resilience - how nature & nurture shape us · stress inoculation. 1. resilience training...

© 2019 Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD Lundbeck, LLC.

The information provided by PsychU is intended for your educational benefit only. It is not intended as, nor is it a substitute for medical care or advice or professional diagnosis. Users seeking medical advice should consult with their physician or other health care professional.

February 2019 MRC2.CORP.D.00402

ResilienceHow Nature & Nurture Shape Us


Today’s Speakers

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Aida Mihajlovic, MD, MS• Clinical Assistant Professor, Psychiatry, UIC• Member, American Psychiatric Association Disaster Psychiatry Committee• Member, GAP Committee On Political Violence & Terrorism• Fellow, American College Of Psychiatrists• Board Member, AASP• Council Member, Illinois Psychiatric Society• Chair, Women’s Committee, Illinois Psychiatric Society

Greg Mattingly, MD• Associate Clinical Professor, Washington University School Of Medicine• Principal Investigator, Clinical Trials, Midwest Research Group• Founding Partner, St. Charles Psychiatric Associates• Board Member, Headway House• Member, Board Of Directors, American Professional Society Of ADHD &

Related Disorders• Certified Evaluator, ADHD / Head Concussions, National Football League

This program is paid for by Otsuka Pharmaceutical Development &

Commercialization, Inc. and Lundbeck, LLC.

Speakers are paid consultants for Otsuka Pharmaceutical Development & Commercialization, Inc.

The information provided by PsychU is intended for your educational benefit only. It is not intended as, nor is it a substitute for medical care or advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional.


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• Understand the meaning of resilience

• Discuss how nature and nurture shape an individual’s response to stress

• Cover factors related to resilience as well as the measurement of resilience in individuals

• Review strategies regarding resilience in individuals

Our Objectives

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Defining Resilience & The Role Of Stress


• The ability to “bounce back” after encountering difficulty

– Complex, multidimensional, and dynamic in nature1

• APA Definition“the process of adapting well in the face of adversity, trauma, tragedy, threats, even significant sources of stress – such as family and relationship problems, serious health problems, or workplace and financial stresses”2

• Can Include Systems “the capacity of a system, enterprise, or person to maintain its core purpose and integrity in the face of dramatically changed circumstances”3

Defining Resilience

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APA = American Psychiatric Association 1. Southwick & Charney 2012 Resilience: The Science of Mastering Life’s Greatest Challenges.2. Zolli & Healy 2013 Resilience: Why Things Bounce Back Simon and Schuster


Stress Response

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1. Russo et al. 2012. Neurobiology of Resilience. Nature Neuroscience 15(11): 1475–1484.

Impaired Adaptation

Control

Stress Innoculation

Impaired Stress Response


Stress & The HPA-Axis

HPA modification may occur as a result of stressful life events

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HPA = Hypothalamus-Pituitary-Adrenal1. Bondy B. Dialogues Clin Neurosci. 2002;4(1):7-202. Russo et al. 2012. Neurobiology of Resilience. Nature Neuroscience 15(11): 1475–1484


Early Life Stress & Epigenetic Change

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BDNF = Brain-Derived Neurotrophic Factor; PFC = Prefrontal Cortex1. Dwyer, J. & Ross, D. 2017 Biological Psychiatry2. Cao-Lei, L. et al., 2017 Neuroscience and Biobehavioral Reviews

3. Conradt , E. et al 2013 Epigenetics4. Morrison, K.et al. 2017 Biological Psychiatry

Stress Events During Animal Or Human Pregnancy

• Depression• Anxiety• Psychosocial

distress1,2,3

Epigenetic Modifications

• DNA methylation• Histone

modification• Non-coding

RNAs1,2

PFC, Hippocampus Alterations In Offspring

• Inefficient negative feedback in HPA axis

• Prolonged stress hormone circulation

• High stress reactivity phenotype

• Psychiatric illnesses1,2,3

Epigenetic changes associated with maternal stress may be transgenerational2


Common Epigenetic Mechanisms

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DNA = Deoxyribonucleic Acid1. Russo et al. 2012. Neurobiology of Resilience. Nature Neuroscience 15(11): 1475–1484.2. National Institutes of Health. https://commonfund.nih.gov/sites/default/files/epigeneticmechanisms.pdf

Methylation of DNA causes nucleosomes to pack tightly together. Transcription factors cannot bind the DNA, and genes are not expressed.

Histone acetylation results in loose packing of nucleosomes. Loose chromatin, in which DNA is relaxed and histones are spread apart. Transcription factors can bind the DNA and genes are expressed.


Genes, Stress, & Resilience

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1. Russo et al. 2012. Neurobiology of Resilience. Nature Neuroscience 15(11): 1475–1484.

Genetics1. NPY

2. 5HT

3. HPA Axis

Stress Inoculation1. Resilience Training

Therapy

2. Early Life Experience

Epigenetics1. K+ Channel Induction & Neuronal Silencing

2. ∆FosB Mediated GluA2 Transcription

3. Crh Gene Methylation & SuppressionStress Resilience1. Active Coping

2. Increased Fitness


Resilience Factors Beyond Stress


• Developmental– Loving & Supportive

Environments – Positive Relationships – Supportive, Attentive, &

Responsible Parenting– Avoidance Of Repeated Exposure

To Unavoidable Stress / Trauma

• Psychosocial– Strong Social Skills & Networks– Secure Attachment– Self-Confidence– Realistic Optimism

• Neurochemical– Neurotransmitters– Neurotrophic Factors (i.e. BDNF)– These may not be static across

the lifespan

Resilience Factors

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BDNF = Brain-Derived Neurotrophic Factor1. Wu et al. 2013 Frontiers in Behavioral Neuroscience 7(10):1-15.


Some health-related factors may be modified to enhance overall wellness and lifespan:

– Smoking status– Cardiovascular Health– Weight management– Diet– Activity Level– Alcohol Consumption

Modifiable Factors To Health & Longevity

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1. Yates et al. 2008 ARCH INTERN MED 168(3):284-290.


Measuring & Building Resilience


• Windle et al. 2011 examined 15 scales for content validity, internal consistency, criterion validity, construct validity, reproducibility, responsiveness, floor and ceiling effects, and interpretability

• No ‘gold standard’ found

• Most robust* psychometric properties found in 3 scales:– Connor Davidson Resilience

Scale– Resilience Scale For Adults– Brief Resilience Scale

Resilience Scales

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1. Windle, Bennett & Noyes 2011 A methodological review of resilience measurement scales. Health and Quality of Life Outcomes, 9, 8

*considered moderate level of quality


Connor-Davidson Resilience Scale

Multiple versions available, original 25 item scale* included assessment of:

– Adaptability to Change– Close & Secure Relationships– Religious Faith– Capacity to deal with change– Past successes with challenge(s)– Ability to Find Humor– Coping with Stress– Tendency to bounce back from illness/hardship– Tenacity/discouragement by failure– Ability to function/think under pressure– Self-assessment of strength– Sense of purpose– Willingness to work for goals– Pride in Achievements

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1. Connor & Davidson 2003 DEPRESSION AND ANXIETY 18:76–82.

*Not all items on the 25 item scale are noted above.


Brief Resilience Scale1,2,3

• Designed and intended to assess resilience under its original etymology – a measure of ability to bounce back or recover from stress

• 6-item self-administered instrument; validated in English and Spanish

• The scale asks the reporter to rate the extent of their agreement with each item utilizing the following 5 point Likert-Scale:

1. = Strongly Disagree2. = Disagree3. = Neutral4. = Agree5. = Strongly Agree

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The BRS is available with permission of author, Bruce W. Smith. 1. Smith, B., et. al. (2018). The brief resilience scale: Assessing the ability to bounce back. International Journal Of Behavioral Medicine, 15(3); pp. 194-200.2. Smith, B., et. al. (2010). The foundations of resilience: What are the critical resources for bouncing back from stress? Resilience in Children, Adolescents, and Adults: Translating Research Into

Practice (pp. 167-187). New York, NY: Springer.3. Smith, B.W., Tooley, E.M., Christopher, P.J., & Kay, V.S. (2010). Resilience as the ability to bounce back from stress: A neglected personal resource? The Journal of Positive Psychology, 5(3); pp.

166-176.

The Psychiatric Rating Scales Collection is Available On

PsychU.org*

*This questionnaire is provided for PsychU member’s screening and educational purposes only and is not to be used as a diagnostic tool.


• Facing Your Fears

• Cultivating Realistic Optimism

• Seeking & Accepting Social Support

• Emulating A Competent Role Model

• Following Your Moral Compass

• Turning To Religion/Spirituality

• Cognitive & Emotional Flexibility

• Emphasizing Physical & Brain Fitness

• Finding Meaning & Opportunities To Problem Solve

• Accepting Responsibility For Your Own Emotional Well-Being

Individual Resilience-Building Factors

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1. Southwick & Charney 2012 Resilience: The Science of Mastering Life’s Greatest Challenges


12-week course for family caregivers of individuals with severe mental illnesses1

Program Goals:

Compared with a wait-list control group, NAMI Family-To-Family2:• Increased empowerment and

knowledge• Improved emotion-focused

coping• Reduced family distress• Improved problem solving

Family-Focused Resilience EducationNAMI Family-To-Family Education Program

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NAMI = National Alliance On Mental Illness.1. National Alliance on Mental Illness. Family-to-Family Education Program. Available at: https://namica.org/programs/family/family-to-family-2/. Accessed February 8, 2019. 2. Dixon LB, et al. Psychiatr Serv. 2011;62(6):591-597.

Impr

ove • Education

• Empathy• Understanding• Problem solving • Listening• Communication• Crisis resolution


UCLA Health’s Families OverComing Under Stress (FOCUS)1 Programhttps://nfrc.ucla.edu/FOCUS

Short-term Intervention(6-8 sessions, customizable)• Identify, manage, and discuss

emotions• Clarify misunderstandings • Build on family strengths• Feel closer and more supported• Use family-level problem solving and

goal setting

Partnership For Resiliencehttps://partnership4resilience.org/about/

Penn Arts & Sciences PERMAhttps://ppc.sas.upenn.edu/services/penn-resilience-training

American Psychological Associationhttps://www.apa.org/HELPCENTER/road-resilience

Family-Focused Resilience EducationOther Available Programs

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1. University of California, Los Angeles. FOCUS Program. Available at: nfrc.ucla.edu/FOCUS. Accessed January 29, 2019.2. Partnership for Resilience. Available at https://partnership4resilience.org. Accessed February 8, 2019.3. University of Pennsylvania. Available at https://ppc.sas.upenn.edu/services/penn-resilience-training Accessed February 8, 2019.4. American Psychological Association Available at https://www.apa.org/HELPCENTER/road-resilience Accessed February 8, 2019.

https://nfrc.ucla.edu/FOCUS

https://partnership4resilience.org/about/

https://ppc.sas.upenn.edu/services/penn-resilience-training

https://www.apa.org/HELPCENTER/road-resilience


• Exercise– Evidence from one study (N=16) of mildly

depressed individuals showed show exercise enhanced the effects of CBGT, significantly increasing1:

• Remission & response rates• Cardiorespiratory fitness• Cognitive function• Sleep quality• BDNF levels

– Pajonk and colleagues found increased hippocampal volume that correlated with improved short-term memory following months aerobic exercise in subjects with schizophrenia2

• Increasing BDNF may impact resilience3

• Sleep quality can impact resilience4

What Builds Resilience?

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MDD = Major Depressive Disorder; CBGT = Cognitive Behavioral Group Therapy; BDNF = Brain-Derived Neurotrophic Factor1. Gourgouvelis et al. 2018 Frontiers in Psychiatry 9(37):1-12. 2. Pajonk F-G, et al. 2010 Arch Gen Psychiatry 67(2):133-143 3. Phillips C 2017 Neural Plasticity 1-17.4. Parrino & Vaudano 2018 Sleep Medicine Reviews 39:98e107


• Fischer et al. conducted a longitudinal study following adolescent females (N=65) at risk for developing depression over a 14 year period

• Positive life events were found to strengthen neural networks (particularly connectivity between the amygdala and orbitofrontal cortex) and decrease the likelihood of developing depression

• The authors concluded that:

Positive life events may lead to increased brain interconnectivity, and ultimately a more resilient brain

Positive Life Events May Increase Resilience

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1. Fischer et al. 2018 JAMA Psychiatry 75(5):493-502.


• Resilience involves a complex number of factors that interact at multiple levels

• Stress, particularly early life adversity, can result in epigenetic as well as adaptive and/or maladaptive changes to an individual’s biological capacity for resilience

• Nature and nurture have their role to play in the development and modification of individual resiliency

• Resilience is a dynamic process that can evolve and be cultivated

Summary

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Questions


Closing


Upcoming Webinars

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Event Speaker(s) Date Time

Understanding Gender Difference in Depression

• Madhukar Trivedi, MD• Laura Melaro, MD March 7, 2019 12:00pmET

Role Of Glutamate In Mood Disorders & Psychosis

• James Murrough, MD, PhD• Laura Rowland, PhD March 19, 2019 12:00pmET

© 2019 Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD Lundbeck, LLC.


February 2019 MRC2.CORP.D.00402

ResilienceHow Nature & Nurture Shape Us

resilience - how nature & nurture shape us · stress inoculation. 1. resilience training...

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