Resilience, Trauma and Narrative

Dr Nigel Hunt

Institute of Work, Health & OrganisationsUniversity of Nottingham

International Reader in Traumatic Stress Studies, University of Helsinki

Aims

• Conceptualising resilience in the context of traumatic stress

• The importance of narrative

• Transforming trauma

‘Traumatic Event’

• An event that involves death, serious injury, or is life-threatening– To self or others

• War, disaster, rape, sexual abuse, other violent crime, , unexpected death of loved one, becoming a refugee, etc– Controversial list– What is traumatic to one person isn’t to

others

History of trauma

• Relatively recent construct– Though widely written about: Iliad,

Battle of Marathon• From shellshock to PTSD

– WWI to Vietnam• Emphasis on the social construct

– Serves different purposes across time• Physiological to psychological• Need for compensation

Problems with trauma research

• Growing expectation of negative outcome

• ‘symptoms’ are often normal distress– Overemphasised by self-report

measures– ‘interest’ rather than ‘intrusion’

• We think what we are told to think

• Minority get PTSD

Adaptiveness

• Historical evolutionary perspective• We are adapted to cope with

stressful and traumatic events• We learn from such experiences• ‘positive growth’• ‘resilience’

Defining resilience

• The ability to bounce back or recover after a setback

• Positive capacity of people to cope after a catastrophe

• A return to homeostasis• Adaptive system, using stress to

provide resistance to future stressful events

Terms used in Psychology

• Resilience• Psychological resilience• Hardiness• Resourcefulness• Mental toughness• Emotional resilience• Ability to thrive

• Note the focus on the individual

Resilience

• Distinct uses:• Negative:

– Outcome (of stress & coping processes)– Process

• Internal factors (eg biological, personality)• External factors (environment, events, people)

• Positive– Humanistic psychology – thriving, fulfilling

potential despite stressful events– Stress as challenging and opportunities for

growth

Trauma and resilience• 3 key areas for research

– Recovery– Resistance– Reconfiguration

• PTG, PTSD, neutral change

• Individual differences– Between and within

• Develop resilience through experience– Build personal resources– Remove risk factors

• Schnurr (2004)– Protect against war-related PTSD with: older

age, more education, higher SES, positive paternal relationship (pre-war), social support (post-war)

Narrative

• We are all storytellers• coherence• Meaning making • Audience• Theory and method• Janet

– From traumatic memory to narrative memory

• Bruner– Narrative and paradigmatic psychology

Resilience and narrative

• We can see successful narrative development as a resilience factor

• Two forms– Narrative of resilience

• Teaching people that they can cope

– Post-trauma narratives• Helping people to rebuild their lives

• Examples of narrative to show how resilience can be built/aided

Narrative coherence

• Burnell, Hunt & Coleman• Interview research with war veterans• Higher levels of coherence linked to

lower level of symptoms• Those with disjointed or incomplete

narratives experienced more PTSD symptoms

Narrative Exposure Therapy

• Developed for use with refugees• Combination of CBT and testimony

therapy• Good evidence for effectiveness

– Systematic review

• Used in China with victims of earthquake

NET and Earthquake survivors

• Yang, Hunt & Cox• Pilot study• 22 survivors of Szechuan earthquake

with significant symptoms of PTSD• NET Adapted for Chinese use

Method

• Measures: IES-R, GHQ, HADS, CiOQ, coping and social support– Translated into Chinese

• Delayed control design, 4 test points– Pretest– Gp 1 intervention Gp 2 control– Test– Gp 1 control Gp 2 intervention– Test– 2 month follow up

PTSD symptoms

General Health Questionnaire

Anxiety & Depression

Negative thoughts

Positive thoughts

• No change for coping or social support• Demonstrates effectiveness of NET• Can teach/help people to tell the story

of their trauma, to become more resilient

• Further research includes larger scale study of NET, Pennebaker paradigm, interviews & questionnaires

Developing narratives in Baghdad

• Jaber, Hunt & Sabin-Farrell• Development of learning package for

Baghdad students– Understanding trauma– Understanding symptoms– Understanding how to deal with

symptoms

Method

• Experimental and control groups– Simplified due to violence in Baghdad

• 125 participants (45M, 80F) – high PTSD score

• Ps work through learning package• Pre- and post-test measures

– HADS, IES-R, COPE

Findings

• Significant reductions in PTSD symptoms and anxiety and depression

• Changes to coping styles– Increased use of:

• Active coping, venting, positive reframing, planning, acceptance

– Decreased use of:• Self-distraction, use of emotional support,

humour, religion, self-blame

Interpretation

• Learning package helped Ps deal with symptoms

• Recognition that their feelings were not their fault

• Making meaning, learning resilience• Changes to coping reflect recognising

which strategies are more effective– Yang coping measure too basic?

Conclusions

• Narrative is important resilience factor– Can help rebuild meaning structure after a

traumatic event

• Resilience linked to making sense of stressful or traumatic events– Improving coping skills– Understanding what traumatic events do to a

person

• Importance of the other– Audience/social support