"How Can I Become More Resilient?"

How new research can help us cope with postmodern stresses by David Hellerstein, M.D. in Heal Your Brain.

What a world we live in!

Clearly we humans weren't designed for [such a complex world in which we now live].  Our stress response systems evolved over hundreds of thousands of years in a world that scarcely resembled our 21st century 24/7 global electronic village.  It's no surprise that many people find themselves overwhelmed by the multiple uncertainties of contemporary life.  This is especially true for people with depression and anxiety disorders, who can be at risk for particularly bad outcomes when disaster strikes.

Despite all this, I tend to be an optimist. All of these events, all these unpredictable and manmade disasters serve to underline the importance of the 6th and final key principle of the New Neuropsychiatry: resilience.

When disaster strikes, some people crumble, yet others thrive. 

Why is this? Over the past few decades, New Neuropsychiatry research has begun to understand the basic factors behind resilience.

What is resilience?  It is a scientifically-based concept of effective coping as a means of alleviating chronic stress. When related to psychiatric conditions such as anxiety disorders and depression, we are increasingly able to use our understanding of resilience to improve long-term outcome.  But resilience also includes principles that are applicable to everyone--not only those who suffer from psychiatric disorders.

Today, in the words of psychiatrists and researchers Dennis Charney and Charles Nemeroff, "...progress in both psychology and neuroscience make [an] ambitious goal possible: the development of psychological resilience and emotional fitness." This insight grows from research in a dozen different neuroscience disciplines, from clinical psychiatry to genetics to epidemiology to neuroimaging to molecular biology to psychopharmacology and psychotherapy research.

In their book The Peace of Mind Prescription, Charney and Nemeroff describe the key components of resilience-and in my book Heal Your Brain, I've added one more (learning).  They include:

• Physical resilience, physical 'toughening' and 'tempering'
• Psychological resilience; "situations viewed as challenges, not threats"
• Activating social network, including confiding relationships
• Adequate external supports
• Challenging one's self
• Looking for meaning through involvement
• Learning

A full discussion of these items is beyond the limits of a single blog posting, but let me pick a few examples:

• Physical toughening and tempering are key components of resilience. Basically, people who are physically toughened are able to withstand prolonged stress better than those who aren't.  Not only does physical fitness make for stronger hearts, lower blood pressure, and lower blood sugar, as well as directly decreasing anxiety and depression and improving sleep--but exercise also increases the levels of neurotrophic factors, like brain-derived neurotrophic factor (BDNF), which improve brain health.
   
• Psychological resilience is equally important.  One key component of psychological resilience is what is called 'appraisal.'  Appraisal means how you look at a challenging situation, whether as a threat or a challenge. And this has major effects on your body's (and mind's) responses.  If you view a situation as a threat, your fear response systems are set off--the amygdala, the brain's fear center, sends signals to the pituitary and adrenal glands to release stress response hormones, which increase blood pressure and pulse and blood glucose level, and increase anxiety.  In the short run, fear responses can be helpful; in the long run, they kill. In contrast, situations that are viewed as challenges set off an entirely different set of psychological and physical reactions. In Charney and Nemeroff's words, "The hormones released by an appraisal of challenge include growth factors, insulin, and other compounds that promote cell repair, trigger relaxation responses, and stimulate efficient energy use."  A person who feels challenged is calm, thoughtful, enthusiastic, and invigorated, whereas a person who feels threatened is anxious, panicky, scared, combative, and reactive. 
   
• Learning is also a key component of resilience. Of course, learning in itself can be helpful when we face difficult life dilemmas, and to help us solve problems. Interestingly, though, in the last decade or so it has become clear that the brain continually reshapes itself through adult life, and that learning is key to the process of ongoing brain plasticity.  Learning helps to grow new connections between brain cells as well to wire the new brain cells that arise in areas of the brain that can be damaged by stress, such as the hippocampus.  Changing behavior, including learning new adaptive behaviors, appears to increase the activity and connectivity of key brain centers such as the brain's reward circuitry, which includes the nucleus accumbens. 

As a clinician, I have learned a lot about resilience from my patients.  Take "Mark M." as I call him in Heal Your Brain.  Prior to treatment, he had been overwhelmed for over a decade of depression and severe OCD, with a constant need to check his wife's whereabouts after a devastating car accident.  Eventually, he responded to antidepressant medicine and psychotherapy, and attained a state of ongoing remission.  Like many people with these disorders, Mark seemed to have had increased activity of the brain's fear systems--which seemed to return toward normal after treatment.  A few years into Mark's recovery from depression, the events of 9/11 happened.  I feared that Mark would crumble, especially since his wife worked in the vicinity of the World Trade Center, and it took him many hours to locate her.  Yet he thrived.  He described to me how many of his friends and colleagues developed depression or PTSD afterward, yet how he felt "protected"--perhaps because he had overcome so many previous obstacles. In retrospect I see that Mark had done many of the things listed above to enhance his own resilience, and that he had moved from a state of feeling continually threatened to a state in which he felt continually challenged.  Calm had replaced fear as his organizing principle.

Back to the hurricane, earthquake, and these innumerable political disasters:  obviously we can only have a limited effect on these threatening world events--natural or man-made. 

But it seems to me that there is a greater need than ever for us to develop and maintain our coping abilities so we can best deal with an increasingly unpredictable environment. 

And resilience is key.

David J. Hellerstein, M.D., is a Professor of Clinical Psychiatry at Columbia University's College of Physicians and Surgeons in New York City, and a research psychiatrist at the New York State Psychiatric Institute.

He is author of the recent book Heal Your Brain: How the New Neuropsychiatry Can Help You Go from Better to Well, from Johns Hopkins University Press. He is widely known for his research on the treatment of chronic depression, including medication and psychotherapy studies.

Dr. Hellerstein has also received national recognition for his literary writing, and has been awarded the Pushcart Prize and several MacDowell Colony Fellowships. His other books include Battles of Life and Death (essays about medical training), Loving Touches (a novel), and A Family of Doctors (a memoir of five generations of doctors in one family), and his journalism has been published in magazines including Harper's and The New York Times Magazine.

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Heal your Brain: How Can I Become More Resilient