When we refer to “core,” we mean the three main components of our human influence: mental, physical, and spiritual. Mental resiliency is our neurological approach, physical refers to the resiliency of our body--both external and internal, and spiritual relates to our consciousness, which can be with or without religious expression. Our training is a balance of these three elements; although more time is spent on the mental, since it has an astronomical influence on the health of the physical and spiritual more than vice-versa.



Pursuing happiness while avoiding conflict sets us up for great disappointment and leaves us feeling like we have nothing to approach life with but a fear of what may go wrong. If we define happiness as some destination that is free from problems, then we allow the existence of problems to rob us of happiness. True joy and happiness comes with a resilient mindset that it can not only coexist with adversity, but actually feed off of adversity, so that it thrives rather than just survives. We shift from a fear conditioned perspective of what can go wrong during any battle we face, to a vision that focuses on what can go right, while managing the possibilities of what can go wrong in the peripheral. Antifragile resiliency maintains an awareness of potential risks and consquences, while giving more credence to solutions and desired outcomes, a topic we cover more under the principle of solution oriented thinking.

Now that we've covered one of the primary influences on what type of resiliency we teach, let's examine in more detail the three core areas of resiliency mentioned before (mind, body, spirit) and how we address them in our curriculum...

Spiritual resiliency refers to the ability to maintain or regain a sense of purpose, hope, and inner strength in the face of challenges, adversity, or trauma. It involves drawing on one's spiritual beliefs, values, and practices to navigate life's difficulties, find meaning in suffering, and ultimately emerge stronger and more grounded. Spiritual resiliency is an important aspect of overall well-being, particularly for individuals facing significant stressors, such as military personnel, healthcare workers, and those who experience personal or collective loss.

Some key elements of spiritual resiliency that we cover in our Core Resiliency training:

• Connection to a Higher Power or Purpose
• Finding Meaning in Suffering
• Faith and Hope
• Self-Reflection and Inner Peace
• Supportive Spiritual Community
• Compassion and Service
• Forgiveness and Letting Go
• Adaptability and Acceptance
  

Ongoing research continues to explore the mechanisms of neuroplasticity and its implications for various aspects of brain function and health. Advances in neuroimaging techniques, such as functional MRI (fMRI) and diffusion tensor imaging (DTI), allow researchers to observe neuroplastic changes in real-time and assess their impact on cognition and behavior. In fact, these imagining innovations are what allowed researchers to prove what was once only a theory of neuroplasticity, countering the long held belief that our brains become fixed at a certain age and brain cells cannot regenerate.

In summary, neuroplasticity highlights the brain's remarkable ability to adapt and change throughout life in response to experiences and environmental influences. Embracing this concept opens doors to new strategies for enhancing cognitive function, improving recovery from brain injuries, and understanding the complexities of mental health and neurological disorders.

Antifragile resiliency can do far more than simply teach first responders to get through the challenges and risks they face—it teaches them to acquire significant benefits from having gone through them, and, perhaps more importantly, it carrys over into their personal lives in such a way that their marriages take on the concept, their personal goals in life, and their overall quality of life gains a leverage they did not have before applying this principle.

In the culture of public safety, which is a greater advantage: first responders who simply endure or first responders who grow from whatever they endure?

Our world is full of antifragile systems that thrive and improve from being exposed to stress. These include biological organisms (which become stronger through exposure to stressors like exercise), certain businesses (that innovate and grow during economic downturns), and ideas or technologies that evolve and improve in response to criticism or challenges.

The Predictive 6 Factor Resilience Model is a framework developed by Dr. Paul Stoltz, an expert and leading researcher on resilience and adversity. This model identifies six key factors that contribute to an individual's resilience:

• Control
• Impact
• Reach
• Endurance
• Alignment
• Equanimity

The Predictive 6 Factor Resilience Model provides a comprehensive framework for understanding and developing resilience across different domains of life. By assessing and strengthening these six factors, individuals can enhance their capacity to navigate adversity, achieve personal and professional goals, and maintain well-being amid challenges. This model is widely used in organizational development, leadership training, and personal coaching to foster resilience and adaptive behavior in individuals and teams. It is relatively new to the field of public safety, but we are determined to change that.

In our Core Resiliency training, we adapt these six factors as the following domains:

• Vision
• Composure
• Reasoning
• Health
• Tenacity
• Collaboration

All of these factors combine to achieve the common characteristics of mentally resilient individuals: adaptability, optimism, emotional regulation, problem-solving skills, and social support connections. Cycle through the tabs below to discover how these six domains make up our overall resiliency:

Goleman popularized the concept of emotional intelligence in his 1995 book "Emotional Intelligence: Why It Can Matter More Than IQ," where he defines emotional intelligence as the ability to recognize, understand, manage, and utilize emotions effectively and argues that it plays a critical role in success, both personally and professionally.

According to Goleman, emotional intelligence consists of several components, which we cover in our training:

• Self-awareness: Recognizing one's own emotions and their effects.
• Self-regulation: Managing one's emotions and impulses.
• Motivation: Channeling emotions towards achieving goals.
• Empathy: Understanding and considering others' emotions.
• Social skills: Managing relationships to move people in desired directions.

Emotional intelligence has been shown in much research to have a huge impact on leadership. In fact, many business leaders in fortune 500 companies have been shown to demonstrate high levels of emotional intelligence. It is, therefore, no surprise that Goleman's work has highlighted the importance of emotional intelligence in leadership effectiveness. Leaders with high emotional intelligence are better able to inspire and motivate others, build strong relationships, and navigate complex social dynamics, not to mention exhibiting strong measures of resiliency.

When the amygdala perceives a threat, it can trigger a rapid and intense emotional reaction, such as anger, fear, or anxiety. This reaction often occurs automatically and without conscious control, overriding the more deliberate and reasoned responses that might come from the prefrontal cortex—the part of the brain responsible for higher cognitive functions.

An amygdala hijack can lead to impulsive behavior, irrational decision-making, and heightened emotional responses that may not align with the actual level of threat or danger present in a situation. It can interfere with effective communication, problem-solving, and interpersonal relationships.

Goleman emphasizes the importance of emotional intelligence in managing and mitigating amygdala hijacks. Developing the skills we teach in Core Resiliency, such as self-awareness, self-regulation, and empathy, can help individuals recognize their emotional triggers, manage their responses, and make more reasoned decisions even under stress.

Understanding amygdala hijack is crucial to the foundation we build our Core Resiliency upon and plays a chief influence on leadership, conflict resolution, and personal development. By learning to identify and regulate emotional responses, individuals can improve their ability to navigate challenging situations effectively and maintain constructive relationships, allowing better regulation of emotional reactions, particularly in high-stress or threatening situations where immediate responses may be driven by unconscious emotional triggers.

Similar to the PR6 domains of resiliency, Daniel Goleman and his co-authors Richard Boyatzis and Annie McKee outlined six domains of emotional intelligence that contribute to resilience in their book "Primal Leadership". These domains help individuals cope with adversity, manage stress, and maintain emotional balance, and we address them in our Core Resiliency training as targets of development in emotional intelligence.

Trauma disrupts the body's stress response system, leading to chronic hyperarousal (feeling constantly on edge) or hypoarousal (feeling emotionally numb or disconnected). These disregulations can manifest as anxiety, depression, or other mental health disorders.

Van der Kolk also related that trauma often manifests in physical symptoms such as chronic pain, gastrointestinal issues, and autoimmune disorders. These somatic symptoms are linked to the body's response to stress and trauma, and have a high rate of misdiagnosis by medical doctors who often react with pharmaceutical approaches that simply mask the symptoms and do not address the cause.

The book also discusses various therapeutic approaches that can help individuals heal from trauma, including trauma-focused therapy, mindfulness techniques, exercise, and other somatic therapies. These approaches aim to help individuals reconnect with their bodies and process traumatic memories in a safe and supportive environment.

Van der Kolk also highlights the importance of social support and cultural context in healing from trauma. Supportive relationships, community involvement, and cultural practices can play a crucial role in recovery. This influence falls under the “collaboration” domain that we cover in our training.

Overall, "The Body Keeps the Score" provides valuable insights into how trauma affects both the body and mind, and offers hope through understanding and effective treatment approaches aimed at restoring a sense of safety, resilience, and well-being. We not only incorporate much of its teaching into ours, but we highly recommend our students read his book to gain a significance advantage in their pursuit of Core Resiliency.

Polyvagal Theory and Core Resiliency

The work of Stephen Porges and his Polyvagal Theory has also led to the development of new therapeutic techniques and has been widely integrated into clinical practices that aim to address trauma, improve emotional regulation, and enhance social bonding.

The vagus nerve is a critical component of the parasympathetic branch of the autonomic nervous system (ANS). It runs from the brainstem through the neck, chest, and abdomen, influencing a wide range of bodily functions, such as heart rate, digestion, and respiratory rate. Polyvagal Theory focuses on how this nerve, particularly its two branches, influences our emotional and physiological states.

Polyvagal Theory offers a new lens through which to understand how our autonomic nervous system drives behavior, emotion, and social interaction. By focusing on the vagus nerve and its influence on stress responses, safety, and social engagement, the theory provides insights into trauma, mental health, and effective therapeutic practices. It has become a foundational concept in understanding how our bodies and minds respond to the world around us and this understanding is one of the principle foundations we build core resiliency upon in our curriculum.

Porges emphasizes that the parasympathetic system, particularly the ventral vagus nerve, is key to our ability to socially engage. When we feel safe, our bodies are more likely to engage in calm social interactions. The "social engagement system" includes facial expressions, vocal tone, and eye contact, all of which are influenced by the ventral vagus nerve and are important for creating connections with others.

Polyvagal Theory has been particularly influential in understanding the effects of trauma and stress on the body and mind. Porges suggests that trauma, especially when experienced in early childhood, can result in disregulation of the autonomic nervous system. When individuals are stuck in a state of hyperarousal (sympathetic activation) or hypoarousal (dorsal vagal shutdown), it can manifest as anxiety, depression, PTSD, and other mental health disorders.

The theory has informed practices in trauma therapy, helping to create approaches that focus on regulating the nervous system. Techniques like breathwork, mindfulness, and certain forms of body-centered therapy aim to activate the ventral vagal system to help individuals feel safe and connected again.

Polyvagal Theory places a significant emphasis on the importance of feeling safe for emotional regulation. According to Porges, the body’s ability to self-regulate (i.e., shift between the three states) is heavily influenced by how safe we feel in our environment and relationships. A supportive, calm, and safe social environment promotes ventral vagal activation, encouraging positive social interactions and emotional resilience.

Solution-oriented thinking is a mindset focused on identifying and implementing solutions to problems or challenges rather than dwelling on obstacles or difficulties. Not to be confused with the idea of simply thinking positively, when we apply solution orientation to resiliency, we use specific strategies in our Core Resiliency training, some of which directly correlate to some of the Six Domains of Resiliency we refer to in our curriculum:

REASONING

Learning from Feedback: Solution-oriented thinking involves learning from feedback and adjusting strategies as needed. It values continuous improvement and sees setbacks as opportunities for growth and refinement (Antifragile Theory)

Focus on Solutions: Instead of getting bogged down by problems, solution-oriented thinking emphasizes looking for ways to address and resolve them. It shifts attention from what went wrong to what can be done to make things better.

Problem-Solving Skills: Solution-oriented thinkers are adept at analyzing problems, breaking them down into manageable parts, and identifying potential solutions. They use logical reasoning and creativity to explore different approaches.

TENACITY

Action-Oriented:   This mindset is action-oriented, focusing on taking practical steps towards achieving goals or overcoming challenges. It encourages proactive behavior rather than passive acceptance of difficulties.

Positive Outlook: It involves maintaining a positive and proactive attitude, believing that there is always a way to improve a situation or find a way forward. This optimism helps in generating creative ideas and maintaining motivation.

COLLABORATION

Working with Others: Solution-oriented thinking often involves working collaboratively with others to brainstorm ideas, gather diverse perspectives, and implement effective solutions. Collaboration harnesses collective intelligence and increases the likelihood of success.

Long-term Vision: While focusing on immediate solutions, solution-oriented thinking also considers long-term implications and sustainability. It aims to create lasting improvements and prevent future issues.

Overall, solution-oriented thinking empowers individuals and teams to tackle challenges effectively, foster innovation, and achieve positive outcomes in various aspects of life and work. It encourages not only resilience, but creativity, and a proactive approach to problem-solving.

"Do One Thing Different" by Bill O'Hanlon is a practical and insightful guide designed to help individuals make changes in their lives by focusing on small, actionable steps. The core idea is that making a single shift in behavior, thinking, or routine can lead to significant, positive changes. O'Hanlon argues that rather than diving into deep analysis of problems, sometimes the most effective way to change is to alter one element in your approach.

O'Hannon's principle of making just one change in our lifestyle habits or our approach to challenges is incorporated into our Core Resiliency training in such a way to create a butterfly effect of both increased resiliency and problem solving. When coupled with Daniel Goleman's principles of emotional intelligence and antifragility, solution oriented principles can work wonders for anyone who could benefit from an increase in their resilience.

"Do One Thing Different" provides a refreshing approach to change by focusing on simplicity, action, and experimentation. It provides a way to overcome obstacles in life by making one intentional shift and building on that change over time, rather than attempting to tackle everything at once.

The key principles of "Do One Thing Different" that we cover in our Core Resiliency training are as follows:

The Power of Small Changes

O'Hanlon suggests that instead of feeling overwhelmed by large problems or goals, people can create lasting change by focusing on small, specific actions. Changing one habit, response, or routine can create a ripple effect, leading to bigger transformations over time.

Challenge Assumptions

The book encourages questioning your assumptions and habitual ways of thinking. Often, we believe that things need to be fixed in big, dramatic ways, but O'Hanlon suggests that it’s the small, consistent changes that lead to success. For example, if you’ve always approached a problem in a particular way (like overthinking it), trying something completely different (like taking action immediately) can produce surprising results.

Focus on Strengths, Not Just Problems

O'Hanlon emphasizes the importance of focusing on what’s working in your life and building from that, rather than only fixing problems. This perspective helps to build momentum by acknowledging progress, no matter how small.

Practical Steps to Take Action

   Step 1: Identify the issue – Clearly define the situation or behavior you want to change.

   Step 2: Choose one small thing to do differently – Choose something simple but significant that is within your control. It                         could be changing the way you react in a certain situation or trying a new approach to a daily task.

   Step 3: Take the step – Implement the change, and see how it affects your behavior or outlook.

   Step 4: Reflect and adjust – Notice how the change influences your emotions or interactions, then adjust as needed.

Doing the Opposite

A technique O'Hanlon often suggests is doing the "opposite" of what you typically do. For instance, if you normally avoid conflict, try standing your ground in a respectful way. If you are usually quiet in social settings, try initiating a conversation. This can help break cycles of avoidance or habitual behavior that may be limiting personal growth.

Success Is About Experimenting

O'Hanlon frames life as an experiment. When you try something new, you’re not locked into it — you can evaluate how it worked and make another adjustment. This mindset reduces the fear of failure and opens up more possibilities. It shifts the focus from "getting it right" to "experimenting and learning."

The Role of Hope and Belief

One of the fundamental beliefs of the book is that even small changes, when practiced consistently, can provide hope. This hope can empower individuals to take more positive steps, which compounds into larger improvements over time.

Use Positive Reinforcement

When you make a small change, it's essential to reinforce it positively. Celebrate even the tiniest victories, as this will increase your motivation to continue making further changes. For example: Suppose you're struggling with time management. Instead of diving into deep analysis or trying to overhaul your entire routine, O'Hanlon’s advice would be to change one small thing. Instead of trying to overhaul your entire schedule, you might start by using a timer to break tasks into shorter, more manageable time blocks. This small action could help shift your behavior and create momentum to tackle larger productivity changes.

Our Core Resiliency training teaches a variation of O'Hanlon's therapy principles as applied to self-regulation--an essential tool of Core Resiliency and conjoined with self-awareness. The following core concepts make up the curriculum section we cover:

Focus on Solutions, Not Problems

Unlike our traditional mindset of approaching problems by analyzing and dissecting the past, Solution-Oriented Resiliency focuses on what is working in the present. It assumes one already has the resources and strengths they need to overcome their current challenges. Examples of how we teach this are given in the next section.

Self Expertise

In Solution-Oriented Resiliency, a person views themselves as the expert in their own life. We do not teach them to become their own therapists, since self-awareness and self-regulation strategies are not replacements for professional therapy, if it is needed; however, we do teach how one can explore existing solutions or perspectives they might not have recognized by putting themselves in the position I asking what advice they would give to a close friend or family member who was facing the same challenge and asked for your expertise. They then take this information and turn it into self-talk. Not only does this strategy uncover possible missed solutions and perspectives, but it creates a sense of self-empowerment by not feeling dependent entirely (or at all) on the therapy or advice from others.

The Miracle Question:

One famous technique in Solution-Oriented Therapy is the Miracle Question, which we adapt into our Solution Oriented Resiliency section. The Miracle Question is a key technique and is designed to help clients envision a future where their issues have been resolved and to identify the steps or actions that would lead them there. It does this by asking a hypothetical question, such as:

"If a miracle happened overnight and your problem was solved, what would be different tomorrow?"

This question encourages the person to:

1. Visualize the desired outcome: It invites them to imagine a world where the problem no longer exists.
2. Identify specific changes: It helps articulate small, achievable steps that would indicate the problem has been resolved.
3. Shift the focus to solutions: By imagining what would be different, they can start to recognize what they are already doing (or could do) that is leading toward positive change.

The Miracle Question helps people break free from the limitations of their current situation, shifts their focus away from the problem, and opens up new possibilities for progress. It can be used for a wide range of issues, including anxiety, depression, relationship problems, and personal growth challenges.

Small, Achievable Goals:

Solution-Oriented Resiliency encourages setting small, realistic goals that can realistically be achieved. This approach avoids being overwhelmed with large, unattainable objectives. By achieving smaller goals, one can experience short bursts of success, which builds a momentum of confidence and motivation to create positive change.

Change Happens in Small Steps:

O'Hanlon and other Solution-Oriented therapists believe that change doesn’t have to be dramatic or overwhelming. Small, incremental steps can accumulate and create significant transformation over time. This self-awareness principle helps focus on small actions or changes that improve the client's situation, rather than attempting to fix everything at once.

Strengths and Resources:

Instead of focusing on deficits or weaknesses, Solution-Oriented Resiliency emphasizes strengths and resources that one already has. We teach specific questions that prompts one to recognize their current abilities in contrast to past successes and coping strategies, in order to solve current problems.

Future-Focused:

Solution-Oriented Resiliency looks forward to the future and encourages a person to imagine their life after the problem is resolved. By focusing on what they want rather than what they don't want, clients are empowered to create a vision for a positive future.

Scaling Questions

A self-awareness strategy of solution orientation is asking yourself scaling questions, such as:

"On a scale of 1 to 10, how confident am I that I can solve this problem?

"On a scale of 1 to 10, how much will this impact me a year from now? Five years? Ten years?

These questions help assess progress and motivate clients to take steps toward improvement, however small they may be.

Coping Questions

Asking yourself questions that explore how you have managed or coped with the issue in question in the past, highlighting your resilience and strengths. Some examples we use:

"How did I manage to get through that tough time?"

"What helped me cope when I was going through that?"

"What things made me feel worse or put me at a disadvantage?"

This strategy builds confidence in one's own ability to overcome difficulties, and contributes to both the Tenacity and the Reasoning resiliency domains from the Six Domains of Resiliency.

Goal Setting and Action Plans

We may have a tendency to overthink during times of struggle and this can overwhelm the Reasoning Domain, leading to burnout and brain fog, not to mention depression. Establishing some specific goals with regard to desired outcomes during challenges and taking action on those goals is an excellent counter to being paralyzed by burnout or depression.

We do this by creating actionable goals through practical steps that are specific, achievable, and measurable.

The Use of Language

In much the same way that we teach intentional strategic goals, the language used in Solution-Oriented Therapy is also intentional and strategic. When we use the language of self-talk/self-imagination, we avoid any formality of use that pathologizes ourselves, and, instead, we use positive, future-oriented language. This solution oriented language would manifest in such ways as:

"What would it look like if I were doing better?" instead of "Why me? Why am I struggling with this?"

"What kind of future would I have if I had less disregulation going on?" instead of "How will this disorder harm my future?"

The Results of Solution-Oriented Resiliency

The more frequently practiced these principles become, the more significant the resiliency grows and the adept one becomes at discovering viable solutions to the challenged faced.

• Efficiency: Strategies that are brief and time-limited, focusing on achieving meaningful change in less time.
• Empowerment: Focusing on the one's strengths and resources empowers them to take control of their own solutions.
• Practical and Goal-Oriented: Provides concrete, actionable strategies for improvement, leading to real-world results.
• Hope and Positivity: Fosters a sense of optimism by focusing on future possibilities, rather than past limitations.

In light of the antifragile resiliency we mentioned previously, a combat mindset is poised to prepare or recover from both physical and mental risks with  benefits that go beyond mere survival (pre-trauma). In turn, we convey self-regulation strategies that evaluate recovery from experiences that subject people to prolonged risk (post-trauma).

The psychological effects of violence and killing on soldiers are examined in Grossman's book, including issues like trauma, moral injury, and the effects of repeated exposure to violence or the aftermath of violence, including its victims. Much of Grossman's examinations of the physiology of combat explains the body’s response to extreme stress, including the fight-or-flight response, adrenaline, and other biological changes.

We detail how these reactions can help or hinder individuals in common first responder situations by addressing the following points:

The Warrior’s Mindset

Grossman discusses how warriors develop a mental approach to violence, and how training and mindset can help soldiers cope with combat stress and improve their performance under pressure. We implement this into our training in such a way as to guard and preserve the humanity of the individual so that they can experience or administer violence, without the spillover of its negative effects into the personal lives of the first responders.

The Psychology of Killing

One of the most notable aspects of the book is Grossman’s exploration of the psychological barriers to killing in combat. He explores how soldiers are often conditioned to overcome their natural aversion to killing, and the effects this can have on them after combat. We bring this matter to light in our moral injury resiliency training, as moral injury is more common in such encounters than post-traumatic issues.

Training and Preparation

Grossman emphasizes the importance of proper training to prepare individuals for the psychological and physiological challenges they will face in combat. We examine what the military has found to work effectively in pre-combat resiliency training and allude to a first responder's version.

Post-Combat Reactions and Recovery

The book also discusses the difficulties soldiers face in reintegrating into society after their time in combat and the long-term effects of trauma. We relay this to the post-recovery or continued recovery from PTSD, moral injury, and accumulative stress disorders first responders face in their "urban homeland" combat experiences.



We bring the Kübler-Ross model into our Core Resiliency training because many trauma experts like Dr. Bessel van der Kolk find the same stages exist in post-trauma experiences. By identifying these stages with relation to resiliency and post-trauma growth, individuals can avoid being blindsided by confusing emotions and abnormal behavior, while responding with strategies to help them cope and manage such dynamics to sustain healing throughout the process. We have found that familiarizing yourself with these stages is far better than simply presenting a list of post-traumatic disorder symptoms.

The Kübler-Ross model of the five stages of grief are as follows:

Denial

Initially, individuals may deny the reality of the loss. This serves as a protective mechanism to buffer the immediate shock and overwhelm of the situation. They may feel numb, unable to accept the truth of what has happened.

Anger

As the reality of the loss sets in, individuals may experience intense emotions such as anger and frustration. They may question "Why me?" or direct their anger towards others, themselves, or even the person who has died.

Bargaining

In this stage, individuals may attempt to negotiate or bargain with a higher power, or even with themselves, in an attempt to reverse or mitigate the loss. This can involve thoughts like "If only..." or "What if I had done something differently?"

Depression

As the full impact of the loss is realized, individuals may enter a period of deep sadness and despair. They may withdraw from others, experience feelings of emptiness or hopelessness, and struggle with sleep, appetite, or energy levels.

Acceptance

The final stage involves coming to terms with the reality of the loss. This does not necessarily mean feeling happy or okay with the loss, but rather finding a way to integrate it into one's life and adjust to a new normal. It's about reaching a place of emotional peace and stability.

Post-traumatic growth refers to the positive psychological changes that some individuals experience after encountering adversity, trauma, or significant life challenges.



Post-traumatic growth as a theory was first developed by psychologists Richard Tedeschi, PhD, and Lawrence Calhoun, PhD, in the mid-1990s, and holds that people who endure psychological struggle following adversity can often see positive growth afterward. It highlights how people may develop new perspectives and strengths, ultimately leading to greater well-being.

To evaluate whether and to what extent someone has achieved growth after a trauma, Tedeschi and Calhoun devised a self-reporting scale called the Post-Traumatic Growth Inventory (PTGI) (Journal of Traumatic Stress, 1996), which identifies positive responses in five domains:

Personal Strength

Individuals often report feeling stronger, more resilient, and capable of handling future challenges after trauma. They recognize their ability to endure difficult circumstances and grow from them.

Relating to Others

Trauma can deepen relationships, making individuals more empathetic, compassionate, and understanding toward others. Some people find a greater sense of connection and intimacy with others after experiencing trauma.

New Possibilities

Post-traumatic growth can lead to a sense of new opportunities or directions in life that might not have been considered before. This can involve personal growth, career changes, or pursuing goals and dreams that were previously put on hold.

Appreciation of Life

Following a traumatic event, many individuals develop a heightened sense of appreciation for life and the small moments of joy. This domain involves living more fully, recognizing the preciousness of life, and embracing both its beauty and fragility.

Spiritual Development

Some individuals experience spiritual growth or a deepened sense of faith and meaning in the aftermath of trauma. This can include reevaluating one's beliefs, fostering a sense of purpose, or finding a deeper connection to a higher power or philosophical worldview.

These domains can vary from person to person, and not everyone who experiences trauma will experience post-traumatic growth in all of these areas. Post-traumatic growth is also not an automatic outcome but depends on various factors like coping strategies, social support, and personal characteristics; by and large, post-traumatic growth is primarily the result of proactive efforts of antifragility, which is one of the most important factors of our Core Resiliency teaching.



Viktor Frankl was a professor of neurology and psychiatry at the University of Vienna, and wrote extensively about the intersection of psychology, spirituality, and human existence. Prior to these accomplishments, Frankl was imprisoned in Nazi concentration camps, including Auschwitz, from 1942 to 1945. During this time, he lost his wife, parents, and brother, but he survived the horrors of the Holocaust.

His experiences in the camps profoundly influenced his psychological theories, and his work has influenced not only the field of psychology, but also philosophy, literature, and education. His emphasis on meaning has been adopted by many practitioners in various fields, particularly those working with individuals facing grief, trauma, or existential crises.

Frankl's book, Man’s Search for Meaning has become one of the most influential books of the 20th century and is often recommended to individuals facing personal crises or seeking a deeper understanding of life’s challenges. His teachings continue to inspire people around the world, particularly those who are facing life’s most difficult challenges. His message of hope, resilience, and the importance of finding meaning in life resonates deeply, especially in times of suffering.

Viktor Frankl emphasized several concepts that we integrate into our Core Resiliency training as key foundations authentic resiliency is built upon:

Logotherapy

Frankl developed logotherapy, a therapeutic approach that emphasizes the search for meaning as the central human drive. Logotherapy is often summarized by the phrase: "He who has a why to live can bear almost any how," attributed to Friedrich Nietzsche. Frankl believed that even in the most challenging circumstances, people can find meaning in their lives.

According to logotherapy, the lack of meaning (often referred to as the existential vacuum) can lead to psychological distress, anxiety, and depression. This sense of emptiness can be addressed by helping individuals discover a sense of purpose, even in difficult or painful situations.

Man's Search for Meaning

Frankl’s most famous work, Man’s Search for Meaning (originally published in 1946 as Ein Psychologe Erlebt Das Konzentrationslager), reflects on his experiences in the concentration camps and explains his psychotherapeutic approach.

He observed that those who managed to survive the brutal conditions were often those who found some meaning or purpose in their suffering, whether it was a hope for the future, the memory of loved ones, or a strong sense of personal or spiritual values. Frankl and others who survived also practiced habitual imaginations of life beyond their present suffering, as though assuming they would survive no matter the odds against them.

The Role of Suffering

Frankl believed that suffering is an inevitable part of life, but it can also be a source of meaning. He argued that people could endure great suffering if they could find a reason or purpose for it, even if the purpose was simply to maintain dignity in the face of hardship.

This perspective was grounded in his own experiences, where he witnessed that some people in the camps, despite their suffering, chose to help others or maintain a sense of hope and purpose.

Freedom of Choice

Frankl’s philosophy emphasizes human freedom—the idea that individuals always have the ability to choose their attitude in any given situation. Even in the face of suffering, he believed people have the power to choose how they respond to it, which can be a source of strength and resilience.

This concept is a central element of his therapeutic practice, where patients are encouraged to recognize that they have the freedom to find meaning, even in the most difficult circumstances.

Existential Vacuum & Self-Transcendence

Frankl described the existential vacuum as a state of emptiness or a lack of purpose, which he saw as a root cause of many mental health problems, including depression and anxiety. He believed that true meaning is often found when people look beyond themselves, either by helping others or by dedicating themselves to a cause greater than their personal suffering.



Moral injury presents an altogether different threat to first responders than PTSD, in that its effects accumulate over time in a subtle way that seems innocuous when experienced, causing first responders to tuck it away as just being “one of the things I hate about a job I love.” Rather than the dramatic manefestation that PTSD presents, moral injury accumulates from fragments of low-level stress and trauma that becomes heavier over time if left unresolved, leading to a decomposition of the quality of life.

WOUNDED BY MORAL DILEMMAS

Moral injury causes a tremendous amount of damage by way of guilt and shame, even though the action behind it was “by the book.”

A police officer who is forced to take a life by way of “suicide by cop” can suffer moral injury because he or she is burdened by the concept that this was a person in need, not a criminal who really intended to hurt anyone.

A firefighter who holds down a parent in the front yard to prevent them from running into a burning house to save their trapped children can suffer Moral Injury because he or she is burdened by the concept that they too would likely need restraint if it were their home and their children.

Moral injury can occur when a first responder is being investigated, leaving them feeling betrayed by their department because they did nothing wrong.

While moral injury is distinct from PTSD, and does not even have to involve trauma at all, it tends to make a person more susceptible to PTSD, not to mention substance abuse or suicide. In fact, much of the PTSD diagnosed of combat veterans is directly linked to moral injury.

MORAL INJURY VS SPIRITUALITY

One of the most damaging distinctions of moral injury to an individual's core wellness is spiritual. Nearly everyone with a religious faith who experiences moral injury with suffer moral conflict with their faith. God becomes more distant and unreachable because the person feels less worthy, more guilty, even deserving of or hopeless to escape damnation or ever be forgiven.

More studies are needed, but moral injury may be one of the most influential reasons first responders who once attended religious activities fall away from attending at all, especially over the course of their career.

Since much of the published research on moral injury is of combat veterans, we examine how it specifically shows up among first responders, and how they can become more resilient to its effects. Some key elements of moral injury to first responders that we consider are:

Definition and Mechanisms of Moral Injury

Moral injury often arises when individuals either participate in, witness, or fail to prevent events that deeply violate their ethical beliefs. Examples include harm to civilians, witnessing trauma in the line of duty, or experiencing betrayal by leadership. The psychological response often includes guilt, shame, or a profound sense of betrayal, leading to a range of mental health issues, including depression, anxiety, and suicidal thoughts.

Prevalence of Moral Injury in First Responders

Police officers may experience moral injury when faced with situations where they feel unable to protect victims or when they witness violence they can’t prevent. In addition, conflicts between their professional role and personal values can contribute to moral injury.

Firefighters and EMS may experience moral injury in cases where, despite their best efforts, lives are lost, or when they feel helpless in tragic situations (e.g., child fatalities in fires).

Mental Health Impact of Moral Injury

Moral injury is often linked to higher rates of depression, guilt, shame, and suicidal ideation. For first responders, these emotions can be particularly acute due to the public and communal nature of their roles. Moral injury can accompany PTSD but is distinct in that it is not triggered by fear but by moral conflict. Individuals with moral injury may struggle with self-forgiveness and disconnection from their own values.

Therapeutic Approaches for Moral Injury

Approaches like Cognitive Processing Therapy (CPT) and Adaptive Disclosure are used to help individuals process and reconcile their moral conflict. Therapy focuses on understanding the source of guilt and shame and fostering self-forgiveness. Recent research has also highlighted the benefits of group therapy and peer support in helping individuals share their experiences and validate each other’s emotional responses. Narrative therapy, where individuals reframe or rewrite their experiences, is also proving effective in treating moral injury.

Preventative and Supportive Measures

Studies show that resiliency training programs like ours that teach ethical decision-making and emotional intelligence help prepare first responders for difficult situations and provide them with a framework to process morally challenging events in a way that is resistant to feelings of inner injustice. Supportive department leadership, debriefing sessions, and a positive organizational culture also play a vital role in mitigating the risk of moral injury. Healthy marriage and family relationships are also significantly shown to build high levels of resiliency against moral injury.

Despite moral injury being a relatively newer term related to mental health in public safety, Research on moral injury has expanded significantly in recent years. Originally identified in military contexts, the concept has been applied to various fields, most notable being healthcare and first responders. Key findings point to the powerful psychological and emotional toll of moral injury, particularly in terms of depression, addiction, marital problems, and suicide risk, as well as the importance of social and organizational support in recovery. Current research is exploring innovative therapeutic interventions, such as CBT and meaning-focused approaches, as well as the role of spirituality and community in the healing process. Future studies are likely to continue focusing on understanding the nuances of moral injury across different populations and developing more effective, tailored treatments.

Here is an overview of key research studies and findings on moral injury that have influenced our Core Resiliency curriculum:

The Origins of Moral Injury: Defining the Concept

Moral Injury and the Military Veteran: A Contextual Exploration of the Moral and Ethical Dimensions of Combat Trauma

This foundational study by Litz and colleagues is one of the first to articulate the concept of moral injury. The researchers defined moral injury as the distressing psychological, social, and spiritual impact resulting from the perpetration, witnessing, or failure to prevent acts that violate one’s deeply held moral beliefs or values. They emphasized that moral injury is distinct from PTSD, as it is linked specifically to moral transgressions and ethical conflicts in extreme situations like combat.

Molendijk, T., Kramer, E. H., & Verweij, D. (2018). Moral Aspects of “Moral Injury”: Analyzing Conceptualizations on the Role of Morality in Military Trauma. Journal of Military Ethics, 17(1), 36–53. https://doi.org/10.1080/15027570.2018.1483173

Moral Injury in Veterans: Effects and Treatment

Moral Injury in Veterans of War

This study explored how moral injury manifests in military veterans. It found that veterans who experienced moral injury were at a higher risk for PTSD, depression, and suicide, as moral injury often leads to feelings of guilt, shame, and betrayal. The researchers suggested that treatment for moral injury should focus on addressing the emotional and spiritual aspects of the injury, including forgiveness, reconciliation, and meaning-making, alongside traditional PTSD treatments.

Bryan, C. J., Bryan, A. O., Anestis, M. D., Anestis, J. C., Green, B. A., Etienne, N., ... & Ray-Sannerud, B. (2016). Measuring moral injury: Psychometric properties of the moral injury events scale in two military samples. Assessment, 23(5), 557-570.

Moral Injury in Healthcare Workers: A Growing Concern

Moral Injury in Healthcare Professionals: A Systematic Review

This systematic review focused on moral injury among healthcare professionals, particularly in the context of the COVID-19 pandemic. The study found that healthcare workers, particularly those dealing with life-or-death decisions in resource-limited settings, often experience moral injury. Factors such as insufficient resources, ethical dilemmas in patient care, and the inability to provide ideal care were significant contributors. The review highlighted the need for mental health interventions tailored to moral injury in healthcare settings.

Rabin, S., Kika, N., Lamb, D., Murphy, D., Am Stevelink, S., Williamson, V., ... & Greenberg, N. (2023). Moral injuries in healthcare workers: what causes them and what to do about them?. Journal of Healthcare Leadership, 153-160.

Moral Injury and Post-Traumatic Growth

The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma

This most cited study on post-traumatic growth examines the relationship between moral injury and post-traumatic growth (the positive psychological change experienced as a result of adversity). The researchers found that moral injury can be a precursor to PTG when individuals engage in meaning-making processes, such as forgiveness or rebuilding their sense of purpose. The study emphasized the potential for growth, resilience, and recovery despite the painful nature of moral injury.

The study concludes five domains of post-traumatic growth: New Possibilities, Relating to Others, Personal Strength, Spiritual Change, and Appreciation of Life.

Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of traumatic stress, 9, 455-471.

Moral Injury and Suicide Risk in Veterans

Examining the association between moral injury and suicidal behavior in military populations: A systematic review

This meta-analysis explored the relationship between moral injury and suicide risk in military veterans. The study found that moral injury was a significant predictor of suicidal thoughts and behaviors. Veterans who reported moral injury also had higher rates of depression, hopelessness, and PTSD. This highlighted the importance of addressing moral injury in suicide prevention efforts for veterans.

Jamieson, N., Carey, L. B., Jamieson, A., & Maple, M. (2023). Examining the association between moral injury and suicidal behavior in military populations: A systematic review. Journal of religion and health, 62(6), 3904-3925.

Moral Injury and the Role of Spirituality

Spiritual features of war-related moral injury: A primer for clinicians

This review explored the intersection of spirituality and moral injury, emphasizing that moral injury often leads to spiritual distress. The study argued that for many individuals, particularly veterans, moral injury is not just a psychological issue but also a spiritual crisis. Interventions that include spiritual care—whether through religious, existential, or meaning-focused approaches—were found to be potentially helpful in the healing process.

Wortmann, J. H., Eisen, E., Hundert, C., Jordan, A. H., Smith, M. W., Nash, W. P., & Litz, B. T. (2017). Spiritual features of war-related moral injury: A primer for clinicians. Spirituality in Clinical Practice, 4(4), 249.

Moral Injury and the Impact of Organizational Culture

Occupational moral injury and mental health: systematic review and meta-analysis

This study examined the role that organizational culture plays in the development of moral injury. It found that rigid, hierarchical organizations like the military or healthcare systems can exacerbate feelings of moral injury when individuals feel compelled to act in ways that conflict with their personal ethics. Supportive, flexible environments that encourage open communication and ethical reflection were shown to mitigate the impact of moral injury.

Williamson, V., Stevelink, S. A., & Greenberg, N. (2018). Occupational moral injury and mental health: systematic review and meta-analysis. The British Journal of Psychiatry, 212(6), 339-346.

Moral Injury and Community Support

Moral injury among first responders: Experience, effects, and advice in their own words

This qualitative study explored how community and social support can play a role in recovering from moral injury. It found that both formal support systems (such as therapy or support groups) and informal networks (family, friends, peers) are essential in helping individuals process and heal from moral injury. Veterans and first responders, in particular, reported feeling more resilient when they had access to social connections that understood the unique nature of their distress.

Knobloch, L. K., & Owens, J. L. (2024). Moral injury among first responders: Experience, effects, and advice in their own words. Psychological services.

Moral Injury and Cognitive Behavioral Therapy (CBT)

Impact of killing in war: A randomized, controlled pilot trial

This pilot study examined the use of Cognitive Behavioral Therapy (CBT) as an intervention for moral injury. The study found that CBT, when adapted to address moral and ethical concerns, was effective in helping individuals reframe their beliefs about themselves, their actions, and the world. The treatment helped individuals with moral injury confront guilt, shame, and anger, and work toward forgiveness and self-compassion.

Maguen, S., Burkman, K., Madden, E., Dinh, J., Bosch, J., Keyser, J., ... & Neylan, T. C. (2017). Impact of killing in war: A randomized, controlled pilot trial. Journal of clinical psychology, 73(9), 997-1012.