Resilience

RESILIENCE
Lecturer of psychiatry / Zeinab El Nagar

Resilience
Developing a comprehensive understanding of resilience across the lifespan is
potentially important for mental health promotion.
Resilience has been vastly understudied compared to disease and
vulnerability.

Resilience
Resilience is closely related to positive coping styles (Xiao et al., 2005; Zhang
et al., 2017).
Based on the concept of resilience, it may be possible to identify
predisposing factors or risk factors for psychopathologies and to develop
new intervention strategies, both preventive and therapeutic.

Resilience stands for one's capacity to recover from extremes of trauma
and stress.
Resilience in a person reflects a dynamic union of factors that encourages
positive adaptation despite exposure to adverse life experiences.
Resilience

Resilience is a process lasts a lifetime, with periods of acquisition ,
maintenance, reduction and loss for assessment.
Resilience is currently recognized as a multidimensional construct
including:
1. Personal characteristics and skills (e.g., Active problem solving)
2. External protective factors (a supportive family & social environment) .
Resilience

One needs to have a three-dimensional construct for understanding
resilience:
 A state (what is it and how does one identify it?)
A condition (what can be done about it?)
A practice (how does one get there?).
Resilience

Three Main Aspects Within
The Concept of Resilience
The ability to achieve positive results in high risk situations
The ability to function competently in situations of acute or chronic stress
The ability to recover from trauma

Theory of Resilience
It is conceptualized as a dynamic process that fluctuates according to age,
gender, individual circumstance and developmental, historical, and
cultural context.
Focused on personal attributes such as:
 Self-esteem
 Self-efficacy
Hardiness

Protective Factors
Religious beliefs and practices:
1. Accessible
2. Afforded a sense of continuity,
3. Comfort
4. Meaning in life
5. Psychosocial training on nonviolent communication
6. Cooperation, and tolerance
Almost any demographic are to have a secure, solid support from family
members, friends, and school

Characteristics of Resilience
 There are number of characteristics of resilience whose integrity or
damage indicates resilient capacity:
Control over the process of remembering traumatic experiences
Integration of memory and emotions
Regulation of emotions related to trauma
Control of symptoms

Characteristics of Resilience
Self-esteem
Internal cohesion (thoughts, emotions and actions)
Establishment of secure links
Understanding the impact of the trauma
Developing a positive meaning.

While Understanding Resilience, One Needs
to Look at The Three Factors:
Identifying resilient factors and qualities
Processes for building resilience
Developing measuring instruments.

Neurobiology of Resilience
Resilience has biological underpinnings
Familial predisposition
 protective pathways against a number of life events.

The neuroscience of resilience is beginning to uncover the circuits and
molecules that protect against stress-related neuropsychiatric diseases.
Glucocorticoids (GCs) are important regulators of basal and stress-related
homeostasis that influence a wide array of genes in almost every organ and
tissue.
GCs promote or prevent adaptation to stress.

Literature on trauma has focused predominately on limbic and cortical
structures that innervate the hypothalamic-pituitary-adrenal (HPA) axis and
influence GC-mediated negative feedback.
Neuroendocrine pathways that a self-perpetuating “fearful memory” can
propagate the long-term effects of early life trauma.

Central neurochemical response to trauma is HPA axes which governs, coordinates, and
modulates changes in hypothalamic-pituitary-thyroid axis, corticotropin-releasing
hormone, and corticotropin-releasing factor
Regulate neurotransmission mechanism
neuronal loss and functional dysconnectivity & neuroplasticity
HPA axis response to stress, neurotransmissions of dopamine, serotonin, and norepinephrine
resilience plasticity

Neurochemical changes suggest that cortisol related sustained, enhancement of
amygdala, and hippocampus loss of functional connectivity.
Resilience is associated with increased connectivity between the ventral and
dorsal prefrontal cortex.

Resilience being an independent paradigm.
 Genetic and environmental factors: (a situation of enhanced vulnerability and
a reduced resilience ).
Early life stress
Chronic stress during adulthood
An unsuccessful aging of the brain

A nother abnormalities in the brain have also been observed:
A. Changes in neurocircuitry mediating reward
B. Activation and regulation of mesolimbic dopaminergic projections from
the ventral tegmental area to the nucleus accumbens

It is not clear whether resilience is a modifiable or nonmodifiable factor
?!
Answer
Studies report that resilience is affected by pharmacological interventions, e.g.,
antidepressant drugs
“Such findings open a new areas of treatment to mental disorder”

Cognittive Model of Psychological
Rescillance

Resilience at Various Stages of Life Cycle
Psychological approach of Resilience

Abstract Within various stages of life.
Individuals encounter events filled challenges and distress for overcoming and moving
forward to the next stage.
 Childhood, youth, adolescence and young adult stages are each delicate stages of
life, in which potentially traumatic events might occur.

Adverse events during family life cycle can translate into issues in family relationships,
mental health and overall family functioning.
These may be escalated due to other challenges such as differences in structure and
composition of families, ethnicity and socioeconomic status.

The Concept of Family Resilience
Family-focused Approaches (Ecological Theory)
The concept of family resilience refers to the capacity of the family, as a functional
system, to withstand and rebound from situations adversity
(Walsh, 1996, 2002, 2003, 2016a, 2016b).

The micro system:
1. The most important system in which to begin strengthening families in their resources and
encourage the traits of resilience in children.
2. Highlighting the importance of familial roles , interactions and feedback loops to
procure desired behaviors as a part of resilience in youth and adolescents.
3. Individual factors in the individual and his/her surrounding environment.

Family systems theory:
A basic premise in family systems theory is that serious crises and persistent life
challenges have an impact on the whole family.
 Adaptation key family processes mediate adaptation (or maladaptation) for individual
members.

Family developmental theory:
The concept of family resilience extended family developmental theory and research on
family stress, coping, and adaptation (McCubbin & McCubbin, 2013).
Severe trauma or very troubled relationships can experience repair and growth over the
life course and across the generations (Walsh, 2007, 2016b).

 Belief systems
 Making meaning of adversity
 Positive outlook
 Transcendence and spirituality
 Organizational processes
 Flexibility
 Connectedness
 Mobilize social and economic resources

 Communication/Problem-solving Processes
 Clarity
 Open emotional sharing
 Painful feelings
 Positive interactions (love, appreciation, gratitude. humor, fun, respite)
 Collaborative problem-solving

Community Resilience
Resilience is “the capacity of a system, be it an individual, a forest, a city or an
economy, to deal with change and continue to develop.”
Resilience is a measure of how well people and societies can adapt to a changed reality
and capitalize on the new possibilities offered.
 The resilient system can improve one’s ability to cope with emergencies through self-
adjustment to cope with changes.

Community Resilience
◦ CCFH Resilience-Oriented, Community-Based Program Applications
◦ Chicago Center for Family Health (1991–2015)
◦ Family resilience-oriented training, services, partnerships
◦ • Recover from crisis, trauma, and loss
◦ • Family adaptation to complicated, traumatic loss (Walsh)
◦ • Mass trauma events; Major disasters (Walsh)
◦ • Relational trauma (Barrett, Center for Contextual Change)
◦ • Refugee families (Rolland, Walsh, Weine)
◦ • War and conflict-related recovery (Rolland, Weine, Walsh)
◦ • Navigate disruptive family transitions
◦ • Divorce, single-parent, stepfamily adaptation (Jacob, Lebow, Graham)
◦ • Foster care (Engstrom)
◦ • Job loss, transition, and re-employment strains (Walsh, Brand)
◦ • Overcome challenges of chronic multistress conditions
◦ • Serious illness, disabilities, end-of-life challenges (Rolland, Walsh, R. Sholtes, Zuckerman)
◦ • Poverty; ongoing complex trauma (Faculty)
◦ • LGBT issues, stigma (Koff)
◦ • Overcome obstacles to success: at-risk youth
◦ • Child and adolescent developmental challenges (Lerner, Schwartz, Gutmann, Martin)
◦ • Family–school partnership program (Fuerst & Team)
◦ • Gang reduction/youth development (Rolland, Walsh & Team)

Resilience Under Dire Situations:
Impact of Circumstances of
Disaster, War, and Terrorism on
Children's Development

What is traumatic to a child?
The response to trauma is different for every child –
some are naturally more resilient than others
What is traumatic to one child may not seem to phase
another child
Trauma is personal to each individual
A child may find an event to be traumatic even if an
adult doesn’t

Childhood Trauma
 Car Accident
 Death of a Family Member
 Failing a test
 Death of a Pet
 Personal Illness or Surgery
 Family Illness
 Witnessing Family Violence
 Being Physically Abused or Neglected
 Emotional Abuse
 Sexual Abuse
 Poverty
 Fire
 Moving
 Family Member in Military
 Divorce
 Drug Use in the Home
 Family Member in Jail
 Surgery
 Bullying
 CPS Removal
 Natural Disasters
 Mental Illness within the Family
 Fleeing home as a refugee or immigrant
 Witnessing Community Violence
 Being Held Back in School
 Repeated Doctor Appointments
 Loss of Family Income

Repeated Trauma
 Some children never experience a true trauma in their lives, some have one instance, and
some experience trauma on a very regular basis.
 Some children build resiliency to situations and seem invincible – some seem to fall under
the stress

Perspectives on Resilience for Military
Readiness and Preparedness

“Soldiers Are and Will Always Be The Centerpiece of Army”
The readiness and resiliency of soldiers, civilians and family members is dependent on
their physical, mental and emotional fitness.
 Success requires engaged leadership at all levels, a collaborative and multidisciplinary
approach, and effective prioritization of resources.

a focus on resiliency in military society:
We will continue to be ready to take on any mission
The army ready resilient and what’s different?
Based on lessons learned from a decade of war, ready and resilient formalizes

Whole-person concept:
Recognizes an individual’s ability to bounce back from adversity (resilience) as a key
component of individual performance and unit readiness
Training & education:
Resilience is increased through education and training, from peer-to-peer teamwork,
recruitment, during service and at separation

Holistic approach:
Better synchronizes and optimizes current readiness and resiliency training and education
programs, and creates measures to improve readiness
A stigma-free climate:
Soldiers don’t quit.
If we get knocked down, we help each other get back up, dust ourselves off and get back
into the fight why is it important?

A healthy mind and body are essential to individual and unit readiness
 Resilience combines mental, emotional, and physical skills to generate
optimal performance (i.e. readiness)
 In combat, healing after injury, and in managing work and home life.

An Army Soldier ….
Is a skilled professional who lives by the Soldier’s Creed and Army Values
 Works with strong Army Civilian teammates who embody the same resilient characteristics
Is a valued member of the Army Team who treats all with dignity and respect
Manages sleep, diet and mind/body conditioning to become stronger and optimize
performance
Bounces back from adversity to thrive and meet goals and objectives
Is self-aware, seeks help when needed and intervenes to help others, treats all with dignity and
respect
Ready and Resilient

 Embraces challenges, solves problems, continuously learns, improves and strengthens An Army
Family ...
 Is an essential member of the Army Team
 Is able to thrive and remain strong through deployments, reassignments, and adversity
 Is aware of resources, and willing to seek help for themselves and their Soldier when needed
 Supports other families, connects with their community and makes positive contributions An Army
Leader ...
 Leads by example, sets and enforces high standards, and holds themselves and others accountable
Ready and Resilient

Establishes a climate that fosters resilience and trust
Knows their team and equips them with the skills to achieve missions, overcome challenges
and grow
Teaches, coaches and mentors team members through positive thinking and effective
problem solving
Follows a moral compass of integrity
Is well-led and cohesive, with members proud to be part of the team
Is trained, resourced and equipped to accomplish assigned tasks and quickly adapt to future
missions
 Is comprised of members who provide each other and their families strength and
encouragement in all situations and conditions
Ready and Resilient

 Is stronger and more resilient than the sum of its individual parts An Army Unit ...
 Is a skilled professional who lives by the Civilian Corps Creed and Army Values
 Works with strong Army Soldiers to provide stability and continuity during war and peace
 Is a valued Army Team member, crucial to military operations support and provides full
complement to military occupational specialties
 Seeks out training and self development opportunities to strengthen readiness and resilience An
Army Civilian ...
 Resilience is the mental, physical, emotional, and behavioral ability to face and cope with adversity,
adapt to change, recover, learn and grow from setbacks.
Ready and Resilient

In the daily military environment, psychological resilience training is used to guide
soldiers to improve their rational understanding, stimulate their internal potential, and
enable them to evaluate and actively respond to situations of stress (Zuo et al., 2013).
Study had shown that high self-resilience can allow soldiers who are exposed to the war
environment to better integrate into normal life after the war.
Psychological Resilience Training

Who have good personal abilities, can withstand stress, and can reduce suicide,
alcohol dependence, PTSD, and other problems (Green et al., 2010).
 Psychological resilience has a positive predictive effect on soldiers’ positive coping
style.

 Due to their remote geographical location, strange and closed environment, monotonous
life, military training intensity, critical mission requirements, and other special military
environmental factors.
 Soldiers can easily develop psychological stress responses that cause anxiety, depression,
and other uncomfortable emotions, and take a negative response.
Coping is the selection and execution of behaviors evaluating the intrinsic or extrinsic
requirements.

It produces behavioral efforts of an individual to control problems.
As an important mediating and regulating factor in the process of psychological stress.
Coping plays a regulatory role between stress and response results and regulates the
mental health of military personnel (liao, 2014).
 To improve soldiers’ mental health, attention should be paid to the cultivation of
soldiers’ active coping styles and the avoidance of negative coping patterns.
These coping situations are believed to be beyond the ability of an individual and
require changing cognitive and behavioral efforts

Relationship Between Resilience and Positive Coping
Style of Air Force Soldiers
 Resilience in military environments generally refers to the psychological process in which
individuals adapt to or maintain adequate mental health when they are injured (Qiao and
Yu, 2013).
 The stronger the mental resilience of soldiers was, the more frequently they were to use
positive coping methods, which was basically consistent with the findings of previous
studies (Miao, 2006; Wu et al., 2015).

Mediating Role of Self-Comfort
psychological resilience significantly predicts self-comfort, which is consistent with
previous research conclusions (Xi et al., 2013).
Soldiers with strong mental resilience show more positive emotions & good emotional
regulation.
At the same time, they are more willing to use self-comfort as an emotional adjustment and
coping method, so that they can be in an optimal emotional state and can adapt better to
the environment (Wu et al., 2015).

The Moderating Effect of Social Support
 The second half of the mediating process of social support regulation is discussed using
the ecosystem theory of psychological development.
 The number of soldiers with more social support who used active coping increased more
quickly than those with less social support and use more positive coping methods.
 A mediated model with moderation, focusing on the mechanism of independent variables
acting on dependent variables, namely, the mediating effect (Wen and Ye, 2014).
 Individuals who actually feel a high degree of social support will be willing to develop
positive psychological qualities and have more positive resilience (Uchino et al., 1996).

Rescliance in Refuges
 Females tended to have higher resilience as well as adolescents refuges.
 Adolescents suffering from depressive symptoms or other emotional or behavioral
problems had lower resilience.
There was little evidence of an association between resilience scores and exposure to
trauma or service utilization.

 The prevalence of psychiatric disorders in refugee children reported rates of 18% and 32%
for any psychiatric disorder.
The most commonly reported mental health problems in refugee children are
posttraumatic stress disorder and depression.
 18% of Iranian refugee children in Sweden, 25% of Bosnian children, and 57% of Cuban
refugee children in the US were found to suffer from PTSD.

 Major depressive disorder were reported among 17% of Bosnian adolescents and 12.9%
Cambodian children exiled in the US while 11.5% Tibetan refugee children in India were
also diagnosed as suffering from both PTSD and major depression.
 A recent Australian study demonstrated a rate of 7.2% for depression in refugee
children and adolescents.

Resilience in The
Context of Psychiatric
Disorders

Resilience in The Context of Psychiatric Disorders
It has been established above that there is a strong interplay between resilience and
mental illness.
There is some evidence that resilience is lower among people who develop mental
disorder, high level of resilience may prevent the development of an illness or minimize
the severity of illness.
The number of traumatic events significantly decreases the level of resilience, and
people are more likely to develop psychiatric disorders such as depression and suicide.

People with an experience of trauma significantly differ, from those who have not had
such experiences, in terms of structural as well as functional changes in the brain.
Resilience helps to minimize the extent of pathogenesis in developmental process or
transition from health to disease, or wellness or illness by facilitating or arresting
conversion to illness.

Researchers have investigated the association of resilience in euthymic patients with bipolar
disorder.
High levels of resilience were shown to be related to low levels of impulsivity and
depressive episodes.
The reciprocal relationship between resilience and impulsivity illustrates that it is important
to enhance resilience in order to maintain mental stability in patients.
Where high levels of resilience correlated to low levels of PTSD.
Resilience has even been shown to play a mitigating role in the ideation of suicide in
depressive and anxious individuals.

Resilience has the potential to be used as a defensive measure toward specific mental
health conditions such as depression and anxiety.
Interestingly baseline resilience is found to be lower among those in the Ultra-high-risk
(UHR) people who converted to frank psychosis.
Treatment strategies for individuals at UHR for psychosis should include promoting
resilience while targeting the reduction of positive and negative symptoms in order to
foster social reintegration and recovery.

 The notion of enhancing resilience through intervention has been studied with patients that had lived
through a high trauma situation.
 The results indicated that significant intraparticipant mean increase in resilience at follow-up assessment,
and greater self-reported improvement in resilience processes for participants who experienced more
traumatic events.
 Therefore, resilience can be modified and enhanced by metallization and cognitive training.
 Other researchers have examined the effect of mindfulness training on resilience mechanisms in active-duty
marines preparing for deployment.
 The resilience models offer a novel and more direct approach to drug discovery for schizophrenia and
neuropsychiatric disorders

Resilience requires the measurement of:
 Internal (personal)
External (environmental) factors
Family and social environment
Evaluating the level of Resilience

Measurments and Tools
1. Resilience was negatively associated with neuroticism, and positively related to extraversion and
conscientiousness.
2. Coping styles also predicted variance in resilience above and beyond the contributions of these
personality traits.
3. Task-oriented coping was positively related to resilience, and mediated the relationship between
conscientiousness and resilience.
4. Emotion-oriented coping was associated with low resilience.
5. Connor-Davidson Resilience Scale (CD-RISC)

1. Connor–Davidson resilience scale
2. Neo five factor inventory
3. Coping inventory for stressful situations
4. Brief symptom inventory
Measurments and Tools

The family’s approach and response are crucial for the resilience of all members, from
young children to vulnerable adults (Walsh, 2016).
In eldercare, mobilizing a family caregiving team can reduce strains on the primary caregiver
as it strengthens family efforts to support the well-being of the elder member (Walsh,
2012a).
Key transactional processes enable the family to rally in highly stressful times:
take proactive steps, to buffer disruptions, to reduce the risk of dysfunction, and to support
positive adaptation and resourcefulness in meeting challenges.
Intervention Directions on Resilience

Intervention Directions on Resilience
Find the best way to increase resilient mechanisms is the chances of the individual going
through an extreme adverse life event.
 Ongoing training of professionals who have direct contact with youth and adolescents (i.e.
school counselors, teachers, social workers, etc.) in strategies to assist with instilling resilient
qualities in youth.
 In the study of the mental health of those in the military and the formulation of effective
intervention programs.

Environments For Application of Resilience
Health
Education
Social policy
Research and analysis with focus on resilience

Research Applications of The Relationship of
Resilience
Personality Traits
Coping Styles
 Psychiatric
Refuges
Military

In conclusion
Finally, resilience was shown to moderate the relationship between a
form of childhood maltreatment (emotional neglect) and current
psychiatric symptoms.
These results augment the literature that seeks to better define resilience
and provide evidence for measurements.
 Fostering resilience may be critical to efforts to prevent or reduce
mental health problems in refugee adolescents and military society.

Referances
 Priyvadan Chandrakant Shastri: Resilience: Building immunity in psychiatry Indian J Psychiatry. 2013 Jul-Sep; 55(3):
224–234. doi: 10.4103/0019-5545.117134.
 Indian J Psychiatry. 2016 Jan-Mar; 58(1): 38–43. doi: 10.4103/0019-5545.174365
 PMID: 26985103, Resilience: A psychobiological construct for psychiatric disorders Amresh Shrivastava and Avinash
Desousa1, Author information Copyright and License information Disclaimer
 Family Resilience, A Dynamic Systemic Framework, Froma Walsh DOI:10.1093/oso/9780190095888.003.0015
 SADGUNA ANASURI, Building Resilience during Life Stages: Current Status and Strategies, March 2016 ,International
Journal of Humanities and Social Science 6(3):1-9.
 (6) (PDF) Building Resilience during Life Stages: Current Status and Strategies. Available from:
https://www.researchgate.net/publication/301652160_Building_Resilience_during_Life_Stages_Current_Status_and_Strate
gies [accessed Sep 15 2021].
◦ 10 Ways to Develop Resilience in Sobriety , Eudaimonia Recovery Homes | Posted on December 3, 2018

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