Moreover, Albert Rizzo developed a therapeutic tool using virtual reality to treat PTSD veterans, applying the cognitive level of analysis. Thus, in ‘Virtual Iraq’ he have traumatized soldiers the opportunity to re-experience the horrors of the war and the therapist could manipulate variables that were relevant for each individual. This therapy was based on the concept of flooding, that is over-exposure to stressful events, because it is well-known that the stress reactions will eventually fade out due to what is called habituation, which is getting used to the stimuli. It was thus considered that the power of the cues that trigger traumatic memories gradually diminishes. However, while providing a practical solution for the patients suffering from PTSD, this experiment does not necessarily state that the traumatic memories will not appear later in life, but only that during the time of the experiment, it was noticed an improvement regarding the patients’ reaction when exposed to similar stimuli as those in the traumatic event. Also, the way the patients respond to the stimuli (and the way PTSD manifests in them) may be different depending on age, culture and gender. For example, non-Western patients may not display affective or behavioral symptoms, but rather somatic ones and if the improvements are measures with questionnaires asking about their feelings, this will not consider the evolution or physical symptoms. Moreover, there is on clear, objective way of assessing improvement for PTSD as there may be a reporting bias or intense anxiety or preoccupation on the part of the patient may affect the process of communication.
Also regarding the cognitive level of analysis, Sutker (1995) found that Gulf War veterans who had a sense of purpose and commitment to the military had less chance of suffering from PTSD han other veterans. This perhaps identifies a correlation between the two, but again there is no evidence of a causal relationship between sense of purpose and diminished chance of suffering from PTSD.
Moreover, Suedfeld’s (2003) study on the attributional patterns of Holocaust survivors found that it tends to be more external, that is God luck or fate and although mentions of help from others were prominent in the study, survivors nevertheless have low trust in others and demonstrate a skeptical view of the world). While this may have some validity, it should be questioned whether the results were due to the fact that were interviewed groups were Jewish (in which case this could be more about socio-cultural factors than cognitive ones). Some other disadvantages would be the fact that interviews and questionnaires were used which, like many evaluation methods occur after the event, so participants may forget important issues.
Also, they are standardised so it is not possible to explain any points in the questions that participants might misinterpret.
Respondents may answer superficially especially if the questionnaire takes a long time to complete.
The participants may not have been willing to answer the questions. They might not wish to reveal the information or they might think that they will not benefit from responding perhaps even be penalised by giving their real opinion. Students should be told why the information is being collected and how the results will be beneficial. Some advantages of the methods would be that information can be collected from a large portion of a group.
The cognitive approach involves neuroscience, philosophy and psychology, being useful because instead of just measuring external behaviours (a method employed by behaviourists), it measures internal states like memory and mental processes, but it does this more accurately because of the scientific methods used, than something like psychoanalysis. The cognitive approach is more reliable than, for example, structuralism because it applies scientific research methods, making it more reliable. Other methods can be very subjective, and the methods of measuring them inaccurate. However, since the cognitive approach uses mainly questionnaires and interviews, it may be subjective, biased and vulnerable to researcher bias, the halo effect (which our judgments of a person’s character can be influenced by our overall impression of him or her) or confirmation bias (such as in Rosenhan’s study, where the clinicians tended to favor information that confirmed their beliefs or the diagnoses already made).
Second of all, the socio-cultural level of analysis can provide an insight into the racial and ethnic differences that may have an impact on the way PTSD is classified and identified and, more important how often and regarding which group of people. For example, Roysircar (2000) found by doing a meta-analysis of the literature that 20.6% of black and 27.6 % of Hispanic veterans met the criteria for a current diagnosis of PTSD, compared to 13 % whites which suggest that experiences with racism and oppression are predisposing factors for PTSD. However, one disadvantage would be that, while it identified the ‘predisposing factors’, it could not identify the cause for PTSD. Another weaknesses include the racial and ethnic bias, where we are more likely to rate non-whites as being less socially competent and more predisposed to mental disorders, such as in Jenkins-Hall and Sacco (1991).One advantage would be that meta-analysis offers the opportunity to critically evaluate and statistically combine results of comparable studies or trials, by increasing the numbers of observations and the statistical power, and by improving the estimates of the effect size of an intervention or an association. Meta-analysis is superior to narrative reports for systematic reviews of the literature, but its quantitative results should be interpreted with caution even when the analysis is performed according to rigorous rules.
Moreover, Kaminer’s (2000) study in Bosnia found that in 1998 close to 73 % of girls and 38 % of boys in Sarajevo suffered from symptoms of PTSD, higher rate in females which he attributed to fear of rape. While this study shows the proportion in which traumatic events affect individuals, it only states that the participants suffered from symptoms of PTSD, not that they actually had PTSD. Moreover, he attributed the higher rate in girl to fear of rape, but there is no evidence to suggest that it was actually so. This highlights one other criticism to assessing abnormality for a socio-cultural perspective: there must be gender considerations. The different rates in PTSD found in male and females may be due to the fact that they tend to show different symptoms, when in fact both genders may suffer from PTSD in the same proportion, just manifest it differently (e.g. in the case of the males it may manifest as juvenile delinquency, while in the case of females, as anxiety ).
These studies however do not provide robust evidence which the biological level does. For example, Geracioti (2001) found that PTSD patients had higher level of noradrenaline than the average and that stimulating the adrenal system in PTSD patients induced a panic attack in 70 % of patients and flashbacks in 40% patients. Also, twin studies may be used, but the biological level overlooks the fact that environmental factors may play a part in the development of the individual (the nature vs. nurture debate).While the study clearly outlines the symptoms of PTSD and the way they develop and manifest, it cannot establish a causal relationship between the two. Also, the biological level generally is vulnerable to criticism of being reductionist, limitative and quite rigid.
In conclusion, while there are numerous controversies regarding the topic of abnormality and the methods used to classify mental disorders (and even to find suitable definition for those mental disorders), there is no doubt the three levels of analysis, the biological, the cognitive and the socio-cultural, have all had their role in influencing the way PTSD is identified, classified and perceived. Even if there will be no ultimate answer to these questions and even our own socio-cultural heritage and specific circumstance will impede the achievement of an objective, detached view, a close, comprehensive study of the symptoms, cause and effects of PTSD will help us better understand it so that we can device more effective therapeutic treatments to it.