Can PTSD Be Prevented Through Education?post-traumatic stress disorder (PTSD) or combat stress after continuous fighting, but most recover—especially if they make use of pre-combat psychological education programs. Having spent the past seven-plus years assisting psychologists, military commanders, and combat veterans with PTSD-associated issues, I hope now to assist in the prevention of PTSD through education. My book Surviving Combat: Mentally and Physically (Twentynine Palms, CA: U.S. Marine Corps, 2007) is the basis of four-hour pre-combat seminars. The American Psychiatric Association defines PTSD as a severe anxiety reaction to a traumatic event such as rape or war. Those who suffer from it repeatedly relive the event, avoid stimuli associated with the trauma, and experience symptoms such as difficulty sleeping and irritability. Typically these reactions develop shortly after the event, but may take years and last at least one month.
But if we educate combatants before they enter the theater, through lectures about the psychological and physiological effects of combat, much of the self-induced stress can be reduced. For example, many were raised hearing the commandment “Thou shalt not kill” (Exodus 20:13). A Marines’ bible would have put this as “thou shall not murder,” meaning kill someone unjustifiably. Educational efforts must be reinforced during and after combat to be truly effective. However, PTSD cannot be totally eliminated for all combat troops.
Case studies aside, the military needs to use scientific methods to gather data on the effects of pre-combat psychological training. The initial phases of research such as this can be easily accomplished within the military community, even though some subjects may drop out as years pass, due to death or unwillingness to continue participating. A longitudinal study (which ascertains causes of inner changes in one person, several individuals, or groups; it is considered ideal for studying age-related human behavior) can be valuable for future generations of combat troops, in particular the Minnesota Multiphasic Personality Inventory (MMPI-2), because it is already the most often used psychological test for military PTSD clients.
Gold Standard Test for PTSD
The MMPI and its updated versions have been used for more than 70 years. The series is useful for many types of psychological issues, with MMPI-2 most often used by military psychologists when attempting to detect PTSD symptoms despite its length. Designed with 567 questions, it is the longest of all commonly used personality inventories. It was developed for psychiatric, not medical patients, but MMPI-2 is not a panacea. It is only a tool to help psychologists assess problems. Once a possible PTSD victim is identified, doctors may use the MMPI-2 to ensure the patient is not feigning the disorder.
Ethics, Research, and Procedures
Some unit commanders try to ensure that their warriors are psychologically trained to help prevent PTSD, while others do not make this effort. For clinicians, the fear of potentially harming patients by attaching to them diagnostic labels has made many cautious. There are also ethical concerns in terms of using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), such as the accurate assessment clients.
To address the question of whether PTSD can be prevented through proper education, new troops could be administered the MMPI-2 before entering combat. They would need to be randomly selected for the test and control groups. One battalion (infantry) could be given extensive pre-combat psychological education, while the control group (another infantry battalion) could receive no more than the mandatory pre-deployment psychological training. It would be imperative that both battalions be sent into the same area for combat operations, at the same time, in an attempt to ensure they have similar experiences.
This study could be easily conducted and relatively cheap. U.S. Navy psychologists could administer the MMPI-2 to all troops both before and after combat, as well as periodically throughout their lives. The major assumption would be that warriors who received pre-combat psychological training would be less likely to show signs of PTSD than those who did not. Such a study would determine what percentages of warriors were diagnosed with PTSD from each group (control and experimental) after combat; they could be tested 90-180 days after returning home and again six months later; this should identify most of the initial cases.
The independent variable of this study would be combat itself, the dependent variable being the level of pre-combat psychological training received. Measuring both would not be difficult. The research requires a range of greater than 200 and less than 300 per group. A possible testing schedule could begin three to six months before deployment and then, following deployment, tests could be repeated at:
• 3 to 6 months
• 2 years
• 5 years
• 10 years
• 20 years
Privacy, Authorizations, Limitations
A study such as this would, of course, require authorization from Headquarters Marine Corps, but the formal gatekeeper would be the U.S. Navy psychology department at Bethesda Naval Hospital, which could manage the entire study. Due to the sensitivity of the information gathered, there would be no interaction with informal gatekeepers at the other locations, including Camp Lejeune, North Carolina; and the Department of Veterans Affairs. Although the two battalions would be from Lejeune, the data would be sent to Bethesda for analysis.
A database would be created and maintained by the psychology department at Bethesda, where the data would be sent via secure networks after the MMPI-2 was administered at Lejeune. As the years went on, the MMPI-2 could be administered at various military bases and VA locations (because participants would be transferred to other bases or discharged from the Marine Corps), and, again, sent to Bethesda.
All data would be secured on the military’s secret computers and networks; this is common practice with sensitive information. The psychology department is trained to analyze and interpret all MMPI-2 information. Due to the nature of this test, there is little chance of any bias issues.
A serious, in-depth, long-term research project such as this has the potential to change the way combat troops are trained. If new procedures are implemented as a result of it, commanders will not have as much latitude as they do now when it comes to pre-combat training. Instead of concentrating solely on destroying the enemy and his will to fight, we will also train warriors to survive the psychological effects of combat. There has never been a longitudinal study done on PTSD, but a plethora of case studies point to its being viable.
We must nurture the warriors’ spirit. We must train to kill—the willingness to kill when needed (not want to kill, but be willing to kill)—and we must be willing to face the consequences. Combat is of such emotional intensity that strange elations can come from the act of killing, and those suffering from PTSD need our ongoing—as well as preemptive—help with this reality. Opponents pit themselves against each other with the certain knowledge that one will be vanquished and one victorious. It is in the topsy-turvy world of war, where violence provides a chance to live another day, that the combatant must be on guard to preserve his own morality.
Sergeant Major Devaney serves as the battalion weapons trainer at Marine Corps Base Quantico, Virginia. He holds a B.S. in social psychology and has spoken at venues around the world about preventing PTSD through education. With most of his career involved in counterterrorism operations, he has served four tours in support of Operation Iraqi Freedom. He is a member of the Naval Institute’s editorial board.
Outmaneuvering Terrorist Communications
Today’s asymmetric adversaries use a variety of approaches to shape attitudes and behaviors of noncombatants and opinions of foreign observers.1 Because of the ease with which almost anyone can communicate, events are increasingly being reported in the “now.” This means the information is often unfiltered, raw, and generally presented out of context. Technology has become a significant factor in influencing U.S. foreign policy and defense planning.
As analyst Carsten Bockstette puts it, our enemies use the same marketing techniques as we do.
While some propaganda messages are intended for a broad audience, the majority are tailored to a particular group. . . . The terrorists select and segment the strategically desired target audience, the transmitting medium, and the targets for destruction. They determine the location and timing of the actions to satisfy media criteria for newsworthiness that fit in with the media’s deadlines and news cycles in order to effectively reach the desired audience.2
Effective communication must use all available means to convey messages that will resonate with an intended audience. As adversaries seek to defeat and discredit U.S. forces through acts such as terrorism and misinformation, our strategic communication efforts must counter their efforts with themes that isolate and marginalize their messages. Words, deeds, and actions coming from the Unites States and its allies must align so that the intended audience perceives them as being credible. Strategic communication is the key to achieving that objective.
The Process of Communicating
The challenge is to instill in the U.S. military an understanding of strategic-communication best practices. If we want the intended audience to perceive the message we wish to send, we must enhance our understanding of global populations’ diverse concerns. It is equally essential that we commit to engaging these populations through new and diversified media channels.
The process of strategic communication needs to be institutionalized, then incorporated into the development of policy, operations planning, training, and exercises. When common goals and objectives are spelled out, better interagency coordination can begin. Further, this effort should be understood to include all aspects of communication: public affairs, information operations (including psychological operations), military support of public diplomacy, key leader engagements, visual information, and all forms of emerging media (Short Message Service, Multimedia Messaging Service, mobile telephones, blogs, and Internet-based social websites).
In general, a strategic communication process includes the following basic steps.
• Establish communication goals based on strategic guidance and desired results.
• Conduct a target-audience analysis.
• Analyze communication infrastructure.
• Develop and execute the strategic-communication management plan.
• Evaluate and provide feedback and message correction.
Strategic Guidance Toward Specific Results
Strategic guidance and the operationally defined desired result drive the development of the plan. Strategic communication needs to synchronize actions, images, and words. As the operational planning process begins for an area of conflict, it is important to have messages firmly grounded in knowledge of the plans and desired results. The communication must be written using terminology common to joint forces and U.S. government agencies. To achieve credibility, the campaign must be designed to be effects-based, relevant, culturally attuned, and able to use all available media to communicate the message.
Borrowing from the world of marketing, the plan must be built on a comprehensive target-audience analysis. A firm, fact-based study establishes the foundation for developing strategic messages that build credibility within the intended audience. Usually information for this analysis is gathered through surveys, focus groups, and historical data. Aside from providing demographic data such as education, ethnicity, and gender, it also identifies what is important to the populace. Further, the analysis can be used as a database to foster a better understanding of the audience’s media-consumption habits and serve as a tool for accurate predictions.
From this baseline, the team can gauge opinion shifts and behavior changes throughout the campaign. Feedback and monitoring efforts must remain aligned along operational objectives and remain flexible enough for campaign focus shifts and data-analysis conclusions.
Each theme or message must be developed with a keen understanding of the local language, religion, social norms, regional history, and culture. Each communication effort (campaign, product, or message) must consider the audience, central theme, the reasons for which this specific audience has been identified, actions we hope these people will take as a result of our campaign, and what behavior we expect as an outcome. The final step is to measure campaign performance and effectiveness.
Communications Infrastructure Analysis
The purpose of conducting an analysis of the communications infrastructure is to identify the most effective means to communicate with the audience and then develop a plan that not only uses it but also measures its effectiveness. Message dissemination should be calculated to maximize reach to the audience and achieve optimum influence.
The plan should include dissemination with thought given to the political tendencies of the media outlet (liberal, conservative, radical, or neutral), audience demographics, peak listening and viewing times, cultural factors, and polling and focus-group feedback and cost. Consideration must also be given to potential message-spillover effects, secondary and tertiary audiences, and the consequences of messages being received by an unintended audience.
Beginning with an understanding of the overall mission focus or area of influence, the strategic communicator develops messaging that supports those. The mission drives the message, but the strategic-communication effort facilitates audience understanding of that message. Each product or message is developed to be used as a stand-alone influencer, but also to support larger campaigns.
Strategic communication should have a two-layered approach. The first (long-term campaign) consists of complementary and varied products designed to provide a baseline constant of core themes and messages. The second addresses a rapid-reaction capacity. While sharing the same core themes and messages as the long-term campaign, this layer has the capability of responding quickly to events so that the adversary has little time to place his messages in the media space—which our strategic themes will dominate.
Like ours, enemy messaging and strategic-communication efforts will persist. However, with careful planning its impact among the target audiences will be minimized. Positive events such as business openings, school openings, success stories among vulnerable populations (youth, women, ethnic minorities) all have the essential elements for furthering positive strategic communication. We must use them as appropriate to further influence attitudes and behaviors.
Evaluating and Correcting the Message
Based on campaign goals and operational guidance, strategic communication needs to assess performance and effectiveness. The timing of this assessment is based on access to operational data and atmospheric information collected about the audience. At a minimum, message effectiveness should be assessed at the mid-campaign point and again at the end.
To measure performance, the team must ensure it has met all dissemination date requirements and ensured the means were appropriate for the audience. The team needs to have achieved 100 percent of scheduled broadcastings or publishing.
To measure effectiveness, the strategic-communication team uses, at a minimum, polling and focus groups as a basis to assess measurable changes in target-audience perceptions and behavior. These key data points (if combined with a comprehensive product dissemination matrix) allow the team to develop a trend analysis. Based on the information gathered from all available sources, messages can be adjusted or the communication method changed to achieve stated goals. The feedback mechanism is indispensible: It identifies why certain messages resonate with target audiences, producing attitude and behavior shifts.
As our military campaigns have matured in Afghanistan and Iraq, many lessons learned are now becoming doctrine or being used as validation of effective procedures on the ground. As reported in the Multinational Force-Iraq (MNF-I) Strategic Communication Best Practices 2007–2008, “MNF-I instituted sweeping changes in its approach to and conduct of strategic communication.”3 Our messages, broadcast in the local language, using images with which the people identify, and capitalizing on our knowledge of cultural nuances, will have a greater impact on the population. By capitalizing on these techniques, our messages will carry more credibility and be more difficult to discredit.
2. Carsten Bockstette, “Jihadist Terrorist Use of Strategic Communication Management Techniques,” George C. Marshall European Center for Security Studies, occasional paper series, December 2008, p. 18.
3. Bradford H. Baylor, project lead, “Multinational Force-Iraq (MNF-I) Strategic Communication Best Practices 2007-2008,” USJFCOM Joint Center for Operational Analysis, p. 1.
Strong Partnerships Need Secure Communications
Developments along the Korean peninsula highlight the imperative for a strong antisubmarine warfare capability.1 The March 2010 sinking of the ROKS Cheonan, with 46 South Korean sailors lost, serves as a grim reminder of the threat posed by even comparatively modest submarine assets.2 Moreover, it reaffirms the need for ASW training against diesel-electric submarines operating in the littorals. The Diesel-Electric Submarine Initiative (DESI) serves this exact purpose.
Begun in 2001 under the auspices of U.S. Fleet Forces Command, DESI grew out of an urgent requirement for realistic ASW against the emerging threat of conventional submarines. Without diesel-electric submarines of its own, the U.S. Navy has turned to partner nations to provide a credible and realistic opposition force. The demand for training against these types of threats has grown and become a key element of strike group ASW training certification.3 Under the auspices of DESI, submarines from South American navies provide a credible “red team” against which U.S. sailors can hone their skills.
But the success of this multinational exercise demands the capability for secure communications. National guidance documents—from the Maritime Strategy to the National Defense Strategy, the 2010 Quadrennial Defense Review, and the National Security Strategy—underscore the importance of partnerships and international cooperation as pillars of global security. This need goes beyond strengthening relationships with longstanding allies; it calls for incorporating new, non-traditional partners to secure the maritime commons.
To this end, the U.S. Navy organizes and participates in activities that cut across the scope of maritime challenges and multilateral frameworks, from anti-piracy to building partner capacity.4 Partners include India, Singapore, France, Japan, Malaysia, South Korea, the European Union, and NATO. The Africa Partnership Station, a Navy-led program aimed at strengthening alliances in West and Central Africa, exemplifies cooperative activity tailored to building capabilities.
Given the range of capability and assets among potential partners, this system should be platform-agnostic (i.e., capable of insertion into nearly any type of ship, irrespective of nationality), cost-effective, and easily deployable. The Combined Enterprise Regional Information Exchange System (CENTRIXS) stands as an example of such a system.
Interactive, Networking Technology
CENTRIXS provides operational commanders with a responsive information-exchange capability in a coalition environment. Its strength lies in its ability to permit highly secure communications between partner nations. Comprising several different security enclaves, it operates at the Secret Releasable level of classification, based on partner-nation membership and the area of operational responsibility. The capability is critical to all installations, and for several years has been an area of focus for the Space and Naval Warfare Systems Center Pacific involving close coordination with the Fleet, combatant commanders, and other agencies.
Web-centric and commercial off-the-shelf hardware and software are normally used with CENTRIXS. However, such products often assume that a high-bandwidth link is available to the user. Many potential nontraditional partner navies and coast guards do not have units capable of using all of the CENTRIXS services available to larger deck ships. Yet the core requirement remains to effectively integrate navies of varying capabilities.
In response, the Space and Naval Warfare Systems Center Pacific led the technical development and management of a low-bandwidth, small-footprint alternative: the CENTRIXS Portable Operations Kit (CPOK). This deploys with a low-cost satellite communications channel that allows ships without otherwise available SATCOM systems to maintain secure connections with other partner-nation ships, thereby enhancing situational awareness and facilitating coordination.
Because of the limited bandwidth, only chat, email, and a geographically filtered common operational picture are normally deployed with a CPOK installation. But these three applications are the cornerstone of the collaboration tool set that allows ships and headquarters to maintain 24/7 situational awareness with any other CENTRIXS-enabled unit. CPOK is easy to use, and its upfront hardware costs are under $10,000.
In terms of command, control, communications, computers, intelligence, surveillance, and reconnaissance, navies have “disparate capabilities, with major differences.”5 CPOK represents a huge leap forward for networking with resource-challenged navies and integrating them into a multinational setting.
First deployed in the 2006 exercise Southeast Asia Cooperation against Terrorism, CPOK facilitated communications between partner-nations’ ships and the exercise’s headquarters, as well as linking navies of the United States and those of four Southeast Asian countries for the first time.
During the 2007 Cooperation Afloat Readiness and Training exercise, then-Rear Admiral William Burke, while serving as commander of Task Force 73, credited the technology with taking training exercises “to a more challenging level.” He noted: “With CENTRIXS, we have an opportunity to reach new heights in combined command and control.”6
Communicating below the Surface
In 2009, CPOK contributed to forging international bonds as well as a successful DESI. In support of the event, held in San Diego, engineers from Space and Naval Warfare Systems Center Pacific implemented a CPOK on the Peruvian submarine BAP Arica. Another was installed at the Peruvian Navy’s submarine headquarters in Callao. Mobile and flexible, each installation took approximately two days to complete and train.
During DESI, the Arica role-played as an adversary of U.S. ASW forces, using CENTRIXS to communicate with the Peruvian headquarters as well as with Commander, U.S. Submarine Pacific Fleet headquarters in Hawaii, via secure chat and email. The CPOK was deemed so successful that the Peruvian navy requested to retain the system during the submarine’s transit home, as well as initiating requests to obtain the CPOKs and other CENTRIXS systems permanently.
In a recent Naval War College Review article, Commander Alberto Soto of the Chilean navy asserts his country’s “unprecedented success in interoperability” with CENTRIXS during RIMPAC 2004, which “increased the desire within the Chilean Navy to be part of the ‘information-sharing club.’”7 Such experiences help to build trust, cooperation, and partnerships.
Developing Solutions for a Complex Future
As the Global Maritime Partnership of navies unites to ensure the rule of law, technical challenges of networking at sea will become more complex. At often vastly different stages of technology development, navies are now creating partnerships to deal with piracy, disaster relief, and humanitarian assistance. Moreover, as the experiences in Korea demonstrate, initiatives like DESI need to be even more widely adopted.
Some have criticized CENTRIXS as not being up to the task of netting larger and more complex naval coalitions.8 But the bedrock technology behind the system, as well as the tactics, techniques, and procedures that have evolved among nations working together on the global commons, will likely form the basis of whatever evolves beyond CENTRIXS.
Multinational Civilian-Military Joint Investigation Group, 2. “Joint Investigation Report on the Attack Against ROK Ship Cheonan,” Ministry of National Defense, Republic of Korea, 10 September 2010, http://www.nautilus.org/publications/essays/napsnet/reports/Cheonan.pdf.
3. Jason Reagle, “DESI: Seven Years of U.S. Diesel Electric Submarine Partnerships,” Undersea Warfare, no. 38 (summer 2008), http://www.navy.mil/navydata/cno/n87/usw/usw_summer_08/desi.html.
4. Ian Graham, “Multinational Forces Keep Pirates at Bay,” Navy.mil, 14 Sept. 2009, http://www.navy.mil/search/display.asp?story_id=48273.
5. Alberto Soto, “Maritime Information-Sharing Strategy: A Realistic Approach for the American Continent and the Caribbean,” Naval War College Review (summer 2010), p. 145.
6. Jessica M. Bailey, “CENTRIXS Provides Vital Communications,” Navy.mil, 16 July 2007, http://www.navy.mil/search/display.asp?story_id=30603.
7. Soto, “Maritime Information-Sharing Strategy,” p. 148.
8. Gordan Van Hook, “How to Kill a Good Idea,” U.S. Naval Institute Proceedings, October 2007, p. 34.