Resilience in ourselves and our clients: Posttraumatic growth and lessons from the Canterbury earthquake sequence
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1 Resilience in ourselves and our clients: Posttraumatic growth and lessons from the Canterbury earthquake sequence Virginia McIntosh University of Canterbury Clinical Psychology Training Programme Department of Psychology
2 12.51PM 22 February 2011
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14 TIERED RESPONSE
15 ASSETT (Adult Specialist Services Earthquake Trauma Team) Following the major earthquakes Recognised that anxiety responses common Anticipated most would improve without treatment Some would need psychological treatment Other pathways available for people primarily depressed Began planning dedicated treatment service for traumatised Collaboration Clinical Research Unit and Anxiety Disorders Service
16 OUR PATIENTS Fear Anxiety symptoms racing heart, feeling shaky Worry about what might/could have happened Hyperarousal/exaggerated startle Reexperiencing Triggers aftershocks, sounds, movements, smells Avoidance Anxiety about being separated from family/home Sleep disturbance - exhaustion Swings in emotions Feeling detached, numb Risk taking Overwhelmed
17 OUR PATIENTS Several hundred referrals to ASSETT Group and/or individual treatment
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60 Observing considerable earthquake exposure and experiences coping well thriving after trauma
61 Questions Why do some people cope well after adverse experiences and others not? Do some people thrive because of the adversity?
62 Groups 100+ referred patients years Variable exposure to EQ-related events Psychological distress (DSM diagnoses; Referred to tertiary mental health service)
63 Groups 100+ referred patients years Variable exposure to EQ-related events Psychological distress (DSM diagnoses; Referred to tertiary mental health service) 100+ self-referred coping well years Moderate to high exposure to EQs Not distressed (No current diagnoses; No tertiary treatment)
64 The research team Caroline Bell Frances Carter Janet Carter Helen Colhoun Jenny Jordan Dianne LeCompte Gini McIntosh Alex Loughlin Bridget Kimber Leila Marie Rebekah Smith Anna Thorpe Julia Martin Wendy Mayes
65 Measures Demographic Structured diagnostic interview MINI Narrative of earthquake experience Exposure, coping, resilience, functioning, posttraumatic growth Psychological Traumatic Exposure Severity Scale Depression, Anxiety, Stress Scale (DASS) PTSD Checklist Work and Social Adjustment Scale Alcohol Use Disorders Inventory Reasons for Drinking Questionnaire Connor Davidson Resilience Scale Posttraumatic Growth Inventory Neuropsychological Rey Auditory-Verbal Learning Test Immediate + delayed recall Groton Maze Learning Test Immediate + delayed recall Digit Symbol Substitution Test Harmer Facial emotion recognition task Biological Salivary cortisol Heart rate variability
66 Measures Demographic Structured diagnostic interview MINI Narrative of earthquake experience Exposure, coping, resilience, functioning, posttraumatic growth Psychological Traumatic Exposure Severity Scale Depression, Anxiety, Stress Scale (DASS) PTSD Checklist Work and Social Adjustment Scale Alcohol Use Disorders Inventory Reasons for Drinking Questionnaire Connor Davidson Resilience Scale Posttraumatic Growth Inventory Neuropsychological Rey Auditory-Verbal Learning Test Immediate + delayed recall Groton Maze Learning Test Immediate + delayed recall Digit Symbol Substitution Test Harmer Facial emotion recognition task Biological Salivary cortisol Heart rate variability
67 Measures Demographic Structured diagnostic interview MINI Narrative of earthquake experience Exposure, coping, resilience, functioning, posttraumatic growth Psychological Traumatic Exposure Severity Scale Depression, Anxiety, Stress Scale (DASS) PTSD Checklist Work and Social Adjustment Scale Alcohol Use Disorders Inventory Reasons for Drinking Questionnaire Connor Davidson Resilience Scale Posttraumatic Growth Inventory Neuropsychological Rey Auditory-Verbal Learning Test Immediate + delayed recall Groton Maze Learning Test Immediate + delayed recall Digit Symbol Substitution Test Harmer Facial emotion recognition task Biological Salivary cortisol Heart rate variability
68 Posttraumatic growth Posttraumatic growth: the positive changes that can occur as a struggle with a potentially traumatic event (Calhoun & Tedeschi, 1998)
69 Facets of posttraumatic growth noted in research to date Growth in the domain of self Boosted personal agency/strength New possibilities for life Changes in life philosophy Greater appreciation of life Spiritual / existential growth Improvements in relating to others
70 Resilience: the lack of pathology in the face of high-risk circumstances (Lepore & Revenson, 2009)
71 How is posttraumatic growth different from resilience? Posttraumatic growth suggests growing from traumatic experiences Posttraumatic growth can co-exist with ongoing distress (posttraumatic stress disorder, negative affect)
72 Comprehensive model of posttraumatic growth (simplified) Person pre-trauma (with assumptive world beliefs) Influenced by individual differences and own culture Potentially disruptive event Distress Assumptive beliefs challenged Coping efforts: ruminate, social support, revise narrative/schema Calhoun, Cann & Tedeschi (2010) Posttraumatic growth More complex narrative Acceptance of changed world
73 Does resilience preclude posttraumatic growth?
74 What did we find? Sample exhibited posttraumatic growth Resilience did not influence levels of posttraumatic growth Posttraumatic growth related to higher peritraumatic distress, distress associated with life events, and ongoing distress from earthquakerelated events (EQC, insurance ) Women showed more posttraumatic growth than men overall Appreciation of Life Relating to Others Personal Strength Women showed more peritraumatic distress than men
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76 Thematic Analysis 100 interviews transcribed in full Data entered into database and examined for presence of themes. Coding scheme developed Interviews tagged with codes where certain themes occurred Common themes noted and grouped together
77 Themes Balanced acknowledgement of positive and negative outcomes Positive appraisal Self Others Silver linings, lucky Earthquake as an opportunity Downplay the negative Role
78 Themes related to posttraumatic growth Greater sense of community Greater appreciation of life, the little things Better relationships Self as stronger Spiritual / existential change
79 Themes related to posttraumatic growth Greater sense of community Greater appreciation of life, the little things Better relationships Self as stronger Spiritual / existential change
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81 Thematic analysis Balanced acknowledgement of positive and negative outcomes Positive appraisal Self Others Silver linings, lucky Earthquake as an opportunity Downplay the negative Role
82 Themes related to posttraumatic growth Greater sense of community Greater appreciation of life, the little things Better relationships Self as stronger Spiritual / existential change
83 Thematic analysis Balanced acknowledgement of positive and negative outcomes Positive appraisal Self Others Silver linings, lucky Earthquake as an opportunity Downplay the negative Role
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86 Thematic analysis Balanced acknowledgement of positive and negative outcomes Positive appraisal Self Others Silver linings, lucky Earthquake as an opportunity Downplay the negative Role
87 Thematic analysis Balanced acknowledgement of positive and negative outcomes Positive appraisal Self Others Silver linings, lucky Earthquake as an opportunity Downplay the negative Role
88 Themes related to posttraumatic growth Greater sense of community Greater appreciation of life, the little things Better relationships Self as stronger Spiritual / existential change
89 Themes related to posttraumatic growth Greater sense of community Greater appreciation of life, the little things Better relationships Self as stronger Spiritual / existential change
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