Exploratory pilot study of driving perceptions among OIF/OEF Veterans with mTBI and PTSD

Abstract

Abstract-Veterans of Iraq and Afghanistan may experience driving-related challenges postdeployment, including more atfault crashes. Causes may include defensive driving tactics learned for combat zones and consequences of traumatic brain injuries (TBIs) and posttraumatic stress disorder (PTSD). Tailoring driver interventions to meet Veterans' needs requires an understanding of their driving perceptions. We explored the driving perceptions of five combat Veterans (4 men, 1 woman) with mild TBI and PTSD using grounded theory methods. Veterans participated in single, semistructured interviews during a comprehensive driving evaluation. Interviews were digitally recorded, transcribed verbatim, verified, and imported into NVivo 8 software for coding and analysis. Veterans were insightful about driving and identified specific environmental triggers for anxious driving, speeding, and road rage. Veterans used strategies to moderate driving behaviors, but continued to drive aggressively. Themes were used to develop a conceptual framework of driving postdeployment, laying the foundation for intervention studies.

Association of posttraumatic stress disorder and traumatic brain injury with aggressive driving in Iraq and Afghanistan combat veterans.

“…This may be important because aggressive driving appears to be unique among driving-related challenges in combat veterans. For example, Hannold et al (2013) found that OEF/OIF veterans sought to implement specific strategies to mitigate most of their driving-related difficulties, with the notable exception of aggressive driving. Individuals with PTSD have been found to be more likely to perceive threat and to attribute hostile intentions to perceived provocation by others (Dodge, Bates, & Pettit, 1990; Taft et al, 2015), and PTSD-related aggression has been found to be largely impulsive in nature (Heinz, Makin-Byrd, Blonigen, Reilly, & Timko, 2015; Miles, Menefee, Wanner, Teten Tharp, & Kent, 2015; Teten et al, 2010) and associated with symptoms of hyperarousal (Kachadourian et al, 2013; Pavic et al, 2003).…”

“…Accidents are not the only adverse consequence of high levels of driving-related anger in combat veterans: In one sample of recently deployed OEF/OIF veterans, over one quarter of respondents reported that they “seek a personal encounter with a bad driver” at a rate of “sometimes”, “often”, or “always” (Hwang et al, 2014). Not surprisingly, veterans in treatment seeking samples cite problems with anger, aggressive driving, and road rage as being among their most pressing driving-related concerns (Hannold, Classen, Winter, Lanford, & Levy, 2013; Lew et al, 2011; Strom et al, 2013).…”

“…There are multiple factors that may contribute to aggressive driving in this population. First, military personnel who served in Iraq or Afghanistan were trained to employ aggressive, life-saving “battlemind” driving tactics that include speeding, swerving around road hazards, straddling the center line, and ignoring traffic signs (Amick, Kraft, & McGlinchey, 2013; Hannold et al, 2013; Lew, Amick, Kraft, Stein, & Cifu, 2010). Second, traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) 1 are common among OEF/OIF veterans, and each has been found to be associated with increased incidence of aggressive driving (Ilie et al, 2015; Kuhn, Drescher, Ruzek, & Rosen, 2010; T.…”

“…The majority of research examining difficulties with aggressive driving or road rage among OEF/OIF veterans has been conducted in veterans who obtain healthcare through the Department of Veterans Affairs (VA) (Hannold et al, 2013; James, Strom, & Leskela, 2014; Kuhn et al, 2010; T. Strom et al, 2013; T.…”

Driving Intervention for Returning Combat Veterans

“…This may be due to battlemind driving habits, as well as the lack of mitigation strategies to combat such driving behaviors (Woodall et al, 2014). However, aside from potential causes such as being male, young, and having an “alpha male” role to fulfill during combat (Hannold, Classen, Winter, Lanford, & Levy, 2014, p. 1324), other documented causes (next discussed) include effects of polytrauma following blast injuries (e.g., residual symptoms of a mild TBI or PTSD; Classen, Cormack, et al, 2014).…”