Page 247 - Biobehavioral Resilence to Stress

224 Biobehavioral Resilience to Stress

was operationally defined in terms of normative levels of symptoms (e.g.,

distressing dreams, muscle tension, headaches, decreased attention span,
anxiety) observed among individuals in a matched group of nonbereaved
individuals (Bonanno et al., 2005). Using this approach, it was shown
that more than half the members of a sample of middle-aged, conjugally
bereaved individuals had symptom levels within the normal range of
symptoms for the married comparison group measured at 4 and 18 months
postbereavement. In other words, resilient, bereaved individuals were no
more symptomatic than their married counterparts. In a second study that
used this same normative comparison approach, more than half the mem-
bers of a sample of bereaved HIV+ caregivers were found to have symptom
levels within the normal range of symptoms for a comparable group of non-
bereaved, noncaregiving HIV+ men (Bonanno et al., 2005).
Resilience was also observed in a large probability sample (N = 2752)
of New York Metropolitan area residents during the fi rst 6 months aft er the
September 11th terrorist attack in 2001 (Bonanno et al., 2006). Using ran-
dom digit phone dialing, investigators were able to recruit a representative
sample that closely mirrored the most recent census data for the New York
area (Galea et al., 2003; Galea, Ahern et al., 2002; Galea, Resnick et al., 2002).
Because assessments of PTSD symptoms were found to be highly reliable in
this sample when obtained at 1, 4, and 6 months (Resnick, Galea, Kilpatrick
& Vlahov, 2004), it was possible to employ a relatively conservative defi ni-
tion of resilience as either zero or one PTSD symptom at any point during

the first 6 months after the attack. Mild trauma/recovery was defined as two
or more PTSD symptoms in the absence of the PTSD diagnosis. Based on

these definitions, nearly two-thirds (65%) of the sample was found to be resil-
ient. When the sample was narrowed to include only those people who had

either witnessed the attack in person or were directly affected by it (e.g., were
injured or lost a friend or loved one), the proportion of the sample that dem-
onstrated resilience was still more than 50%. In some categories of exposure
(e.g., witnessing another person’s death), the percentage of individuals who
showed resilience dropped to slightly lower levels, but never fell below one-
third of the sample even among those who experienced the most extreme
levels of exposure that generated the highest levels of PTSD among their
nonresilient cohorts.
Another study of high-trauma-exposed survivors who were either in
or near the World Trade Center (WTC) during the September 11th attack
employed a more conservative approach, requiring low symptom levels on
multiple outcome measures. However, even within this more stringent con-
text, more than one-third (35%) of survivors met the criteria for a resilient
outcome (Bonanno et al., 2005). Moreover, in each of the New York studies,
recovery was less frequent than resilience.

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