Mitigating Factors in the Development of Posttraumatic Stress Disorder Trauma does not always result in PTSD, and even when it does, many people are able to get better and experience symptom reduction. Typically, most individuals who are exposed to a single, discrete stressor recover over time (Masten, 2015). A number of intrinsic and extrinsic factors influence how and whether an individual will develop PTSD following traumatic events. Individuals placed in the same situation will not all respond in the same way; even within the same family system, children will respond differently to the same upbringing. This means that individual responses to the same stressors can be affected by contextual circumstances. Case Example
their mother abandoned the family. During the time that Teresa’s mother was away, her father became even more violent than he had been previously. Their father died when Teresa and Thomas were young adults. Of the six children, four married and had children. Two of them divorced, and one died in her early 40s of breast cancer. Two became alcoholics themselves. One physically abused her children. One had children without a partner. The youngest, Thomas, married and divorced without having children. Three left the Catholic Church. Two married partners who were abusive to them, and two abused their own partners. Two were marginally employed and could barely make ends meet. However, three siblings had good parenting skills and raised healthy children, two siblings finished college, and two siblings had their own successful business. Teresa divorced after having one daughter, had a subsequent long-term relationship with an abusive man, and then became active in her spiritualist church and became a talented Reiki practitioner. Thomas was successful in his business but struggled in his relationships with women; he developed a secret life that included visiting prostitutes and occasional binge drinking. Both were kindhearted and generous but struggled with anxiety and panic disorders. Despite their siblings having similar ongoing difficulties, Teresa and Thomas were the only ones who entered therapy to address and change the areas in which they struggled. with one another to determine how one responds to stressful experiences.” Factors can be individual or environmental. For example, dispositional optimism was found to be associated with reduced comorbid major depressive disorder in veterans diagnosed with PTSD (Nichter et al., 2020). Distal factors that appear to contribute to resilience are a sense of belonging to a community, cultural traditions, sociodemographic factors, and—particularly in children—facilitative and supportive attachment relationships (Masten, 2015). The most frequently mentioned protective factors that may be modifiable include emotion regulation, positive emotions, cognitive flexibility and reappraisal, and the ability to harness social support (Horn & Feder, 2018) There are numerous proximal factors—among them genetic, developmental, neurobiological, and psychosocial influences— correlated with resilience (Horn & Feder, 2018; Masten, 2015). Individuals high in self-efficacy, self-esteem, and perceived control tend to be more resilient (Southwick et al., 2015). Also, strong adaptive skills, self-regulatory abilities, and meaning- making systems contribute to resilient functioning (Horn & Feder, 2018; Masten, 2015; Southwick et al., 2015). Mastery motivation (i.e., the drive to learn, grow, and adapt from experiences) and active problem-solving strategies (i.e., gathering information, acquiring skills, and reframing negative information) are also effective in promoting resilience (Southwick et al., 2014). Evidence suggests that both altruism and hardiness (i.e., the capacity to experience adversity as challenges to overcome) increase resistance to developing PTSD (Southwick et al., 2015). Fixed, stable biological traits are also associated with resilience. Certain temperamental and genetic profiles may mitigate the effects of trauma (Fino et al., 2020; Wolf et al., 2018). Also, “genetic differences in the reactivity of the stress response system (hypothalamic-pituitary-adrenal axis), sympathetic nervous system, and serotonin systems” may also moderate how an individual responds to and manages trauma (Southwick et al., 2015, p. 1). Daniel Brown (1996) coined the phrase the “twelve C’s” to categorize the various factors that mitigate the development of resilience or PTSD after traumatic experiences. These “twelve C’s” are a helpful summarization of the literature on resilience:
Teresa and Thomas were an adult brother and sister who were raised in an Irish Catholic family of six children. They were treated by the same clinician. Their father was a violent alcoholic who physically abused all of the children, battered his wife, and sexually abused at least several of his daughters. Specifically, Teresa was sexually abused by her father from a very young age until she was 16. She was the direct victim of multiple forms of violence and a witness to others. Their passive and abused mother continually refused help offered by the church and did not allow social service workers to remove any of the children; she frequently lied to keep the family intact and to prevent the neighbors from knowing the extent of the family’s troubles. Their mother temporarily abandoned the family for eight months, when her children ranged from ages 3 to 14. Teresa was 12 years old and her youngest brother, Thomas, was 3 years old when Resilience The ability of many people “to bend but not break, bounce back, and perhaps even grow in the face of adverse life experiences” is called resilience (Southwick et al., 2015). Ann Masten (2015, p. 193) has elegantly referred to resilience as “ordinary magic.” There are many accepted definitions of resilience in the literature. Some see it as the “ability to maintain or regain normal psychological and physical functioning in the face of adversity” (Wolf et al., 2018). Others consider resilience to be the “dynamic ability to adapt successfully in the face of adversity, trauma, or significant threat” (Horn & Feder, 2018). Some focus on the biological response and see resilience as “enhanced psychobiological capacity to modulate the stress response” (Southwick et al., 2015, p. 7). Also, some define resilience as “the process to harness resources to sustain well- being” (Southwick et al., 2014, p. 5). This description highlights the ecological importance of the coping systems surrounding the individual. All of these accepted definitions touch on the potential to overcome and respond to trauma. “Resilience is not a simple or static construct,” and it does not always imply that a disorder never develops (Southwick et al., 2015, p. 1). “An individual may be resilient in one aspect of life” (e.g., their internal well-being), “but not in another” (e.g., the person may be unable to maintain healthy relationships; Southwick et al., 2015, p. 1). Rachel Yehuda (in Southwick et al., 2015) remarks that resilience is not simply the “opposite of psychopathology” (p. 2) or the ability to withstand developing a disorder; that is, individuals can still be resilient, even if they develop or suffer from PTSD, by bouncing back, recovering, or simply managing their symptoms daily to the point at which they can function in life. Resilience is still a relatively new field of research, and the academic community is still attempting to uncover the specific factors that contribute to or promote resilience. Wolf and colleagues (2018) suggest that PTSD and resilience may exist along a single genetic continuum with resilience on one end and high symptom severity on the other. Others have proposed the use of a resilience “R factor” analogous to Spearman’s g factor for intelligence to take a multifactorial view of resilience (Rakesh et al., 2019). According to Southwick and colleagues (2015, p. 7), “Determinants of resilience include a host of biological, psychological, social and cultural factors that interact
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