A. Education And Training to Promote Hardiness and Resiliency

OBJECTIVE

Prepare individuals and groups for exposure to traumatic experiences in ways that minimize the likelihood of development of PTSD and other trauma-related problems.

BACKGROUND

Because exposure to traumatic stressors is part of the expected work experience of some occupations (e.g., military personnel and emergency services workers), it is sensible to make efforts to prepare individuals in these professions for their encounter with traumatic events. This preparation is not explicitly undertaken in most workplaces, with some exceptions (e.g., some military training environments). To date, research has not examined our capacity to prepare individuals or communities for trauma exposure. However, general principles of preparation can be outlined that are consistent with theoretical models of the development of PTSD, research on risk factors for development of PTSD, and emerging concepts of resilience and hardiness.

RECOMMENDATIONS

1. In high-risk occupations for which probability of trauma exposure is moderate or high, effortsshould be undertaken to increase psychological resilience of workers to the negative effects of trauma exposure.

DISCUSSION

Although little is directly known about our capacity to prepare individuals or communities for trauma exposure, it is possible to identify principles of preparation that are consistent with empirical research on risk and resilience factors and with current theories of PTSD development. Such pre-trauma preparation can include attention to both the ability to cope during the trauma itself and to shaping the post-trauma environment so that it will foster post-trauma adaptation.

Some influential theories of PTSD posit that a process of classical conditioning can lead to development of chronic PTSD symptomatology. In this process, stimuli associated with the traumatic experience can elicit responses similar to those experienced during the trauma itself (e.g., intense anxiety). Other theories suggest that individuals who develop negative trauma-related beliefs (e.g., about personal guilt) will be more likely to experience continuing trauma reactions because such beliefs will maintain a sense of threat. Research on risk factors for PTSD indicates that post-trauma social support and life stress affect the likelihood of development of the disorder. Protective factors have also been identified that mitigate the negative effects stress. Research is beginning to delineate the psychological processes that moderate an individual’s response to stress, and to explore training programs for increasing resilience to stress. Hardiness (Kobasa, Maddi, & Kahn, 1982) is one personality factor that has been demonstrated to buffer against traumatic stress and PTSD in military veterans (King et al, 1998; Bartone, 2000). Hardiness is characterized by three key attributes: ability to perceive control over life’s events; ability to make strong commitment to tasks; and ability to see stressful experiences as a challenge to be overcome. Training programs, personnel policies, and leadership strategies that promote hardiness may thereby increase an individual’s ability to resist the negative effects of traumatic stress.

Such findings and theories are consistent with the following principles of preparation:

1. Provide realistic training that includes vicarious, simulated, or actual exposure to traumatic stimuli that may be encountered. Examples of application of this principle in military training include exposure to live weapons fire, survival training, or, for subgroups of military personnel, mock captivity training. This principle can be applied to many work roles; for example, those likely to be involved in body handling might be trained in mortuary environments. It is consistent with classical conditioning theories in that this can help reduce arousal or anxiety associated with particular traumatic stimuli.
   
2. Strengthen perceived ability to cope during the trauma and with the aftermath. Realistic training contributes to this goal. Instruction and practice in use of a variety of coping skills (e.g., stress inoculation training, problem-solving, assertion, and cognitive restructuring) may be helpful in enabling workers to tolerate stressful work environments. In addition, individuals can be trained to cope with acute stress reactions that are common following trauma exposure. Such training experiences help to maximize expectations of mastery of traumatic situations and their physical and emotional sequelae. The training must include specific, practical actions to do to change the threatening or horrifying situation for the better. Without such positive action learning, "simulated" terrifying or horrifying situations and stimuli can induce feelings of helpless that make the training itself traumatizing.
   
3. Create supportive interpersonal work environments that are likely to provide significant social support during and after traumatic events. Efforts to build teams and establish group cohesion among work group members are important in this regard. Identification and training of peer stress management resource persons, and training and practice in the provision of peer social support may also be useful. Families are crucial in post-trauma support and can be given information about and training in ways of providing social support. Finally, competent, ethical leadership at all levels of the organization helps protect against traumatization.
   
4. Develop and maintain adaptive beliefs about the work role and traumatic experiences that may be encountered within it. Key beliefs will be related to realistic expectancies about the work environment, confidence in leadership, confidence in the meaningfulness or value of the work role, positive but realistic appraisals of own coping ability, and knowledge about the commonness and transitory nature of most acute stress reactions. It may be useful to identify and discuss negative beliefs that sometimes arise in the specific work environment, in order to “inoculate” against such beliefs.
   
5. Develop workplace-specific comprehensive traumatic stress management programs. Such programs can be a significant source of post-trauma support (e.g., via mental health professionals) that can minimize trauma-related problems among workers. It is important to take steps to increase awareness of such services and to de-stigmatize and reduce potential negative consequences of their use. For example, employees should be helped to understand that seeking help in confronting symptoms and problems early in their development is likely to be more effective than avoiding them or keeping them secret from others, but that even long hidden or persisting PTSD can be treated.

Comprehensive preparation programs that target and integrate these principles and that are, themselves, integrated into existing unit/community support systems may be expected to be most helpful (Gist & Lubin, 1999).