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Beyond Resilience and PTSD: Mapping the Heterogeneity of Responses to Potential Trauma
Abstract and Figures
The formal acceptance of posttraumatic stress disorder (PTSD) as a legitimate diagnostic category in the 1980 Diagnostic and Statistical Manual of Mental Disorders stimulated a torrent of research on psychological trauma. Not surprisingly, PTSD and its treatment had dominated that research. Another common approach has been to measure the average impact of different potentially traumatic events, as well as the factors that inform that impact. In this article, we consider the limitations of these perspectives and argue for a broader theoretical approach that takes into account the natural heterogeneity of trauma reactions over time. To that end, we review recent attempts to identify prototypical patterns or trajectories of trauma reaction that include chronic dysfunction, but also delayed reactions, recovery, and psychological resilience. We consider the advantages but also the limitations and ongoing controversies associated with this approach. Finally, we introduce promising new research that uses relative sophisticated advances in latent growth mixture modeling as a means of empirically mapping the heterogeneity of trauma responses and consider some of the implications of this approach for existing trauma theories. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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... /fpubh. . symptoms remit with time (typically within 1-2 months) (2) and do not result in the development of mental health disorders (2,3). For example, 82% of rescue and recovery responders to the 2001 World Trade Center attack reported low to moderate trauma symptoms that never rose to the level of a posttraumatic stress disorder (PTSD) diagnosis throughout the nine-year study period (4). ...
... /fpubh. . symptoms remit with time (typically within 1-2 months) (2) and do not result in the development of mental health disorders (2,3). For example, 82% of rescue and recovery responders to the 2001 World Trade Center attack reported low to moderate trauma symptoms that never rose to the level of a posttraumatic stress disorder (PTSD) diagnosis throughout the nine-year study period (4). ...
... For example, 82% of rescue and recovery responders to the 2001 World Trade Center attack reported low to moderate trauma symptoms that never rose to the level of a posttraumatic stress disorder (PTSD) diagnosis throughout the nine-year study period (4). Despite this overall positive outlook, some individuals will develop mental health disorders or experience symptom worsening in the months after a traumatic event (2,5,6). Predicting and tracking mental health outcomes following response to a disaster may lead to the development and improvement of post-disaster prevention, mitigation, and intervention services for first responders. ...
In June 2021, a condominium in Florida collapsed, with the loss of 98 lives. Search and rescue teams spent 2 weeks, recovering the victims. This study's objective was to assess the presence of psychological symptoms that might emerge in the following months, using the PTSD Checklist for DSM-5 (PCL-5), Patient Health Questionnaire−9 (PHQ-9), Generalized Anxiety Disorder – 7 (GAD-7), Suicide Cognitions Scale-Short (SCS-S), and the Insomnia Severity Index (ISI). A monthly survey conducted for 3 months found that overall, mean scores on these measures did not indicate significant emotional distress. We then compared the scores when the group was divided into responders who recovered human remains and those who did not. Scores were significantly higher among the subgroup that recovered human remains. Fifty-three percent (53%) of this sub-group met the cut-off score for a provisional diagnosis of PTSD, depressive disorder or generalized anxiety disorder−15% met the cut-off score criteria on the PCL-5 for probable PTSD, 36.8% for probable depressive disorder on the PHQ-9, and 26.3% for probable generalized anxiety disorder on the GAD-7. The results are consistent with other investigations examining mental health after mass disasters. Specifically, not all first responders will develop emotional distress but certain recovery activities may put some responders at higher risk, with a percentage displaying psychological distress. The results emphasize the need to assess the impact of these events on the mental health of first responders and to consider strategies to prevent or mitigate the development of impairing psychopathology.
... After experiencing trauma, individuals may have a heterogeneous posttraumatic stress response even when exposed to the same traumatic event (Bonanno and Mancini, 2012). Longitudinal studies on the development of CPTSD symptoms are scanty. ...
... This study identified three trajectories of CPTSD symptom development: the low-symptoms group (41.8 %), the moderate-symptoms group (36.7 %), and the high-risk group (21.4 %). The study confirms the existence of heterogeneous posttraumatic stress responses between individuals (Bonanno and Mancini, 2012). In addition, the findings suggest that self-compassion significantly predicted the development of CPTSD trajectories. ...
Background:
Complex posttraumatic stress disorder (CPTSD) is associated with severe impairments in psychosocial functions, but related longitudinal research is limited. To promote the mental health of college students with childhood adversities, it is imperative to investigate the development of CPTSD symptoms and the predictive factors.
Objectives:
The study aimed to examine the latent trajectories of CPTSD symptoms among college students with childhood adversities and to identify the role of self-compassion in differentiating potential trajectories.
Methods:
A total of 294 college students with childhood adversities completed self-report questionnaires on demographic backgrounds, childhood adversities, CPTSD symptoms, and self-compassion three times with an interval of three months. Latent class growth analysis was used to determine the trajectories of CPTSD symptoms. Multinomial logistic regression was performed to examine the association between self-compassion and trajectories subgroups while adjusting for demographic variables.
Results:
Three heterogeneous groups of CPTSD symptoms among college students with childhood adversities were identified: the low-symptoms group (n = 123, 41.8 %), the moderate-symptoms group (n = 108, 36.7 %), and the high-risk group (n = 63, 21.4 %). Multinomial logistic regression showed that, after adjusting for demographic variables, students with higher levels of self-compassion were less likely to belong to the moderate-symptoms and high-risk group in comparison to the low-symptoms group.
Conclusions:
The results suggest the trajectories of CPTSD symptoms of college students with childhood adversities were heterogeneous. Self-compassion was a protective factor against the development of CPTSD symptoms. The present study provided insights into the mental health promotion for individuals with adversities.
... Resilience involves the presence of two components: a) a resistance to adversity; and b) a return to daily life with proper functioning and with a plan for the future (Echeburúa, 2021;Grych et al., 2015). Likewise, resilient coping has to do with the presence of strengths in emotional regulation skills and in prosocial skills (Bonanno & Mancini, 2012). The psychological pillars of resilience are self-esteem, emotional self-regulation, positive thinking and the will to live (Barudy & Dantagnan, 2011;Echeburúa, 2018). ...
... Others, after an intense psychological reaction, are able to cope with the pain, to partially readapt to the situation and attend to their immediate needs. Finally, there are others who draw strength from the weakness of pain, focus on the positive aspects of reality and do not limit themselves to surviving, but manage to live more fully, embarking on exciting future projects (Bonanno & Mancini, 2012;Masten & Narayan, 2012;Zhen & Zhou, 2022). ...
... Resilience describes the process in which someone experiences a critical incident, perhaps temporarily passing through grief and sadness, but then coming back to his or her baseline of functioning, whereas a person who is not as resilient remains symptomatic for a longer period of time and struggles to return to normal functioning (Bonanno & Mancini, 2012). A resilient person experiences the potentially traumatic experience and then adapts (Luthar et al., 2000). ...
As a result of frequent exposure to trauma, aid workers are at high risk for negative psychological symptoms. Training specifically geared at fostering critical incident self-efficacy in humanitarian aid workers may bolster critical incident self-efficacy as well as general self-efficacy as they relate to experiences of traumatic symptomatology and resilience. Sixty-three aid workers completed questionnaires regarding efficacy, resilience, coping, and posttraumatic stress symptomatology at baseline, and 46 aid workers completed the same measures after the training workshop. Multiple regression analysis indicated that higher levels of self-efficacy related to higher resilience levels. General self-efficacy and critical incident coping self-efficacy (CICSE) were stronger after the training, even when controlling for histories of trauma. Histories of trauma contributed significant variance to CICSE before the training but were insignificant after the training. These findings suggest that aid organizations can support their workers by providing training that promotes resilience through enhancing efficacies.
... A stress adaptation model recognizes that stress and resilience may look and manifest differently across various contexts (see for example: Panter-Brick, 2014). As well, three other concepts -knowledge, an individual's perception of events as traumatic (or not), and availability and accessibility of resources -are linked to resilience in the context of adaptation to stress (see for example : Bonanno & Mancini, 2012). The adaptive stress model is relevant to nurses (see for example : Haslam & Mallon, 2003;Murphy, Durkin, & Joseph, 2011) who face ongoing work-related stressors yet tend to remain healthy (as defined by the World Health Organization, 2014) and resilient, and utilize a variety of health-focused resources (McAllister & Lowe, 2011). ...
Few individuals who experience trauma develop posttraumatic stress disorder (PTSD). Therefore, the identification of individual differences that signal increased risk for PTSD is important. Lissek et al. (2006) proposed using a weak rather than a strong situation to identify individual differences. A weak situation involves less-salient cues as well as some degree of uncertainty, which reveal individual differences. A strong situation involves salient cues with little uncertainty, which produce consistently strong responses. Results from fear conditioning studies that support this hypothesis are discussed briefly. This review focuses on recent findings from three learning tasks: classical eyeblink conditioning, avoidance learning, and a computer-based task. These tasks are interpreted as weaker learning situations in that they involve some degree of uncertainty. Individual differences in learning based on behavioral inhibition, which is a risk factor for PTSD, are explored. Specifically, behaviorally inhibited individuals and rodents (i.e., Wistar Kyoto rats), as well as individuals expressing PTSD symptoms, exhibit enhanced eyeblink conditioning. Behaviorally inhibited rodents also demonstrate enhanced avoidance responding (i.e., lever pressing). Both enhanced eyeblink conditioning and avoidance are most evident with schedules of partial reinforcement. Behaviorally inhibited individuals also performed better on reward and punishment trials than noninhibited controls in a probabilistic category learning task. Overall, the use of weaker situations with uncertain relationships may be more ecologically valid than learning tasks in which the aversive event occurs on every trial and may provide more sensitivity for identifying individual differences in learning for those at risk for, or expressing, PTSD symptoms.
This study examines the generalizability of the latent structure of the Polish version of the Ego-Resiliency Scale (ER89-R12), a brief self-report scale that measures ego-resiliency. We investigated the measurement invariance, validity, and reliability of ER89-R12 among three groups of individuals who were facing various major, long-term, life-changing crises ( N = 512): parents of children with Down’s syndrome, women with breast cancer, and individuals after divorce. The analysis of the measurement invariance confirmed the two-factor structure of the questionnaire and the high reliability of this measure in those studied groups. A multigroup confirmatory factor analysis provided evidence of configural, metric, scalar, and residual invariance across the three groups. Moreover, the correlation patterns were similar across the groups. Ego-resiliency was strongly and consistently positively correlated with mental health: psychological well-being, perceived social support, self-esteem, and post-traumatic growth, and negatively correlated with perceived stress. The presented results indicate the potential usefulness of the ER89-R12 tool in studies on people experiencing various crises in their lives.
The majority of youth experience some type of gendered harassment from their peers and these harassment experiences are related to a host of negative psychological, social, and academic outcomes. Much of this harassment occurs within schools; therefore, it is especially important to understand the role of schools and teachers in preventing and mitigating (or at times, exacerbating) youth’s experiences of gendered harassment. In this chapter, we will describe the prevalence and negative psychosocial outcomes associated with two common types of gendered harassment: sexual harassment (SH) and harassment on the basis of sexual orientation, gender identity, and gender expression (SOGIE harassment). We will then discuss how schools may contribute to the prevalence of SH and SOGIE harassment, and how they can respond to and prevent SH and SOGIE harassment from occurring. We conclude by suggesting directions for future research and intervention work.
Henan Province in Central China was hit by unprecedented, rain-triggered floods in July 2021 and experienced a recurrence of the COVID-19 pandemic. The current study aims to identify the latent profiles of psychological status and acceptance of change among Henan residents who have been cumulatively exposed to these floods and the COVID-19 pandemic.
A total of 977 participants were recruited. Latent profile analysis (LPA) was used to explore underlying patterns of psychological status (i.e., perceived risk of the COVID-19 pandemic, post-traumatic stress symptoms, anxiety and rumination) and acceptance of change. The predictors were evaluated with multinomial logistic regression.
LPA identified four patterns of psychological status and acceptance of change: high distress/high acceptance (5.1%), moderate distress/moderate acceptance (20.1%), mild distress/mild acceptance (45.5%), and resilience (29.3%). The additive impact of the floods and COVID-19 pandemic and negative emotion during the floods were the risk factors, while flood coping efficacy, trust, and a closer psychological distance change were the protective factors.
The present study therefore provides novel evidence on psychological status after both a natural disaster and a major public health event. The cumulative effects of the floods and the COVID-19 pandemic may have heightened the risk of post-disaster maladaptation. A complex relationship between psychological outcomes and acceptance of change was also found. The findings of this study thus provide a foundation for both disaster management and psychological assistance for particular groups.
Background:
The COVID-19 pandemic was one of the most devastating disasters of the twenty-first century and has exacted a steep health and economic toll. During times of suffering caused by the pandemic, religion/spirituality may prove to be a consistent and valuable coping resource.
Purpose:
We situate changes in religious importance and reliance on God as key aspects of religious life that may be important coping mechanisms in response to pandemic-related financial hardship, addressing a gap in the literature on religious coping during the pandemic and considering self-reported changes in religiosity.
Methods:
We use data from a nationally representative sample of Americans that was collected in 2021 (N = 1704) and employ a series of OLS Regression Models.
Results:
Our results suggest that relying more heavily on God was associated with lower psychological distress, and a stronger reliance on God buffered the deleterious consequences of financial strain on psychological distress. No such patterns were documented for religious importance.
Conclusion and implications:
We discuss our findings within the broader religion and health literature as to whether secondary control via a divine power reduces or enhances individual agency and discuss religion/spirituality may be a consistent and valuable coping resource through adversity and suffering. Though it may be challenging to maintain, or increase, religious/spiritual beliefs in the face of adversity, that there were observed benefits to well-being for doing so could serve as insightful guidance for both religious leaders and R/S individuals.
Mental health professionals have debated whether posttraumatic stress disorder (PTSD) can be qualitatively distinguished from normal reactions to traumatic events. This debate has been fueled by indications that many trauma-exposed individuals evidence partial presentations of PTSD that are associated with significant impairment and help-seeking behavior. The authors examined the latent structure of PTSD in a large sample of male combat veterans, Three taxometric procedures-MAMBAC, MAXEIG, and L-Mode-were performed with 3 indicator sets drawn from a clinical interview and a self-report measure of PTSD. Results across procedures, consistency tests, and analysis of simulated comparison data all converged on a dimensional solution, suggesting that PTSD reflects the upper end of a stress-response continuum rather than a discrete clinical syndrome.
A review of H. F. ELLENBERGER's book, The Discovery of the Unconscious, opens up this section. In this monumental work the author shows how the main schools of dynamic psychiatry over the past two centuries had their roots in the broad cultural movements of their time. A wide perspective of psychotherapeutic approaches ranging from faith healing to psychoanalysis is presented. J. ZUBIN highlights cultural factors regarding etiological models of schizophrenia and regarding the diagnosis of this illness. He comprehensively discusses emerging trends in descriptive psychopathology and cross-cultural studies. E. F. TORREY has provided us with a preview of his book, The Mind Game: Witchdoctors and Psychiatrists. Based on his experiences in several cultures he has identified com monalities in the activities of psychotherapists all over the world. He offers models based on his experiences with different ethnic groups for future mental health services for these groups and others. The last paper in this section concerns itself with the application of verbal psychological tests in translation for cross-cultural psychological or psychiatric purposes. K. GLATT compared differences in the responses to the MMPI in French, Spanish, and German translations (see also R. Prince and W. Mombour, Transcultural Psychiatric Research.
Posttraumatic stress and depressive symptoms were assessed in 5 1 body handlers after Oklahoma City's 1995 terrorist bombing. Although many handlers were inexperienced and knew someone killed, symptoms were low postdisaster and decreased significantly after 1 year. Higher symptomatology and seeking mental health treatment correlated with increases in alcohol use and new physical problems but not with demographics, exposure, or experience. Four respondents with the highest posttraumatic stress symptoms at both time points reported high physical and alcohol use problems and mental health treatment use, suggesting that these should be carefully assessed in body handlers postdisaster. Coping techniques are described, as well as possible reasons for unexpected resilience in the majority.
This article addresses distinctions underlying concepts of resilience and thriving and issues in conceptualizing thriving. Thriving (physical or psychological) may reflect decreased reactivity to subsequent stressors, faster recovery from subsequent stressors, or a consistently higher level of functioning. Psychological thriving may reflect gains in skill, knowledge, confidence, or a sense of security in personal relationships. Psychological thriving resembles other instances of growth. It probably does not depend on the occurrence of a discrete traumatic event or longer term trauma, though such events may elicit it. An important question is why some people thrive, whereas others are impaired, given the same event. A potential answer rests on the idea that differences in confidence and mastery are self-perpetuating and self-intensifying. This idea suggests a number of variables whose role in thriving is worth closer study, including personality variables such as optimism, contextual variables such as social support, and situational variables such as the coping reactions elicited by the adverse event.
Psychology has increasingly turned to the study of psychosocial resources in the examination of well-being. How resources are being studied and resource models that have been proffered are considered, and an attempt is made to examine elements that bridge across models. As resource models span health, community, cognitive, and clinical psychology, the question is raised of whether there is overuse of the resource metaphor or whether there exists some underlying principles that can be gleaned and incorporated to advance research. The contribution of resources for understanding multicultural and pan-historical adaptation in the face of challenge is considered.