For nearly twenty years my colleagues and I studied post-traumatic stress disorder and the profound negative psychological, social, and neurobiological impact of traumas such as child abuse, natural disasters, physical and sexual abuse, and combat. We often wondered why some survivors succeeded in overcoming adversity, bouncing back, and continuing on with purposeful lives, while others didn't. Some individuals were clearly more resilient than others.
The American Psychological Association defines resilience as "the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of threat." To answer our question, we turned to three groups of highly resilience individuals: former Vietnam prisoners of war, Special Forces instructors, and civilian men and women who had endured and even thrived after surviving harrowing traumas.
In our book, Resilience: The Science of Mastering Life's Greatest Challenges, Dennis Charney M.D. and I systematically address the topic of resilience. Because resilience is the complex product of genetic, psychological, biological, social and spiritual factors, we investigate resilience from multiple scientific perspectives. We synthesize the latest scientific and popular literature on the topic, describe our own psychological and neurobiological research on resilience, and quote from our in-depth interviews with a large number of highly resilient people.
When we began our study, we assumed that resilience was rare and resilient people were somehow special, perhaps genetically gifted. It turns out, we were wrong. Resilience is common and can be witnessed all around us. Even better, we learned that everyone can learn and train to be more resilient. The key involves knowing how to harness stress and use it to our advantage. After all, stress is necessary for growth. Without it the mind and body weaken and atrophy.
Let's take a quick look at some genetic and biological factors that have been associated with resilience. While no one gene or gene variation explains resilience, genetic factors do play an important role in determining how an individual responds to stress and trauma. For example, DNA studies have found that polymorphisms (i.e., variations) of genes that regulate the sympathetic nervous system, the hypothalamic-pituitary-adrenal axis, and the serotonin system partially determine whether our biological response to stress is too robust, too muted, or within a range that is optimal for adaptive functioning. In addition, studies of identical twins, where one twin has been exposed to a traumatic stressor such as combat but the other twin has not, have estimated an overall heritability of posttraumatic stress disorder ranging from 32-38%. This means that genes are important but that they are only part of the story.
A host of neurobiological factors and systems have been associated with resilience including a sympathetic nervous system (i.e., epinephrine and norepinephrine) and a hypothalamic-pituitary-adrenal axis (i.e., cortisol) that respond rapidly to stress and danger but that are well regulated and shut off once the danger has passed; a dopamine reward system that continues to fuel positive emotions even during periods of chronic stress; intact hippocampi that allow us to form new memories, to differentiate between dangerous and safe environments, and help to regulate our stress response; and a highly developed prefrontal cortex that can regulate emotional and behavioral reactivity to stress by inhibiting the amygdala, which plays a central role in processing and triggering raw emotions related to the fight-flight response.
Emerging scientific research has begun to show that neurobiological systems associated with resilience can be strengthened to respond more adaptively to stress. For example, research using EEG and fMRI technology has shown that mindfulness meditation and training in cognitive reappraisal can increase activation of the left prefrontal cortex. This is important because people with greater activation of the left prefrontal cortex recover more rapidly from negative emotions such as anger, disgust, and fear. University of Wisconsin researcher Richard Davidson has proposed that resilience is largely related to activation of the left prefrontal cortex and the strength of neural connections between the prefrontal cortex and the amygdala. Robust activation of the PFC inhibits the amygdala, quiets associated anxiety and fear-based emotions, and allows the PFC to facilitate rational planning and behavior.
As a second example, the hippocampus is another brain region that is critically involved in resilience and how we respond to stress. It is well known that unremitting stress with prolonged elevation of cortisol can damage neurons in the hippocampus. Because the hippocampus helps to regulate the hypothalamic-pituitary-adrenal axis, damage to its neurons can decrease their ability to dampen the stress response. The result may be even greater damage to hippocampal neurons. Fortunately, recent research has found that nerve growth factors, like brain-derived neurotrophic factor, enhance the growth of brain cells, prolong cell survival, and repair damaged nerve cells. In animal studies, vigorous voluntary aerobic exercise increases levels of nerve growth factor and appears to protect against some of the negative effects of stress. This may also be true in humans where research has shown that aerobic exercise can increase hippocampal volume, raise serum levels of BDNF, and improve spatial memory, and that physically active subjects show lower cortisol and SNS responses to psychological laboratory stress compared to less physically active subjects.
As scientists learn more about the complex interplay of genetics, development, cognition, environment, and neurobiology, it will be possible to develop behavioral, social and pharmacological interventions and training programs to enhance resilience to stress.
Steven M. Southwick, MD, a recognized expert on the psychological and neurobiological effects of extreme psychological trauma, is the co-author of Resilience: The Science of Mastering Life's Greatest Challenges (Cambridge University Press 2012). Dr. Southwick is the inaugural Greenberg Professor of Psychiatry, Post-Traumatic Stress Disorder, and Resilience at the Yale Medical School and the Yale Child Study Center, adjunct professor of psychiatry at the Mt. Sinai School of Medicine, and medical director of the Clinical Neurosciences Division of the National Center for Posttraumatic Stress Disorder.
For more information about Dr. Southwick's work and book, please visit ResilienceInUs.com.
Noah Kass: Courage and Fear Are Brothers: Ask Noah
Meryl Hartstein: Having It All
It wasn't until my doctor forcefully insisted that no matter what, even if it hurt like he((, even if it felt like I was dying, even if I thought I couldn't (exactly how I felt), he convinced me that if I exercised, day by day and progressed little by little, I would get better.
I was already eating clean, did stress reduction like joining Al-Anon for a family issue, etc..but just couldn't get over the hump The tipping point was a sleeping aid to keep me sleeping through the night plus exercise. Walking made all the difference in the world.
The first week I nearly crawled down the street and went right to bed after...by the 3rd week I was walking 2 miles with a few minutes of jogging thrown in. I'm the typical post-menopausal woman with stress (a la teenager), if I get tired and lazy, eat refined carbs and don't exercise I regress and fibro fatigue sets in.
If they ever visit me, I will humbly kiss the feet of those three goddesses: Uninterrupted Sleep, Clean Nutrition and Physical Activity.
It destroys your whole concept of the what the world is supposed to be like; you learn to trust no one, it become hard to be around people because they can't be trusted. Some people use drugs or alcohol to try to cope with the traumas that come crashing back when someone or something triggers the memory.
When the memories come back it is like being hit by a freight train...you feel the pain, hear the terrible words, every fear; everything is back in your mind again. The person has to fight to stuff the memories back into the dark place. Forcing the memories out can take weeks, it can take years, and it is very, very hard. Many people commit suicide or become frozen in depression; some start living on the street because they can't get close to people; they can’t get the memories under control.
PTSD is real...believe me...no one wants to have it; it can destroy your whole life.
People making light of the condition need knowledge instead of ignorance, facts instead of opinions. It is their own remarks that may start the cascade of memories; they could be responsible for someone's suicide.
Words cut like knives; slashing a piece of one’s heart away at every trauma; finally, the heart can no longer heal itself. At times the emotional pain and loneliness can become almost unbearable. When the traumas are unremitting for years, especially coming from the very people a person is supposed to be able to trust; the ability to bounce back after being knocked down physically or emotionally can finally ebb to a point where complete isolation is the only way to survive.
Social situations become awkward. The person withdraws more and more; they give up dreams; force themselves to not acknowledge holidays, birthdays, family get-togethers, any of the events that were traumatic, etc. Friends, family, co-workers do not understand why the person is changing, withdrawing, so these people rather than talking with and supporting the person (who can’t verbalize the pain) take the withdrawal as a personal affront. The emotional distance between them grows until the relationships are only shadows.
Annie5676, thank you! I know what you are
It's of interest to me because my (non-twin) sisters and I share some chronic health problems related to those very symptoms: we all were exposed to varying degrees to the same endocrine-disrupting chemicals prenatally, and all had fairly-stressful childhoods, but I kind of got the worst of it, (They're straight, I'm not. I caught all manner of hell for that, and also had a much more stressful young adult life as a runaway and, well, poor person. We all ended up with the same chronic illness problems: mine set in about twenty years earlier, (along with some acute PTSD after some bad scenes, not to mention, speaking of ephinephrine, lack of basic health coverage: I ended up sucking on those over-the-counter inhalers just to breathe, which sure didn't do *my* HAP axis any favors,) I'm convinced there's an interplay between this physical stuff and PTSD but there's so much about shared and different *circumstance* between siblings, that I wonder how much can really be assumed to be in the genes.
Some issues that are in dispute:
1. Diagnosis creep: The amount of PTSD Claims resulting from what would be considered relatively mild incidences has increased. The symptoms are almost entirely based on the subjective account of the patient. All other psychiatric illness have clinical markers that can be measured or demonstrated objectively.
2. Co-morbidities: Almost every case of PTSD also has other clinical symptoms of different psychiatric illness. Eg depression, alcohol/drug dependence etc. Are these symptoms of PTSD or precursers/ triggers?
3. Treatment: With most other psychiatric illness, the treatments are well known, effective and follow a known and predictable clinical route. With PTSD the treatments are vague, inconclusive and the results vary considerably from case to case.
4. Attractive condition: PTSD is usually well compensated. Some good evidence of vets being coached by others on what to say to get compensation. I have been a witness to this.
It is also an attractive alternative to other illness. Eg "I drink to much because of PTSD not because I am an alcoholic"
5. "Lazy" Diagnosis: It is easier to say someone has PTSD than to look to other causes. Similar to the epidemic of RSI in the 80's and Chronic Fatigue in the 90's.
6. Hard to disprove: Back to the subjective account issue.
Several years ago I read an Australian study looking a firefighters and survivors of major bushfires (wildfires in US terms) that compared the PTSD rates of those who received post event counseling and those who rejected it. The conclusion was that those who rejected counseling had much lower rates of PTSD.
It was not possible to firmly conclude whether this was due to counseling techniques reinforcing / causing a tendency to PTSD, or whether higher resilience led some to reject counseling. However there were clear sexual disparities - women benefited from counseling, men appeared to be harmed by it. The researchers posited that the male reaction of "get on with life, it's behind you" might be a very efficient method, and should be left alone.
More research needed, and not my area so unfortunately I didn't keep the citation. Interesting nevertheless.
I certainly wouldn't call it 'lazy' to say 'We don't know what causes this,' as opposed to saying, 'Oh, just go to AA or something, or have a Prozac, you're just depressed. Don't mind the suicidal ideations...' :)
I mean, I've had my bouts with the bottle, myself: but there's nothing mysterious about when that started happening: I remember the *day* I started self-medicating, not a lot at first, but nothing else was working except plain old sedatives, which are addictive of themselves. All you have to do there is actually *ask people.*
And claiming PTSD is an 'attractive' condition when you're standing there assuming there "must be something 'wrong' with you to have these reactions" ain't science, either. Cause nobody really knows what 'causes an alcoholic,' either. Alcohol has its own dangers, particularly to the self-medicating. But people don't *enjoy* doing the equivalent of clubbing themselves to sleep with a rubber mallet. :)
Really, a lot of the problem is that people are *suspicious* of the condition, often till it gets far far worse.
See previous comment
On writing all that I acknowedge there are genuine sufferers of PTSD and they have my sympathy. The above is paraphrasing some the opinions I have read/ heard.
Actually, part of the very problem is that people see this as a 'toughness' contest, even character flaw, even when you're a *kid:* ...and especially in kids, trying to look for a single traumatic event that's 'bad enough to justify' symptoms simply isn't the right approach. They're making some strides in studying 'complex PTSD,' often starting in childhood: to my personal experience, you can survive that and still be pretty set up to develop really acute symptoms in adulthood when too much heavy stuff comes down.
Assuming people are faking it or 'You're just randomly an alcoholic' or as the military does, 'You have a pre-existing personality disorder' is both non-helpful in the extreme and ....really just doesn't connect up with the actual science being described in this article.
May be it counts for mental pain as well. A business man seeing someone killed for the first time is much more likely to be effected than a ER doctor who sees death on a daily basis. On consideration though the black humour that thrives in the medical fraternity could just be a symptom in itself.
As for people witnessing things that may be shocking: having *practice* at dealing with them doesn't mean you're 'tougher' inherently just cause you say, had your time to be shocked before. PTSD isn't about the fact you were shocked or scared or experienced pain: it's usually that the experience became overwhelming and the response never *resolved,* so it kind of stays in your system. It could be the second time you experience the stimuli that it catches up with you, or the two hundredth.
You can even be awesome in an actual crisis routinely, go home, and utterly freeze up cause, say, the washing machine sounds like something you heard in a traumatic circumstance.
I dunno if they'd call that resilience or non-resilience, but that's more what this can be about in the terms you're talking. *How* that can get all tied up in your neurochemistry. emdocrinology, etc's kind of a different thing from what your cognitions of it may be.
Sounds about right.
It's interesting to me, anyway, I'm a survivor of some pretty damn severe PTSD with a wonky HAP axis (probably from birth: ) and he's mentioning a lot of things I found may be pertinent trying to look at things the other way. (Still not sold on 'genetics' being the real cause, but if thye find a mechanism for that, I'm all ears. Really. :) )
I'm not sure if I'd count as 'resilient' for the purposes of this theory or not: I certainly wasn't spared symptoms, but I'm still here. (Let me tell you, it's extremely hard to learn about this stuff when you *have* it, I think. :) But nonetheless, I've been trying to work on the connection between what's going on with my body and that history of symptoms a long time. There's something here. :)