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Post-Traumatic Stress Disorder

4 Factors That May Lower PTSD Risk and Bolster Resilience

A new meta-analysis highlights potential approaches to overcoming trauma.

Post-traumatic stress disorder (PTSD) statistics vary depending on the source, but while the majority of people experience at least one traumatic event over the course of a lifetime, only a fraction develop PTSD, between 6-8 percent.

PTSD has many risks and protective factors. The risks include younger age, female gender, being hurt or seeing someone get hurt, having higher-stress living conditions on top of the trauma, and a prior history of mental illness or substance use disorder.

Protective factors include getting support from others, positive self-appraisal in dealing with the trauma, adaptive coping strategies, having a strong system of meaning and/or faith, and biological factors. While there has been a significant amount of research on resilience and post-traumatic growth, synthesis of research is needed to confirm the highest-value targets for prevention, preparedness, and intervention. Resources are scarce, and trauma uses them up fast on every level, from individual to community.

Hope, Optimism, and Self-Efficacy

In the Journal of Clinical Psychology (2020), authors Gallagher, Long, and Phillips consolidate and analyze the existing literature on four key coping factors: hope, optimism, specific self-efficacy, and general self-efficacy.

While at first glance, there is overlap, these factors are different in critical ways. Understanding those differences is important to understand what works best—and how best to use limited resources.

Researchers sorted over 4,500 published articles, identifying high-quality research on PTSD to include in their final meta-analysis. A meta-analysis is a research design that uses a structured approach to pool data from earlier studies in order to draw more robust conclusions than smaller studies can yield. Selecting about 10 percent which met quality criteria, they looked at correlations between PTSD risk and each of the four factors. When available, they reported on "prospective" studies—where protective factors were measured before trauma happened, suggestive of a possible cause-and-effect relationship.

Review and Findings

1. Hope: Hope can be conceptualized as having two aspects, pathway thinking and agency thinking. Pathway thinking is the ability to consider various ways of reaching goals, anticipating obstacles. Agency thinking is about how strong our belief is in our drive and capacity to accomplish those goals.

They found a moderately strong effect size of -0.34, pointing to a robust relationship between greater hope and reduced PTSD. There weren't enough prospective studies to look at pooled data, but two studies reviewed found a -0.22 effect size of hope on future PTSD.

2. Optimism: Optimism is a personality trait embodying one's overarching sense of positive expectations, the extent to which our default is to believe things will work out well. It is different from hope because it is more general and may include factors outside of oneself, such as chance, with less weight on one's own agency.

For optimism, the effect size was -0.29, reflective of a small to moderate impact on PTSD, with a prospective effect of -0.20.

3. General Self-Efficacy: This is a broad belief in one's ability to handle whatever life brings and achieve one's goals, but it does not map to specific situations.

They found a small to moderate effect size of -0.25, with a prospective effect of -0.26.

4. Specific Self-Efficacy: Specific self-efficacy is targeted to the circumstances at hand, covering the belief one has in one's ability to overcome a particular challenge—in this case, trauma. Unlike hope, which looks at intentions and steps, self-efficacy is about one's faith in oneself.

Specific self-efficacy was the most robust, with an effect size of -0.49, suggesting a large relationship between specific self-efficacy and PTSD. The prospective effect size was also large, coming in at -0.52.

Researchers also looked at whether gender or age affected the relationship between each of the four factors and PTSD. Aside from specific self-efficacy, where data on children were not available, they found no differences after controlling for age and gender. This means that the impact of the four factors appears to hold true across different ages and genders.

Implications for Resilience and Post-traumatic Growth

This meta-analysis consolidates and summarizes years of work across hundreds of studies, providing solid findings across a large and diverse population. While there is much more to say about resilience, post-traumatic growth, and PTSD, it clarifies the differences among key overlapping factors, providing a platform for insight and action by identifying high-value targets.

Hope, optimism, general self-efficacy, and specific self-efficacy are overlapping constructs, all potentially contributing to resilience in the face of adversity, as well as during times of ease. They are not the same, varying depending on how targeted to the particular trauma or person they are, how relevant they are to planning, decision-making, and action.

Optimism and general self-efficacy may support a general context of positivity, framing the situation as one which will ultimately work out well and providing one with the general sense of being able to handle difficulties, without saying why or how. Like belief in free will, optimism and general self-efficacy help to bring forth a world where things can change, enhancing the sense of possibility, creativity, better alternatives, and cognitive flexibility.

Specific self-efficacy and hope emerged as potentially high-impact factors. Together, they emphasize the individual's readiness to deal with problems, the belief in the ability to respond competently, if not masterfully, in the face of great challenge, and skill in identifying and pursuing avenues to success while anticipating and evading hazards.

Individuals equipped with high self-efficacy and hope are thinking ahead and planning for contingencies, carried forward by the clear vision of desirable outcomes, empowered by having worked out the steps to get there—with contingency plans for when things go sideways.

Specific self-efficacy and hope work well because key elements are concrete and detailed; they can be executed and appraised and revised in structured ways. Likewise, self-efficacy can be cultivated via personal development work, as well as with training and psychotherapies targeted at these factors.

Self-efficacy is also supported by community—we can help each other to find the best in ourselves in any given situation by providing "esteem-support," which focuses on rewarding effort and progress, highlights abilities, provides empathy and validation, and discourages self-criticism and blame while supporting self-compassion and related concepts—gratitude for oneself and others, acceptance, forgiveness. Curiosity is a powerful place to begin.


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