CONTINUING EDUCATION

Resilience: A Historical Reviewof the Construct Kathleen Tusaie, PhD, APRN-BC Janyce Dyer, DNSc, CRNP, CS

Evolution of the construct of resilience from physiological and psychological research extends from the 1800sto the present. This review supports 3 observations: (1) the importance of a dynamic, interactive perspectivefor understanding resilience; (2) the complexity of the construct requires a holistic perspective; and (3) theimportance of exposure to diverse experiences and educational perspectives for professional health care students.KEY WORDS: anxiety, holistic, resilience, stress Holist Nurs Pract 2004;18(1):38

CE 1.5Contact HoursSee test on pp. 910

R esilience is a vital attribute for nurses intheir everyday work and particularly amidst thecurrent nursing shortage. It denotes a combination ofabilities and characteristics that interact dynamicallyto allow an individual to bounce back, copesuccessfully, and function above the norm in spite ofsignificant stress or adversity.1 Although researchersagree on multiple domains to the concept of resilience,it can be viewed as a qualitative categorical construct2or as a continuum of adaptation or successexperiences.3 Its complexity necessitates an additionalholistic nursing perspective.

The domains of work or school performance,behavior adjustment, psychosocial adjustment, andphysical health comprise overall resilience.1,2,4Because of a weak correlation among the domains ofresilience, individuals may vary in resiliencecharacteristics. For example, an individual from anabusive, impoverished childhood may demonstrateeducation and work resiliency by obtaining a doctoraldegree and a high-paying job, but be unable tomaintain intimate relationships and demonstrateimpairment in the psychosocial domain. Therefore,current evidence suggests that the idea of overallresilience is of questionable utility.3,5 Definitions thatfocus on aggregating various domains are likely to beweakly correlated with outcomes. So domain

From the University of Akron College of Nursing, Akron, Ohio (Dr Tusaie);and the Barry University School of Nursing, Miami Shores, Fla (Dr Dyer).Corresponding author: Kathleen Tusaie, PhD, APRN-BC, University ofAkron College of Nursing, Mary Gladwin Hall, Akron, OH 44325 (e-mail:ktusaie@uakron.edu).

specificity is more useful in research and practiceapplications than is a global definition of resilience.6

The domains of resilience are developmentallyappropriate and change with different life stages. Forexample, in addition to the absence of illness, childrenwho function above the norm scholastically and inpeer relationships in spite of risk exhibit resilience.711In adolescence and young adulthood, resilience maybe measured by accomplishments higher than thenorm in career development, happiness, relationships,and physical well-being in spite of the presence of riskfactors.12 Resilience is not static.

Resilience has been studied particularly in relationto transitions of greatest stress. Developmentaltransitions include school entry, detachment fromparents during adolescence, and childbearing.Transitions also occur in unexpected or externallycontrolled events such as disaster, family disruption,or unemployment.1317 These and other forms ofstressful situations place individuals at risk for thedevelopment of psychosocial or physical symptoms.Individuals who do experience disruption from stressbut then use personal strengths to grow stronger andfunction above the norm are considered resilient.

Although each individual possesses the potentialfor resilience, an interplay between the individual andthe broader environment is responsible for the level ofresilience.1,7 Further, the interactions among risk andprotective factors at an intrapersonal andenvironmental level are integral to the definition ofresilience. The presence of risk factors indicates that aperson has been identified as with a group that is morelikely than other groups to develop a specific

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4 HOLISTIC NURSING PRACTICE JANUARY/FEBRUARY 2004

difficulty.18 Risk factors do not predict a particularnegative outcome with absolute certainty; they onlyexpose individuals to circumstances associated with ahigher incidence of that outcome. Risk factors stemfrom multiple life stressors, a single traumatic event,or cumulative stress from a number of individual andenvironmental factors.1,3,4,16 The risk may be viewedfrom an epidemiological perspective that wouldinclude an entire group, such as children in poverty oron an individual basis such as an experience of traumaor an adverse event.9 The balance between risk andprotective factors is a dynamic process.

Protective factors are defined as operating to protectthose at risk from the effects of the risk factors.Similar to risk factors, protective factors may beindividual or environmental and they contribute topositive outcomes regardless of the risk status.18 Themanner in which risk and protective factors interact inthe person demonstrating resilience is not clear.Understanding the root of causation often requires afocus on the presence or absence of specific unitaryfactors, and the nature of the interactions within thecollectivity of risk and protective factors. When stressor the number of risk factors is greater than thenumber of protective factors, individuals whoexhibited resilience in the past may be overwhelmedand develop symptoms in one of the domains ofphysical, psychosocial, behavioral school, or work.4

The prevalence of resilience ranges from 15% to50% depending upon the definition of resilience andthe population studied.8,9,14,19 These rates suggest thatresilience does not function uniformly andautomatically, but waxes and wanes in response tocontextual variables.

Experts agree that the potential for change orplasticity exists across the life course.10,11,15,2022 Thisplasticity, or ability to bounce back in spite ofadversity and function above the norm, providesreason for optimism about intervention programs topromote health and prevent illness. Therefore, the areaof resilience is of interest to researchers, clinicians,and educators. Many forms of stress and adversityexist in our workplaces and in our world, but thosewho cope successfully and function above the norm inspite of adversity have valuable knowledge to share.

HISTORICAL DEVELOPMENT

The roots of the construct of resilience are in 2 bodiesof literature: (1) the psychological aspects of coping

and (2) the physiological aspects of stress. Fields ofstudy related to psychology and physiology aresimultaneously pushed apart by academic politics anddrawn together by common elements of the humanexperience.23 This review of the literature will includesome of the literature that led to the evolution of theconstruct of resilience (see Fig 1).

From the psychological literature on stress andcoping, observations of individuals coping better thanexpected and actually improving as a result ofadversity laid the groundwork for the construct ofresilience. Although the construct uses a holistic,multilevel approach similar topsychoneuroimmunology, resilience focuses uponpositive outcomes, not illness. Thus, both constructsare related but have a different emphasis.

The early studies of resilience focused upon factorsor characteristics that assist individuals to thrive fromadversity. These findings can be divided intointrapersonal and environmental factors. Intrapersonalfactors identified include cognitive factors and specificcompetencies. Cognitive factors includeoptimism,2427 intelligence,9,2830 creativity,31,32humor,31,33 and a belief system that providesexistential meaning, a cohesive life narrative, and anappreciation of the uniqueness of oneself.2,3437Competencies that contribute to resilience include awide range of coping strategies,38,39 social skills,educational abilities, and memory above the averagelevel.2,40,41 Physical attractiveness has also beenreported to add to the level of individual resilience.9,42The intraindividual factors contributing to higherlevels of resilience may be considered protectivefactors within the individual.

Environmental factors that influence resilienceinclude perceived social support or a sense ofconnectedness and life events. Social support has beendescribed as an important factor in several domains ofresilience.2,8,9 A brief definition includes the objectivequantity of social resources as well as the process ofmaintaining relationships. Social support is atransaction between the person and the environment.Therefore, it is not only the number or function ofsocial relationships but also the perception of thesupport that encompasses the definition of socialsupport.43 Individuals with a negative outlook towardthe support being offered may repel it, therebyreceiving and perceiving less support.44 Therefore, anindividual is not a passive recipient of social support,but the process of social support is reciprocal anddynamic. For example, parental support has been

A Historical Review of Resilience 5

FIGURE 1. Evolution of the construct of resilience.

reported to be moderately to strongly correlated(r = 0.060.08, P < .001) with adolescent resiliencein all domains.27,45 However, parental overprotectionresulting in lack of successful accomplishments andself-regulation by the child has been significantlycorrelated (r = 0.53, P < .001) to substance abuse,antisocial behavior, and low psychosocial resilience.45Therefore, protective factors change within contextand dosing or amount of the factor present.

Several studies have reported that number andrecency of bad life events directly influence resilience.It was not life change in general, but specifically thenumber of events perceived as bad by the individualthat influenced level of resilience. However, thisresearch on life events raised questions that validatedthe importance of a transactional relationship amongfactors because not all individuals who experience badlife events have low resilience.

As the resiliency literature expanded, it becameclear that individual and environmental factors may benecessary but not sufficient to understand the constructof resilience. The dynamic processes among the

factors mediate between the person and theenvironment and the person and the outcome.Therefore, models of resilience began to emerge in theliterature.

A Resilience Process Model proposed byRichardson46 is similar to other models developed byRutter,1,8 Wolin and Wolin,31 and Masten.2 Thisconceptual model posits the presence ofbiopsychospiritual homeostasis within the individual,which is influenced by adversity, life events, andresilient factors. Following disruption of homeostasis,there is a conscious or unconscious reintegrationresulting in 1 of 4 outcomes: (1) resilient reintegrationresulting in growth, self-understanding, and increasedresilience; (2) reintegration back to homeostasis;(3) reintegration with loss; or (4) dysfunctionalreintegration.

Other researchers focused upon a more narrowmodel of resilience. Mandelco and Rerry11 haveproposed resilience models specifically for childrenand an adolescent model was developed byTusaie-Mumford.27 Another direction in model

6 HOLISTIC NURSING PRACTICE JANUARY/FEBRUARY 2004

development resulted in an expansion to describeresilience in larger systems such as families47 andcommunities.48 All models were consistent inidentifying resilience as a dynamic process involving apersonal negotiation through life and fluctuatingacross time, developmental stage, and context.

The measurement of resilience has lacked empiricalinstruments because of the diversity of definitions aswell as the trend to use qualitative studies for thiscomplex phenomena. However, as research grows,there are more consistent themes in identifyingintraindividual factors that strongly correlate withresilient outcomes in all domains. Early workmeasured the absence of expected symptoms invarious populations. However, only the absence ofexpected symptoms did not measure the essence ofresilience. So, in addition to the absence of symptoms,specific attributes of resilience were measured.Therefore, self-report instruments to quantify resilientfactors within the individual have been developed. TheEgo Resilience Scale (ER89) was developed by JackBlock49 to identify the pure ego resilience qualities ofthe personality. It was developed with communitysamples of adults and used recently to evaluateresilience in individuals residing in war zones.14Several other scales have been developed using theresearch literature as a framework with a communitysample.21,50 Biscoe and Harris (unpublished data,1994) have developed resiliency scales for children,adolescents, and adults, with samples from residentsof a substance abuse treatment center and the clinicalstaff. These scales are based upon the framework fromWolin and Wolin.31 None of these scales has beenwidely used and lack generalizability due todevelopment with specific populations.

Another scale, Connor-Davidson Resilience Scale(CD-RISC), has used the research literature to guidedevelopment but has a wider adult sample consistingof a community group, primary care outpatients,psychiatric outpatients, subjects in a study ofgeneralized anxiety disorder, and subjects in clinicaltrials for posttraumatic stress disorder.51 This scalemay assist in the process of identifying levels ofresilience in a wide range of populations as well asquantifying changes in resilience during therapy. Theclearest descriptions and measurements of resiliencetoday consist of a quantitative scale correlated withoutcome measures specific to the population anddomain of resilience being studied combined with aqualitative piece to address the individualizeddynamics of resilience.

Although the specific relationships among theintraindividual and environmental factors remain onlypartially understood, the need to maximize resiliencein an effort to decrease the rising rates of mental illnesshas driven the development of resiliency trainingprograms. Some programs focused upon maximizing aspecific factor such as social support,52,53 while otherstook a more traditional psychotherapeutic approach.51Richardson54,55 developed a seminar format fortraining adults in a corporate setting as well as highschool students. Although these programs demonstrateinitial improvement following the intervention, thereare no longitudinal studies to date that test resiliencepromotion along with risk reduction in real-worldsettings.

FUTURE DIRECTIONS AND LESSONSOF HISTORY FOR RESILIENCE

What lessons have been learned from this historicalliterature review and what are the likely directions offuture advances? We will make 3 observations: (1) theimportance of a dynamic, interactive perspective forunderstanding resilience; (2) the complexity of theconstruct requires a holistic perspective; and (3) theimportance of exposure to diverse experiences andeducational perspectives for professional health carestudents.

A dynamic, interactive perspective

Reactions to stress can no longer be seen as isolatedevents eliciting a response, but rather the outcome ofwhat has gone on before. There is a dynamicinteraction of patterns of coping responses, personalitycharacteristics, social support, and geneticallydetermined biological reactivity with an individualsappraisal of a stimulus to effect neuroendocrine andimmune responses that influence resilience and health.The historical literature on resilience has added to ourunderstanding of the human response to stress, butmuch remains to be learned. Although the themes incharacteristics of resilient individuals have beenexplored, there is a need to explore the dynamicinteractions of these characteristics. For example, if achild is at risk because of parental loss, will asubstitute parent eliminate or minimize the risk factor?Recent statistical advances such as Structural EquationModeling software allow this concurrent analysis toprovide more understanding of the dynamic nature of

A Historical Review of Resilience 7

resilience. Although it is important to analyzeindividual characteristics in more detail, the historyindicates that the dynamic interaction is also vital toresilience. This finding can be extended to the healtheducator and provider who are cautioned not to take anarrow perspective when working with clients.

Holistic perspective

A historical perspective encourages the recognition ofthe importance of context. The expression ofresilience will be affected by the context, not only theimmediate context, but the larger contexts of agecohort, family history, social class, nation/culture,history, and gender.20 For example, social power or akind of force field affects the formation andexpression of resilience. For example, in 1944, a20-year-old white American male storming the beachin Normandy and a middle-aged Japanese woman inan internment camp for US citizens of Japaneseancestry would certainly express resilience in adifferent manner. When considering the larger socialcontext of an individual, the appreciation of theconcept of resilience becomes more clear. To have thisperspective, it is important to use a holistic framework.

Diverse training

The third and final lesson is to consider the training ofmany of the great figures in history. Sigmund Freudstarted as a neurologist and Florence Nightengaleaddressed issues ranging from sanitation to physicalhealth to interpersonal relationships. The area ofhealth promotion and illness prevention has greatlybenefited by the experiences and perspectives from adiverse range of interests and education. As oursociety continues to become more complex, healthpractitioners in the 21st century will require diversetraining and experiences. The importance ofinterdisciplinary teams and interdisciplinary trainingas part of professional education can only add to theunderstanding and application of the construct ofresilience.

REFERENCES

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2. Masten A. Resilience in individual development: successful adaptationdespite risk and adversity. In: Wang MC, Gordon EW, eds. EducationalResilience in Inner City America: Challenge and Prospects. Hillsdale,NJ: Erlbaum; 1994:325.

3. Luthar S, Doernberger C, Zigler E. Resilience is not a unidimensionalconstruct: insights from a prospective study of inner-city adolescents.Dev Psychopathol. 1993;4:287299.

4. Garmezy N. Resiliency and vulnerability to adverse developmental out-comes associated with poverty. Am Behav Sci. 1991;34:416430.

5. Hunter AJ. A cross-cultural comparison of resilience in adolescents. JPediatr Nurs. June 2001;16:172179.

6. Werner E, Johnson J. Can we apply resilience? In: Glanz M, Johnson J,eds. Resilience and Development: Positive Life Adaptations. New York:Kluwer Academic/Plenum; 1999:259277.

7. Egeland B, Carlson E, Stroufe L. Resilience as a process. Dev Psy-chopathol. 1993;5:517528.

8. Rutter M. Resilience in the face of adversity: protective factors andresistance to psychiatric disorders. Br J Psychiatry. 1987;147:598611.

9. Werner E. Risk, resilience, and recovery: perspectives from Kauai. DevPsychopathol. 1993;5:503515.

10. Resnick MD. Resilience and protective factors in the lives of adoles-cents. J Adolesct Health. 2000;27(1):12.

11. Mandelco BL, Reery JC. An orgazational framework for conceptu-alizing resilience in children. J Child Adolesc Psychiatr Nurs. JulySeptember 2000;13:99111.

12. Baldwin A, Baldwin C, Kasser T, Zax M, Samerof A, Seifer R. Con-textual risk and resilience during late adolescence. Dev Psychopathol.1993;5:741761.

13. Luthar S, Zigler E. Intelligence and social competence among high-riskadolescents. Dev Psychopathol. 1992;4:287299.

14. Al-Naser F, Sandman M. Evaluating resiliency patterns using the ER89:a case study from Kuwait. Soc Behav Pers. 2000;28(5):505514.

15. Sigal JJ, Weinfeld M. Do children cope better than adults with poten-tially traumatic stress? A 40-year follow-up of Holocaust survivors.Psychiatry. Spring 2001;64:6980.

16. Hess CR. Resilience among African American adolescent mothers: pre-dictors of positive parenting in early infancy. J Pediatr Psychol. OctoberNovember 2002;27:619629.

17. Norris FH. 60,000 disaster victims speak: an empirical review 19812001. Psychiatry. Fall 2002;65:207239.

18. Zuckerman M. Vulnerability to Psychopathology. Washington, DC:American Psychological Association; 1999.

19. Richardson GE. The metatheory of resilience and resiliency. J ClinPsychol. 2002;58(3):307321.

20. Lerner R. Americas Youth in Crisis. Thousand Oaks, Calif: Sage; 1995.21. Wagnild G, Young H. Development and psychometric evaluation of the

Resilience Scale. J Nurs Meas. 1993;1(1):165178.22. Felten BS, Hall JM. Conceptualizing resilience in women older than 85:

overcoming adversity from loss or illness. J Gerontol Nurs. November2001;27:4653.

23. Sulloway FJ. Freud: Biologist of the Mind. New York: Basic; 1979.24. Seligman M. Helplessness: On Depression, Development, and Death.

San Francisco: Freeman; 1975.25. Schweizer K, Beck-Seyffer A, Schneider R. Cognitive bias of op-

timism and its influence on psychological well-being. Psychol Rep.1999;84:627636.

26. Chang E, Sanna L. Optimism, pessimism, and positive and negativeaffectivity in middle-aged adults: a test of a cognitive-affective modelof psychological adjustment. Psychol Aging. 2001;16(3):524531.

27. Tusaie-Mumford K. Psychosocial Resilience in Rural Adolescents: Op-timism, Perceived Social Support, and Gender Differences [disserta-tion]. Pittsburgh, Pa: University of Pittsburgh; 2001.

28. Long JVF, Valliant GE. Natural history of male psychological health:escape from the underclass. Am J Psychiatry. 1984;141:341346.

29. White JL, Moffitt TE, Silva PA. A prospective replication of the pro-tective effects of IQ in subjects at high risk for juvenile delinquency. JConsult Clin Psychiatry. 1989;57:719724.

30. McKnight L, Loper A. The effect of risk and resilience factors onthe prediction of delinquency in adolescent girls. Sch Psychol Int.2002;23(2):186198.

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31. Wolin SJ, Wolin S. Bound and Determined: Growing Up Resilient in aTroubled Family. New York: Villard Press; 1993.

32. Simonton DK. Creativity. Am Psychol. 2000;55:151158.33. Masten A. Resilience in individual development: Successful adaptation

despite adversity. In: Gorden EW, ed. Educational Resilience in InnerCity America. Hillsdale, NJ: Erlbaum; 1994:325.

34. Myers DG. The funds, friends, and faith of happy people. Am Psychol.2000;55:5667.

35. Frankl V. Mans Search for Meaning: An Introduction to Logotherapy.Boston: Beacon Press; 1959.

36. Valent P. Documented childhood trauma: its sequelae and applicationto other traumas. Psychiatry Psychol Law. 1995;2:8189.

37. Urman M, Funk J, Elliott R. Childrens experience of traumatic events:the negotiation of normalcy and difference. Clin Child Psychol Psychi-atry. 2001;6(3):403424.

38. Aldwin C. Stress, Coping, and Development. New York: Guilford Press;1994.

39. Barbarin OA, Richter L, deWet T. Exposure to violence, cop-ing resources, and psychological adjustment. Am J Orthopsychiatry.2001;71(1):1625.

40. Davis T. Gone but not forgotten: declarative and nondeclarative mem-ory processes and their contribution to resilience. Bull Menninger Clin.November 2001;65:451470.

41. Rouse K. Resilient students goals and motivation. J Adolesc.2001;24(4):461472.

42. Kaufman J, Zigler E. The intergenerational transmission of child abuse.In: Cicchetti D, Carlson V, eds. Child Maltreatment: Theory and Re-search on the Causes and Consequences of Child Abuse and Neglect.Cambridge, Mass: Cambridge University Press; 1989:129150.

43. Pro cidano M, Hellers K. Perceived social support. Am J CommunityPsychol. 1983;11:124.

44. Varni J, Setogichi Y, Rappaport L, Talbot D. Psychological adjustmentand perceived social support with congenital/acquired limb deficiencies.J Behav Med. 1992;15(1):3144.

45. Neher L, Short J. Risk and protective factors for childrens substanceabuse and antisocial behavior following parental divorce. Am J Or-thopsychiatry. 1998;68(1):154161.

46. Richardson G, Neiger B, Jensen S, Keumpfer K. The resiliency model.Health Educ. 1990;21:3339.

47. Patterson J. Understanding family resilience. J Clin Psychol. March2002;58:233246.

48. Tobin G. Resilience and volcano hazard: the eruption of Tungurahuaand evacuation of the foldas in Ecuador. Disasters. 2002;26(1):2848.

49. Block J, Kremen A. IQ and ego resiliency: conceptual and empiricalconnections and separatedness. J Pers Soc Psychol. 1966;70:349361.

50. Bartone P, Ursano R, Wright K, Ingraham L. The impact of militaryair disaster on the health of assistance workers. J Nerv Ment Disord.1989;177:317328.

51. Connor K, Davidson J. Development of a new resilience scale:the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety.2003;18:7682.

52. Belgrave F, Chase-Vaughn G, Gray F, Addison J, Cherry V. The ef-fectiveness of a cuture- and gender-specific intervention for increasingresiliency among African-American preadolescent girls. J Black Psy-chol. 2000;26(2):133147.

53. Shapiro E. Chronic illness as a family process: a social-developmentalapproach to promoting resilience. J Clin Psychol. 2002;17(11):832838.

54. Richardson GE. High School Resilient Youth Curriculum Guide. SaltLake City, Utah: The Human Experience Institute; 1998.

55. Richardson GE. Corporate Personal Resilience Student Workbook. SaltLake City, Utah: The Human Experience Institute; 1999.

CE Test CEResilience: A Historical Review of the ConstructInstructions: Read the article on page 3. Take the test, recording your answers in the test an-

swers section (Section B) of the CE enrollment form.Each question has only one correct answer.

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CE TEST QUESTIONSGeneral Purpose: To provide registered professionalnurses with information on the construct of resilience.

Learning Objectives: After reading the article andtaking this test, you should be able to:1. Define the construct of resilience and related factors.2. Outline research findings on the physiological and psy-

chological components of resilience.3. Describe the importance of a holistic perspective and

diverse training relating to resilience.

1. Competencies that contribute to re-silience include a wide range of copingstrategies, social skills, educational abil-ities, anda. a belief system that provides existential meaning.b. creativity.c. memory above the average level.d. optimism.

2. Which of the following has been re-ported to be moderately to strongly cor-related with adolescent resilience in alldomains?a. cognitive factors c. intelligenceb. humor d. parental support

3. The prevalence of resilience ranges from15% to 50%, which suggest thata. individuals with a negative outlook toward the sup-

port being offered, may repel it, thereby receivingand perceiving less support.

b. many forms of stress and adversity cannot be pre-vented in our workplaces and in our world.

c. resilience does not function uniformly and automat-ically, but waxes and wanes in response to contex-tual variables.

d. the balance between risk and protective factors is adynamic process.

4. A neuroendocrine model of resiliencespecifically for women was presented bya. Biscoe and Harris.b. Caudell and Gallucci.c. Mandelico and Perry.d. Wolin and Wolin.

5. A self-reported instrument to quantify re-silient factors within the individual devel-oped by Jack Block is thea. Conner-Davidson Resilience Scale (CD-RISC).b. Ego Resilience Scale (ER89).c. Structural Equation Modeling.d. Resilience Process Model.

6. Which is defined as a transaction be-tween the person and the environment?

a. bad life eventsb. health promotionc. risk factorsd. social support

7. According to the Resilience ProcessModel, biopsychospiritual homeostasiswithin the individual is influenced by ad-versity, resilient factors, anda. developmental stage.b. generalized anxiety.c. life events.d. social support.

8. Social power or a kind of force fielda. affects the formation and expression of resilience.b. benefits a diverse range of populations.c. places individuals at risk of developing psychosocial

or physical symptoms.d. stems from multiple life stressors, a single traumatic

event, or cumulative stress.9. The presence of risk factors indicates

a. the absence of expected symptoms in variouspopulations.

b. a person is in a group that is more likely than othergroups to develop a specific difficulty.

c. theres been a personal negotiation through life andfluctuating across time.

d. intraindividual factors that strongly correlate with re-silient outcomes in all domains.

10. Operating to protect those at risk from theeffects of the risk factors definesa. diverse training.b. intraindividual factors.c. patterns of coping.d. protective factors.

11. Several studies have reported that re-silience is directly influenced by the num-ber and recency ofa. bad life events.b. developed coping strategies.c. life change in general.d. acquired social skills.

12. The ability to bounce back in spite of ad-versity and function above the norm isa. competencies. c. plasticity.b. interplay. d. reintegration.

13. Which of the following is software that al-lows concurrent analysis to provide moreunderstanding of the dynamic nature ofresilience?a. Conner-Davidson Resilience Scale (CD-RISC)b. Ego Resilience Scale (ER89)

c. Structural Equation Modelingd. Resilience Process Model

14. Who addressed issues ranging from san-itation to physical health to interpersonalrelationships?a. Nightingale c. Freudb. Block d. Vinson

15. What type of framework does not de-rive from the sum of individual parts, butrather from their dynamic, complex inter-action?a. biological c. holisticb. historical d. social

16. What has driven the development of re-siliency training programs?a. effort to decrease the rising rates of mental illnessb. internment camps for US citizens of Japanese an-

cestryc. continued complexity of our societyd. parental loss and substitute parents

17. Parental overprotection resulting in lackof successful accomplishments and self-regulation by the child has been signif-icantly correlated to substance abuse,antisocial behavior, anda. dysfunctional reintegration.b. higher levels of resilience.c. low psychosocial resilience.d. unemployment.

18. The roots of the construct of resilienceare in the psychological aspects of cop-ing and the physiological aspects ofa. plasticity.b. psychoneuroimmunology.c. stress.d. transitions.

19. During the evolution of the construct ofresilience, what physiological develop-ment occurred in the 1920s?a. brain plasticityb. emotional stress and morbidityc. psychoneuroimmunologyd. quantum physics

20. The psychological idea of coping asa conscious process was introducedinto the evolution of the construct of re-silience during thea. 1920s c. 1960sb. 1950s d. 1990s

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