ειδη ανθεκτικοτητας
ειδη ανθεκτικοτητας
ειδη ανθεκτικοτητας
Psychological Resiliency
Final Report
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Scientific Authority
Dr. Don McCreary
Approved by
Dr. Joseph Baranski
Acting Head, Command Effectiveness and Behaviour Section
Abstract
This report provides a detailed literature review of the current state of
knowledge on resiliency and its application to military personnel. In this report we
summarize (1) the current, accepted definitions of resiliency, (2) factors contributing
to resiliency, (3) theories of resiliency, (4) empirical research findings on resiliency in
protecting individuals from adverse outcomes associated with acute or chronic stress,
(5) empirical research findings on resiliency in military personnel and other high-risk
occupations, and (6) resiliency measures and describe their development and
validation. Existing definitions implicate resiliency with the ability to adapt and
successfully cope with adversity, life stressors, and traumatic events. However,
findings from this review demonstrate the lack of a uniform or accepted definition of
resiliency. Research to date has resulted in the identification of several individual
traits and environmental situations that are contributing factors to resiliency, and this
has led to recent efforts to develop and validate emerging interactive resiliency factor
models. The theoretical bases of resiliency remains controversial and many existing
theories have received modest empirical investigation. Furthermore, the
methodologies used in many of these conceptually-based studies are poor and results
are limited in their generalizability. Empirical research on protective factors remains
limited, and their inter-relationships to risk factors and exposure factors remains
unclear. Relatively few studies have investigated resiliency in military populations.
These studies have primarily investigated protective factors among resilient
individuals who have experienced combat exposure (e.g., prisoners of war). Yet,
much more is to be learned about resiliency across the range of military personnel
experiences (e.g., peace keepers). Lastly, our review identified numerous measures of
resiliency, and of related constructs, however, many lack sufficient validation. To
further advance our knowledge of resiliency, future research will need to use more
sophisticated methodologies and measurement strategies, which can be validated
across a range of populations. Such research efforts have the potential to develop and
evaluate resiliency based interventions, and aid in social policy applications within
military and non-military populations.
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Rsum
Le prsent rapport constitue un examen dtaill de la littrature dcrivant ltat
actuel des connaissances sur la rsilience et leur application au personnel militaire.
Nous y rsumons : 1) les dfinitions actuellement acceptes de la rsilience, 2) les
facteurs qui contribuent la rsilience, 3) les thories de la rsilience, 4) les rsultats
des recherches empiriques sur la protection confre par la rsilience chez des
individus soumis des vnements nfastes associs un stress aigu ou chronique,
5) les rsultats des recherches empiriques sur la rsilience chez les militaires et
dautres professions risque lev et 6) les instruments de mesure de la rsilience et
les travaux scientifiques connexes dcrivant leur laboration et leur validation. Selon
les dfinitions existantes, la rsilience est associe la capacit de sadapter et de
russir faire face des vnements nfastes et traumatisants et aux facteurs de stress
de la vie. Toutefois, dans le cadre de cette tude, on a constat quil nexiste pas de
dfinition uniforme ou universellement accepte de la rsilience. Jusqu prsent, les
recherches ont permis de cerner plusieurs traits individuels et situations
environnementales qui sont des facteurs contribuant la rsilience, et ces rsultats ont
t lorigine des rcents efforts pour laborer et valider des modles mergents et
interactifs de facteurs de rsilience. Les bases thoriques de la rsilience demeurent
controverses, et bon nombre des thories existantes ont fait lobjet de trs peu de
recherches empiriques. En outre, les mthodes employes dans un grand nombre de
ces tudes fondes sur des concepts sont de pitre qualit; la gnralisation des
rsultats est donc restreinte. La recherche empirique sur les facteurs de protection
demeure limite; la relation entre ces facteurs, dune part, et les facteurs de risque
ainsi que les facteurs dexposition, dautre part, demeure obscure. Relativement peu
dtudes se sont penches sur la rsilience dans les populations militaires, et elles
portaient principalement sur les facteurs de protection chez les individus rsilients qui
ont vcu des situations de combat (p. ex., des prisonniers de guerre). Il nous en reste
beaucoup apprendre sur la rsilience face au vaste ventail des expriences
militaires (p. ex., chez les membres des forces de maintien de la paix). Enfin, notre
tude a mis au jour de nombreux instruments de mesure de la rsilience et de concepts
connexes, dont beaucoup nont cependant pas fait lobjet dune validation suffisante.
Pour approfondir davantage notre connaissance de la rsilience, les recherches venir
devront faire appel des mthodes et des stratgies de mesure plus sophistiques,
lesquelles devront pouvoir tre valides chez diffrentes populations. De telles
initiatives de recherche permettent en thorie dlaborer et dvaluer des interventions
fondes sur la rsilience et favorisent les applications axes sur les politiques sociales
lintrieur de populations militaires et non militaires.
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Executive summary
Background
There is growing recognition that psychological resiliency (herein referred to
as resiliency) plays an important role in how individuals adapt to stressful life events.
Yet resiliency remains a poorly defined concept in the traumatic stress literature.
Traditionally, research has focused on pathological reactions and negative outcomes
that arise from exposure to extreme stressors, which includes an increased risk of
psychopathology, physical illness, and disability (e.g., Breslau et al., 2001). Yet,
research shows that there are notable individual differences in the trauma response. To
illustrate, research suggests that about 40-60% of adults in the community have been
exposed to trauma (Kessler et al., 1995; Yehuda, 2004), yet only a fraction of the
general population develops posttraumatic stress disorder (8%: American Psychiatric
Association [APA], 2000). These findings suggest that other factors, in addition to
trauma exposure, must be taken into account when examining the causes of traumarelated psychopathology, such as posttraumatic stress disorder (PTSD). These include
both risk and protective factors. The overemphasis in the research literature on
adverse reactions to trauma has limited our understanding of the individuals ability to
adapt and successfully cope with acute and chronic stress (Bonanno et al., 2004,
2005). Broadening research to focus more on adaptive responses and outcomes to
trauma exposure will lead to a more complete understanding of stress-related
psychopathology, as well as its treatment and prevention.
Much of our knowledge of resiliency has primarily emerged from the
developmental psychology literature. The research has extensively studied children
and adolescents who are at risk of exposure, or who have been exposed, to stressful
life experiences (e.g., Garmezy, 1983; Rutter, 1985). There is a need to extend
resiliency research to other populations who are at heightened risk of directly
experiencing or witnessing traumatic events involving human suffering and death.
Populations who are regularly exposed to acute and chronic stressors in the line of
duty include civilian emergency services workers (e.g., paramedics, police officers,
firefighters) and military personnel (e.g., combat soldiers, peacekeepers,
peacemakers). A large body of research has shown a high prevalence of traumatic
stress disorders, such as PTSD, in these groups (e.g., Asmundson et al., 2002; Beaton,
et al., 1999; North, et al., 2002a; see Pern et al., 2000, for a review). The role of
resiliency to protect these individuals from duty-related stress reactions and
psychopathology remains an understudied, yet critical area of research. To date, only
a handful of studies have investigated resiliency or related constructs in these
populations (e.g., Bartone, 1999; King et al., 1998; Sutker et al., 1995; Taft et al.,
1999; Zakin et al., 2003). Resiliency studies in high-risk civilian occupations are also
limited, and thus far have focused more on general coping responses and adjustment
(e.g., Beaton et al., 1999; North, et al., 2002b), rather than resiliency.
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Objective
The objective of this report was to conduct a review of the concepts, measures,
and research findings associated with psychological resiliency related to acute and
chronic stressors experienced by military personnel. As requested, the content of the
review consists of a detailed summary of the following: (1) current, accepted
definition(s) of resiliency, (2) factors contributing to resiliency, (3) theories of
resiliency, (4) empirical research findings on resiliency in protecting individuals from
adverse outcomes associated with acute or chronic stress, (5) empirical research
findings on resiliency in military personnel and other high-risk occupations (e.g.,
police, firefighters, paramedics), and (6) copies of resiliency measures and associated
scientific papers describing their development and validation.
The literature review provides a detailed summary of the current state of
knowledge on resiliency and its application to military personnel. Results of this
review will have practical implications for identifying important future research
directions, and will help delineate potential clinical and social policy applications.
Future research may build on our review by developing and conducting empirical
research projects in this topic area.
Procedures
Our literature search strategies involved two phases between September 2005
and March 2006. In the first phase (September to December 2005), major electronic
bibliographic databases were searched, including MEDLINE and PsychINFO, using
the search terms resilience or resiliency. Secondary searches were completed for
related concepts using the search terms of posttraumatic growth, hardiness, thriving,
and stress-related growth. There was no specified time limit and articles searched
were limited to English. Publication types included peer-reviewed original empirical
research articles, non-empirical review articles (e.g., theoretical papers, literature
reviews), conference proceedings, and other scientific works (e.g., books, book
chapters, technical reports). Articles were then retrieved by the investigators or
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research assistants. The second phase consisted of reviewing each article and
compiling a synthesis of the relevant literature. In addition to the literature search, one
of the research assistants was assigned to obtaining copies of all relevant, freely
available (published or unpublished) assessment instruments and references to provide
supporting documentation.
In the second phase (January 2006 to March 2006), we reviewed the remaining
articles from our search results and prepared detailed summaries (as described in the
above objectives). We have attached copies of all the available measures (excluding
those with copyright restrictions) of resiliency and related constructs, along with
references of scientific papers on their development and validation (due to copyright
restrictions we were not able to provide copies of the scientific papers themselves).
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SOMMAIRE
Contexte
On reconnat de plus en plus que la rsilience psychologique (ci-aprs appele
rsilience ) joue un rle important dans la manire dont les individus sadaptent
aux vnements stressants de la vie. Pourtant, la rsilience demeure un concept mal
dfini dans la littrature sur le stress traumatique. Dans le pass, les recherches se sont
concentres sur les ractions pathologiques et les rsultats nfastes dcoulant de
lexposition des facteurs de stress extrmes, notamment un risque accru de
psychopathologie, de maladies physiques et dinvalidit (p. ex., Breslau et coll.,
2001). Cependant, les recherches indiquent quil existe des diffrences individuelles
marques dans la rponse aux traumatismes. Ainsi, selon les recherches, de 40 60 %
des adultes de lensemble de la collectivit ont t exposs un traumatisme (Kessler
et coll., 1995; Yehuda, 2004), alors que le syndrome de stress post-traumatique
(SSPT) napparat que chez une fraction de la population gnrale (8 % selon
lAmerican Psychiatric Association [APA], 2000). Il semblerait, la lumire de ces
constatations, que dautres facteurs, en dehors de lexposition au traumatisme, doivent
entrer en ligne de compte lorsquon examine les causes de la psychopathologie lie
un traumatisme, comme le SSPT. Il sagit aussi bien de facteurs de risque que de
facteurs protecteurs. Le fait que les comptes rendus de recherches accordent une place
prpondrante aux ractions nfastes aux traumatismes nous a empchs de nous
pencher sur la capacit de lindividu de sadapter au stress aigu et chronique et de
composer avec ces situations (Bonanno et coll., 2004, 2005). En largissant nos
recherches de manire nous intresser davantage aux ractions dadaptation et aux
rsultats de lexposition aux traumatismes, nous parviendrons mieux comprendre la
psychopathologie lie au stress, ainsi que son traitement et les moyens de la prvenir.
Une bonne partie de nos connaissances sur la rsilience viennent en premier
lieu de la littrature sur la psychologie du dveloppement. Les recherches ont explor
en profondeur le cas des enfants et des adolescents qui sont risque dexposition, ou
qui ont t exposs, des expriences de vie stressantes (p. ex., Garmezy, 1983;
Rutter, 1985). Il faut largir les recherches sur la rsilience de manire englober
dautres populations qui sont exposes un risque accru de vivre, directement ou
titre de tmoins, des vnements traumatiques entranant une souffrance humaine ou
le dcs. Les populations qui sont systmatiquement exposes des facteurs de stress
aigu et chronique dans lexercice de leurs fonctions sont notamment les travailleurs
des services durgence civils (p. ex., les ambulanciers, les agents de police, les
pompiers) et les membres du personnel militaire (p. ex., les soldats au combat et les
membres des forces de maintien de la paix et des oprations de rtablissement de la
paix). Un vaste corpus de recherches a mis en lumire une forte prvalence de troubles
lis au stress traumatique, comme le SSPT, dans ces groupes (p. ex., Asmundson et
coll., 2002; Beaton et coll., 1999; North et coll., 2002a; voir Pern et coll., 2000, pour
une analyse). Le rle de la rsilience dans la protection de ces individus contre les
ractions au stress li au travail et lapparition dune psychopathologie demeure un
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domaine peu tudi, mais critique de la recherche. Jusqu prsent, une petite poigne
seulement dtudes se sont penches sur la rsilience ou sur des concepts connexes,
dans ces populations (p. ex., Barton, 1999; King et coll., 1998; Sutker et coll., 1995;
Taft et coll., 1999; Zakin et coll., 2003). Les tudes sur la rsilience dans les
professions civiles risque lev sont galement peu nombreuses et, jusqu prsent,
elles se sont concentres davantage sur les ractions gnrales dadaptation et
dajustement (p. ex., Beaton et coll., 1999; North et coll., 2002b), que sur la rsilience.
Parmi les rsultats importants des tudes sur la rsilience, mentionnons les
applications quon peut en faire lvaluation, au traitement et la prvention de la
psychologie. Un moyen de rduire les effets nfastes du stress traumatique aigu et
chronique chez les groupes professionnels risque lev consiste laborer et
valuer des programmes de dpistage permettant de reprer les individus risque de
ractions pathologiques au stress. Un autre secteur important est celui des
programmes dintervention fonds sur des preuves visant promouvoir la rsilience
et, par consquent, prvoir ventuellement lapparition de troubles lis au stress
traumatique. Selon des tudes rcentes, il semble que la rsilience chez les individus
souffrant du SSPT (dcoulant de diffrents types de traumas) peut tre rehausse
grce des interventions psychosociales et pharmacologiques (Connor et coll., 2003;
Davidson et coll., 2005). Il faut procder dautres recherches pour rpter ces
rsultats chez des groupes professionnels risque lev.
Objectif
Le prsent rapport a pour objectif dexaminer les concepts, les instruments de
mesure et les rsultats dtudes concernant la rsilience psychologique face aux
facteurs de stress aigu et chronique que vivent les membres du personnel militaire.
Conformment ce qui avait t demand, la prsente tude consiste en un rsum
dtaill des aspects suivants : 1) dfinition(s) actuellement accepte(s) de la rsilience,
2) facteurs contribuant la rsilience, 3) thories de la rsilience, 4) rsultats des
recherches empiriques sur la protection confre par la rsilience chez des individus
soumis des vnements nfastes associs un stress aigu ou chronique, 5) rsultats
des recherches empiriques sur la rsilience chez les militaires et dautres professions
risque lev (p. ex., les agents de police, les pompiers, les ambulanciers) et 6) copies
des instruments de mesure de la rsilience et des travaux scientifiques connexes
dcrivant leur laboration et leur validation.
Lanalyse documentaire fournit un rsum dtaill de ltat actuel des
connaissances sur la rsilience et de leur application aux membres du personnel
militaire. Les rsultats de cette tude ont des implications pratiques; ils permettront de
tracer les orientations importantes des recherches venir et aideront dfinir leurs
applications ventuelles la pratique clinique et aux politiques sociales. Les
chercheurs pourront tirer parti de notre tude en laborant et en menant bien des
projets de recherche empirique dans ce domaine prcis.
Mthodologie
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Table of contents
Abstract....................................................................................................................................... 1
Rsum ....................................................................................................................................... 3
Executive summary .................................................................................................................... 4
Background.................................................................................................................... 4
Objective ....................................................................................................................... 5
Procedures ..................................................................................................................... 5
SOMMAIRE............................................................................................................................... 8
Table of contents ...................................................................................................................... 12
List of figures ........................................................................................................................... 15
List of tables ............................................................................................................................. 15
Acknowledgements .................................................................................................................. 16
Review of the current, accepted definitions of resiliency........................................................... 1
Overview ....................................................................................................................... 1
Hardiness ....................................................................................................................... 4
Thriving ......................................................................................................................... 5
Posttraumatic growth..................................................................................................... 6
Summary ....................................................................................................................... 7
Review of constructs contributing to resiliency ......................................................................... 8
Overview ....................................................................................................................... 8
Individual Factors........................................................................................................ 10
Environmental Factors................................................................................................. 10
Person x Environment Interactions.............................................................................. 11
Summary ..................................................................................................................... 11
Theories of resiliency ............................................................................................................... 15
Richardson et al. (1990) & Richardson (2002)............................................................ 15
Saakvitne et al. (1998)................................................................................................. 17
Dienstbier (1989)......................................................................................................... 18
12
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13
14
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List of figures
Figure 1. Structural representation of hardiness and stress. ....................................................... 5
Figure 2. Richardsons resiliency model. Adapted from Richardson (2002). .......................... 17
Figure 3. Outcomes of challenge: Potential consequences for a single hypothetical stressor.
Adapted from OLeary & Ickovics (1995)........................................................................ 22
Figure 4. The process of posttraumatic growth. Adapted from Tedeschi & Calhoun, 2004. ... 25
Figure 5. Risk and resiliency factors for PTSD for combat-exposed female soldiers. (From
King et al., 1998)............................................................................................................... 45
Figure 6. Risk and resiliency factors for PTSD for combat-exposed male soldiers. (From King
et al., 1998.)....................................................................................................................... 46
Figure 7. Moderator model. A1 and A2 represent genetic influences on twin 1 and twin 2,
respectively. C1 and C2 represent common environmental influences, and E1 and E2
represent unique environmental influences. The definition variable, represented by a
diamond, carries the value of the specified moderator (Mod) for each twin. For
simplicity, means are not represented in the diagram but are included in the model when
using raw data analysis...................................................................................................... 52
List of tables
Table 1. Characteristics of resilient people (adapted from Connor & Davidson, 2003, and
expanded). ......................................................................................................................... 12
Table 2. Summary of theories of resiliency, posttraumatic growth and hardiness. .................. 32
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Acknowledgements
The authors gratefully acknowledge the assistance of Murray Abrams and
Roseann Larstone in preparing this report.
16
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the way psychological symptoms are measured, which were often limited to selfreport measures of depression. To illustrate, in recent bereavement studies, Bonanno
defined resiliency, and distinguished it from other outcomes from loss (e.g.,
recovered), empirically via normative and ipsative methods (e.g., Bonanno et al.,
2005). These methods may yield different results, with one method, but not the other,
classifying a person as resilient. Using the normative comparison method, a trauma
population of interest (e.g., bereaved group) is compared to a normative group (e.g.,
matched non-bereaved group) to delineate normal symptom variation from unique and
context specific symptoms between groups. People are defined as resilient if their
symptom scores remain within a cut-off symptom score (e.g., one standard deviation
of the normative group mean score). The ipsative, or repeated measures, approach
involves comparing symptoms at different assessment points before and after a trauma
event to create outcome trajectories (e.g., resilient, recovered/improved, grief reaction,
chronic depression). In this method, people are categorized as resilient based on cutoff scores of a depression self-report measure. Change of status at assessment points is
defined by cut-off scores based on standard deviation units at each post-trauma
assessment.
A further limitation is that Bonannos conceptualization of resiliency only
concerns isolated traumata (Bonanno, 2004). The concept does not seem to allow for
the possibility that a person may exhibit true resiliency which may crumble over time
in the face of severe, chronic stress. In other words, Bonanno seems to regard
resiliency as a static or trait-like entity, rather than a dynamic process fluctuating
over time and circumstance interplaying with other variables.
In contrast to Bonannos definition, several other investigators have grouped
resiliency and recovery into a single and broader construct (e.g., Connor & Davidson,
2003; Davidson et al., 2005; King et al., 1998, 1999; Luthar & Cicchetti, 2000;
McFarlane & Yehuda, 1996). Among these definitions, resiliency is typically
regarded as a dynamic and context-specific construct, characterized by either the
absence of stress-induced symptoms, or the natural (unaided) resolution of these
symptoms, rather than a representing a personality trait.
In contrast to defining resiliency based on absent or quickly waning
symptoms, other researchers have defined this construct based upon observable
behavioural indicators thought to represent adaptive functioning or competency across
different life domains, such as meeting developmental tasks in school (e.g., Flores et
al., 2005; Matsen et al., 1995, 1999). To illustrate, in a recent study of predictors of
resiliency in children, Flores et al. (2005) defined resiliency based on composite
scores using behavioural measures, in which resilient children were defined as those
having high functioning in 6 8 different areas. A problem with this categorical
approach is the arbitrary classification system that is used to define resiliency (e.g.,
low, medium, high functioning).
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Hardiness
Hardiness is considered to be a dispositional characteristic that is associated
with, and enhances, resiliency (Kobasa, 1979; Maddi, 2002; Ramanaiah et al., 1999;
Tsuang, 2000). Hardiness is defined as comprising three interrelated personality or
dispositional traits characterized by three general assumptions about self and the
world (Kobasa, 1979, 1982; Kobasa & Maddi, 1977; Maddi, 1967, 1970, 2002).
These include (a) a sense of control over ones life (e.g., believing that life
experiences are predictable and that one has some influence in outcomes through
ones efforts); (b) commitment in terms of the ascribed meaning to ones existence
and seeing life activities as important (e.g., believing that you can find meaning in,
and learn from, whatever happens, whether events be negative or positive); and (c) an
openness to viewing change as a challenge (e.g., believing that change, positive or
negative, is an expected part of life and that stressful life experiences are
opportunities). Hardy people are thought to possess all three beliefs about
commitment, control, and challenge (Maddi, 2002). Hardiness is said to be a relatively
stable factor that contributes to resiliency against stress and illness (Bonanno, 2004;
King et al., 1998; Maddi, 2005) and is associated with more active and instrumental
coping efforts, and successful performance-based outcomes (Florian et al., 1995,
Westman 1990).
Although supported by data, there have been challenges to the validity and
utility of the hardiness concept (see Blaney & Ganellen, 1990). For example, how is
hardiness distinct from other similar dispositional traits? Also, the distinction between
hardiness and related terms, such as coping, growth, or well-being is unclear. It is also
unclear whether hardiness affects general well-being (as opposed to influencing
distress). Other criticisms have targeted the lack of clarity regarding the mechanisms
and processes through which hardiness functions to protect the individual. Kobasa is
unclear on whether it is a buffer between stressful life events and emotional responses
to them, or whether it provides both direct and indirect opposing effects against
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psychological strain arising from stressful life events. The Figure below, from Rush et
al. (1995), illustrates the latter formulation of hardiness, in which it exerts direct and
indirect effects on the stress response.
Pres sure to
Change
+
Control
Coping
+
Stress
Withdraw al
Intentions
+
Escape
Coping
Satisfaction
Hardiness
Thriving
Thriving is distinguished from resiliency based on the nature of the outcome
from adversity, in which resiliency reflects recovery to pretrauma functioning and
thriving results in attainment of a higher level of functioning beyond pretrauma status
(Carver, 1998; Parks, 1998). Carver (1998, p. 245) further delineates this construct as
follows:
Thriving (physical or psychological) may reflect decreased reactivity in
subsequent stressors, faster recovery from subsequent stressors, or a
consistently higher level of functioning.
Psychological thriving following stress is associated with various benefits,
including improved physical health and psychological well-being (Epel, et al., 1998).
Other benefits thought to reflect thriving include the acquisition of new skills and
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Posttraumatic growth
This concept refers to personal development, perceived benefits, or growth
that occurs as a result of trauma or adversity (e.g., Affleck & Tennen, 1996; Fontana
& Rosenheck, 1998; Linley & Joseph, 2004; Tedeschi & Calhoun, 2004). Similar to
thriving, but in contrast to resiliency, posttraumatic growth results in improvement
beyond the persons pretrauma level of functioning and creates positive and
meaningful schema changes about themselves, their life, and their relationships. This
concept also differs from resiliency in that some people with so-called posttraumatic
growth may display an illusory (self-deceptive) improvement in well-being or
adaptive functioning after a trauma. In other words, there are two forms of
posttraumatic growth; an illusory, self-deceptive form (e.g., denying that one has been
affected by trauma, when, in fact, ones social and occupational functioning are
severely impaired by PTSD), and a more constructive form (Maercker & Zoellner,
2004).
Linley and Joseph (2004) appear to have equated (or use interchangeably) the
term posttraumatic growth with other constructs, including adversarial growth,
thriving, positive adjustment, and positive adaptation. On the other hand, Tedeschi
and Calhoun (2004) have attempted to identify the differences between posttraumatic
growth and related concepts such as resiliency and hardiness. Although there is some
evidence to suggest that posttraumatic growth is a multidimensional construct distinct
from related concepts, its factor structure remains unclear. Tedeschi and Calhoun
(1996, 2004) have suggested it is a multidimensional construct consisting of five
domains, including an increased appreciation of life, having closer and more intimate
relationships, a greater sense of personal strength, finding new life opportunities, and
increased spiritual/existential development. Armeli et al. (2001) presented somewhat
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Summary
Our review of the literature demonstrates the lack of a uniform definition of
resiliency. There is also a lack of consensus about its relationship to related concepts,
including hardiness, thriving, and posttraumatic growth. These problematic issues
have important implications for developing conceptual models, identifying factors
contributing to resiliency, and using empirical findings to develop and evaluate
resiliency based interventions. Thus, additional empirical research is needed to help
clarify the construct of resiliency, its dimensions, and underlying processes.
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The relationships among protective factors, risk factors, and exposure factors
(e.g., the nature of the adversity or stressor) remain unclear. Much of the research
suggests that the factors contributing to resiliency are pre-existing individual
characteristics (via learning and genetic influences) and life circumstances, which
come into play in times of adversity, stress, and trauma. Resiliency, according to
current definitions, requires exposure to adversity. Research on the possibility of
whether or not resiliency can be acquired through exposure to adversity or challenging
life circumstances is an interesting speculation (Richardson, 2002).
Resiliency factors usually appear together (e.g., an individual who has high
self-esteem is more likely to use active problem solving skills, is achievementoriented, and is likely to have good social support). In the literature, this has been
referred to as pile up of protective factors (Waller, 2001) or protective chains
(Smokowski, 1998; Waller, 2001). These factors also tend to have cumulative or
ripple effects (Masten et al., 1999; Rutter, 1993; Waller, 2001), and have been
illustrated as an asset or resource gradient, in which higher levels of assets leads to
better adjustment outcomes (Masten, 2001). As Fergusson et al. (2003, p. 61) stated,
Vulnerability/resiliency is influenced by an accumulation of factors
positive configurations of these factors confer increased resiliency, whereas
negative configurations increase vulnerability.
Another example of this effect could explain the finding of higher intellectual
functioning being a fairly robust predictor of resiliency. In this relationship, it may the
pile up of specific cognitive and behavioural abilities that are associated with higher
intellectual functioning (e.g., better problem solving and coping skills) that
contributes to resiliency.
Other methodological problems with research on contributors to resiliency are
the limited number of samples in which this research has been conducted, thus
limiting the generalizability of results. Furthermore, many studies that have tested
predictive models on resiliency did not cross validate their results. Also problematic
has been an over-reliance on retrospective self-report measures. Recently,
investigations (e.g., Bonanno et al., 2004) have incorporated multiple methods and
measures (e.g., peer and clinician ratings). Curtis and Cicchetti (2003) have advocated
the importance of multiple levels of analysis including biological measures but
this remains an under-utilized research approach. Another challenge is the issue of
selection bias that is likely involved in many resiliency studies (e.g., people more
distressed following trauma are probably going to be less likely to volunteer to
participate in resiliency research).
The individual, environmental, and interacting factors shown to contribute to
resiliency, which we have identified thus far in our literature review, are presented
below. These findings are also summarized in Table 1.
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Individual Factors
Empirical studies on individual factors (or within-person resources) have
identified the following contributing factors to resiliency: (1) personality traits of
adaptability, flexibility, agreeableness, extraversion, openness to experience (e.g.,
Dumont & Provost, 1999; Frederickson, 2001; Garmezy, 1991, Garmezy et al., 1984;
Rutter, 1979; 1985; Werner & Smith, 1982), (2) self-esteem (Benson, 1997; Garmezy,
1991, Garmezy et al., 1984; Howard, 1996; Werner, 1982; Werner & Smith 1992), (3)
self-mastery (Rutter, 1979; 1985), (4) intelligence (Masten et al., 1999), (5) problemfocused coping strategies (Garmezy, 1991, Garmezy et al., 1984), (6) internal locus of
control (Benson, 1997; Garmezy, 1991, Garmezy et al., 1984), (7) being achievement
and goal-oriented (Benson, 1997; Werner, 1982; Werner & Smith 1992), (8) higher
intellectual functioning (Masten et al., 1988, 1999), (9) ego-resiliency and ego-control
(Flores et al., 2005), and (10) cognitive appraisals about threat, safety, and adversity,
such as benefit-finding cognitions (beliefs about benefits from adversity and using this
knowledge as a coping strategy) (e.g., Affleck & Tennen, 1996).The recent emergence
of the positive psychology field has identified other individual variables shown to
contribute to resiliency, such as optimism, hope, creativity, faith, and forgiveness
(e.g., see Richardson, 2002, for a review). Other emerging constructs, such as a selfenhancing bias, or the tendency to have overly positive view of oneself, has also been
implicated with resiliency (e.g., Bonanno et al., 2004, 2005) but this tendency appears
to also result in negative consequences over time (e.g., being seen by others as less
honest).
Environmental Factors
Early investigations also examined the role of single environmental factors
contributing to resiliency. These studies showed the importance of relational features,
specifically social support (e.g., a connection to other competent adults within and
outside the immediate family) (Flores, et al., 2005; Garmezy, 1991; Garmezy et al.,
1984; Rutter, 1979; 1985; Werner 1982; Werner & Smith, 1992), and positive
parenting qualities (e.g., parental presence, emotional availability, and support)
(Garmezy et al., 1984; Garmezy, 1985; Masten et al., 1988, 1999; Tiet et al., 1998), in
resiliency. Subsequent research findings on the role of social support in contributing
to resiliency have been inconsistent, and the underlying processes between these two
constructs are not clear. For example, researchers have speculated that opportunities
for being able to talk about the trauma within ones social support system may
facilitate cognitive processing and provide opportunities for corrective experiences,
which, in turn, leads to resiliency, rather than social support as the primary
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contributing factor (e.g., Benson, 1997; Howard, 1996; Dumont & Provost, 1999;
Yakim & McMahon, 2003).
Summary
Much of our knowledge on the factors contributing to resiliency has emerged
from the developmental psychology and psychiatry literature. Research on single
factors contributing to resiliency has been limited; however, some individual traits,
environmental situations, and the interaction between these have been identified. The
relationships among protective factors, risk factors, and exposure factors remain
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11
unclear and need further exploration and validation. In addition, future studies need to
address resiliency in a broader range adult populations.
Table 1. Characteristics of resilient people (adapted from Connor & Davidson, 2003, and
expanded).
Characteristic
Achievement oriented
Action oriented approach
Adaptability to change
Agreeableness
Capacity for positive emotional expression
Commitment
Creativity
Critical thinking skills
Educational aspiration
Ego-resiliency and ego-control
Engaging the support of others
Excellence
Extraversion
Flexibility
Good communication skills
12
Reference
Werner, 1982, 1989; Werner &
Smith, 1992
Rutter, 1985
Block & Block, 1980; Bonanno,
et al., 2004; Dumont & Provost,
1999; Frederickson et al., 2001;
Rutter, 1985; Werner, 1982,
1989; Werner & Smith, 1992
Dumont & Provost, 1999;
Frederickson et al., 2001
Bonanno, 2004; Fredrickson, et
al., 2003; Tugade &
Fredrickson, 2004; Tugade et al.,
2004; Zautra, et al. 2005
Connor & Davidson, 2003;
Flores et al., 2005; Fraley &
Bonanno, 2004; Garmezy, 1985,
1987, 1991; Garmezy et al.,
1984; Masten, et al., 1988,
1998l, 1999; Rutter, 1985; Tiet
et al., 1999; Werner, 1982, 1989;
Werner & Smith, 1992
Kobasa, 1979
Simonton, 2000
Garmezy, 1985, 1987, 1991;
Garmezy et al., 1984
Flores et al., 2005
Cicchetti & Rogosch, 1997;
Flores et al., 2005
Rutter, 1985
Lubinski & Benbow, 2000
Affleck & Tennen, 1996;
Kobasa, 1979; Tedeschi &
Calhoun, 1996, 2004; Tedeschi
et al., 1998
Dumont & Provost, 1999;
Frederickson et al., 2001
Werner, 1982, 1989; Werner &
Smith, 1992
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Characteristic
Happiness
High expectancies
High self-esteem
Past successes
Patience
Perceiving positive benefits from trauma exposure
Personal or collective goals
Positive acceptance of change
Presence of an external support system
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Reference
Buss, 2000
Garmezy, 1985, 1987, 1991;
Garmezy et al., 1984
Benson, 1997; Cicchetti &
Rogosch, 1997; Garmezy, 1985,
1987, 1991; Garmezy et al.,
1984; Howard, 1996; Masten &
Reed, 2002; Werner, 1982,
1989; Werner & Smith, 1992
Curtis & Cicchetti, 2003;
Garmezy, 1985, 1987, 1991;
Garmezy et al., 1984; Masten, et
al., 1988, 1998l, 1999
Garmezy, 1985, 1987, 1991;
Garmezy et al., 1984; Luthar,
1991; Werner, 1982, 1989;
Werner & Smith, 1992
Bonanno, Wortman, & Nesse,
2004
Bonanno, Wortman, & Nesse,
2004
Affleck & Tennen, 1996;
Tedeschi & Calhoun, 1996,
2004; Tedeschi et al., 1998
Affleck & Tennen, 1996;
Connor & Davidson, 2003;
Garmezy, 1985, 1987, 1991;
Garmezy et al., 1984; Kumpfer,
1999; Masten & Reed, 2002;
Peterson, 2000
Rutter, 1985
Lyons, 1991
Affleck & Tennen, 1996;
Aldwin, Levenson, & Spiro,
1994
Benson, 1997; Rutter, 1985
Connor & Davidson, 2003
Flores et al., 2005; Garmezy,
1985, 1987, 1991; Garmezy et
al., 1984; Werner, 1982, 1989;
Werner & Smith, 1992
Garmezy, 1985, 1987, 1991;
Garmezy et al., 1984
Connor & Davidson, 2003;
Kobasa, 1979; Rutter, 1985
Werner, 1982, 1989; Werner &
13
Characteristic
Self-determination
Self-discipline
Self-efficacy
Self-enhancement bias
Sense of humor
Socially responsible
Spiritual influences, faith
Subjective well-being
Tolerance of negative affect
Trust in ones instincts
View change or stress as a challenge or opportunity
Wisdom
14
Reference
Smith, 1992
Ryan & Deci, 2000; Schwartz,
2000
Garmezy, 1985, 1987, 1991;
Garmezy et al., 1984
Connor & Davidson, 2003;
Rutter, 1985
Bonanno, Field, Kovacevic, &
Kaltman, 2002; Bonanno,
Rennicke, & Dekel, 2005
Garmezy, 1985, 1987, 1991;
Garmezy et al., 1984; Masten &
Reed, 2002; Rutter, 1985
Werner, 1982, 1989; Werner &
Smith, 1992
Connor & Davidson, 2003;
Myers, 2000
Deiner, 2000
Connor & Davidson, 2003;
Lyons, 1991; Werner, 1982,
1989; Werner & Smith, 1992
Connor & Davidson, 2003
Kobasa, 1979
Baltes & Staudinger, 2000
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Theories of resiliency
The following is a overview of the major theories of resiliency and related
constructs. See Table 2 for a summary of these theories.
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S tressors
Adversi ty
Li fe Event s
Resil ient
R ei ntegrat ion
P rot ect ive F act ors
Bi opsychospi ri tual
Hom eost asi s
R ei ntegrat ion
b ack to
Hom eost asi s
R ei ntegrat ion
wit h Loss
Dis rupt ion
R ei ntegrat ion
Dysfuncti onal
R ei ntegrat ion
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17
reflected in disrupted cognitive schemas in five areas: safety, trust, control, esteem,
and intimacy. Finally, a perceptual and memory system, including biological
(neurochemical) adaptations and sensory experience, is affected.
According to Saakvitne and colleagues (1998), in response to a traumatic
event, the individual must integrate the event, context, and consequences into existing
beliefs about self and others. The intensity of the somatic, affective, and interpersonal
components of the experience determines the availability of the event for cognitive
processing. The more overwhelming or intolerable the experience, given ones selfcapacities (i.e., ability to tolerate affect and maintain a sense of self in connection), the
greater the need for dissociative and amnesiac defenses that preclude conscious
processing of the event. The event and its implications must be incorporated into
ones frame of reference and schemas about central psychological needs.
In terms of this model, growth and pain are not mutually exclusive but rather
inextricably linked in recovery from trauma and loss. Posttraumatic growth is said to
be linked to the increased consonance between an individuals understanding of a
traumatic event and its personal meaning. Such growth occurs as an individual is able
to understand his or her current experience, feelings, perceptions, beliefs, and distressin the context of the past, including past trauma and related adaptations. Growth may
result in major shifts in beliefs about the self, the world, or spirituality, or in
mindfulness and acceptance without resignation or serenity.
While this theory has considerable appeal, it has yet to be empirically tested
and does not appear to have fueled much subsequent research. The theory lacks a clear
direction and conceptualization of the construct it attempts to explain. Further
research with this theory is needed.
Dienstbier (1989)
On the basis of a review of the literature, consisting largely of animal studies,
Dienstbier argued that stress can toughen neuroendocrine responses to future
stressors. Exposure to intermittent stressors was said to result in low base rates in
sympathetic nervous system (SNS) arousal, and also to strong and responsive
challenge- or stress-induced SNS-adrenal-medullary arousal, with resistance to brain
catecholamine depletion and suppression of pituitary adrenal-cortical responses. This
pattern of arousal was said to define physiological toughness and, in interaction with
psychological coping, to correspond with positive performance in complex tasks, with
emotional stability and immune system enhancement. These postulates have been
tested a number of times since inception of the theory and have been consistently
validated (e.g., Mendes et al., 2003; Tomaka et al., 1993; Weidenfeld et al., 1990)
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19
20
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for continuity in childrens development (and context) over time and create
potentialities for change.
This theory has formed the conceptual basis for research involving diverse
risks including family poverty, experiences of maltreatment, and others (Baldwin et
al., 1993; Cicchetti & Lynch, 1993; Cicchetti et al., 1993; Connell, Spencer, & Aber,
1994; Crittenden, 1985; Leadbeder & Bishop, 1994)
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21
are not limited to, hardiness, active coping, a sense of coherence, optimism, and
ability to find meaning in challenge. Social resources include formal (e.g.,
organizational or institutional) or informal (e.g., friends, family, co-workers)
resources.
In a critique of this theory, Carver (1998) suggested that it falls short in its
description of the outcome of thriving. The problem with this sort of cognitive
outcome is that responses of this form are harder than behavioral responses to
distinguish from rationalization or dissonance reduction, which would not be regarded
as thriving under any definition of the term.
Level of Functioning
Challenge
C: Thriving
B: Recovery
A. Survival
Time
Figure 3. Outcomes of challenge: Potential consequences for a single hypothetical stressor.
Adapted from OLeary & Ickovics (1995).
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homeostasis. Data from animals and humans point to the endogenous opioid system as
a critical modulator of the transition from acute (warning signals) to sustained
(stressor) environmental adversity. Ruberio et al. suggested that the existence of
pathways and regulatory mechanisms common to the regulation of both physical and
emotional states transcend classical categorical disease classifications, and point to the
need to utilize dimensional, symptom-related approximations to their study.
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24
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PERSON PRETRAUMA
SEISMIC EVENT
CHALLENGES
MANAGEMENT OF
EMOTIONAL DISTRESS
FUNDAMENTAL SCHEMAS:
BELIEFS & GOALS
RUMINATION
MOSTLY AUTOMATIC & INTRUSIVE
LIFE NARRATIVE
SELF DISCLOSURE
WRITING, TALKING, PLAYING
SOCIAL SUPPORT
MODELS FOR SCHEMAS,
COPING, POST TRAUMATIC
GROWTH
POSTTRAUMATIC
GROWTH
(5 DOMAINS)
WISDOM
Figure 4. The process of posttraumatic growth. Adapted from Tedeschi & Calhoun, 2004.
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general quality that emerges from rich, varied, and rewarding childhood experiences.
Hardiness was conceptualized as comprising three interrelated dispositional
tendencies: control, commitment, and challenge. A hardy person views potentially
stressful situations as meaningful and interesting (commitment), sees stressors as
changeable (control), and sees change as a normal aspect of life rather than a threat,
and views change as an opportunity for growth (challenge). As a result, a hardy
person is able to remain healthy under stress. Hardy people are thought to transform
the meaning of events to their most positive interpretations and ones that lead to goaldirected behavior (Orr & Westman, 1990, p. 143).
More specifically, hardy individuals are thought to reframe their experiences such
that (a) these are viewed in a positive light (e.g., as leading to benefits) and (b) they
embrace meanings or perspectives which imply that something can be done to change
a stressor or to recover from its detrimental effects. Rather than dwell on the negative
outcomes of a traumatic event, hardy people may choose more than others to focus
selectively on its positive effects. They may tend more than others to attribute positive
effects to their traumatic experiences. Attribution of positive effects to traumatic
events may facilitate recovery by helping to restore ones belief in the benevolence of
the world (Janoff-Bulman, 1992), by making senseless suffering meaningful (Frankl,
1978), or both. Hardy trauma victims may tend more than others to embrace
cognitions which imply that there are actions one can take to foster recovery. They are
thus more likely to engage in active coping behavior and less likely to respond in a
passive, helpless manner. Non-hardy people, on the other hand, tend to focus on the
negative meanings of events and are less likely to define problems in a manner that
points to the possibility of finding a solution.
According to Maddi and Kobasa (1984), stressful events lead to a strain reaction
or increased sympathetic arousal. Further, chronic strain may eventually lead to
exhaustion, illness, or psychological distress. Hardiness modifies this strainexhaustion process through several pathways. It alters perceptions of events to make
them less stressful (Rhodewalt & Agustsdottir, 1984; Rhodewalt & Zone, 1989;
Panaga, 1990; Weibe, 1991; Allred & Smith, 1989). It leads to active or
transformational coping (Kobasa, 1982a; Bartone, 1989; Pierce & Molloy, 1990). It
influences coping indirectly through its influence on social support (Kobasa &
Puccetti, 1983; Ganellen & Blaney, 1984). Finally, it leads to change in health
practices that in turn reduce illness (Contrada, 1989; Weibe, 1991; Wiebe and
McCallum, 1986).
Factor analyses have confirmed the presence of the three proposed factors of
control, commitment, and challenge in hardiness measures (Funk, 1992). However,
there has not been as much support for the hierarchical structure (e.g., hardiness). This
has lent to suggestions that hardiness, as a concept on its own, may not be as useful as
its three subcomponents (Funk, 1992). In addition, there has been concern that
hardiness scales actually measuring neuroticism; but, the magnitude of correlations
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between the two have been moderate, indicating they are overlapping, but not
identical.
Further criticisms of this theory have surrounded issues of lack of clarity regarding
the mechanisms through which hardiness functions to protect. Kobasa is unclear on
whether it is a buffer (moderator) between stressful life events and emotional
responses to them or whether it provides both direct and indirect protections against
psychological strain arising from stressful life events. In addition, in a thorough
review of the hardiness literature, Funk (1992) criticized hardiness researchers due to
failures he noted as, (1) a failure to adequately test the theory, (2) the concept has
been poorly operationalized, (3) hardiness researchers should adopt a standard
hardiness measure that has been originally developed to fit hardiness theory, and (4)
more sophisticated statistical analyses should be used to test the theory, most only use
simple correlations and discriminant analyses.
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Indeed, a depressogenic reaction may be more realistic and appropriate. Growth may
leave them sadder, but almost inevitably wiser (cf. Alloy & Abramson, 1979; Linley,
2003), in recognition of the vicissitudes of the human condition. The characteristics of
growth are very much those of psychological well-being: closer relationships, greater
self-acceptance, and deeper spirituality (cf. Ryff & Singer, 1996; van Dierendonck,
2004).
Further, individual differences in trauma response are explained within the
organismic valuing theory of growth in terms of four factors. First, the degree of
disparity between the trauma and preexisting expectations and beliefs is essential. The
greater the incongruence and conflict between the persons previous assumptive world
and the trauma-related information, the greater the potential for posttraumatic stress
reactions and for growth. Second, whether the social environment has previously
impeded or promoted the organismic valuing process will modify how the person
responds to trauma. Organismic valuing process theory posits that the satisfaction of
basic psychological needs of autonomy, competence, and relatedness is necessary for
expression of the organismic valuing process. People who have experienced
satisfaction of these needs earlier in life, during childhood and adolescence, will have
developed generalized orientations of acting concordantly with their organismic
valuing process. Third, the extent to which people act concordantly with their
organismic valuing process will affect their process of response. Organismic valuing
process theory posits that a social environment that is able to meet the individuals
needs for autonomy, competence, and relatedness will lead to the occurrence of
effortful appraisal processes, in turn facilitating positive accommodation and the
search for meaning as significance. These processes will then lead to greater growth.
Finally, whether the social environment impedes or promotes the organismic valuing
process in the aftermath of the traumatic event will have an effect on the outcome of a
persons organismic valuing process. The greater the psychological need satisfaction
afforded by the posttrauma environment to people who are in a state of posttraumatic
stress, the more likely they are to experience growth. This is the most recent theory
presented in this section, and has yet to be empirically evaluated.
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by altering the appraisal of the risk factor or by altering exposure to the risk. In the
former case, controlling exposure to the stress so that the individual can successfully
cope with smaller doses of the experience may mitigate the meaning of the risk. Since
the individual can cope successfully in some circumstances, the impact of the greater
degree risk may be mitigated. Alternatively, a countervailing circumstance may
mitigate the impact. If the experience or rejection, bereavement, or separation causes
damage to self-esteem, the impact of that event may be neutralized by a new love
relationship. Individuals who suffered some adversity in their home environments yet
coped effectively may have experienced additional personal growth beyond that
which characterized the young adults who came from more nurturing environments.
The result also may be explained in the context of stress inoculation theory, whereby a
psychological and physiological toughening occurs through exposure to moderate
levels of stress (Rutter, 1987). Prior experience of stress during childhood and
adolescence may in some cases increase resistance to more minor stresses, which
could translate into lower levels of symptoms.
The second way in which risk impact may be mitigated is through mechanisms
that change the childs exposure to the risk situation. For example, the effect of
association with delinquent peers on subsequent delinquent behaviour may be
mitigated by parental supervision of the child in the environment characterized by
high degrees of peer delinquency. Protection through alteration of the meaning of the
risk also can occur through the steeling (Rutter, 1987, p. 326) qualities that result
from successful coping. The second type of mechanism refers to the reduction of
negative chain reactions that follow exposure to risk and perpetuate risk effects. For
example, early parental loss may lead to greater probability of institutional treatment
that has adverse effects on developmental outcomes. Adequate functioning of the
remaining parent or the provision of alternative care arrangements may mitigate the
impact of parental loss in producing this reaction.
The third mechanism through which protective functions may be served is
through the establishment and maintenance of self-esteem and self-efficacy. Two
types of experiences that are influential in the establishment of self-esteem and selfefficacy are the development of secure and harmonious love relationships, and
opportunities for success in accomplishing tasks that are salient to the individuals. The
resultant feeling of self-worth and self-efficacy provides the individual with
confidence that he or she can successfully cope with the demands made upon the
person. Secure and supportive personal relationships and successful task
accomplishment are important to bolster positive concepts and self-worth.
Finally, protective factors operate through opportunities to obtain experiences
that might mitigate the effect of early risk factors. Thus, delay of marriage may
increase the range of opportunities available to an individual since it would not be
required that the individual cease further education in order to work and support a
spouse and family. In this regard, Rutter (1990) defined three broad variables as
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protective factors: (1) personality coherence, (2) family cohesion, and (3) social
support. Personality factors include level of autonomy, self-esteem and self-efficacy,
good temperament, and positive social outlook. In addition, having more flexible
thinking and expanded behavioral options as a result of positive affect may increase
the personal resources of extraverted individuals during times of adversity.
Furthermore, the tendency of extraverted individuals to build strong networks of
social support may allow them access to this important protective factor during
stressful situations (Rutter, 1985).
This theory has resulted in a great deal of research (e.g., PsycInfo search
results in 496 citations of the 1987 article) and has been very positively regarded in
the literature. No evidence of empirical validation, however, and no specific measures
have resulted from this theory.
Summary
Several theories have attempted to elucidate resiliency factors, their interrelationships, as well as their underlying mechanisms, processes, and outcomes. These
theories have emerged from personality, cognitive, and biological orientations, yet
none to date provide a comprehensive theory of resiliency. Although many of these
theories (e.g., Richardson et al., 1990, 2002; Rutter, 1985, 1987, 1990) have received
modest empirical investigations, findings from these studies are limited by various
methodological shortcomings and in their generalizability. Resulting new theories in
the future will need to use more sophisticated methodologies and measurement
strategies, which can be validated across a range of populations (e.g., civilian and
military).
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Citation(s)
Kobasa (1979,
1982), Maddi &
Kobasa (1984)
Garmezy et al.
(1984)
Construct
Hardiness
Theoretical Orientation
Personality theory
Process
Reframing of cognitions
Identified factors
Control, commitment,
& challenge
Outcome (s)
Hardiness
Resiliency
Cognitive
Personality disposition,
supportive family, & an
external support system
Resiliency
Rutter (1985,
1987, 1990)
Resilience
Cognitive
Level of autonomy,
self-esteem, selfefficacy, good
temperament, positive
social outlook, flexible
thinking
Resilience
Richardson et al.
(1990),
Richardson (2002)
Metatheory of
resilience and
resiliency
Cognitive
Neutralization of risk,
enhancing adaptation, &
protective functions of
factors
Reduction of risk impact,
mitigation of risk impact,
establishment and
maintenance of self-esteem
& self-efficacy, &
mitigation of early risk
factors
Reintegration back to
homeostasis
Coping abilities
Deinstbier (1989)
Physiological
toughness
Physiological
Stress induced
physiological reactions
Resilient
reintegration, return
to baseline
homeostasis,
recovery with loss, &
dysfunctional
reintegration
Toughened
neuroendocrine
responses
Saakvitne et al.
(1998)
Cognitive
Integration of traumatic
event, context and
consequences into existing
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Posttraumatic growth
Citation(s)
Construct
Physical thriving
Adaptation
OLeary &
Ickovics (1995)
Resilience
Process
beliefs about self and
others
Physiological/Cognitive Characteristics of the
stressor & psychological
moderators affect stress
reaction
EcologicalTransaction between
Transactional Model
macrosystem, exosystem,
microsystem, & ontogenic
development
Cognitive
N/A
Resilience
Neural Circuitry
Tedeschi &
Calhoun (1996,
2004), Tedeschi et
al. (1998)
Posttraumatic
Growth
Cognitive
Modulation of the
endogenous opioid system
and receptors
Rumination through selfdisclosure to social
supports resulting in
schema change
Growth through
adversity
Organismic-valuing
theory
Cognitive-emotional
processing
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Theoretical Orientation
Identified factors
Outcome (s)
Cortisol adaptation
Resiliency
N/A
Adaptation the
environment
Hardiness, active
coping, a sense of
coherence, optimism,
ability to find meaning
in challenge
N/A
Survival, Recovery,
Thriving
Improved relationships,
new possibilities for
life, greater
appreciation of life,
greater sense of
personal strength,
spiritual development
Personal schemas,
social support
Posttraumatic
Growth
Resilience
Growth through
adversity
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35
36
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Parental modeling experiences, where the child observes that their parents are
excused from home responsibilities or receive special attention when they are
ill.
Parental overprotection, in which parents treat the child as frail and vulnerable,
thereby leading the child to believe that he or she is at risk for succumbing to
illness.
Parental reinforcement of illness behaviors, which occurs when a child often
receives toys, food treats, attention, sympathy, or special care, or is excused
from school or home chores when ill.
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people to blame others (or themselves) for their problems. Parents learn their
parenting styles from a variety of sources, including their own experiences during
childhood. Parental overprotection and reinforcement may arise because these patterns
are reinforcing to both the parent and child; parents feel they are providing good care,
and children feel cared for. It can be difficult for parents to foresee the long-term
consequences of well-intentioned actions. And, not all children become healthanxious as a result of parental overprotection, reinforcement, or modeling. Parentchild patterns are but one element in the matrix of factors involved in the etiology of
severe health anxiety.
Depression
Stressful life events, such as those related to some kind of loss (e.g., loss of a
job or death of a significant others), combined with low social support, have long been
known to increase the risk for mood disorders, such as major depressive disorder (e.g.,
Brown & Harris, 1978; Denny et al., 2004; Kalil et al., 2001). Stressors combined
with low social support do not inevitably lead to depression; they are thought to
trigger depression in people with some kind of preexisting vulnerability, such as a
lack of social support, preexisting dysfunctional beliefs or cognitive style (e.g.,
pessimistic attributional style), or genetic factors.
Cognitive and personality risk factors
Longitudinal research indicates that non-depressive people who have
pessimistic cognitive style, and people who are better able to recall aversive than
pleasant memories, are at greater risk for subsequently becoming depressed (e.g.,
Alloy et al., 1999; Gotlib & Neubauer, 2000). Personality traits such as neuroticism
(i.e., the tendency to experience negative emotions in response to stress) and stress
reactivity (i.e., a trait similar to neuroticism) have also been found to predict the
development of depression (Riso et al., 2002). The development of chronic depression
may involve increased levels of childhood adversity, protracted environmental stress,
and heightened stress reactivity (Riso et al., 2002).
Genetic factors
The serotonin system has been implicated in the etiology of many disorders,
particularly mood disorders. A component of this system, the serotonin transporter,
plays an important role in serotonergic neurotransmission by facilitating the reuptake
of serotonin from the synaptic cleft. The short polymorphism (i.e., variant) of a
promoter region of the serotonin transporter gene (5HTTLPR), compared to the long
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Panic Disorder
Anxiety sensitivity
The concept of anxiety sensitivity has proved valuable for understanding the
risk factors for stress-related panic attacks and panic disorder (Taylor, 1999, 2000).
Many people find arousal-related sensations to be aversive. Yet people differ
sometimes markedly in the extent to which they are frightened by these sensations.
Anxiety sensitivity (Reiss & McNally, 1985) is the fear of arousal-related sensations,
which arises from beliefs about the consequences of these sensations. Arousalrelated refers to all sensations associated with autonomic arousal, including
palpitations, paresthesias, dyspnea, chest tightness or pain, faintness, and sweating.
These sensations occur during states of anxious arousal and also arise from other
sources, such as physical illness and ingestion of particular substances (e.g., caffeine).
The term arousal sensitivity would be a better term to describe the fear of these
sensations. However, the term anxiety sensitivity will be retained because it is
widely used.
People with low anxiety sensitivity believe that arousal-related sensations are
unpleasant but harmless, with no important consequences. People with high anxiety
sensitivity have catastrophic arousal beliefs. They believe that arousal-related
sensations lead to very harmful and possibly disastrous consequences, such as death,
insanity, or social ostracism. People with high anxiety sensitivity are frightened that
palpitations will to lead to cardiac arrest. Derealization is feared because it is believed
to lead to insanity or loss of behavioural control. Trembling is feared because the
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person believes it will lead to ridicule or rejection. People with high anxiety
sensitivity strive to avoid situations or activities that evoke these sensations. They also
tend to be hypervigilant to arousal related body sensations, and spend more time
focusing on their bodies (Schmidt et al., 1997b).
Anxiety sensitivity is an individual difference variable that remains stable over
time, at least in the absence of panic treatment (Maller & Reiss, 1992). Anxiety
sensitivity appears to contribute to the development and exacerbation of many phobias
and other anxiety reactions, but appears to play an especially important role in panic
disorder (Reiss, 1991; Taylor, 1999). The way that anxiety sensitivity exacerbates or
amplifies anxiety reactions can be seen in the following example. Consider a highly
anxiety sensitive person who has a fear of driving through tunnels. While travelling
through a tunnel, the person becomes anxious, and then becomes anxious about being
anxious. Thus, anxiety is amplified by high anxiety sensitivity, sometimes to the point
of panic.
Longitudinal studies of anxiety sensitivity and panic
A number of longitudinal studies using a measure of anxiety, called the
Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1992), have shown that anxiety
sensitivity predicts who will develop panic attacks, including the unexpected panic
attacks that characterize panic disorder (Ehlers, 1995; Harrington et al., 1996; Maller
& Reiss, 1992; Schmidt, 1999; Telch, 1997). Two of largest studies were conducted
by Schmidt and colleagues. In their first study, Schmidt et al. (1997a) administered
the ASI and other measures to over 1,400 cadets about to undergo five weeks of
military basic training in the US Air Force. A purpose of basic training is to teach
cadets to deal with demanding, unpredictable, and uncontrollable stressors. Cadets are
not given schedules and have no access to clocks or wrist watches. They are unable
predict whether their next activity will be an academic evaluation, a military exercise,
or a 5-mile run. New stressors are continually introduced to ensure that each cadet is
overtaxed.
Schmidt and colleagues assessed whether or not the cadets had panic attacks
during basic training. It was found that anxiety sensitivity (assessed prior to basic
training) predicted the occurrence of unexpected panic attacks, even after controlling
for trait anxiety and history of panic attacks. Anxiety sensitivity also predicted other
anxiety symptoms, along with functional impairment created by anxiety and
disability. Schmidt (1999) replicated these findings on another sample of over 1,000
cadets.
These findings show that anxiety sensitivity predicts vulnerability to have
panic attacks even people who have never before had a panic attack. The results show
that we can estimate a persons vulnerability to panic simply by finding out about
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could be used not to define a disorder but simply to identify factors that indicate that
the person has an increased risk for developing PTSD.
Post-trauma social support
Two types of post-trauma social support have been found to be correlated with
a reduced risk for PTSD; structural social support (defined as the size and complexity
of ones social network) and functional social support (defined as perceived emotional
sustenance and instrumental assistance) (King et al., 1998).
Although social support is a statistical predictor of reduced risk for PTSD, the
nature of the causal links remain to be elucidated. Both could simply be the produce
of pre-trauma factors; for example, people who are not prone to negative emotions
(e.g., those with low scores on Neuroticism) may have better social support, because
they are more likely to enjoy being with people, and people are likely to find them
more enjoyable, compared to people who tend to frequently experience negative
emotions such as sadness or irritability. Thus, low Neuroticism could cause both high
social support and reduced risk for PTSD.
Other links are also possible. Social support might directly reduce the risk for
PTSD because social support provides the trauma survivor with (1) resources for
emotion-focused coping (e.g., sympathetic others who may organize activities that
help reduce the persons hyperarousal symptoms), and (2) cognitive resources that
may provide corrective information (e.g., the presence of reliable, trustworthy others
may serve to counter the trauma survivors beliefs that the world is dangerous or that
people are malevolent). It is also possible that PTSD could directly erode social
support; trauma-related avoidance could extent to interpersonal avoidance,
hyperarousal symptoms (especially irritability) and numbing symptoms (especially
feelings of estrangement from others) could damage interpersonal relations.
Interactions among factors
There are likely to be direct and indirect pathways through which risk and
resiliency factors influence PTSD (King et al., 2004). This matrix of factors is
illustrated in the Figures below, which show the results of structural equation
modeling of PTSD risk and resiliency factors for combat veterans (King et al., 1998).
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T radit iona l
Com bat
.52
At rocit ies/
Abusive
Viol ence
.25
.14
St ressful Lif e
Event s
.50
.12
.30
St ruct ural
Socia l
Support
.25
-.16
PTSD
-.24
.19
.22
. 33
P er ceived
T hreat
-.28
-.32
.45
M a levolent
Environm e nt
W ar Z one St ressors
-.36
Hardiness
.24
-.47
Funct ional
Social
Sup port
Figure 5. Risk and resiliency factors for PTSD for combat-exposed female soldiers. (From
King et al., 1998).
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45
T radit io n al
Com bat
.6 7
At ro cit ies/
Abusive
Violen ce
.2 9
.09
St re ssful Life
E v en t s
.07
.6 5
-.1 3
-.22
.68
St ruct ural
So cial
Sup port
.0 8
-.07
-.1 1
PTSD
-.10
-.10
.28
.2 8
.1 8
-.2 5
P er ceiv ed
T hreat
Hardin ess
.35
.24
-.24
M al evo lent
En viro nm en t
-.3 0
W ar Zo ne St resso r s
-.42
Fun ct ional
So c ial
Supp ort
Figure 6. Risk and resiliency factors for PTSD for combat-exposed male soldiers. (From King
et al., 1998.)
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associated with PTSD, but little research has examined the mechanisms behind these
associations. Understanding why and how stressors or resiliency factors and PTSD
are linked is key to managing the disorder.
This research is in its infancy and much of the current impetus comes from the
field of behavioural genetics. This is an area of research that is concerned with how
individual differences in behaviour are caused by genetic and environmental factors
and their interaction (see Jang, 2005). We begin by exploring why any two measured
variables are related. For example, personality traits are considered to be a risk factor
for PTSD. Behavioural genetic methods test if the observed relationship is
attributable to the fact that both share a common genetic and environmental basis.
Equation 1
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of DSM-III and DSM-III-R PTSD symptoms (e.g., traumatic events are persistently
re-experienced, persistent avoidance of stimuli associated with trauma or numbing of
general responsiveness, persistent symptoms of increased arousal) to range from 32%
- 45% (True et al., 1993). Moreover, these estimates did not vary when the sample
was split into groups of twins who had served in Southeast Asia and those who had
not. This suggests that PTSD is not a disorder solely associated with military service
(e.g., combat). As such, any form of assault, natural disaster, car accident or negative
significant life event can also trigger symptoms of PTSD. This was confirmed by a
study by Stein et al. (2002) who surveyed 222 MZ and 184 DZ general population
twin pairs recruited from Canada on lifetime exposure to traumatic events and their
characteristic responses. The twins were asked to report their experiences on several
classes of traumatic events that ranged from sexual assault to car accidents to the
death of a close family member or friend. None of the twins had been in combat but
75.4% of the total sample had experienced one or more of the other events. These
twins were surveyed on DSM-IV PTSD cluster B through D symptoms and similar to
the study of combat veterans above, the heritability of symptoms was: re-experiencing
(36%), avoidance (28%), numbing (36%), and hyperarousal (29%).
Moreover, this study also found that exposure to traumatic events has a
heritable basis which tests if genes might be controlling the exposure to specific kinds
of traumatic events. This is a key point in testing a risk model. Traumatic events
were factor analyzed yielding two factors. The first described assaultive events
(robbery; held captive; beat up; sexual assault; other life threat) and the second nonassaultive events (sudden family death; motor vehicle accident; fire; and tornado,
flood, or earthquake). The heritability of assaultive trauma exposure (using data from
all subjects; that is, whether or not any trauma was experienced) was h2 = 20.3%, c2 =
21.3% and e2 = 58.4%. In contrast, a purely environmental model provided the best
explanation of liability of exposure to non-assaultive trauma: c2 = 38.6% and e2 =
61.5%. It was also found that PTSD symptoms and the experience of assaultive
trauma was inextricably linked by a common set of genetic factors; the rGs between
exposure to assaultive trauma and PTSD symptoms ranged from 0.71 - 0.83.
The significance in finding that exposure to traumatic events is under partial
genetic control is that it suggests that an event per se is heritable. However, what is
more likely to be inherited are factors that influence the persons risk for placing
oneself in, or creating, potentially hazardous situations such as genetically based
personality traits that work to select specific environments for the expression of these
genes. Thus, the genes underlying exposure to events and PTSD might be actually be
personality genes, and possessing these genes thus increase the liability to PTSD. This
mechanism has been called gene-environment correlation in which genetically
influenced factors (such as personality) influence the probability of exposure to
adverse events critical to the development of specific psychopathologies.
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In the case of PTSD, evidence for such a role for personality was confirmed in
Jang et al. (2003) who found significant genetic correlations between assaultive
trauma and the personality variables juvenile antisocial behaviour (rG = .22), selfdamaging acts (rG = .24), NEO-FFI Openness to Experience (rG = .14) and EPQ-R
Psychoticism (rG = .36) suggesting that personality traits increase the risk for
developing PTSD by placing individuals in higher-risk situations. Other examples
include Saudino et al. (1997) paper that showed that all genetic variance on
controllable, desirable, and undesirable life events in women was common to the
genetic influences underlying EPQ Neuroticism and Extraversion and NEO-FFI
Openness to Experience. The genetic basis to personality has also been shown to
influence family environment. For example, Jang et al. (2000) estimated the genetic
correlation between the Family Environment Scale (FES: Moos and Moos, 1974) and
a measure of traits delineating personality function. Relationships were found
between FES family cohesiveness and emotional liability (rG = -.45) and inhibition (rG
= -.39); FES achievement orientation of the family and antisocial behaviour (rG = .38)
and also inhibition (rG = -.58); and finally, FES intellectual-cultural orientation and
inhibition at rG = -.38. In short, the broad phenomenon of gene-environment
correlation suggests that genetically-based personality factors influence the
probability of exposure to adverse events which increases the risk for the development
of a disorder. Similar analyses, using other risk or resiliency factors, like depression
could also be conducted.
Gene-environment interactions
Another important mechanism underlying risk and resiliency is the geneenvironment interaction (GxE: Plomin, DeFries & Loehlin, 1977). This is
phenomenon by which environmental conditions moderate genetic variability. Using
the previous example, showing how environmental conditions (that may have been
shaped by personality factors by the mechanism of gene-environment correlation) do
indeed cause the onset of another disorder (e.g., PTSD symptoms).
In the behavioural genetic literature, GxE is demonstrated when individuals
who possess a specific genetic polymorphism (a particular form of a gene implicated
in a particular disorder) and have been exposed to specific environmental conditions
(e.g., subjected to high levels of parental mistreatment) develop a disorder compared
to individuals who possess just the polymorphism or have only been exposed to the
salient environmental conditions. Within heritability studies, the gene-environment
interactions are suggested when estimates of h2, c2 and e2 are shown to vary over
different levels of environmental condition. In addition to gene-environment
interaction, behaviour geneticists discuss environment-environment interaction or
experience by environment interaction. An example of experience by environmental
interaction is the finding that some people can live in the most adverse conditions
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(e.g., extreme poverty) but display no ill effects because the presence of another
environmental factor, such as a caring mother that attends to the emotional needs of a
child, cancels out the influence of poverty.
One of the most dramatic examples of gene-environment interaction is Caspi
and colleagues (2002) study of the development of antisocial behaviour. As clinical
research has identified one of the major risk factors for the development of antisocial
behaviour in boys is abuse as a child, such as erratic, coercive, and punitive parenting
and that the risk for conduct disorder increases the earlier the abuse begins. As noted
earlier, there is little 1 to 1 correspondence between environmental conditions and the
development of the disorder and the deciding factor is whether or not the child has
inherited the genetic liability for the disorder. In the case of antisocial behaviour, the
monoamine oxidase A gene (MAOA gene Xp11.23-11.4) was selected because it has
been associated with aggressive behaviour in mice and in some studies of human.
Their sample consisted of 1037 children who had been assessed at 9 different ages for
levels of maltreatment (no maltreatment, probable maltreatment and severe
maltreatment) and MAOA activity (low activity, high activity). They found that the
effect of maltreatment was significantly weaker among males with high MAOA
activity than among males with low MAOA activity. Moreover, the probable and high
maltreatment group did not differ in MAOA activity indicating that the genotype did
not influence exposure to maltreatment. These results demonstrate that the MAOA
gene modifies the influence of maltreatment.
Depression is another excellent example of a complex trait for which geneenvironment interactions are likely to be important. Eley and colleagues (2004)
reported results from a study of gene-environment interaction in adolescent
depression. The group sampled individuals with depression symptoms in the top or
bottom 15% and divided them into high or low environmental risks groups, which
were family-based. Family-based risks include parental psychopathology, social
adversity factors such as poverty or low socio-economic status (SES) and familybased stressful life events. DNA was obtained from 377 adolescents and markers
within, or close to, each of the serotonergic genes; 5HTT, HTR2A, HTR2C, MAOA,
and tryptophan hydroxylase (TPH) were genotyped. A significant genotypeenvironmental risk interaction was found for 4HTTLPR in female subjects only,
reaffirming the notion that an important source of genetic heterogeneity is exposure to
environmental risk.
These approaches are tests of genotype-environment interaction and require that
an actual loci is tested. In most cases with psychiatric disorders, few specific genes, if
any, have been reliably implicated in a disorder or are candidates in many different
disorders. Another approach for finding evidence of gene-environment interaction
uses a classic twin study methodology to test if h2 varies over levels of environmental
conditions (e.g., Dick et al, 2001). This approach was used by Jang et al (in press) to
test if the central ideas in personality disorder theory, where experiences and
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conditions in childhood, with emphasis on parental bonding, traumatic events and the
social environment of the family, moderate genetic and environmental variability
underlying emotional instability. The basic model is shown in Figure 7, below.
A1
C1
E1
1.0
A2
C2
Mod
E2
Mod
Twin 1
Twin 2
Figure 7. Moderator model. A1 and A2 represent genetic influences on twin 1 and twin 2,
respectively. C1 and C2 represent common environmental influences, and E1 and E2
represent unique environmental influences. The definition variable, represented by a
diamond, carries the value of the specified moderator (Mod) for each twin. For simplicity,
means are not represented in the diagram but are included in the model when using raw data
analysis.
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Summary
Research into risk factors for the development of traumatic stress-related
symptoms has been prevalent within the literature with many factors being identified
(e.g., individual dispositions, genetic); however, less research has been done into
factors contributing to resiliency in adults. While one may assume that resiliency
factors may just be the opposite of the identified risk factors for the development of
PTSD, it is clear in the developmental literature resiliency is much more complex than
that. Future studies into the identification of resilient traits in adults and their
mechanisms are clearly needed in order to understand this complex construct.
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problems in social functioning 2 and 3 years after battle were all found to be
associated with (1) attribution of good events to more external and uncontrollable
causes, and (2) attribution of bad events to more internal, stable, and controllable
causes. These results suggest that the use of adaptive attribution styles protects mental
health while the use of maladaptive attribution styles decreases posttraumatic growth.
In a further investigation of posttraumatic growth and attributions following
traumatic events, Elder and Clipp (1989) conducted a longitudinal study of veterans
from both WWII and the Korean conflict. The results suggested that exposure to
combat stress could result in either pathogenic or positive developmental effects. A
number of positive and negative outcomes of military experience were identified. The
positive outcomes included learned to cope with adversity, self-discipline, and a
broader perspective, which were endorsed by approximately 60 to 70% of the
respondents. Negative effects included separation from loved ones, combat
anxiety, and loss of friends. The undesirable experiences generally referred to
losses and negative affective states, whereas positive experiences were more likely to
refer to skills or resource acquisition (Elder & Clipp, 1989). Furthermore, men who
had been in heavy combat were most likely to list coping, self-discipline, and valuing
life as positive outcomes (Elder & Clipp, 1989). At mid-life, exposure to heavy
combat experience increased the likelihood of ego-resilient behaviours and diminished
a sense of helplessness. The least resilient men (identified in a prewar assessment)
were more likely to have experienced both emotional and behavioural problems after
the war compared to those who scored high on pre-combat resiliency (83% vs. 17%).
This archival study, however, was limited by having a relatively small sample and the
unavailability of standardized measures of combat exposure and PTSD.
In another study, Bartone et al. (1989) followed a sample of family assistance
workers who had been involved in the Gander disaster in 1985. This particular study
aimed to identify the major stressors for disaster family assistance workers, to
examine the relationship between degree of exposure to these stressors and health, and
to locate risk factors, or resistance resources, that might modulate any ill effects of
exposure. Results indicated that survivor assistance workers are at risk for increased
illness, psychiatric symptoms, and negative psychological well-being for up to a year
after commencing their support activities. Further, social supports and hardiness (or
dispositional resiliency) interacted to modulate the effects of exposure on illness. The
supports of family, friends, and work supervisors were an important resource for
many assistance workers, particularly at high exposure or stress levels (Bartone, et al.,
1989). Having these kinds of supports appeared to protect individuals from related
psychological and physical morbidity. The authors speculated that individuals high in
hardiness may adjust more readily to chaos and confusion of disaster situations. These
individual might also be more apt to perceive challenges and opportunities for growth
where others perceive threat and disruption. Disaster helpers with a characteristic
hardy worldview may be more likely to regard their assistance activities as highly
meaningful and be more committed to this role. Additionally, they are perhaps better
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equipped to accept, and make sense of, ambiguously defined roles, drawing upon a
personal sense of control to formulate their own definitions and decisions about their
position and responsibilities. Thus, over time, hardy individuals may make optimistic
retrospective appraisals of traumatic experiences (Bartone, et al., 1989).
In 1990, Casella and Motta reported characteristic differences between
Vietnam veterans with and without PTSD. In their study they reported that veterans
without PTSD tended to have lower Neuroticism scores on the Eysenck Personality
Questionnaire (Eysenck & Eysenck, 1975), despite having high combat exposure
indicating emotional strength and resiliency. In addition, veterans without PTSD
tended to score higher on a measure of internal locus of control. These veterans may
have felt they had more control over their destiny, which may have helped them cope
more effectively with their experiences of combat. Further, those veterans without
PTSD tended to provide a cognitive structure to their experience during their time in
Vietnam (e.g., ways of organizing, conceptualizing, and understanding the
experience), similar to the findings of Hendin and Haas (1984). Finally, an interesting
trend emerged where locus of control orientation was positively correlated with ability
to structure the Vietnam experience. This suggests that those veterans who had greater
internal locus of control were motivated toward conceptualizing the Vietnam
experience in meaningful, organized terms.
Taking a step further in investigating the relationship between attributions and
combat exposure, Aldwin et al. (1994) examined whether appraisals of desirable and
undesirable effects of military service mediated the effect of combat stress on
posttraumatic stress disorder (PTSD) symptoms in later life in male veterans. The
researchers sought to link the developmental model of Elder and Clipp (1989) using
measures more commonly used in PTSD research. Furthermore, the authors extended
Elder and Clipp's model by examining appraisals as mediators of the relationship
between combat exposure in early life and PTSD symptoms in late life. In general, the
findings of Aldwin et al.s (1994) study indicated more desirable effects of military
service (e.g., mastery, self-esteem, and coping skills) were reported than undesirable
ones; both increased with greater combat exposure. Path analysis revealed that the
appraisals were independent and opposite mediators, with undesirable effects
increasing and desirable effects decreasing the relationship between combat exposure
and PTSD, even after controlling for depression and response style. Although lifelong
negative consequences of combat exposure were observed, perceiving positive
benefits from the stressful experience mitigated the effect. Perhaps the most
interesting finding in this study was the degree to which the men viewed their military
experience, and even their combat experience, as causing desirable consequences. The
men viewed this period in their lives as having maturational effects, broadening their
perspective, enhancing coping skills and self-esteem, and increasing both selfdiscipline and independence. The authors expected to see an inverted-u relationship
between desirable appraisals and combat stress, with those experiencing moderate
combat exposure highest, similar to the diathesis stress model. There were, however,
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only linear effects: the higher the combat exposure, the more the men reported
positive developmental outcomes (Aldwin et al., 1994).
Sutker et al. (1995) used a discriminant function model to study associations
between personal and environmental resources and psychological outcomes
subsequent to war zone stress among Persian Gulf War veterans. Personality
hardiness, commitment, avoidance coping, and perceived family cohesion emerged as
consistent predictors of a PTSD diagnosis. Findings suggest personal characteristics
and environmental factors may alter vulnerability to negative war stress outcomes.
Among the factors of interest in this study, personal resource variables appeared to be
more strongly related to psychological vulnerability or resistance to the negative
impact of war zone duty than were the resources selected from the environment
domain. Personal resources accounted for 35% of the variance in discriminating troop
subsets, whereas the remaining variables accounted for 5%. Although the commitment
disposition of the hardiness construct appeared to function as a relatively strong
resistance resource, there is the possibility that lower scores on hardiness measures
simply confirm the presence of PTSD as a disorder (Sutker et al., 1995).
The results of this study underscore the conclusions of Kobasa et al. (1982)
and Bartone et al. (1989) that inclination to involve oneself in, and to experience,
purposefulness in activities may protect against the negative effect of stressful events
(Sutker at al., 1995). Although the hardiness constructs of control and challenge
differentiated troop subsets, these dimensions did not contribute meaningfully to the
discriminant function over and above the commitment measure. Results also revealed
a significant association between PTSD symptoms and avoidance coping strategies.
This relationship, as was acknowledged for hardiness results, does not convey
information about the direction of the causal pathway. Use of certain coping strategies
may convey risk for psychological distress under stressful circumstances, or
conversely, increased coping behaviours, and avoidance coping specifically, may be
an expression of PTSD (Sutker at al., 1995).
Neria et al. (1998) conducted an eighteen-year follow-up of Israeli POWs and
combat veterans. Specifically, the effects of social support of subsequent PTSD
symptoms and other psychopathology were investigated. POWs had more PTSD
symptoms than the control group (combat veterans), but those that experienced active
support at homecoming had fewer PTSD symptoms. Those who received social
support at homecoming also reported fewer avoidance symptoms. Negative reactions
at homecoming were associated with higher reports of psychiatric symptoms on the
Symptom Checklist-90. The results of this study highlight the importance of social
support in the conceptualization of resiliency, especially when considering military
populations. Neria et al. (1998) suggest that a warm reception at homecoming may
serve as a corrective emotional experience that bolsters the victims sense of safety,
personhood, and sense of belonging.
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social support, past distress (1965 CMI), and interactions of resiliency and social
support with war trauma all revealed, with some variation, that, in decreasing order of
importance, war trauma and resiliency best predicted current PTSD symptomatology.
Waysman et al. (2001) further investigated two models positing direct versus
moderating effects of hardiness in relation to long-term positive and negative changes
following exposure to traumatic stress. Participants included Israeli POWs and a
matched group of veterans of the 1973 Yom Kippur War. Findings were consistent
with a model that posits moderating effects of hardiness on both long-term negative
and positive changes. Hardiness was found to be associated with lower vulnerability
to negative changes among POWs and, as such, the authors suggested it be conceived
as a protective factor (Rutter, 1987) that mitigates the detrimental effects of extreme
stress. Hardiness was also found to be associated with higher levels of positive change
among POWs, and was subsequently seen as a resource that promotes the ability to
experience psychological growth following traumatic events.
Continuing this line of study, Waysman et al. (2001) investigated whether
these effects are unique to victims of trauma or reflect a more general phenomenon.
Findings indicated (a) direct effects of hardiness on both positive and negative
changes, and (b) a stress moderating effect for hardiness in relation to both positive
and negative changes. This pattern of results supports the second model, which
predicted both direct and moderating effects. This study provided a relatively rare
opportunity to examine the role of hardiness in relation to psychological adjustment
following exposure to traumatic stress. Hardiness was found to function as a
protective factor in relation to negative outcomes and, to a lesser degree, as a boosting
factor in relation to positive outcomes. Moreover, hardiness was found to be not only
of general significance for most people, irrespective of stressful experiences (a direct
effect), but also of particular significance for those exposed to traumatic stressors (a
moderating effect).
Zakin et al. (2003) further assessed the role of hardiness and attachment style,
as personal resources in adjustment to stress of POWs and combat veterans. The
sample consisted of POWs from the 1973 Yom Kippur war as well as comparable
controls who fought in the same war. The study took place almost two decades after
the war. Results indicated that both hardiness and attachment style had a direct main
effect and were inversely related to PTSD and psychiatric symptomatology. Results
also demonstrated that the two resources worked in a mutually compensatory manner.
The results are that, among both combat veterans and ex-POWs, greater hardiness and
secure attachment style were separately associated with reduced vulnerability to
PTSD. These variables are also associated with reduced vulnerability to the associated
symptoms of depression, anxiety and somatization. The findings also indicate a strong
interaction between hardiness and attachment style on the various distress measures
(Zakin et al., 2003). This interaction indicates that, in addition to the direct impact,
hardiness and attachment style may act in a compensatory manner, such that an
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abundance of one may compensate for a paucity of the other; therefore, the attachment
resources of subjects with low levels of hardiness were more effective, while the
hardiness of insecure subjects provided them with more protection.
Other notable findings in this study, included that the moderation effect of
hardiness or attachment with group was not significant (the interaction between each
of these variables and the research group was not significant) (Zaklin et al., 2003).
This finding is of particular importance in light of the debate in the literature
regarding whether or not hardiness in fact buffers stress or only contributes to well
being in a general way (e.g. Blaney & Ganellen 1990). The lack of moderating effects
in this study may be attributed to the fact that both combat and war captivity are
extreme traumatic stressors. The initial assumption was that since war captivity is
more stressful than combat alone, any moderating effect would show up in the
comparison. It seems, however, that in both situations, the extreme stress experienced
by the subjects may have led them to use all their personal resources in full, thereby
obscuring any possible moderating effects of hardiness and attachment. Such effects
may have emerged if the magnitude of the two stress situations were sufficiently
different.
Summary
The empirical research outlined in this section provide insight into resiliency
in military populations. These studies have identified factors that seem to be related to
resiliency (e.g., emotional control, internal locus of control, calmness under pressure,
social support). A number of studies also indicate that these protective factors also
serve their purpose even in high stress/high combat settings (Aldwin et al., 1994;
Bartone, 1999). While the research to date has added a great deal to our understanding
of resiliency in military populations, there is still a great deal of work to be done.
Future studies could examine the validity of theories of resiliency in military
populations, especially given the specialized training and circumstances military
personnel experience. In addition, further case studies of resilient military personnel
could add to our knowledge of mechanisms that lead to resiliency and thus add more
depth to models and theories of resiliency. Indeed, further research into resiliency in
military populations may contribute to the further validation of resiliency measures as
well as provide insight into the differences between military versus non-military
populations.
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References:
King, L. A., King, D. W., Vogt, D. S., Knight, J., & Samper, R. E. (in press).
Deployment risk and resilience inventory. Military Psychology, 00, 000-000.
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Strongly
Disagree
1
2
Strongly
Agree
6
7
66
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Strongly
Disagree
1
2
Strongly
Agree
6
7
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67
68
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strongly agree
agree
1
5
6
7
8
9
10
11
neither
agree disagree strongly
nor
disagree
disagree
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69
12
13
14
15
16
A Measure of Resiliency
Authors: Jew, Green, & Kroger
Variable: Resilience
Description: This measure was developed based on the skills and abilities thought by
Mrazek and Mrazek (1987) to constitute factors rendering children resistant to
psychological harm. These 12 factors include: rapid responsivity to danger,
70
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71
Reliability & Validity: The internal consistency of the RSA was high and all the
subscales were positively related to other measures of personal resources. The RSA
was also able to significantly differentiate between a patient sample and a control
sample.
Location: Friborg, O., Hjemdal, O., Rosenvinge, J. H., & Martinussen, M. (2003). A
new rating scale for adult resilience: what are the central protective resources behind
healthy adjustment? International Journal of Methods in Psychiatric Research, 12,
65-76. A copy of the measure is included in this article.
References:
Hjemdal, O., Friborg, O., Martinussen, M., & Rosenvinge, J. H. (2001) Preliminary
results from the development and validation of a Norwegian scale for
measuring adult resilience/Mestring og psykologisk motstandsdyktighet hos
voksne: Utvikling og forelopig validering av et nytt instrument. Tidsskrift for
Norsk Psykologforening, 38, 310-317
Measure:
Personal
strength/Perception of self
When something unforeseen happens
My personal problems
My abilities
My judgments and decisions
I difficult periods I have a tendency to
72
are unsolvable
I strongly believe in
I often doubt
view everything
gloomily
I manage to come to
terms with
are a constant
source of
worry/concern
Difficult to accomplish
I know how to
accomplish
very promising
possible to
accomplish
I am unsure how to
accomplish
uncertain
I often feel
bewildered
I know how to
solve
I am uncertain
about
I trust completely
find something
good that helps me
thrive
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Social Competence
I enjoy being
unclear
by myself
I make easily
difficult for me
I easily laugh
is really important
to me
I have difficulty
making
something I am
good at
I seldom laugh
difficult
easy
healthy coherence
views the future as
gloomy
loyal towards one
another
do things together
no one
some close
friends/family members
weak
I am informed right
away
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friends/family
members
nowhere
strong
It takes a while
before I am told
73
friends/family members
no one who can help
me
appreciate my qualities
no one
always some one
who can help me
dislike my qualities
74
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75
Validity: The PSS was also a good predictor of health and health-related outcomes,
social anxiety, and was highly correlated with depression, although it was found to
measure a different and independently predictive construct.
Location: Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of
perceived stress. Journal of Health and Social Behaviour, 24, 386-396. A copy of the
measure is included in the article.
Measure:
The questions in this scale ask you about your feelings and thoughts during the last
month. In each case, you will be asked to indicate how often you felt or thought in a
certain way. Although some of the questions are similar, there are differences between
them and you should treat each one as a separate question. The best approach is to
answer each question fairly quickly that is dont try to count up the number of times
you felt a particular way, but rather indicate the alternative that seems like a
reasonable estimate.
For each question choose from the following alternatives:
0.
1.
2.
3.
4.
never
almost never
sometimes
fairly often
very often
1. In the last month, how often have you been upset because of something that
happened unexpectedly? ____
2. In the last month, how often have felt that you were unable to control the
important things in your life? ____
3. In the last month, how often have you felt nervous and stressed? ____
4. In the last month, how often have you dealt successfully with irritating life
hassles? ____*
5. In the last month, how often have you felt confident that you were effectively
coping with important changes that were occurring in your life? ____*
6. In the last month, how often have you felt confident about your ability to handle
your personal problems? ____*
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7. In the last month, how often have you felt that things were going your way?
____*
8. In the last month, how often have you found that you could not cope with all the
things that you had to do? ____
9. In the last month, how often have you been able to control irritations in your life?
____*
10. In the last month, how often have you felt that you were on top of things? ____*
11. In the last month, how often have you been angered because of things that
happened that were outside of your control? ____
12. In the last month, how often have you found yourself thinking about things that
you have to accomplish? ____
13. In the last month, how often have you been able to control the way you spend your
time? ___*
14. In the last month, how often have you felt difficulties were piling up so high that
you could not overcome them? ____
* Scored in the reverse direction
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Reliability: Internal reliability was higher for desirable than undesirable effects (as =
.91 and .62, respectively).
Location: Elder, G., & Clipp, E. (1989). Combat experience and emotional health:
Impairment and resilience in later life. Journal of Personality, 57, 311-341. Email: Dr.
Elder, [email protected]
Comment: The measure of resilience in this paper is based upon items in a 100-item
California Q Sort. Each item ranges from l to 9. Judges read the full set of information
on the person and then sort the items into one of the category, from very characteristic
to not characteristic. This measurement procedure thus comes at a high cost for those
who want to use the measure. Judges need to be trained to apply the Q sort to all
members of the study.
References:
Aldwin, C., Levenson, M., & Spiro, A. (1994). Vulnerability and resilience to combat
exposure: Can stress have lifelong effects? Psychology and Aging, 9, 34-44.
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of students about 2 months later, and the test-retest reliability of the full scale was
0.71. A recent study has since exemplified the PTGI to have similarly high reliability
(.93; Shakespeare-Finch et al., 2003).
Validity: The PTGI was positively correlated with certain specific domains of the
NEO Personality Inventory (Costa & McCrae, 1985). The strongest correlations were
with the Extraversion facets of activity and Positive Emotion, and the Openness facet
of Feelings.
Location: Tedeschi, R. G. & Calhoun, L. G. (1996). The Posttraumatic growth
inventory: Measuring the positive legacy of trauma: Journal of Traumatic Stress, 9,
455-472. Email: Dr. Tedeschi, [email protected]
References:
Park, C., Cohen, L. H., & Murch, R. (1996). Assessment and prediction of stressrelated growth. Journal of Personality, 64, 71-105.
Shakespeare-Finch, J.E., Smith, S.G., Gow, K.M., Embleton, G., & Baird, L. (2003).
The prevalence of posttraumatic growth in emergency ambulance personnel.
Traumatology, 9, 5870.
Measure:
Indicate for each of the statements below the degree to which this change occurred in
your life as a result of your crisis [or researcher inserts specific descriptor here],
using the following scale.
0= I did not experience this change as a result of my crisis.
1= I experienced this change to a very small degree as a result of my crisis.
2= I experienced this change to a small degree as a result of my crisis.
3= I experienced this change to a moderate degree as a result of my crisis.
4= I experienced this change to a great degree as a result of my crisis.
5= I experienced this change to a very great degree as a result of my crisis.
1. I changed my priorities about what is important in life. (V)
2. I have a greater appreciation for the value of my own life. (V)
3. I developed new interests. (II)
4. I have a greater feeling of self-reliance. (III)
5. I have a better understanding of spiritual matters. (IV)
6. I more clearly see that I can count on people in times of trouble. (I)
7. I established a new path for my life. (II)
8. I have a greater sense of closeness with others. (I)
9. I am more willing to express my emotions. (I)
10. I know better that I can handle difficulties. (III)
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Validity: The negative changes scale was positively correlated with other measures of
psychiatric morbidity, however, there was also a trend for the positive changes scale
to also be positively correlated with responses to the Impact of Events Scale (IES:
Horowitz et al., 1979). This trend warrants further investigation.
Location: Joseph, S., Williams, R., & Yule, W. (1993). Changes in outlook following
disaster: The preliminary development of a measure to assess positive and negative
responses. Journal of Traumatic Stress, 6, 271-279. Email: Dr. Stephen Joseph,
[email protected]
References:
Horowitz, M., Wilner, N., & Alvarez, W. (1979). The impact of events scale: a
measure of subjective distress. Psychosomatic Medicine, 41, 209-218.
Measure:
Each of the following statements was made people who experienced stressful and
traumatic events in their lives. Please read each one and indicate, by circling the
number in the appropriate box, how much you agree or disagree with it AT THE
PRESENT TIME:
1 = Strongly disagree, 2 = Disagree, 3 = Disagree a little, 4 = Agree a little, 5 = Agree,
6 = Strongly agree.
Strongly
Disagree
Disagree
Disagree
a little
Agree
a little
Agree
Strongly
Agree
1.
2.
3.
4.
5.
6.
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81
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
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21.
22.
23.
24.
I am more determined to
succeed in life now.
25.
26.
Short Form:
Each of the following statements was made people who experienced stressful and
traumatic events in their lives. Please read each one and indicate, by circling the
number in the appropriate box, how much you agree or disagree with it AT THE
PRESENT TIME:
1 = Strongly disagree, 2 = Disagree, 3 = Disagree a little, 4 = Agree a little, 5 = Agree,
6 = Strongly agree.
Strongly
Disagree
Disagree
Disagree
a little
Agree a
little
Agree
Strongly
Agree
4. I value my relationships
much more now.
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83
5. Im a more understanding
and tolerant person now.
84
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Reliability: Cronbachs alpha for the SRGS was .94 in Park et al.s sample of college
students. The SRGS was re-administered to a subsample of these students about 2
weeks later, and the test-retest reliability was .81.
Validity: Park et al. sampled college students close friends and family members and
requested their assessment of the stress-related growth experienced by the students for
a particular event. They found a significant positive relationship between students
own SRGS scores and those provided by their informants (r =.31 (p < .05). The
student-informant correlation was virtually identical when informants were friends
versus parents. SRGS scores were positively related to residual change in optimism,
positive affectivity, the number of socially supportive others, and satisfaction with
social support; these findings support the validity of the SRGS.
Location: Park, C. L., Cohen, L.H., & Murch, R. L. (1996). Assessment and
prediction of stress-related growth. Journal of Personality, 64, 71-105. Email: Dr.
Cohen, [email protected]
References:
Cohen, L. H., Cimbolic, K., Armeli, S. R., & Hettler, T. R. (1998). Quantitative
assessment of thriving. Journal of Social Issues, 54, 323-334.
Measure:
(A = 0 points, B = 1, C = 2; then add up points for total score)
Instructions: Rate how much you experienced each item below as a result of this past
year's most stressful event. For each item, put an A,B, or C in the blank next to the
statement.
A = Not at all B = somewhat C = a great deal
1. I developed new relationships with supportive others.
2. I gainaed new knowledge about the world
3. I learned that I was stronger than I thought I was.
4. I became more accepting of others.
5. I realized I have a lot to offer other people.
6. I learned to respect others' feelings and beliefs.
7. I learned to be nicer to others.*
8. I rethought how I want to live my life.
9. I learned that I want to accomplish more in life.
10. My life now has more meaning and satisfaction.
11. I learned to look at things in a more positive way.
12. I learned better ways to express my feelings.
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Measures of Hardiness
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87
Location: King, L. A., King, D. W., Fairbank, J. A., Keane, T. M., & Adams, G. A.
(1998). Resilience-recovery factors in post-traumatic stress disorder among female
and male veterans: hardiness, postwar social support, and additional stressful events.
Journal of Personality and Social Psychology, 74, 420-434. Email: Drs. Dan and
Lynda King, [email protected]
References:
King, D. W., King, L. A., Foy, D. W., Keane, T. M., & Fairbank, J. A. (1999).
Posttraumatic stress disorder in a national sample of female and male Vietnam
veterans; risk factors, war-zone stressors, and resilience-recovery variables.
Journal of Abnormal Psychology, 108, 164-170.
88
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Comment: This measure was derived from Kobasas (1979) original description of
hardiness, other measures were published by Maddi and Kobasa but were eventually
modified into the current PVS.
References:
Maddi, S. R. (1987). On the problem of accepting facticity and pursuing possibility. In
S. B. Messer, L. A. Sass, & R. L. Woolfolk (Eds.), Hermeneutics and
psychological theory: Interpretive perspectives on personality, psychotherapy
and psychopathology. New Brunswick, NJ: Rutgers University Press.
Bartone, P. T. (1989). Predictors of stress-related illness in city bus drivers. Journal of
Occupational Medicine, 31, 857-863.
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90
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98
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(unless the document itself is unclassified) represented as (S), (C), (R), or (U). It is not necessary to include here abstracts in both official languages unless the text is
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(U) This report provides a detailed literature of the current state of knowledge on resiliency
and its application to military personnel workers. In this report we summarize (1) the
current, accepted definitions of resiliency, (2) factors contributing to resiliency, (3) theories
of resiliency, (4) empirical research findings on resiliency in protecting individuals from
adverse outcomes associated with acute or chronic stress, (5) empirical research findings
on resiliency in military personnel and other highrisk occupations, and (6) resiliency
measures and describe their development and validation. Existing definitions implicate
resiliency with the ability to adapt and successfully cope with adversity, life stressors, and
traumatic events. However, findings from this review demonstrate the lack of a uniform or
accepted definition of resiliency. Research to date has resulted in the identification of
several individual traits and environmental situations contributing factors to resiliency, and
this has led to recent efforts to develop and validate emerging interactive resiliency factor
models. The theoretical bases of resiliency remains controversial and many existing
theories have received modest empirical investigation. Furthermore, the methodologies
used in many of these conceptuallybased studies are poor and results are limited in their
generalizability. Empirical research on protective factors remains limited, and their
interrelationships to risk factors and exposure factors remains unclear. Relatively few
studies have investigated resiliency in military populations. These studies have primarily
investigated protective factors among resilient individuals who have experienced combat
exposure (e.g., prisoners of war). Yet, much more is to be learned about resiliency across
the range of military personnel experiences (e.g., peace keepers). Lastly, our review
identified numerous measures of resiliency, and of related constructs, however, many lack
sufficient validation. To further advance our knowledge of resiliency, future research will
need to use more sophisticated methodologies and measurement strategies, which can be
validated across a range of populations. Such research efforts have the potential to
develop and evaluate resiliency based interventions, and aid in social policy applications
within military and nonmilitary populations.
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Engineering and Scientific Terms (TEST) and that thesaurus identified. If it is not possible to select indexing terms which are Unclassified, the classification of each
should be indicated as with the title.)
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