Resilience and Disaster: Flexible Adaptation in the Face of Uncertain Threat.

Disasters cause sweeping damage, hardship, and loss of life. In this article, we first consider the dominant psychological approach to disasters and its narrow focus on psychopathology (e.g., posttraumatic stress disorder). We then review research on a broader approach that has identified heterogeneous, highly replicable trajectories of outcome, the most common being stable mental health or resilience. We review trajectory research for different types of disasters, including the COVID-19 pandemic. Next, we consider correlates of the resilience trajectory and note their paradoxically limited ability to predict future resilient outcomes. Research using machine learning algorithms improved prediction but has not yet illuminated the mechanism behind resilient adaptation. To that end, we propose a more direct psychological explanation for resilience based on research on the motivational and mechanistic components of regulatory flexibility. Finally, we consider how future research might leverage new computational approaches to better capture regulatory flexibility in real time.

The three axioms of resilience.

This article summarizes the growing literature on resilience in the face of aversive and potentially traumatic events (PTEs) in three basic axioms: (a) resilience is a common outcome, 2) there are no "key" traits to resilience (resilience is not a type), and (c) resilient outcomes occur through flexible self-regulation. The first axiom highlights the limitation of a traditional, binary view of trauma in terms of the presence-absence of posttraumatic stress disorder, emphasizing instead the heterogeneity of trauma outcomes. Four prototypical trajectories are reviewed: chronic symptoms; delayed symptoms; recovery; and the most common trajectory, resilience. The second axiom reviews the paradoxical inability of known correlates of resilience to adequately predict resilient outcomes. Resilience is instead described as a multifaceted phenomenon with no singular set of key traits, as various factors contribute to resilient outcomes in complex ways. The third axiom provides an explanation of how resilience can emerge from this complex array by introducing the concept of flexible self-regulation. The flexibility mindset is described as providing the motivation for flexible responding. The flexibility sequence is described as explaining the mechanisms underlying flexibility in terms of three serial stages: context sensitivity, strategy repertoire, and feedback adjustment. The final section briefly considers clinical implications.

Prospective trajectories of depression predict mortality in cancer patients.

An ever-growing body of empirical evidence has demonstrated the relationship between depression and cancer. The objective of this study was to examine whether depression trajectories predict mortality risk above and beyond demographics and other general health-related factors. Participants (n = 2,345) were a part of the Health and Retirement Study. The sample consisted of patients who were assessed once before their cancer diagnosis and thrice after. Depressive symptoms and general health-related factors were based on self-reports. Mortality risk was determined based on whether the patient was alive or not at respective time points. Latent Growth Mixture Modeling was performed to map trajectories of depression, assess differences in trajectories based on demographics and general health-related factors, and predict mortality risk. Four trajectories of depression symptoms emerged: resilient (69.7%), emerging (13.5%), recovery (9.5%), and chronic (7.2%). Overall, females, fewer years of education, higher functional impairment at baseline, and high mortality risk characterized the emerging, recovery, and chronic trajectories. In comparison to the resilient trajectory, mortality risk was highest for the emerging trajectory and accounted for more than half of the deaths recorded for the participants in emerging trajectory. Mortality risk was also significantly elevated, although to a lesser degree, for the recovery and chronic trajectories. The data highlights clinically relevant information about the depression-cancer association that can have useful implications towards cancer treatment, recovery, and public health.

Emotion regulation flexibility and psychosis: A longitudinal study disentangling components of flexibility in psychosis-proneness.

OBJECTIVES: Flexibility in self-regulation has emerged as an important component of mental health. Previous findings found that deficits in two components of regulatory flexibility were linked cross-sectionally to psychosis-proneness. We aimed to replicate and extend these findings longitudinally. METHODS: We measured psychosis-proneness and components of emotion regulation flexibility (i.e. context sensitivity, repertoire and feedback) at two time points with three months in between. RESULTS: Two flexibility components predicted psychotic-like experiences. The ability to detect the absence of contextual cues was implicated in both positive and negative dimensions but through opposite pathways. Expressive suppression ability-a subcomponent of repertoire-predicted positive symptoms. None of the flexibility components predicted distress related to the symptoms. CONCLUSIONS: The current study provides further evidence on the implication of emotion regulation flexibility in the longer-term maintenance of psychotic-like experiences. Future studies can advance this work further by evaluating possible bidirectional relationships between psychotic-like experiences and deficits in emotion regulation flexibility.

Does cognitive load influence expressive flexibility? Comparing civilian and veteran populations.

Expressive flexibility (EF) is a component of emotion regulation flexibility repertoire that constitutes the ability to enhance or suppress the expression of emotion in accordance with a given situational context. Previous research has associated EF with healthy adjustment to adversity. This association has also been observed in combat veterans with elevated post-traumatic stress. EF and other elements of regulatory flexibility are believed to rely on functions of cognitive control, such as working memory. However, previous research has yet to investigate this link. Accordingly, we examined performance in veterans (N = 42) and non-veterans (N = 75) on an EF Task with and without the inclusion of a numerical cognitive load task. Results indicate an interaction between cognitive load and expressive condition. Specifically, suppression abilities were weaker in cognitive load conditions. These findings did not vary in veteran and non-veteran samples. These results add to a growing body of work indicating a relationship between cognitive control and regulatory flexibility, and suggest similar mechanisms between veteran and non-veteran populations.

Identifying multilevel predictors of trajectories of psychopathology and resilience among juvenile offenders: A machine learning approach.

Mental ill health is more common among juvenile offenders relative to adolescents in general. Little is known about individual differences in their long-term psychological adaptation and its predictors from multiple aspects of their life. This study aims to identify heterogeneous trajectories of probable psychiatric conditions and their predictors. Participants included 574 juvenile offenders who were first convicted for serious crimes and without detention history. The participants were assessed at 11 timepoints over seven years (2000-2010). Growth mixture modeling revealed the same three trajectories for both probable anxiety and probable depression: stable low trajectory (75.96%; 75.78%), stable high trajectory (15.16%; 10.98%), and recovery (8.89%, 13.24%). Least absolute shrinkage and selection operator (LASSO) logistic regression identified three multilevel predictors for memberships of different trajectories. Risk factors against stable low trajectory lay within personal (e.g., neuroticism), relationship (e.g., parental hostility), and contextual levels (e.g., chaotic neighborhood). Resilience factors for stable low trajectory included strong work orientation and low education level of father. Recovery was predicted by Black race, self-identity, high education level of father, and nonincarcerated sentencing. Our findings suggest that both psychopathology and psychological resilience could be predicted by multiple personal, relationship, and contextual factors in the social ecology of juvenile offenders.

Understanding posttraumatic stress trajectories in adolescent females: A strength-based machine learning approach examining risk and protective factors including online behaviors.

Heterogeneity in the course of posttraumatic stress symptoms (PTSS) following a major life trauma such as childhood sexual abuse (CSA) can be attributed to numerous contextual factors, psychosocial risk, and family/peer support. The present study investigates a comprehensive set of baseline psychosocial risk and protective factors including online behaviors predicting empirically derived PTSS trajectories over time. Females aged 12-16 years (N = 440); 156 with substantiated CSA; 284 matched comparisons with various self-reported potentially traumatic events (PTEs) were assessed at baseline and then annually for 2 subsequent years. Latent growth mixture modeling (LGMM) was used to derive PTSS trajectories, and least absolute shrinkage and selection operator (LASSO) logistic regression was used to investigate psychosocial predictors including online behaviors of trajectories. LGMM revealed four PTSS trajectories: resilient (52.1%), emerging (9.3%), recovering (19.3%), and chronic (19.4%). Of the 23 predictors considered, nine were retained in the LASSO model discriminating resilient versus chronic trajectories including the absence of CSA and other PTEs, low incidences of exposure to sexual content online, minority ethnicity status, and the presence of additional psychosocial protective factors. Results provide insights into possible intervention targets to promote resilience in adolescence following PTEs.

Depressive and anxiety symptom trajectories in Polish adolescents during the COVID-19 pandemic and the outbreak of war in Ukraine: uncovering the role of family relations.

INTRODUCTION: The aim of the study was to investigate longitudinal trajectories of change in anxiety and depression symptoms in Polish adolescents during the second year of the COVID-19 pandemic and after the outbreak of the war in Ukraine. Additionally, we aimed to identify risk/protective factors and outcomes associated with these trajectories. METHOD: We collected data in three waves between November 2021 and May 2022. Adolescents (N = 281 in the first wave) completed the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Filial Responsibility Scale for Youth, and questions related to the COVID-19 pandemic and war in Ukraine. RESULTS: We identified three trajectories of depressive symptoms: resilient with low, stable symptoms (71% of participants), chronically elevated symptoms (11%), and acute symptoms followed by recovery (18%). We distinguished two trajectories of anxiety symptoms: resilient (75%) and chronic (25%). Non-resilient trajectories were predicted by higher levels of familial unfairness (perceived lack of equality and reciprocity in the family), relationship difficulties at school and at home, older age, and poor socioeconomic status. Chronic depressive and anxiety symptoms were associated with higher war-related concerns. DISCUSSION: These findings can inform preventive and therapeutic interventions for at-risk adolescents to reduce negative long-term outcomes of social crises.

Components of emotion regulation flexibility and psychosis: The association between psychosis-proneness and context sensitivity.

OBJECTIVES: Emotion regulation flexibility has been conceptualized as a multi-componential construct involving context sensitivity, repertoire and feedback responsiveness. Psychosis research has yet to incorporate these new developments in the study of emotion regulation. Thus, we sought to advance even further the knowledge on emotion regulation in psychosis by adopting the emotion regulation flexibility approach as proposed by Bonanno and Burton (Perspectives on Psychological Science, 2013, 8, 591). METHOD: In total, 401 participants completed 4 scales assessing the multi-components of emotion regulation flexibility and psychosis-proneness. RESULTS: Our results indicated that Context Sensitivity (i.e., Cue Absence) and Feedback Responsiveness (i.e., Evaluation) were associated with psychosis-proneness. Cue absence was specifically associated with the positive dimension, while both Cue Absence and Enhancement ability were associated with the negative dimension. CONCLUSIONS: Overall, our results suggest that emotional context insensitivity is the most relevant component of regulatory flexibility in the case of psychosis-proneness. Thus, the disruption in this first step of flexible emotion regulation might be already present in those prone to psychosis. Difficulties in decoding appropriately the contextual cues might further disrupt the other steps of emotion regulation contributing to the psychotic (-like) experiences. This study needs replication in clinical and non-clinical samples.

Deep learning-based classification of posttraumatic stress disorder and depression following trauma utilizing visual and auditory markers of arousal and mood.

BACKGROUND: Visual and auditory signs of patient functioning have long been used for clinical diagnosis, treatment selection, and prognosis. Direct measurement and quantification of these signals can aim to improve the consistency, sensitivity, and scalability of clinical assessment. Currently, we investigate if machine learning-based computer vision (CV), semantic, and acoustic analysis can capture clinical features from free speech responses to a brief interview 1 month post-trauma that accurately classify major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). METHODS: N = 81 patients admitted to an emergency department (ED) of a Level-1 Trauma Unit following a life-threatening traumatic event participated in an open-ended qualitative interview with a para-professional about their experience 1 month following admission. A deep neural network was utilized to extract facial features of emotion and their intensity, movement parameters, speech prosody, and natural language content. These features were utilized as inputs to classify PTSD and MDD cross-sectionally. RESULTS: Both video- and audio-based markers contributed to good discriminatory classification accuracy. The algorithm discriminates PTSD status at 1 month after ED admission with an AUC of 0.90 (weighted average precision = 0.83, recall = 0.84, and f1-score = 0.83) as well as depression status at 1 month after ED admission with an AUC of 0.86 (weighted average precision = 0.83, recall = 0.82, and f1-score = 0.82). CONCLUSIONS: Direct clinical observation during post-trauma free speech using deep learning identifies digital markers that can be utilized to classify MDD and PTSD status.

Expressive flexibility and health-related quality of life: The predictive role of enhancement and suppression abilities and relationships with trait emotional intelligence.

This study aims to examine the ability to flexibly enhance and suppress emotional expression, known as expressive flexibility, in relation to physical and psychological health, as well as trait emotional intelligence (EI). A sample of 503 Italian (Mage = 28.65 ± 9.26 years, 85.1% females) participants completed the Italian version of Flexible Regulation of Emotional Expression (FREE) Scale, the TEIQue-SF, and the Short Form-12 Health Survey. Confirmatory factor analysis indicated that the Italian version of FREE showed adequate psychometric properties. In both genders, results of correlational analyses indicated that enhancement ability was associated with well-being, emotionality, and sociability, whereas suppression ability was associated with self-control. Regression analyses, controlling for age and gender, indicated that suppression and inversely enhancement abilities, predicted the perceived psychological but not physical health. Well-being, self-control, and sociability also contributed to explaining variance in the model. The interaction effect of enhancement and suppression was not significantly associated with either physical or psychological health. Overall, these results suggest that enhancement and suppression abilities differentially contribute to psychological health when trait EI is accounted for. Clinical implications and future directions for research on expressive flexibility are discussed.

Trajectories of grief: Comparing symptoms from the DSM-5 and ICD-11 diagnoses.

BACKGROUND: Diagnostic criteria for prolonged grief have appeared in the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5; persistent complex bereavement disorder, PCBD) and in the ICD-11 (prolonged grief disorder, PGD), and the question of which diagnosis is most clinically useful has been hotly debated. This study provides the first longitudinal comparison of PCBD and PGD in their ability to capture symptom change over time and their relation to long-term outcomes. METHODS: A community sample was recruited consisting of 282 individuals who had recently lost a spouse. Structured clinical interviews were conducted at 3, 14, and 25 months postloss for symptoms corresponding to PCBD and PGD criteria. Outcomes at 25 months included PCBD and PGD caseness, depression, global functioning, and interviewer ratings of participant suffering. RESULTS: PCBD and PGD trajectories determined by growth mixture modeling, each captured three primary outcomes: resilience, moderate-improving symptoms, and prolonged-stable symptoms. The PGD solution also identified trajectories of increasing and decreasing distress: prolonged-worsening and acute-recovering symptoms. Prediction of 25-month outcomes indicated differences conforming to the severity of PGD symptoms, and the prolonged-worsening trajectory was associated with the worst adjustment. CONCLUSIONS: PGD symptoms were more differentiated, better-captured psychopathology, and other outcomes and were more sensitive to change over time compared to PCBD.

Free Your Mind: Emotional Expressive Flexibility Moderates the Effect of Stress on Post-Traumatic Stress Disorder Symptoms.

Servicemen are exposed to high levels of stress as part of their daily routine, however, studies which tested the relationship between stress and clinical symptoms reached inconsistent results. The present study examines the role of expressive flexibility, which was determined according to the ability to enhance or suppress either negative or positive emotional expression in conflictual situations, as a possible moderator between stress and Post-Traumatic Stress Disorder (PTSD) symptoms. A total of 82 active-duty firefighters (all men, age range = 25-66, M = 33.59, SD = 9.56, range of years in duty service = 2-41, M = 14.37, SD = 11.79), with different duty-related repeated traumatic exposure, participated in the study. We predicted and found that firefighters with low, but not high, expressive flexibility showed a significant positive correlation between duty-related traumatic exposure and PTSD symptomology (t(81) = 3.85, p < 0.001). Hence, the greater the exposure the higher level of symptoms they exhibited. In addition, we found a difference between the moderating roles of suppressing positive and negative emotional expression, as high but not low, ability to suppress the expression of negative emotions (t(81) = 1.76, p > 0.05), as low but not high, ability to suppress the expression of positive emotions (t(81) = 1.6, p > 0.05), served as a protective factor in buffering the deleterious effect of repeated traumatic exposure. The results provide a pivotal support for the growing body of evidence that a flexible emotional profile is an adaptive one, in dealing with negative life events. However, while there is a need to update behavior, the direction of the adaptive update may differ as a function of valance.

You Can't Take Your Baby Home Yet: A Longitudinal Study of Psychological Symptoms in Mothers of Infants Hospitalized in the NICU.

Evidence suggests that mothers of infants hospitalized in the Neonatal Intensive Care Unit (NICU) experience elevated rates of psychological symptoms. However, previous studies of this population have been mainly cross-sectional and have focused on very preterm infants. Although moderate- to late-preterm infants generally thrive, the possible psychological toll on their mothers has not yet been sufficiently examined. In the current study, we used a longitudinal design to investigate whether mothers of moderate- to late-preterm infants experience elevated rates of psychological symptoms during the infant's hospitalization in the NICU and 6 months later. Results indicated that these mothers did show elevated depression, anxiety, and PTSD symptoms, and that symptom levels were similar in mothers of moderate- versus late-preterm infants. Mothers of moderate- to late-preterm infants hospitalized in the NICU appeared to experience these symptoms steadily over a 6-month period after giving birth. These findings suggest a need for greater support for these mothers while in the NICU.

Symptoms of persistent complex bereavement disorder, depression, and PTSD in a conjugally bereaved sample: a network analysis.

BACKGROUND: Complicated and persistent grief reactions afflict approximately 10% of bereaved individuals and are associated with severe disruptions of functioning. These maladaptive patterns were defined in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as persistent complex bereavement disorder (PCBD), but its criteria remain debated. The condition has been studied using network analysis, showing potential for an improved understanding of PCBD. However, previous studies were limited to self-report and primarily originated from a single archival dataset. To overcome these limitations, we collected structured clinical interview data from a community sample of newly conjugally bereaved individuals (N = 305). METHODS: Gaussian graphical models (GGM) were estimated from PCBD symptoms diagnosed at 3, 14, and 25 months after the loss. A directed acyclic graph (DAG) was generated from initial PCBD symptoms, and comorbidity networks with DSM-5 symptoms of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) were analyzed 1 year post-loss. RESULTS: In the GGM, symptoms from the social/identity PCBD symptoms cluster (i.e. role confusion, meaninglessness, and loneliness) tended to be central in the network at all assessments. In the DAG, yearning activated a cascade of PCBD symptoms, suggesting how symptoms lead into psychopathological configurations. In the comorbidity networks, PCBD and depressive symptoms formed separate communities, while PTSD symptoms divided in heterogeneous clusters. CONCLUSIONS: The network approach offered insights regarding the core symptoms of PCBD and the role of persistent yearnings. Findings are discussed regarding both clinical and theoretical implications that will serve as a step toward a more integrated understanding of PCBD.

Emotions in everyday life during social movements: Prospective predictions of mental health.

Emotion mobilizes and demobilizes a social movement while the movement itself impacts people's emotions. An evidence base is needed for developing timely emotion-focused counseling services for affected populations worldwide. This experience sampling study investigated the impact of a social movement on everyday emotional reactivity, variability, instability, and persistence, and whether and how these predicted subsequent psychological distress and well-being among 108 community-dwelling adults. Fifty-four participants reported momentary events and emotions 5 times daily over 7 days during the Umbrella Movement in Hong Kong. An age-matched, sex-matched comparison group (n = 54) participated during a period without major social/political movement. Psychological distress and well-being were assessed at baseline (Time 1 [T1]) and 3-month follow-up (Time 2 [T2]). Hierarchical linear modeling revealed lower valence ratings of positive events during the Umbrella Movement. Lower positive emotional reactivity and higher negative emotional reactivity in positive events were reported during the movement. Controlling for demographics and T1 scores, the positive association between negative emotional reactivity in positive events and T2 depressive symptoms, and the inverse association between positive emotional instability and T2 positive emotions, were significant only among the comparison group. The positive association between positive emotions in positive events and T2 life satisfaction was significant only among the Umbrella Movement group. People could experience significant changes in their emotions in everyday life during a social movement, even if it is short and relatively nonviolent like the Umbrella Movement. Maximizing positive emotions in positive events during a social movement can uniquely contribute to higher subsequent psychological well-being. (PsycINFO Database Record

A Decade of War: Prospective Trajectories of Posttraumatic Stress Disorder Symptoms Among Deployed US Military Personnel and the Influence of Combat Exposure.

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder among service members and veterans. The clinical course of PTSD varies between individuals, and patterns of symptom development have yet to be clearly delineated. Previous studies have been limited by convenience sampling, short follow-up periods, and the inability to account for combat-related trauma. To determine the trajectories of PTSD symptoms among deployed military personnel with and without combat exposure, we used data from a population-based representative sample of 8,178 US service members who participated in the Millennium Cohort Study from 2001 to 2011. Using latent growth mixture modeling, trajectories of PTSD symptoms were determined in the total sample, as well as in individuals with and without combat exposure, respectively. Overall, 4 trajectories of PTSD were characterized: resilient, pre-existing, new-onset, and moderate stable. Across all trajectories, combat-deployed service members diverged from non-combat-deployed service members, even after a single deployment. The former also generally had higher PTSD symptoms. Based on the models, nearly 90% of those without combat exposure remained resilient over the 10-year period, compared with 80% of those with combat exposure. Findings demonstrate that although the clinical course of PTSD symptoms shows heterogeneous patterns of development, combat exposure is uniformly associated with poor mental health.

Neurocognitive assessment of emotional context sensitivity.

Sensitivity to emotional context is an emerging construct for characterizing adaptive or maladaptive emotion regulation, but few measurement approaches exist. The current study combined behavioral and neurocognitive measures to assess context sensitivity in relation to self-report measures of adaptive emotional flexibility and well-being. Sixty-six adults completed an emotional go/no-go task using happy, fearful, and neutral faces as go and no-go cues, while EEG was recorded to generate event-related potentials (ERPs) reflecting attentional selection and discrimination (N170) and cognitive control (N2). Context sensitivity was measured as the degree of emotional facilitation or disruption in the go/no-go task and magnitude of ERP response to emotion cues. Participants self-reported on emotional flexibility, anxiety, and depression. Overall participants evidenced emotional context sensitivity, such that when happy faces were go stimuli, accuracy improved (greater behavioral facilitation), whereas when fearful faces were no-go stimuli, errors increased (disrupted behavioral inhibition). These indices predicted emotional flexibility and well-being: Greater behavioral facilitation following happy cues was associated with lower depression and anxiety, whereas greater disruption in behavioral inhibition following fearful cues was associated with lower flexibility. ERP indices of context sensitivity revealed additional associations: Greater N2 to fear go cues was associated with less anxiety and depression, and greater N2 and N170 to happy and fear no-go cues, respectively, were associated with greater emotional flexibility and well-being. Results suggest that pleasant and unpleasant emotions selectively enhance and disrupt components of context sensitivity, and that behavioral and ERP indices of context sensitivity predict flexibility and well-being.

Resilience and Other Possible Outcomes After Mild Traumatic Brain Injury: a Systematic Review.

The relation between resilience and mild traumatic brain injury (TBI) outcome has been theorized but empirical studies have been scarce. This systematic review aimed to describe the research in this area. Electronic databases (Medline, CINAHL, PsychINFO, SPORTdiscus, and PILOTS) were searched from inception to August 2015 for studies in which resilience was measured following TBI. The search terms included 'TBI' 'concussion' 'postconcussion' 'resilience' and 'hardiness'. Inclusion criteria were peer reviewed original research reports published in English, human participants aged 18 years and over with brain injury, and an accepted definition of mild TBI. Hand searching of identified articles was also undertaken. Of the 71 studies identified, five studies were accepted for review. These studies were formally assessed for risk of bias by two independent reviewers. Each study carried a risk of bias, most commonly a detection bias, but none were excluded on this basis. A narrative interpretation of the findings was used because the studies reflected fundamental differences in the conceptualization of resilience. No studies employed a trajectory based approach to measure a resilient outcome. In most cases, the eligible studies assessed trait resilience with a scale and used it as a predictor of outcome (postconcussion symptoms). Three of these studies showed that greater trait resilience was associated with better mild TBI outcomes (fewer symptoms). Future research of the adult mild TBI response that predicts a resilient outcome is encouraged. These studies could yield empirical evidence for a resilient, and other possible mild TBI outcomes.