G.R.I.T. - Goal-directed Resilience Intervention Training

This project will utilize an intervention that is to encompass tenets of the New Wave therapies in two important respects: 1. The project's emphasis is on capacity development. The project's focus reaches beyond symptoms to restore and build resilience strengths that nurture in the face of challenge. The concept of resilience first entered the psychological and psychiatric literature with the study of children suffering from stress and disadvantage who, nevertheless, were functioning well. Protective factors included the presence of caring adults and achievement at school . Bonds and achievement have remained the most persistent findings in decades of research . 2. The investigator's aim is to restore and build capacities displaced by symptoms. This will be accomplished by identifying the lost capabilities in narratives of survival and identifying neuroscience models that capture symptoms and lost capacities as bio-behavioral response systems that become visible in extreme environments. Narratives of exceptional survival in extreme situations are characterized by engagement with their circumstances in ways that kept individuals well, by social relatedness, and by an efficient stress response . For example, while imprisoned in the Hanoi Hilton, Robert Shumaker built a dream house and counted the feet of lumber and number of nails that would needed. Fellow inmates also developed a tapping code to communicate with each other. Thus, Shumaker was engaged, was socially connected through tapping and, while engaged, was not hyper-responsive to the threat around him. The positive survival responses are a marked contrast to the symptoms of PTSD described earlier, such as hyperarousal or intrusive thoughts. What distinguishes resilient adaptation in extreme situations from PTSD is that the resilient activities are characterized by goal-directed actions while PTSD is characterized by stimulus-driven responses. The distinction of goal-directed versus stimulus-based responding is extensively developed in the neuroscience and cognitive literature. Action research has identified intention-based and stimulus-based actions in which self-initiated actions involve brain mechanisms and cognitive processes distinctly different from reflexive or responsive movement. Broadly conceived, humans have two types of responses to the environment: they act to achieve results or goals in the environment, thus changing the environment, or they respond to and accommodate the demands of the environment and are changed by it. This distinction has its parallels in other areas of human functions. Attention studies have identified voluntary control of attention (endogenous) that is goal-directed versus automatic reflexive control (exogenous) in which external objects or events claim a subject's attention. A number of cortical models are relevant to goal-directed action and stimulus-based responding, among them the work on intention and reactivity by Astor-Jack and Haggard or the studies of Hannus and colleagues on stimulus-driven and user-driven control of visual attention. Perhaps most relevant is the predictive and reactive control system (PARCS) developed by Tops and colleagues. These two basic bio-behavioral programs control behavior in different environments, the reactive program being most adaptive in unpredictable environments and the predictive program most effective in highly predictable environments. The reactive program is guided by momentary feedback from the environment and responses are close in time and space. The predictive program guides behavior in a feed-forward manner that plans for the future, simulates alternatives, and makes predictions. In PTSD, stimulus-based responding prevails and displaces goal-directed responding at multiple levels of functioning: cortical, endocrine, affective, cognitive - indeed, the entire bio-behavioral system of predictive responding. The abundant research on goal-directed action versus stimulus-based responding has few parallels in clinical psychology or psychiatry. Hints emerge in eudamonic well-being that is goal-directed and required for challenging situations and goal-relevant motivational constructs of self-efficacy or locus of control. This study draws on the extensive neuroscience framework to formulate a model of resilient and traumatic responses and proposes an approach that restores goal-directed responding that will simultaneously reduce the dominance of stimulus based symptoms of PTSD. This is a 5 year study with the anticipation of 148 enrolled.