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10.1177/1524838005277438 TRAUMA, VIOLENCE, & ABUSE / July 2005 Agaibi, Wilson / TRAUMA, PTSD, AND RESILIENCE TRAUMA, PTSD, AND RESILIENCE A Review of the Literature CHRISTINE E. AGAIBI University of Akron JOHN P. WILSON Cleveland State University Based on the available literature, this review article investigates the issue of resil- ience in relation to trauma and posttraumatic stress disorder. Resilient coping to extreme stress and trauma is a multifaceted phenomena characterized as a complex repertoire of behavioral tendencies. An integrative Person Situation model is de- veloped based on the literature that specifies the nature of interactions among five classes of variables: (a) personality, (b) affect regulation, (c) coping, (d) ego de- fenses, and (e) the utilization and mobilization of protective factors and resources to aid coping. Key words: PTSD, resilience, positive coping, resilient behaviors, interactional models THIS REVIEW OF THE LITERATURE on trauma, posttraumatic stress disorder (PTSD), and resilience examines a wide range of studies over several decades. It develops a framework by which to view the historical evolution of re- search on psychological resilience in general and the nature of posttraumatic resilience in particular. The chapter organization reflects the central conceptual issues surrounding the con- cept of resilience; the early developmental stud- ies of resilient children growing up under ad- verse environmental conditions; the paradigm of extreme stress, trauma, and resilient coping during and after exposure to powerful, life- threatening stressors; and the need for a generic model of posttraumatic resilience, coping, and adaptation. Theoretical models of traumatic stress syn- dromes and the literature on PTSD have estab- lished that there is a wide range of outcomes in how persons cope with traumatic experiences (Bonnano, 2004; Wilson, 1995; Wilson & Drozdek, 2004; Wilson, Friedman, & Lindy, 2001; Wilson & Raphael, 1993; Zeidner & Endler, 1996). The models of traumatic stress (Wilson, 1989, 2004a; Wilson et al., 2001; Wilson & Thomas, 2004) and adaptive coping processes (Folkman, 1997) are useful paradigms by which to examine the question of resiliency: How is it that persons recover and “spring back” from psychological trauma? What are the psycholog- ical factors that are associated with resiliency and effective coping? What are its internal mechanisms in the psyche and as manifest in adaptation to environmental demands? 195 TRAUMA, VIOLENCE, & ABUSE, Vol. 6, No. 3, July 2005 195-216 DOI: 10.1177/1524838005277438 © 2005 Sage Publications at UNIV OF OREGON on January 10, 2010 http://tva.sagepub.com Downloaded from

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10.1177/1524838005277438TRAUMA, VIOLENCE, & ABUSE / July 2005Agaibi, Wilson / TRAUMA, PTSD, AND RESILIENCE

TRAUMA, PTSD, AND RESILIENCEA Review of the Literature

CHRISTINE E. AGAIBIUniversity of Akron

JOHN P. WILSONCleveland State University

Based on the available literature, this review article investigates the issue of resil-ience in relation to trauma and posttraumatic stress disorder. Resilient coping toextreme stress and trauma is a multifaceted phenomena characterized as a complexrepertoire of behavioral tendencies. An integrative Person Situation model is de-veloped based on the literature that specifies the nature of interactions among fiveclasses of variables: (a) personality, (b) affect regulation, (c) coping, (d) ego de-fenses, and (e) the utilization and mobilization of protective factors and resourcesto aid coping.

Key words: PTSD, resilience, positive coping, resilient behaviors, interactional models

THIS REVIEW OF THE LITERATURE ontrauma, posttraumatic stress disorder (PTSD),and resilience examines a wide range of studiesover several decades. It develops a frameworkby which to view the historical evolution of re-search on psychological resilience in generaland the nature of posttraumatic resilience inparticular. The chapter organization reflects thecentral conceptual issues surrounding the con-cept of resilience; the early developmental stud-ies of resilient children growing up under ad-verse environmental conditions; the paradigmof extreme stress, trauma, and resilient copingduring and after exposure to powerful, life-threatening stressors; and the need for a genericmodel of posttraumatic resilience, coping, andadaptation.

Theoretical models of traumatic stress syn-dromes and the literature on PTSD have estab-lished that there is a wide range of outcomes inhow persons cope with traumatic experiences(Bonnano, 2004; Wilson, 1995; Wilson &Drozdek, 2004; Wilson, Friedman, & Lindy,2001; Wilson & Raphael, 1993; Zeidner &Endler, 1996). The models of traumatic stress(Wilson, 1989, 2004a; Wilson et al., 2001; Wilson& Thomas, 2004) and adaptive coping processes(Folkman, 1997) are useful paradigms by whichto examine the question of resiliency: How is itthat persons recover and “spring back” frompsychological trauma? What are the psycholog-ical factors that are associated with resiliencyand effective coping? What are its internalmechanisms in the psyche and as manifest inadaptation to environmental demands?


TRAUMA, VIOLENCE, & ABUSE, Vol. 6, No. 3, July 2005 195-216DOI: 10.1177/1524838005277438© 2005 Sage Publications

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In this article, we explore the question oftrauma and resiliency. We present a conceptualmodel of trauma and resilience based on a re-view of the literature. To undertake such ananalysis requires definitional clarity on themeaning of resilience. Understanding the natureof resilience requires conceptual and defini-tional clarity. What is resilience and what con-stitutes resilient behavior? This seemingly sim-ple question turns out to be very complex as apsychological and behavioral process. There areat least five distinct ways to define human resil-ience. First, what is the lexical definition of resil-ience? Second, what constitutes resilience as apsychological phenomenon in its purest formdevoid of contextual parameters? In terms ofbasic processes of perception, cognition, affectregulation, and information processing, whatcharacterizes resilience? Third, what defines re-silient behavior under adverse environmentalconditions? This question spurned the early re-search on resilient children who grew up in pov-erty, in malfunctional families, or in conditionsof cultural deprivation. The focus on resilientbehavior is a way of evaluating resilience byoutcome: How is good performance main-tained in the face of adversity, overwhelmingdisadvantage, or impediments to highly effec-tive adaptation and performance as defined bya range of dependent variables (e.g., mentalhealth, school performance, absence of illnessor psychopathology, etc.)? Fourth, the questionof psychological trauma and resilience is a vari-ation on conceptualizations of effective copingand adaptation under adverse environmentalcircumstances. Trauma, however, is generallydefined by stress events that present extraordi-nary challenges to coping and adaptation. In-deed, the Diagnostic and Statistical Manual ofMental Disorders (DSM-IV-TR; American Psy-chiatric Association, 2000) definition of trau-matic stressors includes “experiencing, witness-ing, or confronting events that involve actual orthreatened death or serious injury, or a threat tothe physical integrity of self or others” (p. 467).Thus, the issue of resilience to traumatic situa-tions raises questions as to the nature of peri-

traumatic (during) and posttraumatic forms ofresilient behavior. Stated differently, what set ofpsychological factors are associated with resil-ient coping in the “face” and “wake” of trauma?Fifth, the issue of PTSD and resilience similarlyraises questions regarding the dimensions of ef-fective coping. For example, what factors areprotective against the onset or later develop-ment of PTSD? What factors (e.g., personal, so-cial, support resources, etc.) are associated withresilient recovery from PTSD versus chronicforms of the disorder? Resilient posttraumaticcoping behavior poses the question as to conti-nuities and discontinuities in resiliency acrossthe life span. Is posttraumatic resiliency a char-acteristic of the person or highly influenced bynormative life crises of aging and unique situa-tional contexts that challenge coping reper-toires?

The Oxford English Dictionary defines resil-ience as “the activity of rebounding or springingback; to rebound; to recoil.” It further defines re-silience as “elasticity; the power of resuming theoriginal shape or position after compression,bending, etc.” It is the ability “to return to theoriginal position.” The lexical analysis also in-cludes the adjectives “cheerful, buoyant, andexuberant.” The linguistic use of the term resil-ience refers to a property: an ability of an objectto restore its original structural form, despite be-ing temporarily altered by external forces that

196 TRAUMA, VIOLENCE, & ABUSE / July 2005

KEY POINTS OF THE RESEARCH REVIEW• Posttraumatic resilience refers to a complex rep-

ertoire of behavioral tendencies.• Posttraumatic resilience is associated with a clus-

ter of personality traits linked to extraversion,high self-esteem, assertiveness, hardiness, inter-nal locus of control, and cognitive feedback.

• Posttraumatic resilience is associated with ego re-silience, which includes flexibility, energy, asser-tiveness, humor, transcendent detachment, and agood capacity for affect regulation.

• Posttraumatic resilience is a form of behavioraladaptation to situational stress and a style of per-sonality functioning.

• Posttraumatic resilience in response to trauma in-cludes recovery from PTSD to optimal states offunctioning and psychological immunity to psy-chopathology.

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would “bend” or “compress” its shape. Theproperty of resilience, then, would apply to be-havioral phenomena in engineering, physiol-ogy, the natural environment, and human be-havior in a variety of environmental contexts.Moreover, resilience is generally viewed as aquality of character, personality, and copingability. Resiliency connotes strength, flexibility,a capacity for mastery, and resumption of nor-mal functioning after excessive stress that chal-lenges individual coping skills (Lazarus & Folk-man, 1984; Richardson, 2002). In somedefinitions, resilience refers to an ability to over-come high loads of stressful events (e.g.,trauma, death, economic loss, disaster, politicalupheaval and cultural changes) and maintainpsychological vitality and mental health (Bon-nano, 2004; Harel, Kahana, & Kahana, 1993;Harel, Kahana, & Wilson, 1993; Wilson, 2004a;Wilson & Drozdek, 2004; Yehuda, 1998). In ex-perimental studies, resilience has been used asindependent and dependent variables. In thisregard, it is meaningful to speak of resilient per-sons and resilient behavioral adaptations andoutcomes in different situations. Clearly, a Per-son × Situation interactional model of resilienceis conceptually critical to the analysis of resil-ience as a posttraumatic phenomena (see Aron-off & Wilson, 1985; Wilson, 1989; Zeidler &Endler, 1996 for a review). What are the charac-teristics of resilient persons that distinguishthem from less resilient persons? What consti-tutes resilient behavior in different types oftraumatic situations with varying degrees ofstress demands, adversity, or the complexity ofproblems to be solved?

In a metatheory of resilience, Richardson(2002) proposed that the history of research onresilience can be classified in three ways: (a)identifying the unique characteristics of per-sons who cope well in the face of adversity, (b)identifying the processes by which resiliency isattained through developmental and life expe-riences, and (c) identifying the cognitive mecha-nisms that govern resilient adaptations. Previ-ous research on the phenomena of resilience hasexamined a substantial domain of critical fac-tors thought to be associated with resilience andinclude genetics, neurobiological factors, child-

hood development, type of trauma or stressfullife event, personality characteristics, cognitivestyle, prior history of exposure to stressfulevents, gender, age, capacity for affect regula-tion, social support, and ego defenses (Agaibi,2003; Fredrickson, 2002; Schore, 2003; South-wick, Morgan, Vythilingham, Krystal, &Charney, 2004; Wilson, 1995; Zeidner & Endler,1996; Zuckerman, 1999).

Resilient Persons, Resilient Behaviorand Its Process Over Time

To facilitate a review of the relevant litera-ture, we will organize this article into sectionsand attempt to draw conclusions from an analy-sis of the findings. To be clear about the impor-tance of resiliency, the concept must be opera-tionally defined. Wilson and Agaibi (in press)suggest that it is conceptually advantageous todefine resilience as a “complex repertoire of be-havioral tendencies.”They state that resiliencecharacterizes a style of be-havior with identifiablepatterns of thinking, per-ceiving, and decisionmaking across differenttypes of situations. Cur-rent definitions of resil-ience vary from absenceof psychopathology in achild of a severely men-tally ill parent, to the re-covery of a brain-injuredpatient, to the resumption of healthy function-ing in survivors of extreme trauma (Folkman,1997; Garmezy, 1996; Harel, Kahana, & Wilson,1993; Wilson & Drozdek, 2004; Wilson & Ra-phael, 1993). In this regard, it is helpful to studylongitudinally the process of resilience, examin-ing positive versus negative adaptation, cop-ing, and the operation of personality variablesin different situational contexts. For example, isresilience a stable characteristic of personalityor a variable dimension of behavioral adapta-tion under situational pressures? Is the study ofresilience in relation to trauma a universal para-digm by which to understand all forms of


Current definitions ofresilience vary from

absence ofpsychopathology in a

child of a severelymentally ill parent, to

the recovery of abrain-injured patient,

to the resumption ofhealthy functioning in

survivors of extremetrauma.

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resilient behavior? Are resilient traumasurvivors the “gold standard” examples of suc-cessful coping and adaptation?

In the most basic sense, resiliency has beendefined as the ability to adapt and cope success-fully despite threatening or challenging situa-tions. Resilience is a good outcome regardless ofhigh demands, costs, stress, or risk. Resilience issustained competence in response to demandsthat tax coping resources. Resilience is healthyrecovery from extreme stress and trauma (Wil-son & Drozdek, 2004). Resilience has been con-ceptually linked with curiosity and intellectualmastery as well as the ability to detach and con-ceptualize problems (J. H. Block & Kremen,1996). Resilience has also been postulated to in-clude strong extroverted personality character-istics (e.g., hardiness, ego resilience, self-es-teem, assertiveness, locus of control) and thecapacity to mobilize resources (Wilson &Agaibi, in press).

Historical Foci in the Study of Resilience:Children, Gender, Competence, Trauma,and PTSD

Richardson (2002) stated that “from a histori-cal view, the first wave of resiliency inquiry fo-cused on the paradigm shift from looking at therisk factors that led to psychosocial problems tothe identification of strengths of an individual”(p. 309). Indeed, prior to the onset of systematicresearch on PTSD in 1980 (Wilson, 1995; Wilsonet al., 2001; Wilson & Raphael, 1993), studiestended to look at how children subjected toharsh developmental and formative experi-ences emerged psychologically healthy ratherthan developing psychopathology. In his suc-cinct review, Richardson (2002) highlighted theresearch of Werner and Smith (1992), MichaelRutter (1990), and Norman Garmezy (1991),who studied children thought to be “at risk” be-cause of economic poverty, severely mentally illparents, or developmental deprivations of dif-ferent types (e.g., neglect, abuse, poverty, socialclass). Among the classic pioneering studies ofpsychological resiliency, Garmezy (1981) andCicchetti and Garmezy (1993) noted that cau-tion is warranted in the study of resilient per-sons by not selecting extremes for study and opt

for a middle ground, studying successful adap-tation in the context to unusually adverse lifecircumstances.

Researchers studying resilience recognize themultifaceted task of understanding the differ-ent forms of adaptation that characterize resil-ient behaviors (Caffo & Belaise, 2003). Multirisksituations as well as psychobiological(Southwick et al., 2004) and sociocultural influ-ences have been analyzed to understand the na-ture and dynamics of resiliency. In regards topsychological trauma, Weisaeth (1995) hasidentified the nature of high-risk persons, situa-tions, and reactions to traumatic stressors andproposes a matrix analysis of their interactiveeffects in coping and adaptation.

In relation to other concepts identified in thetraumatic stress literature, resiliency reflects apattern of competence and self-efficacy in thepresence of extraordinarily difficult events andraises critical questions. Are resilient individu-als primarily characterized by having compe-tence in areas of psychological functioning?Competent performance indicates positive be-liefs about self, task performance, and problemsolving (Weisaeth, 1995). Areas of personalcompetence extend to the successful masteryand ability to cope with traumatic stressors astrauma invariably taxes coping resources(Yehuda, 1998). On the other hand, chronic, ex-cessive stress imposes demands for coping andcan lead to health problems (Schnurr & Green,2004). In analyzing these variables, research evi-dence suggests that competence is related to useof psychosocial resources (Caffo & Belaise,2003). In brief, resources to develop competenceare less prevalent among children growing upin adversity. Competence does develop, how-ever, with sufficient resources even if there arechronically severe stressors present. Researchshows that adolescents with maladaptive be-havior tend to be overly reactive to stress andhave a history of low resource utilization andlack competence in coping with stressor de-mands (Masten et al., 1999). Good parenting isassociated with the development of cognitiveskills that facilitate greater competence in cop-ing with different types of stressors. Among in-dividual difference variables, IQ is a significantpredictor of social competence and intellectual

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functioning (J. H. Block & Kremen, 1996) andacts as a vulnerability factor for antisocial be-havior in “at-risk” groups of children and ado-lescents (Masten et al., 1999).

In terms of vulnerability factors, Masten et al.(1999) found few differences that differentiatedcompetent and resilient individuals. Resilientchildren tended to resemble their competentpeers but differed dramatically from maladap-tive, vulnerable, and at-risk youth. Although itis possible to identify differences that distin-guish resilient from nonresilient children, thequestion remains as to how internal psychologi-cal processes (e.g., stress appraisal, personalitydifferences) interact with situational pressures(e.g., type of trauma, threat level) to set up an ar-ray of possible forms of resilient and nonresilientbehavior.

Taking a broad view of the seminal studies onresilient and “stress-immune” children, it canbe seen that among the keys to understandingresiliency is analyzing risk and vulnerability,protective factors, coping, competence, person-ality factors, and the capacity to effectively useresources. As summarized by Caffo and Belaise(2003), psychological resilience is a consequenceof positive human development and the capac-ity to cope with stressors. Protective andgrowth-promoting factors are necessary to thedevelopment of competence and resilience, es-pecially in disadvantaged urban youth (Par-sons, 1994). Children, as well as adolescents,cope more effectively with adversity if they re-ceive nurturing and stable care from others.Rutter (1990) found that organizational or insti-tutional settings that promote self-esteem andproblem-solving behavior increase the likeli-hood of competence, resilience, and the masteryof situations that challenge coping.

Research evidence suggests that resilience isnot gender specific and does not increase or de-crease with age (Zeidler & Endler, 1996). It is,however, related to psychological developmentand changes in emotional and cognitive compe-tency (Folkman, 1997; Fredrickson, 2001; Fred-rickson & Tudade, 2003). Resiliency and re-sponses to different types of life stressors canchange over time (Felsman & Vaillant, 1982).Moreover, coping mechanisms are situationallydependent and interact with personality vari-

ables (Aronoff & Wilson, 1985; Wilson, 1989;Zeidner & Endler, 1996; Zeidner & Endler,1996). Resiliency is a multidimensional con-struct that is defined by performance outcome,the adequacy of responses to normal and severestressors, including traumatic ones, and howcognitive processes and the ability to modulateemotions influence the ability to utilize person-al and social resources (J. H. Block & Kremen,1996).

Viewed from the perspective of trauma-tology, resilience is efficacious adaptation re-gardless of significant traumatic threats to per-sonal and physical integrity (Harel, Kahana, &Wilson, 1993; Wilson, 2004a; Wilson & Drozdek,2004). Children that have had exposure tochronic stress such as war trauma, refugee sta-tus, civil violence, extreme poverty, and eco-nomic or social deprivation exhibited diverseforms of resiliency (Wilson & Drozdek, 2004). Inexamining “at-risk” populations that exhibit re-siliency (e.g., raped adolescent girls in situa-tions of ethnic cleansing, displaced refugeesand asylum seekers, torture victims, etc.), vari-ous protective factors have been identified (Sol-omon, Neria, Ohry, Waysman, & Ginzburg,1994; Wilson & Drozdek, 2004). Studies of “at-risk” populations (Dugan & Coles, 1989), espe-cially those who do not develop PTSD, mooddisorders, or comorbid disorders (Folkman &Moskowitz, 2000; Fredrickson et al., 2003), is es-pecially important because they hold clues tooptimal functioning in the face of trauma,extreme stress, and adversity in life (Wilson, inpress).

Risk Stressors for Children: EarlyParadigms for Analyzing Resilience

A wide array of stressors exists that puts chil-dren at risk for maladaptive behaviors includingthe development of PTSD. These stressors includepsychological trauma and abuse, mentally illparents, physical disability, life-threateningbirth defects and personal injuries, asylumseeking and refugee status, war, disasters, andlife-threatening illness (Caffo & Belaise, 2003;Masten, Morison, Pellegrini, & Tellegen, 1990;Nader, 1997, 2004; Pynoos & Nader, 1993).


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Garmezy (1991) identified traumatic stressorsthat potentially put children at risk for the devel-opment of psychopathology, including PTSD.He studied disadvantaged children in Amer-ica’s urban cities who were subjected to extremestress. Among other outcomes, Garmezy foundthat these children were twice as likely to die inthe first year of life, be born prematurely, sufferlow birth weight, have mothers who had littleor no prenatal care, and have unemployed par-ent(s). These children were 3 times more likelyto have mothers die during their delivery, beforced to live in foster homes, or die from abuse.They were also 4 times more likely to live with-out a biological parent and be supervised by achild welfare agency. They were also 4 timesmore likely to be the victims of murder by age 1or as teenagers. Clearly, these findings suggest awide range of negative effects to attachmentprocesses, ego development, vulnerability tostressors, and the learning of competencies insocial behavior.

At a higher meta level of analysis, social class,as an independent variable, may be a distal riskfactor but result in proximal stressors that di-rectly affect those subjected to such experiencesand lead to high rates of PTSD (Kinsie, 1988,1994). Risk factors of socially disadvantagedmothers often occur together and include suchthings as poor maternal nutrition, geographicaldisplacement from home, domestic violence,and substance abuse. Garmezy (1991) notedthat the combination of maternal social, biologi-cal, and environmental disadvantages andstressors increases the risk of pathology in thechild. Similarly, Caffo and Belaise (2003) de-scribed children undergoing stressors in a cycli-cal, stress-related pattern that increases thechild’s vulnerability to pathology. Children ofimpoverished environments tend to have poor-er overall health, become school dropouts, andconsequently have limited job opportunities,which further perpetuates the cycle of povertyand allied social pathologies. However, the ma-jority of the children studied that lived inadverse conditions did not repeat the abusivepatterns in their adult lives (Luthar & Zigler,1991).

In the classic study of Hawaiian children,Werner and Smith (1982, 1992) predicted adjust-

ment problems at later stages of developmentfor children with risks such as chronic poverty,low maternal education, and moderate to se-vere perinatal stress. One third of the Hawaiiansample tested was considered resilient becausethey did not develop problems and were psy-chologically healthy at ages 10, 18, and 30. Acomparison was made between resilient chil-dren and a high-risk sample that developed ad-justment problems. Resilient children receivedmore attention as infants and, according to theirmothers, presented as more active and sociallyresponsive. In summarizing her work, EmmyWerner (2004) stated that resilient children“were consistently characterized by their moth-ers as active, affectionate, cuddly, good-natured, and easy to deal with” (p. 61).

How do “distal” and “proximal” risk factorsinteract with each other? How does culture, so-cial status, and economic status influence fam-ily patterns, child development, and the pres-ence or absence of specific stressors? Agaibi(2003) stated that distal risk factors are based onindirect stressors, such as social class. Theserisks are, however, part of the characteristics ofproximal risk factors that are directly experi-enced. Proximal risks include such things aschaotic environments, family trauma (Hark-ness, 1993; Wilson & Kurtz, 1997), familial insta-bility, parental substance abuse, inadequate nu-trition, parental dissension, mental illness, orantisocial behavior (Nader, 1997). Agaibi sug-gested that if a child is exposed to distal risks(e.g., poverty), yet experiences no proximal risk(e.g., neglect, childhood abuse), it is then safer toassume that the family is more resilient thannot.

In the literature on risk and vulnerability, thetwo terms have been used interchangeably. Re-search on classes of risk factors traditionally an-chors itself in epidemiological studies of psy-chopathology. Studies of risk factors havefocused on factors that emphasize or reduce thedisposition to psychopathology or increase sal-utary outcomes. Vulnerability has been seen asan inclination toward negative outcomes, espe-cially after exposure to traumatic stressors. Werefer to this process as peri-traumatic vulnerabil-ity (Wilson, 1989, 2004a, in press). Sources ofvulnerability to adversity, stress, and trauma can

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be present in the individual’s personality andcoping repertoire or in the environment (Wilsonet al., 2001; Wilson & Prabucki, 1989). Thesesources of vulnerability can function independ-ently or in an additive manner. Compas andPhares (1991) identified five sources of vulnera-bility: (a) coping strategies and styles, (b) age ordevelopmental level, (c) personal characteristicsthat relate to gender, (d) social-cognitive factors,and (e) the stress and symptoms experienced byclose family members.

Stress Appraisal Processes

The perception and appraisal of stressors canbe conceptualized as moderating factors toPTSD and comorbidity (Folkman, 1997; Lazarus& Folkman, 1984; Wilson, 2004b). As we willdiscuss, the literature on coping supports theidea that problem-centered versus emotionalcoping is more effective in dealing with trau-matic stress (Folkman & Moskowitz, 2000; Wil-son, Harel, & Kahana, 1988; Wilson & Raphael,1993; Zeidner & Endler, 1996). Lazarus andFolkman (1984) suggested that an event will beperceived as stressful if the person believes thatthe stress exceeds coping capacity. The percep-tion of overwhelming stressor demands maylead to self-attributions of inadequate compe-tence to effect positive outcomes. In this regard,Garmezy (1987) found that children with poorself-esteem are vulnerable to interpersonal andacademic stressors and tend to perceive eventsas more stressful. Compas and Phares (1991)found that using problem solving to cope withinterpersonal stressors is correlated with lowerlevels of maladjustment in children. Compasand Phares predicted that the level of parents’and children’s stress level would be correlatedand found that fathers’ symptoms were signifi-cant predictors of behavior problems and ofchildren’s self-reports of internalizing thestress. They found that mothers’ symptomlevel, in comparison to the fathers’, must bemore severe before children are at risk to the de-velopment of problems. Similar results were re-ported by Harkness (1993) in a study of adoles-cent children of treatment-seeking Vietnamcombat veterans. The fathers’ level of PTSD, an-ger, aggressive behavior, and depression had

different effects on male and female children asdetermined by the mothers’ style of coping androle behaviors (e.g., protective nurturance,central family decision maker, etc.).

To partially summarize the literature’s viewon risk and vulnerability, one can say that al-though these terms are often used interchange-ably, they are distinct processes. Children maybe deemed “at risk” by trauma, genetics, andearly environmental factors (Richardson, 2002).Vulnerability is seen as a response to a stressor.Risk behaviors are seen as responses to trau-matic stressors (Weisaeth, 1995). Rutter (1990)found that psychiatric illness for children in-creases when there are two or more risk factorspresent. In other situations, vulnerability andresiliency seem to be on opposite ends of a con-tinuum, in which vulnerability identifies a riskfactor eventuating in pathology and resiliencyidentifies a factor leading to positive adaptivebehavior (Garmezy, 1996). Although vulnera-bility can be classified in categories (e.g., age,nature of stressor, developmental level, person-ality, etc.), each category is a representation of afactor that is associated with a vulnerability todevelop a prolonged stressreaction (McEwen, 2002).In this sense, Garmezy(1985, 1987, 1991) sawprotective factors as theability to moderate emo-tions, cope with stressors,and manifest positive re-sponsiveness to stressors,a view shared by J. H.Block and Kremen (1996)in their analysis of ego re-silience, intelligence, andcoping.

Research findings sug-gest that effective par-enting can increase self-efficacy by modeling so-lutions to stress. Self-esteem and self-confidencefunction as personality moderators of traumaticexperiences and serve as protective factors. Self-efficacy increases with previous mastery ofstressful situations (White, 1959). Secure andhealthy attachment increases the potential formastering a stressful experience and promotesautonomy (Masten et al., 1990). Similarly, Nunn


Research findingssuggest that effective

parenting canincrease self-efficacyby modeling solutionsto stress. Self-esteemand self-confidence

function aspersonality

moderators oftraumatic

experiences andserve as protective


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(1995) found that intellectual skills and socialcognitive abilities function as protective factors.Resourceful children with problem-solvingskills tend to be more resilient and recognizedanger cues more quickly than intellectuallychallenged children (Nader, 1997, 2004). Be-cause danger is quickly discerned, help seekingis initiated proactively as a response tendencythat may truncate the onset of acute stress disor-der phenomena (Nader, 1997, 2004).

Longitudinal Research and theIdentification of Resilient Factors

In studies of trauma, PTSD, and coping withextreme stress, the personality variable, internallocus of control, has been associated with effec-tive adaptation to stress (Harel, Kahana, & Wil-son, 1993; Wilson, 1989; Wilson, Harel, &Kahana, 1989). Persons with an internal locus ofcontrol tend to exhibit less PTSD and psycho-pathology and have better overall adjustmentthan persons with an external locus of control.In a longitudinal study, Elder and Clipp (1988),using the Oakland Growth studies data bank,were able to evaluate personality variables evi-dent in childhood that predicted PTSD symp-toms in Korean and World War II veterans. Priorto military service, men who were sensitive, in-trospective, obsessive, and introverted weremore likely to manifest psychiatric morbiditythan were men who were extroverted, domi-nant, assertive, and self-assured. Although riskfactors include traumatic life stressors, protec-tive factors are significantly related to positivefamily and peer relationships. Preexisting psy-chopathology tends to be a risk factor for nega-tive psychosocial consequences, including thedevelopment of PTSD following trauma (Fried-man, 2000a; Garmezy & Masten, 1991; Wilson &Drozdek, 2004; Yehuda, 1998). In this regard,Rutter (1990) defined three broad variables asprotective factors: (a) personality coherence, (b)family cohesion, and (c) social support. Person-ality factors include level of autonomy, self-es-teem and self-efficacy, good temperament, andpositive social outlook. In the area of traumaticstress research, Wilson and Raphael (1993) andWilson (1995) identified similar factors associ-ated with resilience, which include internal lo-

cus of control, altruism, the perception of socialand economic resources, self-disclosure, andthe formation of a clear sense of identity as a sur-vivor. Family cohesion, warmth, and lack ofdiscord or tension have been identified as pro-tective factors (Garmezy & Masten, 1991).External support systems, whether perceived orused, promote good coping.

In a 40-year longitudinal study of HarvardUniversity students, Felsman and Vaillant(1982) attempted to identify the childhood andadolescent factors associated with resiliency inlater adulthood. This study has direct relevanceto understanding psychological trauma and re-siliency because of its longitudinal nature andthe wide domain of personal characteristics as-sessed throughout the course of the study (e.g.,Eriksonian life stages, maturity of ego defenses,IQ, boyhood competence, family background,socioeconomic status, etc.).

The results produced an interesting set offindings that tend to “dove-tail” with the find-ings on studies of trauma, PTSD, and resilience.First, IQ and boyhood competence (a measureof active involvement in activities and a goodchildhood environment) were positively corre-lated with current mental health, the attainmentof ego maturity (i.e., generativity), good objectrelations, and the use of mature ego defenses(e.g., altruism, sublimation). Conversely, theirmeasure of childhood emotional problems wasnegatively correlated with these same variablesbut significantly associated with sociopathy.Second, there was considerable variability inpsychosocial development across early adultdevelopment for the more resilient members ofthe study. There was little evidence for a linear,uninterrupted pattern of life-span developmentthat led to successful achievements later in life.There were periods of discontinuity and regres-sion. However, what seemed to distinguish theresilient adults was “a clear pattern of recovery,restoration, and gradual mastery” (Felsman &Vaillant, 1982, p. 311). In terms of resilience,this would suggest that there were identifiableperiods of rest, recuperation, and recovery thatfacilitated a restoration of competence, activecoping, and striving, which “gradually” culmi-nated in the mastery of challenging personal ex-periences. In terms of personological variables,

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the data suggest that men who come from moreor less stable childhood backgrounds, with pos-itive early learning periods that served to facili-tate boyhood competence, developed morefunctional and mature ego defenses that, inturn, may have moderated the development ofself-esteem, locus of control, and prosocial be-havior. This being the case, we would expectthat persons suffering from psychologicaltrauma and PTSD would manifest patterns ofadaptation, coping, and resilience that wouldwax and wane over time, marked by periods ofcontinuity versus discontinuity, ego coherenceversus fragmentation, good versus poor objectrelations, gradual assimilation and mastery ofthe impairment of trauma to their sense of well-being (see Wilson, 2004a, for a discussion).


With the advent of PTSD as a diagnostic entityin 1980, the study of resilience began to moveaway from traditional social-psychological anddevelopmental studies to more in-depth studiesof trauma survivors. Studies of posttraumaticresilience examined pre- and posttrauma areasof adaptive competence among differenttrauma populations, including those who doand do not develop PTSD.

The Core Factors of PosttraumaticVulnerability to PTSD

Zuckerman (1999) reviewed the literature onvulnerability and the development of PTSD. Interms of PTSD, vulnerability and resilience arerelated concepts, as they characterize twin sidesof trauma and the responses to it. In his sum-mary analysis, Zuckerman noted that there areclearly identifiable vulnerability factors to thepsychiatric sequelae of PTSD that include ge-netics (True et al., 1993), individual risk factors(e.g., family background), personality (e.g.,types of ego defense, extraversion), biologicalfactors (e.g., alterations in brain function), cog-nitive style, and information processing. Al-though these findings do not directly addressthe issues of resiliency in the face of trauma,

they do suggest that there are an interrelated setof psychobiological processes at work that in-fluence (a) the genetic predisposition to trauma,(b) the probable protective factors from child-hood development, (c) the operation and mod-erating functions of personality processes, and(d) the nature and cause of prolonged stress re-sponse patterns in the central nervous system(i.e., the active psychobiological metabolism ofthe trauma experience, including traumaticmemories; see Southwick et al., 2004, for areview).

In a review of studies concerned with wartrauma, natural and technological disasters,torture, the Holocaust, and duty-related trauma,Wilson and Raphael (1993) and Wilson (1995)identified seven factors associated with resil-ience. Wilson (1995) found that there were simi-lar constellations of predictors of current well-being, positive mental health, and manifesta-tions of resilience in these survivor populationsthat included: (a) locus of control (i.e., a sense ofefficacy and determination, (b) self-disclosureof the trauma experience to significant others,(c) a sense of group identity and sense of self as apositive survivor, (d) the perception of personaland social resources to aid in coping in theposttrauma recovery environment, (e) altruisticor prosocial behaviors, (f) the capacity to findmeaning in the traumatic experience and life af-terward, and (g) connection, bonding, and so-cial interaction within a significant communityof friends and fellow survivors. Viewed fromthe perspective of resilience, these seven factorsappear to be identifying important classes ofvariables that interact together in generating re-silience. These include factors within the person(i.e., locus of control, cognitive attributions ofbeing a strong survivor, a firm sense of personalidentity as a survivor) as well as specific formsof coping (i.e., perception of personal and socialresources to aid coping, capacity to find mean-ing) and behavioral activities in the recoveryenvironment (e.g., appropriate self-disclosure,altruism, prosocial behaviors, bonding and fel-lowship with other survivors) that promote re-silient functioning. Persons who have an inter-nal locus of control who can find meaning intheir trauma experiences may be able to initiatea set of processes that enables them to shape a


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personal sense of identity by being bonded andattached to fellow survivors who, in turn, areperceived as resources for coping with emo-tional, social, and economic needs (see Zakin,Solomon, & Neria, 2003). Furthermore, within atrusted enclave of fellow survivors, the bondingand networks formed may facilitate healthyself-disclosure and the opportunity to enactprosocial behaviors and positive emotionalstates as part of the natural transformation pro-cess of dealing with individual trauma. In thisway, too, prosocial enactments reinforce per-sonal systems of meaning and validate thestrengths of survivorship. Similar conclusionswere found by Hendin and Haas (1984), whofound that Vietnam combat veterans with highresilience were characterized by six factors: (a)calmness under pressure, (b) acceptance of fearin self and others, (c) low levels of excessive vio-lence in the war zone, (d) the importance of un-derstanding and good judgment, (e) absence ofguilt, and (f) humor.

PTSD symptoms following traumatic stress-ors can be a result of personal vulnerability ortypes of pre-traumatic vulnerability (e.g., priorstressors, trauma, psychological disorders). Insome individuals, exposure to repeated traumamay increase resilience; in other survivors, itcan degrade resiliency. This difference in out-come of traumatic stress response has been re-ferred to as the “steeling effect” or “prior vul-nerability” disposition to develop prolongedstress reactions (Figley, 1985, 1986; Wilson, 1989,1995; Wilson & Raphael, 1993; Wilson & Droz-dek, 2004).

Traumatic Stressors and Peri-Traumaticand Posttraumatic Forms of Resilience

It is a truism to say that not everyone devel-ops PTSD following trauma, a fact that makesthe study of resilience both interesting and im-portant. Clearly, it is necessary to understandvulnerability and resiliency factors to meaning-fully interpret the adaptation to trauma.Yehuda (1998) clarified the difference betweenchronic, non-life-threatening stress and acute,life-threatening stress. She indicates that al-though acute stress reactions have mental andphysical health consequences, it has been as-

sumed that these consequences would lift oncethe stressor terminated (Bryant, 2004). Al-though chronic stress effects developed over aperiod of time, acute stress effects were suddenand immediately impactful. In chronic stress,physiological and emotional processes degradeover time (Friedman, 2000a; McEwen, 2002). Inacute stress, there is a rapid and sudden changein these physiological and mental processes(Friedman, 2000a; Friedman & McEwen, 2004).In chronic stress, the individual experiencesfeelings of being overwhelmed and struggles tocope with the long-term consequences of pro-longed stress-related symptoms. Traumaticstress results in feelings of fear that can activatecomplex allostatic psychological responses(McEwen, 2002; Thomas & Wilson, 2004;Wilson, 2004b; Wilson et al., 2001; Wilson &Thomas, 2004).

In terms of trauma and PTSD, there are sev-eral studies that have examined resilience in re-lation to war trauma, internment, civil violence,and terrorism. L. A. King, King, Fairbank,Keane, and Adams (1998) studied resiliency as-sociated with PTSD among Vietnam veterans inrelation to hardiness, social support, and stress-ful life events. L. A. King et al. predicted thathardy war veterans would cope better with lifestresses than less hardy veterans. They sug-gested that hardy veterans would utilize socialsupports in their environment to overcome astress. They predicted that veterans exposed toextreme war stressors who had strong, currentsocial support would display fewer PTSDsymptoms than veterans with less support.They argued that when war stressors were mea-sured at low levels, there would be a weak rela-tionship between social support and thedevelopment of PTSD.

The results indicated that male and femaleveterans who scored high on the hardiness di-mensions of control, commitment, and chal-lenge showed fewer PTSD symptoms. Hardi-ness was associated with fewer PTSDsymptoms and appears to help the individualestablish relationships that aid coping withPTSD symptoms when present. Contrary totheir hypothesis, hardiness did not seem to pro-tect veterans from PTSD symptoms if these indi-viduals experienced heavy combat, a finding

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replicated in studies of prisoners of war (Zeiss &Dickman, 1989). However, the amount of socialsupport received did predict the extent of PTSDsymptoms. L. A. King et al. (1998) concurredwith Solomon and Mikulincer (1992), whostated that negative life events tend to be nega-tively correlated with prevalence of intact socialsupport. Stressful events can deplete social net-works that, in turn, increase PTSD symptoms.Similar findings were reported by Sutker, Davis,Uddo, and Ditta (1995) in a study of war-zonestress, personal resources, and PTSD in PersianGulf War veterans. From a sample of 775 mili-tary veterans, 97 with diagnosed PTSD werecompared to 484 who did not show pathologicalsigns of distress. The results indicated that vet-erans with PTSD scored lower on Kobasa’s(1979) measure of hardiness (i.e., commitment,control, challenge) and had less social supportand family cohesion as well as avoidant copingstyles with strong tendencies to self-blame.These results illustrate the interaction betweenpersonality characteristics, coping styles, anduse of social support.

There are several studies that examinedstress, coping, and the presence of PTSD amongveterans of the 1991 Gulf War. The findingsshow a similar pattern of results that, as a per-sonality dimension, hardiness moderates the ef-fects of war-zone stress and post-war copingwith civilian stressors. Bartone (1999) studiedsix Army National Guard and reserve medicalunits about a year after the end of the Gulf Warin Kuwait and Iraq. Asample of 787 participantswere given the Kobasa Hardiness Scale, theBrief Symptom Inventory, Holmes-Rahe StressScale, a 20-item measure of current health sta-tus, and a 15-item Gulf War zone stressor assess-ment scale. The results supported a Person × Sit-uation model of resilience (Wilson, 1980). Usinga regression analysis, hardiness interacted withcombat stress in predicting the global severitypsychiatric index for low- and high-hardinessparticipants. High-hardiness persons had fewerpsychological and health-related symptomsthan did low-hardiness individuals. Similarfindings were reported by Benotsch, Brailey,Vasterling, and Sutker (2000), who examined348 Gulf War veterans at two different time in-tervals after repatriation. The authors measured

PTSD, dispositional resilience, coping styles,personal resources, and social support. At thefirst time interval after repatriation, those withmore severe PTSD symptoms were character-ized by avoidance coping and lack of family co-hesion. At the second time interval, conductedabout 2 years after the war, avoidance copingand a general decrease in perceived social sup-port resources predicted PTSD symptoms. In arelated study, Sharkansky, King, King, Wolfe,Erikson, and Stokes (2000) examined 2,949 GulfWar veterans and measured combat exposure,coping styles, PTSD, life stressors, and depres-sion. Results showed that when comparingpostwar adjustment at two different intervalswithin 2 years of repatriation, veterans whoused approach (i.e., active) coping styles hadfewer PTSD symptoms than men who utilizedavoidant forms of coping. However, those withthe highest levels of combat exposure had morePTSD and depressive symptoms, irrespective ofcoping styles.

In an Israeli study, Zakin et al. (2003) exam-ined the relationship between hardiness, at-tachment style, and long-term distress amongIsraeli prisoners of war (POWs) and combat vet-erans of the Yom Kippur War in 1973. Using Is-raeli POWs and matched combat controls, theformer soldiers were administered the Symp-tom Checklist 90 (SCL-90), a measure of attach-ment styles, the Kobasa Hardiness Scale, and ameasure of PTSD based on the DSM-III-R (1987)diagnostic criteria. The results showed that har-diness was associated with low levels of symp-toms reported. Using a hierarchical regressionanalysis, the interaction between hardiness andattachment style account for 20% to 40% of themeasured variance in depression, anxiety, som-atization, and present and past PTSD symptoms.These results are consistent with the findings onhardiness as a personality dimension associ-ated with resilience in the form of fewer mani-fest symptoms of psychiatric distress associatedwith exposure to war-zone stressors.

In a study of former prisoners of war, Goldet al. (2000) examined PTSD symptoms and re-covery in World War II and Korean formerPOWs. Former POWs whose exposure to traumawas severe were at high risk for experiencingpsychological problems such as PTSD, depres-


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sion, anxiety, or cognitive deficits (Beebe, 1975;Eberly & Engdahl, 1991; Engdahl, Dikel, Eberly,& Blank, 1997; Page, Engdahl, & Eberly, 1991;Sutker, Winstead, Galina, & Ayain, 1991; Ten-nant, Goulston, & Dent, 1986). Although com-bat veterans have a lifetime occurrence of PTSDat 30%, POWs have a lifetime occurrence ofPTSD at 67% (Khuznik, Speed, VanVelkenberg,& MacGraw, 1986; Kulka et al., 1990). Gold et al.(2000) suggested that the greater the torture andweight loss experienced while imprisoned, thegreater the PTSD symptoms. They noted thatpremilitary trauma, personality, age, andpostmilitary social support played a role in de-termining the severity of the PTSD symptoms

The predictors for the severity of PTSDsymptoms were thought to include severity oftrauma during imprisonment, factors of resil-ience, and postwar social support. It was foundthat the severity of the trauma experienced dur-ing imprisonment was related to distress expe-rienced 40 to 50 years later. The level of distresswas inversely associated with education andage at the time of the trauma. There was a signif-icant correlation between reexperiencing thetrauma and the initial coping response (i.e.,peri-traumatic coping) of avoiding triggers thatreminded veterans of their POW experience.Contrary to other studies, the presence of socialsupport did not moderate the level of PTSDsymptoms.

In a 40-year follow-up study of formerPOWs, Zeiss and Dickman (1989) assessed fac-tors associated with PTSD among WWII veter-ans who were captured as war prisoners inEurope and the South Pacific war zones. Theyemployed a Person × Situation interactionalanalysis of the variables significantly associatedwith the persistence of PTSD symptoms acrossfour decades. The results revealed that 55.7% re-ported PTSD symptoms using the DSM-III(1980) diagnostic criteria. They note, however,that PTSD symptoms waxed and waned duringthis postwar period of time. In terms of demo-graphic variables, higher military status (rank)and education predicted better outcomes interms of PTSD and postwar adaptation. Dura-tion of internment and age at capture did notcorrelate significantly with assessments ofPTSD over time. The authors suggest that

personal characteristics, such as greater self-efficacy,emotional maturity, intelligence, interpersonal skill,educational level, commitment to the war effort, orlocus of control may be mediating variables that re-sulted in both promotion in rank and relative ease ofadjustment to stresses of POW life and repatriation.(Zeiss & Dickman, 1989, p. 86)

The effects of hardiness as a personality traithave been studied in direct relation to coping,daily hassles, and life stresses. These studieshave direct relevance to traumatic exposure andresilience in persons characterized as hardy. Intwo related studies, Maddi (1999a; Maddi &Hightower, 1999) examined the difference be-tween high- and low-hardiness students on sev-eral measures of coping and attitudinal outlook.In the first study, Maddi and Hightower (1999)found that hardiness predicted actual transfor-mational coping better than measured opti-mism. Undergraduate students with hardinessused more active coping and planning. Hardi-ness was negatively correlated with behavioraldisengagement, denial, mental disengagement,and proneness to use alcohol to cope with stress.Hardiness was positively correlated with emo-tional and instrumental forms of social support.The authors conclude that hardiness reflects apropensity for active problem solving and ca-pacity to mobilize resources as needed toachieve desired outcomes. In the second study,Maddi (1999a) obtained similar results in astudy of coping and strain among 20 male man-agers at a midwestern company. The resultsshowed that high-hardiness participants werecharacterized by active enjoyment and inter-ests, openness of mood, social support, and atransformational work style (i.e., one character-ized by active problem-solving approaches tothe challenges of the workplace). Furthermore,the results indicated that high-hardiness partic-ipants had significant fewer symptoms as mea-sured by the SCL-90 symptom checklist (e.g.,anxiety, depression, somatization, interper-sonal sensitivity, etc.). The lower level of globaldistress on the SCL-90 suggests the possibilitythat the hardy individuals are better at modulat-ing affect in relation to stressful demands.

The concept of hardiness has also been usedto study coping among prisoners of war in Is-

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rael. Waysman, Schwarzwald, and Solomon(2001) studied Israeli POWs of the 1973 YomKippur War. Hardiness was viewed as either adirect or moderating effect leading to long-termpositive or negative change as a result of expo-sure to war trauma. Consistent with the theoret-ical work of Antonovsky and Bernstein (1977),Waysman et al. looked at the role of hardiness inprotecting POWs from long-term negative con-sequences. The results revealed that hardinesswas beneficial for people who were exposed toextreme stressors when compared with thosewho were exposed to lower levels of stress. Har-diness as a stress moderator exerted an effect ofstress-related symptoms in POWs but not oncontrols who fought in the same war but experi-enced less exposure. An inverse relationshipwas found between hardiness and negativechanges in both the POW and non-POWgroups. It was found that the higher the hardi-ness score, the fewer negative changes experi-enced. POWs generally reported more negativechanges in their lives following the trauma ofwar than their non-POW counterparts. HardyPOWs were less adversely impacted by postwarnegative life changes than less hardy formerinternees.

In a study of Holocaust survivors who werechildren at the time of their internment, Cohen,Dekel, and Solomon (2002) examined the role ofattachment as a variable associated with PTSDsymptoms and patterns of adjustment. In com-parison to non-Holocaust controls, the survivorgroup manifested more symptoms of PTSD.However, treatment-seeking survivors showedhigher levels of anxiety, avoidant attachment,and current symptoms of PTSD than did the un-treated survivors and matched controls. The au-thors note that as a cohort, Holocaust survivorsshow a wide range of variability in their scoresfor PTSD, coping styles, and issues related to at-tachment. These findings parallel those re-ported by Eitinger (1980); Harel, Kahana, andKahana (1993); and Kahana, Harel, and Kahana(1988).

As an independent variable, resilience hasbeen conceptualized as a personality character-istic (e.g., hardiness, locus of control) and interms of ego processes. J. H. Block and Kremen(1996) studied the relationship between intelli-

gence and ego resiliency using Block’s measureof ego resilience as an independent variable(Block, 1981; J. H. Block & Block, 1980). The peo-ple were participants in the Longitudinal Studyof Cognitive and Ego Development who wereadministered measures of intelligence, a 14-item scale to assess ego resilience, and the Cali-fornia Adult Q-Sort of personality measure-ment. The study generated a wide set of find-ings that included descriptions of persons withhigh levels of ego resilience who were charac-terized on dimensions that included flexibility,challenge, confidence, curiosity, assertiveness,control, sociability, energy, and prosocial dispo-sitions. When the effects of intelligence werecontrolled, resilient men and women werefound to be outgoing, warm, assertive, calm, en-ergetic, autonomous, active, productive, inter-nally consistent, poised, and responsive to hu-mor. In summarizing their findings, J. H. Blockand Kremen stated, “The biosocial problem ofthe individual is adaptation. Insufficiencies of ad-aptation are signaled to the individual by the intru-sion of affect. Yet, current expanded conceptions ofintelligence have remained ‘cognitive’ and stilllargely ignore affective and motivational aspects ofbehavior” (p. 359, emphasis added). It would ap-pear that ego resilience reflects qualities of per-sonality and their use in adaptation but also acapacity to modulate stress response, an impor-tant issue in the dynamics of PTSD. Consistentwith Fredrickson’s (2001) formulation that posi-tive emotions establish a “broaden and build”domain of effective behaviors in regards tostress modulation, ego resilience appears to re-flect an interrelated set of cognitive and person-ality variables that work in harmony to promoteresilient behavior. These findings match conclu-sions by Siebert (1996), who studied the traits ofsurvivors of extreme environmental hardshipand threats to life. Siebert indicated that survi-vor personalities were characterized by opti-mism, acceptance of their situational fate, cre-ative problem solving, and the integration ofright-brain abilities of intuition and holisticthinking with left-brain analytical thinking.These characteristics of survivor personalitytraits are quite similar to the attributes of ego re-siliency as described by J. H. Block and Kremen.


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In two related studies, Connor and Davidson(2003; Connor, Davidson, & Lee, 2003) reportedfindings on the development of a scale to mea-sure resilience as a concept. In the first study, the25-item Connor-Davidson Resilience Scale(CD-RISC) was developed to measure dimen-sions thought to be associated with resilience(e.g., 1. able to adapt to change, 6. see the humanside of things, 12. when things look hopeless, Idon’t give up). Five groups of participants wereselected for study: (a) general population, (b)psychiatric outpatients, (c) participants in ageneralized anxiety disorder study, (d) patientsin private practice, and (e) participants in astudy of PTSD. The 25-item CD-RISC was ad-ministered to all five groups and subjected to afactor analysis and revealed five factors: (a) per-sonal competence, (b) affect tolerance, (c) accep-tance of change, (d) sense of internal control,and (e) spirituality. The CD-RISC scale was alsocross-validated in this study with the Kobasahardiness measure, the Perceived Stress Scale,and the Stress Vulnerability Scale. The resultsshow that measured resilience was significantlycorrelated with high levels of hardiness and lowlevels of perceived stress vulnerability.

Connor et al. (2003) used the CD-RISC in astudy of survivors of violent trauma who com-pleted an online computer survey that assessedspirituality, anger, health, PTSD, and trauma-related distress. As predicted, resilience was as-sociated with more positive outcomes in termsof current physical and mental health status andfewer PTSD symptoms. The results suggest thatalthough the relationship between trauma andpsychological distress is complex, resilienceis strongly associated with positive outcomesin terms of affect balance (i.e., less anger), fewerPTSD symptoms, and better overall healthstatus.

There are several recent studies that have ex-amined the role of positive emotions in copingwith stress, trauma, and adverse life circum-stances. Fredrickson (1998, 2001) developed the“broaden and build” theory of positive emo-tions, which posits, among other things, thatpositive emotional states may mediate varioustypes of behavioral phenomena. Fredricksonargued that the role of positive emotions hasbeen inadequately investigated but cites re-

search supporting the idea that positive emo-tions are associated with some types of resilientfunctioning. For example, Tugade and Fredrick-son (2004) found that resilient participants in ananxiety-producing experimental task returnedto homeostasis faster than did nonresilient par-ticipants. More specifically, Fredrickson sug-gested that positive emotions, which includejoy, interest, contentment, and love, have a func-tional capacity to broaden a “thought-action”repertoire and lead to effective coping. This ideawas tested in a study of college students whowere evaluated before and after the September11, 2001, terrorist attacks on the World TradeCenter in New York City. Resilience was mea-sured by J. H. Block and Kremen’s (1996) ego re-silience scales. Personality characteristics wereassessed by the neuroticism, extraversion,openness (NEO) five-factor model and by mea-sures of current mood using a scale to rate cur-rent affective states (e.g., sadness/depression,joy/excitement, etc.). The results showed thatpositive emotions were associated with pre-911resilience and the absence of depressive symp-toms post-911. In short, those who manifestgratitude, interest, love, and other positive emo-tions were less distressed emotionally by theterrorist attacks. Similar results were found byFolkman (1997; Folkman & Moskowitz, 2000) instudies of HIV/AIDS-related caregiving(Moskowitz, Acree, & Folkman, 1998, as cited inFolkman & Moskowitz, 2000). Those who hadpositive affect, as assessed by the Bradburn Af-fect Balance Scale, were less clinically depressedduring the course of the study period than thosewho experienced negative affect. Building onthe seminal work of Lazarus and Folkman(1984), Folkman and Moskowitz (2000) identi-fied three different coping styles: (a) positive re-appraisal, (b) problem-focused coping, and (c)the capacity to create meaning. Clearly, resil-ient persons and resilient forms of situationallybased coping responses may use these styles ofpositive coping with stress, trauma, and ordin-ary hassles of daily living.

The relation of exposure to terrorism, warstressors, and resilience among children sub-jected to ongoing violence, chaos, and disrup-tion of normal living was studied by Punamaki,Qouta, and El-Sarraj (2001). They found that

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children exposed to terrorism experience loss,danger, and fear for their lives and can sufferfrom anxiety, emotional problems, and PTSDsymptoms. Children not only experienced po-litical violence but manifested positive changeswhen Israeli troops withdrew from the occu-pied geographical area of Gaza. The environ-mental changes included lifting of a nighttimecurfew, cessation in attacks and bombed hous-ing, the frequency and amount of death andkilling, and a decrease in the general violence.Other relevant changes included political pris-oners returning home and schools reopening.

Punamaki et al. (2001) stated that children’sstress decreased after the 1991 Gulf War’s SCUDmissile attacks ceased. They suggested that re-siliency depends on the parents’ and family’scoping responses and that younger childrenmay be more susceptible to military violencethan older children.

Research on Palestinian children found thatparental love and proper discipline increased achild’s resilience by increasing their creativityand cognitive capacity (Ayalon, 1993; Puna-maki, 1997). If a mother was unable to controlher intrusive PTSD symptoms (e.g., recallinghorrible war images) and had an avoidant cop-ing patterns, her children would be more vul-nerable to war stressors, a finding also reportedby Laor, Wolmer, Mayes, Gersham, and Weiz-man (1997). According to Punamaki et al.(2001), this is evidence that the trauma experi-enced by the child is dependent on how the par-ents react, a finding commonly shown in the di-saster literature (Green, 1993; Gleser, Green, &Winget, 1981; Raphael, 1983; Wilson & Raphael,1993). In addition, Laor and Wolmer (1997; Laor,Wolmer, & Cohen, 2001) reported greater PTSDand psychiatric symptom rates for Israeli chil-dren whose families were displaced and ad-versely effected by SCUD missile attacks duringthe first Gulf War (1991) in Iraq. Punamaki et al.(2001) found that single stressor events do notpredict resiliency or vulnerability. They suggestthat even if a child has positive coping skills(e.g., high cognitive capacity, intelligence, andcreativity) parents need to encourage thesecharacteristics in the service of resilience duringsituations of extreme stress, such as terrorist sui-cide bombings or war violence.

In a study of children in guerrilla urban war-fare, Punamaki et al. (2001) followed Palestin-ian children 3 years after the cessation of mili-tary violence in the Gaza strip and occupiedterritory in Israel. Results indicated that an ac-tive response to military violence, creativity(e.g., high cognitive capacity) and nurturingparenting styles resulted in beneficial copingthat they viewed as resiliency factors. Thosewho had responded proactively to the violenceexhibited fewer PTSD symptoms and emo-tional disorders. The stress-related anxietysymptoms of children decreased significantlyduring the 3-year follow-up period. These chil-dren were considered to have plasticity in theircoping behavior. Nevertheless, other childrenexperienced vulnerability that resulted in in-creases in psychiatric symptoms during thewar-related violence and manifest PTSD symp-toms 3 years later. Gender differences showedthat girls were found to be more vulnerable thanboys and that girls’ symptoms decreased lessacross time.


Based on the studies reviewed above, Figure1 presents a summary illustration of resiliencein response to psychological trauma. The modelidentifies key variables that interact dynami-cally in the determination of resilient behaviorevoked by traumatic life experiences. The figureis a simplification of the various pathways bywhich resilience results from exposure to differ-ent types of traumatic events (see Wilson &Lindy, 1994, for a discussion).

The model is a person-environment para-digm of resiliency in relation to the perception,processing, and adaptation to traumatic stress.As such, it incorporates the earlier models pre-sented by Green, Wilson, and Lindy (1985),Maddi (1999b), Richardson (2002), Wilson(1989), and Wilson et al. (2001). The integrativenature of the model helps to identify the com-plex levels of interaction among many classes ofvariables that can work together to produce acontinuum of adaptive behavior and differentdegrees of resilient behavior in the wake of psy-chological trauma. Furthermore, as our review


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of the literature suggests, the model of resil-iency in response to trauma serves to clarifywhich aspects of the resilience puzzle have been

investigated empiricallyand which ones have notbeen studied at all orwithin the context of aninteractional model thatattempts to specify howtraumatic events impactinternal psychologicalprocesses at multiplelevels of psychologicalfunctioning.

To understand the plas-ticity of behavior in re-sponse to traumatic lifeevents, it is necessary to

recognize the multidimensional nature of trau-matic experiences. Traumas are not equal intheir impact to the psyche and vary greatly intheir stressor dimensions (Wilson, 1989, 2004a;Wilson & Lindy, 1994). Second, there are indi-vidual subjective responses evoked by traumathat set in motion a cascade of internal psycho-logical processes (Wilson, 2004b). Third, thereare different types of stressor events (e.g., sin-gle, multiple, single vs. complex) that vary intheir severity of impact and resultant states ofallostatic load (McEwen, 1998, 2002; Wilsonet al., 2001). As an intricate part of allostatic loadphenomena, there are degrees of affect dysregu-lation that are directly related to the cognitiveprocessing of traumatic experiences (Schore,2002). There are at least five distinct patterns ofallostatic load caused by trauma that result in

210 TRAUMA, VIOLENCE, & ABUSE / July 2005

“At Risk” for PTSD &


High Resilience

Approach / Active Problem-Solving / Coping

Avoidance / Non-Focused Emotional Coping

(a x b x c x d x e = Interactions)

(d) (e) (c) (b) (a)

Traumatic Life Events

Specific stressor dimensions (e.g., duration, severity, degree of threat, etc.) Subjective experience of traumatic stressors (e.g., degree of affect dysregulation) Types of stressor (single, multiple, complex, etc.) Level of stressor impact (e.g., threat, injury, exposure, etc.) Type of allostatic load (e.g., repetitive system failure,e tc.) Level of affect dysregulation (i.e., negative or positive affect balance)

Impact to Personality, Self-Structure & Ego-Processes Caused by Trauma

Structure of Personality Characteristics (e.g., five factor model) Ego-States: (1) static, (2) fluctuating, (3) regressed, (4) accelerated Identity configuration: fragmented vs. integrated Bases of self-worth, ego-strength and ego-resiliency Sense of vulnerability to master anxiety situations and cope competently Ego defenses against injury and vulnerability Changes in ideology, beliefs and world view Cognitive schemas in self, others and reality Dissociative & peri-dissociative processes

Activation of Allostatic Stress Response

Ego Defenses

Personality Characteristics

Affect Modulation

Coping Style

Mobilization & Utilization of Protective Factors

Continuum of Adaptation & Resilience

Low Resilience

Minimal Coping

Optimal Coping

Acute & Long-Term Negative


Acute & Long-Term Positive


Normal Range of Coping





Figure 1: A Model of Resilience in Response to Psychological Trauma©

SOURCE: Wilson (2001, 2004).

To understand theplasticity of behaviorin response totraumatic life events,it is necessary torecognize themultidimensionalnature of traumaticexperiences. Traumasare not equal in theirimpact to the psycheand vary greatly intheir stressordimensions.

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different baseline levels of organismic function-ing following trauma (McEwen, 2002). In otherwords, there is a new “set point” of stressresponse patterns (Wilson et al., 2001; Wilson &Thomas, 2004)

It is a truism to say that traumatic events im-pact preexisting personality organization (i.e.,structure, dynamics, defenses, competencies,self-structure, and ego processes). As Figure 1shows, there are potential impacts to active egostates, identity configurations, and cognitiveschemas of self, others, and situations. Traumahas the power to evoke peri-traumatic dissocia-tion (Marmar, Metzler, & Otte, 2004; Marmar,Weiss, & Metzler, 1997) and full-blowndissociative states (Wilson et al., 2001). Consid-ered from a holistic perspective, trauma’s im-pact to the organism not only has the power toattack personality and self-processes but it alsoautomatically activates allostatic stress re-sponse patterns that are part of the sensory ner-vous system’s (SNS) neurohormonal engineer-ing system governing acute and prolongedforms of human stress response (Friedman,2000b; McEwen, 2002; Wilson, 2004b).

The activation of allostatic stress responsepatterns include at least five interrelated areasof functioning: (a) coping styles, (b) affect mod-ulation and degrees of affect balance, (c) person-ality characteristics (e.g., hardiness, locus ofcontrol, assertiveness, etc.), (d) ego-defensiveprocesses, and (e) the mobilization and utiliza-tion of protective factors that may exist in therepertoire of coping behaviors.

The outcome of the response patterns trig-gered by a traumatic life event is the generationof a continuum of adaptation and resilience.Viewed in this way, the positive end of the con-tinuum reflects optimal coping with trauma.This includes acute and long-term patterns ofadaptation and resilience that results from themastery of excessive stress by (a) the operationof specific personality variables (e.g., hardiness)that moderates the effects of traumatic stressors;(b) the function of ego defenses and protectivefactors that are part of ego states, identity con-figuration, and coping styles; (c) the capacity foraffect modulation (i.e., affect balance); (d) thecapacity to maintain a positive outlook and cre-ate a positive sense of meaning from the trauma

experience that may be aided by mobilizing so-cial support mechanisms; and (e) themanifestation of resilient forms of behavior asrequired by specific stressors that, in turn,evoke a stress response syndrome, whether it isnormal, acute, or prolonged, as in the case ofPTSD.


Our review of the literature on trauma, PTSD,and resilience has identified a core set of find-ings that fit well within the model illustrated inFigure 1. In summary, these results show that re-searchers have implicitly used a Person × Situa-tion interactional model in formulating hypoth-eses about the factors that influence differentforms of resilient behavior for different survivorpopulations. However, the task of predicting re-siliency is further complicated because there isno universally defined concept of what consti-tutes resilient behavior. In some cases, resil-iency is defined by the absence of psycho-pathology, prolonged stress response patterns(e.g., PTSD), or maladaptive coping. In othercases, resilience is defined by having superiorcoping, on average, over a longitudinal courseof life-span development (Felsman & Vaillant,1982). In some studies, resilience is defined as apersonality variable (e.g., locus of control, egoresilience, hardiness) that is presumed to mod-erate outcome variables. As a personality vari-able, high levels of resilience have been exam-ined in terms of how resilience affects thinking,perception, affect modulation, and dispositionto behavior. Personality processes (e.g., hardi-ness, locus of control, self-esteem, assertiveness,etc.) are one side of the person-environmentequation that determines the stress appraisalprocess and, by implication, the level of emo-tional arousal experienced as well as the capac-ity to modulate affect (J. H. Block & Kremen,1996). Personality processes, including intelli-gence and cognitive styles of information pro-cessing, are correlated with coping styles (e.g.,avoidance, approach, problem solving, emo-tional) and the types of ego defenses used underanxiety-provoking situations (Fels & Vaillant,1987; Vaillant, 1977). There is evidence that cop-ing style and ego defense are related to the ca-


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pacity to mobilize and utilize protective factorsto master overwhelmingly stressful situations.In this regard, researchers have identified pro-tective factors such as social and personal sup-port mechanisms, mobilizing aid, and initiatinginstrumental actions directed at finding solu-tions to the problems embedded within thestressful situation.

It is important to attempt to define a concep-tually meaningful continuum of adaptation andresilience as pertains to normal, acute, and pro-longed forms of human stress response (Fried-man, 2000b; McEwen, 2002; Wilson et al., 2001).

Optimal coping and adaptation defines highlyresilient behaviors in terms of acute and long-term positive adaptation. At the other end of thecontinuum, minimal coping defines acute andlong-term negative adaptation and representssignificant risk factors for the development ofPTSD and psychopathology. When consideringposttraumatic resilience on a continuum of opti-mal levels of environmental adaptation, it ispossible to define the property of resilience as acomplex repertoire of behavioral tendenciesthat may be evoked or activated by environ-mental demands.

IMPLICATIONS FOR PRACTICE, POLICY, & RESEARCH• Understanding posttraumatic resilience is criti-

cal to successful treatment.• Posttraumatic resilience can be learned.• Posttraumatic resilience characterizes psy-

chobiologically healthy survivors.

• Posttraumatic resilience can be implementedthrough training programs to reduce the ef-fects of traumatic exposure.

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SUGGESTED FUTURE READINGSAnthony, E. J., & Cohler, B. J. (1987). The invulnerable child.

New York: Guilford.Wilson, J. P. (in press). The posttraumatic self: Restoring mean-

ing and wholeness to personality. New York: Routledge.Wilson, J. P., & Drozdek, B. (2004). Broken spirits: The treat-

ment of traumatized asylum seekers, refugees, war and tor-ture victims. New York: Brunner-Routledge.

Wilson, J. P., & Thomas, R. (2004). Empathy in the treatment oftrauma and PTSD. New York: Brunner-Routledge.

Zuckerman, M. (1999). Vulnerability to psychopathology.Washington, DC: American Psychological Association.

Christine E. Agaibi, M.A., is currently adoctoral student in counseling psychology atthe University of Akron. She received herbachelor’s degree in 1999 from John CarrollUniversity and her master’s in clinical coun-seling psychology in 2003 from Cleveland

State University. Her professional and research interestsare in the areas of resiliency, coping, child development,and posttraumatic growth. She has authored a literaturereview for her master’s thesis titled “UnderstandingResilience to the Effects of Traumatic Stress.” She is a stu-dent affiliate member of the American Psychological Asso-ciation, the Society of Counseling Psychology (APA Divi-sion 17), Division of Theoretical and PhilosophicalPsychology (APA Division 24), Division of ClinicalNeuropsychology (APA Division 40), the Cleveland Psy-chological Association, Psi Chi, and is student representa-tive-elect for her current university’s counseling psychol-ogy graduate student organization.

John P. Wilson, Ph.D., is a professor of psy-chology and a Fulbright Scholar at ClevelandState University. He is cofounder of the Inter-national Society for Traumatic Stress Studies.He is the author of more than 10 books onposttraumatic stress disorder including (with

Boris Drozdek) Broken Spirits: The Treatment of Trau-matized Asylum Seekers, Refugees, War and TortureVictims (Brunner-Routledge 2004); Empathy in theTreatment of Trauma and PTSD (Routledge, 2004, 2nded.); and Assessing Psychological Trauma and PTSD(Guilford, 2004, 2nd ed.). He has received numerousawards for his work, including the George WashingtonHonor Medal.

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