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An important part of the heritage of family resilience is the concept of individual psychological resilience which originates from work with children focusing on what helped them become resilient in the face of adversity. [1] Individual resilience emerged primarily in the field of developmental psychopathology as scholars sought to identify the characteristics of children that allowed them to function "OK" after adversity. Individual resilience gradually moved into understanding the processes associated with overcoming adversity, then into prevention and intervention and now focuses on examining how factors at multiple levels of the system (e.g., molecular, individual, family, community) and using interdisciplinary approaches (e.g., medical, social services, education) promote resilience. [2] [3] Resilience also has origins to the field of positive psychology. The term resilience gradually changed definitions and meanings, from a personality trait [4] [5] to a dynamic process of families, individuals, and communities. [2] [6]
Family resilience emerged as scholars incorporated together ideas from general systems theory perspectives on families, family stress theory, and psychological resilience perspectives. [7] Two prominent approaches to family resilience are to view families as contexts of individual resilience and families as systems. [8] In the field of family therapy the families as systems approach to family resilience is often used based on the assumption that significant risk, protective mechanisms, and positive adaptation occur at multiple interrelated system levels (individual, subsystem, system, or ecosystem). [9] Thus, family resilience involves the application of concepts such as resilience, adaptation and coping to a significant stressor or adversity from a family systems perspective.
One of the common factors associated with successful adaptation and coping is identified as resilience of individual family members. Resilience can be generally defined as the ability to "bounce back" to healthy functioning when faced with significant stressors and events. [5] The concept of resilience has been heavily researched in adolescents and now includes specific character traits and behaviors known as protective and recovery factors. [10] [11] [12] Previously, researchers have focused on identifying the characteristics of resilient individuals and started to explore the possibility of family resilience and family coping with stress. [10] [13] [14] Currently, researchers are focused on specific interventions to increase resilience in the family unit, while considering related genetic and environmental factors. [5]
There are diverse definitions of what resilience and/or family resilience is. The National Network for Family Resiliency [15] defines resilience as "the family's ability to cultivate strengths to positively meet the challenges of life". Atkinson, Martin, & Rankin [16] define resilience as "the ability to bounce back and have better physical and mental health outcomes". For family resilience specifically, McCubbin & McCubbin [17] have posited that "family resilience includes the characteristics, dimensions, and properties of families which help families to be resilient to disruption in the face of change and adaptive in the face of crisis situations". [18]
Using a combination of the above work, family resilience can be generally defined as: a dynamic process of families that have been exposed to a significant stressor or adversity that requires protective and recovery factors, identified by the family, as helpful to promote healthy coping in families and their self-identified family members. In the February 2015 special issue of Family Relations (journal) on individual and family resilience, [19] authors provide a variety of definitions of family resilience. For example, Masten and Monn (p. 6) define resilience as "the capacity for adapting successfully in the context of adversity". [3]
Resilience and family resilience have been studied in the context of various theoretical underpinnings. These include Bandura's Self-Efficacy Theory, Lazarus' Stress Theory, Froma Walsh's Family Resilience Framework, and McCubbin and Patterson's Family Stress and Resilience Model. The family stress theory originates from the family systems model that considers all members of the family as important and as a system where all parts and interactions between and among those parts as important. [14] The Family Stress and Resilience Model by McCubbin & McCubbin [20] [21] has been adopted by the field of family nursing because of the use in diverse families and because of the connection to the nursing metaparadigm of person, environment, health, and nursing [15] This strong theoretical connection to resilience and nursing supports the interest from nursing, which focuses on caring for diverse families and individuals in a holistic manner.
Henry, Morris, & Harrist [9] proposed the overarching Family Resilience Model (FRM) as a general model of family resilience within which existing models fit as ways of looking at family resilience. Based on a review of existing individual and family resilience scholarship, these authors developed the FRM to include key ideas from individual resilience, proposing that significant risk suggests increased risk for negative outcomes. This risk can be lowered through protective mechanisms, increasing the potential for positive outcomes, or heightened through vulnerabilities that pile up to increase the potential for negative outcomes. [9] However, significant risk, protection, vulnerability, and outcomes (or adaptation) occur within the context of family meanings, family adaptive systems (emotional systems, control systems, identity systems, maintenance systems, stress-response systems) in the particular family, and broader ecosystems. [9]
Resilience as a concept has been heavily studied on the individual level in children who have experienced significant stress or adversities. Family resilience is another level of resilience that is related to complex relationships and environmental factors. Fields that have utilized resilience research include psychology [2] [6] [8] [13] [14] [22] sociology, [7] [23] [24] education, [5] psychiatry [25] [26] and nursing. [12] [16] [18] [27] [28] [29] [30] The concept of resilience is attractive to many different health related fields because of all that remains unknown about the process, as well as the potential for reducing or preventing adverse outcomes due to significant experiences with adversity. Once thought of as simply a personality trait, resilience has become known as a dynamic process with many related factors that can change throughout an individual's life. Since resilience is also related to experience to stressors and ultimately results in healthy coping, connections can be made with resilience literature, military family literature, and other stress/coping literature [4] [11] [20] [21] [31] [32] [33] [34] [35] [36]
Family and individual resilience factors are not always the same. Family factors consist of stress management, emotion regulation skills, collaborative goal setting and problem solving. [22] [23] In contrast, individual factors that foster resilience include flexibility, use of social support, rebounding, high expectations, humor, self-efficacy, and self-esteem. [2] [27] [33] While few valid and reliable measures exist to measure resilience or family resilience specifically, much recent work has focused on measuring these attributes [30] of resilient families.
Family resilience is a strengths-oriented approach that tends to emphasize positive outcomes at the overall family system level, within family systems, in individual family members, and in the family-ecosystem fit and recognize the subjective meanings families bring to understanding risk, protection, and adaptation. [9]
According to Henry et al. [9] when examining family resilience is critical to be aware of some key issues: (a) significant risk must be present for resilience to occur, (b) other vulnerabilities (e.g., chronic illness, addiction, poor conflict management or communication beyond the focal risk may "pile-up" to present additional challenges; c) protection (factors or processes of resilience) must be distinguished from outcomes (short or long term indicators of resilience), (d) family situational meanings (how a family collectively perceives the risk, protection, and vulnerabilities) interact with risk, vulnerabilities, protection, and outcomes, (e) these all occur within family adaptive systems (patterns of interaction within families described as meaning systems, control systems, emotion systems, maintenance systems, stress-response systems) and ecosystems. Thus, assessing resilience requires consideration of which component(s) the researcher is addressing. Further, measurement can occur at the level of the family-ecosystem (e.g., school-family, healthcare-family), overall family system, in family subsystems (e.g., couple relationships, sibling relationships, parent-child relationship, grandparent-grandchild relationship). [9] Once the researcher clarifies which level(s) upon which they wish to focus, measures can be identified at the appropriate level.
The problem with a nebulous definition of family resilience is that it is difficult to measure without a concrete definition. Specific measurement tools of resilience include the Family Strengths and Resilience Scale, Connor-Davidson Resilience Scale, the Resilience Scale and other self-report measures such as Brief Symptom Inventory, Child Behavior Checklist, Child Depression Inventory, and Mental Health Inventories [37] have been most commonly used.
One can also measure all of the attributes and antecedents of family resilience individually to attempt to capture what it means to be resilient at a certain phase of a family developmental cycle. Protective factors that can be quantitatively measured include: celebrations, hardiness, time together, routines, traditions, communication, financial management, and health. [18] [34] [36] These factors have been most important when starting to understand the protective factors of resilience, versus the recovery factors, which are employed when the crisis or challenge has already occurred and the family needs to adapt. Recovery factors include: coping, social support, family support, esteem building, optimism, recreation, control, organization, flexibility, and hope. These factors are dependent upon the type of family that utilizes them and the need for certain factors depending upon the type of stressor (e.g. normative or non-normative). In short, it is difficult to measure family resilience.
Card and Barnett (2015) discuss four key methodological issues in researching individual and family resilience: psychometric properties (reliability, validity, measurement equivalence), causality in the absence of experimental research, contrasting variable centered and person centered approaches, and the multilevel nature of family resilience. [38]
Professionals who work with families may employ a variety of educational, therapeutic, or community-based approaches to helping protect families against adversity or facilitate the abilities of families to mobilize their strengths or gain new resources to successfully rebound from adversity (i.e., demonstrate resilience). Examples of such approaches are to inoculate against risk (or expose families to low levels of risk in preparation for potential greater risks), reducing risk, increasing resources, or changing meanings to make them more manageable, according to Henry et a. (2015). [9]
Disability within a family critically affects each family members life. People with disabilities may encounter societal, medical, environmental, physical, and attitudinal barriers. These barriers can have the ability to put these individuals and their families in the face of adversity. Family functioning is also key in identifying basic elements in resilience, including such processes as cohesion, flexibility, open communication, problem-solving, and an affirming belief system. [39] In addition, in order for families to frame the stress and uncertainty of having a child with a disability as a challenge that provides opportunities for finding resilience and meaning finding the right resources and professionals is essential. When a family who is facing adversity is surrounded by a community who lack in responding to hardships they are bound to family disruption. This proves that as family adversities become more challenging and difficult, the availability of community resources and a family's outreach to use them are essential. This may include resources like providing financial security, practical assistance, social support, a basic sense of connectedness through kin and friendship networks, and religious or other group affiliations. [39]
Recent literature has focused on identifying healthy coping and adaptation in military families. [22] With the current wars across the world, more military members are being deployed and are struggling with various issues such as: mental illness, substance abuse, difficulty with transitions, changes in roles, and ensuring their family is safe and healthy. [35] The families of these military members are not immune to these stressors. [36] [40] [41] The stress associated with the military can lead to depression if adequate coping mechanisms are not employed, or if the family does not possess the needed support or strength to adapt to stressors.
The Department of Defense has collaborated with positive psychology scientists to create the Comprehensive Soldier Fitness program for members of the Army. More recently, the Family Skills Component of this program has been released for use by family members in the military. [34] [42] New military, government, and public health initiatives are focused on fostering and promoting resilience in the military family overall. Initial results from pilot studies show that those who are resilient can better cope with stressors and are less likely to suffer from depression or alcohol use. [34] [42]
The Comprehensive Soldier Fitness program in the U.S. Army is the first of its kind. With input from the positive psychology field, a program to increase the physical and psychological health of service members was implemented in 2009. The Family Skills Component of this program is meant to assist military spouses and family members to also increase their levels of resilience.
Additionally to this program, there is also a project called Families OverComing Under Stress (FOCUS). This project was created by a University of California, Los Angeles-Harvard intervention development team at a Marine Corps Base, Camp Pendleton. The program was created as a large-scale demonstration program for the US Marine Corps and US Navy. Essentially FOCUS was created to supply education and skills training designed to aid with coping and deployment-related experiences for military parents and children. [43] Within this program family members of those in the military build a support network with each other by communicating each of their deployment-related experiences. This understanding is from each other aids in supporting the family resiliency processes. Results report an improved understanding of deployment and combat stress, improved family skills like communication, emotional regulation, family goal setting, and stress management. [43] A 2012 American Journal of Public Health study of 331 families who participated in the original military FOCUS program shows it significantly improves children's behavior and family functioning and reduces anxiety and depression among all family members [44]
Stress management consists of a wide spectrum of techniques and psychotherapies aimed at controlling a person's level of stress, especially chronic stress, usually for the purpose of improving everyday functioning. Stress produces numerous physical and mental symptoms which vary according to each individual's situational factors. These can include a decline in physical health, such as headaches, chest pain, fatigue, and sleep problems, as well as depression. The process of stress management is named as one of the keys to a happy and successful life in modern society. Life often delivers numerous demands that can be difficult to handle, but stress management provides a number of ways to manage anxiety and maintain overall well-being.
A nursing diagnosis may be part of the nursing process and is a clinical judgment about individual, family, or community experiences/responses to actual or potential health problems/life processes. Nursing diagnoses foster the nurse's independent practice compared to dependent interventions driven by physician's orders. Nursing diagnoses are developed based on data obtained during the nursing assessment. A problem-based nursing diagnosis presents a problem response present at time of assessment. Risk diagnoses represent vulnerabilities to potential problems, and health promotion diagnoses identify areas which can be enhanced to improve health. Whereas a medical diagnosis identifies a disorder, a nursing diagnosis identifies the unique ways in which individuals respond to health or life processes or crises. The nursing diagnostic process is unique among others. A nursing diagnosis integrates patient involvement, when possible, throughout the process. NANDA International (NANDA-I) is body of professionals that develops, researches and refines an official taxonomy of nursing diagnosis.
Social support is the perception and actuality that one is cared for, has assistance available from other people, and most popularly, that one is part of a supportive social network. These supportive resources can be emotional, informational, or companionship ; tangible or intangible. Social support can be measured as the perception that one has assistance available, the actual received assistance, or the degree to which a person is integrated in a social network. Support can come from many sources, such as family, friends, pets, neighbors, coworkers, organizations, etc.
Psychological resilience is the ability to cope mentally and emotionally with a crisis, or to return to pre-crisis status quickly.
Allostatic load is "the wear and tear on the body" which accumulates as an individual is exposed to repeated or chronic stress. The term was coined by Bruce McEwen and Eliot Stellar in 1993. It represents the physiological consequences of chronic exposure to fluctuating or heightened neural or neuroendocrine response which results from repeated or prolonged chronic stress.
Compassion fatigue is an evolving concept in the field of traumatology. The term has been used interchangeably with secondary traumatic stress (STS), which is sometimes simply described as the negative cost of caring. Secondary traumatic stress is the term commonly employed in academic literature, although recent assessments have identified certain distinctions between compassion fatigue and secondary traumatic stress (STS).
Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.
Chronic stress is the physiological or psychological response induced by a long-term internal or external stressor. The stressor, either physically present or recollected, will produce the same effect and trigger a chronic stress response. There is a wide range of chronic stressors, but most entail relatively prolonged problems, conflicts and threats that people encounter on a daily basis. And several chronic stressors, including "neighbourhood environment, financial strain, interpersonal stress, work stress and caregiving.", have been identified as associated with disease and mortality.
In psychology, posttraumatic growth (PTG) is positive psychological change experienced as a result of struggling with highly challenging, highly stressful life circumstances. These circumstances represent significant challenges to the adaptive resources of the individual, and pose significant challenges to the individual's way of understanding the world and their place in it. Posttraumatic growth involves "life-changing" psychological shifts in thinking and relating to the world and the self, that contribute to a personal process of change, that is deeply meaningful.
Psychological hardiness, alternatively referred to as personality hardiness or cognitive hardiness in the literature, is a personality style first introduced by Suzanne C. Kobasa in 1979. Kobasa described a pattern of personality characteristics that distinguished managers and executives who remained healthy under life stress, as compared to those who developed health problems. In the following years, the concept of hardiness was further elaborated in a book and a series of research reports by Salvatore Maddi, Kobasa and their graduate students at the University of Chicago.
In psychology, stress is a feeling of emotional strain and pressure. Stress is a type of psychological pain. Small amounts of stress may be beneficial, as it can improve athletic performance, motivation and reaction to the environment. Excessive amounts of stress, however, can increase the risk of strokes, heart attacks, ulcers, and mental illnesses such as depression and also aggravation of a pre-existing condition.
Transgenerational trauma is the psychological and physiological effects that the trauma experienced by people has on subsequent generations in that group. The primary modes of transmission are the uterine environment during pregnancy causing epigenetic changes in the developing embryo, and the shared family environment of the infant causing psychological, behavioral and social changes in the individual. The term intergenerational transmission refers to instances whereby the traumatic effects are passed down from the directly traumatized generation [F0] to their offspring [F1], and transgenerational transmission is when the offspring [F1] then pass the effects down to descendants who have not been exposed to the initial traumatic event - at least the grandchildren [F2] of the original sufferer for males, and their great-grandchildren [F3] for females.
Bullying is abusive social interaction between peers can include aggression, harassment, and violence. Bullying is typically repetitive and enacted by those who are in a position of power over the victim. A growing body of research illustrates a significant relationship between bullying and emotional intelligence.
Early childhood trauma refers to various types of adversity and traumatic events experienced during the early years of a person's life. This is deemed the most critical developmental period in human life by psychologists. A critical period refers to a sensitive time during the early years of childhood in which children may be more vulnerable to be affected by environmental stimulation. These traumatic events can include serious sickness, natural disasters, family violence, sudden separation from a family member, being the victim of abuse, or suffering the loss of a loved one. Traumatic experiences in early childhood can result in severe consequences throughout adulthood, for instance developing post-traumatic stress disorder, depression, or anxiety. Negative childhood experiences can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. However, not all children who are exposed to negative stimuli in early childhood will be affected severely in later life; some children come out unscathed after being faced with traumatic events, which is known as resilience. Many factors can account for the invulnerability displayed by certain children in response to adverse social conditions: gender, vulnerability, social support systems, and innate character traits. Much of the research in this area has referred to the Adverse Childhood Experiences Study (ACE) study. The ACE study found several protective factors against developing mental health disorders, including mother-child relations, parental health, and community support. However, having adverse childhood experiences creates long-lasting impacts on psychosocial functioning, such as a heightened awareness of environmental threats, feelings of loneliness, and cognitive deficits. Individuals with ACEs are more prone to developing severe symptoms than individuals in the same diagnostic category.
Dov Shmotkin is Professor Emeritus in the School of Psychological Sciences and Head of the Herczeg Institute on Aging at Tel Aviv University.
Ann S. Masten is a professor at the Institute of Child Development at the University of Minnesota known for her research on the development of resilience and for advancing theory on the positive outcomes of children and families facing adversity. Masten received the American Psychological Association Urie Bronfenbrenner Award for Lifetime Contributions to the Service of Science and Society in 2014. She has served as president of the Society for Research in Child Development and of Division 7 (Developmental) of the American Psychological Association.
Adverse childhood experiences (ACEs) include childhood emotional, physical, or sexual abuse and household dysfunction during childhood. The categories are verbal abuse, physical abuse, contact sexual abuse, a battered mother, household substance abuse, household mental illness, incarcerated household members, and parental separation or divorce. The experiences chosen were based upon prior research that has shown to them to have significant negative health or social implications, and for which substantial efforts are being made in the public and private sector to reduce their frequency of occurrence. Scientific evidence is mounting that such adverse childhood experiences (ACEs) have a profound long-term effect on health. Research shows that exposure to abuse and to serious forms of family dysfunction in the childhood family environment are likely to activate the stress response, thus potentially disrupting the developing nervous, immune, and metabolic systems of children. ACEs are associated with lifelong physical and mental health problems that emerge in adolescence and persist into adulthood, including cardiovascular disease, chronic obstructive pulmonary disease, autoimmune diseases, substance abuse, and depression.
The Shift-and-persist model has emerged in order to account for unintuitive, positive health outcomes in some individuals of low socioeconomic status. A large body of research has previously linked low socioeconomic status to poor physical and mental health outcomes, including early mortality. Low socioeconomic status is hypothesized to get "under the skin" by producing chronic activation of the sympathetic nervous system and hypothalamic–pituitary–adrenal axis, which increases allostatic load, leading to the pathogenesis of chronic disease. However, some individuals of low socioeconomic status do not appear to experience the expected, negative health effects associated with growing up in poverty. To account for this, the Shift-and-Persist Model proposes that, as children, some individuals of low socioeconomic status learn adaptive strategies for regulating their emotions ("shifting") and focusing on their goals ("persisting") in the face of chronic adversity. According to this model, the use of shift-and-persist strategies diminishes the typical negative effects of adversity on health by leading to more adaptive biological, cognitive, and behavioral responses to daily stressors.
Academic buoyancy is a type of resilience relating specifically to academic attainment. It is defined as 'the ability of students to successfully deal with academic setbacks and challenges that are ‘typical of the ordinary course of school life '. It is, therefore, related to traditional definitions of resilience but allows a narrower focus in order to target interventions more precisely. The academic buoyancy model was first proposed by psychologists Andrew Martin and Herbert W. Marsh, following the identification of significant differences between classic resilience and the day-to-day setbacks experienced by students.
The COVID-19 pandemic has impacted healthcare workers physically and psychologically. Healthcare workers are more vulnerable to COVID-19 infection than the general population due to frequent contact with infected individuals. Healthcare workers have been required to work under stressful conditions without proper protective equipment, and make difficult decisions involving ethical implications. Health and social systems across the globe are struggling to cope. The situation is especially challenging in humanitarian, fragile and low-income country contexts, where health and social systems are already weak. Services to provide sexual and reproductive health care risk being sidelined, which will lead to higher maternal mortality and morbidity.