Asthenia--does it exist in space?

OBJECTIVE: First popularized as neurasthenia in the late 1800s by American George Beard, asthenia has been viewed by Russian psychologists and flight surgeons as a major problem that affects cosmonauts participating in long-duration space missions. However, there is some controversy about whether this syndrome exists in space; this controversy is attributable in part to the fact that it is not recognized in the current American psychiatric diagnostic system. METHODS: To address this issue empirically, we retrospectively examined the data from our 4 1/2-year, NASA-funded study of crew member and mission control interactions during the Shuttle/Mir space program. Three of the authors identified eight items of stage 1 asthenia from one of our measures, the Profile of Mood States (POMS). Scores on these items from 13 Russian and American crew members were compared with scores derived from the opinions of six Russian space experts. RESULTS: Crew members' scores in space were significantly lower than the experts' scores on seven of the eight items, and they generally were in the "not at all" to "a little" range of the item scales. There were no differences in mean scores before and after launch or across the four quarters of the missions. There were no differences in response between Russian and American crew members. CONCLUSIONS: We could not demonstrate the presence of asthenia in space as operationally defined using the POMS. However, the POMS addresses only emotional and not physiological aspects of the syndrome, and the subject responses in our study generally were skewed toward the positive end of the scales. Further research on this syndrome needs to be done and should include physiological measures and measures that are specific to asthenia.

Human interactions in space: results from Shuttle/Mir.

BACKGROUND: Anecdotal reports from space and results from simulation studies on Earth have suggested that space crewmembers may experience decrements in their interpersonal environment over time and may displace tension and dysphoria to mission control personnel. METHODS: To evaluate these issues, we studied 5 American astronauts, 8 Russian cosmonauts, and 42 American and 16 Russian mission control personnel who participated in the Shuttle/Mir space program. Subjects completed questions from subscales of the Profile of Mood States, the Group Environment Scale, and the Work Environment Scale on a weekly basis before, during, and after the missions. RESULTS: Among the crewmembers, there was little evidence for significant time effects based on triphasic (U-shaped) or linear models for the 21 subscales tested, although the presence of an initial novelty effect that declined over time was found in three subscales for the astronauts. Compared with work groups on Earth, the crewmembers reported less dysphoria and perceived their crew environment as more constraining, cohesive, and guided by leadership. There was no change in ratings of mood and interpersonal environment before, during, and after the missions. CONCLUSIONS: There was little support for the presence of a moderate to strong time effect that influenced the space crews. Crewmembers perceived their work environment differently from people on Earth, and they demonstrated equanimity in mood and group perceptions, both in space and on the ground. Grant numbers: NAS9-19411.

Crewmember and ground personnel interactions over time during Shuttle/Mir space missions.

BACKGROUND: Anecdotal reports from space and results from simulation studies on Earth have suggested that space crewmembers may experience decrements in their mood and interpersonal environment during the 2nd half of the mission and that negative emotions may be displaced to outside monitoring personnel. METHODS: To evaluate these issues, we studied 5 American astronauts, 8 Russian cosmonauts, and 42 American and 16 Russian mission control personnel who participated in the Shuttle/Mir space program. Subjects completed questions from the Profile of Mood States, the Group Environment Scale (GES), and the Work Environment Scale (WES) on a weekly basis during the missions. Subscale scores from these measures were analyzed using a piecewise linear regression approach that analyzed normally distributed subscales using a mixed model and non-normally distributed subscales by dichotomizing the variables and using a generalized estimating equation. RESULTS: After protecting against possible Type I errors due to multiple significance tests, only weak support was found for the biphasic model: the only significant findings in favor of the hypothesized 2nd half decrements in the interpersonal environment were in crewmember GES Leader Support and astronaut WES Work Pressure. Strongly consistent confirmation was found on all six tested measures for the hypothesized displacement of tension and dysphoria from crewmembers to mission control personnel. The hypothesized displacement of tension and dysphoria from mission control personnel to management was found on five of the six tested measures. CONCLUSIONS: The absence of moderate to strong support for the biphasic model suggests that crewmember interpersonal functioning does not depend appreciably on 1st half/2nd half time effects. The consistent support found for the displacement of tension and dysphoria suggests that countermeasures need to be developed to deal with this phenomenon in both crewmembers and mission control personnel.

Psychosocial issues in space: results from Shuttle/Mir.

Important psychosocial issues involving tension, cohesion, leader support, and displacement of negative emotions were evaluated in a 4 1/2-year study involving five U.S. and four Russian Shuttle/Mir space missions. Weekly mood and group climate questionnaires were completed by five U.S. astronauts, eight Russian cosmonauts, and 42 U.S. and 16 Russian mission control subjects. There were few findings that supported our hypothesized changes in tension, cohesion, and leader support in crew and ground subjects using various time models, although crewmembers reported decreasing leader support in the 2nd half of the missions, and astronauts showed some evidence of a novelty effect in the first few weeks. There was no evidence suggesting a 3rd quarter effect among crewmembers on any of the 21 subscales evaluated. In contrast, there was strong evidence to support the hypothesized displacement of tension and negative emotions from crewmembers to mission control personnel and from mission control personnel to management. There were several significant differences in response between Americans vs. Russians, crewmembers vs. mission control personnel, and subjects in this study vs. people in comparable groups on Earth. Subject responses before, during, and after the missions were similar, and we did not find evidence for asthenia in space. Critical incidents that were reported generally dealt with events on-board the Mir and interpersonal conflicts, although most of the responses were from a relatively small number of subjects. Our findings have implications for future training and lead to a number of countermeasures.

Human interactions during Shuttle/Mir space missions.

To improve the interpersonal climate of crewmembers involved with long-duration space missions, it is important to understand the factors affecting their interactions with each other and with members of mission control. This paper will present findings from a recently completed NASA-funded study during the Shuttle/Mir program which evaluated in-group/out-group displacement of negative emotions; changes in tension, cohesion, and leader support over time; and cultural differences. In-flight data were collected from 5 astronauts, 8 cosmonauts, and 42 American and 16 Russian mission control personnel who signed informed consent. Subjects completed a weekly questionnaire that assessed their mood and perception of their work group's interpersonal climate using questions from well-known, standardized measures (Profile of Mood States, Group and Work Environment Scales) and a critical incident log. There was strong evidence for the displacement of tension and dysphoric emotions from crewmembers to mission control personnel and from mission control personnel to management. There was a perceived decrease in commander support during the 2nd half of the missions, and for American crewmembers a novelty effect was found on several subscales during the first few months on-orbit. There were a number of differences between American and Russian responses which suggested that the former were less happy with their interpersonal environment than the latter. Mission control personnel reported more tension and dysphoria than crewmembers, although both groups scored better than other work groups on Earth. Nearly all reported critical incidents came from ground subjects, with Americans and Russians showing important differences in response frequencies.

Interpersonal and cultural issues involving crews and ground personnel during Shuttle/Mir space missions.

BACKGROUND: Anecdotal reports from space and results from simulation studies on Earth suggest that interpersonal and cultural issues will have an impact on the interactions of crewmembers and mission control personnel during future long-duration space missions. METHODS: To evaluate this impact we studied 5 astronauts, 8 cosmonauts, and 42 American and 16 Russian mission control personnel who participated in the Shuttle/Mir space program. Subjects completed questions from the Profile of Mood States, the Group Environment Scale, and the Work Environment Scale on a weekly basis during the missions. Subscale scores from these measures were analyzed using a two-way ANOVA to examine mean differences as a function of country (American vs. Russian), group (crewmember vs. ground personnel), and their interaction. RESULTS: Americans scored higher on measures of vigor and work pressure, and Russians scored higher on measures of managerial control, task orientation, physical comfort, self discovery, and leader support (which also showed a significant interaction effect). Mission control subjects scored higher than crewmembers on four measures of dysphoric emotions, but both groups scored significantly lower than published norms from other studies. There were significant interaction effects for subscales measuring leader support, expressiveness, and independence, with the American astronauts scoring the lowest of all comparison groups on all three subscales. CONCLUSIONS: In future long-duration space missions, countermeasures should focus on providing support for crewmembers from a culture in the minority, and crews should include more than one representative from this culture. Positive aspects of the interpersonal environment should be enhanced. The needs of mission control personnel should be addressed as well as those of crewmembers.

Summary of research issues in personal, interpersonal, and group dynamics.

People working on space missions, whether they are crewmembers or Mission Control personnel, must interact in groups. Consequently, it is important to consider interpersonal and group dynamic issues to assure that mission goals are accomplished. Simulation studies on Earth and anecdotal reports from space have described a number of such issues that include crew heterogeneity, culture and language variations, leadership roles, and personality differences. Problems that can result include increased group tension, decreased cohesion, subgrouping, scapegoating, miscommunication, role confusion, and displacement of tension and dysphoria from one group to another. The three papers by Drs. Caldwell, Kanas, and Stuster that are presented in this session address some of these issues at the group level. They suggest three critical questions related to: 1) improving communication between space crews and Mission Control personnel; 2) dealing with emotional and interpersonal decrements during the second half of space missions; and 3) minimizing the effects of culture and language differences. These questions in turn lead to six research strategies related to: 1) developing and testing new technologies to enhance crew-ground communication; 2) developing tools to recognize important communication themes and the factors that affect them over time; 3) studying the ability of voice analysis technology to detect on-board interpersonal stress; 4) developing and testing countermeasures to deal with second half emotional and interpersonal decrements; 5) studying the effects of cultural and language differences on crew tension, cohesion, and performance; and 6) studying the effects of crew heterogeneity and size on crew tension, cohesion, and performance.

Social and cultural issues during Shuttle/Mir space missions.

A number of interpersonal issues relevant to manned space missions have been identified from the literature. These include crew tension, cohesion, leadership, language and cultural factors, and displacement. Ground-based studies by others and us have clarified some of the parameters of these issues and have indicated ways in which they could be studied during actual space missions. In this paper, we summarize some of our findings related to social and cultural issues from a NASA-funded study conducted during several Shuttle/Mir space missions. We used standardized mood and group climate measures that were completed on a weekly basis by American and Russian crew and mission control subjects who participated in these missions. Our results indicated that American subjects reported more dissatisfaction with their interpersonal environment than their Russian counterparts, especially American astronauts. Mission control personnel were more dysphoric than crewmembers, but both groups were significantly less dysphoric than other work groups on Earth. Countermeasures based on our findings are discussed which can be applied to future multicultural space missions.

Psychiatric issues affecting long duration space missions.

BACKGROUND: As we move into the next Millennium, increasing numbers of people will travel into space. Psychological screening methods will be relaxed on near-Earth missions, such as might occur on a space station or a lunar colony. Crewmembers on interplanetary missions such as a trip to Mars will have to deal with psychiatric problems themselves with no possibility of evacuating an affected individual. For these reasons, it is important for support personnel on Earth and crewmembers in space to be knowledgeable about psychiatric difficulties that might occur and their appropriate treatments. METHODS: Anecdotal reports from long duration manned space missions and studies from space analog environments on Earth were reviewed for information concerning these issues. RESULTS: Psychiatric problems pertinent to the space environment include adjustment and psychosomatic reactions, asthenia, mood and thought disorders, and post-mission personality changes and family problems. Counter-measures to ameliorate these difficulties involve pre-launch selection and training; monitoring, support, and counseling/psychotherapy during the mission; and post-return debriefings with crew members and their families. Psychoactive medications have been useful during space missions, although unclear pharmacokinetic issues related to microgravity need to be taken into account. CONCLUSION: Although much is known about psychiatric issues related to long duration manned space travel, more empirical work needs to be done during actual space missions.

Subject's perceptions of the crew interaction dynamics under prolonged isolation.

BACKGROUND: The interactions of individuals participating in space simulation studies can give us valuable information about ways that space crew members relate with one another. A promising method of investigating such interactions is based on the Kelly repertory grid technique. HYPOTHESES: We predicted that in a space simulation crew: 1) one's personal self-concept would become closer to concepts about other crew members in a cohesive crew, and vice-versa, and 2) the similarity of one's ego images in the past, present and future influences that person's position in the group. METHOD: Crews from two isolation studies lasting 135 and 90 days at the Institute for Biomedical Problems in Moscow were evaluated using a modification of the Kelly repertory grid technique. Members assessed each other on a monthly basis and during off-nominal simulated docking periods. RESULTS: During both isolations, crew members were unsuccessful in making their personal self-concepts move closer to their concepts about fellow crew members. Crew disintegration resulted, with one member becoming an outsider whose personality was characterized by a disintegrated ego-image and an infantile type of the present ego. CONCLUSIONS: In small isolated groups, failure to make personal self-concepts become more like concepts about other crew members can lead to group disintegration and tension and can result in the appearance of an outsider who has a disintegrated ego-image and an infantile present ego.

Psychosocial issues affecting crews during long-duration international space missions.

Psychosocial issues can negatively impact on crew performance and morale during long-duration international space missions. Major psychosocial factors that have been described in anecdotal reports from space and in studies from analog situations on Earth include: 1) crew heterogeneity due to gender differences, cultural issues, and work experiences and motivations; 2) language and dialect variations; and 3) task versus supportive leadership roles. All of these factors can lead to negative sequelae, such as intra-crew tension and cohesion disruptions. Specific sequelae that can result from single factors include subgrouping and scapegoating due to crew heterogeneity; miscommunication due to major or subtle language differences; and role confusion, competition, and status leveling due to inappropriate leadership role definition. It is time to conduct research exploring the impact of these psychosocial factors and their sequelae on space crews during actual long-duration international space missions.

Content analysis of the crew communication with external communicants under prolonged isolation.

BACKGROUND: The communication between space crews and outside monitoring personnel in Mission Control gives us valuable information about crewmember psychological health. Studying the formal parameters of similar communication during ground-based space simulation missions helps us understand the psychological climate of confined groups over time, and this information can be applied to long-term space missions. HYPOTHESES: We hypothesized that psychological closing and information filtration will be observed in a confined crew as the mission progresses and will differ by the type of communication (e.g., audio vs. computer-generated) with the outside monitors in the simulated Mission Control (MC). In addition, communication patterns will vary with the specific group of people on-duty outside. METHOD: Audio and computer communications between space simulation crews and MC teams were analyzed during two isolation studies lasting 135 and 90 d at the Institute for Biomedical Problems in Moscow. A number of temporal, content and quantitative parameters of verbal activity were examined. RESULTS: The total intensity of communication dropped after month 1 of the missions. The Commander had the highest intensity of communication. There was evidence for the presence of psychological closing and information filtration in the crews over time, with some variation based on type of communication. Communication patterns differed with different outside teams. CONCLUSIONS: The communication between confined groups and outside monitoring personnel is affected by psychological closing and information filtration and by the make-up of the teams that comprise the monitoring groups.

Psychosocial value of space simulation for extended spaceflight.

There have been over 60 studies of Earth-bound activities that can be viewed as simulations of manned spaceflight. These analogs have involved Antarctic and Arctic expeditions, submarines and submersible simulators, land-based simulators, and hypodynamia environments. None of these analogs has accounted for all the variables related to extended spaceflight (e.g., microgravity, long-duration, heterogeneous crews), and some of the stimulation conditions have been found to be more representative of space conditions than others. A number of psychosocial factors have emerged from the simulation literature that correspond to important issues that have been reported from space. Psychological factors include sleep disorders, alterations in time sense, transcendent experiences, demographic issues, career motivation, homesickness, and increased perceptual sensitivities. Psychiatric factors include anxiety, depression, psychosis, psychosomatic symptoms, emotional reactions related to mission stage, asthenia, and postflight personality, and marital problems. Finally, interpersonal factors include tension resulting from crew heterogeneity, decreased cohesion over time, need for privacy, and issues involving leadership roles and lines of authority. Since future space missions will usually involve heterogeneous crews working on complicated objectives over long periods of time, these features require further study. Socio-cultural factors affecting confined crews (e.g., language and dialect, cultural differences, gender biases) should be explored in order to minimize tension and sustain performance. Career motivation also needs to be examined for the purpose of improving crew cohesion and preventing subgrouping, scapegoating, and territorial behavior. Periods of monotony and reduced activity should be addressed in order to maintain morale, provide meaningful use of leisure time, and prevent negative consequences of low stimulation, such as asthenia and crew member withdrawal. Leadership roles and lines of authority need to be studied further to understand the factors leading to status leveling, leadership competition, and role confusion. Finally, the relationship between crews and ground personnel should be characterized in order to minimize the displacement of anger and tension to the outside, to counter the effects of inter-group miscommunications, and to develop support strategies that can help to counter in-group/out-group conflicts. Ground-based space simulations still have a role to play in terms of understanding the impact of these factors and ways of dealing with them. In particular, issues involving language, cultural differences, gender biases, career motivation, monotonous conditions, use of free time, leadership, lines of authority, and the relationship between crews and outside monitoring personnel need to be further characterized and examined under controlled conditions. Until such time as these factors can be studied directly in space, simulations provide an opportunity to learn more about these psychosocial issues and to plan ways of minimizing their negative consequences during actual space missions.

Symptom management of auditory hallucinations in schizophrenia. Results of 1-year follow up.

1. The majority of participants reported that they were still using behavioral strategies to manage their auditory hallucinations throughout the 12-month follow-up period and that they had experienced a decrease in symptom severity. 2. The answers to managing the symptom of auditory hallucinations are as individual as the symptom itself. All of the behavioral management strategies worked for at least one participant, but no strategy worked for everyone. 3. Practicing strategies in a group and at home seemed to promote long-term use of the behavioral strategies.

Crewmember interactions during a Mir space station simulation.

BACKGROUND: Interpersonal problems may negatively affect crews on long-duration space missions. These problems stem from crewmember tension and its displacement to the outside monitoring personnel and from disruptions in crew cohesion and unclear leadership roles. HYPOTHESES: We hypothesized that crew tension and dysphoria would transiently increase following stressful events and be greater in the second half of a mission; that cohesion would be less during the second half of a mission; that tension and dysphoria would be displaced to the outside monitoring personnel; and that high levels of leader support and control would produce high levels of cohesion. METHODS: We tested these hypotheses during a 135-d Mir space station simulation study in Moscow. At weekly intervals, the three crewmembers completed items from two group climate questionnaires, a mood questionnaire, and a log of stressful events. RESULTS: Contrary to expectations, there was significantly (p < 0.05) more total mood disturbance and tension during the first 9 wks than during the subsequent 10 wks of the simulation. Although levels of cohesion remained the same over time, cohesion scores dropped at a significantly greater rate during the last third of the seclusion. There was evidence for the displacement of tension and dysphoria to the outside monitoring personnel. There were significant correlations in the predicted direction between leader support and control and crew cohesion, as well as evidence of status leveling in the mission commander. CONCLUSIONS: Crewmember tension, cohesion, and leadership are important issues affecting people working in secluded environments, and they need to be studied further in space.

Leisure time activities in space: a survey of astronauts and cosmonauts.

Questionnaires were returned from 54 astronauts and cosmonauts which addressed preferences for media and media-generated subjects that could be used to occupy leisure time in space. Ninety-three percent of the respondents had access to records or audio cassettes, and cosmonauts had greater access than astronauts to multiple media. Cosmonauts and long-duration space travelers reported that they missed various media more than their astronaut and short-duration counterparts. Media subjects that related to international events, national events and historical topics were rated as most preferable by all respondents and by several of the respondent groups. The findings are discussed in terms of their relevance for occupying free time during future long-duration manned space missions.

Communication between space crews and ground personnel: a survey of astronauts and cosmonauts.

A total of 54 astronauts and cosmonauts returned questionnaires which addressed several aspects of communication between space crews and ground personnel. Two factors were rated as significantly helping this communication: Shared Experience and Excitement of Space Flight. Two additional factors were judged to significantly hinder space-ground communication: Spacecraft Ambient Noise and Space Sickness. Respondents also significantly endorsed the value of contact with loved ones on Earth as having a positive influence on mission performance, particularly cosmonauts and long-duration space travelers. The need for a private space-ground transmission link was mentioned by several respondents. There was no consensus as to whether or not negative personal information should be withheld until the space crew returned to Earth, although some respondents indicated that this might be justified during short-duration as opposed to long-duration missions. These findings have important scientific and operational implications for future manned space missions.

Group psychotherapy with bipolar patients: a review and synthesis.

Contrary to traditional thinking, a review of the recent literature has suggested that bipolar patients can be treated in homogeneous therapy groups in conjunction with concomitant lithium management. Important psychodynamic and interpersonal features are reviewed that have received empirical support and have enhanced our understanding of these patients. Goals for bipolar groups include educating patients on the nature of the disease, helping them learn ways of coping with its symptoms, and encouraging them to discuss relevant psychodynamic and interpersonal issues. To achieve these goals, therapists have used techniques involving education, support, and facilitation of group discussions. Further clinical and empirical work needs to be done to evaluate the effectiveness and process of these bipolar groups, particularly in the inpatient setting.