Resilience, Protective Factors, and Post Traumatic Growth

1. Resilience, Protective Factors, and Post Traumatic Growth Ruth Pat-Horenczyk, Ph.D. Israel Center for the Treatment of Psychotrauma Herzog Hospital

2. Central questions? • What is resilience? (Definitions) • Why is resilience important? • How does resilience work? • Can resilience be influenced? • How can we build resilience?

3. What is Resilience? Different conceptualizations After facing adversities, resilient people: • Do not develop symptoms? • Develop symptoms but recover (relatively) faster? • Cope better? More flexible? More optimistic? • Less sensitive? More self focused? • Show post traumatic growth? • Are they stronger? Better? More positive?

4. Definitions of Resilience • “The capability of a strained body to recover its size and shape after deformation caused especially by compressive stress” (Merriam Webster) • An ability to recover from or adjust easily to misfortune or change

5. The Spinal Cord: A Metaphor for Resilience

6. Resilience: definition Resilience refers to a pattern of positive adaptation in the context of significant risk or adversity (Masten, 2003) Two fundamental judgments: • The person is doing Okay • Signficant risk or adversity

7. Resilience (APA report) • Resilience – is the process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress – such as family and relationship problems, serious health problems or workplace and financial stressors • Resilience is “bouncing back” from difficult experiences • Resilience is ordinarynot extraordinary • Being resilient does not mean that a person does not experience difficulty or stress; The road to resilience is likely to involve considerable emotional distress • Resilience involves behaviors, thoughts and actions that can be learned and develop in anyone

8. Factors regarding resilienceAPA report • The capacity to make realistic plans and take steps to carry them out • A positive/optimistic view of yourself and confidence in your strengths and abilities • Skills in communication and problem solving • The capacity to manage strong feeling, emotions and impulses

9. But what is Resilience?According to Bonanno: Have we underestimated the human capacity to thrive after extremely aversive events? • Resilience is different from recovery • Resilience represents a distinct and empirically separable outcome trajectory from that normally associated with recovery from trauma

10. But what is Resilience?According to Bonanno: (cont’) • Resilience is common • Resilience is more prevalent that generally accepted in either the lay or professional literature • Resilience to loss • Resilience to violent and life threatening events • There are multiple and sometimes unexpected pathways to resilience • Hardiness • Self enhancement • Repressive coping • Positive emotion and laughter

11. Biological Markers of Stress Resilience • Biologic measures thought to be associated with resilience in PTSD are plasma concentrations of neuropeptide Y (NPY), and the cortisol/DHEA ratio (cit.). • As with adrenergic dysregulation, it is not known whether observed HPA axis disturbances are a result of PTSD, are present prior to exposure in those vulnerable to PTSD, or both.

12. Resilience and Protective Factors • An array of factors identified in these studies have been found to facilitate positive adaptation. • Three categories have been proposed: • a) personal attributes of the individual, • b) affect ional ties within the family, and • c) existence of external support systems at school or within the community (Werner, 1989). • The following factors have been fairly consistently cited as relevant to resilience.

13. Characteristics of Resilience • Bouncing back-bouncing forward? • Elasticity-flexibility • Positive adaptation • Long term • Stamina and strength

14. Charney(2005) identified 10 critical psychological elements and characteristics of resilience, including: • Optimism • Altruism • Having a moral compass • Faith and spirituality • Humor • Having a role model • Social supports • Facing fear • Having a mission or meaning in life • Training

15. Trajectories of posttraumatic adjustment (Layne, 2008): • stress resistance, • resilience • resilient recovery, • protracted recovery, • decline, • post-traumatic growth • severe persisting distress

17. Trauma – Rebuilding Shattered Assumptions (Janoff-Bulman) • Traumatic life events shatter our fundamental assumptions about ourselves and our world: the benevolence of the world; the worthiness of the self; and the world as meaningful. • In the aftermath of these extreme experiences, coping involves the task of reconstructing an assumptive world and establishing a comfortable, integrated assumptive world that incorporates the traumatic experience • Victims become survivors.

18. Posttraumatic Growth (Calhoun and Tedeschi) • Positive psychological change experienced as a result of the struggle with highly challenging life circumstances • Event must be of seismic proportion • Development, at least in some areas, that surpasses what was present before the struggle with the crisis • Growth and distress often coexist

19. Recognition of new possibilities or paths for one’s life A greater sense of personal strength Spiritual and existential change Greaterappreciation of life and changed sense of priorities Warmer, more intimate relationships with others Manifestations of Posttraumatic Growth – Posttraumatic Growth Inventory (PTGI, Tedeschi & Calhoun)

20. www.traumaweb.org Services through the internet