Predictors of lower-than-expected posttraumatic symptom severity in war veterans: The influence of personality, self-reported trait resilience, and psychological flexibility

Behav Res Ther. 2019 Feb:113:1-8. doi: 10.1016/j.brat.2018.12.005. Epub 2018 Dec 8.


Resilience following traumatic events has been studied using numerous methodologies. One approach involves quantifying lower-than-expected levels of a negative outcome following trauma exposure. Resilience research has examined personality and coping-related factors. One malleable factor is psychological flexibility, or the context-dependent ability/willingness to contact the present moment, including emotional distress, in order to engage in valued actions. Among 254 war Veterans who participated in a longitudinal study, we operationalized resilience as lower-than-expected PTSD symptoms and PTSD-related functional impairment one-year following an initial post-deployment assessment based on lifetime exposure to childhood trauma, combat trauma, and sexual trauma during military service. We evaluated the contribution of personality factors, self-reported trait resilience, and psychological flexibility, measured using the Acceptance and Action Questionnaire-II, to PTSD-related resilience after accounting for lifetime and current PTSD symptom severity and depression symptom severity. In hierarchical regression analyses, neither specific personality factors nor self-reported resilience predicted PTSD-related resilience at follow-up after accounting for PTSD and depression symptoms. In the final step, psychological flexibility predicted unique variance and was the only significant predictor of PTSD-related resilience aside from baseline PTSD symptom severity. Findings indicate that psychological flexibility is a predictor of resilience that is distinct from psychiatric symptoms, personality, and self-reported resilience. Trauma survivors may benefit from interventions that bolster psychological flexibility.

Keywords: Personality; Posttraumatic stress disorder; Psychological flexibility; Resilience; Trauma; Veterans.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adaptation, Psychological / physiology
  • Adult
  • Afghan Campaign 2001-
  • Combat Disorders / psychology
  • Depression / psychology
  • Female
  • Humans
  • Iraq War, 2003-2011
  • Longitudinal Studies
  • Male
  • Personality
  • Resilience, Psychological*
  • Self Report
  • Sex Offenses / psychology
  • Stress Disorders, Post-Traumatic / psychology*
  • Veterans / psychology*
  • War Exposure