Ten traits, all of which can be learned, may be the key to enhancing an
individual's ability to be resilient after experiencing major stressors that
often take a severe psychic toll on those who lack these traits.
Can people be “inoculated” against stress? Researchers studying
resilience believe they can. They say adopting protective skills associated
with resilience will enable people to cope better with stress and bounce back
after adversity. Lacking resilience, they may respond poorly and could develop
anxiety disorders, depression, or posttraumatic stress disorder (PTSD). But
just how can people acquire resilience and avoid stress-induced
psychopathology?
To answer that question, researchers took a page out of the playbook that
super-resilient people use to handle stress and formulated a prescription for
resilience that has implications for the prevention and treatment of
stress-induced
psychopathology.FIG1
“When helping patients deal with stressful situations, this may be a
good place to start aiding them in their recovery,” Dennis Charney,
M.D., Ph.D., dean of research and a professor of psychiatry at Mt. Sinai
School of Medicine, told Psychiatric News. Charney said resilience
can be developed through focused training and cognitive-behavioral therapy
(CBT) to form a bulwark against stressful events.
“Also you can learn to recognize your own character strengths and
engage them to deal with difficult and stressful situations,” he
explained. “We all have things we can do very well. The idea is to build
on them when you are faced with stressful situations.”
Charney and Steven Southwick, M.D., a professor of psychiatry at Yale
University, identified personality traits associated with resilience in 250
American POWs during the Vietnam War who were held captive for up to eight
years and subjected to torture and solitary confinement. Remarkably, years
after their release, they had a lower-than-expected incidence of depression
and PTSD. To determine how these men, mostly pilots, handled such a dire
experience yet in many cases came out stronger than before, they videotaped
interviews with them and conducted a battery of neuropsychological tests along
with neuroimaging.
In two other studies, they interviewed a group of women who had suffered
severe trauma, especially sexual and physical abuse, and a group of people who
showed courage and resilience while facing serious medical problems. They
found that the same characteristics of resilience in the POWs were present in
these other two groups. Charney indicated that these studies will be described
in a book he wrote to be published soon by Houghton Mifflin titled The POW
Response: A Prescription for a Resilient Life.
Based on the results of the three studies, Charney described the following
10 psychological characteristics that people can work toward to increase
resilience:
Be optimistic. Optimism is strongly related to resilience,
and it can be learned through CBT. Optimists usually have decreased autonomic
arousal, use more adaptive coping strategies, and seek supportive personal
relationships during crises. “Even in the worst of times resilient
people remain optimistic,” Charney said. Women with this disposition
have shown a better response to a diagnosis of breast cancer, while men have a
lower rate of hospital readmission after coronary artery bypass surgery.
Develop cognitive flexibility or the ability to restructure
knowledge in adaptive ways to changing demands. It is the basis of
psychotherapy for traumatized people, Charney explained. Research has shown
that this trait reduces PTSD after combat and speeds recovery after loss of a
family member or natural disaster. “Resilient POWs regarded their years
in captivity as horrendous, but they learned valuable things about themselves
that they would not have learned any other way, which prepared them to face
challenges later in life,” Charney said. He explained that cognitive
flexibility is linked to neurobiological mechanisms such as memory
consolidation.
Develop a personal moral compass or shatterproof set of beliefs.
Doing so helps people get through adversity. Many victims of Hurricane Katrina
and 9/11 attributed their survival to faith, either through religion or
spirituality. “Many POWs never lost their faith and prayed every
day,” Charney said. After being freed, one man refused to attend a“
coming-out party” until he found a priest and had confession.
Be altruistic. Coping with extreme stress is often made easier by
helping others. “Altruism is underrated and needs to be used more often
as a therapeutic tool,” he asserted. The belief in a survivor mission
can be a lifesaver to traumatized people. He said Mothers Against Drunk
Driving, one of the the world's largest crime-victim organizations, is
indispensable to many women who lost a loved one in a car accident. Similar
groups were formed after 9/11. Researchers are now looking at neural circuits
related to moral decision making and altruism.
Find a resilient role model in a mentor or a heroic figure. This is
important “because imitation is a powerful mode of learning,”
Charney said. “Heroic figures inspire us to greatness even though they
might not achieve success.” He noted that the ill-fated British explorer
Ernest Shackleford failed to reach the South Pole, but his leadership
qualities and perseverance during the expedition made this one of the greatest
survival stories of all time.
Learn to be adept at facing your fears. Resilient POWs were found to
have this trait, which boosted their resilience and self-esteem, Charney said.“
So recognize that fear is normal and can be used as a guide.” He
recommends learning and practicing skills needed to get through one's fears.
He said the neurobiological underpinning is well known in terms of extinction
and stress inoculation.
Develop active coping skills. Resilient individuals do this and
create positive statements about themselves in relation to a threat. They also
seek active support from others. Charney reported that by training young
female Rhesus monkeys to adapt to stress, that is, to become inoculated
against it, and cooperate rather than resist during blood collection, Stanford
researchers Karen Parker, Ph.D., and David Lyons, Ph.D., helped explain the
differences in the biology behind these two types of coping skills.”
They reported their findings in the September 2004 Archives of General
Psychiatry. Similar human experiments are now under way.
Establish and nurture a supportive social network. The value of this
was seen dramatically after 9/11 and Hurricane Katrina. “After a
disaster we don't need psychiatrists running around talking with
people,” Charney asserted. “Intense debriefing doesn't help. What
helps is having family members and close friends share the experience with
victims, because very few people can go it alone.” He said it's not
enough simply to attend a support group and talk with other people. During
times of stress, emotional strength comes from close, meaningful
relationships.
Keep fit. Exercise not only is good for physical well-being but also
enhances brain health and plasticity. Charney cited findings for this notion
from the 2002 study “Exercise: A Behavioral Intervention to Enhance
Brain Health and Plasticity” by Carl Cotman and Nicole Berchtold
published in Neuroscience.
Have a sense of humor and laugh frequently, according to Richard
Wender, M.D., chief of family medicine at Thomas Jefferson University Hospital
in Philadelphia. Humor narrows the gap between doctors and nurses and between
them and patients, especially children, who often feel helpless and forlorn,
and helps them cope with their illness.
Be optimistic. Optimism is strongly related to resilience,
and it can be learned through CBT. Optimists usually have decreased autonomic
arousal, use more adaptive coping strategies, and seek supportive personal
relationships during crises. “Even in the worst of times resilient
people remain optimistic,” Charney said. Women with this disposition
have shown a better response to a diagnosis of breast cancer, while men have a
lower rate of hospital readmission after coronary artery bypass surgery.
Develop cognitive flexibility or the ability to restructure
knowledge in adaptive ways to changing demands. It is the basis of
psychotherapy for traumatized people, Charney explained. Research has shown
that this trait reduces PTSD after combat and speeds recovery after loss of a
family member or natural disaster. “Resilient POWs regarded their years
in captivity as horrendous, but they learned valuable things about themselves
that they would not have learned any other way, which prepared them to face
challenges later in life,” Charney said. He explained that cognitive
flexibility is linked to neurobiological mechanisms such as memory
consolidation.
Develop a personal moral compass or shatterproof set of beliefs.
Doing so helps people get through adversity. Many victims of Hurricane Katrina
and 9/11 attributed their survival to faith, either through religion or
spirituality. “Many POWs never lost their faith and prayed every
day,” Charney said. After being freed, one man refused to attend a“
coming-out party” until he found a priest and had confession.
Be altruistic. Coping with extreme stress is often made easier by
helping others. “Altruism is underrated and needs to be used more often
as a therapeutic tool,” he asserted. The belief in a survivor mission
can be a lifesaver to traumatized people. He said Mothers Against Drunk
Driving, one of the the world's largest crime-victim organizations, is
indispensable to many women who lost a loved one in a car accident. Similar
groups were formed after 9/11. Researchers are now looking at neural circuits
related to moral decision making and altruism.
Find a resilient role model in a mentor or a heroic figure. This is
important “because imitation is a powerful mode of learning,”
Charney said. “Heroic figures inspire us to greatness even though they
might not achieve success.” He noted that the ill-fated British explorer
Ernest Shackleford failed to reach the South Pole, but his leadership
qualities and perseverance during the expedition made this one of the greatest
survival stories of all time.
Learn to be adept at facing your fears. Resilient POWs were found to
have this trait, which boosted their resilience and self-esteem, Charney said.“
So recognize that fear is normal and can be used as a guide.” He
recommends learning and practicing skills needed to get through one's fears.
He said the neurobiological underpinning is well known in terms of extinction
and stress inoculation.
Develop active coping skills. Resilient individuals do this and
create positive statements about themselves in relation to a threat. They also
seek active support from others. Charney reported that by training young
female Rhesus monkeys to adapt to stress, that is, to become inoculated
against it, and cooperate rather than resist during blood collection, Stanford
researchers Karen Parker, Ph.D., and David Lyons, Ph.D., helped explain the
differences in the biology behind these two types of coping skills.”
They reported their findings in the September 2004 Archives of General
Psychiatry. Similar human experiments are now under way.
Establish and nurture a supportive social network. The value of this
was seen dramatically after 9/11 and Hurricane Katrina. “After a
disaster we don't need psychiatrists running around talking with
people,” Charney asserted. “Intense debriefing doesn't help. What
helps is having family members and close friends share the experience with
victims, because very few people can go it alone.” He said it's not
enough simply to attend a support group and talk with other people. During
times of stress, emotional strength comes from close, meaningful
relationships.
Keep fit. Exercise not only is good for physical well-being but also
enhances brain health and plasticity. Charney cited findings for this notion
from the 2002 study “Exercise: A Behavioral Intervention to Enhance
Brain Health and Plasticity” by Carl Cotman and Nicole Berchtold
published in Neuroscience.
Have a sense of humor and laugh frequently, according to Richard
Wender, M.D., chief of family medicine at Thomas Jefferson University Hospital
in Philadelphia. Humor narrows the gap between doctors and nurses and between
them and patients, especially children, who often feel helpless and forlorn,
and helps them cope with their illness.
Charney recommends developing resilience by training regularly in areas
that engage emotions, intellect, morals, and physical endurance and by
overcoming challenges. He believes such training affects what type of adults
young people develop into and suggests that it could be part of high-school
health education.
Charney reported that researchers using techniques of extinction and fear
conditioning and memory reconsolidation have identified in animal models
regions of the brain associated with stress-related psychopathology. The
lateral nucleus of the amygdala forms a link between unconditioned and
conditioned fear stimuli, for example, and animal studies have demonstrated
evidence of amygdala hyperresponsiveness in anxiety disorders and PTSD,
setting the stage for investigating amygdala responsiveness to resilience. He
said these regions are now being studied in humans using neuroimaging
technology. Neuroendocrine markers of resilience and recovery in humans are
also being investigated.
Rachel Yehuda, Ph.D., a professor of psychiatry and director of the
Traumatic Stress Studies Division at Mt. Sinai School of Medicine, outlined a
translational research agenda for studies of resilience in the July 2006
Annals of the New York Academy of Sciences. She told Psychiatric
News that still little is known about resilience, and the construct has
not been very well defined.
“I think resilience is a very seductive concept, and we have to
operationalize it. But we haven't done that. That's what we need to do
now.”
The research and recommendations by Charney and his team appear to be a
major step in doing just that. ▪