Resilience in the Face of Trauma by Barry Borham

Synopsis

In this paper I focus on resilience in the face of trauma. Firstly, I look at factors that foster resilience in individuals, taking into account the work of Worsley and others in developing the Resilience Doughnut. I also explore resilience factors within families and then communities - exploring along the way what are the common factors for resilience in individuals, couples and communities. I also explore how resilience can be fostered in cross cultural communities and look at one of the programs being put in place to make communities more resilient in the face of natural and man made trauma.

 Table of Contents

1          Introduction

2          What is trauma and what is resilience in the face of trauma?

3          Factors that foster resilience in the individual and the family

3.1   Optimistic Thinking – Our view of ourselves, others & situations

3.2   A healthy lifestyle

3.3   Our place in Relationship: attachment as a facilitator of resilience for individuals and families

3.4   What you have, what you are & what you can do: The Resilience Doughnut

4          Resilience and Community

5          Conclusion:

6          References

 

1        Introduction

A significant body of research has been carried out in the area of resilience in the face of trauma. This research has identified a number of factors that can facilitate resilience in individuals, families and communities. Fundamentally, these factors are strength based and look at enhancing an individuals, families or communities strengths rather than identifying and cataloguing deficits and attempting to rectify them.

A number of the factors that facilitate resilience are similar regardless of whether you are looking at individuals or groups of people and focus around positive thinking, connectedness, relationship, resources, skills & education. Importantly, for organisations working with communities in the developing world, these factors appear to apply in cross cultural settings pointing the way to reducing the impact of trauma in those communities.

2        What is trauma and what is resilience in the face of trauma?

In looking at the question of resilience in the face of trauma it prompts the exploration of what we mean by both resilience and trauma. In keeping with the definition of Briere and Scott, who build on the definition provided in the DSM-IV-TR, a traumatic event is seen to be one where there is “actual or threatened death or serious injury, or other threat to one’s” own or another’s psychical integrity or psychological integrity. (Briere & Scott, 2006, p.3-4). Trauma can be human in origin e.g. rape, assault, war, or natural, e.g. flood, fire, earthquake or accidental e.g. a plane, car or train accident. These events can impact on individuals, families or entire communities without regard to culture or economic well being even though it is often the poorest that suffer the most.

As for resilience Sandler et al state that “bereaved children who achieve high levels of competence and low levels of problems are considered to be resilient” (Sandler , Wolchik, Ayers, Tein, Coxe & Chow, 2008, p. 532). Likewise Masten describes resilience as people “succeeding in spite of serious challenges to development” (Masten, 1997, para 1). She went on to emphasise that “resilience does not mean ‘invulnerable’ or ‘unscathed!’” (Masten, 1997, para 4).

Resilience in this paper is understood to be:

the behavioral patterns, functional competence, and cultural capacities that individuals, families, and communities use under adverse circumstances and the ability to make adversity into a catalyst for growth and development (Hooyman & Kramer, 2006, p. 66).

Dr Michael Ungar, Principal Investigator with the Resilience Research Centre has a definition which emphasises the relational aspects of resilience by stating that "resilience is both an individual’s capacity to navigate to health resources and a condition of the individual’s family, community and culture to provide those resources in culturally meaningful ways" (Ungar, 2009, para. 3). The relational nature of resilience is also emphasised by Plants & Walsh who state that “resilience is produced by the interactions among a child, family, peers and community” (Plants & Walsh cited in Worsley, 2006, p.13).

In the face of various trauma events it is apparent that there is variability in how resilient individuals or communities are and people will vary in their resilience in the face of the same trauma event. (Geldard & Geldard, 2002) In fact most people faced with a traumatic event do not go onto develop trauma symptoms demonstrating that resilience in the face of trauma is largely an inherent aspect of our humanity (The Australian Centre for Posttraumatic Mental Health, 2007).

Likewise, various trauma events have the ability to affect us at a deeper level than other trauma events. In responding to the death of a child studies have shown that parents of children who have died as a result of homicide have higher levels of PTSD and lower levels of marital satisfaction, “and the least acceptance of deaths” compared to those who had lost children as a result of accident and suicide (Murphy, 2008, p.380).  In fact, “parents whose children died by suicide, compared with” parents of children who died from homicide or accident, displayed “the lowest mean scores on mental distress and PTSD and the highest mean scores on acceptance of death and marital satisfaction”(Murphy, 2008, p.380).  

3        Factors that foster resilience in the individual and the family

 Given that resilience is variable across individuals and groups of people what are the factors that are key to having and building resilience? The factors are varied but it is worth noting that there are several key factors that, like attachment theory, revolve around how we think about and perceive ourselves and how we think about others.

3.1      Optimistic Thinking – Our view of ourselves, others & situations

Optimistic thinking has been shown to be a key factor in promoting resilience. The way a person thinks directly impacts on “many critical abilities associated with resilience including:

·         “Emotional regulation

·         Impulse control

·         Causal analysis

·         Empathy

·         Maintaining realistic optimism

·         Self-efficacy, and

·         Reaching out to others and taking opportunities” (Worsley, 2006, p.5 ).

 The optimist will see bad events as transitory, they see the events as being caused by issues that have solutions and that they are not responsible for what has happened to them. In contrast the pessimist will see themselves as somehow being responsible for the traumatic event, that every thing is bad and that the situation is unlikely to get better (Worsley, 2006; Bonanno, Boerner & Wortman, 2008; Archer & Fisher, 2008). As pointed out by Worsley this research is important because it indicates that key skills that enhance resilience can be taught and learned (2006).

 The way we think has a powerful impact on how we perceive events and how we feel and behave in response to those perceptions. Ellis and Newman maintain that pessimistic thinking as opposed to optimistic thinking styles about your life and future  can lead us to “magnify our problems and minimize our assets” limiting our ability to bounce back following a traumatic event. (1996, p.31)

 However, there are also external factors that impact on a person’s resilience in the face of trauma. Egan cites Holaday and McPhearson who suggest that “social support, cognitive skills, and psychological resources”(2002, p.359) are the prime factors in promoting resilience. Social support is seen to “include the overall values of a society towards … people in trouble” (2002, p.359) Cognitive skills & intelligence contribute to resilience as does a coping style which emphasizes use of positive thinking styles, belligerence vs. passivity, avoiding self-blame, exercising personal control and the ability to interpret experiences in a way that promotes coping rather than ceding of control and outcomes to chance. (2002, p.359). Psychological resources are the personality characteristics, such as “internal locus of control, empathy, curiosity, a tendency to seek novel experiences” 2002, p.359) as well as a sense of humor.

3.2       A healthy lifestyle

While the data is purely descriptive it is apparent that a healthy lifestyle is also a factor that is conducive to resilience. Healthy protective behaviors in this regard were taken to include “exercise, eating a healthy diet, not smoking, and moderate alcohol use.” Mothers and fathers studied post one of  their children’s death ,who were in poor health, were 3 times more likely to report trauma symptoms while unhealthy fathers were “5 times more likely to report trauma symptoms” (Murphy, 2008, p.381).  

3.3      Our place in Relationship: attachment as a facilitator of resilience for individuals and families

As mentioned earlier, the factors that foster secure attachment also foster resilience. Parkes found while investigating attachment styles in bereavement that “adults who reported having secure attachments to their parents during childhood showed less grief and distress than did those who clung to and demonstrated separation distress with parental figures during childhood”(cited in Hooyman & Kramer, 2006, p. 27).

 When the expected attachment is forthcoming “individuals are better able to reach out to and provide support for others and deal positively” with the stress of trauma. (Johnson, 2003, p. 4). For Levin, secure attachments with significant adults fosters “psychological resilience in children enabling them to develop into emotionally healthy adults.”(Levin, 2000).

 Attachments then, can be working for you or against you, regardless of whether you are an adult or child facing a traumatic event. If the members of the family are securely attached then they are more likely be resilient in the face of traumatic events. However, if the members of the family are insecurely attached, then those very insecurities of attachment may predispose those family members to being less resilient to those same traumatic events. (Kobak. & Mandelbaum, 2003) Belsky, among others, cite studies showing that the nature of attachment early in a child’s life will be an indicator of how that person will react later in life in regard to grief, stress and trauma. (Belsky, 2006; Segal & Jaffe, 2007)

 It is apparent then that attachment and relationship building capabilities in individuals have a lot to do with a family unit’s ability to cope with trauma. A lot of work has been done looking at problems that exist within families presenting for treatment, however, Dallos & Draper point out that very little work has been done looking at resilience in families that do not present with problems following exposure to similar adverse events. (Dallos& Draper, 2007)

 Dallos & Draper sought to overcome this shortfall by studying two groups, one group with a history of mental health issues and another where there was no know clinical history. While both groups had similar histories in terms of the types of early difficulties experienced the “the clinical group’s accounts indicated few resources such as emotional spare capacity in the family and practical support available. Also the clinical group showed less ability to contemplate alternative narratives (negative as well as positive) about how events may have proceeded along different paths” (Dallos& Draper, 2007, p.225). As well as highlighting the fact that a degree of resilience is inherent in individuals and families this research points back to the importance of positive thinking as an important factor in facilitating the resilience. It also emphasises attachment between individuals and the positive regard people have for each other as other key determinants of individual and group resilience in the face of trauma.

 

3.4       What you have, what you are & what you can do: The Resilience Doughnut

 From the above it is apparent that how we think and see our selves and others is important to resilience. Also important is a healthy lifestyle.  Worsley has refined this further and, building on the work of many others including the International Resilience Project, developed the Resilience Doughnut (see Fig.1) which is used as a tool to understand and enhance resilience. In her model resilience is seen as fundamentally strengths based concept in that it seeks to enhance strengths rather than overcome weaknesses (Worsley, 2006; Hooyman & Kramer, 2006). The International Resilience Project identified thirty six factors “that contributed to building an optimistic mindset” split into three categories of what a person has, what they are and what they can do (Worsley, 2006, p.11).

 While keeping the three categories Worsley refined the 36 factors down to seven strength factors being:

·         “The parent factor: characteristics of strong and effective parenting.

·         The skill factor: evidence of self-efficacy.

·         The family factor: where family identity and connectedness is evident.

·         The education factor: experience of connections and relationships during the learning process.

·         The peer group factor: where social and moral development is enhanced through interactions with peers.

·         The community factor: where the morals and values of the local community are transferred and the young person is supported.

·         The money factor: where the young person develops the ability to give as well as take from society through employment and purposeful spending” (Worsley,2007, p.9)

Worsley maintains that by enhancing three of these strength factors you can enhance the overall resilience of the individual. (Worsley, 2006, p. 109)

4        Resilience and Community

Developing these themes and factors as facilitators of resilience there have been a number of projects undertaken by international organisations seeking to engender resilience in communities in the developing world. These groups have also sought to identify the factors that promote resilience and put them into a codified methodology so that communities might enhance their own resilience. As with resilience in individuals it is apparent that these methodologies work best when they focus on enhancing strengths rather than trying to mitigate weaknesses.

 A coalition of groups, including the International Red Cross and Red Crescent organisations, have banded together to form the Disaster Risk Reduction Interagency Coordination Group (DRRICG) and to develop the “Characteristics of a Disaster-resilient Community A Guidance Note.” This document is currently undergoing field testing in a number of communities both in Africa and the Indian sub-continent.

 The aim has been to develop an approach whereby community resilience can be enhanced “through resistance or adaptation capacity to manage, or maintain certain basic functions and structures, during disastrous events and a capacity to recover or ‘bounce back’ after an event” (Twigg, 2007, p.6).

 Page 6 of the Guidance Note states that the focus is on emphasising how community capacities can be strengthened to resist or overcome trauma rather than “concentrating on their vulnerability to disaster or their needs in an emergency.”(Twigg, 2007, p.6) This is a similar strengths based approach to what has been found effective when working to build resilience in individuals.

 The Guidance Note sets out five thematic areas of resilience and twenty seven associated components of resilience (see table one)

Table One:

Thematic area                                                            Components of resilience

Governance	·         Policy, planning, priorities and political commitment ·         Legal and regulatory systems ·         Integration with development policies and planning ·         Integration with emergency response and recovery ·         Institutional mechanisms, capacities and structures; allocation ·         Partnerships ·         Accountability and community participation
Risk assessment	·         Hazards/risk data and assessment ·         Vulnerability and impact data and assessment ·         Scientific and technical capacities and innovation
Knowledge and education	·         Public awareness, knowledge and skills ·         Information management and sharing ·         Education and training ·         Cultures, attitudes, motivation ·         Learning & Research
Risk management and vulnerability reduction	·         Environmental and natural resource management ·         Health and well being ·         Sustainable livelihoods ·         Social protection ·         Financial instruments ·         Physical protection; structural and technical measures ·         Planning regimes
Disaster preparedness and response	·         Organisational capacities and coordination ·         Early warning systems ·         Preparedness and contingency planning ·         Emergency resources and infrastructure ·         Emergency response and recovery ·         Participation, voluntarism, accountability

(Twigg, 2007, p.9)

To determine how applicable these tools are in developing economies and in a cross cultural context, Tearfund, in association with theDisaster Risk Reduction Interagency Coordination Group, has sought to pilot the Guidance Note in a number of communities in a number of states within Africa and Asia . In one such case study Chadburn has show how it wasused ina rural setting, inDhaka , Bangladesh . The exercise showed how the characteristics were valid and applicable in such a setting. .It also showed what gaps existed in current disaster preparedness.  (Chadburn, 2007)

 In looking at the learnings from the Tearfund case study it showed the effectiveness of taking a strengths based approach rather than “looking at disaster from a negative perspective (i.e. communities are forced to reflect on their difficulties when looking at disaster mitigation and preparedness). It was found to be far more effective to view the task from a perspective that looked at what communities “want and could achieve in disaster resilience” (Chadburn, 2007, p5)

 It is interesting to note that when you compare the detail of the thematic areas of community resilience, as produced by the DRRICG with Worsley’s resilience strength factors there is a strong correlation across each area. However, there is one noticeable exception that the DRRICG thematic areas don’t seem to have a strong correlation for the strength factors identified by Worsley that are associated with family. While it is possible to read the strength aspects of family into the “Risk Management and Vulnerability Reduction” thematic area of the DRRICG document I believe that the issues of identity and connectedness fostered through family would be an interesting area for further research in enhancing community resilience..

5         Conclusion:

Resilience is something every individual and group has to some extent. Some of these resilience factors include those that come as a result of our earliest attachments and how we have learned to think about ourselves and about others. Research has shown that increasing resilience, whether for individuals, families and communities, is about building on these strengths.

The skills, education, social support and governance structures, that support individuals or communities facing traumatic events, are all factors that can be enhanced, taught or otherwise implemented. However, the research has also shown that one of the most powerful factors in mitigating trauma is to have a positive outlook about ourselves, the resources we have and the situations we are in.

 

6          References

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