PilotStudy | GetUpWithJohn

Resilience Training Impact Study

Study Summary

Figure represents data from a pilot study of 850+ responses collected during a three-day training session at Ft. Hood, Texas in April, 2026.

Data unpublished, manuscript under review.

Pilot Study Abstract

Click to review each abstract section below (or download full abstract)

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Prior to 2003, U.S. Army suicide rates were lower than civilian rates.

After Operations Enduring Freedom (2001) and Iraqi Freedom (2003), rates rose sharply for over two decades, reaching 36.1 per 100,000 in 2021, the highest since 1938.

Army studies consistently identify key risk factors among enlisted soldiers, especially junior ranks with fewer deployments and recent mental health treatment. Notably, lack of deployment has emerged as a persistent risk factor, highlighting the role of pre-enlistment trauma. Veterans and active-duty personnel report significantly higher adverse Childhood Experiences Scores than civilians, with elevated rates of abuse, household dysfunction, and parental separation.

To address this, retired Army Captain Dr. John M. Arroyo Jr., a Fort Hood shooting survivor and peer specialist, developed a faith-based 8 Self-Care Steps targeted resilience training and supporting interactive curriculum.

This pilot evaluates the targeted training's feasibility and impact on resilience at a high-risk installation as a compliment to the Army’s H2F Spiritual Readiness program.
Drawing from the Resilience Curriculum Finding Resilience in Today’s World, we created a targeted strategic training method to deliver this program in larger groups or corporate settings. The purpose is to outline the key elements of each Self-Care Step and share the insights and wisdom of peer specialist, Dr. John M. Arroyo.
Fort Hood, Texas April 2026

The 8 Self-Care Steps Resilience training session was delivered by a peer specialist to 1,000 soldiers (E1–O3) and 81 leaders (E6–O6) at Fort Hood, one of the Army’s highest-risk installations.

Sessions were conducted in three groups for Soldiers and one for leaders. Participants voluntarily completed an anonymous 6-item pre- and post-session questionnaire assessing resilience skills (confidence after stress, hope/purpose, practical tools, emotional/spiritual grounding, growth mindset, and helping others). No identifiable data was collected. The project was a real-world program evaluation approved by the John Arroyo Ministries Board of Directors. As anonymous quality improvement, it did not require formal IRB review and was conducted in accordance with the Declaration of Helsinki.

The custom 6-item scale demonstrated excellent internal consistency (Cronbach’s α = 0.912 pre-session; α = 0.960 post-session). Improvement analysis included Wilcoxon signed-rank tests with effect sizes, Reliable Change Index (significant RCI > 1.96), Chi-square tests, Spearman correlations, and proxy Number Needed to Treat (pNNT). Results were considered significant when P<0.05.
Soldiers showed the greatest resilience gains.

A. Paired pre- and post-session questionnaires revealed significantly greater improvement among soldiers compared to leaders (53.6% vs. 29.3%, P=0.008).

B. The largest gains occurred in participants with the lowest baseline scores (<18 points). In other words, for soldiers who started with low scores, the effect was significantly stronger, showing real, reliable improvement.

C. The three items with the strongest improvement were Q2: Achieving sense of hope and purpose; Q3: Practical tools for adversity; and Q6: Ability to help others build resilience (all P<0.001, effect size r: 0.290-0.510).
Leaders exhibited smaller but still impactful changes in resilience gains.

A. Paired pre- and post-session questionnaires revealed significantly smaller improvement among leaders compared to soldiers (29.3% vs. 53.6%, P=0.008).

B The largest gains were observed in participants with the lowest baseline scores (<18 points). Leaders in this subgroup showed reliable improvement, whereas those with higher baseline scores demonstrated limited change.

C Overall, leaders entered the sessions with higher baseline scores, resulting in an expected reduced room for growth ('the ceiling effect').
The program induces reliable gains in resilience.

A. Using Spearman correlation, we confirmed that the Reliable Change Index percentages positively correlate with post-session results. This suggests that the intervention was most effective for the participants that needed it the most.

B. Number Needed to Treat is a formula that assesses how many subjects need intervention in order to prevent an adverse outcome. For suicide in the Army, we can only calculate a proxy Number Needed to Treat (pNNT) due to lack of current suicide data. Our pNNT for the overall paired-group population (n=293) we sampled in 5.2, meaning that we need to treat 5-6 soldiers to achieve 1 reliable gain of resilience skills. In the High-Risk Group (those with the lowest baseline scores, n=45), the pNNT is 2.3, meaning that we need to treat 2-3 high risk participants to achieve 1 reliable gain of resilience skills.

To put this in perspective, other programs that target suicide high risk populations exhibit the following NNTs: Brief Cognitive Behavioral Therapy for Suicide Prevention has an NNT of 3.88-4.5, while Crisis Response Planning has an NNT of 7.
Survey feedback analysis.

Comments from soldiers and leaders were categorized by their total post-session resilience score using the following groups: Low score group (≤18 points) with 10.9% of comments, Medium score group (19–23 points) with 15.2% of comments, and High score group (≥24 points) with 73.9% of comments.

Example quotes from each group are shown. Data are drawn from post-session survey responses. Higher final scores indicate stronger reported resilience gains after the training.

Most feedback (and the most positive comments) came from participants who ended up in the High score group.
The 8 Self-Care Steps Targeted Training Session has proven to be a feasible, acceptable, and highly effective intervention for building resilience among soldiers and leaders.

Survey data demonstrated meaningful gains in resilience scores from pre- to post-session, with particularly strong improvements among participants who began with the lowest baseline scores. The majority of respondents finished in the High Post-score group (≥24 points), and qualitative feedback was overwhelmingly positive, with participants describing the training as “inspiring,” “impactful,” and directly applicable to handling the stresses of military life. Even those starting from the lowest resilience levels frequently reported feeling better prepared for challenges ahead, underscoring the program’s ability to address pre-enlistment family factors linked to vulnerability. This will also equip service members with practical tools for long-term wholeness.Wrap

To date, the targeted training has been imparted in 14+ military bases and military & veteran related conferences, including high-tempo and high-risk locations both domestic and internationally (see map). These engagements have allowed us to deliver the 8 Self-Care Steps directly to active-duty soldiers, chaplains, and leaders in real operational environments. Feedback from these sites consistently highlight the program’s relevance and the urgent need for this type of spiritually integrated resilience training.

Looking ahead, we are committed to returning to these locations while expanding to additional sites. By systematically collecting cross-sectional and longitudinal data across multiple touchpoints, we can analyze larger datasets, strengthen the evidence base, track sustained outcomes, and refine the curriculum for greater impact. Larger, controlled studies are warranted to rigorously evaluate long-term resilience gains, effects on unit readiness, and potential contributions to suicide prevention.

The Targeted 8 Self-Care Steps Training offers strong promise as a scalable, complementary component of the Army’s Holistic Health and Fitness (H2F) Spiritual Readiness efforts. By investing in the whole person, mind, body, and spirit, we can help build a more resilient force. The program can provide tools for overcoming adversity, fulfilling their missions, and returning home stronger. Continued partnership and expansion of this work will save lives, restore families, and strengthen our nation’s defense.

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Dr. John M. Arroyo Jr. is a retired U.S. Army veteran, devoted husband to Angel, and proud father of three. A California native, John began his military service in 1998 and dedicated 20 years to the U.S. Army, serving primarily as a Green Beret with the 3rd Special Forces Group at Fort Bragg, North Carolina. His service included deployments to Afghanistan and Iraq. In 2013, he was commissioned as a U.S. Army Medical Service Corps Officer.

In 2014, John survived a life-threatening gunshot wound to the neck during the Fort Hood mass shooting, an injury that left his right arm paralyzed. Though doctors gave little hope for recovery, John experienced what he describes as a miraculous healing, crediting his survival to faith, purpose, and the strength to keep moving forward. That defining moment reshaped his mission and ignited a calling to inspire others.

Today, John is a highly sought-after motivational speaker known for his powerful presence, passionate delivery, and authentic storytelling. Speaking at military bases, troop support organizations, schools, churches, and businesses, he delivers a compelling message of resilience, hope, and overcoming adversity. Through his experiences with trauma, addiction, setbacks, faith, and personal growth, John offers audiences relatable insight and practical encouragement for facing life’s hardest battles. Grounded in faith and strengthened by his family, John’s mission is to help others rise above their struggles, rediscover purpose, and live with courage, resilience, and lasting hope.