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Resilience, Trauma and Narrative. Dr Nigel Hunt Institute of Work, Health & Organisations University of Nottingham International Reader in Traumatic Stress Studies, University of Helsinki. Aims. Conceptualising resilience in the context of traumatic stress The importance of narrative

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Resilience trauma and narrative

Resilience, Trauma and Narrative

Dr Nigel Hunt

Institute of Work, Health & Organisations

University of Nottingham

International Reader in Traumatic Stress Studies, University of Helsinki


Resilience trauma and narrative

Aims

  • Conceptualising resilience in the context of traumatic stress

  • The importance of narrative

  • Transforming trauma


Traumatic event

‘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

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

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

Adaptiveness

  • Historical evolutionary perspective

  • We are adapted to cope with stressful and traumatic events

  • We learn from such experiences

  • ‘positive growth’

  • ‘resilience’


Defining 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

Terms used in Psychology

  • Resilience

  • Psychological resilience

  • Hardiness

  • Resourcefulness

  • Mental toughness

  • Emotional resilience

  • Ability to thrive

  • Note the focus on the individual


Resilience

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

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

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

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

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

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

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

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

PTSD symptoms


General health questionnaire

General Health Questionnaire


Anxiety depression

Anxiety & Depression


Negative thoughts

Negative thoughts


Positive thoughts

Positive thoughts


Resilience trauma and narrative

  • 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

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


Method1

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

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

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

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


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