Promoting Resilience in Long-Term Posttrauma Adaptation: The Dynamic Role of Social Support in a Sample of Veterans Exposed to Combat Related Trauma

Background. There is a growing recognition that adaptation following traumatic events is a complex, nuanced, and dynamic process that results in a diverse range of adaptation trajectories. Social support and healthy coping are two mechanisms thought to promote positive adaptations. However, recent research regarding the trajectory of social support, suggests that, the intensity and availability of social support naturally decreases as the traumatic event becomes more distant; potentially having a negative impact on the adaptation process over time. The current study explores the potentially preventative impact of improving or bolstering social support through a group intervention. More specifically, we suggest that improving social support increase the odds of positive adaption even years after exposure to combat related trauma. Methods.  A sample of Israeli male military veterans (N = 448) took part in a building resilience intervention program on average five years post combat. The current study relied on secondary longitudinal data collected during the program evaluation of the intervention. In the first phase of analysis, we identified four distinct profiles of post-combat adaptation using latent profile mixture modeling. Profiles were developed based on the level of endorsement to the following indicators post-intervention: (1) total PTG (PTGI; Tedeschi & Calhoun, 1996); (2) positive cognitive emotion regulation strategies (CERQ; Garnefski & Kraaij, 2006); and (3) diagnostic criteria for PTSD (PDS; Foa, Cashman, Jaycox, & Perry, 1997). Veterans were assigned to their most likely latent classes using posterior probabilities. The second phase of analysis used hierarchical logistic regression analyses to identify predictors of latent class membership. Three blocks of predictors from pre-intervention data were selected and entered using a step-wise approach, these included: (1) demographic characteristics; (2) coping strategy; and  (3) perceived improvement in social support from baseline to follow-up. Results. Four latent classes were identified and characterized as: (1) Distressed – high PTSD symptomology and low growth (n=12, 3%); (2) Resistant – low PTSD symptomology and low growth (n = 38, 8%); (3) Resilient – high growth and low PTSD symptomology (n= 96, 21%); and (4) Struggling – high PTSD symptomology and high growth (n = 302, 67%). Additional non-combat trauma exposure, martial status, reliance on trauma or forward focused coping strategies, and negative cognitive emotion regulation strategies were not significant predictors of membership in the resilient latent class. However, reported perceived improvement in social support during the intervention increased the odds of being in the resilient latent class by 100% (OR = 2.00, p = 0. 015). Implications. These findings highlight the nuances in trauma adaptation by recognizing the unique interactions between growth, distress, and coping. Further, these results suggest that increasing social support promotes resilient outcomes for veterans post-combat, suggesting current interventions continue to focus on bolstering social support even years after exposure to trauma. However, additional resources may be needed to expand interventions beyond the veteran to include the support network itself. Future research may focus on developing evidence-based interventions to strengthening the ability of these networks to provide support for military service personnel on a long-term basis post-combat.