EUROPEAN JOURNAL OF

PSYCHOTRAUMATOLOGY æ

RESILIENCE AND TRAUMA

Psychosocial facets of resilience: implications for

preventing posttrauma psychopathology, treating
trauma survivors, and enhancing community resilience
Brian M. Iacoviello* and Dennis S. Charney
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Background: There is a range of potential responses to stress and trauma. Whereas, on one extreme,
some respond to stress and trauma by developing psychiatric disorders (e.g., posttraumatic stress disorder,
PTSD), on the other extreme are the ones who exhibit resilience. Resilience is broadly defined as adaptive
characteristics of an individual to cope with and recover from adversity.
Objective: Understanding of the factors that promote resilience is warranted and can be obtained by
interviewing and learning from particularly resilient individuals as well as empirical research. In this paper, we
discuss a constellation of factors comprising cognitive, behavioral, and existential elements that have been
identified as contributing to resilience in response to stress or trauma.
Results: The psychosocial factors associated with resilience include optimism, cognitive flexibility, active
coping skills, maintaining a supportive social network, attending to one’s physical well-being, and embracing
a personal moral compass.
Conclusions: These factors can be cultivated even before exposure to traumatic events, or they can be targeted
in interventions for individuals recovering from trauma exposure. Currently available interventions for PTSD
could be expanded to further address these psychosocial factors in an effort to promote resilience. The
cognitive, behavioral, and existential components of psychosocial factors that promote individual resilience
can also inform efforts to promote resilience to disaster at the community level.
Keywords: Resilience; trauma; psychosocial; factors
Responsible Editors: Ananda Amstadter, Virginia Institute for Psychiatric and Behavioral Genetics, VA, USA.
Nicole Nugent, Warren Alpert Medical School of Brown University, RI, USA.
*Correspondence to: Brian M. Iacoviello, One Gustave L Levy Place, Box 1230, New York, NY 10029, USA,
Email: [email protected]

For the abstract or full text in other languages, please see Supplementary files under Article Tools online

This paper is part of the Special Issue: Resilience and Trauma. More papers from this issue can be found at
http://www.eurojnlofpsychotraumatol.net

Received: 31 January 2014; Revised: 30 March 2014; Accepted: 25 April 2014; Published: 1 October 2014

In the total sense of my life, it’s probably been a how to get through hard things. You just become
good experience for me . . . I wouldn’t erase the tougher emotionally.
experience, because I got benefits out of it. Thomas E. Collins III, former Vietnam
I can’t erase it. I can’t go back and change it prisoner of war
. . . Frankly, it left permanently more good things
in my life than it did bad things . . . Pain creates Trauma comes in many forms, and people’s
character . . . I’m not volunteering to go back, reactions vary
but it’s happened. I’ll take advantage of the good There is a range of potential responses to stress and
things . . . If you can endure pain, you’ll learn trauma. On the one hand, retrospective research studies

Submitted for the special issue of the European Journal of Psychotraumatology (EJPT) titled ‘‘Resilience after Trauma: From Surviving to Thriving.’’

European Journal of Psychotraumatology 2014. # 2014 Brian M. Iacoviello and Dennis S. Charney . This is an Open Access article distributed under the terms of the Creative 1
Commons Attribution 4.0 Unported (CC-BY 4.0) License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any
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Citation: European Journal of Psychotraumatology 2014, 5: 23970 - http://dx.doi.org/10.3402/ejpt.v5.23970
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Brian M. Iacoviello and Dennis S. Charney

have demonstrated strong associations between the pre- components concern patterns of action, and existential
sence of psychiatric disorders and a history of trauma components concern one’s sense of his or her existence,
exposure, with the most severe and impairing manifes- purpose or meaning in the world. This tripartite con-
tations being posttraumatic stress disorder (PTSD), ceptualization is supported by a factor analysis of the
depressive disorders, and substance use disorders. On items on a widely used tool used to assess resilience: the
the other hand, it is noteworthy that in most cases, Connor
Davidson Resilience Scale (Connor & Davidson,
trauma exposure does not lead to psychiatric disorders. 2003). This factor analysis yielded five factors, which the
For example, one high-quality study based on a large authors interpreted as: (1) a sense of personal compe-
community sample found that the risk of developing tence and tenacity; (2) tolerance of negative affect and
PTSD after a traumatic event was approximately 9% acceptance of the strengthening effects of stress; (3)
(Breslau et al., 1998). Furthermore, some have exhibited acceptance of change and cultivating secure relationships;
a remarkable ability to endure and recover from un- (4) sense of control; and (5) spiritual influences (Connor
fathomable stress, torture, trauma, and disaster. Resi- & Davidson, 2003). Factors 1, 2, and 4 include cognitive
lience, as a psychosocial construct, is generally described components: patterns of thinking and core beliefs that,
as adaptive characteristics of an individual to cope when confronted with stressful or traumatic situations,
with and recover from (and sometimes even thrive after) lead one to believe they can endure and survive. Factors
adversity. Considering the range of stressful and trau- 1 and 3 include behavioral components: being active and
matic experiences humans can face, and the range of engaged in one’s response to stress or traumatic situa-
potential responses, the factors that contribute to resi- tions, and actively cultivating relationships and social
lience compared to psychiatric disorders are an important support networks that will enable valuable resources
area of investigation. Understanding these factors can when confronting and recovering from these situations.
help promote resilience in individuals before they even Factor 5, spiritual influences, represents an existential
encounter trauma, can inform psychosocial intervention factor. The literature has also identified neuro-biological
strategies for treating trauma survivors, and can aid in factors that appear to influence resilience, including gene-
the development of resilient communities. tic factors, neurochemical systems involved in the stress
Anecdotal evidence from interviews with resilient response and the functioning of specific neural net-
individuals, and research evidence from studies of trauma works (Charney, 2004; Feder, Nestler, & Charney,
and disaster survivors, suggests that a constellation of 2009), although this is beyond the scope of this article.
psychosocial factors contribute to resilience after trauma Here we provide a focused discussion of some of the
exposure. These psychosocial factors appear to comprise psychosocial factors that have been shown to contri-
cognitive, behavioral, and existential components (see bute to resilience, and later we discuss recommendations
Table 1 for a description of the factors and their com- for cultivating these factors, implications for individual
ponents). In this context, cognitive components concern treatment after trauma exposure, and implications for
people’s patterns of thinking or core beliefs, behavioral developing resilient communities.

Table 1. Cognitive, behavioral, and existential components of psychosocial factors promoting resilience in individuals

Components

Factor Cognitive Behavioral Existential

Optimism Maintain positive expectancies for the future.

Cognitive flexibility Reappraise, reframe, and assimilate traumatic
experiences.
Accept stress (trauma) and failure as ingredients
for growth.
Active coping skills (versus Minimize continued appraisal of threat. Actively seek help
passive) Maintain positive self-regard. and resources.
Physical health Physical activity and
exercise.
Social support network Maintain a social Not feeling isolated or
support network. alone.
Personal moral compass Adaptive, positive core beliefs. Altruistic behavior. Faith/spirituality.
Purpose in life.

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 Psychosocial facets of resilience

Psychosocial factors that promote resilience: accept the brutal facts of their current reality. This is now
cognitive, behavioral, and existential known as the Stockdale Paradox (Collins, 2014).
components
Active coping skills and maintaining a social support
Optimism network
One factor that comprises primarily cognitive elements Active coping skills, as a factor promoting resilience,
is optimism. Optimism refers to the maintenance of pos- incorporates cognitive and behavioral components. Re-
itive expectancies for important future outcomes (Carver, silient individuals use active rather than passive coping
Scheier, & Segerstrom, 2010). Optimism has been con- skills; they act and create their own resilience. The
ceptualized as a personality dimension, suggesting it is cognitive component includes being mindful of one’s
likely more of a trait than a state characteristic, although thoughts about the situations they find themselves in and
an individual’s degree of optimism can be observed to actively minimizing the appraisal of threat (but not
shift over time or across situations. In research studies, denying threat) so as not to become consumed by fear.
optimism (often in addition to other characteristics) At the same time, efforts to create positive statements
has been associated with psychosocial well-being among about oneself and one’s situation, and active efforts to
long-term breast cancer survivors (Carver et al., 2005), seek the help and support of others, comprise the
with psychological adjustment during a life transi- behavioral or action-oriented components. This is also
tion (Brissette, Scheier, & Carver, 2002), and with lower associated with another important factor for promoting
posttraumatic symptom levels after experiencing a deadly resilience, establishing and nurturing a social support
earthquake (Ahmad et al., 2010). As regards resilience network. Very few can ‘‘go it alone’’ and interviews
in the face of adversity or trauma, maintaining optimism with resilient individuals often yield acknowledgment
for the future while suffering in the present can buoy of invaluable social support. Considerable emotional
one’s spirit and provide the stamina to endure. However, strength accrues from close relationships with people
optimism alone is not sufficient to foster resilience. The and even organizations. And the perception of an avail-
response of James Stockdale, the highest-ranking naval able ‘‘safety net’’ can enable one to act in one’s own
officer held as a prisoner of war in Vietnam and someone interest when confronting or recovering from stressful or
known for his resilience to this situation, to the question traumatic situations. Recent studies of PTSD in veterans
‘‘Who did not make it out of Vietnam?’’ reflects this: returning from wars in Iraq and Afghanistan support
Oh, that’s easy, the optimists. Oh, they were the ones this. In one study, PTSD was associated with greater
who said, ‘We’re going to be out by Christmas’. And difficulties in relationships, less social support, and
Christmas would come, and Christmas would go. poorer social functioning. Importantly, this was not just
Then they’d say, ‘We’re going to be out by Easter’. a consequence of PTSD; less social support from the
And Easter would come, and Easter would go. And community and lower availability of secure relation-
then Thanksgiving, and then it would be Christmas ships mediated the association between PTSD and poor
again. And they died of a broken heart. (Collins, social functioning (Tsai, Harpaz-Rotem, Pietrzak, &
2014) Southwick, 2012). In another cross-sectional study of
Cognitive flexibility predominantly older reserve/National Guard veterans
Stockdale’s response illuminates another important factor from the same wars, resilient veterans were more likely
for resilience, cognitive flexibility, which refers to the ability to be in a relationship and active duty, they scored lower
to reappraise one’s perception and experience of a trau- on a measure of psychosocial dysfunction and higher
matic situation instead of being rigid in one’s perception. on a measure of post-deployment social support. Being
Reappraisal can also involve an effort to find meaning and in a relationship, having fewer psychosocial difficulties,
positive outcomes as well as acknowledging the negative and reporting greater perceptions of control and family
and painful consequences. Traumatic experiences can be support were significantly associated with resilience in
reevaluated, altering the perceived value and meaningful- this cohort (Pietrzak & Southwick, 2011). Moreover,
ness of the event. If one can learn to reframe one’s thoughts some research has suggested that having social supports
about a traumatic event, assimilate these thoughts into in place can influence one’s own thinking about oneself
one’s memories and beliefs about the event, one may be able and one’s worlds in a positive way, protecting against
to accept and eventually recover. Acceptance and assimila- hopelessness and negative psychological outcomes of
tion of a traumatic experience into one’s life narrative trauma (Panzarella, Alloy, & Whitehouse, 2006). Taken
involves acknowledging that experiences with stress, or even together, not feeling alone can engender strength to face
trauma, can provide opportunities for growth. Together, fear and trauma, and having effective social support
optimism and cognitive flexibility allow an individual to can minimize the experience of hopelessness while en-
maintain faith that they will prevail or survive regardless of couraging adaptive and active coping. This increases the
the difficulties at hand, and at the same time, confront and likelihood of resilient outcomes versus psychopathology.

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Brian M. Iacoviello and Dennis S. Charney

Physical activity ciated with lower posttraumatic and depressive symptom

Physical activity is another factor that is primarily levels (Feder et al., 2013).
behavioral in nature. Attending to one’s own physical For many, faith in conjunction with religion or
well-being before, during, and after facing stress or trauma spirituality is also an important existential component
can promote resilience. Physical exercise improves physi- of a personal moral compass. Religion and spirituality
cal hardiness, which in-and-of-itself can increase the can provide opportunities for people to ask and gain
chances of survival from certain traumatic situations. some understanding of questions about life and personal
Along with the positive effects on mood and self-esteem meaning when facing traumatic situations. This can aid
that physical exercise confers (Scully, Kremer, Meade, in constructing personal narratives involving healthy
Graham, & Dudgeon, 1998), being mindful of one’s perspectives of traumatic situations, and accordingly,
physical hardiness during a traumatic situation can con- contribute to resilience in the face of trauma. Many
tribute to mental fortitude to endure and survive. Im- studies have investigated the relations between religious
proved mood and increased self-esteem after experiencing involvement and mental health. Positive religious cop-
a traumatic situation could also make establishing and ing has been associated with better physical and mental
nurturing social and interpersonal relationships easier, outcomes in response to a range of situations, from
which, as noted above, is an important factor in promoting disaster survivors (e.g., people affected by large-scale
resilience. floods; Smith, Pargament, Brant, & Oliver, 2000) to
medically ill patients (Pargament, Koenig, Tarakeshwar,
Embracing a personal moral compass & Hahn, 2004). A meta-analysis of the association be-
A psychosocial factor that comprises cognitive, behavior- tween religious coping and psychological adjustment
al, and existential factors is embracing a personal moral to stress, including a total of 13,512 subjects, found
compass. The cognitive component of a personal moral that positive religious coping had a moderate positive
compass involves developing and holding a set of core association with positive psychological adjustment (Ano
beliefs that are positive about oneself and one’s role in & Vasconcelles, 2005).
one’s world, and that few things can shatter. Studies
of the hopelessness theory of depression have shown
that hopelessness and depression can stem from main-
Cultivating psychosocial factors that promote
resilience prior to trauma exposure
taining negative core beliefs regarding the stability
Identification of the psychosocial factors that promote
(enduring over time), globality (permeating different
resilience begs the question: how can people cultivate
areas of one’s life), and internality (regarding one’s own
these factors as a means of preventing negative outcomes
personal characteristics) of the negative life events that
following trauma exposure? The following recommen-
they encounter (Alloy, Just, & Panzarella, 1997). Con-
dations map onto the psychosocial factors, identified
versely, maintaining relatively positive core beliefs results
in more adaptive thinking in the face of negative life above, that are often identified in interviews with resilient
events, preventing the development of hopelessness, and individuals, and some have been studied and have
encouraging resilience. Contributing to one’s core beliefs received empirical research support.
about oneself and one’s worlds is the perception that one
has of one’s own behaviors. So, engaging in positive or Find and identify with a resilient role model
altruistic behavior toward others can result in positive Role models can often be found in one’s own life.
core beliefs. Therefore, altruism is an important beha- As regards resilient role models, find someone who has
vioral component of developing and embracing a per- experienced adversity, disaster, or trauma. Imitation or
sonal moral compass, and, in fact, altruism has been modeling can be a powerful mode of learning throughout
strongly associated with resilience in children and adults the lifespan, and finding a resilient role model can be
(Leontopoulou, 2010; Southwick, Vythilingam, & Charney, an effective way of cultivating resilience-promoting
2005). Altruistic behavior, or other behavior that confers characteristics via modeling and internalizing the experi-
a sense of sense of community and connectedness, can ence of resilience. For example, a role model who has
also contribute to perceived meaning and purpose in life, experienced and successfully navigated a traumatic life
which represent existential components of embracing event can model cognitive flexibility, particularly the
a personal moral compass. In a study of psychosocial experience of acceptance, reappraisal, and assimilation
factors associated with resilience and recovery from the of traumatic experiences. They can become an integral
experience of a traumatic event in primary care patients, part of a supportive social network, can model active
purpose in life emerged as a key factor associated with coping skills, and encourage adaptive behavior. They can
both resilience and recovery (Alim et al., 2008). In a study also model the search for purpose in life and provide
of Pakistani earthquake survivors, purpose in life was asso- spiritual awareness and guidance.

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 Psychosocial facets of resilience

Establish a supportive social network the practical ability to physically endure or survive cer-
As noted above, few can go-it-alone. Having a social tain situations. Physical activity has also been shown to
support network to learn from before traumatic experi- contribute to improved mood and self-esteem (Scully
ences, and to rely on during and after trauma exposure, can et al., 1998) and an emerging body of multidisciplinary
be avaluable resource and can mean the difference between literature has documented the beneficial influence of
resilient outcomes on the one hand and the development physical activity on aspects of cognition and brain func-
of psychopathology on the other. Close relations with tion (Hillman, Erickson, & Kramer, 2008). A growing
others can contribute to emotional strength. Social sup- number of studies support the idea that physical exercise
port can influence one’s perception of oneself and one’s is a lifestyle factor that might lead to increased physical
worlds (Panzarella et al., 2006), which can contribute and mental health throughout life. As regards resilience,
to the cognitive components of resilience, particularly physical activity prior to trauma exposure can provide
maintaining optimism and positive self-regard. A sup- increased self-esteem and optimism about the chances
portive social network can also aid in encouraging active, for survival. During and after trauma exposure, physical
adaptive coping behavior. People may be more inclined to activity can improve mood and cognitive capacities for
minimize the appraisal of threat and to act in their own emotion regulation, cognitive flexibility, etc.
best interest if they perceive a safety net in their social
networks, encouraging some of the behavioral components
Identify, utilize, and foster your particular character
of resilience. Social support networks can include family,
strengths
friends, co-workers, mentors, and role models, spiritual or
We all have our relative strengths as well as weaknesses.
religious leaders, and others. Cultivating and nurturing
One can make attempts to identify his or her particular
these relationships to form a strong and enduring social
character strengths that might contribute to the compo-
support network can be an invaluable means of promoting
nents of resilience described above. These can include
resilience in the face of trauma.
character strengths such extroversion, stress (or fear)
Face your fears instead of avoiding them tolerance, openness to new experiences, and capacities
Oftentimes, our first response to a situation that induces for emotion regulation, among others. These character
fear or anxiety is to try as hard as we can to avoid the strengths can be capitalized on in an effort to cultivate
situation and minimize our experience of fear. Fear is an the psychosocial factors that will promote resilience to
adaptive human experience meant to inform us about trauma. For example, extroversion can go a long way
potential danger in our environment. So while it is to aid in establishing and nurturing a supportive social
important to listen to this emotion to identify truly network. Openness to new experiences and stress or fear
dangerous situations, it is also important to acknowledge tolerance can be capitalized on for stress inoculation and
that avoidance should not be an automatic reaction. facing one’s fears. In addition, we can learn to recognize
Indeed, some psychiatric disorders are conceptualized, our character strengths and engage them when confront-
in part, in terms of nonacceptance of the experience ing and responding to stressful or traumatic situations.
of fear and maladaptive efforts to avoid fear, anxiety, or Lastly, identifying one’s particular character strengths
uncertainty (e.g., Hayes, Wilson, Gifford, Follette, & can also help identify relative weaknesses, which one
Strosahl, 1996). Accepting the experience of fear and can then work on to further develop and strengthen.
anxiety, and pushing oneself to face fears can help Changing in these areas typically involves training reg-
promote resilience when experiencing subsequent trau- ularly and rigorously. Change requires systematic and
matic experiences. Stress inoculation, involving prior disciplined activity. Concentrate on training in multiple
exposure to manageable stressors, has been shown to areas: emotional intelligence, moral integrity, facing fears,
reduce the behavioral and physiological responses to physical endurance, etc.
subsequent stressors (Meichenbaum, 1996). By increasing
one’s sense of control and mastery of stressful situations,
Implications for psychosocial interventions to
and reducing the amount of anxiety experienced when
promote resilience after trauma
confronted with a stressful or traumatic situation, one
Psychosocial interventions to aid people who have
can learn to respond more adaptively. Practice with
experienced trauma could be tailored to promote resi-
facing fears provides opportunities for stress inoculation,
lience by targeting the factors described above. Several
learning to cope with fear actively and adaptively, and
psychosocial interventions have already been developed
possibly increasing one’s self-esteem.
and investigated for individuals who develop PTSD after
Attend to your physical well-being trauma exposure, comprising elements of cognitive

Establishing a regimen of physical exercise and/or activity behavioral psychotherapies. The two interventions that
can have a number of beneficial effects for an individual. have received the most empirical support are prolonged
Physical exercise contributes to physical hardiness and exposure and cognitive processing therapy (CPT).

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Brian M. Iacoviello and Dennis S. Charney

Prolonged exposure therapy (PE; Williams, Cahill, & et al., 2006), victims of sexual assault (Chard, 2005), and
Foa, 2010) is designed to help posttraumatic patients refugees (Schulz, Resick, Huber, & Griffin, 2006).
process traumatic events and reduce psychological dis- The therapeutic approaches described above represent
turbances. As PTSD is characterized by re-experiencing the most empirically supported, state-of-the-art cognitive

the traumatic event through intrusive and upsetting behavioral therapies for recovering from trauma. While
memories, nightmares, flashbacks, and emotional and they include components that map onto some important
physiological reactions to reminders of the trauma, factors for promoting resilience, there are also some
PTSD patients often try to ward off these intrusive that are missing and opportunities exist to tailor these
symptoms and avoid any potential trauma reminders approaches to enhance their ability to engender resilience.
which exacerbate their impairment. PE attempts to Table 2 includes examples of the cognitive and behavioral
address this by including two core components: imaginal psychotherapeutic techniques, from PE and CPT as well
exposure and in vivo exposure. In imaginal exposure, as others, that could be utilized to foster the associated
the traumatic memories are revisited and narrated aloud psychosocial resilience factors.
by the patient, enabling them to process the revisiting PE provides opportunities to engage and practice
experience. After repeated experiences with imaginal active coping skills: minimizing the continued appraisal
exposure, in vivo exposure involves repeated confrontation of threat and facing one’s fears. CPT provides opportu-
with situations and objects that cause distress. Overall, nities to engage these active coping skills, and in addition
the goal of PE is to promote processing of the trauma the factors of cognitive flexibility (reappraisal, reframing,
memory, and in turn, reduce the distress experienced and assimilating traumatic experiences; accepting trauma)
and avoidance behaviors. In this regard, PE maps onto and embracing a personal moral compass (maintaining
adaptive core beliefs; finding meaning in trauma) are
a behavioral component of resilience, facing one’s fears,
also addressed. To enhance these interventions’ ability to
and the cognitive component of minimizing the con-
promote resilience even further, the remaining psychoso-
tinued appraisal of threat. PE has been shown to result
cial factors could also be addressed. In particular, efforts
in clinically significant improvement in approximately 80%
to cultivate interpersonal relationships and form a sup-
of chronic PTSD patients (Eftekhari, Stines, & Zoellner,
portive social network are absent in PE and CPT. Some
2006), suggesting that these behavioral and components
intervention strategies, including brief eclectic psy-
are important for promoting resilience after trauma.
chotherapy for PTSD (Gersons, Carlier, Lamberts, &
Cognitive processing therapy (CPT; Resick & Schnicke,
Van der Kolk, 2000), STAIR narrative therapy (Cloitre
1993) conceptualizes PTSD as a disorder of ‘‘non-
et al., 2010), and dialectical behavior therapy (Bohus
recovery’’ fueled by erroneous beliefs about the causes
et al., 2013), which have begun to receive empirical
and consequences of the traumatic event. These beliefs
support for the treatment of PTSD, explicitly address
result in strong negative emotions, and subsequent avoid-
enhancing interpersonal effectiveness and/or cultivating a
ance of the trauma memory and of situations that trigger
supportive social network in the treatment. Another
reminders. Combined, these prevent adaptive processing approach to addressing this could be to pair trauma
of the trauma memory and the emotions emanating survivors with a mentor or role model who has success-
from the event. CPT incorporates cognitive techniques fully navigated his or her own traumatic experience.
to help more accurately appraise these ‘‘stuck points’’ Including a behavioral activation component (Jacobson,
and progress toward recovery, with a primary focus on Martell, & Dimidjian, 2001) to these interventions, which
helping patients to confront, gain an understanding of, has been shown to be effective in the treatment of
and modify the meaning attributed to the traumatic event. depressive disorders (Spates, Pagoto, & Kalata, 2006),
The early stage of CPT involves learning to identify which often co-occur with PTSD, could also be effective
automatic thoughts and maladaptive beliefs about oneself in promoting resilience. Behaviors including physical
and the trauma, and increasing awareness of the relation activity/exercise and encouraging altruistic or other pro-
between one’s thoughts and feelings. The next stage of social behaviors might be particularly effective, as they
CPT includes formal processing of the trauma, either in correspond to important psychosocial factors of resili-
writing or verbally with the therapist, to break the pattern ence. Lastly, encouraging spiritual or religious coping as a
of avoidance. The final stage of CPT involves learning means of enhancing faith and optimism for the future as
cognitive skills to evaluate and modify one’s beliefs about well as purpose in life could be included as components
oneself and the traumatic events one has experienced, of these expanded interventions. Taken together, there
challenging and reframing one’s maladaptive conclusions exist psychotherapeutic approaches to treating trauma
about one’s traumatic experience (e.g., ‘‘This means that survivors that have been shown to be effective in reducing
no one can ever be trusted’’). CPT has been shown to be PTSD symptoms, and there may be opportunities to
effective for a variety of populations and across a variety expand these interventions to include other psychosocial
of trauma types, including military veterans (Monson factors to promote resilience even more.

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 Psychosocial facets of resilience

Table 2. Psychotherapeutic approaches and techniques to facilitate the psychosocial factors underlying resilience

Factor Cognitive approaches Behavioral approaches

Optimism Modification of core beliefs and expectancies for the future.

Cognitive flexibility Practice reappraising, reframing, and assimilating life experiences
(traumatic and nontraumatic).
Cultivate acceptance for distress, difficulties, etc.
Develop mindfulness for thoughts and feelings.
Active coping skills Monitor automatic thoughts; minimize continued appraisal of Practice asking for/seeking help and
(versus passive) threat; maintain positive self-regard in the face of adversity. resources.
Exposure/inoculation to unwanted/aversive
thoughts and feelings.
Practice facing one’s fears.
Physical health Behavioral activation: physical activity and
exercise.
Social support Establish and maintain interpersonal
network relationships.
Connect with a resilient role model.
Personal moral Maintain adaptive, positive core beliefs. Behavioral activation: altruistic behavior.
compass Engage with faith/spiritual leaders, role
models, etc.
Engage in activities and goals that yield
purpose and meaning for your life.

Resilience-focused training programs are being devel- resilience insofar as they seek to reduce the severity of
oped that specifically target the psychosocial factors PTSD symptoms experienced after trauma. These inter-
described above. These programs aim to develop resi- ventions are generally provided to individuals who have
lience by training mindfulness and attention so that one developed PTSD. However, they could be administered
becomes more aware of the present moment as opposed as secondary prevention strategies by administering these
to ruminating on the past and the difficult emotions treatments to trauma-exposed individuals prior to the
that engenders. In this way, mindfulness is trained as a emergence of PTSD symptoms. Primary prevention stra-
means of enhancing emotion regulation. Using purpose- tegies, such as the Comprehensive Soldier Fitness pro-
ful, trained attention, one may decrease the frequency, gram, are administered to people before they experience
intensity, and duration of negative thoughts and asso- a traumatic event, in an effort to provide skills and a
ciated feelings, and bring greater focus on the present foundation for resilience before trauma exposure.
moment. In addition, these training programs aim to
foster acceptance for the stressful of traumatic event, Implications for developing resilient
find meaning in life, develop gratitude, and even address communities
spirituality. Although still in their infancy, such resilience Unfortunately, community-wide disasters have become
training programs offer the promise of providing an more common and costly over the past several decades.
integrated, multimodal approach to promoting resilience, Examples of recent large-scale disasters include natural
based on the important psychosocial factors described disasters (e.g., hurricanes, floods) as well as man-made
in the literature, and some show promising initial effects disasters (e.g., terrorism), and here too we see a range of
on handling daily-life stress in nontraumatized popula- responses. Whereas hurricane Katrina in New Orleans and
tions (e.g., Rose et al., 2013), while the Comprehensive the 2004 Indian Ocean earthquake and tsunami were
Soldier Fitness program (Lester, McBride, Bliese, & particularly devastating, in part due to the ineffective early
Adler, 2011), currently being researched in a large-scale response in the community, responses to the Boston
study of military soldiers, appears to yield equivocal marathon bombing and Superstorm Sandy were indi-
results (Carr et al., 2013). cative of a resilient community response. Community
Differentiating between interventions aimed at treating resilience, compared to individual resilience, has been
the deleterious outcomes of trauma versus primary or defined as the ability of community members to take
secondary prevention interventions, which aim to prevent meaningful, deliberate, collective action to remedy the
these outcomes, is an important consideration. The in- impact of a problem, including the ability to interpret
terventions described above are designed to enhance the environment, intervene, and move on (Pfefferbaum,

Citation: European Journal of Psychotraumatology 2014, 5: 23970 - http://dx.doi.org/10.3402/ejpt.v5.23970 7

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Brian M. Iacoviello and Dennis S. Charney

Reissman, Pfefferbaum, Klomp, & Gurwitch, 2007). It guidelines for developing these capacities and fostering
is the ability to withstand the stress of disaster, recover, and resilient communities are offered (Norris et al., 2008): (1)
restore functioning, and apply lessons learned from past communities must develop economic resources, reduce
responses to disaster to better withstand future events. risk and resource inequalities, and attend to the areas
Norris, Stevens, Pfefferbaum, Wyche, and Pfefferbaum of greatest social vulnerability; (2) engage the population
(2008) have elaborated this conceptualization of com- meaningfully in every step of the disaster-mitigation
munity resilience as a process linking a set of impor- process, from preparation to action to recovery; (3) uti-
tant adaptive capacities in the community to a positive lize preexisting organizational networks and relationships
trajectory of functioning and adaptation in constituent to rapidly mobilize emergency and ongoing support
populations after a disturbance. This conceptualiza- services for disaster survivors; (4) intervene to support
tion highlights the relevant adaptive capacities and iden- and protect naturally occurring social supports in the
tifies the desired outcome as population wellness: a high aftermath of disaster; and (5) plan, and plan for not
prevalence of wellness in the community, high and having a plan, exercise flexibility and focus on building
nondisparate levels of mental and behavioral health, effective information and communication networks that
role functioning, and quality of life. In an extensive function in the face of unknowns.
review and synthesis of the literature on community It is noteworthy that the capacities identified as im-
resilience, Norris and colleagues (2008) organize the portant for promoting community resilience appear to
adaptive capacities of resilient communities into the comprise cognitive, behavioral, and existential compo-
following clusters: social capital, community competen- nents, as do the psychosocial factors for individual
cies, economic development, and information and com- resilience. Table 3 organizes the capacities identified by
munication. Social capital refers to the capacities for Norris and colleagues (2008) into this tripartite model.
expected social support, enacted social support, social While Norris’ model appears to include many of the
embeddedness (informal community ties), organizational facets of individual resilience, there are some that might
ties to the community and cooperation, citizen partici- also warrant inclusion. For example, this model does
pation (formal community ties), sense of community, not include consideration of the physical health and well-
and attachment to place. Community competence refers being of constituent populations, which could be ad-
to capacities for community action, critical reflection and dressed by population-wide efforts to promote physical
problem-solving, flexibility and creativity, collective effi- activity for disaster readiness. In addition, community
cacy and empowerment, and political partnerships. mentors, and faith-based or spirituality organizations,
Economic development includes capacities for fairness may provide opportunities to organize and support
of risk and vulnerability, level and diversity of economic the population during disaster preparation, response,
resources, and equity of resource distribution. Infor- and recovery.
mation and communication refers to the capacities for
responsible media, skills and infrastructure, trusted Conclusion
sources of information, and narratives of the disaster. People’s reactions to stress and trauma can range from
Based on this conceptualization, the following practical resilience, on the one hand, to severe psychopathology,

Table 3. Cognitive, behavioral and existential components of adaptive capacities promoting resilience in communities

Components

Adaptive capacity Cognitive Behavioral Existential

Social capital Perceived social support. Received social support. Social embeddedness.
Organizational links and Sense of community.
cooperation. Attachment to place.
Citizen participation.
Community competence Critical reflection and problem Community action. Collective efficacy/
solving skills. Political partnerships. empowerment.
Flexibility and creativity.
Economic development Level and diversity of economic Fairness of risk.
resources. Equity of resource
distribution.
Information and Trusted sources of information. Responsible media. Narratives.
communication Skills and infrastructure.

8
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Citation: European Journal of Psychotraumatology 2014, 5: 23970 - http://dx.doi.org/10.3402/ejpt.v5.23970
 Psychosocial facets of resilience

including PTSD, on the other. Understanding of the Carr, W., Bradley, D., Ogle, A. D., Eonta, S. E., Pyle, B. L., &
factors that promote resilience is warranted, and can Santiago, P. (2013). Resilience training in a population of
deployed personnel. Military Psychology, 25, 148
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S., & Derhagopian, R. P. (2005). Optimistic personality and
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new resilience scale: The Connor-Davidson Resilience Scale
There is no conflict of interest in the present study for any (CD-RISC). Depression and Anxiety, 18, 76
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