Steven M. Southwick

Neurobiology of Post-Traumatic Stress Disorder

In the general population, post-traumatic stress disorder (PTSD) has a 1% lifetime prevalence (Heizer et al., 1987). Estimates among war veterans are much higher, with 15% of Vietnam veterans currently meeting criteria for PTSD and 30% meeting lifetime criteria. Since their tour in Vietnam, another 20% of veterans have suffered from partial PTSD, having at least some symptoms disruptive of normal social functioning (Kulka et al., 1990).

Personality factors in resilience to traumatic stress

Introduction The study of individual differences in resilience to traumatic stress has received unprecedented attention in recent years from investigators in the field of post-traumatic stress disorder (PTSD) but there remains a lack of consensus regarding the definition, measurement, and conceptualization of the construct. Trait personality psychologists have grappled with similar issues since the seminal work of Jack Block (1961) on the construct of ego resilience over 50 years ago. In the process, they have developed comprehensive models of personality and psychometrically sophisticated tools for the measurement of its traits that can potentially inform and advance the study of resilience. The primary purpose of this chapter is to review the literature on personality factors involved in resilience to traumatic stress and to outline a model for conceptualizing this interface. Contemporary models of personality aim to identify the structure and basis for behavioral traits – defined as individual differences in patterns of thoughts, feelings, and actions that are consistent across developmental periods and environmental contexts. Personality models differ considerably with regard to the factor structure, number, and definition of specific traits. Because of this, research on personality traits that confer risk or resilience to the development of post-traumatic psychopathology has yielded a complicated collection of studies examining disparate constructs and measures. To provide coherence and organization to this literature, this chapter will focus on three broadband personality dimensions described by Tellegen (1985, 2000) that are also represented with subtle definitional variations in most other contemporary trait models of personality. For this reason, they are known as the “big three” personality factors: positive emotionality/extraversion (PEM), negative emotionality/neuroticism (NEM), and constraint/impulsivity (CON).

Initial Clinical Evidence of Genetic Contributions to Posttraumatic Stress Disorder

There are few topics in the field of traumatic stress studies that clinicians approach more ambivalently than considerations of genetic factors associated with vulnerability or resistance to traumatization. Historically, individuals suffering from combat-related posttraumatic stress disorder (PTSD) received diagnoses including “soldier’s heart” or “neurocirculatory asthenia,” and were frequently viewed as possessing characteristics that cast them in a disparaging light, such as “constitutional inferiority” and “lack of virility” (Campbell, 1918; see Krystal et al., 1989). Early studies implicated race as an important factor influencing the vulnerability to psychological stress (cf. Dunn, 1942). However, these studies attempted to use flawed clinical data to support widely held societal prejudices against minority groups, similar to early misguided efforts to characterize the inheritance of intelligence (Gould, 1981). Similarly, German authorities abused genetic arguments to justify denying the claims of Jewish survivors of the Nazi concentration camps for reparation for long-term psychiatric sequelae of their traumatization (Eisler, 1963/1964, 1967; Kestenberg, 1980). The relatively greater progress made in characterizing the environmental factors that influence subsequent stress response, such as the importance of early childhood trauma (Herman, 1992; Krystal, 1988) and the impact of parental traumatization on parent—child relationships (Danieli, 1980; Oliver, 1993; Rosenheck, 1986), further compounds concerns about overestimating genetic factors associated with PTSD.

Altered White Matter Diffusivity of the Cingulum Angular Bundle in Posttraumatic Stress Disorder

Purpose of the Study: Prior studies showed posttraumatic stress disorder (PTSD)-related alterations in white matter integrity, but most of these studies have used region-based approaches. We address this limitation by investigating the relationship between PTSD severity and fractional anisotropy (FA) using a tract-based approach. Procedures: Structural and diffusion magnetic resonance imaging were acquired from 67 combat-exposed US Veterans and processed using FSL/FreeSurfer TRActs Constrained by UnderLying Anatomy. Partial correlations were conducted between PTSD severity and FA of the cingulum and uncinate fasciculi covarying for age, sex, and head motion. Results: Only FA of the left cingulum angular bundle (CAB) was positively correlated with PTSD symptom severity (r = 0.433, p = 0.001, df = 57) and remained significant after Bonferroni correction. Conclusions: This finding may imply greater organization of the CAB with increasing PTSD severity. The CAB connects directly to the cingulate cortex and the hippocampal subiculum, critical nodes of the default mode network, as well as being implicated in neurodegeneration pathology, decision-making, and executive functions, which may help explain previously shown alterations in this network in PTSD. Message of the Paper: Further study of white matter tract integrity in PTSD is warranted, particularly to investigate whether the CAB connections with both higher-order cognitive functioning and emotion processing regions contribute to the pathophysiology and comorbidity of PTSD.

Textbook of Disaster Psychiatry: Neurobiology of disaster exposure: fear, anxiety, trauma, and resilience

This chapter reviews the findings of human and animal studies which have characterized normal function in the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis, and then briefly describes post-traumatic stress disorder (PTSD)-associated abnormalities seen in each system. Neurobiological models of the structure, function and neurochemistry of the brain have evolved significantly as a result of recent input from findings of neuroimaging studies. In recent years several neurochemicals have been associated with resilience. In humans, neuroimaging studies of PTSD have primarily focused on the amygdala, the hippocampus, medial prefrontal cortex, and anterior cingulate cortex. Multidisciplinary studies that use neurochemical, neuroimaging, genetic, and psychosocial approaches may in the future clarify the complex relationships between genotype, phenotype, and psychobiological responses to stress. Pharmacological intervention aimed at treating early severe symptoms which are known to be predictive of later PTSD, such as excessive arousal, is one possible avenue of study.

Resilience and Mental Health: Contributors

Preface Part I. Pathways to Resilience: 1. Neurobiology of resilience Adriana Feder and Kate Collins 2. Resilience in the face of stress: emotion regulation as a protective factor Allison S. Troy and Iris Mauss 3. Cognitive factors and resilience: how self-efficacy contributes to coping with adversities Charles C. Benight and Roman Cieslak 4. Personality factors in resilience to traumatic stress Mark Miller and Kelly M. Harrington 5. Social ties and resilience in chronic disease Denise Janicki-Deverts and Sheldon Cohen 6. Religious and spiritual factors in resilience Dave W. Foy, Kent D. Drescher and Patricia J. Watson Part II. Resilience Across the Lifespan: 7. Resilience in children and adolescents Ann S. Masten, Amy R. Monn and Laura M. Supkoff 8. Toward a lifespan approach to resilience and potential trauma George A. Bonanno and Anthony D. Mancini 9. Resilience in older adults Diane L. Elmore, Lisa M. Brown and Joan M. Cook Part III. Resilience in Families, Communities, and Societies: 10. Family resilience: a collaborate approach in response to stressful life challenges Froma Walsh 11. Community resilience: concepts, assessment, and implications for intervention Fran H. Norris, Kathleen Sherrieb and Betty Pfefferbaum 12. Trauma, culture and resiliency Carl C. Bell Part IV. Specific Challenges: 13. Loss and grief: the role of individual differences Anthony D. Mancini and George Bonanno 14. Reorienting resilience: adapting resilience for post-disaster research Jennifer Johnson and Sandro Galea 15. Rape and other sexual assault Heidi S. Resnick, Constance Guille, Jenna L. McCauley and Dean G. Kilpatrick 16. The stress continuum model: a military organizational approach to resilience and recovery William P. Nash, Maria Steenkamp, Lauren Conoscenti and Brett Litz 17. Resilience in the face of terrorism: linking resource investment with engagement Stevan E. Hobfoll, Brian Hall, Katie J. Horsey and Brittain E. Lamoureux 18. Resilience in the context of poverty John C. Buckner and Jessica S. Waters 19. Resiliency in persons with serious mental illness Piper S. Meyer and Kim T. Mueser Part V. Training for Resilience 20. Interventions to enhance resilience and resilience-related constructs in adults Steven M. Southwick, Robert H. Pietrzak and Jerry White 21. Childhood resilience: adaptation, mastery and attachment Angie Torres, Steven Southwick and Linda C. Mayes 22. Military mental health training: building resilience Carl Andrew Castro and Amy B. Adler 23. Public health practice and disaster resilience: a framework integrating resilience as a worker protection strategy Dori B. Reissman, Kathleen M. Kowalski-Trakofler and Craig L. Katz Index.

Resilience and Mental Health: Contents

Preface Part I. Pathways to Resilience: 1. Neurobiology of resilience Adriana Feder and Kate Collins 2. Resilience in the face of stress: emotion regulation as a protective factor Allison S. Troy and Iris Mauss 3. Cognitive factors and resilience: how self-efficacy contributes to coping with adversities Charles C. Benight and Roman Cieslak 4. Personality factors in resilience to traumatic stress Mark Miller and Kelly M. Harrington 5. Social ties and resilience in chronic disease Denise Janicki-Deverts and Sheldon Cohen 6. Religious and spiritual factors in resilience Dave W. Foy, Kent D. Drescher and Patricia J. Watson Part II. Resilience Across the Lifespan: 7. Resilience in children and adolescents Ann S. Masten, Amy R. Monn and Laura M. Supkoff 8. Toward a lifespan approach to resilience and potential trauma George A. Bonanno and Anthony D. Mancini 9. Resilience in older adults Diane L. Elmore, Lisa M. Brown and Joan M. Cook Part III. Resilience in Families, Communities, and Societies: 10. Family resilience: a collaborate approach in response to stressful life challenges Froma Walsh 11. Community resilience: concepts, assessment, and implications for intervention Fran H. Norris, Kathleen Sherrieb and Betty Pfefferbaum 12. Trauma, culture and resiliency Carl C. Bell Part IV. Specific Challenges: 13. Loss and grief: the role of individual differences Anthony D. Mancini and George Bonanno 14. Reorienting resilience: adapting resilience for post-disaster research Jennifer Johnson and Sandro Galea 15. Rape and other sexual assault Heidi S. Resnick, Constance Guille, Jenna L. McCauley and Dean G. Kilpatrick 16. The stress continuum model: a military organizational approach to resilience and recovery William P. Nash, Maria Steenkamp, Lauren Conoscenti and Brett Litz 17. Resilience in the face of terrorism: linking resource investment with engagement Stevan E. Hobfoll, Brian Hall, Katie J. Horsey and Brittain E. Lamoureux 18. Resilience in the context of poverty John C. Buckner and Jessica S. Waters 19. Resiliency in persons with serious mental illness Piper S. Meyer and Kim T. Mueser Part V. Training for Resilience 20. Interventions to enhance resilience and resilience-related constructs in adults Steven M. Southwick, Robert H. Pietrzak and Jerry White 21. Childhood resilience: adaptation, mastery and attachment Angie Torres, Steven Southwick and Linda C. Mayes 22. Military mental health training: building resilience Carl Andrew Castro and Amy B. Adler 23. Public health practice and disaster resilience: a framework integrating resilience as a worker protection strategy Dori B. Reissman, Kathleen M. Kowalski-Trakofler and Craig L. Katz Index.

Resilience and Mental Health: Index

Preface Part I. Pathways to Resilience: 1. Neurobiology of resilience Adriana Feder and Kate Collins 2. Resilience in the face of stress: emotion regulation as a protective factor Allison S. Troy and Iris Mauss 3. Cognitive factors and resilience: how self-efficacy contributes to coping with adversities Charles C. Benight and Roman Cieslak 4. Personality factors in resilience to traumatic stress Mark Miller and Kelly M. Harrington 5. Social ties and resilience in chronic disease Denise Janicki-Deverts and Sheldon Cohen 6. Religious and spiritual factors in resilience Dave W. Foy, Kent D. Drescher and Patricia J. Watson Part II. Resilience Across the Lifespan: 7. Resilience in children and adolescents Ann S. Masten, Amy R. Monn and Laura M. Supkoff 8. Toward a lifespan approach to resilience and potential trauma George A. Bonanno and Anthony D. Mancini 9. Resilience in older adults Diane L. Elmore, Lisa M. Brown and Joan M. Cook Part III. Resilience in Families, Communities, and Societies: 10. Family resilience: a collaborate approach in response to stressful life challenges Froma Walsh 11. Community resilience: concepts, assessment, and implications for intervention Fran H. Norris, Kathleen Sherrieb and Betty Pfefferbaum 12. Trauma, culture and resiliency Carl C. Bell Part IV. Specific Challenges: 13. Loss and grief: the role of individual differences Anthony D. Mancini and George Bonanno 14. Reorienting resilience: adapting resilience for post-disaster research Jennifer Johnson and Sandro Galea 15. Rape and other sexual assault Heidi S. Resnick, Constance Guille, Jenna L. McCauley and Dean G. Kilpatrick 16. The stress continuum model: a military organizational approach to resilience and recovery William P. Nash, Maria Steenkamp, Lauren Conoscenti and Brett Litz 17. Resilience in the face of terrorism: linking resource investment with engagement Stevan E. Hobfoll, Brian Hall, Katie J. Horsey and Brittain E. Lamoureux 18. Resilience in the context of poverty John C. Buckner and Jessica S. Waters 19. Resiliency in persons with serious mental illness Piper S. Meyer and Kim T. Mueser Part V. Training for Resilience 20. Interventions to enhance resilience and resilience-related constructs in adults Steven M. Southwick, Robert H. Pietrzak and Jerry White 21. Childhood resilience: adaptation, mastery and attachment Angie Torres, Steven Southwick and Linda C. Mayes 22. Military mental health training: building resilience Carl Andrew Castro and Amy B. Adler 23. Public health practice and disaster resilience: a framework integrating resilience as a worker protection strategy Dori B. Reissman, Kathleen M. Kowalski-Trakofler and Craig L. Katz Index.

Resilience and Mental Health: Personality factors in resilience to traumatic stress

Introduction The study of individual differences in resilience to traumatic stress has received unprecedented attention in recent years from investigators in the field of post-traumatic stress disorder (PTSD) but there remains a lack of consensus regarding the definition, measurement, and conceptualization of the construct. Trait personality psychologists have grappled with similar issues since the seminal work of Jack Block (1961) on the construct of ego resilience over 50 years ago. In the process, they have developed comprehensive models of personality and psychometrically sophisticated tools for the measurement of its traits that can potentially inform and advance the study of resilience. The primary purpose of this chapter is to review the literature on personality factors involved in resilience to traumatic stress and to outline a model for conceptualizing this interface. Contemporary models of personality aim to identify the structure and basis for behavioral traits – defined as individual differences in patterns of thoughts, feelings, and actions that are consistent across developmental periods and environmental contexts. Personality models differ considerably with regard to the factor structure, number, and definition of specific traits. Because of this, research on personality traits that confer risk or resilience to the development of post-traumatic psychopathology has yielded a complicated collection of studies examining disparate constructs and measures. To provide coherence and organization to this literature, this chapter will focus on three broadband personality dimensions described by Tellegen (1985, 2000) that are also represented with subtle definitional variations in most other contemporary trait models of personality. For this reason, they are known as the “big three” personality factors: positive emotionality/extraversion (PEM), negative emotionality/neuroticism (NEM), and constraint/impulsivity (CON).