The concept of `mindfulness´, which has now become an integral part of mind-body medicine, was operationalized primarily for patients suffering from chronic pain and stress, and is until now rarely used in military contexts. However, research has suggested that a similar health component, “mind fitness training” in soldiers, operationalized as “mental agility, emotional regulation, attention and situational awareness”  may be protective in building resilience and leading to faster recovery from psychological stress. Mind fitness comprises various training components, including mindfulness based interventions such as the Mindfulness-based Stress-Reduction [MBSR] programs. Bates et al. argued that spiritual and psychological fitness are inter-related, and highlighted that mindfulness, as a specific form of spiritual practices and mind-body training, may improve attention and self-regulation.
Several meta-analyses indicate that mindfulness based interventions and programs may both improve mental stability and coping with stress [3–6]. In cancer patients, MBSR programs improve patients´ mental health with moderate effect sizes, while the impact on physical health effects is rather weak . A meta-analysis of Musial et al. additionally found that MBSR programs can improve quality of life and mood, and reduce distress in cancer patients. However, the reported effects were found to be strong only for stress reduction, moderate concerning emotional regulation and rather impacting upon generic quality of life . In healthy individuals, Chiesa and Serretti  observed that mindfulness based interventions may reduce stress, ruminative thinking and trait anxiety as well as increase empathy and self-compassion. To attenuate stress and concerns - factors known to hamper overall sleep quality -, MBSR programs have been used as interventions to improve self-management and to reduce or reframe intrusive thoughts. The systematic review of Winbush et al. found “some evidence” that mindfulness techniques may attenuate sleep-interfering cognitive processes and could thus improve sleep disturbances. Praissman´s 2008 literature review and clinician´s guide  stated that “MBSR is a safe, effective, integrative approach for reducing stress”, with beneficial effect to enhance the interaction between healthcare providers and patients.
However, these findings were predominantly observed in clinical and nonclinical civilian populations, and it is currently unclear whether I) mindfulness programs are accepted by (predominantly male) soldiers and military personnel, II) are of relevance to improve resilience, performance and coping in/with critical (combat theatre and peacekeeping mission) situations. Some studies indicate that MBSR may improve posttraumatic stress disorder (PTSD) symptoms such as depression, behavioural activation, and acceptance [8, 9]. In a randomized controlled study enrolling veterans, Kearney et al. [8, 9] found a significant six month effect for a MBSR program on PTSD symptoms, depression, behavioral activation, mental quality of life, acceptance and mindfulness  with medium to large effect sizes for depression, mental health-related quality of life [HRQOL], and mindfulness skills” . A similar study with fire fighters also implied that mindfulness may be associated with fewer posttraumatic stress disorder [PTSD] symptoms, depressive symptoms, physical symptoms, and alcohol problems . A concept very similar to MBSR called “Mindfulness-based Mind Fitness Training” [MMFT], was tested in a pilot study in 31 US Marine Reservists before they were deployed to their combat theatre . The authors stated that “some Marines resisted the effort required by the training”, while others have “personalized their approach to the MMFT exercises”. Stanley and Jha  reported that those who spent more time in their mind fitness exercises showed an improvement in their cognitive performance, while those soldiers who spent less time engaging in these practices showed an increase of their perceived pre-deployment distress levels. Interestingly, more than half of population studied reported to have used the MMFT skills during their period of deployment.
Although the concept of `mindfulness´ originates in ancient Buddhist philosophy, MBSR and other interventions have been developed and operationalized as secular interventions in the context of the modern Western medical system and secular societies [11–13].
Mindfulness refers to the ability to experience the given situation in a non-judgmental way, in a state of consciousness that allows an individual to be fully present and aware of arising emotions and feelings, conflicting memories and disturbing worries, which could distract the conscious awareness and concentration. Although mindfulness focuses on the present situation, it is not meant as a technique to actively control the situation - instead it allows one to be present with full awareness and attention (whatever the underlying emotional components might be) . Bishop et al. stated that they regard “mindfulness as a process of regulating attention in order to bring a quality of non-elaborative awareness to current experience and a quality of relating to one’s experience within an orientation of curiosity, experiential openness, and acceptance”. Mindfulness training therefore also allows an individual to deal with distracting or ambivalent emotions and feelings, conflicting memories and disturbing worries that may arise in stressful situations. Empirical research has identified two interrelated sub-facets of mindfulness, i.e., `awareness/presence´ and `openness/acceptance´ [16, 17]. While `presence´ refers to the cognitive capacity to focus on the experience of the present moment, `acceptance´ pertains to the emotional ability to control the automatically generated emotional responses to a given situation so that an individual’s attention is not dragged away by uncontrolled emotions.
Although mindfulness is not a term commonly used in a military context, it is of interest to note that the term “situational awareness”, which is a pivotal construct in military psychology and information warfare, shares some common conceptual ground with mindfulness. However, in contrast to mindfulness, which comprises both the milieu intérieur and extérieur, situational awareness only refers to the sensual awareness of the outer world. Situational awareness has been defined as “the perception of the elements in the environment within a volume of space and time, the comprehension of their meaning, the projection of their status into the near future, and the prediction of how various actions will affect die fulfillment of one´s goals” by Endsley . The ability to acquire situational awareness skills may be moderated by individual mindfulness levels. Recently the concept of “mind fitness” was introduced, suggesting that the ability to be present and to self-regulate emotions may be helpful to enhance soldiers´ competencies to react adequately in critical situations, to manage better with stress, and to improve resilience and recovery from psycho-emotional affections and impairment . A similar concept (“Warrior Spirit”) was brought up by Strozzi-Heckler  who investigated the impact of awareness training in 25 Green Berets, and reported an improvement of their skills to view “themselves in relation to the world around”.
To measure mindfulness, several instruments have been published , but not all of them have been validated extensively . Among the relevant instruments are the Mindfulness Attention and Awareness Scale and the Freiburg Mindfulness Inventory (FMI; ). Particularly the shortened 14-item version of the FMI is widely used and seems to be a promising instrument. The primary 30-item version of the FMI was tested among participants of a mindfulness meditation retreat and had a very good internal consistency (Cronbach´s alpha = .93); also the 14-item version of the FMI, which was tested in a sample of individuals with and without meditation experience, and individuals with clinical problems, had a good psychometric quality (alpha = .86) . For this instrument, the authors suggested a one-factorial  and a two factorial solution . Recent Rasch analysis of data obtained from patients with different psychosomatic conditions as well as a large non-clinical population indicated the possibility of extant bottom and ceiling effects . Additionally, Rasch analysis suggested that a 13-item version with two subfactors would be more appropriate, while the one-factor solution seems to be less appropriate [25–27]. These two factors can be described as the `presence´ and `acceptance´ subfacet of mindfulness. Rasch analysis indicated that the item difficulty of the items referring to the `presence´ component was lower than that of the `acceptance´ items . The authors therefore suggested that “the ability to be present is established before the ability to accept things” can be learnt.
However, several items of the FMI are difficult to understand, particularly for those individuals who have no experience with mindfulness meditation and the underlying concepts. Belzer et al.  have shown that participants with lack of mindfulness experience had greater difficulties with item comprehension than individuals with mindfulness experience. The authors therefore recommended “a modification of the wording of several FMI items”, at least for populations with lack of familiarity with the concept of mindfulness as they opine there may be “insufficient construct validity to use the current FMI in mindfulness-naïve samples” .
Indeed, as preliminary studies with the FMI have clearly revealed that military personnel and soldiers have difficulties with understanding at least some items of the FMI-14, we aimed to develop and validate a modified instrument on the basis of the FMI that is specifically tailored to military personnel. This is achieved by shifting the conceptual focus to the conscious presence and perception of a given situation as well as the attentional self-control of individuals in stressful situation. In this paper, we describe the construction and validation of the Conscious Presence and Self Control (CPSC) scale as a measure of situational awareness in soldiers with and without psycho-emotional affections. This implies the analysis of variables with an influence on CPSC scores, i.e. socio-demographic variables and health affections.