Resilience Important for Mental Health
A symposium at the 2014 meeting of the American Psychiatric Association suggested that resilience may hold the key to healthy aging, and overcoming trauma and stress.
Resilience in Aging
Former APA president Dilip Jeste began the symposium with a discussion of successful aging. He noted the importance of optimism, social engagement, and wisdom (or healthy social attitudes) in aging. In a group of 83-year-olds, those with an optimistic attitude had fewer cardiovascular illnesses, less cancer, fewer pain syndromes, and lived longer. Those with high degrees of social engagement had a 50% increase in survival rate. Wisdom comprises skills such as seeing aging in a positive light, and having a memory that is biased toward the positive (the opposite of what happens in depression, where negatives are selectively recalled and remembered). Jeste encouraged psychiatrists to focus not just on the treatment of mental illness, but on behavioral change and the enhancement of wellbeing. He suggested asking patients not just, “How do you feel?” but instead, “How do you want to feel?”
Resilience in the Military
Researcher Dennis Charney gave a talk on resilience based on his work with people in the military, some of whom experienced post-traumatic stress disorder (PTSD). He cited a series of important principles that could enhance resilience. The first principle was to reframe adversity—assimilating, accepting and recovering from it. The second principle was that failure is essential to growth. The third principle was that altruism helps, as does a mission for the survivor of trauma. Charney suggested that a personal moral compass is also critical, whether this is based on religion or general moral principles. Other factors that are important for resilience include having a role model, facing one’s fears, developing coping skills, having a support network, increasing physical well-being, and training regularly and rigorously in multiple areas.
Charney and colleagues studied Navy SEALS who went through SERE (Survival, Evasion, Resistance, Escape) training. Those SEALS who had the highest resilience during this severe training exercise had the highest levels of the neurotransmitter norepinephrine and NPY (an antianxiety neuropeptide). NPY levels are low in people with PTSD. Charney and colleagues reasoned that giving a peptide that acted on the NPY-1 receptors intranasally (so that it could cross the blood brain barrier) might be therapeutic. In a rodent model of PTSD, the peptide prevented and reversed PTSD-like behaviors. Further clinical development of the peptide is now planned.
The Effects of Stress
Researcher Owen Wolkowitz described how stress accelerates the mental and physical aspects of aging. Telomeres are strands of DNA at the end of each chromosome that protect the DNA during each cell replication. Telomere length decreases with stress and aging.
Telomeres also shorten with inflammation, oxidative stress, and increases in stress hormones (all of which occur during depression). The number of depressions a person experiences is correlated with shorter telomeres, and eight studies have indicated that those with depression have a shortening of their telomeres equivalent to 11.7 years of lost life expectancy. In a study of depressed patients, elevated levels of the inflammatory marker IL-6 were associated with telomeres that were 1.3 times shorter, and elevated levels of another inflammatory marker, TNF alpha, were associated with telomeres that were 1.5 times shorter.
Childhood adversity shortens telomeres and decreases telomerase activity, while positive parenting and a supportive environment increase telomerase activity. High levels of measured resilience are associated with greater telomerase activity. Other factors associated with telomere length or high telomerase activity include: exercise, good diet, vitamins, folate, omega-3-fatty acids, meditation or yoga, good sleep habits, and the drug lithium, which directly stimulates telomerase activity. Having a positive purpose in life also increases telomere length. In contrast, obesity, high homocysteine (a risk factor for cardiac problems that is also associated cognitive dysfunction), and chronic anger are associated with decreased telomere length.
Positive Psychology in Psychiatry
At the symposium, researcher Samantha Boardmen described the usage of ideas from positive psychology in psychiatry. Instead of focusing on what is wrong, she encourages psychiatrists to “build on what is strong.” Boardmen discussed the importance of kindness, a positive attitude, and gratitude in countering some of the self-preoccupation that occurs in depression. She suggested that patients write down three good things in life and three good things about themselves, identify their strengths, and identify something they can be grateful for. Boardmen suggests encouraging a new act of conscious kindness each week, such as volunteering. She writes a blog and newsletter called “Positive Prescription.”
Murali Doraiswamy, the discussant of the symposium on resilience, noted that the Connor-Davidson Resilience Scale takes only about one minute to fill out. He emphasized that a positive early childhood is the key to wellbeing and resilience, and that resilience can also be cultivated as a good habit.
Editor’s Note: Of the many lessons of the symposium, I took away the idea of a positive family environment as one of the most critical factors for physical and mental well-being. Given the importance of the family environment for mental health, Family Focused Therapy (FFT), a treatment paradigm developed by researchers David Miklowitz and Kiki Chang, would be an important intervention for a family struggling with childhood-onset psychiatric illnesses such as bipolar disorder or the first symptoms of anxiety and depressive disorders. A positive family environment has been associated with increases in telomere length and children’s hippocampal volume. Verbal abuse, which is associated with a worse course of bipolar disorder and many medical comorbidities in adulthood, could be reduced with the FFT focus on good family communication skills. A positive family environment could also reduce chaos and stress and its effect on increased methylation of the glucocorticoid receptor, resulting in decreased expression of the glucocorticoid receptor and increased cortisol. It would also increase chances for good habits such as diet, exercise, and sleep, as well as stress immunization and enhanced self control.
Studies have consistently shown that families with a child with bipolar illness are more chaotic and have poorer communication than comparable control families. For this and all of the above reasons, I would recommend FFT or its equivalent for families with a parent who has bipolar disorder and a child who is beginning to show anxiety, depression, or bipolar dyscontrol symptoms. This kind of early intervention has been shown to be highly effective in circumstances where a child has a diagnosis of depression, cyclothymia (slow oscillation between mild depression and hypomania) or bipolar disorder not otherwise specified in an article by David Miklowitz published in the Journal of the American Academy of Child and Adolescent Psychiatry in 2013. Fostering a caring family environment could have lifelong positive consequences.
