Week 6

Resilience Truths: Trauma Resilience Workers’ Points of View Toward Resilience in Continuous Traumatic Situations

Orit Nuttman-Shwartz1 and Ohad Green2 1 School of Social Work, Sapir College

2 Department of Social Policy and Intervention, University of Oxford

Objective: Many people who are exposed to continuous violence show resilience. Although resilience is considered an umbrella term to describe a range of processes and theories, there is still a debate relating to its nature and definition. Therefore, the current study aimed to explore attitudes, perceptions, processes, and actionable knowledge regarding resilience, and to validate existing knowledge and conceptualizations about this concept.Method:Using a mixed-methods approach, 27 semi-structured interviews were conducted and two resilience questionnaires were administered to trauma resilience workers living in a war zone, in an attempt to describe and analyze resilience as manifested among residents living in a continuous security threat situation. Findings: Content analysis helped validate the conceptual basis for the two questionnaires, and raised three main themes related to the definition of resilience: It is an ecological phenomenon that combines four systems (micro, meso, exo, and macro); it exists during periods of routine, periods of emergency, and periods leading from one to the other; and it is a resource that can be learned and developed. Conclusions: The findings highlight that resilience is an ecological concept, as it is characterized by the interaction between the individual (micro-level) and the meso and macro circles. It is important to recognize these complex interactions in order to encourage and promote successful coping, to predict which individuals will do well, and to use this insight to promote suitable mental health interventions. Further research among different groups who live under different existential threats is also recommended.

Keywords: continuous traumatic stress, resilience, trauma work, war and terror, ways of coping

Resilience is considered to be a positive multidimensional umbrella term that describes a range of processes and theories (Bonanno et al., 2015) which include three orientations (Oshio et al., 2018): trait, outcome, and process. The trait orientation (or trait resilience) views resilience as a personality characteristic that inoculates individuals against the impact of adversity or stressful events or, according to Connor and Davidson (2003, p. 76), as a measure of the “personal qualities that enable one to thrive in the face of adversity.” Although over the years the above definition became broader, personal characteristic conceptualizations of resil- ience still focus mainly upon the inherent qualities of the individual (e.g., Hu et al., 2015), an idea that has recently been supported with evidence of a genetic influence, offering an additional explanation of psychological adaptation to adverse events (Niitsu et al., 2019). An outcome-based definition of resilience, on the other hand, sees

positive adaptation post-adversity as being central (Vella & Pai, 2019). This orientation regards resilience as a functional or behav- ioral outcome that can help individuals overcome and recover from a stressful event (Masten, 2001) as a result of their ability to “maintain a stable equilibrium” (Bonanno, 2004, p. 20). Finally, the process-oriented approach regards resilience as a

dynamic process in which individuals adapt to and recuperate quickly from major stressful events (Fergus & Zimmerman,

2005). Luthar et al. (2000) defined resilience as “a dynamic process encompassing positive adaptation within the context of significant adversity” (p. 543). That is, resilience in this conceptualization is a dynamic process characterized by constant change, activity, or progress, but it is also context-specific, with an individual poten- tially being highly resilient in one context but not in another.

In light of the above dimensions, several theories have succeeded inweaving together the social–ecological perspective (Bronfenbrenner, 1979) with the trauma resilience approach (Harvey, 1996). The first social–ecological perspective was offered by Hobfoll (1989), who proposed the Conservation of Resources (COR) theory and claimed that those individuals who possessed more resources were less vulnerable to resource loss and more capable of resource gain (Hobfoll et al., 2018). Thus, it can be argued that when individuals have numerous personal resources (e.g., trait resilience), they are less vulnerable to resource loss and in a better position to invest resources in becoming psychologically engaged—a process which, in turn, may result in positive health and well-being (Hobfoll, 2011). Drawing on COR theory (Hobfoll, 1989), one would expect that individuals with high trait resilience would remain more psychologically engaged when confronted with terrorism-related risk perceptions and feelings of fear than those with low trait resilience.

The second social–ecological perspective emerged from research- ers and theorists who were primarily interested in the mental health and psychological well-being of adults (e.g., Bonanno, 2004). In their view, resilience was the capacity of a system to anticipate, adapt, and reorganize itself under conditions of adversity in ways that promote and sustain its successful functioning (in human terms, its well-being; Ungar, 2011). That capacity is seldom a trait of the system itself. Rather, it is the result of facilitative interactions with

Orit Nuttman-Shwartz https://orcid.org/0000-0001-5709-1343 Correspondence concerning this article should be addressed to Profes-

sor Orit Nuttman-Shwartz, School of Social Work, Sapir College, D.H. Hof Ashkelon 7619500, Israel. Email: [email protected]

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This article was published Online First December 31, 2020.

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International Journal of Stress Management

© 2020`` American Psychological Association ISSN: 1072-5245 https://doi.org/10.1037/str0000223

2019, Vol. 1, No. 999, 0002021, Vol. 28, No. 1, 1–10

co-occurring, subordinate, and supraordinate systems that makes it possible for a system or its parts to function well during and after a disturbance. In the same vein, based on the protective model of resilience and

aiming to expand the understanding of the mechanisms behind social support’s protective effects (Lee, 2019), Ungar (2008) pro- posed a definition of resilience which focused on the interaction between person and environment: “ : : : the capacity of individuals to navigate their way to resources that sustain well-being; the capacity of individuals’ physical and social ecologies to provide those resources; and the capacity of individuals, their families, and communities to negotiate culturally meaningful ways for resources to be shared” (Ungar, 2008, p. 225). This definition reflects the ability of individuals and the dynamic system to provide essential resources, as well as the ability of the community and the individual to adapt successfully to traumatic events (Norris et al., 2008; Ungar, 2008). Resilience, as such, relates to the individual processes that increase survival as well as to the protective processes initiated by larger systems that aim to provide opportunities for individuals to cope with stress (e.g., Ungar & Liebenberg, 2011). These include individual resilience resources (i.e., personal skills, social skills, and peer support), relational resources (i.e., physical and psychological support from caregivers), and contextual resources (i.e., sense of belonging, educational adhesion, and spirituality; Liebenberg et al., 2012), the latter two of which could also be categorized as social support systems. Henceforth, individual, relational, and contextual resources will be referred to as “resilience resources.” Yet scholars have critiqued resilience theories and practice

models because the definitions, measures, and uses of resilience remain too complex and multifaceted (e.g., Masten, 2018). As the debate on the nature of resilience continues, several attempts have been made to understand this concept. A unique attempt to explore the resilience phenomenon was made by Corzine et al. (2017), who developed axioms on the basis of qualitative interviews with seven Israeli trauma resilience experts, most all of whom were men with combat service experience. The interviews focused on the partici- pants’ “resilience truths,” meaning the truths they had arrived at themselves, from their own experience, about resilience. Among these axioms were “sense of mission,” “the importance of being connected to others,” and individual characteristics such as “inner strength, coping skills, and hope” (Corzine et al., 2017, p. 8). Although the above group experiences are illuminating, they

do not reveal the whole picture, as we still lack the insights of trauma resilience workers who work under ongoing conditions of exposure to real threats in the context of persistent violence. These situations are known as continuous traumatic situations (CTS), with the term CTS having been developed to describe the situation of individuals living in areas of ongoing political violence and national security threats (Nuttman-Shwartz & Shoval-Zukerman, 2016). These CTS can be seen as circular processes characterized by periods of escalation alternating with periods of relative calm, and situations in which past and future perceptions of threat and fear are combined, profoundly affecting exposed civilian populations (e.g., Nuttman- Shwartz & Shoval-Zukerman, 2016). Several research studies have noted the positive aspects found

among mental health professionals, caregivers, and emergency volunteers who work under conditions of ongoing exposure to stress. Among these positive aspects, or resilience components, is sense of meaning (Baum, 2014; Nuttman-Shwartz, 2015). Sense of

meaning was detected among disaster responders and resilience teams who were found to be resilient in the aftermath of the 9/11 World Trade Center rescue efforts (Bonanno et al., 2007), and among volunteers doing disaster work (Harvey & Kathleen, 2015), which in and of itself is considered to be a traumatic experience with long-term effects.

Despite the abovementioned findings, recent systematic reviews of resilience have claimed that there is still a dearth of knowledge and lack of clarity surrounding the term resilience, both in mental health research and in the wider resilience literature (Vella & Pai, 2019). Beyond that, in terms of the role of gender in resilience, although some researchers have found gender to be a promotive and protective factor (Ungar & Theron, 2019), others have revealed that when type of traumatic event was taken into account, these differ- ences became insignificant (e.g., Portnoy et al., 2018). As such, in order to explore the potential role of gender in resilience, it is of value to focus on men and women who were exposed to the same traumatic events. It is also important to stress that given the masculine nature of war and terror, very few studies have been conducted among front-line trauma workers of both genders (Cohen et al., 2017; Sousa et al., 2013). The question of whether gender differences are a factor that promote resilience is therefore still in need of further investigation. In addition, learning from the experi- ence of local emergency teams may shed light on what it is like to be close to the traumatic event, and to work side by side with a variety of people. This knowledge could be beneficial for understanding the complexity of the resilience construct, which is still being debated.

Against this backdrop, the current study aimed to explore attitudes, perceptions, and processes aswell as personal know-how and actionable knowledge that have helped trauma resilience workers living in war zones to cope and function in such situations (for the purposes of this paper, the term “trauma resilience workers” will be used to refer both to paid workers and community volunteers). In the current study, we aimed to deepen our collective understanding of resilience in different contexts by giving people a voice and therefore examining the validity of existing knowledge and conceptualizations regarding resilience.

The Research Context

Since 2001, Israel’s western border with the Palestinian Authority has been the target of more than 20,000 missile attacks. Over the years, the Israel Defense Forces (IDF) has engaged in three operations (2009, 2012, and 2014). Following each operation, the number of missile attacks decreased dramatically for a short period. Neverthe- less, since 2018, Israeli residents of the Gaza-envelope area have been contending with the launching of explosive kites and balloons as well as with the threat of missile attacks and terrorist penetration into Israeli territory. Accordingly, the Israeli government opened resil- ience centers in the area, which aim to help residents better cope with ongoing adversity through psychosocial interventions conducted by trained trauma resilience workers (Nuttman-Shwartz, 2015). Although the number of residents diagnosed with Post traumatic stress disorder ( PTSD) has increased over the years, people have also reported high levels of resilience (Stein et al., 2018).

Method

The present study was conducted using a mixed-methods approach: The qualitative aspect being embodied in the participant

2 NUTTMAN-SHWARTZ AND GREEN

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interviews, and the quantitative aspect embodied in the collection of quantitative data as needed (Mertens & Hesse-Biber, 2013). This approach has been found to be the most suited to revealing the “lived experience” of study participants (Eberle, 2014). The use of the mixed-methods paradigm allows for a comparison of the results of the quantitative findings with the experiences of the interviewees, thus maximizing the strengths of the interviews. The use of mixed- methods paradigms also enhances the reliability and validity of study findings (Ungar, 2011).

Participants

Twenty-seven residents (9 men and 18 women) who are trauma resilience workers in the area were asked to participate in the study. Participants ranged in age from 25 to 72 and lived in residential areas (kibbutzim) on the Israeli side of the border with Gaza. Of them, 75% were married with children, 85% defined their health as being “excellent,” and 75% considered themselves secular. All but one was exposed to missile attacks, and around 50% experienced a missile hit close to their home. Around 30% were social workers, around 40% were educators, and 30% of the participants were affiliated with an emergency team as paraprofessionals (they worked in a variety of occupations, including farming). Seventy percent had more than 10 years of professional experience.

Procedure

The study was approved by the School of Social Work’s Institu- tional Review Board. Beginning in January 2018, nine research students used a snowball approach to choose trauma resilience workers in the exposed area to ask them to participate in the study. To ensure that the interviewers were sufficiently skilled in the ques- tioning processes, the primary researcher trained them in the qualitative interview process, and guided them throughout data collection. All interviews took place in the participants’ homes and were recorded and later transcribed verbatim and then anonymized. At the beginning of each interview, the rationale and course of

the research were explained, informed consent forms were signed, and the potential challenges of dealing with sensitive issues were mentioned again. In addition, ways of receiving future support were reviewed. Upon receiving informed consent, semi-structured in- depth interviews (Patton, 2015) were conducted in accordance with an interview guide that addressed the issue of resilience. Questions referred to ways of coping, perceptions of resilience, coping strate- gies, and concepts regarding coping that the participants had developed over the years on both the personal and interpersonal level. Interviews lasted 90 min on average. At the end of the interview, the participants were asked to answer three questionnaires:

1. A sociodemographic questionnaire, which included age, marital status, education, and health status (Dekel & Nuttman-Shwartz, 2009).

2. The Resilience Research Center Adult Resilience Measure (RRC-ARM), which measures social–ecological resil- ience in adult populations (Liebenberg & Moore, 2018; Hebrew version by Al-Krenawi, 2017). This measure consists of 28 statements reflecting individual, relational, and contextual resilience processes (Liebenberg et al., 2012). The scale is scored by summing the responses to

each item answered on a 5-point Likert scale ranging from 1 (not at all) to 5 (all the time). The minimum scale score is 28, and the maximum is 140. It has excellent psychomet- rics (e.g., high internal consistency, Jefferies et al., 2019; test–retest reliability of ≥7 at 2-week and 3-month inter- vals, Daigneault et al., 2013; face validity, Daigneault et al., 2013). In the current study, the measure’s internal consistency was 86.

3. The Resilience Truism Scale (RTC; Corzine et al., 2017). This scale contains 17 statements that pertain to individual and community-based issues. The scale was developed on the basis of findings revealed by seven Israeli experts on trauma resilience, and reflects their knowledge, experi- ences, and the perceptions they derived from an online trauma resilience survey conducted with 13 other members of an expert Israeli panel. The scale is scored by summing responses to items answered on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). The minimum scale score is 19, and the maximum is 95. A higher score reflects higher resilience. The tool was first translated into Hebrew by one of the authors of this paper for the purpose of the current research. In the current study, the internal consistency of the scale was 82.

Data Analysis

Data analysis was conducted using a mixed-methods approach. First, data analysis was carried out separately for each research tool, and then a comparison wasmade between the two analyses. As such, the data were first analyzed in accordance with thematic content analysis (Clark et al., 2015) and in keeping with an interpretive phenomenological approach (Shinebourne, 2011). This approach follows participants’ descriptions in the construction of meanings derived from the data, which enables the deconstruction and recon- struction of the text beyond what is actually said in the interview. Then, to enhance the reliability of these findings and based on deductive content analysis, the abovementioned themes were com- pared with the three main subthemes derived from the resilience tool (Bengtsson, 2016; Ungar, 2011). This method involves identifying the components of theoretical concepts and showing the interplay between the thematic analysis and the areas that appear in the research questionnaires. We also relied on the Sandelowski et al. (2012) framework of a mixed-methods synthesis, or “synthesis by aggregation,” to integrate and explore the relationships between the quantitative and qualitative types of data and to see whether there was any repetition of the findings. All statistical procedures were performed with International Business Machines (IBM SPSS 24 (International Business Machines [IBM], 2016). No missing values or outliers were found. In order to control for multiple comparisons, we used the Benjamini-Hochberg (1995) false discovery rate (FDR), with a q value of .1 (i.e., 10% of the significant results will be false positives at p < .05).

Rigor

To maintain an observant, inquisitive, and unbiased attitude (Finlay, 2009), the interviewers did not interview residents with whom they were already acquainted. In addition, the interviewers used an interview manual to help them stay focused on the subject

RESILIENCE TRUTHS 3

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(Patton, 2015), and they were supervised by one of the study’s authors. As mentioned, the data were analyzed by the students and their supervisor, who met on a bi-weekly basis to share their proposed conceptualizations. The findings and the theoretical con- ceptualizations were compared with the participants’ questionnaires, ensuring that the findings reflected their actual life experiences.

Results

Descriptive results regarding the RRC-ARM and RTC scores, as mean and standard deviation scores, are presented in Table 1. The RRC-ARM average was 120.92 (out of a maximum of 140), and the RTC average score was 72.74 (out of a maximum of 95). In both questionnaires, the participants received high scores on each of the separate components, implying that the participants saw each component as an equally important factor in building their resil- ience. In order to explore whether there were differences between women and men in their resilience, a series of independent sample t- tests was performed (see Table 1). Although gender is usually considered to be a robust predictor of resilience (e.g., Kimhi & Eshel, 2016), no differences were found between men and women in the RRC-ARM total score or in the RTC score, even when compar- ing each component separately. A main goal of the open-ended interview (see Appendix) was to

explore the participants’ definitions of resilience, to learn more about their ways of coping with the adverse situations they found themselves in, and to understand how they were able to do their jobs and help others in the context of being members of an emergency team living near the border. Their reflections formed the basis of the content analysis of the interviews, which revealed three main themes: (a) resilience is an ecological phenomenon comprising four systems: the microsystem, the mesosystem, the exosystem, and the macrosystem; (b) resilience exists during periods of routine, periods of emergency, and periods leading from one to the other; and (c) resilience is a dynamic phenomenon; it is a resource that can be learned and developed.

The Ecological Definition of Resilience: “The Individual Is Not Enough.”

Most of the participants considered resilience to be a kind of coping that interweaves four systems: the individual, the family, the

community, and the country. Most of them defined resilience on the basis of an ecological perspective that combines characteristics of the individual and the environment. For example, Idit said the following:

[Resilience is] a combination that begins with the individual : : : It’s not enough, because there is also the need to consider the environment : : : it’s not possible to consider the environment without the individual : : : and it’s not possible that the individual is there without the environment : : : That is, there’s more, but first of all it’s personal resources, and then what do you do with them? : : : What you do with them is the environment.

Resilience Is Imprinted: The Hereditary Component

A small number of participants (six) said that resilience was a matter of genetics. These participants emphasized that inherited personality traits were the basis for the emergence and presence (or absence) of resilience. For example, Sigal said:

Nothing can be done. It’s human nature, it’s something genetic, it’s something hereditary : : : It’s something inherent. You can build it and reinforce it, but it’s not something we can control.

Ronen supported the perspective that resilience was a stable personality trait ingrained in the individual: Something that accom- panied people everywhere. As he said:

Personal resilience is when I feel strong (inside) and I feel the same thing outside : : : I’m sure I’ll have the same problems elsewhere— even if I live in Berlin. Because in the end it’s personal, personal resilience.

Gila detailed the personality traits that she perceived to be related to resilience:

Optimism, the ability to receive assistance : : : the ability to stand on your feet and function : : : people with self-confidence : : : and what else is a personality trait : : : I don’t knowwhether it’s courage because sometimes it’s stupidity, but it’s a kind of naive belief that things will get better : : : it’s optimism. That’s a nicer word : : : and lack of fear : : : like, someone who’s afraid doesn’t need to be here.

Resilience in the Context of Individual, Family, and Community Roles

Parenting Role of Care and Concern for Children. Many of the interviewees talked about the experience of being parents in the context of living amid an ongoing security threat, and described the parental role as requiring coping skills and resilience. Their state- ments indicated that they were aware they had taken on more responsibility when they brought children into the world, and that they were responsible not only for themselves but for their whole family. For example, Alon argued:

No doubt there’s a difference between being a parent and living here as a bachelor or a young couple without children. You have much more responsibility, you have a lot of responsibility for your children.

In addition, the participants’ statements also reflected gender differences in terms of associations between parenting and resil- ience. Whereas the male participants in general saw parenthood as something that strengthened resilience, the women had a more nuanced/complicated perspective on the matter.

Table 1 RRC-ARM and RTC: Gender Comparison

Males (n = 9) Females (n = 18) Total

SUM SD SUM SD t SUM SD

RRC-ARM Individual 48.77 2.05 49.50 3.86 −.50 49.25 3.51 Personal 31.56 2.35 32.06 2.66 −.83 31.89 2.53 Context 41.11 6.86 41.02 4.47 −.33 41.04 5.25 Total 121.44 10.23 122.55 9.38 −.28 122.18 9.49

RTC Individual 50.55 5.24 52.17 6.04 −.68 51.63 5.73 Community 20.33 2.64 21.50 1.97 −1.29 21.11 2.24 Total 70.88 7.15 73.67 7.45 −.93 72.74 7.33

Note. RRC-ARM=Resilience Research Center Adult ResilienceMeasure; RTC = Resilience Truism Scale.

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For example, Alon indicated that the responsibilities that accom- panied being a father increased and improved his resilience, as a result of his commitment and desire to protect his family:

When you’re aware that someone relies on you, that they depend on you a lot : : : it’s the little boy that you know is waiting for you at home—it also obligates you to take care of yourself, [so you can] come back and take care of him.

By contrast, the majority of the women claimed that their resil- ience was weakened by their concern for their own well-being and the well-being of their children. Anat, for instance, highlighted the fact that she needed to at least externally exhibit resilience toward her children (she termed this kind of resilience “visible resilience,”) but that her sense of resilience was not the same as it had been prior to becoming a mother.

Today I understand that I need to protect both my children andmyself in order to be there for them : : : The security situation motivates me to show resilience in advance : : : I call it “visible resilience”when they at least feel that mommy is resilient and strong : : : but motherhood also undermines something in the resilience I had before : : :

Dana also saw gender-based differences when it came to resilience:

Women have some kind of power internally : : : I can’t tell you if it’s because women, for generations, have been raised like this : : : the ability of women, adapting themselves, adapting : : : before World War II they were housewives but they went out to work when they needed to, they adapted and went to work, they were amazing, after that they were told to come back home : : : . So women do both : : : they showed a lot of power, a lot of ability to adapt : : : then and now.

Ofra addressed the connection between the two, seeing mother- hood as something that fed and nourished her resilience:

It gives me strength. My motherhood. It is a very significant component of my resilience, that I have to be “the one” for them. Steady, supportive, supportive : : : it is an essential component that affects my resilience.

Role of Care andConcern forOthers (Outside the Family). A few of the participants looked outside of the family milieu and mentioned social systems as well as interpersonal relations within these systems. According to these participants, social responsibility strengthens resilience. For example, Uzi said:

When you know that your neighbor is 80 years old, that he hasn’t left the kibbutz and needs help, this strengthens you : : : it’s a kind of mirror— a kind of feedback that increases your resilience every time. Youwant to help others, because you feel they need it; they rely on you, and it strengthens you.

Alon referred to the contribution of the emotional dimension (within one’s concern for others) to one’s sense of resilience:

The knowledge that you have someone to love and someone who loves you does a lot. And so does your ability to take care of people— altruism. It’s another thing that really, really helps you cope with these things. It’s on the level of “doing.”

Role of a Cohesive Community. Maintaining common life- style rituals, routines, and services in the community lent to the development of resilience. Study participants emphasized the con- tribution of community, particularly in the context of military

escalation and war. They pointed to two dimensions of commu- nity: The concrete environment and landscape, and the social matrix, both of which serve as major factors that have an impact on resilience.

Orna and Ruthie mentioned mutual support among community members, particularly during periods of escalation. Orna said:

So the people in the group of 60 community members who have stayed here have created a small, very cohesive community that maintains a common lifestyle. They eat meals together. They bring entertainers and all kinds of people who come to be with the residents. And the feeling of togetherness among those who stay is a major source of cohesiveness. Again, togetherness is what brings security. That’s a fact.

Ruthie talked about the community atmosphere during times of war:

The manifestation of resilience is the incredible atmosphere here : : : It doesn’t matter how dangerous or scary it is here. Every evening there was a meal in the war room : : : People wanted to be together, and there was a kind of nostalgia for the kibbutz of the past where they ate meals together and held a service to bring in the Sabbath : : : It was festive : : : Afterwards, people missed it, because it was a manifestation of resilience : : :

Role ofMacro System Support (Social Governmental Systems) in Creating Resilience. Participants also mentioned support at the macro level, coming from the regional council, the local authority, and the government, as factors related to the emotional dimension of resilience, and no less to the instrumental dimension. This perspective on resilience represents a broader perspective, which sees resilience as depending on the individual and the environment, as well as on the ecological system of relationships. For example, Ronen talked about his sense of security when he heard that the IDF would be protecting the border:

One of the things that I feel has affected my resilience over the years is, among other things, the state’s response. Recently, there has been a more assertive policy and I feel it affects my resilience. The belief that I am being guarded by others, and I don’t have to only rely on myself for protection. It provides a feeling of reinforcement. That someone sees and someone cares.

Arieh added a comment about the important role of the govern- ment and the broader environment in creating resilience:

I think there was help during the war. There is usually help from people all over the country and help from the government, as well as help from the public and help from the regional resilience centers.

Resilience From the Perspective of Time

Resilience at Two Timepoints

Participants talked mainly about resilience at two timepoints: (a) during the emergency event, and (b) during times of quiet in general, and the return to routine in particular. Most of the participants talked about resilience’s basic stability and continuity, and about the ability to function in any situation, whether routine or emergency. Orna said:

Resilience is the ability of a locality, of the people living in the locality, to cope with any situation—emergency and routine—and to know what to do under any circumstances.

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Resilience Reflects the Ability to Move Between the Two Timepoints

Functioning and fulfilling roles in emergency situations can also promote resilience. Some of the participants (10) emphasized that continuing to function and maintaining a certain routine in times of emergency were factors that strengthened resilience. They also indicated that the opposite, inactivity, could have a negative effect on resilience. In Uzi’s words:

When we continue functioning, it strengthens our resilience in the face of an event, and even protects us afterwards. In cases when I see that this doesn’t happen, when people stop functioning for whatever reason and think “what bad luck we have now,” they break down : : : we need a framework that protects us.

And Orna said:

When you’re essential, you feel more confident : : : so the fact that they needme gives me confidence. That is, when I am essential it makes a big difference. The need and the ability to stop for a moment and look at others, rather than at myself, is power : : : I think that this is the clearest manifestation of resilience : : : not breaking down, and helping others.

A few of the participants indicated that in their opinion resilience was characterized by the ability to move between modes. In other words, it was reasonable to expect that in emergency situations, functioning would be impaired. Then, when life “went back to normal,” one would be expected to return to normative functioning. For example, Arieh said:

I think that not being harmed at all by stress situations is utopia. In my view, resilience is the ability to be harmed but also the ability to return to normal functioning and to a routine.

Anat further argued that the ability to function should go beyond one’s ability to function during a difficult security situation, and that resilience could be defined as:

The ability to rise above crises, or to overcome challenges : : : It doesn’t always have to be a crisis : : : It is a challenge that we can overcome : : :

Galit put an emphasis on the return to routine, and claimed that:

Resilience appears to be measurable afterwards : : : by how you get out [of the crisis], and by how it affects you; how it affects your everyday life. If I’m not in control of my behavior, or if I am in control.

Strategies and Activities to Promote Resilience

Practice and Advance Preparation

Many of the participants highlighted the important role of pre- paring oneself in advance, and repeating these preparations, if the goal is to create/maintain resilience. For example, Orna argued:

Knowing what you need to do is the result of a lot of practice; it is not spontaneous. Then you won’t lose control the minute something happens.

Eitan lent his support to this argument:

Practice, practice, and practice. If you get it into your head that you need to act in a certain way even if you feel stress, you’ll do what you were taught or act the way they said you should.

In the same vein, Ofra said:

I am much stronger in my ability to cope with my stress. Certainly : : : the regional council, they are very careful about providing training for resilience and emergency teams. Lectures, conferences, study days. They really trained me step by step to be what I am today.

Task Preparation and Emotional Preparation

The study participants argued that in order to be resilient, one must cope on two levels—the knowledge level, and the staying- calm level—and they combined these two aspects. For example, Eitan emphasized the importance of information dissemination as being instrumental to preparation.

I think that participating in public activities together, explaining what is taking place, keeping the situation transparent and not hiding anything : : : all of that can increase resilience.

Uzi indicated that as part of his need to be in control, staying aware and being updated about the security situation helped him feel more resilient:

Knowing what’s going on with the security situation : : : I follow it closely. At least for me, as a father of a family, it creates resilience.

However, Idit and Alon emphasized the emotional dimension and highlighted the importance of emotional processing and venting. Thus, Idit stated:

: : : There is a need to process emotions when things happen; to identify stressors and sensitive people, to take care of them, to do a lot of preparation and organize practice drills based on scenarios and contin- gency plans : : : meaning, you need to keep working on it even during routine periods and prepare for it so that when there’s an emergency it doesn’t take you by surprise : : : It’s true that today everything they do is based on what has already happened, because we can’t anticipate extraordinary events—so you need to do something about that too.

Alon talked about fight-or-flight responses in the context of resil- ience, and about the importance of leaving the area and taking a break.

That is, from a situation where you understand that you’re fighting against this, or fighting to maintain a routine : : : then I’m actually fightingwithmyself : : : “OK, this situation is not so bad, I can deal with it : : : ” The moment you realize that the situation is at a boiling point and that it’s not healthy, then you decide on flight—to disappear, to get out of here : : : and when the crazy ones [Alon used this expression to describe the people who were rocketing] calm down you’ll come back.

Several participants believed it was extremely important to create and foster a sense of teamwork.

I think the most important thing is to foster a working groupwith a sense of pride : : : with a strong sense of trust and with incredible leadership.

Finally, a few participants emphasized the importance of feeling safe in their own private lives and homes, in terms of resilience. Specifically, Uzi and Alon talked about the protected space in their apartments as a place that enabled them to feel they were in control and protected against missiles.

The protected room creates a better sense of resilience, where people know they have a place of refuge and feel they can be safe. When you are in a place where you are in control, you feel safe : : : . That knowledge is resilience, or at least it provides resilience.

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Discussion

The current research aimed to contribute to the obtaining of a universally accepted definition of the complex construct of resilience. We attempted to realize this goal by learning from the experiences of residents who live in a CTS and serve as trauma resilience workers in their communities. In general, the participants showed a high level of resilience, reflected not only in the qualitative interviews, but also in the quantitative measures. In both questionnaires, our participants scored high on resilience and received high scores on each of the separate components. In addition, each component was found to be an equally important factor in the building of their resilience. The implication of these findings is that participants see resilience as a complex phenom- enon: A bio-psycho-ecological concept with genetic, personality, and personal aspects, connected with family and community contexts. As such, our research findings support the idea that resilience is a complex construct that can be seen through the prism of three orientations: trait, outcome, and process (Oshio et al., 2018). As mentioned, six parti- cipants saw resilience as a genetic-based phenomenon. On the one hand, it could be said that our findings are therefore in line with current resilience studies claiming that there is a genetic influence on psycho- logical resilience (Niitsu et al., 2019). On the other hand, the findings overall stress the idea that resilience is a complex biopsychosocial phenomenon influenced by an individual’s genetic makeup, the inter- action between genes and environment, and epigenetics, which relate to behavioral and psychosocial variables. There are other theories as well, such as the idea that resilience is something one can learn or be taught to acquire (Galatzer-Levy et al., 2018). In any event, until recently studies on psychological resilience have focused on behavioral and psychosocial variables, with far less examination of the genetic contribution. As such, the genetic basis of the concept as a whole needs to be further addressed in order to help develop an individually tailored approach to fostering resilience (Niitsu et al., 2019). The current results also provide empirical evidence for the

“multidimensional five-part model of resilience,” coined by de Terte et al. (2009), which states that individual, family, community, and societal attributes are considered holistically to be part of resilience building. Based on this perspective, the current results support the social ecology (environment) theory of resilience, which has shown that environment × individual interactions are related to resilience (Ungar, 2013). Within this broader perspective, the participants stressed the importance of the individual bio-psycho- logical components, which have been well documented in previous empirical data (Connor & Davidson, 2003). The participants even talked about resilience in the family (Pagorek-Eshel & Finklestein, 2019), as well as intergenerational transmission. These findings are in line with the results of recent studies in neuroscience (e.g., Lehrner & Yehuda, 2018). They are also in line with the Connor and Davidson resilience scale, which has demonstrated that resil- ience factors vary widely across developmental, social, cultural, and environmental contexts. In addition, adaptability—another compo- nent of resilience—was found to be a reflection of culture and training and is heavily emphasized in the tasks and responsibilities often required of service members (Green et al., 2014). According to Freedman and Burns (2010), “Adaptability requires the capacity to take decisive and effective action in a timely manner, often under pressure.” Perhaps this ability to cope or adapt within stress- inducing conditions, as reflected by the current research participants, serves as a fundamental source of protection against this popula- tion’s development of vulnerability and even mental illness.

Moreover, the participants shed light on the idea that resilience is something that either exists or does not exist, in emergencies as well as in routine situations. This notion is important, as most studies have dealt with measuring resilience in extreme situations such as war or terror, and not specifically in CTS. In these chronic situations, one must be able to oscillate between emergency and routine, and to have the flexibility to do so when needed. These ideas are in line with the definitions proposed by several scholars, who view resil- ience as a stable trajectory of healthy functioning, and the capacity of a dynamic system to adapt successfully to disturbances that threaten the viability, functioning, or development of that system beyond the adverse event (Bonanno & Burton, 2013).

Study results showed that the question “What strengthens resil- ience?” goes beyond the meso level and includes a variety of “others.” That is, one’s sense of responsibility and concern for others serves as another thread weaving together the micro and the meso levels. Participants mentioned several interactional factors that they felt contributed to resilience, including—as mentioned previously— caring for others, as well as taking on interpersonal and social responsibilities. They claimed that these were the main contributors that strengthened them and enabled them to function during periods of adversity. That said, they perceived one of their roles—the parental role—as a dual role. On the one hand, as parents, they knew they needed to help their children cope and show resilience; on the other hand, this sense of responsibility increased their anxieties and impaired their ability to adjust and function. That the parenting role was found to be more stressful in the CTS context might be explained as follows: Parents likely influence their young children’s interpretations of the security situation around them, and the chil- dren’s understanding of the situation, in turn, can then have a negative impact on the parents’ functioning, their ability to be effective, and their ability to be sensitive to their children’s needs (e.g., Gewirtz et al., 2008). In addition, parents may experience feelings of guilt, helplessness, and frustration as a result of their decision to raise their children in dangerous areas that lack political security. They may fear for their children’s (including their adult children’s) current and future mental health (Litvak-Hirsch & Lazar, 2011).

In terms of the role gender plays in resilience in the face of political violence, it is important to emphasize that the evidence has been mixed, and very few studies have been conducted among front-line trauma workers (Cohen et al., 2017; Sousa et al., 2013). Moreover, although several studies regarding gender and resilience have con- cluded that women are less resilient than men following adversity (e.g., Buikstra et al., 2010; Kimhi & Eshel, 2016), and other findings showed that fathers felt more resilient in caring for their children whereas mothers felt more distress (Pagorek-Eshel & Finklestein, 2019), in the current research, interestingly, the resilience scores were similar between men and women. It seems that this feeling of distress regarding their maternal role did not affect the women participants’ levels of resilience. This finding might be explained by women’s more active engagement in providing assistance during times of political violence via their participation in the military, as well as in the provision of emergency services to civilians (Drolet et al., 2015; Laurence, 2017). In Israel, women comprise 30%–40%of these team members, similar to their representation in the IDF (Huss & Cwikel, 2015). These gender-related aspects, as far as their impact on resilience, deserve continued discussion and future research.

The reciprocal effect described previously, in terms of parents and children, is also true of what transpires between trauma resilience

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workers and the people they help (Dekel & Nuttman-Shwartz, 2014). It is important to point out the mutually beneficial aspects of these two roles: the helper and the help-ee. Specifically, being an adult involved in trauma resilience work can be helpful both to one’s self as well as to the people one is helping. The participants highlighted the importance of a sense of competence, meaningful- ness, and belonging, stemming from their containing and holding role. This was also found to be the case among mental health professionals (Lavi et al., 2017), and underscores the important role of the community and its social climate as well as the role of solidarity in promoting resilience. These previous findings are in line with the findings of the current research as well as with other studies (Norris et al., 2008; Ungar, 2008). In this context, it is important to mention the impact of cultural setting, which has been found to be important and may serve as a protective factor against adversity as well as promote resilience (Tengö et al., 2014). As mentioned, Israeli society values the military (Huss & Cwikel, 2015), and it is a community-based society, both of which factors may serve as cultural sources of resilience (Dekel & Nuttman- Shwartz, 2009). The results of the current study also point to skills that help people be resilient. These skills are a combination of cognitive and emotional preparedness on the one hand, and practical strategies that can be implemented in routine as well as in emergency situations on the other. Hence, we must not treat as separate issues the strength of the individual versus the strength of the family. Before concluding, several limitations of the study should be

mentioned. The sample was small, and the participants did not represent all of the residents or trauma resilience workers in the localities in the region. In addition, they were unequal in terms of gender and quite heterogeneous in terms of their age, education, and professions. There was no baseline or control group, and the individ- ual interviews were conducted during a period of calm—a situation that is always subject to change in this geographical area. Owing to the lack of a control group, the results presented here are preliminary, and largely relied on residents involved in trauma work. However, despite these limitations, the main contribution of the current findings is that for the first time, the ecological perspective toward resilience— a perspective that sees resilience as being characterized by interac- tions between the individual, meso, macro, and exo systems— received a “stamp of approval” from trauma resilience workers. The definition of resilience must include individual protective

traits; processes; a consideration of family, community, and environ- mental and social context; and how all thesemechanisms interact. The definition of resilience emphasizes effective emotional, cognitive, and concrete adaptation, adjustment, and acceptance. Developing resil- ience must therefore be viewed through the ecological perspective and the four circles of systems: micro, meso, macro, and exo. We must also be mindful of the importance of support/reinforce-

ment in the context of a person being able to play a role in an emergency. Such support (or lack thereof) may affect the person on both the individual and family level and carrying out this role successfully depends to a great degree on significant emotional and physical preparation. In the same vein, this preparation must also be seen from an ecological perspective. That is, one must be emotionally prepared for the task, in order to first gain physical protection and environmental support. Lastly, there is a need to recognize the complex interactions across systems that predict which individuals will do well, and to use this insight to advance mental health interventions. It would therefore be worthwhile to

conduct further research, among additional populations, in order to examine whether the definition of ecological resilience and the above-described complexity also reflects other regions, as well as different marital, family, age, and gender groups. An additional goal would be to explore to what extent and how people from these other populations can achieve and develop resilience.

As with any other mental health research on issues related to disaster scenarios, this paper was motivated by a sense of mission, potentially raising issues of replicability, study design, and scientific rigor, which are legitimate ethical concerns (Norris et al., 2006). Still, we should remember that this kind of research is important for two reasons: (a) it explores the effects of disaster events and traumatic exposure on mental health and related constructs; and (b) it explores the implications for trauma workers, thereby helping to prevent or reduce disaster-related mental health problems (Norris et al., 2006). For these reasons, the present study is vital to resilience mental health literature and practice.

References

Al-Krenawi, A. (2017).Building peace through knowledge. Springer. https:// doi.org/10.1007/978-3-319-56279-7

Baum, N. (2014). Professionals’ double exposure in the shared traumatic reality of wartime: Contributions to professional growth and stress. British Journal of Social Work, 44(8), 2113–2134. https://doi.org/10.1093/bjsw/bct085

Bengtsson, M. (2016). How to plan and perform a qualitative study using content Analysis. Nursing Plus Open, 2, 8–14. https://doi.org/10.1016/j .npls.2016.01.001

Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society. Series B. Methodological, 57, 289–300. https://www.jstor .org/stable/2346101. https://doi.org/10.1111/j.2517-6161.1995.tb02031.x

Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59, 20–28. https://doi.org/10.1037/0003- 066X.59.1.20

Bonanno, G. A., & Burton, C. L. (2013). Regulatory flexibility: An individual differences perspective on coping and emotion regulation. Perspectives on Psychological Science, 8, 591–612. https://doi.org/10 .1177/1745691613504116

Bonanno, G. A., Galea, S., Bucciarelli, A., & Vlahov, D. (2007). What predicts psychological resilience after disaster? The role of demographics, resources, and life stress. Journal of Consulting and Clinical Psychology, 75(5), 671–682. https://doi.org/10.1037/0022-006X.75.5.671

Bonanno, G. A., Romero, S. A., & Klein, S. I. (2015). The temporal elements of psychological resilience: An integrative framework for the study of individuals, families, and communities. Psychological Inquiry, 26, 139–169. https://doi.org/10.1080/1047840X.2015.992677

Bronfenbrenner, U. (1979). The ecology of human development: Experi- ments by nature and design. Harvard University Press.

Buikstra, E., Ross, H., King, C. A., Baker, P. G., Hegney, D., McLachlan, K., & Rogers-Clark, C. (2010). The components of resilience—Perceptions of an Australian rural community. Journal of Community Psychology, 38(8), 975–991. https://doi.org/10.1002/jcop.20409

Clark, V., Braun, V., & Hayfield, N. (2015). Thematic analysis. In J. A. Smith (Ed.), Qualitative psychology: A practical guide to research methods (3rd ed., pp. 222–248). Sage Publication.

Cohen, O., Goldberg, A., Lahad, L., & Aharonson-Daniel, L. (2017). Building resilience: The relationship between information provided by municipal authorities during emergency situations and community resil- ience. Technological Forecasting and Social Change, 121, 119–125. https://doi.org/10.1016/j.techfore.2016.11.008

8 NUTTMAN-SHWARTZ AND GREEN

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor–Davidson resilience scale (CDRISC). Depression and Anxiety, 18, 76–82. https://doi.org/10.1002/da.10113

Corzine, E., Figley, C. R., Marks, R. E., Cannon, C., Lattone, V., & Weatherly, C. (2017). Identifying resiliency truisms axioms: Israeli experts on trauma resilience. Traumatology, 23(1), 4–9. https://doi.org/ 10.1037/trm0000094

Daigneault, I., Dion, J., Hébert, M., McDuff, P., & Collin-Vézina, D. (2013). Psychometric properties of the child and youth resilience measure (CYRM-28) among samples of French–Canadian youth. Child Abuse & Neglect, 37(2-3), 160–171. https://doi.org/10.1016/j.chiabu.2012.06.004

de Terte, I., Becker, J., & Stephens, C. (2009). An integrated model for understanding and developing resilience in the face of adverse events. Journal of Pacific Rim Psychology, 3(1), 20–26. https://doi.org/10.1375/ prp.3.1.20

Dekel, R., &Nuttman-Shwartz, O. (2009). Posttraumatic stress and growth: The contribution of cognitive appraisal and sense of belonging to the country. Health & Social Work, 34, 87–96. https://doi.org/10.1093/hsw/34.2.87

Dekel, R., & Nuttman-Shwartz, O. (2014). Being a parent and a helping professional in a continuous shared traumatic reality in southern Israel. In R. Pat-Horenczyk, D. Brom, C. Chemtob, & J. Vogel (Eds.), Helping children cope with trauma: Individual, family and community perspectives (pp. 224–240). Routledge.

Drolet, J., Dominelli, L., Alston, M., Ersing, R., Mathbor, G., & Wu, H. (2015). Women rebuilding lives post-disaster: Innovative community practices for building resilience and promoting sustainable development. Gender and Development, 23(3), 433–448. https://doi.org/10.1080/ 13552074.2015.1096040

Eberle, T. S. (2014). Phenomenology as a research method. In U. Flick (Ed.), The Sage handbook of qualitative data analysis (pp. 184–202). Sage Publication. https://doi.org/10.4135/9781446282243.n13

Fergus, S., & Zimmerman, M. A. (2005). Adolescent resilience: A frame- work of understanding healthy development in the face of risk. Annual Review of Public Health, 26, 399–419. https://doi.org/10.1146/annurev .publhealth.26.021304.144357

Finlay, L. (2009). Debating phenomenological research methods. Phenom- enology & Practice, 3, 6–25. https://doi.org/10.29173/pandpr19818

Freedman,W. D., & Burns,W. R. (2010).Developing an adaptability training strategy and policy for the Department of Defense (IDA Paper P-4591). http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA531765&Location=U2& doc=GetTRDoc.pdf

Galatzer-Levy, I. R., Huang, S. H., & Bonanno, G. A. (2018). Trajectories of resilience and dysfunction following potential trauma: A review and statistical evaluation. Clinical Psychology Review, 63, 41–55. https:// doi.org/10.1016/j.cpr.2018.05.008

Gewirtz, A., Forgatch, M., & Wieling, E. (2008). Parenting practices as potential mechanisms for child adjustment following mass trauma. Jour- nal of Marital and Family Therapy, 34(2), 177–192. https://doi.org/10 .1111/j.1752-0606.2008.00063.x

Kimberly T. Green, Laura C. Hayward, Ann M. Williams, Paul A. Dennis, Brandon C. Bryan, Katherine H. Taber, Mid-Atlantic Mental Illness Research, Education and Clinical Center Workgroup, Jonathan R. T. Davidson, Jean C. Beckham & Patrick S. Calhoun (2014). Examining the factor structure of the Connor–Davidson Resilience Scale (CD-RISC) in a Post-9/11 U.S.Military Veteran Sample. Assessment, 21(4), 443–451. https://doi.org/10.1177/1073191114524014

Harvey, J. B., & Kathleen, W. (2015). The compassion fatigue and resilience connection: A survey of resilience, compassion fatigue, burnout, and compassion satisfaction among trauma responders. Journal of Emergency Mental Health and Human Resilience, 17(1), 318–326. https://doi.org/10 .4172/1522-4821.1000165

Harvey, M. R. (1996). An ecological view of psychological trauma and trauma recovery. Journal of Traumatic Stress, 9, 3–23. https://doi.org/10 .1002/jts.2490090103

Hobfoll, S. E. (1989). Conservation of resources: A new attempt at concep- tualizing stress. American Psychologist, 44, 513–524. https://doi.org/10 .1037/0003-066X.44.3.513

Hobfoll, S. E. (2011). Conservation of resource caravans and engaged setting. Journal of Occupational and Organizational Psychology, 84, 116–122. https://doi.org/10.1111/j.2044-8325.2010.02016.x

Hobfoll, S. E., Halbesleben, J., Neveu, J., & Westman, N. (2018). Conser- vation of resources in the organizational context: The reality of resources and their consequences. Annual Review of Organizational Psychology and Organizational Behavior, 5, 103–128. https://doi.org/10.1146/annurev- orgpsych-032117-104640

Hu, T., Zhang, D., & Wang, J. (2015). A meta-analysis of the trait resilience and mental health. Personality and Individual Differences, 76, 18–27. https://doi.org/10.1016/j.paid.2014.11.039

Huss, E., & Cwikel, J. (2015).Women’s stress in compulsory army service in Israel: A gendered perspective. “Work” Journal: Special Issue on Women in the Army, 50(1), 35–50. https://doi.org/10.3233/WOR-141930

International Business Machines. (2016). IBM SPSS statistics for windows, version 24.0.

Jefferies, P., McGarrigle, L., & Ungar, M. (2019). The CYRM-R: A Rasch- validated revision of the child and youth resilience measure. Journal of Evidence-Based Social Work, 16, 70–92. https://doi.org/10.1080/ 23761407.2018.1548403

Kimhi, S., & Eshel, Y. (2016). Demographic characteristics and sense of danger predicting a new measure of individual resilience following a war. Journal of Community Medicine & Health Education, 6(5), 472–480. https://doi.org/10.1016/j.socscimed.2020.113389

Laurence, J. H. (2017). Women and the US military: Progress & challenges. In D. E. Rohall, M. C. Enger, & D. Mathews (Eds.), Inclusion in the American Military: A force for diversity (pp. 111–128). Lexington Books.

Lavi, T., Nuttman-Shwartz, O., &Dekel, R. (2017). Therapeutic intervention in a continuous shared traumatic reality: An example from the Israeli/ Palestinian conflict. British Journal of Social Work, 47(3), 919–935. https://doi.org/10.10973/bjsw/bcv127

Lee, J. S. (2019). Perceived social support functions as a resilience in buffering the impact of trauma exposure on PTSD symptoms via intrusive rumination and entrapment in firefighters. PLOS One, 14(8), Article e0220454. https://doi.org/10.1371/journal.pone.0220454

Lehrner, A., & Yehuda, R. (2018). Trauma across generations and paths to adaptation and resilience. Psychological Trauma: Theory, Research, Prac- tice, and Policy, 10(1), 22–29. https://doi.org/10.1037/tra0000302

Liebenberg, L., & Moore, J. C. (2018). A social ecological measure of resilience for adults: The RRC-ARM. Social Indicators Research, 136, 1–19. https://doi.org/10.1007/s11205-016-1523-y

Liebenberg, L., Ungar, M., & Vijver, F. V. (2012). Validation of the child and youth resilience measure-28 (CYRM-28) among Canadian youth. Research on Social Work Practice, 22, 219–226. https://doi.org/10.1177/ 1049731511428619

Litvak-Hirsch, T., & Lazar, A. (2011). On being here, and potentially there, and why: The case of attaining European passports by Israeli third generation Holocaust survivors. International Journal of Intercultural Relations, 35, 387–394. https://doi.org/10.1016/j.ijintrel.2011.02.004

Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71(3), 543–562. https://doi.org/10.1111/1467-8624.00164

Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56, 227–238. https://doi.org/10.1037//0003-066X .56.3.227

Masten, A. S. (2018). Resilience theory and research on children and families: Past, present, and promise. Journal of Family Theory & Review, 10, 12–31. https://doi.org/10.1111/jftr.12255

Mertens, D. M., & Hesse-Biber, S. (2013). Mixed methods and credibility of evidence in evaluation. New Directions for Evaluation, 2013, 5–13. https://doi.org/10.1002/ev.20053

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y.

Niitsu, K., Rice, M. J., Houfek, J. F., Stoltenberg, S. F., Kupzyk, K. A., & Barron, C. R. (2019). A Systematic Review of Genetic Influence on Psychological Resilience. Biological Research for Nursing, 21(1), 61–71. https://doi.org/10.1177/1099800418800396

Norris, F. H., Galea, S., Friedman, M. J., & Watson, P. J. (Eds.). (2006). Methods for disaster mental health research. The Guilford Press.

Norris, F. H., Stevens, S. P., Pfefferbaum, B., Wyche, K., & Pfefferbaum, R. L. (2008). Community resilience as a metaphor, theory, set of capaci- ties, and strategy for disaster readiness. American Journal of Community Psychology, 41, 127–150. https://doi.org/10.1007/s10464-007-9156-6

Nuttman-Shwartz, O. (2015). Post-traumatic stress in social work. In J. Wright (Ed.), The international encyclopedia of social & behavioural sciences (2nd ed., Vol. 18, pp. 707–713). Elsevier. https://doi.org/10 .1016/B978-0-08-097086-8.28116-6

Nuttman-Shwartz, O., & Shoval-Zukerman, Y. (2016). Continuous trau- matic situations in the face of ongoing political violence: The relationship between CTS and PTSD. Trauma, Violence, & Abuse, 17, 562–570. https://doi.org/10.1177/1524838015585316

Oshio, A., Taku, K., Hirano, M., & Saeed, G. (2018). Resilience and big five personality traits: A meta-analysis. Personality and Individual Differ- ences, 127, 54–60. https://doi.org/10.1016/j.paid.2018.01.048

Pagorek-Eshel, S., & Finklestein, M. (2019). Family resilience among parent–adolescent dyads exposed to ongoing rocket fire. Psychological Trauma: Theory, Research, Practice, and Policy, 11(3), 283–291. https:// doi.org/10.1037/tra0000397

Patton, M. Q. (2015). Qualitative research & evaluation methods: Integrat- ing theory and practice (4th ed.). Sage Publication.

Portnoy, G. A., Relyea, M. R., Decker, S., Shamaskin-Garroway, A., Driscoll, M., Brandt, C. A., &Haskell, S. G. (2018). Understanding gender differences in resilience among veterans: Trauma history and social ecology. Journal of Traumatic Stress, 31(6), 845–855. https://doi.org/10.1002/jts.22341

Sandelowski,M., Voils, C. I., Leeman, J., & Crandell, J. L. (2012).Mapping the mixed methods-mixed research synthesis terrain. Journal of Mixed Methods Research, 6(4), 317–331. https://doi.org/10.1177/1558689811427913

Shinebourne, P. (2011). Interpretative phenomenological analysis. In N. Frost (Ed.), Qualitative research methods in psychology: Combining core approaches (pp. 44–65). McGrawHill/Open University Press.

Sousa, C. A., Haj-Yahia, M. M., Feldman, G., & Lee, J. (2013). Individual and collective dimensions of resilience within political violence. Trauma, Violence, & Abuse, 14(3), 235–254. https://doi.org/10.1177/ 1524838013493520

Stein, J. Y., Levin, Y., Gelkopf, M., Tangir, G., & Solomon, Z. (2018). Traumatization or habituation? A four-wave investigation of exposure to continuous traumatic stress in Israel. International Journal of Stress Management, 25(S1), 137–153. https://doi.org/10.1037/str0000084

Tengö, M., Brondizio, E. S., Elmqvist, T., Malmer, P., & Spierenburg, M. (2014). Connecting diverse knowledge systems for enhanced ecosystem governance: The multiple evidence-based approach. Ambio, 43, 579–591. https://doi.org/10.1007/s13280-014-0501-3

Ungar, M. (2008). Resilience across cultures. British Journal of Social Work, 38, 218–235. https://doi.org/10.1093/bjsw/bcl343

Ungar, M. (2011). The social ecology of resilience: Addressing contextual and cultural ambiguity of a nascent construct. American Journal of Orthopsychi- atry, 81, 1–17. https://doi.org/10.1111/j.1939-0025.2010.01067.x

Ungar, M. (2013). Resilience, trauma, context, and culture. Trauma, Violence, & Abuse, 14, 255–266. https://doi.org/10.1177/1524838013487805

Ungar, M., & Liebenberg, L. (2011). Assessing resilience across cultures using mixed methods: Construction of the child and youth resilience measure. Journal of MixedMethods Research, 5, 126–149. https://doi.org/ 10.1177/1558689811400607

Ungar, M., & Theron, L. (2019). Resilience and mental health: How multisystemic processes contribute to positive outcomes. Lancet Psychiatry. Advance online publication. https://doi.org/10.1016/S2215- 0366(19)30434-1

Vella, S. L., & Pai, N. B. (2019). A theoretical review of psychological resilience: Defining resilience and resilience research over the decades. Archive of Medicine and Health Sciences, 7, 233–239. https://doi.org/10 .4103/amhs.amhs_119_19

Appendix

Interview guide

Main questions:

1. Tell me briefly about yourself.

2. What is resilience for you?

3. Tell me your story of resilience.

4. Howdo you think one can, if at all, developmental resilience?

5. What role does living under a continuous traumatic situa- tion play in your perception of resilience?

Elaborative questions (used only if the participant raised the issue):

1. In your opinion, what is the role of time in shaping your perception of resilience?

2. Can you tell me where resilience is expressed in your story. In all the things that you said, can you point out where resilience is expressed?

3. Describe how the transition to motherhood/fatherhood shaped your perception of resilience.

4. Describe your experiences of resilience before and after you became a parent.

5. How do you think one can, if at all, develop mental resilience?

6. Tell me which personality traits help you with your coping?

7. Describe which systems help you with your coping?

Closing question Would you like to add something that has not been said?

Received February 7, 2020 Revision received October 16, 2020

Accepted October 21, 2020 ▪

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