- freely available
Behav. Sci. 2015, 5(2), 264-304; https://doi.org/10.3390/bs5020264
The experiences of camp life show that man does have a choice of action…become a plaything of circumstances…or striv(e) and struggl(e) for a worthwhile goal…Viktor E. Frankl
1.1. Approach/Engagement versus Withdrawal/Defense
1.1.1. Motivational Models: Approach-Avoidance
1.1.2. Emotional Models: Approach-Avoidance
1.1.3. Action Models: Intention-Based versus Stimulus-Based Responding
1.1.4. Attention Models: Goal-Directed versus Stimulus-Driven
1.1.5. Brain Functions: Predictive and Reactive Biobehavioral Programs
1.1.6. Clinically Relevant Concepts
184.108.40.206. Well-Being: Eudaimonia versus Hedonia
220.127.116.11. Goal-Relevant Motivational Constructs and PTSD
1.1.7. Beyond Dualities
1.1.8. Summary: Engagement and Withdrawal
1.2. Goal-Directed and Stimulus-Based Responding in Clinical Practice
1.2.1. Not all Extreme Experiences Result in Trauma
1.2.2. New Wave Therapies
1.3.1. Resilience Training as Primary Prevention
18.104.22.168. Resilience Prevention Programs with Children
22.214.171.124. Resilience Prevention in the Armed Forces
1.3.2. Resilience Training as Secondary Intervention
1.3.3. Resilience Training as Restoring and Training Goal-Directed Skills: A Model
- Goal-directedness: The actions in the examples of engagement and the social relatedness examples were goal-directed. As reviewed earlier, the ideomotor theory defined goals as rooted in responses made to the effects or consequences of actions. Poetry chanting by Eugenia Ginzburg, a Russian journalist who became a political prisoner for 18 years in the Gulag, exemplifies this well. One line of poetry anticipates and has as its goal the chanting of the next line. Parenthetically, it can be noted that skilled performance is goal-directed.
- Emotional valence: The actions of survivors were ones they valued and were accompanied by a certain emotional intensity, even passion.
- Context independence: These actions were independent of the threatening context. This independence came as a result of the actors responding to the consequences of their actions rather than to the threatening environmental stimuli. This feature is easily missed and is so central that it requires to be underscored as a particularly adaptive element.
- Altered environment: These goal-directed actions changed the environment or experiences of the environment whereas merely reacting to threat, or reactivity, changed the person.
- Engagement/Social relatedness: Finally, the actions of engagement as expressed in interest, curiosity, or appreciation and social relatedness of empathy, compassion, or helping become resilience skills and life-preserving abilities when expressed in adverse contexts. They become the focal activity that holds its ground and prevails in the face of adversity.
1.3.4. Iconic Exemplars of Resilient Action
126.96.36.199. Social Relatedness
1.3.5. Simulation of Goal-Directed Resilience
1.3.6. Summary of Survivor Themes
2.1.2. Grounding New Skills in Sensation
2.2. Goal-Directed Resilience in Training (GRIT): A Model
- Preparation. To allow participants to do the work of the program, a readily available calming response is required. Participants are asked to set traumatic experiences aside and find an episode from childhood or early adult years in which they are cherished and loved, or they cherish and love someone or something else. When stressed during the intervention, they are to return to this episode rather than remain stressed. Experiences of secure attachment restore feelings of safety even during high threat conditions and aid in healing trauma even when mobilized symbolically .
- The elements. Participants identify approach/engagement and social relatedness experiences from childhood and early adulthood. Since these experiences are not novel but are already biologically established, they facilitate the re-experiencing of goal-directed responding and ground these in sensations. The view of memory as a construction made up of fragments of the past  is particularly compatible with the ‘simulated constructive’ approach of the program. Participants have an opportunity to find relevant past fragments and fashion new themes out of them.
- Transformation. Approach/engagement and social relatedness episodes are used in a return to traumatic events. As noted earlier, engagement activities of interest or curiosity and social activities in themselves are relatively pleasant and innocuous. However, they become tools for transformation when facing challenges, thereby demonstrating adaptive action and ‘resilience’. A case example of transformation from past trials of the intervention comes from a Vietnam-era veteran who returned to a battle scene in his narrative with the activity and sensations of holding his first frog in his hands when he was five years old. The battle scene felt like the wiggling magical creature in his hands. Another case: a veteran returned to Baghdad as the boy fixing his toys and selling them on the sidewalk in Cleveland. The veteran described the sensations of the Cleveland sidewalk sale in Baghdad, the humid air of Ohio in Baghdad. The bombing in the Baghdad market took on a different feel and perspective. In this constructive approach to memory and sensation, the past is rearranged into a recombined memory with goal-directed action that is grounded in sensation and a prospective direction to the future.
- The future. The goal-directed approach/engagement and social relatedness are applied to designing a good life with resilient responses to possible future challenges. Participants’ futures contain their own goals and interests and pathways to achieving them. Goal-directed engagement and relatedness are essential for flexible anticipatory adaptation capable of transforming reactivity. This process enables participants to create a new, resilient, and more integrated narrative of their lives that is rooted in their experiences and sensations.
|Introduction||Introduction and Psychoeducation:|
|Module II||Social relatedness:|
Simulation is used to integrate the newly re-established engagement and relatedness experiences of Modules I and II with an evocative context such as a stressful life event. Challenging experiences are revisited in a graded manner with the above practiced engagement and social relatedness experiences.
|Module IV||Building a Good Life:|
Participants will be asked to identify the key characteristics of a life well lived.
2.3. A Model for Goal-Directed Resilience Training in Evocative Contexts
- Physiological Features
- Stress and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in PTSD and chronic pain.
- Changes in cortical circuits that include PFC dysregulation and changes in the reward circuitry in all three conditions. Dysregulation of reward circuits.
- Change in energy regulation and sleep.
- Environment as Precipitant
- Environmental precipitants that include childhood trauma and adult trauma.
- Hyperresponsivity to environmental stimuli, salience of threat or reward stimuli.
- Behavioral Features
- Interference in social functions.
- Interference in daily activities and work roles.
- Change in reward system such that normal rewards from valued activities and social relationships are no longer rewarding and are replaced by avoidance of threat, seeking cessation of pain, overeating.
- Attention is automatic and reflexive, with a negativity bias in PTSD and pain, reward salience in obesity, salience of threat and pain in PTSD and chronic pain, hypervigilance in PTSD.
- Dysregulation of executive functions in all three conditions evident in the reduced ability to inhibit responses and pursue goal-directed action in order to realize future goals.
- Learning is rapid and implemented by principles of conditioning, rather than slow learning, as in the learning of skills.
- All three conditions are chronic and are difficult to terminate or reverse.
- All three curtail new experiences, new learning, and personal growth.
- The results are a constricted range of experiences and an impoverished life.
2.4. A Model for Testing the Efficacy of Goal-Directed Resilience Training
- Neuropsychological tests: Executive functions assessed with the Word Generation subtest of the Neuropsychological Assessment Battery , the Category Fluency, Category Switching, and Color-Word Switching subtests of the Delis-Kaplan executive Function System , Repeatable Battery for the Assessment of Neuropsychological Status  subtests assessed working memory and episodic memory. Alternative versions of all cognitive tests were employed at pre- and post-assessment.
- Physiological/endocrine measures: We explored the feasibility of assessing cortisol changes with salivary cortisol and evaluated several devices for ease of use and reliability to assess heart rate variability.
3. Results Supporting the Model for Goal-Directed Resilience Training
3.1. Posttraumatic Stress Disorder (PTSD)
3.3. Chronic Pain
4.1. Innovations of the Goal-Directed Resilience Training Model
- Theory and model. We identify goal-directed action as the main element that needs to be restored in chronic evocative contexts in which stimulus-based reactivity has resulted in maladaptive conditions such as PTSD or obesity. Our model posits a reciprocal relationship between prospective and reactive responding that accounts for both adaptive and maladaptive behaviors, rather than just focusing on a theory that accounts for symptoms.
- Method. Simulation is used in a step-by-step approach that includes re-experience of goal-directed elements that are then taken into a challenging situation, thereby simulating a resilient response. Our approach draws on personal experience and sensation to change bottom-up brain functions that have downstream effects that, in turn, help to restore top-down cognitive and affective processes through goal-directed action and positive affect, as are exemplified in engagement and social relatedness. The simulation includes repeated practice; special attention to sensation and expanding sensation beyond those felt in trauma, obesity, or pain; and special attention paid to the retention and generalization of gains.
- Efficacy. Multiple functions are assessed with a multi-method approach for testing efficacy. Effectiveness of the intervention assesses not only symptoms but also well-being, effects on cortical functions as assessed by neuropsychological measures, and effects on biological functions as assessed with endocrine measures of cortisol, leptin and adeponectin.
- Retention and generalization. Exercises allowed participants to apply concepts to their own lives, such as in “Life on Three Stages”. We sought to devise methods that incorporated the new knowledge gained from the intervention into participants’ lives. One approach was to have participants design a ‘good life’ with goals and a future they could look forward to, that could apply new learning that is generalized to other areas of their lives.
4.2. Limitations of the Goal-Directed Resilience Training Model
- At the level of theory and model building, numerous details need to be developed. Examples are the adjustments and additional techniques in the intervention method for conditions that have unique characteristics beyond the evocative commonality, such as features unique to each of PTSD, obesity, pain, and others.
- Simulation can be enhanced by applications developed for new technologies.
- The multi-modal tests of efficacy do not yet include a wider array of endocrine functions and functional imaging. In addition, there is as yet no single scale that tests the main elements of the model, notably the predictability of the environment, approach-engagement, and social relatedness and how these three are affected by the intervention. So far we have used a patchwork of subscales from a variety of standardized tests, such as the SF-36 or Ryff’s Psychological Well-Being Scale. We are attempting to rectify this for chronic pain by developing a scale that will specifically test the main elements of the intervention.
- The extent to which gains are retained and generalized need to be evaluated over time.
4.3. Future Directions of Goal-Directed Resilience Training
Conflicts of Interest
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