by Donald Meichenbaum
Institute Press, 2012
Review by Roy Sugarman, Ph.D, on Mar 19th 2013
PTSD has not been regarded as a blind process, affecting everyone. Let us take for instance children who are subjected to abuse. The availability heuristic that makes psychologists logically believe, given the numbers of people they counsel who later in life present with mental injury, that abuse will result in mental illness, has been disproven, by such luminaries as Prof Scott Lilienfeld and others.
The truth about trauma is that some people increase their resilience to such disasters through their experience, and others collapse. Indeed, violence experienced in childhood in the family in the context of mental illness or substance abuse might predict about a third of the vulnerability to soldiers who will later present with post-traumatic disorders; early life stressors might predict either traumatic responses in the positive or negative.
Meichenbaum first presents the evidence about resilience to traumatic response by defining resilience, some facts around resilience and post traumatic growth, and then the evidence for resilience in both military and civilian populations.
He then addresses his views on the areas in which fitness or resilience can be built or rebuilt in the areas of physical, interpersonal, emotional, cognitive, behavioral, spiritual areas, as well as given action items for the reader to consider, for each category of fitness.
He concludes with the psychological characteristics of those who are resilient, those who ‘get stuck’ as he calls it, and ways to successfully reintegrate and become more resilient.
He follows the opening tenet of whatever does not kill us has the potential of making us stronger or in South Africa as we had it, what does not kill us makes us strong, in Afrikaans. 70% of us across a lifetime, when exposed to stress, will respond with resilience, thinking in terms perhaps of Londoners during the Blitz in WW2, or of Israelis responding to chronic rocket attacks at them which do little real damage, but are a constant threat to psychological wellbeing. So exposure to stressful events can work as an inoculator and breed resilience, and this means in fact a more positive response to the vicissitudes of life than people no so exposed. Resilience is thus a common response, rather than the 30% who will go on to present with signs of illness. This resilience is known as post traumatic growth, which is the target of this book. Too prolonged or too intense PTSD is not a good outlook for the sufferer, and so something has to be done to promote PTG.
The vast majority of returning soldiers in the above reasoning do indeed espouse that their experiences were positive rather than negative, and represent proud growth in them and their lives, and found it meaningful. 61% of the POW’s from the Vietnam era say that they benefited psychologically from the resilience they gained during their ideal, I guess on return to the real world, they didn’t sweat much of the small stuff, and of course, compared to what they went through, it was all small stuff.
What is also apparently true is that the worse the imprisonment experiences, the more likely the veterans were to report PTG rather than PTSD. However, when they are affected, only half of them seek help, which is a negative outcome for them and everyone else.
Otherwise, the evidence is apparently that both families and spouses, and the soldiers themselves, find the stressors associated with deployment are a positive rather than negative experience, and only 10% of spouses will report the deployment hurt their relationship.
If there are unseen wounds, there are also effective responses available to those who need it, if more would only reveal these injuries. The same resiliency is evident in the civilian population.
For each of the areas he then goes into, he gives a series of action items to follow in those who want to breed resilience. In essence he is teaching a TRAP-TRAC response where people move from a trigger-response-avoidant pattern to a trigger-response-alternative coping flow, where the AC is in fact exercise or movement response. Action 3 for instance under physical will include sleep behavior and deal with nightmares, and later on food hygiene as well. It is clear he is following an integrated approach to lifestyle and wellness to breed resiliency in his charges. In each area he strives to give inspirational quotes and helpful information on each subject he tackles under those headings above, namely: physical, interpersonal, emotional, cognitive, behavioral, spiritual fitness areas.
In one section he creates what he calls ‘re-verbs’ which are words to which adding the re- prefix changes them positively: re-activating, re-configuring etc, then he gives sentence examples of how this works, so “I am re-building” for example, or “re-placing my ruminative brooding”.
After going thoroughly through each area, with quotes, action items, useful information, direction to resources etc, he concludes with a choice, a narrative fork as he calls it, for each individual to consider who is faced with resilience vs. collapse.
He looks at the characteristics of resilient individuals, suggesting they bolster supportive relationships, experience positive emotions and regulate negative emotions that threaten to get out of hand, they adopt a task-oriented coping style, are cognitively flexible, undertake meaning-making missions, and keep fit and safe. Those who get stuck in the trauma are also documented here in terms of their thinking levels, emotional levels, behavioural and social levels, and this is a much more populated list, and of course he introduces the spiritual level too, failing to use faith and religion as a means of coping.
In terms of the areas he addresses in his resilience focus, he produces a helpful table of Do’s and Don’ts for us in each area. So under Spiritual as a heading, his do’s include using an active style of coping, namely problem solving and acceptance strategies, and so on. In order to simplify and help further, he produces a resilience checklist in each arena, for instance take care of my body or eat healthy, or under interpersonal fitness, reconnect with social supports or readjustment takes time after redeployment.
So his approach is highly pragmatic, nowhere does he define the trauma or stress, but launches straight into the ‘what to do’ when you are feeling poorly after returning from active service when feeling stressed. He is normalizing the condition first of all, by saying it is highly common, but highly resolvable, which does not minimize the stressor, but says resilience is achievable in most. The idea of most, as in 50% of those who remain ill for longer, is actually a little off-putting as it implies that there is a significant population of those who have prolonged symptoms who do not recover . Since half of those who are affected do not seek treatment, it is essential that everyone normalize the idea of PTSD and adjustment difficulties as transient, but stresses the need for everyone, not just those affected surely, to do an obligatory period of resilience training post-deployment. I do not see him calling for this, but I think it is a logical flow-on from what he is saying.
It is a simply put together book, which makes it all the more effective, and it is definitely straight- forward, and thus easy to comprehend and use. I like the integrated approach to trauma, and think this is a real gift to any family or friend who is undergoing deployment, uncommon in my home country of Australia, but common enough in many others where conflict is using up young men and women.
I highly recommend it for its pragmatism and positive approach to resilience.
© 2013 Roy Sugarman
Roy Sugarman PhD, Director: Applied Neuroscience, Athletes’ Performance, Arizona USA