Trauma and Resilience
Resilience is generally defined as the process of “adapting well in the face of trauma, tragedy, threats, or significant sources or stress” (American Psychological Association, 2018). In simpler terms, resilience describes bouncing back from stressful and/or traumatic experiences. There is ongoing debate about the utility of resilience as a scientific construct, variations in different domains of functioning involved in resilience, and the stability of resilience over time (Luthar, Cicchetti, and Becker, 2000). Furthermore, resilience is a challenging concept to operationalize in research, and the approach varies by investigator, though most focus on protective factors and processes.
Resilience researchers have examined numerous populations and sources of adversity and traumas, though research focused specifically on LGBTQ populations remains relatively limited. Early on, investigators noticed that some people maintain good mental health despite facing severe adversity, while others do not. This pattern of mental health outcomes has been observed across many populations and with many types of adversity (Bonanno, Westphal & Mancini, 2011; Boden & McLeod, 2015; Chang et al., 2015). Resilience researchers have generally focused on children thought to have a high risk of psychopathology due to their genes or life experiences, including those with serious medical conditions and disabilities and children from urban school settings. Psychologists Norman Garmezy and Ann Masten showed that youths who demonstrate resilience turn out much like their successful peers who have faced less adversity over time (2012). In their studies, high-quality relationships with parents and other adults, as well as good cognitive and social-emotional skills, were protective. Other studies have similarly suggested that close relationships with supportive adults—family members and others in the community—as well as effective schooling increase resilience (Luthar, Cicchetti, and Becker, 2000). Current health research focuses on ways to improve the mechanisms that protect people against stress (Kalisch et al, 2017).
Masten’s model of resilience is particularly helpful in conceptualizing stressors and trauma experienced by LGBTQ populations, which are known to be at high risk of violence, stigma, and other forms of severe adversity, in addition to the usual challenges faced throughout life. Numerous studies and surveys have established that LGBTQ youth experience elevated levels of violence, victimization, and harassment, as well as high levels of discrimination (Institute of Medicine, 2011). Traumatic exposures can increase the risk of poor mental health outcomes, as well as health, academic performance, and coping issues (Bethell et al. 2014). As clinicians, it is important to identify and address trauma and stressors affecting our patients, while also providing guidance for improving social relationships and supportive activities.
Studies on LGBTQ youth have shown that family support is protective against suicidal behaviors (Eisenburg & Resnick, 2006, Mustanski & Liu, 2013, Ryan et al., 2010), while family rejection is a strong risk factor for depression, suicidality, substance use, and other risk behaviors (Ryan, 2009). Gender diverse youth with support have better mental health outcomes (SAMHSA, 2014). As clinicians, we may wish to engage families in care, with the goal of helping families become more accepting and validating over time. Helping patients connect with a positive role model and positive activities through school or the community is also advisable, especially if families do not foster a supportive environment.
CME Question: Resilience researchers have shown that which of the following factors mitigate experienced adversity?
(a) strong cognitive skills
(b) quality relationships with parent(s)
(c) experiencing stress early in life
(d) both a and b
Answer: D