medicine, 45(8), 1207-1221. Gauron, E. F. (1984). Mental training for peak performance.Lansing, NY: Sport Science Associates. Gould, D. & Damarjian, N. (1998). Imagery training for peakperformance. In J. L. Van Raalte & B. W. Brewer (ed.). Exploringsport and exercise psychology (pp. 25-50). Washington, DC: AmericanPsychological Association. Heck, A., Bedeian, A., & Day, D. (2005). Mountains out ofmolehills? Tests of the mediating effects of self-esteem in predictingworkplace complaining. Journal of Applied Social Psychology, 35(11),2262 - 2289 Kennedy, K. (2008). Army thins warrior in transition entry rules.Army Times. Retrieved from: http://www.armytimes.com/ news/2008/08/armydisabled 080908w/ Martin, K., Moritz, S., & Hall, C. (1999). Imagery use insport: A literature review and applied model. The Sport Psychologist,13, 245 -268. Nugent, W.R., Thomas J.W. (1993). Validation of the Self-EsteemRating Scale. Research in Social Work Practice, 3, 191-207. Olthuis, G., Leget, C. & Dekkers, W. (2007). Why nurse hospiceworkers need high self-esteem. Nursing Ethics Nursing ethics is the discipline of evaluating the merits, risks, and social concerns of activities in the field of nursing. There are many defined codes of ethics for nurses. , 14(1), 62-71. Petlichkoff, L.M. (2004). Self-regulation skills for children andadolescents. In M.R. Weiss (Ed.), Developmental sport and exercisepsychology: A lifespan perspective (pp. 269-288). Morgantown, WV:Fitness Information Technology. Rosenberg, M. (1965). Society and the adolescent self-image.Princeton, NJ: Princeton University Princeton University,at Princeton, N.J.; coeducational; chartered 1746, opened 1747, rechartered 1748, called the College of New Jersey until 1896.Schools and Research Facilities Press. Rushall, B. S. (1979). Psyching in sports. London: Pelham Noun 1. Pelham - a bit with a bar mouthpiece that is designed to combine a curb and snafflebit - piece of metal held in horse's mouth by reins and used to control the horse while riding; "the horse was not accustomed to a bit" . Rushall, B. (1988). Covert modeling as a procedure for altering anelite athlete's psychological state. The Sport Psychologist, 2,131-140. Sheftick, G. & Holzer, F. (2007). Warrior Transition Units atCenter of Army Medical Action Plan. Army.Mil News. Retrieved fromhttp:// www.army.mil/-news/2007/10/08/5494-warrior-transition-units-at-center-of-army-medical-action-plan. Seligman, M. (1991). Learned optimism. New York: Knopf. Syer, J., & Connolly, C. (1984). Sporting body sporting mind:An athlete's guide to mental training. New York: CambridgeUniversity Press Cambridge University Press (known colloquially as CUP) is a publisher given a Royal Charter by Henry VIII in 1534, and one of the two privileged presses (the other being Oxford University Press). . Vealey, R., & Campbell, J. (1988). Achievement goals ofadolescent figure skaters: Impact on self-confidence, anxiety, andperformance. Journal of Adolescent Research, 3, 227-243. Weiner, B. (1985).An attribution theory Attribution theory is a social psychology theory developed by Fritz Heider, Harold Kelley, Edward E. Jones, and Lee Ross.The theory is concerned with the ways in which people explain (or attribute) the behavior of others, or themselves (self-attribution), with something of achievement motivationand emotion. Psychological Review, 92,548-573. Jon Hammermeister, Ph.D., Michael A. Pickering, Ph.D., LTC LTCabbr.lieutenant colonel Carl J.Ohlson, Ph.D., Army Center for Enhanced Performance, United StatesMilitary Academy, West Point, NY. Correspondence concerning this article should be addressed to Dr.Jon Hammermeister at 23011 Kingsbury Road, S.W., Vashon, WA 98070.Table 1Summary of Stepwise Selection in Multiple Regression Analysis ofOMSAT-3Variables Predicting Self-EsteemVariables Step Partial ModelEntered Entered [R.sup.2] [R.sup.2]Self-Confidence 1 .41 .41Imagery 2 .08 .49Mental Practice 3 .06 .55VariablesEntered Beta p pSelf-Confidence .41 15.30 .0004Imagery .60 3.40 .08Mental Practice -.33 2.50 .13