On January 12, 2010, a magnitude 7.0 earthquake struck Haiti, leaving approximately 220,000 people dead, 300,000 people injured, and 1.5 million people displaced (CNN Library, 2017). For years, many (if not most) of the survivors have struggled to make sense of this catastrophic event. In the current article, we present results from a two-wave qualitative study of the resilience processes utilized by adult survivors of this 2010 Haiti earthquake. These findings inform a process model of resilience in a postdisaster context. We describe each of the emergent themes from this model, including specific quotes to illustrate each theme. Finally, we discuss implications for practice and provide recommendations for future research.

Trauma and Resilience

Resilience refers to "an outcome of successful adaptation to adversity" (Zautra, Hall, & Murray, 2010, p. 3). Resilient processes are traditionally categorized into two types: recovery processes (i.e., "[processes related to] how well people bounce back and recover fully from challenge," Zautra et al., 2010, p.) and sustainability processes (i.e., "[processes related to] the capacity to continue forward in the face of adversity," Zautra et al., 2010, p. 4). These processes can be characteristics of individuals, groups (e.g., communities), or situations (Zautra et al., 2010). In this study, we will focus on resilience processes employed by individuals in the wake of a disaster. In particular, we will explore the resilience processes adult disaster survivors use in their attempts to navigate how a catastrophic event has disrupted their cosmology--that is, their beliefs (i.e., overarching worldview) about the world and their place in it (Weick, 1993).

For instance, the emotional processing theory of Posttraumatic Stress Disorder (PTSD) holds that people with more rigid (as opposed to more flexible) pretrauma belief systems are more inclined to develop PTSD following the experience of a traumatic event (Foa & Rothbaum, 1998; Park, Mills, & Edmondson, 2012). Tedeschi and Calhoun's (2004) theory of posttraumatic growth (PTG) advanced the notion that people can experience positive change due to struggling with adversity, and research supporting this theory has found that, if trauma-exposed people reexamine their trauma-disrupted core beliefs, then they are less likely to develop PTSD and more likely report experiencing perceived PTG (Triplett, Tedeschi, Cann, Calhoun, & Reeve, 2012). More recently, Park and colleagues' meaning making model (Park, 2010; Park, Currier, Harris, & Slattery, 2017) has conceptualized trauma recovery as occurring when survivors reconcile their situational meaning of a traumatic event with their global meaning, using adaptive assimilation or accommodation processes.

In a landmark article, Bonanno (2004) challenged the premise that trauma-exposed people are more prone to develop PTSD from trauma than to exhibit resilience to trauma. He differentiated resilience from recovery, reviewed the empirical evidence that resilience is actually quite common, and discussed how there are varied and oftentimes unexpected pathways to resilience. Bonanno's (2004) article was effective in prompting trauma researchers to re-engage in exploring the previously overlooked topic of resilience. Since then, the scientific study of resilience has grown exponentially (Kumar, 2016; Lightsey, 2006; Park et al., 2017; Reich, Zautra, & Hall, 2010; Wong, 2012).

Disasters, Resilience, and Spirituality

Within this line of research, one focus of attention has been the empirical study of resilience in a disaster context (Bonanno & Gupta, 2009), and some of those studies have examined the role of religion/spirituality as a source of resilience and meaning making in the wake of disasters (Park, 2016b; cf. Park, 2016a, Park et al., 2017). Indeed, research has shown that when people experience a disaster (i.e., "a potentially traumatic event that is collectively experienced, has an acute onset, and is time-delimited," McFarlane & Norris, 2006, p. 4), they often struggle to make sense of their new postdisaster realities, and religion/spirituality help them toward that end (Park, 2016b; cf. Park et al., 2017). Disasters and traumatic events can disrupt foundational aspects of people's understanding of the world, compelling them to reconsider their core beliefs (i.e., cosmology) against the backdrop of their current circumstances (Groleau, Calhoun, Cann, Tedeschi, 2013; Janoff-Bulman, 1992).

Psychologist and organizational theorist Weick (1993) coined the term "cosmology episodes" (p. 633) to describe such events. He explained:

A cosmology episode occurs when people suddenly and deeply feel that the universe is no longer a rational, orderly system. What makes such an episode so shattering is that both the sense of what is occurring and the means to rebuild that sense collapse together. (Weick, 1993, p. 633)

In other words, a cosmology episode represents the deep and sudden "collapse" of sensemaking (i.e., how people provide meaning to their experiences), because the traumatic has shattered one's core beliefs and assumptions (Janoff-Bulman, 1992; Weick, 1993). That cosmology episodes strike at these core aspects of human experience, it is no surprise that such episodes will often require people to address fundamental existential and religious/spiritual questions if they are to rebuild their lives and respond resiliently (O'Grady & Orton, 2016; Park, 2016a).

The Current Study

There is growing empirical evidence that most disaster-exposed adults demonstrate resilience (Bonanno, Brewin, Kaniasty, & La Greca, 2010; Bonanno, Galea, Bucciarelli, & Vlahov, 2007; Bonanno & Gupta, 2009). What is less clear are the processes which they do so. There also is very limited research on postdisaster resilience in disaster contexts outside the U.S. Hence, the current two-wave qualitative study was conducted primarily to explore the resilience processes utilized by adult survivors of the 2010 Haiti earthquake. Secondarily, because the vast majority of Haitians believe in a higher power and consider religion/spirituality to be a fundamental component of their cosmologies (O'Grady, Orton, Schreiber-Pan, & Wismick, 2013; O'Grady, Rollison, Hanna, Schreiber-Pan, & Ruiz, 2012), this study was also designed to explore how survivors' religion/spirituality intersected with their postdisaster resilience processes.

We chose to utilize a qualitative approach for this study, because there has been so little research in this area to date and because a qualitative approach is well suited for exploratory and process-focused research. Qualitative research is also well suited for cross-cultural research, given its historic emphasis on contextualization of research questions and findings (Denzin & Lincoln, 2011).

Methods

Participants

To study our research questions, we recruited participants in person through purposive sampling in religious communities, tent communities, and educational institutions in Portau-Prince and its surrounding areas (e.g., Petion-Ville, Croix-des-Missions), which all were heavily impacted by the earthquake. Indeed, all recruited participants had experienced some level of loss (e.g., property damage, loss of loved ones, etc.; see O'Grady, Orton, White, & Snyder, 2016, for a description of the broader project of which this study was a part). The study's three inclusion criteria were that all participants had to (a) be at least 18 years old, (b) have been a survivor of the 2010 Haiti earthquake, and (c) report (on the demographics form) that the disaster had disrupted their sensemaking.

We conducted this interview study at two time points: Time 1 was 6-months postdisaster, and Time 2 was 3-years postdisaster. At Time 1 there were 42 participants (19 men [45%], 23 women [55%]), and at Time 2 there were 40 participants (18 men [45%], 22 women [55%]). Most Time 2 participants (n = 34) had participated in the study at Time 1; however, some Time 1 participants (n = 8) could not be located at Time 2. In those cases, we recruited a Time 2 participant who had similar demographic characteristics (e.g., was the same sex and roughly the same age) as the Time 1 participant whom we could not locate. Because some of the Time 1 participants could not be located at Time 2, we have refrained from referring to this study as a longitudinal qualitative study; instead, we refer to it as a two-wave qualitative study.

At Time 1 the average age of participants was 28.3 years (SD = 11.7), and at Time 2 the average age was 30.7 years (SD =11.4). All Time 1 and Time 2 participants were of African ethnic descent, thereby reflecting the ethnic composition of Haiti (Central Intelligence Agency, n.d.). In terms of religious affiliation, participants were Roman Catholic Christian (ns = 22 at Time 1, 23 at Time 2), Mormon/Latter-Day-Saint Christian (ns = 19 and 15, respectively), and Protestant Christian (ns = 1 and 2, respectively). (Almost 90% of the Haitian population has a Christian religious affiliation [Pew Research Center, 2017].) Of note, it is likely that many participants additionally engaged in some folk religious practices (e.g., voodoo rituals; Central Intelligence Agency, n.d.), but they did not spontaneously report about such practices. The primary language of all participants was Creole (the native language of Haiti); only 5% of participants had proficiency in the English language.

Data Collection

The Time 1 interview questions were developed by the first through fifth authors, based on their expertise in the trauma literature and in conducting cross-cultural trauma research. The Time 1 semistructured interview protocol consisted of 9 questions, asking about people's psychological, social, and religious/spiritual experiences with the earthquake. Two example questions are: What has your experience been like since the earthquake? and What helps you cope with the difficulties? Time 1 interviews were conducted in person in July 2010 (6-months postdisaster). Interviews were conducted individually in churches, tent communities, homes, schools, and parks, and they lasted from 30 to 90 minutes. Because the primary language of all participants was Creole (the native language of Haiti) and only 5% of participants had proficiency in the English language, all interviews were conducted through the assistance of competent translators. Subsequently, the audio-recorded interview was translated and transcribed verbatim into English by the sixth author (who is from Haiti, speaks Creole as his primary language, has advanced proficiency in the English language, and has 2 years of training in English language translation).

Before conducting the Time 2 interviews, the first through fifth authors (and doctoral-student members of their respective research teams) traveled to Port-au-Prince and met with a doctoral-level Haitian professor and four student members of his research team. The Haitian research team provided feedback about the cultural appropriateness and relevance of the Time 1 interview questions. As part of this feedback, they suggested semantic revisions such as replacing the word "cope" with the word "sustain" (e.g., What helps you cope with the difficulties? was revised to Does anything help sustain you through the difficult times? Please explain?). After two days of discussion, everyone was satisfied with the revised version of the interview protocol. This Time 2 semistructured interview protocol is presented in Appendix A.

Time 2 interviews were again conducted in person and individually, in churches, tent communities, homes, schools, and parks. As before, these interviews lasted from 30 to 90 minutes, were conducted through the assistance of a translator, and the audio-recorded interview was subsequently translated and transcribed verbatim into English.

Data Analysis

For data analysis, we used a qualitative content analysis strategy (Hsieh & Shannon, 2005). specifically, we utilized a directed content-analysis strategy, which "starts with a theory or relevant research findings as guidance for initial codes" (Hsieh & Shannon, 2005, p. 1277). Data analysis began with the first and second author (Ph.D.-level researchers with a high level of expertise on the topic) conducting an extensive review of the scientific literature on cosmology episodes. (The results of this review are published in Orton and O'Grady, 2016, which presents a qualitative meta-analysis of 164 articles on cosmology episodes). This meta-analytic review revealed that resilience during cosmology episodes tends to involve five related yet distinct resilience processes: (a) anticipating (beliefs, resources, and practices that are in place prior to the triggering event), (b) sense-losing (the collapse of aspects of the cosmology in response to the triggering event), (c) improvising (creative, collaborative problem solving to reconstruct meaning), (d) sense-remaking (rebuilding a suitable cosmology), and (e) renewing processes (processes in place as one moves forward in life; Orton & O'Grady, 2016). Therefore, the current study's directed content-analysis coding proceeded with these five categories of resilience processes as the guide for our initial coding of themes.

The coding team was comprised of the first and second author and their research team (three Ph.D. students and two master's students) that studies trauma and resilience. Each Time 1 and Time 2 interview transcript was coded independently by three members of the coding team. Coding was conducted using a software program. The initial coding was conducted line by line, by using clarifying codes that arose from the data and by highlighting significant statements. The coding team met regularly for peer debriefing, in order to compare coded transcripts for consistency, identify themes and patterns, and discuss instances of coding discrepancy or uncertainty. In such instances, the lead author's extensive experience conducting research with Haitians was drawn upon to provide contextual information that could help guide coding decisions. During coding and deliberations, a devil's advocate was assigned, in order to mitigate the potential for groupthink in analysis. The data was triangulated with quantitative findings conducted at Time 1 and Time 2 (e.g., O'Grady et al., 2012) and with literature on the topic (e.g., Orton & O'Grady, 2016) to enhance the methodological integrity (fidelity and utility) of the data.

Results

Data analysis yielded themes for four of the five overarching resilience processes: sense-losing, improvising, sense-remaking, and renewing. Themes for anticipating processes would likely have emerged too, if the interview protocol had contained questions asking about survivors' resources, beliefs, and practices prior to the earthquake. However, such questions were not included at Time 1 and thus were not asked at Time 2 either, in order to maintain a level of consistency (reliability) between the interview protocols.

Emergent themes (with supporting quotes) are presented in Table 1. The themes that emerged as characterizing resilient sense-losing were: (a) courage, (b) acceptance, (c) spiritual endurance, and (d) social support. Next, the themes that emerged as characterizing resilient improvising were: (a) creative imagination, (b) spiritual identity, (c) divine intervention, and (d) collaborative coping (with God and others). Third, the themes that emerged as characterizing resilient sense-remaking were: (a) positive reappraisal, (b) sense of purpose, (c) spiritual devotion, and (d) community outreach. Lastly, the themes that emerged as characterizing resilient renewing were: (a) new identity, (b) increased courage, (c) increased altruism, (d) increased sense of community, (e) increased strength, (f) increased knowledge, and (g) increased faith.

Not all participants exhibited postdisaster resilience and growth, however. On the contrary, some (albeit a small minority) exhibited posttraumatic depreciation (Marshall, Frazier, Frankfurt, & Kuijer, 2015). Content analysis revealed that this depreciation was characterized by rigid psychological processes--specifically, by rigid sense-losing, improvising, sense-remaking, and renewing. For these processes, emergent themes (with supporting quotes) are presented in Table 2. The themes that emerged as characterizing rigid sense-losing were: (a) fear, (b) negative appraisal, (c) disengagement, and (d) denial and disassociation. Next, the themes that emerged as characterizing rigid improvising were: (a) deferring coping (with God and others), (b) self-directing coping, (c) maladaptive conservation of beliefs, and (d) stagnant imagination. Third, the themes that emerged as characterizing rigid sense-remaking were: (a) sense of abandonment (b) isolation, and (c) hopelessness. Lastly, the themes that emerged as characterizing rigid renewing were: (a) decreased self-efficacy, (b) decreased faith (c) decreased resources, and (d) general resignation.

Discussion

This two-wave qualitative study contributes to the literature on postdisaster psychosocial resilience by identifying what characterizes the resilient processes survivors engage in to recover and move forward in the wake of disasters. More broadly, it advances understanding of the role that religion/spirituality can play in people's postdisaster resilience (Park, 2016b; cf. Pargament & Cummings, 2010), and it advances cross-cultural understanding of postdisaster resilience.

The themes that emerged are resonant with existing theory and research on cosmology episodes (Orton & O'Grady, 2016), adult resilience (Bonanno, 2004; Bonanno et al., 2007, 2010; Bonanno & Gupta, 2009; Zautra et al., 2010), religious coping (Pargament et al., 1988; Pargament, Koenig, & Perez, 2000), meaning making (Park, 2016a, 2016b; Park et al., 2017), PTG (Tedeschi & Calhoun, 2004; Triplett et al., 2012), and posttraumatic depreciation (Marshall et al., 2015). For instance, the themes that emerged suggest there are related yet distinct resilience processes that characterize people's responses to a disaster (Orton & O'Grady, 2016). Results also supported the finding that most adults exhibit resilience in the face of adversity generally (Bonanno, 2004) and disaster-related adversity specifically (Bonanno et al., 2007, 2010; Bonanno & Gupta, 2009).

Furthermore, in line with Pargament and colleagues' theorizing and research on religious coping and problem solving (Pargament et al., 1988, 2000), results revealed there are resilient forms of religious coping and problem solving (e.g., collaborative coping, positive reappraisal) and nonresilient forms of religious coping and problem solving (e.g., deferring coping and self-directing coping). Likewise, results supported theory and research on Park and colleagues' meaning making model (Park, 2010, 2016a, 2016b; Park et al., 2017), in that resilient survivors tended to engage in adaptive processes of assimilation (e.g., spiritual identity) or accommodation (e.g., new identity), whereas nonresilient survivors tended to engage in maladaptive processes of assimilation (e.g., maladaptive conservation of beliefs) or accommodation (e.g., resignation). In the same way, results supported theory and research on PTG (Taku, Cann, Tedeschi, & Calhoun, 2015; Tedeschi & Calhoun, 2004; Triplett et al., 2012). For example, resilient survivors seemed to have engaged in adaptive forms of deliberate rumination (e.g., divine intervention, positive reappraisal), and they reported having (a) better relationships (e.g., social support, increased sense of community), (b) a stronger religious/spiritual life (e.g., spiritual devotion, increased faith), (c) greater personal strength (e.g., increased strength, increased courage), (d) shifted priorities (e.g., community outreach, increased altruism), and (e) increased life appreciation (e.g., sense of purpose).

In contrast, nonresilient survivors exhibited rigid psychological processes that seemed to contribute to their posttraumatic depreciation (Marshall et al., 2015; Triplett et al., 2012), consistent with emotional processing theory of PTSD (Foa & Rothbaum, 1998; Park et al., 2012). For instance, one participant exhibited rigid sense-losing that manifested as denial and disassociation. Both at Time 1 (6-months postdisaster) and Time 2 (3-years postdisaster), this 25-year-old woman reported she was unable to feel any emotion. She described how she continued to attend church, but it was an emotionless experience for her, which was in stark contrast to the joy she consistently experienced at church prior to the earthquake.

Religious and spiritual beliefs were at the core of most (if not all) participants' cosmologies, and as disasters often do, the catastrophic nature of this earthquake thrust many survivors into a state of freefall in which they had to "negotiate difficult existential and spiritual questions [in order to reconstruct] a new and coherent life narrative" (Bray, 2010, p. 304). To illustrate, in the current study, one male survivor recalled an experience immediately following the disaster. He witnessed religious leaders and local government workers leave a young seminarian to die but instead "rescue" the body of a dead Brazial woman pinned next to him. This participant said that, for a while after the disaster, he struggled with the ruminative thought: "Usually it is the living that are rescued, not the dead." For well over a year postdisaster, that thought played over and over like a tape in his head. But eventually, after months of deliberate rumination, he restored his predisaster belief in a just God and just government. In fact, at Time 2 (3-years postdisaster), he proclaimed: "I have redefined myself and ... my relationships with other people." He described drawing upon this newly defined relationship with God to help him foster positive momentum for his community.

Importantly, our study's findings were similar to results from prior studies with earthquake survivors. For example, in a study of adult survivors of the 2015 Nepal earthquake, Itzhaky, Weiss-Dagan, and Taubman-Ben-Ari (2017) found that survivors with higher coping and cognitive flexibility demonstrated better postdisaster resilience (e.g., lower PTSD symptoms). In the current study, one educator described the improvising resilience process of a young student she knew who had lost his arm in the earthquake: "When somebody was discouraged, I said: 'Well, look at Gason [pseudonym]! Before [the earthquake], he wrote with his right hand, but now he writes with his left hand.'" Another participant described how she engaged in an improvising process of innovatively planting trees, partly to help mitigate future disaster-related flood damage and partly to create a more sustainable future for Haiti.

In another study, Fu, Chow, Li, and Cong (2017) found that, among adolescent survivors of the 2008 Wenchuan earthquake in China, their postdisaster psychological well-being (i.e., postdisaster resilience) was related to their emotional and cognitive flexibility. In addition, Taku and colleagues' (2015) previous research with adult survivors of the 2011 Japan earthquake found evidence that adaptive deliberate rumination was linked to survivors' level of perceived PTG (i.e., postdisaster resilience). Zhou, Wu, Fu, and An (2015) replicated this finding in a study of adolescent survivors of the 2008 Wenchuan earthquake. Taken together, our study's findings are consistent with these previous findings and suggest that adaptive deliberate rumination and psychological flexibility may be core ingredients of postdisaster resilience.

Our findings are also consistent with research that social support (e.g., from family and friends) and religious support (e.g., from God and fellow members of a faith community) are core ingredients of postdisaster resilience (Aten et al., 2018; Prati & Pietrantoni, 2009). For instance, in large studies of disaster survivors in China and the United States, Bonanno and colleagues (2007, 2008) have found evidence that social support is one of the main contributors to adult survivors' postdisaster resilience. Correspondingly, in a study of child survivors of the 2010 Chilean earthquake, Garfin and colleagues (2014) found that postdisaster declines in psychological well-being were associated with lack of perceived social support from caregivers. Similarly, in their longitudinal population-level study of survivors of the 2011 Christchurch New Zealand earthquake, Sibley and Bulbulia (2012) found that the loss of faith was the strongest predictor of declines in survivors' psychological well-being. In particular, there is growing evidence that religious support may play an especially important role in promoting the postdisaster resilience of survivors of African ethnic descent (Ai et al., 2013; Hackbarth, Pavkov, Wetchler, & Flannery, 2012; Laditka, Murray, & Laditka, 2010; Leavell, Aten, & Boan, 2012). Such a finding is unsurprising, given the central role of religion and spirituality in the lives of people of African descent around the world (Mattis & Grayman-Simpson, 2013).

Limitations

Our study has some limitations that need to be noted. First of all, as with most qualitative research, our sample size was relatively small. Also, not all Time 1 survivors could be located to participate in the study at Time 2. Third, our sample only consisted of religiously affiliated adult survivors; hence, conclusions about child disaster survivors or nonreligiously affiliated adult disaster survivors cannot be made. Furthermore, our sample only included Haitians, so conclusions about disaster survivors from other countries should be made with caution. Similarly, our sample only consisted of earthquake survivors, so conclusions about survivors of other types of disasters should be made with caution as well. Methodologically, there were several limitations too: (a) we did not use the exact same interview protocol at Times 1 and 2, (b) our data collection was of course limited by the exact questions we asked interviewees, (c) we used a specific theoretical framework (i.e., Orton and O'Grady's [2016] framework of cosmology episode resilience processes) to guide data analysis, and (d) we used a content analysis strategy to analyze the data. Consequently, another qualitative study of psychological resilience processes might reveal somewhat different findings if a different interview protocol was used, if a different theoretical framework (or no theoretical framework) was used to guide data collection and analysis, or if a different data-analytic strategy was used (e.g., a grounded theory, narrative analysis, phenomenological, ethnographic, or consensual qualitative research strategy).

Implications for Practice and Future Research

This study's findings have implications for providing disaster spiritual and emotional care to disaster survivors (see Schruba et al., 2018a, 2018b, this volume). For example, our findings highlight the importance of incorporating religion/spirituality into efforts to promote survivors' postdisaster mental health, especially if those survivors are religiously affiliated. There are several resources that can help inform such efforts, such as (a) Light Our Way: A Guide for Spiritual Care in Times of Disaster (Massey, 2006), (b) Psychological First Aid: Field Operations Guide for Community Religious Professionals (Brymer et al., 2006), (c) Disaster Spiritual Care (2nd ed.; Roberts & Ashley, 2017), and (d) Disaster Ministry Handbook (Aten & Boan, 2016). There are other resources that are broader in scope but can nonetheless help inform spiritually integrated mental health care following a disaster, such as (a) Trauma, Meaning, and Spirituality: Translating Research Into Practice (Park et al., 2017); (b) Spiritually Oriented Psychotherapy for Trauma (Walker, Courtois, & Aten, 2015); (c) Treating Trauma in Christian Counseling (Gingrich & Gingrich, 2017); and (d) Spiritually Oriented Interventions for Counseling and Psychotherapy (Aten, McMinn, & Worthington, 2011).

Our findings also suggest that disaster spiritual and emotional care providers should concentrate on promoting some of the core resilience ingredients we mentioned previously: psychological flexibility, adaptive deliberate rumination, and enhanced social and religious support. Meaning-enhancing interventions (e.g., Park et al., 2017; Shin & Steger, 2014), interventions that focus on cultivating psychological flexibility (e.g., acceptance and commitment therapy; Hayes, Strosahl, & Wilson, 2012), and social support interventions (Hogan, Linden, & Najarian, 2002) may be especially effective with disaster survivors too.

Future research could explore these possibilities, both through outcome research (e.g., evaluating the effectiveness of certain approaches to disaster spiritual and emotional care in promoting postdisaster resilience) and process research (e.g., evaluating what change mechanisms are responsible for such psychotherapeutic effectiveness). In addition, future researchers could address some of this study's limitations, thereby advancing the scientific study of resilience processes generally and in postdisaster contexts specifically. Moreover, researchers could continue to advance the scientific study of resilience in cross-cultural contexts (O'Grady, 2016; O'Grady et al., 2016). We are excited to see what such research reveals.

Conclusion

Field studies on disasters can challenge even the most robust researchers. The traumatic nature of disasters (which at times take place on foreign ground) discourages many researchers from investigating the people who experience disasters. Those researchers who do attempt to study populations in the aftermath of trauma often feel uncertain about which constructs to study and what is the best means for capturing those constructs. The qualitative study of cosmology episodes provides a framework for explicitly addressing fundamental features of the human experience following disasters, including the role of spirituality "for the threatened entity (what now is my role in the universe?), for the source of improvising (what now am i able to do to respond to the event?), and for the reestablished entity (what now is my different role in the universe?)" (Orton & O'Grady, 2016, p. 112).

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Kari A. O'Grady

Carol Stewart

James Douglas Orton

William W Flythe

Loyola University Maryland

Nicole Snyder

Old Dominion University

Jean-Philippe Desius

LDS Emergency Response Haiti

Correspondence concerning this article should be addressed to Kari A. O'Grady, Department of Pastoral Counseling, Loyola University Maryland, 8890 McGaw Rd. Columbia, MD 21045; kaogrady@loyola.edu

Authors

Kari A. O'Grady (Ph.D. in Counseling Psychology, Brigham Young University) is Associate Professor of Psychology and Pastoral Counseling and Founding Director of the Center for Trauma Studies and Resilience Leadership at Loyola University Maryland. Dr. O'Grady's interests include disasters, sensemaking, and resilience.

James Douglas "Doug" Orton (Ph.D., University of Michigan) is a Professor at the Center for Trauma Studies and Resilience Leadership. His work focuses on reducing human suffering through studies of cosmology episodes and the dissemination of best practices in resilience management.

Carol K. Stewart (Masters in Social Work, Doctoral Candidate in Pastoral Counseling and Counselor Education, Loyola University of Maryland) is the Chaplaincy Fellow at Uniformed Service University of the Health Sciences, Suicide Care, Prevention, and Research (CPR) Initiative. Her interests include moral injury, trauma, resilience and meaning making.

William W. Flythe III (M.S. in clinical mental health counseling). He is a doctoral candidate at Loyola University Maryland, and he practices as a licensed clinical professional counselor. His research focuses on the spiritual and religious aspects of personality.

Nicole C. Snyder (M.S. in Pastoral Counseling, Loyola University) is a Ph.D. student at Old Dominion University on a graduate assistantship. Ms. Snyder was the graduate assistant to Dr. O'Grady during the foundation process of the Center for Trauma Studies and Resilience Leadership at Loyola University Maryland. Ms. Snyder's interests include self-efficacy, community formation, resilience, and agency.

Jean-Philippe Desius (Student in Translation-Centre d'Etudes Diplomatiques et Internationales, Port-au-Prince, Haiti; Student in IT-Network Administration, Western Governors University, Utah) served as a translator and interpreter following the 2010 Haiti earthquake. Mr. Desius is currently working as a Solutions Analyst at Intermountain Healthcare.

Appendix A

Time 2 Semistructured Interview Protocol

1. What has your experience been like since the earthquake until now?

2. What continues to be difficult for you?

3. Does anything help sustain you through the difficult times? Please explain.

4. How are you different from before the earthquake to now? What differences do you see in yourself?

5. Did you have any experiences with God during or following the earthquake?

6. Has your relationship with God changed from before the earthquake until after the earthquake?

7. How has Haiti changed since the earthquake?

8. What advice would you give other people who have gone through a natural disaster?

9. Is there anything else that you would like to share with us about your experience?

Table 1

Emergent Themes and Supporting Quotes for Resilient Sensemaking
Processes

Categories and themes           Illustrative quotes

Courage                         "When I feel discouraged, I always ask
                                myself if I have something to do. [If
                                so, I just] need to do it, because God
                                trusted me [to do it]. He [entrusted]
                                me as a leader in the church. And that
                                is why I [just] need to keep going."

Acceptance                      "If you have an earthquake, you [just]
                                accept it, and you need to overcome."

Spiritual endurance             "After the 10th of January [2010],
                                there were many things that weren't
                                there anymore. And the lesson that
                                we've [all] learned was [that] if
                                something is going to happen, we have
                                to fight together.... We learned that
                                we needed to work together as a
                                community to make things happen. And
                                in my experience ... when you do work
                                for the community, God will bless
                                those efforts."

Social support                  "My family and friends helped me quite
                                a bit."

Resilient improvising

Creative imagination            "[After the earthquake, I met a boy
                                who had lost his arm in the
                                earthquake]. It was an extraordinary
                                experience. My experience with him
                                marked me and had a big impact on me.
                                When somebody was discouraged, I would
                                say: 'Well, look at Gason [pseudonym]!
                                Before [the earthquake], he wrote with
                                his right hand, but now he writes with
                                his left hand.' You help them see that
                                there is another way of doing things."

Spiritual identity              "I know that I am a son of God. But
                                after the earthquake, I'd ask myself:
                                 'Why did God protect me?'.... I
                                [would answer] 'Because He needs me.
                                He has a special plan for me.' Since
                                [then], I do my best to become closer
                                to God, and I've become closer to
                                Him."

Divine intervention             "The biggest marvel that I experienced
                                was that I was able to do the things I
                                was able to do, even though I was
                                wounded and traumatized. So I still
                                look back on that time and see it as a
                                true miracle."

Collaborative coping            "As religious people ... our most
(with God and others)           effective actions are when God is
                                working through us. So we need to
                                nourish our faith and be able nourish
                                the faith of other people, so that God
                                can act through us."

Resilient sense-remaking

Positive reappraisal            "Before January 10th, I prayed to God.
                                And after January 10th, I was more
                                aware that God was present. [After the
                                earthquake] the decisions we made at
                                the school were helped by God. God was
                                [helping us] in those decisions."

Sense of purpose                "I didn't do it so people would see me
                                and [praise me]; I just did [things
                                for others] as a real brother in
                                Jesus."

Spiritual devotion              "So I always pray before leaving my
                                house."

Community outreach              "People from outside came in to work
                                with people in the hospital, and they
                                came in and ... asked me to help. I
                                began working with children who were
                                handicapped."

Resilient renewing

New identity                    "I just got a dream ... to become a
                                psychologist or a social worker. And
                                now I am [achieving] my dream."

Increased courage               "Before the earthquake, I didn't have
                                the courage to help people. But now I
                                have the courage to help people who
                                are helpless."

Increased altruism              "I opened a school ... And I began to
                                work with hospitals and [provide
                                counseling to] children who [sur-
                                vived] the earthquake."

Increased sense of community    "Before, it was difficult to
                                communicate with someone [but] now it
                                is really easy to communicate, because
                                [everyone] works together.... Now all
                                [Haitians] are confident that they are
                                brothers and sisters, and now they
                                work together."

Increased strength              "[Now] I [am] able to work long hours,
                                [until] seven or eight o'clock."

Increased knowledge             "There were a lot of changes in Haiti
                                [after] the earth-quake. The first one
                                is that people now know exactly what
                                to do if a disaster like that happens
                                [again]."

Increased faith                 "Before, I was thinking that God does
                                not love me as [much as] He loves
                                everyone [else]. But now, after the
                                earthquake, my faith is much stronger.
                                I realize that God loves me, and I am
                                supposed to be who God wants me to
                                be."

Table 2

Emergent Themes and Supporting Quotes for Rigid Sensemaking
Processes

Categories and themes                  Illustrative quotes

Rigid sense-losing

Fear                           "We live in Haiti, and Haiti is a
                               country where can hap-pen.... We are
                               just afraid about something like that
                               happening [again]. What are we to do?"

Negative appraisal             "God must not love me or Haiti, for
                               this to happen to us."

Disengagement                  "I couldn't stay here in Port-au-
                               Prince. I had to liberate myself from
                               the ghosts of the earthquake."

Denial and disassociation      "I [just] feel that I'm not emotive.
                               The after-shocks did not frighten me,
                               but they frightened others."

Rigid improvising

Deferring coping               "As we know, when someone knows God,
(with God and others)          even though things are hard, you should
                               always act like things are okay for you
                               ... I tell [people of] faith: 'Prayer
                               fixes every-thing.'"

Self-directing coping          "People should be educated as to what
                               happens in a natural disaster. God
                               will not protect them ... They need to
                               know where to go and what to do."

Maladaptive conservation of    "Before I didn't have anything to do,
beliefs                        and now I have nothing to do. I know
                               that the Lord doesn't always right
                               away. Like if I pray, I might not get
                               my blessing today, but I hope to get my
                               blessing one day. Even though I am
                               getting old, I am still thinking that
                               God can help me in the future--before I
                               die."

Stagnated imagination          "I am just going to wait here in my
                               tent until I die, and then I can be
                               with my family again in heaven."

Rigid sense-remaking?

Sense of abandonment           "I can tell you it has been a long time
                               since the women of the church come into
                               my home."

Isolation                      "I lost all my family. I am living by
                               myself now, and you know, it's not good
                               for me."

Hopelessness                   "It became clear that this government
                               does not have a clear strategy for
                               integrating young people into the [gov-
                               ernmental] administration or into the
                               country [at large]."

Rigid renewing

Decreased self-efficacy        "Life used to be better for me before
                               the earthquake. But now things are [a
                               lot] harder for me."

Decreased faith                "Just after the earthquake, people felt
                               closer to God. [But now people have]
                               just up and wanted to enjoy their
                               flesh."

Decreased resources            "It is not good, because I have two
                               daughters and a son, even though I live
                               in a small little room like this. It's
                               hard for them to play and stuff. Also,
                               I am not working."

General resignation            "My mind is changed, because I don't
                               think I will really get back to [my old
                               self] because everything is just so
                               hard."