Abstract
Resilience following trauma is the rule, not the exception. The minority of individuals who go on to suffer chronic pathology such as posttraumatic stress disorder (PTSD) will likely benefit from a number of evidence-based treatments. The study of resilience provides a new framework to examine and build upon these existing therapies. This article outlines an evidence-based theoretical model for understanding psychotherapy for PTSD through the lens of resilience. Specifically, we explore three broad factors thought to underlie resilience: social support, returning to daily routine, and meaning making. We review the literature regarding the impact of these factors on natural recovery after a trauma as well as treatment response. We connect these processes to interventions and techniques used in several empirically supported therapies, highlighting compatibility and synergy with therapeutic goals. With this review, we aim to map our existing knowledge about resilience onto theoretical models of treatment efficacy to broaden our conceptualization of treatment mechanisms and spur new ideas to improve clinical outcomes for those suffering due to trauma.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
This vignette represents a mixture of various clients whom we have seen in our clinical work who have experienced PTSD. Any resemblance to a specific individual is purely coincidental.
References
Aguirre-McLaughlin, A., Keller, S. M., Feeny, N. C., Youngstrom, E. A., & Zoellner, L. A. (2014). Patterns of therapeutic alliance: Rupture–repair episodes in prolonged exposure for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 82(1), 112. doi:10.1037/a0034696.
Alim, T. N., Feder, A., Graves, R. E., Wang, Y., Weaver, J., Westphal, M., & Charney, D. S. (2008). Trauma, resilience, and recovery in a high-risk african-american population. The American Journal of Psychiatry, 165(12), 1566–1575. doi:10.1176/appi.ajp.2008.07121939.
Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59(1), 20–28. doi:10.1037/0003-066X.59.1.20.
Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68(5), 748–766. doi:10.1037/0022-006X.68.5.748.
Cheavens, J. S., Strunk, D. R., Lazarus, S. A., & Goldstein, L. A. (2012). The compensation and capitalization models: A test of two approaches to individualizing the treatment of depression. Behaviour Research and Therapy, 50(11), 699–706. doi:10.1016/j.brat.2012.08.002.
Cloitre, M., Stolbach, B. C., Herman, J. L., Kolk, V. D., Pynoos, R., Wang, J., & Petkova, E. (2009). A developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22(5), 399–408. doi:10.1002/jts.20444.
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. doi:10.1037/0033-2909.98.2.310.
Dimidjian, S., Barrera, M. J., Martell, C., Muñoz, R. F., & Lewinsohn, P. M. (2011). The origins and current status of behavioral activation treatments for depression. Annual Review of Clinical Psychology, 7, 1–38. doi:10.1146/annurev-clinpsy-032210-104535.
Dolbier, C. L., & Steinhardt, M. A. (2000). The development and validation of the sense of support scale. Behavioral Medicine, 25(4), 169–179. doi:10.1080/08964280009595746.
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. doi:10.1016/S0005-7967(99)00123-0.
Feeny, N. C., & Zoellner, L. A. (2014). Conclusion: Risk and resilience following trauma exposure. In L. A. Zoellner, N. C. Feeny, L. A. (Eds.), Facilitating resilience and recovery following trauma, (pp. 325–334). New York: Guilford Press. http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2014-05879-014&site=ehost-live
Foa, E. B., Dancu, C. V., Hembree, E. A., Jaycox, L. H., Meadows, E. A., & Street, G. P. (1999a). A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology, 67(2), 194–200. doi:10.1037/0022-006X.67.2.194.
Foa, E. B., Ehlers, A., Clark, D. M., Tolin, D. F., & Orsillo, S. M. (1999b). The posttraumatic cognitions inventory (PTCI): Development and validation. Psychological Assessment, 11(3), 303–314. doi:10.1037/1040-3590.11.3.303.
Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A. M., Riggs, D. S., Feeny, N. C., & Yadin, E. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73(5), 953–964. doi:10.1037/0022-006X.73.5.953.
Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences: Therapist guide. New York: Oxford University Press. http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2007-01296-000&site=ehost-live
Foa, E. B., Huppert, J. D., & Cahill, S. P. (2006). Emotional processing theory: An update. In B. O. Rothbaum (Ed), Pathological anxiety: Emotional processing in etiology and treatment (pp. 3–24). New York: Guilford Press. http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2005-16244-001&site=ehost-live
Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132(6), 823–865. doi:10.1037/0033-2909.132.6.823.
Gros, D. F., Price, M., Strachan, M., Yuen, E. K., Milanak, M. E., & Acierno, R. (2012). Behavioral activation and therapeutic exposure: An investigation of relative symptom changes in PTSD and depression during the course of integrated behavioral activation, situational exposure, and imaginal exposure techniques. Behavior Modification, 36(4), 580–599. doi:10.1177/0145445512448097.
Hobfoll, S. E., Hall, B. J., Canetti-Nisim, D., Galea, S., Johnson, R. J., & Palmieri, P. A. (2007). Refining our understanding of traumatic growth in the face of terrorism: Moving from meaning cognitions to doing what is meaningful. Applied Psychology: An International Review, 56(3), 345–366. doi:10.1111/j.1464-0597.2007.00292.x.
Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9–16. doi:10.1037/a0022186.
Hyman, S. M., Gold, S. N., & Cott, M. A. (2003). Forms of social support that moderate PTSD in childhood sexual abuse survivors. Journal of Family Violence, 18(5), 295–300. doi:10.1023/A:1025117311660.
Kashdan, T. B., Elhai, J. D., & Frueh, B. C. (2006). Anhedonia and emotional numbing in combat veterans with PTSD. Behaviour Research and Therapy, 44(3), 457–467. doi:10.1016/j.brat.2005.03.001.
Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27. doi:10.1146/annurev.clinpsy.3.022806.091432.
King, D. W., Taft, C., King, L. A., Hammond, C., & Stone, E. R. (2006). Directionality of the association between social support and posttraumatic stress disorder: A longitudinal investigation. Journal of Applied Social Psychology, 36(12), 2980–2992. doi:10.1111/j.0021-9029.2006.00138.x.
Kleim, B., Grey, N., Wild, J., Nussbeck, F. W., Stott, R., Hackmann, A., & Ehlers, A. (2013). Cognitive change predicts symptom reduction with cognitive therapy for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 81(3), 383–393. doi:10.1037/a0031290.
Layne, C. M., Beck, C. J., Rimmasch, H., Southwick, J. S., Moreno, M. A., & Hobfoll, S. E. (2009). Promoting ‘resilient’ posttraumatic adjustment in childhood and beyond: ‘unpacking’ life events, adjustment trajectories, resources, and interventions. In D. Brom, R. Pat-Horenczyk, J. D. Ford (Eds.), Treating traumatized children: Risk, resilience and recovery, (pp. 13–47). New York: Routledge/Taylor & Francis Group. http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2008-07817-002&site=ehost-live
Layne, C. M., Warren, J. S., Watson, P. J., & Shalev, A. Y. (2007). Risk, vulnerability, resistance, and resilience: Toward an integrative conceptualization of posttraumatic adaptation. In M. J. Friedman, T. M. Keane, & P. A. Resnick (Eds.), Handbook of PTSD: Science and practice (pp. 497–520). New York: Guilford. http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2007-14029-024&site=ehost-live
Litz, B. T. (2005). Has resilience to severe trauma been underestimated? American Psychologist, 60(3), 262. doi:10.1037/0003-066X.60.3.262a.
Mallinckrodt, B. (1996). Change in working alliance, social support, and psychological symptoms in brief therapy. Journal of Counseling Psychology, 43(4), 448–455. doi:10.1037/0022-0167.43.4.448.
Marshall, R. D., & Suh, E. J. (2003). Contextualizing trauma: Using evidence-based treatments in a multicultural community after 9/11. Psychiatric Quarterly, 74(4), 401–420. doi:10.1023/A:1026043728263.
Marx, B. P., & Sloan, D. M. (2005). Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology. Behaviour Research and Therapy, 43(5), 569–583. doi:10.1016/j.brat.2004.04.004.
Overholser, J. C. (2010). Psychotherapy according to the socratic method: Integrating ancient philosophy with contemporary cognitive therapy. Journal of Cognitive Psychotherapy, 24(4), 354–363. doi:10.1891/0889-8391.24.4.354.
Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129(1), 52–73. doi:10.1037/0033-2909.129.1.52.
Park, C. L. (2010). Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin, 136(2), 257–301. doi:10.1037/a0018301.
Prati, G., & Pietrantoni, L. (2009). Optimism, social support, and coping strategies as factors contributing to posttraumatic growth: A meta-analysis. Journal of Loss and Trauma, 14(5), 364–388. doi:10.1080/15325020902724271.
Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70(4), 867–879. doi:10.1037/0022-006X.70.4.867.
Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), 748–756. doi:10.1037/0022-006X.60.5.748.
Riggs, D. S., Rothbaum, B. O., & Foa, E. B. (1995). A prospective examination of symptoms of posttraumatic stress disorder in vicitms of nonsexual assault. Journal of Interpersonal Violence, 10(2), 201–214. doi:10.1177/0886260595010002005.
Rothbaum, B. O., & Davis, M. (2003). Applying learning principles to the treatment of post-trauma reactions. In J. A. King, C. F. Ferris, I. I. Lederhendler (Eds.), Roots of mental illness in children (pp. 112–121). New York: New York Academy of Sciences. http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2004-00322-009&site=ehost-live
Rothbaum, B. O., Foa, E. B., Riggs, D. S., Murdock, T., & Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress, 5(3), 455–475. doi:10.1002/jts.2490050309.
Savoca, E., & Rosenheck, R. (2000). The civilian labor market experiences of vietnam-era veterans: The influence of psychiatric disorders. Journal of Mental Health Policy and Economics, 3(4), 199–207. doi:10.1002/mhp.102.
Schnurr, P. P., Friedman, M. J., Engel, C. C., Foa, E. B., Shea, M. T., Chow, B. K., & Bernardy, N. (2007). Cognitive behavioral therapy for posttraumatic stress disorder in women: A randomized controlled trial. JAMA. Journal of the American Medical Association, 297(8), 820–830. doi:10.1001/jama.297.8.820.
Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social Science and Medicine, 32(6), 705–714. doi:10.1016/0277-9536(91)90150-B.
Sloan, D. M., & Wisco, B. E. (2014). Disclosure of traumatic events. In L. A. Zoellner, N. C. Feeny (Eds.), Facilitating resilience and recovery following trauma (pp. 191–209). New York: Guilford Press. http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2014-05879-009&site=ehost-live
Steenkamp, M. M., Dickstein, B. D., Salters-Pedneault, K., Hofmann, S. G., & Litz, B. T. (2012a). Trajectories of PTSD symptoms following sexual assault: Is resilience the modal outcome? Journal of Traumatic Stress, 25(4), 469–474. doi:10.1002/jts.21718.
Steenkamp, M. M., Nickerson, A., Maguen, S., Dickstein, B. D., Nash, W. P., & Litz, B. T. (2012b). Latent classes of PTSD symptoms in vietnam veterans. Behavior Modification, 36(6), 857–874. doi:10.1177/0145445512450908.
Tiet, Q. Q., Rosen, C., Cavella, S., Moos, R. H., Finney, J. W., & Yesavage, J. (2006). Coping, symptoms, and functioning outcomes of patients with posttraumatic stress disorder. Journal of Traumatic Stress, 19(6), 799–811. doi:10.1002/jts.20185.
Trickey, D., Siddaway, A. P., Meiser-Stedman, R., Serpell, L., & Field, A. P. (2012). A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clinical Psychology Review, 32(2), 122–138. doi:10.1016/j.cpr.2011.12.001.
Tull, M. T., Gratz, K. L., Salters, K., & Roemer, L. (2004). The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. Journal of Nervous and Mental Disease, 192(11), 754–761. doi:10.1097/01.nmd.0000144694.30121.89.
Williams, M. T., Malcoun, E., Sawyer, B. A., Davis, D. M., Nouri, L. B., & Bruce, S. L. (2014). Cultural adaptations of prolonged exposure therapy for treatment and prevention of posttraumatic stress disorder in african americans. Behavioral Sciences, 4(2), 102–124. doi:10.3390/bs4020102.
Yehuda, R., & Flory, J. D. (2007). Differentiating biological correlates of risk, PTSD, and resilience following trauma exposure. Journal of Traumatic Stress, 20(4), 435–447. doi:10.1002/jts.20260.
Yehuda, R., Flory, J. D., Southwick, S., & Charney, D. S. (2006). Developing an agenda for translational studies of resilience and vulnerability following trauma exposure. In R. Yehuda (Ed.), Psychobiology of posttraumatic stress disorders (pp. 379–396). Malden: Blackwell Publishing. http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2006-10981-028&site=ehost-live
Yufik, T., & Simms, L. J. (2010). A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms. Journal of Abnormal Psychology, 119(4), 764–776. doi:10.1037/a0020981.
Zalta, A. K., Gillihan, S. J., Fisher, A. J., Mintz, J., McLean, C. P., Yehuda, R., & Foa, E. B. (2014). Change in negative cognitions associated with PTSD predicts symptom reduction in prolonged exposure. Journal of Consulting and Clinical Psychology, 82(1), 171–175. doi:10.1037/a0034735.
Zoellner, L. A., Foa, E. B., & Brigidi, B. D. (1999). Interpersonal friction and PTSD in female victims of sexual and nonsexual assault. Journal of Traumatic Stress, 12(4), 689–700. doi:10.1023/A:1024777303848.
Acknowledgments
This manuscript was supported in part by grants from the National Institute of Mental Health (R01MH066347: Zoellner; R01MH06648: Feeny).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Burton, M.S., Cooper, A.A., Feeny, N.C. et al. The Enhancement of Natural Resilience in Trauma Interventions. J Contemp Psychother 45, 193–204 (2015). https://doi.org/10.1007/s10879-015-9302-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10879-015-9302-7