Research Proposal on "Coping Mediates the Relationship Between Personality Traits and PTSD in Combat Veterans"

Research Proposal 18 pages (4919 words) Sources: 35 Style: APA

[EXCERPT] . . . .

Coping Mediates the Relationship Between Personality Traits and PTSD in Combat Veterans

The work of Solomon, Mikulincer and Avitzur (1988) entitled: "Coping, Locus of Control, Social Support and Combat-Related Posttraumatic Stress Disorder: A Prospective Study" states that participation puts soldiers "under intense pressures that can impair their functioning. The most widespread manifestation of psychopathology on the battlefield is combat stress reaction (CSR), also known as battle shock and battle fatigue." (Solomon, Mikulincer, and Avitzur, 1998) states that characteristics of CSR include: (1) psychomotor retardation; (2) withdrawal; (3) increased sympathetic activities; (4) stuttering; (5) confusion; (6) nausea; (7) vomiting; and (8) paranoid reactions. (p. 279) Stated as the most common element in "all of these varied manifestations" is the cease to function efficiency by soldiers in the military's view resulting in a potential endangerment to not only themselves but "their comrades" as well. (Ibid, p. 279) Locus of control is defined in the work of Solomon, Mikulincer and Avitzur (1998) as "internal when individuals tend to attribute environmental events to themselves and as external when individuals attribute such events to things outside their power." (p. 279) the internal locus of control is different from the external locus in that better health outcomes are associated with the internal "preventive behavior, efforts to improve functioning, and greater resistance to psychological dysfunctions." (Solomon, Mikulincer and Avitzur, 1998) Those who possess an external locus of control "express greater motivation to take inoculations, tend to use safety belts when driving, are more likely to have regular dental examinations, are more successful in weight reduction programs, and more often obey doctor's orders and persist in required medical treatment. (Ibid, p. 280)

It is related by Solomon, Mikulincer and Avitzur that in regards to mental health and locus of control that "people with internal locus of control suffered less from severe psychiatric disorders, especially from chronic depression." (Ibid, p. 280) Therefore, states Solomon, Mikulincer and Avitzur "In light of these findings, one could hypothesize that CSR casualties with internal locus of control, PTSD will be less severe than in casualties with external locus of control." (1998, p. 279) Coping is stated by Solomon, Mikulincer and Avitzur to consist of "the cognitions and behaviors that people use to assess and reduce stress and to moderate the tension that accompanies it." (1998, p. 279) in other words, coping states Solomon, Mikulincer and Avitzur is a behavior "designed to fill two functions: (1) a problem-focused function-channeling resources to solve the stress-creating problem with which they are dealing,; and (2) Personality types (1998, p. 279)

It has been stated in research findings that these two coping styles tend to be "combine[d] in according with the context and the specific problem with which they are dealing, as well as with their personalities." (Solomon, Mikulincer and Avitzur, 1998, p. 279) the optimal style of coping is comprised by "the largest possible repertoire of coping responses. Even if intrapsychic coping aids in maintaining emotional balance, the nonuse of problem-solving strategies will in the end have negative psychological outcomes." (1998, p. 280) Those experiencing depression have a tendency to utilize an "intrapsychic coping at the expense of instrumental coping" and in contrast, those who are generally health individuals tend to have a problem-solving coping style." (Solomon, Mikulincer and Avitzur, 1998, p. 280) it could be hypothesized, from this view that "among CSR casualties, a coping style that emphasizes problem-solving coping will be associated with the less PTSD, whereas a copy style that emphasizes intrapsychic coping will be associated with more severe PTSD." (Solomon, Mikulincer and Avitzur, 1998, p.280) Intrapsychic coping is defined as that which exists of takes place "within the mind or psyche." (the Free Dictionary, 2008) Intrapsychic is also stated to denote the "psychological dynamics that occur inside the mind without reference to the individuals exchanges with other persons or events." (Biology Online, 2008)

The intrapsychic benefits to patients are addressed in the work of Dr. Peter L. Giovacchini entitled: 'Intraspsychic Focus Can Have Lasting Benefits for Patients" published in the Psychiatric Times journal (1996) who states that psychiatry and psychoanalysis "have been drifting apart...in recent years" (p.1) the contribution of psychoanalysis is described as "unique...[in] its adherence to the belief that patients' behavior, attitudes, and feelings are meaningful even when they appear to be most irrational. The intrapsychic focus stresses unconscious motivation, which means that the causes of emotional disturbances frequently stem from inner sources. To some degree, it assumes that patients are the masters of their own destiny, that they are not just the hapless victims of cruel circumstances. This means that, in most instances, there is a potential for control and this leads to the hope that emotional equilibrium can be established." (Giovacchini, 1996, p.1)

Giovacchini states that the move away from the focus on the intrapsychic "takes us into the realm of biology and neurochemistry, areas that are making significant advances. Unfortunately this movement has led to a polarization between the inner workings of the mind form a psychological perspective and external traumas as they affect the brain. The brain and the mind have once again become separated, leading to a Cartesian dualism that in the past had been considered naive and anachronistic." (Giovacchini, 1996, p.1) the reduction of the focus upon intrapsychic study are linked with a "certain notable deterioration of Western civilization." (Giovacchini, 1996, p.2) Giovacchini states a belief that "Reflection, introspection, contemplation and even empathy have been shoved aside in favor of action which often escalates to violence. Ours is a materialistic concrete society, and our approaches to mental illness seem to be a reflection of the decline of values as exemplified by current mechanistic outlooks." (Giovachinni, 1996, p. 2)

The most common element among therapeutic approaches is stated by Giovacchini to be their lack of an intrapsychic focus. In fact, Giovacchini states that in many of the cognitive therapies "the intrapsychic is "assiduously avoided" (Giovacchini, 1996, p. 2) in views that are narrowly focused upon modification of behavior only. There are those who seek superficial quick fixes however, others seek to strike the problem's root before moving on to symptomatic adaptations. dealing with sensitive, vulnerable psyches that are immersed in misery and desperately seeking help. In many instances they are met with a mechanistic approach and formulaic procedures. dealing with sensitive, vulnerable psyches that are immersed in misery and desperately seeking help. In many instances they are met with a mechanistic approach and formulaic procedures." (Giovacchini, 1996, p. 1)

The example provided by Giovachinni of a man who will be referred to as "John" for the purpose of relating this case in this present study. John an individual nearing 30 years of age who was placed in the hospital due to auditory hallucinations that had become disruptive in nature. The truth was that John had been hearing these voices since he was an adolescent but didn't tell anyone. John lived alone and had "practically no social relationships" and bare minimum contact with an older brother who lived in a city far away. John was for the most part "isolated at work but highly respect...a wizard in programming computers...solving complicated technical problems...his employers would present him with a problem and then leave him alone until he solved it, which he invariably did." (Giovacchini, 1996-page 2) John initially saw a psychiatrist due to depression and finally confided that he was hearing voices and was placed on both an antidepressant and a phenothiazine, both of which had little effect on him." (Giovacchini, 1996, pg. 2) John did not follow the advice of the psychiatrist concerning socializing and life moved on "following a fixed routine and allowing no variability until he made a particularly important discovery.

When John's employer gave him a raise and promotion which meant that he would be more in contact with other employees and that those individuals would be his subordinates. Rather than feeling pleased with his achievements, he had a psychotic decompensation." (Giovacchini. 1996, pg, 2) the voices that had previously only "engaged him in conversation" turned "threatening and accusatory. They reviled him as being wicked and worthless and vowed that eventually they were going to tear him apart limb by limb. He suffered intense panic and had to be hospitalized." (Giovacchini, 1996, pg. 2) John was placed on a moderately heavy dose of Haldol, or haloperidol with the hallucinations completely disappearing and his mood stabilizing. Arrangements were made for John to see Dr. Giovachinni and during the first session, John "ironically remarked that he was cured, because that was what he was told at the hospital. He confirmed that he no longer heard voices, but, oddly enough, he wanted them back." (Giovacchini, 1996, pg, 2) it was learned by Giovachinni that John was the youngest child of elderly parents with an older brother already in college when he was very young and that he had no companionship and thereby had not developed social skills. Since John was miserable due to missing the voices Dr. Giovachinni discontinued his use of Haldol and the voices returned… READ MORE

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