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Home » All, Resilience

Using Positive Psychology to Prevent PTSD

By on November 25, 2009 – 5:38 pm  15 Comments

Sherri Fisher, MAPP '06, M.Ed., Director of Learn & Flourish LLC, is a leader in the field of positive education. An education management consultant and coach, workshop facilitator and author, Sherri uses the POS-EDGE Model to incorporate research-based findings from strengths psychology and behavioral economics into positive, personalized, best-practice strategies for learning, parenting, and work. Full Bio. Sherri's articles are here.



Helicopters in Iraq

Helicopters in Iraq

The Army News Service formally announced last week that the U. S. Army has a new approach it hopes can prevent the psychological effects of warfare from turning into post traumatic stress disorder. The first official “master resilience training” program is one part of the Army’s Comprehensive Soldier Fitness approach aimed at enhancing physical, emotional, social, family, and spiritual soldier fitness. The resilience program is being developed and customized for the Army by the University of Pennsylvania’s resilience program. Details can be seen here.

Getting Ready for Another Night in Iraq

Getting Ready for Another Night in Iraq

Why train military personnel to become more psychologically fit? PTSD is crippling for many soldiers back from deployment. Moreover, according to the military, posttraumatic stress disorder affects about one out of every five returning personnel deployed to Iraq or Afghanistan. Symptoms include recurrent intrusive memories, emotional numbing, and a hyperfocus on avoiding the disorder’s symptoms, all likely to have costs to the veteran’s unit and family. Fortunately, more people who go into combat have post-traumatic growth. They’re confronted by something very difficult, and they emerge stronger as a result.

 

Martin Seligman says, “We can teach people to recognize the most catastrophic, unrealistic things they say to themselves when adversity strikes and to argue against the most catastrophic thoughts; realistically, to put them into perspective. This is a well-defined technique that’s been validated with tens-of-thousands of people in cognitive therapy procedures.” The US Department of Defense, in conjunction with the Veterans Administration, agrees. They list cognitive therapies with their top evidence-based interventions for PTSD.

 

Soldiers Together

Soldiers Together

New research (in-press) by Todd Kashdan and colleagues at George Mason University, however, showed that soldiers diagnosed with PTSD did not respond equally well to treatment, even to cognitive therapies that are considered most effective. Kashdan’s study analyzed the content of veterans’ most important strivings–the things they wanted to accomplish in their life. Strivings, Kashdan says, are “a compass directing people toward cherished interests and values across time,” the generally important plans or aspirations of a person, the important underpinnings of our personality, hopes, and dreams. An example of an approach striving would be, “I want to be a good father,” whereas an avoidance striving might be “I don’t want to lose my spouse.”

 

Unlike goals, a striving does not need to have an endpoint when it will be completed. Compared to those who have approach strivings, veterans diagnosed with PTSD who strived to avoid or who focused on improving emotional self-regulation did not become happier, despite allocating significant emotional, time, and financial resources toward achieving those things for which they strived and using evidence-based cognitive interventions to support their recovery. In this study, they also experienced less purpose, meaning and joy.

 

Routine Headscan

Routine Headscan

At the treatment level, there is now brain imaging that can identify regions of the brain affected by PTSD. Attention and memory abilities normally moderate the exaggerated fear response which accompanies reliving a trauma. These areas are underactive in the brains of PTSD sufferers. This pattern is also seen in patients without PTSD but with anxiety, irritability, depression or insomnia. More research needs to be done to see—literally—which treatments can alleviate PTSD symptoms.

 

Hopefully, teaching soldiers the skills of resilience before they are exposed to the traumas of warfare will prevent many incidences of PTSD. Army Chief of Staff Gen. George W. Casey Jr. asserts, “I firmly believe that this effort to build resilience and enhance performance is fundamentally necessary if we are going to sustain this force over the coming years.”

 

References
Kashdan, T.B., Breen, W.E., & Julian, T. (in press). Everyday strivings in combat veterans with posttraumatic stress disorder: Problems arise when avoidance and emotion regulation dominate. Behavior Therapy

Neergaard, L. (2009). Scans show PTSD effects: May prompt earlier diagnosis. Associated Press, November 10, 2009.

 

Images
Iraq (helicopters) courtesy of The U. S. Army
devil dogs (Marines getting ready for night in Iraq) courtesy of rcvernor
BCT me and liller courtesy of Katrina*Rey
Routine Head Scan on Me courtesy of Andrew Ciscel

15 Comments »

  • Darius says:

    Very interesting. Do you think it’s possible that all these resiliency preparations could be setting the soldiers up for PTSD? It almost seems like it could potentially cause the soldiers to expect PTSD to happen to them, thus making them more likely to have trauma after war.

  • Hi, Darius-
    I’m not sure why you are asking this, and no, I do not believe that resiliency training leads to the very things it sets out to prevent. (That would be pretty silly, don’t you think?)

    Soldiers already know that PTSD is a risk of warfare. With multiple deployments the risk is even greater. Soldiers have to be prepared to kill, die, or watch others die, after all. The military is pretty clear about that before you get to boot camp!! Comprehensive Soldier Fitness rounds out numerous prevention approaches used in the military to reduce and treat all sorts of stresses our armed forces experience. Do go to the links above for a more thorough discussion of what is included.
    –Sherri Fisher

  • Rose says:

    Dear Sherri Fisher,
    I think that is wonderful that the Army is implementing programs in resiliency training; to help soldiers prevent the possibilities of getting PTSD from fighting in Afghanistan or Iraq. Since many soldiers (you stated 1 in 5) face this when they return home to their families, which can be hard on the whole family not just the soldier. Since my best friend deals with his PTSD daily since her Army husband was in Afghanistan for a 6 months and he witnessed death. Will the Army also have programs to help families deal with the possibilities that their loved one may suffer from PTSD and how they can deal with those stresses in their loved one? Do you think certain people are more prone in getting PTSD? Say for example, an unhappy or depressed person versus a well rounded happy person? Or does it not matter who will suffer from PTSD?
    I enjoyed reading your article!
    Happy Thanksgiving!

  • Joseph says:

    Sherri,

    Please don’t be too quick to dismiss the criticism as absurd. The above poster is not the first to level that concern, and it’s grounded in experience and

    In particular, I speak of Critical Incident Stress Management. The idea of CISM, at least, was to quickly intervene after a trauma to help give victims a safe place to deal with and effectively compartmentalize issues. The reality, though, was that the treatment seemed to be ineffective or even iatrogenic. It wasn’t good to make people focus on the potential for a problem, however positively slanted. At least not at first.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC137400/?tool=pmcentrez

    More generally, there have been concerns over stress management techniques that have been in place already in the military, whether they would unduly focus people onto trauma either before or after the fact:

    [useful study: Battlemind debriefing and battlemind training as early interventions with soldiers returning from iraq: Randomization by platoon.
    Adler, Amy B.; Bliese, Paul D.; McGurk, Dennis; Hoge, Charles W.; Castro, Carl Andrew
    Journal of Consulting and Clinical Psychology. Vol 77(5), Oct 2009, 928-940.]

    The point is that just because a program has a positive intent or even a positive mindset, we can’t be so glib to simply assume a guarantee that results will follow in kind, and we certainly shouldn’t see silliness around those who replace that assumption with an inquiry. I for one find the question wholly appropriate.

    With that said, the response I would give to your question, Darius, is that I think that such concerns are at least being addressed here. The language and approach of this CSF program mirrors some of the earlier Battlemind program mentioned in the above study, and the study paper talks about Battlemind attempting to avoid such effects (and improve relative to existing methods of preparation/debriefing).

    Whether it’s ultimately effective, then, will depend on how well it’s deployed.
    Army culture can be extremely harsh in nature, and a top-down intervention of this sort will not necessarily triumph against such entrenched attitudes on the ground. But for now, I think in form it is a step in the right direction.

  • Joseph says:

    Small error in the first paragraph, my apologies. The last sentence should have ended with “and empirical data.”

  • Sarah says:

    Sherri,

    Interesting article! I definitely agree that if you prepare for what you will face that you will be able to cope with it better. Could you further explain the research on the brain after a traumatic event and what you mean when you say: “Attention and memory abilities normally moderate the exaggerated fear response which accompanies reliving a trauma”?

    Thank you!

    Sarah

  • Hi, Rose-
    Yes, the Army (and the rest of the military, too) has programs for the families of service members. Please check the links above for more about these programs. http://www.army.mil is a huge site full of information on Comprehensive Soldier Fitness and other programs. Many people, even those in the military, are not aware of the many opportunities available for them. CSF is brand new.

    There are many unknowns regarding PTSD. Are certain people more likely to develop it? We do not know, since we do not have routine brain scans or neuropsychological evaluations of everyone who is deployed. Chances are that the answer is partly yes, but we also know that more resilient people are able to overcome extreme challenges despite having many risk factors. See my May 2009 article for an example. http://positivepsychologynews.com/news/sherri-fisher/200905131894

  • Joseph-
    While supported by the top brass, Comprehensive Soldier Fitness is not a top-down intervention. It is being disseminated to NCO’s, each of whom will use it with their 10 enlisted reports. The “entrenched” behaviors of which you speak are most being directly addressed.

    This approach is similar to the dissemination of PRP in schools, which has successfully reduced depression by 1/3 in students who participate. There is very good reason to believe teaching a skill before it is needed, rather than debriefing after the fact or treating a disorder, is a better approach. There is no denying the PTSD happens. We need to look at many potential causes and their prevention.

    -Sherri

  • Hi, Sarah-

    You wanted to know more about this quotation: “Attention and memory abilities normally moderate the exaggerated fear response which accompanies reliving a trauma.” This is based on activity in MRI brain scans of PTSD patients.

    PTSD patients exaggerate their memory of the traumatic event and pay excruciating attention to it. It is like a super-intense surround-sound 3-D movie that you cannot turn off or walk out of. Worse still, the actors are often real people you know. MRI’s of patients show areas of the brain that contribute to (or perhaps cause, or perhaps are a result of) their symptoms.

    –Sherri

  • Jarrod Gadd says:

    Sheri,
    I found this article interesting because a colleague and I were discussing the possibilities in counseling veterans who were returning from war in Iraq and Afghanistan. The increasing numbers in PTSD are alarming and it seems like there need to be programs in place to deal with this growing problem. Your article points out that there is a push to see that this condition is treated seriously. It will be interesting to see the need for counselors experienced in positive psychology grow as the influx of veterans eventually make their way home.

  • Hi, Jarrod-
    The idea with Comprehensive Soldier Fitness is to develop resilience skills and prevent PTSD. Treatment is tricky, and as the recent research cited above (Kashdan, et. al.) indicates, cognitive-based treatments are not effective for all.

    A Google books search will lead you to titles devoted to PTSD treatment research, some published in the last few years, that I did not cite here.

    –Sherri

  • Shannon M. says:

    Hi Sheri,

    In your opinon, should treatmtent for these soldiers incorporate positve event sharing? (I read an article on supporitve responses by Shelly Gable) Do you think that this would be a realistic and effective method of enriching a soldier’s relationships with his/her loved ones? Lastly, could this benefit his/her recovery from PTSD?

    Thanks,

    Shannon M.

  • Hi, Shannon-
    Part of CSF is family-based. Do check out http://www.army.mil for more information.
    Positive event sharing (called capitalization) is not an intervention for treating PTSD but is a powerful relationship building tool. Positive Psychology is different from traditional psychology as it looks at what works and how to get more of that rather than treating things that can perhaps be prevented.

    You can search this site for more information about how Capitalization and Active Constructive Responding work to improve relationships.

    excerpt from http://positivepsychologynews.com/news/sherri-fisher/200901051280

    “Watch How You Respond

    Finally, practice Active Constructive Responding (ACR). For me, ACR is an antidote for disgust, too. Try to elicit something good recently experienced by the other person. Sharing good news is called “capitalizing”. Cultivate ways to say, “What’s new?” Try, “I heard that you had a very interesting vacation.” Be enthusiastically (fake it till you make it here) interested in the other person’s capitalizing. Instead of being annoyed by the person who goes on and on—It’s all about me!—listen for places to ask questions so that there is some give and take. In workshops I ask people to be in the ACR role for 5 whole minutes, so stick with it. Don’t fall into the trap of talking about yourself, or trying to one-up the other person. You’ll just be more irritated, and that’s not constructive. ACR makes the other person feel understood, validated and cared for. You’ll both like each other better!”

  • MK says:

    Hi,
    About this: “PTSD patients exaggerate their memory of the traumatic event and pay excruciating attention to it. It is like a super-intense surround-sound 3-D movie that you cannot turn off or walk out of. Worse still, the actors are often real people you know”

    I do not quite understand what is meant by ” exaggerating memory”, do you mean survivors of trauma, as one might call them, do not remember in the right way, make their memories of the trauma worse than it was? I have not been in a war-situation as such but have suffered of PTSD. I did not make the actual trauma worse or bigger, but I remembered it a lot of the time. I got the memories in situations that were not as dangerous as the actual trauma, but in other ways reminded me of it. I would also react as such.

    (Please let me also accentuate that it is not the reaction that is the problem, since it is a natural reaction on a unnatural, or dangerous situation. But it is right that soldiers need help as quickly as possible after trauma, so they need not suffer PTSD too long, or at all.)

    With kind regards, MK

  • Hi, MK-
    I think you have it right here:
    “I did not make the actual trauma worse or bigger, but I remembered it a lot of the time. I got the memories in situations that were not as dangerous as the actual trauma, but in other ways reminded me of it. I would also react as such.”
    One of the 17 symptoms of PTSD is the inability to manage recurring intense memories such that this interrupts thinking, feeling and everyday life. The suggestion in the article above is not that this is by choice, but that it is part of what defines the disorder. I hope that clarifies for you. I’m sorry that you suffer from PTSD and wonder about your thoughts on prevention versus treatment?

    –Sherri

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