Peer Reviewed Nursing and Health Care Journal

Review Article

Trauma, Mental Health, Coping, Resilience, and Post Traumatic Growth (PG)-Palestinian Experience

Abdel Aziz Mousa Thabet*

Consultant Psychiatrist at Child and Family Training and Counselling Center, Al Quds University, Palestine

Submission: May 03, 2017; Published: June 07, 2017

*Corresponding author: Abdel Aziz Mousa Thabet, M.B.Ch.B, DPM, DCAC, PhD , Emeritus Professor of Child and Adolescent Psychiatry-School of Public Health- Al Quds University-Palestine. Consultant Child and Adolescent Psychiatrist. Affiliated Professor with Center for Refugee Studies- York University.

President of Child and Adolescent Psychiatry sector at the Arab Federal Psychiatrists- Chief Editor of Arab Journal of Child and Adolescent Psychiatry. Member of the Executive Committee of Arab Federal Psychiatrists, Tel 009782834292; Mobile 00970599604400;Email: abdelizizt@hotmail.com,abdelizizt@hotmail.com.

How to cite this article: Abdel A M T. Trauma, Mental Health, Coping, Resilience, and Post Traumatic Growth (PG)-Palestinian Experience. JOJ Nurse Health Care. 2017; 2(2): 555583. DOI: 10.19080/JOJNHC.2017.02.555583

Introduction

Coping

Based on Lazarus and Folkman's [1] model, coping refers to the behavioral and cognitive efforts one uses to manage the internal and external demands of a stressful situation. Coping can be classified as being either problem-focused or emotion- focused in nature. Lazarus & Folkman's [1] stress-coping theory, in which the individual assesses both the relevance of the environmental stressor (i.e. what he or she has at stake in the encounter) and his or her coping options before deciding on coping strategies to deal with the stressor. This theory's general emphasis on “coping,” however, could be expanded to encompass “development” or “growth.” There are three dimensions are most commonly used to categorize coping strategies:

Problem-focused and emotion-focused coping.
Primary and secondary control coping.
Engagement and disengagement coping (also referred to as approach versus avoidance coping) [2].
Problem-focused coping involves activities that focus on directly changing elements of the stressful situation.
Emotion-focused coping involves activities that focus more on modifying one's internal reactions resulting from the stressful situation.

Coping strategies includes a broad diversity of thoughts and behaviors used to manage the demands of a taxing situation [1]. Multiple research groups have attempted to organize coping strategies (and styles) into different categories.

The approach/avoidance construct, as the label implies, indicates whether the individual makes attempts to change the situation or distance him- or herself from the stressor as a way to reduce negative outcomes.

Coping strategies implemented immediately following trauma exposure, and in response to post traumatic stress. Avoidance as a sort of coping, such as behavioral or emotional avoidance, have been associated with increased psychological distress among interpersonal violence PTSD populations [3]. Avoidance behaviors could lead to withdrawal from support networks and reduced opportunities for positive experience, thereby compounding negative affect and reduced emotional experiencing. Approach-oriented coping strategies, such as active coping, planning, and support seeking, have been generally deemed adaptive following exposure to stress [4].

Social support is a variable that has been considered as both a means of coping and a resource contributing to the availability of other forms of coping [5]. The different ways of conceptualizing the role of social support in coping, and the relative lack of studies that examine reciprocal relationships between coping factors, has created some confusion about what roles social support may play in helping women deal with domestic violence.

Resilience

Over the decades, definitions of resilience in sciences concerned with child and family systems have become more dynamic, multilevel, and process oriented in focus, reflecting a broad theoretical shift toward a relational developmental systems framework in life course human developmental science and related fields [6].

Resilience and post traumatic growth (PG) theory and research are rooted in the philosophical stance that emphasizes the consideration of positive (salutogenic), rather than pathological or negative factors in trauma research [7]. Distinctions should also be made between posttraumatic growth and the concepts of resilience, hardiness, optimism, and sense of coherence. All these concepts describe certain personal characteristics that allow people to manage adversity well.

Resilience is usually considered to be an ability to go on with life after hardship and adversity, or to continue living a purposeful life after experiencing hardship and adversity. Smith defined resilience as a process that leads to "strength awareness", but psychological resilience may be operationally defined as strength awareness itself-that is, the belief that one can persevere or accomplish goal-relevant tasks across varied challenges and adverse situations.

Given this growing interest in scalable definitions, resilience can be defined broadly as "the capacity of a dynamic system to adapt successfully to disturbances that threaten its function, viability, or development" [8]. This definition of resilience could apply to an individual, family, computer system, economy, or ecosystem, among other systems. The capacity of any given system to adapt to challenges depends on the function of many interacting, changing systems. The resilience of children and their families are intertwined and also linked to supports and systems beyond the family in community, culture, and the physical environment.

Child resilience investigators have long recognized that resilience is inferred from judgments about risk (discussed further below) and adaptive function or development [9]; What are the criteria or standards by which we identify whether a person, a family, or any other system is adapting well? Issues in defining positive child development, adaptation, competence, or success have received considerable attention in child resilience science. What are the criteria or standards by which we identify whether a person, a family, or any other system is adapting well? One major approach to the criteria for judging adaptation is positive, focused on age-related expectations for behavior and achievement defined by communities and societies, often termed "developmental tasks" [10]. A second approach for judging adaptation, defined by low levels or absence of symptoms or disorder, stems from the initial focus on children at risk for psychopathology in the history of child resilience science. This negative approach has been criticized theoretically [11] and also from a common-sense perspective.

Family Resilience

What does it mean for a family system to be doing well or fulflling its functions effectively? Walsh [12], the concept of family resilience shifted attention from family as a resource or protective system for the individual members of a family to the function of the family unit as a whole, studied in terms of family adaptation or maladaptation in the context of adversity and the family processes that sustain family resilience. McCubbin [13] described the desired outcomes of family resilience in terms of success in fulfilling important expected functions of the family. These tasks included functions such as providing a sense of belonging and meaning, affording economic support, educating and socializing family members, and protecting vulnerable members of the family [14]. The effectiveness or success of a family would then be judged according to these expectations. Again, the criteria were multidimensional.

Post Traumatic Growth

In contrast, post traumatic growth refers to a change in people that goes beyond an ability to resist and not be damaged by highly stressful circumstances. Calhoun defined post traumatic growth as "positive change that an individual experiences as a result of the struggle with a traumatic event". In contrast to the construct of resilience, in which the individual returns to baseline functioning following highly stressful or traumatic experience, post traumatic growth is characterized by post-event adaptation that exceeds pre-event levels. Despite this interesting body of literature, there is still limited evidence on how living in areas of war and political conflict impact on university students, and which types of personal growth they may develop in response in relation to resilience. The aim of this paper to review papers conducted in Gaza Strip targeting children and adults using coping, resilience, and PTG.