Resilience to potential trauma and adversity through regulatory flexibility

Responses to highly aversive or potentially traumatic events are typically defined in terms of binary outcomes, most commonly the presence or absence of post-traumatic stress disorder (PTSD). However, most people exposed to trauma do not develop PTSD or other forms of psychopathology. Moreover, a binary conceptualization says little about how resilient adaptation arises. In this Review, we describe a broader approach that goes beyond binary distinctions and identifies multiple outcome trajectories following potentially traumatic events and the psychological mechanisms that inform them. We first lay out the conceptual and statistical basis for this approach and then summarize prototypical trajectories (chronically elevated symptoms, moderate symptoms that gradually worsen, acute symptoms followed by recovery and stable psychological health or resilience) as well as trajectories that account for the period before the potentially traumatic event (prospective trajectories). Next, we consider the correlates of these trajectories and note the limited capacity of these correlates to robustly predict the most prevalent resilience trajectory. We suggest that this limitation can be addressed by considering regulatory flexibility and its various components. Finally, we discuss implications from research on regulatory flexibility and resilience trajectories for developing training and intervention strategies to protect against negative effects of potentially traumatic effects. Responses to potentially traumatic events go beyond the typical binary classification based on the presence or absence of psychopathology. In this Review, Bonanno et al. describe multiple outcome trajectories following adversity and consider how the different components of regulatory flexibility can promote resilience.