Resilience, Trauma and Narrative

1. Resilience, Trauma and Narrative Dr Nigel Hunt Institute of Work, Health & Organisations University of Nottingham International Reader in Traumatic Stress Studies, University of Helsinki

2. Aims • Conceptualising resilience in the context of traumatic stress • The importance of narrative • Transforming trauma

3. ‘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

4. 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

5. 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

6. Adaptiveness • Historical evolutionary perspective • We are adapted to cope with stressful and traumatic events • We learn from such experiences • ‘positive growth’ • ‘resilience’

7. 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

8. Terms used in Psychology • Resilience • Psychological resilience • Hardiness • Resourcefulness • Mental toughness • Emotional resilience • Ability to thrive • Note the focus on the individual

9. 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

10. 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)

11. Narrative • We are all storytellers • coherence • Meaning making • Audience • Theory and method • Janet • From traumatic memory to narrative memory • Bruner • Narrative and paradigmatic psychology

12. 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

13. 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

14. 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

15. NET and Earthquake survivors • Yang, Hunt & Cox • Pilot study • 22 survivors of Szechuan earthquake with significant symptoms of PTSD • NET Adapted for Chinese use

16. 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

17. PTSD symptoms

18. General Health Questionnaire

19. Anxiety & Depression

20. Negative thoughts

21. Positive thoughts

22. 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

23. 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

24. 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

25. 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

26. 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?

27. 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