A Behavioral Economic Analysis of PTSD Using Ecological Momentary Assessment (Project BRAVE)

Posttraumatic stress disorder (PTSD) can cause distress that puts individuals at risk for behavior that inhibits recovery from their trauma. That behavior too often includes social withdrawal, avoidance of certain situations, and substance misuse.

Traditional PTSD diagnosis typically looks at internal distress, based on self-reported ratings by patients.

This study for the Consortium to Alleviate PTSD seeks to enhance diagnosis and treatment by assessing individuals’ behavior rather than their thoughts and emotions. It will use what is known as “behavioral economics,” which involves examining the context in which a given behavior occurs, considering all possible available alternatives. Decisions about behavior are seen as the result of a complex cost/benefit analysis. For example, a person with PTSD may choose a behavior such as social withdrawal, which could bring immediate relief to someone who wishes to avoid social interaction. Or that person may choose a behavior that involves engaging with others, which could bring a more delayed pattern of benefits over time, such as strengthened relationships, or stable employment.

“Project BRAVE”

In a novel approach, Principal Investigator Meghan McDevitt-Murphy, PhD, of the University of Memphis, and her research team will focus on the daily choices that patients make. Using hand-held electronic devices, 70 combat veterans with PTSD will record their activity, its context, and their emotional responses several times a day for three weeks. This type of data collection is known as “ecological momentary assessment” because participants are giving a self report about their behavior while in their natural environment.

This study operates under the name “Project BRAVE,” an acronym for Behavioral Recording of Activities in Veterans’ Environments.

The data will be consolidated and analyzed to determine the proportion of behavior allocated to avoidance, constructive activity, social activity, and substance use. Investigators will look at the reinforcement gained from each of those types of behavior to predict PTSD severity and functional impairment. From the data obtained from this daily reporting of behavior, they will develop a questionnaire for clinicians to use with patients and for researchers to use in future studies. The questionnaire will allow for collection of information from patients on various aspects of activity engagement without having to repeat the daily recording of information by individuals.

Benefits

Findings from this study may help guide improvements to psychotherapy for PTSD by demonstrating how the activity patterns of individuals with PTSD may contribute to persistent PTSD and functional impairment. In the future, study investigators hope to develop intervention modules that will promote greater activity engagement among individuals with PTSD. This potentially could help the hundreds of thousands of active duty military personnel and veterans suffering from PTSD and related psychological trauma.