The Routledge International Handbook of Psychosocial Resilience

Updesh Kumar

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9781138954878
• eBook ISBN: 9781317355939
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Psychological resilience has emerged as a highly significant area of research and practice in recent years, finding applications with a broad range of different groups in many settings. Contemporary discourse is not limited to ways of effective coping with adversity but also introduces mechanisms that can lead to enhanced capacity after dealing with difficult circumstances and recognises the importance of enriching the field with varied perspectives. The Routledge International Handbook of Psychosocial Resilience is a comprehensive compendium of writings of international contributors that takes stock of the state-of-the-art in resilience theory, research and practice.

The Routledge International Handbook of Psychosocial Resilience covers the many different trajectories that resilience research has taken in four parts. Part One delineates the 'Conceptual Arena' by providing an overview of the current state of theory and research, exploring biological, psychological, and socio-ecological perspectives and discussing various theoretical models of personal and social resilience. The 'Psychosocial Correlates' of resilience are discussed further in Part Two, from personal and personality correlates, socio-environmental factors and the contextual and cultural conditions conducive to resilient behaviour. In Part Three, 'Applied Evidences' are introduced in order to build upon the theoretical foundations in the form of several case studies drawn from varied contexts. Examples of resilient behaviour range from post-disaster scenarios to special operation groups, orphaned children, and violent extremism. Finally, Part Four, 'Proposed Implications and Resilience Building', sums up the issues involved in discussing post-traumatic growth, wellbeing and positive adaptation in the varied contexts of personal, familial, organizational and societal resilience.

The volume provides a comprehensive overview of resilience theory, practice and research across disciplines and cultures, from varied perspectives and different populations. It will be a key reference for psychiatrists, psychologists, psychotherapists and psychiatric social workers in practice and in training as well as researchers and students of psychology, sociology, human development, family studies and disaster management.

Section IV
Proposed implications and resilience building

25
Resilience and vulnerability in coping with stress and terrorism

Zvi Zemishlany

The world-wide increase in terrorist activities poses new challenges to health professionals, clinicians and policy makers who need to confront the impact of terror-related trauma on individuals and communities. Many communities across the world are chronically exposed to extreme violence. Exposure to a potentially traumatic event, like a terror attack, disrupts the homeostatic state, triggering a series of responses intended to enable the organism to adjust to the altered condition. These responses are generally adaptive in the short run but can lead to a state of chronic dysregulation and psycho-physiologic imbalance. Studies of the impact of war, political violence and terrorism around the world have revealed a range of detrimental mental consequences, including heightened anxiety and depression; reduced sense of safety; increased use of tobacco, alcohol, drugs and psychotropic medications; and post-traumatic stress symptoms. On the community level, the resulting damage to the community infrastructure has an impact on the economy, displaces populations and lowers community morale and well-being.

The immediate mental health effects of the notorious terrorist attack of September 11, 2001, in the United States were assessed using a nationally representative sample of American adults who were asked about their reactions to the terrorist attack and their perceptions of it. Three to five days following the attack, 44% of this cohort reported that they experienced at least one of five substantial stress symptoms. Although the people who were in or close to New York City had the highest rate of substantial stress reactions, others throughout the country, in large and small communities, also suffered from them. Five to nine weeks after the attack, 7.5% of adults living south of 110th Street in Manhattan reported symptoms consistent with post-traumatic stress disorder (PTSD), and 9.7% reported symptoms consistent with current major depression. Additionally, those living closest to the World Trade Center site were nearly three times as likely to develop PTSD as those living farther away. The people who experienced the attack directly as well as those who experienced it indirectly, through the media, showed elevated levels of distress, a lowered sense of security and subsequent pathological reactions such as PTSD and depression (Galea et al., 2002). In their severe form, these stress reactions can lead to acute stress disorder (ASD) and chronic PTSD in keeping with the time-span they occupy.

Lawyers et al. (2006) characterized peri-traumatic reactions of residents of New York City during and immediately following the September 11th terrorist attack, identified predictors of those reactions and identified predictors of PTSD four months later. Three related, but distinct, peri-traumatic response patterns were revealed: dissociation, emotional reactions, and panic/physiological arousal. These results support a growing literature concerning the predictive value of peri-traumatic reactions in relation to PTSD. Understanding the early phase of emotional disturbances may shed some light on the development of the early stages of chronic stress reaction that result from repeated terrorist attacks.

Amital and colleagues (Amital, Amital, Shohat, Soffer, & Bar-Dayan, 2012) reported on the short-term emotional effects and disturbances in daily life two days after a suicide bomber’s attack in the southern Israeli city of Dimona. A higher prevalence of stress and fear and a lower prevalence of joy were reported in the population of Dimona compared with the general population in Israel. Subjects who reported being less resilient had a higher prevalence of stress and fear, disturbances in daily life activities and changes in leisure activities than subjects who reported being more resilient.

The immediate response to the traumatic event in individuals who may develop ASD or PTSD involves intense fear, helplessness or horror. ASD is experienced during or immediately after the trauma, lasts for at least two days, and either resolves within four weeks or the diagnosis has to be adjusted. A diagnosis of PTSD may be appropriate provided the full criteria for PTSD are met (American Psychiatric Association, 2013). Of the individuals who respond to the trauma with intense fear or horror, 15–35% develop eventually a significant degree of dysfunction and distress (Fairbank, Ebert, & Costello, 2000), namely PTSD, lasting a considerable length of time. The PTSD symptoms can be grouped into four main clusters. The first is persistent re-experience of the traumatic event, such as recurrent dreams and flashbacks. The second is persistent avoidance of internal or external cues associated with the trauma. The third consists of negative alterations in cognitions or mood. These negative alterations can be expressed in exaggerated negative beliefs and expectations about oneself, others or the world; feelings of fear, anger, shame, guilt or detachment; and diminished interest and inability to experience positive emotions. The fourth is increased arousal, which is manifested in difficulty in concentrating, hypervigilance and exaggerated startle response (American Psychiatric Association, 2013). PTSD is a devastating disorder chronically disrupting the lives of the sufferer and his family, while imposing a burden on society.

Resilience and vulnerability

The marked discrepancy between the proportion of the general population exposed to traumatic events and the proportion that ultimately fulfill the criteria for PTSD is a challenging aspect of the study of stress-related disorders. Identification of factors that increase vulnerability of individuals and factors that increase resilience may have important implications in public health.

Recent studies have addressed the characteristics of resilience, defined by Bonanno (2004) as “the ability … to maintain a relatively stable, healthy level of psychological and physical functioning in the face of highly disruptive events.” This concept is particularly important in view of the findings that following a range of traumatic events, a large percentages of people (40–78.2%) exposed to these events are either entirely or almost entirely symptom free (Bonanno, Rennicke, & Dekel, 2005; Bryant, Harvey, Guthrie, & Moulds, 2000; Galea et al., 2002).

Moscardino, Scrimin, Capello, and Altoe (2010) investigated the influence of socio-contextual variables on depressive symptoms in 158 adolescent survivors of the 2004 terrorist attack in Balsan, Russia. Over 1,300 children and adults were taken hostage by a group of 32 terrorists at the traditional celebration for the opening school day. Hundreds of young children spent fifty-seven hours sitting in an overcrowded gymnasium wired with explosives. They witnessed the beating and murder of family members, friends and teachers. On the third day, the hostage crisis ended in extreme violence that caused the deaths of 329 persons and the injury of many hundreds. The survivors were assessed eighteen months after the traumatic event for depressive symptoms, social support, sense of community and collectivism. The findings suggest that social support and community connectedness may serve as protective resources and were associated with lower rates of depressive symptoms.

Kaplan, Matar, Kamin, Sadan and Cohen (2005) investigated stress-related responses after three years of exposure to terror from Gaza Strip (2003–2005) in three different types of population centers in Israel: a suburb of Tel Aviv, a settlement in the West Bank (Kiryat Arba) and the Gush Katif settlement cluster around the Gaza Strip. Symptoms of acute stress and chronic (post-traumatic) stress as well as symptoms of general psychopathology and distress were assessed. The inhabitants of Gush Katif, in spite of first-hand daily exposure to violent attacks, reported the fewest and least severe symptoms of stress-related complaints, the least sense of personal threat and the highest level of functioning of all three samples. The most severely symptomatic and functionally compromised were the inhabitants of the Tel Aviv suburb, who were the least affected by exposure to violent attacks both in terms of frequency and of directness. Due to the Gush Katif population tending to be particularly religious, the data were reassessed according to religiousness. The religious inhabitants of Kiryat Arba had almost the same symptom profile as the Gush Katif population, whereas secular inhabitants of Kiryat Arba reported faring worse than any of the other populations. The authors conclude that religiousness combined with common ideological convictions and social cohesion is associated with substantially higher resilience as compared to the secular metropolitan urban populations.

In another Israeli study by Dekel and Nuttman-Shwartz (2009) the findings are similar. Their study assessed a sample of 134 residents, 67 of whom were residents from two kibbutzim and the other 67 were inhabitants from the city of Sderot. Both groups have been the target of Qassam rocket attacks. The city residents reported more post-traumatic symptoms. It was suggested that the kibbutz ideology, solidarity and communal lifestyle provide a measure of protection against stress.

Similar findings were shown recently by Gelkopf, Berger, Bleich, and Silver (2012) who compared the responses to seven years of continuous rocket fire of residents from the urban community of Sderot, with the rural communities bordering the Gaza Strip, and with non-exposed rural and urban populations as comparison groups. As expected, the residents bordering the Gaza Strip evidenced little symptomatology. In contrast, PTS, distress, functional impairment and health care utilization were substantially higher in the highly exposed urban community of Sderot than in the other three communities. The authors explain the low level of vulnerability in the rural community that was exposed to chronic rocket attacks by their reporting on higher levels of community commitment and feeling that they were an integral part of their community. They reported having a strong social network for both instrumental and social support and having greater confidence in the army and in the national leadership of the country, which seemed to be protective against the chronic stress. In addition, each rural community had a local officer who was responsible for the security of the inhabitants and served as the liaison with the army and an elected committee handling community issues. These officers were responsible for the state of the local shelters, which was in contrast to the situation in the cities, where shelters were not always clean, lacked water and electricity, and lacked liaison personnel for less mobile populations. These emphasize the role of the logistic preparations and the creation of “culture of safety” in the development of resilient communities.

When combining all these findings, “sense of belonging” appears to be an important characteristic of resilience. “Sense of belonging” refers to people feeling part of a collective, be it the neighborhood, the immediate community, the nation or any other group or place. It is characterized by mutual concern, connection, community loyalty and trust that one’s personal needs will be fulfilled by means of commitment to the group as a whole. Within the same line, it was found that during the 1973 war in Israel, there were lower rates of combat stress in army units that had high levels of solidarity and cohesion than in those in which the soldiers’ sense of belonging was lower (Steiner & Neumann, 1978).

Even residents of communities that are indirectly exposed to political violence and terrorism show psychological effects (Bleich, Gelkopf, Melamed, & Solomon, 2006; Gelkopf, Solomon, Berger, & Bleich, 2008), but here, too, variability in response across communities is evident (Gelkopf et al., 2008). This is likely a function of differences in ethnic, economic, ideological and social composition across communities, with different resources and risk factors. Thus, the impact of exposure to political violence may depend on the wider social context in which it occurs. This context can be defined by proximity to the disaster as well as by social factors (Kawachi & Subramanian, 2006). Indeed, Nakagawa and Shaw (2004) observed that, within the same cities, neighborhoods recovered at different rates depending upon the available social capital, and Kawachi and Berkman (2001) have discussed the importance of availability of social connections as a buffer against the impact of disasters. Residents of poorer communities (Ahern & Galea, 2006) and communities with a narrow range of economic resources (Cutter et al., 2006) appear more vulnerable to stressful conditions. Furthermore, war and political violence can cause or worsen local stressful social and material condition such as poverty, social marginalization, isolation, inadequate housing and changes in family structure and functioning (Miller & Rasmussen, 2010), which can exacerbate mental health problems.

The central role of the contextual and community risk factors can be illustrated in the case of minorities. Minority ethnic groups share a common heritage and cultural values that differ from the mainstream population. Identification as a member of an ethnic minority may affect the individual’s interaction with the social network. The actual and perceived low social support can lead to different traumatic exposure rates and increased vulnerability to develop PTSD (Gelkopf et al., 2012; Perilla, Norris, & Lavizzo, 2002). Discriminated minority groups often have disparities in access to economic and social resources like healthcare, education and income, leading to increased risk of psychosocial distress when further resources are threatened. Furthermore, the perception of discrimination may prevent the individual from seeking support and using available social resources and may intensify feelings of decreased self-worth. Moreover, the degree of integration and acculturation affects PTSD development. In a stu...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Dedication
• Contents
• List of figures
• List of tables
• About the editor and contributors
• Foreword
• Preface
• Section I Conceptual arena
• Section II Psychosocial correlates
• Section III Applied evidence
• Section IV Proposed implications and resilience building
• Index