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Resilience in the Face of Potential
Trauma
George A. Bonanno
Teachers College, Columbia University
ABSTRACT—Until recently, resilience among adults exposed to potentially traumatic events was thought to occur rarely and in either pathological or exceptionally healthy indi- viduals. Recent research indicates, however, that the most common reaction among adults exposed to such events is a relatively stable pattern of healthy functioning coupled with the enduring capacity for positive emotion and gen- erative experiences. A surprising finding is that there is no single resilient type. Rather, there appear to be multiple and sometimes unexpected ways to be resilient, and some- times resilience is achieved by means that are not fully adaptive under normal circumstances. For example, peo- ple who characteristically use self-enhancing biases often incur social liabilities but show resilient outcomes when confronted with extreme adversity. Directions for further research are considered.
KEYWORDS—loss; grief; trauma; resilience; coping
Life is filled with peril. During the normal course of their lives, most adults face one or more potentially traumatic events (e.g., violent or life-threatening occurrences or the death of close friends or relatives). Following such events, many people find it difficult to concentrate; they may feel anxious, confused, and depressed; and they may not eat or sleep properly. Some people have such strong and enduring reactions that they are unable to function normally for years afterward. It should come as no surprise that these dramatic reactions have dominated the lit- eratures on loss and trauma. Until recently, the opposite reac- tion—the maintenance of a relative stable trajectory of healthy functioning following exposure to a potential trauma—has re- ceived scant attention. When theorists have considered such a pattern, they have typically viewed it either as an aberration resulting from extreme denial or as a sign of exceptional emo- tional strength (e.g., McFarlane & Yehuda, 1996).
RESILIENCE (NOT RECOVERY) IS THE MOST COMMON RESPONSE TO POTENTIAL TRAUMA
Over a decade ago, my colleagues and I began an ongoing in- vestigation of this supposedly rare response, and the means by which people might achieve such presumably superficial (or exemplary) functioning in the aftermath of a potentially traumatic event. The results of our research have consistently challenged the prevailing view on the subject. We took as our starting point the burgeoning developmental literature on resilience. Devel- opmental researchers and theorists had for several decades highlighted various protective factors (e.g., ego-resiliency, the presence of supportive relationships) that promote healthy tra- jectories among children exposed to unfavorable life circum- stances such as poverty (e.g., Garmezy, 1991; Rutter, 1987). We sought to adapt this body of research to the study of resilient outcomes among adults in otherwise normal circumstances who are exposed to isolated and potentially highly disruptive events. Our research led to three primary conclusions, each mirroring but also extending the insights gained from developmental re- search. First, resilience following potentially traumatic events represents a distinct outcome trajectory from that typically as- sociated with recovery from trauma. Historically, there have been few attempts to distinguish subgroups within the broad category of individuals exposed to potential trauma who do not develop post-traumatic stress disorder (PTSD). When resilience had been considered, it was often in terms of factors that ‘‘favor a path to recovery’’ (McFarlane & Yehuda, 1996, p. 158). However, studies have now demonstrated that resilience and recovery are discrete and empirically separable outcome trajectories follow- ing a dramatic event such as the death of a spouse (e.g., Bonanno, Wortman, et al., 2002) or direct exposure to terrorist attack (e.g., Bonanno, Rennicke, & Dekel, in press). Figure 1 depicts the prototypical resilience and recovery trajectories, as well as tra- jectories representing chronic and delayed symptom elevations (discussed later). In this framework, recovery is defined by moderate to severe initial elevations in psychological symptoms that significantly disrupt normal functioning and that decline only gradually over
Address correspondence to George A. Bonanno, Clinical Psychology Program, 525 West 120th St., Box 218, Teachers College, Columbia University, New York, NY 10027; e-mail: [email protected].
CURRENT DI RE CTIONS IN PSYCHOLOGICAL SCIENCE
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the course of many months before returning to pre-trauma levels. In contrast, resilience is characterized by relatively mild and short-lived disruptions and a stable trajectory of healthy func- tioning across time. A key point is that even though resilient in- dividuals may experience an initial, brief spike in distress (Bonanno, Moskowitz, Papa, & Folkman, 2005) or may struggle for a short period to maintain psychological equilibrium (e.g., several weeks of sporadic difficulty concentrating, intermittent sleep- lessness, or daily variability in levels of well-being; Bisconti et al., in press), they nonetheless manage to keep functioning effectively at or near their normal levels. For example, resilience has been linked to the continued fulfillment of personal and social re- sponsibilities and the capacity for positive emotions and genera- tive experiences (e.g., engaging in new creative activities or new relationships), both immediately and in the months following ex- posure to a potentially traumatic event (Bonanno & Keltner, 1997; Bonanno, Wortman, et al., 2002; Bonanno, Rennicke, & Dekel, in press; Fredrickson et al., 2003). A second conclusion that emerges from our research is that resilience is typically the most common outcome following ex- posure to a potentially traumatic event. It has been widely as- sumed in the literature that the most common response to such an occurrence is an initial but sizeable elevation in trauma symp- toms followed by gradual resolution and recovery (McFarlane & Yehuda, 1996). However, although symptom levels tend to vary for different potentially traumatic events, resilience has con- sistently emerged as the most common outcome trajectory. In one study, for example, over half of the people in a sample of middle- aged individuals who had lost their spouses showed a stable, low level of symptoms; and stable low symptoms were observed in more than a third of a group of gay men who were bereaved after providing care for a partner dying of AIDS, a considerably more stressful context (Bonanno, Moskowitz, et al., 2005). Resilience was also readily observed in a random phone-dialing survey of
Manhattan residents following the September 11 terrorist attack (Bonanno, Galea, Bucciarelli, & Vlahov, 2005). Following con- ventions established in the study of subthreshold depression, we defined a mild to moderate trauma reaction as two or more PTSD symptoms and resilience as one or no PTSD symptoms in the first 6 months following the attack. Over 65% in the New York met- ropolitan area were resilient. Among people with more concen- trated exposure (e.g., those who had either witnessed the attack in person or who were in the World Trade Center during the attack), the proportion showing resilience was still over 50%. Finally, even among people who were physically injured in the attack, a group for whom the estimated proportion of PTSD was extremely high (26.1%), one third (32.8%) of the individuals were resilient. In establishing the validity of the resilient trajectory it is im- perative to distinguish stable, healthy functioning from denial or other forms of superficial adjustment. To this end, several studies have now documented links between resilience and generally high functioning prior to a potentially traumatic event (Bonanno, Wortman, et al., 2002; Bonanno, Moskowitz, et al., 2005). Several studies have also documented resilient outcomes using relatively objective measures that go beyond participant self-report, in- cluding structured clinical interviews and anonymous ratings of functioning from participants’ friends or relatives (e.g., Bonanno, Rennicke, & Dekel, in press; Bonanno, Moskowitz, et al., 2005). For example, we (Bonanno, Rennicke, & Dekel, in press) re- cruited the friends and relatives of high-exposure survivors of the World Trade Center terrorist attack and asked them to assign the survivors to either the resilience trajectory or one of the other outcome trajectories depicted in Figure 1. The assignments of friends and relatives closely matched the survivors’ actual symptom levels over time, and thus provided important valida- tion for the resilience trajectory.
THE HETEROGENEITY OF RESILIENCE: FLEXIBLE AND PRAGMATIC COPING
A third conclusion to emerge from our research, again extending the conclusions of developmental researchers, is that there are multiple and sometimes unexpected factors that might promote a resilient outcome. At the most general level, many of the same characteristics that promote healthy development should also foster adult resilience. These would include both situational factors, such as supportive relationships, and individual factors, such as the capacity to adapt flexibly to challenges (Block & Block, 1980). The capacity for adaptive flexibility was mirrored in a recent study associating resilience among New York City college students in the aftermath of September 11 with flexibility in emotion regulation, defined as the ability to effectively enhance or suppress emotional expression when instructed to do so (Bonanno, Papa, LaLande, Westphal, & Coifman, 2004). In addition to these general health-promoting factors, however, our research also underscores a crucial point of departure from the developmental literature. Childhood resilience is typically
Fig. 1. Prototypical trajectories of disruption in normal functioning dur- ing the 2-year period following a loss or potential trauma.
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subset of individuals exposed to potentially traumatic events (5– 10%) typically exhibit delayed PTSD. Preliminary evidence indicates that delayed-PTSD responders have higher initial symptom levels than do resilient individuals (e.g., Bonanno et al., in press). Further evidence of this distinction would hold potentially important diagnostic implications for early inter- vention. Finally, another question pertains to how resilient individuals experience the crucial early weeks after an extreme stressor event. A recent study by Bisconti, Bergeman, and Boker (in press) shed some welcome light on this issue by examining daily well- being ratings in the early months after the death of a spouse. Although resilient bereaved typically show only mild and rela- tively short-lived overall decreases in well-being, examination of their daily ratings indicated marked variability across the first 3 weeks and then a more stable but still variable period that endured through the second month of bereavement. Perhaps similar research using larger samples and Internet methods might illuminate how resilient individuals manage to continue functioning and meeting the ongoing demands of their lives while nonetheless struggling, at least for a short period, to maintain self-regulatory equilibrium.
Recommended Readings Bonanno, G.A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events. American Psychologist, 59 , 20–28. Bonanno, G.A., & Kaltman, S. (2001). The varieties of grief experience. Clinical Psychology Review, 21 , 705–734. Gilbert, D.T., Pinel, E.C., Wilson, T.D., Blumberg, S.J., & Wheatley, T. (1998). Immune neglect: A source of durability bias in affective forecasting. Journal of Personality and Social Psychology, 75, 617–638. Luthar, S.S. (in press). Resilient adaptation. In D. Cicchetti & D.J. Cohen (Eds.), Developmental psychopathology: Risk, disorder, and adap- tation. New York: Wiley.
Acknowledgments—This research was supported by grants from the National Institutes of Health (R29-MH57274) and the Na- tional Science Foundation (BCS-0202772 and BCS-0337643).
REFERENCES
Bisconti, T.L., Bergeman, C.S., & Boker, S.M. (in press). Social support as a predictor of variability: An examination of recent widows’ adjustment trajectories. Psychology and Aging.
Block, J.H., & Block, J. (1980). The role of ego-control and ego-resil- iency in the organization of behavior. In W.A. Collins (Ed.), The Minnesota Symposia on Child Psychology (Vol. 13, pp. 39–101). Hillsdale, NJ: Erlbaum. Bonanno, G.A., Field, N.P., Kovacevic, A., & Kaltman, S. (2002). Self- enhancement as a buffer against extreme adversity: Civil war in Bosnia and traumatic loss in the United States. Personality and Social Psychology Bulletin, 28 , 184–196. Bonanno, G.A., Galea, S., Bucciarelli, A., & Vlahov, D. (2005). Psy- chological resilience after disaster: New York City in the aftermath of the September 11th terrorist attack. Manuscript submitted for publication. Bonanno, G.A., & Keltner, D. (1997). Facial expressions of emotion and the course of conjugal bereavement. Journal of Abnormal Psy- chology, 106 , 126–137. Bonanno, G.A., Moskowitz, J.T., Papa, A., & Folkman, S. (2005). Resilience to loss in bereaved spouses, bereaved parents, and bereaved gay men. Journal of Personality and Social Psychology, 88 , 827–843. Bonanno, G.A., Papa, A., Lalande, K., Nanping, Z., & Noll, J.G. (2005). Grief processing and deliberate grief avoidance: A prospective comparison of bereaved spouses and parents in the United States and China. Journal of Consulting and Clinical Psychology, 73 , 86–98. Bonanno, G.A., Papa, A., LaLande, K., Westphal, M., & Coifman, K. (2004). The importance of being flexible: The ability to both en- hance and suppress emotional expression predicts long-term ad- justment. Psychological Science, 15 , 482–487. Bonanno, G.A., Rennicke, C., & Dekel, S. (in press). Self-enhancement among high-exposure survivors of the September 11th terrorist attack: Resilience or social maladjustment? Journal of Personality and Social Psychology. Bonanno, G.A., Wortman, C.B., Lehman, D.R., Tweed, R.G., Haring, M., Sonnega, J., Carr, D., & Neese, R.M. (2002). Resilience to loss and chronic grief: A prospective study from pre-loss to 18 months post-loss. Journal of Personality and Social Psychology, 83 , 1150–
Fredrickson, B.L., Tugade, M.M., Waugh, C.E., & Larkin, G.R. (2003). What good are positive emotions in crisis? A prospective study of resilience and emotion following the terrorist attacks on the United States on September 11th, 2001. Journal of Personality and Social Psychology, 84 , 365–376. Garmezy, N. (1991). Resilience and vulnerability to adverse develop- mental outcomes associated with poverty. American Behavioral Scientist, 34 , 416–430. McFarlane, A.C., & Yehuda, R. (1996). Resilience, vulnerability, and the course of posttraumatic reactions. In B.A. van der Kolk, A.C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress (pp. 155–181). New York: Guilford. Rutter, M. (1987). Psychosocial resilience and protective mechanisms. American Journal of Orthopsychiatry, 57 , 316–331.
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