Editor's Note

Identifying Psychological Resilience

December 21, 2009

Editor, Primary Psychiatry and Psychiatry Weekly, Professor of Psychiatry, Interim Chairman, Department of Psychiatry, New York University

First published in Psychiatry Weekly, Volume 4, Issue 30, on December 21, 2009

Psychiatry is identified with a focus on the causes and management of maladaptive emotional responses that lead to symptoms and disorders. The paradigm has long been to explore an individual’s vulnerabilities. Psychoanalysts have looked at the obverse, describing defense mechanisms that are considered healthy and associated with adaptive responses. In recent years an increasing number of researchers have identified the concept of resilience as a framework for identifying factors that make some individuals more successful at coping with adversity than others. There is growing interest in why some people not only adapt, but also grow in the face of adversity.

While much evidence shows that stress in early childhood increases the likelihood of adult mental disorder, there is some evidence that exposure to early life stress diminishes subsequent psychopathology. Called “stress inoculation,” it may increase exploration of novel situations, decreases stress levels of pituitary-adrenal hormones and enhance prefrontal-dependent cognitive control of behavior. It is known that patients with bipolar disorder often become ill when subjected to stress. Activity in the prefrontal cortex may differentiate bipolar disorder patients who became symptomatic compared to those who do not.

Efforts are being made to develop resilience scales that might be used to evaluate coping skills and possibly predict response to treatment.¹ The military is looking into ways to mitigate the effects of post traumatic stress disorder by training soldiers to be more mentally resilient in advance. In light of the high rates of PTSD associated with combat veterans, the military now sees the need for soldiers to be both physically and mentally fit to avoid the problems associated with PTSD. The United States Army is developing a “Global Assessment Tool” to help assess soldiers’ fitness.

Dr. Dennis Charney has been a leading proponent for more research into resilience. He has described distinct neurochemical response patterns to acute stress,² and he emphasizes the importance of optimism, “cognitive reappraisal” and a supportive social network in improving response to adversity.

References

1. Lopez CT. Soldiers may better handle trauma with resilience training (http://www.army.mil/-news/2009/03/23/18611-soldiers-may-better-handle-trauma-with-resilience-training/) Accessed 12/3/09.

2. Charney DS. Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. Am J Psychiatry. 2004;161(2):195-216.

Disclosure: Dr. Sussman reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest.