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On This Day … 11 January [2023]

People (Births)

  • 1842 – William James, American psychologist and philosopher (d. 1910).
  • 1867 – Edward B. Titchener, English psychologist and academic (d. 1927).

People (Deaths)

  • 2007 – Robert Anton Wilson, American psychologist, author, poet, and playwright (b. 1932).

William James

William James (11 January 1842 to 26 August 1910) was an American philosopher, historian, and psychologist, and the first educator to offer a psychology course in the United States. James is considered to be a leading thinker of the late 19th century, one of the most influential philosophers of the United States, and the “Father of American psychology”.

Along with Charles Sanders Peirce, James established the philosophical school known as pragmatism, and is also cited as one of the founders of functional psychology. A Review of General Psychology analysis, published in 2002, ranked James as the 14th most eminent psychologist of the 20th century. A survey published in American Psychologist in 1991 ranked James’s reputation in second place, after Wilhelm Wundt, who is widely regarded as the founder of experimental psychology. James also developed the philosophical perspective known as radical empiricism. James’s work has influenced philosophers and academics such as Émile Durkheim, W.E.B. Du Bois, Edmund Husserl, Bertrand Russell, Ludwig Wittgenstein, Hilary Putnam, Richard Rorty, and Marilynne Robinson.

Born into a wealthy family, James was the son of the Swedenborgian theologian Henry James Sr. and the brother of both the prominent novelist Henry James and the diarist Alice James. James trained as a physician and taught anatomy at Harvard, but never practiced medicine. Instead he pursued his interests in psychology and then philosophy. He wrote widely on many topics, including epistemology, education, metaphysics, psychology, religion, and mysticism. Among his most influential books are The Principles of Psychology, a groundbreaking text in the field of psychology; Essays in Radical Empiricism, an important text in philosophy; and The Varieties of Religious Experience, an investigation of different forms of religious experience, including theories on mind-cure.

Edward B. Titchener

Edward Bradford Titchener (11 January 1867 to 03 August 1927) was an English psychologist who studied under Wilhelm Wundt for several years. Titchener is best known for creating his version of psychology that described the structure of the mind: structuralism. After becoming a professor at Cornell University, he created the largest doctoral program at that time in the United States. His first graduate student, Margaret Floy Washburn, became the first woman to be granted a PhD in psychology (1894).

Robert Anton Wilson

Robert Anton Wilson (born Robert Edward Wilson; 18 January 1932 to 11 January 2007) was an American author, futurist, psychologist, and self-described agnostic mystic. Recognised within Discordianism as an Episkopos, pope and saint, Wilson helped publicise Discordianism through his writings and interviews.

Wilson described his work as an “attempt to break down conditioned associations, to look at the world in a new way, with many models recognised as models or maps, and no one model elevated to the truth”. His goal was “to try to get people into a state of generalised agnosticism, not agnosticism about God alone but agnosticism about everything.”

In addition to writing several science-fiction novels, Wilson also wrote non-fiction books on extrasensory perception, mental telepathy, metaphysics, paranormal experiences, conspiracy theory, sex, drugs and what Wilson called “quantum psychology”.

Following a career in journalism and as an editor, notably for Playboy, Wilson emerged as a major countercultural figure in the mid-1970s, comparable to one of his co-authors, Timothy Leary, as well as Terence McKenna.

On This Day … 09 January [2023]

People (Births)

  • 1879 – John B. Watson, American psychologist and academic (d. 1958).

John B. Watson

John Broadus Watson (09 January 1878 to 25 September 1958) was an American psychologist who popularised the scientific theory of behaviourism, establishing it as a psychological school.

Watson advanced this change in the psychological discipline through his 1913 address at Columbia University, titled Psychology as the Behaviourist Views It. Through his behaviourist approach, Watson conducted research on animal behaviour, child rearing, and advertising, as well as conducting the controversial “Little Albert” experiment and the Kerplunk experiment. He was also the editor of Psychological Review from 1910 to 1915. A Review of General Psychology survey, published in 2002, ranked Watson as the 17th most cited psychologist of the 20th century.

On This Day … 08 January [2023]

People (Births)

  • 1902 – Carl Rogers, American psychologist and academic (d. 1987).

Carl Rogers

Carl Ransom Rogers (08 January 1902 to 04 February 1987) was an American psychologist and among the founders of the humanistic approach (and client-centred approach) in psychology. Rogers is widely considered one of the founding fathers of psychotherapy research and was honoured for his pioneering research with the Award for Distinguished Scientific Contributions by the American Psychological Association (APA) in 1956.

The person-centred approach, Rogers’s unique approach to understanding personality and human relationships, found wide application in various domains, such as psychotherapy and counselling (client-centred therapy), education (student-centred learning), organisations, and other group settings. For his professional work he received the Award for Distinguished Professional Contributions to Psychology from the APA in 1972. In a study by Steven J. Haggbloom and colleagues using six criteria such as citations and recognition, Rogers was found to be the sixth most eminent psychologist of the 20th century and second, among clinicians, only to Sigmund Freud. Based on a 1982 survey of 422 respondents of US and Canadian psychologists, he was considered the most influential psychotherapist in history (Freud ranked third).

On This Day … 07 January [2023]

People (Births)

  • 1946 – Michele Elliott, author, psychologist and founder of child protection charity Kidscape.

Michele Elliott

Michele Irmiter Elliott OBE is an author, psychologist, teacher and the founder and director of child protection charity Kidscape.

She has chaired World Health Organisation and Home Office working groups and is a Winston Churchill fellow.

On This Day … 06 January [2023]

People (Births)

  • 1915 – John C. Lilly, American psychoanalyst, physician, and philosopher (d. 2001).

People (Deaths)

  • 2014 – Julian Rotter, American psychologist and academic (b. 1916).

John C. Lilly

John Cunningham Lilly (06 January 1915 to 30 September 2001) was an American physician, neuroscientist, psychoanalyst, psychonaut, philosopher, writer and inventor. He was a member of a generation of counterculture scientists and thinkers that included Timothy Leary, Ram Dass, and Werner Erhard, all frequent visitors to the Lilly home. He often stirred controversy, especially among mainstream scientists.

Lilly conducted high-altitude research during World War II and later trained as a psychoanalyst. He gained renown in the 1950s after developing the isolation tank. He saw the tanks, in which users are isolated from almost all external stimuli, as a means to explore the nature of human consciousness. He later combined that work with his efforts to communicate with dolphins. He began studying how bottlenose dolphins vocalise, establishing centres in the US Virgin Islands, and later San Francisco, to study dolphins. A decade later, he began experimenting with psychedelics, including LSD, often while floating in isolation. His work inspired two Hollywood movies, The Day of the Dolphin (1973) and Altered States (1980), as well as the videogame series Ecco the Dolphin.

Julian Rotter

Julian B. Rotter (22 October 1916 to 06 January 2014) was an American psychologist known for developing social learning theory and research into locus of control. He was a faculty member at Ohio State University and then the University of Connecticut. A Review of General Psychology survey, published in 2002, ranked Rotter as the 64th most eminent and 18th most widely cited psychologist of the 20th century. A 2014 study published in 2014 placed at #54 among psychologists whose careers spanned the post-World War II era.

What is the Scale of Protective Factors?

Introduction

The Scale of Protective Factors (SPF) is a measure of aspects of social relationships, planning behaviours and confidence.

These factors contribute to psychological resilience in emerging adults and adults.

Brief History

The SPF was developed by Dr. Elisabeth Ponce-Garcia at the science of protective factors laboratory (SPF Lab) to capture multiple aspects of adult resilience. A Confirmatory Factor Analysis was subsequently published as collaborative research. The SPF was found to assess resilience effectively in both men and women, across risk and socio-economic status, and ethnic/racial categories.

In order to verify effectiveness in comparison to other measures, Madewell and Ponce-Garcia (2016) analysed the SPF and four other commonly used measures of adult resilience. They found that the SPF was the only measure that assessed social and cognitive aspects and that it outperformed three other measures and performed comparably with a fourth.

The structure of the SPF in comparison to four other adult resilience measures, as well as comparison data, is available as a Data in Brief article. Noticing the absence of research examining the effectiveness of adult resilience measures in child or adult sexual assault, Ponce-Garcia, Madewell and Brown (2016) demonstrated SPF’s effectiveness in that domain. An investigation of the effectiveness of the SPF in the Southern Plains Tribes of the Native American and American Indian community in 2016.

A brief version of the 24 item SPF was developed in 2019 to result in 12 item measure that can be taken as a self-assessment. The SPF-24 and the SPF-12 have been used throughout the United States and in several other countries to include Saudi Arabia, Pakistan, India, Australia, Malesia, Paraguay, Mexico, and Canada. It is listed as a resource by Harvard University, was included in the United States Army Substance Abuse Programme (ASAP-Fort Sill, OK), and is provided by the State of Oklahoma ReEntry Programme.

Contents

The SPF consists of twenty-four statements for which individuals are asked to rate the degree to which each statement describes them. The SPF assesses a wider range of protective factors than other scales. The SPF is the only measure that has been shown to assess social and cognitive protective factors. The SPF includes four sub-scales that indicate the strengths and weaknesses that contribute to overall resilience. The SPF is the only measure to have been used in measuring resilience in sexual assault survivors within the United States.

Properties

The SPF consists of four sub-scales, two social protective factors and two cognitive protective factors.

Social Subscales

Social support measures the availability of social resources in the form of family and/or friends. Social skill measures the ability to make and maintain relationships. The two should be positively correlated. Higher scores on the social sub-scales indicate unity with friends and/or family, friend/family group optimism and general friend/family support.

Cognitive Subscales

The goal efficacy sub-scale measures confidence in the ability to achieve goals. The planning and prioritising behaviour sub-scale measures the ability to recognise the relative importance of tasks, the tendency to approach tasks in order of importance, and the use of lists for organisation.

Scoring

Adding the scores from the four sub-scales results in an overall resilience score. Adding scores from either the two social sub-scales or the two cognitive sub-scales results in a social resilience or cognitive resilience score, respectively. The sub-scale scores can also be viewed as an individual profile of strengths and deficits to indicate priorities for therapeutic plans.

This additive approach could theoretically allow varying subscale scores to cancel each other out and incorrectly indicate low overall resilience. However, research shows that social and cognitive characteristics work together to support resilience. This concern is also not supported by the characteristics of the SPF. Rather than assessing the number of friends or the frequency of social interaction, the SPF assesses the level of comfort in interacting socially. Similarly, rather than assessing the number of goals or tasks, the SPF assesses confidence in reaching goals once set.

The sub-scales are moderately positively correlated and that they all contribute to overall resilience.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Scale_of_Protective_Factors >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Experiential Avoidance?

Introduction

Experiential avoidance (EA) has been broadly defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences – even when doing so creates harm in the long run.

The process of EA is thought to be maintained through negative reinforcement – that is, short-term relief of discomfort is achieved through avoidance, thereby increasing the likelihood that the avoidance behaviour will persist. Importantly, the current conceptualisation of EA suggests that it is not negative thoughts, emotions, and sensations that are problematic, but how one responds to them that can cause difficulties. In particular, a habitual and persistent unwillingness to experience uncomfortable thoughts and feelings (and the associated avoidance and inhibition of these experiences) is thought to be linked to a wide range of problems.

Background

EA has been popularised by recent third-wave cognitive-behavioural theories such as acceptance and commitment therapy (ACT). However, the general concept has roots in many other theories of psychopathology and intervention.

Psychodynamic

Defence mechanisms were originally conceptualised as ways to avoid unpleasant affect and discomfort that resulted from conflicting motivations. These processes were thought to contribute to the expression of various types of psychopathology. Gradual removal of these defensive processes are thought to be a key aspect of treatment and eventually return to psychological health.

Process-Experiential

Process-experiential therapy merges client-centred, existential, and Gestalt approaches. Gestalt theory outlines the benefits of being fully aware of and open to one’s entire experience. One job of the psychotherapist is to “explore and become fully aware of [the patient’s] grounds for avoidance” and to “[lead] the patient back to that which he wishes to avoid”. Similar ideas are expressed by early humanistic theory:

“Whether the stimulus was the impact of a configuration of form, color, or sound in the environment on the sensory nerves, or a memory trace from the past, or a visceral sensation of fear or pleasure or disgust, the person would be ‘living’ it, would have it completely available to awareness…he is more open to his feelings of fear and discouragement and pain…he is more able fully to live the experiences of his organism rather than shutting them out of awareness.”

Behavioural

Traditional behaviour therapy utilises exposure to habituate the patient to various types of fears and anxieties, eventually resulting in a marked reduction in psychopathology. In this way, exposure can be thought of as “counter-acting” avoidance, in that it involves individuals repeatedly encountering and remaining in contact with that which causes distress and discomfort.

Cognitive

In cognitive theory, avoidance interferes with reappraisals of negative thought patterns and schema, thereby perpetuating distorted beliefs. These distorted beliefs are thought to contribute and maintain many types of psychopathology.

Third-Wave Cognitive-Behavioural

The concept of EA is explicitly described and targeted in more recent CBT modalities including acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), functional analytic psychotherapy (FAP), and behavioural activation (BA).

Associated Problems

  • Distress is an inextricable part of life; therefore, avoidance is often only a temporary solution.
  • Avoidance reinforces the notion that discomfort, distress and anxiety are bad, or dangerous.
  • Sustaining avoidance often requires effort and energy.
  • Avoidance limits one’s focus at the expense of fully experiencing what is going on in the present.
  • Avoidance may get in the way of other important, valued aspects of life.

Empirical Evidence

  • Laboratory-based thought suppression studies suggest avoidance is paradoxical, in that concerted attempts at suppression of a particular thought often leads to an increase of that thought.
  • Studies examining emotional suppression and pain suppression suggest that avoidance is ineffective in the long-run. Conversely, expressing the unpleasant emotions can lead to improvements in the long term, even though it increases negative reactions in the short term.
  • Exposure-based therapy techniques have been shown to be effective in treating a wide range of psychiatric disorders.
  • Numerous self-report studies have linked EA and related constructs (avoidance coping, thought suppression) to psychopathology and other forms of dysfunction.

Relevance to Psychopathology

Seemingly disparate forms of pathological behaviour can be understood by their common function (i.e., attempts to avoid distress). Some examples include:

DiagnosisExample BehavioursTarget of Avoidance
Major Depressive Disorder (MDD)Isolation/SuicideFeelings of sadness, guilt, and low self-worth.
Posttraumatic Stress Disorder (PTSD)Avoiding trauma reminders and hypervigilanceMemories, anxiety, and concerns of safety.
Social PhobiaAvoiding social situationsAnxiety and concerns of judgement of others.
Panic DisorderAvoiding situations that might induce panicFear and physiological sensations.
AgoraphobiaRestricting travel outside of home or other ‘safe areas’Anxiety and fear of having symptoms of panic.
Obsessive-Compulsive DisorderChecking/RitualsWorry of consequences (e.g. ‘contamination’).
Substance Use DisordersAbusing alcohol/drugsEmotions, memories, and withdrawal symptoms.
Eating DisordersRestricting food intake and purgingWorry about becoming overweight and fear of losing control.
Borderline Personality DisorderSelf-harm (e.g. cutting)High emotional arousal.

Relevance to Quality of Life

Perhaps the most significant impact of EA is its potential to disrupt and interfere with important, valued aspects of an individual’s life. That is, EA is seen as particularly problematic when it occurs at the expense of a person’s deeply held values. Some examples include:

  • Putting off an important task because of the discomfort it evokes.
  • Not taking advantage of an important opportunity due to attempts to avoid worries of failure or disappointment.
  • Not engaging in physical activity/exercise, meaningful hobbies, or other recreational activities due to the effort they demand.
  • Avoiding social gatherings or interactions with others because of the anxiety and negative thoughts they evoke.
  • Not being a full participant in social gatherings due to attempts to regulate anxiety relating to how others are perceiving you.
  • Being unable to fully engage in meaningful conversations with others because one is scanning for signs of danger in the environment (attempting to avoid feeling “unsafe”).
  • Inability to “connect” and sustain a close relationship because of attempts to avoid feelings of vulnerability.
  • Staying in a “bad” relationship to try to avoid discomfort, guilt, and potential feelings of loneliness a break-up might entail.
  • Losing a marriage or contact with children due to an unwillingness to experience uncomfortable feelings (e.g. achieved through drug or alcohol abuse) or symptoms of withdrawal.
  • Not attending an important graduation, wedding, funeral, or other family event to try to avoid anxiety or symptoms of panic.
  • Engaging in self-destructive behaviours in an attempt to avoid feelings of boredom, emptiness, worthlessness.
  • Not functioning or taking care of basic responsibilities (e.g. personal hygiene, waking up, showing up to work, shopping for food) because of the effort they demand and/or distress they evoke.
  • Spending so much time attempting to avoid discomfort that one has little time for anyone or anything else in life.

Measurement

Self-Report

The Acceptance and Action Questionnaire (AAQ) was the first self-report measure explicitly designed to measure EA, but has since been re-conceptualised as a measure of “psychological flexibility”. The 62-item Multidimensional Experiential Avoidance Questionnaire (MEAQ) was developed to measure different aspects of EA. The Brief Experiential Avoidance Questionnaire (BEAQ) is a 15-item measure developed using MEAQ items, which has become the most widely used measure of experiential avoidance.

What is Psychological Flexibility?

Flexibility is a personality trait that describes the extent to which a person can cope with changes in circumstances and think about problems and tasks in novel, creative ways. This trait is used when stressors or unexpected events occur, requiring a person to change their stance, outlook, or commitment. Flexible personality should not be confused with cognitive flexibility, which is the ability to switch between two concepts, as well as simultaneously think about multiple concepts. Researchers of cognitive flexibility describe it as the ability to switch one’s thinking and attention between tasks. Flexibility, or psychological flexibility, as it is sometimes referred to, is the ability to adapt to situational demands, balance life demands, and commit to behaviours.

  • Refer to:
  • Opposite concepts:
    • Acceptance.
    • Distress tolerance.
    • Psychological flexibility.
  • Related concepts:
    • Denial.
    • Expressive suppression.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Experiential_avoidance >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Psychological Resilience

Introduction

Psychological resilience is the ability to cope mentally or emotionally with a crisis or to return to pre-crisis status quickly.

The term was coined in the 1970s by Emmy E. Werner, a psychologist, as she conducted a forty year long study of a cohort of Hawaiian children who came from low, socioeconomical back grounds. Resilience exists when the person uses “mental processes and behaviours in promoting personal assets and protecting self from the potential negative effects of stressors”. In simpler terms, psychological resilience exists in people who develop psychological and behavioural capabilities that allow them to remain calm during crises/chaos and to move on from the incident without long-term negative consequences. A lot of criticism of this topic comes from the fact that it is difficult to measure and test this psychological construct because resiliency can be interpreted in a variety of ways. Most psychological paradigms (biomedical, cognitive-behavioural, sociocultural, etc.) have their own perspective of what resilience looks like, where it comes from, and how it can be developed. Despite numerous definitions of psychological resilience, most of these definitions centre around two concepts:

  • Adversity; and
  • Positive adaptation.

Many psychologists agree that positive emotions, social support, and hardiness can influence an individual to become more resilient.

Refer to Scale of Protective Factors.

Brief History

The first research on resilience was published in 1973. The study used epidemiology, which is the study of disease prevalence, to uncover the risks and the protective factors that now help define resilience. A year later, the same group of researchers created tools to look at systems that support development of resilience.

Emmy Werner was one of the early scientists to use the term resilience in the 1970s. She studied a cohort of children from Kauai, Hawaii. Kauai was quite poor and many of the children in the study grew up with alcoholic or mentally ill parents. Many of the parents were also out of work. Werner noted that of the children who grew up in these detrimental situations, two-thirds exhibited destructive behaviours in their later teen years, such as chronic unemployment, substance abuse, and out-of-wedlock births (in case of teenage girls). However, one-third of these youngsters did not exhibit destructive behaviours. Werner called the latter group resilient. Thus, resilient children and their families were those who, by definition, demonstrated traits that allowed them to be more successful than non-resilient children and families.

Resilience also emerged as a major theoretical and research topic from the studies of children with mothers diagnosed with schizophrenia in the 1980s. In a 1989 study, the results showed that children with a schizophrenic parent may not obtain an appropriate level of comforting caregiving – compared to children with healthy parents – and that such situations often had a detrimental impact on children’s development. On the other hand, some children of ill parents thrived well and were competent in academic achievement, and therefore led researchers to make efforts to understand such responses to adversity.

Since the onset of the research on resilience, researchers have been devoted to discovering the protective factors that explain people’s adaptation to adverse conditions, such as maltreatment, catastrophic life events, or urban poverty. The focus of empirical work then has been shifted to understand the underlying protective processes. Researchers endeavour to uncover how some factors (e.g. connection to family) may contribute to positive outcomes.

Definition

Resilience is generally thought of as a “positive adaptation” after a stressful or adverse situation. When a person is “bombarded by daily stress, it disrupts their internal and external sense of balance, presenting challenges as well as opportunities.” However, the routine stressors of daily life can have positive impacts which promote resilience. It is still unknown what the correct level of stress is for each individual. Some people can handle greater amounts of stress than others. A portion of psychologists believe that it is not the stress itself that promotes resilience but rather the individual’s perception of their stress and their perceived personal level of control. The presence of stress allows people to practice this process. According to Germain and Gitterman (1996), stress is experienced in an individual’s life course at times of difficult life transitions, involving developmental and social change; traumatic life events, including grief and loss; and environmental pressures, encompassing poverty and community violence. Resilience is the integrated adaptation of physical, mental and spiritual aspects in a set of “good or bad” circumstances, a coherent sense of self that is able to maintain normative developmental tasks that occur at various stages of life. The Children’s Institute of the University of Rochester explains that “resilience research is focused on studying those who engage in life with hope and humour despite devastating losses”. It is important to note that resilience is not only about overcoming a deeply stressful situation, but also coming out of the said situation with “competent functioning”. Resiliency allows a person to rebound from adversity as a strengthened and more resourceful person. Some characteristics of psychological resilience include: an easy temperament, good self-esteem, planning skills, and a supportive environment inside and outside of the family. Aaron Antonovsky in 1979 stated that when an event is appraised as comprehensible (predictable), manageable (controllable), and somehow meaningful (explainable) a resilient response is more likely.

Process

Psychological resilience is most commonly understood as a process. It is a tool a person can use and it is something that an individual develops overtime. Others assume it to be a trait of the individual, an idea more typically referred to as “resiliency”. Most research now shows that resilience is the result of individuals being able to interact with their environments and participate in processes that either promote well-being or protect them against the overwhelming influence of risk factors. This research could be used in support of psychological resilience being a process rather than a trait. Resilience is seen as something to develop. Making it something to pursue and not an endpoint.

Ray Williams (Canadian businessman and author) saw that resilience comes from people able to effectively cope with their environment. He believed that there are three basic ways individuals could react when faced with a difficult situation.

  • Respond with anger or aggression.
  • Become overwhelmed and shut down.
  • Feel the emotion about the situation and appropriately handle the emotion.

The third option is the one he believed that truly helps an individual promote wellness. Individuals that follow this pattern are people who show resilience. Their resilience comes from coping with the situation. People who follow the first and second option tend to label themselves as victims of their circumstance or they may blame others for their misfortune. They do not effectively cope with their environment, they become reactive, and they tend to cling to negative emotions. This often makes it difficult to focus on problem solving or bounce back. Those that are more resilient will respond to their conditions by coping, bouncing back, and looking for a solution. Along with continual coping methods, William believed that the resilience process can be aided by good environments. These environments include supportive social environments (such as families, communities, schools) and social policies.

Criticism

Like other psychological phenomena, by defining specific psychological and affective states in certain ways, controversy over meaning will always ensue. How the term resilience is defined affects research focuses; different or insufficient definitions of resilience will lead to inconsistent research about the same concepts. Research on resilience has become more heterogeneous in its outcomes and measures, convincing some researchers to abandon the term altogether due to it being attributed to all outcomes of research where results were more positive than expected.

There is also some disagreement among researchers in the field as to whether psychological resilience is a character trait or state of being. Psychological resilience has also been referred to as ecological concept, ranging from micro to macro levels of interpretation. However, it is generally agreed upon that resilience is a buildable resource.

Recently there has also been evidence that resilience can indicate a capacity to resist a sharp decline in other harm even though a person temporarily appears to get worse. Similarly, studies have shown that adolescents who have a high level of adaptation (i.e. resilience) tend to struggle with dealing with other psychological problems later on in life. This is due to an overload of their stress response systems. There is evidence that the higher one’s resilience is, the lower their vulnerability.

Related Factors

Studies show that there are several factors which develop and sustain a person’s resilience:

  • The ability to make realistic plans and being capable of taking the steps necessary to follow through with them.
  • Confidence in one’s strengths and abilities.
  • Communication and problem-solving skills.
  • The ability to manage strong impulses and feelings.
  • Having good self-esteem.

However, these factors vary among different age groups. For example, these factors among older adults are external connections, grit, independence, self-care, self-acceptance, altruism, hardship experience, health status, and positive perspective on life.

Resilience is negatively correlated with personality traits of neuroticism and negative emotionality, which represents tendencies to see and react to the world as threatening, problematic, and distressing, and to view oneself as vulnerable. Positive correlations stands with personality traits of openness and positive emotionality, that represents tendencies to engage and confront the world with confidence in success and a fair value to self-directedness.

Positive Emotions

There is significant research found in scientific literature on the relationship between positive emotions and resilience. Studies show that maintaining positive emotions whilst facing adversity promote flexibility in thinking and problem solving. Positive emotions serve an important function in their ability to help an individual recover from stressful experiences and encounters. That being said, maintaining a positive emotionality aids in counteracting the physiological effects of negative emotions. It also facilitates adaptive coping, builds enduring social resources, and increases personal well-being.

The formation of conscious perception and the monitoring of one’s own socioemotional factors is considered a stabile aspect of positive emotions. This is not to say that positive emotions are merely a by-product of resilience, but rather that feeling positive emotions during stressful experiences may have adaptive benefits in the coping process of the individual. Empirical evidence for this prediction arises from research on resilient individuals who have a propensity for coping strategies that concretely elicit positive emotions, such as benefit-finding and cognitive reappraisal, humour, optimism, and goal-directed problem-focused coping. Individuals who tend to approach problems with these methods of coping may strengthen their resistance to stress by allocating more access to these positive emotional resources. Social support from caring adults encouraged resilience among participants by providing them with access to conventional activities.

Positive emotions not only have physical outcomes but also physiological ones. Some physiological outcomes caused by humour include improvements in immune system functioning and increases in levels of salivary immunoglobulin A, a vital system antibody, which serves as the body’s first line of defence in respiratory illnesses. Moreover, other health outcomes include faster injury recovery rate and lower readmission rates to hospitals for the elderly, and reductions in a patient’s stay in the hospital, among many other benefits. A study was done on positive emotions in trait-resilient individuals and the cardiovascular recovery rate following negative emotions felt by those individuals. The results of the study showed that trait-resilient individuals experiencing positive emotions had an acceleration in the speed in rebounding from cardiovascular activation initially generated by negative emotional arousal, i.e. heart rate and the like.

Forgiveness is also said to play a role in predicting resilience, among patients with chronic pain (but not the severity of the pain).

Social Support

Many studies show that the primary factor for the development of resilience is social support. While many competing definitions of social support exist, most can be thought of as the degree of access to, and use of, strong ties to other individuals who are similar to one’s self. Social support requires not only that you have relationships with others, but that these relationships involve the presence of solidarity and trust, intimate communication, and mutual obligation both within and outside the family.

In military studies it has been found that resilience is also dependent on group support: unit cohesion and morale is the best predictor of combat resiliency within a unit or organisation. Resilience is highly correlated to peer support and group cohesion. Units with high cohesion tend to experience a lower rate of psychological breakdowns than units with low cohesion and morale. High cohesion and morale enhance adaptive stress reactions. Post-war veterans who had more social support were less likely to develop post-traumatic stress disorder.

Other Factors

A study was conducted among high-achieving professionals who seek challenging situations that require resilience. Research has examined 13 high achievers from various professions, all of whom had experienced challenges in the workplace and negative life events over the course of their careers but who had also been recognised for their great achievements in their respective fields. Participants were interviewed about everyday life in the workplace as well as their experiences with resilience and thriving. The study found six main predictors of resilience: positive and proactive personality, experience and learning, sense of control, flexibility and adaptability, balance and perspective, and perceived social support. High achievers were also found to engage in many activities unrelated to their work such as engaging in hobbies, exercising, and organizing meetups with friends and loved ones.

Additional factors are also associated with resilience, like the capacity to make realistic plans, having self-confidence and a positive self image, developing communications skills, and the capacity to manage strong feelings and impulses.

Temperamental and constitutional disposition is considered as a major factor in resilience. It is one of the necessary precursors of resilience along with warmth in family cohesion and accessibility of prosocial support systems. There are three kinds of temperamental systems that play part in resilience, they are the appetitive system, defensive system and attentional system.

Another protective factor is related to moderating the negative effects of environmental hazards or a stressful situation in order to direct vulnerable individuals to optimistic paths, such as external social support. More specifically a 1995 study distinguished three contexts for protective factors:

  • Personal attributes, including outgoing, bright, and positive self-concepts;
  • The family, such as having close bonds with at least one family member or an emotionally stable parent; and
  • The community, such as receiving support or counsel from peers.

Furthermore, a study of the elderly in Zurich, Switzerland, illuminated the role humour plays as a coping mechanism to maintain a state of happiness in the face of age-related adversity.

Besides the above distinction on resilience, research has also been devoted to discovering the individual differences in resilience. Self-esteem, ego-control, and ego-resiliency are related to behavioural adaptation. For example, maltreated children who feel good about themselves may process risk situations differently by attributing different reasons to the environments they experience and, thereby, avoid producing negative internalised self-perceptions. Ego-control is “the threshold or operating characteristics of an individual with regard to the expression or containment” of their impulses, feelings, and desires. Ego-resilience refers to “dynamic capacity, to modify his or her model level of ego-control, in either direction, as a function of the demand characteristics of the environmental context”.

Maltreated children who experienced some risk factors (e.g. single parenting, limited maternal education, or family unemployment), showed lower ego-resilience and intelligence than non-maltreated children. Furthermore, maltreated children are more likely than non-maltreated children to demonstrate disruptive-aggressive, withdraw, and internalised behaviour problems. Finally, ego-resiliency, and positive self-esteem were predictors of competent adaptation in the maltreated children.

Demographic information (e.g. gender) and resources (e.g. social support) are also used to predict resilience. Examining people’s adaptation after disaster showed women were associated with less likelihood of resilience than men. Also, individuals who were less involved in affinity groups and organisations showed less resilience.

Certain aspects of religions, spirituality, or mindfulness may, hypothetically, promote or hinder certain psychological virtues that increase resilience. Research has not established connection between spirituality and resilience. According to the 4th edition of Psychology of Religion by Hood, et al., the “study of positive psychology is a relatively new development…there has not yet been much direct empirical research looking specifically at the association of religion and ordinary strengths and virtues”. In a review of the literature on the relationship between religiosity/spirituality and PTSD, amongst the significant findings, about half of the studies showed a positive relationship and half showed a negative relationship between measures of religiosity/spirituality and resilience. The United States Army has received criticism for promoting spirituality in its (then) new Comprehensive Soldier Fitness programme as a way to prevent PTSD, due to the lack of conclusive supporting data.

Biological Models

Three notable bases for resilience – self-confidence, self-esteem and self-concept – all have roots in three different nervous systems – respectively, the somatic nervous system, the autonomic nervous system and the central nervous system.

Research indicates that like trauma, resilience is influenced by epigenetic modifications. Increased DNA methylation of the growth factor Gdfn in certain brain regions promotes stress resilience, as does molecular adaptations of the blood brain barrier.

The two primary neurotransmitters responsible for stress buffering within the brain are dopamine and endogenous opioids as evidenced by current research showing that dopamine and opioid antagonists increased stress response in both humans and animals. Primary and secondary rewards reduce negative reactivity of stress in the brain in both humans and animals. The relationship between social support and stress resilience is thought to be mediated by the oxytocin system’s impact on the hypothalamic-pituitary-adrenal axis.

“Resilience, conceptualized as a positive bio-psychological adaptation, has proven to be a useful theoretical context for understanding variables for predicting long-term health and well-being”.

Building Resilience

In cognitive behavioural therapy (CBT), building resilience is a matter of mindfully changing basic behaviours and thought patterns. The first step is to change the nature of self-talk. Self-talk is the internal monologue people have that reinforce beliefs about the person’s self-efficacy and self-value. To build resilience, the person needs to eliminate negative self-talk, such as “I can’t do this” and “I can’t handle this”, and to replace it with positive self-talk, such as “I can do this” and “I can handle this”. This small change in thought patterns helps to reduce psychological stress when a person is faced with a difficult challenge. The second step a person can take to build resilience is to be prepared for challenges, crises, and emergencies. In business, preparedness is created by creating emergency response plans, business continuity plans, and contingency plans. For personal preparedness, the individual can create a financial cushion to help with economic crises, he/she can develop social networks to help him/her through trying personal crises, and he/she can develop emergency response plans for his/her household.

Resilience is also enhanced by developing effective coping skills for stress. Coping skills help the individual to reduce stress levels, so they remain functional. Coping skills include using meditation, exercise, socialisation, and self-care practices to maintain a healthy level of stress, but there are many other lists associated with psychological resilience.

The American Psychological Association suggests “10 Ways to Build Resilience”, which are to:

  • Maintain good relationships with close family members, friends and others;
  • Avoid seeing crises or stressful events as unbearable problems;
  • Accept circumstances that cannot be changed;
  • Develop realistic goals and move towards them;
  • Take decisive actions in adverse situations;
  • Look for opportunities for self-discovery after a struggle with loss;
  • Develop self-confidence;
  • Keep a long-term perspective and consider the stressful event in a broader context;
  • Maintain a hopeful outlook, expecting good things and visualizing what is wished; and
  • Take care of one’s mind and body, exercising regularly, paying attention to one’s own needs and feelings.

The Besht model of natural resilience building in an ideal family with positive access and support from family and friends, through parenting illustrates four key markers. They are:

  • Realistic upbringing.
  • Effective risk communications.
  • Positivity and restructuring of demanding situations.
  • Building self efficacy and hardiness.

In this model, self-efficacy is the belief in one’s ability to organise and execute the courses of action required to achieve necessary and desired goals and hardiness is a composite of interrelated attitudes of commitment, control, and challenge.

A number of self-help approaches to resilience-building have been developed, drawing mainly on the theory and practice of CBT and rational emotive behaviour therapy (REBT). For example, a group cognitive-behavioural intervention, called the Penn Resiliency Programme (PRP), has been shown to foster various aspects of resilience. A meta-analysis of 17 PRP studies showed that the intervention significantly reduces depressive symptoms over time.

The idea of ‘resilience building’ is debatably at odds with the concept of resilience as a process, since it is used to imply that it is a developable characteristic of oneself. Those who view resilience as a description of doing well despite adversity, view efforts of ‘resilience building’ as method to encourage resilience. Bibliotherapy, positive tracking of events, and enhancing psychosocial protective factors with positive psychological resources are other methods for resilience building. In this way, increasing an individual’s resources to cope with or otherwise address the negative aspects of risk or adversity is promoted, or builds, resilience.

Contrasting research finds that strategies to regulate and control emotions, in order to enhance resilience, allows for better outcomes in the event of mental illness. While initial studies of resilience originated with developmental scientists studying children in high-risk environments, a study on 230 adults diagnosed with depression and anxiety that emphasized emotional regulation, showed that it contributed to resilience in patients. These strategies focused on planning, positively reappraising events, and reducing rumination helped in maintaining a healthy continuity. Patients with improved resilience were found to yield better treatment outcomes than patients with non-resilience focused treatment plans, providing potential information for supporting evidence based psychotherapeutic interventions that may better handle mental disorders by focusing on the aspect of psychological resilience.

Building Resilience Through Language

As the world globalises, language learning and communication have proven to be helpful factors in developing resilience in people who travel, study abroad, work internationally, or in those who find themselves as refugees in countries where their home language is not spoken.

Research conducted by the British Council ties a strong relationship between language and resilience in refugees. Their language for resilience research conducted in partnership with institutions and communities from the Middle East, Africa, Europe and the Americas claims that providing adequate English-learning programmes and support for Syrian refugees builds resilience not only in the individual, but also in the host community. Their findings reported five main ways through which language builds resilience: home language and literacy development; access to education, training, and employment; learning together and social cohesion; addressing the effects of trauma on learning; and building inclusivity.

The language for resilience research suggests that further development of home language and literacy helps create the foundation for a shared identity. By maintaining the home language, even when displaced, a person not only learns better in school, but enhances the ability to learn other languages. This enhances resilience by providing a shared culture and sense of identity that allows refugees to maintain close relationships to others who share their identity and sets them up to possibly return one day. Thus, identity is not stripped and a sense of belonging persists.

Access to education, training, and employment opportunities allow refugees to establish themselves in their host country and provides more ease when attempting to access information, apply to work or school, or obtain professional documentation. Securing access to education or employment is largely dependent on language competency, and both education and employment provide security and success that enhance resilience and confidence.

Learning together encourages resilience through social cohesion and networks. When refugees engage in language-learning activities with host communities, engagement and communication increases. Both refugee and host community are more likely to celebrate diversity, share their stories, build relationships, engage in the community, and provide each other with support. This creates a sense of belonging with the host communities alongside the sense of belonging established with other members of the refugee community through home language.

Additionally, language programmes and language learning can help address the effects of trauma by providing a means to discuss and understand. Refugees are more capable of expressing their trauma, including the effects of loss, when they can effectively communicate with their host community. Especially in schools, language learning establishes safe spaces through storytelling, which further reinforces comfort with a new language, and can in turn lead to increased resilience.

The fifth way, building inclusivity, is more focused on providing resources. By providing institutions or schools with more language-based learning and cultural material, the host community can better learn how to best address the needs of the refugee community. This overall addressing of needs feeds back into the increased resilience of refugees by creating a sense of belonging and community.

Additionally, a study completed by Kate Nguyen, Nile Stanley, Laurel Stanley, and Yonghui Wang shows the impacts of storytelling in building resilience. This aligns with many of the five factors identified by the study completed by the British Council, as it emphasizes the importance of sharing traumatic experiences through language. This study in particular showed that those who were exposed to more stories, from family or friends, had a more holistic view of life’s struggles, and were thus more resilient, especially when surrounded by foreign languages or attempting to learn a new language.

Other Development Programmes

The Head Start programme was shown to promote resilience. So was the Big Brothers Big Sisters Programme, Centred Coaching & Consulting, the Abecedarian Early Intervention Project, and social programmes for youth with emotional or behavioural difficulties.

The Positive Behaviour Supports and Intervention programme is a successful trauma-informed, resilience-based for elementary age students with four components. These four elements include positive reinforcements such as encouraging feedback, understanding that behaviour is a response to unmet needs or a survival response, promoting belonging, mastery and independence, and finally, creating an environment to support the student through sensory tools, mental health breaks and play.

Tuesday’s Children, a family service organisation that made a long-term commitment to the individuals that have lost loved ones to 9/11 and terrorism around the world, works to build psychological resilience through programmes such as Mentoring and Project COMMON BOND, an 8-day peace-building and leadership initiative for teens, ages 15-20, from around the world who have been directly impacted by terrorism.

Military organisations test personnel for the ability to function under stressful circumstances by deliberately subjecting them to stress during training. Those students who do not exhibit the necessary resilience can be screened out of the training. Those who remain can be given stress inoculation training. The process is repeated as personnel apply for increasingly demanding positions, such as special forces.

Children

Resilience in children refers to individuals who are doing better than expected, given a history that includes risk or adverse experience. Once again, it is not a trait or something that some children simply possess. There is no such thing as an ‘invulnerable child’ that can overcome any obstacle or adversity that he or she encounters in life – and in fact, the trait is quite common. All children share the uniqueness of an upbringing, experiences which could be positive or negative. Adverse Childhood Experiences (ACE’s) are events which occur in a child’s life that could lead to maladaptive symptoms such as feeling tension, low mood, repetitive and recurring thoughts, and avoidance. The psychological resilience to overcome adverse events is not the sole explanation of why some children experience post-traumatic growth and some do not. Resilience is the product of a number of developmental processes over time, that has allowed children experience small exposures to adversity or some sort of age appropriate challenges to develop mastery and continue to develop competently. This gives children a sense of personal pride and self-worth.

Research on ‘protective factors’, which are characteristics of children or situations that particularly help children in the context of risk has helped developmental scientists to understand what matters most for resilient children. Two of these that have emerged repeatedly in studies of resilient children are good cognitive functioning (like cognitive self-regulation and IQ) and positive relationships (especially with competent adults, like parents). Children who have protective factors in their lives tend to do better in some risky contexts when compared to children without protective factors in the same contexts. However, this is not a justification to expose any child to risk. Children do better when not exposed to high levels of risk or adversity.

Building in the Classroom

Resilient children within classroom environments have been described as working and playing well and holding high expectations, have often been characterised using constructs such as locus of control, self-esteem, self-efficacy, and autonomy. All of these things work together to prevent the debilitating behaviours that are associated with learned helplessness.

Role of the Community

Communities play a huge role in fostering resilience. The clearest sign of a cohesive and supportive community is the presence of social organisations that provide healthy human development. Services are unlikely to be used unless there is good communication concerning them. Children who are repeatedly relocated do not benefit from these resources, as their opportunities for resilience-building, meaningful community participation are removed with every relocation

Role of the Family

Fostering resilience in children is favoured in family environments that are caring and stable, hold high expectations for children’s behaviour and encourage participation in the life of the family. Most resilient children have a strong relationship with at least one adult, not always a parent, and this relationship helps to diminish risk associated with family discord. The definition of parental resilience, as the capacity of parents to deliver a competent and quality level of parenting to children, despite the presence of risk factors, has proven to be a very important role in children’s resilience. Understanding the characteristics of quality parenting is critical to the idea of parental resilience. Even if divorce produces stress, the availability of social support from family and community can reduce this stress and yield positive outcomes. Any family that emphasizes the value of assigned chores, caring for brothers or sisters, and the contribution of part-time work in supporting the family helps to foster resilience. Resilience research has traditionally focused on the well-being of children, with limited academic attention paid to factors that may contribute to the resilience of parents.

Families in Poverty

Numerous studies have shown that some practices that poor parents utilise help promote resilience within families. These include frequent displays of warmth, affection, emotional support; reasonable expectations for children combined with straightforward, not overly harsh discipline; family routines and celebrations; and the maintenance of common values regarding money and leisure. According to sociologist Christopher B. Doob, “Poor children growing up in resilient families have received significant support for doing well as they enter the social world—starting in daycare programs and then in schooling.”

Bullying

Beyond preventing bullying, it is also important to consider how interventions based on emotional intelligence are important in the case that bullying does occur. Increasing emotional intelligence may be an important step in trying to foster resilience among victims. When a person faces stress and adversity, especially of a repetitive nature, their ability to adapt is an important factor in whether they have a more positive or negative outcome.

A 2013 study examined adolescents who illustrated resilience to bullying and found some interesting gendered differences, with higher behavioural resilience found among girls and higher emotional resilience found among boys. Despite these differences, they still implicated internal resources and negative emotionality in either encouraging or being negatively associated with resilience to bullying respectively and urged for the targeting of psychosocial skills as a form of intervention. Emotional intelligence has been illustrated to promote resilience to stress and as mentioned previously, the ability to manage stress and other negative emotions can be preventative of a victim going on to perpetuate aggression. One factor that is important in resilience is the regulation of one’s own emotions. Schneider et al. (2013) found that emotional perception was significant in facilitating lower negative emotionality during stress and Emotional Understanding facilitated resilience and has a positive correlation with positive affect.

Education

Many years and sources of research indicate that there are a few consistent protective factors of young children despite differences in culture and stressors (poverty, war, divorce of parents, natural disasters, etc.):

  • Capable parenting.
  • Other close relationships.
  • Intelligence.
  • Self-control.
  • Motivation to succeed.
  • Self-confidence & self-efficacy.
  • Faith, hope, belief life has meaning.
  • Effective schools.
  • Effective communities.
  • Effective cultural practices.

Ann Masten coins these protective factors as “ordinary magic,” the ordinary human adaptive systems that are shaped by biological and cultural evolution. In her book, Ordinary Magic: Resilience in Development, she discusses the “immigrant paradox”, the phenomenon that first-generation immigrant youth are more resilient than their children. Researchers hypothesize that “there may be culturally based resiliency that is lost with succeeding generations as they become distanced from their culture of origin.” Another hypothesis is that those who choose to immigrate are more likely to be more resilient.

Research by Rosemary Gonzalez and Amado M. Padilla on the academic resilience of Mexican-American high school students reveal that while a sense of belonging to school is the only significant predictor of academic resilience, a sense of belonging to family, a peer group, and a culture can also indicate higher academic resilience. “Although cultural loyalty overall was not a significant predictor of resilience, certain cultural influences nonetheless contribute to resilient outcomes, like familism and cultural pride and awareness.” The results of Gonzalez and Padilla’s study “indicate a negative relationship between cultural pride and the ethnic homogeneity of a school.” They hypothesize that “ethnicity becomes a salient and important characteristic in more ethnically diverse settings”.

Considering the implications of the research by Masten, Gonzalez, and Padilla, a strong connection with one’s cultural identity is an important protective factor against stress and is indicative of increased resilience. While many additional classroom resources have been created to promote resilience in developing students, the most effective ways to ensure resilience in children is by protecting their natural adaptive systems from breaking down or being hijacked. At home, resilience can be promoted through a positive home environment and emphasized cultural practices and values. In school, this can be done by ensuring that each student develops and maintains a sense of belonging to the school through positive relationships with classroom peers and a caring teacher. Research on resilience consistently shows that a sense of belonging – whether it be in a culture, family, or another group – greatly predicts resiliency against any given stressor.

Specific Situations

Divorce

Often divorce is viewed as detrimental to one’s emotional health, but studies have shown that cultivating resilience may be beneficial to all parties involved. The level of resilience a child will experience after their parents have split is dependent on both internal and external variables. Some of these variables include their psychological and physical state and the level of support they receive from their schools, friends, and family friends. The ability to deal with these situations also stems from the child’s age, gender, and temperament. Children will experience divorce differently and thus their ability to cope with divorce will differ too. About 20-25% of children will “demonstrate severe emotional and behavioural problems” when going through a divorce. This percentage is notably higher than the 10% of children exhibiting similar problems in married families. Despite this, approximately 75-80% of these children will “develop into well-adjusted adults with no lasting psychological or behavioural problems”. This comes to show that most children have the tools necessary to allow them to exhibit the resilience needed to overcome their parents’ divorce.

The effects of the divorce extend past the separation of both parents. The remaining conflict between parents, financial problems, and the re-partnering or remarriage of parents can cause lasting stress. Studies conducted by Booth and Amato (2001) have shown that there is no correlation between post-divorce conflict and the child’s ability to adjust to their life circumstance. On the other hand, Hetherington (1999) completed research on this same topic and did find adverse effects in children. In regards to the financial standing of a family, divorce does have the potential to reduce the children’s style of living. Child support is often given to help cover basic needs such as schooling. If the parents’ finances are already scarce then their children may not be able to participate in extracurricular activities such as sports and music lessons, which can be detrimental to their social lives.

Re-partnering or remarrying can bring in additional levels of conflict and anger into their home environment. One of the reasons that re-partnering causes additional stress is because of the lack of clarity in roles and relationships; the child may not know how to react and behave with this new “parent” figure in their life. In most cases, bringing in a new partner/spouse will be the most stressful when done shortly after the divorce. In the past, divorce had been viewed as a “single event”, but now research shows that divorce encompasses multiple changes and challenges. It is not only internal factors that allow for resiliency, but the external factors in the environment are critical for responding to the situation and adapting. Certain programmes such as the 14-week Children’s Support Group and the Children of Divorce Intervention Programme may help a child cope with the changes that occur from a divorce.

Natural Disasters

Resilience after a natural disaster can be gauged in a number of different ways. It can be gauged on an individual level, a community level, and on a physical level. The first level, the individual level, can be defined as each independent person in the community. The second level, the community level, can be defined as all those inhabiting the locality affected. Lastly, the physical level can be defined as the infrastructure of the locality affected.

UNESCAP funded research on how communities show resiliency in the wake of natural disasters. They found that, physically, communities were more resilient if they banded together and made resiliency an effort of the whole community. Social support is key in resilient behaviour, and especially the ability to pool resources. In pooling social, natural, and economic resources, they found that communities were more resilient and able to over come disasters much faster than communities with an individualistic mindset.

The World Economic Forum met in 2014 to discuss resiliency after natural disasters. They conclude that countries that are more economically sound, and have more individuals with the ability to diversify their livelihoods, will show higher levels of resiliency. This has not been studied in depth yet, but the ideas brought about through this forum appear to be fairly consistent with already existing research.

Research indicates that resilience following natural disasters can be predicted by the level of emotion an individual experienced and were able to process within and following the disaster. Those who employ emotional styles of coping were able to grow from their experiences and then help others. In these instances, experiencing emotions was adaptive. Those who did not engage with their emotions and employed avoidant and suppressive coping styles had poorer mental health outcomes following disaster.

Death of a Family Member

Little research has been done on the topic of family resilience in the wake of the death of a family member. Traditionally, clinical attention to bereavement has focused on the individual mourning process rather than on those of the family unit as a whole. Resiliency is distinguished from recovery as the “ability to maintain a stable equilibrium” which is conducive to balance, harmony, and recovery. Families must learn to manage familial distortions caused by the death of the family member, which can be done by reorganizing relationships and changing patterns of functioning to adapt to their new situation. Exhibiting resilience in the wake of trauma can successfully traverse the bereavement process without long-term negative consequences.

One of the healthiest behaviours displayed by resilient families in the wake of a death is honest and open communication. This facilitates an understanding of the crisis. Sharing the experience of the death can promote immediate and long-term adaptation to the recent loss of a loved one. Empathy is a crucial component in resilience because it allows mourners to understand other positions, tolerate conflict, and be ready to grapple with differences that may arise. Another crucial component to resilience is the maintenance of a routine that helps to bind the family together through regular contact and order. The continuation of education and a connection with peers and teachers at school is an important support for children struggling with the death of a family member.

Professional Settings

Resilience has also been examined in the context of failure and setbacks in workplace settings. Representing one of the core constructs of positive organizational behaviour (Luthans, 2002), and given increasingly disruptive and demanding work environments, scholars’ and practitioners’ attention to psychological resilience in organisations has greatly increased. This research has highlighted certain personality traits, personal resources (e.g. self-efficacy, work-life balance, social competencies), personal attitudes (e.g., sense of purpose, job commitment), positive emotions, and work resources (e.g. social support, positive organisational context) as potential facilitators of workplace resilience.

Beyond studies on general workplace resilience, attention has been directed to the role of resilience in innovative contexts. Due to high degrees of uncertainty and complexity in the innovation process, failure and setbacks are naturally happening frequently in this context. As such failure and setbacks can have strong and harmful effects on affected individuals’ motivation and willingness to take risks, their resilience is essential to productively engage in future innovative activities. To account for the peculiarities of the innovation context, a resilience construct specifically aligned to this unique context was needed to address the need to diagnose and develop innovators’ resilience to minimise the human cost of failure and setbacks in innovation. As a context-specific conceptualisation of resilience, Innovator Resilience Potential (IRP) serves this purpose and captures the potential for innovative functioning after the experience of failure or setbacks in the innovation process and for handling future setbacks. Based on Bandura’s social cognitive theory, IRP is proposed to consist of six components: self-efficacy, outcome expectancy, optimism, hope, self-esteem, and risk propensity. The concept of IRP thus reflects a process perspective on resilience. On the one hand, in this process, IRP can be seen as an antecedent of how a setback affects an innovator. On the other hand, IRP can be seen as an outcome of the process that, in turn, is influenced by the setback situation. Recently, a measurement scale of IRP was developed and validated.

Cross-Cultural Resilience

Areas of Difference

There is controversy about the indicators of good psychological and social development when resilience is studied across different cultures and contexts. The American Psychological Association’s Task Force on Resilience and Strength in Black Children and Adolescents, for example, notes that there may be special skills that these young people and families have that help them cope, including the ability to resist racial prejudice. Researchers of indigenous health have shown the impact of culture, history, community values, and geographical settings on resilience in indigenous communities. People who cope may also show “hidden resilience” when they do not conform with society’s expectations for how someone is supposed to behave (in some contexts, aggression may be required to cope, or less emotional engagement may be protective in situations of abuse).

Resilience in Individualist and Collectivist Communities

Individualist cultures, such as those of the US, Austria, Spain, and Canada, emphasize personal goals, initiatives, and achievements. Independence, self-reliance, and individual rights are highly valued by members of individualistic cultures. Economic, political, and social policies reflect the culture’s interest in individualism. The ideal person in individualist societies is assertive, strong, and innovative. People in this culture tend to describe themselves in terms of their unique traits- “I am analytical and curious” (Ma et al. 2004). Comparatively, in places like Japan, Sweden, Turkey, and Guatemala, Collectivist cultures emphasize family and group work goals. The rules of these societies promote unity, brotherhood, and selflessness. Families and communities practice cohesion and cooperation. The ideal person in collectivist societies is trustworthy, honest, sensitive, and generous- emphasizing intrapersonal skills. Collectivists tend to describe themselves in terms of their roles – “I am a good husband and a loyal friend” (Ma et al. 2004). In a study on the consequences of disaster on a culture’s individualism, researchers operationalised these cultures by identifying indicative phrases in a society’s literature. Words that showed the theme of individualism include, “able, achieve, differ, own, personal, prefer, and special.” Words that indicated collectivism include, “belong, duty, give, harmony, obey, share, together.”

Differences in Response to Natural Disasters

Natural disasters threaten to destroy communities, displace families, degrade cultural integrity, and diminish an individual’s level of functioning. Comparing individualist community reactions to collectivist community responses after natural disasters illustrates their differences and respective strengths as tools of resilience. Some suggest that disasters reduce individual agency and sense of autonomy as it strengthens the need to rely on other people and social structures. Therefore, countries/regions with heightened exposure to disaster should cultivate collectivism. However, Withey (1962) and Wachtel (1968) conducted interviews and experiments on disaster survivors which indicated that disaster-induced anxiety and stress decrease one’s focus on social-contextual information – a key component of collectivism. In this way, disasters may lead to increased individualism.

Mauch and Pfister (2004) questioned the association between socio-ecological indicators and cultural-level change in individualism. In their research, for each socio-ecological indicator, frequency of disasters was associated with greater (rather than less) individualism. Supplementary analyses indicated that the frequency of disasters was more strongly correlated with individualism-related shifts than was the magnitude of disasters or the frequency of disasters qualified by the number of deaths. Baby-naming practices is one interesting indicator of change. According to Mauch and Pfister (2004), urbanization was linked to preference for uniqueness in baby-naming practices at a 1-year lag, secularism was linked to individualist shifts in interpersonal structure at both lags, and disaster prevalence was linked to more unique naming practices at both lags. Secularism and disaster prevalence contributed mainly to shifts in naming practices.

There is a gap in disaster recovery research that focuses on psychology and social systems but does not adequately address interpersonal networking or relationship formation and maintenance. A disaster response theory holds that individuals who use existing communication networks fare better during and after disasters. Moreover, they can play important roles in disaster recovery by taking initiative to organize and help others recognise and use existing communication networks and coordinate with institutions which correspondingly should strengthen relationships with individuals during normal times so that feelings of trust exist during stressful ones.

In a collectivist sense, building strong, self-reliant communities, whose members know each other, know each other’s needs and are aware of existing communication networks, looks like an optimum defence against disasters.

In comparing these cultures, there is really no way to measure resilience, but one can look at the collateral consequences of a disaster to a country to gauge its resilience.

  • Collectivist resilience:
    • Returning to routine.
    • Rebuilding family structures.
    • Communal sharing of resources.
    • Emotional expression of grief and loss to a supportive listener.
    • Finding benefits from the disaster experience.
  • Individualist resilience:
    • Redistribution of power/resources.
    • Returning to routine.
    • Emotional expression through formal support systems.
    • Confrontation of the problem.
    • Reshaping one’s outlook after the disaster experience.

Whereas individualistic societies promote individual responsibility for self-sufficiency, the collectivistic culture defines self-sufficiency within an interdependent communal context (Kayser et al. 2008). Even where individualism is salient, a group thrives when its members choose social over personal goals and seek to maintain harmony and where they value collectivist over individualist behaviour (McAuliffe et al. 2003).

The Concept of Resilience in Language

While not all languages have a direct translation for the English word “resilience”, nearly every culture and community globally has a word which relates to a similar concept. The differences between the literal meanings of translated words shows that there is a common understanding of what resilience is. Even if a word does not directly translate to “resilience” in English, it relays a meaning similar enough to the concept and is used as such within the language.

If a specific word for resilience does not exist in a language, speakers of that language typically assign a similar word that insinuates resilience based on context. Many languages use words that translate to “elasticity” or “bounce”, which are used in context to capture the meaning of resilience. For example, one of the main words for “resilience” in Chinese literally translates to “rebound”, one of the main words for “resilience” in Greek translates to “bounce”, and one of the main words for “resilience” in Russian translates to “elasticity,” just as it does in German. However, this is not the case for all languages. For example, if a Spanish speaker wanted to say “resilience”, their main two options translate to “resistance” and “defence against adversity”. Many languages have words that translate better to “tenacity” or “grit” better than they do to “resilience”. While these languages may not have a word that exactly translates to “resilience”, note that English speakers often use tenacity or grit when referring to resilience. While one of the Greek words for “resilience” translates to “bounce”, another option translates to “cheerfulness”. Moreover, Arabic has a word solely for resilience, but also two other common expressions to relay the concept, which directly translate to “capacity on deflation” or “reactivity of the body”, but are better translated as “impact strength” and “resilience of the body” respectively. On the other hand, a few languages, such as Finnish, have created words to express resilience in a way that cannot be translated back to English. In Finnish, the word “sisu” could most closely be translated to mean “grit” in English, but blends the concepts of resilience, tenacity, determination, perseverance, and courage into one word that has even become a facet of Finnish culture and earned its place as a name for a few Finnish brands.

Criticism of Application

Brad Evans and Julian Reid criticise resilience discourse and its rising popularity in their book, Resilient Life. The authors assert that policies of resilience can put the onus of disaster response on individuals rather than publicly coordinated efforts. Tied to the emergence of neoliberalism, climate change, third-world development, and other discourses, Evans and Reid argue that promoting resilience draws attention away from governmental responsibility and towards self-responsibility and healthy psychological effects such as post-traumatic growth.

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What is the Health Belief Model?

Introduction

The health belief model (HBM) is a social psychological health behaviour change model developed to explain and predict health-related behaviours, particularly in regard to the uptake of health services.

The HBM was developed in the 1950s by social psychologists at the US Public Health Service and remains one of the best known and most widely used theories in health behaviour research. The HBM suggests that people’s beliefs about health problems, perceived benefits of action and barriers to action, and self-efficacy explain engagement (or lack of engagement) in health-promoting behaviour. A stimulus, or cue to action, must also be present in order to trigger the health-promoting behaviour.

Original Health Belief Model.

Brief History

One of the first theories of health behaviour, the HBM was developed in 1950s by social psychologists Irwin M. Rosenstock, Godfrey M. Hochbaum, S. Stephen Kegeles, and Howard Leventhal at the US Public Health Service. At that time, researchers and health practitioners were worried because few people were getting screened for tuberculosis (TB), even if mobile X-ray cars went to neighbourhoods. The HBM has been applied to predict a wide variety of health-related behaviours such as being screened for the early detection of asymptomatic diseases and receiving immunisations. More recently, the model has been applied to understand intentions to vaccinate (e.g. COVID-19), responses to symptoms of disease, compliance with medical regimens, lifestyle behaviours (e.g. sexual risk behaviours), and behaviours related to chronic illnesses, which may require long-term behaviour maintenance in addition to initial behaviour change. Amendments to the model were made as late as 1988 to incorporate emerging evidence within the field of psychology about the role of self-efficacy in decision-making and behaviour.

Health Belief Model in action.

Theoretical Constructs

The HBM theoretical constructs originate from theories in Cognitive Psychology. In the early twentieth century, cognitive theorists believed that reinforcements operated by affecting expectations rather than by affecting behaviour directly. Mental processes are severe consists of cognitive theories that are seen as expectancy-value models, because they propose that behaviour is a function of the degree to which people value a result and their evaluation of the expectation, that a certain action will lead that result. In terms of the health-related behaviours, the value is avoiding sickness. The expectation is that a certain health action could prevent the condition for which people consider they might be at risk.

The following constructs of the HBM are proposed to vary between individuals and predict engagement in health-related behaviours.

Perceived Susceptibility

Perceived susceptibility refers to subjective assessment of risk of developing a health problem. The HBM predicts that individuals who perceive that they are susceptible to a particular health problem will engage in behaviours to reduce their risk of developing the health problem. Individuals with low perceived susceptibility may deny that they are at risk for contracting a particular illness. Others may acknowledge the possibility that they could develop the illness, but believe it is unlikely. Individuals who believe they are at low risk of developing an illness are more likely to engage in unhealthy, or risky, behaviours. Individuals who perceive a high risk that they will be personally affected by a particular health problem are more likely to engage in behaviours to decrease their risk of developing the condition.

The combination of perceived severity and perceived susceptibility is referred to as perceived threat. Perceived severity and perceived susceptibility to a given health condition depend on knowledge about the condition. The HBM predicts that higher perceived threat leads to a higher likelihood of engagement in health-promoting behaviours.

Perceived Severity

Perceived severity refers to the subjective assessment of the severity of a health problem and its potential consequences. The HBM proposes that individuals who perceive a given health problem as serious are more likely to engage in behaviours to prevent the health problem from occurring (or reduce its severity). Perceived seriousness encompasses beliefs about the disease itself (e.g. whether it is life-threatening or may cause disability or pain) as well as broader impacts of the disease on functioning in work and social roles. For instance, an individual may perceive that influenza is not medically serious, but if he or she perceives that there would be serious financial consequences as a result of being absent from work for several days, then he or she may perceive influenza to be a particularly serious condition.

Through studying Australians and their self-reporting in 2019 of receiving the influenza vaccine, researchers found that by studying perceived severity they could determine the likelihood that Australians would receive the shot. They asked, “On a scale from 0 to 10, how severe do you think the flu would be if you got it?” to measure the perceived severity and they found that 31% perceived the severity of getting the flu as low, 44% as moderate, and 25% as high. Additionally, the researchers found those with a high perceived severity were significantly more likely to have received the vaccine than those with a moderate perceived severity. Furthermore, self-reported vaccination was similar for individuals with low and moderate perceived severity of influenza.

Perceived Benefits

Health-related behaviours are also influenced by the perceived benefits of taking action. Perceived benefits refer to an individual’s assessment of the value or efficacy of engaging in a health-promoting behaviour to decrease risk of disease. If an individual believes that a particular action will reduce susceptibility to a health problem or decrease its seriousness, then he or she is likely to engage in that behaviour regardless of objective facts regarding the effectiveness of the action. For example, individuals who believe that wearing sunscreen prevents skin cancer are more likely to wear sunscreen than individuals who believe that wearing sunscreen will not prevent the occurrence of skin cancer.

Perceived Barriers

Health-related behaviours are also a function of perceived barriers to taking action. Perceived barriers refer to an individual’s assessment of the obstacles to behaviour change. Even if an individual perceives a health condition as threatening and believes that a particular action will effectively reduce the threat, barriers may prevent engagement in the health-promoting behaviour. In other words, the perceived benefits must outweigh the perceived barriers in order for behaviour change to occur. Perceived barriers to taking action include the perceived inconvenience, expense, danger (e.g. side effects of a medical procedure) and discomfort (e.g. pain, emotional upset) involved in engaging in the behaviour. For instance, lack of access to affordable health care and the perception that a flu vaccine shot will cause significant pain may act as barriers to receiving the flu vaccine. In a study about the breast and cervical cancer screening among Hispanic women, perceived barriers, like fear of cancer, embarrassment, fatalistic views of cancer and language, was proved to impede screening.

Modifying Variables

Individual characteristics, including demographic, psychosocial, and structural variables, can affect perceptions (i.e. perceived seriousness, susceptibility, benefits, and barriers) of health-related behaviours. Demographic variables include age, sex, race, ethnicity, and education, among others. Psychosocial variables include personality, social class, and peer and reference group pressure, among others. Structural variables include knowledge about a given disease and prior contact with the disease, among other factors. The HBM suggests that modifying variables affect health-related behaviours indirectly by affecting perceived seriousness, susceptibility, benefits, and barriers.

Cues to Action

The HBM posits that a cue, or trigger, is necessary for prompting engagement in health-promoting behaviours. Cues to action can be internal or external. Physiological cues (e.g. pain, symptoms) are an example of internal cues to action. External cues include events or information from close others, the media, or health care providers promoting engagement in health-related behaviours. Examples of cues to action include a reminder postcard from a dentist, the illness of a friend or family member, mass media campaigns on health issues, and product health warning labels. The intensity of cues needed to prompt action varies between individuals by perceived susceptibility, seriousness, benefits, and barriers. For example, individuals who believe they are at high risk for a serious illness and who have an established relationship with a primary care doctor may be easily persuaded to get screened for the illness after seeing a public service announcement, whereas individuals who believe they are at low risk for the same illness and also do not have reliable access to health care may require more intense external cues in order to get screened.

Self-Efficacy

Self-efficacy was added to the four components of the HBM (i.e. perceived susceptibility, severity, benefits, and barriers) in 1988. Self-efficacy refers to an individual’s perception of his or her competence to successfully perform a behaviour. Self-efficacy was added to the HBM in an attempt to better explain individual differences in health behaviours. The model was originally developed in order to explain engagement in one-time health-related behaviours such as being screened for cancer or receiving an immunisation. Eventually, the HBM was applied to more substantial, long-term behaviour change such as diet modification, exercise, and smoking. Developers of the model recognised that confidence in one’s ability to effect change in outcomes (i.e. self-efficacy) was a key component of health behaviour change. For example, Schmiege et al. found that when dealing with calcium consumption and weight-bearing exercises, self-efficacy was a more powerful predictors than beliefs about future negative health outcomes.

Rosenstock et al. argued that self-efficacy could be added to the other HBM constructs without elaboration of the model’s theoretical structure. However, this was considered short-sighted because related studies indicated that key HBM constructs have indirect effects on behaviour as a result of their effect on perceived control and intention, which might be regarded as more proximal factors of action.

Empirical Support

The HBM has gained substantial empirical support since its development in the 1950s. It remains one of the most widely used and well-tested models for explaining and predicting health-related behaviour. A 1984 review of 18 prospective and 28 retrospective studies suggests that the evidence for each component of the HBMl is strong. The review reports that empirical support for the HBM is particularly notable given the diverse populations, health conditions, and health-related behaviours examined and the various study designs and assessment strategies used to evaluate the model. A more recent meta-analysis found strong support for perceived benefits and perceived barriers predicting health-related behaviours, but weak evidence for the predictive power of perceived seriousness and perceived susceptibility. The authors of the meta-analysis suggest that examination of potential moderated and mediated relationships between components of the model is warranted.

Several studies have provided empirical support from the chronic illness perspective. Becker et al. used the model to predict and explain a mother’s adherence to a diet prescribed for their obese children. Cerkoney et al. interviewed insulin-treated diabetic individuals after diabetic classes at a community hospital. It empirically tested the HBM’s association with the compliance levels of persons chronically ill with diabetes mellitus.

Applications

The HBM has been used to develop effective interventions to change health-related behaviours by targeting various aspects of the model’s key constructs. Interventions based on the HBM may aim to increase perceived susceptibility to and perceived seriousness of a health condition by providing education about prevalence and incidence of disease, individualised estimates of risk, and information about the consequences of disease (e.g. medical, financial, and social consequences). Interventions may also aim to alter the cost-benefit analysis of engaging in a health-promoting behaviour (i.e. increasing perceived benefits and decreasing perceived barriers) by providing information about the efficacy of various behaviours to reduce risk of disease, identifying common perceived barriers, providing incentives to engage in health-promoting behaviours, and engaging social support or other resources to encourage health-promoting behaviours. Furthermore, interventions based on the HBM may provide cues to action to remind and encourage individuals to engage in health-promoting behaviours. Interventions may also aim to boost self-efficacy by providing training in specific health-promoting behaviours, particularly for complex lifestyle changes (e.g. changing diet or physical activity, adhering to a complicated medication regimen). Interventions can be aimed at the individual level (i.e. working one-on-one with individuals to increase engagement in health-related behaviours) or the societal level (e.g. through legislation, changes to the physical environment, mass media campaigns).

Multiple studies have used the Health Belief Model to understand an individual’s intention to change a particular behavior and the factors that influence their ability to do so. Researchers analysed the correlation between young adult women’s intention to stop smoking and their perceived factors in the construction of HBM. The intention to stop smoking among young adult women had a significant correlation with the perceived factors of the Health Belief Model.

Another use of the HBM was in 2016 in a study that was interested in examining the factors associated with physical activity among people with mental illness (PMI) in Hong Kong (Mo et al., 2016). The study used the HBM model because it was one of the most frequently used models to explain health behaviours and the HBM was used as a framework to understand the PMI physical activity levels. The study had 443 PMI complete the survey with the mean age being 45 years old. The survey found that among the HBM variables, perceived barriers were significant in predicting physical activity. Additionally, the research demonstrated that self-efficacy had a positive correlation for physical activity among PMI. These findings support previous literature that self-efficacy and perceived barriers plays a significant role in physical activity and it should be included in interventions. The study also stated that the participants acknowledged that most of their attention is focused on their psychiatric conditions with little focus on their physical health needs.

This study is important to note in regards to the HBM because it illustrates how culture can play a role in this model. The Chinese culture holds different health beliefs than the United States, placing a greater emphasis on fate and the balance of spiritual harmony than on their physical fitness. Since the HBM does not consider these outside variables it highlights a limitation associated with the model and how multiple factors can impact health decisions, not just the ones noted in the model.

Applying the Health Belief Model to Women’s Safety Movements

Movements such as the #MeToo movements and current political tensions surrounding abortion laws have moved women’s rights and violence against women to the forefront of topical conversation. Additionally, many organisations, such as Women On Guard, have begun to place emphasize on trying to educate women on what measures to take in order to increase their safety when walking alone at night. The murder of Sarah Everard on 03 March 2021, has placed further attention on the need for women to protect themselves and stay vigilant when walking alone at night. Everard was kidnapped and murdered while walking home from work in South London, England. The health belief model can provide insight into the steps that need to be taken in order to reach more women and convince them to take the necessary steps to increase safety when walking alone.

Perceived Susceptibility

As stated, perceived susceptibility refers to how susceptible an individual perceives themselves to be to any given risk. In the case of encountering violence while walking along, research shows that many women have high amounts of perceived susceptibility in regards to how susceptible they believe themselves to be to the risk of being attacked while walking along. Studies show that around 50% of women feel unsafe when walking alone at night. Since women may already have increased perceive susceptibility to night-violence, according to the health belief model, they may be more apt to engage in behaviour changes to help them increase their safety/ defend themselves.

Perceived Severity

As the statistics on perceived susceptibility demonstrate, many women feel they are at risk for encountering night-violence. Thus, women also have a higher perception of the severity of the violence as stories such as the tragic death of Sarah Everard demonstrate that night-violence attacks can be not only severe, but fatal.

Perceived Benefits and Barriers

As the health belief model states, individuals must consider the potential benefits of adopting the change in behaviour that is being suggested to them. In the case of night-violence against women organisations that seek to prevent it do so by using advertising to demonstrate to women that tools such as pocket knives, pepper spray, self-defence classes, alarm systems, and traveling with a “buddy” can outweigh barriers such as the cost, time, and other inconveniences that pursuing these changes in behaviour may require. The benefit to implementing these behaviours would be that women could feel more safe when walking alone at night.

Modifying Variable

It is not surprise that the modifying variable of sex plays a large role in applying the health belief model to women’s safety agendas/ movements. While studies show that around 50% of women feel unsafe walking at night, they also show that fewer than one fifth of men feel the same fear and discomfort. Thus, it is evident that the modifying variable of gender plays a large role in how night-time violence is perceived. According to the model, women may be more likely to change their behaviour toward preventing night-time violence than men.

Cues to Action

Cues to action are perhaps the most powerful part of the health belief model and of getting individual to change their behaviour. In regards to preventing night-time violence against women, stories of the horrific violent acts committed against women while they are walking at night serve as external cues to action that can spur individuals to take the necessary precautions and make the necessary change to their behaviour in order to reduce the likelihood of them encountering night-time violence. Cues to action further factor into increased perceived susceptibility and severity of the given risk.

Self Efficacy

Self efficacy is another important factor both in the health belief model and in behaviour change in general. When people believe that they actually have the power to prevent the given risk, then they are more likely to take the appropriate measures to do so. When individuals believe that they cannot change their behaviour or prevent the risk no matter what they do, then they are less likely to engage in behaviour to stop the risk. This concept factors greatly into initiatives to help women defend themselves against night violence because, based on the statistics, many women do feel that if they carry items such as tasers, pepper spray, or alarms they will be able to defend themselves against attackers. Self-defence classes are also things that organisations offer in order to teach individuals that they have the power to learn how to defend themselves and acquire the proper skills to do so. These classes can help to increase self efficacy. Organisations such as community centres may offer classes along these lines.

The issues of night violence against women is an issue of safety and wellness which makes it applicable to a health belief model approach. Defence and preparation for night violence can require behavioural changes on behalf of women if they feel that doing so will help them protect themselves should they ever be attacked.

Limitations

The HBM attempts to predict health-related behaviours by accounting for individual differences in beliefs and attitudes. However, it does not account for other factors that influence health behaviours. For instance, habitual health-related behaviours (e.g. smoking, seatbelt buckling) may become relatively independent of conscious health-related decision-making processes. Additionally, individuals engage in some health-related behaviours for reasons unrelated to health (e.g. exercising for aesthetic reasons). Environmental factors outside an individual’s control may prevent engagement in desired behaviours. For example, an individual living in a dangerous neighbourhood may be unable to go for a jog outdoors due to safety concerns. Furthermore, the HBM does not consider the impact of emotions on health-related behaviour. Evidence suggests that fear may be a key factor in predicting health-related behaviour.

Alternative factors may predict health behaviour, such as outcome expectancy (i.e. whether the person feels they will be healthier as a result of their behaviour) and self-efficacy (i.e. the person’s belief in their ability to carry out preventive behaviour).

The theoretical constructs that constitute the HBM are broadly defined. Furthermore, the HBM does not specify how constructs of the model interact with one another. Therefore, different operationalisations of the theoretical constructs may not be strictly comparable across studies.

Research assessing the contribution of cues to action in predicting health-related behaviours is limited. Cues to action are often difficult to assess, limiting research in this area. For instance, individuals may not accurately report cues that prompted behaviour change. Cues such as a public service announcement on television or on a billboard may be fleeting and individuals may not be aware of their significance in prompting them to engage in a health-related behaviour. Interpersonal influences are also particularly difficult to measure as cues.

Another reason why research does not always support the HBM is that factors other than health beliefs also heavily influence health behaviour practices. These factors may include: special influences, cultural factors, socioeconomic status, and previous experiences. Scholars extend the HBM by adding four more variables (self-identity, perceived importance, consideration of future consequences and concern for appearance) as possible determinants of healthy behaviour. They prove that consideration of future consequences, self-identity, concern for appearance, perceived importance, self-efficacy, perceived susceptibility are significant determinants of healthy eating behaviour that can be manipulated by healthy eating intervention design.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Health_belief_model >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Social Support Questionnaire?

Introduction

The Social Support Questionnaire (SSQ) is a quantitative, psychometrically sound survey questionnaire intended to measure social support and satisfaction with said social support from the perspective of the interviewee.

Degree of social support has been shown to influence the onset and course of certain psychiatric disorders such as clinical depression or schizophrenia. The SSQ was approved for public release in 1981 by Irwin Sarason, Henry Levine, Robert Basham and Barbara Sarason under the University of Washington Department of Psychology and consists of 27 questions. Overall, the SSQ has good test-retest reliability and convergent internal construct validity.

Refer to Peer Support.

Overview

The questionnaire is designed so that each question has a two-part answer. The first part asks the interviewee to list up to nine people available to provide support that meet the criteria stated in the question. These support individuals are specified using their initials in addition to the relationship to the interviewee. Example questions from the first part includes questions such as “Whom could you count on to help if you had just been fired from your job or expelled from school?” and “Whom do you feel would help if a family member very close to you died?”.

The second part asks the interviewee to specify how satisfied they are with each of the people stated in the first part. The SSQ respondents use a 6 -point Likert scale to indicate their degree of satisfaction with the support from the above people ranging from “1 – very dissatisfied” to “6 – very satisfied”.

The Social Support Questionnaire has multiple short forms such as the SSQ3 and the SSQ6.

Brief History

The SSQ is based on 4 original studies. The first study set out to determine whether the SSQ had the desired psychometric properties. The second study tried to relate SSQ and a diversity of personality measures such as anxiety, depression and hostility in connection with the Multiple Affect Adjective Checklist. The third study considered the relationship between social support, the prior year’s negative and positive life events, internal-external locus of control and self- esteem in conjunction with the Life Experiences Survey. The fourth study tested the idea that social support could serve as a buffer when faced with difficult life situations via trying to solve a maze and subsequently completing the Cognitive Interference Questionnaire.

Scoring

The overall support score (SSQN) is calculated by taking an average of the individual scores across the 27 items. A high score on the SSQ indicates more optimism about life than a low score. Respondents with low SSQ scores have a higher prevalence of negative life events and illness. Scoring is as follows:

  1. Add the total number of people for all 27 items (questions). (Max. is 243). Divide by 27 for average item score. This gives you SSQ Number Score, or SSQN.
  2. Add the total satisfaction scores for all 27 items (questions). (Max is 162). Divide by 27 for average item score. This gives you SSQ Satisfaction score or SSQS.
  3. Finally, you can average the above for the total number of people that are family members – this results in the SSQ family score.

Reliability

According to Sarason, the SSQ takes between fifteen and eighteen minutes to properly administer and has “good” test-retest reliability.

Validity

The SSQ was compared with the depression scale and validity tests show significant negative correlation ranging from -0.22 to -0.43. The SSQ and the optimism scale have a correlation of 0.57. The SSQ and the satisfaction score have a correlation of 0.34. The SSQ has high internal consistency among items.

Linkages

The SSQ has been used to show that higher levels of social support correlated with less suicide ideation in Military Medical University Soldiers in Iran in 2015. A low level of social support is an important risk factor in women for dysmenorrhea or menstrual cramps. Low Social Support is the strongest predictor of dysmenorrhea when compared to affect, personality and alexithymia.

Related Surveys

SSQ3

The SSQ3 is a short form of the SSQ and has only three questions. The SSQ3 has acceptable test-test reliability and correlation with personality variables as compared to the long form of the Social Support Questionnaire. The internal reliability was borderline but this low level of internal reliability is as expected since there are only three questions.

SSQ6

The SSQ6 is a short form of the SSQ. The SSQ6 has been shown to have high correlation with: the SSQ, SSQ personality variables and internal reliability. In the development of the SSQ6, the research suggests that professed social support in adults may be a connected to “early attachment experience.” The SSQ6 consists of the below 6 questions:

  1. Whom can you really count on to be dependable when you need help?
  2. Whom can you really count on to help you feel more relaxed when you are under pressure or tense?
  3. Who accepts you totally, including both your worst and your best points?
  4. Whom can you really count on to care about you, regardless of what is happening to you?
  5. Whom can you really count on to help you feel better when you are feeling generally down-in-the-dumps?
  6. Whom can you count on to console you when you are very upset?

Interpersonal Support Evaluation List (ISEL)

The Interpersonal Support Evaluation List includes 40 items (questions) with four sub-scales in the areas of Tangible Support, Belonging Support, Self-Esteem Support and Appraisal Support. The interviewee rates each item based on how true or false they feel the item is for themselves. The four total response options are “Definitely True”, “Probably True”, “Probably False”, and “Definitely False”.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Social_Support_Questionnaire >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.