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How Resilience Affects Post-Traumatic Stress Symptoms: The Mediating Role of Acceptance

Abstract

Not every individual who experiences a traumatic event is diagnosed with post-traumatic stress disorder (PTSD) or shows its symptoms. Resilience has been understood to be a key factor that helps individuals adapt successfully following an adversity. Acceptance has also been considered a therapeutic factor for such individuals. However, there are few studies that investigated the relationship between resilience and acceptance, and their impacts on post-traumatic stress symptoms. The current study examined the effect of resilience on post-traumatic stress symptoms and the mediating role of acceptance in the relationship. A total of 140 participants who experienced trauma (80 females and 60 males) were included in the analyses. Resilience was found to be negatively correlated with post-traumatic stress symptoms and acceptance was found to mediate the relationship between the two. This study provides an understanding of the mechanism underpinning the effect of resilience on post-traumatic stress symptoms. Study limitations and suggestions for future research are also discussed.

keywords
resilience, acceptance, post-traumatic stress symptoms, mediating effect

Reference

1.

Abela, J. R., & Hankin, B. L. (2011). Rumination as a vulnerability factor to depression during the transition from early to middle adolescence: A multiwave longitudinal study. Journal of Abnormal Psychology, 120, 259-271.

2.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). Arlington, VA: American Psychiatric Pub.

3.

Arabaci, L. B., Dikec, G., Buyukbayram, A., Uzunoglu, G., & Ozan, E. (2018). Traumatic growth and psychological resilience status of female victims of violence inpatients in a district psychiatric hospital. Archives of Psychiatric Nursing, 32, 568-573.

4.

Back, S. E., Dansky, B. S., Carroll, K. M., Foa, E. B., & Brady, K. T. (2001). Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: Description of procedures. Journal of Substance Abuse Treatment, 21, 35-45.

5.

Bajaj, B., & Pande, N. (2016). Mediating role of resilience in the impact of mindfulness on life satisfaction and affect as indices of subjective well-being. Personality and Individual Differences, 93, 63-67.

6.

Benetti, C., & Kambouropoulos, N. (2006). Affect-regulated indirect effects of trait anxiety and trait resilience on self-esteem. Personality and Individual Differences, 41, 341-352.

7.

Blackburn, L., & Owens, G. P. (2016). Rumination, resilience, and posttraumatic stress disorder symptom severity among veterans of Iraq and Afghanistan. Journal of Aggression, Maltreatment and Trauma, 25, 197-209.

8.

Bonanno, G. A., & Mancini, A. D. (2012). Beyond resilience and PTSD: Mapping the heterogeneity of responses to potential trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 74-83.

9.

Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., . . . Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42, 676-688.

10.

Bryant, R. A. (2003). Early predictors of posttraumatic stress disorder. Biological Psychiatry, 53, 789-795.

11.

Charney, D. S. (2004). Psychobiological mechanisms of resilience and vulnerability: Implications for successful adaptation to extreme stress. American Journal of Psychiatry, 161, 195-391.

12.

Cho, Y. R. (2014). The influence of resilience on mental well-being and post-traumatic stress symptoms of trauma-exposed individuals:Mediating effects of post-traumatic growth and post-traumatic negative cognitions. Cognitive Behavior Therapy in Korea, 14, 359-386.

13.

Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC). Depression and Anxiety, 18, 76-82.

14.

Fergus, S., & Zimmerman, M. A. (2005). Adolescent resilience: A framework for understanding healthy development in the face of risk. Annual Review of Public Health, 26, 399-419.

15.

Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A., Riggs, D. S., Feeny, N. C., & Yadin, E. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73, 953-964.

16.

Follette, V. M., Palm, K. M., & Hall, M. L. R. (2004). Acceptance, mindfulness, and trauma. In S. C. Hayes, V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive-behavioral tradition (pp. 192-208). New York, NY: Guilford.

17.

Follette, V. M., Pal, K. M., & Pearson, A. N. (2006). Mindfulness and trauma: Implications for treatment. Journal of Rational-Emotive and Cognitive Behavior Therapy, 24, 45-61.

18.

Harvey, J., & Delfabbro, P. H. (2004). Psychological resilience in disadvantaged youth: A critical overview. Australian Psychologist, 39, 3-13.

19.

Hayes, A. (2013). Introduction to mediation, moderation, and conditional process analysis. New York, NY: Guilford Press.

20.

Hayes, S. C. (2004). Acceptance and commitment therapy and the new behavior therapies: Mindfulness, acceptance, and relationship. In S. C. Hayes, V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive-behavioral tradition (pp. 1-29). New York, NY: Guilford.

21.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford.

22.

Held, P., Klassen, B. J., Zou, D. S., Schroedter, B. S., Karnik, N. S., Pollack, M. H., & Zalta, A. K. (2017). Negative posttrauma cognitions mediate the association between morally injurious events and trauma‐related psychopathology in treatment‐seeking veterans. Journal of Traumatic Stress, 30, 698-703.

23.

Heo, J. H., Choi, M. S., & Jin, H. J. (2009). Study on the reliability and validity of Korean translated acceptance-action questionnaire-II. The Korean Journal of Counseling and Psychotherapy, 21, 861-878.

24.

Hoge, E. A., Austin, E. D., & Pollack, M. H. (2007). Resilience: Research evidence and conceptual considerations for posttraumatic stress disorder. Depression and Anxiety, 24(2), 139-152.

25.

Horn, S. R., Charney, D. S., & Feder, A. (2016). Understanding resilience:New approaches for preventing and treating PTSD. Experimental Neurology, 284, 119-132.

26.

Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209-218.

27.

Hu, T., Zhang, D., & Wang, J. (2015). A meta-analysis of the trait resilience and mental health. Personality and Individual Differences, 76, 18-27.

28.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602.

29.

King, A. P., Erickson, T. M., Giardino, N. D., Favorite, T., Rauch, S. A., Robinson, E., . . . Liberzon, I. (2013). A pilot study of group mindfulness‐based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD). Depression and Anxiety, 30, 638-645.

30.

King, L. A., King, D. W., Fairbank, J. A., Keane, T. M., & Adams, G. A. (1998). Resilience–recovery factors in post-traumatic stress disorder among female and male Vietnam veterans: Hardiness, postwar social support, and additional stressful life events. Journal of Personality and Social Psychology, 74, 420-434.

31.

Kim, J. I., & Byeon, Y. S. (2013). A study on the factors affecting resilience in parients with colon cancer. Asian Oncology Nursing, 13, 256-264.

32.

Lang, P. J., & McTeague, L. M. (2011). Discrete and recurrent traumatization in PTSD: Fear vs. anxious misery. Journal of Clinical Psychology in Medical Settings, 18, 207-209.

33.

Lim, H. K., Woo, J. M., Kim, T. S., Kim, T. H., Choi, K. S., Chung, S. K., . . . Chae, J. H. (2009). Reliability and validity of the Korean version of the Impact of Event Scale-Revised. Comprehensive Psychiatry, 50, 385-390.

34.

Mak, W. W., Ng, I. S., & Wong, C. C. (2011). Resilience: Enhancing well-being through the positive cognitive triad. Journal of Counseling Psychology, 58, 610-617.

35.

McCracken, L. M., & Gutiérrez-Martínez, O. (2011). Processes of change in psychological flexibility in an interdisciplinary groupbased treatment for chronic pain based on acceptance and commitment therapy. Behaviour Research and Therapy, 49, 267-274.

36.

McRae, K., Ciesielski, B., & Gross, J. J. (2012). Unpacking cognitive reappraisal: Goals, tactics, and outcomes. Emotion, 12, 250-255.

37.

Min, J. A., Jung, Y. E., Kim, D. J., Yim, H. W., Kim, J. J., Kim, T. S., . . ., & Chae, J. H. (2013). Characteristics associated with low resilience in patients with depression and/or anxiety disorders. Quality of Life Research, 22, 231-241.

38.

Min, J. A., Lee, C. U., Hwang, S. I., Shin, J. I., Lee, B. S., Han, S. H., . . . Chae, J. H. (2014). The moderation of resilience on the negative effect of pain on depression and post-traumatic growth in individuals with spinal cord injury. Disability and Rehabilitation, 36, 1196-1202.

39.

Morina, N., Stangier, U., & Risch, A. K. (2008). Experiential avoidance in civilian war survivors with current versus recovered posttraumatic stress disorder: A pilot study. Behaviour Change, 25, 15-22.

40.

Noh, N. N., & Hong, C. H. (2017). The moderating effect of egoresilience and the mediating effect of social support in the realtionship between abuse experience and complex PTSD. The Korean Journal of Developmental Psychology, 30, 1-19.

41.

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29, 95-129.

42.

Orsillo, S. M., Roemer, L., & Barlow, D. H. (2003). Integrating acceptance and mindfulness into existing cognitive-behavioral treatment for GAD: A case study. Cognitive and Behavioral Practice, 10, 222-230.

43.

Orsillo, S. M., Roemer, L., Lerner, J. B., & Tull, M. T. (2004). Acceptance, mindfulness, and cognitive-behavioral therapy: Comparisons, contrasts, and application to anxiety. In S. C. Hayes, V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance:Expanding the cognitive-behavioral tradition (pp. 66-95). New York, NY: Guilford.

44.

Padesky, C. A., & Mooney, K. A. (2012). Strengths-based cognitive–behavioural therapy: A four-step model to build resilience. Clinical Psychology and Psychotherapy, 19, 283-290.

45.

Ramírez-Maestre, C., & Esteve, R. (2014). The role of sex/gender in the experience of pain: Resilience, fear, and acceptance as central variables in the adjustment of men and women with chronic pain. The Journal of Pain, 15, 608-618.

46.

Ruiz-Párraga, G. T., & López-Martínez, A. E. (2014). The role of experiential avoidance, resilience and pain acceptance in the adjustment of chronic back pain patients who have experienced a traumatic event: A path analysis. Annals of Behavioral Medicine, 49, 247-257.

47.

Silver, R. C., Holman, E. A., McIntosh, D. N., Poulin, M., & Gil-Rivas, V. (2002). Nationwide longitudinal study of psychological responses to September 11. Jama, 288, 1235-1244.

48.

Song, Y. S. (2017). The relationship between fire-fighter’s resilience and PTSD. Fire Science and Engineering, 31, 119-126.

49.

Spasojević, J., & Alloy, L. B. (2001). Rumination as a common mechanism relating depressive risk factors to depression. Emotion, 1, 25-37.

50.

Streeck-Fischer, A., & van der Kolk, B. A. (2000). Down will come baby, cradle and all: Diagnostic and therapeutic implications of chronic trauma on child development. Australian and New Zealand Journal of Psychiatry, 34, 903-918.

51.

Sturgeon, J. A., & Zautra, A. J. (2010). Resilience: A new paradigm for adaptation to chronic pain. Current Pain and Headache Reports, 14, 105-112.

52.

Taylor, S., Thordarson, D. S., Maxfield, L., Fedoroff, I. C., Lovell, K., & Ogrodniczuk, J. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71, 330-338.

53.

Thompson, R. W., Arnkoff, D. B., & Glass, C. R. (2011). Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma. Trauma, Violence, and Abuse, 12, 220-235.

54.

Tugade, M. M., Fredrickson, B. L., & Feldman Barrett, L. (2004). Psychological resilience and positive emotional granularity: Examining the benefits of positive emotions on coping and health. Journal of Personality, 72, 1161-1190.

55.

Tull, M. T., Barrett, H. M., McMillan, E. S., & Roemer, L. (2007). A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behavior Therapy, 38, 303-313.

56.

Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2013). The Life Events Checklist for DSM-5(LEC-5). Instrument available from the National Center for PTSD. Retrieved from www.ptsd.va.gov

57.

Weiss, D., & Marmar, C. (1997). The Impact of Event Scale-Revised. In J. P. Wilson & T. M. Keane (Eds.), Assessing Psychological Trauma and PTSD (pp. 399-411). New York, NY: Guliford.

58.

Wilson, J. P., & Keane, T. M. (2004). Assessing Psychological Trauma and PTSD. New York, NY: Guilford Press.

59.

Yoo, M. R., Choi, S. Y., Han, H. L., Seo, Y. M., & Noh. M. I. (2015). The effect of post-traumatic growth, resilience, and optimism on quality of life among the disaster victims. Journal of Military Nursing Research, 33, 1-14.

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