Download - Resilience Posttraumatic Growth
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Resilience and
Posttraumatic Growth
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Resilience
dynamic developmental process
positive adaption
despite adversity or trauma
personality trait or attribute
Two-dimensional construct Exposure to adversity
Positive adjustment outcomes
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Posttraumatic Growth PTG!
"rowth process
experienced positive chan"e
as a result o# traumatic experience
traumatic event itsel#$ but a#termath
%han"e beyond e##ective copin" &eyond pre-trauma level o# adaption
'ualitative chan"e across di##erent domains
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Posttraumatic Growth
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(ome chan"es associated with
PTG
)ncreased sense o# personal stren"th discover new perspectives about relationships )denti#y salient characteristics in others
pos* and ne"*! +odi#ied priorities$ shi#t in perspectives and
value systems appreciate ,smaller thin"s in li#e
increased appreciation o# li#e in "eneral richer reli"ious$ spiritual$ and existential lives
%alhoun . Tedeschi$ /0012 Tedeschi . %alhoun$ /001!
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PTG and posttraumatic stress
symptoms 3lthou"h bene#its and positive chan"e
(till distress and stru""le
4ess emotional well-bein" in individual reportin" PTGcompared to resilient! contributes to "rowth process
#acilitates constructive co"nitive processin" o# trauma
3ttempts to ma5e sense o# trauma and a#termath
Productive ruminative process yields schema chan"e
(upportive others provide means to cra#t narratives
o##er new perspectives
%alhoun . Tedeschi$ /001!
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6actors potentially! a##ectin" PTG
3"e older!
Gender #emale!
(everity and type o# stressor7trauma
8i"her income +ore time since traumatic event
Existential awareness li#es #ra"ility!
Reli"iosity 8i"her levels o# social support
%alhoun . Tedeschi$ 9:::$ /001 +ilam et al*$ /001!
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;iscussion
;oes this sound a bit li5e a clich< to you=
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(o$ whats the evidence=
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+easures o# PTG
'ualitative indirect! measures (econdary analysis o# PT(; interviews %odin" #or elements o# PTG
(alter . (tallard$ /001!
'uantitative measures 6or adults> Posttraumatic Growth )nventory Tedeschi
. %alhoun$ 9::?! PTG)-Revised #or %hildren and 3dolescents
@as5owich$ /00/! Posttraumatic Growth )nventory #or %hildren Revised
PTG)-%-R! Ailmer et al*$ /00:! Perception o# %han"es in (el# scale AaBa5 et al*$ /009!
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Posttraumatic Growth )nventory #or
%hildren Revised PTG)-%-R!
Ailmer et al* /00:!$ used with C-90 year-olds
Two open ended Duestions
90 items assessin" PTG in #ive domains ew possibilities
Relatin" to others
Personal stren"th3ppreciation o# li#e
(piritual chan"es
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Fther measures #or children and
adolescents
(econdary analysis o# PT(; interviews(alter . (tallard$ /001!
,#ramewor5 techniDue Ritchie . (pencer$
9::1! 6ive steps 6amiliariBation$ thematic #ramewor5$
indexin"$ chartin"$ interpretation!
areas o# PTG
Perception o# (el#
)nterpersonal relationships
Philosophy o# li#e
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PTG in children and adolescents
Empirical studies with children and
adolescents
+ilam$ Ritt-Flson . Hn"er /001!
&ara5at$ 3lder#er . AaBa5 /00?!
(tudies with youn" children
(alter . (tallard /001!
%ryder$ Ailmer$ Tedeschi . %alhoun /001!
Ailmer et al* /00:!
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3dolescent with ne"ative li#e events+ilam$ Ritt-Flson . Hn"er /001!
1I adolescents "rades :-9/$ mJ 9I*Ky! Predominantly 8ispanic
PTG)
e"ative li#e events within previous years! %losed-ended chec5list o# ,li#e chan"e units$ includin"90 major ne"* events %oddin"ton et al$ 9:C/!
%ommon ne"* li#e events ;eath o# #amily member 1L!
+ove to new home 9?L! 4oss o# close #riend 99L! +ajor illness to #amily member 90L! Parents divorce7separation 90L!
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3dolescent with ne"ative li#e events+ilam$ Ritt-Flson . Hn"er /001!
+ean PTG score was *I? Jmild amount!
o di##erent in PTG between types o#events
o di##erent in amount o# PTG #or "ender$ethnicity
%orrelations between PTG and
3"e M! Reli"iosity M!
(ubstance use -!
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3dolescent cancer survivors&ara5at et al* /00?!
9I0 adolescents cancer survivors 99-9:years!
8ypothesis +ore time since$ and hi"her perceived
intensity o# treatment J more PTG
Flder a"e at dia"nosis J more PTG
PTG +easure Perceptions o# %han"es in (el# P%(!
AaBa5 et al*$ 9::?$ /009
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3dolescent cancer survivors&ara5at et al* /00?!
K1*CL o# adolescents reported at least onepositive conseDuence IL thin5 about li#e
1/L plans #or #uture 19L how care#ul
/L reported 1M pos* conseD*
PTG and other variables correlations!
3"e at dia"nosis M!$ time since treatment -!$household income n*s*!
perceived! past and current li#e threat$ treatmentintensity$ PT(( )E(-R! all correlations J M!
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%hildren in road tra##ic accident(alter . (tallard /001!
9IK C-9Ky old children
(econdary Dualitative analysis o# PT(;interviews %3P(-%!$ )E(
1/L report PTG CL o# them also PT(;
+ean a"e o# children reportin" PTG J 9?y
;omains o# PTG
Perception o# (el# least applicable
one used words ,survivor or ,victim
6ace reality o# vulnerability
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%hildren in road tra##ic accident(alter . (tallard /001!
;omains o# PTG )nterpersonal Relationships
improved )R> 9/L "eneral$ /0L with people involved inaccident
Relationships ,closer ,cementedN learnin" to disclose more about #eelin"$ and ability to
express more openly
Philosophy o# 4i#e +ost common theme 3ppreciation o# li#e 9L! Reevaluation o# what was important 9L! 6eelin" ,i# there is somethin" that you want to do$ try do it-
dont wait 6ew reports o# a more relaxed approach to li#e
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%hildren a##ected by a natural
disaster %ryder et al*$ /001!
8urricane 6loyd (ept 9:::! 9 year later
F# /9 contacted only 1? 9IL! ?-9I years mJ:*I1y! I0L evacuated7displaced
PTG)-% PTG score C-K1 mJ?I*99!
%orrelations with other variables (i"n* corr* with competency belie# o other si"n* corr* e*"* a"e$ "ender$ severity$ social
support!
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%hildren a##ected by a natural
disaster Ailmer et al*$ /00:! 8urricane Aatrina 3u" /00I!
T9J9y later$ T/J/y later
?K C-90 year olds mJK*y! +ajority 3#rican 3merican
C*IL prior Trauma
PTG)-%-R ran"e 0-0! T9J/0$ TJ9:*/ I0L av"*$ 90*?L little!
o "ender di##erence
%orrelations with other variables (i"n corr* Oith subjective response to 8A and PT(( only PT(( in
re"ression!
o corr* with a"e
T9 PTG only si"n* predictor o# T/ PTG
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+odel o# PTG in children%ryder et al*$ /001!
Extended model see Ailmer$ /00I!
Pre-trauma belie#s
Trauma
Ruminative thin5in"(ocial
support
%ompetency belie#s
PTG
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%ritiDue
8ypothesiBed model
(everal #actors remain untested
%ryder et al* discuss lin5 between PTG and
social support but no si"n* %orr*!
o control "roups
ormal developmental process=
Positive bias
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3 positive bias=
J/C? adults
Two #actors Exposure to traumatic event!
1/*IL exposure
+ethod PTG)! lin5ed to stress#ul event
not lin5ed to speci#ic event "enerally past 1 years!
PTG hi"her in unlin5ed "roup with event exposure! si"n* )nteraction exposure x method
(u""ests that "rowth underestimated$ rather thanin#lated
PTG) usually lin5ed to speci#ic event
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;evelopment and PTG
%o"nitive maturity and ,psycholo"ical mindedness )nterpersonal awareness and insi"ht %ryder et al*$ /001!
3##ective Duality o# chan"e and learnin" Response re#lects dev* level7tas5
4ieberman . an 8orn /001! Hnderstand M internaliBe dependin" upon
co"nitive7emotional capacities Fso#s5y$ /001! %o"nitive capabilities may in#luence understandin" M
appraisal o# trauma 8asan . Power$ /001!
3ttributions about circumstances Repertoire o# copin" s5ills7strate"ies 3bility to marshal resources e##ectively %apacity to attend to and report internal experiences %ryder et al*
/001!
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;evelopment and PTG
Possibly years be#ore PTG on some dimensions!mani#ests in children
Positive relationship between a"e and PTG
+ilman et al*$ /001! %o"nitive maturity necessary
PTG process maybe Dualitatively di##erent inchildren
(chemas not as clearly set in children ew experiences incorporated into internal
representations
%hildren more vulnerable Qano##-&ulman$ 9::/!
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3"e and PTG
&ara5at et al* /00?!
3"e Iy at dia"nosis as cuto##
3"e I shi#t in co"nitive #unctionin"$ better process and
re#lect on their experiences 3lder#er et al*$ /00! Iy #ewer positive conseDuences
Fnly ?*L reported M positive chan"es
)n comparison> 11L o# S Iy reported M pos* chan"es
%hilde a"e SIy more PT(( &ut si"n* %orrelation between PTG and PT(( in both
SIy and Iy
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Relevant research areas
,Theory o# mind To+!
Hnderstandin" o# own and others mental
states
;esires$ belie#s$ emotions$ intentions
)mportant area in developmental psyc
3"e Iy important shi#t in development
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To+> &elie#-based emotions8arris et al*$ 9:K:2 (prun"$ /00K!
Ohich one do you
li5e the most=
spongeOhich one do you
li5e the least=
doll
4ater youll "et
whats in thisbox* (o$ put
the one you
li5e the most in
the box*
SIy
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To+> &elie#-based emotions8arris et al*$ 9:K:2 (prun"$ /00K!
ow$ lets wor5
on another tas5
and later you
"et whats in
the box*
8ow do you #eel now$about whats in the box=
SIy
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To+> &elie#-based emotions8arris et al*$ 9:K:2 (prun"$ /00K!
ery "ood$ now
you "et whats
in the box*
8ow do you#eel now=
Ohats in
the box=Ohat did you
thin5 is in the
box=
&e#ore you openthe box$ how did
you #eel
sponge
doll
Iy
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To+> )ntrospection6lavell et al*$ 9::I!
Do notDo not
thinkthink
Ohile you where sittin" in the
no thin5in" chair$ did you
have no thou"hts or did you
have some thou"hts=
o
thou"hts
easy
havin" no
thou"hts
K years
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Theory o# mind
ot mentioned in literature on PTG
3lthou"h Ailmer mentions ,psycholo"ical
mindedness
Theory o# mind and Trauma
+ore advanced To+ J more reports o# PT((
(prun" /00K!
PTG not assessed
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Fther relevant research areas
,internal wor5in" models
Qohn &owlby
3ttachment theorist ,stran"e situation!
6irst care"iver-child$ later extended toother people7situations
3lso not addressed in PTG lit*
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ulnerability versus protection
&asic assumptions sa#ety$ protection #rom harm$predictability! violated Goldman$ /00/!
4oss o# trust$ meanin"$ #aith 6ormation o# traumatic expectation distortin" Pynoos et al*$
9::I! Emotional$ co"nitive$ moral concepts )nner representations o# sel#$ object relations$ social environment
;isrupt sense o# sel#7others$ emotion re"ulation$explorative learnin" 4ieberman . an 8orn$ /001!
Trauma in in#ancy7early childhood derails normativedevelopmental course 4ieberman . an 8orn$ /001! Pynoos 9::0! ;i##iculties in multiple domains &osDuet$ /001!
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ulnerability versus protection
%hildrens basic assumptions less #irmlyentrenched7embedded Fpen to adaptive inputs Protective
6actors to help bu##er a"ainst traumatic impact Emotional carin"7interpretive e##ort o# others
especially parents! (upportive environment #or child to attempt
understand$ incorporate )nput o# others can "uide interpretation$ re#rame$trans#orm
Qano##-&ulman$ 9::/!
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;iscussion
;o you thin5 PTG in youn" children is
possible=
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(ome problems>
Extend o# literature two #ields> clin* and dev*!
;ev* lit> childrens understandin" Duite
sophisticated
stru""le about similar issues
&ut limitations e*"* introspection!
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PTG> reality or illusion
Real vs* illusory process (umalla et al$ /00:!
Real positive! identity chan"e
)llusory process %opin" strate"y
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Resilience
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Three #acets o# resilience4epore . Revenson /00?!
Recovery Tree will bend to accommodate wind$ so it wont
brea5$ and will return to upri"ht position when windstops
Resistance Tree stands still$ undisturbed$ in #ace o# howlin" wind
Recon#i"uration
Tree not simply ma5e temporary accommodation$then resume ori"inal shape
instead$ it chan"es its shape ma5in" it more resitantto brea5 in #uture winds!
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Three #acets o# resilience4epore . Revenson /00?!
Recovery (tressor disrupts a persons normal state o# #unctionin"$
Ohen stressor passes$ person resumes her normal pre-stressorlevel o# #unctionin"
Resistance People who exhibit normal #unctionin" be#ore$ durin"$ and a#ter a
stressor even lon" a#ter a stressor!
Recon#i"uration )ndividuals recon#i"ure their co"nitions$ belie#s$ and behaviors in
manner that allows them to adapt to traumatic experiences Possibly withstandin" #uture trauma
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;iscussion
Ohats normal response #ollowin"
traumatic event=
E*"* loss o# a loved one
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Two 5inds o# jud"ments
9! Threat ot resilient$ i# no threat! Ris5s$ such as> low (E($ ne"ative li#e events$
community trauma$ etc* also cumulative! %o-occur with psychosocial competence$
psychopatholo"y$ health Ris5 "radients can be inverted to ,assets or,resources
Pure ris5 J car accident$ pure asset J talent or #riend +ostly pos* and ne"* end
e*"* "ood parentin" vs* poor parentin" %ompetent parents produce #ewer stress#ul #am* li#e events
ris5s!$ choose to live in nei"hborhoods with low crime ris5s!$"ood community resources assets!$ more li5ely to hire tutorsassets!
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Two 5inds o# jud"ments
/! 'uality o# adaption or dev* outcome
assessed or evaluated as ,"ood or ,FA
a! +eetin" major expectations o# a "iven
society or culture Jsalient developmentaltas5s$ competence criteria$ cultural a"e
expectation! Elder$ 9::K2 +asten et al*$ 9::K!
b! 3bsence o# psychopatholo"y or low level o#symptoms and impairment Tiet et al*$ 9::K!
c! &oth aMb Greenber" et al*$ 9:::!
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Related Duestion
External adaption criteria
3ccommodation$ achievement$ absence o#
delinDuency
)nternal
Psycholo"ical well-bein"$ low level o# distress
Fr both
4uther et al* /000!
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8istorical overview
3typical schiBophrenics GarmeBy$ 9:C0! %hildren #rom mothers with schiBophrenia GarmeBy$ 9:C12
+asten et al*$ 9::0!
Emmy Oerners "roundbrea5in" studies with %hildren in8awaii Oerner et al*$ 9:C92 Oerner . (mith$ 9:CC!
(tudies o# multiple adverse conditions search #orprotective #actors! 4ow (E( Parental mental illness Hrban poverty %ommunity violence %hronic illness %atastrophic live events
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+odels7approach to resilience+asten$ /009!
ariable #ocused 4in5 amon" measures o# de"ree o# ris57or
adversity$ outcome$ potential Duality o#
individual or environment tocompensate7protect!
Person #ocused %ompare people with di##erent pro#iles within
or across time! on sets o# criteria to ascertainwhat di##erentiates resilient #rom non resilientchildren
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ariable #ocused studies
%ompensatory e##ects
Enou"h positive assets could o##set the
burden in childs li#e #rom one or many ris5
in#luences
Three models
+ain e##ect
)ndirect )nteraction
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ariable #ocused studies
+ain e##ect models
3sset
&ipolar
predictor
Ris5
Futcome
-
M
-M
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ariable #ocused studies
)ndirect models example!
3sset
E##ective
parentin"
Ris5
Futcome
-
M
M
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ariable #ocused studies
)nteraction models
+oderator
Ris5 activated
moderator
Ris5
Futcome
ot #ound very o#ten di##icult to detect!
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ariable #ocused studies
6actors emer"in"
Parentin" Duality
)ntellectual #unctionin"
(E(
Positive sel#-perception
&road$ pervasive corr* with multiple
domains o# adaptive behavior
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Person #ocused studies
(in"le case studies +asten . F%onnor$ 9:K1!
Groups o# individuals with patterns o# "ood
versus poor adaptive #unctionin" in context or
hi"h vs* low ris57threat! Two "roups #rom same hi"h-ris5 "roups Oerner .
(mith$ 9:K/2 %owen et al*$ 9:K1!
4ow ris5 "roups
ariety o# ,stress-a##ected and ,stress-resilient
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Person #ocused studies
Emer"in" pro#ile +asten$ /009!3vera"e or better competence on three
salient domains
3cademic %onduct
(ocial
Resultin" in similar psychosocial resources
intellectual #unctionin" Parentin" Duality
Positive sel#-concepts
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Pros and %ons
ariable #ocused
M +ax* stats power$ suitable #or searchin"speci#ic lin5s between predictor and outcome
- 6ail to capture stri5in" patterns in lives o# realpeople$ ris5 o# losin" sense o# the whole
Person #ocused
M variables assembled in naturally occurrin"
con#i"uration$ well suited #or search #orcommon and uncommon patterns in lives
- %an obscure speci#ic lin5a"es
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Positive Psycholo"y
The role o# positive emotions
6rederic5sons ,broaden-and-built theory
+ore positive emotions J more resilient=