Ver el código de «Interpersonal conflicts in spaceflight»

==Background==
* Significant physical and psychosocial stressors experienced during mission training, space flight, and mission recovery contribute to the emergence of interpersonal conflicts between crew members.<ref>Flynn, Christopher F. Chapter 19: Behavioral Health and Performance Support. In: Barratt MR, Baker  E, Pool SL, eds. Principles of  Clinical Medicine for Spaceflight. Springer  Nature; 2020.</ref>
	 	 	 
* At least one crew has been dissolved before a long-duration flight due to interpersonal conflicts.<ref>Blagov D, Bogdashevskiy R, Myasnikov VI, Kozarenko O, Bronnikov SV. Experts discuss psychological support measures for cosmonauts. Moscow Literaturnaya Gazeta. January 4, 1989.</ref>

* Interpersonal behavioral issues linked to changes in medical status have significantly contributed to the early termination of several space missions.<ref>Davis JR. Medical issues for a mission to Mars. Aviat Space Environ Med. 1999;70(2):162-168.</ref><ref>Nicogossian AE, Pool SL, Uri JJ. Historical perspectives. In: Nicogossian AE, Huntoon CL, Pool SL, eds. Space Physiology and Medicine. 3rd ed. Philadelphia, PA: Lea & Febiger; 1994:3-49.</ref>

==Clinical Features==
===Common Sources===
* Dissimilar goals of space travel among crewmembers. 
* Perceived or actual differences in cultural or personal values among crewmembers.
* Personalization of issues or stressors encountered during spaceflight.
* Poor communication among crew members.
* Poor psychosocial adaptation to long-term space travel.
* Personality or behavioral changes due to a new or exacerbated medical or psychiatric condition, including:<ref>Flynn, Christopher F. Chapter 19: Behavioral Health and Performance Support. In: Barratt MR, Baker  E, Pool SL, eds. Principles of  Clinical Medicine for Spaceflight. Springer  Nature; 2020.</ref>
** Adjustment disorder 
** Anxiety disorder 
** Mood disorder
** Personality disorder 
** Sleep disorder 
** Substance use disorder 
** Trauma and stressor-related disorder 
** Underlying medical illness 

===Behavioral Characteristics<ref>Angelo E. Managing interpersonal conflict: Steps for success. Nurs Manage. 2019;50(6):22-28. doi:10.1097/01.NUMA.0000558479.54449.ed</ref>===
* Openly voicing grievances
** Expressing dissatisfaction or concerns directly to fellow crewmembers.
* Behavioral changes
** Notable shifts in behavior during work or rest, including impulsive or risk-seeking actions.
* Negative personality shifts
** Development of irritability, hostility, or other adverse personality changes.
* Impairment of fair judgement
** Reduced individual or crew ability to make sound decisions, especially under stress.
* Social withdrawal or subgroup development
** Decreased cohesion and collaboration manifesting as avoidance of team interactions and/or formation of divisive subgroups.
* Communication breakdown
** Withholding or difficulty with conveying or receiving critical information effectively.
* Team tension and hostility
** Increased frequency of arguments or passive-aggressive behavior between crew members and/or ground crew.
* Decline in Team Performance
** Reduced efficiency and collaboration in completing mission-critical tasks.

==Differential Diagnosis==
{{Space medicine}}

==Evaluation==
* Individually address crewmembers in conflict, ensuring unbiased listening. Begin with open-ended questions, followed by targeted prompts.<ref>Flynn, Christopher F. Chapter 19: Behavioral Health and Performance Support. In: Barratt MR, Baker  E, Pool SL, eds. Principles of  Clinical Medicine for Spaceflight. Springer  Nature; 2020.</ref>
** Evaluating interpersonal conflicts may require multiple interactions with crewmembers, with encouragement for continued discussion as needed.
** Avoid aggressively questioning crewmembers, for aggressive questioning can generate a strong defensive reaction against “prying” for information.
** Consider performing a thorough history and physical exam if suspicious for underlying medical or psychological causes of changes in behavior or personality contributing to conflict. 

* Reference NASA Johnson Space Center’s four primary elements of behavioral health and performance support to evaluate potential contributors to interpersonal conflict:<ref>Flynn, Christopher F. Chapter 19: Behavioral Health and Performance Support. In: Barratt MR, Baker  E, Pool SL, eds. Principles of  Clinical Medicine for Spaceflight. Springer  Nature; 2020.</ref>
** Sleep and circadian physiology 
** Behavioral health 
** Psychological adaptation 
** Interaction with human-system interface in the on-orbit workplace			

* Consult with a behavioral specialist when available. 

==Management==
''Before applying general conflict resolution strategies, it is essential to rule out interpersonal conflicts driven by personality or behavioral changes resulting from new or worsening medical or psychiatric conditions. If a disorder is identified, treatment should precede reevaluation to assess whether the conflict remains.''

===Comprehensive Approach to Conflict Resolution<ref>Garmel GM. Conflict Resolution in Emergency Medicine. In: Adams JG, ed. Emergency Medicine: Clinical Essentials. 2nd ed. Saunders; 2013:1615-1620.</ref>===
#Acknowledge the presence of a conflict. 
#Maintain a broad perspective. 
#Separate the parties from the source of the conflict. 
#Clarify and identify the root cause of the conflict. 
#Address one problem at a time, starting with the easiest. 
#Engage the involved parties in a neutral, unbiased environment and manner. 
#Listen with understanding and interest, rather than perceived evaluation. 
#Validate all issues and concerns. 
#Identify areas of agreement and focus on shared interests.
#Challenge data, facts, and conclusions - not individuals.
#Brainstorm solutions in which both parties benefit.
#Use objective criteria when possible.
#Do not delay or prolong conflict resolution.
#Implement the plan and regularly reassess the conflict until resolved. 

==Disposition== 
* The described four-factor model offers crewmembers an effective framework for identifying common causes of behavioral problems and interpersonal conflicts in spaceflight.

* Early collaboration among crewmembers and simulation of known mission stressors can help preserve behavioral health, optimize performance, and enhance the positive psychological effects of spaceflight.

==Prevention<ref>Flynn, Christopher F. Chapter 19: Behavioral Health and Performance Support. In: Barratt MR, Baker  E, Pool SL, eds. Principles of  Clinical Medicine for Spaceflight. Springer  Nature; 2020.</ref>==
* Pre-flight selection of individuals with strong teamwork and coping skills, and identification of those at higher risk of conflict or behavioral issues triggered by spaceflight stressors.
* Participation in pre-flight field exercises simulating spaceflight stressors to assess crew compatibility.
* Provide crewmembers with designated time for personal leisure and family communication.

==See Also== 
* Space adaptation syndrome
* Sleep disorders of spaceflight

==References==
<references/>

[[Category:Space Medicine]]