Change Resilience: Learning from Our Patients Daytz, Anna E; Silverman, Julia B; Tanna, Neil
Plastic and reconstructive surgery (1963),
2024-Apr-01, Letnik:
153, Številka:
4
Journal Article
The COVID-19 pandemic poses an acute threat to the well-being of children and families due to challenges related to social disruption such as financial insecurity, caregiving burden, and ...confinement-related stress (e.g., crowding, changes to structure, and routine). The consequences of these difficulties are likely to be longstanding, in part because of the ways in which contextual risk permeates the structures and processes of family systems. The current article draws from pertinent literature across topic areas of acute crises and long-term, cumulative risk to illustrate the multitude of ways in which the well-being of children and families may be at risk during COVID-19. The presented conceptual framework is based on systemic models of human development and family functioning and links social disruption due to COVID-19 to child adjustment through a cascading process involving caregiver well-being and family processes (i.e., organization, communication, and beliefs). An illustration of the centrality of family processes in buffering against risk in the context of COVID-19, as well as promoting resilience through shared family beliefs and close relationships, is provided. Finally, clinical and research implications are discussed.
Public Significance Statement
The current paper reviews the literature on historical adversities that have threatened societies, such as natural and human-made disasters and recessions, in order to highlight the possible consequences of the current crisis on the well-being of families and children. Families are facing imminent threats to their relationships, rules, rituals, and routines due to COVID-19, which can have major implications for children's coping during this time. Some families will be more impacted than others, due to their prior circumstances, such as those with lower income, mental health and/or special needs, and/or experiences of racism or marginalization. It is important for families to preserve and nourish their relationships and shared beliefs as a way to provide security and hope for children during this time of stress and uncertainty.
Amid the global outbreak of COVID-19, resilience is likely to be one of the many possible outcomes. Studies pertaining to resilience following potentially traumatic events including disease outbreak ...have shown that the vast majority of individuals are resilient, and that outcomes depend on a combination of resilience factors including exposure severity, individual differences, family context, and community characteristics. To better understand psychological dysfunction and resilience during the global outbreak of COVID-19, researchers are encouraged to investigate long-term patterns of mental health rather than cross-sectional prevalence rates, adopt prospective designs and analyses, integrate multiple risk and resilience factors to enhance outcome prediction, and consider the importance of flexibility as the situation unfolds.
Spreading rapidly across the United States beginning in the spring of 2020, the coronavirus disease 2019 (COVID-19) pandemic radically disrupted Americans' lives. Previous studies of community-wide ...disasters suggested people are fairly resilient and identified resources and strategies that promote that resilience. Yet, the COVID-19 pandemic is in some ways unique, with high levels of uncertainty, evolving implications and restrictions, and varied and uneven impacts. How resilient were Americans as the pandemic progressed? What psychosocial resources and coping strategies facilitated adjustment as the country moved into a summer of uneven reopenings and reclosures? Data from a national sample of 674 Americans were gathered at the height of early lockdowns and peaking infections in mid-April, 2020, and again, 5 and 10 weeks later. The study aimed to determine levels and sources of distress and to identify the resources and coping efforts that promoted or impeded resilience. Early levels of distress diminished to some extent over subsequent months while levels of wellbeing were comparable with usual norms, suggesting a largely resilient response. COVID-19-related stress exposure also decreased gradually over time. Older age, higher levels of mindfulness and social support, and meaning focused coping predicted better adjustment, reflecting resilience, while avoidance coping was particularly unhelpful. In models predicting change over time, approach-oriented coping (i.e., active coping, meaning-focused coping, and seeking social support) was minimally predictive of subsequent adjustment. Given the unique and ongoing circumstances presented by COVID-19, specific interventions targeting psychosocial resources and coping identified here may help to promote resilience as the pandemic continues to unfold.
Public Significance StatementA national sample of 674 Americans surveyed at the height of early lockdowns and peaking coronavirus disease 2019 (COVID-19) infections in mid-April, 2020, and again, 5 and 10 weeks later, reported lower levels of COVID-19-related stress exposure and distress while levels of wellbeing were comparable with usual norms, suggesting a largely resilient response. Older age, higher levels of mindfulness and social support, and meaning focused coping predicted better adjustment while avoidance coping was particularly unhelpful. Mental health professionals can provide suggested structure and content for broadly disseminated online resources promoting mindfulness and meaning-focused coping such as reappraisal and acceptance.
Research has generally shown the benefits of social support, such as the buffering effects on life stressors, yet there has been little empirical investigation of different types of support resources ...for transgender individuals. We examined family support, support from friends, and connectedness to a transgender community and how these forms of support come together to influence mental health and resilience. The sample included 695 transgender participants (mean age = 25.52 years, SD = 9.68, range = 16-73; 75.7% White) who completed an online survey. Greater than half of participants reported moderate to severe levels of anxious and depressive symptoms. Family social support had the strongest correlations with symptoms of anxiety and depression (r = −.31 and −.37, respectively, p < .01) and was the only form of support associated with resilience when controlling for other forms of support. Latent profile analyses revealed 4 groups based on levels of social support from family and friends and community connectedness. Notably, Class 1 (n = 323; 47.1%) had high levels of support from family and friends and high levels of community connectedness. This class had lower levels of depression and anxiety symptoms and higher levels of resilience compared to other classes (Class 2, n = 276, 40.3%, high friend/community, low family; Class 3, n = 47, 6.9%, low support; Class 4, n = 39, 5.7%, high family, low friend/community). This study highlights the importance of examining support from a more holistic approach and provides insight into unique associations between familial social support and resilience.
Psychological flexibility (PF), defined as the ability to pursue valued life aims despite the presence of distress, is a fundamental contributor to health (Kashdan & Rottenberg, 2010). Existing ...measures of PF have failed to consider the valued goals that give context for why people are willing to manage distress. Using 4 independent samples and 3 follow-up samples, we examined the role of PF in well-being, emotional experience and regulation, resilience, goal pursuit, and daily functioning. We describe the development and psychometric properties of the Personalized Psychological Flexibility Index (PPFI), which captures tendencies to avoid, accept, and harness discomfort during valued goal pursuit. Correlational, laboratory, and experience-sampling methods show that the PPFI measures a trait-like individual difference dimension that is related to a variety of well-being and healthy personality constructs. Unlike existing measures of PF, the PPFI was shown to be distinct from negative emotionality. Beyond trait measures, the PPFI is associated with effective daily goals and life strivings pursuit and adaptive emotional and regulatory responses to stressful life events. By adopting our measurement index, PF may be better integrated into mainstream theory and research on adaptive human functioning.
Public Significance Statement
Psychological flexibility is defined as the pursuit of valued life aims despite the presence of distress, but existing measures fail to account for the personalized nature of these aims. We created and validated the Personalized Psychological Flexibility Index to measure 3 ways of managing distress (avoiding, accepting, and harnessing) that arises during the pursuit of personally meaningful goals. Our scale offers an improvement in the measurement of psychological flexibility in basic research and clinical trials.
This systematic review presents findings from a conceptual and methodological review of resilience measures using an interactionist theoretical framework. The review is also intended to update ...findings from previous systematic reviews. Two databases (EBSCOHost and Scopus) were searched to retrieve empirical studies published up until 2013, with no lower time limit. All articles had to meet specific inclusion criteria, which resulted in 17 resilience measures selected for full review. Measures were conceptually evaluated against an interactionist framework and methodologically reviewed using Skinner's (1981) validity evidence framework. We conclude that inconsistencies associated with the definition and operationalization of resilience warrant further conceptual development to explain resilience as a dynamic and interactive phenomenon. In particular, measures of resilience may benefit from a greater focus on within-person variance typically associated with behavioral consistency across situations. The use of alternative measurement modalities to self-report scales, such as situational judgment tests, is proposed as a way of advancing knowledge in this area.
The American Indian historical trauma (HT) concept is an important precursor to racial trauma (RT) theory that reflects the distinct interests of sovereign Indigenous nations but shares much of the ...same promise and challenge. Here, that promise and challenge is explored by tracing HT's theoretical development in terms of its anticolonial ambitions and organizing ideas. Three predominant modes of engaging HT were distilled form the literature (HT as a clinical condition, life stressor, and critical discourse), each informing a research program pursuing a different anticolonial ambition (healing trauma, promoting resilience, practicing survivance) organized by distinct ideas about colonization, wellness, and Indigeneity. Through critical reflection on these different ambitions and dialogue of their organizing ideas, conflict between research programs can be mitigated and a more productive anticolonialism realized in psychology and related health fields. Key recommendations emphasized clarifying clinical concepts (e.g., clinical syndrome vs. idiom of distress), disentangling clinical narratives of individual pathology (e.g., trauma) from social narratives of population adversity (e.g., survivance stories), attending to features of settler-colonialism not easily captured by heath indices (e.g., structural violence), and encouraging alignment of anticolonial efforts with constructive critiques establishing conceptual bridges to disciplines that can help to advance psychological understandings of colonization and Indigenous wellness (e.g., postcolonial studies). This conceptual framework was applied to the RT literature to elaborate similar recommendations for advancing RT theory and the interests of ethnic/racial minority populations through engagement with psychology and related health fields.
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