Here’s a fun game. Count how many times you hear the word ‘resilience’ this week. During these pandemic-affected years, conversations about resilience are everywhere, both in our psychology community and in the wider public. A quick Google search shows the proliferation of media articles on this topic since 2020. As we continue to live in disrupted and uncertain times, resilience is certainly important, yet in this article we’ll look at the possibility that there is something beyond resilience – adversarial growth.
What is psychological resilience?
In the 1970s, Emmy Werner, Professor of Human Development at UCLA, brought the concept of resilience to the forefront of psychology following her findings in a prospective study that tracked learning, mental health and behavioural problems of children experiencing perinatal stress, chronic poverty, troubled family environments, and parental psychopathology.
In the 18-year follow up, Werner and her team discovered that two-thirds of the children who had experienced four or more risk factors had developed learning, mental health or behavioural problems. However, an unexpected result caught her attention: one-third of the high-risk children grew into mentally healthy and socially well-adjusted young people, succeeding in school and able to manage their lives, despite their dysfunctional/abusive home.
Werner spoke about the resilience of these 18-year-olds in terms being “competent in coping with their problems” and, in her later research, when the sample were in their early 30s, she added the notion of recovery to her description of resilience on account of some people who had experienced problems in their teens but had managed to course-correct and go on to lead happy, functional adult lives.
Professors Ann Masten and George Bonanno, two other pioneer researchers, have also found that resilience in the face of adversity is more common than is often believed. Masten, of the Institute of Child Development, University of Minnesota, describes psychological resilience as a form of “stress resistance” such that one is able to resist or withstand pressure. More formally she describes it as “The capacity of a dynamic system (i.e. a person or a group of people) to adapt successfully to disturbances.”
Bonanno, of the Loss, Trauma and Emotion Lab, Teachers College, Columbia University, describes resilience as the “the ability to maintain a stable equilibrium” and to continue functioning relatively normally in adversity. In an interview for The Guardian about resiliency during the pandemic, he suggested that resilience is seen when “people struggle, but they basically continue to show a stable trajectory of health – mental and physical”.
The past 50+ years of research on resilience have been instrumental in helping psychologists to support their clients to withstand, heal from and recover following life’s crises. We have learnt that resilience can be common, and thus, that it’s something we can help our clients achieve. We have learnt that, even under considerable hardship, people can be resilient and that they can recover and course-correct from downward spirals. We have also learnt that it is a process shaped by both intra-personal and extra-personal factors. These are important findings and certainly resilience is something to develop during a pandemic or for any of the myriad hardships your clients may be experiencing. But is there something beyond resilience?
Adversarial growth
Let’s look at the definitions of resilience above: “maintain a stable equilibrium”, “competent in coping with problems”, “adapt successfully to disturbances” and “continue to show a stable trajectory”. The idea is appealing because if we are resistant, or impervious, to stress, it cannot affect us negatively. But this also means it cannot affect us positively. And while it might be nice to maintain a stable equilibrium, experiencing disequilibrium and being knocked off course can also help us find out who we are. Besides, while resilience has been shown to be common, it is not always possible.
What happens when a client experiences the type of adversity from which a “stable trajectory” is not an option? This has been the case for many people during the pandemic. When resilience, i.e. maintaining a stable equilibrium, isn’t achievable, does it mean your client will spiral into psychopathology and PTSD?
The field of psychotraumatology has considered these questions for the past 25 years and it turns out, that in addition to a downward trajectory (psychopathology) and a stable trajectory (resilience), there is a third trajectory – and that’s to grow. Adversarial growth, often referred to as post-traumatic growth (PTG), is the process of positive changes in perception of self, philosophy of life, relationships with others and meaning-making that occur during or after a crisis or trauma.
The presence of growth has been investigated in people who have lived through terrorism, natural disaster (floods, earthquake, hurricane), violence (rape, robbery), relational trauma (domestic violence, child abuse), recovery from substance addiction, illness (HIV/AIDs, cancer, multiple sclerosis), accident (motorbike or car crash, acquired brain injury), injury, stroke, suicide loss and bereavement. The results consistently show that growth occurs even through the most horrific times. In fact, Professor Wu from Central South University, Changsha, China, led a recent meta-analysis of PTG using studies conducted between 2005 to 2017, with a total sample size of 10,000+ people, across 18 countries (Wu et al., 2019). The results of this meta-analysis found that, on average, 53 per cent of people grow across a range of different traumas.
Do we have to wait until after the adversity for growth to occurs?
You might be wondering whether your client must be at the back end of the adversity before they can start to grow. In other words, when does adversarial growth begin? To some extent this depends on the type of trauma they’ve been through. For a one-off, time-bound trauma, growth obviously won’t occur in the moment, where your client is mobilising all their resources to defend and survive. But, growth can occur quite soon afterward.
Take, for example, the study done by Patricia Frazier and her colleagues at University of Minnesota, with women survivors of sexual assault who had reported to hospitals immediately post-rape. Professor Frazier and her co-researchers partnered with these women and the sexual assault nurses who provide follow-up support to survivors for a year. The noteworthy finding of this study is that, within two weeks post the assault, survivors reported increased empathy for others and improved relationships, especially their bond with their family.
Two months following the assault, a higher percentage of woman were positive about their ability to assert themselves and had an understanding of their own strength. At the 12-month mark, appreciation of life, sense of purpose and spiritual wellbeing had increased. These positive changes were all occurring at the same time as the women were experiencing PTSD and reporting that they felt the world was unsafe and unfair. Trauma and transformation can co-exist.
If you are working with a client in a situation of extended adversity, growth can begin in the midst of it all. I’ve been involved in several research studies looking at this very thing, with people who are unemployed, flood survivors, adult LGBTQI+ people who have come out, and teenagers living through lockdown during the pandemic. All of these groups were experiencing ongoing hardship. For example, many of flood survivors had injuries and were mourning the death of friends or family on top of dealing with loss or damage to their belongings and property. In our study with LGBTQI+ people, 43.8 per cent met the criteria for PTSD, having to deal with the stress of coming out and the fear, or actual experience, of being the target of homophobia/transphobia, being rejected, harassed, assaulted and discriminated against. Unemployment brings adversity with its financial hardship and emotional toll. Furthermore, job loss often leads to identity loss and a psychological rupture that makes people feel invalid in our society. The teens we studied were coping with the shock of the first global wave of the COVID-19 crisis in April 2020. Within a week they went from life as usual, to being in extreme lockdown, scrambling to set up technology to learn from home, watching their parents worry, fearing they might catch the virus and missing their friends desperately.
All of these samples were struggling and yet in each of these diverse samples, we found that growth had already begun. In the flood sample, 38 per cent met the cut-off score for moderate PTG and 13 per cent met the cut-off for high PTG. In the LGBTQI+ sample, 20.7 per cent met the cut-off score for moderate PTG and 42.8 per cent met the cut-off for high PTG. These growth percentages may reflect differences in the type of trauma and time since event (LGBTQI+ had longer time since coming out as compared to floor survivors who were only one year post-flood).
There is debate in the literature about the role of time and movement through to high PTG, however a considerable percentage in both of the samples above displayed moderate to high growth. The teenagers we studied had a mean average of 16.65 (range 11–22.30) from a possible total score of 30 on a measure of stress-related growth. As a result of dealing with the challenges of unemployment, people in our study became connected with their inner strengths, experienced gratitude for their supportive relationships, felt compassion for other unemployed people and became open to new career pathways.
The good news is that the studies revealed that the factors which supported this growth in the samples above are ones that you can encourage your clients to engage in, such as emotional processing, cognitive reframing, drawing on social support and developing a new story about the experience.
Moving beyond resilience
Resilience, a buzzword during these pandemic years, is a beneficial process and an outcome we can help our clients to achieve. As psychologists, though, we can also consider if there is more we can do. Can we help our clients move beyond resilience to growth? And for clients who have dealt with the types of adversity and trauma that render resilience impossible, can we help steer their trajectory away from a downward spiral to an upward one?
Research shows that people who grow through adversity evolve a new understanding of themselves. They acknowledge their capacity to endure and realise that they are stronger than they thought. They have improved awareness of their emotions and find it easier to resolve, or let go of, past concerns. They are more tolerant but at the same time more assertive. Finally, people who grow through adversity have greater confidence that they can handle future loss and hardship. This is a key outcome we are aiming for as psychologists, to help our clients leave our care feeling prepared to handle life’s future challenges and ready to enjoy life’s good times.