Conceptualizing a resilience research framework at The National Institutes of Health

The National Institutes of Health (NIH) have recently gathered internal and external input towards a shared understanding of resilience in the wide context of human health and the biomedical sciences that would help accelerate advances in human health and its maintenance. This shared view is that resilience refers in general to a system's capacity to recover, grow, adapt, or resist perturbation from a challenge or stressor. Over time, a system's response to a challenge might show varied degrees of reactions that likely fluctuate in response to the type of challenge (internal and/or external), severity of the challenge, the length of time exposed to the challenge, other external factors and/or biological factors (innate and/or external). We have embarked on this special issue as an opportunity to explore commonalities amongst viewpoints on the science of resilience covered by the various NIH Institutes, Centers, and Offices (ICOs) with respect to the characterization of various systems, stressors, outcomes measures and metrics, and interventions and/or protective factors that are shared within each domain and across multiple domains. Here, resilience is characterized broadly by four areas of scientific study: molecular/cellular, physiologic, psychosocial and spiritual, and environmental/community resilience. Each area or domain provides general frameworks for designing studies that may help advance the science of resilience within the context of health maintenance. This special issue will also acknowledge the remaining gaps that impede advancement of the science of resilience and offer considerations for potential next steps towards addressing the research gaps.     

Complementary and integrative health therapies in whole person resilience research

Complementary and integrative health approaches can improve health and well-being, as well as play an important role in disease prevention. The concept of whole person health builds on these concepts by empowering individuals, families, communities, and populations to improve their health in multiple interconnected domains: biological, behavioural, social, and environmental. Research on whole person health involves studies of interconnected biological systems and complex approaches to prevention and treatment. Some of these approaches may involve methods of diagnosis and therapy that differ from those used in conventional Western medicine. Of growing interest is how complementary, integrative, and whole person health approaches contribute to resilience. This brief commentary describes an integrated framework for mapping the connections between various complementary and integrative health therapeutic inputs onto aspects of resilience, including the ability to resist, recover (partially or fully), adapt, and/or grow in response to a following a stressor. The authors present selected examples of research studies supported by the National Institutes of Health that test whether complementary and integrative health approaches can promote some aspect of resilience. We conclude with a discussion of the challenges and opportunities in incorporating the study of resilience in complementary, integrative, and whole person health research.     

Integrating sleep health into resilience research

Sleep is a biological necessity that is a critical determinant of mental and physical well-being. Sleep may promote resilience by enhancing an individual's biological preparedness to resist, adapt and recover from a challenge or stressor. This report analyzes currently active National Institutes of Health (NIH) grants focussed on sleep and resilience, specifically examining the design of studies that explore sleep as a factor that promotes health maintenance, survivorship, or protective/preventive pathways. A search of NIH R01 and R21 research project grants that received funding in Fiscal Years (FY) 2016–2021 and focussed on sleep and resilience was conducted. A total of 16 active grants from six NIH institutes met the inclusion criteria. Most grants were funded in FY 2021 (68.8%), used the R01 mechanism (81.3%), were observational studies (75.0%), and measured resilience in the context of resisting a stressor/challenge (56.3%). Early adulthood and midlife were most commonly studied and over half of the grants focussed on underserved/underrepresented populations. NIH-funded studies focussed on sleep and resilience, or the ways in which sleep can influence an individual's ability to resist, adapt, or recover from a challenging event. This analysis highlights an important gap and the need to expand research focussed on sleep as a promotor of molecular, physiological, and psychological resilience.     

Strength through adversity: Moderate lifetime stress exposure is associated with psychological resilience in breast cancer survivors

Stress research typically emphasizes the toxic effects of stress, but recent evidence has suggested that stress exposure, in moderation, can facilitate resilience. To test whether moderate stress exposure promotes psychological resilience to cancer, we examined the relationship between lifetime stress exposure prior to cancer diagnosis and postdiagnosis psychological functioning among 122 breast cancer survivors. Lifetime acute and chronic stress was assessed using an interview‐based measure, and psychological functioning was assessed using measures of cancer‐related intrusive thoughts and positive and negative affect. Results indicated that acute stress exposure was associated with cancer‐related intrusive thoughts in a quadratic fashion (p = .016), such that participants with moderate acute stress reported fewer intrusive thoughts compared to those with low or high acute stress. Similarly, a quadratic relationship emerged between acute stress exposure and positive affect (p = .009), such that individuals with moderate acute stress reported the highest levels of positive affect. In contrast, acute and chronic stress were related to negative affect in a positive, linear fashion (ps < .05). In conclusion, moderate stress exposure was associated with indicators of psychological resilience among breast cancer survivors, supporting stress exposure as a key factor influencing adjustment to breast cancer and providing evidence for stress‐induced resilience in a novel population.     

The stress and coping inventory: an educational and research instrument

Most research studies of stress and coping in a person's life utilize only one or two measures. As scientists, therefore, we become accustomed to seeing these topics in a limited perspective. As health care practitioners, however, we profit from a broader view of these fields. Practitioners of health promotion strive to alert patients and clients to several areas of life adjustment pertinent to health and disease. The Stress and Coping Inventory (SCI) was designed for this kind of health promotion, primarily as an educational instrument and secondarily as a research tool. Reliability testing, using Cronbach alpha correlations, was performed utilizing a sample of 1772 individuals. Intercorrelations run between SCI stress and coping indicators were all in the predicted direction and several were at moderately high orders of magnitude. Analysis of variance was carried out for stress and coping measures according to subjects' reports of recent health problems. Finally, stepwise multiple regression analysis was done, including validation, cross‐validation. Copyright © 2000 John Wiley & Sons, Ltd.     

Ageing and physical resilience after health stressors

The objectives of this article are to introduce a conceptual framework for physical resilience in the context of ageing and to discuss key elements and challenges in the design of studies of physical resilience after health stressors. Advancing age is associated with increasing exposure to multiple stressors and declining capacity to respond to health stressors. Resilience is defined broadly as the ability to resist or recover well from the adverse effects of a health stressor. In ageing-related study designs of physical resilience after a health stressor, this dynamic resilience response can be observed as changes in repeated measures of function or health status in various domains important to older adults. Methodologic issues in selecting the study population, defining the stressor, covariates, outcomes, and analytic strategies are highlighted in the context of an ongoing prospective cohort study of physical resilience after total knee replacement surgery. The article concludes with approaches to intervention development to optimize resilience.     

Stress‐related growth: pre‐intervention correlates and change following a resilience intervention

Correlates of stress‐related growth and the effectiveness of a resilience intervention to enhance stress‐related growth were examined. College students were randomly assigned to intervention (n = 31) and waiting list control (n = 33) groups. The intervention group received the psychoeducational intervention, Transforming Lives Through Resilience Education, in four weekly 2‐hour sessions. Measures of personal, environmental and stressor characteristics, coping strategies, adjustment and stress‐related growth were assessed. Multiple regressions revealed that pre‐intervention self‐esteem, self‐leadership, hopeful coping and depressive symptoms significantly related to pre‐intervention growth. A repeated measures analysis of variance yielded a significant group by time interaction for total growth; the intervention group showed greater increases in growth pre‐ to post‐intervention compared with the control group. Our results supported the relationships of self‐esteem and adaptive coping strategies to stress‐related growth and introduce a new correlate of growth, self‐leadership, to the literature. In addition, our results highlighted the complex role depressive symptoms may play in relation to growth, indicating that depressive symptoms might decrease one's inner resources while simultaneously serving as a catalyst for growth. Further, the findings supported the resilience intervention as a promising approach to facilitate growth. Copyright © 2009 John Wiley & Sons, Ltd.     

心理弹性对社区老年人心理压力与心理健康的中介效应

目的探讨心理弹性对社区老年人心理压力与心理健康的中介作用,尝试从新的角度为其缓解心理压力、促进心理健康提供干预的依据。方法采用心理弹性量表(RS-14)、中文版知觉压力量表(CPSS)和一般健康量表(CHQ-12),调查辽宁省锦州市凌河区、古塔区和太和区三个社区410名老年人,并运用SPSS17.0软件和AMOS17.0软件进行数据统计分析。结果心理弹性、心理压力和心理健康三者间存在线性相关关系,且心理弹性与心理健康、心理压力呈负相关。心理压力和心理弹性对心理健康都有预测作用,心理弹性亦可作为心理压力和心理健康之间的中介变量。结论心理弹性作为心理压力与心理健康的中介变量,使其不良影响有所下降。关注心理弹性的作用,并对其影响因素进行干预,是提升老年人心理健康的积极探索。     

The strength of pursuing your values: Valued living as a path to resilience among college students

Although stressful life events (SLEs) frequently relate to negative outcomes, many individuals demonstrate resilience by positively adapting to stressors without significant impairment. Valued living, a key process in the theory underpinning acceptance and commitment therapy is a response style characterized by daily purposeful actions that are linked to important values and may promote resilience in college students. This study examined the main and interactive effects of SLEs and valued living in the prediction of a multidimensional measure of resilience. Results supported a strong positive relationship between resilience and valued living. Further, valued living moderated the association between SLE negative impact scores and resilience (but not the association between cumulative prior year SLEs and resilience). Although SLE negative impact scores were negatively associated with resilience at lower levels of valued living, there was no demonstrated relationship at higher levels of valued living. Implications related to promoting valued living among college students in the service of increasing resilience are discussed.     

A dynamic,multilevel approach to conceptualising and designing resilience research in the context of military stress

Challenges in conceptualising resilience have impeded advancements in resilience science. In response, the National Institutes of Health (NIH) developed a general framework for harmonising the conceptualisation of resilience as a dynamic process determined by multiple systems and levels of analysis. Consistent with the NIH Resilience Framework, this paper presents a conceptual model of resilience applied to military service members. This model encompasses four core components necessary for resilience research: (1) the presence of significant challenge, (2) successful adaptation in response to the challenge, (3) the capacity for resilience (i.e., protective factors), and (4) the processes (i.e., mechanisms) by which protective factors exert positive effects on an individual's response. Guided by this conceptual model, we outline key methodological recommendations to advance resilience research and illustrate each using the Advancing Research on Mechanisms of Resilience study as an exemplar. We emphasise the need for future research to examine resilience as a dynamic process and apply a multilevel approach. We hope to provide a basic road map to those interested in improving the rigour of future research on resilience in a military context, the results of which can inform the development of interventions.     

A resilience intervention involving mindfulness training for transplant patients and their caregivers

Solid organ and stem cell transplant patients and their caregivers report a substantial level of distress. Mindfulness‐based stress reduction has been shown to alleviate distress associated with transplant, but there is limited experience in this population with other mindfulness‐based interventions, or with combined transplant patient and caregiver interventions. We evaluated a novel, 6‐week mindfulness‐based resilience training (MBRT) class for transplant patients and their caregivers that incorporates mindfulness practice, yoga, and neuroscience of stress and resilience. Thirty‐one heart, liver, kidney/pancreas, and stem cell transplant patients and 18 caregivers at Mayo Clinic in Arizona participated. Measures of stress, resilience, depression, anxiety, health‐related quality of life, positive and negative affect, and sleep were completed at baseline, 6 weeks, and 3 months postintervention. At 6 weeks and 3 months, patients demonstrated significant (P<.005) improvements from baseline in measures of perceived stress, depression, anxiety, and negative affect. Quality‐of‐life mental component (P=.006) and positive affect (P=.02) also improved at follow‐up. Most participants adhered to the program, were satisfied with class length and frequency, and reported improved well‐being as a result of the class. MBRT holds promise as an intervention to enhance resilience and manage stress for transplant patients and their caregivers.     

Perspectives on resilience: Trait resilience,correlates of resilience in daily life,and longer-term change in affective distress

Resilience describes successful adaptation in the face of adversity, commonly inferred from trajectories of well-being following major life events. Alternatively, resilience was conceptualised as a psychological trait, facilitating adaptation through stable individual characteristics. Both perspectives may relate to individual differences in how stress is regulated in daily life. In the present study, we combined these perspectives on resilience. Our sample consisted of N = 132 middle-aged adults, who experienced major life events in between two waves of a longitudinal study. We implemented latent change regression models to predict change in affective distress. As predictors, we investigated trait resilience and correlates of resilience in daily life (stressor occurrence, stress reactivity, positive reappraisal, mindful attention, and acceptance), measured using experience sampling (T = 70 occasions). Unexpectedly, trait resilience was not associated with change in distress. In contrast, resilience correlates in daily life, most notably lower stress reactivity, were associated with more favourable change. Higher trait resilience related to higher average mindfulness, higher reappraisal, and lower negative affect. Overall, while trait resilience translated into everyday correlates of resilience, it was not predictive of changes in affective distress. Instead, precursors of changes in well-being may be found in correlates of resilience in daily life.     

Cognitive function is well preserved in a cohort of breast cancer survivors: Roles of cognitive reserve,resilience, and general health

Many patients return to cognitively demanding work after breast cancer treatments. This makes treatment-related cognitive decline an important research topic. Psychological resilience, cognitive reserve and better perceived general health may work as protective factors against cognitive decline. The aim of this study was to analyse whether these factors are associated with cognitive function among such women.Data from 384 breast cancer survivors who underwent neuropsychological examination at follow-up 4–9 years after surgery were used. The neurocognitive domain variable Learning and Memory was computed from Wechsler Memory Scale-III subtests Learning and Delayed Recall. Another variable, Attention, Processing speed and Executive function, was computed from semantic and verbal fluency tests, Trail Making Test A and B, and Wechsler Adult Intelligence Test-IV subtest Coding. Psychological resilience was measured with Resilience Scale-14, and perceived general health with RAND-36 subitem General Health.Resultsshowed that levels of cognitive performance and general health were statistically higher than population average. Resilience and general health in separate models were associated with Attention, Processing speed and Executive function (β = 0.14, p = 0.01; β = 0.13, p = 0.03, respectively). When added simultaneously in the same model, resilience was significant (β = 0.13, p = 0.04), but general health was not. These associations were nonsignificant after controlling for confounding factors. Learning and Memory was not associated with resilience or general health.Future research should focus on longitudinal studies identifying patients at a high risk of developing cognitive decline after breast cancer treatments and on preventive and therapeutic approaches.     

Stress management and sexual health of young adults: a pilot randomised controlled trial

Young people often experience excessive stress that definitely undermines their sexual life and leads them to adopt risky sexual behaviours. As such, the design and application of a stress management programme in this particular age group is, undoubtedly, a crucial matter. In this parallel randomised controlled trial, 60 psychology students of the Panteion University of Athens, aged 18–20, were randomly assigned to undergo either an 8‐week stress management programme (n = 30; diaphragmatic breathing–progressive muscle relaxation and guided imagery, twice a day) or not (n = 30). Self‐reported validated measures were used to evaluate stress, stressful life events, health locus of control, general health status, sexual behaviours, sexual desire, satisfaction from sexual life and interpersonal relationships. Between‐group analyses revealed statistically significant differences in internal health locus of control and general health evaluation. Within the intervention group analyses showed reductions in BMI, stress, the ‘chance’ subscale of multidimensional health locus of control (MHLC) and greater satisfaction from sexual life. No other significant change was reported. We deem that our results should encourage relevant future studies.     

书写表达对妊娠期糖尿病患者心理弹性及自我效能的影响

目的探讨书写表达对妊娠期糖尿病患者心理弹性及自我效能的影响。方法将确诊的116例妊娠期糖尿病患者随机分为干预组和对照组各58例。对照组按常规实施健康教育及心理干预,干预组在对照组的基础上以书面表达形式进行干预。干预前后测评患者心理弹性及自我效能。结果干预后干预组心理弹性总分为54.10±11.23,自我效能得分为6.39±0.95,对照组得分分别为47.70±11.07、5.67±0.82,两组比较,差异有统计学意义(均P0.01)。结论以书面表达方式对妊娠期糖尿病患者进行干预,可提高其心理弹性,并提升患者自我效能,对改善患者妊娠期间的负性心理以及生活质量有重要作用。     

A Model of First‐responder Coping: An Approach/Avoidance Bifurcation

The work of first responders is fraught with numerous stressors, ranging from potentially traumatic critical incidents to institutional strains. The severity and pervasiveness of these difficulties prompt a necessary consideration of the coping methods employed by first responders. The present study developed an empirical model of first‐responder coping strategies, based upon a nationally representative survey sample of 6240 first responders. Participants were drawn from Swedish first responders in the following occupations: coast guard, customs control, military, emergency medical services, fire department and police services. In the final model, exposure to stress related to well‐being through several indirect paths that in sum accounted for the original direct relationship between these constructs. These several indirect paths were classified theoretically as either approach or avoidance coping behaviours or subsequent health outcomes. In general, approach coping behaviours were related to better well‐being; and avoidance was related to a decrease in the outcome. The size of the present sample, as well as the diverse nature of the included first responders, suggests that the resulting model may offer a unique insight into potentially adaptive pathways for first‐responder coping. Copyright © 2016 John Wiley & Sons, Ltd.