Wednesday, 14 September 2011

9/11 – Trauma, therapy, and resilience

Last Sunday was the 10th anniversary of the September 11th attacks in New York. Many of those who survived experienced traumata. There was a wide range of immediate psychological help right after the disaster, and there were also long term programmes. Right after the disaster, it was expected that many people would suffer from lasting emotional distress. However, ten years later, researchers gained a number of different insights. One of them is that humans are apparently more resilient than one might think.

An article in the New York Times summarises some findings from a special issue of the journal American Psychologist on 9/11 and its consequences for therapy and therapy research. In this special issue, Patricia J. Watson, Melissa J. Brymer, and George A. Bonnano review studies on the question what percentage of people exposed to trauma develops posttraumatic stress disorder (PTSD) or other disorders, and they come to the conclusion that the prevalence of the disorders is a lot lower than one might expect. For example, 7.5% Manhattan residents exposed to the events on 9/11 showed symptoms of PTSD one month after the disaster, but the number had decreased to 0.6% half a year after. The rest of the inhabitants seem to be resilient, that is, able to bounce back from adversity. So exposure to a disaster does not necessarily mean that we develop a mental disorder. Only the combination with other factors like lack of social support or maladaptive attributional styles (the way how people explain certain events to themselves) leads to problems like PTSD.

These findings are in line with what Martin Seligman writes in his book “Flourish”: Those that are mentally healthy before the disaster are a lot less likely to develop PTSD afterwards than those who are already close to the bottom of mental health. Therefore, mental health is once more an important factor. How it can be achieved is described for example by Barbara L. Fredrickson in her book “Positivity”: Positive emotions build resources. Therefore, we should increase the proportion of positive emotions. Also, as Patricia Watson and her colleagues point out in their article, social support is important for resilience – and at the same time, for positive emotions!

But Martin Seligman even goes one step further and describes how adversity can be turned into post-traumatic growth because if bad things happen to us, we can appreciate the good things in life even more, we can empathise better with people in difficult situations, or we can rethink our lives. So to some extent, also attitudes make a big difference. Seligman and his colleagues even developed a Master Resilience Training that builds mental toughness and uses character strengths as a basis.

What does this all mean? We can’t do much against disasters happening. But we can be prepared. We can build resilience by fostering positive emotions, by identifying our character strengths, by building close relationships and by all the other measures that improve mental health. Apart from the fact that this helps us overcome adversity, this also helps us flourish every day.

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