For many people, dealing with adversity is an all-too-common issue in their daily lives. Programs like UCLA’s Families Overcoming Under Stress and Strategies for Enhancing Early Developmental Success are striving to break through the barriers to help.
Melissa Comeau: “I am one of the very lucky caregivers, in that my husband reached out on his own and was willing to accept help.” Photo: Robin Jerstad
In hindsight, it all seems to have been so obvious. But at the time, Melissa Comeau remembers wondering what was wrong with her husband Stephen and questioning the state of her marriage.
Staff Sgt. Stephen Comeau was a proud member of the U.S. Marine Corps who completed four combat deployments in Iraq and Afghanistan over the course of his 13-year active-duty career. For the initial invasion of Fallujah, Iraq, in 2004, Comeau was part of the first group to go in — the so-called “tip of the spear.” He returned to Fallujah later in the year to serve in Operation Phantom Fury, the bloodiest battle of the Iraq war.
It was after Comeau came back from his third deployment, to Afghanistan, that his wife knew something was wrong. Comeau showed little interest in spending time with Melissa and their 18-month-old son, even though it had been six months since he had seen them. “He would just stay in the garage all day, shutting us out and listening to music,” Melissa Comeau recalls. “Everything irritated him. The person in front of us at Starbucks would complain that his coffee had the wrong milk, and Stephen would become infuriated that people didn’t understand what real problems were.”
Melissa Comeau feared that the relationship was teetering, as her husband became more distant and angry. “I always felt like I was walking on eggshells, trying not to set him off, but of course it wasn’t really about me,” she says.
The day after one of Stephen Comeau’s particularly explosive outbursts, he returned from the military base early, sat his wife down and told her he had visited the deployment health center, where he was told he had the symptoms of post-traumatic stress (PTS).
“I am one of the very lucky caregivers, in that my husband reached out on his own and was willing to accept help,” Melissa Comeau says.
IN 2006, PATRICIA LESTER, MD (FEL ’00), AND COLLEAGUES AT UCLA AND HARVARD created Families Overcoming Under Stress (FOCUS) to provide training to military family members in skills designed to build on strengths and reduce stress through communication, problem-solving and proactive strategies, including learning how to recognize and cope with emotional triggers. In the decade-plus since, the program has grown substantially. Now administered through a contract with the U.S. Department of Defense, FOCUS offers resilience-building training at 34 U.S. military installations around the world, with UCLA continuing to provide the training, support and evaluation to ensure that it runs effectively. FOCUS is based in the UCLA Nathanson Family Resilience Center, directed by Dr. Lester, Jane and Marc Nathanson Family Professor of Psychiatry. The center is part of the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA.
As Stephen Comeau was in the process of being treated for his PTS, the case-management team suggested that he and his wife enroll in a FOCUS resilience-training program at the Marine Corps Recruit Depot in San Diego. The results were dramatic. “The communication skills we got from FOCUS continue to serve us today,” Melissa Comeau says. The couple learned how to break down problems to make them more manageable. They learned to label undesired behaviors as a self-awareness strategy to facilitate stepping back, calming down and reevaluating a situation. Through a better understanding of her husband’s continued struggles, Melissa Comeau was able to recognize emotional triggers. “Knowing you have the skills to get through the hardest times gives you a feeling of strength,” she says.
Building on the success of FOCUS with military families, the Nathanson Center has initiated a range of new family-centered programs designed to enhance natural strengths and provide tools to overcome current and future setbacks and challenges. Among its ongoing partnerships, the center has joined with the Los Angeles Unified School District on an adaptation and implementation of the FOCUS curriculum to enhance the resilience of elementary, middle and high school students, reaching more than 2,900 students in the 2017-2018 school year. Recently, the Los Angeles County Department of Mental Health collaborated with the Nathanson Center to develop a Prevention Training Center of Excellence to support provider training in trauma and resilience-informed practice across Los Angeles County.
Although the programs’ designers tailored them to meet the needs of their target populations, they share the goal of building psychological resilience — defined by Dr. Lester as the ability to cope with, adapt to and thrive amidst stress, illness, injury, trauma, loss and other adversity. “Everyone faces stressors and challenges,” Dr. Lester says. “The ability to navigate those challenges and stay on course is a critical skill.”
RESILIENCE MIGHT WELL BE AS IMPORTANT AS INTELLIGENCE in determining lifelong success and well-being. Dr. Lester notes that research has found low resilience levels to be associated with poor self-control, lack of focus, an inability to manage the demands of school and work life and a greater likelihood of engaging in risky and unhealthy behaviors.
The ability to navigate through significant stress and trauma once was thought to be a rare trait, but researchers now recognize that the capacity referred to as “ordinary magic” by University of Minnesota researcher Ann Masten, PhD, resides within most of us. “Certainly, there are levels of adversity that are so substantial that resilience skills aren’t going to be enough, and we need to provide additional levels of support and care,” Dr. Lester says. “But we also understand that in less overwhelming situations, most people, families and communities are capable of extraordinary resilience.”
Scholarship coming out of disparate fields — from neuroscience and psychiatry to epidemiology and public health — has led to a better grasp of the constellation of factors that contribute to that capacity, Dr. Lester adds. The foundation, not surprisingly, comes from loving, stable early bonds with parents or, in their absence, other family members or other caregivers. As children move into adolescence and early adulthood, meaningful relationships with other adult mentors such as teachers and coaches also can contribute to the development of resilience.
Positive early relationships help to foster a key resilience characteristic: the capacity for emotional and behavioral regulation. As Dr. Lester describes it: “Can you manage intense emotions such as anxiety, stress and anger, and if you do have a spike in an emotional response, are you able to use positive coping skills to bring that reaction back down so that you can engage in effective communication and problem solving?”
Some emotional dysregulation is typical, particularly in childhood but even for adults, Dr. Lester notes; the question is how the individual manages that dysregulation. Other factors found to contribute to resilience include spirituality and religion; the ability to make meaning out of an experience, even when it’s negative; and the ability to communicate effectively and seek out support when needed.
It is important to note that all of these traits can be taught and developed. “Research has consistently shown that resilience isn’t a trait that some people are born with,” Dr. Lester says. “Resilience reflects a set of dynamic processes that begin in the context of family structures and can be supported by schools, communities and health care systems.”
IDEALLY, EFFORTS TO FOSTER RESILIENCE SKILLS should start in early childhood — building family bonds and ensuring that parents and other caregivers are equipped to impart critical tools. “In very young children, adversity can affect how the brain develops,” says Blair Paley, PhD, a clinical psychologist who directs the Nathanson Center’s Strategies for Enhancing Early Developmental Success (SEEDS) program, which she and colleagues codeveloped. “The earlier we can support children and their families in overcoming adversity, the better the long-term outcomes for children.”
Top: Dr. Blair Paley: “In very young children, adversity can affect how the brain develops. The earlier we can support children and their families in overcoming adversity, the better the long-term outcomes for children.” Second: Dr. Patricia Lester: “Everyone faces stressors and challenges. The ability to navigate those challenges and stay on course is a critical skill.” Third: Dr. Norweeta Milburn: “We’re trying to give both the young person and the adult the tools to rebuild their relationships.” Bottom: Dr. Peter C. Whybrow: “We have built an enormous technological reserve, but that doesn’t change the fact that human beings have a long period of development, and unless that is thought through carefully, many of our children are not going to grow up resilient.” Photos: Jessica Pons
SEEDS is a trauma-informed, family-centered school-readiness intervention initially developed through a grant from the U.S. Department of Education for preschool-age children with early adversities and developmental challenges, including prenatal exposure to alcohol and other substances, a history of trauma and/or loss and disruption in the parent-child relationship. The program works with the young children and their parents or caregivers to build skills shown to promote resilience, including problem solving, persistence and flexibility when encountering obstacles.
School readiness programs have traditionally focused on early academic skills, but SEEDS is especially concerned with building skills in self regulation — the ability to manage behaviors, feelings and thinking processes. “We know this is critical, not only for success in school, but also to be able to thrive throughout life,” Dr. Paley says. “Skills that help children get past frustrations and overcome obstacles are the same ones that will help them in their jobs, in their family life, in their relationship with a partner and in their parenting.”
A pilot study found that parents of children who participated in SEEDS reported greater decreases in negativity and improvements in self-regulation compared with children who had not yet gone through the program. SEEDS parents also reported reduced stress in interactions with their children. The study even found improvements in the child participants’ early literacy skills, despite that not being an emphasis — consistent with previous research indicating that school-based interventions focusing on self-regulation also can improve academic performance.
For Dr. Paley, one of the most significant lessons from the pilot study is the need to work not just with the children, but also with the adults in their lives. With her SEEDS colleagues, she has developed a shorter module for early-childhood professionals in the community. SEEDS has recently partnered with the Emergency Child Care Bridge Program for Foster Children, a program administered by the California Department of Social Services and the Child Care Resource & Referral Network to enhance trauma- and resilience-informed practices in child care settings in Los Angeles County.
Adolescence is another key developmental period. Numerous studies have shown that a strong relationship with an adult figure is among the most important determinants of positive outcomes for at-risk adolescents. Project STRIVE (Support to Reunite, Involve, and Value Each Other) was developed at UCLA in 2004 to reconnect homeless and runaway youth with a positive, caring adult. The program currently is being adapted for adolescents who are reentering communities from the juvenile justice system.
The adolescents originally targeted by Project STRIVE face a litany of risks, notes psychologist Norweeta Milburn, PhD, who heads the Nathanson Center-based program. Many leave home because of unresolved family strife, conflicts around sexual identity and problems with peer relationships. “The longer these youth are not stably housed, the greater their risk for mental health problems, substance use, risky sexual behavior, victimization and exploitation and becoming chronically homeless adults,” Dr. Milburn says. “Building resilience is a way to either prevent these problems from occurring or lessen their long-term impact.”
Project STRIVE was developed as a five-session intervention to address family conflict and promote positive interactions between the adolescent and adult (most often a family member), while the adolescent is still in a shelter and/or being served by a community agency, as well as during the transition back home. The program facilitator models appropriate behaviors and teaches strategies for identifying and resolving conflicts. Participants learn emotional regulation skills through a “feeling thermometer” — red means emotions are elevated, green is for calm. “The idea is that you don’t want to problem-solve when you’re in the red zone,” Dr. Milburn says. “You want to calm down before having some of those difficult conversations.” As part of rebuilding the relationship, Project STRIVE also uses a behavioral economy approach, with adult and adolescent participants handing out tokens to affirm positive interactions.
“We’re trying to give both the young person and the adult the tools to rebuild their relationships,” Dr. Milburn says. The results of a randomized controlled trial found that the intervention was successful in improving mental health outcomes and reducing substance use and HIV risk behaviors. In addition to adapting the program for youth reentering communities from the juvenile justice system, Dr. Milburn and her colleagues are in the process of scaling up Project STRIVE and embedding it in systems most likely to encounter at-risk youth, training providers in delivering the intervention.
Evidence that resilience is modifiable and dynamic isn’t lost on Natalia Ramos, MD (RES ’15, FEL ’17), MPH, assistant clinical professor of psychiatry and bio behavioral sciences and a child, adolescent and adult psychiatrist. As part of the Semel Institute’s Stress, Trauma, and Resilience (STAR) Clinic, Dr. Ramos founded the UCLA EMPWR Program to promote well-being and resilience in LGBTQ children, teens and young adults. EMPWR delivers individual, group and family interventions; collaborates with community groups; and offers clinical training for mental health professionals.
Dr. Ramos has developed resilience classes for LGBTQ adolescents, with funding from the American Academy of Child and Adolescent Psychiatry, and is studying the impact of the intervention on depression and anxiety. Grounded in evidence from the field of cognitive behavioral therapy, the class curriculum is designed to be easily delivered by nonprofessionals in community-based settings.
In the group, teens learn practical strategies to manage stress, such as relaxation techniques, assertive communication and ways to identify support and build social networks. In addition to internal coping methods, participants are advised on connecting with external resources, such as community groups and mentors that can help them, particularly in the absence of family support. “We can’t predict what adversity these adolescents will face throughout their lives, but we can assume that there will be some degree of discrimination, stigma, shame, micro-aggressions and family rejection,” says Dr. Ramos, who is in the process of analyzing the results of her pilot study. “The idea is to provide a toolbox they can carry with them, so that they can apply concrete strategies to get through the inevitable hard times — whether it’s drawing, reaching out to a friend or listening to a favorite song.”
Aside from the concrete coping skills, the group has shown Dr. Ramos the power of peer support. “At first the teens complained to their parents about having to come, but after a couple of classes, they didn’t want to leave and were exchanging phone numbers,” she says. “Having a community space for a teen who has felt alienated or isolated can be extremely powerful.”
AT THE NATHANSON CENTER, DR. LESTER AND HER COLLEAGUES are looking to go beyond the individually targeted programs to focus on building systems. “Through a multi-level, multi-system approach that involves not just families, but also schools, health systems and other institutions, the ultimate goal is to have an entire community take on a common language and methods for developing these resilience capacities,” Dr. Lester says. Toward that end, Dr. Lester’s team is leading the recently funded UCLA-DMH Prevention Training Center of Excellence, which aims to build a trauma/ resilience-informed system in Los Angeles County through sustainable workforce development, training, coaching and consultation for county providers.
One of the reasons there is such a dire need for FOCUS and its Nathanson Center offshoots is that the level of trauma and stress is so high in modern U.S. society, says Peter C. Whybrow, MD, executive chair of UCLA’s Department of Psychiatry and Biobehavioral Sciences and director of the Semel Institute. In his 2015 book The Well-Tuned Brain: Neuroscience & The Life Well Lived (W.W. Norton & Company), Dr. Whybrow makes the case that for all of the remarkable technological and material advances in recent decades, humans are at their core social beings — and by failing to maintain a strong social infrastructure, modern U.S. society is producing a less-resilient population.
“We have built an enormous technological reserve, but that doesn’t change the fact that human beings have a long period of development, and unless that is thought through carefully, many of our children are not going to grow up resilient,” Dr. Whybrow says. “We must ask ourselves why, despite being such a wealthy country, our social indicators are so poor. The answer may be that we don’t pay enough attention to the fundamental human interactions that build resilience or to the social institutions that would contribute to building more resilient children and young adults.”
AFTER HER EXPERIENCE WITH FOCUS, Melissa Comeau decided to make some changes, foremost among them leaving her career as an accountant to devote her time to assisting families going through the hardships she and her husband had endured. Today, she is director of the Military and Veteran Caregiver Network, a program of the American Red Cross that trains spouses, parents, children and other loved ones of service members or veterans to provide peer support or serve as peer mentors or peer-group facilitators. She was appointed to the Federal Advisory Committee for Veteran’s Family, Caregivers and Survivors of the U.S. Department of Veterans Affairs, and she published a book, Sleeping with the War (War Writers’ Campaign), in 2014. Her husband Stephen Comeau was medically retired in 2013 and is involved with the Wounded Warrior Project Independence Program. The couple now live outside of Houston, Texas, where “we’ve just been trying to build our best life, one day at a time,” Melissa Comeau says.
“For me,” she adds, “resilience is knowing that I won’t always be in a state of adversity, but that when I do face tough times, I have the skills and tools within me to move forward. That awareness is itself empowering.”
Dan Gordon is a regular contributor to U Magazine.
