Student Perspectives: Changes in Conceptualization and Assessment of Resilience – Sophie Brickman, MA, and Kelly Dixon, MA

With appreciation to Dr. Steve Bistricky for his feedback on this piece
 

How do we define resilience?

Over time, scholars have asked, is resilience a trait or a state? Typically, traits (i.e., personality traits) are inherent, stable, and require great effort to develop when absent. For example, Klohnen (1996) describes ego-resiliency as “a personal trait comprised of confident optimism, productive and autonomous activity, interpersonal warmth and insight, and skilled expressiveness that leads to effective functioning in diverse areas of life.” On the other hand, states are transitory, and more accessible through learning (e.g., a person can learn to be in a mindful state). Connor and colleagues (2003) define resilience as a state, “a multi-dimensional characteristic that varies with context, time, age, gender, and cultural origin, as well as within an individual subject to different life circumstances.” For example, a person could be more resilient in one context than another. The state-based perspective implies that we all have the capacity to be resilient.
 
Resilience has typically been viewed through two distinct frameworks. The first is a deficit model, in which resilience is the absence of psychopathology. The alternative approach is a strength model, in which resilience is an additive, biobehavioral construct that involves active strengths, and it is not necessarily dependent on the absence of psychopathology (Feldman, 2020). While there appears to be more of an emphasis on the strength model in definitions of resilience, a recent review of resilience modeling emphasized that resilience is often operationalized as the absence of pathology (Galatzer-Levy et al., 2018).
 
Many definitions of resilience have been proposed by leading scholars in the field of traumatic stress (the first four presented below were discussed in a 2014 ISTSS Annual Meeting panel):

• Southwick (2014): “process of stable trajectory of healthy functioning despite adversities”
• Bonanno (2014): “a trajectory characterized by a relatively brief period of disequilibrium, but otherwise continued healthy functioning”
• Panter-Brick (2014): “process to harness resources to sustain wellbeing”
• Yehuda (2014): “involves a reintegration of self, includes a conscious effort to move forward in an insightful, integrated positive manner as a result of lessons learned from an adverse experience”
• Masten (2021): “capacity of a dynamic system to adapt successfully through multisystem processes to challenges that threaten the function, survival, or development of the system”
• American Psychological Association (2014, 2018): “the process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress”

Further, the Social-Cognitive Research Interest Group of the Lyda Hill Institute for Human Resilience, affiliated with these authors’ graduate training, defines resilience as follows:

How do we model resilience?

Dr. George Bonanno, a prolific resilience researcher, has proposed criteria for modeling resilience (Bonanno et al., 2012).

• Timepoints of the aversive event must be clearly defined.
• Measurements of adjustment are obtained at multiple points in time; the first assessment of functioning should be obtained relatively near to the occurrence of the aversive event.
• Healthy adjustment includes more than the absence of diagnosable pathology and is more generally good health/average adjustment.

He proposes four trajectories of adaptation to trauma. The resilient trajectory is characterized by brief and mild disruption in functioning. This resolves over limited time and is followed by consistent healthy functioning. In 54 studies utilizing these trajectories, more than 65% of people were typically classified as resilient (Galatzer-Levy et al., 2018). Bonnano clarifies that resilience may look different depending on the timepoints of the aversive event; if a trauma or stressor is isolated with a clear beginning and end point, the type of resilience (as described in this trajectory) is considered minimal impact. If a trauma or stressor is chronic, the adjustment may be slightly more gradual; this is described as emergent resilience. Other researchers have established more nuanced trajectories (e.g., Layne et al., 2007) that consider pre-trauma functioning and posttraumatic growth, as well as other factors. 

Limitations of Current Definitions and Models

Despite the growing literature and continual modifications to definitions of resilience, current models are limited. First, definition and/or modeling of a resilient ‘type’ implies homogeneity of a construct that is often anything but (Bonanno, 2021; Layne et al., 2021). Acknowledgement of heterogeneity in resilience is clinically important, as the application of an all-encompassing term can obfuscate our ability to predict who will be resilient, how, and why (Bonanno, 2021). Second, our understanding of resilience in trauma research and practice often adopts a short-term and reactive orientation (Layne et al., 2021). This may prioritize immediate gains in the aftermath of trauma, but it does not necessarily ensure long-term adjustment. Herein lies a third limitation: that with a reactive and short-term approach to building resilience, opportunities to build an array of sustainable, developmentally appropriate coping resources are lost (Layne et al., 2021). As trauma exposure often begets increased risk for future trauma exposure, shifting towards preventatively and proactively building resilience capacities is of paramount importance. Finally, current approaches to building resilience often concern targeted recovery efforts of a specific trauma-exposed person or subgroup, but this comes at the expense of promoting population-level stress resistance, wellness, and growth (Layne et al., 2021). This narrow focus may not only be less resource-efficient (as the saying goes, an ounce of prevention is worth a pound of cure) but can also reveal inequities in systems related to resilience. 

Equitable Resilience

Matin and colleagues (2018) coined the term equitable resilience to highlight the need to attend to environmental and structural disparities that position particular groups at a resilience ‘disadvantage,’ while elevating resilience-building resources for others. Equitable resilience is a practice-oriented approach that aims to distill disparate and broadly conceptual theories of resilience into practical and testable terms that incorporate understanding of social vulnerabilities and differentiated access to power, knowledge, and resources. For example, in the aftermath of a natural disaster, it may be critical to ascertain which persons in the affected community have historically experienced disenfranchisement as a function of their identity (e.g., gender, race, housing instability, literacy) and how tenets of the trauma may intersect with this marginalization in ways that impact ability to receive information about recovery efforts, to afford to rebuild, to receive social support, or to have particular needs met. Equitable resilience asserts that when such dynamics are recognized and addressed appropriately, resilient outcomes will exceed those of interventions not couched in sociocultural context. As such, this approach has gained substantial traction in international and humanitarian contexts as a way to design and evaluate interventions. However, it is still making its way into mainstream trauma psychology. Nevertheless, the equitable resilience approach holds potential value as a means by which researchers and clinicians can plan and implement services that increase resilience in more meaningful and impactful ways. 

Considerations for Clinical Practice

Theoretically, resilience is complex—and oftentimes, our understanding of how to foster resilience in applied contexts is no more straightforward. There is no one-size-fits-all, gold-standard resilience intervention. While acknowledgement of the adaptable and amorphous nature of resilience is important, as clinicians we can foster resilience in clients by continuing to keep these issues front of mind and challenging ourselves to think critically about what resilience for the individual looks like. Some questions that may help guide clinical practice include:

• Does my practice consider social dynamics, power structures, and resource availability relevant for my clients?
• Does my practice draw upon and harness strengths and resources indigenous to the client?
• Is my practice building context-dependent resilience to a particular stressor, or am I promoting broader-domain stress resistance?
• Is my practice proactive or reactive?
• Is my practice appropriately scaled to developmental stage and cultural context?
• Does my practice focus not just on symptoms, but also on wellbeing and functioning? 

Assessment Considerations

A number of scales purport to assess resilience. Many have attained robust support and boast impressive psychometric properties. Ultimately, however, the question of which is best? is less important than what do you really want to assess? As detailed above, resilience has been sliced and diced dozens of different ways, and measures often correspond to a particular theory or framework of resilience. Thus, what becomes useful is understanding how a particular scale maps onto the construct as conceptualized by the framework the researcher is most interested in. Does it align more with a trait or state definition? Is resilience assessed as a unidimensional construct, or as a multidimensional latent entity comprised of various sub-factors? The table below summarizes a selection of widely used resilience scales and details how each defines resilience. Of note, this is not an all-encompassing list, and some of these measures assess constructs that are often of interest in resilience research, without directly assessing resilience itself.
 

About the Authors

Sophie Brickman, M.A., is a current doctoral student in clinical psychology with an emphasis in trauma at the University of Colorado Colorado Springs. She earned her bachelor's degree from Brandeis University. Her research and clinical interests include posttraumatic growth, trauma memory, and the role of creative writing in trauma healing. Please note that the opinions expressed in this piece are her own and do not necessarily reflect the position of the University of Colorado Colorado Springs.
 
Kelly Dixon, M.A., is a current doctoral student in clinical psychology with an emphasis in trauma at the University of Colorado Colorado Springs. She earned her bachelor's degree from the University of Michigan. Her research and clinical interests include risk and protective factors in posttraumatic adjustment trajectories, mechanisms of comorbidity between PTSD and substance use disorders, and post-disaster outcomes among refugees, immigrants, and asylum seekers. 

References

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.  https://doi.org/10.1037/0003-066X.59.1.20
 
Bonanno, G. A. (2012). Uses and abuses of the resilience construct: Loss, trauma, and health-related adversities. Social Science & Medicine, 74(5), 753–756. 
 
Bonanno G. A. (2021). The resilience paradox. European Journal of Psychotraumatology, 12(1), 1942642. https://doi.org/10.1080/20008198.2021.1942642
 
Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18(2), 76–82. 

Feldman, R. (2020). What is resilience: an affiliative neuroscience approach. World Psychiatry, 19(2), 132-150. 
 
Galatzer-Levy, I. R., Huang, S. H., & Bonanno, G. A. (2018). Trajectories of resilience and dysfunction following potential trauma: A review and statistical evaluation. Clinical Psychology Review, 63, 41-55. 
 
Klohnen E. C. (1996). Conceptual analysis and measurement of the construct of ego-resiliency. Journal of Personality and Social Psychology, 70(5), 1067–1079. 
 
Layne, C. M., Ruzek, J. I., & Dixon, K. (2021). From resilience and restoration to resistance and resource caravans: A developmental framework for advancing the disaster field. Psychiatry, 84(4), 393-409. 
 
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. Resick (Eds.), Handbook of PTSD: Science and practice (pp. 497–520). The Guilford Press.
 
Matin, N., Forrester, J., & Ensor, J. (2018). What is equitable resilience?. World Development, 109, 197-205. 
 
Masten A. S. (2001). Ordinary magic. Resilience processes in development. The American Ppsychologist, 56(3), 227–238. 
 
Masten, A. S., Lucke, C. M., Nelson, K. M., & Stallworthy, I. C. (2021). Resilience in development and psychopathology: Multisystem perspectives. Annual Review of Clinical Psychology, 17, 521-549. 
 
Southwick, S. M., Bonanno, G. A., Masten, A. S., Panter-Brick, C., & Yehuda, R. (2014). Resilience definitions, theory, and challenges: interdisciplinary perspectives. European Journal of Psychotraumatology, 5, 10.3402/ejpt.v5.25338. https://doi.org/10.3402/ejpt.v5.25338