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Layne, C.M. et al. (2004, November). Risk, Vulnerability, Resistance, and Resilience Following Disaster.



This is an invited symposium presentation given at a peer-reviewed international conference in 2004. In it I point out many conceptual and methodological shortcomings in the traumatic stress field and ways in which these impede our efforts to better understand and promote resilient adjustment. Although presented in 2004, my experience as an invited reviewer for many scientific journals during the past decade leads me to conclude that the critique and recommendations provided herein are still highly relevant in 2013 and merit more widespread adoption.
© (2004) Christopher M. Layne.
All rights reserved. 1
Risk, Vulnerability,
Resistance, and Resilience Following
Christopher M. Layne, Ph.D.
UCLA National Center for Child Traumatic Stress
Citation: Layne, C. M., Steinberg, A., Warren, J., Cohn, B., Neibauer, N., Carter, B., Beck, C.,
Walser, B., Money, K., Tanner, J., & Legerski, J. P. (2004, November). Risk, resistance, and
resilience following disaster. In R. Pynoos, Chair, Risk, Resistance, and Resilience in Trauma-
Exposed Populations: Emerging Concepts, Methods, and Intervention Strategies. Invited
symposium presented at the Annual Meeting of the International Society for Traumatic Stress
Studies, New Orleans, LA, USA.
Note: This is an annotated set of slides from an invited symposium I
presented in 2004 at the International Society for Traumatic Stress
Studies. Herein I present ideas that I have further developed in later
publications. If you use any part of these slides, please be respectful by
properly citing it (see citation on cover slide above). If these ideas are
of interest, you may also find the following publications to be useful:
1. Layne, C. M., Warren, J. S., Saltzman, W. R., Fulton, J., Steinberg, A. M., & Pynoos, R. S. (2006). Contextual influences on post-traumatic
adjustment: Retraumatization and the roles of distressing reminders, secondary adversities, and revictimization. In Schein, L. A., Spitz, H. I.,
Burlingame, G. M., & Muskin, P. R., (Eds.), Group Approaches for the Psychological Effects of Terrorist Disasters (pp. 235-286). New York:
2. Layne, C. M., Warren, J., Watson, P., & Shalev, A. (2007). Risk, vulnerability, resistance, and resilience: Towards an integrative model of
posttraumatic adaptation. In M. J., Friedman, T. M., Kean, & P. A. Resick (Eds.), PTSD: Science & practice-A comprehensive handbook. New
York: Guilford.
3. Layne, C. M., Beck, C. J., Rimmasch, H., Southwick, J. S., Moreno, M. A. & Hobfoll, S. E. (2009). Promoting “resilient” posttraumatic
adjustment in childhood and beyond: “Unpacking” life events, adjustment trajectories, resources, and interventions. In D. Brom, R. Pat-
Horenczyk, & J. Ford (eds). Treating traumatized children: Risk, resilience, and recovery (pp. 13-47). New York: Routledge.
4. Layne, C. M., Warren, J. S., Hilton, S., Lin, D., Pasalic, A., Fulton, J., Pasalic, H., Katalinski, R., & Pynoos, R. S. (2009). Measuring
adolescent perceived support amidst war and disaster: The Multi-Sector Social Support Inventory. In B. K. Barber, (Ed.), Adolescents and
Violence. Oxford University Press (pp. 145-176).
5. Layne, C. M., Olsen, J. A., Baker, A. Legerski, J. P., Isakson, B., Pašalić, A., Duraković-Belko, E., Đapo, N., Ćampara, N., Arslanagić, B.,
Saltzman, W. R., & Pynoos, R. S. (2010). Unpacking Trauma Exposure Risk Factors and Differential Pathways of Influence: Predicting Post-
War Mental Distress in Bosnian Adolescents. Child Development, 81, 1053-1075.
6. Steinberg, J.R., Layne, C.M., & Steinberg. A.M. (2012). Ceteris paribus laws in scientific inquiry. Journal of Theoretical and Philosophical
Psychology, 32(3): 180-190.
7. Layne, C.M., Steinberg, J.R., & Steinberg, A.M. (2012). Causal reasoning skills training for mental health practitioners: Promoting sound
clinical judgment in evidence-based practice. Manuscript submitted for publication. 2
Undergraduate Contributors:
Bradley Cohn
Nicole Niebaur
Benjamin Carter
Jacob Tanner
Paul McClaren
Richard Hagen
Callie Beck
Brendan Rowlends
Sarah Turner
Benjamin Walser
Joshua Downs
John Paul Legerski
Kristy Money
Marko Moreno
Stephanie Donnely
Ryan Curtis
Co-Authors: Alan Steinberg, Ph.D.
Jared Warren, Ph.D.
10-Year Flashback:
Garmezy’s Rebuke and Challenge
ISTSS Keynote address
Developmental psychopathology (DP) pioneer
Norman Garmezy critiqued concepts, terminology,
methodology, and findings of the traumatic stress
Strongly rebuked us for our simplistic theoretical,
methodological, clinical approaches, and for not
learning from DP’s 15+ years’ experience.
Urged trauma researchers to study and adopt
concepts, methods, findings from DP.
10 Year Checkup:
An Explosion in the Literature
Trauma Field
Articles with key words: resilience
and trauma
Total Articles-289
DP Field
Articles with key word: Resilience
Total Articles-2,673
1980 84 88 92 96 2000 2004
1980 84 88 92 96 2000 2004
How “Prophetic” and Relevant
Was Garmezy’s Counsel?
Increased focus in literature on childhood risk
variables and intervening variables (e.g.,
vulnerability and protective factors) other than
characteristics of trauma exposure per se (e.g.,
proximity, severity).
Brewin et al.’s (2002) meta-analytic review
identified several major risk indicators:
absence of social support
life stress (adversities)
trauma exposure
Brewin et al.’s Findings
Gender Low SES Lack of
Education Low IQ Psych.
History Childhood
Abuse Other
Severity Lack of
Life Stress
Why This Current Highlight on
Contextual Variables?
Why are Risk and Protective
Variables So Relevant
for All Shareholders?
Why are Risk & Protective Variables
Relevant for Everyone? (cont.)
Task 1:
Promote theory-building efforts
Require studying focal variables in context (e.g., families,
peers, physical environment, development)
Explicates how the influences of traumata and their
aftermath are conveyed, exacerbated, or mitigated over
time & throughout the ecology
Protect against scientific hubris
Fad variables & concepts
Unfounded, untested assumptions re: causal mechanisms
Presuming that your square meter of the meadow is “where all
the action is”, where the most influential mechanisms are found;
where the majority of the variance in the outcomes that really
matter is explained. (Rather than seeking to understand where
and how your work fits into, and contributes to, the broader
ecological context.)
Why are Risk & Protective Variables
Relevant for Everyone? (cont.)
Task 2:
Promote the use of sophisticated,
highly informative research methodologies
Longitudinal designs (delineate pathways of influence, test
causal mechanisms, elucidate processes through which
mechanisms operate)
Statistical analyses:
Structural equation modeling
Latent growth curve modeling
Encourage use of broad-spectrum assessment batteries
spanning multiple ecological levels
Organ/Organ Systems
Task 3:
Promote Effective, Efficient Interventions
Mediating/moderating variables are highly informative:
Markers of risk/protection
Vulnerability-enhancing variables/processes
– Protection-enhancing variables/processes
Helps us discriminate between etiological, maintenance, and
(inert) risk/vulnerability/protection marker variables
Identify subgroups placed at elevated risk for specific
adverse outcomes via specific mechanisms, processes,
and pathways of influence, as they operate within pre-
trauma, peri-trauma, and post-trauma time periods
Why are Risk & Protective Variables
Relevant for Everyone? (cont.)
Why are Risk & Protective Variables
Relevant for Everyone? (cont.)
Task 3: Promote Effective, Efficient Interventions
Identify foci for assessment and intervention
Mediating variables are “relay stations” that convey influences over time
Moderating variables assist in identifying protection- and vulnerability-
enhancing factors
Provide valuable information that assists in risk identification, treatment
triage, case conceptualization, treatment planning, monitoring/surveillance,
program evaluation
Without this information we are confined to less informative
“shopping lists” of risk and protective variables
Identify variables that discriminate between groups (e.g., “resilient” vs.
Lack theoretical richness or coherence
Cannot explain mechanisms and processes
Beyond a Simple Approach to Resilience:
How Can DP Concepts Enrich Our Own?
Risk factors
Protective factors
Vulnerability factors
Stress resistance
Pathways of influence
Domain-specific adaptation
Developmental tasks
and milestones
Distinguishing between
markers (static or
causally inert
indicators) and causal
processes (dynamic)
In Summary:
How Well Have We Followed
Dr. Garmezy’s Counsel?
Taking a Close Look
at Ourselves as a Field
The Good News:
We are looking at intervening variables
Studies increasingly include the terms
“risk” and “resilience.”
How Often are the Basic
(and Potentially Simple) Terms
Used in Trauma Journals?
1980 84 88 92 96 2000 4
Number of
Trauma & Resilience
Articles: 261
Taking a Close Look (cont.)
The Bad News:
We appear to be using basic terms (e.g.,
resilience) incorrectly, inconsistently, imprecisely,
and/or in an oversimplified way
We are using only basic concepts, terms,
methods in unsophisticated ways that are not
nearly as informative and useful as they
could be for a wide variety of applications
(theory-building, measurement, intervention)
Terms in Articles (Cont.)
Beyond “Resilience”: How Often Do We Use
More Sophisticated Concepts & Terms?
1980 84 88 92 96 2000 4
Number of
1980 84 88 92 96 2000 4
Number of
Trauma & Resistance
Articles: 182
Trauma & Developmental
Articles: 7
Another ProblemDefinitional Inconsistencies:
Imprecise or Incorrect Use of Terms
Potential Sorting Errors
1. Using two different terms in reference to
the same concept
2. Using the same term in reference to two
different concepts
3. Using one distinct term to define another
distinctly different term
Examples of Definitional Problems
1. Using two different terms to define the
same concept
(example) “Resilient individuals, although
giving the impression of being somewhat
Herculean in their resistance to stress, must
also undergo struggles associated with this
Examples of Definitional Problems
2. Using the same term to define two
distinct concepts
(2 examples):
1: Resilience: “Ability to maintain stability
after trauma”
2: Resilience: “Capacity for early, effective
adjustment and notion of restoration and
progression following exposure to stress”
3. Using one distinct term to define another
(example) “Resilience is a term used to describe
relative resistance to psychosocial risk
Examples of Definitional Problems
What is the cost if we continue on our present
Inefficient progress as a scientific field
Less effective, efficient theory, methods,
Ongoing confusion over the meaning of essential
“building block” terms (e.g., resilience, resistance)
Confusion about what we do & do not know
Scientific inquiry will lack clear vision, direction
about how to learn what we don’t know
Definitional Problems (cont.)
An Important First Step:
What We Currently Know
Attributes of “Resilient” Children and Families
Resilient children and adolescents are optimistic.
Resilient children and adolescents have self-efficacy.
Resilient children and adolescents have a sense of mastery.
Resilient children and adolescents have personal competencies.
The families of resilient children and adolescents are
cohesive and supportive.
The families of resilient children and adolescents use
effective coping skills to deal with stress.
The families of resilient children and adolescents are hardy.
Adapted from: Fostering Resilience in Response to Terrorism: For Psychologists Working With Children, 11/05/2004.
Our Problem and Challenge
The Good News: “Shopping List”-type
studies DO help to distinguish between
“resilient” versus “non-resilient” groups
Help to identify risk, protective,
vulnerability markers
Help to identify who is at risk for severe
distress, functional impairment, and
developmental disturbance
Help us to identify who is at lower risk
Our Problem and Challenge
The Bad News:
Attributes that empirically distinguish
between “resilient” and “non-resilient”
groups may or may not constitute “active
ingredients” that actually promote stress
resistance or resilience in a causal sense.
Instead, these attributes may instead be markers,
end products, or other “proxies” of other
(neglected, misunderstood, or unknown)
underlying processes.
Our Problem and Challenge (cont.)
The Bad News: Pervasive lack of effort at both
conceptual and methodological levels to
distinguish between:
Risk markers (liberal concept: a variable that is
significantly correlated with a given outcome, whose
presence or level is associated with an increase in the
probabilistic “risk” that the outcome is present);
Causal risk factors (conservative concept: a variable
that rigorous empirical study implicates as a causal
contributor to the occurrence of an adverse outcome).
Most “risk factors” as identified and discussed in the
literature only meet the lax standard of a risk marker.
Our Problem and Challenge (cont.)
The Bad News: Pervasive lack of effort at both
conceptual and methodological levels to
distinguish between:
Risk markers (a “value-neutral” statistical
concept/term: a correlate of any focal outcome,
whether negative or positive; e.g., buying a lottery
ticket places you “at risk” for winning the lottery);
Causal risk factors (carries a negative valence: a
harmful causal contributor to an adverse outcome).
Promotive Factor (neglected direct-effect counterpart
to causal risk factor, carries a positive valence; often
confused with “moderated effect” protective factor)
Our Problem and Challenge (cont.)
Thus, “shopping list”-type studies (which
typically involve the use of quasi-
experimental between-group designs to
differentiate between “resilient” and “non-
resilient” groups, or alternatively,
correlational designs) generally cannot
distinguish between risk and protective
markers/proxies, versus causal risk and
promotive (and perhaps protective) factors.
Our Problem and Challenge (cont.)
The resulting (methodologically weak)
evidence base thus does not necessarily
justify the practice of therapeutically
targeting and seeking to change those
attributes that best distinguish “resilient”
from “non-resilient” groups.
Our Problem and Challenge
The Bad News (cont.):
Even if the attributes that differentiate
“resilient” from “non-resilient” groups
actually “cause” them to be resilient…
How do we know how they work?
Or how to harness, augment, or mitigate
Our Problem and Challenge
The Problem: Are we content with merely
admonishing our clients to:
“be optimistic”
“be hardy”
“be resourceful”
“be intelligent”
“be likeable”
“have a sense of mastery and self-efficacy”
“be competent”
“have good social support”
or to “cope effectively with your difficulties”?
Our Problem and Challenge
Problem: (cont.)
If not, then we must increase our level of
theoretical, methodological, and therapeutic
-We must figure out how risk, vulnerability,
protective, and promotive mechanisms
actually work.
Our Problem and Challenge
This requires that we move away from a
broad search for “resilient”-characteristic
attributes, to a more specific focus on:
causal risk, protective, and promotive
vulnerability and protective factors,
and the processes through which they work and
interconnect to form pathways of influence
between causes and consequences.
Our Problem and Challenge
Problem: (cont.)
What makes risk and protective mechanisms increase
or decrease? Become potent or inert? Turn on or off?
Interact or exert direct effects?
How can we facilitate naturally-occurring protective
mechanisms, to decrease the number of individuals who
require specialized interventions?
How can we harness naturally-occurring protective
mechanisms to augment our “specialized” interventions
so as to increase their effectiveness, efficiency, impact, and
Our Problem and Challenge:
“Shopping list” study findings can only
lead to “shopping list” interventions.
(and by extension)
“If we keep doing what we’re doing, we’ll
keep getting what we’re getting.”
A Potential Solution:
“Nature, to be commanded,
must be obeyed”
-Sir Francis Bacon
If we wish to create more effective, efficient prevention
& intervention programs, we must understand how risk-,
protective-, and vulnerability-enhancing mechanisms and
processes actually work.
We need to construct “instruction manuals” that
hold direct relevance for theoreticians, interventionists,
administrators, and policy makers.
How Can We Move from the
Steel Age to the Information Age?
How Can We Get More “Bang” From
Our Research Studies So That We Know
What We Are Doing, When to Do It,
How to Do It,
and With Whom to Do It?
How Can We Move from the
Steel Age to the Information Age? (cont.)
Why can’t we import DP concepts and methods directly,
without modification?
Two Caveats:
Cannot import, without modification, the conceptual
frameworks from DP
Contains ambiguities and inconsistencies that will reduce precision and overall utility
– Not entirely appropriate for our needs: Fundamental
differences in the nature of problems/populations studied
DP: Primarily chronically stressed populations
E.g., poverty, marital discord, community violence…
Traumatic Stress: Acute, Chronic, and Serial or Sequential
E.g., natural disasters, terrorist attacks, war, sexual abuse, domestic abuse, etc.
Differences Between DP and Trauma (cont.)
The Pivotal Concept of Time
DP Research Methodology: Development
over time
Developmental trajectories
Trauma Research Methodology:
Pre, peri, and post trauma (we deal with focal
traumatic events, not just chronic adversities!)
and development over time (including
developmental trajectories
Are We Splitting Hairs
or Advancing the Field?
(Does making a distinction
make a difference?)
Making a Distinction
Does Make a Difference!
The inherent complexity of trauma and its
aftermath requires increased sophistication and
precision in theory, terminology, methodology,
and interventions relative to investigations of
the effects of chronic hardships alone.
Does Time Matter?
Length of Study Duration in the Two
Dev. Psych.
The trauma
literature has very
few studies > 3
years’ duration
Conclusion: We Should Adapt and Refine
DP Concepts for Our Own Populations,
Questions, and Problems
Question: How Can We Enrich Our
Conceptual Framework So That We Learn
More From Our Own Studies?
Recommendation 1: Distinguish Between
Resistance, Resilience, and Related Terms
Resistance (n): (c. 1350) from Latin
resistere “to make a stand against, oppose,
stand back, withstand” from re (against) +
sistere (take a stand, stand firm)
oResistance thus means withstand, stand firm
oRelated to the word “insist” (to take a stand
oManifest by a stable trajectory of functioning in
the aftermath of a stressor.
We need to understand differences in these
terms at the level of their etymologic roots:
Resilience (n): (c. 1620s) “rebounding," from
Latin resilire "to rebound, recoil," from re-
"back“ + salire "to jump, leap”.
o Resilience thus means “to bounce or jump back
oRelated to word “salient” (to leap or jump out)
oManifest by a “V-shaped” trajectory of a (time-
limited) decrement in functioning followed by
“bouncing back” to prior functioning.
We need to understand differences in these
terms at the level of their etymologic roots:
Path 1: Stress resistance (stable
adaptive functioning)
Path 2: Resilience (temporary
perturbation in functioning followed
by full recovery)
Path 3: Protracted recovery (major
perturbation followed by gradual
return to positive adaptation)
Path 4: Posttraumatic growth
(perturbation followed by growth)
Path 5: Chronic severe distress
(persisting decrement in functioning)
Path 6: Decline (initial resistance
followed by decompensation)
Path 7: Stable maladaptive
functioning (persisting pre- and post-
traumatic poor functioning)
Path 4
Path 5
Path 2
Path 7
Path 3
Path 1
Path 6
Time in Reference to a
Focal Traumatic Stressor
Recommendation 2: Approach Resistance, Resilience,
Recovery, & Chronic Distress as Distinct , Ongoing
Processes that are Distinguished by Different Trajectories
Adapted from: Compas, B.E., Gerhardt, C.A., and Hinden,
B.R.1995. Adolescent Development: Pathways and processes of
risk and resilience. Annual Review of Psychology. 46: 265-293.
Recommendation 3: Approach Resistance, Resilience, Recovery, &
Chronic Distress as
Psychosocial Domain:
Recommendation 4: Incorporate the Concepts of
Equifinality and Multifinality Into Our Models
Equifinality: A number of different
antecedent risk events/circumstances
may eventuate in the same outcome
(i.e., equal endpoint).
In other words, a given adverse outcome may
be the consequence (via direct effects,
interactive effects, or both) of multiple causal
risk factors and vulnerabilities as they operate
through different pathways of influence.
Recommendation 4: Incorporate the Concepts of
Equifinality and Multifinality Into Our Models (cont)
Multifinality: The same antecedent risk
may eventuate in a number of different
outcomes (i.e., multiple endpoints)
In other words, a given adverse event or
circumstance may causally contribute to
multiple adverse outcomes through
different pathways of influence.
Illustration of Equifinality and Multifinality
(Layne et al.: Long-Term Post-War Adaptation in War-Exposed Bosnian Adolescents)
Parental Dysfunction
Trauma & Adversity
Direct Contact with Harm
Physical Threat
Witness Violence
Traumatic Death
Harm to Loved Ones
Material Loss
Threat to Loved Ones
Non-Combat Related
Trauma & Adversity
Displacement & Separation
Family Dysfunction
Post-War Illness, Injury, or
Death of Loved One
Trauma Reminder
Stress Reaction
Grief Reactions
B Criteria
C Criteria
D criteria
Cluster 1
cluster 2
Cluster 1
Cluster 2
Model C: Pre-War, War-Time, and Post-War Predictors of Long-Term Post-War Adjustmen
.89 .87
.12 .11
.24 .10
Recommendation 5: Remember the Big Picture
Aim: To Understand, Predict, and Control Behavior
Understand: Develop theory that explicates how risk factors,
vulnerability factors, & protective factors intersect and interact to
form pathways of influence.
Which risk and vulnerability factors place youths at increased risk for which
maladaptive outcomes, and at decreased risk for which positive outcomes, via
which pathways?
Which protective factors place youths at decreased risk for which maladaptive
outcomes, and at increased likelihood for which positive outcomes, via which
How do risk, vulnerability, and protective factors combine or interact?
With which risk factor(s) is a given protective factor maximally protective?
With which risk factor(s) is a given vulnerability factor maximally influential?
Which risk factors increase the likelihood of which adverse outcomes?
Control: Harness mechanisms, processes, and pathways of influence
according to the following intervention algorithm:
Harness and augment naturally occurring protective processes, &
(as needed) use specialized, time-limited interventions to:
1.Identify, prevent, or mitigate the influences of, risk factors
2.Identify, reduce, or mitigate the influences of, vulnerability factors
3.Identify, augment, and therapeutically harness the influences of, naturally
existing promotive and protective factors
As needed, supplement the above efforts with specialized
Conduct ongoing monitoring and surveillance activities
Make “course corrections” as needed in objectives, strategies
Systematically evaluate outcomes and impacts:
Increased likelihood of positive adaptation
Reduced likelihood of maladaptation
Recommendation 5: Remember the Big Picture (cont)
The Bottom Line
To develop a model we need to put the component
parts together
To put the parts together we need to clearly define and
distinguish them
To communicate how to use the model we need to
standardize the definitions (a Lingua Franca)
Clinicians, researchers, and theoreticians need to know
what is meant by such terms as risk, vulnerability,
protective, resistance, resilience, etc. in order to
effectively apply them.
Notwithstanding our diversity and the complexity of the
phenomena under study, can we clearly and efficiently
communicate in a common tongue?
Beyond Shopping Lists
“Nature, to be commanded, must be obeyed.”
To command nature, one must understand its governing
Mechanisms, processes, and pathways of influence
are the forces that, operating according to discoverable
laws and principles, govern the trajectories of
posttraumatic adaptation and, more broadly, of
ontogenetic development
In order to implement goal-oriented, coherent, effective,
and efficient prevention and intervention programs, we
must understand the laws and principles of operation that
govern and regulate developmental and recovery trajectories
Where Do We Go From Here?
“Far too much research into psychosocial risk
factors has been content to stop at the point of
identifying risk variables. There is no shortage
of data on such variables and we know a good
deal about the identification of risks. What we
know much less about is how these risk mechanisms
operate. Inevitably, that means that we are in a weak
position when designing interventions to prevent or
treat disorders.”
(Rutter, 1996, p. 365, italics added).
The End
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Full-text available
In defending the scientific legitimacy of ceteris paribus qualified causal generalizations, we situate and specify the reference of the ceteris paribus proviso within a fundamental causal framework consisting of causal agents, pathways of influence, mediators, moderators, and causal consequences. In so doing, we provide an explication of the reference and utility of the ceteris paribus proviso in terms of mediators and moderators as these constitute the range of factors that can impinge on the relation between cause and effect. We argue that the conceptual causal roadmap embodied by the ceteris paribus qualification serves as a schematic template for the ongoing identification of causally relevant factors and plays an indispensable heuristic role in advancing scientific inquiry into causal relations. We then provide guidelines for differentiating between acceptable and unacceptable uses of ceteris paribus and describe how mediators and moderators conceptually encompassed by the ceteris paribus proviso can be employed in evaluating the meaning and acceptability of proposed ceteris paribus causal generalizations, as well serve as a guide to investigators in the process of designing studies to identify a causal agent, mediators, moderators, pathways of influence, and causal consequences. (PsycINFO Database Record (c) 2012 APA, all rights reserved)