MILITARY MEDICINE, 179, 10:1113, 2014
Combat Near-Death Experiences: An Exploratory Study Tracy H. Goza, PhD; Janice M. Holden, EdD; Lee Kinsey, MS
ABSTRACT The purpose of this study was to add to the professional literature regarding combat near-death experiences (cNDEs) and to help clinicians and experiencers (cNDErs) recognize this phenomenon as an experience that is not indicative of mental illness. cNDErs were military personnel whose NDEs occurred during active combat or sequelae. Sixty-eight self-reported survivors of combat-related close brushes with death completed an online survey that included the Near-Death Experience Scale1 (NDE Scale), the Life-Changes Inventory-Revised2, and a few open-ended questions. Respondents were 20 cNDErs—participants who scored at least 7 on the NDE Scale— and 48 non-NDErs. Compared to NDErs from two methodologically similar studies, cNDErs scored lower on Bonferroni corrected t-tests than NDErs on the NDE Scale overall3 ( p < 0.0003) and on Affective and Transcendental subscales; they scored higher on the Cognitive subscale1 ( p < 0.0007). In Life-Changes Inventory-Revised total change and six of seven value clusters, cNDErs, compared to non-NDErs, scored in the same direction as numerous other studies of NDE aftereffects, but none of the differences were statistically significant and all reflected small effect sizes except total change and changes in spirituality that reflected medium effect sizes— a finding that corresponded to analysis of narrative responses.
COMBAT NEAR-DEATH EXPERIENCES: AN EXPLORATORY STUDY In the wake of over a decade of war, active personnel and Veterans of the U. S. military exposed to combat situations face myriad challenges as they attempt to reintegrate into civilian society, their families, and the workplace. Among these challenges, Veterans exposed to life-threatening com bat may have had a near-death experience (NDE). Beyond the life-threatening physical event, NDEs are “profound psy chological events with transcendental and mystical elements, typically occurring to individuals close to death or in situa tions of intense physical or emotional danger”4 (pp 315,316). Approximately one in five research subjects who have sur vived a close brush with death have reported an NDE.5 They typically described these events as hyper-real experiences involving nonordinary perception; as permeated with feelings of peace, love, and acceptance; and as ineffable. Although most NDEs are pervaded with pleasurable feel ings, they often have profound and sometimes distressing psychological, emotional, and systemic impact.6 NDE after effects involve fundamental shifts in perceptions of self, others, and the world that include decreased interest in mate rial gain and increased concern for others and that often result in changes in vocation, changes in religious and spiritual values, and increased sense of meaning in life. Although these changes are, in the long term, mostly developmentally healthy, near-death experiencers (NDErs) attempting to inte grate them often report, in the short term, increased anxiety, depression, and relationship discord. Researchers have found that many NDErs are reluctant to disclose the experience and distressing aspects of after effects to health care providers out of fear of stigmatization
Department of Counseling and Higher Education, University of North Texas, 1155 Union Circle #310829, Denton, TX 76203-5017. doi: 10.7205/MILMED-D-14-00051
M ILITARY MEDICINE, Vol. 179, October 2014
or of being considered mentally ill or demonic.7 Combat NDErs may struggle not only with these issues but also with the potentially complicating factor of post-traumatic stress disorder.3 However, combat NDErs’ experiences and needs remain a matter of speculation, because research focusing specifically on combat NDEs (cNDEs) is scarce. Our literature review yielded only one study. Sullivan8 interviewed 100 male Vet erans who reportedly had survived a close brush with death during combat, of which 24 met his criteria for having had a cNDE. His qualitative observation was that cNDErs were not significantly different than noncombat NDErs. He noted a tendency for Veterans to suffer in silence with distressing memories related to combat. To better understand the contents and aftereffects of cNDEs as compared to NDEs that occurred under a variety of circum stances, we undertook this exploratory study. Our research question was twofold: (a) How do the contents of cNDEs compare to those of NDEs that occurred in a variety of cir cumstances? (b) How do the aftereffects of cNDEs compare to those of NDEs? With these data, we hoped to help military health care personnel—medical, psychological, and spiritual— better understand and meet the needs of cNDErs. METHODS This study was approved by the University of North Texas Institutional Review Board. We defined NDErs as individuals who reported having had an NDE during any of a variety of actual or perceived life-threatening circumstances and who scored 7 or higher on the Near-Death Experience Scale1 (NDE Scale). Because extant NDE literature indicates that NDE contents and aftereffects do not differ based on circum stances of a close brush with death, we defined cNDErs as military personnel whose NDEs reportedly occurred during active combat or sequelae to active combat, such as during surgery following an injury from combat.
Combat Near-Death Experiences: An Exploratory Study
Sample and Participant Selection We attempted to sample the full range of military personnel, active duty, nonactive, and retired; by definition, these par ticipants would be 18 years of age and older. To recruit participants, we developed an advertisement inviting military personnel who had survived a close brush with death during combat to participate in our online survey and linking them to it. The online format enabled even military personnel sta tioned overseas to participate in the study. We identified 45 military and Veteran organizations, including student Veteran organizations on university and college campuses, that maintained a web site and e-mailed them requesting that they post our research study ad on their sites. Of these, 26 organization representatives did not respond or wanted payment for posting the ad and were excluded from further correspondence; three responded but chose not to par ticipate; 10 responded “possibly” or “maybe” but did not follow up. To the remaining six who responded positively we sent the ad for posting. In addition, we posted the ad on the lead author’s Facebook page as well as on six other organizations’ Facebook pages hosting military members’ posts. Potential participants were informed of the possibility to enter a drawing to win an Apple iPad as incentive to partic ipate in our study. Assessments and Measures Our survey consisted of five instruments. Three were established, and two were author-developed. The NDE Scale1 is a 16-item instrument that assesses the presence, contents, and depth of an NDE. A total score of at least 7 indicates an NDE; the higher the score above 7, the deeper or more complex the experience. Four subscales mea sure experiential components. Cronbach’s a reliability for the total scale was 0.881 and 0.913; reliability for the subscales was cognitive 0.75, affective 0.86, paranormal 0.66, and tran scendental 0.76.1 The Life Changes Inventory-Revised2 (LCI-R) assesses aftereffects of a close brush with death. Following Ring’s9 original Life Changes Questionnaire and subsequent LCI, Greyson and Ring2 incorporated into the LCI-R several researchers’ findings to improve the instrument’s validity. The LCI-R’s 50 items yield a total score and nine value cluster scores. Because the authors did not report reliabil ity data, this study presented an opportunity to assess the LCI-R’s reliability. We developed a basic demographics/background ques tionnaire to collect nonidentifying information on partici pants, their combat experiences, and their close brushes with death. In addition to basic demographics, we asked a series of open-ended follow up questions about their close brushes with death, any subsequent changes, and their experiences of disclosing their close brushes with death to family members and health care providers. These follow-up questions were as follows: (a) What is the single most important change you
have had since your NDE? (b) To whom have you disclosed your NDE? What was their response to you? (c) In what if any way has your NDE been addressed in your aftercare? (d) How has the NDE affected your spiritual life? Data Collection and Analysis We used Qualtrics, an online software program, to design and implement our survey. Although Qualtrics collected the Internet protocol address of each respondent, Qualtrics used this information only to block multiple responses from the same Internet protocol address. After completing the survey, participants could enter the iPad drawing through a process separate from their survey responses. The survey was active for 3 weeks, a duration that yielded a response rate with sufficient power to conduct our analysis. Our a priori G*Power10 analysis recommended 15 to 16 responses. We utilized the Statistical Package for the Social Sci ences for analysis. We calculated NDE Scale total scores and used a score 7 or higher to differentiate cNDErs from non-NDErs (nNDErs). We compared cNDErs’ NDE Scale total and four subscale scores to Greyson’s 1983 and 2001 NDErs’ scores using f-tests with Bonferroni correction to reduce the risk of Type 1 error. We also calculated LCI-R total scores and nine value cluster scores, and we compared NDE Scale total and subscale scores with LCI-R total and value cluster scores using multiple t-tests with Bonferroni correction. For all these data, we calculated effect sizes using Cohen’s d and, in the absence of norms for this popu lation, utilized Cohen’s cautious suggestion for interpreting the effect sizes of 0.2 for small, 0.5 for medium, and 0.8 for large effect. We conducted an informal analysis of participants’ narra tive responses. For each question, we created tables for cNDE and nNDEr narrative responses and listed responses in order from highest to lowest cumulative NDE Scale scores. We then consulted together to determine various response cate gories or overall themes reflected in the responses. Wherever we observed a distinct theme shared by at least two responses, we specified the theme with a category label we believed captured the theme. We then independently rated each response as either reflecting or not reflecting that theme. We calculated an initial percentage agreement between our ratings; conferred together on disagreement ratings to enable one or the other of us to revise our rating if, upon discussion, it seemed appropriate; and then recalculated percentage agreement between our ratings. RESULTS Of the 125 respondents who began the survey, 68 completed it. Of these, 20 scored 7 or higher on the NDE Scale and comprised the cNDErs, and 48 scored below 7 and comprised the nNDErs. Participants’ relevant demographic data appear in Table I. The results indicate a reasonably diverse group of military personnel.
MILITARY MEDICINE, Vol. 179, October 2014
Combat Near-Death Experiences: An Exploratory Study TABLE I.
Demographic Age Mean Range Sex Male Female Ethnicity White American Indian/Alaska Native Native Hawaiian/Other Pacific Islander Non-White/Latino White/Latino American Indian/Alaska Native/White Black/African-American/White Military Branch Air Force Army Coast Guard Marines Navy Reserve Guard
cNDErs (n = 20)
nNDErs (n = 48)
80% 5% 5% 5% 5%
55% 10% 20% 5% 10%
2% 65% 15% 8% 10%
Hypothesis 1 W e hypothesized no significant difference between (a) NDE Scale total and subscale scores of cNDErs from this study and (b) variety-of-circumstances NDErs from two other studies.11,12'The two comparison studies represented the result of our search of the professional literature for studies that, like this one, were retrospective rather than prospective, involved survey rather than only interviews, involved the largest sample size of participants, included methodology similar to this study, were conducted in the United States, and had relatively recent publication dates. After Bonferroni correction, the criterion for statistical significance was p