Self Efficacy And Veterans Essay

Celina Tennant
Indiana University-Bloomington

Abstract
The number of mental illness cases among American veterans returning from war continues to grow. There is much concern over how to provide the necessary treatment for these veterans, especially those that have acquired disabilities. Many of the injuries they bring home with them are not visible. In particular, conditions such as post-traumatic stress disorder (PTSD), depression, and anxiety are common among military members exposed to combat and trauma. Research suggests that therapeutic programs focusing on self-efficacy can increase confidence and decrease levels of psychological stress. The presented information suggests how recreational therapy and leisure services can benefit veterans with various disabilities, both physical and psychological. Recommendations for further research on this topic is discussed.
KEYWORDS: self-efficacy, veterans, PTSD, leisure, disabilities

Introduction
There is a large number of veterans returning from

war with physical and psychological disabilities. The most recent description of PTSD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), defines post-traumatic stress disorder as significant trauma associated with “exposure to actual or threatened death, significant injury, or sexual assault” (American Psychiatric Association, 2013). Also, when PTSD is triggered, it can create feelings of panic, anxiety, anger, or avoidance. PTSD affects a significant number of veterans and if left untreated, can lead to various other psychological issues and negative behaviors. For example, the suicide rate among the veteran population is 50% higher than civilians with similar demographic characteristics. (Zarembo, 2015). Also, it is common for veterans to avoid seeking necessary treatment, because they do not want to appear damaged or weak. Many experience frustrations with the long waitlists for doctors appointments at the Veteran Affair hospitals which can prevent or delay access to proper medical care. In order to cope, many veterans self-medicate using illegal substances or alcohol. Not only can this be illegal and highly dangerous, but it can worsen their symptoms and could lead to incarceration. Without necessary medical attention and therapeutic services it is likely that the condition of the veteran will worsen, and affect all aspects of their life, including relationships with family and friends. Most importantly, their physical, psychological, and emotional health is at stake.
While there is some research focusing on the effects of leisure experiences on increasing the self-efficacy of individuals, additional research regarding how self-efficacy affects disabled veterans in need of treatment would be beneficial to the recreational therapy community. This paper highlights the major concepts in self-efficacy among disabled veteran populations and examines psychological conditions and harmful behaviors associated with combat exposure such as PTSD, depression, substance abuse and risk of suicide. Applying self-efficacy into recreational therapy programs in order to improve quality of life for veterans is also examined. A final discussion ties the concepts together, concluding with suggested areas of further research and general implications to the leisure field.
Historical Perspectives
Psychologist Albert Bandura created the social learning theory which describes learning as a cognitive process within a social context that occurs through observational learning (Bandura, 1971). Later, this theory was relabeled the social cognitive theory because it describes a broad range of factors that can determine behavior. Bandura suggested that environmental factors, personal factors, and behavioral factors can influence one another and is termed reciprocal determinism (Wise, 2002, p.336).
According to Bandura (2011), the self-efficacy component of the theory was introduced when Bandura and colleagues hypothesized that neutral or positive experiences can counteract the effects of a negative or aversive event.

He indicated that self-efficacy is the judgement of one’s personal capabilities. It is dependant on how a person perceives their past performances as well as how they feel they will perform in the future (Luszczynska, Benight, Cieslak, 2009). Therefore, someone who has high self-efficacy, has confidence that they can successfully master a specific task. On the other hand, an individual with low self-efficacy does not feel confident in their abilities to perform a certain behavior or reach a particular goal. Bandura considered self-efficacy to be the most important aspect of behavioral change. As stated by Glanz & Rimer (2005), in order to increase self-efficacy, an individual must set achievable goals in increments that will have

rewards.
Research findings have indicated that high self-efficacy can positively influence a person’s ability to effectively overcome various obstacles in life. In fact, the concept of self-efficacy has been utilized within the field of recreational therapy since the mid 1980s (Wise, 2002). For military veterans, this could mean dealing with the psychological trauma of war like PTSD, anxiety, and depression. It could also mean learning to adapt to life with a newly acquired prosthetic limb. Regardless of the injury, self-efficacy is a necessary component of recovery and quality of life for these individuals.
Self-Efficacy
Self-efficacy is considered the most valuable component of the social cognitive theory and it has been widely researched within the field of social psychology. It can be defined as having confidence in one’s abilities to create a desired outcome with one’s available resources (Bandura, 1997). Within the field of recreational therapy, there is a significant amount of research regarding self-efficacy during leisure experiences. While the effects of self-efficacy among disabled veterans has not been explored at length, there is a significant amount of research suggesting self-efficacy during leisure experiences can decrease negative effects of war related trauma. Having self-efficacy prior to a traumatic event can mediate the effects of psychological symptom severity (Bandura, 1997). This suggests that individuals with high self-efficacy prior to a traumatic event may be less likely to develop symptoms of post-traumatic stress disorder and related symptoms. Therefore, it is likely that self-efficacy can serve as a necessary tool for pre- and post-deployment veterans to prevent psychological trauma.
Influence of Self-Efficacy on Disabled Veterans
Returning from long deployments involving exposure to combat can be difficult for military veterans. Some have newly acquired physical disabilities, while others suffer from psychological and emotional trauma. Adjusting to civilian life and it’s challenges can be difficult as well. These disabilities acquired from war will most likely require extensive psychological and physical rehabilitation. Research suggests that self-efficacy can benefit these disabled veterans by increasing their self-confidence while adapting to the challenges of their disability and could prevent the onset of any negative behaviors they might engage in while trying to cope with their disability. Incorporating recreational therapy programs that promote high self-efficacy would be beneficial for those with psychological trauma.
Influence of Self-Efficacy on PTSD
The rate of veterans with post-traumatic stress disorder is approximately 23% among those currently returning from war (Fulton et al., 2015). The Department of Veteran Affairs estimates that 20% of veterans returning from Iraq, 11% of Afghanistan veterans, and 30% of Vietnam veterans are affected by PTSD (Vella, Milligan & Bennett, 2013, p.254). Multiple deployments for several months can be physically, mentally, and emotionally exhausting as well as increase the likelihood of developing psychological trauma. According to Lapierre, Schwegler & LaBauve (2007), the average length of deployment for US veterans is approximately 15 months. Their research findings have indicated that the probability of developing PTSD symptoms increases as length of exposure to stress increases (p.394). The transition to civilian life can be difficult for some veterans. Many may feel uncomfortable in crowded areas, become startled by loud noises, or experience nightmares. This can lead to avoidance behaviors that cause the veteran to withdraw from social situations and avoid everyday tasks such as grocery shopping or dining at restaurants. Also, PTSD can be difficult to diagnose in some veterans because they may not want to admit that they have the condition. In order to avoid the stigma of appearing weak or damaged, many veterans are not willing to admit that they may have post-traumatic stress disorder (Hoge et al., 2004). Increasing self-efficacy could benefit these veterans by decreasing feelings of guilt, shame and anxiety as they learn to accept themselves and their condition.
Self-efficacy has the potential to influence those with PTSD by acting as a mediator between negative experiences and post-traumatic stress. In fact, some studies have suggested that self-efficacy can act as a predictor of recovery for those suffering from various types of trauma, especially among those exposed to combat (Oman & Bormann, 2014). Those with high self-efficacy may feel more capable of coping with stressful situations and may be more likely to seek support from others when they feel overwhelmed. This suggests that having high self-efficacy prior to a traumatic experience can prevent or decrease severity of PTSD symptoms. Low self-efficacy can be increased through successfully task performance, observational learning, and positive emotional states (Martin, Dick, Scioli-Salter & Mitchell, 2015). When assessing and treating an individual for post-traumatic stress disorder, it is important to remember that it can be associated with comorbid conditions such as anxiety, depression, suicidal ideation and sleep disturbances. In particular, depression and guilt have been associated with increasing PTSD symptoms (Owens, Steger, Whitsell & Herrera, 2009). A comprehensive approach to treatment would be beneficial when assisting postdeployment veterans.
Influence of Self-Efficacy on Depression
Although depression and PTSD are highly correlated, a study by Lapierre, Schwegler & LaBauve (2007) indicated that it is possible for veterans to report feelings of depression without symptoms of PTSD. This study revealed that only 24% of participants had significant levels of both PTSD and depression symptoms. There are several factors that can influence depression symptom severity among veterans. Research findings from Blackburn and Owens (2014), stated that in terms of depression symptom severity “only rank, presence of meaning in life, and general self-efficacy were significant predictors” (p. 225). There are several factors that could explain symptom severity for the lower ranking military members. The authors of the study discussed the possibility that those of lower rank may be exposed to more combat than officers, which can explain symptom severity. They may also have lower self-efficacy than officers because they have less experience, or because they do not make decisions but are simply obligated to follow orders (Blackburn & Owens, 2014). Another study suggested that social support and personal relationships may also affect depression severity. For example, single or divorced veterans experienced an increase in depressive symptoms than those that were married (LaPierre, Schwegler & LaBauve, 2007). These findings may imply that having meaningful personal relationships can promote levels of self-efficacy and protect against symptoms of depression in veterans.