The Boys from the Cave: The Case for Resilience

The story of the Thai boys rescued through coordinated and heroic efforts of authorities in Thailand and experts from many countries has been uplifting to observers around the world. Details about their time in the cave, first alone and then with rescuers, are only starting to emerge. The extensive and ongoing medical surveillance and treatment raises hope that there will be no long lasting physical effects from their experience. A related concern is whether there may be long lasting psychological damage. There are risks for specific phobias about the dark or water, or even PTSD from the entire experience.

But this is far from inevitable. This may prove to be a story of resilience as much as or more than a story of trauma. As we have learned much more about the enduring effects of stress and trauma, we have also been learning about the key elements leading to resilience, “bouncing back” from adversity. It’s important to keep in mind this side of the psychological equation of stress and trauma: the potential for resilience. Key factors that promote resilience may have been working in these boys’ favor.

The strongest factor supporting resilience comes from social connections, and it is highly likely that this source of resilience was strong for these boys during their ordeal. Their coach, a surrogate parent in these circumstances, appears to have been a source of strength for his team. Even under highly stressful circumstances, having a trusted adult taking the lead in dealing with challenges and providing a supportive presence is likely to have mitigated the fear and panic that could lead to lasting trauma. The boys were also part of a team that had been together for some time, and peer connections in this age group – adolescents from ages 11 to 16 – are especially important, as we know from behavioral and brain studies. Weathering this ordeal together likely evoked those social connections. One final feature of social connection is the arrival of rescuers who provided food, basic medical care, and hope for escape – and who stayed with them throughout the rescue.

Another prominent aspect of resilience is mindfulness, with proven effects on stress reduction. A unique aspect of this story is that the coach, who had lived in a Buddhist monastery after having been orphaned at age 12, taught and engaged the boys in meditation exercises. Early reports suggest that the group had maintained the presence of mind to effectively engage the initial rescuers. A multilingual boy, a refugee living in Thailand, was able to calmly interpret for the group in the first conversations with British rescuers.

One other factor in minimizing stress and enhancing resilience is the perception of some control over the situation. In the early planning of the rescue, the boys were taught basic swimming and diving that might have been needed for their extraction. Although not essential in the final rescue plan – the boys were partially sedated to avoid the risk of panic during the journey, which likely had the side benefit of further trauma exposure – the training activities likely contributed to a sense of regaining control.

It’s important to focus on resilience so as to build on the protective factors that mitigate negative effects, not to deny that the risks are real. We know that stress and trauma can lead to long lasting psychological harm. The strong scientific consensus about these risks for children forcibly separated from their parents at the US border has received wide attention recently. But there is a strong chance that the effects for the “cave boys” will be quite different, even though their experience was no doubt highly stressful. Careful monitoring of both their physical and psychological health remains important, psychological interventions can be effective in dealing with trauma. The risks of trauma are real, but so is resilience.