The resilience handbook approach to stress and trauma

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The Resilience Handbook

How are people and communities able to prevail despite challenge? What helps them bounce
back from adversity and even grow in knowledge and understanding? And can this resilience
be taught? During the past decade, exciting scientific advances have shed light on how resilience operates from neurons to neighborhoods. In The Resilience Handbook, experts in the
science of resilience draw on human and animal research to describe the process of resilience
and follow its course as it unfolds both within individuals and in social networks. Contributors also highlight the promise of new interventions that apply what we know about resilience processes to bolster positive health, and raise some of the pressing questions and issues
for the field as it matures.
This handbook is designed to be used by students as an invitation to a burgeoning field;
by researchers, as a framework for advancing theories, hypotheses, and empirical tests of
resilience functions; and by clinicians, as a comprehensive and up-to-the-minute integration
of theory and practice.
Martha Kent is a research scientist at the Phoenix VA Health Care System and a member of
the Resilience Solutions Group at Arizona State University.
Mary C. Davis is a professor in the department of psychology at Arizona State University
and a member of the Resilience Solutions Group.
John W. Reich is an emeritus professor of psychology at Arizona State University and the
coeditor of the Handbook of Adult Resilience.


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The Resilience Handbook
Approaches to Stress and Trauma

Edited by

Martha Kent, Mary C. Davis,
and John W. Reich


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First published 2014
by Routledge
711 Third Avenue, New York, NY 10017
Simultaneously published in the UK
by Routledge
27 Church Road, Hove, East Sussex BN3 2FA
© 2014 Taylor & Francis
Routledge is an imprint of the Taylor & Francis Group, an informa business
The right of the editors to be identified as the author of the editorial material,
and of the authors for their individual chapters, has been asserted in accordance
with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission in
writing from the publishers.

Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and
explanation without intent to infringe.
Library of Congress Cataloging in Publication Data
The resilience handbook : approaches to stress and trauma / edited by Martha Kent,
Mary C. Davis, and John W. Reich.
pages cm
Includes bibliographical references and index.
1. Resilience (Personality trait) 2. Stress (Psychology) I. Kent, Martha
(Research scientist) II. Davis, Mary C. editor of compilation.
III. Reich, John W., 1937- editor of compilation.
BF698.35.R47R47117 2013
155.2'4—dc23
2013008550
ISBN: 978–0–415–69987–7 (hbk)
ISBN: 978–0–415–81883–4 (pbk)
ISBN: 978–0–203–13530–3 (ebk)
Typeset in Galliard
by Swales & Willis Ltd, Exeter, Devon

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Contents

List of Contributors
Acknowledgments
Introduction

viii
xi
xii

SECTION 1

Resilience as Adaptive Process to Stress and Trauma
Part A: Resilience as Biobehavioral Adaptation
1 Seeking and Loss in the Ancestral Genesis of Resilience, Depression,
and Addiction

1

3

JAAK PANKSEPP

2 The Roles of Predictive and Reactive Biobehavioral Programs in
Resilience

15

MATTIE TOPS, PHAN LUU, MAARTEN A. S. BOKSEM, AND DON M. TUCKER

3 Approach/Engagement and Withdrawal/Defense as Basic Biobehavioral
Adaptations: Resilient Transcendence of a Popular Duality
33
MARTHA KENT

4 Introduction to Allostasis and Allostatic Load

44

GRETA B. RAGLAN AND JAY SCHULKIN

Part B: Resilience as Intrapersonal Process
5 The Automatic Basis of Resilience: Adaptive Regulation of Affect
and Cognition

53
55

SUSANNE SCHWAGER AND KLAUS ROTHERMUND

6 The Regulatory Power of Positive Emotions in Stress: A TemporalFunctional Approach
CHRISTIAN E. WAUGH

73


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vi

Contents

7 Responding to Trauma and Loss: An Emotion Regulation Perspective

86

MATTHEW TYLER BODEN, MADHUR KULKARNI, ASHLEY SHURICK,

MARCEL O. BONN-MILLER, AND JAMES J. GROSS

8 Music as an Agent of Resilience

100

DONALD A. HODGES

Part C: Resilience as Interpersonal Process
9 Oxytocin and Attachment Facilitate a Shift From Seeking Novelty
to Recognizing and Preferring Familiarity: The Key to Increasing
Resilience?

113

115

MATTIE TOPS, FEMKE T. A. BUISMAN-PIJLMAN, AND C. SUE CARTER

10 Social Touch and Resilience

131

MARY H. BURLESON AND MARY C. DAVIS

11 Empathy and Resilience in a Connected World

144

GRIT HEIN

12 An Attachment Perspective on Resilience to Stress and Trauma

156

MARIO MIKULINCER AND PHILLIP R. SHAVER

13 Using the Caregiver System Model to Explain the Resilience-Related
Benefits Older Adults Derive From Volunteering

169

STEPHANIE L. BROWN AND MORRIS A. OKUN

Part D: Resilience as Social Process

183

14 Resilience Is Social, After All

185

ALEX J. ZAUTRA

15 Developmental Social Factors as Promoters of Resilience in
Childhood and Adolescence

197

BEKH BRADLEY, TELSIE A. DAVIS, JOANNA KAYE, AND ALIZA WINGO

SECTION 2

Resilience Interventions
Part A: Activating Interventions
16 Behavioral Activation as a Treatment for Depression: Theory,
Neurobiologic Effects, and Potential Linkages to Resilience
GABRIEL S. DICHTER, MORIA SMOSKI, ROSELINDE K. HENDERSON,
AND SONA DIMIDJIAN

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209

211


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Contents vii

17 Resilience Training for Action and Agency to Stress and Trauma:
Becoming the Hero of Your Life

227

MARTHA KENT AND MARY C. DAVIS

Part B: Intrapersonal Interventions

245

18 Different Strokes: Empathy, Individual Characteristics, and Helping

247

ALICIA J. HOFELICH AND STEPHANIE D. PRESTON

19 Forgiveness Interventions and the Promotion of Resilience Following
Interpersonal Stress and Trauma

256

NATHANIEL G. WADE, JERITT R. TUCKER, AND MARILYN A. CORNISH

20 Resilience Interventions With a Focus on Meaning and Values

270

CRYSTAL L. PARK AND JEANNE M. SLATTERY

Part C: Interpersonal Interventions

283

21 The Skills Training in Affective and Interpersonal Regulation
(STAIR) Narrative Model: A Treatment Approach to Promote
Resilience

285

CHRISTINA M. HASSIJA AND MARYLENE CLOITRE

22 Promoting Resilience After Trauma: Clinical Stimulation of the
Oxytocin System

299

JESSIE L. FRIJLING, MIRJAM VAN ZUIDEN, SASKIA B. J. KOCH, LAURA NAWIJN,
DICK J. VELTMAN, AND MIRANDA OLFF

Index

309


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Contributors

Matthew Tyler Boden, PhD, Program Evaluation and Resource Center, Center for Health
Care Evaluation, Veterans Administration, Menlo Park, CA.
Maarten A. S. Boksem, PhD, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; and Rotterdam School of Management,
Erasmus University, Rotterdam, the Netherlands.
Marcel O. Bonn-Miller, PhD, Center for Health Care Evaluation/Center for Excellence
in Substance Abuse Treatment and Education, Veterans Administration/Philadelphia
VAMC, Menlo Park, CA/Philadelphia, PA.
Bekh Bradley, PhD, Mental Health Service, Atlanta VA Medical Center, Atlanta, GA; and
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA.
Stephanie L. Brown, PhD, Department of Preventive Medicine, Stony Brook University,
Stony Brook, NY; and Institute for Social Research, University of Michigan, Ann Arbor,
MI.

Femke T. A. Buisman-Pijlman, PhD, Department of Pharmacology and Department of
Psychiatry, University of Adelaide, Adelaide, South Australia, Australia.
Mary H. Burleson, PhD, Department of Psychology, Arizona State University, Tempe,
AZ.
C. Sue Carter, PhD, Translational Research in Neural Medicine, Research Triangle Institute International, Research Triangle Park, NC.
Marylene Cloitre, PhD, National Center for PTSD, VA Palo Alto Health Care System,
Menlo Park, CA; and New York University Langone Medical Center, New York, NY.
Marilyn A. Cornish, MS, Department of Psychology, Iowa State University, Ames, IA.
Mary C. Davis, PhD, Department of Psychology, Arizona State University, Tempe, AZ.
Telsie A. Davis, PhD, Department of Psychiatry and Behavioral Sciences, Emory University
School of Medicine, Atlanta, GA.
Gabriel S. Dichter, PhD, UNC-Chapel Hill, Chapel Hill, NC.
Sona Dimidjian, PhD, Department of Psychology, University of Colorado at Boulder,
Boulder, CO.

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Contributors ix
Jessie L. Frijling, MS, Department of Psychiatry, Academic Medical Center, University of
Amsterdam, Amsterdam, the Netherlands.
James J. Gross, PhD, Department of Psychology, Stanford University, Stanford, CA.
Christina M. Hassija, PhD, National Center for PTSD, VA Palo Alto Health Care System,
Menlo Park, CA; and Stanford University School of Medicine, Stanford, CA.
Grit Hein, PhD, Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland.
Roselinde K. Henderson, MA, Department of Psychology, University of Colorado at
Boulder, Boulder, CO.
Donald A. Hodges, PhD, Music Research Institute, University of North Carolina at Greensboro, Greensboro, NC.
Alicia J. Hofelich, PhD, Department of Psychology, Williams College, Williamstown,

MA.
Joanna Kaye, BA, Department of Psychiatry and Behavioral Sciences, Emory University
School of Medicine, Atlanta, GA.
Martha Kent, PhD, Research Service, Phoenix VA Health Care System, Phoenix, AZ; and
Department of Psychology, Arizona State University, Tempe, AZ.
Saskia B. J. Koch, MS, Department of Psychiatry, Academic Medical Center, University of
Amsterdam, Amsterdam, the Netherlands.
Madhur Kulkarni, PhD, Center for Health Care Evaluation, Veterans Administration,
Menlo Park, CA.
Phan Luu, PhD, Department of Psychology, University of Oregon; and Electrical Geodesics, Inc., Eugene, OR.
Mario Mikulincer, PhD, Department of Psychology, Interdisciplinary Center Herzliya,
Herzliya, Israel.
Laura Nawijn, MS, Department of Psychiatry, Academic Medical Center, Amsterdam, the
Netherlands.
Morris A. Okun, PhD, Department of Psychology, Arizona State University, Tempe, AZ.
Miranda Olff, PhD, Department of Psychiatry, Academic Medical Center, University of
Amsterdam, Amsterdam, the Netherlands; and Arq Psychotrauma Expert Group, Diemen, the Netherlands.
Jaak Panksepp, PhD, Department of Anatomy, Pharmacology and Physiology, College of
Veterinary Medicine, Washington State University, Pullman, WA.
Crystal L. Park, PhD, Department of Psychology, University of Connecticut, Storrs, CT.
Stephanie D. Preston, PhD, Department of Psychology, University of Michigan, Ann
Arbor, MI.
Greta B. Raglan, BS, Research, American College of Obstetricians and Gynecologists, Washington, DC; and Department of Psychology, American University, Washington, DC.


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x

Contributors

Klaus Rothermund, Department of Psychology, Friedrich Schiller University, Jena,
Germany.
Jay Schulkin, PhD, Research, American College of Obstetricians and Gynecologists, Washington, DC; and Neuroscience, Georgetown University, School of Medicine, Washington, DC.
Susanne Schwager, Department of Psychology, Friedrich Schiller University, Jena,
Germany.
Phillip R. Shaver, PhD, Department of Psychology, University of California at Davis,
Davis, CA.
Ashley Shurick, BS, Department of Psychology, Stanford University, Stanford, CA.
Jeanne M. Slattery, PhD, Department of Psychology, Clarion University of Pennsylvania,
Clarion, PA.
Moria Smoski, PhD, Department of Psychiatry and Behavioral Sciences, Duke University,
Durham, NC.
Mattie Tops, PhD, Department of Clinical Psychology, VU University of Amsterdam,
Amsterdam, the Netherlands.
Don M. Tucker, PhD, Department of Psychology, University of Oregon; and Electrical
Geodesics, Inc., Eugene, OR.
Jeritt R. Tucker, MS, Department of Psychology, Iowa State University, Ames, IA.
Dick J. Veltman, MD, PhD, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; and Department of Psychiatry, VU
University Medical Center, Amsterdam, the Netherlands.
Nathaniel G. Wade, PhD, Department of Psychology, Iowa State University, Ames, IA.
Christian E. Waugh, PhD, Department of Psychology, Wake Forest University, Winston
Salem, NC.
Aliza Wingo, MD, Mental Health Service, Atlanta VA Medical Center, Atlanta, GA; and
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA.
Alex J. Zautra, Department of Psychology, Arizona State University, Tempe, AZ.
Mirjam van Zuiden, PhD, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

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Acknowledgments

This volume has its source in a number of activities, the most immediate one being the
resilience panel presented at the 2010 meeting of the International Society for Traumatic
Stress Studies, entitled “Modes of Resilience in the Treatment of Stress and Trauma: Characteristics and Interventions.” The development of this panel in the context of treatment
approaches to posttraumatic stress brought to the fore processes involved in resilient adaptations to stressful challenges. The study of resilience as strength-based adaptation has been a
central focus of the Resilience Solutions Group at Arizona State University. We appreciate
the ongoing explorations with the members of this group, details of whom can be found
on the Web site: The research activities and discussions
of this interdisciplinary group have sustained abiding vibrant interests that are reflected in
the publication of a preceding handbook on adult resilience, the editing of a special journal
issue, and the present volume focused on resilience approaches to stress and trauma. We
wish to thank the Research Department of the Phoenix VA Health Care System and the
assistance of the Phoenix VA library staff members Vicki Armstrong and Mark Simmons.
John Reich gratefully acknowledges the love and continuing support of his wife, Deborah,
and Mary Davis that of her husband, John Anderten. Martha Kent thanks her husband, Dale
Kent, for building a computer stand that will allow her to also work while standing at the
computer, a lovely choice, as well as uncomplaining help with countless computer questions
and problems.


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Introduction
Martha Kent, Mary C. Davis, and John W. Reich

This volume views resilience as a process rather than as a set of traits, outcomes, and risk, or
protective factors, a focus that will allow the emergence of constituent elements of resilience
from the research literature. Included is a review of interventions that impact adaptation
to challenge and threat in ways that result in improved functioning and well-being. Future

needs and directions emerge from chapter discussions throughout the volume.
When considering what is really basic to resilience, the question quickly becomes a heuristic in search for its elementary constituents. We side with the simple definitions (e.g.
Szanton, Gill, & Thorpe, 2010; Zautra, 2009) that see resilience composed of three elements: resilience as a sustained adaptive effort that prevails despite challenge, as a bouncing
back and recovery from a challenge, and as a process of learning and growth that expands
understanding, new knowledge, and new skills. Szanton and colleagues refer to this threesome as resistance, recovery, and rebound and growth. Resilience preserves and promotes
the individuals and their contexts, as it simultaneously keeps harm at bay. What are the characteristics that enhance and, at the same time, shield in ways that evolve into growth and a
life of quality (Goodwin, 1999)?
When considering resilience as a process, it is evident that resilience is markedly embodied, something that involves the physical being of the person, and that it is dynamic, an
action the person as a living organism does. Thus, the focus of this book will be on what happens with dynamic embodied persons when they express or demonstrate resilience, that is,
when they prevail, bounce back, and grow from what is learned in a positive adaptive process. Our emphasis will include resilience interventions that enhance resilience and achieve
gains in adaptation.
At the top of most dictionary definitions of “process” is an understanding of the word as
a feature of nature, “a natural phenomenon marked by gradual changes that lead toward a
particular result,” such as in the process of growth (Merriam-Webster, 2011). The “process”
has a beginning, has a progression as it unfolds in multiple physical and behavioral aspects,
and moves toward the result and outcome. From the varied, abundant resilience literature
we will piece together parts that form a solid and comprehensive understanding of resilience
as a process.
Across a wide range of writings the emergence of a consistent set of features can be
grouped into three categories: intrapersonal qualities or inner processes of the person, interpersonal qualities or qualities of relationships, and social resilience or qualities of relationships to larger groupings. Not addressed is how a resilience response is initiated and begun.
Discussions and studies of how resilience might get started are nearly entirely missing, while
an emphasis on the end, outcome, or result of resilience abounds, to an extent where outcome and protective factors most frequently define resilience. This emphasis on outcome

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Introduction

xiii

and protective factors has frequently rendered opaque resilience as a coherent biological and
behavioral process that is as coherent as the fight–flight response and as adaptive.
We propose to start with the beginnings of resilience as a process and follow its course
as it unfolds from person to context in the following steps: (1) initiation of resilience, (2)
intrapersonal resilience, (3) interpersonal resilience, and (4) social resilience. We also aim
to present main exemplar treatments of these groupings that: (a) show significant empirical
support, and (b) are important components of positive adaptation and protect or promote
well-being. Resilience as outcome will not be covered, since much of the resilience literature
represents this perspective well. The following is a selection, partly informed by the features
of resilience found in the adult resilience literature (e.g. Fry & Keysers, 2010; Kent & Davis,
2010; Reich, Zautra, & Hall, 2010), and the large developmental literature summarized in
a variety of sources (e.g. Luthar, 2006; Masten, 2001; Rutter, 2006).
Resilience begins with the initiation of the first responses that occur in the face of challenge. Of relevance are qualities of attentional control, particularly attention that can override environmental demands, that selects, and that has direction and focus. It is executive
attention that is not stimulus driven and responsive to the environment but is characterized
by initiative, is voluntary or emanates from the individual, and is planned (Corbetta & Shulman, 2002). Another feature supporting initiation of a resilience response includes unconscious aspects such as anticipation or the preparation to respond in a ready manner, such as
the action tendency of positive emotions supporting openness and approach.
Resilience as process is next reviewed at the intrapersonal, interpersonal, and social levels,
taking into account the modality and context of this process. At the intrapersonal level the
modality can be attentional flexibility (Schwager & Rothermund, Chapter 5), positive emotion resources (Waugh, Chapter 6), increased emotion regulation skills (Boden, Kulkarni,
Shurick, Bonn-Miller, & Gross, Chapter 7), and resilience through music (Hodges, Chapter
8). Process at the interactive interpersonal level includes affiliation (Tops, Buisman-Pijlman,
& Carter, Chapter 9), social touch (Burleson & Davis, Chapter 10), empathy (Hein, Chapter 11), attachment (Mikulincer & Shaver, Chapter 12), and caregiving and volunteering
(Brown & Okun, Chapter 13). The larger social context is treated at the adult level (Zautra,
Chapter 14) and developmental level (Bradley, Davis, Kaye, & Wingo, Chapter 15).
We identify empirically tested interventions that support the above resilience processes.
Interventions that initiate resilience are represented by activation treatment approaches
(Dichter, Smoski, Henderson, & Dimidjian, Chapter 16) and approaches that support
agency (Kent & Davis, Chapter 17). Intraindividual resilience to strengthen participants’
inner resources for buffering stress include forgiveness (Wade, Tucker, & Cornish, Chapter

19) and meaning making and values (Park & Slattery, Chapter 20). Interactive interindividual interventions include interpersonal skills training (Hassija & Cloitre, Chapter 21) and
an oxytocin/social contact preventative intervention (Frijling, van Zuiden, Koch, Nawijn,
Veltman, & Olff, Chapter 22). Resilience interventions based on group processes and tested
with larger social groupings appear to be in various phases of development or lack the empirical support of clinical trials and will not be reviewed. The above outline is summarized in
Table P.1.
The chapters of this volume are organized into two sections: empirical studies of resilience and the resilience interventions. Within each section there are parts that treat biobehavioral, intrapersonal, interpersonal, and social processes of resilience that cover specific
expressions of these broader topics.


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xiv

Introduction

Table P.1 Summary of Resilience as an Adaptive Process and Resilience Interventions
Initiation

Intrapersonal

Resilience as adaptive process:
SEEKING
Counterregulation
Panksepp
Schwager & Rothermund

Interpersonal

Social

Affiliation/oxytocin

Tops, Buisman-Pijlman,
& Carter

Adult social Zautra

Developmental social
Bradley, Davis, Kaye,
& Wingo

Prospective control
Tops, Luu, Boksem,
& Tucker

Positive emotions
Waugh

Social touch
Burleson & Davis

Transformation
Kent

Emotion regulation
Boden, Kulkarni,
Shurick, Bonn-Miller,
& Gross

Empathy
Hein

Allostasis
Raglan & Schulkin

Music
Hodges

Adult attachment
Mikulincer & Shaver
Caregiving
Brown & Okun

Resilience interventions:
Activation
Empathy
Dichter, Smoski,
Hofelich & Preston
Henderson, &
Dimidjian
Action–agency
Kent & Davis

Forgiveness
Wade, Tucker, & Cornish

Skills training
Hassija & Cloitre

Insufficient empirical
clinical trials

Oxytocin stimulation
Frijling, van Zuiden, Koch,
Nawijn, Veltman, & Olff

Meaning and values
Park & Slattery

SECTION 1: RESILIENCE AS ADAPTIVE PROCESS TO STRESS
AND TRAUMA
Neurobehavioral approaches to adaptive responses to stress offer models and examine qualities of attention, emotion regulation, social connections, touch, attachment, and empathy
as resilient approaches.
Part A: Resilience as Biobehavioral Adaptation
Jaak Panksepp examines basic flexible life-preserving behavioral and emotional patterns
that form action systems supported by mammalian physiological and cortical makeup. He
identifies seven networks, which include SEEKING, RAGE, FEAR, sexual LUST, maternal
CARE, separation-distress PANIC/GRIEF, and joyful PLAY. These are survival circuits
that regulate life processes and survival needs. Depression results from overactivity of the
separation-distress PANIC/GRIEF system and from diminished SEEKING or the diminished desire to engage with the world. Therapeutic approaches can promote the euphoriaenthusiasm of the SEEKING system and the positive social emotions of LUST, DARE, and
PLAY.
Mattie Tops, Phan Luu, Maarten A. S. Boksem, and Don M. Tucker discuss two brain
pathways for behavioral control. The ventral corticolimbic pathways have specialized in

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Introduction

xv

reactive behavioral control that incorporates fast associative learning that is adaptive in lowpredictable environments. This contrasts with dorsal control pathways that specialized in
guiding behavior proactively by context models formed in long-term memory that are adaptive in high-predictable environments. The reactive systems produce momentary experiences
close in time and space, and are emotion-focused. Context model control is less immediate, includes positive experience, and allows active coping. Tops and colleagues discuss the
involvement of these programs in the development of resilience.
Martha Kent samples models of approach/engagement and withdrawal/defense and of
resilient flexibility to threat and challenge at biobehavioral, cognitive, and affective levels.
Studies of stress mechanisms have moved from concepts of homeostasis and reactive regulation to allostasis and long-term flexibility. At the cortical level the prefrontal cortex is seen as
widely interconnected and widely involved in behavioral and systemic responses to threat in
circuits involving the hippocampus, amygdala, and others. Recent studies consider reactive
and prospective behavioral control systems.
Greta B. Raglan and Jay Schulkin review allostatic regulation and the physiology of
change, emphasizing longer-term anticipatory and feed-forward systems in contrast to reactive homeostatic regulation. Allostatic regulation allows coping even with severe changes
and recovery from trauma. Allostatic load refers to the reduction of physical and psychological ability to rebound from acute or prolonged stress. The implications of allostatic regulation and allostatic load for resilience are discussed.
Part B: Resilience as Intrapersonal Process
The inner life contributes to adaptive resilience through emotion regulation that includes
automatic regulation, positive emotions, and music.
Susanne Schwager and Klaus Rothermund propose counter-regulation principles in which
attention is automatically oriented towards stimuli that are opposite in valence (positive or
negative) to the current affective motivational focus. Counter-regulation may facilitate the
processing of positive (or negative) aspects of a situation. Counter-regulation prevents the
escalation or the emergence of chronic states and supports sensitivity to danger, thus promoting adaptive coping with critical life-events.
Christian E. Waugh starts with the robust evidence that resilient people are characterized by experiences of positive emotions during stress. He proposes a process model of how
positive emotions might be beneficial during stress. Stressors have distinct temporal phases,
including anticipation, preparation, engagement, recovery, and an inter-stress period. He
suggests that the influence of positive emotions on stress depends on when the positive
emotions occur during the stressor, such as in stress anticipation or stress recovery. Future
studies may benefit from adopting a process-model approach.
Matthew Tyler Boden, Madhur Kulkarni, Ashley Shurick, Marcel O. Bonn-Miller, and
James J. Gross describe a new model linking adaptive emotion regulation to positive outcomes, including posttraumatic growth, and maladaptive emotion regulation to negative
outcomes, including posttraumatic stress. Emotion regulation is conceptualized as the strategies people use to modify what emotions they feel, how they feel them, and how they use

and express their emotions. Contextual factors and emotion-specific factors influence when
and how emotion regulation strategies are adaptive and maladaptive.
Donald A. Hodges explores music as a universal agent of resilience and coping with the
circumstances of life through the examples of the role of music in enabling Jews to maintain
their traditions during 2,000 years of exile, or the singing of the anthem We Shall Overcome


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xvi

Introduction

by civil rights activists, or a cellist of Sarajevo performing during the Siege of Sarajevo.
Research evidence for the use of music for survival ranges from anthropology, through sociology, psychology, medicine, and biochemistry, to cutting-edge data from neuroscience.
Part C: Resilience as Interpersonal Process
Resilience is supported by interpersonal processes that regulate stress through such mechanisms as neuroendocrine functions of oxytocin, social touch, empathy, attachment, and
caregiving.
Mattie Tops, Femke T. A. Buisman-Pijlman, and C. Sue Carter address the capacity of
attachments to increase resilience in the face of stress and to resist addiction. Dopamine may
be involved in the “wanting” aspect of reactive reward processing, while oxytocin as seen in
attachment may be more related to “liking.” Obtaining a reward may increase the “liking”
but, through satiety, decrease the “wanting” of that reward. Continued drug use reduces
liking and increases the wanting of drugs. By contrast, strong partner relationships progress
from approach or “wanting” to “liking.” Oxytocin may be involved in balancing this shift
between wanting and liking, between the reactive reward systems and prospective “internal
working models,” thus increasing resilience.
Mary H. Burleson and Mary C. Davis review evidence for physical affection and other
forms of touch as a major mechanism by which social contact enhances well-being. They
discuss the importance of friendly and nurturant touch for the formation and conduct of
social relations in normal human development. Social touch influences directly or indirectly

psychological and physiological responding within a number of different contexts. Touch
indicates physical presence and may signal support or other resources for resilience.
Grit Hein emphasizes the crucial role of empathy in interpersonal human emotions. She
reviews empirical work on empathy, from the perspective of both the empathizer and the
recipient of empathy. She covers recent contributions from the newly emerging field of
social neuroscience. She discusses the link between empathy and resilience during aversive
events, such as stress and physical pain, and raises important questions for future research.
Mario Mikulincer and Phillip R. Shaver consider the importance of John Bowlby’s concept
of attachment for emotion regulation and mental health. Research shows that attachment
security acts as an inner resilience resource during periods of stress and distress. Attachment
security promotes reliance in the use of more constructive coping strategies, fosters positive
appraisals of the world, the self, and others, and allows people to maintain emotional equanimity in times of stress. Finally, the sense of attachment security allows people to devote mental
resources to activities that facilitate psychological growth and the development of personality.
Stephanie L. Brown and Morris A. Okun hypothesize that providing support to another
person (helping behavior) promotes the physical and psychological well-being of the helper.
It improves the helper’s mood and relationship satisfaction, and reduces the negative states
of sadness. Helping behavior is associated with accelerated recovery from depression and
reduced mortality among caregivers. Volunteering was also associated with reduced risk of
mortality. Why volunteering has these beneficial outcomes is analyzed. An overview of the
caregiver system model of active help and stress regulation is presented.
Part D: Resilience as Social Process
Resilience as expressed in interactions with larger social groupings is treated in the context
of adult and developmental adaptation.

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Introduction

xvii

Alex J. Zautra identifies three components of successful resilient striving: recovery, sustainability, and growth. Whereas individual resilience emphasizes the personal capacities to
recover and even grow stronger following stress, social resilience emphasizes how people
work together to overcome adversity. In social resilience recovery is a return to homeostasis after social loss, which is sustained through continued social engagement, and which
grows through new learning. This chapter illustrates how social resilience can be examined
and how to intervene and enhance the capacity of people and groups to work and live well
together.
Bekh Bradley, Telsie A. Davis, Joanna Kaye, and Aliza Wingo focus on aspects of adverse
childhood experiences (ACEs). Most individuals exposed to ACEs do not develop later
health, mental health, and behavioral problems. This chapter focuses on empirical and theoretical knowledge related to developmental, social, and communal factors that benefit later
resilience. These include proximal factors (e.g., family environment) and distal factors (e.g.,
neighborhood and community factors). During sensitive developmental periods the skills
associated with resilience may be best nurtured.

SECTION 2: RESILIENCE INTERVENTIONS
Activation and agency are illustrated by empirically tested resilience interventions that
enhance strengths in response to depression, stress, and trauma. These chapters are followed
by interventions that focus on intrapersonal processes and on interpersonal processes to
enhance resilient functioning.
Part A: Activating Interventions
Gabriel S. Dichter, Moria Smoski, Roselinde K. Henderson, and Sona Dimidjian review
behavioral activation (BA) treatments for depression as a structured and validated reinforcement-based psychotherapy method that reduces avoidance behaviors and increases engagement with rewarding stimuli. Behavior change is the primary mode of the intervention.
Increases in values-consistent goal-directed behaviors are theorized to increase energy,
motivation, and positive thinking. Recent functional magnetic resonance imaging (fMRI)
data suggest that BA therapy for depression impacts striatal reward centers of the brain
and prefrontal brain regions governing cognitive control of emotional processes. These
findings help to illuminate the pathophysiology of major depression and mechanisms for
interventions.
Martha Kent and Mary C. Davis identify three characteristics of good survival in extreme

situations: approach/engagement, social relatedness, and an efficient stress response. They
recognized that resilience and traumatic experiences both occurred in the same extreme
environments. They identified the structure of action as the important element of resilience
that is prospective and goal directed rather than reactive to the immediate environment.
Posttraumatic stress disorder (PTSD) is seen as a disorder of action and agency, which
are restored through experience-dependent simulation. The re-experiencing of approach/
engagement and social relatedness episodes from childhood and early adult times is applied
in a return to traumatic episodes. Supporting neuroscience literature and a clinical trial are
reviewed.


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xviii

Introduction

Part B: Intrapersonal Interventions
Interventions that bolster intrapersonal processes through empathy, forgiveness, and meaning making and values are reviewed.
Alicia J. Hofelich and Stephanie D. Preston report a series of studies on factors that affect
success and failure in empathy. They find that expressions of empathy depend on the shared
experience in empathy. People display their needs in different ways, and the observers’ own
experiences influence observer responses. Although not an intervention, their finely grained
studies reviewed here can inform empathy and compassion training interventions.
For Nathaniel G. Wade, Jeritt R. Tucker, and Marilyn A. Cornish, forgiveness in the face
of interpersonal injuries is an adaptive and resilient response to stress and trauma. People
can be assisted in attaining forgiveness that is associated with numerous positive outcomes.
Forgiveness interventions increase hope and personal well-being, and reduce anger, rumination, and psychological problems such as depression and anxiety.
Crystal L. Park and Jeanne M. Slattery describe meaning-making processes in the context
of stressful events. Some interventions increase general levels of meaning in life by promoting a more authentic and existentially aware life. Other interventions follow exposure to
potentially traumatic or highly stressful events. These help individuals cope with and make

meaning from their encounters and help to identify areas of positive change and growth.
Current research and future directions are summarized.
Part C: Interpersonal Interventions
Strengthening interpersonal adaptation is emphasized in affective skills training and narrative
story telling and by an innovative approach to stimulate the oxytocin system after trauma.
Christina M. Hassija and Marylene Cloitre pay particular attention to the integration of
self-efficacy and emotion regulation with interpersonal effectiveness. Skills Training in Affective and Interpersonal Regulation (STAIR) followed by Narrative Story Telling (NST) is an
example of a resilience-building treatment that promotes the acquisition and/or strengthening of emotional and interpersonal capacities. Support for the efficacy of this model as a
treatment for PTSD and other co-occurring trauma sequelae are reviewed.
Jessie L. Frijling, Mirjam van Zuiden, Saskia B. J. Koch, Laura Nawijn, Dick J. Veltman, and Miranda Olff review the presence or absence of social support as modulators of
stress and fear reported by many studies. A familiar supportive person attenuates heart rate
responses, diminishes cortisol responses to a stressor, and decreases brain activity in areas
related to threat. Oxytocin (OT) facilitates bonding, parental behavior, and social contact.
These investigators are testing the effectiveness of intranasal OT and social support in preventing PTSD in randomized controlled trials. They review issues in an OT stimulation
approach that may be helpful for oxytocin-based interventions.

REFERENCES
Corbetta, M., & Shulman, G. L. (2002). Control of goal-directed and stimulus-driven attention in the
brain. Nature Reviews Neuroscience, 3, 201–215.
Fry, P. S., & Keysers, C. L. M. (Eds.). (2010). New frontiers in resilient aging: Life strengths and wellbeing in late life. New York: Cambridge University Press.
Goodwin, B. (1999). Reclaiming a life of quality. Journal of Consciousness Studies, 6, 229–235.

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Introduction

xix

Kent, M., & Davis, M. C. (2010). The emergence of capacity-building programs and models of resilience. In J. W. Reich, A. J. Zautra, & J. S. Hall (Eds.), Handbook of adult resilience (pp. 427–449).
New York: Guilford Press.
Luthar, S. S. (2006). Resilience in development: A synthesis of research across five decades. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psychopathology (2nd ed., pp. 739–795). Hoboken,
NJ: Wiley.
Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist,
56, 227–238.
Merriam-Webster. (2011). Retrieved from Web site.
Reich, J. W., Zautra, A. J., & Hall, J. S. (Eds.). (2010). Handbook of adult resilience. New York: Guilford Press.
Rutter, M. (2006). Implications of resilience concepts for scientific understanding. Annals of the New
York Academy of Sciences, 1094, 1–12.
Szanton, S. L., Gill, J. G., & Thorpe, R. J. (2010). The society to cells model of resilience in older
adults. Annual Reviews of Gerontology and Geriatrics, 30, 5–34.
Zautra, A. J. (2009). Resilience: One part recovery, two parts sustainability. Journal of Personality, 77,
1935–1943.


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Section 1

Resilience as Adaptive Process
to Stress and Trauma

Part A

Resilience as Biobehavioral Adaptation


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1

Seeking and Loss in the
Ancestral Genesis of Resilience,
Depression, and Addiction
Jaak Panksepp

In the context of basic mammalian adaptation, resilience refers to the intrinsically endowed
capacities of an organism to manage challenges in a life-preserving manner. For humans it
is the ability to maintain composure and equanimity along with creative and productive life
problem solving in the face of repeated vicissitudes. Resilience refers to basic flexible lifepreserving behavior patterns that are promoted by mammalian affective systems of the brain
and the organism’s interaction with the environment. Fundamental brain emotional systems
consisting of primary-process emotions mediate rewarding and punishing states (Panksepp,
1998, 2005; Panksepp & Biven, 2012).
Such primal affective systems ramify widely in the brain, establishing hierarchical bottomup controls that often dictate the more developmentally programmed top-down controls.
Animal research tells us more about the bottom-up controls than human research, since we
have access to deep brain mechanisms. Human research has much more to say about the topdown controls than animal brain–behavior relationships, since humans can provide direct verbal descriptors of the internal cognitive features of their minds. In sum, animal research tells us
much more about the cross-mammalian affective foundations of mind, while human research
is vastly more informative about higher mental abilities, many of which are truly unique to

humans. But the lower subcortical mind that elaborates affective consciousness (Panksepp,
2007a) is a critical platform upon which higher human mental abilities are constructed, and
is supported by the vastly expanded neocortex. This nested hierarchical view is illustrated in
Figure 1.1.
This nested hierarchical arrangement consists of the intrinsic, foundational emotional
systems of the brain, termed primary process. These systems not only generate instinctual
forms of action readiness (Darwin, 1872; Panksepp, 1982) but are also experienced as primal affective states (Panksepp, 1998, 2005). Higher cognitive elaborations, or tertiary processes, are linked to emotional feelings, the feelings that intrinsically guide not only behavioral
choices but patterns of thinking and cognitive styles that lead to top-down controls. The
bridge between the primary-process feelings and higher cognition is the vast intermediate
layer or secondary-process brain functions that control learning and memory. Secondary process arises from and represents deeply unconscious processes of the brain. This intermediate
bridge allows the affective states to interface effectively with the environment and to provide
knowledge for the higher mental apparatus to generate complex perceptions, thoughts,
and ideas of human cognitive consciousness. This higher-order tertiary mind stuff is almost
impenetrable in animal research subjects, especially since most of it is learned developmentally and culturally through vast plastic potentials of our expanded cortex.
My focus will be largely on the foundational layer of the BrainMind,1 critical for affective consciousness. It has received the least attention in neuroscientific and psychological


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4

Jaak Panksepp

Twe-Way er "Circular" Causatien
Tertiary-Process Cognitions
Largely Neocortical
Top-down
Cognitive
Regulation

Bottom-Up Influences on

Ruminations and Thoughts

Secondary-Process Learning
Largely Upper Limbic
Top-down
Conditioned
Responses

Bottom-Up Learnlng
and Development

Primary-Process Emotions
Affects Deeply Subcortical

Nested BrainMind Hierarchies
Figure 1.1 Nested hierarchical structure of primary, secondary, and tertiary affective processes. The figure
illustrates how nested hierarchies are integrating lower brain functions into higher brain functions that exert
top-down regulatory control of behavior at mature development. Adapted from Northoff, Wiebking, Feinberg, & Panksepp (2011).

studies of the human mind. The interactions of these distinct types of consciousness—affective and cognitive—can be described as state-and-channel functions of the brain (Panksepp,
2003). Their interactions are not well understood, but we can be confident that the emotional-affective mind is evolutionarily very ancient and homologous (genetically similar) in
all mammals. The cognitive layer is more recent and is capable of diverse cognitive learning
about oneself and the world. Determining how these levels of mind can be integrated will
be a challenge and a great opportunity for 21st-century psychology and neuroscience as well
as the topic covered here—the interrelations of mental health and resilience.
The reason that affective forms are best understood neuroscientifically through brain–
behavior studies of other animals, while cognitive forms are much easier to study in humans,
is simple. We can directly manipulate and monitor the subcortical affective/emotional activities in animals, since those evoked states are clearly rewarding and punishing; in humans, such
work cannot be conducted. Animal research opens a window into human emotional primes
and their mammalian neuro-evolution that can be explored empirically. My guiding premise

will be that adaptive strengths and weaknesses of mammalian functions will be manifested
dramatically in the construction of the higher cognitive mental apparatus of humans (Solms
& Panksepp, 2012), one that promotes sustainable positive affect, optimism, and resilience
as well as establishes chronic negative affect and pessimism. Cognitive functions surely contribute to the emergence of affects, but their affectively desirable and troublesome features
originate in the ancient psychological processes that arise from below the neocortex.

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