Category: Mental Health

An Overview of Salutogenesis

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Introduction

Salutogenesis is the study of the origins of health and focuses on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis).

More specifically, the “salutogenic model” was originally concerned with the relationship between health, stress, and coping through a study of Holocaust survivors. Despite going through the dramatic tragedy of the holocaust, some survivors were able to thrive later in life. The discovery that there must be powerful health causing factors led to the development of salutogenesis. The term was coined by Aaron Antonovsky, a professor of medical sociology. The salutogenic question posed by Aaron Antonovsky is, “How can this person be helped to move toward greater health?”

Antonovsky’s theories reject the “traditional medical-model dichotomy separating health and illness”. He described the relationship as a continuous variable, what he called the “health-ease versus dis-ease continuum”. Salutogenesis now encompasses more than the origins of health and has evolved to be about multidimensional causes of higher levels of health. Models associated with salutogenesis generally include wholistic approaches related to at least the physical, social, emotional, spiritual, intellectual, vocational, and environmental dimensions.

Refer to Positive Psychology.

Derivation

The word “salutogenesis” comes from the Latin salus (meaning health) and the Greek genesis (meaning origin). Antonovsky developed the term from his studies of “how people manage stress and stay well” (unlike pathogenesis which studies the causes of diseases). He observed that stress is ubiquitous, but not all individuals have negative health outcomes in response to stress. Instead, some people achieve health despite their exposure to potentially disabling stress factors.

Development

In his 1979 book, Health, Stress and Coping, Antonovsky described a variety of influences that led him to the question of how people survive, adapt, and overcome in the face of even the most punishing life-stress experiences. In his 1987 book, Unravelling the Mysteries of Health, he focused more specifically on a study of women and aging; he found that 29% of women who had survived Nazi concentration camps had positive emotional health, compared to 51% of a control group. His insight was that 29% of the survivors were not emotionally impaired by the stress. Antonovsky wrote: “this for me was the dramatic experience that consciously set me on the road to formulating what I came to call the ‘salutogenic model’.”

In salutogenic theory, people continually battle with the effects of hardship. These ubiquitous forces are called generalised resource deficits (GRDs). On the other hand, there are generalised resistance resources (GRRs), which are all of the resources that help a person cope and are effective in avoiding or combating a range of psychosocial stressors. Examples are resources such as money, ego-strength, and social support.

GRDs will cause the coping mechanisms to fail whenever the sense of coherence is not robust to weather the current situation. This causes illness and possibly even death. However, if the sense of coherence is high, a stressor will not necessarily be harmful. But it is the balance between GRDs and GRRs that determines whether a factor will be pathogenic, neutral, or salutary.

Antonovsky’s formulation was that the GRRs enabled individuals to make sense of and manage events. He argued that over time, in response to positive experiences provided by successful use of different resources, an individual would develop an attitude that was “in itself the essential tool for coping”.

Sense of Coherence

The “sense of coherence” is a theoretical formulation that provides a central explanation for the role of stress in human functioning. “Beyond the specific stress factors that one might encounter in life, and beyond your perception and response to those events, what determines whether stress will cause you harm is whether or not the stress violates your sense of coherence.” Antonovsky defined Sense of Coherence as:

“a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable; (2) the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement.”

In his formulation, the sense of coherence has three components:

  • Comprehensibility: a belief that things happen in an orderly and predictable fashion and a sense that you can understand events in your life and reasonably predict what will happen in the future.
  • Manageability: a belief that you have the skills or ability, the support, the help, or the resources necessary to take care of things, and that things are manageable and within your control.
  • Meaningfulness: a belief that things in life are interesting and a source of satisfaction, that things are really worthwhile and that there is good reason or purpose to care about what happens.

According to Antonovsky, the third element is the most important. If a person believes there is no reason to persist and survive and confront challenges, if they have no sense of meaning, then they will have no motivation to comprehend and manage events. His essential argument is that “salutogenesis” depends on experiencing a strong “sense of coherence”. His research demonstrated that the sense of coherence predicts positive health outcomes.

Fields of Application

Health and Medicine

Antonovsky viewed his work as primarily addressed to the fields of health psychology, behavioural medicine, and the sociology of health. It has been adopted as a term to describe contemporary approaches to nursing, psychiatry, integrative medicine, and healthcare architecture. The salutogenic framework has also been adapted as a method for decision making on the fly; the method has been applied for emergency care and for healthcare architecture. Incorporating concepts from salutogenesis can support a transition from curative to preventive medicine.

Workplace

The sense of coherence with its three components meaningfulness, manageability and understandability has also been applied to the workplace.

Meaningfulness is considered to be related to the feeling of participation and motivation and to a perceived meaning of the work. The meaningfulness component has also been linked with job control and task significance. Job control implies that employees have more authority to make decisions concerning their work and the working process. Task significance involves “the experience of congruence between personal values and work activities, which is accompanied by strong feelings of identification with the attitudes, values or goals of the working tasks and feelings of motivation and involvement”.

The manageability component is considered to be linked to job control as well as to access to resources. It has also been considered to be linked with social skills and trust. Social relations relate also to the meaningfulness component.

The comprehensibility component may be influenced by consistent feedback at work, for example concerning the performance appraisal.

Salutogenics perspectives are also considered in the design of offices.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Salutogenesis >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Scale of Protective Factors?

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Introduction

The Scale of Protective Factors (SPF) is a measure of aspects of social relationships, planning behaviours and confidence. These factors contribute to psychological resilience in emerging adults and adults.

Brief History

The SPF was developed by Dr. Elisabeth Ponce-Garcia at the science of protective factors laboratory (SPF Lab) to capture multiple aspects of adult resilience. A Confirmatory Factor Analysis was subsequently published as collaborative research. The SPF was found to assess resilience effectively in both men and women, across risk and socio-economic status, and ethnic/racial categories.

In order to verify effectiveness in comparison to other measures, Madewell and Ponce-Garcia (2016) analysed the SPF and four other commonly used measures of adult resilience. They found that the SPF was the only measure that assessed social and cognitive aspects and that it outperformed three other measures and performed comparably with a fourth.

The structure of the SPF in comparison to four other adult resilience measures, as well as comparison data, is available as a Data in Brief article. Noticing the absence of research examining the effectiveness of adult resilience measures in child or adult sexual assault, Ponce-Garcia, Madewell and Brown (2016) demonstrated SPF’s effectiveness in that domain. An investigation of the effectiveness of the SPF in the Southern Plains Tribes of the Native American and American Indian community in 2016.

A brief version of the 24 item SPF was developed in 2019 to result in 12 item measure that can be taken as a self-assessment. The SPF-24 and the SPF-12 have been used throughout the United States and in several other countries to include Saudi Arabia, Pakistan, India, Australia, Malesia, Paraguay, Mexico, and Canada. It is listed as a resource by Harvard University, was included in the United States Army Substance Abuse Programme (ASAP-Fort Sill, OK), and is provided by the State of Oklahoma ReEntry Programme.

Contents

The SPF consists of twenty-four statements for which individuals are asked to rate the degree to which each statement describes them. The SPF assesses a wider range of protective factors than other scales. The SPF is the only measure that has been shown to assess social and cognitive protective factors. The SPF includes four sub-scales that indicate the strengths and weaknesses that contribute to overall resilience. The SPF is the only measure to have been used in measuring resilience in sexual assault survivors within the United States.

Properties

The SPF consists of four sub-scales, two social protective factors and two cognitive protective factors.

Social Subscales

Social support measures the availability of social resources in the form of family and/or friends. Social skill measures the ability to make and maintain relationships. The two should be positively correlated. Higher scores on the social sub-scales indicate unity with friends and/or family, friend/family group optimism and general friend/family support.

Cognitive Subscales

The goal efficacy sub-scale measures confidence in the ability to achieve goals. The planning and prioritising behaviour sub-scale measures the ability to recognise the relative importance of tasks, the tendency to approach tasks in order of importance, and the use of lists for organisation.

Scoring

Adding the scores from the four sub-scales results in an overall resilience score. Adding scores from either the two social sub-scales or the two cognitive sub-scales results in a social resilience or cognitive resilience score, respectively. The sub-scale scores can also be viewed as an individual profile of strengths and deficits to indicate priorities for therapeutic plans.

This additive approach could theoretically allow varying subscale scores to cancel each other out and incorrectly indicate low overall resilience. However, research shows that social and cognitive characteristics work together to support resilience. This concern is also not supported by the characteristics of the SPF. Rather than assessing the number of friends or the frequency of social interaction, the SPF assesses the level of comfort in interacting socially. Similarly, rather than assessing the number of goals or tasks, the SPF assesses confidence in reaching goals once set.

The sub-scales are moderately positively correlated and that they all contribute to overall resilience.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Scale_of_Protective_Factors >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Neuropsychopharmacology?

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Introduction

Neuropsychopharmacology, an interdisciplinary science related to psychopharmacology (study of effects of drugs on the mind) and fundamental neuroscience, is the study of the neural mechanisms that drugs act upon to influence behaviour.

It entails research of mechanisms of neuropathology, pharmacodynamics (drug action), psychiatric illness, and states of consciousness. These studies are instigated at the detailed level involving neurotransmission/receptor activity, bio-chemical processes, and neural circuitry. Neuropsychopharmacology supersedes psychopharmacology in the areas of “how” and “why”, and additionally addresses other issues of brain function. Accordingly, the clinical aspect of the field includes psychiatric (psychoactive) as well as neurologic (non-psychoactive) pharmacology-based treatments. Developments in neuropsychopharmacology may directly impact the studies of anxiety disorders, affective disorders, psychotic disorders, degenerative disorders, eating behaviour, and sleep behaviour.

Brief History

Drugs such as opium, alcohol, and certain plants have been used for millennia by humans to ease suffering or change awareness, but until the modern scientific era knowledge of how the substances actually worked was quite limited, most pharmacological knowledge being more a series of observation than a coherent model. The first half of the 20th century saw psychology and psychiatry as largely phenomenological, in that behaviours or themes which were observed in patients could often be correlated to a limited variety of factors such as childhood experience, inherited tendencies, or injury to specific brain areas. Models of mental function and dysfunction were based on such observations. Indeed, the behavioural branch of psychology dispensed altogether with what actually happened inside the brain, regarding most mental dysfunction as what could be dubbed as “software” errors. In the same era, the nervous system was progressively being studied at the microscopic and chemical level, but there was virtually no mutual benefit with clinical fields – until several developments after World War II began to bring them together. Neuropsychopharmacology may be regarded to have begun in the earlier 1950s with the discovery of drugs such as MAO inhibitors, tricyclic antidepressants, thorazine and lithium which showed some clinical specificity for mental illnesses such as depression and schizophrenia. Until that time, treatments that actually targeted these complex illnesses were practically non-existent. The prominent methods which could directly affect brain circuitry and neurotransmitter levels were the prefrontal lobotomy, and electroconvulsive therapy, the latter of which was conducted without muscle relaxants and both of which often caused the patient great physical and psychological injury.

The field now known as neuropsychopharmacology has resulted from the growth and extension of many previously isolated fields which have met at the core of psychiatric medicine, and engages a broad range of professionals from psychiatrists to researchers in genetics and chemistry. The use of the term has gained popularity since 1990 with the founding of several journals and institutions such as the Hungarian College of Neuropsychopharmacology. This rapidly maturing field shows some degree of flux, as research hypotheses are often restructured based on new information.

Overview

An implicit premise in neuropsychopharmacology with regard to the psychological aspects is that all states of mind, including both normal and drug-induced altered states, and diseases involving mental or cognitive dysfunction, have a neurochemical basis at the fundamental level, and certain circuit pathways in the central nervous system at a higher level. Thus the understanding of nerve cells or neurons in the brain is central to understanding the mind. It is reasoned that the mechanisms involved can be elucidated through modern clinical and research methods such as genetic manipulation in animal subjects, imaging techniques such as functional magnetic resonance imaging (fMRI), and in vitro studies using selective binding agents on live tissue cultures. These allow neural activity to be monitored and measured in response to a variety of test conditions. Other important observational tools include radiological imaging such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT). These imaging techniques are extremely sensitive and can image tiny molecular concentrations on the order of 10-10 M such as found with extrastriatal D1 receptor for dopamine.

One of the ultimate goals is to devise and develop prescriptions of treatment for a variety of neuropathological conditions and psychiatric disorders. More profoundly, though, the knowledge gained may provide insight into the very nature of human thought, mental abilities like learning and memory, and perhaps consciousness itself. A direct product of neuropsychopharmacological research is the knowledge base required to develop drugs which act on very specific receptors within a neurotransmitter system. These “hyperselective-action” drugs would allow the direct targeting of specific sites of relevant neural activity, thereby maximising the efficacy (or technically the potency) of the drug within the clinical target and minimising adverse effects. However, there are some cases when some degree of pharmacological promiscuity is tolerable and even desirable, producing more desirable results than a more selective agent would. An example of this is Vortioxetine, a drug which is not particularly selective as a serotonin reuptake inhibitor, having a significant degree of serotonin modulatory activity, but which has demonstrated reduced discontinuation symptoms (and reduced likelihood of relapse) and greatly reduced incidence of sexual dysfunction, without loss in antidepressant efficacy.

The groundwork is currently being paved for the next generation of pharmacological treatments, which will improve quality of life with increasing efficiency. For example, contrary to previous thought, it is now known that the adult brain does to some extent grow new neurons – the study of which, in addition to neurotrophic factors, may hold hope for neurodegenerative diseases like Alzheimer’s, Parkinson’s, ALS, and types of chorea. All of the proteins involved in neurotransmission are a small fraction of the more than 100,000 proteins in the brain. Thus there are many proteins which are not even in the direct path of signal transduction, any of which may still be a target for specific therapy. At present, novel pharmacological approaches to diseases or conditions are reported at a rate of almost one per week.

Neurotransmission

So far as we know, everything we perceive, feel, think, know, and do are a result of neurons firing and resetting. When a cell in the brain fires, small chemical and electrical swings called the action potential may affect the firing of as many as a thousand other neurons in a process called neurotransmission. In this way signals are generated and carried through networks of neurons, the bulk electrical effect of which can be measured directly on the scalp by an EEG device.

By the last decade of the 20th century, the essential knowledge of all the central features of neurotransmission had been gained. These features are:

  • The synthesis and storage of neurotransmitter substances;
  • The transport of synaptic vesicles and subsequent release into the synapse;
  • Receptor activation and cascade function; and
  • Transport mechanisms (reuptake) and/or enzyme degradation.

The more recent advances involve understanding at the organic molecular level; biochemical action of the endogenous ligands, enzymes, receptor proteins, etc. The critical changes affecting cell firing occur when the signalling neurotransmitters from one neuron, acting as ligands, bind to receptors of another neuron. Many neurotransmitter systems and receptors are well known, and research continues toward the identification and characterisation of a large number of very specific subtypes of receptors. For the six more important neurotransmitters Glu, GABA, Ach, NE, DA, and 5HT (listed at neurotransmitter) there are at least 29 major subtypes of receptor. Further “sub-subtypes” exist together with variants, totalling in the hundreds for just these 6 transmitters (refer to serotonin receptor, for example). It is often found that receptor subtypes have differentiated function, which in principle opens up the possibility of refined intentional control over brain function.

It has previously been known that ultimate control over the membrane voltage or potential of a nerve cell, and thus the firing of the cell, resides with the transmembrane ion channels which control the membrane currents via the ions K+, Na+, and Ca++, and of lesser importance Mg++ and Cl−. The concentration differences between the inside and outside of the cell determine the membrane voltage.

Precisely how these currents are controlled has become much clearer with the advances in receptor structure and G-protein coupled processes. Many receptors are found to be pentameric clusters of five transmembrane proteins (not necessarily the same) or receptor subunits, each a chain of many amino acids. Transmitters typically bind at the junction between two of these proteins, on the parts that protrude from the cell membrane. If the receptor is of the ionotropic type, a central pore or channel in the middle of the proteins will be mechanically moved to allow certain ions to flow through, thus altering the ion concentration difference. If the receptor is of the metabotropic type, G-proteins will cause metabolism inside the cell that may eventually change other ion channels. Researchers are better understanding precisely how these changes occur based on the protein structure shapes and chemical properties.

The scope of this activity has been stretched even further to the very blueprint of life since the clarification of the mechanism underlying gene transcription. The synthesis of cellular proteins from nuclear DNA has the same fundamental machinery for all cells; the exploration of which now has a firm basis thanks to the Human Genome Project which has enumerated the entire human DNA sequence, although many of the estimated 35,000 genes remain to be identified. The complete neurotransmission process extends to the genetic level. Gene expression determines protein structures through type II RNA polymerase. So enzymes which synthesize or breakdown neurotransmitters, receptors, and ion channels are each made from mRNA via the DNA transcription of their respective gene or genes. But neurotransmission, in addition to controlling ion channels either directly or otherwise through metabotropic processes, also actually modulates gene expression. This is most prominently achieved through modification of the transcription initiation process by a variety of transcription factors produced from receptor activity.

Aside from the important pharmacological possibilities of gene expression pathways, the correspondence of a gene with its protein allows the important analytical tool of gene knockout. Living specimens can be created using homolog recombination in which a specific gene cannot be expressed. The organism will then be deficient in the associated protein which may be a specific receptor. This method avoids chemical blockade which can produce confusing or ambiguous secondary effects so that the effects of a lack of receptor can be studied in a purer sense.

Drugs

The inception of many classes of drugs is in principle straightforward: any chemical that can enhance or diminish the action of a target protein could be investigated further for such use. The trick is to find such a chemical that is receptor-specific (cf. “dirty drug”) and safe to consume. The 2005 Physicians’ Desk Reference lists twice the number of prescription drugs as the 1990 version. Many people by now are familiar with “selective serotonin reuptake inhibitors“, or SSRIs which exemplify modern pharmaceuticals. These SSRI antidepressant drugs, such as Paxil and Prozac, selectively and therefore primarily inhibit the transport of serotonin which prolongs the activity in the synapse. There are numerous categories of selective drugs, and transport blockage is only one mode of action. The FDA has approved drugs which selectively act on each of the major neurotransmitters such as NE reuptake inhibitor antidepressants, DA blocker anti-psychotics, and GABA agonist tranquilisers (benzodiazepines).

New endogenous chemicals are continually identified. Specific receptors have been found for the drugs THC (cannabis) and GHB, with endogenous transmitters anandamide and GHB. Another recent major discovery occurred in 1999 when orexin, or hypocretin, was found to have a role in arousal, since the lack of orexin receptors mirrors the condition of narcolepsy. Orexin agonism may explain the antinarcoleptic action of the drug modafinil which was already being used only a year prior.

The next step, which major pharmaceutical companies are currently working hard to develop, are receptor subtype-specific drugs and other specific agents. An example is the push for better anti-anxiety agents (anxiolytics) based on GABAA(α2) agonists, CRF1 antagonists, and 5HT2c antagonists. Another is the proposal of new routes of exploration for antipsychotics such as glycine reuptake inhibitors. Although the capabilities exist for receptor-specific drugs, a shortcoming of drug therapy is the lack of ability to provide anatomical specificity. By altering receptor function in one part of the brain, abnormal activity can be induced in other parts of the brain due to the same type of receptor changes. A common example is the effect of D2 altering drugs (neuroleptics) which can help schizophrenia, but cause a variety of dyskinesias by their action on motor cortex.

Modern studies are revealing details of mechanisms of damage to the nervous system such as apoptosis (programmed cell death) and free-radical disruption. Phencyclidine has been found to cause cell death in striatopallidal cells and abnormal vacuolisation in hippocampal and other neurons. The hallucinogen persisting perception disorder (HPPD), also known as post-psychedelic perception disorder, has been observed in patients as long as 26 years after LSD use. The plausible cause of HPPD is damage to the inhibitory GABA circuit in the visual pathway (GABA agonists such as midazolam can decrease some effects of LSD intoxication). The damage may be the result of an excitotoxic response of 5HT2 interneurons (Note: the vast majority of LSD users do not experience HPPD. Its manifestation may be equally dependent on individual brain chemistry as on the drug use itself). As for MDMA, aside from persistent losses of 5HT and SERT, long-lasting reduction of serotonergic axons and terminals is found from short-term use, and regrowth may be of compromised function.

Neural Circuits

It is a not-so-recent discovery that many functions of the brain are somewhat localized to associated areas like motor and speech ability. Functional associations of brain anatomy are now being complemented with clinical, behavioural, and genetic correlates of receptor action, completing the knowledge of neural signalling (refer to Human Cognome Project). The signal paths of neurons are hyperorganised beyond the cellular scale into often complex neural circuit pathways. Knowledge of these pathways is perhaps the easiest to interpret, being most recognizable from a systems analysis point of view, as may be seen in the following abstracts.

Almost all drugs with a known potential for abuse have been found to modulate activity (directly or indirectly) in the mesolimbic dopamine system, which includes and connects the ventral tegmental area in the midbrain to the hippocampus, medial prefrontal cortex, and amygdala in the forebrain; as well as the nucleus accumbens in the ventral striatum of the basal ganglia. In particular, the nucleus accumbens (NAc) plays an important role in integrating experiential memory from the hippocampus, emotion from the amygdala, and contextual information from the PFC to help associate particular stimuli or behaviours with feelings of pleasure and reward; continuous activation of this reward indicator system by an addictive drug can also cause previously neutral stimuli to be encoded as cues that the brain is about to receive a reward. This happens via the selective release of dopamine, a neurotransmitter responsible for feelings of euphoria and pleasure. The use of dopaminergic drugs alters the amount of dopamine released throughout the mesolimbic system, and regular or excessive use of the drug can result in a long-term downregulation of dopamine signalling, even after an individual stops ingesting the drug. This can lead the individual to engage in mild to extreme drug-seeking behaviours as the brain begins to regularly expect the increased presence of dopamine and the accompanying feelings of euphoria, but how problematic this is depends highly on the drug and the situation.

Significant progress has been made on central mechanisms of certain hallucinogenic drugs. It is at this point known with relative certainty that the primary shared effects of a broad pharmacological group of hallucinogens, sometimes called the “classical psychedelics”, can be attributed largely to agonism of serotonin receptors. The 5HT2A receptor, which seems to be the most critical receptor for psychedelic activity, and the 5HT2C receptor, which is a significant target of most psychedelics but which has no clear role in hallucinogenesis, are involved by releasing glutamate in the frontal cortex, while simultaneously in the locus coeruleus sensory information is promoted and spontaneous activity decreases. 5HT2A activity has a net pro-dopaminergic effect, whereas 5HT2C receptor agonism has an inhibitory effect on dopaminergic activity, particularly in the prefrontal cortex. One hypothesis suggests that in the frontal cortex, 5HT2A promotes late asynchronous excitatory postsynaptic potentials, a process antagonised by serotonin itself through 5HT1 receptors, which may explain why SSRIs and other serotonin-affecting drugs do not normally cause a patient to hallucinate. However, the fact that many classical psychedelics do in fact have significant affinity for 5HT1 receptors throws this claim into question. The head twitch response, a test used for assessing classical psychedelic activity in rodents, is produced by serotonin itself only in the presence of beta-Arrestins, but is triggered by classical psychedelics independent of beta-Arrestin recruitment. This may better explain the difference between the pharmacology of serotonergic neurotransmission (even if promoted by drugs such as SSRIs) and that of classical psychedelics. Newer findings, however, indicate that binding to the 5HT2A-mGlu2 heterodimer is also necessary for classical psychedelic activity. This, too, may be relevant to the pharmacological differences between the two. While early in the history of psychedelic drug research it was assumed that these hallucinations were comparable to those produced by psychosis and thus that classical psychedelics could serve as a model of psychosis, it is important to note that modern neuropsychopharmacological knowledge of psychosis has progressed significantly since then, and we now know that psychosis shows little similarity to the effects of classical psychedelics in mechanism, reported experience or most other respects aside from the surface similarity of “hallucination”.

Circadian rhythm, or sleep/wake cycling, is centred in the suprachiasmatic nucleus (SCN) within the hypothalamus, and is marked by melatonin levels 2000-4,000% higher during sleep than in the day. A circuit is known to start with melanopsin cells in the eye which stimulate the SCN through glutamate neurons of the hypothalamic tract. GABAergic neurons from the SCN inhibit the paraventricular nucleus, which signals the superior cervical ganglion (SCG) through sympathetic fibres. The output of the SCG, stimulates NE receptors (β) in the pineal gland which produces N-acetyltransferase, causing production of melatonin from serotonin. Inhibitory melatonin receptors in the SCN then provide a positive feedback pathway. Therefore, light inhibits the production of melatonin which “entrains” the 24-hour cycle of SCN activity. The SCN also receives signals from other parts of the brain, and its (approximately) 24-hour cycle does not only depend on light patterns. In fact, sectioned tissue from the SCN will exhibit daily cycle in vitro for many days. Additionally, (not shown in diagram), the basal nucleus provides GABA-ergic inhibitory input to the pre-optic anterior hypothalamus (PAH). When adenosine builds up from the metabolism of ATP throughout the day, it binds to adenosine receptors, inhibiting the basal nucleus. The PAH is then activated, generating slow-wave sleep activity. Caffeine is known to block adenosine receptors, thereby inhibiting sleep among other things.

Research

Research in the field of neuropsychopharmacology encompasses a wide range of objectives. These might include the study of a new chemical compound for potentially beneficial cognitive or behavioural effects, or the study of an old chemical compound in order to better understand its mechanism of action at the cell and neural circuit levels. For example, the addictive stimulant drug cocaine has long been known to act upon the reward system in the brain, increasing dopamine and norepinephrine levels and inducing euphoria for a short time. More recently published studies however have gone deeper than the circuit level and found that a particular G-protein coupled receptor complex called A2AR-D2R-Sigma1R is formed in the NAc following cocaine usage; this complex reduces D2R signalling in the mesolimbic pathway and may be a contributing factor to cocaine addiction. Other cutting-edge studies have focused on genetics to identify specific biomarkers that may predict an individual’s specific reactions or degree of response to a drug or their tendency to develop addictions in the future. These findings are important because they provide detailed insight into the neural circuitry involved in drug use and help refine old as well as develop new treatment methods for disorders or addictions. Different treatment-related studies are investigating the potential role of peptide nucleic acids in treating Parkinson’s disease and schizophrenia while still others are attempting to establish previously unknown neural correlates underlying certain phenomena.

Research in neuropsychopharmacology comes from a wide range of activities in neuroscience and clinical research. This has motivated organizations such as the American College of Neuropsychopharmacology (ACNP), the European College of Neuropsychopharmacology (ECNP), and the Collegium Internationale Neuro-psychopharmacologicum (CINP) to be established as a measure of focus. The ECNP publishes European Neuropsychopharmacology, and as part of the Reed Elsevier Group, the ACNP publishes the journal Neuropsychopharmacology, and the CINP publishes the journal International Journal of Neuropsychopharmacology with Cambridge University Press. In 2002, a recent comprehensive collected work of the ACNP, “Neuropsychopharmacology: The Fifth Generation of Progress” was compiled. It is one measure of the state of knowledge in 2002, and might be said to represent a landmark in the century-long goal to establish the basic neurobiological principles which govern the actions of the brain.

Many other journals exist which contain relevant information such as Neuroscience. Some of them are listed at Brown University Library.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Neuropsychopharmacology >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Psychoneuroimmunology?

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Introduction

Psychoneuroimmunology (PNI), also referred to as psychoendoneuroimmunology (PENI) or psychoneuroendocrinoimmunology (PNEI), is the study of the interaction between psychological processes and the nervous and immune systems of the human body. It is a subfield of psychosomatic medicine. PNI takes an interdisciplinary approach, incorporating psychology, neuroscience, immunology, physiology, genetics, pharmacology, molecular biology, psychiatry, behavioural medicine, infectious diseases, endocrinology, and rheumatology.

The main interests of PNI are the interactions between the nervous and immune systems and the relationships between mental processes and health. PNI studies, among other things, the physiological functioning of the neuroimmune system in health and disease; disorders of the neuroimmune system (autoimmune diseases; hypersensitivities; immune deficiency); and the physical, chemical and physiological characteristics of the components of the neuroimmune system in vitro, in situ, and in vivo.

Brief History

Interest in the relationship between psychiatric syndromes or symptoms and immune function has been a consistent theme since the beginning of modern medicine.

Claude Bernard, a French physiologist of the Muséum national d’Histoire naturelle (National Museum of Natural History in English), formulated the concept of the milieu interieur in the mid-1800s. In 1865, Bernard described the perturbation of this internal state: “… there are protective functions of organic elements holding living materials in reserve and maintaining without interruption humidity, heat and other conditions indispensable to vital activity. Sickness and death are only a dislocation or perturbation of that mechanism” (Bernard, 1865). Walter Cannon, a professor of physiology at Harvard University coined the commonly used term, homeostasis, in his book The Wisdom of the Body, 1932, from the Greek word homoios, meaning similar, and stasis, meaning position. In his work with animals, Cannon observed that any change of emotional state in the beast, such as anxiety, distress, or rage, was accompanied by total cessation of movements of the stomach (Bodily Changes in Pain, Hunger, Fear and Rage, 1915). These studies looked into the relationship between the effects of emotions and perceptions on the autonomic nervous system, namely the sympathetic and parasympathetic responses that initiated the recognition of the freeze, fight or flight response. His findings were published from time to time in professional journals, then summed up in book form in The Mechanical Factors of Digestion, published in 1911.

Hans Selye, a student of Johns Hopkins University and McGill University, and a researcher at Université de Montréal, experimented with animals by putting them under different physical and mental adverse conditions and noted that under these difficult conditions the body consistently adapted to heal and recover. Several years of experimentation that formed the empiric foundation of Selye’s concept of the General Adaptation Syndrome. This syndrome consists of an enlargement of the adrenal gland, atrophy of the thymus, spleen, and other lymphoid tissue, and gastric ulcerations.

Selye describes three stages of adaptation, including an initial brief alarm reaction, followed by a prolonged period of resistance, and a terminal stage of exhaustion and death. This foundational work led to a rich line of research on the biological functioning of glucocorticoids.

Mid-20th century studies of psychiatric patients reported immune alterations in psychotic individuals, including lower numbers of lymphocytes and poorer antibody response to pertussis vaccination, compared with nonpsychiatric control subjects. In 1964, George F. Solomon, from the University of California in Los Angeles, and his research team coined the term “psychoimmunology” and published a landmark paper: “Emotions, immunity, and disease: a speculative theoretical integration.”

Origins

In 1975, Robert Ader and Nicholas Cohen, at the University of Rochester, advanced PNI with their demonstration of classic conditioning of immune function, and they subsequently coined the term “psychoneuroimmunology”. Ader was investigating how long conditioned responses (in the sense of Pavlov’s conditioning of dogs to drool when they heard a bell ring) might last in laboratory rats. To condition the rats, he used a combination of saccharin-laced water (the conditioned stimulus) and the drug Cytoxan, which unconditionally induces nausea and taste aversion and suppression of immune function. Ader was surprised to discover that after conditioning, just feeding the rats saccharin-laced water was associated with the death of some animals and he proposed that they had been immunosuppressed after receiving the conditioned stimulus. Ader (a psychologist) and Cohen (an immunologist) directly tested this hypothesis by deliberately immunizing conditioned and unconditioned animals, exposing these and other control groups to the conditioned taste stimulus, and then measuring the amount of antibody produced. The highly reproducible results revealed that conditioned rats exposed to the conditioned stimulus were indeed immunosuppressed. In other words, a signal via the nervous system (taste) was affecting immune function. This was one of the first scientific experiments that demonstrated that the nervous system can affect the immune system.

In the 1970s, Hugo Besedovsky, Adriana del Rey and Ernst Sorkin, working in Switzerland, reported multi-directional immune-neuro-endocrine interactions, since they show that not only the brain can influence immune processes but also the immune response itself can affect the brain and neuroendocrine mechanisms. They found that the immune responses to innocuous antigens triggers an increase in the activity of hypothalamic neurons and hormonal and autonomic nerve responses that are relevant for immunoregulation and are integrated at brain levels. On these bases, they proposed that the immune system acts as a sensorial receptor organ that, besides its peripheral effects, can communicate to the brain and associated neuro-endocrine structures its state of activity. These investigators also identified products from immune cells, later characterized as cytokines, that mediate this immune-brain communication.

In 1981, David L. Felten, then working at the Indiana University School of Medicine, and his colleague JM Williams, discovered a network of nerves leading to blood vessels as well as cells of the immune system. The researchers also found nerves in the thymus and spleen terminating near clusters of lymphocytes, macrophages, and mast cells, all of which help control immune function. This discovery provided one of the first indications of how neuro-immune interaction occurs.

Ader, Cohen, and Felten went on to edit the groundbreaking book Psychoneuroimmunology in 1981, which laid out the underlying premise that the brain and immune system represent a single, integrated system of defence.

In 1985, research by neuropharmacologist Candace Pert, of the National Institutes of Health at Georgetown University, revealed that neuropeptide-specific receptors are present on the cell walls of both the brain and the immune system. The discovery that neuropeptides and neurotransmitters act directly upon the immune system shows their close association with emotions and suggests mechanisms through which emotions, from the limbic system, and immunology are deeply interdependent. Showing that the immune and endocrine systems are modulated not only by the brain but also by the central nervous system itself affected the understanding of emotions, as well as disease.

Contemporary advances in psychiatry, immunology, neurology, and other integrated disciplines of medicine has fostered enormous growth for PNI. The mechanisms underlying behaviourally induced alterations of immune function, and immune alterations inducing behavioural changes, are likely to have clinical and therapeutic implications that will not be fully appreciated until more is known about the extent of these interrelationships in normal and pathophysiological states.

The Immune-Brain Loop

PNI research looks for the exact mechanisms by which specific neuroimmune effects are achieved. Evidence for nervous-immunological interactions exist at multiple biological levels.

The immune system and the brain communicate through signalling pathways. The brain and the immune system are the two major adaptive systems of the body. Two major pathways are involved in this cross-talk: the Hypothalamic-pituitary-adrenal axis (HPA axis), and the sympathetic nervous system (SNS), via the sympathetic-adrenal-medullary axis (SAM axis). The activation of SNS during an immune response might be aimed to localise the inflammatory response.

The body’s primary stress management system is the HPA axis. The HPA axis responds to physical and mental challenge to maintain homeostasis in part by controlling the body’s cortisol level. Dysregulation of the HPA axis is implicated in numerous stress-related diseases, with evidence from meta-analyses indicating that different types/duration of stressors and unique personal variables can shape the HPA response. HPA axis activity and cytokines are intrinsically intertwined: inflammatory cytokines stimulate adrenocorticotropic hormone (ACTH) and cortisol secretion, while, in turn, glucocorticoids suppress the synthesis of proinflammatory cytokines.

Molecules called pro-inflammatory cytokines, which include interleukin-1 (IL-1), Interleukin-2 (IL-2), interleukin-6 (IL-6), Interleukin-12 (IL-12), Interferon-gamma (IFN-Gamma) and tumour necrosis factor alpha (TNF-alpha) can affect brain growth as well as neuronal function. Circulating immune cells such as macrophages, as well as glial cells (microglia and astrocytes) secrete these molecules. Cytokine regulation of hypothalamic function is an active area of research for the treatment of anxiety-related disorders.

Cytokines mediate and control immune and inflammatory responses. Complex interactions exist between cytokines, inflammation and the adaptive responses in maintaining homeostasis. Like the stress response, the inflammatory reaction is crucial for survival. Systemic inflammatory reaction results in stimulation of four major programs:

  • The acute-phase reaction.
  • Sickness behaviour.
  • The pain programme.
  • The stress response.

These are mediated by the HPA axis and the SNS. Common human diseases such as allergy, autoimmunity, chronic infections and sepsis are characterised by a dysregulation of the pro-inflammatory versus anti-inflammatory and T helper (Th1) versus (Th2) cytokine balance. Recent studies show pro-inflammatory cytokine processes take place during depression, mania and bipolar disease, in addition to autoimmune hypersensitivity and chronic infections.

Chronic secretion of stress hormones, glucocorticoids (GCs) and catecholamines (CAs), as a result of disease, may reduce the effect of neurotransmitters, including serotonin, norepinephrine and dopamine, or other receptors in the brain, thereby leading to the dysregulation of neurohormones. Under stimulation, norepinephrine is released from the sympathetic nerve terminals in organs, and the target immune cells express adrenoreceptors. Through stimulation of these receptors, locally released norepinephrine, or circulating catecholamines such as epinephrine, affect lymphocyte traffic, circulation, and proliferation, and modulate cytokine production and the functional activity of different lymphoid cells.

Glucocorticoids also inhibit the further secretion of corticotropin-releasing hormone from the hypothalamus and ACTH from the pituitary (negative feedback). Under certain conditions stress hormones may facilitate inflammation through induction of signalling pathways and through activation of the Corticotropin-releasing hormone.

These abnormalities and the failure of the adaptive systems to resolve inflammation affect the well-being of the individual, including behavioural parameters, quality of life and sleep, as well as indices of metabolic and cardiovascular health, developing into a “systemic anti-inflammatory feedback” and/or “hyperactivity” of the local pro-inflammatory factors which may contribute to the pathogenesis of disease.

This systemic or neuro-inflammation and neuroimmune activation have been shown to play a role in the aetiology of a variety of neurodegenerative disorders such as Parkinson’s and Alzheimer’s disease, multiple sclerosis, pain, and AIDS-associated dementia. However, cytokines and chemokines also modulate central nervous system (CNS) function in the absence of overt immunological, physiological, or psychological challenges.

Psychoneuroimmunological Effects

There are now sufficient data to conclude that immune modulation by psychosocial stressors and/or interventions can lead to actual health changes. Although changes related to infectious disease and wound healing have provided the strongest evidence to date, the clinical importance of immunological dysregulation is highlighted by increased risks across diverse conditions and diseases. For example, stressors can produce profound health consequences. In one epidemiological study, all-cause mortality increased in the month following a severe stressor – the death of a spouse. Theorists propose that stressful events trigger cognitive and affective responses which, in turn, induce sympathetic nervous system and endocrine changes, and these ultimately impair immune function. Potential health consequences are broad, but include rates of infection HIV progression cancer incidence and progression, and high rates of infant mortality.

Understanding Stress and Immune Function

Stress is thought to affect immune function through emotional and/or behavioural manifestations such as anxiety, fear, tension, anger and sadness and physiological changes such as heart rate, blood pressure, and sweating. Researchers have suggested that these changes are beneficial if they are of limited duration, but when stress is chronic, the system is unable to maintain equilibrium or homeostasis; the body remains in a state of arousal, where digestion is slower to reactivate or does not reactivate properly, often resulting in indigestion. Furthermore, blood pressure stays at higher levels.

In one of the earlier PNI studies, which was published in 1960, subjects were led to believe that they had accidentally caused serious injury to a companion through misuse of explosives. Since then decades of research resulted in two large meta-analyses, which showed consistent immune dysregulation in healthy people who are experiencing stress.

In the first meta-analysis by Herbert and Cohen in 1993, they examined 38 studies of stressful events and immune function in healthy adults. They included studies of acute laboratory stressors (e.g. a speech task), short-term naturalistic stressors (e.g. medical examinations), and long-term naturalistic stressors (e.g. divorce, bereavement, caregiving, unemployment). They found consistent stress-related increases in numbers of total white blood cells, as well as decreases in the numbers of helper T cells, suppressor T cells, and cytotoxic T cells, B cells, and natural killer cells (NK). They also reported stress-related decreases in NK and T cell function, and T cell proliferative responses to phytohaemagglutinin [PHA] and concanavalin A [Con A]. These effects were consistent for short-term and long-term naturalistic stressors, but not laboratory stressors.

In the second meta-analysis by Zorrilla et al. in 2001, they replicated Herbert and Cohen’s meta-analysis. Using the same study selection procedures, they analysed 75 studies of stressors and human immunity. Naturalistic stressors were associated with increases in number of circulating neutrophils, decreases in number and percentages of total T cells and helper T cells, and decreases in percentages of natural killer cell (NK) cells and cytotoxic T cell lymphocytes. They also replicated Herbert and Cohen’s finding of stress-related decreases in NKCC and T cell mitogen proliferation to phytohaemagglutinin (PHA) and concanavalin A (Con A).

A study done by the American Psychological Association did an experiment on rats, where they applied electrical shocks to a rat, and saw how interleukin-1 was released directly into the brain. Interleukin-1 is the same cytokine released when a macrophage chews on a bacterium, which then travels up the vagus nerve, creating a state of heightened immune activity, and behavioural changes.

More recently, there has been increasing interest in the links between interpersonal stressors and immune function. For example, marital conflict, loneliness, caring for a person with a chronic medical condition, and other forms on interpersonal stress dysregulate immune function.

Communication Between the Brain and Immune System

  • Stimulation of brain sites alters immunity (stressed animals have altered immune systems).
  • Damage to brain hemispheres alters immunity (hemispheric lateralisation effects).
  • Immune cells produce cytokines that act on the CNS.
  • Immune cells respond to signals from the CNS.

Communication Between Neuroendocrine and Immune System

  • Glucocorticoids and catecholamines influence immune cells.
  • Hypothalamic Pituitary Adrenal axis releases the needed hormones to support the immune system.
  • Activity of the immune system is correlated with neurochemical/neuroendocrine activity of brain cells.

Connections Between Glucocorticoids and Immune System

  • Anti-inflammatory hormones that enhance the organism’s response to a stressor.
  • Prevent the overreaction of the body’s own defence system.
  • Overactivation of glucocorticoid receptors can lead to health risks.
  • Regulators of the immune system.
  • Affect cell growth, proliferation and differentiation.
  • Cause immunosuppression which can lead to an extended amount of time fighting off infections.
  • High basal levels of cortisol are associated with a higher risk of infection.
  • Suppress cell adhesion, antigen presentation, chemotaxis and cytotoxicity.
  • Increase apoptosis.

Corticotropin-Releasing Hormone (CRH)

Release of corticotropin-releasing hormone (CRH) from the hypothalamus is influenced by stress.

  • CRH is a major regulator of the HPA axis/stress axis.
  • CRH Regulates secretion of Adrenocorticotropic hormone (ACTH).
  • CRH is widely distributed in the brain and periphery.
  • CRH also regulates the actions of the Autonomic nervous system ANS and immune system.

Furthermore, stressors that enhance the release of CRH suppress the function of the immune system; conversely, stressors that depress CRH release potentiate immunity.

  • Central mediated since peripheral administration of CRH antagonist does not affect immunosuppression.
  • HPA axis/stress axis responds consistently to stressors that are new, unpredictable and that have low-perceived control.
  • As cortisol reaches an appropriate level in response to the stressor, it deregulates the activity of the hippocampus, hypothalamus, and pituitary gland which results in less production of cortisol.

Relationships Between Prefrontal Cortex Activation and Cellular Senescence

  • Psychological stress is regulated by the prefrontal cortex (PFC).
  • The PFC modulates vagal activity.
  • Prefrontally modulated and vagally mediated cholinergic input to the spleen reduces inflammatory responses.

Pharmaceutical Advances

Glutamate agonists, cytokine inhibitors, vanilloid-receptor agonists, catecholamine modulators, ion-channel blockers, anticonvulsants, GABA agonists (including opioids and cannabinoids), COX inhibitors, acetylcholine modulators, melatonin analogues (such as Ramelton), adenosine receptor antagonists and several miscellaneous drugs (including biologics like Passiflora edulis) are being studied for their psychoneuroimmunological effects.

For example, SSRIs, SNRIs and tricyclic antidepressants acting on serotonin, norepinephrine, dopamine and cannabinoid receptors have been shown to be immunomodulatory and anti-inflammatory against pro-inflammatory cytokine processes, specifically on the regulation of IFN-gamma and IL-10, as well as TNF-alpha and IL-6 through a psychoneuroimmunological process. Antidepressants have also been shown to suppress TH1 upregulation.

Tricyclic and dual serotonergic-noradrenergic reuptake inhibition by SNRIs (or SSRI-NRI combinations), have also shown analgesic properties additionally. According to recent evidences antidepressants also seem to exert beneficial effects in experimental autoimmune neuritis in rats by decreasing Interferon-beta (IFN-beta) release or augmenting NK activity in depressed patients.

These studies warrant investigation of antidepressants for use in both psychiatric and non-psychiatric illness and that a psychoneuroimmunological approach may be required for optimal pharmacotherapy in many diseases. Future antidepressants may be made to specifically target the immune system by either blocking the actions of pro-inflammatory cytokines or increasing the production of anti-inflammatory cytokines.

The endocannabinoid system appears to play a significant role in the mechanism of action of clinically effective and potential antidepressants and may serve as a target for drug design and discovery. The endocannabinoid-induced modulation of stress-related behaviours appears to be mediated, at least in part, through the regulation of the serotoninergic system, by which cannabinoid CB1 receptors modulate the excitability of dorsal raphe serotonin neurons. Data suggest that the endocannabinoid system in cortical and subcortical structures is differentially altered in an animal model of depression and that the effects of chronic, unpredictable stress (CUS) on CB1 receptor binding site density are attenuated by antidepressant treatment while those on endocannabinoid content are not.

The increase in amygdalar CB1 receptor binding following imipramine treatment is consistent with prior studies which collectively demonstrate that several treatments which are beneficial to depression, such as electroconvulsive shock and tricyclic antidepressant treatment, increase CB1 receptor activity in subcortical limbic structures, such as the hippocampus, amygdala and hypothalamus. And preclinical studies have demonstrated the CB1 receptor is required for the behavioural effects of noradrenergic based antidepressants but is dispensable for the behavioural effect of serotonergic based antidepressants.

Extrapolating from the observations that positive emotional experiences boost the immune system, Roberts speculates that intensely positive emotional experiences – sometimes brought about during mystical experiences occasioned by psychedelic medicines – may boost the immune system powerfully. Research on salivary IgA supports this hypothesis, but experimental testing has not been done.

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What is Health Realisation?

Published on by Andrew MarshallLeave a comment

Introduction

Health realisation (HR) is a resiliency approach to personal and community psychology first developed in the 1980s by Roger C. Mills and George Pransky, and based on ideas and insights these psychologists elaborated from attending the lectures of philosopher and author Sydney Banks. HR first became known for its application in economically and socially marginalised communities living in highly stressful circumstances (refer to Community Applications below).

HR focuses on the nature of thought and how it affects one’s experience of the world. Students of HR are taught that they can change how they react to their circumstances by becoming aware that they are creating their own experience as they respond to their thoughts, and by connecting to their “innate health” and “inner wisdom.”

HR also goes under the earlier name of “Psychology of Mind” and most recently “Three Principles” understanding.

The Health Realisation Model

In the Health Realisation (“HR”) model, all psychological phenomena, from severe disorder to glowing health, are presented as manifestations of three operative “principles” first formulated as principles of human experience by Sydney Banks:

  • Mind – the universal energy that animates all of life, the source of innate health and well-being.
  • Consciousness – the ability to be aware of one’s life.
  • Thought – the power to think and thereby to create one’s experience of reality.

“Mind” has been likened to the electricity running a movie projector, and “Thought” to the images on the film. “Consciousness” is likened to the light from the projector that throws the images onto the screen, making them appear real.

According to HR, people experience their reality and their circumstances through the constant filter of their thoughts. Consciousness makes that filtered reality seem “the way it really is.” People react to it as if this were true. But, when their thinking changes, reality seems different and their reactions change. Thus, according to HR, people are constantly creating their own experience of reality via their thinking.

People tend to experience their reality as stressful, according to HR, when they are having insecure or negative thoughts. But HR suggests that such thoughts do not have to be taken seriously. When one chooses to take them more lightly, according to HR, the mind quiets down and positive feelings emerge spontaneously. Thus, HR also teaches that people have health and well-being already within them (in HR this is known as “innate health”), ready to emerge as soon as their troubled thinking calms down. When this happens, according to HR, people also gain access to common sense, and they can tap into the universal capacity for creative problem solving or “inner wisdom.” Anecdotal reports suggest that, when a person grasps the understanding behind HR in an experiential way, an expansive sense of emotional freedom and well-being can result.

Health Realisation as Therapy

In contrast to psychotherapies that focus on the content of the clients’ dysfunctional thinking, HR focuses on “innate health” and the role of “Mind, Thought, and Consciousness” in creating the clients’ experience of life.

The HR counsellor does not attempt to get clients to change their thoughts, “think positive”, or “reframe” negative thoughts to positive ones. According to HR, one’s ability to control one’s thoughts is limited and the effort to do so can itself be a source of stress. Instead, clients are encouraged to consider that their “minds are using thought to continuously determine personal reality at each moment.”

HR characterizes feelings and emotions as indicators of the quality of one’s thinking. Within the HR model, unpleasant feelings or emotions, or stressful feelings, indicate that one’s thinking is based on insecurity, negative beliefs, conditioning or learned patterns that are not necessarily appropriate to the live moment here and now. They simultaneously indicate that the individual has temporarily lost sight of what HR asserts is his or her own role in creating experience. Pleasant or desired feelings (such as a sense of well-being, gratitude, compassion, peace, etc.) indicate, within the HR model, that the quality of one’s thinking is exactly as it needs to be.

HR holds that the therapeutic “working through” of personal issues from the past to achieve wholeness is unnecessary. According to the HR model, people are already whole and healthy. The traumas of the past are only important to the extent that the individual lets them influence his or her thoughts in the present. According to HR, one’s “issues” and memories are just thoughts, and the individual can react to them or not. The more the clients’ experience is that they themselves are creating their own painful feelings via their own “power of Thought,” HR suggests, the less these feelings bother them. Sedgeman has compared this to what happens when we make scary faces at ourselves in the mirror: because we know it is just us, it is impossible to scare ourselves that way.

Thus HR deals with personal insecurities and dysfunctional patterns almost en masse, aiming for an understanding of the “key role of thought”, an understanding that ideally allows the individual to step free at once from a large number of different patterns all connected by insecure thinking. With this approach, it is rare for the practitioner to delve into specific content beyond the identification of limiting thoughts. When specific thoughts are considered to be limiting or based on insecurity or conditioning, the counsellor encourages the individual to disengage from them.

Relationships

From the perspective of HR, relationship problems result from the partners’ low awareness of their role in creating their own experience via thought and consciousness. Partners who respond to HR reportedly stop blaming and recriminating and react to each other differently. HR counsellors aim to get couples to consider that each one’s own feelings are not determined by one’s partner and that the great majority of issues that previously snarled their interactions were based on insecure, negative, and conditioned thinking. HR counsellors further suggest that every person goes through emotional ups and downs and that one’s thinking in a “down” mood is likely to be distorted. HR teaches that it is generally counterproductive to try to “talk through” relationship problems when the partners are in a bad mood. Instead HR suggests that partners wait until each has calmed down and is able to discuss things from a place of inner comfort and security.

Chemical Dependency and Addiction

HR sees chemical dependency and related behaviours as a response to a lack of a sense of self-efficacy, rather than the result of disease. That is, some people who are, in HR terms, “unaware” of their own “innate health” and their own role in creating stress via their thoughts turn to alcohol, drugs, or other compulsive behaviours in the attempt to quell their stressful feelings and regain some momentary sense of control. HR aims to offer deeper relief by showing that negative and stressful feelings are self-generated and thus can be self-quieted and it seeks to provide a pathway to well-being that does not depend on external circumstances.

Community Applications

The Health Realisation (“HR”) model has been applied in a variety of challenging settings. An early project, which garnered national publicity under the leadership of Roger Mills, introduced HR to residents of a pair of low-income housing developments in Miami known as Modello and Homestead Gardens. After three years, there were major documented reductions in crime, drug dealing, teenage pregnancy, child abuse, child neglect, school absenteeism, unemployment, and families on public assistance. Jack Pransky has chronicled the transformation that unfolded there, in his book Modello, A Story of Hope for the Inner City and Beyond.

Later projects in some of the most severely violence-ridden housing developments in New York, Minnesota, and California and in other communities in California, Hawaii, and Colorado built upon the early experience in the Modello/Homestead work. The Coliseum Gardens housing complex in Oakland, California, for example, had previously had the fourth highest homicide rate of such a complex in the US, but after HR classes were launched, the homicide rate began to decline. Gang warfare and ethnic clashes between Cambodian and African-American youth ceased. In 1997, Sargeant Jerry Williams was awarded the California Wellness Foundation Peace Prize on behalf of the Health Realisation Community Empowerment Project at Coliseum Gardens. By the year 2006, there had been no homicides in the Complex for nine straight years.

The HR model has also found application in police departments, prisons, mental health clinics, community health clinics and nursing, drug and alcohol rehabilitation programmes, services for the homeless, schools, and a variety of state and local government programmes. The County of Santa Clara, California, for example, has established a Health Realisation Services Division which provides HR training to County employees and the public. The Services Division “seeks to enhance the life of the individual by teaching the understanding of the psychological principles of Mind, Thought and Consciousness, and how these principles function to create our life experience,” and to “enable them to live healthier and more productive lives so that the community becomes a model of health and wellness.” The Department of Alcohol and Drug Services introduced HR in Santa Clara County in 1994. The Health Realisation Services Division has an approved budget of over $800,000 (gross expenditure) for FY 2008, a 41% increase over 2007, at a time when a number of programmes within the Alcohol and Drug Services Department have sustained budget cuts.

HR community projects have received grant funding from a variety of sources. For example, grant partners for the Visitacion Valley Community Resiliency Project, a five-year, multimillion-dollar community revitalisation project, have included Wells Fargo Bank, Charles Schwab Corporation Foundation, Charles and Helen Schwab Foundation, Isabel Allende Foundation, Pottruck Family Foundation, McKesson Foundation, Richard and Rhoda Goldman Fund, S.H. Cowell Foundation, San Francisco Foundation, Evelyn & Walter Haas, Jr. Fund, Milagro Foundation, and Dresdner RCM Global Investors. Other projects based upon the HR approach have been funded by the National Institute of Mental Health, the US Department of Justice, the National Institute on Drug Abuse, the California Wellness Foundation, and the Shinnyo-en Foundation.

Ongoing community projects organised by the Centre for Sustainable Change, a non-profit organisation founded by Dr. Roger Mills and Ami Chen Mills-Naim, are funded by the W.K. Kellogg Foundation. The Centre for Sustainable Change works in partnership with grassroots organisations in Des Moines, Iowa; Charlotte, North Carolina; and the Mississippi Delta to bring Three Principles training to at-risk communities under the umbrella of the National Community Resiliency Project. The Centre also works with schools, agencies and corporations.

Organisational Applications

From the original applications, as people in the business world have been introduced to HR or the “Three Principles” (as the core understanding is known), they have started to bring these ideas into the business world they have come from. The approach has been introduced to people in medicine, law, investment and financial services, technology, marketing, manufacturing, publishing, and a variety of other commercial and financial roles. It has been reported anecdotally to have had significant impact in the areas of individual performance and development, teamwork, leadership, change and diversity. According to HR/Three Principles adherents, these results flow naturally as the individuals exposed to the ideas learn how their thoughts have been creating barriers to others and barriers to their own innate creativity, common sense, and well being. As people learn how to access their full potential more consistently, HR adherents say, they get better results with less effort and less stress in less time.

Two peer-reviewed articles on effectiveness with leadership development were published in professional journals in 2008 (ADHR) and 2009 (ODJ):

  • C.L. Polsfuss & A.Ardichvili, “Three Principles Psychology: Applications in Leadership Development & Coaching”, Advances in Developing Human Resources Journal, 2008; 10; 671 doi:10.1177/1523422308322205. Online article at: http://adh.sagepub.com/cgi/content/abstract/10/5/671.
  • C.L. Polsfuss & A.Ardichvili, “State of Mind as the Master Competency for High-Performance Leadership”, Organizational Development Journal, Volume 27, Number 3, Fall 2009.

Philosophical Context

Health Realisation (“HR”) rests on the non-academic philosophy of Sydney Banks, which Mr. Banks has expounded upon in several books. Mr. Banks was a day labourer with no education beyond ninth grade (age 14) in Scotland who, in 1973, reportedly had a profound insight into the nature of human experience. Mr. Banks does not particularly attempt to position his ideas within the larger traditions of philosophy or religion; he is neither academically trained nor well read. His philosophy focuses on the illusory, thought-created nature of reality, the three principles of “Mind”, “Thought”, and “Consciousness”, the potential relief of human suffering that can come from a fundamental shift in personal awareness and understanding and the importance of a direct, experiential grasp of these matters, as opposed to a mere intellectual comprehension or analysis. Mr. Banks suggests that his philosophy is best understood not intellectually but by “listening for a positive feeling;” and a grasp of HR is said to come through a series of “insights,” that is, shifts in experiential understanding.

Teaching of Health Realisation

Health Realisation (“HR”), like Sydney Banks’s philosophy, is deliberately not taught as a set of “techniques” but as an experiential “understanding” that goes beyond a simple transfer of information. There are no steps, no uniformly appropriate internal attitudes, and no techniques within it. The “health of the helper” is considered crucial; that is, trainers or counsellors ideally will “live in the understanding that allows them to enjoy life,” and thereby continuously model their understanding of HR by staying calm and relaxed, not taking things personally, assuming the potential in others, displaying common sense, and listening respectfully to all. Facilitators ideally teach in the moment, from “what they know” (e.g. their own experience), trusting that they will find the right words to say and the right approach to use in the immediate situation to stimulate the students’ understanding of the “Three Principles”. Rapport with students and a positive mood in the session or class are more important than the specific content of the facilitator’s presentation.

Evaluations of Health Realisation

A 2007 peer-reviewed article evaluating the effectiveness of HR suggests that the results of residential substance abuse treatment structured around the teaching of HR are equivalent to those of treatment structured around 12-step programmes. The authors note that “these results are consistent with the general findings in the substance abuse literature, which suggests that treatment generally yields benefits, irrespective of approach.”

A small peer-reviewed study in preparation for a planned larger study evaluated the teaching of HR/Innate Health via a one-and-a-half-day seminar, as a stress- and anxiety-reduction intervention for HIV-positive patients. All but one of the eight volunteer participants in the study showed improved scores on the Brief Symptom Inventory after the seminar, and those participants who scored in the “psychiatric outpatient” range at the beginning of the seminar all showed improvement that was sustained upon follow-up one month later. The study’s authors concluded that “The HR/IH psychoeducational approach deserves further study as a brief intervention for stress-reduction in HIV-positive patients.”

A 2007 pilot study funded by the National Institutes of Health evaluated HR in lowering stress among Somali and Oromo refugee women who had experienced violence and torture in their homelands, but for whom Western-style psychotherapeutic treatment of trauma was not culturally appropriate. The pilot study showed that “the use of HR with refugee trauma survivors was feasible, culturally acceptable, and relevant to the participants.” In a post-intervention focus group, “many women reported using new strategies to calm down, quiet their minds and make healthier decisions.” Co-investigator Cheryl Robertson, Assistant Professor in the School of Nursing at the University of Minnesota, was quoted as saying, “This is a promising intervention that doesn’t involve the use of highly trained personnel. And it can be done in the community.”

The Visitacion Valley Community Resiliency Project (VVCRP) was reviewed by an independent evaluator hired by the Pottruck Foundation. Her final report notes that “Early program evaluation…found that the VVCRP was successful in reducing individuals’ feelings of depression and isolation, and increasing their sense of happiness and self-control. The cumulative evaluation research conducted on the VVCRP and the HR model in general concludes that HR is a powerful tool for changing individuals’ beliefs and behaviours.” In the Summary of Case Studies, the report goes on to state, “The VVCRP was effective over a period of five years of sustained involvement in two major neighbourhood institutions…at influencing not just individuals, but also organisational policies, practices, and culture. This level of organisational influence is impressive when the relatively modest level of VVCRP staff time and resources invested into making these changes is taken into account. The pivotal levers of change at each organisation were individual leaders who were moved by the HR principles to make major changes in their own beliefs, attitudes, and behaviours, and then took the initiative to inspire, enable, and mandate similar changes within their organisations. This method of reaching “critical mass” of HR awareness within these organisations appears to be both efficient and effective when the leadership conditions are right. However, this pathway to change is vulnerable to the loss of the key individual leader.”

Research Efforts on Effectiveness

Pransky has reviewed the research on HR (through 2001) in relation to its results for prevention and education, citing about 20 manuscripts, most of which were conference papers, and none peer-reviewed journal articles, although two were unpublished doctoral dissertations. (Kelley (2003) cites two more unpublished doctoral dissertations.) Pransky concludes:

“Every study of Health Realization and its various incarnations, however weak or strong the design, has shown decreases in problem behaviors and internally experienced problems. This approach appears to reduce problem behaviors and to improve mental health and well-being. At the very least, this suggests the field of prevention should further examine the efficacy of this … approach by conducting independent, rigorous, controlled, longitudinal studies….”

Criticism

In a criticism of the philosophy of Sydney Banks and, by implication, the HR approach, Bonelle Strickling, a psychotherapist and Professor of Philosophy, is quoted in an article in the Vancouver Sun as objecting that “it makes it appear as if people can, through straightforward positive thinking, ‘choose’ to transcend their troubled upbringings and begin leading a contented life.” She goes on to say that “it can be depressing for people to hear it’s supposed to be that easy. It hasn’t been my experience that people can simply choose not to be negatively influenced by their past.” Referring to Banks’s own experience, she says, “Most people are not blessed with such a life-changing experience…. When most people change, it usually happens in a much more gradual way.” Strickling, however, displays by her very criticism, a lack in understanding of the Health Realization approach which has nothing at all to do with “choosing” or “positive thinking”.

The West Virginia Initiative for Innate Health (at West Virginia University Health Sciences Centre), which promotes HR/Innate Health and the philosophy of Sydney Banks through teaching, writing, and research, was the centre of controversy soon after its inception in 2000 as the Sydney Banks Institute for Innate Health. Initiated by Robert M. D’Alessandri, the Dean of the medical school there, the institute reportedly was criticized as pushing “junk science,” and Banks’s philosophy was characterized as “a kind of bastardized Buddhism” and “New Age.” William Post, an orthopaedic surgeon who quit the medical school because of the institute, was reported along with other unnamed professors to have accused the Sydney Banks Institute of promoting religion in a state-funded institution, and Harvey Silvergate, a civil-liberties lawyer, was quoted as agreeing that “essentially [the institute] seems like a cover for a religious-type belief system which has been prettified in order to be secular and even scientific.”

There is, however, no organised religion associated with the principles uncovered by Mr. Banks.

A Dr. Blaha, who resigned as chairman of Orthopaedics at WVU, was quoted as criticising the institute as being part of a culture at the Health Sciences Centre that, in his view, places too much emphasis on agreement, consensus, and getting along. Other professors reportedly supported the institute.

Anthony DiBartolomeo, chief of the rheumatology section, was quoted as calling it “a valuable addition” to the health-sciences centre, saying its greatest value was in helping students, residents, and patients deal with stress.

Reportedly in response to the controversy, the WVIIH changed its name from The Sydney Banks Institute to the West Virginia Initiative for Innate Health, although its mission remains unchanged.

Support for Specific Tenets of HR from other Philosophies and Approaches

Some of the tenets of HR are consistent with the theories of philosophers, authors and researchers independently developing other approaches to change and psychotherapy.

A large body of peer-reviewed case literature in psychotherapy by Milton Erickson, M.D., founding president of the American Society for Clinical Hypnosis, and others working in the field of Ericksonian psychotherapy, supports the notion that lasting change in psychotherapy can occur rapidly without directly addressing clients’ past problematic experiences.

Many case examples and a modest body of controlled outcome research in solution focused brief therapy (SFBT), have likewise supported the notion that change in psychotherapy can occur rapidly, without delving into the clients’ past negative experiences. Proponents of SFBT suggest that such change often occurs when the therapist assists clients to step out of their usual problem-oriented thinking.

The philosophy of social constructionism, which is echoed in SFBT, asserts that reality is reproduced by people acting on their interpretations and their knowledge of it. (HR asserts that thought creates one’s experience of the world.)

A major body of peer-reviewed research on “focusing”, a change process developed by philosopher Eugene Gendlin, supports the theory that progress in psychotherapy is dependent on something clients do inside themselves during pauses in the therapy process, and that a particular internal activity – “focusing” – can be taught to help clients improve their progress. The first step of the six-step process used to teach focusing involves setting aside one’s current worries and concerns to create a “cleared space” for effective inner reflection. Gendlin has called this first step by itself “a superior stress-reduction method”. (HR emphasizes the importance of quieting one’s insecure and negative thinking to reduce stress and gain access to “inner wisdom,” “common sense,” and well-being.)

Positive psychology emphasizes the human capacity for health and well-being, asserts the poor correlation between social circumstances and individual happiness, and insists on the importance of one’s thinking in determining one’s feelings.

Work by Herbert Benson argues that humans have an innate ‘breakout principle’ which provides creative solutions and peak experiences which allow the restoration of a ‘new-normal’ state of higher functioning. This breakout principle is activated by severing connections with current circular or repetitive thinking. This is heavily reminiscent of Health Realisation discussion of the Principle of Mind and of how it is activated.

Finally, resilience research, such as that by Emmy Werner, has demonstrated that many high-risk children display resilience and develop into normal, happy adults despite problematic developmental histories.

See also National Resilience Resource Centre LLC additional discussion of resilience research and complimentary science found on the Research page at http://www.nationalresilienceresource.com .

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What is Vantage Sensitivity?

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Introduction

Vantage sensitivity is a psychological concept related to environmental sensitivity, initially developed by Michael Pluess and Jay Belsky. It describes individual differences in response to positive experiences and supportive environmental influences. According to vantage sensitivity, people differ considerably in their sensitivity to positive aspects of the environment, with some people benefitting particularly strongly from positive experiences such as parental care, supportive relationships, and psychological interventions, whereas others tend to respond less or not at all.

Refer to Diathesis-Stress Model.

Background

The concept of vantage sensitivity is related to other theories of environmental sensitivity such as differential susceptibility according to which some people are more sensitive than others to both negative and positive experiences. Vantage sensitivity provides a specific theoretical perspective and terminology to describe individual differences in response to exclusively positive experiences.

According to vantage sensitivity theory, people who benefit from positive experiences display vantage sensitivity as a function of vantage sensitivity factors (i.e. genetic, physiological, or psychological traits) whereas those who benefit less show vantage resistance due to the presence of vantage resistance factors (or the absence of vantage sensitivity factors). Differences in vantage sensitivity are considered to reflect neurobiological differences in the central nervous system, which are influenced by genetic as well as environmental factors.

Figure 1: Graphical illustration of vantage sensitivity; in response to a positive exposure, the level of functioning increases in Individual A, reflecting vantage sensitivity, whereas it remains unchanged in Individual B, reflecting vantage resistance.

Evidence

A growing number of studies provide empirical evidence for individual differences in vantage sensitivity across a wide range of established sensitivity markers, including genetic, physiological, and psychological ones.

Genetic Markers

Several studies report that differences in response to positive experiences are associated with genetic sensitivity. For example, Keers et al. created a polygenic score for environmental sensitivity based on thousands of gene variants and found that children with higher genetic sensitivity responded more strongly to higher quality of psychological treatment.

Physiological Markers

Studies suggest that a higher physiological reactivity to stress (indicated by cortisol) is associated with a stronger positive response to positive influences. For instance, a study testing the efficacy of exposure-based psychotherapy, a type of psychological treatment that is used with people suffering from panic disorders and agoraphobia, found that people whose cortisol response was higher during exposure were also more likely to recover faster and benefit more from the treatment.

Psychological Markers

A number of studies have shown that children who score high on the Highly Sensitive Child (HSC) scale, a psychometric tool designed to measure sensitivity, respond more positively to psychological interventions. For example, Nocentini et al. conducted a randomised controlled trial to investigate whether sensitivity was associated with greater response to a school-based anti-bullying intervention. Results indicated that sensitive children benefitted significantly more from the positive effects of the intervention. Vantage sensitivity has also been found to influence the socio-emotional well-being of young people in school. The wellbeing of sensitive adolescents increased in response to positive changes in the school environment. In adults, high sensitivity has been found to predict a greater response to positive pictures and increased leader-rated employee task performance.

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What is Differential Susceptibility?

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Introduction

The differential susceptibility theory proposed by Jay Belsky is another interpretation of psychological findings that are usually discussed according to the diathesis-stress model.

Both models suggest that people’s development and emotional affect are differentially affected by experiences or qualities of the environment. Where the Diathesis-stress model suggests a group that is sensitive to negative environments only, the differential susceptibility hypothesis suggests a group that is sensitive to both negative and positive environments.

A third model, the vantage-sensitivity model, suggests a group that is sensitive to positive environments only. All three models may be considered complementary, and have been combined into a general environmental sensitivity framework.

Differential Susceptibility versus Diathesis-Stress

The idea that individuals vary in their sensitivity to their environment was historically framed in diathesis-stress or dual-risk terms. These theories suggested that some “vulnerable” individuals, due to their biological, temperamental and/or physiological characteristics (i.e. “diathesis” or “risk 1”), are more vulnerable to the adverse effects of negative experiences (i.e. “stress” or “risk 2”), while other “resilient” individuals are not affected by these negative experiences (see Figure 1). The differential susceptibility hypothesis and the related notion of biological sensitivity to context suggested that individuals thought to be “vulnerable” are not only sensitive to negative environments, but also to positive environments (see Figure 2). Thus, according to the differential susceptibility hypothesis, some individuals are “susceptible” or “plastic”, in that they are more influenced than others by environmental influences in a “for better and for worse” manner.

Figure 1. The diathesis-stress/dual-risk model. Developmental outcome as it relates to environmental quality. A “vulnerable” group experiences negative outcome when exposed to a negative environment, although this group is identical to the other, “resilient” group in a positive environment.
Figure 2. The differential susceptibility model. The lines depict two categorical groups that differ in their responsiveness to the environment: the “plastic” group is disproportionately more affected by both negative and positive environments compared to the “fixed” group.

Theoretical Background

Belsky suggests that evolution might select for some children who are more plastic, and others who are more fixed in the face of, for example, parenting styles.

Belsky offers that ancestral parents, just like parents today, could not have known (consciously or unconsciously) which childrearing practices would prove most successful in promoting the reproductive fitness of offspring – and thus their own inclusive fitness. As a result, and as a fitness optimising strategy involving bet hedging, natural selection might have shaped parents to bear children varying in plasticity. This way, if an effect of parenting had proven counterproductive in fitness terms, those children not affected by parenting would not have incurred the cost of developing in ways that ultimately proved “misguided”.

Importantly, natural selection might favour genetic lines with both plastic and fixed developmental and affective patterns. In other words, there is value to having both kinds at once. In light of inclusive-fitness considerations, children who were less malleable (and more fixed) would have “resistance” to parental influence. This could be adaptable some times, and maladaptive other times. Their fixedness would not only have benefited themselves directly, but even their more malleable siblings indirectly. This is because siblings, like parents and children, have 50% of their genes in common. By the same token, had parenting influenced children in ways that enhanced fitness, then not only would more plastic offspring have benefited directly by following parental leads, but so, too, would their parents and even their less malleable siblings who did not benefit from the parenting they received, again for inclusive-fitness reasons. The overall effect may be to temper some of the variability in parenting. That is, to make more conservative bets.

This line of evolutionary argument leads to the prediction that children should vary in their susceptibility to parental rearing and perhaps to environmental influences more generally. As it turns out, a long line of developmental inquiry, informed by a “transactional” perspective, has more or less been based on this unstated assumption.

Criteria for the Testing of Differential Susceptibility

Belsky, Bakermans-Kranenburg, & Van IJzendoorn, (2007) delineated a series of empirical requirements – or steps – for evidencing the differential susceptibility hypothesis. Particularly they identify tests that distinguish differential susceptibility from other interaction effects including diathesis-stress/dual-risk.

While diathesis-stress/dual-risk arises when the most vulnerable are disproportionately affected in an adverse manner by a negative environment but do not also benefit disproportionately from positive environmental conditions, differential susceptibility is characterised by a cross-over interaction: the susceptible individuals are disproportionately affected by both negative and positive experiences. A further criterion that needs to be fulfilled to distinguish differential susceptibility from diathesis-stress/dual-risk is the independence of the outcome measure from the susceptibility factor: if the susceptibility factor and the outcome are related, diathesis-stress/dual-risk is suggested rather than differential susceptibility. Further, environment and susceptibility factor must also be unrelated to exclude the alternative explanation that susceptibility merely represents a function of the environment. The specificity of the differential-susceptibility effect is demonstrated if the model is not replicated when other susceptibility factors (i.e. moderators) and outcomes are used. Finally, the slope for the susceptible subgroup should be significantly different from zero and at the same time significantly steeper than the slope for the non- (or less-) susceptible subgroup.

Susceptibility Markers and Empirical Evidence

Characteristics of individuals that have been shown to moderate environmental effects in a manner consistent with the differential susceptibility hypothesis can be subdivided into three categories: Genetic factors, endophenotypic factors, phenotypic factors.

Bakermans-Kranenburg and Van IJzendoorn (2006) were the first to test the differential susceptibility hypothesis as a function of Genetic Factors regarding the moderating effect of the dopamine receptor D4 7-repeat polymorphism (DRD4-7R) on the association between maternal sensitivity and externalizing behaviour problems in 47 families. Children with the DRD4-7R allele and insensitive mothers displayed significantly more externalizing behaviours than children with the same allele but with sensitive mothers. Children with the DRD4-7R allele and sensitive mothers had the least externalising behaviours of all whereas maternal sensitivity had no effect on children without the DRD4-7R allele.

Endophenotypic Factors have been examined by Obradovic, Bush, Stamperdahl, Adler and Boyce’s (2010). They investigated associations between childhood adversity and child adjustment in 338 5-year-olds. Children with high cortisol reactivity were rated by teachers as least prosocial when living under adverse conditions, but most prosocial when living under more benign conditions (and in comparison to children scoring low on cortisol reactivity).

Regarding characteristics of the category of Phenotypic Factors, Pluess and Belsky (2009) reported that the effect of child care quality on teacher-rated socioemotional adjustment varied as a function of infant temperament in the case of 761 4.5-year-olds participating in the NICHD Study of Early Child Care and Youth Development (NICHD Early Child Care Research Network, 2005). Children with difficult temperaments as infants manifest the most and least behaviour problems depending on whether they experienced, respectively, poor or good quality care (and in comparison to children with easier temperaments).

Table 1: List of Proposed Susceptibility Factors that emerge across studies, according to Belsky and colleagues.

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What is Distress Tolerance?

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Introduction

Distress tolerance is an emerging construct in psychology that has been conceptualised in several different ways. Broadly, it refers to an individual’s:

“perceived capacity to withstand negative emotional and/or other aversive states (e.g. physical discomfort), and the behavioral act of withstanding distressing internal states elicited by some type of stressor.”

Some definitions of distress tolerance have also specified that the endurance of these negative events occur in contexts in which methods to escape the distressor exist.

Measurement

In the literature, differences in conceptualisations of distress tolerance have corresponded with two methods of assessing this construct.

As self-report inventories fundamentally assess an individual’s perception and reflection of constructs related to the self; self-report measures of distress tolerance (i.e. questionnaires) specifically focus on the perceived ability to endure distressful states, broadly defined. Some questionnaires focus specifically on emotional distress tolerance (e.g. the distress tolerance scale), some on distress tolerance of negative physical states (e.g. discomfort intolerance scale), and others focus specifically on tolerance of frustration as an overarching process of distress tolerance (e.g. frustration-discomfort scale).

In contrast, studies that incorporate behavioural or biobehavioural assessments of distress tolerance provide information about real behaviour rather than an individual’s perceptions. Examples of stress-inducing tasks include those that require the individual to persist in tracing a computerised mirror under timed conditions (i.e. computerised mirror tracing persistence task) or complete a series of time-sensitive math problems for which incorrect answers produce an aversive noise (i.e. computerised paced auditory serial addition task). Some behavioural tasks are conceptualised to assess physical distress tolerance, and require individuals to hold their breath for as long as possible (breath holding task).

As this is a nascent field of research, the relationships between perceptual and behavioural assessments of distress tolerance have not been clearly elucidated. Disentangling distinct components of emotional/psychological distress tolerance and physical distress tolerance within behavioural tasks also remains a challenge in the literature.

Theoretical Structures

Several models about the structural hierarchy of distress tolerance have been proposed. Some work suggests that physical and psychological tolerance are distinct constructs. Specifically, sensitivity to feelings of anxiety and tolerance of negative emotional states may be related to each other as aspects of a larger construct representing sensitivity and tolerance of affect broadly; discomfort surrounding physical stressors, however, was found to be an entirely separate construct not associated with sensitivity to emotional states. Notably, this preliminary work was conducted with self-report measures and findings are cross-sectional in nature. The authors advise that additional longitudinal work is necessary to corroborate these relationships and elucidate directions of causality.

Recent work expands on the distinctness of emotional and physical distress tolerance to a higher-order construct of global experiential distress tolerance. This framework draws upon tolerance constructs that have been historically studied as distinct from distress tolerance. The five following constructs are framed as lower-order factors for the global distress tolerance construct, and include:

  • Tolerance of uncertainty, or “the tendency to react emotionally, cognitively, or behaviourally to uncertain situations”.
  • Tolerance of ambiguity, or “the perceived tolerance of complicated, foreign, and/or vague situations of stimuli”.
  • Tolerance of frustration, or “the perceived capacity to withstand aggravation (e.g. thwarted life goals)”.
  • Tolerance of negative emotional states, or “the perceived capacity to withstand internal distress”.
  • Tolerance of physical sensations, or “the perceived capacity to withstand uncomfortable physical sensations”.

Within models that solely conceptualise distress tolerance as the ability to endure negative emotional states, distress tolerance is hypothesized to be multidimensional. This includes individual processes related to the anticipation of and experience with negative emotions, such as perceived and actual ability to tolerate the negative emotion, the appraisal of a given situation as acceptable or not, the degree to which an individual can regulate his/her emotion in the midst of a negative emotional experience, and amount of attention dedicated to processing the negative emotion.

Biological Bases

There are several candidate biological neural network mechanisms for distress tolerance. These proposed brain areas are based on the conceptualisation of distress tolerance as a function of reward learning. Within this framework, individuals learn to attune to and pursue reward; reduction of tension in escaping from a stressor is similarly framed as a reward and thus can be learned. Individuals differ in how quickly and for how long they display preferences for pursuing reward or in the case of distress tolerance, escaping from a distressful stimulus. Therefore, brain regions that are activated during reward processing and learning are hypothesized to also serve as neurobiological substrates for distress tolerance. For instance, activation intensity of dopamine neurons projecting to the nucleus accumbens, ventral striatum, and prefrontal cortex is associated with an individual’s predicted value of an immediate reward during a learning task. As the firing rate for these neurons increases, individuals predict high values of an immediate reward. During instances in which the predicted value is correct, the basal rate of neuronal firing remains the same. When the predicted reward value is below the actual value, neuronal firing rates increase when the reward is received, resulting in a learned response. When the expected reward value is below the actual value, the firing rate of these neurons decreases below baseline levels, resulting in a learned shift that reduces expectancies about reward value. It is posited that these same dopaminergic firing rates are associated with distress tolerance, in that learning the value of escaping a distressing stimulus is analogous to an estimation of an immediate reward There are several potential clinical implications if these posited distress tolerance substrates are corroborated. It may suggest that distress tolerance is malleable among individuals; interventions that change neuronal firing rates may shift predicted values of behaviours intended to escape a distressor and provide relief, thereby increasing distress tolerance.

Other neural areas may be implicated in moderating this reward learning process. Excitability of inhibitory medium spiny neurons in the nucleus accumbens and ventral striatum have been found to moderate the association between the value of an immediate reward and probability of pursuing reward or relief. Within rats, it has been demonstrated that increasing the excitability of these neurons via increased CREB expression resulted in an increased amount of time that the rats would keep their tail still when a noxious thermal paste was applied, as well as an increased amount of time spent in the open arms of a complex maze; these behaviours have been conceptualised as analogous distress tolerance in response to pain and anxiety.

Associations with Psychopathology

Distress tolerance is an emerging research topic in clinical psychology because it has been posited to contribute to the development and maintenance of several types of mental disorders, including mood and anxiety disorders such as major depressive disorder and generalised anxiety disorder, substance use and addiction, and personality disorders. In general, research on distress tolerance have found associations with these disorders that are tied closely to specific conceptualisations of distress tolerance. For instance, Borderline Personality Disorder is posited to be maintained through a chronic unwillingness to engage in or tolerate emotionally distressful states. Similarly, susceptibility to developing anxiety disorders is often characterised by low emotional distress tolerance. Low distress tolerance of both physical and emotional states is perceived to be a risk factor in maintaining and escalating addiction. Distress tolerance is particularly important in neurobiological theories that posit that advanced stages of addiction are driven by use of a substance to avoid physical and psychological withdrawal symptoms.

As a result of this interest in distress tolerance and its relationship with clinical psychopathology, several psychosocial treatments have been developed to improve distress tolerance among populations that are traditionally resistant to treatment. Many of these interventions (e.g. acceptance-based emotion regulation therapy) aims to boost distress tolerance by increasing the willingness to engage with emotion and meta-skills of acceptance of emotional conflict. Other behavioural interventions include components of building distress tolerance for various treatment targets, including acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), functional analytic psychotherapy, integrative behavioural couples therapy, and mindfulness-based cognitive therapy. Multiple studies suggest that such distress tolerance interventions may be effective in treating generalised anxiety disorder, depression, and borderline personality disorder.

Therapy Approaches to Improving Distress Tolerance

ACT and DBT are therapy approaches which include specific focus on distress tolerance.

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What is Experiential Avoidance?

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Introduction

Experiential avoidance (EA) has been broadly defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences – even when doing so creates harm in the long run.

The process of EA is thought to be maintained through negative reinforcement – that is, short-term relief of discomfort is achieved through avoidance, thereby increasing the likelihood that the avoidance behaviour will persist. Importantly, the current conceptualisation of EA suggests that it is not negative thoughts, emotions, and sensations that are problematic, but how one responds to them that can cause difficulties. In particular, a habitual and persistent unwillingness to experience uncomfortable thoughts and feelings (and the associated avoidance and inhibition of these experiences) is thought to be linked to a wide range of problems.

Background

EA has been popularised by recent third-wave cognitive-behavioural theories such as acceptance and commitment therapy (ACT). However, the general concept has roots in many other theories of psychopathology and intervention.

Psychodynamic

Defence mechanisms were originally conceptualised as ways to avoid unpleasant affect and discomfort that resulted from conflicting motivations. These processes were thought to contribute to the expression of various types of psychopathology. Gradual removal of these defensive processes are thought to be a key aspect of treatment and eventually return to psychological health.

Process-Experiential

Process-experiential therapy merges client-centred, existential, and Gestalt approaches. Gestalt theory outlines the benefits of being fully aware of and open to one’s entire experience. One job of the psychotherapist is to “explore and become fully aware of [the patient’s] grounds for avoidance” and to “[lead] the patient back to that which he wishes to avoid”. Similar ideas are expressed by early humanistic theory:

“Whether the stimulus was the impact of a configuration of form, color, or sound in the environment on the sensory nerves, or a memory trace from the past, or a visceral sensation of fear or pleasure or disgust, the person would be ‘living’ it, would have it completely available to awareness…he is more open to his feelings of fear and discouragement and pain…he is more able fully to live the experiences of his organism rather than shutting them out of awareness.”

Behavioural

Traditional behaviour therapy utilises exposure to habituate the patient to various types of fears and anxieties, eventually resulting in a marked reduction in psychopathology. In this way, exposure can be thought of as “counter-acting” avoidance, in that it involves individuals repeatedly encountering and remaining in contact with that which causes distress and discomfort.

Cognitive

In cognitive theory, avoidance interferes with reappraisals of negative thought patterns and schema, thereby perpetuating distorted beliefs. These distorted beliefs are thought to contribute and maintain many types of psychopathology.

Third-Wave Cognitive-Behavioural

The concept of EA is explicitly described and targeted in more recent CBT modalities including acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), functional analytic psychotherapy (FAP), and behavioural activation (BA).

Associated Problems

  • Distress is an inextricable part of life; therefore, avoidance is often only a temporary solution.
  • Avoidance reinforces the notion that discomfort, distress and anxiety are bad, or dangerous.
  • Sustaining avoidance often requires effort and energy.
  • Avoidance limits one’s focus at the expense of fully experiencing what is going on in the present.
  • Avoidance may get in the way of other important, valued aspects of life.

Empirical Evidence

  • Laboratory-based thought suppression studies suggest avoidance is paradoxical, in that concerted attempts at suppression of a particular thought often leads to an increase of that thought.
  • Studies examining emotional suppression and pain suppression suggest that avoidance is ineffective in the long-run. Conversely, expressing the unpleasant emotions can lead to improvements in the long term, even though it increases negative reactions in the short term.
  • Exposure-based therapy techniques have been shown to be effective in treating a wide range of psychiatric disorders.
  • Numerous self-report studies have linked EA and related constructs (avoidance coping, thought suppression) to psychopathology and other forms of dysfunction.

Relevance to Psychopathology

Seemingly disparate forms of pathological behaviour can be understood by their common function (i.e., attempts to avoid distress). Some examples include:

DiagnosisExample BehavioursTarget of Avoidance
Major Depressive Disorder (MDD)Isolation/SuicideFeelings of sadness, guilt, and low self-worth.
Posttraumatic Stress Disorder (PTSD)Avoiding trauma reminders and hypervigilanceMemories, anxiety, and concerns of safety.
Social PhobiaAvoiding social situationsAnxiety and concerns of judgement of others.
Panic DisorderAvoiding situations that might induce panicFear and physiological sensations.
AgoraphobiaRestricting travel outside of home or other ‘safe areas’Anxiety and fear of having symptoms of panic.
Obsessive-Compulsive DisorderChecking/RitualsWorry of consequences (e.g. ‘contamination’).
Substance Use DisordersAbusing alcohol/drugsEmotions, memories, and withdrawal symptoms.
Eating DisordersRestricting food intake and purgingWorry about becoming overweight and fear of losing control.
Borderline Personality DisorderSelf-harm (e.g. cutting)High emotional arousal.

Relevance to Quality of Life

Perhaps the most significant impact of EA is its potential to disrupt and interfere with important, valued aspects of an individual’s life. That is, EA is seen as particularly problematic when it occurs at the expense of a person’s deeply held values. Some examples include:

  • Putting off an important task because of the discomfort it evokes.
  • Not taking advantage of an important opportunity due to attempts to avoid worries of failure or disappointment.
  • Not engaging in physical activity/exercise, meaningful hobbies, or other recreational activities due to the effort they demand.
  • Avoiding social gatherings or interactions with others because of the anxiety and negative thoughts they evoke.
  • Not being a full participant in social gatherings due to attempts to regulate anxiety relating to how others are perceiving you.
  • Being unable to fully engage in meaningful conversations with others because one is scanning for signs of danger in the environment (attempting to avoid feeling “unsafe”).
  • Inability to “connect” and sustain a close relationship because of attempts to avoid feelings of vulnerability.
  • Staying in a “bad” relationship to try to avoid discomfort, guilt, and potential feelings of loneliness a break-up might entail.
  • Losing a marriage or contact with children due to an unwillingness to experience uncomfortable feelings (e.g. achieved through drug or alcohol abuse) or symptoms of withdrawal.
  • Not attending an important graduation, wedding, funeral, or other family event to try to avoid anxiety or symptoms of panic.
  • Engaging in self-destructive behaviours in an attempt to avoid feelings of boredom, emptiness, worthlessness.
  • Not functioning or taking care of basic responsibilities (e.g. personal hygiene, waking up, showing up to work, shopping for food) because of the effort they demand and/or distress they evoke.
  • Spending so much time attempting to avoid discomfort that one has little time for anyone or anything else in life.

Measurement

Self-Report

The Acceptance and Action Questionnaire (AAQ) was the first self-report measure explicitly designed to measure EA, but has since been re-conceptualised as a measure of “psychological flexibility”. The 62-item Multidimensional Experiential Avoidance Questionnaire (MEAQ) was developed to measure different aspects of EA. The Brief Experiential Avoidance Questionnaire (BEAQ) is a 15-item measure developed using MEAQ items, which has become the most widely used measure of experiential avoidance.

What is Psychological Flexibility?

Flexibility is a personality trait that describes the extent to which a person can cope with changes in circumstances and think about problems and tasks in novel, creative ways. This trait is used when stressors or unexpected events occur, requiring a person to change their stance, outlook, or commitment. Flexible personality should not be confused with cognitive flexibility, which is the ability to switch between two concepts, as well as simultaneously think about multiple concepts. Researchers of cognitive flexibility describe it as the ability to switch one’s thinking and attention between tasks. Flexibility, or psychological flexibility, as it is sometimes referred to, is the ability to adapt to situational demands, balance life demands, and commit to behaviours.

  • Refer to:
  • Opposite concepts:
    • Acceptance.
    • Distress tolerance.
    • Psychological flexibility.
  • Related concepts:
    • Denial.
    • Expressive suppression.

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An Overview of Psychological Resilience

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Introduction

Psychological resilience is the ability to cope mentally or emotionally with a crisis or to return to pre-crisis status quickly.

The term was coined in the 1970s by Emmy E. Werner, a psychologist, as she conducted a forty year long study of a cohort of Hawaiian children who came from low, socioeconomical back grounds. Resilience exists when the person uses “mental processes and behaviours in promoting personal assets and protecting self from the potential negative effects of stressors”. In simpler terms, psychological resilience exists in people who develop psychological and behavioural capabilities that allow them to remain calm during crises/chaos and to move on from the incident without long-term negative consequences. A lot of criticism of this topic comes from the fact that it is difficult to measure and test this psychological construct because resiliency can be interpreted in a variety of ways. Most psychological paradigms (biomedical, cognitive-behavioural, sociocultural, etc.) have their own perspective of what resilience looks like, where it comes from, and how it can be developed. Despite numerous definitions of psychological resilience, most of these definitions centre around two concepts:

  • Adversity; and
  • Positive adaptation.

Many psychologists agree that positive emotions, social support, and hardiness can influence an individual to become more resilient.

Refer to Scale of Protective Factors.

Brief History

The first research on resilience was published in 1973. The study used epidemiology, which is the study of disease prevalence, to uncover the risks and the protective factors that now help define resilience. A year later, the same group of researchers created tools to look at systems that support development of resilience.

Emmy Werner was one of the early scientists to use the term resilience in the 1970s. She studied a cohort of children from Kauai, Hawaii. Kauai was quite poor and many of the children in the study grew up with alcoholic or mentally ill parents. Many of the parents were also out of work. Werner noted that of the children who grew up in these detrimental situations, two-thirds exhibited destructive behaviours in their later teen years, such as chronic unemployment, substance abuse, and out-of-wedlock births (in case of teenage girls). However, one-third of these youngsters did not exhibit destructive behaviours. Werner called the latter group resilient. Thus, resilient children and their families were those who, by definition, demonstrated traits that allowed them to be more successful than non-resilient children and families.

Resilience also emerged as a major theoretical and research topic from the studies of children with mothers diagnosed with schizophrenia in the 1980s. In a 1989 study, the results showed that children with a schizophrenic parent may not obtain an appropriate level of comforting caregiving – compared to children with healthy parents – and that such situations often had a detrimental impact on children’s development. On the other hand, some children of ill parents thrived well and were competent in academic achievement, and therefore led researchers to make efforts to understand such responses to adversity.

Since the onset of the research on resilience, researchers have been devoted to discovering the protective factors that explain people’s adaptation to adverse conditions, such as maltreatment, catastrophic life events, or urban poverty. The focus of empirical work then has been shifted to understand the underlying protective processes. Researchers endeavour to uncover how some factors (e.g. connection to family) may contribute to positive outcomes.

Definition

Resilience is generally thought of as a “positive adaptation” after a stressful or adverse situation. When a person is “bombarded by daily stress, it disrupts their internal and external sense of balance, presenting challenges as well as opportunities.” However, the routine stressors of daily life can have positive impacts which promote resilience. It is still unknown what the correct level of stress is for each individual. Some people can handle greater amounts of stress than others. A portion of psychologists believe that it is not the stress itself that promotes resilience but rather the individual’s perception of their stress and their perceived personal level of control. The presence of stress allows people to practice this process. According to Germain and Gitterman (1996), stress is experienced in an individual’s life course at times of difficult life transitions, involving developmental and social change; traumatic life events, including grief and loss; and environmental pressures, encompassing poverty and community violence. Resilience is the integrated adaptation of physical, mental and spiritual aspects in a set of “good or bad” circumstances, a coherent sense of self that is able to maintain normative developmental tasks that occur at various stages of life. The Children’s Institute of the University of Rochester explains that “resilience research is focused on studying those who engage in life with hope and humour despite devastating losses”. It is important to note that resilience is not only about overcoming a deeply stressful situation, but also coming out of the said situation with “competent functioning”. Resiliency allows a person to rebound from adversity as a strengthened and more resourceful person. Some characteristics of psychological resilience include: an easy temperament, good self-esteem, planning skills, and a supportive environment inside and outside of the family. Aaron Antonovsky in 1979 stated that when an event is appraised as comprehensible (predictable), manageable (controllable), and somehow meaningful (explainable) a resilient response is more likely.

Process

Psychological resilience is most commonly understood as a process. It is a tool a person can use and it is something that an individual develops overtime. Others assume it to be a trait of the individual, an idea more typically referred to as “resiliency”. Most research now shows that resilience is the result of individuals being able to interact with their environments and participate in processes that either promote well-being or protect them against the overwhelming influence of risk factors. This research could be used in support of psychological resilience being a process rather than a trait. Resilience is seen as something to develop. Making it something to pursue and not an endpoint.

Ray Williams (Canadian businessman and author) saw that resilience comes from people able to effectively cope with their environment. He believed that there are three basic ways individuals could react when faced with a difficult situation.

  • Respond with anger or aggression.
  • Become overwhelmed and shut down.
  • Feel the emotion about the situation and appropriately handle the emotion.

The third option is the one he believed that truly helps an individual promote wellness. Individuals that follow this pattern are people who show resilience. Their resilience comes from coping with the situation. People who follow the first and second option tend to label themselves as victims of their circumstance or they may blame others for their misfortune. They do not effectively cope with their environment, they become reactive, and they tend to cling to negative emotions. This often makes it difficult to focus on problem solving or bounce back. Those that are more resilient will respond to their conditions by coping, bouncing back, and looking for a solution. Along with continual coping methods, William believed that the resilience process can be aided by good environments. These environments include supportive social environments (such as families, communities, schools) and social policies.

Criticism

Like other psychological phenomena, by defining specific psychological and affective states in certain ways, controversy over meaning will always ensue. How the term resilience is defined affects research focuses; different or insufficient definitions of resilience will lead to inconsistent research about the same concepts. Research on resilience has become more heterogeneous in its outcomes and measures, convincing some researchers to abandon the term altogether due to it being attributed to all outcomes of research where results were more positive than expected.

There is also some disagreement among researchers in the field as to whether psychological resilience is a character trait or state of being. Psychological resilience has also been referred to as ecological concept, ranging from micro to macro levels of interpretation. However, it is generally agreed upon that resilience is a buildable resource.

Recently there has also been evidence that resilience can indicate a capacity to resist a sharp decline in other harm even though a person temporarily appears to get worse. Similarly, studies have shown that adolescents who have a high level of adaptation (i.e. resilience) tend to struggle with dealing with other psychological problems later on in life. This is due to an overload of their stress response systems. There is evidence that the higher one’s resilience is, the lower their vulnerability.

Related Factors

Studies show that there are several factors which develop and sustain a person’s resilience:

  • The ability to make realistic plans and being capable of taking the steps necessary to follow through with them.
  • Confidence in one’s strengths and abilities.
  • Communication and problem-solving skills.
  • The ability to manage strong impulses and feelings.
  • Having good self-esteem.

However, these factors vary among different age groups. For example, these factors among older adults are external connections, grit, independence, self-care, self-acceptance, altruism, hardship experience, health status, and positive perspective on life.

Resilience is negatively correlated with personality traits of neuroticism and negative emotionality, which represents tendencies to see and react to the world as threatening, problematic, and distressing, and to view oneself as vulnerable. Positive correlations stands with personality traits of openness and positive emotionality, that represents tendencies to engage and confront the world with confidence in success and a fair value to self-directedness.

Positive Emotions

There is significant research found in scientific literature on the relationship between positive emotions and resilience. Studies show that maintaining positive emotions whilst facing adversity promote flexibility in thinking and problem solving. Positive emotions serve an important function in their ability to help an individual recover from stressful experiences and encounters. That being said, maintaining a positive emotionality aids in counteracting the physiological effects of negative emotions. It also facilitates adaptive coping, builds enduring social resources, and increases personal well-being.

The formation of conscious perception and the monitoring of one’s own socioemotional factors is considered a stabile aspect of positive emotions. This is not to say that positive emotions are merely a by-product of resilience, but rather that feeling positive emotions during stressful experiences may have adaptive benefits in the coping process of the individual. Empirical evidence for this prediction arises from research on resilient individuals who have a propensity for coping strategies that concretely elicit positive emotions, such as benefit-finding and cognitive reappraisal, humour, optimism, and goal-directed problem-focused coping. Individuals who tend to approach problems with these methods of coping may strengthen their resistance to stress by allocating more access to these positive emotional resources. Social support from caring adults encouraged resilience among participants by providing them with access to conventional activities.

Positive emotions not only have physical outcomes but also physiological ones. Some physiological outcomes caused by humour include improvements in immune system functioning and increases in levels of salivary immunoglobulin A, a vital system antibody, which serves as the body’s first line of defence in respiratory illnesses. Moreover, other health outcomes include faster injury recovery rate and lower readmission rates to hospitals for the elderly, and reductions in a patient’s stay in the hospital, among many other benefits. A study was done on positive emotions in trait-resilient individuals and the cardiovascular recovery rate following negative emotions felt by those individuals. The results of the study showed that trait-resilient individuals experiencing positive emotions had an acceleration in the speed in rebounding from cardiovascular activation initially generated by negative emotional arousal, i.e. heart rate and the like.

Forgiveness is also said to play a role in predicting resilience, among patients with chronic pain (but not the severity of the pain).

Social Support

Many studies show that the primary factor for the development of resilience is social support. While many competing definitions of social support exist, most can be thought of as the degree of access to, and use of, strong ties to other individuals who are similar to one’s self. Social support requires not only that you have relationships with others, but that these relationships involve the presence of solidarity and trust, intimate communication, and mutual obligation both within and outside the family.

In military studies it has been found that resilience is also dependent on group support: unit cohesion and morale is the best predictor of combat resiliency within a unit or organisation. Resilience is highly correlated to peer support and group cohesion. Units with high cohesion tend to experience a lower rate of psychological breakdowns than units with low cohesion and morale. High cohesion and morale enhance adaptive stress reactions. Post-war veterans who had more social support were less likely to develop post-traumatic stress disorder.

Other Factors

A study was conducted among high-achieving professionals who seek challenging situations that require resilience. Research has examined 13 high achievers from various professions, all of whom had experienced challenges in the workplace and negative life events over the course of their careers but who had also been recognised for their great achievements in their respective fields. Participants were interviewed about everyday life in the workplace as well as their experiences with resilience and thriving. The study found six main predictors of resilience: positive and proactive personality, experience and learning, sense of control, flexibility and adaptability, balance and perspective, and perceived social support. High achievers were also found to engage in many activities unrelated to their work such as engaging in hobbies, exercising, and organizing meetups with friends and loved ones.

Additional factors are also associated with resilience, like the capacity to make realistic plans, having self-confidence and a positive self image, developing communications skills, and the capacity to manage strong feelings and impulses.

Temperamental and constitutional disposition is considered as a major factor in resilience. It is one of the necessary precursors of resilience along with warmth in family cohesion and accessibility of prosocial support systems. There are three kinds of temperamental systems that play part in resilience, they are the appetitive system, defensive system and attentional system.

Another protective factor is related to moderating the negative effects of environmental hazards or a stressful situation in order to direct vulnerable individuals to optimistic paths, such as external social support. More specifically a 1995 study distinguished three contexts for protective factors:

  • Personal attributes, including outgoing, bright, and positive self-concepts;
  • The family, such as having close bonds with at least one family member or an emotionally stable parent; and
  • The community, such as receiving support or counsel from peers.

Furthermore, a study of the elderly in Zurich, Switzerland, illuminated the role humour plays as a coping mechanism to maintain a state of happiness in the face of age-related adversity.

Besides the above distinction on resilience, research has also been devoted to discovering the individual differences in resilience. Self-esteem, ego-control, and ego-resiliency are related to behavioural adaptation. For example, maltreated children who feel good about themselves may process risk situations differently by attributing different reasons to the environments they experience and, thereby, avoid producing negative internalised self-perceptions. Ego-control is “the threshold or operating characteristics of an individual with regard to the expression or containment” of their impulses, feelings, and desires. Ego-resilience refers to “dynamic capacity, to modify his or her model level of ego-control, in either direction, as a function of the demand characteristics of the environmental context”.

Maltreated children who experienced some risk factors (e.g. single parenting, limited maternal education, or family unemployment), showed lower ego-resilience and intelligence than non-maltreated children. Furthermore, maltreated children are more likely than non-maltreated children to demonstrate disruptive-aggressive, withdraw, and internalised behaviour problems. Finally, ego-resiliency, and positive self-esteem were predictors of competent adaptation in the maltreated children.

Demographic information (e.g. gender) and resources (e.g. social support) are also used to predict resilience. Examining people’s adaptation after disaster showed women were associated with less likelihood of resilience than men. Also, individuals who were less involved in affinity groups and organisations showed less resilience.

Certain aspects of religions, spirituality, or mindfulness may, hypothetically, promote or hinder certain psychological virtues that increase resilience. Research has not established connection between spirituality and resilience. According to the 4th edition of Psychology of Religion by Hood, et al., the “study of positive psychology is a relatively new development…there has not yet been much direct empirical research looking specifically at the association of religion and ordinary strengths and virtues”. In a review of the literature on the relationship between religiosity/spirituality and PTSD, amongst the significant findings, about half of the studies showed a positive relationship and half showed a negative relationship between measures of religiosity/spirituality and resilience. The United States Army has received criticism for promoting spirituality in its (then) new Comprehensive Soldier Fitness programme as a way to prevent PTSD, due to the lack of conclusive supporting data.

Biological Models

Three notable bases for resilience – self-confidence, self-esteem and self-concept – all have roots in three different nervous systems – respectively, the somatic nervous system, the autonomic nervous system and the central nervous system.

Research indicates that like trauma, resilience is influenced by epigenetic modifications. Increased DNA methylation of the growth factor Gdfn in certain brain regions promotes stress resilience, as does molecular adaptations of the blood brain barrier.

The two primary neurotransmitters responsible for stress buffering within the brain are dopamine and endogenous opioids as evidenced by current research showing that dopamine and opioid antagonists increased stress response in both humans and animals. Primary and secondary rewards reduce negative reactivity of stress in the brain in both humans and animals. The relationship between social support and stress resilience is thought to be mediated by the oxytocin system’s impact on the hypothalamic-pituitary-adrenal axis.

“Resilience, conceptualized as a positive bio-psychological adaptation, has proven to be a useful theoretical context for understanding variables for predicting long-term health and well-being”.

Building Resilience

In cognitive behavioural therapy (CBT), building resilience is a matter of mindfully changing basic behaviours and thought patterns. The first step is to change the nature of self-talk. Self-talk is the internal monologue people have that reinforce beliefs about the person’s self-efficacy and self-value. To build resilience, the person needs to eliminate negative self-talk, such as “I can’t do this” and “I can’t handle this”, and to replace it with positive self-talk, such as “I can do this” and “I can handle this”. This small change in thought patterns helps to reduce psychological stress when a person is faced with a difficult challenge. The second step a person can take to build resilience is to be prepared for challenges, crises, and emergencies. In business, preparedness is created by creating emergency response plans, business continuity plans, and contingency plans. For personal preparedness, the individual can create a financial cushion to help with economic crises, he/she can develop social networks to help him/her through trying personal crises, and he/she can develop emergency response plans for his/her household.

Resilience is also enhanced by developing effective coping skills for stress. Coping skills help the individual to reduce stress levels, so they remain functional. Coping skills include using meditation, exercise, socialisation, and self-care practices to maintain a healthy level of stress, but there are many other lists associated with psychological resilience.

The American Psychological Association suggests “10 Ways to Build Resilience”, which are to:

  • Maintain good relationships with close family members, friends and others;
  • Avoid seeing crises or stressful events as unbearable problems;
  • Accept circumstances that cannot be changed;
  • Develop realistic goals and move towards them;
  • Take decisive actions in adverse situations;
  • Look for opportunities for self-discovery after a struggle with loss;
  • Develop self-confidence;
  • Keep a long-term perspective and consider the stressful event in a broader context;
  • Maintain a hopeful outlook, expecting good things and visualizing what is wished; and
  • Take care of one’s mind and body, exercising regularly, paying attention to one’s own needs and feelings.

The Besht model of natural resilience building in an ideal family with positive access and support from family and friends, through parenting illustrates four key markers. They are:

  • Realistic upbringing.
  • Effective risk communications.
  • Positivity and restructuring of demanding situations.
  • Building self efficacy and hardiness.

In this model, self-efficacy is the belief in one’s ability to organise and execute the courses of action required to achieve necessary and desired goals and hardiness is a composite of interrelated attitudes of commitment, control, and challenge.

A number of self-help approaches to resilience-building have been developed, drawing mainly on the theory and practice of CBT and rational emotive behaviour therapy (REBT). For example, a group cognitive-behavioural intervention, called the Penn Resiliency Programme (PRP), has been shown to foster various aspects of resilience. A meta-analysis of 17 PRP studies showed that the intervention significantly reduces depressive symptoms over time.

The idea of ‘resilience building’ is debatably at odds with the concept of resilience as a process, since it is used to imply that it is a developable characteristic of oneself. Those who view resilience as a description of doing well despite adversity, view efforts of ‘resilience building’ as method to encourage resilience. Bibliotherapy, positive tracking of events, and enhancing psychosocial protective factors with positive psychological resources are other methods for resilience building. In this way, increasing an individual’s resources to cope with or otherwise address the negative aspects of risk or adversity is promoted, or builds, resilience.

Contrasting research finds that strategies to regulate and control emotions, in order to enhance resilience, allows for better outcomes in the event of mental illness. While initial studies of resilience originated with developmental scientists studying children in high-risk environments, a study on 230 adults diagnosed with depression and anxiety that emphasized emotional regulation, showed that it contributed to resilience in patients. These strategies focused on planning, positively reappraising events, and reducing rumination helped in maintaining a healthy continuity. Patients with improved resilience were found to yield better treatment outcomes than patients with non-resilience focused treatment plans, providing potential information for supporting evidence based psychotherapeutic interventions that may better handle mental disorders by focusing on the aspect of psychological resilience.

Building Resilience Through Language

As the world globalises, language learning and communication have proven to be helpful factors in developing resilience in people who travel, study abroad, work internationally, or in those who find themselves as refugees in countries where their home language is not spoken.

Research conducted by the British Council ties a strong relationship between language and resilience in refugees. Their language for resilience research conducted in partnership with institutions and communities from the Middle East, Africa, Europe and the Americas claims that providing adequate English-learning programmes and support for Syrian refugees builds resilience not only in the individual, but also in the host community. Their findings reported five main ways through which language builds resilience: home language and literacy development; access to education, training, and employment; learning together and social cohesion; addressing the effects of trauma on learning; and building inclusivity.

The language for resilience research suggests that further development of home language and literacy helps create the foundation for a shared identity. By maintaining the home language, even when displaced, a person not only learns better in school, but enhances the ability to learn other languages. This enhances resilience by providing a shared culture and sense of identity that allows refugees to maintain close relationships to others who share their identity and sets them up to possibly return one day. Thus, identity is not stripped and a sense of belonging persists.

Access to education, training, and employment opportunities allow refugees to establish themselves in their host country and provides more ease when attempting to access information, apply to work or school, or obtain professional documentation. Securing access to education or employment is largely dependent on language competency, and both education and employment provide security and success that enhance resilience and confidence.

Learning together encourages resilience through social cohesion and networks. When refugees engage in language-learning activities with host communities, engagement and communication increases. Both refugee and host community are more likely to celebrate diversity, share their stories, build relationships, engage in the community, and provide each other with support. This creates a sense of belonging with the host communities alongside the sense of belonging established with other members of the refugee community through home language.

Additionally, language programmes and language learning can help address the effects of trauma by providing a means to discuss and understand. Refugees are more capable of expressing their trauma, including the effects of loss, when they can effectively communicate with their host community. Especially in schools, language learning establishes safe spaces through storytelling, which further reinforces comfort with a new language, and can in turn lead to increased resilience.

The fifth way, building inclusivity, is more focused on providing resources. By providing institutions or schools with more language-based learning and cultural material, the host community can better learn how to best address the needs of the refugee community. This overall addressing of needs feeds back into the increased resilience of refugees by creating a sense of belonging and community.

Additionally, a study completed by Kate Nguyen, Nile Stanley, Laurel Stanley, and Yonghui Wang shows the impacts of storytelling in building resilience. This aligns with many of the five factors identified by the study completed by the British Council, as it emphasizes the importance of sharing traumatic experiences through language. This study in particular showed that those who were exposed to more stories, from family or friends, had a more holistic view of life’s struggles, and were thus more resilient, especially when surrounded by foreign languages or attempting to learn a new language.

Other Development Programmes

The Head Start programme was shown to promote resilience. So was the Big Brothers Big Sisters Programme, Centred Coaching & Consulting, the Abecedarian Early Intervention Project, and social programmes for youth with emotional or behavioural difficulties.

The Positive Behaviour Supports and Intervention programme is a successful trauma-informed, resilience-based for elementary age students with four components. These four elements include positive reinforcements such as encouraging feedback, understanding that behaviour is a response to unmet needs or a survival response, promoting belonging, mastery and independence, and finally, creating an environment to support the student through sensory tools, mental health breaks and play.

Tuesday’s Children, a family service organisation that made a long-term commitment to the individuals that have lost loved ones to 9/11 and terrorism around the world, works to build psychological resilience through programmes such as Mentoring and Project COMMON BOND, an 8-day peace-building and leadership initiative for teens, ages 15-20, from around the world who have been directly impacted by terrorism.

Military organisations test personnel for the ability to function under stressful circumstances by deliberately subjecting them to stress during training. Those students who do not exhibit the necessary resilience can be screened out of the training. Those who remain can be given stress inoculation training. The process is repeated as personnel apply for increasingly demanding positions, such as special forces.

Children

Resilience in children refers to individuals who are doing better than expected, given a history that includes risk or adverse experience. Once again, it is not a trait or something that some children simply possess. There is no such thing as an ‘invulnerable child’ that can overcome any obstacle or adversity that he or she encounters in life – and in fact, the trait is quite common. All children share the uniqueness of an upbringing, experiences which could be positive or negative. Adverse Childhood Experiences (ACE’s) are events which occur in a child’s life that could lead to maladaptive symptoms such as feeling tension, low mood, repetitive and recurring thoughts, and avoidance. The psychological resilience to overcome adverse events is not the sole explanation of why some children experience post-traumatic growth and some do not. Resilience is the product of a number of developmental processes over time, that has allowed children experience small exposures to adversity or some sort of age appropriate challenges to develop mastery and continue to develop competently. This gives children a sense of personal pride and self-worth.

Research on ‘protective factors’, which are characteristics of children or situations that particularly help children in the context of risk has helped developmental scientists to understand what matters most for resilient children. Two of these that have emerged repeatedly in studies of resilient children are good cognitive functioning (like cognitive self-regulation and IQ) and positive relationships (especially with competent adults, like parents). Children who have protective factors in their lives tend to do better in some risky contexts when compared to children without protective factors in the same contexts. However, this is not a justification to expose any child to risk. Children do better when not exposed to high levels of risk or adversity.

Building in the Classroom

Resilient children within classroom environments have been described as working and playing well and holding high expectations, have often been characterised using constructs such as locus of control, self-esteem, self-efficacy, and autonomy. All of these things work together to prevent the debilitating behaviours that are associated with learned helplessness.

Role of the Community

Communities play a huge role in fostering resilience. The clearest sign of a cohesive and supportive community is the presence of social organisations that provide healthy human development. Services are unlikely to be used unless there is good communication concerning them. Children who are repeatedly relocated do not benefit from these resources, as their opportunities for resilience-building, meaningful community participation are removed with every relocation

Role of the Family

Fostering resilience in children is favoured in family environments that are caring and stable, hold high expectations for children’s behaviour and encourage participation in the life of the family. Most resilient children have a strong relationship with at least one adult, not always a parent, and this relationship helps to diminish risk associated with family discord. The definition of parental resilience, as the capacity of parents to deliver a competent and quality level of parenting to children, despite the presence of risk factors, has proven to be a very important role in children’s resilience. Understanding the characteristics of quality parenting is critical to the idea of parental resilience. Even if divorce produces stress, the availability of social support from family and community can reduce this stress and yield positive outcomes. Any family that emphasizes the value of assigned chores, caring for brothers or sisters, and the contribution of part-time work in supporting the family helps to foster resilience. Resilience research has traditionally focused on the well-being of children, with limited academic attention paid to factors that may contribute to the resilience of parents.

Families in Poverty

Numerous studies have shown that some practices that poor parents utilise help promote resilience within families. These include frequent displays of warmth, affection, emotional support; reasonable expectations for children combined with straightforward, not overly harsh discipline; family routines and celebrations; and the maintenance of common values regarding money and leisure. According to sociologist Christopher B. Doob, “Poor children growing up in resilient families have received significant support for doing well as they enter the social world—starting in daycare programs and then in schooling.”

Bullying

Beyond preventing bullying, it is also important to consider how interventions based on emotional intelligence are important in the case that bullying does occur. Increasing emotional intelligence may be an important step in trying to foster resilience among victims. When a person faces stress and adversity, especially of a repetitive nature, their ability to adapt is an important factor in whether they have a more positive or negative outcome.

A 2013 study examined adolescents who illustrated resilience to bullying and found some interesting gendered differences, with higher behavioural resilience found among girls and higher emotional resilience found among boys. Despite these differences, they still implicated internal resources and negative emotionality in either encouraging or being negatively associated with resilience to bullying respectively and urged for the targeting of psychosocial skills as a form of intervention. Emotional intelligence has been illustrated to promote resilience to stress and as mentioned previously, the ability to manage stress and other negative emotions can be preventative of a victim going on to perpetuate aggression. One factor that is important in resilience is the regulation of one’s own emotions. Schneider et al. (2013) found that emotional perception was significant in facilitating lower negative emotionality during stress and Emotional Understanding facilitated resilience and has a positive correlation with positive affect.

Education

Many years and sources of research indicate that there are a few consistent protective factors of young children despite differences in culture and stressors (poverty, war, divorce of parents, natural disasters, etc.):

  • Capable parenting.
  • Other close relationships.
  • Intelligence.
  • Self-control.
  • Motivation to succeed.
  • Self-confidence & self-efficacy.
  • Faith, hope, belief life has meaning.
  • Effective schools.
  • Effective communities.
  • Effective cultural practices.

Ann Masten coins these protective factors as “ordinary magic,” the ordinary human adaptive systems that are shaped by biological and cultural evolution. In her book, Ordinary Magic: Resilience in Development, she discusses the “immigrant paradox”, the phenomenon that first-generation immigrant youth are more resilient than their children. Researchers hypothesize that “there may be culturally based resiliency that is lost with succeeding generations as they become distanced from their culture of origin.” Another hypothesis is that those who choose to immigrate are more likely to be more resilient.

Research by Rosemary Gonzalez and Amado M. Padilla on the academic resilience of Mexican-American high school students reveal that while a sense of belonging to school is the only significant predictor of academic resilience, a sense of belonging to family, a peer group, and a culture can also indicate higher academic resilience. “Although cultural loyalty overall was not a significant predictor of resilience, certain cultural influences nonetheless contribute to resilient outcomes, like familism and cultural pride and awareness.” The results of Gonzalez and Padilla’s study “indicate a negative relationship between cultural pride and the ethnic homogeneity of a school.” They hypothesize that “ethnicity becomes a salient and important characteristic in more ethnically diverse settings”.

Considering the implications of the research by Masten, Gonzalez, and Padilla, a strong connection with one’s cultural identity is an important protective factor against stress and is indicative of increased resilience. While many additional classroom resources have been created to promote resilience in developing students, the most effective ways to ensure resilience in children is by protecting their natural adaptive systems from breaking down or being hijacked. At home, resilience can be promoted through a positive home environment and emphasized cultural practices and values. In school, this can be done by ensuring that each student develops and maintains a sense of belonging to the school through positive relationships with classroom peers and a caring teacher. Research on resilience consistently shows that a sense of belonging – whether it be in a culture, family, or another group – greatly predicts resiliency against any given stressor.

Specific Situations

Divorce

Often divorce is viewed as detrimental to one’s emotional health, but studies have shown that cultivating resilience may be beneficial to all parties involved. The level of resilience a child will experience after their parents have split is dependent on both internal and external variables. Some of these variables include their psychological and physical state and the level of support they receive from their schools, friends, and family friends. The ability to deal with these situations also stems from the child’s age, gender, and temperament. Children will experience divorce differently and thus their ability to cope with divorce will differ too. About 20-25% of children will “demonstrate severe emotional and behavioural problems” when going through a divorce. This percentage is notably higher than the 10% of children exhibiting similar problems in married families. Despite this, approximately 75-80% of these children will “develop into well-adjusted adults with no lasting psychological or behavioural problems”. This comes to show that most children have the tools necessary to allow them to exhibit the resilience needed to overcome their parents’ divorce.

The effects of the divorce extend past the separation of both parents. The remaining conflict between parents, financial problems, and the re-partnering or remarriage of parents can cause lasting stress. Studies conducted by Booth and Amato (2001) have shown that there is no correlation between post-divorce conflict and the child’s ability to adjust to their life circumstance. On the other hand, Hetherington (1999) completed research on this same topic and did find adverse effects in children. In regards to the financial standing of a family, divorce does have the potential to reduce the children’s style of living. Child support is often given to help cover basic needs such as schooling. If the parents’ finances are already scarce then their children may not be able to participate in extracurricular activities such as sports and music lessons, which can be detrimental to their social lives.

Re-partnering or remarrying can bring in additional levels of conflict and anger into their home environment. One of the reasons that re-partnering causes additional stress is because of the lack of clarity in roles and relationships; the child may not know how to react and behave with this new “parent” figure in their life. In most cases, bringing in a new partner/spouse will be the most stressful when done shortly after the divorce. In the past, divorce had been viewed as a “single event”, but now research shows that divorce encompasses multiple changes and challenges. It is not only internal factors that allow for resiliency, but the external factors in the environment are critical for responding to the situation and adapting. Certain programmes such as the 14-week Children’s Support Group and the Children of Divorce Intervention Programme may help a child cope with the changes that occur from a divorce.

Natural Disasters

Resilience after a natural disaster can be gauged in a number of different ways. It can be gauged on an individual level, a community level, and on a physical level. The first level, the individual level, can be defined as each independent person in the community. The second level, the community level, can be defined as all those inhabiting the locality affected. Lastly, the physical level can be defined as the infrastructure of the locality affected.

UNESCAP funded research on how communities show resiliency in the wake of natural disasters. They found that, physically, communities were more resilient if they banded together and made resiliency an effort of the whole community. Social support is key in resilient behaviour, and especially the ability to pool resources. In pooling social, natural, and economic resources, they found that communities were more resilient and able to over come disasters much faster than communities with an individualistic mindset.

The World Economic Forum met in 2014 to discuss resiliency after natural disasters. They conclude that countries that are more economically sound, and have more individuals with the ability to diversify their livelihoods, will show higher levels of resiliency. This has not been studied in depth yet, but the ideas brought about through this forum appear to be fairly consistent with already existing research.

Research indicates that resilience following natural disasters can be predicted by the level of emotion an individual experienced and were able to process within and following the disaster. Those who employ emotional styles of coping were able to grow from their experiences and then help others. In these instances, experiencing emotions was adaptive. Those who did not engage with their emotions and employed avoidant and suppressive coping styles had poorer mental health outcomes following disaster.

Death of a Family Member

Little research has been done on the topic of family resilience in the wake of the death of a family member. Traditionally, clinical attention to bereavement has focused on the individual mourning process rather than on those of the family unit as a whole. Resiliency is distinguished from recovery as the “ability to maintain a stable equilibrium” which is conducive to balance, harmony, and recovery. Families must learn to manage familial distortions caused by the death of the family member, which can be done by reorganizing relationships and changing patterns of functioning to adapt to their new situation. Exhibiting resilience in the wake of trauma can successfully traverse the bereavement process without long-term negative consequences.

One of the healthiest behaviours displayed by resilient families in the wake of a death is honest and open communication. This facilitates an understanding of the crisis. Sharing the experience of the death can promote immediate and long-term adaptation to the recent loss of a loved one. Empathy is a crucial component in resilience because it allows mourners to understand other positions, tolerate conflict, and be ready to grapple with differences that may arise. Another crucial component to resilience is the maintenance of a routine that helps to bind the family together through regular contact and order. The continuation of education and a connection with peers and teachers at school is an important support for children struggling with the death of a family member.

Professional Settings

Resilience has also been examined in the context of failure and setbacks in workplace settings. Representing one of the core constructs of positive organizational behaviour (Luthans, 2002), and given increasingly disruptive and demanding work environments, scholars’ and practitioners’ attention to psychological resilience in organisations has greatly increased. This research has highlighted certain personality traits, personal resources (e.g. self-efficacy, work-life balance, social competencies), personal attitudes (e.g., sense of purpose, job commitment), positive emotions, and work resources (e.g. social support, positive organisational context) as potential facilitators of workplace resilience.

Beyond studies on general workplace resilience, attention has been directed to the role of resilience in innovative contexts. Due to high degrees of uncertainty and complexity in the innovation process, failure and setbacks are naturally happening frequently in this context. As such failure and setbacks can have strong and harmful effects on affected individuals’ motivation and willingness to take risks, their resilience is essential to productively engage in future innovative activities. To account for the peculiarities of the innovation context, a resilience construct specifically aligned to this unique context was needed to address the need to diagnose and develop innovators’ resilience to minimise the human cost of failure and setbacks in innovation. As a context-specific conceptualisation of resilience, Innovator Resilience Potential (IRP) serves this purpose and captures the potential for innovative functioning after the experience of failure or setbacks in the innovation process and for handling future setbacks. Based on Bandura’s social cognitive theory, IRP is proposed to consist of six components: self-efficacy, outcome expectancy, optimism, hope, self-esteem, and risk propensity. The concept of IRP thus reflects a process perspective on resilience. On the one hand, in this process, IRP can be seen as an antecedent of how a setback affects an innovator. On the other hand, IRP can be seen as an outcome of the process that, in turn, is influenced by the setback situation. Recently, a measurement scale of IRP was developed and validated.

Cross-Cultural Resilience

Areas of Difference

There is controversy about the indicators of good psychological and social development when resilience is studied across different cultures and contexts. The American Psychological Association’s Task Force on Resilience and Strength in Black Children and Adolescents, for example, notes that there may be special skills that these young people and families have that help them cope, including the ability to resist racial prejudice. Researchers of indigenous health have shown the impact of culture, history, community values, and geographical settings on resilience in indigenous communities. People who cope may also show “hidden resilience” when they do not conform with society’s expectations for how someone is supposed to behave (in some contexts, aggression may be required to cope, or less emotional engagement may be protective in situations of abuse).

Resilience in Individualist and Collectivist Communities

Individualist cultures, such as those of the US, Austria, Spain, and Canada, emphasize personal goals, initiatives, and achievements. Independence, self-reliance, and individual rights are highly valued by members of individualistic cultures. Economic, political, and social policies reflect the culture’s interest in individualism. The ideal person in individualist societies is assertive, strong, and innovative. People in this culture tend to describe themselves in terms of their unique traits- “I am analytical and curious” (Ma et al. 2004). Comparatively, in places like Japan, Sweden, Turkey, and Guatemala, Collectivist cultures emphasize family and group work goals. The rules of these societies promote unity, brotherhood, and selflessness. Families and communities practice cohesion and cooperation. The ideal person in collectivist societies is trustworthy, honest, sensitive, and generous- emphasizing intrapersonal skills. Collectivists tend to describe themselves in terms of their roles – “I am a good husband and a loyal friend” (Ma et al. 2004). In a study on the consequences of disaster on a culture’s individualism, researchers operationalised these cultures by identifying indicative phrases in a society’s literature. Words that showed the theme of individualism include, “able, achieve, differ, own, personal, prefer, and special.” Words that indicated collectivism include, “belong, duty, give, harmony, obey, share, together.”

Differences in Response to Natural Disasters

Natural disasters threaten to destroy communities, displace families, degrade cultural integrity, and diminish an individual’s level of functioning. Comparing individualist community reactions to collectivist community responses after natural disasters illustrates their differences and respective strengths as tools of resilience. Some suggest that disasters reduce individual agency and sense of autonomy as it strengthens the need to rely on other people and social structures. Therefore, countries/regions with heightened exposure to disaster should cultivate collectivism. However, Withey (1962) and Wachtel (1968) conducted interviews and experiments on disaster survivors which indicated that disaster-induced anxiety and stress decrease one’s focus on social-contextual information – a key component of collectivism. In this way, disasters may lead to increased individualism.

Mauch and Pfister (2004) questioned the association between socio-ecological indicators and cultural-level change in individualism. In their research, for each socio-ecological indicator, frequency of disasters was associated with greater (rather than less) individualism. Supplementary analyses indicated that the frequency of disasters was more strongly correlated with individualism-related shifts than was the magnitude of disasters or the frequency of disasters qualified by the number of deaths. Baby-naming practices is one interesting indicator of change. According to Mauch and Pfister (2004), urbanization was linked to preference for uniqueness in baby-naming practices at a 1-year lag, secularism was linked to individualist shifts in interpersonal structure at both lags, and disaster prevalence was linked to more unique naming practices at both lags. Secularism and disaster prevalence contributed mainly to shifts in naming practices.

There is a gap in disaster recovery research that focuses on psychology and social systems but does not adequately address interpersonal networking or relationship formation and maintenance. A disaster response theory holds that individuals who use existing communication networks fare better during and after disasters. Moreover, they can play important roles in disaster recovery by taking initiative to organize and help others recognise and use existing communication networks and coordinate with institutions which correspondingly should strengthen relationships with individuals during normal times so that feelings of trust exist during stressful ones.

In a collectivist sense, building strong, self-reliant communities, whose members know each other, know each other’s needs and are aware of existing communication networks, looks like an optimum defence against disasters.

In comparing these cultures, there is really no way to measure resilience, but one can look at the collateral consequences of a disaster to a country to gauge its resilience.

  • Collectivist resilience:
    • Returning to routine.
    • Rebuilding family structures.
    • Communal sharing of resources.
    • Emotional expression of grief and loss to a supportive listener.
    • Finding benefits from the disaster experience.
  • Individualist resilience:
    • Redistribution of power/resources.
    • Returning to routine.
    • Emotional expression through formal support systems.
    • Confrontation of the problem.
    • Reshaping one’s outlook after the disaster experience.

Whereas individualistic societies promote individual responsibility for self-sufficiency, the collectivistic culture defines self-sufficiency within an interdependent communal context (Kayser et al. 2008). Even where individualism is salient, a group thrives when its members choose social over personal goals and seek to maintain harmony and where they value collectivist over individualist behaviour (McAuliffe et al. 2003).

The Concept of Resilience in Language

While not all languages have a direct translation for the English word “resilience”, nearly every culture and community globally has a word which relates to a similar concept. The differences between the literal meanings of translated words shows that there is a common understanding of what resilience is. Even if a word does not directly translate to “resilience” in English, it relays a meaning similar enough to the concept and is used as such within the language.

If a specific word for resilience does not exist in a language, speakers of that language typically assign a similar word that insinuates resilience based on context. Many languages use words that translate to “elasticity” or “bounce”, which are used in context to capture the meaning of resilience. For example, one of the main words for “resilience” in Chinese literally translates to “rebound”, one of the main words for “resilience” in Greek translates to “bounce”, and one of the main words for “resilience” in Russian translates to “elasticity,” just as it does in German. However, this is not the case for all languages. For example, if a Spanish speaker wanted to say “resilience”, their main two options translate to “resistance” and “defence against adversity”. Many languages have words that translate better to “tenacity” or “grit” better than they do to “resilience”. While these languages may not have a word that exactly translates to “resilience”, note that English speakers often use tenacity or grit when referring to resilience. While one of the Greek words for “resilience” translates to “bounce”, another option translates to “cheerfulness”. Moreover, Arabic has a word solely for resilience, but also two other common expressions to relay the concept, which directly translate to “capacity on deflation” or “reactivity of the body”, but are better translated as “impact strength” and “resilience of the body” respectively. On the other hand, a few languages, such as Finnish, have created words to express resilience in a way that cannot be translated back to English. In Finnish, the word “sisu” could most closely be translated to mean “grit” in English, but blends the concepts of resilience, tenacity, determination, perseverance, and courage into one word that has even become a facet of Finnish culture and earned its place as a name for a few Finnish brands.

Criticism of Application

Brad Evans and Julian Reid criticise resilience discourse and its rising popularity in their book, Resilient Life. The authors assert that policies of resilience can put the onus of disaster response on individuals rather than publicly coordinated efforts. Tied to the emergence of neoliberalism, climate change, third-world development, and other discourses, Evans and Reid argue that promoting resilience draws attention away from governmental responsibility and towards self-responsibility and healthy psychological effects such as post-traumatic growth.

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