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Psychology, Health & Medicine
ISSN: 1354-8506 (Print) 1465-3966 (Online) Journal homepage:
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Feasibility and effectiveness of psychosocial
resilience training: A pilot study of the READY
program
Nicola W. Burton , Ken I. Pakenham & Wendy J. Brown
To cite this article: Nicola W. Burton , Ken I. Pakenham &
Wendy J. Brown (2010) Feasibility and
effectiveness of psychosocial resilience training: A pilot study
of the READY program, Psychology,
Health & Medicine, 15:3, 266-277, DOI:
10.1080/13548501003758710
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Published online: 17 May 2010.
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58710#tabModule
Feasibility and effectiveness of psychosocial resilience training:
A pilot
study of the READY program
Nicola W. Burton
a
*, Ken I. Pakenham
b
and Wendy J. Brown

a
a
School of Human Movement Studies, The University of
Queensland, Blair Drive, St Lucia,
Brisbane 4072, Australia;
b
School of Psychology, The University of Queensland, Blair
Drive,
St Lucia, Brisbane 4072, Australia
(Received 11 September 2009; final version received 4 February
2010)
Despite many studies on the characteristics associated with
resilience, there is
little research on interventions to promote resilience in adults.
The aims of this
study were to gather preliminary information regarding the
feasibility of
implementing a group psychosocial resilience training program
(REsilience and
Activity for every DaY, READY) in a workplace setting, and to
assess if program
would potentially promote well-being. The program targets five
protective factors
identified from empirical evidence: Positive emotions, cognitive
flexibility, social
support, life meaning, and active coping. Resilience
enhancement strategies reflect
core acceptance and commitment therapy (ACT) processes and
cognitive
behavior therapy strategies. Sessions involve psychoeducation,
discussions,

experiential exercises, and home assignments. Sixteen
participants completed
11 6 two h group sessions over 13 weeks. Baseline and post-
intervention
assessment included self-administered questionnaires,
pedometer step counts, and
physical and hematological measures. Data were analyzed using
standardized
mean differences and paired t-tests. There was a significant
improvement between
baseline and post intervention scores on measures of mastery (p
¼ 0.001), positive
emotions (p ¼ 0.002), personal growth (p ¼ 0.004), mindfulness
(p ¼ 0.004),
acceptance (p ¼ 0.012), stress (p ¼ 0.013), self acceptance (p ¼
0.016), valued
living (p ¼ 0.022), autonomy (p ¼ 0.032) and total cholesterol
(p ¼ 0.025).
Participants rated the program and materials very highly. These
results indicate
that the READY program is feasible to implement as a group
training program in
a workplace setting to promote psychosocial well-being.
Keywords: resilience; well-being; mental health; health
promotion; ACT;
depression; stress management
Background
Resilience is the capacity of people to effectively cope with,
adjust, or recover from
stress or adversity. When faced with adversity, people with low
resilience are at risk
of depression, stress, anxiety and interpersonal difficulties, and
may adopt health

compromising behaviors and experience somatic complaints and
poor physical
health. Prolonged stress and poor psychosocial functioning may
negatively impact
on physical health for example, via biological mechanisms such
as hypertension and
*Corresponding author. Email: [email protected]
Psychology, Health & Medicine
Vol. 15, No. 3, May 2010, 266–277
ISSN 1354-8506 print/ISSN 1465-3966 online
� 2010 Taylor & Francis
DOI: 10.1080/13548501003758710
http://www.informaworld.com
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blood pressure reactivity to stress, atherogenic lipid profiles,
pro-inflammatory
cytokines (e.g. C reactive protein), and the development of
metabolic syndrome
(Rozanski, Blumenthal, & Kaplan, 1999; Strike & Steptoe,
2004).
Most studies of resilience have focused on young people or
individuals
experiencing specific adverse circumstances, and have explored
the personal
characteristics associated with effective coping (Richardson &
Waite, 2002). Only
a few studies have focused on adults and investigated the
effectiveness of
resilience training. A worksite trial of the ‘‘Personal Resilience
and Resilient
Relationships’’ program, with 5 6 7 h modules implemented
weekly over five
weeks, demonstrated significantly higher levels of self esteem,
locus of control,
purpose in life, and interpersonal relations among program
participants compared
with a control group (Waite & Richardson, 2004). A modified
version of this
program, with 10 6 90 min modules implemented twice weekly
over five weeks

for people with diabetes, found no significant difference
between program
participants and a usual care group on the same psychological
measures or
glycosylated hemoglobin or waist circumference (Bradshaw et
al., 2007).
Participants of a worksite trial of the ‘‘Resilience
Reintegration’’ program,
implemented in approximately 14 days during six months for
employees with
illnesses attributed to work stress, demonstrated higher levels of
effective coping
(including seeking social support) and lower levels of
depression at post-
intervention compared with baseline (Steensma, Den Heijer, &
Stallen, 2006).
These latter two programs involved a tertiary approach to
psychosocial well-
being, as they targeted individuals with developed conditions so
as to minimize
suffering associated with poor health. Only the first program
adopted a primary
approach of promoting resilience in otherwise healthy adults.
We have developed a psychosocial resilience training program
(READY:
REsilience and Activity for every DaY) to promote resilience
and psychosocial
well-being in adults. The program is designed as a primary or
secondary level of
intervention, and targets adults at risk of stress or stress
induced depressive
symptoms, but otherwise generally healthy. The aim of this
article is to describe a
pilot study of the program that was conducted to obtain
information on the

feasibility of implementing the program as group-based training
in a workplace
setting. The study also examined the potential effectiveness of
the program to
promote subjective well-being, and reduce symptoms associated
with depression and
stress.
Method
The study protocol was approved by The University of
Queensland Medical
Research Ethics Committee (2007000303).
Study design
This study was a single group pre–post trial with outcome
measures assessed the
week immediately prior to and after the 13 week intervention
period.
Setting
The program was conducted with employees of a university in a
capital city.
Psychology, Health & Medicine 267
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Participants
An invitation to participate in the program, without cost, was
circulated in a weekly
email communication to administrative staff at The University
of Queensland
(Australia). Interested respondents contacted the project staff by
return email, and
were then contacted by telephone by a research assistant who
provided preliminary
study information. Respondents were considered ineligible if
they reported receiving
current psychiatric/psychological treatment (pharmacological or
therapy-based).
Those who provided preliminary consent to participate were
then asked to attend a
group-based assessment session at the University. No incentives
were offered for

participation.
The intervention
The READY program targets five key resilience protective
factors that were identified
from empirical literature: (1) positive emotions; (2) cognitive
flexibility (e.g. accep-
tance), (3) life meaning, (4) social support, and (5) active
coping strategies (including
physical activity) (Southwick, Vythilingam, & Charney, 2005).
The intervention approach is based on Acceptance and
Commitment Therapy
(ACT), which is an empirically based third generation Cognitive
Behavioral Therapy
that uses acceptance and mindfulness strategies, and
commitment and behavior
change strategies to produce psychological flexibility and
resilience through six core
processes: Acceptance, cognitive defusion (changing our
relationship with thoughts),
being present (mindfulness), self-as-context, values and
committed action (Hayes,
Luoma, Bond, Masuda, & Lillis, 2006). The program also
includes cognitive
behavioral therapy processes of skills training for relaxation
and building social
support. One program module promotes participation in
purposive and incidental
physical activity. Physical activity has previously been
identified as a potential
coping resource (Southwick et al., 2005) that can provide
enduring resilience to stress
(Salmon, 2001), enhance well-being (Penedo & Dahn, 2005;
Scully, Kremer, Meade,

Graham, & Dudgeon, 1998; Stathopoulou, Powers, Berry, Smits,
& Otto, 2006), and
protect against incident depression symptoms (Brown, Ford,
Burton, Marshall, &
Dobson, 2005; Strawbridge, Deleger, Roberts, & Kaplan, 2002;
van Gool et al.,
2007).
The program has 11 modules, and sessions include
psychoeducation, discussion,
experiential exercises, and structured learning and practice
activities. Session topics
include an introduction to the READY resilience model,
physical activity,
mindfulness, defusion (two modules including self-as-context),
acceptance, life
values, social connectedness, relaxation and pleasant activities,
and activating and
trouble shooting strategies (two modules).
Participants receive a detailed workbook that includes an audio
compact disc
(with guided exercises), written notes, sections for critical
reflection, and
structured learning activities to complete. The reflection and
learning activities
comprise the READY Personal Plan, which is a personalized
resource to help
participants apply the generalized information to their specific
context and
individual style.
Eleven sessions each of two h duration were run weekly over 13
weeks (with 1
week off in weeks three and 10 because of public holidays) at
the university. Sessions

268 N.W. Burton et al.
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were held during the week after work hours (five–seven pm),
and were led by two of
the authors (N.B., K.P.) who are clinical and health
psychologists.
Measures

Group assessment sessions were conducted at the university, in
the week before and
the week after the program, by three independent research
assistants (one each for
questionnaire, physical, and hematological measures) with the
lead investigator
(N.B.) in attendance.
Feasibility and acceptability
Participant attendance records were kept for each session by the
interventionists,
and reasons for non-attendance were recorded. The post
intervention ques-
tionnaire included items to obtain participant feedback on the
program and
materials.
Psychosocial well-being
A battery of self completed questionnaires included:
(1) Ryff’s Scales of Psychological Well-Being, including
subscales of autonomy,
environmental mastery, personal growth, positive relations,
purpose in life,
and self-acceptance (Ryff, 1989). This measure is widely used,
has well
established reliability and validity (Ryff & Singer, 2003), and
has previously
been shown to be sensitive to detecting treatment effects (Fava,
Rafanelli,
Grandi, Conti, & Belluardo, 1998).
(2) The Center for Epidemiological Studies Depression Scale
(CES-D) (Radloff,

1977). This is one of the most commonly used self report
questionnaires on
depression for a general (vs. clinical) population, and has
established
reliability and validity (Radloff, 1977).
(3) The Short Version of the Depression Anxiety Stress Scale
(DASS-21) with
subscales of depression (DASS_Dep), stress (DASS_Stress),
and anxiety
(DASS_Anx), (Lovibond & Lovibond, 1995). Each subscale has
been shown
to have high internal consistency and has yielded meaningful
discriminations
in a variety of settings in both Australian clinical and
community samples
(Lovibond & Lovibond, 1995).
(4) The positive affect scale from The Positive and Negative
Affect Schedule
(PANAS-X), which is widely used with well established
psychometric
properties (Watson & Clark, 1999).
(5) The action consistency items from The Valued Living
Questionnaire
(Wilson & Groom, 2002). Psychometric data on this measure is
not yet
available.
(6) The Mindful Attention Awareness Scale, which has been
shown to be
reliable, valid, and sensitive to change (Brown & Ryan, 2003).
(7) The Acceptance and Action Questionnaire II (AAQII), which
has

acceptable levels of factorial validity, criterion validity, and
reliability (Hayes
et al., 2006).
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(8) The MOS Social Support Survey (Sherbourne & Stewart,
1991), which has
acceptable levels of reliability and validity (Hays, Sherbourne,
& Mazel,

1995).
Physical activity
Physical activity was measured via self-report using items
adapted from the Active
Australia surveys that ask about the total time spent during the
previous week in
walking (Australian Institute of Health and Welfare (AIHW),
2003). These items
have acceptable levels of reliability and validity (Brown,
Bauman, Chey, Trost, &
Mummery, 2004; Brown, Burton, Marshall, & Miller, 2008;
Brown, Trost, Bauman,
Mummery, & Owen, 2004). Total time spent in activity was
calculated by summing
the time spent in minutes of activity across these three
categories, after weighting
minutes in vigorous activity by two to allow for the greater
intensity [i.e. (minutes
walking) þ (minutes moderate activity) þ (minutes vigorous
activity 62)]. Physical
activity was also assessed using pedometer step counts.
Participants were asked to
wear a pedometer for seven consecutive days and record the
total number of steps
taken each day. The pedometer and the step log were returned at
the first group
training session, and by mail after the program completion. Data
was used to derive
average daily step counts.
Physical and hematological measures
Physical measures included height and weight (used to derive
body mass index

[BMI]) and blood pressure (BP_Sys and BP_Dias).
Hematological data involved a
fasting blood sample to measure blood glucose, total
cholesterol, C-reactive protein
(CRP), and cortisol.
Sociodemographic measures
Questionnaire data were used to assess age, gender, country of
birth, household
composition, educational qualifications, employment status,
occupation, ability to
manage on income received, overall health status, caffeine and
alcohol consumption,
and tobacco cigarette consumption.
Analyses
Descriptive statistics were used to analyze attendance records,
responses to
questionnaire items about the program, and sociodemographic
data. Outcome
measure data were analyzed on an as per protocol basis.
Standardized
mean differences (with Hedges adjustment for a small sample
size) and 95%
confidence intervals were used to examine the relative size of
the intervention
effect across the different measures. For the following
variables, scores were
interpreted as positive intervention effects when the post-
intervention values were
lower than baseline: DASS_Stress, DASS_Dep (depression),
DASS_Anx (anxiety),
CES-D (depression), BP_Dias and BP_Sys (blood pressure),
cholesterol, CRP (C-

reactive protein), and BMI. Cohen’s standards (large [0.8],
medium [0.5], and
small [0.2]) were used to interpret the magnitude of intervention
effects (Cohen,
1988).
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Paired t-tests were used to determine the significance of
differences between

baseline and post intervention scores. As this was a feasibility
study with a small
sample, an a of 0.05 was used initially instead of a more
conservative value. However
given the number of planned comparisons, results were also
examined using a
sequential Bonferroni adjustment of a levels.
Results
Participants
The sociodemographic characteristics of participants are
presented in Table 1. The
age of participants ranged from 24 to 50 years, with a mean of
36.5 (SD 8.6). The
self-reported time spent in physical activity ranged from 45 to
1200 min/week, with a
median of 205 minutes/week. Average daily steps ranged from
4956 to 14,249, with a
mean of 9801 (SD ¼ 2784).
Feasibility
Thirty-five people responded to the study invitation and 18
people consented to
participate. Two participants did not complete the program; one
moved interstate,
and the other discontinued because of a change in personal
circumstances.
The average proportion of sessions attended by participants was
81%, with three
participants attending all 11 sessions. During the program, 37%
(n ¼ 6) missed one
or two sessions, and 44% (n ¼ 7) missed three or four sessions.

The most common
reasons given for missing sessions were time conflicts with
work meetings and
planned recreation leave.
Participant feedback on the program was very positive. On a
five-point Likert
scale, the mean rating for the program overall was 4.67 (where
5 was excellent and 4
was very good), and the mean rating of personal helpfulness
was 4.44 (where 5 was a
lot and 4 was moderately so). On a four-point Likert scale
(where 4 was very helpful
and 3 was moderately helpful), the mean rating for the
workbook was 3.87, and the
mean rating for the READY Personal Plan was 3.5. The
majority of participants
agreed with the weekly frequency (75%) and the two hour
session duration (87%). In
terms of the overall program length, 56% agreed that it was
good, and 31% thought
it was too short.
Effect on psychosocial, physical activity, physical, and
hematological measures
Figure 1 shows the standardized mean differences and 95%
confidence intervals for
each measure. There were large favorable intervention effects
on measures of
acceptance, environmental mastery, positive emotions,
mindfulness and personal
growth; moderate effects on measures of stress, self acceptance,
valued living,
autonomy, and depression; and a small effect on the total
cholesterol measure.

The mean scores at baseline and post-intervention are shown in
Table 2. Paired
t-tests indicated a significant difference (p 5 0.05) between
baseline and post
intervention scores on measures of mastery (t[15] ¼ 4.234, p ¼
0.001), positive
emotions (t[15] ¼ 3.696, p ¼ 0.002), personal growth (t[15] ¼
3.357, p ¼ 0.004),
mindfulness (t[15] ¼ 3.362, p ¼ 0.004), acceptance (t[15] ¼
2.847, p ¼ 0.012), stress
(t[15] ¼ 72.807, p ¼ 0.013), self acceptance (t[15] ¼ 2.720, p ¼
0.016), valued living
(t[15] ¼ 2.557, p ¼ 0.022), autonomy (t[15] ¼ 2.369, p ¼
0.032), and total
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cholesterol (t[15] ¼ 72.483, p ¼ 0.025). The difference on a
measure of depression
(CES-D) had borderline significance (t[15] ¼ 72.063, p ¼
0.057). Using the
sequential Bonferroni adjustment of a levels, only mastery
remained significant.
Discussion
These results provide promising preliminary support for the
READY program as an
intervention that can be feasibly implemented as group-based
training in a
Table 1. Sociodemographic characteristics of study sample.
Study sample % (n)
Gender
Men 85 (15)
Women 17 (3)
Age group (years)
20–30 33 (6)
31–40 33 (6)
41–50 33 (6)
Country of birth

Australia 61 (11)
UK/USA 17 (3)
Other 22 (4)
Highest educational qualification completed
School only 11 (2)
Certificate/diploma 11 (2)
University degree 78 (14)
Household composition
Living alone 11 (2)
Single and living with others 17 (3)
Couple, no children 50 (9)
Couple with children 22 (4)
Employment status
Full time 83 (15)
Part time/casual 17 (3)
Occupational group
Manager or Senior Administrator 28 (5)
Professional or Associate Professional 33 (6)
Clerical/Other 39 (7)
Ability to manage on income received
Easy 33 (6)
Not too bad/Difficult sometimes 61 (11)
Impossible 6 (1)
General health status
Excellent/very good 17 (3)
Good 33 (6)
Fair/Poor 50 (9)
Body mass index
518.5–525 67 (12)

425 33 (6)
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workplace setting to improve psychosocial well-being. Our
three-month implemen-
tation period was twice as long as both the original and the
modified Personal
Resilience and Resilient Relationships program (Bradshaw et
al., 2007; Waite &

Richardson, 2004), but half the length of the Resilience and
Reintegration program,
although the majority of that was conducted in the first seven
weeks (Steensma et al.,
2006). READY involved 22 h of contact time, which was
slightly longer than the
Personal Resilience and Resilient Relationships Program
(Bradshaw et al., 2007) but
much shorter than the other two training programs that required
40 h (Waite &
Richardson, 2004) and (approximately) 14 days (Steensma et
al., 2006).
Written feedback indicated that the READY participants liked
the weekly
frequency of sessions, as this kept training issues ‘‘on the
agenda’’ while also
allowing time for reflection and skills practice. Although the 11
6 2 h sessions were
seen as a significant time commitment, and less than 20% of
participants attended all
sessions, a shorter implementation period or shorter sessions
was not favored by the
majority of participants. There was some support for having a
longer implementa-
tion period to allow for more breaks during the program, e.g.
the occasional two
week break from weekly sessions, so as to consolidate learning
and prevent fatigue.
Consideration of this for future applications of the program
would however, need to
be in consultation with the employer organization; in this trial
the implementation
period was within one term in the university calendar.
Participants rated the program highly, and saw it as personally

helpful and
enjoyable. The participant workbook and READY Personal Plan
were well received
Figure 1. Standardized mean difference and 95% confidence
intervals for study measures.
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and seen as a useful resource both during and after the program.

Specific suggestions
to improve the program were to have more time in each session
to review homework
and activities from the previous week, more small group work,
and more time to
review the overall program and the READY Personal Plan.
There were large and significantly favorable intervention effects
on measures of
acceptance (acknowledging both positive and negative
experiences), environmental
mastery (effective and competent use of opportunities and
external activities), positive
emotions (e.g. interest, enthusiasm, determination), mindfulness
(conscious attention
and awareness), and personal growth (self improvement,
openness to new experiences).
There were also moderate and significant favorable intervention
effects on
measures of stress, self acceptance (positive self attitude),
valued living (actions
consistent with life priorities and desires), and autonomy (self-
determination, self
regulation). As the READY program targeted positive emotions,
problem solving,
and life purpose as key protective factors, and included session
modules on
mindfulness and acceptance (targeting the protective factor of
cognitive flexibility),
improvements in these areas were particularly pleasing.
Although there was a
moderate favorable effect on depression, this did not reach
statistical significance.
This may reflect low baseline levels; the mean score for both
the DASS_Depression

Table 2. Mean differences in measures between baseline and
post-intervention.
Measure
Mean
difference (SD)
95% confidence
interval p
Questionnaire measures
Ryff_Autonomy 3.06 (5.17) 0.31–5.82 0.03
Ryff_Environmental mastery 6.25 (5.91) 3.10–9.40 0.001
Ryff_Personal growth 4.37 (5.21) 1.60–7.15 0.004
Ryff_Positive relations 1.06 (6.29) 72.29–4.41 0.509
Ryff_Life purpose 3.87 (9.82) 71.36–9.11 0.135
Ryff_Self acceptance 3.94 (5.79) 0.85–7.02 0.016
CES-D (Depression)
a 75.25 (10.18) 710.67–0.17 0.057
DASS_Depression
a 73.75 (9.46) 78.79–1.29 0.134
DASS_Stress
a 75.75 (8.19) 710.12 to 1.38 0.013
DASS_Anxiety
a
0.50 (7.17) 73.32–4.32 0.784
PANAS_positive affect 6.44 (6.97) 2.72–10.15 0.002
Valued living questionnaire 7.19 (11.24) 1.20–13.18 0.022
Mindful attention awareness scale 7.12 (8.48) 2.61–11.64 0.004

Acceptance and action questionnaire II (AAQII) 6.81 (9.57)
1.71–11.91 0.012
MOS social support survey 0.87 (2.03) 70.21 to 1.96 0.105
Physical activity
Minutes/week 15.33 (289) 7144–175 0.840
Average steps/day 223.85 (2870) 71356–1823 0.757
Physical measures
Body mass index
a
0.09 (1.11) 70.49–0.68 0.74
Blood pressure_systolic
a 72.87 (7.62) 76.94–1.19 0.152
Blood pressure_diastolic
a 70.87 (6.25) 74.20–2.45 0.584
Hematological measures
Fasting blood glucose
a 70.74 (0.42) 70.30–0.15 0.489
Total cholesterol
a 70.26 (0.41) 70.48 to 0.03 0.025
C-Reactive protein
a 70.07 (0.83) 70.52–0.37 0.730
Cortisol
a
0.500 (27.69) 714.26–15.26 0.943
a

Negative mean difference implies favorable change.
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subscale (Lovibond & Lovibond, 1995) and the CES-D (Radloff,
1977) were below
‘‘clinical’’ levels.
Because of the different measures used, our results are not
directly comparable

with other resilience training studies. There is however,
conceptual similarity
between our improvements on measures of valued living,
autonomy, and self
acceptance, and the higher levels of life purpose, locus of
control, and self esteem
reported by Waite and Richardson (2004). Consistent with
Steensma et al., (2006)
our study demonstrated improvements in depression, although
as previously stated,
this had only borderline significance.
Unlike other studies (Steensma et al., 2006; Waite &
Richardson, 2004), we did
not find significant improvements on measures of interpersonal
relations. We used
the MOS Social Support Survey (Sherbourne & Stewart, 1991),
which assesses the
frequency of the availability of sources of support (e.g.
someone whose advice you
really want, someone to show you love and affection), which
may not have been
sufficiently sensitive to change. Resilience was conceptualized
as a primarily intra-
personal construct to be developed by participants, while this
measure assesses
supportive behaviours provided by inter-personal networks,
which was not under the
direct influence of program participants. Other studies used
measures that assessed
seeking social support as a coping strategy (Steensma et al.,
2006) and the frequency
of specified interpersonal experiences (Waite & Richardson,
2004).
Consistent with the findings of Bradshaw et al., (2007), we did

not find significant
changes in the physical or haematological measures, or in self-
reported physical
activity. A lack of significant change in the hematological
measures may be because
these were largely within the accepted healthy ranges at
baseline. We did however, have
a small but significant change in total cholesterol. No
significant changes in physical
activity may have been because of high baseline levels; the
median of 205 min/week is
higher than the 5 6 30 min/week of moderate activity or 3 6 20
min/week of
vigorous activity specified in national recommendations
(Haskell et al., 2007). It should
be noted however, that physical activity was conceptualized as
only one aspect of
resilience, and already active participants could still benefit
from other program
modules. Furthermore, participants may have qualitatively
changed their experience of
physical activity participation in response to the other program
modules, such as doing
physical activity with mindfulness. This could have had a
synergistic effect on other
outcome measures, such as for example positive emotions.
Limitations
As this study was a small-scale feasibility study, and not a
controlled trial, we are
unable to make conclusions about the efficacy of the program.
There were however,
significant pre–post improvements in specific indicators of well
being and
psychosocial functioning. Without a follow-up assessment, we

are unable to
comment on the sustainability of these improvements. As the
construct of resilience
is such that it implies a protective effect against future
adversity, the longevity of any
improvements will be important to assess in future research.
The short implementa-
tion period may have been insufficient to see changes in the
physiological measures
such as BMI. The study relied heavily on self-report data, which
are vulnerable to
social desirability bias and measurement error. However, we
used questionnaires
that have previously been demonstrated to have acceptable
levels of sensitivity to
change and reliability, and complemented the physical activity
questionnaire data
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with objective step count (pedometer) data. As the study sample
was recruited from
staff at a university in a capital city, and included a majority of
women and people
with a university education, further work is needed to examine
the acceptability and
effectiveness of the program with a more heterogenous sample.
Conclusions
These results suggest that it is feasible to implement the
READY program as a group
training program in a worksite setting to promote psychosocial
functioning and well-
being. Participant feedback indicated that no major changes
were required to the
session duration, session frequency or program materials, but
that a longer
implementation period and more time for review activities could
be considered.
Sessions could also be restructured to allow for more small
group work, and more
review of previous sessions and homework activities. An
alternative measure of social
support, that focuses on the behaviours of the respondent (e.g.
seeking support) rather

than others (e.g. support provision) may be more useful. Future
work will examine the
efficacy of the program in a controlled trial, the sustainability
of any improvements,
and the mechanisms of change. This will facilitate our
conceptual understanding of
resilience, and our practical understanding of how to positively
influence it.
Acknowledgements
Nicola Burton is a Heart Foundation Research Fellow (PH 08B
3904), and is also supported
by a (Australian) National Health and Medical Research Council
Capacity Building Grant
(ID 252977) and Program Grant (ID 310200). This study was
funded by a Program Grant
from the (Australian) National Health and Medical Research
Council (ID 301200). The
authors thank the participants for their ongoing enthusiasm and
support for the program, and
Sarah Walters for research support.
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Promoting Resilience in Children
and Youth
Preventive Interventions and Their Interface
with Neuroscience
MARK T. GREENBERG
Prevention Research Center, Pennsylvania State University,
University Park,
Pennsylvania, USA
ABSTRACT: Preventive interventions focus on reducing risk
and promot-
ing protective factors in the child as well as their cultural
ecologies (family,
classroom, school, peer groups, neighborhood, etc). By
improving com-
petencies in both the child and their contexts many of these
interventions
promote resilience. Although there are now a substantial
number of pre-
ventive interventions that reduce problem behaviors and build
competen-
cies across childhood and adolescence, there has been little
integration
with recent findings in neuropsychology and neuroscience. This
article
focuses on the integration of prevention research and
neuroscience in the
context of interventions that promote resilience by improving
the exec-
utive functions (EF); inhibitory control, planning, and problem
solving
skills, emotional regulation, and attentional capacities of

children and
youth. Illustrations are drawn from recent randomized
controlled trials
of the Promoting Alternative Thinking Strategies (PATHS)
curriculum.
The discussion focuses on the next steps in transdisciplinary
research in
prevention and social neuroscience.
KEYWORDS: prevention; intervention; neuroscience; children;
youth;
frontal lobe
PROMOTING RESILIENCE IN CHILDREN AND YOUTH:
PREVENTIVE INTERVENTIONS AND THEIR INTERFACE
WITH NEUROSCIENCE
As a psychologist interested in creating change in communities
and influenc-
ing public policy, I am often asked questions about
developmental processes
and trajectories in children. For example, “How can we help
children resist
Address for correspondence: Dr. Mark T. Greenberg, Prevention
Research Center, Henderson Build-
ing, South Room 109, Penn State University, University Park,
PA 16802. Voice: 814-863-0112; fax:
814-865-2530.
e-mail: [email protected]
Ann. N.Y. Acad. Sci. 1094: 139–150 (2006). C© 2006 New
York Academy of Sciences.
doi: 10.1196/annals.1376.013

139
140 ANNALS NEW YORK ACADEMY OF SCIENCES
negative influences when they live in high-risk neighborhoods?”
“How can we
improve children’s academic outcomes when their families have
experienced
an intergenerational history of school failure?” “How can we
help children
control their emotions when their peers are bringing out the
worst in them
through teasing and taunting?” All of these questions imply the
notion that
many children are exposed to high-risk situations and the
implication is that
unless something is done, the probability of a poor outcome for
some chil-
dren is relatively high. Such situations are ripe for efforts to
attempt to prevent
difficulties that may spiral into longer-term poor outcomes
across childhood,
adolescence, and even adulthood. Beginning with the War on
Poverty and the
emergence of Head Start in the 1960s, preventive interventions
have become
central to our nation’s public policy. As a result of the
increased rate of both
adolescent delinquency and drug use seen in the ensuing
decades, the devel-
opment of both preventive intervention programs and
social/legislative policy
initiatives has dramatically increased. The role of
developmental science in

public policy making has never been greater or more influential.
Improving the public’s health, especially for those at greatest
risk, is a com-
plex problem that involves interventions at the level of
economic and social
policy as well as the ability to strengthen the skills of
educators, parents, and
youth themselves. Macrolevel interventions focused on
changing community-
level ecologies, attitudes, and behavior have ranged from large
experiments in
economic policy (e.g., earned income tax credits, TANF),
changes in housing
patterns,1 social legislation ranging from raising the age at
which youth can
drive to building community partnerships to reduce youth
problem behaviors
and build positive youth development at the community level.2
At a more mi-
crolevel, attempts to improve the culture, attitudes, and
relations in families,
peer groups, and schools have focused on building
communication skills and
values that promote positive developmental outcomes. Finally,
there has been
recognition that some attributes inside the individual, including
skills, cogni-
tions, and behaviors, may be malleable in response to
preventive efforts. The
enormous scope of activities undertaken is a testimony to our
implicit under-
standing that child and youth outcomes are multidetermined and
that various
levels of influence impact developmental trajectories. Although
at times these

initiatives seem (or are) both random and chaotic, at another
level they clearly
reflect the combination of our growing basic knowledge of both
the ecology of
human development,3 the advances made in developmental
psychopathology,4
and the emergent development of the field of prevention
science.5
The study of resilience emerges out of the large research
endeavor of public
health epidemiology and the study of risk and protective factors
and how they
impact development. A number of guiding principles have
emerged both from
epidemiology and developmental psychopathology.6,7 First, it
is unlikely that
there is a single “cause” of many of the preventable outcomes
(e.g., mental
disorders, substance abuse, school failure, delinquency); even in
the case of
disorders in which a biochemical or genetic mechanism has
been discovered,
GREENBERG: PREVENTIVE INTERVENTIONS 141
the expression of the disorder is influenced by other biological
or environ-
mental events.8,9 Second, there are multiple pathways both to
and from risk
and problem outcomes; for example, there are different
combinations of risk
factors that might lead to the same disorder. Third, no single

cause may be
either necessary or sufficient10 and the effect of a risk factor
will depend on
its timing and relation to other risk factors. Fourth, many risk
factors are not
disorder-specific, but instead relate to a variety of outcomes.
Finally, risk fac-
tors may vary in influence with host factors, such as gender,
ethnicity, and
culture.
Resiliency is commonly defined as positive or protective
processes that re-
duce maladaptive outcomes under conditions of risk. That is,
they are protective
factors that may be especially important under conditions of
risk. Although
much less is known about protective factors and their
operation,7,11 at least
three broad types of protective factors have been identified.
These include
characteristics of the individual (e.g., temperamental qualities
and intelligence/
cognitive ability), the quality of the child’s relationships, and
broader ecological
factors, such as quality schools, safe neighborhoods, and
regulatory activities.
An essential question related to adversity and resilience is the
individual’s
development of an effective set of responses to stress. Central
components of
the stress response include the initial appraisal of the event and
its emotional
meaning, the ability to sufficiently regulate one’s emotions and
arousal to

initiate problem solving and gather more information, the fuller
cognitive-
affective interpretation of the event, and one’s behavioral
response. Masten12
has noted that among the most important resiliency factors are
these very
cognitive and emotion regulation skills.
Prospective longitudinal designs are critical to understanding
the role of
resiliency as they can identify (a) which risk factors are
predictive of different
developmental stages of a problem, (b) the dynamic relation
between risk and
protective factors in different developmental periods, and (c)
what factors are
most likely to “protect” or buffer persons under risk conditions
from negative
outcomes. In addition, randomized trials of preventive
interventions can test
these theories by examining how behavior changes are
mediated.
THE INTERFACE OF PREVENTION, DEVELOPMENTAL
PSYCHOPATHOLOGY, AND NEUROSCIENCE
Although developmental psychopathology, prevention, and
neuroscience
have developed in isolation, integrated research on protective
factors and re-
silience has the potential to answer central questions regarding
plasticity and
the role of environmental and genetic process. While the
primary goal of
prevention science is to change behavior, behavior can be

broadly defined
as action, emotion, and cognition. Further, biological substrates
underlie all
of these processes and may serve as moderators, mediators, or
outcomes of
TABLE 1. Levels and measures of the biological substrate
I. Neural processes II. Autonomic nervous system
1. Structural aspects 1. Parasympathetic activity
A. Neuronal development and connections A. Cardiac vagal
tone
B. Localization of action
2. Functional aspects 2. Sympathetic nervous system
A. Neurochemical systems (dopamine, A. Resting heart rate
noradrenaline, serotonin, brain-
derived neurotrophic factor)
3. Neurocognitive function 3. Neuroendocrine function
A. Neuropsychological testing A. HPA axis–Glucocorticoids
4. Immunological function
A. T cells/antibody titers to vaccines
preventive interventions.13 A broad vision of the integration of
prevention and
neuroscience would examine how a variety of biological
processes play a role
in a deeper understanding of the processes and effects of

preventive interven-
tions. TABLE 1 provides a list of some of the biological
substrates that would
be of interest at the levels of both the brain and autonomic
nervous system.
A central task for the next decade is to understand in much
greater detail
the relations between the multiple levels of the biological
substrate and these
resilience processes involved in cognitive processes and
emotional regulation.
With transdisciplinary collaboration involving neuroscientists
and the use of
multilevel models of measurement driven by the theory/logic
model, prevention
research has the potential to make a major contribution to
understanding the
developing interplay of biology and behavior.
Many preventive interventions focus on supporting improved
emotion reg-
ulation and problem-solving skills in which executive functions
(EF) and the
actions of the prefrontal lobes play a central role. EF generally
refers to the psy-
chological processes that are involved in the conscious control
of thought. Ex-
amples of processes include inhibition, future time orientation,
consequential
thinking, and the planning, initiation, and regulation of goal-
directed behav-
ior.14 Substantial data indicate that EF skills as assessed by
neuropsychological
tasks are related to childhood maladaptation.13,15 However,
there has been lit-

tle evidence in childhood between the performance of EF tasks
(inhibitory
control, working memory, planning) and neuroanatomical
localization of ac-
tivity in areas of the frontal lobe.16,17 Due to the
methodological requirements
for valid Functional Magnetic Resonance Imaging (fMRI)
assessments with
young children, few data are available before the age of 10
years, although
recent work using high-density Event Related Potential (ERP)
assessments
are particularly promising.18 A series of methodological and
conceptual chal-
lenges still have to be solved in order to fully assess the
specific brain local-
ization of neurocognitive and affective skills in children.19
Further, there is a
need to broaden methods to understand how childhood cognitive
and affective
processing (especially under conditions of stress) are related to
other biologi-
cal processes, including action in the autonomic nervous
systems that include
correlates of the hypo-pituitary-adrenal (HPA) axis,20,21
immunological func-
tion, the parasympathetic system (vagal tone), as well as
functional analysis of
brain action (neurotransmitter release).
Pioneering work with children has already begun to show the

potential yield
of this vision in which interventions use measurement models
and theories
based on our rapidly developing knowledge of neuroscience.
Research has
indicated that there is correspondence between improved
reading skills and
changes in brain activity in reading-deficient children.22 An
intervention to im-
prove the outcomes of children in the foster care system has
indicated changes
in both behavior and children’s salivary cortisol.23 Computer-
based training for
children with Attention-Deficit Hyperactivity Disorder (ADHD)
has indicated
changes in EF and behavior.16 Meditation training in adults has
been shown
to alter both frontal brain activity (hemispheric laterality) and
immunological
response.24 Further, a number of studies has shown the
moderating role of
biological variables, including how EF moderates the effect of a
brief inter-
vention on high-risk teens25 and how the hypoactivity of
anterior cingulate
cortex predicts poor response to treatment for depression.26
Although neuroanatomical findings on cognitive and emotion
regulation
skills in childhood are sparse, there is a burgeoning literature
on adults re-
garding brain localization of EF that can judiciously guide
theory and action
with children. The field of social–cognitive neuroscience
(studies with lesion
patients, patients with psychopathologies, and normally

developing adults) has
clearly implicated the orbital/dorsolateral/limbic circuit in the
processing of
emotional stimuli and the cognitive control and regulation of
behavior.27,28
Findings indicate a clear role for the anterior cingulate in the
processing of
emotions, executive attention processes, and working
memory.29–31 The role of
the dorsolaternal prefrontal area has been shown in cognitive
control and inhibi-
tion of emotional arousal.32,33 Further, the orbital frontal area
has been related
to emotion processing and regulation.34 Although research has
attempted to
completely localize processes in single neuroanatomical areas,
it is clear that
there is strong and rapid connectivity between these areas
during decision
making and there are sometimes contradictory findings between
studies of
specific loci.35 As most of this work is less than a decade old,
conclusions re-
garding specific loci may be premature. Further, noradrenaline,
serotonin, and
dopamine are projected to all these areas and thus energize
action across sys-
tems. Double dissociation36 and lesion studies as well as
intervention trials24
will play substantial roles in further differentiation.
THE DEVELOPMENT OF EF
Although infancy and toddlerhood provide a basis for critical

aspects of later
coping,21,37 much of the child’s more complex cognitive
processes, coping,
and regulation skills arise with neurocognitive maturation in the
frontal lobes.
This maturation proceeds from the preschool years through late
adolescence.
Although numerous linguistic and cognitive processes are
developing, the de-
velopment of EF appears crucial to healthy development and
deficiencies in
EF have been related to numerous poor outcomes. These
outcomes involve
cognitive processes related to effective emotional regulation
and behavioral
performance, including aggression, delinquency, depression,
and disorders of
attention.13,38
INTERVENTION AND EF: ILLUSTRATIONS
FROM THE PROMOTING ALTERNATIVE THINKING
STRATEGIES (PATHS) CURRICULUM
During the past few decades our research group has been
involved in the
development, implementation, evaluation, and refinement of a
social and emo-
tional learning curriculum based on neuroscientific principles
that focus on
promoting emotional awareness and effective cognitive control.

The PATHS
curriculum is a universal school-based prevention curriculum
aimed at re-
ducing aggression and behavior problems by promoting the
development of
social–emotional competence in children during the preschool
and elementary
school years.39 PATHS is based on the affective-behavioral-
cognitive-dynamic
(ABCD) model of development.40 The ABCD model focuses on
how cogni-
tion, affect, language, and behavior become integrated in the
developing child.
A fundamental concept is that as youth mature, emotional
development pre-
cedes most forms of cognitive development. That is, young
children experience
emotions and react to them long before they can verbalize their
experiences.
Early in life, emotional development is an important precursor
to other ways of
thinking and must be integrated with cognitive and linguistic
abilities, which
are much slower to develop. Then, during the elementary years,
further devel-
opmental integration occurs among affect, behavior, and
cognition/language
through maturation of the prefrontal circuit. These processes of
brain matu-
ration are important in achieving socially competent action and
healthy peer
relations.
The PATHS curriculum places special attention on
neurocognitive models
of development.41 Of significant importance are the concepts of

vertical con-
trol and verbal processing of action (e.g., horizontal control).
Vertical control
refers to the process of higher-order cognitive processes
exerting control over
lower-level limbic impulses vı̀s-a-vı̀s the development of
frontal cognitive con-
trol.14 PATHS attempts to consciously teach children the
processes of vertical
control by providing opportunities to practice conscious
strategies for self-
control. This is achieved via instruction with curriculum lessons
and a variety
of cognitive/behavioral techniques that are developmentally
appropriate from
the ages of 4 to 11 years. One central example is the use of a
control signals
poster that teaches children the steps for problem solving in
social contexts.
The curriculum also has an intentional and intensive focus on
helping children
to verbally identify and label feelings in order to manage them.
This is achieved
through curriculum lessons and the integration of “feeling
faces” that children
use throughout the day to identify their feelings and those of
others.
A series of outcome trials have indicated that effective
implementation of
the PATHS curriculum leads to decreases in externalizing and

internalizing
problems by both teacher and self-report and to increases in
social and emo-
tional competence.42–45 However, as with many preventive
interventions, there
has been little investigation of how such change is mediated.
Although some
aspect of this mediation may be due to changes external to the
child (improved
classroom environment, warmer teacher–student relations), we
believe that
the curriculum promotes more effective inhibitory control,
emotion regula-
tion, and planning skills. The curriculum logic model is based
on the idea that
the intervention will lead children (1) to become less impulsive
and more plan-
ful in their social interactions, and (2) to recruit language to
regulate behavior
and communicate effectively with others.
We recently tested this mediation model in a randomized
controlled study
of 318 second-and third-grade children.46 Schools were
randomized to receive
the PATHS intervention or to control status. Intervention
teachers received
both a 3-day initial training workshop as well as ongoing
weekly coaching in
curriculum implementation. The PATHS lessons were taught
approximately
three times per week, with each lesson lasting 20–30 min. In
addition, teachers
used techniques to generalize PATHS skills with the goal of
supporting stu-
dents to apply the PATHS skills in the “hot” naturally occurring

contexts of
their school day. These situations of high emotional arousal
usually occurred
during conflictual interactions with peers, with their teachers,
or when feel-
ing academic frustration. Students were assessed at pretest,
posttest (7 months
later), and follow-up (1 year after the curriculum ended).
Outcome findings examined teachers’ ratings of both
internalizing and exter-
nalizing behavioral problems using the Child Behavioral
Checklist (CBCL47).
EF were assessed by two well-known measures validated to
activate anterior
cingulate and dorsolateral prefrontal cortex.48 Inhibitory
control was assessed
with the Stroop Test and verbal fluency was assessed using the
Verbal Fluency
Subtest of the McCarthy Scales of Children Abilities. To test a
mediational
model, it was first necessary to demonstrate that the
intervention affected
both behavior and EF. Results indicated that there were
significant differences
at posttest showing greater improvements in both inhibitory
control and ver-
bal fluency in the intervention children. At the 1-year follow-
up, intervention
children also were rated by teachers as lower in externalizing
and internaliz-
ing problems. Further, posttest changes in both inhibitory
control and verbal
fluency were significantly related to teacher ratings of behavior
problems at
follow-up.

The specific mediational hypothesis we tested was that EF
would me-
diate the relationship between prevention/control group
assignment and
teacher-reported externalizing and internalizing behavior
problems. The find-
ings indicated that improvements in inhibitory control at
posttest signifi-
cantly mediated the relation between experimental condition
and both teacher-
reported externalizing and internalizing behavior at 1-year
follow-up. In
addition, improvements in verbal fluency significantly mediated
the relation
between experimental condition and teacher-reported
internalizing behavior.
However, improvements in verbal fluency showed only a trend
toward explain-
ing change in teacher-reported externalizing behavior.
These findings provide empirical support for the conceptual
theory of action
that underlies the PATHS curriculum model. That is, child
neurocognitive
functioning plays a key role in children’s social and emotional
adaptation and
changes in EF directly relate to reductions in behavioral
problems. However,
a broader view and greater incorporation of the biological
substrate into our

understanding of the processes would begin to assess less
peripheral systems
of mediation than only the use of neuropsychological tests.
Although our own work with the PATHS intervention is very
preliminary, I
use it as a case example of how we might develop
transdisciplinary connec-
tions between prevention scientists and neuroscientists. A clear
logic model
of the intervention might hypothesize that such behavioral
changes would
lead to greater activation in the anterior cingulate and
dosolateral prefrontal
areas. Although such assessments could not be readily
accomplished using
fMRI at these younger ages, EEG–ERP assessments might be
used. One
might also hypothesize that such an intervention might impact
the child’s
stress reactivity (HPA axis) or their parasympathetic activity
under moder-
ately stressful testing conditions. Finally, if such an
intervention impacted
both frontal activity and stress-reactivity, one might
hypothesize that over
time it might impact overall bodily health as assessed by
immunological
function.
The point here is that effective preventive models that have
more fully ar-
ticulated logic models of action should begin to ask “deeper”
questions about
the neuroscientific underpinnings of either change processes or
obstacles to

intervention impact. That is, how might measures of the
biological substrate
serve as mediators, moderators, and outcomes?
Of course, there are some important caveats at this stage in the
scientific
enterprise. First, children may recruit different brain regions
than do adults to
accomplish the same task and extrapolated theories from
research on adults
should be used with caution.49 Further, even when fMRI can be
used with
older children, there are substantial conceptual and
methodological challenges
in interpreting such findings.19 Finally, although some aspects
of the effects of
preventive interventions may be better understood by taking a
neuroscientific
perspective, much of the action of some prevention models
occurs primarily
through changes in the environment (quality of the classroom or
community)
or in the context of social interactions that may not be well-
captured by current
models of neuroscience.
These findings and others in neuroscience point to the
importance of con-
sidering social–emotional development as best understood
within broader the-
ories that take into account how children’s experiences and
relationships affect

their brain organization, structuralization, and development.38
As such, there
is a need for an extensive research agenda in which there is a
transdisciplinary
collaboration among prevention scientists, developmental
psychopathologists,
and neuroscientists. However, this will require not only clearer
logic models
of change and possibly more potent preventive interventions,
but substantial
advances in basic research in childhood neuroscience including
improvements
in both measurement and conceptualization. Through such work,
carefully de-
veloped studies should take us past the “black box” outcome to
more fully
understand the cognitive and neural mediators and moderators
of change.
ACKNOWLEDGMENTS
This work was supported by the National Institute of Mental
Health (NIMH)
grant R01MH42131. Dr. Greenberg is one of the developers of
the PATHS cur-
riculum program and has a publishing agreement with
Channing–Bete Pub-
lishers.
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Enhancing Resilience in Children: A Proactive Approach
Mary Karapetian Alvord and Judy Johnson Grados
Alvord, Baker & Associates, LLC

Many clinical practitioners today are interested in helping
children be more resilient. The authors briefly
review the literature and identify protective factors that are
related to or foster resilience in children. After
discussing individual and family intervention strategies
currently in use, the authors present a practical,
proactive, resilience-based model that clinicians may use in a
group intervention setting. The model
entails interactive identification of protective factors with
children, free play and behavioral rehearsal,
training in relaxation and self-control techniques, practice in
generalizing skills acquired, and active
parent involvement. Implications of this group intervention
model are discussed.
Keywords: resilience, children, social skills, groups, cognitive–
behavioral therapy
Vala is a 16-year-old Russian girl who first came to our practice
at age 6. Neglected as a child, separated from her younger
sister,
and taken to an orphanage following her mother’s suicide, she
was
adopted by an American family and came to this country. The
tribulations she experienced were extreme. However, because of
her intelligence, easygoing temperament, and other personal
strengths, as well as loving support of family and friends and a
positive school environment, she is functioning well today and
appears to be successful and happy.
Many children encounter fewer and less severe traumatic expe-
riences than did Vala. Yet they do experience the inevitable
stresses and adversities in life that may challenge their healthy
development and successful functioning. In the past three
decades,

a group of children have been identified in the research who
appear
to have fared well despite exposure to severe adversity. These
children, who have been referred to as stress-resistant, invulner-
able, and, more recently, resilient, were found to possess certain
strengths and to have benefited from protective influences that
helped them to overcome adverse conditions and to thrive. As
practitioners, we must understand what environmental factors
place children at risk and what protective factors may be
fostered
to enhance and strengthen resilience in children.
In this article we define resilience and provide an overview of
the literature and recent advances that are guiding work in the
field
today. We then define and discuss protective factors linked with
the resilience process. Finally, we offer clinical implications for
individual, family, and group therapy with children.
Definitions of Resilience
The term resilience has been defined in many ways. Masten,
Best, and Garmezy’s (1990) definition of resilience as “the
process
of, capacity for, or outcome of successful adaptation despite
chal-
lenging or threatening circumstances” (p. 426) is one of the
more
familiar and widely accepted in the field. Many definitions of
resilience require specification of an identified risk or challenge
to
which an individual is subjected, followed by some defined
mea-
sure of positive outcome. However, controversy remains
regarding
what constitutes resilient behavior and how to best measure suc-

cessful adaptation to adversity. Some have suggested that a
resil-
ient person must show positive outcomes across several aspects
of
his life over periods of time (Cicchetti & Rogosch, 1997).
Further,
resilience is not a one-dimensional, dichotomous attribute that
persons either have or do not have (Reivich & Shatté, 2003).
Rather, resilience implies the possession of multiple skills, in
varying degrees, that help individuals to cope.
For the purpose of this article, we define resilience broadly as
those skills, attributes, and abilities that enable individuals to
adapt
to hardships, difficulties, and challenges. Although some
attributes
are biologically determined, we believe resilience skills can be
strengthened as well as learned.
Early Studies in Resilience
Early clinical case descriptions spawned an interest in determin-
ing why some children manage to cope with adversity whereas
others succumb. One such case of a 14-year-old Swiss girl was
described by Bleuler (1984; as cited in Anthony, 1987a).
“Vreni,”
in the absence of her mother (who was hospitalized with mental
illness), raised her siblings, cared for her alcoholic and
physically
compromised father, and later reported having a happy marriage
and contented life. Anthony’s description of “invulnerable”
chil-
dren (Anthony, 1987b) and Murphy and Moriarty’s “good
copers”
MARY KARAPETIAN ALVORD received her PhD from the

University of
Maryland in 1977. She is currently the director of the Group
Therapy
Center at Alvord, Baker & Associates, LLC, an independent
therapy
practice in the Washington, DC, metropolitan area. Her interests
are
focused on resilience and social skill development of children
and adoles-
cents.
JUDY JOHNSON GRADOS received her PsyD from Indiana
State University in
1995. She currently practices with Alvord, Baker & Associates,
LLC. Her
research interests include social skills training for children and
resilience in
children and adolescents.
WE GRATEFULLY ACKNOWLEDGE Dr. W. Gregory Alvord,
Dr. Patricia K. S.
Baker, and Ms. Anne McGrath for their support and editorial
comments.
We also thank Mrs. Maria Manolatos for assistance in the
preparation of
the manuscript.
CORRESPONDENCE CONCERNING THIS ARTICLE should
be addressed to Mary
Karapetian Alvord, Alvord, Baker & Associates, LLC, 11161
New Hamp-
shire Avenue, Suite 307, Silver Spring, MD 20904. E-mail:
[email protected]
Professional Psychology: Research and Practice Copyright 2005
by the American Psychological Association
2005, Vol. 36, No. 3, 238 –245 0735-7028/05/$12.00 DOI:
10.1037/0735-7028.36.3.238
238

T
hi
s
do
cu
m
en
t i
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by
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e
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ic
an
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ch
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A
ss
oc
ia
tio
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or
o
ne
o
f i
ts
a
lli
ed
p
ub
lis

he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
s
ol
el
y
fo
r t
he
p
er
so

na
l u
se
o
f t
he
in
di
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du
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is
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ot
to
b
e
di
ss
em

in
at
ed
b
ro
ad
ly
.
(Murphy & Moriarty, 1976) sparked early interest as well.
Rutter’s
Isle of Wight studies (Rutter, Tizard, Yule, Graham, &
Whitmore,
1976), large-scale longitudinal undertakings such as Project
Com-
petence (Garmezy, Masten, & Tellegen, 1984; Masten, 2000),
and
Werner’s now four-decade-long study of high-risk infants born
into poverty on the Hawaiian island of Kauai (Werner, 1993;
Werner & Smith, 2001) have helped to lay the groundwork for
what we know today.
Recent Advances
The emerging research in the area of resilience encompasses
many areas. These include investigations of children from
various
cultures (Grotberg, 1995; Hart, Hofmann, Edelstein, & Keller,
1997), studies of the influences of biological mechanisms
(Curtis

& Cicchetti, 2003; Rutter, 2002), new findings in recovering to
normal functioning in varying stages of development, research
on
the impact of internal challenges, and theories on the processes
that
promote resilience under nonrisk conditions. We consider the
latter
three areas below.
Evidence that children can recover and develop normally comes
from a recent study of Romanian children who experienced
severe
deprivation in orphanages and were later adopted into nurturing
homes in the United Kingdom. At the time of adoption, most of
these children showed substantial gross physical and cognitive
lags
in development. Later, when assessed at age 4, many of these
adoptees showed significant “catch-up,” both physically and
cog-
nitively (Rutter & The English and Romanian Adoptees (ERA)
Study Team, 1998; Rutter, Pickles, Murray, & Eaves, 2001).
Follow-up in Werner and Smith’s (2001) Kauai study revealed
that
even those individuals who were troubled as adolescents were
able
to change the course of their lives in dramatic ways by making
wise choices and taking advantage of opportunities, for
example,
by continuing their education, learning new skills, joining the
military, relocating to break ties with deviant peers, and
choosing
healthy life partners.
Major longitudinal studies have followed the outcome of indi-
viduals with learning disabilities and attention-
deficit/hyperactiv-

ity disorder (ADHD) to determine those factors that contribute
to
their resilience (Gerber, Ginsburg, & Reiff, 1990, and Spekman,
Goldberg, & Herman, 1992, as cited in Katz, 1997; Werner &
Smith, 2001). Studies reveal that resilient learning-disabled
youth
search for personal control over their lives, possess a strong
desire
to succeed, set goals, demonstrate high levels of persistence,
and
are willing to seek out and accept support. Resilient learning-
disabled young adults report better ability to identify their suc-
cesses and unique strengths, are more likely to report turning
points in their lives as motivations to overcome their
challenges,
and show a stronger self-determination (Miller, 2002).
Hechtman
(1991; as cited in Katz, 1997), in a long-term prospective
follow-up of young adults diagnosed with ADHD as children,
found that the presence of an influential person in their lives
who
believed in them (e.g., parent, teacher, coach) was most signifi-
cant. Effort is being put forth to better understand the risk and
resilience processes in this population of youth (Murray, 2003).
Masten (2001) challenged the notion that resilient children
possess some rare and special qualities. She suggested that
resil-
ience stems from a healthy operation of basic human
adaptational
systems. If systems are intact, children should develop
appropri-
ately even if challenged. However, if children’s basic
adaptational
systems are impaired, prior to or following challenge, the risk

for
problems in development is increased.
Protective Factors
Protective factors are “influences that modify, ameliorate, or
alter a person’s response to some environmental hazard that pre-
disposes to a maladaptive outcome” (Rutter, 1985, p. 600). Pro-
tective factors arise from within the child, from the family or
extended family, and from the community (Werner, 1995). A
child’s intelligence, success at making friends, and ability to
regulate his behavior are examples of internal strengths that
pro-
mote resilience. Examples of external influences that enhance
resilience are competent parents, friendships, support networks,
and effective schools.
Protective factors that help children successfully adapt and cope
with life’s challenges must be viewed in the context of their
individual cultures and developmental stages. The International
Resilience Project (Grotberg, 1995) showed, for example, that
faith operates as a stronger protective factor in some cultures
than
in others. In addition, children’s developmental and cognitive
levels affect their ability to use various protective factors, as do
internal and biological vulnerabilities such as ADHD and
learning
disabilities.
While researchers forge ahead to examine the complex interplay
between risk factors, protective factors, and prevention and
inter-
vention strategies, practitioners need to know what factors may
be
strengthened in children to further promote positive appropriate
responses. Below we discuss six protective factors that appear

to
buffer against risk factors. These factors have been categorized
in
accordance with the accumulating resilience literature and our
experience in clinical practice. These six categories are not
mutu-
ally exclusive. Many of the components described in one factor
are
related to components in other factors. For example, a child
who
can self-regulate is more apt to make friends and connect with
others. A child who experiences academic success is likely to
have
higher self-esteem. The presence of several factors seems to en-
hance performance in multiple arenas.
Proactive Orientation
Proactive orientation, that is, taking initiative in one’s own life
and believing in one’s own effectiveness, has been identified as
a
primary characteristic defining resilience in the literature. Such
terms as self-efficacy and self-esteem (Rutter, 1985), positive
fu-
ture expectations (Wyman, Cowen, Work, & Kerley, 1993),
good
coping (Murphy & Moriarty, 1976), primary and secondary con-
trol coping (Thurber & Weisz, 1997), personal control (Walsh,
1998), problem solving (Werner, 1995), initiative (Wolin &
Wolin,
1993), optimistic thinking (Seligman, 1995), and internal
motiva-
tion (Masten, 2001) have been identified as protective factors of
resilience in studies across heterogeneous populations and envi-
ronments. These terms mean that resilient individuals have a
realistic, positive sense of self. They regard themselves as

survi-
vors (Wolin & Wolin, 1993). They feel that they can have an
impact on their environment or situation, rather than just be
pas-
sive observers. They are hopeful about the future. They are con-
fident in their ability to surmount obstacles (Werner, 1993),
make
use of resources and opportunities around them, and view hard-
ships as “learning experiences” (Werner & Smith, 2001).
Resilient
239SPECIAL SECTION: ENHANCING RESILIENCE IN
CHILDREN
T
hi
s
do
cu
m
en
t i
s
co
py
ri
gh
te
d

by
th
e
A
m
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
tio
n
or
o
ne

o
f i
ts
a
lli
ed
p
ub
lis
he
rs
.
T
hi
s
ar
tic
le
is
in
te
nd
ed
s

ol
el
y
fo
r t
he
p
er
so
na
l u
se
o
f t
he
in
di
vi
du
al
u
se
r a
nd

is
n
ot
to
b
e
di
ss
em
in
at
ed
b
ro
ad
ly
.
individuals take positive action in their lives, such as seeking
mentors, pursuing educational opportunities, participating in ex-
tracurricular activities, and choosing supportive mates (Werner,
1993; Werner & Smith, 2001). Those who possess a high degree
of
“perceived self-efficacy” are more likely to interpret successes
as
an indication of their capabilities (Bandura, Pastorelli, Bar-

baranelli, & Caprara, 1999). Seligman (2002) pointed out that
when people think adverse events are permanent and pervasive
for
long periods of time, they assume feelings of helplessness and
hopelessness. In contrast, he noted, when they think that
negative
things are temporary, this attitude encourages resilience.
Teaching children to help others is an effective way to promote
responsibility, empathy, and self-esteem (Brooks, 1994; Werner,
1993). Giving of oneself in an effort to ease the plight of others,
such as contributing time and effort at a soup kitchen, nursing
home, hospital, and so forth, fosters resilience. Similarly,
“required
helpfulness” (Rachman, 1979) refers to the process that occurs
when an individual is striving to overcome adversity and during
the course of this pursuit is required to perform actions to help
others in their personal times of need.
Self-Regulation
One of the most fundamental protective factors is success in
developing self-regulation or self-control. Masten and
Coatsworth
(1998) define self-regulation as gaining control over attention,
emotions, and behavior. If a child is able to modulate her
emotions
and behavior and can self-soothe or calm herself, she will most
likely elicit positive attention from others (including parents)
and
will have healthy social relationships. She will more likely be
independent and will be more able to put things in perspective.
Easygoing temperament and good self-regulation have been
iden-
tified as protective factors in resilience (Buckner, Mezzacappa,
&

Beardslee, 2003; Eisenberg et al., 1997, 2003; Werner, 1993).
Additionally, impulse control and delay of gratification are part
of
self-control. The ability to self-regulate also seems to be at the
core
of good interpersonal relationships and peer relationships
(Rubin,
Coplan, Fox, & Calkins, 1995), rule compliance (Feldman &
Klein, 2003), reduced risk of depression and anxiety, and a host
of
other areas fundamental to successful adaptation and
functioning.
Common sense would dictate that positive emotionality should
result in positive outcomes. Although this is true, recent
research
indicates that perhaps it is not positive or negative emotion per
se
that is the critical variable in adaptation, but the ability to
regulate
the emotion. In a longitudinal study of 5-year-olds, Rydell,
Berlin,
and Bohlin (2003) found that low regulation of positive
emotions
and exuberance was correlated with externalizing problem
behav-
iors and low levels of prosocial behavior, whereas high
regulation
of positive emotions and exuberance was associated with high
levels of prosocial behavior.
Proactive Parenting
Children with at least one warm, loving parent or surrogate
caregiver (grandparent, foster parent) who provides firm limits
and

boundaries (Masten & Coatsworth, 1998) are more likely to be
resilient. They tend to be more compliant with their parents
(Feld-
man & Klein, 2003) and have better peer relationships
(Contreras,
Kerns, Weimer, Gentzler, & Tomich, 2000). A significant longi-
tudinal study that began in 1959 has identified the authoritative
parenting style as associated with “optimal competence” in chil-
dren and adolescents (Baumrind, 1989). Authoritative parents
are
characterized as “responsive” and “demanding” (Baumrind,
1991).
Responsive parents are warm, loving, and supportive and
provide
a cognitively stimulating environment. They are also demanding
in
that they apply rational, firm, and consistent, but not
overbearing,
control on their children and place high behavioral expectations
on
them (Baumrind, 1991). Eisenberg et al. (2003) found that
mater-
nal expression of positive emotion is related to children’s social
competence and adjustment. Correspondingly, Rubin, Burgess,
Dwyer, and Hastings (2003) found that dysregulated toddlers
who
experienced high levels of maternal negativity had a greater
like-
lihood of externalizing problem behaviors 2 years later than
tod-
dlers whose mothers showed low to average levels of negativity.
Connections and Attachments
The desire to belong and to form attachments with family and

friends is considered a fundamental human need (Baumeister &
Leary, 1995). Multiple positive health and adjustment effects
have
been associated with a sense of belonging and attachments. It is
also through supportive relationships that self-esteem and self-
efficacy are promoted (Werner, 1993). Having social
competence
and having positive connections with peers, family, and
prosocial
adults are significantly related to children’s ability to adapt to
life
stressors (Masten & Coatsworth, 1998). Resilient children also
elicit positive attention from others (Werner, 1993).
For children, the development of friendships and the ability to
get along with peers individually and in groups is paramount.
Friendships provide support systems that can foster emotional,
social, and educational adjustment (Rubin, 2002). Being part of
at
least one best friendship may also improve children’s
adjustment
(Hartup & Stevens, 1997). Positive peer relationships have been
shown to protect children during times of family crisis.
Acceptance
by a group lowers the risk of externalizing behavior problems
(Criss, Pettit, Bates, Dodge, & Lapp, 2002). A child who has
friends and is well liked is less likely to be bullied or otherwise
victimized (Pellegrini, Bartini, & Brooks, 1999; Rubin,
Bukowski,
& Parker, 1998).
Although possessing a strong social support network renders
children less vulnerable to stress, depression, and externalizing
problems, the availability of social supports cannot be taken for
granted. “Social support is not a self-forming entity waiting
around

to buffer harried people against stressors” (Bandura et al., 1999,
p.
259). An active process is involved, and children, like adults,
need
to create and maintain supportive relationships. Connections
affect
how one treats and responds to others and how they, in turn,
respond, thus forming a reciprocal relationship. It is easier for
people to respond with more positive feedback and affection to
an
easygoing child who is sensitive to others and shows good self-
control than to a child who is impulsive, who overreacts to
events,
and whose emotions are not well regulated. Children who share,
who are compliant with social rules, and who are positive with
peers are more likely to sustain their relationships.
School Achievement and Involvement, IQ, and Special
Talents
Schools give young people a chance to excel academically and
socially. Educational aspirations (Tiet et al., 1998) and active
240 ALVORD AND GRADOS
T
hi
s
do
cu
m
en
t i

s
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss

oc
ia
tio
n
or
o
ne
o
f i
ts
a
lli
ed
p
ub
lis
he
rs
.
T
hi
s
ar
tic

le
is
in
te
nd
ed
s
ol
el
y
fo
r t
he
p
er
so
na
l u
se
o
f t
he
in
di

vi
du
al
u
se
r a
nd
is
n
ot
to
b
e
di
ss
em
in
at
ed
b
ro
ad
ly
.

engagement in academics (Morrison, Robertson, Laurie, &
Kelly,
2002) have been associated with resilience in challenged youth.
Although the reasons for this are not yet clear, a number of
factors
are likely to contribute. Encouragement from teachers fosters
resilience through connections, as noted above. Further,
involve-
ment in extracurricular activities such as art, music, drama,
special
interest clubs, and sporting activities gives youth opportunities
to
participate in prosocial groups and achieve recognition for their
efforts. A positive orientation toward school and school
activities
has been shown to protect against antisocial behavior (Jessor,
Van
Den Bos, Vanderryn, Costa, & Turbin, 1995).
Cognitive ability has been found to be associated with resilience
in children (Fergusson & Lynskey, 1996). It also appears to
exert
a strong influence on other factors that contribute to resilience.
For
example, strong cognitive skills may allow youth to excel in
school, as well as to make the most of educational opportunities
and cultural experiences. Additionally, a commitment to school
helps to counter the risk of violent behaviors (Department of
Health and Human Services, 2001).
Fostering competence in children is central to resilient outcome.
Brooks and Goldstein (2001) believe each child possesses at
least

one small “island of competence,” or area that has the potential
to
be a source of pride or achievement. Fostering resilience in
youth
requires that parents highlight children’s areas of competence to
help them experience a sense of accomplishment. They suggest
involving children in daily activities that allow them to feel
they
are contributing to the world. Examples include assisting other
children, acting as a school patrol, or helping an older neighbor.
Community
Community factors, including the availability of supportive
relationships outside of the family (Masten, 2001; Werner,
1995),
are also well documented as having a protective influence on
children. Resilient youth form relationships with positive role
models and elders outside of their own family (Wolin & Wolin,
1993). Youths often join clubs, teams, and other groups and
frequently find mentors such as coaches, teachers, scout leaders,
and other prosocial adults in their communities. Effective
schools
identify the needs of their students and address those needs with
services, as well as by consideration of class size and curricula.
Important elements of an effective community are environments
and social structures that promote resilience. Early prevention
and
intervention programs, safety in neighborhoods, support
services,
recreational facilities and programs, accessibility to adequate
health services, and economic opportunities for families have
all
been identified as protective factors (Thomlison, 1997).
Religious

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