Decades of Research Lead to ‘Prescription’ for Resilience
Abstract
A patient’s symptoms and history of trauma are not enough for determining a diagnosis.
When it comes to coping with the aftereffects of violent trauma, Dennis Charney, M.D., has experienced it firsthand.
Years of research and one moment of trauma coalesced in a clarifying set of principles around resilience in the face of stress, according to Dennis Charney, M.D.
Charney, a professor of psychiatry and dean of the Icahn School of Medicine at Mt. Sinai in New York, spoke about pathways to resilience at the 14th Annual Amygdala, Stress, and PTSD Conference held in April in Bethesda, Md.
When he was the chief of psychiatry at the VA hospital in West Haven, Conn., Charney began studying resilience to develop better treatments for posttraumatic stress disorder (PTSD) and to learn how people cope with severe stress. He interviewed hundreds of Navy SEALS, former prisoners of war from Vietnam, and victims of sexual and physical abuse.
“Ultimately, we developed a ‘prescription’ for becoming more resilient,” he said. “But I never knew if I was resilient.”
Then he found out the hard way.
In August 2016, a disgruntled former faculty member confronted Charney with a shotgun outside a Chappaqua, N.Y., deli, and shot him. Charney was struck in the right shoulder. He spent five days in the intensive care unit and eventually recovered completely, although with 15 pellets still lodged in his shoulder.
Can Medicine Strengthen Resilience?
Ongoing research—in humans and animals—is exploring the biological components of stress to determine whether medical treatments that target these mechanisms can promote resilience during and after a traumatic experience.
One potential target is neuropeptide Y (NPY), a brain molecule that naturally helps the body manage anxiety and fear in response to stress. A study in elite military personnel during intense training found that higher levels of NPY are associated with better performance under stress. Based on studies like these and animal studies, Dennis Charney, M.D., and colleagues are planning to test whether treating people with an intranasally delivered formulation of NPY before exposure to stress can help them manage stress better during the event or reduce symptoms afterwards. Charney is a psychiatrist and expert in resiliency and posttraumatic stress disorder .
The anesthetic ketamine also is being studied for trauma. A pilot study of intravenous ketamine in patients with chronic PTSD found that their symptoms improved significantly within 24 hours of infusion. A randomized, controlled trial is now under way to better characterize that effect.
Additionally, pretreatment with ketamine may improve response to future trauma. For example, research by Christine Denny, Ph.D., an assistant professor of clinical neurobiology in psychiatry at Columbia University, found that mice pretreated with ketamine exhibited a reduced stress response when exposed to stress a week later.
Charney now is conducting a randomized, controlled trial to better characterize that protective effect in humans.
“Neuropeptide Y, Resilience, and PTSD Therapeutics” can be accessed here. “Efficacy of Intravenous Ketamine for Treatment of Chronic Posttraumatic Stress Disorder: A Randomized Clinical Trial” is available here. “Ketamine as a Prophylactic Against Stress-Induced Depressive-like Behavior” is posted here.
“I learned a lot about trauma not only by being a researcher, but [also] firsthand,” he said. “It does change your life.”
10 Essential Principles of Resilience
Charney described to conference attendees what he believes—based on years of research—are 10 essential principles of resilience:
Be optimistic, but not unrealistically so. Charney recalled the words of Adm. James Stockdale, who was a prisoner of war: “Retain faith that you will prevail in the end, regardless of the difficulties; and at the same time, confront the most brutal facts of your current reality, whatever they might be.” While optimism is partly genetic, Charney said that it can be learned.
Develop cognitive flexibility. “One can reframe, assimilate, accept, and recover,” he said. Studies of Pakistani earthquake survivors found that optimism and purpose in life, among others, were associated with lower levels of PTSD and depressive symptoms. “These skills can be learned,” Charney said.
Embrace a personal moral compass. For some, views of right and wrong stem from religion. A study of inner-city residents in Washington, D.C., found that people who went to church more often developed fewer posttraumatic symptoms and also received more social support. However, religion can have the opposite effect. While some people can draw on the internal strength it provides, others may believe that trauma was God’s punishment.
Find a resilient role model. “Finding a role model who went through the same thing is very important,” said Charney.
After Charney recovered from his injuries, he became a role model for a medical resident injured during a shooting at a New York City hospital. “I am your brother, because I know what you’re going through,” he told the young man. “I know what the process of recovery is going to be both psychologically and physically.”
Face your fears. Fear is normal in traumatic situations. Facing one’s fears is possible, and one can learn and practice skills that control fear. “Children raised in a stress-free environment don’t learn to cope with stress,” he said. Even a family camping trip can expose children to new situations that help them develop a psychological toolbox they can call on in moments of stress.
Use active coping skills. Active coping includes reaching out to others for help.
Develop a social support network. “The support I got from my family, my friends, my medical school was critical to my recovery,” he said. “You can’t do it alone.”
Make time for exercise. Getting and staying in shape has positive effects on hardiness, mood, and self-esteem and can boost cognition, health, and emotion. All of these are useful traits in times of stress.
Develop your emotional intelligence and moral integrity. Emotional intelligence is the capacity to be tuned in to your own emotions as well as the emotions of others and is developed when you use that information to guide behavior and interactions with others. Boosting moral integrity comes from helping others or serving the common good and learning from others who do just that.
Recognize your strengths. “Learn to recognize your character strengths [like kindness, humor, and persistence] and engage them to deal with difficult and stressful situations,” he said.
“You don’t need all these factors [to survive trauma],” Charney added. “Find the ones that fit you. What are your signature strengths? How do you enhance them? Some things you can definitely do, like seeking out roles models or finding a social support network. I found them very important.” ■
