Resilience as a moderator of pain and stress

OBJECTIVE: To study the predictive validity of the Resilience Scale for Adults (RSA) experimentally in relation to pain and stress. METHOD: The submaximum tourniquet method was used to induce ischemic pain and stress. Eighty-four subjects were randomized to a low- or a high stress group, and selected to a low- or a high resilience group according to their scores on the RSA. Measures of pain and stress were taken every 5 min. RESULTS: Perceived pain and stress increased significantly throughout the experimental session, but individuals scoring high on the RSA reported less pain and stress. This protection was more pronounced for the high stress group, thus supporting a protective effect of resilience as measured by the RSA. CONCLUSIONS: The predictive validity of the RSA was confirmed. Due to the positive role of these factors in pain and stress perception, it may also be a promising measure for studies on pain patients.     

Low resilience in suicide attempters.

Resilience is an important personality feature that is thought to be protective against the development of psychiatric disorder. However, it appears not to have been previously examined directly in relation to suicidal behavior. Therefore, with the recent development of a resilience scale, the purpose of this preliminary study was to examine resilience in relation to attempting suicide. In order to do this 100 abstinent substance dependent patients were interviewed about whether or not they had ever attempted suicide and completed the Connor-Davidson Resilience Scale. The results showed that patients who had attempted suicide (N=41) had significantly lower resilience scale scores than patients who had never attempted suicide (N=59). This suggests the possibility that low resilience may be a risk factor for suicidal behavior. Longitudinal studies among suicide attempters, including measures of depression, may further evaluate the possible relevance of resilience to suicidal behavior.     

The recognition of mental health disorders and its association with psychiatric scepticism,knowledge of psychiatry,and the Big Five personality factors: an investigation using the overclaiming technique

The present study examined the general public’s ability to recognise mental health disorders and this ability’s association with psychiatric scepticism, knowledge of psychiatry, and the Big Five personality factors. A total of 477 members of the British general public completed an overclaiming scale, in which they were asked to rate the degree to which they believed 20 mental health disorders (of which five were foils designed to resemble real disorders) were real or fake. Participants also completed a novel scale measuring psychiatric scepticism, a single-item measure of knowledge of psychiatry, and a measure of the Big Five personality factors. Results showed that participants were significantly more likely to rate foils as fake disorders than real disorders. In addition, the difference between real and foil ratings was significantly predicted by knowledge of psychiatry, psychiatric scepticism, and the Big Five personality factors of agreeableness and openness to experience. These results are discussed in relation to the overclaiming technique as a novel method to study mental health literacy.     

Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC)

Resilience may be viewed as a measure of stress coping ability and, as such, could be an important target of treatment in anxiety, depression, and stress reactions. We describe a new rating scale to assess resilience. The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to subjects in the following groups: community sample, primary care outpatients, general psychiatric outpatients, clinical trial of generalized anxiety disorder, and two clinical trials of PTSD. The reliability, validity, and factor analytic structure of the scale were evaluated, and reference scores for study samples were calculated. Sensitivity to treatment effects was examined in subjects from the PTSD clinical trials. The scale demonstrated good psychometric properties and factor analysis yielded five factors. A repeated measures ANOVA showed that an increase in CD-RISC score was associated with greater improvement during treatment. Improvement in CD-RISC score was noted in proportion to overall clinical global improvement, with greatest increase noted in subjects with the highest global improvement and deterioration in CD-RISC score in those with minimal or no global improvement. The CD-RISC has sound psychometric properties and distinguishes between those with greater and lesser resilience. The scale demonstrates that resilience is modifiable and can improve with treatment, with greater improvement corresponding to higher levels of global improvement.     

Quelles échelles utiliser pour mesurer la résilience en psychiatrie adulte ?

This communication based on a literature review, summarizes the most appropriate evaluation scales which measure resilience in adult psychiatry, and lists the principal clinical dimensions studied in the articles on the topic. The objective of this communication is to provide psychiatric institutions which receive adult patients with a list of resilience evaluation scales we consider to be the most pertinent to measure resilience in that sector.MethodThe review was done using Pubmed on articles written between 2016 and 2019, using the terms “resilience scales in psychiatry” and “resilience scales in psychology”. Two hundred and seventy-eight articles were found. Fifty articles concerning mental health in adult psychiatry more precisely were kept, and we looked at which resilience evaluation scales were most used in those researches, and which associated clinical dimensions were studied. We started by defining resilience, as defined originally in physics, and how it was then derived in psychology, notably introduced in France by Boris Cyrulnik. We then looked at how resilience is measured in adult psychiatry. Some researchers such as Wagnild used instruments specifically designed to measure resilience. Ionescu & Jourdan-Ionescu did an inventory of the instruments, and Windle, Bennett & Noyes a review.ResultAfter briefly defining what resilience is, particularly in the psychological field, we succinctly summarized the 6 scales we consider to be the most adapted for researches on resilience in adult psychiatry and listed the main clinical dimensions that have been researched in the articles we kept. These six scales, are widely used, validated and adapted to clinical psychiatry. This communication is therefore a mini guide of the most adapted resilience evaluation scales for potential future researches in adult psychiatry. The Wagnild & Young Resilience scale was validated among women aged 53 to 95 and it has a French version widely used to measure resilience among the general and clinical population. The Fryborg et al. RSA also measures adult resilience and is useful to measure protective factors against psychological disorders. The Ponce-Garcia, Madwell & Kennison SPF apprehends a complete measure of resilience and is a reliable scale among survivors of violent trauma. The Roussow & Roussow Predictive 6-Factor Resilience Scale was based on a neurobiological basis of resilience and has also a good consistence with health hygiene scores. It is considered an efficient measure to use in improving resilience. Finally, The Resilience Questionnaire for Bipolar Disorder from Echezarraga, Las Hayas, González-Pinto & Jones specifically measures resilience among a bipolar disorders population. The main clinical dimensions which figured in researches on resilience were varied and numerous. Many refer to post-traumatic stress disorder (PTSD), especially among American veterans. Besides PTSD, dimensions linked to stress, depression and psychiatric disorders were also researched. Scales are the same as those used in general population. However, some are validated for a clinical population. These scales can measure the link between resilience and various clinical dimensions and disorders. This opens the door for researches in adult psychiatry using one or more of the scales described in this article.     

Personality differences in schizophrenia are related to performance on neuropsychological tasks

Altered cognition and personality appear to emerge in tandem and adversely affect outcome in schizophrenia, yet little research has been done to determine whether these are related or independent domains. In this study, the relationship between the Big Five personality traits--neuroticism, extraversion, openness, agreeableness, conscientiousness--and cognitive and motor performance in outpatients with chronic, clinically stable schizophrenia (N = 30) and age-matched healthy comparison subjects (N = 45) was examined. Subjects completed tests of attention, executive and motor functions, and the NEO-Five Factor Personality Inventory. Patients scored significantly higher on neuroticism and lower on extraversion and agreeableness, but after variance due to neuropsychological performance was statistically removed from NEO scale scores, personality dimensions and profiles no longer differed between groups. Neuropsychological performance and demographic variables, but not diagnosis, uniquely accounted for statistically significant amounts of personality variance, and neuropsychological task performance was correlated with personality dimensions in both patients and comparison subjects. These cross-sectional data provide preliminary evidence that personality dysfunction in schizophrenia may be mediated by disease-related changes in cognitive operations, or the neural processes underlying them. Longitudinal studies utilizing more comprehensive measures of neurocognitive performance are needed to define further the relationship between neuropsychological function and personality in schizophrenia.     

Factors associated with resilience in healthy adults

Mature defenses comprise one well-validated indicator of resilience. We investigated the relationships of resilience to trauma, attachment, temperament, cortisol, and cognitive performance in adult healthy volunteers. Participants were administered the Defense Style Questionnaire; the Relationship Questionnaire; the Childhood Trauma Questionnaire, and the Tridimensional Personality Questionnaire. Cortisol determinations included 24-h urinary, mean hourly plasma, response to low-dose dexamethasone suppression, and reactivity to the Trier social stress test (TSST). Mathematical performance during the TSST was quantified. Twenty-five women and 29 men participated. Resilience was significantly negatively correlated with childhood interpersonal trauma and with harm avoidance. Resilience was significantly positively correlated with urinary cortisol, secure attachment, reward dependence, and superior performance. In a linear regression analysis, the strongest predictor of resilience was childhood trauma, followed by math performance under stress and harm avoidance. We conclude that in young adults without manifest psychiatric disorder, resilience was associated with developmental, biological, and cognitive measures which merit further investigation.     

Measurement and predictors of resilience among community-dwelling older women

BackgroundResilience, the ability to adapt positively to adversity, may be an important factor in successful aging. However, the assessment and correlates of resilience in elderly individuals have not received adequate attention.MethodA total of 1395 community-dwelling women over age 60 who were participants at the San Diego Clinical Center of the Women’s Health Initiative completed the Connor–Davidson Resilience Scale (CD-RISC), along with other scales pertinent to successful cognitive aging. Internal consistency and predictors of the CD-RISC were examined, as well as the consistency of its factor structure with published reports.ResultsThe mean age of the cohort was 73 (7.2) years and 14% were Hispanic, 76% were non-Hispanic white, and nearly all had completed a high school education (98%). The mean total score on the CD-RISC was 75.7 (sd = 13.0). This scale showed high internal consistency (Cronbach’s alpha = 0.92). Exploratory factor analysis yielded four factors (somewhat different from those previously reported among younger adults) that reflected items involving: (1) personal control and goal orientation, (2) adaptation and tolerance for negative affect, (3) leadership and trust in instincts, and (4) spiritual coping. The strongest predictors of CD-RISC scores in this study were higher emotional well-being, optimism, self-rated successful aging, social engagement, and fewer cognitive complaints.ConclusionsOur study suggests that the CD-RISC is an internally consistent scale for assessing resilience among older women, and that greater resilience as assessed by the CD-RISC related positively to key components of successful aging.     

Resilience by design: How nature,nurture, environment,and microbiome mitigate stress and allostatic load

Resilience to psychological stress is defined as adaption to challenging life experiences and not the absence of adverse life events. Determinants of resilience include personality traits, genetic/epigenetic modifications of genes involved in the stress response, cognitive and behavioral flexibility, secure attachment with a caregiver, social and community support systems, nutrition and exercise, and alignment of circadian rhythm to the natural light/dark cycle. Therefore, resilience is a dynamic and flexible process that continually evolves by the intersection of different domains in human’s life; biological, social, and psychological. The objective of this minireview is to summarize the existing knowledge about the multitude factors and molecular alterations that result from resilience to stress response. Given the multiple contributing factors in building resilience, we set out a goal to identify which factors were most supportive of a causal role by the current literature. We focused on resilience-related molecular alterations resulting from mind-body homeostasis in connection with psychosocial and environmental factors. We conclude that there is no one causal factor that differentiates a resilient person from a vulnerable one. Instead, building resilience requires an intricate network of positive experiences and a healthy lifestyle that contribute to a balanced mind-body connection. Therefore, a holistic approach must be adopted in future research on stress response to address the multiple elements that promote resilience and prevent illnesses and psychopathology related to stress allostatic load.     

Validation of the deployment risk and resilience inventory in French-Canadian veterans: findings on the relation between deployment experiences and postdeployment health.

OBJECTIVES: This study had a twofold purpose: to validate the French-Canadian version of a measure of deployment risk and resilience factors and to examine the relation between deployment risk and resilience factors and postdeployment functioning. METHOD: Canadian veterans at an outpatient clinic (n = 131) completed a mail-in survey that included a measure on deployment risk and resilience factors, the Deployment Risk and Resilience Inventory (DRRI) (1), as well as measures on psychological and physical health. RESULTS: Internal consistency and test-retest reliability coefficients for the DRRI scales were very good. As expected, DRRI risk factors were negatively associated with psychological and physical functioning, and DRRI resilience factors were positively associated with psychological and physical functioning. Low- as well as high-magnitude deployment risk factors were associated with functioning. CONCLUSIONS: The French-Canadian version of the DRRI is a reliable and valid measure of deployment risk and resilience factors. Deployment risk and resilience factors are associated with a host of problems in physical and psychological functioning for veterans.     

Measuring resilience in women experiencing infertility using the CD-RISC: Examining infertility-related stress, general distress, and coping styles

Psychological morbidity concurrent with fertility problems has been the focus of substantial scientific inquiry. However, researchers have largely overlooked psychological resilience within this population. This study explored the associations between resilience, infertility-related and general distress, and coping behaviors in forty women from nine fertility clinics throughout the United States. Participants completed the Connor-Davidson Resilience Scale (CD-RISC), Symptom Checklist-90 (SCL-90), Beck-Depression Inventory-II (BDI-II), Fertility Problem Inventory (FPI), and Ways of Coping Questionnaire (WCQ). Women with fertility problems evidenced significantly lower resilience scores than published norms. This study established evidence for the reliability and convergent validity of the CD-RISC with infertile populations. However, similar to other studies using this instrument, the factor structure reported by Connor and Davidson [Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC). Depression and Anxiety 2003;18:76-82] was not well supported. Resilience was negatively associated with infertility-specific and general distress. Engagement in action-focused coping skills was positively correlated with resilience. Implications for enhancing resilience with this population as are discussed.     

Morphological brain measures of cortico‐limbic inhibition related to resilience

Resilience is the ability to adequately adapt and respond to homeostatic perturbations. Although resilience has been associated with positive health outcomes, the neuro‐biological basis of resilience is poorly understood. The aim of the study was to identify associations between regional brain morphology and trait resilience with a focus on resilience‐related morphological differences in brain regions involved in cortico‐limbic inhibition. The relationship between resilience and measures of affect were also investigated. Forty‐eight healthy subjects completed structural MRI scans. Self‐reported resilience was measured using the Connor and Davidson Resilience Scale. Segmentation and regional parcellation of images was performed to yield a total of 165 regions. Gray matter volume (GMV), cortical thickness, surface area, and mean curvature were calculated for each region. Regression models were used to identify associations between morphology of regions belonging to executive control and emotional arousal brain networks and trait resilience (total and subscales) while controlling for age, sex, and total GMV. Correlations were also conducted between resilience scores and affect scores. Significant associations were found between GM changes in hypothesized brain regions (subparietal sulcus, intraparietal sulcus, amygdala, anterior mid cingulate cortex, and subgenual cingulate cortex) and resilience scores. There were significant positive correlations between resilience and positive affect and negative correlations with negative affect. Resilience was associated with brain morphology of regions involved in cognitive and affective processes related to cortico‐limbic inhibition. Brain signatures associated with resilience may be a biomarker of vulnerability to disease. © 2016 Wiley Periodicals, Inc.     

Effects of dental fear treatment on general distress. The role of personality variables and treatment method

This study aimed to clarify the effects of applied relaxation, cognitive therapy, and nitrous oxide sedation on dental fear and general emotional distress symptoms. Relationships among outcome measures and the Big Five personality dimensions (i.e., Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness) were also investigated. After treatment, a highly significant decline in a broad range of emotional distress symptoms as well as dental fear was found. No main treatment method effect or treatment x phase interaction effect with regard to dental fear or distress symptoms was found. Thus, the three treatment methods had highly similar effects, at least on a short-term basis. Significant correlations between neuroticism, extraversion, and agreeableness on one hand, and emotional distress symptoms on the other, were demonstrated. However, when initial symptom level was controlled for in multiple regression analysis, the statistical effects of personality variables generally disappeared.     

Understanding the role of social capital in adolescents' Big Five personality effects on school-to-work transitions

The school-to-work transition constitutes a central developmental task for adolescents. The role of Big Five personality traits in this has received some scientific attention, but prior research has been inconsistent and paid little attention to mechanisms through which personality traits influence job-search outcomes. The current study proposed that the joint effects of Big Five personality traits and social capital (i.e., available resources through social relations) would shed more light on adolescents' job-search outcomes. Analyses on 685 Dutch vocational training graduates showed that extraversion and emotional stability were related to better job-search outcomes after graduation. Some relations between Big Five personality traits and job-search outcomes were explained by social capital, but no relations were dependent on social capital. Social capital had a direct relation with the number of job offers. Contrary to popular belief, this study shows that Big Five personality traits and social capital relate to job-search outcomes largely independently.     

Personality traits and self-harm behaviors among Chinese children and adolescents: The mediating effect of psychological resilience

BACKGROUNDPrevious studies have shown that personality traits are associated with self-harm (SH) in adolescents. However, the role of resilience in this association remains unclear. Our research aims to explore the hypothesized mediation effect of resilience in the relationship between personality traits and SH in Chinese children and adolescents.AIMTo evaluate resilience as a mediator of the association between personality traits and SH.METHODSA population-based cross-sectional survey involving 4471 children and adolescents in Yunnan province in southwestern China was carried out. Relevant data were collected by self-reporting questionnaires. Univariate and multivariate logistic regression models were employed to identify associated factors of SH. A path model was used to assess the mediation effect of resilience with respect to personality traits and SH association.RESULTSAmong the 4471 subjects, 1795 reported SH, with a prevalence of 40.1% (95%CI: 34.4%-46.0%). All dimensions of personality traits were significantly associated with SH prevalence. Resilience significantly mediated the associations between three dimensions of personality (extroversion, neuroticism, psychoticism) and SH, accounting for 21.5%, 4.53%, and 9.65%, respectively, of the total associations. Among all dimensions of resilience, only emotional regulation played a significant mediation role.CONCLUSIONThe results of the study suggest that improving emotion regulation ability might be effective in preventing personality-associated SH among Chinese children and adolescents.     

Some Youths have a Gloomy Side: Correlates of the Dark Triad Personality Traits in Non-Clinical Adolescents

This cross-sectional study examined the Dark Triad personality traits and their correlates in non-clinical youths aged 12–18 years (N = 117). Child- and parent-report data were obtained on Machiavellianism, narcissism, and psychopathy as well as on Big Five personality factors and symptoms of aggression and delinquency. Results indicated that especially Machiavellianism and psychopathy were in a theoretically meaningful way related to Big Five factors: that is, both traits were associated with lower levels of agreeableness, conscientiousness, and openness/intellect, and higher levels of emotional instability. Further, Machiavellianism and psychopathy also emerged as significant and unique correlates of symptoms of aggression and delinquency, which further underlines the importance of these Dark Triad traits in the pathogenesis of disruptive behavior problems in youths.     

An abbreviated version of the Connor-Davidson Resilience Scale (CD-RISC), the CD-RISC2: psychometric properties and applications in psychopharmacological trials

Resilience may be an important component of the prevention of neuropsychiatric disease. Resilience has proved to be quantifiable by scales such as the Connor-Davidson Resilience Scale (CD-RISC). Here, we introduce a two-item version of this scale, the CD-RISC2. We hypothesize that this shortened version of the scale has internal consistency, test-retest reliability, convergent validity, and divergent validity as well as significant correlation with the full scale. Additionally, we hypothesize that the CD-RISC2 can be used to assess pharmacological modification of resilience. We test these hypotheses by utilizing data from treatment trials of post-traumatic stress disorder, major depression, and generalized anxiety disorder with setraline, mirtazapine, fluoxetine, paroxetine, venlafaxine XR, and kava as well as data from the general population, psychiatric outpatients, and family medicine clinic patients.     

Measurement and predictors of resilience among community-dwelling older women

Background

Resilience, the ability to adapt positively to adversity, may be an important factor in successful aging. However, the assessment and correlates of resilience in elderly individuals have not received adequate attention.

Method

A total of 1395 community-dwelling women over age 60 who were participants at the San Diego Clinical Center of the Women’s Health Initiative completed the Connor-Davidson Resilience Scale (CD-RISC), along with other scales pertinent to successful cognitive aging. Internal consistency and predictors of the CD-RISC were examined, as well as the consistency of its factor structure with published reports.

Results

The mean age of the cohort was 73 (7.2) years and 14% were Hispanic, 76% were non-Hispanic white, and nearly all had completed a high school education (98%). The mean total score on the CD-RISC was 75.7 (sd = 13.0). This scale showed high internal consistency (Cronbach’s alpha = 0.92). Exploratory factor analysis yielded four factors (somewhat different from those previously reported among younger adults) that reflected items involving: (1) personal control and goal orientation, (2) adaptation and tolerance for negative affect, (3) leadership and trust in instincts, and (4) spiritual coping. The strongest predictors of CD-RISC scores in this study were higher emotional well-being, optimism, self-rated successful aging, social engagement, and fewer cognitive complaints.

Conclusions

Our study suggests that the CD-RISC is an internally consistent scale for assessing resilience among older women, and that greater resilience as assessed by the CD-RISC related positively to key components of successful aging.     

Risk Factors as Major Determinants of Resilience: A Replication Study

The present study was conducted in the context of current concerns about replication in psychological research. It claims that risk factors should be regarded as an integral part of the definition of individual resilience, which should be defined in terms of the balance between individual strength or protective factors, and individual vulnerability or risk factors (IND-SVR). Five independent samples, including 3457 Israeli participants, were employed to determine the effects of resilience promoting and resilience suppressing variables on the IND-SVR index of resilience, and on its two components: recovery from adversity, and distress symptoms. Five path analyses were employed for determining the role of distress symptoms as a measure of psychological resilience, as compared to other indices of this resilience. Results indicated the major role of risk factors (distress symptoms) as an integral component of resilience. This role was generally replicated in the five investigated samples. Risk factors are legitimate, valid, and useful parts of the definition of psychological resilience. Resilience research has shifted away from studying individual risk factors to investigating the process through which individuals overcome the hardships they experience. The present data seem to suggest that this shift should be reexamined.