resilience

[animas]

any good resources on this concept?

---

Members don't see this ad.

 

[masterofmonkeys]

Jerome Kagan's book Temperamental Thread. Easy read but great intro to the concept.

I think resilience might be in some ways a barrier to treatment though. At least from a psychodynamic perspective. I would like to write more, but A) I'm tired and B) I'm lazy.

 

[Atilla]

I remember reading an article in sunday New york times few years ago. It was about a researcher at Yale who investigating a family of 3 sisters who were physically/sexually abused in childhood, went through the foster care system. Two of them ended up with drug addiction, poor social/occupational functioning.

The third one went to college, got a decent job and had a family. The researcher studied the third sister to find out what made her resilient and overcome such odds to live a normal life.

Alas in our field the focus is more on pathology, not on positive outcomes.

 

[whopper]

With so much focus simply on pathology, we don't get so much training on personality factors such as resilience. Before a psychologist (or psychiatrist) wants to jump in and chime in and devolve the thread into another iatry vs. ology wrestlemania, we psychiatrists do get a heck of a lot of training in other areas they don't that too are important.

(and by the way, I say if such a thread develops in the future all participants that want to further fuel that war record their post in video format while adopting the vocal mannerisms of a pro-wrestler and also wear tight speedos, a flamboyant outfit, and call himself by his SDN handle. Then put the file on their post for download).

I think we psychiatrists should try to strive to incorporate more understanding of psychological development of personality and other non-pathological understanding of the human mind in terms of emotional well-being. If the psychiatrist doesn't do this by studying it on his/her own, he/she should at least work in collaboration with those that have been trained in this model.

 

[IT514]

Obviously the concept of resiliency will look different depending on the type of pathology. The clearest example of low resiliency that I can think of are those with autism. The restricted range of interests and the aggression thats seen in these kids is a result of the same drive that we all have of wanting to get through the day with the least amount of irritation as possible. To do so sucessfully requires an amygdala of normal size and adequate prefrontal control, which those kids dont have. I think anxiety and depression in adults represent a more subtle variation of the same concept.

Whats interesting to me is that SSRIs help all of the above. I think that ppl who say that meds dont help kids with autism simply arent familiar with the literature and obviously havent tried doing ABA with an agressive kid before and after an SSRI. They dont work in all kids with autism but I think that has more to do with the unique side effect profiles in these kids than the mechanism itself. IMHO, SSRIs increase resiliency in these kids and make them more receptive to the intense therapies that constantly (but necessarily) bring them out of their comfort zone.

Regarding other therapeutic interventions, CBT and emotion focused therapies are great for increasing resiliency in the majority of mild and some moderate cases. For severe cases, meds are an absolute must, as years of abuse and complex trauma can impair even the best of inborn resiliency.

As a neuropsych student I'm way more interested in talking about the anatomical basis for resiliency, but, if you havent read the story of Ruby Bridges (first African American girl to attend an integrated school after desegregation) by Bob Coles, its a great case study in moral and family dynamics leading to resiliency.

 

[F0nzie]

Thanks for posting. I am interested in this topic as well. Presumably under high enough levels of stress any person with or without risk factors can become clinically depressed with resilience serving as a protective factor.

I found an article on Medscape entitled "Stress and Resilience: Implications for Depression and Anxiety
Jerrold F. Rosenbaum, MD; Jennifer M. Covino, MPA. You may need a login to view the article.

In the article they identify 10 critical psychological elements and characteristics of resilience:
1. Optimism. Those who are extremely optimistic tend to show greater resilience, which has implications for cognitive therapies that enhance a patient's positive view of his or her options, thereby increasing optimism;
2. Altruism. Those who were resilient often found that helping others was one way to handle extreme stress, which can also be used therapeutically as a recovery tool;
3. Having a moral compass or set of beliefs that cannot be shattered;
4. Faith and spirituality. For some POWs, prayer was a daily ritual, although others were not at all involved or interested in religion;
5. Humor;
6. Having a role model. Many people with role models draw strength from this; for treatment, using a role model, role modeling, or helping someone discover a role model can be beneficial;
7. Social supports. Having contact with others who can be trusted, either family or friend, with whom one can share most difficult thoughts was important in recovery;
8. Facing fear (or leaving one's comfort zone);
9. Having a mission or meaning in life; and
10. Training. One can train to become a resilient person or to develop resilience by experience in meeting and overcoming challenges. Dr. Charney believes the importance of training has implications for how we prepare young people for adulthood. He suggested that high school health courses could be adapted to help with this preparation.

Anybody want to add to the list?

 

[OldPsychDoc]

Thanks for posting. I am interested in this topic as well. Presumably under high enough levels of stress any person with or without risk factors can become clinically depressed with resilience serving as a protective factor.

I found an article on Medscape entitled "Stress and Resilience: Implications for Depression and Anxiety
Jerrold F. Rosenbaum, MD; Jennifer M. Covino, MPA. You may need a login to view the article.

In the article they identify 10 critical psychological elements and characteristics of resilience:
1. Optimism. Those who are extremely optimistic tend to show greater resilience, which has implications for cognitive therapies that enhance a patient's positive view of his or her options, thereby increasing optimism;
2. Altruism. Those who were resilient often found that helping others was one way to handle extreme stress, which can also be used therapeutically as a recovery tool;
3. Having a moral compass or set of beliefs that cannot be shattered;
4. Faith and spirituality. For some POWs, prayer was a daily ritual, although others were not at all involved or interested in religion;
5. Humor;
6. Having a role model. Many people with role models draw strength from this; for treatment, using a role model, role modeling, or helping someone discover a role model can be beneficial;
7. Social supports. Having contact with others who can be trusted, either family or friend, with whom one can share most difficult thoughts was important in recovery;
8. Facing fear (or leaving one's comfort zone);
9. Having a mission or meaning in life; and
10. Training. One can train to become a resilient person or to develop resilience by experience in meeting and overcoming challenges. Dr. Charney believes the importance of training has implications for how we prepare young people for adulthood. He suggested that high school health courses could be adapted to help with this preparation.

Anybody want to add to the list?

This is really a neat list. Seems to have a lot of overlap with some of the Positive Psychology stuff that's out there now.

So I'm just musing here...but fine, here's these 10 things that help highly trained, selected men survive extreme stress (Vietnam POWs, mostly pilots). How can we develop these traits post-stress? How would you take this list to my burnt-out borderline patient, who wants nothing more than to be discharged so she can go home and overdose on her insulin once and for all, and say, "Let's work on building up a couple of these areas and make your life worth living again."

Ideas?