Sunday, November 27, 2011

Martial Arts Develops Predators

Has the title of this blog got your attention?

Aggression and violence is often classified in the literature into two broad categories. Meloy provides the following explanation of these two categories with reference to violence. The same explanation applies to aggression.
Affective violence is preceded by high levels of autonomic (sympathetic) arousal, is characterised by the emotions of anger and/or fear, and is a response to a perceived imminent threat. Other researchers refer to affective violence as impulsive, reactive, hostile, emotional or expressive. Its evolutionary basis is self-protection. Predatory violence is not preceded by autonomic arousal, is characterised by the absence of emotion and threat, and is cognitively planned. Other researchers refer to predatory violence as instrumental, premeditated, proactive or cold blooded. Its evolutionary basis is hunting for food.

Meloy developed for forensic practice 10 criteria for distinguishing between affective and predatory violence.

Affective violence: 1. Intense autonomic arousal; 2. Subjective experience of emotion; 3. Reactive and immediate violence; 4. Internal or external perceived threat; 5. Goal is threat reduction; 6. Possible displacement of target; 7. Time-limited behavioural sequence; 8. Preceded by public posturing; 9. Primarily emotional/defensive; and 10. Heightened and diffuse awareness.

Predatory violence: 1. Minimal or absent autonomic arousal; 2. No conscious emotion; 3. Planned or purposeful violence; 4. No imminent perceived threat; 5. Variable goals; 6. No displacement of target; 7. No time limited sequence; 8. Preceded by private ritual; 9. Primarily cognitive/attack; 10. Heightened and focused awareness.

Firstly, what is violence? Violence is variably defined, but can be thought of as physical behaviour that is intended to produce deliberate harm to another. Violence can be thought of as a subset of aggression, which refers to any form of behaviour and not just physical behaviour. Aggression and violence can be defensive and offensive. All the activities that teach fighting behaviours are teaching their trainees to be aggressive and violent. They may not like to think so, and mostly do not describe their activity as such, due to the value-laden nature of these terms. Nonetheless, that is what they are doing.

Secondly, the second characteristic of affective violence is the presence of the subjective experience of emotion. This is why it has also been called emotional violence. What emotion? It is mostly associated with anger, hence why it has also been called angry violence. However, Meloy refers to both anger and/or fear.

Angry aggression and violence in humans is well studied within the aggression and violence disciplines. Fear aggression and violence in humans is not. So what? Fight is fight no matter the subjective feeling, right?

The concept of autonomic specificity has shown that different physiological reactions occur with different emotions (item 1). For instance, blood moves away from the hands with fear but moves to the hands with anger in an evolutionarily designed attempt to assist a person to fight. Fear and anger have different provocations (item 4) and different goals (item 5). Fear is about reducing the threat and getting away; anger is about harming the subject. Blanchard and Blanchard suggest there are different attack patterns associated with fear and anger, which is not unexpected given that 'different emotions produce different behaviours' (item 8). However, they also explain that it is difficult to verify the different attack patterns due to the paucity of direct human studies of physical aggression.

Interestingly, while basically studying the same evolved process in humans, fight-or-flight and stress focus on fear. Those activities associated with preparing a person to survive a violent encounter who refer to fight-or-flight and stress are therefore focusing on fear-induced physiological and behavioural responses. While the aggression and violence literature tends to ignore fear-induced physiological and behavioural responses, the fight-or-flight and stress based literature tends to ignore anger-induced physiological and behavioural responses. Just as Cannon incorrectly suggested the same physiological response is associated with fear and anger, so the aggression and violence literature incorrectly assume the same physiological response is present with all forms of emotional aggression and violence.

Related to the above, what about positive emotions? Howard refers to four types of aggression and violence which includes positive emotions. Appraisal theory in the stress discipline refers to three types of appraisal eliciting a fight-or-flight/stress response: harm, threat, or challenge. Challenge would be associated with positive emotions. Challenge-appraised fight-or-flight/stress responses are largely unstudied.

Thirdly, what do all activities associated with preparing a person to survive a violent encounter attempt to instill in their trainees? What is Siddle's model for designing a survival system attempting to do with respect to training warriors? What is stress training, stress inoculation training, and stress exposure training attempting to do when training law enforcement and military personnel for operational experiences? They are all attempting to reduce fear and therefore fear responses. They are mostly not attempting to replace fear with another emotion, but rather for their trainees to enact fight behaviours with no emotion. They are all attempting to train their trainees to enact predatory violence rather than affective/emotional violence.

Do any of the texts associated with these activities refer to predatory aggression or violence, but whatever name? No. Given predatory violence is the goal of these activities, would you not think it advantageous to have some understanding of what the training is attempting to achieve rather than what it is trying to prevent? For instance, Siddle's Sharpening the Warrior's Edge explains fear-induced survival stress and its 'catastrophic' effects on cognition and motor function in detail. Nothing on no-emotion-induced predatory violent effects. It's a little like describing in detail the place you want to leave without any understanding of the place you want to go to.

Lastly, Sun Tzu said if you know yourself and your enemy you'll not be bested in 100 battles; if you know yourself and not your enemy you'll only win 50; and if you know neither you'll lose all. Does an understanding of fear-induced fight assist you in understanding both yourself and your enemy, just yourself, or neither? Given violence can include fear, anger, no emotion, and positive emotions, a fear-induced understanding is but one small part of aggression and violence. A fear-induced understanding is but one of the blind men attempting to explain an elephant by touching just one part of it. My Beyond Fight-of-Flight is an attempt to describe the entire elephant.

PS: I refer to Siddle's work, not to denigrate it, but because it is the authority in the field of applying the theories and concepts of stress to combat performance. It is obvious illustration to use to demonstrate the limited insight that is gained by referring to stress theory.

Sunday, November 20, 2011

Fight-or-Flight: Different 'Fights'

Fight-or-flight is a concept developed by Walter Cannon to refer to our evolved responses to a threat. The fight-or-flight response refers to our physiological reaction which prepares our body for fight or flight.

When fight-or-flight is referred to within those activities engaged in preparing a person to survive a violent encounter, the action tendencies of fight or flight are associated with fear. For instance, Siddle refers to anxiety or fear initiating the sympathetic nervous system (SNS), which begins a catastrophic spiral in motor and cognitive functions.

When fight-or-flight is recognised as being simplistic and limited, and is subsequently expanded, the expanded range of behavioural responses are all associated with fear. Freeze, flight, fight, fright (tonic immobility), flag, faint are all associated with fear. But does all fighting behaviour involve fear?

Blanchard and Blanchard refer to defensive and offensive attack and aggression. Defensive attack/aggression involves fear and offensive attack/aggression involves anger.

The aggression literature has a long tradition of categorising aggression into two broad areas. One of the more common typologies is hostile vs instrumental aggression. Hostile aggression denotes the specific intention of harming another person and is triggered by cues that lead to anger, fear, or frustration (McEllistrem 2004). Most homicides and assaults appear to be predominantly expressions of hostile aggression involving anger. Instrumental aggression is not accompanied by strong emotion and the aggressive act serves another goal. A planned assassination and an assault solely for purpose of theft are examples of instrumental aggression. A wide variety of terms have been used in the literature to describe what is essentially the same distinction, for instance reactive, retaliatory, impulsive, angry, affective, emotional, subjective, hot-blooded vs proactive, premeditated, non-angry, predatory, planned, cold-blooded. The former type of aggression is characterised by intense central nervous system autonomic arousal and a subjective experience of conscious emotion, hence why it has been called emotional aggression, while the latter is characterised by the absence of both.

Howard integrates the Blanchards' offensive-defensive typology with the traditional impulsive-instrumental typology to describe four types of aggression: offensive/controlled, offensive/impulsive, defensive/controlled, defensive/impulsive, each with its own specific goals, affects and emotions. Offensive aggression and violence are associated with positive emotions, while defensive aggression and violence are associated with negative emotions.

So now we have fight behaviours associated with fear, anger, no emotion, and positive emotions - not just fear. 'So what?' you may ask. Fight is fight, right?

Emotion means more than feeling. Emotion is a broader construct that involves an appraisal process which generates a subjective feeling and physiological response, a related action tendency which can lead to a behavioural response. Each emotion has its own unique signature in terms of these responses. For instance, your body reacts differently when you are fearfully than when you are sexually aroused. Fear and its attendant flight action tendency is accompanied by a physiological response which redirects blood away from the hands and face to fuel the muscles for flight. Anger and its attendant fight action tendency is accompanied by a physiological response which directs blood to the hands and face to fuel the body for fight.

Negative emotions, such as fear and anger, narrow a person’s momentary 'thought-action repertoire' by calling to mind and body an urge to act in a particular way (e.g. flee in fear, attack in anger). Fredrickson argues that positive emotions have a complimentary effect: they broaden people's momentary thought-action repertoires, widening the array of the thoughts and actions that come to mine.

Its long been established that the harm inflicted with hostile aggression is greater than with instrumental aggression. Blanchard and Blanchard refer to different attack patterns being associated with their defensive and offensive attack/aggression. Different fight behaviours are associated with different types of aggression, which in turn are associated with different emotions.

What is Siddle proposing in order to better prepare a person for combat? He proposes methods to reduce the catastrophic effects that the activation of SNS can have on cognitive and motor function. He is essentially proposing methods to change aggressive behaviour from fear-motivated to no-emotion-motivated aggression behaviour; from emotional aggression to instrumental aggression. How do you do that? By understanding the different types of aggression, that is to say, by understanding the different emotional states associated with the different types of aggression.

The threat-induced, fear-motivated defence cascade includes fight when flight is not available. Despite what is often promoted by many, we are not defenceless without some form of training. If we were, we would not have survived as a species. William James said 'ancestral evolution has made us all potential warriors.' Yes, but what is our warrior behaviour motivated by?

A women's self defence instructor suggested a strategy to her students: When fearful, think of the worse thing your attacker could do to you and your children; turning fear into anger. While flight is the action tendency of fear, and fight is the action tendency of anger, the defence cascade for fear includes fight behaviours when flight is not possible. The fight pattern is different for fear fight and anger fight because the motivation is different. Unbeknown to the aforementioned instructor, turning fear into anger also avoids the possibility of fright (tonic immobility), flag, and faint behaviours as they are all associated with fear and not anger.

Is there scope to develop positive emotion motivated aggression in trainees? Absolutely. When a violent encounter is seen as a challenge rather than a threat it elicits positive emotions along with sympathetic activity and a broadened thought-action repertoire.

In the Art of War, Sun Tzu wrote:
If you know others and know yourself, you will not be imperilled in a hundred battles; if you do not know others but know yourself, you win one and lose one; if you do not know others and do not know yourself, you will be imperilled in every single battle.
What form of aggression is your opponent engaged in? If it is fear motivated, executing methods that are designed to elicit fear in the opponent may only inflame the aggressive behaviour. On the other hand, fear is a weapon that can be used to counter anger-motivated or no-emotion-motivated instrumental aggression.

Each form of aggression has its own goals. Withdrawal may resolve an aggressive encounter when the opponent is engaged in fear-motivated aggression as you no longer pose a threat. However, withdrawal may not resolve an anger motivated aggressive encounter as the opponent's goal is to inflict harm. Likewise with positive emotion motivated anger as the opponent is enjoying inflicting harm, and the aggression is being reinforced by your suffering. Harm is inflicted in instrumental aggression as a means to an end. Knowing the 'end' may provide a strategy to reduce the harm being inflicted.

Those who are engaged in activities associated with preparing a person to survive a violent encounter are engaged in teaching aggressive behaviours primarily when an opponent is engaging in aggressive behaviour. It behoves those so engaged to understand fight behaviour beyond the threat-induced, fear-motivated fight behaviour of the traditional fight-of-flight model.

Monday, November 14, 2011

Fight or Flight - Did Walter Cannon Get It Wrong?

Fight-or-flight dominates threat-induced behaviour thinking. This domination has led to certain ingrained assumptions about what to expect of ourselves and others in response to a perceived threat. Fight-or-flight is a concept which is often referred to within activities associated with preparing a person to survive a violent encounter.

Walter Cannon proposed the fight-or-flight model in the early 1920s to explain the automatic physiological reaction (fight-or-flight response, aka stress response) that prepares the body for action: fight to defend ourselves or flee to escape the source of a perceived threat.

Behaviourally, the fight-or-flight model is obviously limited. I'll just consider the F models and those proposed by Bruce Siddle and Dave Grossman.

Siddle is described as an internationally recognised authority on use of force training and the effects of survival stress (aka fight-or-flight response) on combat performance. Those activities associated with preparing a person to survive a violent encounter who refer to fight-or-flight are referring to Siddle's theories. Whether they acknowledge the source of their wisdom, or even know the source, is another matter. Siddle proposed 3Fs: fight, flight, freeze in place (hypervigilance). With regards to Siddle's hypervigilance behaviour: 'Siddle uses a unique law enforcement interpretation of the term hypervigilance. ... the term, hypervigilance is used to denote what others might call panic or hyperarousal.'

Grossman is described as being one of the foremost experts in the field of human aggression and the psychology of combat. Grossman appreciates that the fight-or-flight model needs updating: 'One of the roots of our misunderstanding of the psychology of the battlefield lies in the misapplication of the fight-or-flight model to the stresses of combat.' He argues that adding posture and submission to the standard fight-or-flight model (fight, flight, posture, or submit) helps to explain many of the actions on the battlefield. Sadly he didn't use F words to describe these behavioural options. Grossman suggests the first behaviour is posture, and if that is unsuccessful then fight, flight, or submission behaviours are elicited.

Jeffrey Grey, a British psychologist, proposed a 3F model: 'freezing (keeping absolutely still and silent), flight, or fight.' This freeze response is different to Siddle's freeze response as will be explained below.

In 2004 Bracha and some colleagues asked: 'Does fight or flight need updating?' The answer is, absolutely! That is the purpose of my Beyond Fight or Flight.

Bracha et al propose 4Fs: freeze, flight, fight, or fright. When referring to Cannon's 2Fs, they suggest that 'both the order and the completeness of Cannon’s famous phrase are suspect.' The order should be flight or fight reflecting the initial tendency to flee when threatened with fight only being elicited if flight is not possible. Freeze is the initial response which they describe as the stop, look, and listen response. Fright is a term they use to refer to tonic immobility (TI)- a behavioural response all people involved in preparing a person to survive a violent encounter should be aware of, but of which sadly most are ignorant. TI refers to an evolved defensive response which is an involuntary catatonic state. It is argued that TI is elicited when fight is unsuccessful. Bracha et al provide an explanation for the use of the term fright, however, I'd suggest they chose the term because 4Fs are catchier than 3Fs and a TI.

Not long after the above proposal, Bracha, alone this time, proposed 5Fs: freeze, flight, fight, fright, and faint. The different between fright/TI and faint is that in the former the subject is still conscious and processing the experience whereas in the latter they are unconscious and not processing the experience.

Schauer and Elbert propose 6Fs: freeze, flight, fight, fright, flag, or faint. Flag appears to be a half-way house between fight and faint where the body goes from being rigid to flaccid - it starts to flag.

There are other defensive behaviour models proposed that go beyond the F models, however for our purposes the F models are sufficient.

All of the above F models refer to threat-induced behaviours. All of the above models refer to fear motivated behaviours. As fear increases, the behaviours travel along a defence cascade starting with freeze and ending with faint. Actually, there is one more evolved behavioural response - death. A previous post explained that the dominance of the parasympathetic nervous system in the latter half of the defence cascade can literally scare a person to death.

All of the above models refer to fear motivated behaviours - all except Cannon's, the originator of the fight-or-flight concept, 2F model. Cannon associated flight with fear and fight with anger. Did he get it wrong? Or did the others get it wrong? And does it matter?

Blanchard and Blanchard distinguish between defensive attack and offensive attack behaviours. They suggest that defensive attack is associated with physical threats and is motivated by fear. Defensive attack is engaged when an existential threat is proximal and imminent and escape is impossible. Offensive attack, on the other hand, is associated with threats to resources and is motivated by anger.

Defensive attack and offensive attack are also referred to as defensive aggression and offensive aggression. Aggression has been categorised as reactive aggression (also called hostile, affective, subjective, angry, impulsive, irritable, emotional, or retaliatory aggression) and proactive aggression (also called instrumental aggression). Reactive aggression is motivated by an emotion. It would include both fear-motivated defensive aggression and anger-motivated offensive aggression. In contrast, proactive aggression, or instrumental aggression, is not motivated by an emotion. It is cold blooded, premeditated, calculated behaviour that is motivated by some other nonaggressive goal (obtaining money, territory, social dominance, object acquisition). Sympathetic activation is usually absent and there is minimal negative emotion.

Did Cannon get it wrong? Based on the above, it would appear he did. It would appear that his fight response was actually motivated by fear and not anger.

This misattribution of the fight response to anger helps explain why Cannon thought the same physiological response is activated with both anger and fear. Plutchik explains that the notion of physiological differences between emotions seemed to be pretty much taken for granted until the researches of Cannon during the 1920s which apparently indicated the autonomic changes observed in cats and dogs during fear and anger were the same. This led many psychologists to assume that the autonomic changes for all emotions in humans were also the same, a conclusion which he suggests was by no means justified by the evidence. Since that time an increasing body of research has begun to show the existence of definite, physiological differences between emotions. Different emotions = different physiological responses.

Does it matter? Society seems to think so. If your aggressive actions result in the death of another person, to take an extreme example, and you are charged with that homicide, the difference between fear-motivated defensive aggression, anger-motivated offensive aggression, and nonemotional instrumental aggression will determine your fate.

Fear-motivated defensive aggression, within the limits of the law, will result in a self-defence defence. The difference between angry aggression and instrumental aggression could mean the difference between manslaughter and murder respectively:
In American common law, the heat-of-passion defence reduces a charge of murder to manslaughter if the defendant successfully demonstrates that he or she (a) was first adequately provoked by his or her victim, (b) became emotionally disturbed as a direct result of said adequate provocation, (c) did not have enough time to cool off before killing his or her perceived provocateur, and (d) did not, in fact, cool off before committing the homicide in question. (Fontaine 2008)
Emotion, as conceived by the emotion discipline, is more than subjective feeling. It is a construct that includes appraisal, feeling, physiological, action tendency, and behaviour. Feeling activates the other responses.

Different emotions = different behaviours. All fight behaviours are not the same. The Blanchards described different defensive and offensive attack patterns. It has long been accepted that anger-motivated violence is more vicious than instrumental violence. Stephen (1883) suggested, impulsive killings such as heat of passion homicide are crueler, more dangerous, and more ferocious than its premeditated counterpart. The reason for the difference is the goal of the aggression. Anger-motivated offensive aggression's goal is to cause harm and suffering. Nonemotional-motivated instrumental aggression's goal is a nonaggressive goal, eg. obtain money, territory, etc. Interestingly enough, society's law punishes the crueler form of aggression less than the less cruel form of aggression.

The different forms of aggression have tactical implications. Disengaging from an aggressive encounter when the other party is engaged in fear-motivated defensive aggression should terminate the encounter. It will not if the aggression is anger-motivated offensive aggression where harm is the goal, or nonemotional instrumental aggression where the obtaining of an extrinsic goal is the goal. A different strategy is needed to extricate oneself from those encounters when the other party is engaged in anger-motivated offensive aggression or nonemotional instrumental aggression. One has to know the resource which is being challenged or the extrinsic goal being sought in order to terminate the aggression in those cases.

Anger and fear are negative emotions. I'm working on aggression that is motivated by positive emotions. I've seen hints of these, but they are not as well studied as anger and fear motivated aggression.

Every activity that is involved in preparing a person to survive a violent encounter which refer to fight-or-flight, any of the F models, Siddle's theories, and any similar models and theories by whatever name, are only referring to threat-induced, fear-motivated behaviours and physiological responses. This applies to stress training, stress inoculation training, and stress exposure training which are training programs designed to better prepare military and law enforcement officers for operational duties. These models and theories are focusing only on one small part of human aggressive and violent behaviour. These fact are not explicitly acknowledged by these activities, if they are understood by them at all. Nor are the limitations of these models and theories understood when attempting to use them to understand aggressive or violent behaviour and to better prepare a person to survive a violent encounter.

Wednesday, November 9, 2011

An Evolved Defence Mechanism - Hair

Evolutionary psychiatrist Randolph Nesse explains one of the most basic advances in biology during the past twenty years is the clear recognition that two kinds of explanation are needed for all biological traits: (a) a proximate explanation of how the trait works, and (b) an evolutionary explanation of what the trait is for. He explains that an evolutionary perspective provides a clear focus on the function of a particular trait.

I first came to the idea of adopting an evolutionary perspective when writing the first chapter in my originally conceived how-to book on Jan de Jong Jujutsu. It was titled 'What is Jujutsu?'. Jujutsu is often described in terms of the generic nature of the term, techniques, history, and the application of the philosophical concept of ju. When attempting to compare jujutsu to other martial arts, I started to come to an evolutionary explanation. Why is jujutsu different from karate, kung fu, pencak silat, boxing, etc? It's because of its evolutionary past; the evolutionary forces which shaped these different martial arts. I remember now, I was nudged in this direction by the work of Karl Friday in Legacies of the Sword.
To be sure, all such 'martial arts,' as forms of single combat, share some commonality of function - but then, so do Chinese tai chi chuan and US Air Force fighter tactics. They also, as arts developed in neighboring countries through which individuals - and armies - regularly traveled back and forth, show some degree of cross influence and even some common vocabulary. But the historical circumstances under which these various arts evolved, the purposes they served, and the statuses they assumed in their respective cultures diverged in fundamental ways. (p6)
The first kyu grading in the Jan de Jong jujutsu grading system includes an oral explanation of the history of jujutsu. The first dan grading includes a written essay on the history of jujutsu. The history does not necessarily tell why jujutsu is what it is. An evolutionary explanation does. I'll be changing these gradings to an evolutionary explanation rather than a historical explanation, as an evolutionary perspective has a clear focus on function.

I came across this paper this morning: 'What can animal aggression research tell us about human aggression?' by Blanchard and Blanchard in Hormones and Behavior 44 (2003) 171–177. They made the following comment which specifically refers to martial arts training:
Although factors such as weapons and specific training in martial arts undoubtedly alter the response characteristics of aggression in people, there are some hints that human physical attack may be more similar to the aggression of nonhuman animals than might be thought, for example, target sites for attack.
They go to explain that in some mammalian species, structural adaptations have evolved to defend vulnerable targets for attack.
Thus in lions, the only group-living large cats, males (only) have developed a thick mane that covers from the top of the head to the shoulders, potentially affording protection for this site during fights among males within social groups, as well as protection for the group and its young from nomadic males. The late Margaret Manning,a distinguished child psychologist working primarily with young children, suggested that in these children, the head is the primary target for offensive attack (personal communication). In this regard, two seeming anomalies of human physiology are of interest: first, human head hair is unique in growing indefinitely, potentially (and especially if unwashed, as it likely was during most of human prehistory) providing a thick mat offering a great deal of resistance to blows. Second, humans, like lions, have a gender-specific locus for particularly coarse and wiry hair; in humans, the lower face. Moreover, beards appear at precisely the developmental time period when male–male aggression becomes particularly dangerous, due to the enhanced strength that accompanies adolescence and the additional motivation associated with fights over access to females. While beards are often taken to have evolved as signals of sexual maturity, it is not clear why yet another addition to the many behavioral as well as structural signals of maturity in males would be necessary or adaptive. Similarly, if beards have evolved on the basis that they elicit sexual interest in females, one might expect at least some indication of this interest in contemporary women. However, a recent survey of 80 undergraduate women from a number of different cultural backgrounds indicated little (in fact a slight net negative)sexual response to male beards.
Now I'm conflicted over shaving off my beard. Evolution is about increasing the chances of survival and reproduction. It would appear the two evolutionary imperatives are at odds in this case. Increase my chances of surviving an offensive attack by a cospecific, or increase my chances of reproduction with a cospecific. What to do, what to do. ... I'm male, so it's pretty obvious which imperative is going to win out.

Just something of interest concerning our evolved defence mechanism.

Monday, November 7, 2011

Prerequisite Knowledge for Instructors

Beyond Fight-or-Flight is aimed at all activities associated with preparing a person to survive a violent encounter. These activities include martial arts, self defence, combatives, close-quarter combat, hand-to-hand combat, unarmed combat, and whatever politically neutral name law enforcement is referring to their methods in the various jurisdictions. I'll refer to these collectively as the Activities.

Hopefully, the instructors of the Activities are required to have and maintain an up to date first aid qualification. That takes care of the body, but what about the mind?

As reported in previous blogs, medicine is beginning to appreciate the mind-body connection. While I'm stretching the idea here, I believe there is value in having some understanding of the mind in the same way that first aid gives you some understanding of the body.

I've been working on post traumatic stress (PTS). PTS was officially recognised by the American Psychiatric Association (APA) in 1980 when post traumatic stress disorder (PTSD) was included in their Diagnostic and Statistical Manual of Mental Disorders (DSM) third edition. Prior to that, the condition was categorised as gross stress reaction. The definition of a traumatic event and the symptoms of PTSD within the DSM have changed over the decades.

In 2000, the APA revised the PTSD diagnostic criteria in the fourth edition of its DSM. Diagnostic criteria for PTSD include a history of exposure to a traumatic event meeting two criteria and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms. The diagnostic criteria are:

Criterion A: Stressor
The person has been exposed to a traumatic event in which both of the following have been present:

1.The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
2.The person's response involved intense fear,helplessness, or horror.

Criterion B: Intrusive Recollection
The traumatic event is persistently re-experienced in at least one of the following ways:

1.Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.
2.Recurrent distressing dreams of the event.
3.A sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes.
4.Intense psychological distress at exposure to internal or external cues that recall the traumatic event.
5.Physiologic reactivity upon exposure to internal or external cues that recall the traumatic event

Criterion C: Avoidant/Numbing
Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

1.Efforts to avoid thoughts, feelings, or conversations associated with the trauma
2.Efforts to avoid activities, places, or people that arouse recollections of the trauma
3.Inability to recall an important aspect of the trauma
4.Markedly diminished interest or participation in significant activities
5.Feeling of detachment or estrangement from others
6.Restricted range of affect (e.g. unable to have loving feelings)
7.Sense of foreshortened future (e.g. does not expect to have a career, marriage, children, or a normal life span)

Criterion D: Hyper-arousal
Persistent symptoms of increasing arousal (not present before the trauma), indicated by at least two of the following:

1.Difficulty falling or staying asleep
2.Irritability or outbursts of anger
3.Difficulty concentrating
4.Hyper-vigilance
5.Exaggerated startle response
Criterion E: duration
Duration of the disturbance (symptoms in B, C, and D) is more than one month.

Criterion F: Functional Significance
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

It is not the Activities instructor's responsibility to diagnose PTSD. It is, however, their responsibility to be aware of the condition given the nature of the activities they are involved in. People who have experienced a traumatic event, such as being assaulted, often look to some form of self defence training to regain some sense of control over their lives. Obviously, law enforcement and the military are training their personnel who have often experienced traumatic events.

My work integrates stress theory and emotion theory to develop a survival process model (SPM). This SPM enables you to understand our evolved survival mechanism, the mechanism designed to increase our chances of survival when threatened. It also enables you to understand reactions such as PTSD.

Richard Lazarus argues that stress theory is a subset of emotion theory. They both study the same process, but stress does so in a limited fashion. Stress theory is like one of the blindmen studying an elephant by touching just one part of it. Emotion theory studies the entire elephant. Stress theory is considered a practical subject whereas emotion theory is considered of interest for its own sake. Nothing could be further from the truth. Emotion theory reveals so much more about our survival process than does stress theory.

Just to clarify, emotion and feelings are often used interchangeably. However, feelings are considered to be just one component of a larger construct that is emotion. Emotion involves a subjective feeling, physiological reaction, action tendency, and behavioural component.

I highly recommend Passion and Reason: Making Sense of Our Emotions by Richard S. Lazarus and Bernice N. Lazarus to the readers of this blog. It is a book written for laypersons by a towering figure in the stress and emotion fields.

The SPM involves an appraisal component. A stimuli is appraised, and based on that appraisal evokes an emotion, or not. The appraisal is personal to each person and to each situation. Lazarus argues that emotions are not irrational. They are entirely rational to the person experiencing the emotion. He emphasises:
again and again one could see that it is the way a person appraises what is happening, rather than the realities themselves, that determines the stressful impact. In emotion too, thinking is the powerful agent that influences both the kind and degree of emotion and the potential for coping. Research such as this provides the modern chapter and verse for Shakespeare's intuition expressed in Hamlet: 'For there is nothing either good or bad but thinking makes it so.
When a trainee/student reacts in what may be considered an overreaction, think on the uniqueness of their appraisal which shaped the nature and intensity of their reaction.

I recall a women in a women's self defence class who screamed and panicked when the instructor put her hands lightly around her throat to demonstrate a strangulation attack. Some considered it an overreaction. But we don't know how she is appraising the situation. By judging her and her reaction, are we not becoming part of the problem and not part of the solution?

Hopefully, the Activities have prospective students/trainees complete an application form of some kind. This form will hopefully ask questions concerning medical conditions and background. There is an argument that some form of generic question concerning traumatic events as defined in DSM-IV criterion A could be included on the application form. This may guide the instructor.

The above, and particularly the above recommended book, should reinforce to instructors that one size, one style of instructing, does not fit all. Those disciplinarian/militaristic instructors may not be as helpful as they think they are for people who have experienced trauma and are experiencing PTS to some degree; the people who need our help the most.

Friday, October 28, 2011

Does Fight or Flight Need Updating?

Does fight or flight need updating? This is a question that was asked by a group of mental health professionals in 2004. The answer to their question is: most definitely.

The authors of this question were looking at the evolved behavioural responses to a threat. I've looked at this in previous blogs. We've gone from 2Fs to 3Fs, and now up to 6Fs: Freeze, Flight, Fight, Fright, Flag, Faint. This blog looks at the automatic physiological response.

Those activities associated with preparing a person to survive a violent encounter who refer to fight-or-flight are referring to stress theory, whether they know it or not. Cannon, the author of the fight-or-flight concept, described the fight-or-flight response which is an automatic physiological response to mobilise our body to fight to defend against a threat or to flee from danger. The stress discipline adopted the fight-or-flight response and called it the stress response.

Seley, the father of stress, defined stress in physiological terms. He defined stress as the non-specific response of the body to any demand for change. He explains that the demand is non-specific in that any demand on a body to change produces the same physiological response. This has also been referred to as the global arousal model.

What colour does a person's face go when they are angry? Red. What colour does a person's face go when they are scared? White. Surely this suggests there is different physiological responses associated with different emotions.

The emotion discipline refers to autonomic specificity (AS). Autonomic refers to the autonomic nervous system (ANS) which regulates unconscious activities of the body. AS refers to different ANS activity with specific emotions.

Levenson (1992) states that 'following decades of controversy and uncertainty, there is now sufficient empirical basis for asserting the existence of a limited set of autonomic differences among emotions.' Support for AS is found in the metaphors we use to refer to emotions. For instance, heat is associated with anger while coolness is associated with fear. Levenson (2003) explains that the differences in the metaphorical language of anger and fear concur with consistent empirical findings of peripheral vascular differences between the two emotions.

In a study that supported AS, Levenson, Ekman and Friesen (LEF; 1990) refer to the functionality of emotions and their associated physiological needs:
If fear is primarily associated with fleeing, it would be functional for blood flow to be diverted away from the periphery and redirected toward the large skeletal muscles. This would be consistent with the decrease in peripheral finger temperature that we found for fear. Similarly, anger, with its close association with fighting, might recruit increased blood flow to the muscles of the hand to support grasping weapons and opponents. This would be consistent with the increase in peripheral finger temperature that we found for anger.
LEF raise an interesting theoretical issue. Is there different ANS activity associated with different behavioural responses/motor programs which are associated with the same emotion. They refer to freeze and flight associated with fear. A more salient example is fainting which is associated with fear. How does the activation of a physiological response which is evolutionarily designed to mobilise our bodies for action result in the complete opposite behaviour - fainting?

The ANS is made up of the sympathetic nervous system (ANS) and the parasympathetic nervous system (PNS). The SNS is geared towards mobilising energy and to dealing with the environment, whereas the PNS can be seen as geared to establishing and conserving energy reserves. The SNS is often described as the fight-or-flight system while the PNS is described as the rest-and-digest system.

Ortony and Turner (1990) suggest situations in which actions such as flight or attack are desirable and possible, appear to produce physiological responses indicative of SNS activation, whereas situations where escape is highly desirable but impossible tend to be dominated by PNS activation. Frijda (1986) explains that stimuli that increase sympathetic activity tend also to increase parasympathetic activity, only less so. Fainting from fright, he explains, is a result of an increase of parasympathetic activity so that it comes to dominates sympathetic activity. He suggests that there seems to be a relationship between parasympathetic dominance and the inability to respond, which corresponds with Ortony and Turner’s observation.

The image reproduced at the top of this blog is Schauer and Thomas's (2010) defence cascade. It shows SNS dominance for the first half of the cascade, which includes fight or flight, and PNS dominance for the second half of the cascade, which includes fainting. All associated with fear.

A more extreme example is being scared to death. Cannon (1942) reviewed numerous reports of voodoo death in primitive cultures. In a typical case, a previously healthy person is cursed by a chief or medicine man and the victim quite literally dies a death from fear within hours or days. Cannon attributed the death to overstimulation of the SNS, however Richter (1957) has shown the PNS is to blame for these deaths.

Siddle is described as being an internationally recognised authority on use of force and the effects of survival stress on combat performance. Those who refer to fight-or-flight or stress in activities associated with preparing a person to survive a violent encounter are, in fact, referring to Siddle's work. His ideas have come to take on the authority of commonly conceived wisdom or popular theory. Whether those in the aforementioned activities acknowledge of even know the source of their insights into the physiological response is another matter.

Grossman is described as being one of the world's foremost experts in the field of human aggression adn the psychology of combat. His much lauded On Combat describes the psychology and physiology of 'deadly conflict'. His physiological explanation comes direct from Siddle. Siddle is referencing stress theory. Stress theory refers to one stress response. What is an underlying assumption when using the stress/fight-or-flight response to understand the physiological response to a threat in a violent situation? That the feeling response is fear. What if the feeling response is anger? In fact, Cannon, the author of the fight-or-flight concept associated the flight response with fear and the fight response with anger. AS tells us that there is a different physiological response with both emotions. Rather than the fight-or-flight response, stress response, or survival stress response, maybe it should be referred to as the fear response. In fact, Grossman does specifically associate his physiological discussion with fear.

Siddle states that PNS is 'dominant during nonstress environments where an individual perceives he/she is safe.' Grossman refers to 'parasympathetic backlash' and only discusses PNS activity in relation to its activation after combat has been completed. They both focus on SNS activity, not surprisingly given the source of their insights lay within the stress discipline. Based on Schauer and Thomas's defence cascade, they are only describing one half of the cascade, one half of the evolved stress responses associated with fear, for one emotion, fear.

Our evolved survival mechanism is more complex than this one-half-one-emotion response. Siddle and Grossman, and those referring to their work, would appear to be like one of the blindmen of Indostan who attempt to describe an elephant by touching only one part of it. This is a reflection of the reference only to stress theory.

Lazarus (1993) suggests: 'Use of stress as a source of information about an individual's adaptation to environmental pressures is extremely limited compared with the use of the full array of emotions.' This is most definitely true in relation to our evolved survival responses.

Does fight-or-flight need updating? Definitely! My work, presented in Beyond Fight-or-Flight, integrates stress theory and emotion theory to provide a more complete understanding of our evolved survival responses. This forms the basis for understanding our learned survival responses as well. This work is unique in that no other author has attempted to integrate the theory of these two disciplines for this purpose.

Monday, October 24, 2011

Survival Scores Research Project

The U.S. Federal Law Enforcement Training Center (FLETC) provides training to law enforcement personnel from numerous federal, state, and local agencies. A law enforcement officer's survival requires that he or she is able with to quickly assess a situation and respond with appropriate actions in dynamic, life-threatening, time-pressured situations that are likely to be encountered in carrying out their duties. A research program was initiated to examine the extent to which stress training can better prepare law enforcement officers to perform under highly stressful conditions. Initial results from the research program have been reported in a technical report entitled the Survival Scores Research Project (FLETC 2004).

The report refers to an FBI report for the year 200 which 'provides some alarming statistics in the area of officer survival':
The number of law enforcement officers feloniously killed in the line of duty was up 21.4 percent from the previous year’s number – 51 officers were slain in 2000, and 42 officers were killed in 1999.

Slightly more than half (53%) of the felonious shootings took place at a distance of 0-5 feet, and 70% were at 0-10 feet. These close range killings are also representative of the ten-year period for 1991 – 2000.

Body armor appears to provide minimal protection in close range shooting scenarios, as 29 of the 47 (62%) slain officers wore protective clothing.
When discussing the requirement to train law enforcement officers to perform under stress:
A Department of Justice report on 40 attempted shootings of officers found that victim officers returning fire averaged a hit on their target 41% of the time, while the offenders achieved a 91% hit rate. Of course, each of these officers was reacting to being shot at (the majority were actually shot), and under severe stress ... Preparing individuals for such moments is among the challenges law enforcement trainers face.
FLETC researchers developed a scenario designed to replicate real-world law enforcement situations. One of the scenarios was 'gun take-away and shout-out':
Maximum levels of arousal were achieved as the scenario deteriorates with the return of the theft suspect, an escalating argument, and the decision by the 'senior partner' to remove the hostile theft suspect from the building. The 'senior partner' has his weapon taken and is shot by the suspect, who then takes the complainant hostage which he also shoots. Stress is further escalated by loud music limiting communication, the sound of a loud, barking dog in the adjoining room, very close quarters and very limited cover. The exit is blocked by the downed 'body' of the 'senior partner.' The suspect (a firearms instructor) has cover and produces a shotgun (simunitions) which he uses in conjunction with the downed 'senior partner’s' weapon to fire at exposed parts of the trainee with simunitions rounds. The trainee’s third round in the magazine in the weapon provided has been altered to not fire, forcing the trainee to respond to the development. The suspect is either shot by the officer and eventually falls, or commits suicide if the officer does not disable the suspect.
What were the results? 'Overall, performance deteriorated, as expected, and only 28.2% performed well enough to pass this event.'
Popular theory has long held that a loss of fine and complex motor skill could be observed as a result of high stress levels. The trainees observed in this study did not appear to be unable to perform fine and complex motor skills as noted when weapons handling skills were evaluated. Rather, they seemed to perform them in the incorrect sequence or perform the wrong function all together, thereby producing a 25.8% success rate.
The popular theory to which they refer is Bruce Siddle's theories first espoused in Sharpening the Warrior's Edge. His ideas appear to have taken on the authority of popular theory or commonly conceived wisdom. Many in activities associated with preparing a person to survive a violent encounter who refer to these theories often are unaware of their origins, and their limitations.

In Performance Under Stress (Hancock and Szalma 2008), in the contribution concerning Stress Exposure Training, Driskell et al refer to the FLETC research project. They explain that 'weapons handling skills were seriously degraded as trainees were unable to perform complex motor skills ...'. This observation appears to be at odds with the authors of the FLETC report.

Siddle's thesis is that as combat stress increases, a survival stress response is initiated which has 'catastrophic' effects on cognitive and motor performance. He suggests that 'fine and complex motor skills begin to deteriorate when the working heart rate accelerates beyond 145 beats per minute.' The trainees heart rate approached but did not exceed 140 bpm.
These scores show a majority of the trainees made poor tactical decisions as to courses of action, did not effectively resort to more advanced/complex and less utilized re-loading methods, could not perform a sequence skill under stress, did not employ tactical movement concepts of 'shoot and move', and did not use the instructed kneeling position behind cover.
The shot placement data was interesting, if not disturbing:
Overall performance in this element showed a 28% passing rate. Analysis determined only 3.4% of the trainees demonstrated 70% accuracy or better when all rounds expended during the engagement were considered. Only 19.4% of all rounds fired hit the suspect who was approximately 3 yards from the trainee. In addition to shots going low, trainees scored poorly in applying fire to center mass or available center mass. Approximately 20% shot the hostage. The only performance item in the upper 50 percentile was proper clearing on the weapon, with 63% passing this element.

Of note was the statistically significant difference in overall shot placement scores by gender. 94.74% of females failed the shot placement element, while 66.25% of males failed. Further analysis was conducted to examine firearms qualification scores achieved during training. Once again, a statistically significant difference was, observed (as expected), with females averaging 248 compared to 273 for males. These data would suggest that a lower degree of accuracy in a static training environment may translate into a lower level of accuracy in a dynamic environment.
One of the research questions was: 'Can specific psychological factors be identified that predict performance in a highly stressful law enforcement encounter?' In their discussion they suggest, 'the relationship of psychological factors to performance in a high stress encounter will require further examination.'

This is the basis of my work in Beyond Fight-or-Flight: Surviving a Violent Encounter (an extended title I'm trying out). Our survival mechanism includes an appraisal process and a subjective feeling, physiological, motor expression, action tendency, and behavioural response. These are all highly interconnected. The stress discipline studies this mechanism in a limited and biased way reflecting their disciplinary interest. Another discipline, the emotion discipline, studies the same process but in a more complete, survival focused, way. Integrating the theories and concepts of the two disciplines, as I do, provides a more complete understanding of our evolved survival mechanism. It also provides the basis for understanding all of the methods developed by those activities associated with preparing a person to survive a violent encounter. These methods are interventions in the survival process.

When differentiating between physical stress and psychological stress, albeit without the benefit of an explicit understanding of the difference, they suggest that, 'training under psychological/emotional stress will better prepare the brain to perform under those conditions when the need arises versus having trainees exercise. The focus should be in the process of how the stress is created (the stimulus), rather than in the product of how the stress is measured (the response). I agree, to a point. The first step should be to understand our survival process. This then would lead to an appreciation that the appraisal process and subjective feelings are the important elements in the process. The stress discipline tends to focus on the physiological response. This is reflected in Siddle's focus, and the focus of the FLETC research program.

In The Definitive Textbook for Military and Law Enforcement Reality Based Training, Murray refers to the FLETC research program. He suggests that 'trainers must have the knowledge and skills to decode student behaviour to achieve optimum results.' I agree, but I don't believe the knowledge is available when only stress theory is referred to in connection with a person's survival response. This is the basis of my Beyond Fight-or-Flight.