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Home > Public Resources > Trauma Blog > 2016 - January > Retrospective Appraisals of Combat

Retrospective Appraisals of Combat

March 4, 2016

A life-threatening traumatic experience can cause physical and psychological distress, but it can also be remembered with pride from having demonstrated one’s courage and abilities under severe circumstances. Characteristics of the event, the role of the individual, as well as later personal reflection, together determine one’s long-term reaction to a traumatic event. We investigated how combat experiences and later reflections affect reports of posttraumatic stress and depression symptoms in 324 U.S. Army medics.

Few studies have taken into account specific military operational specialties when examining the effects of combat. Although two soldiers may both experience an attack on a convoy, an infantry soldier plays a more active role in engaging the enemy and returning fire, while a truck driver plays a more passive role in getting his truck away from the area safely. Army medics are unique in that their role requires that they perform passive duties, such as providing medical care to injured soldiers, as well as active duties, such as engaging in a firefight. These duties may overlap, as medics often provide combat casualty care on the battlefield. As such, medics are trained for and exposed to both potentially traumatic battle experiences and post-battle medical experiences.

We asked medics to complete surveys about deployment experiences, behavioral health symptoms, and other related factors, three months after returning from a combat deployment. The intensity of one’s battle experiences moderately predicted symptoms of post-traumatic stress but did not predict symptoms of depression. However, a closer examination of the data indicated two opposing mediators or “forces”—one which increased behavior health symptoms and one which decreased symptoms. One mediator was negative cognitive appraisals of threat to life, such as positive answers to questions such as “I was afraid I would encounter a mine or booby trap.” High scores on this measure were associated with greater reports of PTS and depression symptoms.  The other mediator was positive cognitive appraisals of the value of the deployment, such as acknowledgement of the statement “Overall this deployment has had a positive effect on my life.” High scores on this measure were associated with lesser reports of PTS and depression symptoms.  Essentially, the effects of these two underlying mediators cancelled each other out, so it appeared that combat experiences had only a moderate relationship with PTS symptoms and no relationship to depression. 

The underlying dynamics suggest two ways of dealing with the behavioral health consequences of combat. One way tries to help soldiers deal with the memories of the threatening nature of the event.  Another way may be to help them remember and appreciate the value of what they accomplished—e.g., they were brave and courageous, their unit accomplished its mission, etc. Emphasizing the positive outcomes of these experiences, while also acknowledging their traumatic and horrific nature, may reduce the negative effects of these experiences. Our findings warrant the further study of such interventions and their effect on behavioral health symptoms and treatment.

Discussion Questions 

  1. Here we studied two ways that one might remember combat experiences – one positive and one negative. What are some other ways to remember combat that may play a similar role?
  2. Do you think everyone recognizes positive effects of their combat experiences? What factors (individual differences) might play a role in one’s ability to see their experiences in a positive light?
  3. In what ways can a clinician emphasize the positives of combat experiences, while also acknowledging the negatives that the experiences entailed?

Reference Article

Pitts BL, Safer MA. Retrospective Appraisals Mediate the Effects of Combat Experiences on PTS and Depression Symptoms in U.S. Army Medics. Journal of Traumatic Stress. 2016;29(1):65-71.

Author Biographies 

Barbara L. Pitts, Ph.D. is an applied experimental psychologist and has contributed to research protocols with the Uniformed Services University of Health Sciences and the National Institutes of Health.
 
Martin A. Safer, Ph.D. is a Professor of Psychology, Catholic University of America, Washington, D.C., and has written multiple papers on emotion and memory.