February 20th, 2024
Written by: Margaret Gardner
After decades of research, neuroscientists and psychologists have found many things, such as stress, trauma, low socioeconomic status, or genetic factors, that can negatively impact your brain and mental health. Experiencing the psychiatric risk factors increases a person’s odds of having mental illness or other types of neurological dysfunction. But it’s not all doom and gloom. Scientists have also identified plenty of protective psychological factors, or things that are associated with brain health, including yoga, a healthy gut microbiome, spending time in nature, and getting plenty of sleep. But what happens when you pit these risk factors and protective factors against each other? What wins out?
How do people overcome psychological risk?
Recently, researchers have begun to look at resilience, or the ability to adapt and maintain one’s mental and physical health in the face of psychological risk factors1. For example, not everyone who survives a traumatic event, like a natural disaster, will go on to have symptoms of post-traumatic stress disorder. What enables these people to cope? Do they have more protective factors, like regular exercise and a good diet? Do they have fewer additional risk factors, for example, lower everyday stress levels than those who did have psychiatric symptoms after the disaster? Or do they have some other quality or type of support that’s specifically helpful in adapting to and recovering from difficult situations? Researchers have dubbed this last kind of trait a psychological resilience factor, or something that helps protect the brain and mind against risk.
Some of these resilience factors may also be beneficial for everyone (for example, sleep and exercise2). However, research suggests that other resilience factors may not be helpful until they’re needed to “fight off” psychiatric risk. For instance, maybe you’re someone who has a Swiss army knife on your keychain. Most days you probably don’t think about it, and all the years you’ve had it you’ve certainly never needed those dinky little tweezers. Then one day, you get an enormous splinter – but lo! The tweezers! Even though they never made a difference before, the tweezers (resilience factor) were able to remove the splinter (risk factor) and your day wasn’t completely ruined. Researchers have found many examples of factors – like performance on a cognitive test, brain structure and activation, and genetic mutations – that promote resilience to different kinds of psychiatric risk3.
Is resilience really as good as it seems?
Amazing news, right? Well, problems can arise if we only use one measure – or one moment in time – to declare that someone is resilient to a particular risk factor. Some researchers have begun sounding the alarm bells about skin-deep resilience, which describes those who appear resilient on measures like mental illness questionnaires or cognitive tests but whose bodies are paying a heavy toll from the risk factors they experience4. For instance, one large study recently found that among Black and Hispanic youth from disadvantaged neighborhoods, better cognitive scores were associated with faster development during puberty5. Thus, while these kids seemed to be resilient (high cognitive function) to risk (minority stress, low socioeconomic status), under the surface they were showing signs of accelerated aging. This is important because as neuroscientists studying psychiatric risk and resilience, we tend to focus on whether someone has psychiatric symptoms and consider them healthy if they don’t. However, skin-deep resilience shows us that mental health is only part of the picture, and we can’t ignore the effects that psychological risk factors can have on the rest of the body. In addition to these physical harms, there’s evidence that some people who seem resilient as children experience more mental illness than their non-risk-facing peers later in life6, suggesting that maybe the resilience factors that help individuals overcome risk in the short term may not be all that effective in the long run.
What’s the point?
It’s possible that at this point you’re thinking “ok, why bother studying resilience anyway? Shouldn’t we just try to keep bad things from happening to people in the first place?” And the answer is yes, of course we should be doing everything we can as a society to minimize someone’s risk for mental illness. And neuroscience shows us that many of those efforts are paying off, such as how state-level assistance to low-income families reduces the negative impacts of poverty on children’s brain structure and depressive symptoms7. However, not all risk factors are preventable. Two common groups of focus in resilience research are survivors of childhood cancer or other serious illnesses8,9 and, more recently, all of us whose lives were affected by the COVID-19 pandemic. Ironically yet predictably, the social distancing that reduced the risk for COVID also increased risk for psychological problems10, and that’s not even to mention all the stress caused by illness, job loss, or working in healthcare11. Researchers have already identified a number of factors that seem to have protected people against the negative impacts of the COVID pandemic, from social support2 to level of education12 to humor13.
By identifying what sets resilient people apart, the ultimate goal of many resilience researchers is to increase these factors in others who are or may be at risk for mental illness. Some small studies have already begun testing different interventions designed to promote resilience, such as apps or school programs designed to teach emotional regulation14,15. While results so far have been limited16,17, they have the potential to improve the lives of countless people. However, researchers will need to ensure that these health benefits are lasting and more than just skin deep before declaring victory.
PS: Want to learn more about “skin deep” resilience? Check out this video from the University of Georgia!
References
1. Masten AS, Lucke CM, Nelson KM, Stallworthy IC. Resilience in Development and Psychopathology: Multisystem Perspectives. Annu Rev Clin Psychol. 2021;17:521-549. doi:10.1146/ANNUREV-CLINPSY-081219-120307
2. Kiss O, Alzueta E, Yuksel D, et al. The Pandemic’s Toll on Young Adolescents: Prevention and Intervention Targets to Preserve Their Mental Health. J Adolesc Health Off Publ Soc Adolesc Med. 2022;70(3):387-395. doi:10.1016/J.JADOHEALTH.2021.11.023
3. Stainton A, Chisholm K, Kaiser N, et al. Resilience as a multimodal dynamic process. Early Interv Psychiatry. 2019;13(4):725-732. doi:10.1111/EIP.12726
4. Skin-deep resilience. Center for Family Research. Accessed February 14, 2024. https://cfr.uga.edu/for-researchers/research-digests/skin-deep-resilience/
5. Barton AW, Yu T, Gong Q, Chen E, Miller GE, Brody GH. Skin-deep Resilience and Early Adolescence: Neighborhood Disadvantage, Executive Functioning, and Pubertal Development in Minority Youth. J Youth Adolesc. Published online November 28, 2023. doi:10.1007/s10964-023-01911-6
6. Copeland WE, Halvorson-Phelan J, McGinnis E, Shanahan L. Adult Mental Health, Substance Use Disorders, and Functional Outcomes of Children Resilient to Early Adversity. Am J Psychiatry. 2023;180(12):906-913. doi:10.1176/appi.ajp.20230038
7. Weissman DG, Hatzenbuehler ML, Cikara M, Barch DM, McLaughlin KA. State-level macro-economic factors moderate the association of low income with brain structure and mental health in U.S. children. Nat Commun. 2023;14(1):2085. doi:10.1038/s41467-023-37778-1
8. Salsman JM, Rosenberg AR. Fostering resilience in adolescence and young adulthood: Considerations for evidence-based, patient-centered oncology care. Cancer. n/a(n/a). doi:10.1002/cncr.35182
9. Seiler A, Jenewein J. Resilience in Cancer Patients. Front Psychiatry. 2019;10:208. doi:10.3389/fpsyt.2019.00208
10. Low RST, Overall NC, Chang VT, Henderson AME, Sibley CG. Emotion regulation and psychological and physical health during a nationwide COVID-19 lockdown. Emot Wash DC. 2021;21(8):1671-1690. doi:10.1037/emo0001046
11. Vindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun. 2020;89:531-542. doi:10.1016/j.bbi.2020.05.048
12. Shilton T, Mancini AD, Perlstein S, et al. Contribution of risk and resilience factors to anxiety trajectories during the early stages of the COVID-19 pandemic: A longitudinal study. Stress Health J Int Soc Investig Stress. 2023;39(4):927-939. doi:10.1002/smi.3233
13. Kuhlman KR, Straka K, Mousavi Z, Tran ML, Rodgers E. Predictors of Adolescent Resilience During the COVID-19 Pandemic: Cognitive Reappraisal and Humor. J Adolesc Health Off Publ Soc Adolesc Med. 2021;69(5):729-736. doi:10.1016/J.JADOHEALTH.2021.07.006
14. Chen J, Johnstone KM, Kemps E. A randomised controlled trial evaluating two universal prevention programs for children: Building resilience to manage worry. J Affect Disord. 2022;297:437-446. doi:10.1016/j.jad.2021.10.079
15. MacIsaac A, Mushquash AR, Mohammed S, Grassia E, Smith S, Wekerle C. Adverse Childhood Experiences and Building Resilience With the JoyPop App: Evaluation Study. JMIR MHealth UHealth. 2021;9(1):e25087. doi:10.2196/25087
16. Eadeh HM, Breaux R, Nikolas MA. A Meta-Analytic Review of Emotion Regulation Focused Psychosocial Interventions for Adolescents. Clin Child Fam Psychol Rev. 2021;24(4):684-706. doi:10.1007/S10567-021-00362-4
17. Leppin AL, Bora PR, Tilburt JC, et al. The Efficacy of Resiliency Training Programs: A Systematic Review and Meta-Analysis of Randomized Trials. PLOS ONE. 2014;9(10):e111420. doi:10.1371/JOURNAL.PONE.0111420
Cover photo by Bhuwan Purohit from Pixabay
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