resilience posttraumatic growth

7/25/2019 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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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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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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+ain e##ect models

3sset

&ipolar

predictor

Ris5

Futcome

-

M

-M


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)ndirect models example!

3sset

E##ective

parentin"

Ris5

Futcome

-

M

M


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)nteraction models

+oderator

Ris5 activated

moderator

Ris5

Futcome

ot #ound very o#ten di##icult to detect!


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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=

resilience posttraumatic growth

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