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These findings are truly alarming given the fact that fully 65% of the military personnel who have served in Iraq report a history of combat experience and these experiences can clearly result in physical and emotional injuries, with PTSD being expected to develop in between 5 and 15%, with other estimates ranging even higher (Gutierrez & Brenner, 2009). For instance, Gutierrez and Brenner cite the results of a recent analysis conducted by the RAND Corporation that found the range of prevalence estimates for PTSD was 5% to 15% of the military personnel deployed the Middle East; when these rates were applied to the 1.64 million military personnel who have already completed their deployment, Rand estimated the number of individuals with PTSD will be between 75,000 to 225,000.
Given the large numbers of returning combat veterans today and these disturbing rates of PTSD, these findings suggest that more needs to be done to help these brave men and women make the readjustment from a combat zone to a civilian life, and those clinicians who treat these veterans in family counseling settings must be able to differentiate between PTSD-related hostilities and the disagreements and conflicts that are characteristic of all marital relationships. For example, Gutierrez and Brenner (2000) emphasize that, "In part, clinicians' ability to facilitate treatment for those with PTSD will be enhanced by understanding that symptoms such as hypervigilance are adaptive while in theater. For some, the long-term adoption of such strategies may have been reinforced across multiple deployments. Upon returning home, these same symptoms can impede reintegration with the civilian community" (p. 96).
It is possible for combat veterans to experience many of the effects of PTSD without gong on to develop the condition in its full-blown state according to the diagnostic criteria provided by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (4th ed). In this regard, Gutierrez and Brenner (2009) emphasize that the more clinicians understand and appreciate these factors and the earlier clinical interventions are provided, the better. According to these researchers, "As individuals return from deployments to Iraq and Afghanistan, clinicians will be seeing clients at differing points in their recovery. Many individuals are exhibiting symptoms but do not yet meet the full diagnostic criteria for PTSD" (Gutierrez & Brenner, 2009, p. 95). By providing interventions that can help these combat veterans better manage their transition and cope with the expected and unexpected problems they will inevitably encounter on their return, it may be possible to minimize the impact of full-blown PTSD on some while preventing its development in others. As Gutierrez and Brenner conclude, "Providing treatments which help these individuals more effectively manage their symptoms may indeed lead to fewer clients developing PTSD. Early interventions may change the trajectory of recovery in positive directions" (p. 96).
The study proposed herein will be guided by the research question, "Do veterans with PTSD (post traumatic stress disorder) who seek couples therapy have a higher level of domestic violence than veterans without PTSD who seek couples therapy?" The independent variable related to this research question will be veterans with PTSD who seek couples therapy vs. those veterans who do not have a PTSD diagnosis; the dependent variable will be the respective rates of domestic violence among these subjects.
Statement of the Hypothesis
The working hypothesis of the study proposed herein is that veterans with PTSD who seek couples therapy will have a higher level of domestic violence than veterans without a PTSD diagnosis who seek couples therapy. Based on the growing body of evidence concerning PTSD, this hypothesis is based on the notion that the nature of PTSD combined with combat experience will naturally lead to increased levels of domestic violence.
Significance of Study
While many Americans may have forgotten about the impact that the two world wars, and the Korean and Vietnam wars had on entire generations of veterans, many of these men and women still suffer from the effects of their involvement in a war that they fought because they felt that it was their duty to do so. Although the majority of these veterans have managed to go on to lead meaningful and fulfilled lives with normal family relationships, numerous others have been adversely affected by posttraumatic stress disorder in ways that remain better describes in the literature than they are understood. What is known, though, is that PTSD can affect combat veterans in ways that detract from their ability to maintain normal relationships with others, including those they were close to prior to their combat experiences. According to Johnson and Williams-Keeler (1998), "Distressed and unstable relationships are a significant part of the aftereffects of trauma and posttraumatic stress disorder. It is not surprising that traumatized partners seek out marital therapy to help them deal with the relationship distress that has been generated, maintained, or exacerbated by the effects of trauma" (p. 25).
The method to be used by the proposed study will be a quantitative analysis of the self-reported rates of domestic violence from combat veterans with PTSD compared to those combat veterans without PTSD who participate in a community-sponsored couples therapy program and agree to participate in the study.
Participants in a Future Administration of the Study
The participants in the proposed study will be recruited through coordinators of local community-sponsored couples therapy programs for referral for participation in the proposed study and appropriate informed consent will be obtained and the anonymity of the participants will be assured. A minimum of 20 combat veterans with PTSD and 20 combat veterans without PTSD will be sought; however, fewer participants will be used if these numbers are not referred for participation and in the event dissimilar numbers of PTSD and non-PTSD veterans are referred, percentage comparisons will be used. Participants must have completed at least 6 weeks of the couples therapy regimen in order to be eligible for participation in the study. Permission for the study will be obtained from the administrator of the couples therapy program which will be included as an appendix to the completed study, together with proforma copies of the questionnaire and informed consent forms used. The informed consent forms and questionnaires will be destroyed upon completion of the study.
Instruments, Design, and Procedure
Because the participants in the proposed study will have already been formally diagnosed as having PTSD, no instrument will be used to assess this condition; likewise, it will be assumed that there have been instances of marital discord experienced by the participants given their enrollment in a couples therapy program. To measure the respective levels of domestic violence between the two populations of combat veterans with and without PTSD, a custom questionnaire will be developed to collect relevant demographic information, including age, duration of deployment and location of combat experience(s), gender, race and so forth. The questionnaire will also request subjects to report instances of domestic violence of three types: (a) physical abuse; (b) verbal abuse and (c) emotional or psychological abuse. The participants will be requested to indicate on a 5-level Likert-scale how frequently they have engaged in such abusive practices (e.g., very frequently, frequently, sometimes, infrequently, very infrequently). The questionnaire will also request that the participants indicate on a similar Likert-scale how these behaviors have affected their marital and familial relationships. Face validity of the custom questionnaire will be achieved by having the draft instrument reviewed by clinicians, faculty members and colleagues with comparable credentials to ensure that it appears to collect the desired type of data and that it contains no ambiguous questions (Neuman, 2003).
The paper-and-pencil questionnaire will be administered by the principal researcher at the couples therapy venue. The statistical data that result from the questionnaire will be aggregated and analyzed using SPSS Version 11.0 for Windows (Student Version) and the findings reported in tabular and graphic form, and interpreted in a narrative fashion. Although no compensation will be offered for participation in the proposed study, all participants will be offered a copy of the completed study upon request.
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