Cognitive Processes to “Getting Back Up”

by Lea Bdeir and Daniel Tannir

Many individuals experience traumatic events that lead to significant effects on their mental health. The effects, long or short-lasting, positive or negative, are vital to the understanding of our research in the Cognitive Science Department at Operation Twelve. One of such effects is Post-Traumatic Stress Disorder, better recognized as PTSD. PTSD is a clinical phenomenon recognized as a chronic impairing disorder with re-experience and avoidance symptoms as well as negative alterations in cognition and arousal (Miao et al., 2018). There are many symptoms of PTSD, including, but not limited to: trouble with remembering traumatic events, negative thoughts about oneself, blaming oneself or others, ongoing negative emotions, loss of interest in previous activities, and re-experiencing symptoms (Mann & Marwaha, 2023). Initially introduced to the 3rd edition DSM in 1980 with 17 divided into 3 clusters, PTSD is now classified into 20 symptoms in the DSM-5 with 4 clusters, intrusion, active avoidance, negative alterations in cognitions and mood, and marked alterations in arousal and reactivity (Miao et al., 2018). It has proven difficult to truly understand the etiology of PTSD, although many treatments remain accessible (Munro et al., 2004). However, good things can also arise from trauma. Post-Traumatic Growth and Resilience are strong examples of such developments. 

Post-Traumatic Growth or PTG is defined as a positive change that occurs as a result of struggle with highly challenging life crises. PTG manifests itself in a variety of manners, including an increased appreciation for life, more meaningful interpersonal relationships, an increased sense of personal strength, changed priorities, and a richer existential and spiritual life (Tedeschi & Calhoun, 2004). Although Post-Traumatic Growth is a relatively new term, the concept itself has been present for a long time. The idea that individuals can prosper despite challenges speaks to the adaptability of the human mind and its ability to prevail during times of crises, as well as that challenges can stimulate growth. For instance, someone losing their loved one may start to view their relationships with more significance, strengthening their bonds with their friends and family. More severe symptoms have also been linked to PTG. PTSS, also known as Post Traumatic Stress Symptoms, have been studied to decrease as PTG increases. This has led many psychologists to believe that post-traumatic growth is able to decrease post-traumatic stress symptoms in the long term (Chen et al., 2015). 

A focus on recent trauma in the Middle East brings us to Lebanon, which has experienced humanitarian crises, a large-scale port explosion, and significant political unrest. A cross-sectional study conducted has found that two-thirds of the Beirut Port explosion survivors have PTSD, as well as more than half have depression (Al Hariri et al., 2022). It is undeniable that the effect of the blast in Beirut was responsible for many psychological symptoms. Facilitation or stimulation of Post-Traumatic growth may prove significant in reducing the symptoms presented by the Beirut port explosion. An article studying the facilitation of PTG after critical illness has found that there are a number of contributions that can facilitate post-traumatic growth. These contributions include recognizing one’s worth, helping one to envision a good future with potential, actively involving each person in their own care, and celebrating changes to each individual’s self (Turner & Cox, 2004).

We must also consider resilience, which is strongly related to Post-Traumatic Growth, though distinct. Resilience is defined as the process of overcoming difficult life situations, particularly through psychological, emotional, and interpersonal flexibility (American Psychological Association, 2022). This trait enables people to endure and adapt to even the most trying situations. The factors that play a role in resilience include: the ability to adapt to challenges, the skill to regulate feelings and thoughts after exposure, the availability of social support and network, the capacity to effectively think and solve problems, and the ability to create coping mechanisms (American Psychological Association, 2022). 

To better understand resilience, we must give it an operational definition: resilience is the measurement of the effectiveness of psychological and physical recovery following a stressor (Vanderbilt-Adriance & Shaw, 2008). Based on this operational definition, we can examine the cognitive model of resilience that discusses the different processes needed to overcome a traumatic event. This is important to understand based on one of our research topics at Operation Twelve, which targets the effect of traumatic exposure on cognitive processes. The article “A Cognitive Model of Psychological Resilience” found that cognitive resilience can be achieved through the use of executive control processes (which include inhibitory regulation, capacity for working memory, and psychological flexibility) and information processing bias (Parsons et al., 2016). These cognitive elements work together to influence a person’s capacity for adaptation in response to a traumatic event, providing important insights into therapies that can promote psychological resilience in the face of difficulty. 

When dealing with the idea of resilience from a psychological perspective, we must consider positive psychology that promotes active positive thoughts and adaptable biases. These elements mutually reinforce one another to contribute to having better mental health. i.e. positive thoughts and feelings influence emotional reactions, leading to positive reappraisals and optimistic thoughts (Parsons et al., 2016). This emphasizes the importance of developing a positive mindset to reduce the effects that exposure to a traumatic incident may induce. 

But developing a positive mindset is easier said than done, which introduces the need to use different types of therapies that are scientifically backed up and can be implemented to improve resilience; one of which is Cognitive Behavioral Therapy (CBT). As resilience targets cognitive processing, CBT is a plausible intervention that can be used. The study by Joyce et al. makes use of a systematic review and meta-analysis of different therapies (CBT, mindfulness-based interventions, and mixed interventions) that are believed to improve people’s psychological resilience. Using 17 studies that matched the inclusion, results found that both CBT and mindfulness-based resilience therapies seem to have a favorable effect on a person’s resilience (Joyce et al., 2018). 

Linking back to our initial example of the Beirut Blast, one study by Lange et al. evaluated the clinical value of PTSD, decreased resilience, insufficient sleep, and blast exposure as risk factors for subsequent neurobehavioral deficits following traumatic brain injury (TBI). Participants included 591 members of the American military. Results show that PTSD has the strongest predictive value alone or in conjunction with poor sleep and/or low resilience. Importantly, even without PTSD, poor sleep and low resilience are still shown to be potent indicators. These results reveal the correlation between PTSD and resilience and emphasize the importance of post-traumatic growth (Lange et al., 2022). They also provide insight into the factors investigated in our studies that can be applied to the context of the Beirut Blast and the effects it has played. 

In conclusion, both Post-Traumatic Growth and Resilience can be seen to be interlinked as they allow individuals to both adapt and transform from traumatic experiences. They are strong positive outcomes that arise from negative experiences. Our research at Operation Twelve aims to address the positive changes that can arise from negative experiences, in order to understand the different ways in which resilience and growth can be stimulated from negative situations. 

References

• Al Hariri, M., Zgheib, H., Abi Chebl, K., Azar, M., Hitti, E., Bizri, M., Rizk, J., Kobeissy, F., & Mufarrij, A. (2022). Assessing the psychological impact of Beirut Port blast: A cross-sectional study. Medicine, 101(41), e31117. https://doi.org/10.1097/MD.0000000000031117 
• American Psychological Association. (2022). Resilience. American Psychological Association. https://www.apa.org/topics/resilience 
• Chen, J., Zhou, X., Zeng, M., & Wu, X. (2015). Post-Traumatic Stress Symptoms and Post-Traumatic Growth: Evidence from a Longitudinal Study following an Earthquake Disaster. PloS One, 10(6), e0127241. https://doi.org/10.1371/journal.pone.0127241 
• Joyce, S., Shand, F., Tighe, J., Laurent, S. J., Bryant, R. A., & Harvey, S. B. (2018). Road to resilience: a systematic review and meta-analysis of resilience training programmes and interventions. BMJ Open, 8(6), e017858. https://doi.org/10.1136/bmjopen-2017-017858 
• Lange, R. T., French, L. M., Bailie, J. M., Merritt, V. C., Pattinson, C. L., Hungerford, L. D., Lippa, Sara. M., & Brickell, T. A. (2022). Clinical utility of PTSD, resilience, sleep, and blast as risk factors to predict poor neurobehavioral functioning following traumatic brain injury: A longitudinal study in U.S. military service members. Quality of Life Research, 31(8), 2411–2422. https://doi.org/10.1007/s11136-022-03092-4 
• Mann, S. K., & Marwaha, R. (2023, January 30). Posttraumatic stress disorder. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK559129/ 
• Miao, X.-R., Chen, Q.-B., Wei, K., Tao, K.-M., & Lu, Z.-J. (2018). Posttraumatic stress disorder: From diagnosis to prevention. Military Medical Research, 5(1), 32. https://doi.org/10.1186/s40779-018-0179-0
• Munro, C. G., Freeman, C. P., & Law, R. (2004). General practitioners’ knowledge of post-traumatic stress disorder: A controlled study. The British Journal of General Practice : The Journal of the Royal College of General Practitioners, 54(508), 843–847. 
• Parsons, S., Kruijt, A.-W., & Fox, E. (2016). A Cognitive Model of Psychological Resilience. Journal of Experimental Psychopathology, 7(3), jep.053415. https://doi.org/10.5127/jep.053415 
• Tedeschi, R. G., & Calhoun, L. G. (2004). TARGET ARTICLE: “Posttraumatic growth: Conceptual foundations and empirical evidence.” Psychological Inquiry, 15(1), 1–18. https://doi.org/10.1207/s15327965pli1501_01 
• Turner, de S., & Cox, H. (2004). Facilitating post traumatic growth. Health and Quality of Life Outcomes, 2(1), 1–9. https://doi.org/10.1186/1477-7525-2-34 Vanderbilt-Adriance, E., & Shaw, D. S. (2008). Conceptualizing and Re-Evaluating Resilience Across Levels of Risk, Time, and Domains of Competence. Clinical Child and Family Psychology Review, 11(1-2), 30–58. https://doi.org/10.1007/s10567-008-0031-2