What Resilience Is, What Not, And Why It Is So Important

The problem

After decades of research on stress-related disorders and massive improvements in their treatment, we still haven’t been able to reduce their frequency. Still, each year, more than half a billion people in the world are affected by anxiety, post-traumatic stress disorder (PTSD), depression, or addiction, that is, conditions that often occur as a consequence of exposure to stressors, such as traumatic events, challenging life circumstances or life transitions, or physical illness . 

Still, each year, more than half a billion people in the world are affected by a stress-related disorder.

In the year 2013, major depression was found to be the second leading cause of disability in the world; anxiety disorders ranked 9th . Behind these numbers, there is much individual suffering, heavy burden on families, friends, colleagues as well as on health  systems - and important economic consequences. So, in Europe alone, stress-related disorders are believed to cause direct and indirect economic costs in the range of €200 billion every year . 

The ten leading causes of disability

The ten leading causes of disability in 2013, world-wide, adapted from

Prevalence of common mental disorders world-wide (WHO)

Prevalence (frequency) of depression and anxiety disorders, adapted from WHO Global Health Estimates 2017

An alternative strategy

As resilience researchers, we are intrigued by the observation that we make again and again and that has been confirmed by studies in different countries, cultures, and circumstances: most people maintain good mental health although they are exposed to severe psychological or physical adversity . Hence, we try to understand why some people do not, or only temporarily, develop stress-related mental dysfunction when life hits them, whereas the same kind of challenges cause long-term dysfunction in other people. Our thinking is: If we can find out what protects resilient people against disease, we might use this knowledge to develop new methods to also prevent disease in people who are at a particular risk of developing stress-related mental disorders. Improving prevention could be a genuine contribution to reducing the prevalence of these disorders and could be more efficient than trying to treat a disorder at a stage where significant individual suffering and other costs have already occurred . For these reasons, CRC 1193 has set itself the overarching goal to operate a paradigm shift away from investigating mechanisms of disease towards investigating mechanisms of health. 

Paradigm shift

Related paper:

For a detailed conceptual discussion, see our resilience review and theory paper in Behavioral and Brain Sciences.

Paper Behavioral and Brain Sciences

What resilience is, and what not

It is frequently believed that resilience is a fixed trait or individual characteristic or predisposition that, if you have it, will protect you against the negative consequences of stressor exposure . However, individuals change while they successfully cope with stressors. This sometimes manifests at the level of altered perspectives on life , as emergence of new strengths or competences , as partial immunization against the effects of future stressors , or even as epigenetic alterations and modified gene expression patterns . What this probably means is that the maintenance or quick recovery of mental health results from some kind of positive adaptation to stressors. 

Recent animal studies strongly support the idea that organisms learn to cope with adversity when they meet adversity, and that such adaptive changes are the immediate cause of why an organism maintains its function . This also means that resilience is not simply insensitivity to stressors, or inertia, or passivity, but a consequence of an active and dynamic process of adaptation .

Related paper:

A detailed discussion of the definition, operationalization and measurement of resilience can soon be found in our position paper in Nature Human Behaviour.

Paper Nature Human Behaviour

CRC 1193 therefore has the primary goal to identify and understand the processes, or mechanisms, that protect individuals against stress-related dysfunction. In line with this process-oriented perspective, we define resilience as the maintenance or quick recovery of mental health during and after periods of adversity, resulting from a dynamic process of adaptation .

Vos T, Global Burden of Disease Study 2013 Collaborators (2015) Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet 386:743–800.

Vos T, Global Burden of Disease Study 2013 Collaborators (2015) Global,  regional, and national incidence, prevalence, and years lived with  disability for 301 acute and chronic diseases and injuries in 188  countries, 1990–2013: a systematic analysis for the Global Burden of  Disease Study 2013. The Lancet 386:743–800.

Olesen J, Gustavsson A, Svensson M, Wittchen HU, Jönsson B, CDBE2010 study group, European Brain Council (2012) The economic cost of brain disorders in Europe. Eur J Neurol 19:155–162.

Vos T, Global Burden of Disease Study 2013 Collaborators (2015) Global,  regional, and national incidence, prevalence, and years lived with  disability for 301 acute and chronic diseases and injuries in 188  countries, 1990–2013: a systematic analysis for the Global Burden of  Disease Study 2013. The Lancet 386:743–800.

WHO Global Health Estimates 2017

Bonanno GA, Westphal M, Mancini AD (2011) Resilience to Loss and Potential Trauma. Annu Rev Clin Psychol 7:511–535.

Boden JM, McLeod GFH (2015) Resilience and psychiatric epidemiology: Implications for a conceptual framework. Behav Brain Sci 38:e95.

Chang LJ, Reddan M, Ashar YK, Eisenbarth H, Wager TD (2015) The challenges of forecasting resilience. Behav Brain Sci 38:e98.

Sapienza JK, Masten AS (2011) Understanding and promoting resilience in children and youth. Curr Opin Psychiatry 24:267–273.

Schultze-Lutter F, Schimmelmann BG, Schmidt SJ (2016) Resilience, risk, mental health and well-being: associations and  conceptual differences. Eur Child Adolesc Psychiatry 25:459–466.

Tedeschi RG, Calhoun LG (2004) Posttraumatic growth: conceptual foundations and empirical evidence. Psychol Inq 15:1–18.

Joseph S, Linley PA (2006) Growth following adversity: Theoretical perspectives and implications for clinical practice. Clin Psychol Rev 26:1041–1053.

Johnson SF, Boals A (2015) Refining our ability to measure posttraumatic growth. Psychol Trauma Theory Res Pract Policy 7:422–429.

Luthar SS, Cicchetti D, Becker B (2000) The construct of resilience: a critical evaluation and guidelines for future work. Child Dev 71:543–562.

Seery MD, Holman EA, Silver RC (2010) Whatever does not kill us: Cumulative lifetime adversity, vulnerability, and resilience. J Pers Soc Psychol 99:1025–1041.

Seery MD, Leo RJ, Lupien SP, Kondrak CL, Almonte JL (2013) An upside to adversity?: moderate cumulative lifetime adversity is associated with resilient responses in the face of controlled stressors. Psychol Sci 24:1181–1189.

Boks MP, van Mierlo HC, Rutten BP, Radstake TR, De Witte L, Geuze E, Horvath S, Schalkwyk LC, Vinkers CH, Broen JC, Vermetten E (2015) Longitudinal changes of telomere length and epigenetic age related to traumatic stress and post-traumatic stress disorder. Psychoneuroendocrinology 51:506–512.

Breen MS, Maihofer AX, Glatt SJ, Tylee DS, Chandler SD, Tsuang MT, Risbrough VB, Baker DG, O'Connor DT, Nievergelt CM, Woelk CH (2015) Gene networks specific for innate immunity define post-traumatic stress disorder. Mol Psychiatry 20:1538-1545.

Krishnan V, Han MH, Graham DL, Berton O, Renthal W, Russo SJ, Laplant Q, Graham A, Lutter M, Lagace DC, Ghose S, Reister R, Tannous P, Green TA, Neve RL, Chakravarty S, Kumar A, Eisch AJ, Self DW, Lee FS, Tamminga CA, Cooper DC, Gershenfeld HK, Nestler EJ (2007) Molecular Adaptations Underlying Susceptibility and Resistance to Social Defeat in Brain Reward Regions. Cell 131:391–404.

Friedman AK, Walsh JJ, Juarez B, Ku SM, Chaudhury D, Wang J, Li X, Dietz DM, Pan N, Vialou VF, Neve RL, Yue Z, Han MH (2014) Enhancing depression mechanisms in midbrain dopamine neurons achieves homeostatic resilience. Science 344:313–319.

Wang M, Perova Z, Arenkiel BR, Li B (2014) Synaptic modifications in the medial prefrontal cortex in susceptibility and resilience to stress. J Neurosci 34:7485–7492.

Russo SJ, Murrough JW, Han MH, Charney DS, Nestler EJ (2012) Neurobiology of resilience. Nat Neurosci 15:475–1484.

Kalisch R, Baker DG, Basten U, Boks MP, Bonanno GA, Brummelman E, Chmitorz A, Fernàndez G, Fiebach CJ, Galatzer-Levy I, Geuze E, Groppa S, Helmreich I, Hendler T, Hermans EJ, Jovanovic T, Kubiak T, Lieb K, Lutz B, Müller MB, Murray RJ, Nievergelt CM, Reif A, Roelofs K, Rutten BPF, Sander D, Schick A, Tüscher O, Van Diest I, van Harmelen A-L, Veer IM, Vermetten E, Vinkers CH, Wager TD, Walter H, Wessa M, Wibral M, Kleim B (2017) The resilience framework as a strategy to combat stress-related disorders. Nat Hum Behav 1:784-90.