Evidence-Based Reviews

6 keys to resilience for PTSD and everyday stress

Current Psychiatry. 2007 April;6(4):23-30

References

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Table 2

Neurobiology of resilience:
Factors that influence physiologic stress response

Selected neurobiological factors	Effect on stress response
Up-regulators
Norepinephrine	Neurohormone and neurotransmitter released by the locus ceruleus in response to stress; sympathetic nervous system mediator; increases autonomic arousal (elevates blood pressure, heart rate); facilitates fear memory formation
Cortisol	Glucocorticoid released by adrenals in response to HPA axis activation by locus ceruleus; increases arousal, attention, and fear memory formation; initially adaptive, but prolonged/excess release has harmful systemic effects (hypertension, osteoporosis, immune suppression)
Down-regulators
DHEA	Steroid released by adrenal cortex under stress; down-regulates stress response; has antiglucocorticoid activity; may protect against PTSD
NPY	Neuropeptide that counters locus ceruleus activity; blocks release of cortisol; anxiolytic
Galanin	Neuropeptide that counters locus ceruleus activity; anxiolytic
Other neurotransmitters
Dopamine	Optimal levels enable reward system functioning; excess or deficit linked to learned helplessness and stress
Serotonin	Mixed effects, but high activity at 5HT1A receptors is linked to resilience
DHEA: dehydroepiandrosterone; HPA: hypothalamic-pituitary-adrenal; NPY: neuropeptide Y; PTSD: posttraumatic stress disorder

CASE CONTINUED: ‘I’m not bitter’

Ms. M can make an occasional joke about her attack and the massive stacks of paperwork she must sort through to pay medical bills and get reimbursed by insurance. She says, “I’m not bitter. I don’t want to carry that anger around for the rest of my life, so I won’t.”

4. A moral compass

Religious faith is associated with lower rates of depression in many populations, including college students, bereaved adults, and elderly hospitalized patients.²¹ Religious faith is not essential to a strong moral compass, however.

Morality appears to have a neural basis—a hypothesis supported by the observation that brain injury can damage one’s moral sense. “Acquired sociopathy” can result from trauma to certain brain areas, including the anterior prefrontal cortex and anterior temporal lobes.

‘Required helpfulness.’ Altruism—putting one’s moral compass into action—benefits the person who practices it and the person who receives it. Persons who help others perceive themselves as necessary and derive fulfillment. This phenomenon known as “required helpfulness” was first described during World War II, when those who cared for others after bombardments suffered less posttraumatic psychopathology than those who did not.²²

Some individuals find healing in a “survivor mission” after personal tragedy, helping others cope with the same problem they faced. Mothers Against Drunk Driving—founded by mothers who lost children in car accidents—is one example.²³

CASE CONTINUED: Altruism in action

Ms. M hopes to prevent attacks on other women. She participates in an organization that teaches women self-defense. She also speaks publicly for women’s safety and works with a local board to help defray crime survivors’ medical costs.

5. Social support

Individuals with strong social support tend to be more resilient than those without.²⁴ Social support can reduce risk-taking behavior, encourage active coping, decrease loneliness, increase feelings of self-worth, and help a person put problems into perspective. A lack of social support correlates with depression, stress, and increased morbidity and mortality during medical illness.

Role models. People can learn to manage stress by mimicking the behavior of someone they respect. Many resilient adults credit a parent, grandparent, or other role model for teaching them to act honestly and inspiring them to be strong. In a study of 770 teenagers, those who had a strong nonparental mentor (such as a neighbor, teacher, or coach) reported less drug use and delinquency and a greater belief in the importance of school than those without such a mentor.²⁵

Clinical Point

Individuals who successfully overcome adverse events usually manage to find meaning in their tragedy

CASE CONTINUED: Dad’s her role model

When she has bad days, Ms. M draws strength by thinking about her father, who has suffered much and whom she respects.

6. Cognitive flexibility

Being able to positively reframe negative events (“cognitive reappraisal”) is crucial to resilience. Individuals who successfully overcome adverse events usually manage to find some meaning in their tragedy.

Psychiatrist and Holocaust survivor Viktor Frankl²⁶ wrote of the importance of “meaning making.” Despite suffering for years in Nazi concentration camps, Frankl wrote that he gained the opportunity to exercise inner strength and be “brave, dignified and unselfish.” He struggled to survive because he came to believe that his suffering had a purpose: to live to teach others about his experiences.

Neuroimaging studies indicate that individuals who use cognitive reappraisal to deal with adversity have strong “top-down control” of emotions. They can modify their reaction to stress or trauma by activating the prefrontal cortex, which then modulates amygdalar response to the situation.²⁷

CASE CONTINUED: Reappraisal

Although Ms. M wishes she had never been attacked and can find no rational explanation for it, she is weaving the event into the fabric of her life. She insists she has become stronger, wiser, and safer and wants to share her story with others.