A little paper I wrote for school.
PTSD as it is now commonly known is one of the most prolific
ailments that is coming out of the global war on terrorism. Combat
PTSD, is a very difficult emotional and behavioral problem to overcome
due to the high level of stress and emotional response associated with
the actions. A large population of veterans are given medication and
simply told to give it time and they will overcome it, time is not
always on their side as evidenced by the climbing suicide rates.
However, there is another school of thought among the veterans that
focuses on behavior modification through a combination of operant
conditioning and immersion therapy. We will begin by examining two
learning theories concerned with the behavior modification before
attempting to apply one of them towards behavior modification. B.F.
Skinner’s learning theory of behaviorism and Albert Bandura’s social
cognitive learning theory are the two theories with which we will be
primarily concerned.
B.F. Skinner introduced the learning theory of behaviorism early in
his career but it continued to develop throughout his life. He states
that it is through reinforcement both negative and positive that the
desired behavior is learned or reinforced. An action followed by a
reward is more likely to occur again rather than if it were followed by
a punishment. He states that punishment is for suppressing behavior
rather than reinforcing it. This introduction of either a positive of
negative stimuli in response to a behavior is called Operant
Conditioning. Skinner understood that this did not completely explain
human learning however he stated that the rest was immeasurable and
should be avoided. (Maisto, 2004, p. 184). Albert Bandura’s theory of
social cognitive learning involves modeling. Modeling is where
something is learned by watching others perform the action, it is also
known as observational learning. The process involves three components:
the behavior, the person, and the environment. These 3 components
operate interconnected to a summed result. Cognitive learning is a more
complicated theory considering more of the intricacies of the human
brain. (Santrock, 2010, p.26). It holds that a person can learn
something without ever performing the task and then recall it a later
time. One example that was given in Dr. Schoger’s lecture was that of a
person seeing how to use a gun on TV and then when their life depended
on it they were able to operate the weapon without ever having touched
one before, this would be impossible through Skinner’s theory. These
theories seem to have several things in common on the surface but as
you delve deeper into the theory the divergence becomes more and more
clear.
These theories are both learning theories and are both based in the
scientific method. They both search for quantative information within
the realm of learning. Both rely heavily on the environment as a factor
in the learning and development process. However, Skinner’s theory does
not contain the concepts of free-will, cognition, feeling, and
motivation, they were thought of us unobservable. He once referred to
these attributes as “psychology’s black box’ meaning that once it had
been opened it could never be closed or fully measured. Bandura’s
theory embraced these attributes as necessary and essential to learning
(Dr. Schoger, Learning Theory Lecture, 2010). Bandura focused more on
cognition and the internal thought processes that would be necessary to
learn from observation. Bandura however doesn’t focus on any form of
reinforcement or punishment but simply the cognition of learning. Both
theories receive criticism for failing to focus on developmental stages
(Santrock, 2010, p.26).
To understand how to change a behavior, the cause and method of
instruction must first be understood. PTSD is defined by the Veteran
Affairs Office PTSD Department (2010) as, “Posttraumatic stress
disorder (PTSD) is an anxiety disorder that can occur after you have
been through a traumatic event. A traumatic event is something horrible
and scary that you see or that happens to you. During this type of
event, you think that your life or others’ lives are in danger. You may
feel afraid or feel that you have no control over what is happening.” A
soldier is trained to kill this is a known fact. Soldiers have their
social norms and preconceptions about right and wrong removed during
basic training and become more able to take a human life. In combat a
soldier’s survival skills are pushed to the limits, they become more
alert and vigilant. The constant strain and dependency on their senses
lead to a state of heightened awareness. After several years in combat
a soldier’s mind and body are in over-drive, processing information and
seeing warning signs that most people are completely oblivious too.
Chemical precursors to the body’s stress chemicals are present in their
bodies at much higher rates than in a normal well-adjusted person.
(Mount Sinai Psychiatry, 2010) This helps the soldier to survive, but
what happens when they come home. They are aggressive, angry, depressed
by the loss of friends, guilty because they survived, and overall
unable to fit back into society. The trauma that is witnessed goes
beyond what most can imagine. Either through personal fear for life and
limb or through the trauma of watching friends die or become wounded.
These wounds are buried deep and leave a strictly regimented system of
responses in their wake. Responses like adrenaline rushes, panic
attacks, involuntary physical strikes, trained reactions with weapons,
physical actions in response to loud noises e.g. taking cover,
involuntary eye fixation e.g. scanning the road while driving, and the
myriad of other symptoms continues uniquely defined to a soldier’s
personal experience. These are simple yet deeply ingrained responses
making them very difficult to retrain and remove.
There are many behaviors associated with combat PTSD, we will focus
on one simple symptom for modification. The constant desire of a
veteran suffering from PTSD to monitor his surroundings in public
places is the behavior we will attempt to modify. This is not a typical
glance around the room, but a focused and driven mental process that
has become so habitual and ritualized that it must be constantly
maintained to prevent a panic attack. Combat PTSD suffers tend to look
for weapons, methods of egress and ingress, they will role play combat
actions to escape a room, and some go as far as to try to find weapons
sub-consciously. It is common for these veterans to find their steak
knife in their right hand under the table with no idea how they got it.
Through the use of a simple rewards and punishment system, behavior
modification will be attempted on the subject. The veteran will be
placed in a compromised position with his back to the room and to the
door. This will make the veteran subject very uncomfortable and the
desire to turn and survey his surroundings will be immense and at first
nearly impossible to deny. These lessons to constantly monitor their
surroundings have been written into their habitual system in blood and
pain. They are not mere suggestions to a soldier but some of the most
basic survival skills in combat. Through the use of operant condition
the veteran’s behavior will hopefully undergo modification. The
positive stimuli that will be used will be a reward, the veteran’s
beverage of choice e.g. beer. The negative stimuli will be a rubber
band smack across the wrist. The veteran will wear this rubber band
during the training session and the accompanying person will deliver a
negative stimulus for each time the veteran subject turns their head to
either look at the door or the room. A fix-ratio schedule of reward
will be implemented to prevent fast extinction of the learned behavior.
For every fifteen minutes that the veteran is able to maintain eye
contact with the accompanying person he will be rewarded with his
beverage of choice. As the veteran’s ability to maintain the eye
contact improves the schedule for reward will continue to be prolonged
in increments of 15 minutes. This is an example of a fixed rate
schedule of reward, B.F. Skinner describes this in, A Brief Survey of Operant Behavior,
“If a response is reinforced when a given number of responses has been
emitted, the rat responds more and more rapidly as the required number
is approached. (That is a fixed-ratio schedule of reinforcement.) The
number can be increased by easy stages up to a very high value; the rat
will continue to respond even though a response is only very rarely
reinforced. “Piece-rate pay” in industry is an example of a
fixed-ratio schedule, and employers are sometimes tempted to “stretch”
it by increasing the amount of work required for each unit of
payment.”As an added negative stimulus, if the veteran looks away for a
prolonged period of time some of his beverage will be removed from his
glass until he returns his focus to the proper alignment. This will
ensure that the subject will pay the proper attention to the negative
stimuli. This is necessary due to combat veteran’s commonly high
threshold for pain to prevent actual injury. The end state goal is for
the veteran to be able to maintain eye contact for the duration of a
meal or conversation without the reinforcement of either the positive
stimulus or the suppression of incorrect behavior through the use of
negative stimuli.
Skinner and Bandura are both considered the father’s of their
respective fields. Skinner’s behaviorism and the more popular social
cognitive learning theory of Bandura have both been increasingly
influential on the entire field of human development and learning.
Their theories have contributed greatly to the progression of
understanding learning. PTSD is an incredibly complicated disorder,
which I have very much over simplified for the purposes of this paper.
It is a daily struggle for many veterans and trauma survivors. I know
because I fight it every day and face it every night in my sleep. I
tongue in cheek poke fun at it, but with such a daunting disorder what
else is there to do but laugh at it and with it.
Maisto, Albert A., and Charles G. Morris. “Learning.”Psychology: An Introduction (12th Edition). 12 ed. Alexandria, VA: Prentice Hall, 2004. 184-186. Print.
“Mount Sinai – Department of Psychiatry.” Mount Sinai Medical School – Home. N.p., n.d. Web. 9 June 2010. http://www.mymsonsitehealth.net/psychiatry/tssp/studiesandfindings.shtml
Santrock, John. “Theories of Development.” A Topical Approach to Lifespan Development. 5 ed. New York City: McGraw-Hill Humanities/Social Sciences/Languages, 2009. 25-26. Print.
Dr. Schoger, Kimberly. Lecture, “Learning Theories”. 3 June 2010.
Skinner, B.F.. “B.F. Skinner Foundation – A Brief Survey of Operant Behavior.” B.F. Skinner Foundation. N.p., n.d. Web. 9 June 2010. <http://www.bfskinner.org/BFSkinner>
U.S. Department of Veteran Affairs. (2010, May 18). What is PTSD?. National Center for PTSD. (2010, Jun 8). http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp
Wilden, Daniel. ” The Room Assessment.” The Jolly Roger | Ensuring that no Veteran is left behind . N.p., 14 Feb. 2010. Web. 9 June 2010. <http://jollyrogertoolbox.com>