Predicting profiles of post-trauma adaptation in first responders and civilians after the 2013 Boston Marathon bombings: The role of distress, growth, and emotion regulation


  • Sophie Brickman, MA
  • Leia Y. Saltzman, PhD
  • Steven L. Bistricky, PhD
  • Ellen J. Wright, PhD



trauma, post-traumatic growth, first responders, coping flexibility, emotion regulation


Introduction: Responses to trauma are often characterized either by the presence or absence of psychological distress; however, the process of adapting after trauma also includes potential positive change. While some studies document that the majority of individuals exposed to single event terrorism report low levels of psychological distress, more research is needed to understand different adaptation profiles following this type of trauma, and the factors that might predict responses.

Methods: We examined post-trauma responses in 257 first responders/medical professionals (66.8 percent) and civilians (33.2 percent) exposed to the 2013 Boston Marathon Bombings. Data for post-trauma profiles—post-traumatic growth (PTG), posttraumatic stress, and emotion regulation—and profile predictors—trauma proximity, trauma history, and coping flexibility—were collected approximately 2.5 years after the bombings. Latent profile analysis identified response profiles, and multinomial logistic regression identified demographic, event-specific, and psychological predictors of profile membership.

Results: Four profiles emerged: (1) symptomatic, (2) resistant, (3) resilient, and (4) struggling growth. First responder role decreased the odds of belonging to the struggling growth profile, as compared to the symptomatic profile. Greater coping flexibility and adaptive emotion regulation increased the odds of membership in the struggling growth, rather than symptomatic profile.

Conclusion: A subset of individuals experiencing post-traumatic stress symptoms years after trauma exposure may also be utilizing flexible, adaptive coping strategies and experiencing PTG. First responders may have difficulty experiencing simultaneous distress and growth, and interventions designed to promote healthy post-trauma adaptation for this population could be tailored accordingly.

Author Biographies

Sophie Brickman, MA

Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, Colorado

Leia Y. Saltzman, PhD

School of Social Work, Tulane University, New Orleans, Louisiana

Steven L. Bistricky, PhD

Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, Colorado

Ellen J. Wright, PhD

Department of Psychology, Brandeis University, Waltham, Massachusetts


Kilpatrick DG, Resnick HS, Milanak ME, et al.: National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. J Traumatic Stress. 2013; 26(5): 537-547. DOI: 10.1002/jts.21848.

Galatzer-Levy IR, Huang SH, Bonanno GA: Trajectories of resilience and dysfunction following potential trauma: A review and statistical evaluation. Clin Psychol Rev. 2018; 63: 41-55. DOI: 10.1016/j.cpr.2018.05.008.

Jones S: Describing the mental health profile of first responders: A systematic review. J Am Psychiatr Nurses Assoc. 2017; 23(3): 200-214. DOI: 10.1177/1078390317695266.

Bonanno GA, Westphal M, Mancini AD: Resilience to loss and potential trauma. Annu Rev Clin Psychol. 2011; 7: 511-535. DOI: 10.1146/annurev-clinpsy-032210-104526.

Pat-Horenczyk R, Saltzman LY, Hamama-Raz Y, et al.: Stability and transitions in post-traumatic growth trajectories among cancer patients: LCA and LTA analyses. Psychol Trauma. 2016; 8(5): 541-549. DOI: 10.1037/tra0000094.

Saltzman LY, Pat-Horenczyk R, Lombe M, et al.: Post-combat adaptation: Improving social support and reaching constructive growth. Anxiety Stress Coping. 2018; 31(4): 418-430. DOI: 10.1080/10615806.2018.1454740.

Tedeschi RG, Calhoun LG: The post-traumatic growth inventory: Measuring the positive legacy of trauma. J Trauma Stress. 1996; 9(3): 455-471. DOI: 10.1007/BF02103658.

Calhoun LG, Tedeschi RG: Post-traumatic growth: The positive lessons of loss. In Neimeyer RA (ed.): Meaning Reconstruction & The Experience of Loss. Washington, DC: American Psychological Association, 2001: 157-172. DOI: 10.1037/10397-008.

Triplett KN, Tedeschi RG, Cann A, et al.: Post-traumatic growth, meaning in life, and life satisfaction in response to trauma. Psychol Trauma. 2012; 4(4): 400-410. DOI: 10.1037/a0024204.

Hobfoll SE, Watson P, Bell CC, et al.: Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry. 2007; 70(4): 283-315. DOI: 10.1521/psyc.2007.70.4.283.

Stump MJ, Smith JE: The relationship between post-traumatic growth and substance use in homeless women with histories of traumatic experience. Am J Addict. 2008; 17(6): 478-487. DOI: 10.1080/10550490802409017.

Leykin D, Lahad M, Bonneh N: Post-traumatic symptoms and post-traumatic growth of Israeli firefighters, at one month following the Carmel fire disaster. Psychiatry J. 2013; 2013: 1-5. DOI: 10.1155/2013/274121.

Surgenor LJ, Snell DL, Dorahy M: Factors associated with psychiatric morbidity, post-traumatic stress disorder and posttraumatic growth in paramedic first responders: The role of core beliefs. Australas J Paramed. 2020; 17. DOI: 10.33151/ajp.17.727.

O’Bryan EM, McLeish AC, Kraemer KM, et al.: Emotion regulation difficulties and post-traumatic stress disorder symptom cluster severity among trauma-exposed college students. Psychol Trauma. 2015; 7(2): 131-137. DOI: 10.1037/a0037764.

Tull MT, Barrett HM, McMillan ES, et al.: A preliminary investigation of the relationship between emotion regulation difficulties and post-traumatic stress symptoms. Behav Ther. 2007; 38(3): 303-313. DOI: 10.1016/j.beth.2006.10.001.

Mennin DS, Heimberg RG, Turk CL, et al.: Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behav Res Ther. 2005; 43(10): 1281-1310. DOI: 10.1016/j.brat.2004.08.008.

Singh S, Mishra RC: Emotion regulation strategies and their implications for well-being. Soc Sci Int. 2011; 27(2): 179-198.

Zhou X, Wu X, Chen J: Longitudinal linkages between posttraumatic stress disorder and post-traumatic growth in adolescent survivors following the Wenchuan earthquake in China: A threewave, cross-lagged study. Psychiatry Res. 2015; 228(1): 107-111. DOI: 10.1016/j.psychres.2015.04.024.

Baumeister RF, Bratslavsky E, Finkenauer C, et al.: Bad is stronger than good. Rev Gen Psychol. 2001; 5(4): 323-370. DOI: 10.1037/1089-2680.5.4.323.

Cann A, Calhoun LG, Tedeschi RG, et al.: Assessing posttraumatic cognitive processes: The event related rumination inventory. Anxiety Stress Coping. 2011; 24(2): 137-156. DOI: 10.1080/10615806.2010.529901.

Eftekhari A, Zoellner LA, Vigil SA: Patterns of emotion regulation and psychopathology. Anxiety Stress Coping. 2009; 22(5): 571-586. DOI: 10.1080/10615800802179860.

Compas BE, Jaser SS, Dunbar JP, et al.: Coping and emotion regulation from childhood to early adulthood: Points of convergence and divergence. Aust J Psychol. 2014; 66(2): 71-81. DOI: 10.1111/ajpy.12043.

Bonanno GA: The resilience paradox. Eur J Psychotraumatology. 2021; 12(1): 1942642. DOI: 10.1080/20008198.2021.1942642.

Bonanno GA, Papa A, Lalande K, et al.: The importance of being flexible: The ability to both enhance and suppress emotional expression predicts long-term adjustment. Psychol Sci. 2004; 15(7): 482-487. DOI: 10.1111/j.0956-7976.2004.00705.x.

Galatzer-Levy IR, Burton CL, Bonanno GA: Coping flexibility, potentially traumatic life events, and resilience: A prospective study of college student adjustment. J Soc Clin Psychol. 2012; 31(6): 542-567. DOI: 10.1521/jscp.2012.31.6.542.

Pat-Horenczyk R, Kenan AM, Achituv M, et al.: Protective factors based model for screening for post-traumatic distress in adolescents. Child Youth Care Forum. 2014; 43(3): 339-351. DOI: 10.1007/s10566-013-9241-y.

Sattler DN, Boyd B, Kirsch J: Trauma-exposed firefighters: Relationships among post-traumatic growth, post-traumatic stress, resource availability, coping and critical incident stress debriefing experience. Stress Health. 2014; 30(5): 356-365. DOI: 10.1002/smi.2608.

Ozer EJ, Best SR, Lipsey TL, et al.: Predictors of post-traumatic stress disorder and symptoms in adults: A meta-analysis. Psychol Bull. 2003; 129(1): 52-73. DOI: 10.1037/0033-2909.129.1.52.

Pat-Horenczyk R, Qasrawi R, Lesack R, et al.: Post-traumatic symptoms, functional impairment, and coping among adolescents on both sides of the Israeli-Palestinian conflict: A cross-cultural approach. Appl Psychol. 2009; 58(4): 688-708. DOI: 10.1111/j.1464-0597.2008.00372.x.

Bonanno GA, Galea S, Bucciarelli A, et al.: What predicts psychological resilience after disaster? The role of demographics, resources, and life stress. J Consult Clin Psychol. 2007; 75(5): 671-682. DOI: 10.1037/0022-006X.75.5.671.

North CS, Nixon SJ, Shariat S, et al.: Psychiatric disorders among survivors of the Oklahoma city bombing. JAMA. 1999; 282(8): 755-762. DOI: 10.1001/jama.282.8.755.

North CS, Pfefferbaum B, Tivis L, et al.: The course of posttraumatic stress disorder in a follow-up study of survivors of the Oklahoma city bombing. Ann Clin Psychiatry. 2004; 16(4): 209-215. DOI: 10.3109/10401230490522034.

Tucker P, Pfefferbaum B, Nitiema P, et al.: Intensely exposed Oklahoma city terrorism survivors. J Nerv Ment Dis. 2016; 204(3): 203-209. DOI: 10.1097/NMD.0000000000000456.

Bonanno GA, Galea S, Bucciarelli A, et al.: Psychological resilience after disaster: New York city in the aftermath of the September 11th terrorist attack. Psychol Sci. 2006; 17(3): 181-186. DOI: 10.1111/j.1467-9280.2006.01682.x.

Goodwin R, Kaniasty K, Sun S, et al.: Psychological distress and prejudice following terror attacks in France. J Psychiatr Res. 2017; 91: 111-115. DOI: 10.1016/j.jpsychires.2017.03.001.

Gates JD, Arabian S, Biddinger P, et al.: The initial response to the boston marathon bombing: Lessons learned to prepare for the next disaster. Ann Surg. 2014; 260(6): 960-966. DOI: 10.1097/SLA.0000000000000914.

United Stats Census Bureau: Data profiles. Available at Accessed April 24, 2022.

Weathers FW, Litz BT, Keane TM, et al.: The PTSD checklist for DSM-5 (PCL-5). 2013. Available at Accessed April 24, 2022.

Garnefski N, Kraaij V, Spinhoven P: Negative life events, cognitive emotion regulation and emotional problems. Pers Individ Diff. 2001; 30(8): 1311-1327. DOI: 10.1016/S0191-8869(00)00113-6.

Pat-Horenczyk R, Peled O, Miron T, et al.: Risk-taking behaviors among Israeli adolescents exposed to recurrent terrorism: Provoking danger under continuous threat? AJP. 2007; 164(1): 66-72. DOI: 10.1176/ajp.2007.164.1.66.

Bonanno GA, Pat-Horenczyk R, Noll J: Coping flexibility and trauma: The perceived ability to cope with trauma (PACT) scale. Psychol Trauma. 2011; 3(2): 117-129. DOI: 10.1037/a0020921.

Levy-Gigi E, Bonanno GA, Shapiro AR, et al.: Emotion regulatory flexibility sheds light on the elusive relationship between repeated traumatic exposure and post-traumatic stress disorder symptoms. Clin Psychol Sci. 2016; 4(1): 28-39. DOI: 10.1177/2167702615577783.

May CL, Wisco BE: Defining trauma: How level of exposure and proximity affect risk for post-traumatic stress disorder. Psychol Trauma. 2016; 8(2): 233-240. DOI: 10.1037/tra0000077.

Peters J, Bellet BW, Jones PJ, et al.: Post-traumatic stress or post-traumatic growth? Using network analysis to explore the relationships between coping styles and trauma outcomes. J Anxiety Disord. 2021; 78: 102359. DOI: 10.1016/j.janxdis.2021.102359.

Maercker A, Zoellner T: The Janus face of self-perceived growth: Toward a two-component model of post-traumatic growth. Psychol Inq. 2004; 15(1): 41-48.

Boehm-Tabib E, Gelkopf M: Post-traumatic growth: A deceptive illusion or a coping pattern that facilitates functioning? Psychol Trauma. 2021; 13(2): 193-201. DOI: 10.1037/tra0000960.

Layne CM, Ruzek JI, Dixon K: From resilience and restoration to resistance and resource caravans: A developmental framework for advancing the disaster field. Psychiatry. 2021; 84(4): 393-409. DOI: 10.1080/00332747.2021.2005444.

Bistricky SL, Long LJ, Lai BS, et al.: Surviving the storm: Avoidant coping, helping behavior, resilience and affective symptoms around a major hurricane-flood. J Affect Disord. 2019; 257: 297-306. DOI: 10.1016/j.jad.2019.07.044.

Benight CC, Shoji K, Yeager CM, et al.: Predicting change in post-traumatic distress through change in coping self-efficacy after using the My Trauma Recovery eHealth intervention. JMIR Ment Health. 2018; 5(4): e10309. DOI: 10.2196/10309.

Smith AJ, Shoji K, Griffin BJ, et al.: Social cognitive mechanisms in healthcare worker resilience across time during the pandemic. Soc Psychiatry Psychiatr Epidemiol. 2022; 57: 1457-1468. DOI: 10.1007/s00127-022-02247-5.



How to Cite

Brickman, S., L. Y. Saltzman, S. L. Bistricky, and E. J. Wright. “Predicting Profiles of Post-Trauma Adaptation in First Responders and Civilians After the 2013 Boston Marathon Bombings: The Role of Distress, Growth, and Emotion Regulation”. Journal of Emergency Management, vol. 21, no. 4, Sept. 2023, pp. 311-22, doi:10.5055/jem.0754.