Deck 9: Stability and Change

Question 1

Describe one way that resilience can be assessed in research, and list a strength and weakness associated with the method that you chose. Support your answer with relevant examples.

Answer 1

Even setting aside the complexity of stability and change in resilience, some tricky issues remain in fully describing it. The first is how to calibrate what counts as a good outcome.
One (non-ideal) approach might be to define resilient responses as those which are better than average. We would first need to decide who is included in the relevant group (e.g. all widows, young widows, widows who were primary caregivers), then assess them and then define the least distressed half as resilient. However, this arbitrarily assumes that 50% of people are resilient. Beyond arbitrary, you might also be surprised to learn that the 50% resilience rate is actually lower than research estimates using other methods (Galatzer-Levy, Huang, & Bonanno, 2018).
For example, a study surveyed residents of New York City for symptoms of post-traumatic stress disorder (PTSD) six months after the 2001 terrorist attack (Bonanno, Galea, Bucciarelli, & Vlahov, 2006). Overall, about 65% of people reported zero or one symptom, and the researchers considered them resilient. About 6% reported high symptom levels, suggesting continued PTSD stemming from the attack, with the remaining 29% showing moderate or recovering levels. Although this study documents substantial suffering, it also suggests that the most common response was resilience in the face of a potentially traumatic event.
Another way to find resilience is to track people over time, ideally with a measurement taken before the potentially traumatic event. This approach presents a challenge to researchers, yet dozens of studies have been able to measure people before and after adverse events. Many of these are studies of predictable events (e.g., military deployment, bereavement following illness), but others rely on luck, clever adjustments or good records.
For example, comprehensive medical records in the Netherlands were used to examine children's mental health before and after a major fireworks factory accident (more on that later; Dirkzwager, Kerssens, & Yzermans, 2006). As another example, in 2004-2005 researchers began a study about scholarships for low income women in New Orleans which included some measures of distress and social support. After hurricane Katrina hit the city, they located most of the participants for a follow-up, and could track distress from before to after this major disaster (Lowe & Rhodes, 2013). In pre-post-event studies like this, changes over time can be used to sort people into groups. Understandably, some people respond with a significant increase in distress. Others, however, are quite stable, with low levels of distress before the event which remain similar through it and after it. These people are considered resilient for maintaining psychological heath despite difficult circumstances.
Another challenge in characterizing resilience is deciding what, exactly, must go right to qualify.
For example, if a chronically ill person has pervasive uncertainty about her purpose in life, but generally experiences pleasant moods, is she resilient? For practical reasons, individual studies typically consider only a small set of potentially relevant factors. Returning to the study of 2001 New Yorkers, many people seemed resilient on measures of PTSD, but perhaps they were still depressed or had substantially reduced life satisfaction-we simply do not know. Some critics argue that we cannot trust the high resilience rate estimates because there could always be unmeasured variables which would display problems (e.g. Infurna & Luthar, 2016). It is hard to dismiss this idea, and caution is warranted to avoid making too much of exact estimates for resilience rates. However, it also seems unlikely that research consistently measures the wrong things, and that substantial ill-being is hiding in those unmeasured factors. Most individual studies are too limited to make confident conclusions about psychological health broadly (complete resilience), but critiques become unfalsifiable if they appeal to an endless list of hidden or unmeasured possibilities.

Question 2

How might objective and perceived post-traumatic growth promote good psychological health? Is it better to promote one or the other?

Answer 2

For objective change over time, the question seems to answer itself. Growth is defined by increases in desirable characteristics such as strong interpersonal relationships, self-esteem and mastery; these are hallmarks of psychological health. Some studies also hint that actual growth is associated with less distress (Frazier et al., 2009). The primarily limitation here is that actual growth may not extend across all potential areas of well-being simultaneously. Still, with little evidence of trade-offs across domains (e.g. mastery at the cost of spirituality), the actual growth seems like a real benefit.
Turning to perceptions of growth and well-being, the answer is frustratingly ambiguous. The perception of growth is comforting in and of itself, and it connotes a subjective sense of wellbeing, at least in those growth domains. In addition, many individual studies found that perceptions of growth were associated with less distress and other desirable outcomes (Lechner et al., 2009; Linley & Joseph, 2004). In addition, perceived growth is associated with positive coping strategies, and can be viewed as part of those coping efforts (Jayawickreme & Blackie, 2014; Lechner et al., 2009). On the other hand, some studies find that perceptions of growth are associated with higher levels of distress.
It seems plausible that the experience of distress might prompt perceptions of growth. To the extent that distress is the catalyst, we should expect that the most distressed people will feel like they changed the most. On the other hand, if perceptions of growth are genuinely helpful, that distress should then fade with time. This seems to happen for some people (e.g. the spinal cord patients who found meaning had less depression over time, Davis & Novoa, 2013), but results differ across studies.
Nonetheless, the current state of research suggests that trying to build actual strengths-rather than mere perceptions of increased strengths-has better potential to help people who have experienced trauma. Said another way, there is probably little value in trying to convince people that their lives are better because of traumatic experiences; yet, fostering actual strengths is obviously beneficial.

Question 3

What is the ultimate goal of positive interventions? Knowing this, describe two limitations that typically qualify positive interventions' success.

Answer 3

The overall message is that positive interventions can work, but this does not mean that we have strong evidence for every individual tool in the collection. For example, the technique of using active-constructive responding is frequently mentioned in reviews (based on encouraging nonintervention research; see Chapter 8), but the only two studies that tested it as an intervention produced inconclusive results (Schueller, 2010; Woods, Lambert, Brown, Fincham, & May, 2015).
Additionally, when the results of many intervention studies are averaged, the degree of well-being change is relatively small, compared to control conditions. The potential upsides of widespread use and the relatively low cost of these interventions mean that reliable but small effects could still produce tremendous benefits. Still, dramatic boosts in happiness are not the norm.
Moreover, as more time passes between the initial intervention and the follow-up tests, we see fewer studies, and among the studies that do exist, the size of the happiness boosts gets smaller. For example, writing a gratitude letter today is unlikely to make you happy a year from now. This may seem obvious; yet, the ultimate goal for positive interventions is to foster lasting gains in well-being. The more intensive interventions, such as those that involve direct contact with a counsellor and that involve weeks of (group) therapy, tend to produce larger and longer lasting results. Such interventions are not the prototypical positive activities, but they are usually included in the meta-analyses that conclude successful well-being increases. We must be careful to avoid ascribing the effects of intensive interventions to trivial activities.

Question 4

With much prior exposure to traumatic events, resilience is ______ on average.

A) lesser
B) greater
C) unchanged

Question 5

______ predicts the completion of stressful tasks, and it includes elements of self-efficacy, emotion regulation, attention regulation and optimism.

A) Extraversion
B) Post-traumatic growth
C) Mental toughness
D) All of these

Question 6

A study by Seery, Holman, and Silver (2010) on predictors of resilience found that ______ of cumulative lifetime adversity (like divorce, natural disasters, and injury) were associated with the highest life satisfaction and the lowest distress.

A) high levels
B) moderate levels
C) low levels
D) the complete absence

Question 7

Perceptions of growth often ______.

A) focus more on the past
B) focus more on the future
C) mimic reality
D) differ from reality

Question 8

______ is defined by positive change following a major good event.

A) Post-ecstatic growth
B) Post-traumatic growth
C) Benefit finding
D) Meaning making

Question 9

Even though well-being is fairly stable over time, happiness can improve if ______.

A) people are content with their present levels of happiness
B) people imagine a happier future self
C) people invest effort in the goal of becoming more happy
D) people tell others they want to be happier

Question 10

Positive interventions are designed to ______, rather than ______.

A) treat dysfunction; boost happiness
B) boost happiness; treat dysfunction
C) keep happiness at a neutral level; increase happiness
D) boost happiness short-term; focus on long-term increases

Question 11

Notwithstanding limitations to his methods, the researcher and teacher Michael Fordyce showed that happiness could be increased through instruction and effort by ______.

A) keepings busy and more active
B) spending more time socializing
C) lowering expectations and aspirations
D) cultivating close relationships
E) All of these

Question 12

With positive interventions, people who ______ and ______ typically benefit more with longer-lasting increases in well-being.

A) are assigned; stick with this one activity
B) actively seek out variety; stick with activities
C) seek out short-term pleasure; spend more time by themselves
D) read about happiness; observe their own behaviour

Question 13

The heart of the positive activity model is labeled ______, which describes the match of an activity's features to an individual's personality and circumstances.

A) person-activity fit
B) well-being fit
C) personality-happiness fit
D) activity-circumstance fit

Question 14

Acceptance and commitment therapy (ACT) teaches ______ to develop an engaged yet non-judgmental approach to present circumstances.

A) patience
B) passiveness
C) mindfulness
D) empathy

Question 15

Overall, resilience training is viewed as ______ mental health care.

A) short-term
B) prescriptive
C) preventative
D) highly effective