The STRONG Study: A Multi-Tiered, Multimodal Investigation of Resilience and Recovery Following Prolonged Collective Adversity

Stress-related disorders are among the most common and burdensome mental health conditions worldwide, yet the mechanisms that allow most trauma-exposed individuals to maintain or regain mental health remain poorly understood. Decades of research have focused on identifying risk factors for psychopathology rather than the active processes that promote resilience and recovery. Here, we present the study protocol for Stress and Trauma Resilience: Opportunities for National Growth (STRONG), a multi-tiered, multi-domain, multi-level investigation of resilience conducted in Israel in the aftermath of the October 7, 2023 attack and the prolonged national adversity that followed. STRONG uses a nested design that integrates nationally representative longitudinal data with in-depth neurobehavioral assessment. STRONG-1 is a longitudinal, population-based study of approximately 4,600 Israeli adults assessed across five waves over three years, characterizing individual, social, and societal predictors of resilience trajectories. STRONG-2 is a controlled laboratory study of highly resilient and highly vulnerable individuals selected from STRONG-1, assessing behavioral and physiological mechanisms alongside cognitive tests and ecological momentary assessment. STRONG- 3 examines a subset of these individuals in the MRI scanner, capturing structural and functional neural markers with synchronized physiological and eye-tracking data. Advanced computational approaches will integrate data across tiers, levels, and domains into predictive models of resilience. STRONG will establish Israel's first nationally representative dataset on stress resilience and provide a rare opportunity to study human adaptation at scale and in a real-world context. These findings will inform early detection strategies and the development of empirically grounded, modifiable targets for intervention.