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"Bonanno, George"
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The resilience paradox
Decades of research have consistently shown that the most common outcome following potential trauma is a stable trajectory of healthy functioning, or resilience. However, attempts to predict resilience reveal a paradox: the correlates of resilient outcomes are generally so modest that it is not possible accurately identify who will be resilient to potential trauma and who not. Commonly used resilience questionnaires essentially ignore this paradox by including only a few presumably key predictors. However, these questionnaires show virtually no predictive utility. The opposite approach, capturing as many predictors as possible using multivariate modelling or machine learning, also fails to fully address the paradox. A closer examination of small effects reveals two primary reasons for these predictive failures: situational variability and the cost-benefit tradeoffs inherent in all behavioural responses. Together, these considerations indicate that behavioural adjustment to traumatic stress is an ongoing process that necessitates flexible self-regulation. To that end, recent research and theory on flexible self-regulation in the context of resilience are discussed and next steps are considered.
Although correlates of resilience after trauma are known, paradoxically, prediction of resilient outcomes is surprisingly weak.
Predictors have generally small effects which suggests that the solution to the paradox must involve flexible self-regulation.
Journal Article
Regulatory Flexibility: An Individual Differences Perspective on Coping and Emotion Regulation
People respond to stressful events in different ways, depending on the event and on the regulatory strategies they choose. Coping and emotion regulation theorists have proposed dynamic models in which these two factors, the person and the situation, interact over time to inform adaptation. In practice, however, researchers have tended to assume that particular regulatory strategies are consistently beneficial or maladaptive. We label this assumption the fallacy of uniform efficacy and contrast it with findings from a number of related literatures that have suggested the emergence of a broader but as yet poorly defined construct that we refer to as regulatory flexibility. In this review, we articulate this broader construct and define both its features and limitations. Specifically, we propose a heuristic individual differences framework and review research on three sequential components of flexibility for which propensities and abilities vary: sensitivity to context, availability of a diverse repertoire of regulatory strategies, and responsiveness to feedback. We consider the methodological limitations of research on each component, review questions that future research on flexibility might address, and consider how the components might relate to each other and to broader conceptualizations about stability and change across persons and situations.
Journal Article
Symptoms of persistent complex bereavement disorder, depression, and PTSD in a conjugally bereaved sample: a network analysis
Complicated and persistent grief reactions afflict approximately 10% of bereaved individuals and are associated with severe disruptions of functioning. These maladaptive patterns were defined in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as persistent complex bereavement disorder (PCBD), but its criteria remain debated. The condition has been studied using network analysis, showing potential for an improved understanding of PCBD. However, previous studies were limited to self-report and primarily originated from a single archival dataset. To overcome these limitations, we collected structured clinical interview data from a community sample of newly conjugally bereaved individuals (N = 305).
Gaussian graphical models (GGM) were estimated from PCBD symptoms diagnosed at 3, 14, and 25 months after the loss. A directed acyclic graph (DAG) was generated from initial PCBD symptoms, and comorbidity networks with DSM-5 symptoms of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) were analyzed 1 year post-loss.
In the GGM, symptoms from the social/identity PCBD symptoms cluster (i.e. role confusion, meaninglessness, and loneliness) tended to be central in the network at all assessments. In the DAG, yearning activated a cascade of PCBD symptoms, suggesting how symptoms lead into psychopathological configurations. In the comorbidity networks, PCBD and depressive symptoms formed separate communities, while PTSD symptoms divided in heterogeneous clusters.
The network approach offered insights regarding the core symptoms of PCBD and the role of persistent yearnings. Findings are discussed regarding both clinical and theoretical implications that will serve as a step toward a more integrated understanding of PCBD.
Journal Article
The Temporal Elements of Psychological Resilience: An Integrative Framework for the Study of Individuals, Families, and Communities
Psychological resilience has become a popular concept. Owing to that popularity, the word resilience has taken on myriad and often overlapping meanings. To be a useful framework for psychological research and theory, the authors argue, the study of resilience must explicitly reference each of four constituent temporal elements: (a) baseline or preadversity functioning, (b) the actual aversive circumstances, (c) postadversity resilient outcomes, and (d) predictors of resilient outcomes. Using this framework to review the existing literature, the most complete body of evidence is available on individual psychological resilience in children and adults. By contrast, the research on psychological resilience in families and communities is far more limited and lags well behind the rich theoretical perspective available from those literatures. The vast majority of research on resilience in families and communities has focused primarily on only one temporal element, possible predictors of resilient outcomes. Surprisingly, however, almost no scientific evidence is actually available for community or family resilient outcomes. We close by suggesting that there is room for optimism and that existing methods and measures could be relatively easily adapted to help fill these gaps. To that end, we propose a series of steps to guide future research.
Journal Article
Deep learning-based classification of posttraumatic stress disorder and depression following trauma utilizing visual and auditory markers of arousal and mood
Visual and auditory signs of patient functioning have long been used for clinical diagnosis, treatment selection, and prognosis. Direct measurement and quantification of these signals can aim to improve the consistency, sensitivity, and scalability of clinical assessment. Currently, we investigate if machine learning-based computer vision (CV), semantic, and acoustic analysis can capture clinical features from free speech responses to a brief interview 1 month post-trauma that accurately classify major depressive disorder (MDD) and posttraumatic stress disorder (PTSD).
N = 81 patients admitted to an emergency department (ED) of a Level-1 Trauma Unit following a life-threatening traumatic event participated in an open-ended qualitative interview with a para-professional about their experience 1 month following admission. A deep neural network was utilized to extract facial features of emotion and their intensity, movement parameters, speech prosody, and natural language content. These features were utilized as inputs to classify PTSD and MDD cross-sectionally.
Both video- and audio-based markers contributed to good discriminatory classification accuracy. The algorithm discriminates PTSD status at 1 month after ED admission with an AUC of 0.90 (weighted average precision = 0.83, recall = 0.84, and f1-score = 0.83) as well as depression status at 1 month after ED admission with an AUC of 0.86 (weighted average precision = 0.83, recall = 0.82, and f1-score = 0.82).
Direct clinical observation during post-trauma free speech using deep learning identifies digital markers that can be utilized to classify MDD and PTSD status.
Journal Article
Resilience definitions, theory, and challenges: interdisciplinary perspectives
In this paper, inspired by the plenary panel at the 2013 meeting of the International Society for Traumatic Stress Studies, Dr. Steven Southwick (chair) and multidisciplinary panelists Drs. George Bonanno, Ann Masten, Catherine Panter-Brick, and Rachel Yehuda tackle some of the most pressing current questions in the field of resilience research including: (1) how do we define resilience, (2) what are the most important determinants of resilience, (3) how are new technologies informing the science of resilience, and (4) what are the most effective ways to enhance resilience? These multidisciplinary experts provide insight into these difficult questions, and although each of the panelists had a slightly different definition of resilience, most of the proposed definitions included a concept of healthy, adaptive, or integrated positive functioning over the passage of time in the aftermath of adversity. The panelists agreed that resilience is a complex construct and it may be defined differently in the context of individuals, families, organizations, societies, and cultures. With regard to the determinants of resilience, there was a consensus that the empirical study of this construct needs to be approached from a multiple level of analysis perspective that includes genetic, epigenetic, developmental, demographic, cultural, economic, and social variables. The empirical study of determinates of resilience will inform efforts made at fostering resilience, with the recognition that resilience may be enhanced on numerous levels (e.g., individual, family, community, culture).
Journal Article
Resilience in the Face of Potential Trauma
Until recently, resilience among adults exposed to potentially traumatic events was thought to occur rarely and in either pathological or exceptionally healthy individuals. Recent research indicates, however, that the most common reaction among adults exposed to such events is a relatively stable pattern of healthy functioning coupled with the enduring capacity for positive emotion and generative experiences. A surprising finding is that there is no single resilient type. Rather, there appear to be multiple and sometimes unexpected ways to be resilient, and sometimes resilience is achieved by means that are not fully adaptive under normal circumstances. For example, people who characteristically use self-enhancing biases often incur social liabilities but show resilient outcomes when confronted with extreme adversity. Directions for further research are considered.
Journal Article
A validated predictive algorithm of post-traumatic stress course following emergency department admission after a traumatic stressor
Annually, approximately 30 million patients are discharged from the emergency department (ED) after a traumatic event
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. These patients are at substantial psychiatric risk, with approximately 10–20% developing one or more disorders, including anxiety, depression or post-traumatic stress disorder (PTSD)
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–
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. At present, no accurate method exists to predict the development of PTSD symptoms upon ED admission after trauma
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. Accurate risk identification at the point of treatment by ED services is necessary to inform the targeted deployment of existing treatment
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–
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to mitigate subsequent psychopathology in high-risk populations
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,
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. This work reports the development and validation of an algorithm for prediction of post-traumatic stress course over 12 months using two independently collected prospective cohorts of trauma survivors from two level 1 emergency trauma centers, which uses routinely collectible data from electronic medical records, along with brief clinical assessments of the patient’s immediate stress reaction. Results demonstrate externally validated accuracy to discriminate PTSD risk with high precision. While the predictive algorithm yields useful reproducible results on two independent prospective cohorts of ED patients, future research should extend the generalizability to the broad, clinically heterogeneous ED population under conditions of routine medical care.
A machine-learning algorithm using electronic medical records and self-reported measures of stress at admission to the emergency department due to trauma can predict the risk and long-term trajectories of post-traumatic stress disorder in two independent cohorts.
Journal Article
Validation of the French Versions of the Context-Sensitivity Index (CSI) and the Flexible Regulation of Emotional Expression Scale (FREE)
Emotion regulation (ER) flexibility is defined as the ability to match ER strategies to situational demands. Several components of flexibility have been identified, such as the ability to detect the presence or absence of contextual cues (i.e., context-sensitivity), the ability to use flexibly diverse strategies (i.e., repertoire), and the ability to monitor and adapt strategies (i.e., feedback). The goal of this study was to validate French versions of the Context-Sensitivity Index (CSI) and the Flexible Regulation of Emotional Expression (FREE) scale. This online study comprised questionnaires designed to analyse the psychometric properties of the two questionnaires in a French population (N = 397). Both scales show satisfactory internal consistency (with ω = 0.81 for the FREE), convergent validity and acceptable test-retest validity (with 0.81 for the FREE; 0.71 for the CSI). Our findings support the hierarchical and four-dimension structures of the FREE scale, with all approximate fit indices demonstrating adequate model fit (CFI = 0.94; RMSEA = 0.05; Chi-square = 1450.656, df = 120, p < .001). Common limits of self-reported measures are associated with this study. Moreover, our results should be replicated in future studies. The French versions of the CSI and FREE scale can be considered as adequate instruments for assessing context-sensitivity and repertoire as components of ER flexibility.Significance StatementThe present study explores the psychometric properties of two questionnaires measuring two components of emotion regulation flexibility. The results reveal that the French versions of the Context Sensitivity Index (CSI) and of the Flexible Regulation of Emotional Expression scale (FREE) display proper psychometric properties and can be considered reliable instruments in the French community.
Journal Article