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Understanding and Fostering Resilience in Persons Exposed to Trauma

Understanding and Fostering Resilience in Persons Exposed to Trauma

Resilience after traumaIn the past few decades, there has been growing interest in resilience-building interventions that help individuals prepare for and recover from exposure to potentially traumatic stress, such as disasters, wars, and personal trauma. However, research that focuses on resilience and related constructs has not been systematic. Conducted in multiple settings across different age ranges, exposures, and contexts, it provides little or no cross-referencing between fields. Consequently, many important questions have not been addressed.

Definitions

Resilience is “the capacity of a given system to implement early, effective adjustment processes to alleviate strain imposed by exposure to stress, and thus efficiently restore homeostatic balance or adaptive functioning.”1 Resilience is common and derives from the basic human ability to adapt to new situations. Transient stress is typically the most common outcome following traumatic events.

Resilience is not a fixed attribute but a type of “functional trajectory” that depends on the quality of the stressor, the surrounding culture and circumstances, and individual variations in response to risk. For instance, a person can exhibit resilience to similar stressors at certain times in his or her life, but not at other times.

Stress resistance refers to the capacity of a system to use effective adjustment processes to maintain homeostatic balance (and thus to maintain an adaptive level of functioning) on exposure to stress. While resistance implies a complete absence of a stress response, most people, including resilient individuals, typically experience at least some transient distress during or immediately after potentially traumatic events.

Posttraumatic growth (PTG) is often used to describe positive adaptation to traumatic stress and adversity. PTG manifests as change in 3 broad domains: sense of self, relationships, and philosophy of life. With PTG, a certain level of threat and struggle are necessary to promote growth. Persons who report stress response symptoms at intermediate levels demonstrate higher levels of growth than those who have mild or severe reactions.2-4

Table 1

Determinants of resilience post disaster

Determinants

Remarkably, across most trauma types, including disasters, a significant proportion of the population is minimally affected and able to adapt. Only a minority of the exposed groups will exhibit maladaptive response and clinical symptoms. Disaster research has suggested various determinants (Table 1). The majority of trauma survivors show a stable pattern of healthy adjustment and do not require the attention of mental health professionals. Formal interventions are, however, needed for persons who have significant or prolonged disruptions in functioning.

Research may inform interventions that mitigate the post-event risk factors that correlate with a higher probability of psychopathology and decrements in functioning. These risk factors include the absence of social supports or the presence of negative social support as well as higher levels of contextual life stress; lack of practical resources; and negative appraisals of the event, their role in it, response to it, and their potential for future risk.

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