The Social Cognitive Theory (SCT) best fits our target population of veterans and the health condition of diagnosed PTSD. The SCT is an interpersonal level that takes a dynamic environment into account factoring in personal, behavioral and environmental concepts. Key dynamics of the theory include personal factors, reciprocal determinism and adaptive environments in which a person can influence their environments and be influenced by their environment. When working with a dynamic population such as veterans, it is important to examine the interaction between personal characteristics such as belief, motivation and behavioral choices, and environmental factors such as collective efficacy, self-control, and observational learning.
Theory Selection: Social Cognitive Theory
Developed by Albert Bandura, Social Cognitive Theory (SCT) is an interpersonal theory based on a reciprocal model of the three-way dynamic interplay between an individual’s personal factors, behavior and environment. The fundamental construct of the SCT, reciprocal determinism, emphasizes that a person’s behavior both influences and is influenced by personal factors and the social environment. Taking the multifaceted attributes of an individual, the theory examines one’s self-efficacy based on personal factors such as an individual’s behavioral capability, expectations, expectancies, self-control and emotional coping abilities. In addition to personal factors, it examines the environmental factors such as vicarious learning, one’s situation or environment, reinforcement and reciprocal determinism that may affect personal factors. Perceived self-efficacy is a key construct of the theory as it addresses the impact of personal determinants, an individual’s motivation, actions and behavior on socio-structural determinants.
The Social Cognitive Theory is used in health behavior modification programs for disease prevention and management because it synthesizes concepts and processes from cognitive, behavioristic, environmental and emotional models of behavior change. The SCT views health behavior as the outcome of individual belief, dynamic interactions and social processes. Through analysis of a dynamic three-way reciprocal model, SCT provides a real-world deduction for behavioral research and health promotion practice. The theory assumes that people learn from observing the action of others, knowledge may or may not motivate a behavior and behavior are directed toward particular goals.
Components of the Social Cognitive Theory
Individual Constructs. Behavioral modification programs need to focus on engagement in follow-up treatment and social support in conjunction with initial screening procedures. Engagement and retention in follow-up mental health services by the target population is highly associated with self-efficacy to seeking treatment. Veterans are disproportionately affected by stigma, which can be caused by personal beliefs and/or military culture, causing apprehension
to receiving mental health care. PTSD is associated with maladaptive changes in self-identity, including poorly perceived self-efficacy (Brown, et al., 2016). While examining the relationship between enhanced perceptions of self-efficacy in combat veterans with and without symptoms of PTSD and cognitive strategies associated with positive mental health outcomes, Brown et al. found that individuals with symptoms of PTSD could not generate self-efficacious statements. Additionally, veterans with PTSD had trouble with social problem solving and visualizing an optimistic future. In summary, by increasing perceptions of self-efficacy, veterans will be able to visualize a future and utilize problem-solving techniques that will help to overcome trauma and adversity (Brown, et al., 2016).
Veterans are more likely to be candid, listen and contemplate behavior change within a peer supported group. By creating a safe environment with knowledge, outreach, and peer support, the target population is encouraged to engage in follow-up treatment. The constructs of behavioral capability, expectations, self-control and emotional coping will proportionately increase with self-efficacy as the group feels more in control of their circumstances, knowledge and abilities to seek follow-up treatment. It is crucial to address self-coping with alternative solutions, peer mentors and resources while veterans attempt to change their behavior (Yoon, Lo, Gehlert, Johnson, & O’Toole, 2017). In a study conducted by Mittal et al. (2013), at first treatment seeking veterans experienced some degree of self-stigma but after treatment sessions with fellow veterans they began resisting personal and environmental stereotypes.
Environmental Constructs.
Peer support delivered by fellow veterans will help to develop a social network, creating a different supportive environment for the veteran population. The collective group experience, training and social support structure of the military reinforces observational learning, situational and environmental factors and reinforcements. As a target population, veterans are secluded in their experiences, roles and knowledge with their unit allowing them to sympathize and empathize with one another more than others who have not shared the experience. This seclusion allows increase likelihood of shared reciprocal determinism.
Studies have found that veteran peers are the most highly valued component of their social network (Laffaye, et al.,2008). Veterans within the study reported receiving influential assistance from equal numbers of veterans and relatives, veteran peers were their most common source of emotional support. This is consistent with clinical reports that veterans who have sought PTSD treatment tend to seek support from other veterans more than they do from nonveteran friends and even from their families. Decreased interaction with one’s unit and post-deployment social network increased the likelihood of PTSD and depressive symptoms, in turn decreasing resilience and psychosocial functioning (Pietrzaka, et al., 2010).
Conclusion
Developing the program with use of the Social Cognitive Theory will decrease the prevalence of PTSD in our target veteran population. Addressing the reciprocal effect of personal factors such as self-efficacy, behavioral capability, and self-control as well as observation situational learning and reinforcement should increase the rate of treatment seeking behavior while developing a social support network.