Following the September 11th terrorist attacks, over twenty percent of military personnel who served in the wars of Afghanistan and Iraq, suffer from Post-Traumatic Stress Disorder (PTSD).  Low quality of life and functioning that has become impaired are associated with PTSD. There are several factors which represent targets for treatment of PTSD, and it is first important, to understand exactly what factors contribute to the disorder. Not just the development but also included must be the maintenance of it. Bringing substantial attention to the construct of PTSD is the Acceptance and Commitment Therapy (ACT). ACT Conceptualizes psychological inflexibility as the overwhelming factor of supremacy of psychological responses to unwanted internal experiences over contextual influences and individual lives principles in directing behavior (Meyer, E. 2019).

The PTSD epidemic is becoming more and more wide spread across America and amongst military veterans as the number of veterans returning home from various wars and conflicts continues to grow daily after over a decade of battle (Clark, A. 2012).  Veterans are increasingly exposed to traumas which could impact them for life, in addition to are at a higher risk for mental health disorders as well as finding it difficult to reintegrate back into the family dynamics.  Those who have served in Afghanistan and Iraq following the September 11, 2001 attacks on U.S. soil, a growing twenty three percent veterans have been diagnosed with having PTSD symptoms.  The symptoms of PTSD are connected to a low quality of life and impaired functioning (Meyer).

Directly correlated with developing PTSD is combat exposure.  Not standing alone, veterans of Operation Enduring Freedom and Operation Iraqi Freedom, also suffer and are at risk to a mix of other conditions such as depression and psychological distress (Clark, 2012).  In addition to those, veterans suffering from PTSD may also experience a higher level of divorce, problems staying and keeping relationships, physical and verbal aggression. 

Although a vast majority of PTSD risk factors have been acknowledged, none have readily been identified with a potential treatment attached to it.  Thus, it has become even more critical that we understand and put a face to what truly causes PTSD, and how to possibly lean forward in the saddle and discover or create ways to prevent it from occurring versus how to treat it.

The way to go about doing this is to apply the Big Five personality traits and investigate if PTSD develops only during experiencing war or if it is already something which may be inside of veterans even before they go off to war.  Throughout this proposal I will investigate which traits from the big-five model as motivational factors to veterans developing PTSD from the aftermath of war experiences.

As we take a deeper look into the big-five personality theories and how it relates to PTST, we have to first isolate extraversion.  With extraversion or even extroversion, simulates both war experiences and post experiences from battle and reintegration that consequently weakens through associations but simultaneously strengthen from extraversions levels increasing (Caska, C. 2013).  Furthermore, the correlation between post war and PTSD is moderate throughout the big-five, while relation was weaker at higher level of conscientiousness, openness, and agreeableness, but possibly lower with neuroticism.

What I hope to uncover is that, a veterans personality trait pre-war, is a direct response to war trauma, especially as it relates to the fight or flight mentality.  Personality traits are a very important factor to consider in how people respond to trauma.  Their beliefs, values and insecurities, pre-war can manifest itself to post war and ultimately be the driving determination which leads to PTSD and how veterans may respond to traumatic events (Caska).

The reason why a proposal such as this is of ever most importance, since 2001 over ninety five percent of veterans have reported being exposed to war experiences such as motor attacks, firing at an enemy with the intent to kill, and also being shot at themselves. This does not take into account those who have not only experienced the before mentioned things but also reporting being exposed to refugees and devastated communities.  All of these type of war experiences are directly responsible for veterans developing PTSD.

Due to this notion, there has become an even greater need to understand the mental state of military personnel before they head off to war.  Understanding the risk they are facing with the level of resilience they possess.  This all encompasses the personality traits that military personnel has currently instilled within them and that is where the big-five comes into play.  Normal personality traits, as stated by experts, who possess a vast range of highly qualified experience and many decades of research and analysis, rest within the dimensions of openness, conscientiousness, extraversion, neuroticism, and agreeableness (Caska). 

1. Openness – One who has an attention to their internal emotions, an active imagination, many and varied opinions and things that interest them, an appreciation for aesthetics, and finally a curiosity that is intellectually driven.
2. Conscientiousness – Consisting of organization, follow-through, competence, deliberation, efficiency, and striving.
3. Extraversion – The tendency to experience and seek out positive emotions.  Factors representing a warmth level, assertiveness, gregariousness, and excitement seeking. 
4. Agreeableness – Not able to be willing to trust nor forgive.  Possessing straightforwardness, a level of cooperation, modesty, altruism, and sensitivity towards others.
5. Neuroticism – Consist of elements representing levels of hostility, tension, impulsiveness, anxiety, a vulnerability to stress, and lack of self-consciousness.

            Throughout this grant proposal we will research if those preexisting big-five personalities in veterans before they go to war, play a significant or miniscule role in those that return home with PTSD symptoms versus those who return from war not displaying any PTSD symptoms.  Research after research has been currently done into what PTSD is and that the results of veterans returning from war whom has been diagnosed with PTSD or various other mental disorders, directly is contributed to various trauma they experienced.  The missing research is, if due to their upbringing and previous instilled beliefs, morals, and values, that forms their personality plays a bigger role in them developing PTSD then simply the trauma they experienced during war.

            The five-factor model of personality, is to date the most reliable model of personality, which has been established across all humanities. Furthermore, as the heritability of its dimensions, the Big Five personality theory appears to be substantial and has both a genetic and physiological basis (Jaksic, N. 2012).  As a dimension of the differences amongst individuals within the tendencies to show patterns of consistency of feelings, actions, and thoughts across context and developmental periods is what personality traits are traditionally conceptualized (Jaksic, 2012). 

            Over the decades of study and research on personality, there has been a tremendous amount of emphasis placed on the boundary between psychopathology and personality, to include PTSD.  In the case of PTSD, the Big Five makes the assumption that there are numerous differences between the personality structures as it regards to its resilience to mental disorders (Jaksic, 2012).  Researchers have even suggested, having both indirect and direct effects, personality traits and the development of psychological symptoms.  Symptoms with direct influence of personality traits, externalizing and internalizing symptoms within the aftermath of the stress of a traumatic event, to include the indirect influence of personality from combat contact (Koffel, E. 2016). 

            The correlation between the Big Five and PTSD consist of three applicable steps in the psychotraumatization procedure.  These three steps are; abnormal reactions and traumatic events, possible deficits in personality functioning and structure, and exposure to stressful situations (Jaksic, 2012).  Veterans who show signs of being on the extreme vulnerability end of the spectrum, a lesser amount of trauma is needed for mental distress to show up.  On the other hand, while resilient veterans must experience a lot more severe combat trauma before the develop PTSD or some form of mental illness.  Affective dispositions is linked to personality.  In addition to that, personality is also linked to its role in the etiology of psychopathology, and also the biochemical and structural system in the brain (Jaksic, 2012).  This is done while options for treatment must be focused on aiding veterans utilized their personality strengths and resources to promote a stronger resilient individual and also develop personal well-being. 

            Symptoms at the baseline, displayed significant indirect and direct effects on post-deployment symptoms.  Due to this, trying to control both symptoms and pre-exposure personality, majority of veterans who had combat experiences remained positively associated to both externalizing and internalizing symptoms.  In conclusion, the repetitive correlation with PTSD is positively related to negative emotions.  In addition to that negative emotion, PTSD is also positively related to self-transcendence, harm avoidance, trait anxiety, and hostility and anger.  On the other side of this model is that PTSD is then negatively associated with traits from the Big Five, such as conscientiousness and extraversion, along with the combination of high positive and low negative emotions. 

            Through all the research conducted on the Big Five, it continues to be suggested across a wide range of psychologist, that both environmental and biological influences have a huge role in personality shaping.  In addition to that, nature versus nurture also play a significant role in the development of all the personality factors of the Big Five (Cherry, K. 2019).  It is significant to constantly remember that behavior itself correlates the relationship between the underlying personality of an individual and variables derived from certain situations.  How an individual reacts, is often based on the situation they find themselves in (Kandler, C. 2015).  The caveat to this is that in most cases an individual’s reaction to those situations are subconsciously due to their pre-existing personality development which if their emotions are positive could migrate in to no change in mental disorders, while on the other hand, if the reaction is that of a negative emotion could lead to PTSD symptoms as well as depression and other behavioral and mental disorders. 

Proposed Study

Participants:

            40 current and former military Service Members (SM) will be selected from a wide variety of ages, ethnicity, demographics, sex and race.  The ages will range from 20-50, in order to capture those with military careers as short as three years to those with twenty-year careers.  All selected service members will come from those who were directly involved in the wars and conflicts of Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF).  The ages and demographics are broken down as follows. 

Age Groups: 20-27 / 28-35 / 36-42 / 43-50  

Numbers: 10 (SM)

Demographics: Washington, DC / Detroit, MI / San Diego, CA / Atlanta, GA     

            In addition to this, we will study an additional ten members of local law enforcement, who have not been in the military but has face some form of trauma while serving in the line of duty.

Each group will be assigned a mental health physician from Fort Belvoir Community Hospital, in northern Virginia, on the Fort Belvoir Military Installation.  Each age group will subsequently be broken into half, with one half of the group receiving resilience training from a military professional first, and then shown a video of what a mental health disorder is facilitated by a civilian therapist.  While the other half receives the mental health video first, then followed by the resilience training. 

            This type of testing could prove to be both a proper diagnoses of Post-Traumatic Stress Disorder (PTSD) or prove to be that a service member was improperly diagnosed and simply may be suffering from depression and loneliness.  In either case there are protocols and treatment procedures readily available for everyone involved in the study.

Procedures:

            Each participant will be given a three-part diagnosis exam as follows;

1. Perform a physical exam to check for medical problem that may be causing the symptoms.
2. Do a psychological evaluation which includes a discussion of signs and symptoms, also to include questions on the trauma that they believed led to those signs and symptoms.
3. Evaluate and make recommendation utilizing the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), authored by the American Psychiatric Association.

Those that continue to show signs and symptoms of having PTSD will then be selected to receive further treatment and have another test performed.  In addition, statistical analysis will be documented based on the groups who received the resilience training and their reluctance on committing to having PTSD or just experiencing a feeling of depression and loneliness versus the group who received the PTSD video first. 

Hypotheses & Analysis:

            The demographics of those who continue to show signs of having PTSD symptoms, should come from those who experienced or witnessed a fellow SM die in front of them or, was in close contact in exchanging gun fire with the enemy during OEF/OIF conflict.  This is very likely to come from the population of 20-27 year old, coming from well to do family history, who before joining the military, were limited or had zero experience with trauma, death, setbacks, or failures, but also having less than five years serving in the military.

            Specific cognitive assessments will be made to those who came in as having symptoms of PTSD, but now no longer display those same symptoms and understand what factors in their personal life drove them to be misdiagnosis at their local Veterans Administration Hospital (VA).  The hopes is to find a correlation, or rather disconnect between, SM, VA, and need for establishing a baseline for disability compensation.

            Likewise, the control group which came in displaying zero signs of PTSD, but now show symptoms, being because their control was presented with the PTSD video first, which in turn birth the idea of them having symptoms.  This is expected to be identified more in the 53-50-year-old control group. 

            Each participant must complete the entire week process in order to receive follow treatment and testing.  The willingness for each participant to be forth coming and truthful about their level of depression based on the trauma of war and conflict they experienced.  SM, who are at or close to retirement age who have a pre-diagnosis of showing signs of PTSD may be reluctant to answer truthful due to the possibility of losing potential VA benefits.  By having skilled and experienced researchers, psychiatrist and mental health specialist on staff will prove invaluable in receiving hones feedback.

Budget Justification

            Funding is requested to fill three full-time positions, which consist of a top mental health provider, highly experienced psychiatrist, as well as a research data analysis.  An additional resource is requested for a high-ranking military official to oversee the protection of data collected and be responsible for communicating the results publicly.

            Travel funding is requested, for participants to travel from the four demographic areas to Fort Belvoir, VA.  In addition, a stipend of $100 per day is requested for each participant. 

            See Appendix A: Budget for detailed budget figures.