Resource caravans and resource caravan passageways: a new paradigm for trauma responding
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Hobfoll
Resource caravans and resource
caravan passageways: a new
paradigm for trauma responding
Stevan Hobfoll
We have long outgrown the capacity of the accepted viewpoint, with particular emotional com-
clinical models of trauma, and a paradigm shift in ponents based almost in their entirety on
our thinking is long overdue.The data on traumatic individuals seeking treatment for posttrau-
stress were posited from a certain cognitive-beha- matic stress disorder (PTSD), and focusing
vioural viewpoint, with particular emotional com- on that time frame. Further, this viewpoint
ponents based almost in their entirety on western, was accomplished mostly within a western,
mostly white individuals seeking treatment for post- European and American social context,
traumatic stress disorder, and focusing on that time and mainly by studying middle-class, white
frame.Assuch,mechanismssuchasfearandemotional patients. It then had a layer added by key
conditioningtheory and the waystraumas are encoded work in neuroscience, again almost entirely
in memory only partially explain trauma response. with the same limitations, which was then
Conservation of resources theory posits that severe force-¢tted to the cognitive-behavioural
trauma responses occur when personal, social or model. One important area of challenge
material resources, which are key to the self, survival emerged from those who argued that PTSD
and social attachments, are lost severely and rapidly. could be more complex than was originally
These resources tend to aggregate or fail to aggregate presented, meaning that it is more multifa-
inwhatconservationofresourcestheoryterms ‘resource ceted (Cloitre et al., 2009; van der Kolk,
caravans’; they do not exist in isolation. Because et al., 2005). However, all these viewpoints
resource caravans are created and sustained within focus on clinical, western, mostly white
the environmental and social context of resource cara- populations, which represent a small frac-
vanpassageways,environmentalcontextisfundamen- tion of those with PTSD or other trauma-
tal to trauma response. It is argued that resource loss related disorders (de Jong, 2004; 2005).
and the maintaining of resource caravans are the best A key limitation to this model building has
predictorsoftraumaresponse,bothintermsofposttrau- beenthe lack of consideration of ¢ndings from
matic stress disorder and in terms of the idioms of large scale studies that included nonpatient
trauma distress across cultures. populations over longer periods of time, stu-
dies from nonwestern nations and more
Keywords: posttraumatic stress disorder, anthropological evidence. In particular,
resilience, resource loss, stress, trauma research has focused naturally on the time
around the trauma event for clinical popu-
lations, or the time period when individuals
Introduction seek treatment. This, in turn, meant that
It is my thesis in this paper that we have long researchers did not incorporate the fuller time
outgrown the capacity of the accepted sequenceincludingeventsbeforeandlongafter
models of trauma. A paradigm shift in our trauma, which greatly impact PTSD and
thinking is overdue (Hobfoll & de Jong, cause a di¡erentconceptualisationandtheory
2013). The data on traumatic stress were pos- to understand trauma response and recovery.
ited from a certain cognitive-behavioural Finally, the consideration of resilience, and
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Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited.Resource caravans and resource caravan passageways: a new paradigm for trauma responding
Intervention 2014, Volume 12, Supplement 1, Page 21 - 32
the fact that none of the accepted trauma and maintain resources when at their best,
models account for the extent to which people but that often produces the groundwork for
(even those with PTSD) are resilient, has led resource loss (Hobfoll, 1988; 1998). COR
toafurtherchallengethat hasnotbeen incorp- theory greatly broadens the landscape of
orated into the accepted models of trauma how we see PTSD. It emphasises, in particu-
and trauma response. lar, that trauma responding is deeply
a¡ected by life history—long prior, during
and long after events^which this paper will
Resource caravans and their tie examine in depth (King, et al, 1999; Vogt
to world view, body and brain et al., 2011). Traumatic circumstances not
Conservation of resources (COR) theory only challenge the individual, but compro-
posits that individuals strive to obtain, mise the ability of this social structure to sup-
retrain and protect their personal, social port and protect people.
and material resources. COR theory envi-
sions this process as a basic evolutionary
principle that has many consequences and Current models of trauma: their
correlates. Foremost, it sees the seeking and strengths and limitations
preservation of resources as a primary At the outset, I will outline which key ¢nd-
human motivation, and Hobfoll (1991) ings must be incorporated in any trauma
theorised that trauma response will occur model from current clinical models. First,
when there is major loss of fundamental there is clearly something about exposure
resources and where this loss occurs rapidly. to events that threaten life or bodily integrity
What appears to characterise traumatic that produces a powerful cognitive,
resource loss is a rupture of the constellation emotional and physiological response. This
of ¢ve principal resource groups: safety, is well captured in emotional processing
calmness, attachment, hope, and e⁄cacy theory (Foa & Kozak, 1986; Rauch & Foa,
(i.e., the ability to a¡ect positive change) 2006). Speci¢cally, trauma events create a
(Hobfoll et al., 2007). As resource conserva- fear structure that is comprised of associated
tion is of primary concern, the processes stimuli, responses and meaning elements
inherent in building and maintaining ‘resource that become linked. Further, for some indi-
caravans’are also the essential building blocks viduals, these fear structures become exces-
of culture and society. As individuals strive sive and resistant to modi¢cation. It follows
to obtain, retrain and protect personal, that treatment that could extinguish the
social and material resources for the self, interweaving of this fear structure with
they create social structures that necessarily responding would aid recovery, and there
support this primary motivation. is ample evidence that this is the case
COR theory has held, from its origin, that (McLean & Foa, 2011).
personal, social and material resources are Second, there are neurological rami¢cations
not possessed piecemeal, but that rather they of trauma that are accompanied by bio-
are developed and associate in aggregate logical perturbations, some of which can
(Hobfoll, 1989, 1998). More recently, Hobfoll become chronic (Brewin, et al., 2010). While
(2010) further developed the long-standing these sequences are interesting and import-
underpinning of COR that asserts that ant to note, they do not add greatly to
resource caravans, the association of linked emotional processing theory nor to the ear-
resources, are created and sustained within lier dual representation theorising of Brewin
a resource caravan passageway. That is, (Brewin & Holmes, 2003). Tying neurologi-
families, organisations and societies create cal ¢ndings to theory helps support theory,
and maintain circumstances that create but these neurological ¢ndings have not led
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Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited.Hobfoll
to changes in what is predicted by fear pro- and possibly much later in life. Indeed,
cessing theory or dual representation theory. resource loss is one of the best predictors of
Of greater importance for my thesis here, whether someone will develop PTSD or
the neurological research has continued the other trauma responses, a fact that is not
focus on memories and images embedded incorporated in the emotional processing
at the time of the trauma event, and the or dual representation theory. These
rather unfounded supposition that persons resource losses need not occur at the time
with PTSD have‘repeated visual intrusions corre- of trauma. They may occur in earlier child-
sponding to a small number of real or imaginary hood or earlier life or well after the event
events’ (Brewin et al., 2010, p. 210). This (Kaniasty, 2012; King et al., 1999; Vogt
assumption is likely because so much et al., 2011). Hence, studies ¢nd that exposure
research has been on clinical samples where to childhood trauma and possessing fewer
there was a speci¢c target event. I do not social resources combine to predict an adult
believe that this key assumption, on which trajectory of posttraumatic disorder (Lowe
so much of current trauma theory rests, has et al., 2014). Referring to a later lifetime
ever been empirically tested. sequence, individuals who escaped the
This point is already cogently covered in the Katrina disaster appeared to develop PTSD
discussion of complex PTSD (van der Kolk after they returned home and witnessed
et al., 2005). Those who have experienced their destroyed homes (Adeola, 2009; De
trauma at times have a principal or worst Salvo et al., 2007). This moment was not
set of memories, but many report that they life-threatening, but it had elements that
have multiple images and memories that may both be critical and o¡er us insight as
are often disorganised and unsequenced, to a broader theory of PTSD. Speci¢cally,
and are an amalgam. As proponents of com- when people lose a sense of safety or have a
plex PTSD have argued, traditional PTSD chronic sense of lack of safety, and this is
diagnosis o¡ers a rather limited, if partially paired with a sequence of events in which
correct, set of responses to trauma. Such they can imagine or actually experience
limitations are critical, as they con¢ne events that are life threatening or threaten-
understanding, research and intervention, ing to their sense of bodily integrity, they
which in turn have to be narrowly con- can develop PTSD and other posttrauma
strained in order to ¢t into more limited sequelae.
models. Giving just one concrete example: This point is especially germane to those
if shame or honour are not included in PTSD who live in chronically unsafe circum-
measures, then the many factor analyses of stances, such as zones of con£ict or many
what is PTSD appear to indicate that shame urban inner-city environments that are
and honour are not central. However, for characterised by pervasive violence. Such
many collectivist cultures, honour is central environments result in an ongoing loss of
to the trauma experience, not ancillary. safety, fear of loss of loved ones and those
relationships, and a sense of future hopeless-
ness and the inability to a¡ect positive
Resource caravans and change. This hopelessness may be better
passageways understood when we appreciate that it is rea-
Trauma responding, including PTSD, is not lity based and the darkened sense of future
only a product of the occurrences around is an accurate representation of likely future
the time of the event, but is strongly a¡ected events. Once this is understood, each
by the cascade of personal, social and moment of life a¡ords ample opportunity
material losses that may occur weeks or to tie visual, environmental and physiologi-
months or years before or after the event, cal sequelae in ways that may have more of
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Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited.Resource caravans and resource caravan passageways: a new paradigm for trauma responding
Intervention 2014, Volume 12, Supplement 1, Page 21 - 32
the elements that have been tied to complex (Brewin, 2001) fail to explain more than a
PTSD (van der Kolk et al., 2005) and fewer small portion of how PTSD comes about or
of the elements that have been tied classically how it is sustained. These theories are
to PTSD with a particular well-framed important, but they are partial and
memory of a speci¢c event. This also avails represent a small element of the whole in
intervention to a broad array of alternative terms of predictive capacity. Rather, as
foci for intervention and types of interven- COR theory predicts, PTSD is predicted
tion. Traditional theories focus on the mind by the rupture of personal, social and
and perception; however, the alternative material resource losses that combatants
presented here further encourages social experience, and the web of safety and con-
and environmental intervention, so as to nections at the home front have as much to
shape environments to enable healing. do with PTSD as fear conditioning or the
Several studies of veterans make these points laying down of traumatic memories. Further,
cogently. In the ¢rst study, King et al. these results challenge neurological ¢ndings,
(1999) found that PTSD was the outgrowth which are important, but clearly are being
of multiple cumulative e¡ects of stressors, interpreted without consideration of the
beginning in family and personal life events full context.
decades earlier. Most important, this study
found that the cascade of resource loss was
the key element in the endpoint of PTSD. Cultural adaptation models
Indeed, events around the time of deploy- Crosscultural ¢ndings also illustrate the
ment were only partially related to PTSD, need for a paradigm shift and indicate the
and the fuller context of postdeployment partiality, and even inaccuracy, of current
experience was as fundamental. More trauma models. PTSD is one manifestation
recently, Vogt et al. (2011) found that PTSD of trauma responding. It appears to be uni-
is best explained by multiple chains of risk, versal, but is not necessarily the principal
with many of these originating in predeploy- aspect of trauma response in non western
ment experiences. These pathways led to cultures (Akello, Richters, & Reis, 2009; de
major psychosocial and material resource lo- Jong & Reis, 2010; Hagengimana & Hinton,
ss and an inability to access critical resources 2009; Hinton & Lewis-Ferna¤ndez, 2011;
when needed. Central to the discussion of Hobfoll & de Jong, 2013; Igreja, 2008; van
resource caravans and passageways, not only Duijl et al. 2010; van Ommeren et al., 2001).
was the availability of postdeployment social This should appear obvious, but it is not a
support a larger predictor of posttraumatic well accepted supposition. The reason it
response than was exposure to warfare, but should be obvious is that it follows in
that social support was largely in£uenced a straightforward manner from both
by childhood family resources, relationship emotional processing theory (Foa & Kozak,
disruptions, perceived threat of warfare 1986) and dual processing theory (Brewin
exposure and postdeployment stressors.This & Holmes, 2003), if they are not so strictly
was examined more closely by Interian tied to western cognitive models and if we
et al. (2014), who found that home-front stres- do not prematurely tie neurological evidence
sors predicted PTSD whether they occurred as meaning that mind^brain connections
before or after deployment. Moreover, these are universal.
factors were stronger predictors of PTSD What needs to be understood is that, in many
than combat exposure or unit cohesion. cultures, the borders between real and
These studies further clearly illustrate that unreal, this world and the dream world,
emotional processing theory (Foa & Kozak, and the very acceptance of the linear nature
1986) and dual representation theory of events are looser, or even rejected. Further,
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Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited.Hobfoll
there is good evidence that somatic response regimen for Cambodians that does not relate
to psychological distress and illness has quite to the memory and cognition based treat-
varied somatic correlations that are cultu- ments e¡ective in western populations. Con-
rally evidenced. Recent research on neural sider also that, whereas in American and
plasticity (Chiao, 2009; Dom|¤ nguez, Turner, western European patients, panic disorder
Lewis, & Egan, 2010) would even mean that typically leads to further panic disorder,
the brain itself would develop to accommo- Puerto Ricans who experience ataque de ner-
date these views of the world. This would vios, which close resembles panic disorder,
help to explain why the principal reactions widely report relief after the attack (Lewis-
to traumatic events in many cultures have Ferna¤ndez et al., 2002). Such a paradoxical
been reported to be so culturally speci¢c reaction means either that emotional proces-
(Hinton & Kirmayer, 2013) and produce sing theory (Foa & Kozak, 1986) and the
di¡erent idioms of distress and di¡erent dual processing^neural systems model (Bre-
pathways to wellness. win et al., 2010) are specious (which I do
Hinton & Otto (2006), in their careful not think is the case) or that they are partial
research on Cambodian refugees of a certain and have been over-generalised, especially
era, are illuminating on this point. Consider regarding to the argument that neurological
their description of many of the Cambodian evidence supports these models.
refugees that they have studied and treated. Miller & Rasmussen (2010) similarly chal-
Profound and rapid loss of personal, social lenge cognitive-emotional theories of PTSD.
and often material resources are common Based on their work with adults in Afghani-
elements of their reactions, as would ¢t what stan, they found that PTSD was not the
is found in western European and American major pathway of expression of traumatic
trauma (Hobfoll, 1991). However, the symp- experience. They found, like Hinton, that
tom expressions on cognitive, social, indigenous idioms of distress were more
emotional and physical levels are quite common and primary than PTSD, even if
di¡erent in remarkable ways. The refugees PTSD certainly did occur. For example, jigar
experience frequent palpitations, startled khun was a long-term kind of melancholy,
responses and poor appetite and sleep, feel which adults reported as more salient than
physically weak (khsaoy) and report a weak intrusive images. Asabi was described as a
heart (khsaoy beh doung). They often report synthesis of nervousness and anger that often
khyal attacks, which in some ways resemble led to verbal and physical violence and self-
panic attacks, but which are also accom- beating. What is also key here was that
panied by catastrophic cognitions about Miller & Rasmussen found these culturally
imminent bodily dysfunction and loss of speci¢c symptoms to be more predictive of
use of their arms and legs. Sleep paralysis, functional impairment than was PTSD.
which is rather uncommonly reported in Bracken, Giller & Summer¢eld (1995) made
the PTSD literature, was found to be evi- a similar argument based on their studies
denced by 67% of Cambodians with PTSD in Uganda. For example, among Ugandans,
(Hinton et al., 2005). dissociation in the form of spirit possession
Hinton et al. (2012) found that both natural is a common pathway of expression for those
healing and e¡ective treatment pathways exposed to trauma (van Duijl et al., 2010).
between cultures likewise di¡er markedly. A sense of spirit possession is consistent with
This is a key point, as if trauma produced cultural norms and social learning. Hence,
speci¢c emotional and memory sequences, it is not surprising that, among northern
then recovery and treatment pathways Ugandan former child soldiers, being
would ¢t well across cultures. Hinton prac- haunted by spirits called Cen is common post
tices a somatic-psychological treatment trauma (Akello et al., 2009). Add to this that
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Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited.Resource caravans and resource caravan passageways: a new paradigm for trauma responding
Intervention 2014, Volume 12, Supplement 1, Page 21 - 32
mass dissociative trance behaviour has been were key predictors of PTSD and depression
reported among Bhutanese refugees in among Iraqi asylum seekers. These factors
Nepal (van Ommeren et al., 2001), in post- outweighed the impact of direct war-related
war Guinea Bissau (de Jong & Reis, 2010), exposure, which is inconsistent with domi-
in Mozambique (Igreja, 2008) and in nant models of PTSD (Laban et al., 2008),
Rwanda (Hagengimana & Hinton, 2009). but highly consistent with COR theory.
Trauma response follows cultural patterns This was also noted in the responding of
that have some common bases, but there is those a¡ected by the World Trade Center
much elasticity because the environmental (WTC) attack on 11 September 2001. On
conditions that create, sustain or impede one hand, peritraumatic reaction was a
resource acquisition and maintenance are major predictor of PTSD outcomes (Galea
culturally embedded. Resource caravans et al., 2002). However, loss of job and loss of
will ¢t cultural and environmental impera- possessions were as predictive of PTSD as
tives through social development and life- was any aspect of the experience that
long social processing, and intervention occurred closer in time to the trauma. Again,
must occur along the paths of these caravans these factors are not part of the trauma mem-
or the structures that support caravan path- ory and are not even present when fear pro-
ways. Hence, we will see responding that cessing associated with the event occurs.
resembles PTSD worldwide, but as we By focusing on the trauma memory and
become more distanced from western cul- initial fear responding, we remove ourselves
ture, the major expressions of trauma will from context, which appears to be a para-
look increasingly less like PTSD, or PTSD mount factor found for those who more care-
will become a more secondary or fully include context, resource caravans
tertiary response. and resource passageways in their designs.
So, studying survivors of Hurricane Katrina,
Adeola (2009) found that the most signi¢-
How current models remove us cant predictors of distress were: residency
from factors of social context in the poorest parishes of New Orleans, hav-
and social intervention ing dependent children, unemployment,
If we do not study social context, and the car- degree of property damage, and ¢nancial
avan of resources and resource passageways impacts sustained due to the disaster. Like-
that are contextually evidenced, we miss wise, others noted that, among Katrina
both a deeper understanding of PTSD as evacuees, not being insured, the degree of
well as many avenues for potential social home destruction and human loss were the
intervention. Following the 1992 Hurricane strongest predictors of posttrauma exposure
Andrew in Florida, Ironson et al. (1997) distress (De Salvo et al., 2007; Lee, Shen, &
found that cognitive-emotional or infor- Tran, 2009). However, even this human loss
mation-processing variables were hardly was seldom witnessed. Add to this, De Salvo
related to trauma responding. Rather, they et al. (2007) found that lack of property
found that the extent of material resource insurance, longer evacuation and commut-
loss and length of time before receipt of ing distance to work during the rebuilding
insurance settlements were the major predic- period and obstacles to obtaining quality
tors. Further, the extent of material loss and new residences were important predictors
waiting for insurance settlements that would of PTSD symptoms. Again, for most people,
allow rebuilding were only modestly related they were evacuated before home destruc-
to the initial trauma experience. Likewise, tion, and this was witnessed only when
the prolonged time period waiting for asy- they were allowed to return weeks or
lum and posttraumatic living conditions months later.
26
Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited.Hobfoll
Incorporating resilience in and Gaza during a period of intense con£ict.
trauma models This is one of the few multiwave studies in a
Nowhere are the limitations ofcurrentclinical zone of con£ict, and the only to examine both
models of trauma more evident than in their PTSD symptoms and positive adaptation as
irrelevance to people’s resilience in the face of measuredbydegreeofengagementinlifetasks.
trauma. Accepted trauma models, being Engagement is a concept adopted from organ-
pathology-based and concentrating on the isationalpsychology. It is comprisedof dedica-
time of the trauma event, fail to account for tion, absorption and vigour (Schaufeli et al.,
aspects of resilience that are present, even 2002). In many ways,theseelementsofengage-
when individuals develop PTSD.The paucity mentcanbeseenasthepolaroppositeofPTSD,
of attention, and therefore the future need for whichresults inavoidance,inabilitytoconcen-
emphasis on resilience inthe face of traumatic trate and be positive and drained energy and
stress, is cogently presented in a recent key depressive e¡ect.
paper by Southwick & Charney (2012) on The results of path analysis indicated clearly
resilience and depression. I am referring not that trauma exposure is only weakly related
only to resilience in terms of not experiencing to engagement (Hobfoll et al., 2012). As pre-
a powerful initial response, quick or early dicted by COR theory, and consistent with
recovery from severe response, or only experi- the model of resource caravans, the impact of
encing a moderate response. Rather, the resource loss on both trauma symptoms and
accepted models fail to make or even to engagement far outweighs the impact of
attempt to make any predictions about who trauma exposure. Likewise, positive aspects
continues to engage and even enjoy life tasks. of social support were related to greater
Even those with severe PTSD have a wide engagement, but again, as COR theory pre-
range of levels of engagement in life tasks and dicts, resource gains in the form of sustained
in resilience processes. social support are overshadowedby the larger
In contrast to leading clinical theories of in£uence of resource loss.
PTSD, COR theory makes speci¢c predic- In another of the rare prospective studies of
tionsaboutbothlevelsofpsychologicaldistress resilience in the face of the kind that is often
as well as resilience.These predictions are well linked with PTSD, Pietrzak et al. (2014)
supported, although the literature regarding examined more than 10,000 (World Trade
adult resilience is still nascent and requires Center) WTC responders 3, 6, and 8 years
much more exploration. In contrast to a more after the WTC attacks. They also examined
developed child literature on resilience (see the di¡erential responding of police versus
Masten & Narayan, 2012), the adult literature nontraditional responders who were gener-
has focused only more recently on resilience ally less well trained, such as construction
and bolstering and protecting personal, social workers security guards and transportation
and material resources (Bonanno, Westphal, workers. Here, resilience was de¢ned as the
& Mancini, 2011). Basically, COR theory pre- degree to which PTSD symptoms were not
dicts that, to the extent that the caravan of appreciably experienced at any time point.
resources that people possess remains intact, The majority of police and nontraditional
the more likely they will be resilient, resistant responders were resilient, but the police were
or quickly recover. That is, their lifetime signi¢cantly more likely to be resilient than
resourcetrajectoryand resource reservoir will nontraditional responders. Correspond-
be more central to their response than will be ingly, nontraditional responders were more
the type or extent of trauma exposure. likely to have chronic PTSD.
InoneofthefewstudiesofPTSDandresilience In this situation, the predictors of trauma
in a zone of con£ict, Hobfoll et al. (2012) inter- sensitivity (i.e., lower likelihood of being
viewed1196PalestinianadultsoftheWestBank resilient) were Hispanic ethnicity, prior
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Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited.Resource caravans and resource caravan passageways: a new paradigm for trauma responding
Intervention 2014, Volume 12, Supplement 1, Page 21 - 32
psychiatric history, WTC exposure severity, chronic nature of the trauma and the low h-
number of life stressors in the year prior to ope for future positive political relief (Hob-
the attack, number of WTC-related medical foll, Mancini, Hall, Canetti, & Bonanno,
conditions that developed after the attack 2011). The context of ongoing trauma, which
and having less family support. Consistent is characterised as a resource caravan passa-
with COR’s resource caravan model, prior life geway with intense trauma exposure and
stressors, having a medical condition follow- daily threat, and little hope for future change
ing the events and the level of social support resulted in a virtual reverse of the proportion
combined to have a much greater in£uence of individuals who were resilient versus
thanWTC exposure severity. experienced chronic symptoms of trauma.
That two aspects of status and role, being a Indeed, the level of chronic distress versus
police o⁄cer and Hispanic ethnicity, were so resilience was so great as to result in a recon-
critical is a re£ection of the di¡erent resource sideration of resilience theory by Bonanno,
caravans and resource caravan passageways one of the co-authors. As previously
that these groups’status re£ects. Hispanic eth- Bonanno had theorised that resilience was
nicity is likely to be explained as a factor by evidenced by most of those facing trauma,
language and cultural gaps that are obstacles this key aspect of his pioneering theorising
to translation of resources to action, as in di⁄- on resilience had to be modi¢ed for those liv-
culty of getting accurate news from main- ing within chronic traumatic circumstances
stream media, di⁄culty in accessing (Bonanno et al., 2011).
treatment and possibly having more precar-
ious employment stability. Importantly,
police selection and training made a major Conclusions
di¡erencein resilience outcomes, eventhough Responding is ¢rst and foremost an expres-
the police had much greater trauma exposure sion of the extent and chronicity of trauma
in witnessing dead bodies, threats to their in the environment and people’s ability to
own lives and witnessing the death of peers. seek safety, retain close attachments and
Clearly, their selection for traits of strength realistically hope for an end to the risk of
and resilience and training on dealing with trauma. When circumstances limit people’s
trauma were critical determinants of PTSD ability to retain or recreate resources and
versus resilience. where personal, social and material resource
Examination of the trauma literature, incor- loss is prominent, then high levels of PTSD
porating clinical, epidemiological and more and depression occurs, and recovery path-
anthropological study, illustrates the import- ways become blocked. The resource caravan
ance of resource caravan passageways, when and resource caravan pathways concept are
we compare them to a similar study of resili- key predictors of both pathological and
ence trajectories examined in a resilience resilience outcomes. This is especially true
trajectory study with the abovementioned for vulnerable populations and low resource
cohort of Palestinians. In this regard, the settings, as in such cases there are often
critical di¡erence in ¢ndings compared to multiple traumas occurring over a lifetime,
the WTC study was that the majority of with a continued spiralling of resource loss.
respondents were not resilient. Indeed, more Only a partial element to predictive models
than four times the proportion of partici- is added by clinically based theories of
pants were in the severe, chronic distress emotions or recorded memories. Nor would
group in this study than in the WTC study, neurological ¢ndings add much at this stage
and even those in the best trajectories were of research.
nevertheless, experiencing considerable dis- We must incorporate social context as cen-
tress. This di¡erence was attributed to the tral to responding. By focusing on the
28
Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited.Hobfoll
caravan of resources and resource passage- cultural understanding of resource caravan
ways that are contextually evidenced, we passageways, helps to predict and explain
create a deeper, more ecologically valid trauma responding and expands insights
understanding of PTSD and the array of for intervention across cultures and settings.
idioms of distress that are represented in Future research needs to examine trauma
di¡erent cultures. This, in turn, opens in the social and cultural context. It will be
multiple new avenues for potential clinical important to examine whether and to which
and social intervention. By way of example, extent more traditional western concepts of
the centrality of honour to many collectivist PTSD ¢t within these other contexts, but at
cultures would require intervention to focus the same time to be creative in conceptualis-
on steps to ‘repair tears in the fabric’ of honour ing distinctions that are more culturally
and shame through community reinte- speci¢c. By expanding our view of time, by
gration, acceptance and recognition. This comparing groups in context and by com-
means that intervention would not be only, paring groups in di¡erent contexts, we will
or perhaps not at all, on the individual level, engender a richer view of trauma responding
but instead would be a community process, and how treatment can likewise evolve.
incorporating such concepts as collective
e⁄cacy (Benight, 2004).
As Norris, Sherrieb & Pfe¡erbaum (2011) References
prescribe, intervention must work to build Adeola, F. O. (2009). Mental health and psycho-
communities’ economic resources, increase social distress sequelae of Katrina: An empirical
access to services and mitigate risks associ- study of survivors. Research in Human Ecology, 16(2),
ated with social injustice in order to build 195-210.
resilience systems. Social support should be Akello, G., Richters, A. & Reis, R. (2009). Coming
translated to building stronger social net- totermswithaccountability:Why the reintegration
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