1. Resilience, Trauma and Narrative Dr Nigel Hunt Institute of Work, Health & Organisations University of Nottingham International Reader in Traumatic Stress Studies, University of Helsinki

2. Aims Conceptualising resilience in the context of traumatic stress The importance of narrative Transforming trauma

3. ‘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

4. 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

5. 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

6. Adaptiveness Historical evolutionary perspective We are adapted to cope with stressful and traumatic events We learn from such experiences ‘positive growth’ ‘resilience’

7. 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

8. Terms used in Psychology Resilience Psychological resilience Hardiness Resourcefulness Mental toughness Emotional resilience Ability to thrive Note the focus on the individual

9. 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

10. 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)

11. Narrative We are all storytellers coherence Meaning making Audience Theory and method Janet –From traumatic memory to narrative memory Bruner –Narrative and paradigmatic psychology

12. 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

13. 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

14. 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

15. NET and Earthquake survivors Yang, Hunt & Cox Pilot study 22 survivors of Szechuan earthquake with significant symptoms of PTSD NET Adapted for Chinese use

16. 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

17. PTSD symptoms

18. General Health Questionnaire

19. Anxiety & Depression

20. Negative thoughts

21. Positive thoughts

22. 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

23. 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

24. 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

25. 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

26. 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?

27. 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